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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
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 .tissue to return gradully to prestretch state after the stretch force is removed.
contractile elements contractility and irritability .Mechnical Properties of Contractile Tissue Muscle .non contractile connective tissue resist deforming force connective tissueinnermost 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 .
there is mechanical disruption of cross-bridges as filaments slide apart.Response to stretch: During passive stretch both longitudinal and lateral force transduction occurs. Initial lengthening-sharp rise in tension After a point. leading to abrupt lengthening of sarcomere (sarcomere give) After release of force gain normal length. .
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 .Response to immobilization and remobilization morphological changes: Decay of contractile protein decrease in muscle fibre dia. dec in no.
± atropy and weakness ± inc fibrous and fatty tissue in muscle. tonic(slow twitch)postural > phasic(fast twitch) .
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 SHORTENED POSITION Reasons??? Reduction in length of muscle and its fibre In no.
.IMMOBILIZATION IN LENGTHENDED POSITION Application of serial casts. 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.use of dynamic splints to stretch a long standing contracture or inc ROM Muscle adapts by inc in no.
. Muscle spindle & golgi tendon organ ± convey information to the CNS about muscle tendon unit & affect a muscle response to stretch.Neurophysiological Properties of Contractile tissue Two sensory organs.
Muscle spindle: -functn to rcv and convey information abt change in length of m and velocity of length change -intrafusal.chain . types??. Ia n IIa sensory fibre. motor neuron at ends?? . -primary respond to quick n sustain stretchbag -sec only to sustain.
-reciprocal inhibition -autogenic inhibition .. Golgi tendon -musculotendinius junctn -monitor change in tension of m t unit being stretch Neurophysiological response of m to stretch.
collagen -elastin and reticulin -nonfibrous ground tissue .Mechanical Properties of Non Contractile Soft Tissue Composition of connective tissue .
Collagen fibers: -strength and stiffness of tissue -resist tensile deformation -joint stability Tropocollagen-building block of collegen microfibrils .
Elastin ± Greater flexibility -Smaller in diameter than collagen fibers. Elastin fibers: .break at higher load .fibrillin -grt elongation with small load. branch & join together to form a network within a tissue -Consists of protein elastin surrounded by glycoprotein .
-Component of connective tissues between the cells & fibers -Supports cells & binds them together. Reticulin fibers: -provide tissue with bulk Ground Substance: -made up of proteoglycans(PGs) and glycoprotein. & provides a medium through which substances are exchanged between the blood & cells . stores water.
resist compresive force Glycoproteins ± Linkage between matrix components & between the cells & matrix components.Reduces friction 2. PG ± stabilize collagen network. .transport nutrients 3.1.Prevent excessive cross linking between fibers. hydrate matrix.
resist high tensile load in conc.withstand greater compressive load . of PGs . in PGs ---.Mechanical Behaviour of Noncontractile Tissue It depends on collagen. PGs in collagen .
ligaments. skin. jt capsules . Collagen«.Tension generation -10% collagen elongate for 150% elastin elongate -collagen 5 times strong thn elastin -alignment reflects tensile force tendon. .
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 .
STRAIN CURVE 33 .ELASTIC RANGE PLASTIC RANGE TOE REGION ELASTIC LIMIT NECKING STRESS FAILURE STRAIN STRESS ± STRAIN CURVE STRESS .
Regions of the stress .strain curve Toe region Elastic range/linear phase Elastic limit Plastic range Ultimate strength Failure Structural stiffness .
relaxation Cyclic loading & connective tissue loading .Connective tissue responses to loads Creep ± Related to viscosity & time dependent Stress .
Changes in Collagen affecting StressStrain 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 .
manual or mechanical -active or passive -self .broad categories of stretching exercise -Static stretching -cyclic stretching -ballistic stretching -stretching tech based on principles of pnf other types.
Eg : rectus femoris stretch Alternate position in case of discomfort. -for comfort n stability during ex. .Alignment Positioning a limb or the body such that the stretch force is directed to the appropriate muscle grp. -influence the amount of tension in soft tissue and affect ROM available in jts. inadequate nmsclr control. cardiopulmonary capacity.
distal -Multiple seg stabilizatin 4 effective stretch Eg iliopsoas stretch . -either proximal or distal site -Manual stretching±proximal -Self stretching.Stabilization Fixation of one site of attachment of muscle as the stretch force is applied to the other bony attachment.
Sources of stabilization-manual contact. body weight or firm surface such as table. wall or floor .
O theforce applied Magnitude of the stretch . 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.Intensity of stretch -it is determined by load placed on soft tissue to elongate it.
-effective for dense connective tissue elongation with less soft tisssue damage and post ex soreness thn high int stretch .-good for inc ROM without exposing the weakened tissue to excessive loads n potential injury.
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 .Duration of stretch The period of time a stretch force is applied and shortened tissue is held in a lengthened position -safe. effective .
sustained. or intermittent no specific time period assign .static.cyclic. maintained and prolonged Short duration stretch. ballistic.Long duration stretch.
safer .Contractile n non-contractile tissues less tissue trauma and less m soreness .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.Tension half . Static stretching .Effective to inc flexibiity. .
Static progressive stretching -capitalize on stress relaxation properties of soft tissue Eg dynamic orthosis .
.Applied for multiple repetitions during single treatment session. .Slow vel controlled manner n low int. Cyclic (intermittent) stretching .A relatively short duration stretch force tht is repeatedly but gradually applied. . released and thn reapplied is described as cyclic stretch.
ensure optimal m relaxation . activate stretch reflex .Speed of stretch slowly applied stretch .prevent injury -less likely to inc tensile stress on conn tissue. inc tnsn in contractile tissue.
is called ballistic stretching. forceful intermittant stretch-tht is. a high speed and high intensity stretch. Ballistic stretching -A rapid. -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 .
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 . Frequency of stretch -no.sessions?? .
continued low grade inflammation from repetitive stress can cause excessive collagen formation and hypertrophic scarring. If there is progressive loss oof ROM over time rather thn gain in range. .
degree of pts participation(passive. self) . active). . Mode of stretching Form or manner in which the . cyclic) . ballistic.stretch force is applied (static.or the sourse of the stretch force(manual. assisted. mechanical. .
for this stretch procedure shud b preceded by either low intensity active ex or heat to warm up tissue . It is imperative tht shortened m remains relaxed n tht connective tissue yield as easily as possible to stretch.
Manual stretching .
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