3-stretching for impaired mobility.pptx

stretching

1. Stretching for Impaired Mobility By the end of this lecture the student must be able to Define Terms Associated with Mobility and Stretching Discus Indications, Contraindications, and Potential Outcomes of Stretching Exercises Explain Properties of Soft Tissue: Response to Stretch Identify Determinants and Types of Stretching Exercises Describe Procedural Guidelines for Application of Stretching Interventions Interpret Precautions for Stretching Describe Adjuncts to Stretching Interventions Apply Manual Stretching Techniques in Anatomical Planes of Motion

2. Definition of Terms Associated with Mobility and Stretching Mobility Flexibility Hypomobility Contracture Selective Stretching Overstretching and Hypermobility

3. Mobility It is the ability of structures or segments of the body to move or be moved to allow the presence of range of motion for functional activities (functional ROM).

4. Flexibility It is the extensibility of soft tissues that cross or surround joints—muscles, tendons, fascia, joint capsules, ligaments, nerves, blood vessels, skin), which are necessary for unrestricted, pain-free movements of the body during functional tasks of daily living.

5. Dynamic and Passive Flexibility Dynamic flexibility . This form of flexibility, also referred to as active mobility or active ROM, is the degree to which an active muscle contraction moves a body segment through the available ROM of a joint. It is dependent on the degree to which a joint can be moved by a muscle contraction and the amount of tissue resistance met during the active movement. Passive flexibility. This aspect of flexibility, also referred to as passive mobility or passive ROM, is the degree to which a body segment can be passively moved through the available ROM and is dependent on the extensibility of muscles and connective tissues that cross and surround a joint. Passive flexibility is a prerequisite for—but does not ensure— dynamic flexibility.

6. Hypomobility Hypomobility (restricted motion) caused by adaptive shortening of soft tissues can occur as the result of many disorders or situations. Factors include (1) prolonged immobilization of a body segment; (2) sedentary lifestyle; (3) postural malalignment and muscle imbalances; (4) Impaired muscle performance (weakness) associated with an array of musculoskeletal or neuromuscular disorders; (5) tissue trauma resulting in inflammation and pain; (6) Congenital or acquired deformities.

7. Contracture Contracture is defined as the adaptive shortening of the muscle-tendon unit and other soft tissues that cross or surround a joint resulting in significant resistance to passive or active stretch and limitation of ROM, which may compromise functional abilities. It can be range from mild muscle shortening to irreversible contractures.

8. Contractures are described by identifying the action of the shortened muscle. e.g. If a patient has shortened elbow flexors and cannot fully extend the elbow, he or she is said to have an elbow flexion contracture. When a patient cannot fully abduct the leg because of shortened adductors of the hip, he or she is said to have an adduction contracture of the hip.

9. Contracture Versus Contraction The terms contracture and contraction (the process of tension developing in a muscle during shortening or lengthening) are not synonymous and should not be used interchangeably.

10. Types of Contracture Myostatic contracture. Pseudomyostatic contracture. Arthrogenic and periarticular contracture. Fibrotic contracture and irreversible contracture. Unable to be corrected with stretching exercise

11. Selective Stretching Selective stretching is a process whereby the overall function of a patient may be improved by applying stretching techniques selectively to some muscles and joints but allowing limitation of motion to develop in other muscles or joints. In a patient with spinal cord injury, stability of the trunk is necessary for independence in sitting. With thoracic and cervical lesions, the patient does not have active control of the back extensors. If the hamstrings are routinely stretched to improve or maintain their extensibility and moderate hypomobility is allowed to develop in the extensors of the low back, this enables a patient to lean into the slightly shortened structures and have some degree of trunk stability for long term sitting. However, the patient must still have enough flexibility for independence in dressing and transfers. Too much limitation of motion in the low back can decrease function.

12. Overstretching and Hypermobility Overstretching is a stretch well beyond the normal length of muscle and ROM of a joint and the surrounding soft tissues, resulting in hypermobility Stretching Athletes Instability

13. Indications

14. Contra indication

15. Potential Benefits and Outcomes of Stretching Increased Flexibility and ROM General Fitness prevention or reduction of the risk of soft tissue injuries reduced postexercise (delayed onset) muscle soreness enhanced physical performance

16. Considerations for Selecting Methods of Stretching ■ Based on the results of your examination, what tissues are involved and impairing mobility? ■ Is there evidence of pain or inflammation? ■ How long has the hypomobility existed? ■ What is the stage of healing of restricted tissues? ■ What form(s) of stretching have been implemented previously? How did the patient respond? ■ Are there any underlying diseases, disorders, or deformities that might affect the choice of stretching procedures? ■ Does the patient have the ability to actively participate in, assist with, or independently perform the exercises? Consider the patient’s physical capabilities, age, ability to cooperate, or ability to follow and remember instructions. ■ Is assistance from a therapist or caregiver necessary to execute the stretching procedures and appropriate stabilization? If so, what is the size and strength of the therapist or the caregiver who is assisting the patient with a stretching program?