active stretching techniques definition
- Asks the patients to work the muscle
- Increases ROM or flexibility by decreasing the tension in the muscle and surrounding connective tissues
types of stretching
- static - (active or passive)
- dynamic
- ballistic (bouncing)
- loaded (weight)
- proprioceptive neuromuscular function
PNF different techniques
- hold relax
- reciprocal relaxation
- rhythmic stabilisation
Hold relax explained
- take the target muscle into its lengthened position.
- isometrically contact muscle through applying and matching resistance. isometrically hold the muscle restricting movement (agonist).
- voluntary relaxation (small refractory period)
- stretch target muscle into further range actively or passively (more effective is active)
reciprocal relaxation explained
- Cycle of concentric, then isometric, then eccentric, then concentric again in antagonist to muscle(s)
- take target muscle into range. antagnoist muscle will concentrically contract.
- isometric contraction of antagonist muscle by matching resistance
- eccentric contraction of antagonist muscle by slightly beating resistance.
- move target muscle into new ROM, involves concentric contraction again of antagonist.
Rhythmic stabilisation explained
- Using both hold relax and reciprocal inhibition
- Alternating isometric contractions of the agonist and the antagonist before relaxing and taking into new range
PNF stretching Repetitions, frequency, and duration
- Hold between 3s and 15s found to be effective
- At least one repetition, less gain with subsequent repetitions
- Frequency - at least twice per week
- Duration - 1 day to 12 weeks all investigated and found to be effective
- can self-resist or therapist-resist, both effective
- anywhere from 20% to 100% maximum voluntary contraction found effective, lower is safer
Arthroplasty explained
Replacement of a joint with artificially produced material
Total - replacement of all joint surfaces concerned
Partial - replacement of only one or some of the surfaces but not the entire joint
PREHABILITATION
-Process of enhancing an individual’s functional capacity to enable them withstand a forthcoming stressor
-Major surgery results in a reduction in functional status postoperatively followed by a recovery period
-Patients suffering a complication may experience a slower and incomplete recovery threatening longer-term independence
- Pre-habilitated patients are better placed to cope should a complication occur
- Prehabilitation crucial to safeguarding longer-term functional status and independence
PREHABILAITION multimodal apprach
- Medical optimisation
- Physical exercise
- Nutritional support
- Psychological support
PREHABILITATION for arthroplasty
Education
-Anatomy
- Surgery
- Post-surgery management and support Exercise
Lifestyle modification
PREHABILITATION- physiotherapy approach
- Mobilising
- Pain management
- Support/positioning
- Range of movement
- Preparing for returning home
TKA indications
- guided by these domains: pain, function, radiological changes, failed conservative treatment
- mostly based on expert opinion
common indication:
- Symptomatic OA or inflammatory arthritis of the knee that is not responsive to conservative therapy
- Severe knee pain or stiffness that limits ADLs
- Moderate or severe knee pain while resting, either day or night
- Chronic knee inflammation and swelling that does not improve with rest or medications
- Knee deformity
Why/why not PREHAB for TKA?
WHY
- Can have an effect on quadriceps strength, walking speed and mental health before TKA
- Prehabilitation improved performance in functional tasks, decreases pain measures and increased quadriceps strength
- Pre-operative exercises increased quadriceps strength… but not at 3 months following TKA
WHY not
- Did not impart lasting benefits to patients 12 weeks after TKA
- No evidence that multi-discipline prehabilitation before TKR for OA improves short-term functional independence or reduces midterm activity limitations after surgery
- Low to moderate evidence that pre-operative interventions, particularly exercise, decrease pain for patients with OA prior to joint replacement
