Adequate Flexibility is required to perform this motion.

CHAPTER 4

FLEXIBILITY

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WARNING!

FLEXIBILITY: THE ABILITY TO BEND WITHOUT BREAKING

Before you try and stretch someone, I think its important to realize what you are actually stretching. Muscles attach to fascia, bone or a tendon which transmits the force of the muscle through the bone. Lets begin with the fascia. Your whole body is basically surrounded by fascia. Each myofibril is wrapped by a layer of connective tissue or fascia called endomysium that electrically insulates each fiber from each other. The endomysium is also continuous with the fiber sarcolemma or cell membrane. These muscle fibers (up to 150) are wrapped in groups called fasciculi. Fasciculi are wrapped in yet another layer of connective tissue called the perimysium that becomes continuous with the tendon. The entire muscle belly consists of many fasciculi bundled together and wrapped by another connective tissue sheath called the epimysium. The tendon attaches to the periosteum, which is a special type of connective tissue covering all your bones. In a comparison of the relative contribution of soft-tissue to joint resistance, the muscle along with the fascia account for 41% of the resistance. (RTS manual Mastery Course 3rd edition) The three-component mechanical model of the muscle consists of the contractile component found in the cross-bridging of the actin and myosin filaments and the two passive components, the parallel elastic component and the series elastic component. The parallel elastic component consists of the endomysium, perimysium and the epimysium. The PEC is primarily responsible for the force exerted by a relaxed muscle when it is stretched beyond its resting length. Remember, resting length of a muscle is the length of the muscle if you cut it off your body and laid it on the table. Optimal length is approximately 1.2 times the resting length. However, 1.5 times resting length has very few crossbridges and is approaching passive insufficiency. You also have the series elastic component which consists of the tendon, cross-bridges and z-discs. The SEC is immediately put under tension in an actively contracted muscle. Thats why if you stretch too far, mechanical tension is stored in the muscle. Upon receiving tension created by the contractile force, the elastic components store the tension which can then be transferred to the bone. (Biomechanical Basis of Human Movement, Hamill & Knutzen) There also exists an involuntary response that maintains muscle tonus. Proprioceptors located within the nerve endings are protective sensory receptors that provide rapid feedback or stimuli to the Central Nervous System (CNS). This action is referred to as Neuromuscular Inhibition. When stretching, your muscles are protected by these proprioceptors. A Stretch reflex is when a muscle is stretched. The stretch reflex is activated by a sensory receptor in the muscle cell called the muscle spindle. The muscle spindle lies parallel with the muscle fibers and detects both the length and the rate of stretch. The nuclear chain monitors muscle length and the Nuclear bag monitors muscle length and rate of change. These receptors are stimulated and send a message to the spinal cord or central nervous system when the muscle is being extended ballistically or too far. If the muscle is either over-stretched or stretched too fast, the spinal cord sends a reflex (involuntary) or red flag for muscle to contract. Stretch reflex is a protective mechanism to prevent injury from overstretch. Muscle spindle causes stretch reflex, causing a muscle contraction when the stretch is either too far or too fast. If the goal is to lengthen the muscle, it is important not to engage this reflex.
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Tendons on the other hand are mostly made up of collagen (the most abundant protein in the body) and wound together like a rope. They attach muscle to bone. Tendons are resistant to a tensile force and are not meant to be stretched. This is due to cross links between the collagen fibers and their relative inextensibility. They are meant to transmit force. If you had slack in your tendons, playing the guitar or any intricate motion would be impossible. There is also a sensory organ situated at the musculotendinous junction called the Golgi Tendon Organ. The GTO senses degree and extent of muscle tension by monitoring tendon length. When necessary the GTO rapidly reacts and detects tension in the muscle, eliciting an inhibitory response, causing the muscle to relax or shut off. This is sometimes referred to as Reflex Inhibition. Ligaments do have elastic properties. Elastic meaning the ability to return back to their original shape. They primarily contain collagenous fibers so are highly resistant to a tensile force. The elastic properties allow freedom of movement. Too much elasticity can create an unstable joint. You dont want to overstretch your ligaments. So, before you start stretching someone or yourself, be aware of what youre trying to stretch. Thats why stretching is not unlike any other component of fitness. Its an art. The Art of Stretching Out of the four components of fitness (flexibility, stabilization, strength and cardiovascular) the most overlooked and under worked is flexibility. If you dont use it, you lose it. When we apply this to stretching and flexibility, we can see the potential for loss of ROM and an increased risk for potential joint and muscle injury. Range of motion: The possible movement about a joint in a static (held) or dynamic (moving) state, within the anatomical limits of the joint structure. Anatomical limits include the joint surfaces, joint capsule, soft tissue (ligaments and cartilage) as well as the bone itself. ROM can be an indicator of flexibility. Improved flexibility may reduce injury risk by allowing the muscles to work. Flexibility A joint should be capable of moving freely in every direction or, specifically, through a full or normal range of motion. Flexibility is developed by stretching or training through a full ROM and can be developed at any age with the appropriate training. However, the rate of development is not always the same at every age. Although daily stretching is advocated, flexibility cannot be improved overnight. Too much flexibility is often associated with joint instability and should be avoided as well. Additionally, flexibility is joint specific; an individual may be able to perform the splits yet unable to clasp their hands behind their back. Daily changes in muscular tension may affect flexibility. Therefore, if range of motion is more limited on some days, forcing a stretch may cause injury.

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Some of the factors which can influence or limit your joint mobility are:

3. Hypokinesis: a fancy word for physically inactive or low physical activity, allows adaptive shortening to connective tissues. This shortening will diminish the connective tissues ability to reach full range of motion. When connective tissue becomes shorter and less resilient, increased risk of injury due to imbalance and improper alignment of the body becomes more likely.

2. Age: After age 25, most individuals especially those with inactive lifestyles lose flexibility with significant changes in the connective tissue (CT). Aging causes a loss of elasticity (decreased elastin, collagen breakdown, bone demineralization, tissue dehydration) in connective tissue (CT) which surrounds muscle. This lack of water in soft tissue structures diminishes lubrication and the flow of nutrients to the site, ultimately creating a more fragile unit. The more active a person tends to be throughout the aging process, the more flexible they will be.

1. Genetics: Genetics play a role in potential ROM. Some clients have natural stretching ability and can achieve greater ROM potential than others.

4. Gender: Females generally are more flexible than men. Women are designed for a greater range of flexibility, specifically in the pelvic region in order to accommodate child bearing. Some of the structural characteristics of the female pelvises that distinguish it from the male pelvis are: Bones are lighter and smoother. Brims are round. Cavities are shallower and more capacious. Outlets are larger. Sacrosciatic notches are wider. Acetabula are further apart. Pubic Arches are wider. Sacrums are wider and more curved. 5. Body type: Many comparisons have been made between body type and flexibility. Recent studies show little or no correlation between weight, body type and the ability to achieve range of motion (ROM). Many still believe weight training causes the body to become musclebound and lack overall flexibility. It is true that overdeveloping muscles may encourage muscular imbalances if stretching is not incorporated into the training program. However, the perception that strength training independently decreases flexibility is a myth. Since each person may have different concerns with regard to musculature, joint structure, dysfunction and genetic composition, you want to create programs that are individual to each of your clients.

6. Body Temperature: Body temperature has a direct effect on joints and ROM. A warm up is essential and vital to prepare the body for what is to come. A warm up will elevate the clients core temperature, increase circulation, muscle warmth, and synovial fluid to joints. This will allow your body to be treated gently, eased in and out of hard work. It is important to warm up first and cool down after.
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Warm up should be in the duration of five to fifteen minutes. Individual design of the warm up depends on various factors such as weather conditions and special populations (i.e., older clients, arthritis, high blood pressure, pregnant, etc.). Warm up should mimic a slower, less intense version of the movements required by the activity. Simply going through the motions for a few minutes works. Warm up can be used to prepare soft tissue structure for the flexibility necessary for any particular activity. Benefits of a good warm-up

Increase in body and tissue temperature.

Increase in heart rate, which prepares the cardiovascular system for work. Increase in respiration helping the exchange of oxygen from hemoglobin. Increase in viscoelasticity of tissue. Increase in physical work capacity.

Increase in rate at which energy is released in the body (i.e., the metabolic rate). Increase in speed at which nerve impulses travel, facilitating body movements.

Increase in efficiency in the process of reciprocal innervation (thus allowing muscles to contract and relax faster and more efficiently). Increased metabolism (enzyme activity) 1013%. Enhancement of the athlete psychologically.

Increase force production potential by 24% (length/tension ratios). Appropriate neuroendocrine response for supplying energy and rebuilding tissue. Decrease in muscular tension. Increase of blood flow through the active muscles.

The general purpose of stretching is to restore muscles that are shortened, tight or weak to their optimum length. Tight, shortened muscles are more susceptible to tearing, limiting normal ROM, increasing risk of injury. Types of Stretches Static (active or passive): Holding the body part in a stationary position in order to stabilize the muscles and its connective tissues safely at their greatest length. Lengthening the muscle requires a slow, smooth movement. Breathe into the movement as you stretch. When you feel a natural limit in your range of motion, then stop and relax. Forcing yourself or letting an outside force (gravity) push you past that position or into pain can involve the Golgi Tendon Organ, create injury or even make you sore. Use moderation and dont overstretch or force a muscle. Back off at the point of pain or shaking (stress). The standard duration of stretch per muscle group is approximately 1030 seconds, the best results can be achieved with durations of 30 seconds to 1 minute.
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Dynamic (active) stretch: The bodys own movement causes the stretch. Slow rhythmic movement, similar to the training or sport/recreation activity as near as possible. Begin slowly, restricting the range of motion and gradually increase to a larger ROM ending with the activity youre stretching for. This stretch can involve speed, strength, power and neuromuscular coordination during physical activity to achieve greater ROM. (High force/short duration) This type of dynamic stretching is controlled and is designed to challenge the elastic characteristics of connective tissue thus increasing the elastic qualities of the tissue, preparing you for your goal. Ballistic stretching: Uncontrolled bouncing, jerking, bobbing or pulsing to achieve greater ROM. This technique incorporates a high force, short duration stretch. Although ballistic stretching may appear to be effective, the speed of bouncing during ballistic movements may elicit the stretch reflex. This stretch may cause the muscle to contract, leading to possible tearing of muscle fibers and connective tissue. Because of its possible risks of injury and soreness, ballistic stretching is not the preferred stretching technique for the general population. The disadvantages to ballistic stretching are: The tissues dont have adequate time to adapt to the stretch. It can engage the stretch reflex, increasing muscular tension, making it more difficult to stretch out the connective tissues.

Inadequate time for neurological adaption to take place.

Ballistic stretching can be sport-specific and thus appropriate for some athletes.

PNF stretching (Proprioceptive Neuromuscular Facilitation) is another type of stretching that was developed by physicians and physical therapists for the rehabilitation of patients. These exercises require a knowledgeable and well-trained partner. This technique uses the reflex action of two proprioceptors, the muscle spindle and the Golgi tendon organ in order to facilitate muscle relaxation and a fuller ROM stretch. There are two types of PNF. You must use clear and concise communication when using these types of stretching. C-R (contractrelax) This technique is assisted to move a joint or stretch a muscle to its maximum ROM. The client isometrically contracts the desired muscle to be stretched (agonist) for a count of eight followed by a short period of relaxation. Then the limb is actively moved further (by the client themselves) into the desired range. Repeat the sequence three-to-five times. With increased muscle relaxation you should bypass the stretch reflex. C-R-A-C (contractrelaxantagonist-contract) Repeat the isometric contraction of desired muscle group for a count of eight and immediately contract the antagonist muscle for six seconds before relaxing. The client should be able to move into a deeper fuller range of motion stretch because the amount of inhibition that occurs in the agonist muscle becomes lessened. Benefits of Stretching Improves muscular balance and body alignment awareness. Reduces low back pain. Increases neuromuscular coordination. Studies have shown that nerve impulse velocity (time it takes an impulse to travel to the brain and return) is enhanced with dynamic flexibility training.
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Healthier synovial fluid allows a greater freedom of movement and may decelerate joint degenerative process. Decreases risk of injury. Increasing ROM decreases the resistance in various tissues and clients are less likely to incur injury by exceeding tissue extensibility during activities. Reduces stress and helps promote mental relaxation. Enhances body awareness while increasing physical efficiency and performance. A flexible joint requires less energy to move through ROM. Helps prevent or reduce delayed onset muscle soreness (DOMS) by increasing blood supply and nutrients to joint structures. Also contributes to improved circulation and nutrient transport, allowing greater elasticity of tissues. Reduces severity of painful menstruation (dysmenorrhea) for female clients.

Increases maintenance of ROM due to an increase in the quantity and the decrease in the viscosity (thickness) of synovial fluid enhancing a better nutrient exchange.

Precautions to stretching

You need to be aware of potential dangers associated with overtraining for excessive flexibility. Excessive stretching can lead to injury caused from joint instability from over-stretched ligaments. Muscle tissue that is over-stretched for prolonged periods has a tendency to develop stretch weakness and lose contractile force which may increase vulnerability to injury even in mild daily activities. Remember to use balance in everything. Too much of a good thing can turn out to be detrimental. When not to stretch: When CT or muscles are injured. (Sprain, strain) When a muscle or joint is inflamed. When a bone has been recently fractured.

When stretching produces sharp pain in either muscle or joint. When you suffer from certain vascular diseases. When there is a loss of function or decrease in ROM.

When osteoporosis is suspected or known.

Stretching limitations*: Genetics, age, gender, prior stretch patterns

Flexibility/ROM about a joint is affected by: a) bone structure b) ligaments (attach bone to bone) c) elasticity of skin d) muscles e) tendons (attach muscles to bones) * Avoid hyper extending, hyper flexing or torquing any joint
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Although daily stretch is advocated, flexibility cannot be increased overnight (shouldnt be rushed)

What to stretch:

Back of neck (Splenius Capitis) Sides of neck Chest (Pectorals)

Low Back (Erector Spinae Front of hip (Iliopsoas) Front of thigh (Quadriceps) Back of thigh (Hamstrings) Calves (Gastrocnemius/Soleus)

Dangers of hyper flexibility:

Over flexibility may cause joint instability

Precautions during pregnancy would include moderate stretching

EVERYONE CAN BENEFIT FROM STRETCHING! REFERENCES 1. Norkin, Cynthia, Levange, Pamela, Joint Structure and Function, 2nd edition F.A. Company, 1992 2. Hamill Joseph, Knutzen M. Kathleen, Biomechanical Basis of Human Movement, William and Wilkins, 1995 3. McArdle, D. William, Katch, I. Frank, Katch, L. Victor, Exercise Physiology, Lea & Febiger Philadelphia, 2nd edition 1986 4. Simon, Mitch, RTS Manual, Mastery Course 3rd edition

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Muscles stretched: Upper Trapezius, Levator Scapulae and Sub-occipital. Contraindicated: Cervical strain, disc bulge or herniation, spondolythisis (although rare in this region).

Muscles stretched: Sternocleidomastoid, Longissimis, Anterior Scalenes. Contraindicated: Cervical strain, disc bulge or herniation, spondolythisis (although rare in this region).

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Muscles stretched: Upper Trapezius, Levator Scapulae and Scalenes. John is performing a more progressive stretch by pulling on the arm and contracting the latissimus dorsi on the same side. Contraindicated: Cervical strain, disc bulge or herniation, spondolythisis (although rare in this region).

Muscles stretched: Levator Scapulae, Upper trapezius, Posterior and middle Scalenes. Contraindicated: Cervical strain, disc bulge or herniation, spondolythisis (although rare in this region).

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Muscles stretched: Pectoralis Major, Anterior Deltoid, Corachobrachialis, Biceps and Anterior shoulder capsule. Contraindicated: Shoulder subluxation or dislocation Comments: Do not let the chin jut forward.

Muscles stretched: Latissimus dorsi. Contraindicated: central stenosis.

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Muscles stretched: Latissimus dorsi. Contraindicated: Shoulder laxity, elbow, wrist, finger pain or injury. Comments: Note the angle between Kellys shoulder and her extended arm. John is performing a more progressive stretch.

Muscles stretched: Triceps Brachii (long head is emphasized).

Muscles stretched: Quadriceps. Comments : Dont arch the Lumbar Spine. Dont yank on the foot.

Muscles stretched: Hip Flexors.

Contraindicated: Lumbar strain or injury or hip injury.

Muscles stretched: Soleus or Gastrocnemius. Contraindicated: Ankle injury. Comments: My leg is straight so Im emphasizing the Gastrocnemius while Kellys leg is bent emphasizing the soleus.

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Muscles stretched: Hamstrings and lower back. Comments:

Contraindicated: Lower back injury, muscle strain. I am performing a more progressive stretch than Kelly.

Muscles stretched: Lower back, hamstrings.

Contraindicated: Lumbar strain, disc bulge or herniation, spondolythisis, hamstring strain or some knee injuries. Comments: Dont let knees hyperextend.
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Muscles stretched: Adductors. Comments:

Contraindicated: Muscle strain. Keep the spine straight. Imagine youre being pulled upward by a string through your spine.

Muscles stretched: Assisted adductor stretch. Contraindicated: Muscle strain. Comments: This is a more progressive stretch. Dont pull on your client.
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Muscles stretched: Hamstring, lower back and adductor stretch. Comments:

Contraindicated: Muscle strain, disc problem, lumbar strain or spondolythisis. The client can bend their knee if it starts to tremble. For a more progressive stretch, try dorsi flexing or extending the ankle on the extended leg.

Muscles stretched: Hamstrings and lower back. Comments:

Contraindicated: Muscle strain, disc problem, lumbar strain or spondolythisis. The client can bend their knees if they start to tremble. For a more progressive stretch try dorsi flexing or extending the ankles.
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Muscles stretched: Pectoralis major, anterior deltoid, corachobrachialis and biceps.

Contraindicated: Weak anterior wall from shoulder subluxation, rotator cuff injury, muscle strain or wrist injury. Comments: Keep the spine straight and try not to jut the head forward. For some people, sitting on their knees will not be comfortable.

Muscles stretched: Quadriceps, hip flexors. Comments:

Contraindicated: Knee or lower back problems. Im performing a more progressive stretch. Do not perform this stretch if there are knee problems.
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Muscles stretched: Latissimus dorsi and lower back.

Contraindicated: Shoulder subluxation, rotator cuff injury or muscle strain.

Muscles stretched: Abdominals. Comments:

Contraindicated: Lower back pain, injury. Most people wont need to stretch their abdominals.

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Muscles stretched: Quadriceps. Comments:

Contraindicated: Knee problems. Notice my foot is inverted because the girth in my thigh wont allow that much range of motion. That was the only way I could bring my foot to my Glute.

Muscles stretched: Neck extensors. Comments:

Contraindicated: Cervical strain, disc bulge or herniation. Never yank or drop someones head.
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Muscles stretched: Upper trapezius, scalenes, splenius capitis. Comments: Watch their face and move slowly.

Contraindicated: Cervical strain, disc bulge or herniation.

Muscles stretched: Levator scapulae, upper trapezius. Comments:

Contraindicated: Cervical strain, disc bulge or herniation. Aim the chin towards the armpit. Always maintain the head directly over the body in neutral. Do not flex the head forward or extend the head backward.
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Muscles stretched: Latissimus dorsi. Comments:

Contraindicated: Shoulder laxity, impingement, frozen shoulder, rotator cuff injury. Stabilize the client by cupping their anterior superior iliac crest. Dont go so far that you affect the head.

Contraindicated: Lower back strain, spondolythisis, hip injury or shoulder injury. Comments: Do not try to make a sound or crack their back. Thats not the goal.
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Muscles stretched: Obliques, gluteus maximus, external rotators, lower backs, chest.

Muscles stretched: Hamstrings. Comments:

Contraindicated: Hip replacement, hip pain, low back injury, knee pain, muscle strain. This is a great position to perform PNF (Proprioceptive Neuro Muscular Facilitation.) Keep the shoulder close to the knee.

Muscles stretched: Quadriceps. Comments:

Contraindicated: Knee injury. Note the ankle as well.

Muscles stretched: Soleus. Comments:

Contraindicated: Ankle Injury. Keep good posture yourself.

Muscles stretched: Hip flexors (iliopsoas). Comments:

Contraindicated: Hip injury, lower back injury, muscle strain. Watch the range in the hip extension.

Muscles stretched: Hip flexors, external rotators, lower back. Comments:

Contraindicated: Hip replacement, hip pain, lower back injury, muscle strain. This stretch just feels good. Keep proper alignment yourself. Move forward if the person is heavy. Try not to hyper-extend the lumbar spine.
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