PROPERTIES OF SOFT

TISSUE-

Response To Immobilization And

Stretch
 TYPES OF TISSUES
• Contractile
Muscle, tendon, musculotendinous
junction, tenoperiosteal junction
• Non contractile / Inert
Capsule, ligament, blood vessels,
articular cartilage, bursa, Dura, etc
 The ability of the body to move freely,i.e.
without restrictions and with control during
functional activities, is dependent on
• passive mobility of soft tissues
• active neuromuscular control.
The soft tissue that become restricted and
impair mobility are muscles with their
contractile and non contractile elements and
various types of connective tissue
( tendons, ligaments, joint capsules, fascia,
skin).
• It’s the decreased extensibility of connective
tissue not the contractile elements of
muscle tissue which is the primary cause of
restriction ROM.

• Changes when soft tissues are stretched

elastic ,
viscoelastic,
plastic
• ELASTICITY:
it is ability of soft tissue to return to its
prestretch resting length directly after a short
duration stretch force has been removed.eg.
Contractile & non contractile
• VISCOELASTICITY:
it is time dependent property of soft tissue
that initially resist deformation of tissue
when stretch force is first applied.if force is
sustained, viscoelaasticity allows a change in
length of tissue and enables the
 tissue to return gradully to prestretch
state after the stretch force is removed.
eg. Connective tissues
• PLASTICITY :
it is the tendency of soft tissue to
assume a new and a greater length after
the stretch force is removed.
Eg. Contractile and non contractile tissues
 Mechnical Properties of Contractile
Tissue
• Muscle - contractile elements
contractility and irritability
- non contractile connective tissue
resist deforming force
 connective tissue-
innermost endomysium separates myofibrils
perimysium encase fibre bundle
• Epimysium envelope fascial sheath
around entire muscle.
-adhesions

contractile elemnts of muscle

Muscle muscle fibres myofibrils
sarcomeres myofilaments of actin and
myosin
 Response to stretch:
• During passive stretch both longitudinal
and lateral force transduction occurs.
• Initial lengthening-sharp rise in tension
• After a point, there is mechanical
disruption of cross-bridges as filaments
slide apart, leading to abrupt lengthening
of sarcomere (sarcomere give)
• After release of force gain normal length.
 Response to immobilization and remobilization
morphological changes:
• Decay of contractile protein
• decrease in muscle fibre dia.
• dec in no. of myofibrils
• Dec in cross sectional size of m fibres over
time
• Significant deterioration in motor unit
recruitment reflected in emg
• dec in intramuscular capillary density
– atropy and weakness – inc fibrous and
fatty tissue in muscle.
tonic(slow twitch)postural > phasic(fast
twitch)
 IMMOBILIZATION IN SHORTENED
POSITION
• Reasons???
• Reduction in length of muscle and its fibre
• In no. of sarcomere in series within
myofibrils as a result of sarcomere
absorption – muscle atrophy and weakness
• Shift to left in length-tension curve
• Frank-Sterling’s law???
 IMMOBILIZATION IN LENGTHENDED
POSITION
Application of serial casts,use of dynamic
splints to stretch a long standing contracture
or inc ROM
• Muscle adapts by inc in no. of sarcomere in
series(myofibrillogenesis)
may lead to permanent form of m
lengthening if newly gained length is used in
regular basis in ADL.
• prestate if not use in 3 to 5 weeks.
 Neurophysiological Properties of
Contractile tissue
• Two sensory organs, Muscle spindle &
golgi tendon organ – convey information
to the CNS about muscle tendon unit &
affect a muscle response to stretch.
• Muscle spindle:
-functn to rcv and convey information abt
change in length of m and velocity of
length change
-intrafusal, types??, motor neuron at ends??
, Ia n IIa sensory fibre,
-primary respond to quick n sustain
stretch-bag
-sec only to sustain- chain
• Golgi tendon
-musculotendinius junctn
-monitor change in tension of m t unit
being stretch

• Neurophysiological response of m to
stretch..
-reciprocal inhibition
-autogenic inhibition
 Mechanical Properties of Non
Contractile Soft Tissue
• Composition of connective tissue
- collagen
-elastin and reticulin
-nonfibrous ground tissue
• Collagen fibers:
-strength and stiffness of tissue
-resist tensile deformation
-joint stability

Tropocollagen-building block of collegen

microfibrils
• Elastin fibers:
- ↑ Elastin – Greater flexibility
-Smaller in diameter than collagen fibers,
branch & join together to form a network
within a tissue
-Consists of protein elastin surrounded by
glycoprotein - fibrillin
-grt elongation with small load,break at
higher load
• Reticulin fibers:
-provide tissue with bulk
• Ground Substance:
-made up of proteoglycans(PGs) and
glycoprotein.
-Component of connective tissues between
the cells & fibers
-Supports cells & binds them together, stores
water, & provides a medium through which
substances are exchanged between the
blood & cells
 1.Reduces friction
2.transport nutrients
3.Prevent excessive cross linking between
fibers.
• PG – stabilize collagen network, hydrate
matrix, resist compresive force
• Glycoproteins – Linkage between matrix
components & between the cells & matrix
components.
 Mechanical Behaviour of Noncontractile
Tissue

It depends on collagen, PGs

• ↑ in collagen , ↓ in PGs
---- resist high tensile load

• ↑ in conc. of PGs - withstand greater

compressive load
• Collagen….
- Tension generation
-10% collagen elongate for 150% elastin
elongate
-collagen 5 times strong thn elastin
-alignment reflects tensile force
tendon, skin, ligaments, jt capsules
 Interpreting Mechanical Behaviour of
Connective Tissue:
Stress-Strain Curve
• Stress – force per unit area
resistance to external load
• Kinds
-tension
-compression
-shear
• strain –amount of deformation tht occurs
when load or stretch force is applied
 ELASTIC PLASTIC
RANGE RANGE

TOE
ELASTIC
REGION
LIMIT
NECKING
STRESS
FAILURE

STRAIN

STRESS – STRAIN CURVE

STRESS - STRAIN CURVE 33

 Regions of the stress - strain curve

• Toe region
• Elastic range/linear
phase
• Elastic limit
• Plastic range
• Ultimate strength
• Failure
• Structural stiffness
 Connective tissue responses to loads

• Creep – Related to
viscosity & time dependent
• Stress - relaxation
• Cyclic loading &
connective tissue loading
 Changes in Collagen affecting Stress-Strain
Response
• Effects of immobilization
• Age
• Inactivity(Dec in normal activity)
• Corticosteroid
• Injury
 Determinants of Stretching
interventions
• Alignment
• Stabilization
• Intensity of stretch
• Duration of stretch shorter the duration –
greater the no of repetitions & vice versa)
• Speed of stretch
• Frequency of stretch
• Mode of stretch
 broad categories of stretching exercise
-Static stretching
-cyclic stretching
-ballistic stretching
-stretching tech based on principles of
pnf
other types- manual or mechanical
-active or passive
-self
Alignment
• Positioning a limb or the body such that the
stretch force is directed to the appropriate
muscle grp.
-for comfort n stability during ex.
-influence the amount of tension in soft tissue
and affect ROM available in jts.
Eg : rectus femoris stretch
Alternate position in case of discomfort,
inadequate nmsclr control, cardiopulmonary
capacity.
Stabilization
• Fixation of one site of attachment of muscle as
the stretch force is applied to the other bony
attachment.
-either proximal or distal site
-Manual stretching–proximal
-Self stretching- distal
-Multiple seg stabilizatin 4 effective stretch
Eg iliopsoas stretch
• Sources of stabilization-manual contact,
body weight or firm surface such as table,
wall or floor
Intensity of stretch
•
O the
Magnitude of the stretch force applied
-it is determined by load placed on soft
tissue to elongate it.
Low intensity stretch better than high
intensity
-maneuver more comfortable
-minimize vol or invol muscle guarding so
pt remain relaxed or assist with stretching
maneuver.
-good for inc ROM without exposing the
weakened tissue to excessive loads n
potential injury.
-effective for dense connective tissue
elongation with less soft tisssue damage
and post ex soreness thn high int stretch
Duration of stretch
• The period of time a stretch force is applied
and shortened tissue is held in a lengthened
position
-safe, effective ,practical and efficient for
each situation.
-Inverse relation betn I and D
I and F
30 sec twice = 10 sec 6 times
But 15 sec thrice significant thn 5 sec 9 times
Long duration stretch- static, sustained,
maintained and prolonged
Short duration stretch- cyclic, ballistic, or
intermittent
no specific time period assign
• Static stretching
- Here softt tissues are elongated just past
point of tissue resistance and then held in
lengthened position with a sustain stretch
force over a period of time.
- Effective to inc flexibiity, safer
- Tension half
- Contractile n non-contractile tissues
less tissue trauma and less m soreness
• Static progressive stretching
-capitalize on stress relaxation properties
of soft tissue
Eg dynamic orthosis
• Cyclic (intermittent) stretching
- A relatively short duration stretch force
tht is repeatedly but gradually applied,
released and thn reapplied is described as
cyclic stretch.
- Applied for multiple repetitions during
single treatment session.
- Slow vel controlled manner n low int.
Speed of stretch
• slowly applied stretch
- ensure optimal m relaxation
- prevent injury
-less likely to inc tensile stress on conn
tissue, inc tnsn in contractile tissue,
activate stretch reflex
• Ballistic stretching
-A rapid, forceful intermittant stretch-tht
is, a high speed and high intensity stretch-
is called ballistic stretching.
-greater trauma and m soreness
-not recommended for elderly or sedentary
individuals or pts with mskltl pathology
or chronic contracture… reason??
- athlete , young active pt
• Frequency of stretch
-no. of bouts per day or per week
-depend on
underlying cause of impaired mobility
quality and level of tissue healing
chronicity and severity of contracture
pts age
use of cortcosteroids
- sessions??
• If there is progressive loss oof ROM over
time rather thn gain in range, continued
low grade inflammation from repetitive
stress can cause excessive collagen
formation and hypertrophic scarring.
• Mode of stretching
• Form or manner in which the
- stretch force is applied (static, ballistic,
cyclic) ;
- degree of pts participation(passive,
assisted, active);
- or the sourse of the stretch force(manual,
mechanical, self)
• It is imperative tht shortened m remains
relaxed n tht connective tissue yield as
easily as possible to stretch.
for this stretch procedure shud b
preceded by either low intensity active ex
or heat to warm up tissue
Manual stretching