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amills1
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Myostatic Contracture
Muscle/tendon short, responds well to stretch
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Pseudomyostatic Contracture
- Increase in tone due to CNS dysfunction (severe spasticity)
- Looks like but is not muscular; result is muscle tightness
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Osteophyte
Small, abnormal bony outgrowth.
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Fibrotic Contracture
Replacement of CT resulting in irreversible contracture (may require surgery)
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Arthrogenic/Periarticular Contracture
- Joint effusion
- Synovial proliferation
- Articular cartilage irregular
- Osteophytes
- Adhesions
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Passive Stretch
Patient relaxed
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Patient assists in moving joint
Assisted stretching
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Types of self stretching
Flexibility exercise, active stretching, self-stretching
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Neuro muscular inhibition techniques: muscle spindle
- Muscle sensory organ that senses muscle length
- Stimulated by quick stretch, causing contraction of muscle and inhibition of antatgonist
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Neuro muscular inhibition techniques: GTO
- Golgi tendon organ
- By muscular junction
- Senses tension in muscle from prolonged stretch or prolonged contraction
- Protective mechanism to inhibit tension in muscle
- Relaxes muscle
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3 types of CT behavior during stress
- Tension- Force pulling away
- Compression- force pushing towards
- Shear- Parallel force
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Toe Region CT
Deformation of CT without much force. Stretches out wave of collagen fibers.
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Elastic Range
- Go to EOR and a gentle stretch is applied
- Bonds between fibers strained.
- Micro failure between collagen bonds begins
- Tissue returns to original size and shape when load released if not maintained
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Plastic Range
- Range beyond elastic going to point of rupture
- Tissue strained will have permanent deformation when stress released
- Failure of bonds between collagen fibrils and eventually collagen fibers
- Heat released
- Collage fibers rupture resulting in increased ROM
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Tissue will return to shortened length after a stretch unless...
The tissue is used
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To increase ROM...
Collagen bonds must be broken, realignment of fibers must occur for permanent elongation
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Complete failure may occur from...
Manipulation/trauma or repetitive submaximal stress
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Effects of immobilization on CT
- Weakening of tissue and bonds
- Adhesion formation
- Return to normal tensile strength slow
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Effects of Inactivity on CT
- Decrease in size/amount collagen
- Weakening of tissue
- More elastic fibers
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Effects of corticsteriods on CT
Decrease in tensile strength
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Determinants of stretching
- Alignment and stability
- Stabilization
- Intensity of stretch
- - Gentle, low intensity for increased comfort and to prevent muscle guarding
- Long duration
- - To increase ROM without excessive load/possible injury
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After application of stretch what position and modality?
Cool in a lengthened position
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Immobilized tissue reaches...
Failure more easily
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Remodeling and maturation beings.... (time)
3 weeks and continues months to a year
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