Athletic Stretching Exercises
Research suggests that fibril diameters appear to be inversely related to collagen molecular flexibility (19) and that the application of external mechanical loading appears to be consistent with stretching of the flexible regions (19). Energy storage during stretching is thought to be linked with an increase in steric energies owing to van der Waals and electrostatic interactions that occur with the stretching of oppositely charged pairs of amino acid side chains on collagen (see Fig. 2 24). Modeling studies on a five-molecule-wide subfibrillar structure composed of quarter-staggered collagen molecules suggest that the most flexible regions are bands a3, a4, a2, b1, b2, and d and regions between bands b1 and b2 and between bands c1 and c2 (see Fig. 2). These areas are consistent with the flexible sites identified by Hofmann et al. (27) and are consistent with Ramachandran plots constructed based on peptide sequences observed in collagen (27).
A major factor that often impedes the recovery of soft tissue to injury is contracture associated with the injury, which may lead to an inhibition of normal motion. Slight tissue heating may increase mobility. Lehmann et al. (1970), for example, have described how the application of heat during stretching exercises may increase the elastic properties of collagenous structures. Gersten (1955) has shown that ultrasonic heating can lead to an increase in tendon extensibility. Scar tissue may also be rendered more supple by the use of ultrasonic treatment. Specific applications in physiotherapy are discussed in Section 13.3.
The energetics of distortion of the lipid bilayer have been analysed in terms of the bulk bending properties of the lipid bilayer described above, with stretching of the lipid chains being required when the lipid bilayer is too thin and compression when the bilayer is too thick (Fig. 6.10) (Mouritsen and Bloom 1984 Fattal and Ben-Shaul 1993 Nielsen et al. 1998). A comparison of relative lipid binding constants estimated from the results of such a theoretical calculation (Fattal and Ben-Shaul 1993) with experimental data shows that agreement is reasonable for moderate levels of mismatch for the P-barrel protein OmpF but is poor for the a-helical protein MscL (O'Keeffe et al. 2000 Powl et al. 2003) (Fig. 6.11). Presumably, the P-barrel structure of OmpF makes it relatively rigid so that distortion of the lipid bilayer to provide hydrophobic matching is less costly than distortion of the protein. Similarly, the effects of bilayer thickness on the properties of the dimer-channel formed by...
The importance and effectiveness of physical therapies as applied to the frozen shoulder has been highlighted (44). Miller, Wirth, and Rockwood have presented a review of 50 patients treated with home therapy, moist heat, and anti-inflammatory medications under close supervision by a physician (51). At review, all patients regained significant range of motion and returned to activities of daily living without pain. The objective of such physical therapies is to restore function by reducing inflammation and pain, thus allowing the reestablishment of normal shoulder mechanics. Historically, they have taken the form of simple repetitive stretching exercises and have been shown to be effective in the vast majority of cases (52). In the early stage, gentle pain-free mobilization using the opposite arm can be used to decrease nociceptive input to break the cycle of pain and muscle spasm. Exercises should progress to include ROM and pendulum movements to increase the pain-free range of...
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