Definitions of terms related to mobility and stretching

Therapeutic exercises

1. DEFINITIONS OF TERMS RELATED TO STRETCHING Dr. Marina khan (PT) DPT (IPM&R , KMU) Lecturer/physiotherapist RMI-CRS

2. Stretching Stretching  is a form of physical exercise in which a specific muscle or tendon (or muscle group) is stretched in order to improve the muscle's elasticity and achieve comfortable muscle tone.

3. Mobility The ability of structure or segment of the body to move or to be moved to allow the presence of range of motion for functional activities. OR The ability of an individual to initiate control or sustain active movement of the body to perform simple to complex motor skills.

4. Flexibility Flexibility is the ability to move a single joint or series of joints smoothly and easily through an unrestricted, pain-free ROM. Muscle length, joint integrity and extensibility of periarticular soft tissues determine flexibility . It has two types. Dynamic flexibility Passive flexibility

5. Dynamic flexibility ( active mobility or active ROM) It 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.

6. Passive flexibility (passive mobility or passive ROM It is the degree to which a joint can be passively moved through the available ROM. It is dependent on the extensibility of muscles and connective tissues that cross and surround a joint.

7. Hypomobility: Hypomobility refers to decreased mobility or restricted motion. Contributing Factors: Prolonged immobilization Extrinsic : Casts and splints Intrinsic: Pain Joint inflammation and effusion Muscle or tendon disorders Skin disorders Vascular disorders Sedentary lifestyle Paralysis Postural malalignment: congenital or acquired

8. Contracture Contracture is defined as the adaptive shortening of the muscle-tendon unit and other soft tissues that cross or surround a joint. It leads to significant resistance to passive or active stretch and limitation of ROM, and it may compromise functional abilities.

9. Designation of Contractures by Location Contractures are described by identifying the action of the shortened muscle. 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.

10. Types of Contracture Myostatic Contracture Pseudomyostatic Contracture Arthrogenic Contractures Periarticular Contractures Fibrotic Contracture (Irreversible Contracture)

11. Myostatic Contracture In a Myostatic (myogenic) contracture, although the musculotendinous unit has adaptively shortened and there is a significant loss of ROM, there is no specific muscle pathology present. Myostatic contractures can be resolved in a relatively short time with stretching exercises.

12. Pseudomyostatic Contracture These contractures may be the result of hypertonicity (i.e., spasticity or rigidity) associated with a central nervous system lesion such as a cerebral vascular accident, a spinal cord injury, or traumatic brain injury. Muscle spasm or guarding and pain may also cause a Pseudomyostatic contracture .

13. Arthrogenic Contractures An Arthrogenic contracture is the result of intra-articular pathology. These changes may include adhesions, synovial proliferation , joint effusion, irregularities in articular cartilage, or osteophyte formation

14. Periarticular Contractures A periarticular contracture develops when connective tissues that cross or attach to a joint or the joint capsule lose mobility, thus restricting normal arthrokinematic motion.

15. Fibrotic Contracture (Irreversible Contracture) It may occur when normal muscle tissue and connective tissue are replaced with a large amount of nonextensible, fibrotic adhesions and scar tissue or even heterotopic bone. Permanent loss of extensibility of soft tissues occur that cannot be reversed by nonsurgical intervention. Healed by stretching and surgical intervention.

16. ROM is limited because soft tissues have lost their extensibility as the result of contractures, and scar tissue formation, causing functional limitations or disabilities. There is muscle weakness and shortening of opposing tissue . May be used as part of a total fitness program designed to prevent musculoskeletal injuries. May be used prior to and after vigorous exercise potentially to minimize postexercise muscle soreness. Indications for Use of Stretching

17. A bony block limits joint motion. Recent fracture, and bony union is incomplete. Acute inflammatory or infectious process (heat and swelling) could be disrupted in the tight tissues and surrounding region . Sharp , acute pain with joint movement or muscle elongation . Hematoma or other indication of tissue trauma. Hypermobility already exists. Shortened soft tissues enable a patient with paralysis or severe muscle weakness to perform specific functional skills otherwise not possible. Contraindications to Stretching

18. The end..!!

19. Home assignment

20. What is hypomobility?  What are factors leading to hypomobility? What is dynamic flexibility? What is passive flexibility dependent on ? What is dynamic flexibility dependent on ? What is a contracture? What does a contracture lead to ? What are the types of contractures?

21. What is a myostatic contracture? How can Myostatic Contracture be healed? What is Pseudomyostatic Contractures a result of? Who usually suffers from Pseudomyostatic Contractures ? What is an Arthrogenic and Periarticular Contracture a result of? How are fibrotic Contractures caused ? What are the treatments for Fibrotic Contractures ? What are indications of stretching exercises? What are contraindications for stretching exercises?