RangeofMotion and Flexibility

1
Range-of-Motion and Flexibility
2
ROM

• Definition
• When a body segment or limb is moved through the
  full motion possible by either internal or
  external forces
• NO OVERPRESSURE
• General Influences
• Joint Structure Musculature
• Body Type Congenital Factors

3
Flexibility

• Ability to move a single joint or series of
  joints though an unrestricted, pain-free ROM
• USE OVERPRESSURE
• Factor Limiting Flexibility
• Muscle, bone, fat skin

4
Mechanical Properties Affecting Elongation of
Connective Tissue (CT)

• Composition of CT
• Types of CT
• Collagen
• Elastic
• Viscoelastic
• Plasticity

5
Physical Properties of CT Affecting ROM and
Flexibility

• Creep
• Stress-Strain Curve
• Hookes Law
• Toe
• Elastic
• Yield Point
• Plastic
• Failure
• Hysteresis

6
Properties of Contractile Tissue Affecting
Elongation of CT

• Muscle Components
• Neurophysiological Properties
• Muscle Spindles
• GTOs
• Response to Stretch

7
Factors Limiting Flexibility

• Contractures
• Types of Contractures
• Immobilization
• General Changes
• Effects on Muscle Tissue
• Effects on Articular Cartilage
• Effects on Periarticular Tissue
• Effects of Remobilization

8
ROM Techniques

• Passive ROM
• Indications
• Limitations

9
ROM Techniques

• Active ROM
• Indications
• Limitations

10
ROM Techniques

• Active Assistive ROM
• Indications
• Limitations

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Stretching Techniques

• Goals
• Precautions
• Contraindications
• Ballistic
• Concerns

12
Stretching Techniques

• Passive (Static)
• Manual or mechanical
• Manual
• Benefits
• Mechanical
• Benefits
• Ballistic vs Passive

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Proprioceptive Neuromuscular Facilitation
Techniques Stretching

• Technique 1 Contract-Relax Houglum (specified
  by author to improve limited ROM)
• Passively flex the hip to stretch antagonist
  (hamstrings) for 30 seconds (RELAX).
• Ask the patient to perform an isotonic hamstring
  contraction through full ROM (CONTRACT).
• Then immediately instruct the patient to relax
  once again and apply a passive hip flexion into a
  greater range of motion than achieved the first
  time. Hold this new position for 10-15 seconds
  (RELAX).

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Proprioceptive Neuromuscular Facilitation
Techniques

• Technique 2a Hold-Relax  Kisner and Colby
• Passively flex the hip to stretch antagonist
  (hamstrings) for 30 seconds (RELAX).
• Then ask patient perform a 10 second isometric
  contraction against your resistance by
  contracting the hamstrings (HOLD).
• Then immediately instruct the patient to relax
  once again. The clinician applies a passive hip
  flexion into a greater range of motion achieved
  than the first time. Hold this new position for
  10-15 seconds (RELAX).

15
Proprioceptive Neuromuscular Facilitation
Techniques

• Technique 2b Hold-Relax Houglum (specified by
  author to use for muscle spasm)
• Passively flex the hip to stretch antagonist
  (hamstrings) to end motion and HOLD.
• Then ask patient perform a 10 second isometric
  contraction against your resistance by
  contracting the hamstrings (HOLD).
• Then tell patient to immediately RELAX the
  hamstrings and contract the agonist (quadriceps)
  5-10 seconds to achieve greater ROM. 

16
Proprioceptive Neuromuscular Facilitation
Techniques

• Technique 3 Slow-reversal-hold-relax Kisner
  Colby
• Concentrically contract the agonist (quads) to
  actively flex hip to motion limit.
• Then ask patient to perform a 10 second isometric
  contraction against your resistance by
  contracting the antagonist (hamstrings). (HOLD)
• Ask the patient to contract the agonist
  (quadriceps), actively engaging in a further
  stretch (SLOW-REVERSAL).  Do not passively push
  the hip into greater hip flexion during this step.

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Proprioceptive Neuromuscular Facilitation
Techniques

• Technique 4 Hold Relax with Agonist Contraction
  Kisner and Colby
• Passively flex the hip to stretch antagonist
  (hamstrings) for 30 seconds.
• Then ask patient to perform a 10 second isometric
  contraction against your resistance by
  contracting the hamstrings (HOLD).
• Ask the patient to contract the agonist
  (quadriceps), actively engaging in a further
  stretch (AGONIST).  Do not passively push the hip
  into greater hip flexion during this step.
• Precautions to PNF