THERAPEUTIC EXERCISES II
Dr. Saeed Mohamed Ibraheem
PHD, P.T, Cairo University
Lecturer of physical therapy
Basic Science Department
October 6 University
Muscle
Stretching
performance
exercises
exercises
THERAPEUTIC EXERCISES II
Mobilization Neural
exercises mobilization
exercises
STRETCHING EXERCISE
• Stretching is a form of physical exercise in which a
specific muscle or tendon (or muscle group) is
deliberately flexed or stretched to improve the muscle's
felt elasticity and achieve comfortable muscle tone.
• Also, defined: as a general term used to describe any
therapeutic maneuver designed to increase the
extensibility of soft tissues, thereby improving flexibility
by elongating (lengthening) structures that have
adaptively shortened and have become hypomobile over
time
Definition of Terms Associated with Mobility and
Stretching
A. Flexibility is the ability to move a single joint or series of joints
smoothly and easily through an unrestricted, pain-free ROM.
Flexibility is related to the extensibility of muscle tendon units that
cross a joint, based on their ability to relax or deform and yield to a
stretch force.
• Types of Flexibility
1. Dynamic flexibility: referred to as active mobility or active ROM, is
the degree to which an active muscle contraction moves a body
segment through the available ROM of a joint.
2. Passive flexibility : referred to as passive mobility or passive ROM, is
the degree to which a body segment can be passively moved through
the available ROM and is dependent on the extensibility of muscles
and connective tissues that cross and surround a joint.
• B- Hypomobility
Hypomobility refers to decreased mobility or restricted motion.
A wide range of pathological processes can restrict movement
and impair mobility. There are many factors that may contribute
to hypomobility and stiffness of soft tissues:
1) the potential loss of ROM.
2) the development of contractures.
• C-Contracture
Contracture is defined as the adaptive shortening of the muscle-
tendon unit and other soft tissues that cross or surround a joint
resulting in significant resistance to passive or active stretch and
limitation of ROM, which may compromise functional abilities.
contracture is defined as an almost complete loss of motion,
whereas the term shortness is used to denote partial loss of
motion.
• the term tightness to describe restricted motion due to
adaptive shortening of soft tissue despite its common
usage in the clinical and fitness settings to describe mild
muscle shortening.
• the term muscle tightness used to denote adaptive
shortening of the contractile and noncontractile elements of
muscle.
Types of Contracture
1. Myostatic contracture
A myostatic (myogenic) contracture, although the
musculotendinous unit has adaptively shortened ,there is a
significant loss of ROM and there is no specific muscle pathology
present.
From a morphological perspective:
a. there may be a reduction in the number of sarcomere units in
series
b. there is no decrease in individual sarcomere length
Types of Contracture (continue)
2- Pseudomyostatic contracture
Muscle spasm or guarding and pain due to
Impaired mobility and limited ROM may
also be the result of hypertonicity (i.e.,
spasticity or rigidity) associated with a
central nervous system lesion.
Such as: - a cerebrovascular accident
- spinal cord injury
- traumatic brain Injury
The involved muscles appear to be in a
constant state of contraction, giving rise to
excessive resistance to passive stretch.
Types of Contracture (continue)
3-Arthrogenic and periarticular contracture.
• An arthrogenic contracture is the result of intra-articular pathology.
• 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.
• These changes may include:
₋ Adhesions - irregularities in articular cartilage
₋ synovial proliferation - osteophyte formation
₋ joint effusion
Types of Contracture (continue)
4-Fibrotic contracture and irreversible contracture
Fibrous changes in the connective tissue of muscle and
periarticular structures can cause adherence of these tissues and
subsequent development of a fibrotic contracture.
Although it is possible to stretch a fibrotic contracture and
eventually increase ROM
Permanent loss of extensibility of soft tissues that cannot be
reversed by nonsurgical intervention may occur when normal
muscle tissue and organized connective tissue are replaced with a
large amount of relatively nonextensible, fibrotic adhesions and
scar tissue or even heterotopic bone.
• Located within the belly of
the muscle, between and
parallel to the main muscle
fibers, are muscle spindles.
These muscle spindles are
made up of spiral threads
called intrafusal fibers, and
nerve endings, both encased
within a connective tissue
sheath. These spindles
monitor the speed at which a
muscle is lengthened and are
very sensitive to stretch.
MECHANISM- STRETCH REFLEX
• When a stretch force is applied to a muscle-tendon unit either
quickly or over a prolonged period of time, The primary and
secondary afferents of intrafusal muscle fibers sense the length
changes and activate extrafusal muscle fibers via alpha motor
neurons in the spinal cord, Thus activating the stretch reflex and
increasing (facilitating) tension in the muscle being stretched.
• The increased tension causes resistance to lengthening and, in
turn, is thought to compromise the effectiveness of the stretching
procedure.
Golgi tendon Organ
• During static stretching it
is thought that the GTO,
which monitors tension
created by stretch of a
muscle-tendon unit, may
contribute to muscle
elongation by overriding
any facilitative impulses
from the primary
afferents of the muscle
spindle (Ia afferent fibers)
and may contribute to
muscle relaxation by
inhibiting tension in the
contractile units of the
muscle being stretched.
• Reciprocal Inhibition
• When the stretch reflex is activated in a muscle
being lengthened, decreased activity (inhibition) in
the muscle on the opposite side of the joint, referred
to as reciprocal inhibition
• To minimize activation of the stretch reflex and the
subsequent increase in muscle tension and reflexive
resistance to muscle lengthening during stretching
procedures, a slowly applied, low intensity,
prolonged stretch is considered prefereable to a
quickly applied, short-duration stretch.
• Autogenic Inhibition
• In contrast, the GTO, as it monitors tension in the muscle fibers
being stretched, has an inhibitory impact on the level of muscle
tension in the muscle-tendon unit in which it lies, particularly if
the stretch force is prolonged. This effect is called autogenic
inhibition.
• Inhibition of the contractile components of muscle by the GTO
contributes to reflexive muscle relaxation during a stretching
maneuver, enabling a muscle to be elongated against less muscle
tension.
• It is thought that if a low-intensity, slow stretch force is applied
to muscle, the stretch reflex is less likely to be activated as the
GTO fires and inhibits tension in the muscle, allowing the parallel
elastic component (the sarcomeres) of the muscle to remain
relaxed and to lengthen.
