Athletic Stretching Exercises
The occupational therapist and physical therapist can offer help that is of paramount importance in the rehabilitation of the patient with weakness. Strengthening and stretching exercises maintain the weak muscles in maximum tone and keep the joints from developing contractures, which further limit movement. The patient can be trained to use adaptive movements to facilitate function and to use canes and walkers, assessing which ones produce the maximum benefit. Splints and braces can be used to stabilize the joints.
Through them, rupturing the cell walls as it travels and releasing juice. If the tissue is being crushed between molars, then the pressure will be increased in many cells between the teeth, providing a potential path of fully stretched cells along which a crack can travel. If a tissue has lost moisture through evaporation (e.g. wilted celery), or if the extent of elastic extension of the cell walls has increased for whatever reason (e.g. asparagus stored under anaerobic conditions as described by Waldron and Selvendran, 1990), then turgidity will be low. In such a situation, a much greater degree of tissue deformation will have to be induced before the walls can be stretched to breaking point. Such tissues will have a rubbery texture. Hence, tissues containing turgid cells are crisper and are characterised by greater stiffness and lower toughness or work of fracture than flaccid tissues containing low turgor pressure cells (Hiller and Jeronimidis, 1996).
Management should initially be directed toward passive stretching of the Achilles tendon. Older children can be given home stretching exercises.22 Rigid inserts may not be tolerated due to pressure against the unyielding medial arch eminence of the insert.23 Soft inserts or running shoes and regular stretching should reduce the symptoms in most children and adolescents with this condition. Surgery should be the last resort in a few selected patients. Persistent pain over the prominent talar head and medial arch pain on activity despite prolonged nonoperative treatment may constitute an indication for surgery.
Cryotherapy has been regarded as a useful intervention in the acute phase of Achilles tendi-nopathy, as it has an analgesic effect, reduces the metabolic rate of the tendon, and decreases the extravasation of blood and protein from new capillaries found in tendon injuries.25 However, recent evidence in upper limb tendinopathy indicates that the addition of ice did not offer any advantage over an exercise program consisting of eccentric and static stretching exercises.105
Much progress has occurred in our understanding of Achilles insertional tendinopathy since Clain and Baxter classified Achilles tendon disorders into noninsertional and insertional tendi-nopathy in 1992.1 Insertional tendinopathy of the Achilles tendon is a degenerative rather than an inflammatory condition, although the accompanying bursitis may paint an inflammatory picture. The etiology of tendinopathy is likely to be multifactorial, with factors including some of the traditional ones such as overuse, inflexibility, and equipment problems. However, other factors need to be considered as well, such as age-related tendon degeneration and biomechanical considerations as outlined in this chapter. Recent in vivo and in vitro studies have shed some light on the biomechanics of the main body of tendon, but more research is needed to determine the significance of tensional loads, stress shielding, and compression in tendinopathy. The current biome-chanical studies indicate that certain...
The causes of fecal incontinence are divided into factors that alter anorectal anatomy (trauma, surgery), overwhelm physiologic control mechanisms (diarrhea, secretory tumors, fecal impaction), or interfere with neurologic function (diabetes, spinal cord injury, pudendal nerve injury). In many cases, a combination of factors leads to incontinence ( Table 31-1 ). For example, incontinence associated with rectal prolapse is due to excessive physical stretching of both the anal sphincter and pudendal nerves. Similarly, diminished sphincter strength associated with aging can unmask a previously well-compensated obstetric sphincter injury.
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