-
Myostatic Contracture
Muscle/tendon short, responds well to stretch
-
Pseudomyostatic Contracture
- Increase in tone due to CNS dysfunction (severe spasticity)
- Looks like but is not muscular; result is muscle tightness
-
Osteophyte
Small, abnormal bony outgrowth.
-
Fibrotic Contracture
Replacement of CT resulting in irreversible contracture (may require surgery)
-
Arthrogenic/Periarticular Contracture
- Joint effusion
- Synovial proliferation
- Articular cartilage irregular
- Osteophytes
- Adhesions
-
Passive Stretch
Patient relaxed
-
Patient assists in moving joint
Assisted stretching
-
Types of self stretching
Flexibility exercise, active stretching, self-stretching
-
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
-
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
-
3 types of CT behavior during stress
- Tension- Force pulling away
- Compression- force pushing towards
- Shear- Parallel force
-
Toe Region CT
Deformation of CT without much force. Stretches out wave of collagen fibers.
-
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
-
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
-
Tissue will return to shortened length after a stretch unless...
The tissue is used
-
To increase ROM...
Collagen bonds must be broken, realignment of fibers must occur for permanent elongation
-
Complete failure may occur from...
Manipulation/trauma or repetitive submaximal stress
-
Effects of immobilization on CT
- Weakening of tissue and bonds
- Adhesion formation
- Return to normal tensile strength slow
-
Effects of Inactivity on CT
- Decrease in size/amount collagen
- Weakening of tissue
- More elastic fibers
-
Effects of corticsteriods on CT
Decrease in tensile strength
-
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
-
After application of stretch what position and modality?
Cool in a lengthened position
-
Immobilized tissue reaches...
Failure more easily
-
Remodeling and maturation beings.... (time)
3 weeks and continues months to a year
|
|