Prof.

Edgar Lopategui
MA MA

.,

Physiology
ítoí Exercise

Corsino

AND AN
lithic:
.
 AND FLEXIBILIT
FLEXIBILITY
DEFINITIONS:
ability of

the MTJ to extend the application of a stretch

 AND FLEXIBILIT
FLEXIBILITY
DEFINITIONS:

ability of the muscle to relax and generate

 AND FLEXIBILIT
DEFINITIONS:

stretching exercises designed to increase

stretching
AND FLEXIBILIT
MOBILIZATION
DEFINITIONS:

movements

performed by

athletic therapist at a rate low enough so that the in

 RANGE OF MOTION

AND FLEXIBILIT
DEFINITIONS:

amount

of mobility of a joint, determined by the soft

general term AND FLEXIBILIT
STRETCHING
DEFINITIONS:

used to

describe any

therapeutic maneuver designed to extend (exten

 AND FLEXIBILIT
DEFINITIONS:
STRAIN

(tightness)
moderate reduction in the length of a con
 AND FLEXIBILIT
DEFINITIONS:
TIRANTEZA
occurs

(tautness)

in muscle or connective tissue before a ful

 overstretching
sobreestiramientoes
AND FLEXIBILIT
DEFINITIONS:

stretching

being performed untouched outside normal

Flexómetrode ARCO MOTION:
AND FLEXIBILIT
Goniometro
inclinometer PotentiometerMEASUREMENT
Scale 180 ° ARCO MOTION:

MEASUREMENT

passive motion (AMP, or PROM) Measurement Units:

of joint movement and measured movement

 * STRETCHING:
Causes*
Causes
tissue diseases or neuromuscular

immobilisation restrictive Mobility

soft

tissue
pathology due to trauma and congenital around
bone a joint (los
deformities acq
 MOBILITY AND FLEX

COMPONENTS

soft tissue joint mobility

MOBILITY AND FLE
MUSCLES
Muscle assumes a shortened position

MUSCLES
immobility: Effect / results:

contracture: Loss of flexibility

 Golgi

properties

MUSCLES

of muscle: role of proprioceptors: Muscular Time

exercises to restore full flexibility:

tendon organs of relaxation process:

/ methods:

Active

Passive Active-assistive

MUSCLES

exercises to restore full flexibility:

 / structure: Network:
substance is inert CONNECTIVE TISSUE
 CONNECTIVE TISSUE
can slowly be extended with a sustained stretch

immobilized, it is shortened as an adaptive mechanism

It is somewhat flexible:
It has
You
no can
resilience
not stretch
properties
Develop Scars

when Scarring:CONNECTIVE TISSU

soft tissue is immobilized during healing (healing)

are composed of a connective tissue denser form

 CONNECTIVE
prolonged immobilization TISSUE
soft tissue:
Fibrotic

Prevent:

tissue

formation, which are in the irreversible scars contracture

 for CONNECTIVE TISSUE
This is accomplished passively

maintaining mobility connective tissue: Technique:

exercise: Concept / Target:

normal
movement: Determinants:

SKIN

mobility of

skin: The skin flexibility allowed to occur: Active body stretching

 SKIN: Skin Scarrin
MOBILITY OF

possible,

wounds severe burns:

start the movement as early as possible can help minimize numbness resulting
measures: Early Mobility:

/ results: Stretching is difficult:

 capsular laxity: MOBILITY
ARTICULAR AN
MOBI
Any appropriate

capsular
restriction
looseness

of themovement
normal capsule is
orrequired
Fatula relationship
for slippagebetween the between
may occur joint surfaces, will interfere
the normal shot of w

normal movement may occur, a kinematic n

 MOBILITY
ARTICULAR AND FL
MOBILITY

- - Joint mobilization techniques:

General, or
specific

normal joint mobility: Methods / Techniques:

therapeutic exercises:
 MOBILITY AND FL
TYPES

mechanical

OF EXERCISE JOINT MOBI

or positional stretching of soft tissues, in which the f

 MOBILITY AND FL
TYPES
technique

is

employed

where inhibition reflects and subsequent elongation of

OF EXERCISE JOINT MOBI

 MOBILITY AND FL
TYPES

general

term

used to describe the exercises performed by a perso

OF EXERCISE JOINT MOBI
 MOBILITY AND FL
TYPES
drive or

sliding

movements

of the joint

surfaces that maintain or restore joint play normally perm

OF EXERCISE JOINT MOBI
 STRETCHING
Increases the risk for  muscle strain

- Improves elasticity
The Consequently:

muscle
REQUIREMENTS
of a muscle decreases with cooling: Resul

(or muscle group) is in better condition for training and competition

Physiological principles:
warmed: Effects / Benefits:

the muscle metabolism muscle contracts faster: 

crucial role in muscle activity

REQUIREMENTS
optimal use of levers body: Importance:
REQUIREMENTS
Muscle
Ligaments
Connective tissue Skin
there is a
INDICATIONS

limitation

in range of motion, as a result of adhesio

 INDICATIONS
limitation

that can

produce structural deformities (skeletal)

 weakness

of a muscle (or muscular group) and `tigh

INDICATIONS

stretch

/ lengthen muscles trincos so that later they can effectively strength

 CONTRAINDICATIONS
the bone block limits joint movemen
inflammation the presence of a strong and sharp pain
 CONTRAINDICATIONS

contractures

or

a hematoma or other indications of

shortening of the soft tissues provide increased jo

contractures CONTRAINDICATIONS

or

shortening

of soft tissues are the basis for an increas

 normal range of motion of joints

GOALS

the expected mobility of the soft tissues surrounding

the overall

GOALS
flexibility

of a body part before incorporating an exercise progra

or

GOALS

minimize

the risk of injury musculotendinosasrelacionado s

 of STRETCHING E

therapeutic RECOMMENDATION

methods of stretching and mobil

modalities

Itinerary of programs Quantification dose auto-mobil

 the longitudinal
mobilizesthe various stretching
through
stretching
RECOMMENDATION
axis of thetechniques:
joint is  It 

of stretching and mobilization m

along the rotational axis translacionalesy

different needs, depending on the flexibility profile of each athlete

 RECOMMENDATIONS
Tip:
stretching, warm-up period is recommended
 They
RECOMMENDATIONS
are used
Justification:
for to

increase flexibility: The viscoelastic nature of collagen with increa

 The
RECOMMENDATIONS

Justification:
ability

the
of collagen temperature
and intramuscular
elastin components has a in
to deform positive effect on:
the musculotendi
 The
RECOMMENDATIONS

Justification:
ability

of the tendon organs Golgipara relax muscle reflexively by auto

RECOMMENDATIONS
 Trotting
RECOMMENDATIONS
Protocol:

very low

intensity fast Stationary cycling Walking

 pain Muscle spasms
RECOMMENDATIONS:
injuries in soft tissue that may cause:

cold (cryotherapy) Directions:

inhibition when running the arc of movement in the joint and limb

ÍÍ
SICA
cold (cryotherapy): Uses:
RECOMMENDATIONS:

ÍÍ
SICA
 theory,
RECOMMENDATIONS:
once the plastic deformation occurs, lowering the temperature c

cold (cryotherapy): Justification:

is used as the thermal properties advantage possessed by the connective

ÍÍ
SICA
This allows stretching
The pain
Muscle
inhibition
spasmin the arc of movement
RECOMMENDATIONS:
cold (cryotherapy): Effects:

ÍÍ
SICA
 RECOMMENDATIONS:
application in

the form of:

Massage with
cold (cryotherapy): Protocol / Procedure:

ice cold water immersion bags / ice packs Roceadorfrío (vapocoolant)

ÍÍ
SICA
 RECOMMENDATIO
- application
myofascial syndromes:
◊Estaafecciónse
The

in the form of: Roceadorfrío (vapocoolant): Note:

cold (cryotherapy): Protocol / Proce

caracterizapor: o  Muscle spasms

ÍÍ
SICA

usode estemétodosolo esefectivoen aquelloscasosde s índromesmiofa

 STRETCHING

- RECOMMENDATIO
Relaxation effect:
This
(PNF, English acronym) application

has a
cold (cryotherapy): Protocol / Pro
in the form of: Roceadorfrío (vapocoolant): Justificati

similar
ÍÍ
SICA

to the techniques used for stretching exercises known as physiological

 RECOMMENDATIONS:
cold (cryotherapy): Duration:

ÍÍ
SICA
 Fixed
RECOMMENDATIONS:
contracture injury Advantages:

Indications:

Athletic Injury

ÍÍ
SICA
competitive sportstotraining:
transitori sports training:
RECOMMENDATIONS
stretch:
RECOMMENDATIONS
of dose: Duration:
First reps:

15 seconds

workout: 12-20 minutes

last repetition: 30 seconds
 RECOMMENDATIONS
replicates for each movement, to each end
of dose: Repeats:
 RECOMMENDATIONS

exercises self-mobilization: Description:

self-: A

level segmentalde the region Thoracic trunk Lumbar spine

 RECOMMENDATIONS
athletes
self-mobilization Directions:

who require: Rotation upper body hold loads

must RECOMMENDATIONS

take place within a "window" Safety and Effectiveness

stretching

(active) Active

static

stretching stretch (AROM) Active-assistive str

/ description Disadvantages 
Risk of injury
Indications /

Uses Advantages Disadvantages 

and constant application of a stretching force on
Not think the psychosocial problems
progressively
STRETCH
Static ME
stretching

body part stretching the position reach

has been

found to

be equally effective to maintain the stretch position for 15 s

a

workout,

it is used as a warm-up activities, employee befor

 make it safe

risk of acquiring a reduced muscle soreness after exer

- - instabilidades
In association
Especiallywith
cervical
impermanence
or

specific there is the presence of certain injuries: Examples:

degenerative joint disease of the intervertebral disc:

 ACTIVE STRETCH
Technical Protocol Contraindications
 ACTIVE STRETCH

includes

active

stretching flexibility exercises that are executed by

 ACTIVE STRETCH

patient

is involved in the maneuver of stretching to inhibit

 ACTIVE STRETCH
Actively inhibit trinco / tense muscle

injured athlete takes an active role in the stretch

patient is actively involved in the maneuver stretching to:

athlete uses his own body to produce stretching a particular area

 ACTIVE STRETCH

on the duration and repetition of active stretchin

 ACTIVE STRETCH

the

helps restore neuromuscular control of the affe

patient has control over an affected limb are commonly in
 ACTIVE STRETCH

- Increases (or restored) the:

Muscle Flexibilidadnormal

If the antagonist is provided, the agonist is inhibited:

/ benefits: When using the:  Reciprocal inh

ACTIVE STRETCH
 ACTIVE STRETCH
support:
each year: 4-5
Duration:

15 to 30 seconds Repetitions:
 ACTIVE STRETCH
Particularly
It

Repeats:

patients who have a significant loss in joint movement:

during the formation of scar tissue and shrinkage:

is recommended that repeated sessions of stretching exercises daily

 ACTIVE STRETCH
Stretches

Repeats:

also be carried out: After the activity

 METHODS / TECH
Reciprocal * STRETCHING
- STRETCH ACTIVE *
A

◊Un
Recommendation:

Estoprevieneun
músculoagonistase
Pérdidaen the movement Arcode

balance acortacuando suanatgonistaesmásdébil: "Effect:

inhibition (antagonist inhibition): Profit / res

between the two (agonistay antagonist) or Result:

estiramientomásefectivo: Explicaciónfisiológica:
 Inhibition

-
músculoagonista is relajael:
Increases

of agonist: Profit / results:

Protocol
the flexibility of this muscle (that is desired stretch)
 Improves
trying inhibition: Example:

to stretch the hamstring muscles (hamstrings), contracting th

stretching the hamstring muscles (hamstrings)

Protocol
bend STRETCHING E
(double)
from the hip (waist) to touch the tips of his toes, but with your knees bent
a

Inhibition Experiment:

position,

first evaluates the flexibility of the hamstring muscles (

Protocol
 STRETCHING E

return your
Inhibition Experiment:

to a full hands on the tips of toes, straighten your knees to

standing position (erect) and the flexibility of reevaluate your "hams

Protocol
need to be able to reach further, compared with the first attempt   
(Hold-Relax)

Collapse-Relax-Collapse

(Hold-Relax-Collapse) Reciprocal Inhibition

TT
and and
techniques
 *
(TO CONTRACT
HOLD

technique was originally associated with the meth

- -
RELAX)
RELAX *

TT
and and
techniques
 *
(TO CONTRACT
HOLD

a
contraciónpre-stretch

- -
RELAX)
RELAX *

TT
and and
muscle contracting maximally, there is a brief peri
techniques
tight muscle can cause stimulation of tendon organ Golgiy muscle ref

it is relatively easy to lengthen the muscle while it is in a relaxed state

is believed
*
(TO CONTRACT
HOLD

that this

method provides a greater degree of relaxation in the

- -
RELAX)
RELAX *

TT
and and
techniques
 *
(TO CONTRACT
HOLD
has

been

-
reported that the -RELAX)
-RELAX of
contraction * pre-stretch tight mu

TT
and and
techniques
pre-stretching is due to the persistent facilitation tight muscle contraction aft
 *
(TO CONTRACT
/ risk: Danger:HOLD

- -
RELAX)
RELAX *
result, it has been postulated that, during the elongation, this method

TT
and and
techniques
 *
(TO CONTRACT
HOLD
the

the tensed muscle in a comfortable position elong

patient

- -
RELAX)
RELAX *

isometrically contracting muscle tight against a substantial r

TT
and and
techniques
 instruct the patient* to voluntarily relax
(TO CONTRACT
HOLD

the

the whole procedure after several seconds of rest

athletic therapist lengthens muscle to passively move the li
- -
RELAX)
RELAX *

TT
and and
techniques
technique is

similar to
-RELAX
-
RELAX

contract-relax,

except that
-CONTRACT)
-CONTRACT*
after
TT
and and
techniques
contraction of prestretching of tight muscle and phases of
 -RELAX
-
RELAX
has

-CONTRACT)
-CONTRACT*

TT
been suggested that thisand and
combination of facilitation
techniques
 INHIBICI

the muscle

OR OR
N REC
contracts

ÍPROCA
Í *

actively and
TT
and and
techniques

dynamically (eccéntricas includes concentric contract

 INHIBICI
the

antagonist

OR OR
muscle taut N REC

dynamically (eccéntricas includes concentric contract

ÍPROCA
Í *

TT
and and
techniques
 INHIBICI
spasms

causing tension in the muscle and a secondary re

OR OR
N REC

ÍPROCA
Í *

TT
and and
techniques
 INHIBICI

the

OR OR
N trinco
patient dynamically shrink REC antagonist muscle agai
with a tight muscle in a comfortable position, b

ÍPROCA
Í *

TT
and and
techniques
 INHIBICI
the

muscle

OR OR
contracts simultaneously
N RECreciprocally trinco inhibit

ÍPROCA
Í *

TT
and and
techniques
Notes

Protocol Requirements 

-assistive
assistive
means

when the

movement of a body segment through the arc of mov

-assistive
assistive
the injured

athlete is

strong enough

-assistive
(and pain is no assistive

longer a problem) to produce a muscle contraction, but n

-assistive
assistive
 -assistive
assistive
joint is mobilized with mutual support clinical an
 PASSIVE STRETCH
Meta Protocol
Requirements 
 PASSIVE STRETCH

stretching

involves using a computer or another person, whe

 PASSIVE STRETCH

stretching

is

performed by applying an external force, with minim

 PASSIVE STRETCH

the

patient relaxes, an external force either manually or

 PASSIVE STRETCH
athlete

relaxes as something outside its tip moves through an arc of spec

stretching does not involve work by the individu
therapist ACTIVE STRETCH
uses passive to assist in the recovery of the athlete stretch afte

/ Benefits: For the injured athlete:

 STRETCHING E
PASSIVE STRETCH
training
- An
It canadverse consequence:
cause damage to muscle tissue
required

to be performed by people with training and experience

unqualified

person may think that stretching should be carried out beyond the ra
 METHODS / TECH
Restoring STRETCHING
movements PASSIVE STRETCH
movement joint accessories and physiological

are
accessories

necessary for the physiological movements m

(twists, ruts

and landslides)

only occur with

technical

mobilization and manipulation implemented by the athletic therapis

 PASSIVE STRETCH

passive Forced:

exercises

forced

movements produce more alláde the limits available range of mo

types of stretching are rarely indicated and should be performed by experienced

 unforced
PASSIVE STRETCH

passive exercises are those used to maintain normal joint m

unforced:

are

commonly kept within the limits of a range of motion in the absence of pa

it affects the elastic range of connective tissue

Protocol
 clinician
estiramentose maintained for 15 seconds

moves the injured part of the patient throu

therapist applies a stretch at the end of such a move

Protocol
to stabilize

the

proximal segment of the joint being stretched

Protocol
 pressure is

applied

patient shoulduntil
feel athe slack or
stretch is tension,
taken connective tissue and
but no pain

Protocol
has two

joints, then

first place a

joint position along the muscle, then do the sa

Protocol
passive

prolonged stretch produces a plastic deformation of the conn

/ stable over a period of time as:

most effective stretches involve an app

Protocol
duration for prolonged stretch:

Protocol
 stretch: Applies with a reduced load Advant

increases

the movement because of its impact on stress-strain curves (stre

Protocol
may be

provided

by: Bodyweight or segment thereof, or mechanical device, such as a w

passive stretch: Procedure:

stabilizes the stretched portion to allow the correct charge

Protocol
 is

slowly and steadily / stably applied until point voltage (tightn

passive stretch: Procedure:

Protocol

the segment is secured in this position and is held during the amount
 the

patient does not feel much, if anything, when stretching is applied for th

passive stretch: Procedure:

Protocol
muscle that crosses two joints is stretched, secondary joint
in 5 to 10 minutes, the patient habráde feel the effect of stretching
the
passive stretch: Procedure:

duration of prolonged stretch: 15 -20 minutes

patient can not tolerate stress, reduce force to allow the patient to s

Protocol
 METHODS / TECH
to the STRETCHING

stretching
the
should be instructed that the patient before releasi

is released, you should advise the patient to contract the muscle stretched si
is

stretching load is removed, the por

Protocol
recommended that the athlete perform active joint mobility a
another person Traction Pressure 

Protocol
stretch position is maintained for a period of tim

Protocol
sufficiently
a slight stretch, gradually increasing intensity Dri
heated, are brought to a position very stretched by the tensile me

Protocol
 Uses Indications

techniques Methods / Techniques

neuromuscular facilitation (PNF, a

 OR OR
* N Proprioceptive Neuromu
(PNF, acronym in English)
CONCEPT*

to promote

or

accelerate the response of neuromuscular m

 OR OR
N Proprioceptive Neuromu
(PNF, acronym in English)
application of *
CONCEPT*

three

techniques

involving some combination of isometric con

 OR OR
for therapeutic N Proprioceptive Neuromu
(PNF, acronym in English)
*
CONCEPT*
exercises

using

proprioceptive

and cutaneous auditory inputs to produce a functio

 OR OR
N Proprioceptive Neuromu
* (PNF, acronym in English)

CONCEPT*

combination

of active and passive targeting stretching s

 Te foundations
OR OR
N Proprioceptive Neuromu
(PNF, acronym in English)
techniques

are based on

or or
rich *
reducing

sensory activity via spinal reflexes, which is aime

 Te foundations
OR OR
N Proprioceptive Neuromu
principle of (PNF, acronym in English)

the

Sherringtonde  or or
rich *

reciprocal inhibition demonstrating relaxation of m

 OR OR
N Proprioceptive Neuromu
* (PNF, acronym in English)
the
Indications*

antagonist muscle caused by a muscle spasm

 OR OR
methods N Proprioceptive Neuromu
(PNF, acronym in English)

were described as a rehabilitation technique for

*

Applications*
 OR OR
to
N Proprioceptive Neuromu
(PNF, acronym in English)
improve flexibility and movement arc treatment for v

*
athletes with various neuromuscular diso

Applications*
 OR OR
N Proprioceptive Neuromu
(PNF, acronym in English)

muscle
Prop
or or
site *

relaxation through an inhibitory response in

 *
effectiveness OR /OR
Advantages Benefits *
of PNF N Proprioceptive Neuromu
(PNF, acronym in English)
methods and showing greater increases in flexibili
 Cross *
OR /OR
Advantages Benefits *
N Proprioceptive Neuromu
(PNF, acronym in English)

training effect on hip flexibility

 OR OR
N Proprioceptive Neuromu
(PNF, acronym in English)

*
principle

Teor
íto*í to*

of reciprocal inhibition mechanism is used a

 OR OR
occurs when estácontrayendo towards its shortened condition
N Proprioceptive Neuromu
(PNF, acronym in English)

Teor
íto*í to*
patterns: Pattern agonist muscle:

is diagonally opposite the standard agonist and occurs when the muscle is ap
 descriptions it * OR OR
would be easier N Example
Proprioceptive Neuro
group is the agonist  MODEL: *
to visualize a (PNF, acronym in English)
Think example a
quadricepshamstring muscle (posterior thigh or hamstring
muscle is
MM
brought OR OR
AND AND N Proprioceptive Neuro
ALL T
(PNF,contraction
to its final movement, isometric acronym in English)
trinco mu

or or
nn
- AND AND
rELAXATION
TECHNICAL:

or or
nn
 MM
OR OR
AND ANDN Proprioceptive Neuro
ALL T
(PNF, acronym in English)

technique

or or
nn
is - AND AND
rELAXATION
TECHNICAL:

executed in the same sequence as the contraction-rela

or or
nn
 MM
OR OR
AND ANDN Proprioceptive Neuro
ALL T
(PNF, acronym in English)

or or
nn
- AND AND
rELAXATION
TECHNICAL:

or or
nn

intensity of each contraction is gradually increase

 MM
OR OR
AND ANDN Proprioceptive Neuro
ALL T
(PNF, acronym in English)

or or
nn
- AND AND
rELAXATION
TECHNICAL:

or or
nn
 MM
OR OR
AND ANDN Proprioceptive Neuro
ALL T
(PNF, acronym in English)

or or
nn
- AND AND
rELAXATION
TECHNICAL:
the joint restriction is accompanied by muscle spas

or or
nn
 MM
OR OR
AND ANDN Proprioceptive Neuro
ALL T
(PNF, acronym in English)

or or
nn
increase - AND AND
rELAXATION
TECHNICAL:

or or
nn

the range of motion which is based on an isometric co

 MM
OR OR
AND ANDN Proprioceptive Neuro
a maximum ALL T
(PNF, acronym in English)

antagonist or or
nn
- AND AND
rELAXATION
TECHNICAL:
(hamstring)

isometric contraction or or three planes of movement and

in all
nn
 It

starts with

an

neuromuscular facilitation (PNF, a

isometric

contraction of the antagonist (the muscle be stretched) against a resistance, fol

 The The

hold-relax

/ techniques: hold-relax (SR)

technique is similar to the contraction-relaxation, except that an isometri

neuromuscular facilitation (PNF, a

patient moves the body part to a point where a resistance is met; then, you