>Hi gang!
> A few of our group have mentioned "stretching exercises". Could you
>possibly describe these? I have found that my own invented routine can
>help my walking and balance but the positive results of my own
>stretching does not last very long. Were your exercises given to you by
>a physical therapist? How long do you hold each position? Anything
>else you could share on this topic would be helpful. I have significant
>atrophy on my right side due to my partial paralysis from my waist down.
>The muscles and tendons on that side are tight and short, tending to
>spasm right after being stretched.
>
>My physical
>therapy at the rehabilitation hospitan I was in right after my stay in the
>acute care hospital gave me daily Range Of Motion exercises(ROM). This is a
>routine that stretches each of your affected joints, muscles and tendons,
>stretching them to their limits to hepl prevent a shrinkage of the tendons
>due to lack of use.
Stretching exercises have a twofold effect on muscles. One is a change in
tone and the other is prevention of muscle shortening (contractures).
Stretching and Tone: Usually when you slowly stretch muscles with SCI, you
get a reduction in tone and when you stretch quickly the central nervous
system reacts with a spasm. Usually the longer you stretch, the greater the
reduction in tone. This is good for muscles that have high tone
(hypertonic). Controlling hypertonic muscles is more difficult than muscles
with (more) normal tone.
This would explain that you can walk and do things easier after stretching.
Stretching has a temporary effect on tone and as the cause of high tone has
changed, high tone will return making walking and doing things more
difficult again.
It can happen that you stretch your muscles too long and the reduction in
tone so great that the muscles that were high tone have become low tone.
This would make walking still difficult but for different reasons. Instead
of stiff legs, your legs are like jello all of a sudden.
This means that you cannot say that there is a proper time for stretching
re: tone reduction. It depends on your tone and how sensitive your central
nervous system is to stretching. I've treated people with Stroke and SCI
whose tone was not effected by stretching at all or it lasted as long as
they relaxed and did nothing. As soon as they moved the tone shot right
back up.
No matter what the effect on tone, stretching has on you. You should always
stretch high tone muscles to prevent muscle shortening. If you have muscles
that are very high tone and there is the threat of muscle shortening, the
best prevention and therapy is positioning. For example if your calf
muscles have really high tone and they've already shortened a little bit.
you should keep your ankles at 90 degrees as much and as long as possible.
as for atrophy of muscles and shrinkage of tendon due to lack of use.
a muscle consists basically of two tendons at both ends with muscle tissue
in between.
Tendons are like steel wires, they practically doesn't contract, shrink or
stretch.
Muscle tissue (the middle part of the muscle) contracts and relaxes, over
the long term it can adjusts its maximum length by building extra parts or
taking parts away. For people with SCI, stroke or TM the problem is that
high tone muscles tend to shorten (a contracture) For example the claw hand
that some people after stroke develop on the affected side. Ballet Dancers
and Martial Arts Fighters try the opposite ,lengthening muscles by doing a
lot of stretching so they can do splits and make incredible kicks.
Stretching to prevent contractures is basically reminding muscles that they
should stay long.
Atrophy of muscles relates to thickness of the muscle. Atrophy means thin
muscles and ypertrophic muscles mean thick muscles. Atrophy is caused by
lack of use of muscles. This happens to people who have been inactive for
long time, astronauts who have been in space for a long time. In case of
TM, low tone muscles are at risk of becoming atrophied.
High tone muscles don't have this risk, because the spinal cord is firing
signals to these muscles all the time. Extreme high tone muscles might
actually become hypertrophic.
So this creates the following paradox. High tone muscle might become
shorter but thicker and low tone muscles might become atrophied but longer.
Somebody also mentioned TENS and Muscle stimulation. I would like to say
that TENS can also be used to reduce pain, itch and burning sensation by
stimulating the neural fibers in the skin.
Simon Kruithof PT