STRETCHING FOR IMPAIRED MOBILITY - Copy - Copy (1).pptx

STRETCHING FOR IMPAIRED MOBILITY

1. STRETCHING??

2. At the end of this lesson, try to know: What stretching? Use of stretching Types of stretching Components of stretching Demonstrate stretching

3. Introduction Stretching- is a therapeutic maneuver designed to increase the extensibility of soft tissues , thereby improving flexibility by elongating structures that have adaptively shortened and have become hypomobile over time. Can be manual stretching “hands-on” by PT self-stretching exercised by a patient use of mechanical stretching devices

4. Mobility - 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 ). is associated with joint integrity as well as the flexibility (i.e., extensibility of soft tissues that cross or surround joints—muscles, tendons, fascia , joint capsules, ligaments, nerves, blood vessels , skin).

5. Hypomobility ( restricted motion) caused by adaptive shortening of soft tissues can occur as the result of many disorders or situations .

6. Factors include prolonged immobilization of a body segment postural malalignment and muscle imbalances impaired muscle performance (weakness) tissue trauma resulting in inflammation and pain congenital or acquired deformities Sedentary life style. Hypomobility,in turn, can lead to functional limitations and disability in a person’s life.

7. Flexibility- is the ability to move a single joint or series of joints smoothly and easily through an unrestricted, pain-free ROM. is related to the extensibility of musculotendinous units that cross a joint & arthrokinematics of the moving joint. Contracture- is adaptive shortening of the muscle-tendon unit and other soft tissues that cross or surround a joint that results in significant resistance to passive or active stretch and limitation of ROM.

8. Types of Contracture Myostatic Contracture (myogenic)- musculotendinous unit has adaptively shortened 2. Scar tissue adhesion ; i t means laying down scar tissue between normal tissues, which results in scar tissue adhesions . 3 . Pseudomyostatic Contracture- spasticity or rigidity associated with a central nervous system lesion such as a CVA,SCI & TBI.

9. Cont… 4 . Arthrogenic and Periarticular Contractures Arthrogenic result of intra- articular pathology . ( adhesions, synovial proliferation, joint effusion, irregularities in articular cartilage, or osteophyte formation.) Periarticular develops when connective tissues that cross or attach to a joint or the joint capsule lose mobility.

10. Cont… 5. Fibrotic Contracture and Irreversible Contracture Fibrotic - Fibrous changes in the connective tissue of muscle and periarticular structures Irreversible- Permanent loss of extensibility of soft tissues that cannot be reversed by nonsurgical intervention fibrotic adhesions and scar tissue or even heterotopic bone.

11. The following are terms that describe a number of procedures designed to increase soft tissue and joint mobility Manual or Mechanical/Passive or Assisted Stretching. Self-Stretching Neuromuscular Facilitation and Inhibition Techniques. Muscle Energy Techniques Joint Mobilization/Manipulation. Soft Tissue Mobilization and Manipulation Neural Tissue Mobilization

12. Indications ROM is limited because soft tissues have lost their extensibility as the result of adhesions, contractures, and scar tissue formation, causing functional limitations or disabilities. • Restricted motion may lead to structural deformities that are otherwise preventable. • If 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 .

13. Contraindications • A bony block limits joint motion. • A recent fracture, and bony union is incomplete • An acute inflammatory or infectious process (heat and swelling) or soft tissue healing could be disrupted in the tight tissues and surrounding region. • sharp, acute pain with joint movement or muscle elongation.

14. Cont… A hematoma or other indication of tissue trauma • Hypermobility already exists. • Shortened soft tissues provide necessary joint stability in reduced of normal structural stability or neuromuscular control. • Shortened soft tissues enable a patient with paralysis or severe muscle weakness to perform specific functional skills otherwise not possible.

15. Types of stretching exercises 1.Static - is a commonly used method of stretching in which soft tissues are elongated just past the point of tissue resistance and then held in the lengthened position with a sustained stretch force over a period of time. sustain from 5sec - 5min for manual/self stretching per repetition & almost an hour to several days or weeks for mechanical device (splint). Common & well accepted as an effective form of stretching Static progressive stretching is another term that describes how static stretch is applied for maximum effectiveness.

16. 2.Cyclic - low velocity (hold & relax)- every 10 sec or more. With cyclic stretching the end-range stretch force is applied at a slow velocity, in a controlled manner, and at relatively low intensity.

17. Cont… Ballistic - fast forceful & no hold, used for athletes. A rapid, forceful intermittent stretch—that is, a high-speed and high-intensity stretch. 4. PNF can be carried out in various manners-manually or mechanically, passively or actively, and by a therapist or independently by a patient.

18. Manual - can be performed passively, with assistance from the patient. most appropriate in the early stages of a stretching program. if a patient cannot perform self-stretching. Self -is often an integral component of a home exercise program and is necessary for long-term self-management. Teach patient to carry out self-stretching procedures correctly and safely. 30- to 60-second duration per repetition is considered the safest.

19. Mechanical- a cuff weight or weight-pulley system or adjustable orthosis or automated stretching machines & serial casts or splints. Longer overall duration ranges from 15 to 30 minutes to as long as 8 to 10 hours at a time. serial casts or splints worn for days or weeks at a time. newly gained motion has to bee used regularly in daily activities.

20. Mechanical stretching

21. Components of stretching Alignment Proper alignment or positioning of the patient and the specific muscles and joints to be stretched is necessary for patient comfort and stability during stretching. influences the amount of tension present in soft tissue & ROM available in joints. For example, rectus femurs(i ts functions are to flex the thigh at the hip joint and to extend the leg at the knee joint)

22. Cont… Stabilization stabilize (fixate) proximal or distal attachment site of the muscle-tendon unit being elongated. For example- quadriceps manual & self. Intensity The intensity (magnitude) of a stretch force is determined by the load placed on soft tissue to elongate it. should be applied at a low intensity by means of a low load.

23. Cont.. Duration How long a single cycle of stretch is applied. Or cumulative time of all the stretch cycles. low-intensity, long-duration stretch is considered safest and yields the most significant plastic changes in soft tissues. Elderly - cycles of 15, 30, and 60 seconds applied for four repetitions produced significant gains in ROM.

24. Cont… young and adults- 15, 30, 45, or 60 seconds or 2 minutes to lower extremity musculature produced significant gains in ROM. Use of prolonged static stretch with splints or casts is more effective for chronic, fibrotic contractures. Frequency- minimum of two times per week for healthy hypomobile individuals, more frequent for patients with soft tissue pathology.

25. Cont… Speed To ensure optimal muscle relaxation and prevent injury to tissues, the speed of stretch should be slow. Frequency based on the underlying cause, chronicity and severity of a contracture & patient’s age. Mode who or what is applying the stretch force. manual and mechanical or self as well as passive, assisted, or active stretching

26. cuff weight adjustable orthosis

27. Effective stretching Assistive modalities that increases quality of stretch can be given before stretching regime. Heat modalities Massage oscillation Joint mobilization active exercise

28. strength of soft tissue is altered when it is immobilized for a period of time. begin low load resistance exercises to improve muscle performance as early as possible in a stretching program. Initially agonist MS. Integrate functional activities into a stretching program to achieving permanent increases in ROM. include reaching, grasping, turning, twisting, bending, pushing, pulling, and squatting. Apply cold to the soft tissues after stretching to minimize post-stretch muscle soreness.

29. General Precaution for stretching Do not passively force a joint beyond its normal ROM. Remember, normal (typical) ROM varies among individuals. In adults, flexibility is greater in women than in men. When treating older adults, be aware of age related changes in flexibility.

30. PROCIDER MANUAL & SELF STRETCHING Upper ext shoulder- Flex, ext, abd , add, ER, IR & H.abd. Elbow-flex, ext, sup, & pron. Wrist- flex, ext, R & U diviation . Digities Lower ext Hip- flex, ext, abd , add, ER & IR. Knee-flex, ext Ankle- DF, PF, inversion & eversion . Trunk -cervical, thoracic & lumbar.

31. Hamstring

32. Stretching for the Chest

33. Stretching for the Groin

34. Stretching for the Quadriceps and Hip Flexors

35. Stretching for the Shoulders

36. Stretching Techniques: Neck Rotation of the neck to the right Rotation of the neck to the left Look Right and Left

37. Stretching Techniques: Neck Neck flexion Neck extension Flexion and Extension

38. Stretching Techniques: Shoulders and Chest Stretching the shoulder joints—standing Straight Arms Behind Back

39. Stretching Techniques: Shoulders and Chest Stretching the shoulder joints—seated Seated Lean-Back

40. Stretching Techniques: Posterior of Upper Arm Stretching the triceps Behind-Neck Stretch (Chicken Wing)

41. Stretching Techniques: Upper Back Stretching the upper back Cross Arm in Front of Chest

42. Stretching Techniques: Upper Back Stretching the upper back Arms Straight Up Above Head (Pillar)

43. Stretching Techniques: Lower Back Stretching the lower back and sides Spinal Twist (Pretzel)

44. Stretching Techniques: Lower Back Stretching the lower back from a seated position Semi-Leg Straddle

45. Stretching Techniques: Hips Stretching the hip flexors Forward Lunge (Fencer)

46. Stretching Techniques: Hips Stretching the gluteals and hamstrings Supine Knee Flex

47. Stretching Techniques: Torso Stretching the sides and upper back Side Bend With Straight Arms

48. Stretching Techniques: Torso Stretching the sides, triceps, and upper back Side Bend With Bent Arm

49. Stretching Techniques: Anterior of Thigh and Hip Flexor Stretching the quadriceps Side Quadriceps Stretch

50. Stretching Techniques: Posterior of Thigh Stretching the low back, hamstrings, and calves Sitting Toe Touch

51. Stretching Techniques: Posterior of Thigh Stretching the low back, hamstrings, and calf Semistraddle (Figure Four)

52. Stretching Techniques: Groin Stretching the hamstrings and hip adductors Straddle (Spread Eagle) Stretching the hamstrings, hip adductors, and lower back

53. Stretching Techniques: Groin Stretching the hip adductors Butterfly

54. Stretching Techniques: Calf Stretching the calves Wall Stretch

55. Stretching Techniques: Calf Stretching the calf standing on a step Step Stretch Preparing to stretch the Achilles tendon by slightly bending the knee Stretching the Achilles tendon by lowering the heel

56. References -Therapeutic exercise, Carolyn Kisner - Allen Colby

57. THANK YOU!!!