Transcript Flexibility

Restoring ROM &
Improving Flexibility
Chapter 8
Importance of Flexibility
 Important Goal: Restore or improve to normal pre-injury
range of motion
 With injury there is generally some degree of lost range
of motion
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Due to pain, swelling, muscle guarding, &/or inactivity
resulting in tissue shortening
Need to encourage stretching exercises
 Restricted range of motion can impact performance &
result in uncoordinated motion
 Essential for successful physical performance & injury
prevention
Flexibility
 Ability of neuromuscular system to allow
for efficient movement of a joint or series
of joint through a full, non-restricted pain
free range of motion
Flexibility
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Flexibility refers to the total range of motion
(ROM) of a joint or group of joints.
The ability of a joint to move freely through the
full range of motion.
It differs from person to person and from joint to
joint.
What affects the extent of movement around a
given joint?
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Structural characteristics of the joint
Mechanical properties of the connective tissues
Flexibility
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The GOAL should be to optimize joint mobility
while maintaining joint stability.
Primary FOCUS should be on the systematic,
safe and effective application of the range of
motion techniques used.
You should be able to communicate to the
client WHY they should devote time to
improving flexibility
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It will enhance their program.
Flexibility
 Keep the requirements of the activity in
mind
 A person’s activity level alone will not
improve flexibility
 Stretching exercises are essential if
flexibility is to be maintained or
increased
Anatomic Factors Impacting Flexibility
 Muscles
 Increasing flexibility relies on the elastic properties of muscle
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Length can be changed over time
 Connective Tissue
 Ligaments & joint capsules, while possessing some elastic
properties, can lose their elasticity during periods of disuse &
immobilization
 Bony Structures
 Can limit end point range
 Bony prominences can also stop movements at normal end
points in the range
 Fat
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Can act as a wedge between lever arms
Restricts movement wherever it is found
 Skin
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Injury or surgical procedure may alter skin – variable in elasticity
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Skin adheres to underlying tissue
 Neural tissue
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Develops tightness as a result of compression, chronic repetitive
microtrauma, muscle imbalances, joint dysfunction or
morphological adaptations due to posture
Could stimulate nociceptors & pain
 Cause muscle guarding & spasm to protect irritated neural
structures
Neural fibrosis ultimately results causing decreased elasticity &
restricted motion
 Except for bone structure, age & gender all other
flexibility limiting factors can be modified & altered
to increase range of motion
Soft Tissue Properties that Affect
Immobilization & Elongation
 Responses that affect soft tissue during
stretching
Velocity, intensity, frequency & duration of
stretch force
 Temperature of tissues
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 Elasticity – ability of soft tissue to return to
its resting length after passive stretch
 Plasticity – tendency of soft tissue to
assume a new & greater length after
stretch force has been removed
Soft Tissue Properties that Affect
Immobilization & Elongation
 Contractile tissue: gives muscle
characteristics of contractility & irritability
 Noncontractile tissue: has same properties
as all CT, including ability to resist
deforming forces as well as viscoelasticity
 CT structures of muscle-tendon unit
Epimysium – enveloping fascial sheath
 Perimysium – encases bundles of fasciculi
 Endomysium – innermost layer that separates
individual m. fibers & myofibrils
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Benefits of Flexibility Training
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Increases Range of Motion
Reduction of lower back pain and injury
Reduction in the incidence & severity of injuries
Improved posture & muscle symmetry
Delay in the onset of muscular fatigue
Prevents or alleviates muscle soreness post
exercise
 Increases the level of certain skills & muscular
efficiency
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Picking something up off the floor
 Promotes mental relaxation
Flexibility
 It must be based upon the needs of the
client.
 Deliberate stretching should be done
AFTER a general warm-up, but BEFORE
the primary bout BUT….
 It is dependant upon the activity to be
performed.
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Stair climbing vs. Basketball
General Warm Up
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Full body rhythmic activities
Low-moderate intensities
~ 5 minutes
Increase core temp
Should not lead to fatigue
Specific Warm Up
 Specific warm up for the activity
 ~ 10 minutes
Factors Affecting Flexibility
 Joint Structure
 Age
 Gender
 Muscle & Connective Tissue
 Exercise History
 Temperature
 Resistance Training
 Pregnancy
Joint Structure
 Joint Structure
 Some joints allow more range than
others
Age & Gender
 Young more flexible than older
 Females more flexible than men
 Youth become less flexible between ages
10-12
 Childhood is the ideal time to start a
flexibility program
 Seniors lose flexibility due to inactivity
Muscle & Connective Tissue
 Tendons, ligaments, fascia, joint
capsules, skin
 Elasticity – the ability to return to original
resting length after passive stretch
 Plasticity – the tendency to assume a
new and greater length after passive
stretch
 Hyperlaxity – allows the joints to achieve
a ROM that exceeds the normal range of
motion
Active & Passive Range of
Motion
 Active range of motion (AROM)
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Dynamic flexibility
Joint movement via muscle contraction
Ability to move a joint with little resistance
 Passive range of motion (PROM)
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Static flexibility
Motion of joint to end points without muscle contraction
Critical in injury prevention
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Muscles can be forced to stretch beyond “normal” limits
Without elasticity it is likely that the musculotendinous unit will be injured
 During athletic activity
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Must be able to move through unrestricted range
Must have elasticity for additional stretch encountered during
activity
Measuring Range of Motion
 Essential to assess improvement during
rehabilitation
 Goniometer
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Utilizes alignment of two arms parallel to
longitudinal axis of two segments involved in
motion
Relatively accurate tool
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Ensures accuracy standardize techniques & methods of
recording AROM & PROM
Agonist vs. Antagonist Muscles
 Joints are capable of multiple movements
 Example:
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Quadriceps will extend knee with contraction
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Quads (muscle producing movement) = agonist
Hamstrings will stretch during knee extension
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Hamstrings undergoing stretch = antagonist
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Agonist & antagonist work together to produce
smooth coordinated movements
Muscles that work together function synergistically
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What is another pair of agonist/antagonist muscles?
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Stretching Strategies
 2 times per week, for 5 weeks, has been
shown to improve flexibility
 Varies depending upon the sport / activity
 General warm up for ~ 5 minutes
 Activity specific warm up ~ 10 minutes
 Post activity stretching ~ 5 minutes
 Hold each stretch for about 30 - 60
seconds
 Do 3 - 4 reps
Proprioceptors & Stretching
 Muscle Spindles
 Within muscle
 Causes stretch reflex
 Muscle contracts when stretch too fast
 Golgi Tendon Organs
 MT Junction
 Produces inverse stretch reflex
 Relaxes muscle when there is too much
tension
Types of Stretching
 Static – slow & steady
 Ballistic - bouncing type movements
 Dynamic – avoids bouncing but includes
movements specific to the activity
 PNF – generally involves a 10 second
passive stretch followed by the specific
technique:
Hold-Relax
 Contract-Relax
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Static Stretching
 Most commonly used
 Safe & effective
 Muscle gradually stretched to the point of mild
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tension
If discomfort is felt, back off a little
Does not activate the stretch reflex
Beginners should hold the stretch for 15-20 s;
progress to 30 s
Longer holds do not reap more rewards
Significant improvements can occur
Repeat 3-5 times
Ballistic Stretching
 Rapid, jerky, uncontrolled movement
 Difficult to control the motion
 Higher risk of injury
 No longer considered acceptable however, is
appropriate for some activities
 Disadvantages:
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Increased danger of exceeding the extensibility
limits of involved tissues
Higher energy requirements
Greater chance of causing muscle soreness
Activation of the stretch reflex
Dynamic Stretching
 Similar to ballistic but avoids bouncing
 Puts an emphasis on functionally based
movements
 Includes movements specific to the activity
 Example  lunge walk
 Requires balance and coordination
 Clients may experience muscle soreness
initially
PNF Stretching
 Widely accepted as an effective method for
increasing range of motion
 Performed with a partner
 Uses both passive movement & active muscle
action
 Technique:
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Take the muscle into a static stretch while relaxing
muscle
Hold stretch for 10 s, then contract muscle for 6 s with a
strong isometric contraction against partner
Following a 1-2 s rest, repeat another 30 s passive
stretch
Repeat
Proprioceptive Neuromuscular
Facilitation
 Three techniques that combine alternating
isometric or isotonic contractions & relaxation
of both agonist & antagonists
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Slow-reversal-hold-relax
Contract-relax
Hold-relax
 Hold Relax (HR)
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Isometric contraction of antagonist followed by concentric
contraction of agonist with light pressure
Facilitates stretch of antagonist
Effective with muscle tension on one side of joint
 Contract Relax (CR)
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Moves body passively into agonist pattern
Athlete instructed to contract antagonist isotonically against
resistance
Athlete then relaxes & allow athletic trainer to push body further
(passively) into agonist pattern
Utilized when flexibility is limited due to muscle tightness
 Slow Reversal-Hold-Relax (SRHR)
 Isotonic contraction of agonist
 Follow with isometric contraction of antagonist
 During relax phase antagonist is relaxed while
agonist contracts in agonist pattern
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Results in stretch of antagonist
Useful to stretch antagonist
Comparing Stretching
Techniques
 Ballistic stretching is recommended for athletes
engaged in dynamic activity
 Static stretching most widely used
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Safe & effective
 PNF techniques
 Capable of producing dramatic increases in ROM
 Limitation – partner is required
 Maintaining flexibility
 Can decrease considerable after only 2 weeks
 Should be engaged in at least once per week
Specific Stretching Exercises
Stretching Neural Structures
 Requires
differentiation
between
musculotendinous &
neural tightness
 Assess movements
that create tension in
neural structures
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May cause numbness
& tingling
Straight-leg raise
example
Myofascial Release Stretching
 Techniques used to relieve abnormally tight
fascia
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Myofascial restrictions are unpredictable & may occur
in different planes & directions
 Requires specialized training & in depth
understanding of fascial system
 Fascia
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Connective tissue that runs throughout the body &
establishes interconnectedness of body
If altered or injured can result in localized response
at focal point of injury or away from injury site
Responds to gentle pressure
 Sometimes called: Soft-tissue Mobilization
 Treatment
 Localize restriction
 Considerably more subjective component & relies
heavily on clinician’s experience
 Focuses on large treatment area
 Work superficial to deep
 Joint mobilizations may follow
 Tissue stretching & elongation as well as
strengthening should follow
 Postural re-training may also be required
 Dramatic results may occur
 Treatment should be done at least 3 times per week
 Perform manually or via foam roller
Neurophysiological Basis of
Stretching
Stretch Reflex
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Muscle is placed on stretch – muscle spindle
Muscle spindles fire relaying info. to spinal cord
Spinal cord relays message to golgi tendon &
increases tension
After 6 seconds, golgi tendon organ (GTO) relays
signal for muscle tension to decrease
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Cause reflex relaxation
Prevents injury - protective mechanism
Ballistic stretching does not allow this overriding
response by GTO
 With static stretching GTO’s are able to
override impulses from muscle spindle
following initial reflex resistance
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Allows muscle to remain stretched without
injury
 PNF benefits greatly from these
principles
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With slow-reversal hold technique, maximal
contraction of muscle stimulates GTO reflex
relaxation before stretch applied
 Autogenic inhibition
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Relaxation of antagonist during contraction
During relaxation phase, antagonist is placed
under stretch but assisted by agonist
contraction to pull further into stretch
GTO is protective mechanism that inhibits
tension in the muscle
 Reciprocal inhibition
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Isotonic contraction of an agonist muscle elicits
a reflex relaxation of antagonist muscle group (protect against injury)
Effect of Stretching on Physical &
Mechanical Properties of Muscle
 Physical lengthening of muscle occurs due to
reflex relaxation
 Contractile & non-contractile elements of muscle
dictate capability of deformation & recovery
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Both resist deformation
Deformation is dependent on degree of stretch &
velocity
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Non-contractile – limit degree
Contractile – limit velocity
Greater stretch = more non-contractile components
contribute
 Stretches sustained long enough
(autogenic inhibition) result in viscoelastic
& plastic changes in collagen & elastin
 Viscoelastic
changes allow slow deformation
& imperfect recovery (not permanent)
 Plastic changes result in permanent
changes in length
 Greater velocity = greater chance for
exceeding tissue capacity (viscoelastic &
plastic)
Effects of Stretching On Kinetic
Chain
 Joint hypomobility causes:
 Faulty posture
 Muscular imbalance
 Abnormal neuromuscular control
 Alteration in arthrokinematics
 Change in muscle tension to reduce translation
 Alters degrees of tension & activation in synergist,
stabilizers & neutralizers
 Compensatory response
Muscle Tightness &
Hypertonicity
 Impact on length-tension
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relationships
Alters force couples &
arthrokinematics
Impacts normal force
couple relationships &
creates kinetic chain
reaction
Impacts synergistic
function of kinetic chain
Causes abnormal joint &
tissue stresses, neural
compromise &
vascular/lymphatic stasis
Alters recruitment
strategies & stabilization
 Alters neuromuscular
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efficiency impacting
activation/firing sequence
Additionally altered joint
function & stress response
Can causes reciprocal
inhibition
Increases muscle spindle
activity
May impart inhibitory
response (decreased
neuromuscular control)
Result = synergistic
dominance – synergist
compensatory action for
weak & inhibited muscle
Importance of Warm-up Prior to
Stretching
 Intramuscular temperature should be increased
prior to stretching
 Positive effect on ability of collagen & elastin to
deform
 Enhances reflexive relaxation associated with
golgi tendon organs
 Optimal temperature 39oC/103oF
 To increase = low intensity, warm-up type
exercise or modalities
 Exercise should be primary means of warm-up
 Environment - Heat vs. Cold
Flexibility vs. Strength
 Co-exist
 Muscle bound
 Negative connotation
 Loss of motion
 Encourage full pain free movements during
rehabilitation
 Strength training will provide individual with
ability to develop dynamic flexibility through full
range of motion
 Develop more powerful & coordinated
movements
Guidelines & Precautions for
Stretching
 Warm-up
 Overload or stretch beyond
normal range
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Not to point of pain
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Stretch to point of resistance
 Increases in range will be
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specific to muscle being
stretched
Use caution when stretching
around painful joints
Avoid overstretching ligaments
& capsules
Exercise caution with low back
& neck stretches
Stretch from seated position to
reduce stress on back
 Continue normal breathing
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while stretching
For improvements in ROM,
utilize static & PNF stretching
techniques
Ballistic stretching should be
used by those who possess
flexibility & are accustomed to it
Ballistic stretching should follow
period of static stretching
Stretching should be performed
a minimum of 3 times per week
For maximum gains stretching
5-6 times per week is ideal
5-10 second stretch prepares
muscles for activity, 30-60
second stretch increases
flexibility.
Summary
 Assess client’s flexibility to pinpoint strengths
& weakness
 Design program that stretches the specific
muscles used by the client during activity
 Warm up before stretching to increase temp
 Perform stretches daily
 Stretch all major muscle groups and opposing
groups
Summary
 Focus on technique during the stretch
 Hold stretches for 30 seconds initially; later 60
seconds
 Do 4 reps each stretch for optimal gains
 Stretch to mild discomfort, not pain
 Keep breathing slow and rhythmical during
stretch
 Stretch muscles in different positions and
planes
 Stretch after primary bout
Stretching Body Regions
 Neck
 Posterior Arm
 Shoulders & Chest
 Anterior Thigh & Hip
 Torso
Flexor
 Posterior Thigh
 Adductors “Groin”
 Calf
 Upper Back
 Lower Back
 Hips