Transcript continued - Human Kinetics

chapter
chapter
11
11
Designing
Programs for
Flexibility and Low
Back Care
Author name here for Edited books
Objectives
•
•
•
•
Apply training principles to flexibility programs
Understand issues of safety and efficacy of stretching
Identify guidelines for design of flexibility programs
Individualize flexibility programs based on client goals,
starting values, and abilities
• Understand low back syndrome and methods to
prevent it
• Identify exercises useful for low back care
Principles of Flexibility Training
• Flexibility training is a systematic program of stretching
exercises designed to progressively increase the range
of motion (ROM) of joints over time.
• Flexibility programs should be individualized to address
the needs, abilities, and physical activity interests of
each client.
Training Principles
• Specificity: Flexibility is joint specific.
• Overload: Stretch muscles beyond normal resting
length but beneath point of pain.
• Progression: Increase duration of each stretch or
increase repetitions.
• Interindividual variability: Point of pain in ROM,
stretch tolerance, and perception of stretch and pain
vary by individual.
Stretching Methods
Three methods historically used to improve ROM:
1. Ballistic: fast, jerky, bouncing
2. Static stretching: slow, sustained, muscle lengthening
3. Proprioceptive neuromuscular facilitation (PNF):
isometric or dynamic of target (agonist) and opposing
(antagonist) muscle groups followed by passive
stretching of agonists; requires a knowledgeable
assistant
Stretching Techniques
Pros and cons for each stretching technique:
1. Active: Client moves body part without external
assistance.
2. Passive: Client relaxes target muscle group as
assistant moves the body part.
3. Active assisted: Client moves body part to end of its
active ROM; assistant then moves body part beyond its
active ROM.
Table 11.1
Types of PNF Stretches
• Contract-relax (CR): Client isometrically contracts
target muscle group; follows immediately with slow,
passive stretching of target muscle group.
• Contract-relax agonist contract (CRAC): Initially
identical to CR except that client assists CRAC
stretching phase by actively contracting opposing
muscle group; improves ROM more effectively.
Figure 11.1a
Figure 11.1b
Theories of PNF-Induced Increases in
ROM
• Neurophysiologic modifications such as inhibition of
stretch reflex and Golgi tendon organ (GTO), reflex in
target muscles
• Voluntary antagonist contraction during CRAC
stretching explained by reciprocal inhibition (as the
opposing muscle group is voluntarily contracted, the
target muscle group is reflexively inhibited)
Designing Flexibility Programs:
Exercise Prescription
• Identify joints and muscle groups needing
improvement.
• Select appropriate stretching method and specific
exercises for the exercise prescription.
• Include one stretch per major muscle group.
• Select exercises for problem areas; include more than
one exercise for these muscle groups.
• Workout should take 15 to 30 minutes.
(continued)
Designing Flexibility Programs:
Exercise Prescription (continued)
• Familiarize yourself with stretches to avoid—
those causing stress for low back and knees.
• Intensity is to the point of mild discomfort;
below pain threshold.
• ACSM recommends 15 to 60 seconds duration
for each stretch.
• ACSM recommends 4 reps per stretch initially.
• For clients with lower flexibility, use shorter
stretch duration (10-15 sec) and higher reps.
(continued)
Designing Flexibility Programs:
Exercise Prescription (continued)
• Progress the stretch by changing either the stretch
duration (10-30 sec) or the number of repetitions so
that the total time in stretched position gradually
increases.
• Gradually increase the total stretching time for each
exercise in order to ensure overload and further
improvements in ROM.
(continued)
Designing Flexibility Programs:
Exercise Prescription (continued)
• Recommended stretching program is minimum of two
times weekly (preferably daily) for 10 minutes total per
session.
• Stretch after moderate to vigorous exercise program.
• Stretching is a good cool-down routine from a strength
or cardio workout.
• Stretching is not a good warm-up; it may actually hinder
performance or strength.
(continued)
Designing Flexibility Programs:
Exercise Prescription (continued)
• Vibration may be a promising method for increasing
ROM beyond what is obtainable with static stretching.
• Stretching improves ROM in older adults, especially if a
stretch is held for 60 seconds.
• Caution is urged using PNF stretches with older
adults—they have lower stretch tolerance.
• Individualize the stretching program, regardless of
client age!
Designing Low Back Care Exercise
Programs
• No best way yet to prevent and rehabilitate low
back injuries.
• Select method that matches client’s needs and
goals:
– Traditional approach: Focus is spinal alignment
– Alternative approach: Focus is lumbar stability
Traditional Approach to Low Back
Care
• Improve ROM by strengthening and stretching hip
flexors, hamstrings, and low back extensors.
• Strengthen abdominal muscles.
• Some programs include exercises to increase the
strength and endurance of both the abdominal and low
back extensor muscles.
• Strengthening the low back (lumbar extensor) muscles
requires pelvic stabilization.
(continued)
Traditional Approach to Low Back
Care (continued)
• Strengthening abs requires exercises that maximize
abdominal muscle activation while minimizing
compression (load) on lumbar vertebrae.
• Minimize influence of psoas muscle to reduce lumbar
vertebrae compressive load.
Alternative Approach to Low Back
Care
• Muscle endurance is more protective than muscle
strength for reducing low back injury.
• Lumbar mobility is directly related to low back injury.
(continued)
Alternative Approach to Low Back
Care (continued)
• Brace lumbar spine during activity by isometrically cocontracting the abdominal wall and low back muscles.
• Maintain a neutral spine during activity.
• Avoid fully flexed or extended ROM positions of trunk
while lifting or exercising.
• Perform exercises emphasizing endurance rather than
strength.