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Rheumatoid arthritis. Present-day physical therapy.

Physical therapy is an important therapeutic agent for patients with rheumatoid arthritis. Well directed exercise balanced with rest is fundamental. Careful muscular reeducation is as important in the treatment of patients with arthritis as it is in caring for a patient with paralysis. Pain with slight malalignment and limitation in the joint will cause muscles to lose their sequence of action and so upset the rhythm of motion. Active exercise with a balanced use of assistance and resistance to movement, combined, as indicated, with traction upon the joint or stretching of constricted tissues may result in (1) stabilization of the joint, (2) increase in range of movement, (3) relaxation of antagonists, and (4) reduction of atrophy. The objectives of muscular exercise then are (1) reduction of pain, spasm and deformity, (2) development of muscular power, and (3) restoration of the normal rhythm of movement.

Arthritis↗

Interaction between fascicle and tendinous tissues in short-contact stretch-shortening cycle exercise with varying eccentric intensities.

The interaction between fascicle and tendinous tissues (TT) in short-contact drop jumps (DJ) with three different drop heights [low (Low), optimal (OP), and high (High)] was examined with 11 subjects. The ground reaction force (F(z)) and ankle and knee joint angles were measured together with real-time ultrasonography (fascicle length) and electromyographic activities of the medial gastrocnemius (MG) and vastus lateralis (VL) muscles during the movement. With increasing drop height, the braking force and flight time increased from Low to OP (P < 0.05). In High, the braking force increased but the flight time decreased compared with OP (P < 0.05). During contact of Low and OP conditions, the length of muscle-tendon unit and TT underwent lengthening before shortening in both MG and VL muscles. However, the two muscles differed in the fascicle behaviors. The MG fascicles behaved isometrically or shortened, and the VL fascicles underwent lengthening before shortening during contact. In High, the TT lengthening in both muscles decreased compared with OP (P < 0.05). The rapid stretch occurred in the MG fascicles but not in VL fascicles during the braking phase. The elastic recoil ratio decreased in both muscles with increasing the intensity during DJ. These findings demonstrated that TT underwent lengthening before shortening during DJ. However, the efficacy of elastic recoil decreased with increasing the drop intensity. The effective catapult action in TT can be limited by the drop intensity. In addition, the measured muscles behaved differently during DJ, providing evidence that each muscle may have a specific means of fascicle-TT interaction.

Adult↗

Effect of eccentric muscle contractions on Golgi tendon organ responses to passive and active tension in the cat.

To investigate the possibility of a peripheral contribution to the perturbations of force sensation reported to occur after eccentric exercise, responses to passive and active tension were recorded from Golgi tendon organs in the medial gastrocnemius muscle of the anaesthetised cat, before and after a series of eccentric contractions. After the eccentric contractions, nearly all tendon organs commenced firing at a shorter muscle length during slow passive stretch than before, probably because of a rise in whole muscle passive tension. There was a small drop in the sensitivity to incremental tension, but no mean change in tension threshold. Following the eccentric contractions, there was a small, but not significant, increase in tendon organ sensitivity to active tension, which was graded using a method of optimised, distributed stimulation of divided ventral roots. Sensitivity was estimated as the mean response over a range of tensions and as the change in discharge rate in response to incremental tension. The experiments provided the opportunity of comparing tendon organ sensitivities to graded passive and active whole muscle tension. In agreement with previous work in which whole muscle nerve stimulation was employed, little difference was found. It was concluded that the peripheral contribution to perturbations of force perception after eccentric exercise is likely to be small and that the centrally derived sense of effort plays the dominant role. Tendon organs appear to be remarkably reliable in signalling whole muscle tension, whether passive or active, and even after the muscle's force production has been disturbed by fatigue or eccentric exercise.

Animals↗

The effect of prolonged static and cyclic stretching on ankle joint stiffness, torque relaxation, and gait in people with stroke.

BACKGROUND AND PURPOSE: Continuous passive motion (cyclic stretching applied to the subject's limb) has been used for the rehabilitation of some orthopedic impairments; however, few researchers have considered its application in the management of neurological disorders such as stroke. The purpose of this study was to examine the short-term effects of prolonged static and cyclic calf stretching on passive ankle joint stiffness, torque relaxation, and gait in people with ischemic stroke. SUBJECTS: Ten community-dwelling people (mean age=64.6 years, SD=8.76, range=53-76) who were diagnosed with a cerebrovascular accident volunteered to be subjects. METHODS: Participants engaged in one 30-minute static stretch and one 30-minute cyclic stretch of the calf muscle, using an isokinetic dynamometer that also collected torque and angle measurements. Before and after treatments, 10-m walking times were collected. Ankle joint stiffness was calculated from the slope of the torque and angle curves before and immediately after treatments, and torque relaxation was calculated as the percentage of decrease in peak passive torque over the 30-minute stretch durations. RESULTS: Ankle joint stiffness decreased by 35% and 30% after the static and cyclic stretches, respectively. Stiffness values and 10-m walk times were not different between conditions. The amount of torque relaxation was 53% greater for static stretching than for cyclic stretching. DISCUSSION AND CONCLUSION: These preliminary data from a very small sample of people with stroke indicate that ankle joint stiffness decreases after both prolonged static and cyclic stretches; however, neither technique appears to be better at reducing stiffness in people with stroke. Torque relaxation is greater after static stretching than after cyclic stretching, and walking speed does not appear to be influenced by the stretching treatments used in our study.

Aged↗

Sensory adaptation after a 2-week stretching regimen of the rectus femoris muscle.

OBJECTIVE: To study the effects of a muscle stretching regimen for the rectus femoris muscle on subjective stretch sensation and range of motion (ROM). DESIGN: A 2 x 2 crossover design comprising 2 treatments and 2 intervention periods. SETTING: A military base in Sweden. PARTICIPANTS: A volunteer sample of 29 male military conscripts divided into 2 groups, with each group subjected to both experimental and control treatments at different time periods. INTERVENTION: Two weeks of supervised stretching (4 times/wk) of the rectus femoris muscle (experimental treatment) and the calf muscles (control treatment). MAIN OUTCOME MEASURES: Subjective rating of the stretch sensation for the anterior aspect of the thigh determined on a category ratio scale. Passive knee flexion ROM determined on each test with the same applied torque, specific for each subject. RESULTS: An additive analysis of variance revealed that the stretch sensation after the experimental treatment was decreased, compared with the control treatment (p <.01). The knee flexion, however, remained the same regardless of the treatment. CONCLUSION: Sensory adaptation seems to be an important mechanistic factor in the effect stretching has on ROM changes. The lack of change in knee flexion suggests that the stretching, as performed in this study, did not influence stiffness of the rectus femoris muscle. Sensory adaptation may also be an underlying mechanism in the alleviating effect of stretching when applied to tired, tender, and painful muscles.

Adaptation, Physiological↗

Contraction specific changes in passive torque in human skeletal muscle.

The present investigation examined passive torque and electromyographic response in human skeletal muscle during passive static stretch within 60 s after maximal repetitive eccentric and concentric contractions. Passive torque (Nm) offered by the hamstring muscle group was measured during passive knee extension in a modified dynamometer in 10 subjects. The distal thigh was elevated to 0.52 rad from horizontal and the backrest was positioned at 1.57 rad. The lever arm moved the leg passively at 0.09 rad s-1 from a starting position of 1.48 rad below horizontal to the final position where it remained stationary for 90 s. Gross electrical activity of the human hamstring muscle group was recorded simultaneously. The effect of concentric or eccentric contraction was tested on separate days. Two stretch manoeuvres with a 45 min hiatus were administered on a control and experimental side. The experimental side performed 40 maximal effort repetitive concentric or eccentric hamstring muscle contractions at 1.05 rad s-1 prior to the second stretch. Passive torque during the 90 s stretch declined 30-35% on the experimental and control side in all stretches, P < 0.001, without a significant effect of prior contraction mode. Passive peak and final torques were lower on the experimental side, P < 0.01 after concentric contractions. Passive peak and final torques remained unchanged after eccentric contractions on the experimental side. The low level EMG response of the hamstring muscle during the stretch was unchanged after maximal repetitive concentric or eccentric contractions. These data demonstrate acute contraction specific alteration in passive torque in human skeletal muscle, which cannot be accounted for by EMG activity. Furthermore, the lack of difference on the control side implies that one 90 s stretch has no effect on passive torque of the muscle 45 min later.

Adult↗

A workplace stretching program. Physiologic and perception measurements before and after participation.

The purpose of this study was to implement a primary prevention program in the workplace targeted to prevent muscle strains. Physiologic and perception measurements were taken before and after participation in a stretching program developed to improve flexibility through conditioning. A one group pre-test post-test design was used with 60 employees enrolled in a 36 session stretching program in the workplace. Flexibility was measured by a flexibility profile including the sit and reach test, bilateral body rotation measurements, and shoulder rotation measurements. A statistically significant increase was found in all flexibility measurements at the conclusion of the study for the participants as a total group. Perception, as measured by the Fox Physical Self Perception Profile, was statistically significant in relation to participants' perceptions of their body attractiveness, physical conditioning, and overall self worth at the program's conclusion. In addition, participants who completed the program had zero occurrences of musculoskeletal injuries during the 2 month period. The results of this study suggest that continued development and implementation of stretching programs in the workplace may benefit employees by increasing flexibility and potentially preventing injuries due to muscle strains. Stretching programs in the workplace also may improve components of employees' perceptions of their physical bodies.

Adult↗

Physical models of rehabilitation in neuromuscular disease.

Physical methods of treatment for neuromuscular diseases constitute the mainstay of current management. The overall goals of management are the maintenance of independent ambulation and the optimal functional state consistent with the disease process. Maintenance of muscle strength requires regular daily physical activity. An active exercise program can give limited increases of strength in muscular dystrophy dependent on the severity of the disease. Active exercise programs do not result in overwork weakness when properly supervised. Endurance exercise training does not appear to be suitable for Duchenne muscular dystrophy but may have value in the less rapidly progressive neuromuscular diseases. contracture development can be retarded by passive stretching and splinting initiated early in the disease course. Weight control is important both for ambulatory and wheelchair-bound patients. Reliable assessment of the results of physical therapy programs has been improved by the introduction of newer, more objective methods for measuring muscle strength.

Body Weight↗

Chiropractic correction of congenital muscular torticollis.

OBJECTIVE: To present a case of congenital muscular torticollis and discuss the clinical manifestations and chiropractic treatment. CLINICAL FEATURES: A 7-month-old male infant with significant head tilt since birth was brought to a chiropractic physician for evaluation. The infant's history included ear infections, facial asymmetry and regurgitation. Significant spasm of the left sternocleidomastoid and trapezius muscles, a left lateral atlas and suboccipital joint dysfunctions were present upon examination. A diagnosis of congenital muscular torticollis was made. INTERVENTION AND OUTCOME: Treatments included chiropractic manipulation, trigger point therapy, specific stretches, pillow positioning and exercises. Excellent results were obtained. CONCLUSION: Suggests that chiropractic intervention is a viable treatment option for congenital muscular torticollis. Further studies should be performed to compare the effectiveness of other treatment options.

Cervical Vertebrae↗

Effects of running, static stretching and practice jumps on explosive force production and jumping performance.

AIM: The interaction between running, stretching and practice jumps during warm-up for jumping tests has not been investigated. The purpose of the present study was to compare the effects of running, static stretching of the leg extensors and practice jumps on explosive force production and jumping performance. METHODS: Sixteen volunteers (13 male and 3 female) participated in five different warm-ups in a randomised order prior to the performance of two jumping tests. The warm-ups were control, 4 min run, static stretch, run + stretch, and run + stretch + practice jumps. After a 2 min rest, a concentric jump and a drop jump were performed, which yielded 6 variables expressing fast force production and jumping performance of the leg extensor muscles (concentric jump height, peak force, rate of force developed, drop jump height, contact time and height/time). RESULTS: Generally the stretching warm-up produced the lowest values and the run or run + stretch + jumps warm-ups produced the highest values of explosive force production. There were no significant differences (p<0.05) between the control and run + stretch warm-ups, whereas the run yielded significantly better scores than the run + stretch warm-up for drop jump height (3.2%), concentric jump height (3.4%) and peak concentric force (2.7%) and rate of force developed (15.4%). CONCLUSION: The results indicated that submaximum running and practice jumps had a positive effect whereas static stretching had a negative influence on explosive force and jumping performance. It was suggested that an alternative for static stretching should be considered in warm-ups prior to power activities.

Adult↗

Glucocorticoid-induced skeletal muscle atrophy in vitro is attenuated by mechanical stimulation.

Glucocorticoids induce rapid atrophy of fast skeletal myofibers in vivo, and either weight lifting or endurance exercise reduces this atrophy by unknown mechanisms. We examined the effects of the synthetic glucocorticoid dexamethasone (Dex) on protein turnover in tissue-cultured avian fast skeletal myofibers and determined whether repetitive mechanical stretch altered the myofiber response to Dex. In static cultures after 3-5 days, 10(-8) M Dex decreased total protein content 42-74%, total protein synthesis rates 38-56%, mean myofiber diameter 35%, myosin heavy chain (MHC) content 86%, MHC synthesis rate 44%, and fibronectin synthesis rate 29%. Repetitive 10% stretch-relaxations of the cultured myofibers for 60 s every 5 min for 3-4 days prevented 52% of the Dex-induced decrease in protein content, 42% of the decrease in total protein synthesis rate, 77% of the decrease in MHC content, 42% of the decrease in MHC synthesis rate, and 67% of the decrease in fibronectin synthesis rate. This in vitro model system will complement in vivo studies in understanding the mechanism by which mechanical activity and glucocorticoids interact to regulate skeletal muscle growth.

Animals↗

Exercise training increases K+-channel contribution to regulation of coronary arterial tone.

The present study examined whether regulation of coronary tone in conduit arteries (>1.0 mm ID) is altered by exercise training. Yucatan miniature swine were treadmill trained for 16-20 wk (Ex) and compared with sedentary counterparts (Sed). Endothelium-denuded arterial rings were stretched to optimal length and allowed to equilibrate for 60 min. Inhibition of either Ca2+-activated channels [1 mM tetraethylammonium (TEA) or 10 nM iberiotoxin (IBTX)] or voltage-dependent K+ channels [1 mM 4-aminopyridine (4-AP)] significantly increased resting tension in both groups; however, the effect of all K+-channel blockers was greater in Ex. Addition of 1 mM sodium nitroprusside reduced resting tension in both groups, confirming the presence of active basal tone; however, sodium nitroprusside-sensitive tone was increased approximately twofold in Ex compared with Sed group. Perforated patch-clamp experiments on isolated smooth muscle cells demonstrated no effect of exercise training on whole cell TEA-sensitive, 4-AP-sensitive, or basal K+ current. Similarly, whereas TEA, 4-AP, and IBTX all decreased resting membrane potential, there was no difference in depolarization between groups. The greater effect of TEA on resting tension in Ex could be mimicked in Sed by addition of the Ca2+-channel agonist BAY K 8644. In conclusion, the greater response to K+-channel blockers after exercise training is consistent with an increased contribution of K+ channels to regulation of basal tone in conduit coronary arteries. The lack of an effect of training on K+ current characteristics or membrane potential responses in isolated cells suggests that a requisite factor for enhanced K+-channel activation in arteries from Ex, possibly stretch, is absent in isolated cells.

4-Aminopyridine↗

Voluntary and reflex responses to fatigue with stretch-shortening exercise.

The effects of 50 depth-vertical jumps (DJ) on counter-movement vertical jump (CMJ), squat jump (SJ), and DJ, isometric knee extension force (MVC), and patellar tendon response were examined in 12 men. There was no reduction in the height of the 50 DJs, but the contact time lengthened by 16%. Height of CMJ and DJ did not change after the 50 DJs, but the activity duration of the leg muscles averaged 13.2% longer. Conversely, height of SJ declined by 11.3%. MVC decreased by 20.1%. No changes occurred in reflex latency and peak-to-peak duration of the compound muscle action potential (AP), but reflex time, AP duration, and AP amplitude increased by 6.4, 6.1, and 23.3%. Thus, subjects compensated for the loss of voluntary force by lengthening the activity duration of the prime movers, potentiating muscle fiber action potentials, and/or enhancing muscle spindle sensitivity.

Action Potentials↗

Thoracic outlet syndrome--a myofascial variant: Part 2. Treatment.

Thoracic outlet syndrome (TOS) may be treated successfully with a powerful form of myofascial release manipulation and stretching. Self-stretching exercises complement all other treatment modalities for TOS. Maximal effect is achieved with high-frequency, progressive stretching, tapered rapidly to a maintenance level as symptoms diminish. Stretching must be demonstrated "hands on" with the patient and reviewed and modified regularly. The techniques are similar to those of Travell and Simons, with modifications. The pain of TOS is intimately connected with short, contracted muscles that develop trigger points. An engram for the shortened muscles develops centrally. The myofascial release technique involves local release of myofascial structures, re-energizing of the tissues, and reprogramming of the central engram for the particular muscle length.

Exercise Therapy↗

Theory and rationale for surface EMG-assisted stretching as an adjunct to chronic musculoskeletal pain rehabilitation.

A clinical protocol is reviewed, which utilizes supportive intervention, education, and surface EMG biofeedback to facilitate movement and to maximize effective stretching with chronic musculoskeletal pain patients. Support for this clinical protocol is provided with an overview of the physiological basis of stretching, surface EMG patterns associated with stretching, and the effects of pain and emotional factors on stretching and movement inhibition.

Acute Disease↗

Unusual responses of nocturnal pineal melatonin synthesis and secretion to swimming: attempts to define mechanisms.

The effect of swimming at night on rat pineal melatonin synthesis was compared with that of light exposure at night. Rats were forced to swim at 0030 hr (lights out at 2000 hr) and sacrificed by decapitation 15 and 30 min later, immediately after swimming. Other groups of animals were exposed to white light (650 muW/cm2) for 15 and 30 min at same time. Swimming caused a rapid and highly significant drop in the melatonin content in the pineal gland; however, the activity of N-acetyltransferase (NAT), the supposed rate limiting enzyme in the melatonin production, was not changed. Despite the drop in pineal melatonin levels, serum concentrations of the indole remained elevated in the rats that swam. In contrast, melatonin levels in the pineal and serum of light exposed rats fell precipitously, accompanied by a significant suppression of NAT activity. Since we anticipated that the strenuous exercise associated with swimming may induce release of artrial natriuretic peptide (ANP) from the heart, which in turn could cause the release of pineal melatonin, in a second study we injected physiological saline intravenously to stretch the cardiac muscle and release ANP. Three milliliters of normal saline was injected during the day into the jugular vein of anesthetized rats that were pretreated with isoproterenol to stimulate pineal melatonin production. Animals were killed 15 min after the saline injection, and pineal NAT activity and pineal melatonin levels were measured. The saline injections caused no alteration in the elevated levels of either NAT or melatonin.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

Alpha7beta1-integrin regulates mechanotransduction and prevents skeletal muscle injury.

Alpha7beta1-integrin links laminin in the extracellular matrix with the cell cytoskeleton and therein mediates transduction of mechanical forces into chemical signals. Muscle contraction and stretching ex vivo result in activation of intracellular signaling molecules that are integral to postexercise injury responses. Because alpha7beta1-integrin stabilizes muscle and provides communication between the matrix and cytoskeleton, the role of this integrin in exercise-induced cell signaling and skeletal muscle damage was assessed in wild-type and transgenic mice overexpressing the alpha7BX2 chain. We report here that increasing alpha7beta1-integrin inhibits phosphorylation of molecules associated with muscle damage, including the mitogen-activated protein kinases (JNK, p38, and ERK), following downhill running. Likewise, activation of molecules associated with hypertrophy (AKT, mTOR, and p70(S6k)) was diminished in mice overexpressing integrin. While exercise resulted in Evans blue dye-positive fibers, an index of muscle damage, increased integrin protected mice from injury. Moreover, exercise leads to an increase in alpha7beta1 protein. These experiments provide the first evidence that alpha7beta1-integrin is a negative regulator of mechanotransduction in vivo and provides resistance to exercise-induced muscle damage.

Animals↗

The effect of stretching during warming-up on the flexibility of junior handball players.

AIM: The purpose of the investigation was to examine in field conditions the acute effects of warming-up on lower extremity joints and trunk flexibility in junior team handball players. METHODS: Forty-seven junior team handball players participated in this study forming an experiment (n=32) and a control group (n=15). The first group performed warming-up and stretching exercises (20 min) whereas the second group only performed warming-up exercises. Passive range of joint motion was determined in hip flexion, hip extension, hip abduction, knee flexion, ankle dorsiflexion and the trunk flexion using a goniometer and a flexometer. RESULTS: The warming-up session induced a significantly increased range in all lower extremity joints and trunk flexion (p<0.01 to p<0.001) of both groups. CONCLUSION: Flexibility improves as a result of muscle elongation during warming-up or even through an incorporated pathetic stretching program.

Adolescent↗