Mid Semester - Warm up/cool down and flexibility assesments

RAMP Protocol

- Raise: Elevate body temperature, heart rate, respiration rate, blood flow, and joint fluid viscosity via low-intensity activities that simulate the movement patterns of the upcoming activity. - Activate and Mobilize: Actively move through a range of motion. - Potentiate: Perform sport-specific activities that progress in intensity until the athlete is performing at the intensity required for the subsequent competition or training session.

WARM-UP

-specific to activity being performed • Should consist of a period of aerobic exercise, followed by stretching, and ending with a period of activity similar to the upcoming activity • Components - A general warm-up period may consist of 5 to 10 minutes of slow activity such as jogging or skipping. - A specific warm-up period incorporates movements similar to the movements of the athlete's sport. - The whole warm-up typically lasts between 10 and 20 minutes. The warm-up is an integral part of the training session. Strength and conditioning professionals should plan warm-ups incorporating short-, medium-, and long-term considerations that will contribute to the overall development of the athlete

Static Flexibility • Most common; slow and constant motion (sustained muscle lengthening) that is held in the final position, or point of mild discomfort, for 15 to 30 seconds. • The advantage of using this method involves both relaxing and concurrent elongation of the stretched muscle without stimulation of a stretch reflex. Thus, stretch reflex is lessened. • Since static stretching is slow and controlled, it does not provide an increase in muscle temperature and blood flow redistribution that is needed before and after exercise.

Ballistic Flexibility • Involves rapid, jerky and bouncing-like movements in which the resultant momentum of the body or body segments is used to extend the affected joint through the full ROM • No longer recommended, though used by some athletes to increase body temp and blood flow pre-comp • Muscle spindles detect change in muscle length and contraction speed - Spindle activity is directly proportional to speed of movement - Evokes stretch reflex (increase resistance to stretch) • Increased muscle strain, risk of injury (creates higher risk for injury than static or PNF) • However, the hypothesis that ballistic stretching leads to muscle injury isn't supported by scientific literature • Hence, it is recommended that static & PNF stretching is safer.

COOL DOWN

Dependent on intensity, mode and duration → • 3 - 5 min active, aerobic recovery (never stop exercising suddenly!!!) • Critical for people with high CV risk: Why? Epinephrine (adrenaline) & norephinephrine (2 natural stimulants produced by adrenal glands) increased during strenuous exercise; BP also increases • If you stop suddenly, BP drops but levels of epinephrine and norepinephrine keep increasing (which can trigger potentially dangerous irregular heartbeats after strenuous exercise) and your heart is beating at a high and inefficient rate • Not enough blood gets to heart, and ischaemia may result; which may lead to sudden death (Cooper, 1985). • Gradually continues slow exercising to ↓ the HR to < 100 b.p.m. if > 50 Y of age or < 120 b.p.m. if < 50 Y of age; • Prevents blood pooling in extremities by ↑ venous return → reducing chance of: • - muscular stiffness • - possible dizziness & fainting (hypotensive blackout) • If you feel dizzy, lie down flat on back & raise feet higher than heart level

Dynamic Flexibility • Utilizes slow and controlled, sport-specific, movements which are designed to increase core temperature and enhance activity related flexibility and balance. • No comprehensive list of movements is available; up to coaches knowledge/experience. • Eccentric training was recently introduced as a new technique that is designed to reduce the occurrence of injuries and improve flexibility and performance. • Participant is requested to resist a flexion in a given joint by eccentrically contracting the antagonist muscles during the entire ROM. Two studies have shown some merit compared to static stretching.

Dynamic flexibility (continued) • Dynamic stretch - Carry out 5 to 10 repetitions for each movement, either in place or over a given distance. - Progressively increase the ROM on each repetition. - Increase the speed of motion on subsequent sets where appropriate. - Actively control muscular actions as you move through the ROM.

Flexibility Basic Principles

Flexibility - Basic Principles • Flexibility is a component of health related fitness. • Defined as ROM of a joint or group of joints, as per the skeletal muscles and not any external forces. • Static flexibility can be achieved through the use of gravitational force, a partner, or specific exercise equipment. • Dynamic flexibility is the full ROM of a given joint achieved through the voluntary use of skeletal muscles in combination with external forces. • ROM of one particular joint may not predict the ROM of other joints. • Adequate ROM is necessary to perform ADL effectively

Flexibility Assessment Protocols (cont.) • Functional Movement Screenings - Rely on both qualitative and quantitative observations during specific movement patterns in order to make prescription recommendations. - The use of FMS includes seven tests that are scored using a rank order scale: squat, hurdle step, lunge, shoulder mobility, active straight leg raise, push up and rotary stability. - Proper training for FMS shows high inter-rater reliability and can be a successful tool for screening. - The use of these screening tests is capable of predicting individuals at risk for injury in military force, professional footballers, and firefighters.

Flexibility Program Design • Structured around the same underlying principles that all health related fitness components utilize: - Progressive overload (stretch beyond normal range) by increasing frequency of sessions; intensity = point of stretch; time of each stretch - Specificity of training - Individual differences - Reversibility (Flexibility gains are lost within 4 - 8 weeks of no stretching)

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.

Flexibility Program Design (cont.) • Assessment of ROM at specific joints helps to determine the need for a flexibility program. • Once adequate ROM is achieved, a maintenance program should be prescribed. • For individuals with hypermobility in joint ROM, there doesn't seem to be any benefit of participation in flexibility (for apparently healthy; though elite sport = need to maintain maximum ROM). • The principle of overload for flexibility training may be applied by increasing frequency (sessions per day or week), intensity (point of stretch) and/or time for each session. • Principle of reversibility also shows that flexibility gains are lost within 4 to 8 weeks of ceasing flexibility exercises.

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. F

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!

Muscle Spindles • When stimulated, there is a dual response in which a rapid tension development is initiated in the stretched muscle and inhibited in the antagonist muscle. • Response in the stretched muscle is known as a stretch or myostatic reflex. • Response in the antagonist muscle is known as reciprocal inhibition. • These responses serve an important role in both static and PNF stretching. • Since the myotatic reflex is less likely to occur in slow, and controlled movements, static stretch is viewed as more safer & more effective than ballistic stretching. • During PNF, when there's an increase in tension in the antagonist muscle with concurrent elongation of the agonist muscle, a further lengthening of the stretched muscle is mediated by reciprocal inhibition.

GTOs • When the GTOs are stimulated, there is a dual response in which tension development is inhibited in the contracting muscle (autogenic inhibition) and initiated in the antagonist muscles. • The active tension development in the muscle prior to a stretch elicits autogenic inhibition, which promotes further lengthening of the affected muscle.

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.

Modes of Flexibility Training • Four types: dynamic, static, ballistic, and proprioceptive neuromuscular facilitation (PNF) • Static stretching has three subcategories: - Slow and constant stretch with a partner (passive) - Slow and constant stretch without any assistance (self-stretching) - Slow and constant stretch against a stationary object (isometric)

To stretch or not prior to competing? Does stretching prevent injuries? • Lack of scientific evidence that stretching before PA prevents injury (Shrier, 1999; Thacker at al 2004; Weldon & Hill, 2003; Pope eta la., 2000) • Only 1 of 17 articles used a control group; 7 suggest it's beneficial, 3 detrimental; 7 articles = no difference whether pre-stretching prevents injury (MacAuley & Best, 2007) • Well-controlled randomized trials needed • Stretching immediately before performance may impair strength & Perf (if muscle isn't allowed enough time to take up slack). • Prolonged stretching may create a strength deficit for up to 1hr afterward (Fowles et al., 2000). • Dancing, diving & Gymnastics where extreme ROM is required, may be exceptions (Knudson, 1999)

Overall Recommendations • When determining the appropriate program design: - Differentiate between flexibility training with the sole purpose of increasing range of motion (often using static stretching for those with limited ROM because of disuse or injury or lack of PA) - Or flexibility exercises with the primary purpose of preparing for fitness training or sportspecific training. • Preexercise static stretching is not recommended. Instead: - Preactivity ROM should be dynamic - Flexibility programming should occur during or immediately after activity - Dynamic exercises during the warm-up period with the purpose of increasing body temperature & blood flow will naturally increase ROM during activity. - Some research has demonstrated a reduction of overuse injuries while other studies have NOT produce a reduction at all. Thus, NO substantial evidence-based research!!!!! - Initial assessment of ROM is recommended and if client needs increased ROM, implement that and if client has adequate or hyper ROM, follow a maintenance program.

PNF (Proprioceptive neuromuscular fascilitation) • Techniques combining passive stretch with isometric and concentric muscle actions designed to utilize the autogenic and reciprocal inhibition responses of the Golgi tendon organs (GTO). • It is hypothesized that through the responses of the GTOs, the muscle & tendons are able to elongate & achieve greater ROM • PNF initially developed to assist Physios / EPs treat patients with neuromuscular paralysis and later adopted for use by athletes to increase ROM • Three techniques: - Hold-relax - Contract-relax - Hold-relax with agonist contraction

PNF (cont.) • Each technique has three phases: - Passive prestretch - Passive stretch - Contractions • For PNF stretching to be effective, a partner must be properly trained in the technique. - However, data is inconclusive to determine PNF is better than other stretching methods. Some studies showed PNF to be superior, while others no difference - Limitations? Need a partner to assist and potential higher risk for MS injury

Warm Up effects

Positive effects on performance - Faster muscle contraction and relaxation of both agonist and antagonist muscles - Improvements in the rate of force development and reaction time - Improvements in muscle strength and power - Lowered viscous resistance in muscles - Increased blood flow to active muscles - Enhanced metabolic reactions - An increased psychological preparedness for performance

Flexibility • Flexibility is a measure of range of motion (ROM) and has static and dynamic components. • Static flexibility is the range of possible movement about a joint and its surrounding muscles during a passive movement. • Dynamic flexibility is the available ROM during active movements; it requires voluntary muscular actions.

Principles of Flexibility Training • Flexibility means "to bend" (Latin word) • 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. • 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.

Flexibility Training Program • A training program may be necessary to increase or maintain ROM relative to individual goals. • In order to improve ROM, 2 to 3 training sessions per week for at least 3 to 4 weeks may be required. • Each exercise should include 2 to 4 repetitions in which the stretch is held between 10 and 30 seconds with a goal of accumulating 60 seconds of stretch across 2 to 4 repetitions. - 30 to 60 seconds holds in older individuals. - For clients with lower flexibility, use shorter stretch duration (10- 15 sec) and higher reps.

The neck, shoulders, upper & lower back, pelvis, hips and legs will need to be trained as it relates to daily activity & performance. • Increasing the duration of each repetition beyond 30 to 60 seconds appears to have limited benefit. • Flexibility should be performed when a muscle is warm - 5-minute aerobic warm up and general flexibility exercises. • Post-exercise flexibility training may be more beneficial than pre-exercise. • Generally, increased ROM has been demonstrated in all modes of flexibility training. • Recommended that stretch is hold to point of slight discomfort • Static stretching should be approx 10 minutes and PNF, a 6-sec hold for contraction, followed by 10-30 seconds assisted stretch is recommended.

Types of PNF Stretching • Proprioceptive neuromuscular facilitation (PNF) stretch - Hold-relax • Passive prestretch (10 seconds) • Isometric hold (6 seconds) • Passive stretch (30 seconds)

Types of PNF Stretching (cont.) • Proprioceptive neuromuscular facilitation (PNF) stretch - Contract-relax • Passive prestretch (10 seconds) • Concentric muscle action through full ROM • Passive stretch (30 seconds) - Hold-relax with agonist contraction • During third phase (passive stretch), concentric action of the agonist is used to increase the stretch force.

Factors Affecting Flexibility • Physical activity and exercise: PA can lead to greater flexibility of the affected joints, e.g., flexibility of dominant tennis arm/hand better compared to nondominant playing.(Exercise through a full ROM and develop both agonist and antagonist muscles to prevent loss of ROM). However, activity alone will not improve flexibility. • Anatomical structures: The ROM of a given joint is influenced by its structure and the anatomical structures surrounding it. Soft tissue bulk e.g., fat or large muscle may hinder joint flex due to potential movement restriction • Muscle properties: The inherent properties of muscle tissue play a major role in the ROM of a given joint (e.g., external thermal modality: heat pad, phys act warm-up lead to increase in ROM). Elasticity and plasticity of connective tissues affect ROM.

• Age and Gender: With aging, there is a reduction in collagen solubility which may lead to increases in tendon rigidity and therefore, reduction in ROM. This reduction may be further exacerbated by age-related conditions such as degenerative joint disease & decreased levels of PA. • Women have a more compliant Achilles tendon, resulting in greater ankle flexibility and lower muscle stiffness. Females have smaller muscles, wider hips, and different hormone levels (estradiol & progesterone levels), which during ovulation led to greater degree of knee joint laxity. Factors affecting flexibility (cont.) • Factors affecting flexibility - Stretch tolerance • The ability of an athlete to tolerate the discomfort of stretching. - Neural control • Range of motion is controlled by the central and peripheral nervous system, including both afferent and efferent mechanisms.

• Proprioceptors and stretching - Stretch reflex • A stretch reflex occurs when muscle spindles are stimulated during a rapid stretching movement. • This should be avoided during stretching, as it will limit motion. • Caused by stimulation of muscle spindles.

• Proprioceptors and stretching - Autogenic inhibition and reciprocal inhibition • Autogenic inhibition is accomplished via active contraction before a passive stretch of the same muscle. • Reciprocal inhibition is accomplished by contracting the muscle opposing the muscle that is being passively stretched. • Both result from stimulation of Golgi tendon organs, which cause reflexive muscle relaxation

Flexibility Assessment Protocols • Goniometers - Similar to a protractor and is used to measure a joint's range of motion expressed in degrees. - Consists of two arms: a stabilization arm that is fixed to the proximal body segment, and the other, a movement arm that follows the distal body segment as it is moved through its range of motion. - Axis is placed at a predetermined anatomical landmark, generally at the joint axis of rotation. - If average ROM is lesser than 50 degrees, it is recommended that the measures fall within 5% of degrees. If average is greater than 50 degrees, the 3 measures should fall within 10 degrees of the mean.

• Sit and reach tests - Most commonly used assessment for flexibility in the low-back and hip joint. - It should be noted that sit and reach testing may need to be modified for various subpopulations including the young, the old and the pregnant although specific procedures and norms are lacking. - Fig. 5.7 describes two different procedures. - Tables 5.3 and 5.2 contain norms to be applied after data collecting.

Advantages and Limitations of PNF • Advantage - Potentially more effective • Limitations - Requires partner with knowledge of technique - Overstretching can cause injury

• The hold-relax with agonist contraction is the most effective PNF stretching technique due to facilitation via both reciprocal and autogenic inhibition.