Orthopaedic Physical Therapy Secrets - E-Book

Jeffrey D. Placzek, David A. Boyce

• Publisher: Elsevier
• Year: 2016
• ISBN:
  9780323286831
• Edition: 3
• Topic: Medicina
• Subtopic: Fisioterapia, medicina física y rehabilitación

Whether you're preparing for the OCS or just want to brush up on your orthopedic knowledge, you don't want to be without Placzek and Boyce's new third edition of Orthopaedic Physical Therapy SECRETS. As with previous editions, SECRETS covers a variety of different physical therapy concepts, healing modalities, specialties, and orthopedic procedures to ensure you are well-prepared to pass the OCS and provide the best orthopedic therapy options for today's patients. Common diseases are included as well as more innovative diagnostic tools. Each chapter features thoroughly updated content that's entirely evidence-based and outcome-based. This ebook also features insightful anecdotes — including clinical tips, memory aids, and secrets — and helpful review tools — such as bulleted lists, algorithms and illustrations — to help you thoroughly master all aspects of orthopedic physical therapy practice.

• Coverage of topics found on the orthopedic specialty exam makes this a useful review resource for those studying for the exam.
• Clinical tips provide insightful guidance on a variety of clinical situations and tasks.
• Charts, tables, and algorithims simplify information into logical frameworks.
• Evidence-based content supports the latest orthopedic research.
• Strong chapter on the shoulder and hand succinctly presents important information on this complex topic.
• Annotated references provide a useful tool for research.

• NEW! Completely updated content reflects the latest physical therapy guidelines.
• NEW! Electronic-only format makes this study tool completely portable and accessible on a variety of devices such as the Kindle, Nook, iPad, and more.

Section IV

Special Topics

Chapter 11

Stretching

D.A. Boyce, PT, EdD, ECS, OCS

1 What is stress relaxation?

Stress relaxation is a physical property of viscoelastic structures, such as a muscle tendon unit (MTU). If an MTU is elongated to a specific length and held in that position, the internal tension within the MTU decreases with the passage of time. Clinically, this is what occurs during a static stretch of an MTU.

2 Define creep.

Creep occurs when an MTU is elongated to a specific length and then allowed to continue to elongate as stress relaxation occurs. Clinically, this is what occurs when a therapist performs a stretch in which joint range is increased during the stretch repetition. Creep is partially responsible for the immediate increase in joint range of motion (ROM) during a stretch repetition.

3 When stretching a muscle joint complex, what structures are influenced?

• Joint capsule

• Ligaments

• Nerves

• Vessels

• Skin

• MTU

4 What is ballistic (dynamic) stretching?

Ballistic stretching places the muscle joint complex at or near its limit of available motion and then cyclically loads the muscle joint complex (bouncing motion at the end ROM). The rate and amplitude of the stretch are variable. Ballistic muscle stretching is indicated for preconditioning a muscle joint complex for activities such as sprinting, high jump, or other events that depend on the elastic energy in an MTU to enhance the performance of a particular movement pattern.

5 Define static stretching.

Static stretching is a technique that places a muscle joint complex in a specific ROM until a stretch is perceived. The position is held for a specific period of time and repeated as necessary to increase joint ROM.

6 Describe some commonly used proprioceptive neuromuscular facilitation (or active inhibition) stretching techniques.

• Hold-relax—the muscle to be stretched is placed in a lengthened but comfortable starting position. The patient is instructed to contract the target muscle for approximately 5 to 10 seconds. After the 10-second contraction, the patient is instructed to relax the target muscle completely as the therapist passively increases joint ROM. This is repeated for a specific number of repetitions. Intensity of the stretch is limited by the patient.

• Hold-relax-antagonist contraction—the muscle to be stretched is placed in a lengthened but comfortable starting position. The patient is instructed to contract the target muscle for approximately 5 to 10 seconds. After the 10-second contraction, the patient is instructed to relax and then contract the muscle opposite (reciprocally inhibiting the target muscle) the target muscle, actively increasing joint ROM. Intensity of the stretch is limited by the patient.

• Antagonist contraction—the muscle to be stretched is placed in a lengthened but comfortable starting position. The patient is instructed to contract the muscle opposite (reciprocally inhibiting the target muscle) the target muscle, actively increasing joint ROM. Intensity of the stretch is limited by the patient.

7 What is the optimal number of static stretch repetitions?

The optimal number of stretch repetitions is four. Boyce and Brosky in 2008 found that passive stretching beyond five repetitions results in insignificant gains in hamstring length and that the greatest increase in range of motion occurs during the first stretch repetition.

8 What is the optimal amount of time that a static stretch should be held?

The literature reports stretching durations from 6 seconds to 60 minutes. When looking at immediate increases in range of motion, the literature recommends (on average) stretch times between 15 and 60 seconds. Overwhelmingly the literature reports that prolonged stretching times impair performance. Additionally, it has been found that shorter stretch times < 30 seconds result in the least performance impairments and stretch times of 6 seconds (repeated 6 times) can improve ROM while significantly lessening the negative impairment effects of static stretching. Thus stretch durations between 6 to 30 seconds are advocated.

9 What is the optimal intensity of a static stretch?

Stretching to the point of discomfort (POD) is a common practice and is often believed to yield the greatest results. The vast majority of the literature has found that stretching to the POD results in decreased performance measures (decreased force production, jump height, and balance). Literature examining stretch intensities under a person’s POD reports results of improved ROM and has been found to have less negative effects on performance.

10 How often must static stretching be performed to maintain gains experienced during a static stretch session?

Bohannon found that stretch gains lasted 24 hours after a stretching session of the hamstrings. Zito reported no lasting effect of two 15-second passive stretches of the ankle plantar flexors after a 24-hour period. Clinically, this suggests that stretching should be performed at least every 24 hours.

11 If an individual statically stretches on a regular basis, how long will the gains be retained?

According to Zebas, after a 6-week regimen of stretching, gains realized during that period were retained for a minimum of 2 weeks and in some subjects a maximum of 4 weeks.

12 Does static muscle stretching alter performance?

According to a recent review the majority of the literature surrounding performance measures such as (force production, isokinetic power, and vertical jump) are impaired with static stretching. Impairments caused by static stretching can last upward of 2 hours in some instances. It should be noted that in some instances static stretching can improve performance of activities that require slower submaximal force production such as jogging and submaximal running or in jumping and hopping activities with longer contact times. Additionally, shorter stretch durations (< 30 seconds) have less negative effects on dyna...

Table of contents

• Cover image
• Title page
• Table of Contents
• Copyright
• Dedication
• Contributors
• Preface
• Section I: Basic Science
• Section II: Disease Processes
• Section III: Electrotherapy and Modalities
• Section IV: Special Topics
• Section V: The Shoulder
• Section VI: The Elbow and Forearm
• Section VII: The Wrist and Hand
• Section VIII: The Spine
• Section IX: The Sacroiliac Joint
• Section X: The Hip and Pelvis
• Section XI: The Knee
• Section XII: The Foot and Ankle
• Answers to Study Questions
• Index