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AT 250 Study Guide - Midterm Guide: Continuous Passive Motion, Joint Capsule, Proper Motion

Athletic Training
Course Code
AT 250
Dr. Susan Norkus
Study Guide

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Flexibility: ability to move a joint/series of joints through a full, non-restricted, pain free range of motion
Dependent on combination of joint ROM and soft tissue extensibility
Specific to each joint & movement
Interpreting evaluation results
Identify cause of motion restriction → apply most appropriate intervention
ROM exercises of manual intervention
Joint capsule tightness doesn't allow proper motion
Stretching/flexibility exercises
Muscle tightness restricts motion
Weakness → decreased motion
Results of Tx plan
Improve muscle flexibility → increased joint range of motion
Improve joint ROM → muscle flexibility may not be impacted
Active Assistive ROM exercises
Mvmt of body part through arc of motion w combo of active muscle contraction and external force
When muscles weak or when jt motion causes pain
Pt move w limbs, outside force helps w mvmt
PROM exercises
Mvmt of body part through arc of motion by external force
No effort from pt
When pt cannot actively participate
When contraindicated for muscle to contract
AROM if pt can do w/o pain/inflammation
Then AAROM, if pt can’t do AROM start with AAROM
Then PROM, if pt can’t do AROM or AAROM or muscle contraction is contraindicated, start w PROM
Examples of ROM equipment and techniques
Continuous passive motion machines
UBEs and bikes
T-bars, broom sticks
Towels, pulleys, walls, wall wheels
Muscle Flexibility
Most sport activities require some ‘normal’ flexibility, some require more than normal
Leads to success in sport
Need functional flexibility/functional ROM
Anatomical limits to flexibility
Normal structures (tissue, muscles, tendons, skin, bone, neural tissue etc)
Age and gender (younger → pliable; females more flexible than males in general)
All except bone, age and gender can be altered to increase joint ROM
Neurophysiology basis of stretching
When a muscle stretched
Muscle spindles & GTOs (neural receptors that provide sensory input (info)) stimulated,
shape change → send afferent impulses to spinal cord
Afferent: sensory; towards spinal cord
GTOs in tendon
Synapse w motor neuron at spinal cord; informs muscle being stretched
Efferent impulses (away from spinal cord) come back to same muscle → contract and
resist stretch
GTO responds to both change in length and change in tension
Stretch held for period of time (6 seconds), GTO sends afferent impulses back to spinal cord
Senses increase in tension
Signals synapse with a motor neuron at spinal cord

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Efferent impulses back to muscles causes reflex relaxation of muscle being stretched
All without having to send impulses to brain
Neurophysiological Phenomena
Autogenic inhibition
Contraction during ‘push’ phase → increased tension
Stimulates GTO production of reflex relaxation before muscle placed on stretch
slow reversal hold
Reciprocal inhibition
Contraction of agonist → reflex relaxation in antagonist muscle → stretch
Effects on Mechanical and Physical Properties of Muscle
Muscles and tendons composed largely of non-contractile collagen and elastin
Collagen- resist mechanical forces, deformity
Elastin- assists in recovery from deformity
Muscle has active contractile components
Actin and myosin filaments
Both components determine muscle’s capability of deforming and recovering
Both components resist deformity
% of each depends on degree muscle is stretched and velocity of deformity
Non-contractile primarily resist degree of stretch
Stretch, more these components contribute
Contractile elements limit high velocity deformity
Stretches held long enough allow for viscoelastic and plastic changes to occur in
collagen and elastin fibers
The > the velocity of deformity, the > the chance of exceeding tissue’s capability to
undergo viscoelastic and plastic changes
Increasing Muscle Temperature
To most effectively stretch a muscle during rehab, intramuscular temperature should be
increased before stretching
+ effect on collagen and elastin
Enhances ability of GTO to inhibit
39oC or 103oF
Low intensity warm-up or modalities
Cold: helpful to decrease muscle guarding that may limit ROM
Stretching Techniques
Goal: improve active ROM by altering extensibility of motor units
Over time, motor units will increase ROM possible
Proprioceptive Neuromuscular Facilitation
Dynamic stretching
Repetitive contraction of agonist to create quick stretch of antagonist
Many sports = ballistic
Functional → late stages of healing
Tail end of warm up → resembles dynamic activity
Static stretching
To point of discomfort, then hold
3-60 seconds
15-30s is most effective
3-4 times
Contraction of agonist, passively use BW, partner, AT, t-bar, towel, etc.
Safer than ballistic

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Early in warm-up, can progress to ballistic
Proprioceptive neuromuscular facilitation
Alternating isometric/isotonic contractions of agonist and antagonist
10s push / 10s rest
3 different techniques
Contract relax
Beneficial when ROM limited by muscle tightness
Move body part passively into agonist pattern until resistance is felt
Instruct athlete to push by contracting antagonist muscle (muscle
being stretched) isotonically (through the range)
Resist motion through ROM for 10s
Instruct athlete to relax; passively move limb to increased stretched
position (until resistance felt) for 10s
Repeat 2 to 3 times
Hold relax
Appropriate when muscle tension on 1 side of joint
Move partner to point of resistance and instruct athlete to ‘hold’
Instruct to contract antagonist (muscle to be stretched) isometrically
10 seconds
Apply resistance allowing no motion
Instruct athlete to relax
Apply gentle pressure to produce max stretch for 10 seconds
Repeat 2 to 3 times
Slow reversal-hold relax
Useful for increasing ROM when primarily limiting factor is
antagonistic muscle group
Instruct athlete to move limb to max ROM by contracting agonist
Instruct athlete to isometrically contract antagonist (muscle that will
be stretched) for 10 seconds
Instruct athlete to contract agonist, causing movement in agonist
pattern (stretching antagonist)
Apply gentle pressure to produce max stretch for 10 seconds
Repeat 2-3 times
No evidence one better/worse
Stretching Neural Structures
Should be able to differentiate between muscle and neural tension
Stretching Recommendations
3-6 times a week
Muscle must be maximally relaxed
May need to help patient attain proper relaxation
Location of treatment- quiet, low lighting
Deep breathing
Conscious relaxation
Requires significant concentration of patient
Involves contraction/relaxation of one muscle group at a time
Feeling for sense of warmth and heaviness in muscles once relaxed
Start with contraction of distal muscles working towards more proximal
Continue until entire extremity has been contracted and relaxed
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