The Student​ Physical Therapist
  • Home
    • Newsletter
    • About
  • Featured Articles
    • Sports Physical Therapy >
      • Functional Return to Sport Testing
    • Residency Corner >
      • Research Articles
    • Cervical Course
    • Lumbar Course
  • Special Tests
    • Cervical Spine >
      • Alar Ligament Test
      • Bakody's Sign
      • Cervical Distraction Test
      • Cervical Rotation Lateral Flexion Test
      • Craniocervical Flexion Test (CCFT)
      • Deep Neck Flexor Endurance Test
      • Posterior-Anterior Segmental Mobility
      • Segmental Mobility
      • Sharp-Purser Test
      • Spurling's Maneuver
      • Transverse Ligament Test
      • ULNT - Median
      • ULNT - Radial
      • ULNT - Ulnar
      • Vertebral Artery Test
    • Thoracic Spine >
      • Adam's Forward Bend Test
      • Passive Neck Flexion Test
      • Thoracic Compression Test
      • Thoracic Distraction Test
      • Thoracic Foraminal Closure Test
    • Lumbar Spine/Sacroiliac Joint >
      • Active Sit-Up Test
      • Alternate Gillet Test
      • Crossed Straight Let Raise Test
      • Extensor Endurance Test
      • FABER Test
      • Fortin's Sign
      • Gaenslen Test
      • Gillet Test
      • Gower's Sign
      • Lumbar Quadrant Test
      • POSH Test
      • Posteroanterior Mobility
      • Prone Knee Bend Test
      • Prone Instability Test
      • Resisted Abduction Test
      • Sacral Clearing Test
      • Seated Forward Flexion Test
      • SIJ Compression/Distraction Test
      • Slump Test
      • Sphinx Test
      • Spine Rotators & Multifidus Test
      • Squish Test
      • Standing Forward Flexion Test
      • Straight Leg Raise Test
      • Supine to Long Sit Test
    • Shoulder >
      • Active Compression Test
      • Anterior Apprehension
      • Biceps Load Test II
      • Drop Arm Sign
      • External Rotation Lag Sign
      • Hawkins-Kennedy Impingement Sign
      • Horizontal Adduction Test
      • Internal Rotation Lag Sign
      • Jobe Test
      • Ludington's Test
      • Neer Test
      • Painful Arc Sign
      • Pronated Load Test
      • Resisted Supination External Rotation Test
      • Speed's Test
      • Posterior Apprehension
      • Sulcus Sign
      • Thoracic Outlet Tests >
        • Adson's Test
        • Costoclavicular Brace
        • Hyperabduction Test
        • Roos (EAST)
      • Yergason's Test
    • Elbow >
      • Biceps Squeeze Test
      • Chair Sign
      • Cozen's Test
      • Elbow Extension Test
      • Medial Epicondylalgia Test
      • Mill's Test
      • Moving Valgus Stress Test
      • Push-up Sign
      • Ulnar Nerve Compression Test
      • Valgus Stress Test
      • Varus Stress Test
    • Wrist/Hand >
      • Allen's Test
      • Carpal Compression Test
      • Finkelstein Test
      • Phalen's Test
      • Reverse Phalen's Test
    • Hip >
      • Craig's Test
      • Dial Test
      • FABER Test
      • FAIR Test
      • Fitzgerald's Test
      • Hip Quadrant Test
      • Hop Test
      • Labral Anterior Impingement Test
      • Labral Posterior Impingement Test
      • Long-Axis Femoral Distraction Test
      • Noble Compression Test
      • Percussion Test
      • Sign of the Buttock
      • Trendelenburg Test
    • Knee >
      • Anterior Drawer Test
      • Dial Test (Tibial Rotation Test)
      • Joint Line Tenderness
      • Lachman Test
      • McMurray Test
      • Noble Compression Test
      • Pivot-Shift Test
      • Posterior Drawer Test
      • Posterior Sag Sign
      • Quad Active Test
      • Thessaly Test
      • Valgus Stress Test
      • Varus Stress Test
    • Foot/Ankle >
      • Anterior Drawer
      • Calf Squeeze Test
      • External Rotation Test
      • Fracture Screening Tests
      • Impingement Sign
      • Navicular Drop Test
      • Squeeze Test
      • Talar Tilt
      • Tarsal Tunnel Syndrome Test
      • Test for Interdigital Neuroma
      • Windlass Test
  • Insider Access
  • HEP
    • Neck and Shoulder >
      • Supine Chin Tuck
      • Supine DNF with Towel Assist
      • Supine DNF
      • Standing Chin Tuck Against Wall
      • Standing Chin Tuck Against Wall with Scaption
      • Seated Cervical Retraction Repeated
      • Seated Cervical Retraction with Extension Repeated
      • Seated Cervical Retraction with Sidebend Repeated
      • Seated Cervical Retraction with Rotation Repeated
      • Standing Wall Shrugs at 90 Degrees Flex
      • Seated Thoracic Whips
      • Standing Ballistic Shoulder Extensions
      • Standing Repeated Shoulder Extension with Squat
      • Standing Repetead Shoulder Horiz. Abd. with Ext. CKC
      • Seated with Arms on Pillows Cervical AROM (Flex/Ext/Rot/SB)
      • Seated with Arms on Pillows Shrugs
      • Seated with Arms on Pillows Shrug with Scapular Retraction
      • Supine Shoulder IR with GH Centralization
      • Supine Shoulder ER with GH Centralization
      • Holding Dumbbell at 180 Degrees Flexion for Time
      • Cat Camel
      • Prone T's
      • Prone Y's
      • Quad Chin Tuck w/ Shoulder Flexion
    • Low Back >
      • Supine TA Isometric
      • Standing TA Isometric Agains Wall with Squat
      • Supine BKFO
      • Quad Rock Back
      • Standing Hip Hinge
      • Sit to Stand with Hip Hinge
      • Repeated Lumbar Sideglides
      • Repeated Standing Lumbar Extension
      • Repeated Standing Lumbar Flexion
      • Repeated Prone Press-Ups
      • Repeated Supine DKC
      • Slump Sciatic Nerve Glides
      • Birddog Progression
    • Hip and Knee >
      • Clamshells with Progressions
      • Fire Hydrants with Progressions
      • Donkey Kicks
      • Bridge Variations
      • Repeated Hip Flexion
      • Squats
      • Seated Repeated Knee Extensions
      • CKC Seated Repeated Knee Extensions
      • Heel Slides
      • CKC DF with Tibial IR
    • Foot and Ankle >
      • Calf Raises
      • Calf Raises with Soccer Ball Between Medial Malleoli
      • Towel Scrunches with Foot in PF
      • Toe Flexion Using T-Band with Foot in PF
      • PF with Toes Flexed Using T-Band
      • DF with Toes Flexed Using T-Band
      • Forefoot Adduction
      • Gastroc Stretch
      • Repeated PF
    • Examination Templates
  • Store
Picture

A New Way to Look at Asymmetries

6/10/2013

3 Comments

 
When assessing the length of a muscle, it is important to distinguish between muscle stiffness and adaptive shortening. Take the Thomas Test, for example. You will notice that the ASIS will begin to rise far earlier than when motion stops. The reason for this: stiffness, or resistance to stretch. Adaptive shortening, on the other hand, is when motion no longer occurs due to muscle restriction. Should we still prescribe stretching exercises for our patients if stiffness is the issue?

Mizuno et al found in a couple studies that, while changes in stiffness did occur after stretching, those changes disappeared in as soon as 10 minutes. It would seem that we should not address stiffness with stretching. Just because muscle length isn't an issue doesn't mean we should ignore any differences in stiffness. Increased resistance to stretch on one side of the body compared to the other can still place abnormal stresses on certain tissues. Think about increased stiffness on one hip flexor in a patient with SIJ Dysfunction. Some of our training may lead us to think that we should direct our patients to stretching of the hip flexor, but as you can see, we would have little effect on the impairments.
Picture
So how do we address these differences? Shirley Sahrmann discussed this topic in a lecture that we highly recommend listening to. Instead of focusing on the side with increased stiffness, we should address the side with decreased stiffness. Strength training has been found to increase muscle stiffness (Magnusson, 1998). By bringing both sides of the body to symmetry (equal stiffness), an equal distribution of forces prevents any abnormal stresses on the body. Stretching still has its place, of course, but we must be sure to distinguish between muscle stiffness and adaptive shortening when choosing to apply the intervention. Next time you're measuring muscle length, check for stiffness and muscle length!
References:
Magnusson SP. (1998). Passive properties of human skeletal muscle during stretch maneuvers. A review. Scand J Med Sci Sports. 1998 Apr;8(2):65-77. Web. 10 June 2013.

Mizuno T, Matsumoto M, Umemura Y. (2013). Decrements in Stiffness are Restored within 10 min. Int J Sports Med. 2013 Jun;34(6):484-90. Web. 10 June 2013.

Mizuno T, Matsumoto M, Umemura Y. (2013). Viscoelasticity of the muscle-tendon unit is returned more rapidly than range of motion after stretching. Scand J Med Sci Sports. 2013 Feb;23(1):23-30. Web. 10 June 2013.
3 Comments
Scott
7/13/2013 09:06:27 am

Interesting topic. Seems intuitively off to me though, so would love to hear your opinion. If one side is stiff AND limited, just strengthening would not fully create symmetry would it? If the increased resistance to stretch was still within normal range, maybe the other side is just weak. Am I thinking about this the right way?

Even in my DPT curriculum the terms tight, stiff, and short have been thrown around a bit and used interchangeably by some. Maybe you have a good resource that goes into detail about the differences and what is actually going on physiologically?

Reply
Chris link
7/19/2013 01:21:04 am

Thanks Scott, great comments. You are correct that if one side is both stiff and limited, you would not only want to strengthen the opposite side, but stretch the ipsilateral side until normal range was achieved. And you are correct, from my understanding of Sahrmann's lecture, decreased stiffness on one side would be associated with weakness, so we would want to strengthen that side. Basically, we should be looking at stiffness and adaptive shortening as two different impairments, thus requiring different interventions. Both can contribute to injury, especially if asymmetry persists. That is a great point about the confusion between stiffness, tight, etc. Since you brought it up, I think it is an excellent opportunity for a review on the topic, especially with the neurological components contributing to mechanical stiffness. I'll let you know what the review is ready. Thanks again!

Reply
BDSM Olathe link
10/13/2013 04:45:10 am

Was just bored and thought I would post to say hello

Reply



Leave a Reply.

    We value quality PT education & CEU's.  Click the MedBridge logo below for TSPT savings!

    Picture
    Picture
    Buy Now!
    ​Use Promo Code: Save20
    ​at checkout to save

    Archives

    March 2018
    February 2018
    January 2018
    December 2017
    November 2017
    October 2017
    September 2017
    August 2017
    July 2017
    June 2017
    May 2017
    April 2017
    March 2017
    February 2017
    January 2017
    December 2016
    November 2016
    October 2016
    September 2016
    August 2016
    July 2016
    June 2016
    May 2016
    April 2016
    March 2016
    February 2016
    January 2016
    December 2015
    November 2015
    October 2015
    September 2015
    August 2015
    July 2015
    June 2015
    May 2015
    April 2015
    March 2015
    February 2015
    January 2015
    December 2014
    November 2014
    October 2014
    September 2014
    August 2014
    July 2014
    June 2014
    May 2014
    April 2014
    March 2014
    February 2014
    January 2014
    December 2013
    November 2013
    October 2013
    September 2013
    August 2013
    July 2013
    June 2013
    May 2013
    April 2013
    March 2013
    February 2013
    January 2013
    December 2012
    November 2012
    October 2012
    September 2012
    August 2012

    Categories

    All
    Chest
    Core Muscle
    Elbow
    Foot
    Foot And Ankle
    Hip
    Knee
    Manual Therapy
    Modalities
    Motivation
    Neck
    Neural Tension
    Other
    Research
    Research Article
    Shoulder
    Sij
    Spine
    Sports
    Therapeutic Exercise


    RSS Feed

Home

Contact Us

Copyright © The Student Physical Therapist LLC 2017
Photos used under Creative Commons from dsearls, moo.review, liverpoolhls, matturick, lwpkommunikacio, Lake Clark NPS, Tobyotter, Charly Meunier, Vincent Albanese, CNBP, Zepfanman.com, aotaro, sportEX journals, jillccarlson, Yann07, US Department of Education, osseous, TheeErin, ajy591, Mark P / PIX41, Thomas Fisher Rare Book Library, UofT, teresatrimm, donnierayjones, NNelumba, Tobyotter, Frédéric de Villamil, Jordanhill School D&T Dept, danabooo, cadillacjr2002, ingridkreuz, RDECOM, Wonderlane, hectorir, Jeffrey, Chris Hunkeler, quillons, COD Newsroom, Alan Cleaver, CCFoodTravel.com, liverpoolhls, Dr.Farouk, Jeffrey, Sten Dueland, Håkan Dahlström, PPGWings, Parker Michael Knight, MLazarevski, dno1967b, Fimb, Jim Larrison, infomatique, U.S. Naval Forces Central Command/U.S. Fifth Fleet, Idhren, iwona_kellie, AnEternalGoldenBraid, quinn.anya, jlk.1, Villainette, mlsaero, roelandpype, Defence Images, CiscoANZ, istolethetv, Our Dream Photography (Personal), BraNewbs, Meg Stewart, phalinn, akeg, hectorir, philcampbell, MilitaryHealth, akeg, Army Medicine, Shar Ka, Subconsci Productions, Eric Kilby, Anonymous9000, quinn.anya, COD Newsroom, UMN Department of Plant Pathology, familymwr, all of olive., JD Hancock, Synergy by Jasmine, roger_mommaerts, John-Morgan, a.drian, Instant Vantage, Beshef, markhillary, Vegar S Hansen Photography, DEC International, kaolin fire, smith_cl9, cinnamon_girl, jillccarlson, Extra Ketchup, brain_blogger, heyjoewhereyougoinwiththatguninyourhand, tv42, COMSALUD, Nicholas_T, Ano Lobb. @healthyrx, kaibara87, mlinksva, smbuckley23, sappsnap, Menage a Moi, brain_blogger, MaloMalverde, One Way Stock, ethet., ~ggvic~, MAClarke21, Keith Allison, pictures of money, mendolus shank, HotlantaVoyeur, Mr. T in DC, abbamouse, HystericalMark, Travis Hornung, jenny downing, shock264, Peter Mooney, Futurilla, sfslim, Emily Carlin, PFX Photo, ITU Pictures, TP studio, akunamatata, Magdalena Roeseler, osseous, smith_cl9, warrenski, Sh4rp_i, mrbichel, Renaud Camus, sicamp, GreenFlames09, infomatique, mark i geo, Volker Davids, TerryJohnston, Daniela Vladimirova, CJS*64, VarsityLife, Quentin Verwaerde, Annie Mole, US Army Africa, RLHyde, openBIT e. V., Vox Efx, fabola, Gerry Dincher, mlsaero, Infomastern, N4n0, Wonderlane, TheeErin, Nanagyei, gogogadgetscott, Pulmonary Pathology, PELeCON, Elvert Barnes, @RunRockPrincess, woodleywonderworks, Asbestos Bill, Joelk75, otisarchives4, jillccarlson, sportEX journals, The Wandering Angel, perpetualplum, V31S70, colecamp, jpalinsad360, JulyYu, Andres Rueda, Whenleavesfall, melloveschallah, Pink Sherbet Photography, canonim, BrianHenry ////|//, Leonard John Matthews, mikecogh, Zepfanman.com, Kevin M. Gill, Claire L. Evans, afunkydamsel, The Official CTBTO Photostream, cyOFdevelin fame, dok1, Pam loves pie, hoshi7, opensourceway
  • Home
    • Newsletter
    • About
  • Featured Articles
    • Sports Physical Therapy >
      • Functional Return to Sport Testing
    • Residency Corner >
      • Research Articles
    • Cervical Course
    • Lumbar Course
  • Special Tests
    • Cervical Spine >
      • Alar Ligament Test
      • Bakody's Sign
      • Cervical Distraction Test
      • Cervical Rotation Lateral Flexion Test
      • Craniocervical Flexion Test (CCFT)
      • Deep Neck Flexor Endurance Test
      • Posterior-Anterior Segmental Mobility
      • Segmental Mobility
      • Sharp-Purser Test
      • Spurling's Maneuver
      • Transverse Ligament Test
      • ULNT - Median
      • ULNT - Radial
      • ULNT - Ulnar
      • Vertebral Artery Test
    • Thoracic Spine >
      • Adam's Forward Bend Test
      • Passive Neck Flexion Test
      • Thoracic Compression Test
      • Thoracic Distraction Test
      • Thoracic Foraminal Closure Test
    • Lumbar Spine/Sacroiliac Joint >
      • Active Sit-Up Test
      • Alternate Gillet Test
      • Crossed Straight Let Raise Test
      • Extensor Endurance Test
      • FABER Test
      • Fortin's Sign
      • Gaenslen Test
      • Gillet Test
      • Gower's Sign
      • Lumbar Quadrant Test
      • POSH Test
      • Posteroanterior Mobility
      • Prone Knee Bend Test
      • Prone Instability Test
      • Resisted Abduction Test
      • Sacral Clearing Test
      • Seated Forward Flexion Test
      • SIJ Compression/Distraction Test
      • Slump Test
      • Sphinx Test
      • Spine Rotators & Multifidus Test
      • Squish Test
      • Standing Forward Flexion Test
      • Straight Leg Raise Test
      • Supine to Long Sit Test
    • Shoulder >
      • Active Compression Test
      • Anterior Apprehension
      • Biceps Load Test II
      • Drop Arm Sign
      • External Rotation Lag Sign
      • Hawkins-Kennedy Impingement Sign
      • Horizontal Adduction Test
      • Internal Rotation Lag Sign
      • Jobe Test
      • Ludington's Test
      • Neer Test
      • Painful Arc Sign
      • Pronated Load Test
      • Resisted Supination External Rotation Test
      • Speed's Test
      • Posterior Apprehension
      • Sulcus Sign
      • Thoracic Outlet Tests >
        • Adson's Test
        • Costoclavicular Brace
        • Hyperabduction Test
        • Roos (EAST)
      • Yergason's Test
    • Elbow >
      • Biceps Squeeze Test
      • Chair Sign
      • Cozen's Test
      • Elbow Extension Test
      • Medial Epicondylalgia Test
      • Mill's Test
      • Moving Valgus Stress Test
      • Push-up Sign
      • Ulnar Nerve Compression Test
      • Valgus Stress Test
      • Varus Stress Test
    • Wrist/Hand >
      • Allen's Test
      • Carpal Compression Test
      • Finkelstein Test
      • Phalen's Test
      • Reverse Phalen's Test
    • Hip >
      • Craig's Test
      • Dial Test
      • FABER Test
      • FAIR Test
      • Fitzgerald's Test
      • Hip Quadrant Test
      • Hop Test
      • Labral Anterior Impingement Test
      • Labral Posterior Impingement Test
      • Long-Axis Femoral Distraction Test
      • Noble Compression Test
      • Percussion Test
      • Sign of the Buttock
      • Trendelenburg Test
    • Knee >
      • Anterior Drawer Test
      • Dial Test (Tibial Rotation Test)
      • Joint Line Tenderness
      • Lachman Test
      • McMurray Test
      • Noble Compression Test
      • Pivot-Shift Test
      • Posterior Drawer Test
      • Posterior Sag Sign
      • Quad Active Test
      • Thessaly Test
      • Valgus Stress Test
      • Varus Stress Test
    • Foot/Ankle >
      • Anterior Drawer
      • Calf Squeeze Test
      • External Rotation Test
      • Fracture Screening Tests
      • Impingement Sign
      • Navicular Drop Test
      • Squeeze Test
      • Talar Tilt
      • Tarsal Tunnel Syndrome Test
      • Test for Interdigital Neuroma
      • Windlass Test
  • Insider Access
  • HEP
    • Neck and Shoulder >
      • Supine Chin Tuck
      • Supine DNF with Towel Assist
      • Supine DNF
      • Standing Chin Tuck Against Wall
      • Standing Chin Tuck Against Wall with Scaption
      • Seated Cervical Retraction Repeated
      • Seated Cervical Retraction with Extension Repeated
      • Seated Cervical Retraction with Sidebend Repeated
      • Seated Cervical Retraction with Rotation Repeated
      • Standing Wall Shrugs at 90 Degrees Flex
      • Seated Thoracic Whips
      • Standing Ballistic Shoulder Extensions
      • Standing Repeated Shoulder Extension with Squat
      • Standing Repetead Shoulder Horiz. Abd. with Ext. CKC
      • Seated with Arms on Pillows Cervical AROM (Flex/Ext/Rot/SB)
      • Seated with Arms on Pillows Shrugs
      • Seated with Arms on Pillows Shrug with Scapular Retraction
      • Supine Shoulder IR with GH Centralization
      • Supine Shoulder ER with GH Centralization
      • Holding Dumbbell at 180 Degrees Flexion for Time
      • Cat Camel
      • Prone T's
      • Prone Y's
      • Quad Chin Tuck w/ Shoulder Flexion
    • Low Back >
      • Supine TA Isometric
      • Standing TA Isometric Agains Wall with Squat
      • Supine BKFO
      • Quad Rock Back
      • Standing Hip Hinge
      • Sit to Stand with Hip Hinge
      • Repeated Lumbar Sideglides
      • Repeated Standing Lumbar Extension
      • Repeated Standing Lumbar Flexion
      • Repeated Prone Press-Ups
      • Repeated Supine DKC
      • Slump Sciatic Nerve Glides
      • Birddog Progression
    • Hip and Knee >
      • Clamshells with Progressions
      • Fire Hydrants with Progressions
      • Donkey Kicks
      • Bridge Variations
      • Repeated Hip Flexion
      • Squats
      • Seated Repeated Knee Extensions
      • CKC Seated Repeated Knee Extensions
      • Heel Slides
      • CKC DF with Tibial IR
    • Foot and Ankle >
      • Calf Raises
      • Calf Raises with Soccer Ball Between Medial Malleoli
      • Towel Scrunches with Foot in PF
      • Toe Flexion Using T-Band with Foot in PF
      • PF with Toes Flexed Using T-Band
      • DF with Toes Flexed Using T-Band
      • Forefoot Adduction
      • Gastroc Stretch
      • Repeated PF
    • Examination Templates
  • Store
✕