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Therapeutic Exercise I

by: Jovani Gleichner

Therapeutic Exercise I PT 220

Jovani Gleichner

GPA 3.96


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Class Notes
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This 22 page Class Notes was uploaded by Jovani Gleichner on Monday October 5, 2015. The Class Notes belongs to PT 220 at California State University - Sacramento taught by Staff in Fall. Since its upload, it has received 31 views. For similar materials see /class/218809/pt-220-california-state-university-sacramento in Physical Education at California State University - Sacramento.


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Date Created: 10/05/15
Stretching Lms Buu gandes m DPT MS w 22m STRETCH NG ncvease cr marmam nssue eng h ewbwhty SEVSUEIEH o Manua cr mec anma Actwe assrsteu passwe Neurnmuscmar racrmatunmmcmcn w Musde Energy 0 Jmnt mubmzatmnineun mnbmzatun Indications 0 Increase cr mamtam RoM ewbmty Adhesmn CuntracturE Decreased ROM r par 0 Decrease tensmn andc n u MVDfasma Dam Svndmme 0 mm mus2 25 arrecmq Wma ahqnment 59 39quarqu39cramv o m pruve pasture o Neum ug ca mvn vement M Parkmsnn39s Stmke o Mamtam functmn m n der amms Contraindicationsprecautions o Bony block Acute infection 0 Beyond normal ROM of ajoint o Prolonged immobilization Severe tissue damage Acute inflammation Acute pain Osteoporosis Prolonged increased pain or soreness after treatment oooooo Definitions of Terms Related to Mobility and Stretching o Flexibility 0 Dynamic flexibility 0 Passive flexibility o Hypomobility o Contracture 0 Adaptive shortening o Elbow flexion contracturequot o Contracture vs contraction Definitions of Terms Related to Mobility and Stretching pes of contracture o Myostatic o Pseudomyostatic o Arthrogenic and periarticular o Fibrotic andor irreversible contracture Stretch affects muscle and non contractile connective tissue Nuneenncramle elemem m musde tendnnrfas a avsule ligaments Muscle Tissue Response to Immobilization and Stretch Immobilization in shortened position Decreased nurnber sarcorneres in series on the ends cf the muscle resorbe Decreased length Possible increased atrnunvWeakness Immobilization in lengthened position Used to meet contracmres Series Dostonal casts dvnarnic Splints May increase it sarcorneres m series Result Permanent muscle lENQtHEHlNQ Continued use er new ROM necessarv Muscle Stretching Myo lament slides 0n release Sarcomeres return n to resting positlo Muscle Stretching Neuromuscular response 0 Muscle spindle stretch receptors activate alpha motor neuron stretch reflex Increase M tension 0 Slow sustained stretch minimizes o Golgi Tendon Organ GT0 0 Inhibis alpha motor neuron o PNF muscle inhibition Stretch HMH le Spindle A lpha Motor Neuron Muscle Stretch HOLD RELAX 01pnfholdmov HOLDRELAX AND THE GOLGlTENDON ORGAN THEORY A lpha Motor Neuron s tre tch Largest effect of stretch occurs in non contractile tissue 0 Muscle o Epimesium perimesium o Tendon o Fascia o Skeletal o Ligament 0 Joint capsule o Fascia Non Contractile Tissue Stretching o Slack is taken out of the actinmyosin units 0 Stretch occurs next in the non contracile collagenous connective tissues in and around the myofibrils Epimycium mswmu E o Fascia Eventually deeper to joint capsuleliga menis NonContractile Tissue Elastic Phase 0 Wav Colla en Fibe s Straighten out KMKJ am NonContractile Tissue Elastic to Plastic Phase 0 COLLAGEN FIBRIL BONDS BREAK AND REMODEL STRETCH bmdlt FORCE bund STRETCH 1 quot FORCE 194mm NonContractile Tissue Plastic Phase 0 When enough bonds have broken fibers fail fibersfibrils break lt STRETCH FORCE a STRETCH FORCE X Stressstrain curve z o e Mr rJONeCONTRACTwLE T SSUE PHASES OF STRETCH CDHaQEn Frbers strerunten nut Home PhasE Trssue returns tn ur gwna enuth 1 Na Bands Break 1 Heat r5 Rereeseu z Recavew r5 camp ete stretch 1 a nds between bers break and rerfarm 1 xnuwruuer caHaqen bers rupture 1 Na eammeze recaverv Derannemn remams o Trssue fa ure FIND 3 PHASES ON YOUR PARTN ER 0 PHASE1 You omy strargmen mewavy coHagen bers 0 PHASEZ e asuc You between me ers to be broken and reeformed 0 PHASE 3 nos 510 be broken and re ay cause coHagen rrbers to be 0 AVO D PHASE 4 T SSUE FA LURE Discuss o How can vou oertorrh stretches to mawmtze astmg trssoe changes o What have vou seeh oohe h the cthtrammg room to optu mze ewbmtv o What rs the drtterehce between orotohged stretch and statrc progresswe stretch MAXIMIZE TISSUE CHANGES o INCREASE LOAD stretch harder INCREASETIME stretch unger CVCLIC STRETCH WHAT TYPE OF ROMSTREI39CH WOULD U RECOMMEND protohged or cvchc7 Actwe or passwe7 Mahoat or mechamcaW Theraprst or se streth 1 Acute m amed ahkte sprarhv 2 Dam and trrgger pomt m the gastrochermosv 3 TWO davs post etbow surgerW 4 4 months post etbow surgerv wrth etbow exton contracture ot 740 degrees otextehsrohv VIGOR o How far into resistance the stretch is ta en 0 Considerations 1 Tissue integrity Stage of healing 2 Inflammation present 3 Pain 4 Goal of treatment 0 Questions comments examples DURATION and REPITITIONS o HEALTHY OLDERADULTS Comparih 15 30 stretch stretch greatest and longestrlasting improvement ou NG ADU LTS I 30 and 60 Sec Stretch more effective than 15 Sec Hamstrin S 15 sec and 2 min stretch equal Adductors No behetit past al rhih oi I 3 X 30 Sec Oi 60 Sec no more effective than 1 X 30 Oi 60 Sec It total durat on equal cvcl c and prolonged stretch are equallv bene cial DURATION and REPITITIONS 0 Pathological condition 0 Post immobilization 0 Adhesive capsulitis 0 Patient who does not rspond to shorter duration 0 Chronic fibrotic contractures 0 se o very prolonged stretch with splint cast or static progressive stretch device may lie 0 ASSESSMENT IS KEY FREQUENCY 0 Healthy At least 2 times per week for gains in ROM 0 Soft tissue pathology More frequently for gains in ROM 0 23 time day may be necessary 0 Based on individual s response 0 EXAMPLES MAINTENANCE o Gains last a week after stretching 0 Maintenance requires Use of new ROM in functional activities ANDOR a maintenance stretch program RELATIONSHIP BETWEEN PAIN AND RESISTANCE 0 Pain dominant Pain limits motion Immediately after knee surgery 0 Resistance dominant Stiff with pain at the end Stiff ankle after casting 0 Pain and resistance are closely related Shoulder capsulitis 0 Resistance dominant Tight Hamstring in normal personathlete What vigor repetitions duration should be used PROPRIOCEPTJIVE NEUROMUSCULAR FACILTA39I39JION DEMONSTRATION CONTRACT RELAX 02pnfcontractmov AGONIST CONTRACT 03pmfagonistmov Fascial Stretch Neural Stretch o Span multiple joints 0 Stretchmobilization winds upquot each component 0 Use caution 0 Can be quite uncomfortable 0 Can cause moderate to severe raction 0 Examples o Ulnar N 0 Lu mbosacral plexus o Downward facing dogquot Stretching Lab Goals 0 Logical selection of technique 0 Including vigor duraton reps neummuscular facilitationinhibit on 0 Based on sound anatom cal principles 0 Appropriate to age pathology 0 Skillful technique 0 Body mechanics 0 Stabilization of proximaldistal segments 0 Ability to teach the patient 0 Explain rationale 0 Written and verbal instruct on I m not sure how to stretch this muscle Think of what motions the muscle does during the manual muscle test To stretch take it to the end range of motions in the opposite directions Biceps Shoulder Elbow Forearm Hold RelaxHamstring o Passively raise leg straight up to moderate resistance 0 Hold don t let me push your leg upquot Try to push leg up patient resists 5 sec 0 Relax give time to relax o Passively raise leg to moderate resistance 0 Repeat 35 times Agonist ContractHip Flexion o Passively flex hip to moderate resistance 0 Pull your knee to your chest you follow the patient s movement but don t pus o Relax you maintain the position that the patient achieved 0 Repeat 3 5 times Stretching Lab 2 Joint Muscle Stretching o Hamstring o Prevent posterior pelvic tilt o Stabilize opposite eg 0 Avoid abduction or external rotation of BOTH legs 0 DO NOT include dorsiflexion unless you want to include possible nervefascia component Stretching Lab 2 Joint Muscle Stretching o Rectus Femoris 0 Example in the book Problems 0 Anter or tilt of pelvis will 0 Increase lumbar lordosis and aggravate pain 0 Give slack h RF decreasing effectiveness of Stremh 0 Control anterior tilt o Prone o Supine o Sidelying Stretching Lab Differentiate 2 joint and singlejoint Ms 0 Stretch RF 0 Stretch Iliacus 0 Stretch Psoas Teaching Self Stretch 0 Focus on alignment 0 Stabilization of proximal segments 0 Prevent deviation out of plane of motion 0 Look for cheating Neural mobilizationstretch 0 Remember pain is REFERRED from lesion pain location is not source 0 BE CAREFUL 0 Limit duration and reps 0 Learn in depth in ortho class 0 Exampe L5 Nerve Root SLR Add DF Siump sit teststretch The good the bad and the ugly Range of Motion PT 220 Lois Boulgarides PT DPT MS Indications and Goals for ROM 0 Passive ROM 7 Indicationsfor PROM AROM is not oossioie or is contraindicated Severe in amed iniury 7 Goalsfor PROM Minimize contracmresmaintain eiasticityrnooiiity Assist neaiing Assist circuiation improve synoviai rnovernent nutrition of cartiiage Decrease oain Maintain oatientawareness 7 Other usesfor PROM Ex rnination Patientteacning Preparation for stretch Types of ROM Exercises 0 Passive 0 Active 0 Active Assisted 0 Manual 0 SelfExercise 0 Mechanical CPM machine Assistive tools recip pulley wand skateboard Indications and Goals for ROM 0 Active and activeassistive ROM Indications for AROM Patient strong enough Use AROM Weakness UseAA o I Aerobic conditionin I Above and below area of injury during healing Goalsfor AROM Maintain elasticity and strength rv feedback Stimulate soft tissue and bone integrity Improve circulationprevent thrombus formation I Coordination and motor skill development Limitations of ROM Exercises 0 Limitations of passive motion Does not prevent atrophy or increase strengh Limited improvement in circulation Limitations of active ROM Does not increase strength of STRONG muscles Principles and Procedures for Applying ROM Techniques Examination evaluation and treatment planning Patient preparation Application of techniques Application ofPROM Application of AROM Application of ROM Techniques crummg in p n hen cs 7 Se enEWraDnatetreatmentlmwtmrm garandmethad 7 PatxentCLOSElwhen ewreprrem s 5 ems HAD 7 mmquot nermenermom 7 Emmetxme shgmha dattheenda herange Upper Extremity ROM echniques Shou der exr on and extension 7 Hand p acementand procedure enextensmn H t Wm Em shomderAbducrron 7 A ternztepusmuns Upper Extremity ROM Techniques cont shuumernrrterrrerrrredrer shumdermcrrzunu 2 and extem abductmn Extensmn and ratater n Scapu a e evatfo depressfon retractionretraction and upwarddownward rotation Elbow flexion and extension 7 Hand placement and procedure eamtrhedhrpehdkheenexmh Upper Extremity ROM Techniques cont E ungztmnuftwujumtbmepsbrzcmmusc e 7 shdmder 21 edge tame 7 Stabmzesczpu z m retrsetrdh anddepressmn rter Wanttu pmtrsd r Prunztefurezrm r Extend Show 7 Extend shduderehdree rs not suff r Shght abdudmn Hf shm der E ungztmn uftwujumt uhg head ufthemcepsbrzchu rhusde 7 Va ddthrs Upper Extremity ROM Techniques cont Forearm prohatr39oh and supr39hatr39oh wh39st exr39oh pah ar exr39ohp and extehsr39oh 1dorsr exr ohh radia abduction and u nar adductfonh deviation Upper Extremity ROM Techniques cont hshd Cuppmg shd attemng the arch urthe hshd at the carpammzczrpz shd rhterrhetsesrpsuurhts 7 For Carper tunne syhdrdrhe shddr past surgery Jumtsufthethumb shd rrhgersmexmh shd Extensmn shd abdumun shd adductmn 7 S L ztejumtsfmmEndund Upper Extremity ROM Techniques cont E ungztmn uf Extrmsm musdesuf the wnsl shd hshd exur and e ehsur drgrtururh musdes Dd hdtusethrsteehhrduerdrhhger exarswhen pssswe msuf mency drthetehddhsrs reqmredfurhznd mdmn c5 Spmz curd wary Lower Extremity ROM Te chnique s and MW hrp extehsmh Lhyperextehsmm whrth drremah davau want ta emphasue Elongation oflhe wosjoinl hamstring muscle group 7 WHEN vow St Pr ROGRBS TOSTRETCHWG BEsuRETO abmxe DEM umhar suppan ehthar appasrte we eventahduman arratatmna mth tgs cahtrd knee extehsmh 7 FOR RANGE or MOTon W THouTSTRETCH stemhtetmh rsxessrmpartem Lower Extremity ROM Techniques cont Hipnbductiunznd adductiun Eiongation of tne twosjoi39nt rectus ferrioris muscie 7 wHENsWETcHiNG stabiiiltveivis 7 rmntwrmmthitsnangnganwnimnnnnnr 7 Suvinewnh vv i ekneehuggedlntheil 7 Side vingwim vv i ekneehuggwlnzhen Extendh Fiexknee rnzi med i and Hip inte i2 externzi izterzi rutztiun WHENGOiNGTHROUGHRANGEOFMOTiONWiTHOUTSTRETCH Peivi stahiiilatian is his impartsquot 1 invranevasitianstabiiiltveiviswithhand 2 nipisaireadyextendedinoease With Dadunderthighi 3 Fiexknee Lower Extremity ROM Lower Extremity ROM Techniques cont Techniques cont Amide dorsinexion Transverse tarsai ioint I Joints of the toes exion and extension and abduction and adducti39on metatarsopnaiangeai and interonaiangeai iointsi Ankie piantar exi39on Subtaiar iiower ankiei ioint inversion and eversion Lumbar Spine ROM Techniques Cervical Spine ROM Techniques I Fiexi39on I Rotation Precautions 7 VBA 7 UCLigzmentuusizxity SelfAssisted ROM 0 Selfassistance o Wand Tbar exercises 0 Wall climbing SelfAssisted ROM cont Overhead pulleys Shoulder ROM Skate boardpowder board Reciprocal exercise unit bicycleUE cycle Continuous passive motion Benefits of CPM General guidelines for CPM


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