ACSM Chapter 16. 5th.ed Flexibility Trainig

Hypermobility syndrome is known as

"congenital laxity" of ligaments and joints. This condition is characterized by extreme ROM accompanied by mild- to moderate-intensity pain (25). Although it is suggested that certain individuals or athletes (e.g., gymnasts) may possess extraordinary joint ROM, there is insufficient scientific evidence to link hypermobility to flexibility training.

Guideline for arthritis flexibility trainin

1. Avoid strenuous exercises during acute flare ups and periods of inflammation. However, it is appropriate to gently move joints through their full ROM during these periods. 2. Encourage individuals with arthritis to stretch during the time of day when pain is typically least severe and/ or in conjunction with peak activity of pain medications. 3.If the client experiences greater joint pain following a training session, the session may have been too intense and may need to be modified. 4. Avoid overworking individuals who have taken anti-inflammatory medications (e.g., aspirin, ibuprofen, and naproxen sodium); these drugs can temporarily lessen musculoskeletal pain and make it possible for a client to do too much. 5. Discuss with clients the importance of wearing shoes that have good shock absorption and stability. 5.Functional activities such as sit-to-stand, step-ups, and stair climbing are good exercises that assist in ADLs.

Evaluating flexibility

1. Initial ROM prior to the start of the exercise program 2. Baseline measurements from which plans can be made for future exercise goals 3. Immediate ROM feedback 4. Identification of muscular imbalances

overall loss of flexibility of approximately______ by age 70 years

25%- 30%

Static stretching suggested holding time

60s

Typical warm-up exercises include

stationary cycling, treadmill walking/ running, or rowing.

Flexibility program development: volume

A total of 60 seconds of flexibility exercises per joint

Static stretching

All major muscle groups should be targeted at least 2- 3 d ∙ wk − 1. Hold each static stretches for 10- 30 s, 30- 60 s for older adults. ACSM recommends stretches be repeated 2- 4 times to accumulate a total of 60 s for each flexibility exercise.

Exercises to avoid for hip fracture or replacement

Internal rotation of the hip (turning the foot inward) Hip adduction (crossing the legs beyond the midline) Hip flexion (thigh more than parallel to floor)

Reason female more flexible than male

Different pattern of skeletal architecture and connective tissue morphology and hormone

Dynamic stretching

Dynamic stretching involves moving parts of your body through a full ROM while gradually increasing the reach and/ or speed of movement in a controlled manner. These exercises are very rhythmic in nature. Dynamic stretching is often incorporated in the "active" phase of the group exercise warm-up due to their similarity to the movements or patterns that will be used during the conditioning period. Begin gradually with a small ROM progressing to larger ROM, repeating each activity 5- 12 times.

Benefits of flexibility training

Improved ROM Improved performance for daily activities (ADLs) (directly from ROM or postural control)

Risks of flexibility training

Joint hypermobility Decreased strength (muscle strength and endurance performance reduced after short-term static stretching) thus suggested after exercises Ineffective for preventing injury

Example static flexibility

Lateral flexion Arms across chest Chest stretch elbow extension kneeling cat modified cobra seated hip rotator prone quadriceps seated hamstring standing calf stretch

Correct postural alignment for flexibility

Maintain neutral position of the spine (characterized by having a slight inward curve at the cervical and lumbar spines and a slight outward curve of the thoracic spine). Shoulders should remain back and away from the ears. Hips should be in a neutral and level position

Impact of physical activity history on ROM

More active greater ROM

Flexibility program development: Intensity

Moving into position of tightness or mild discomfort before holding a stretch for PNF, below maximal voluntary isometric contractions. Borg Rating of Perceived Exertion scale (12) and suggest that clients position themselves for (static) stretching at an intensity that corresponds to a 13- 15 (somewhat hard to hard) range.

PNF

PNF stretching involves both the stretching and contraction of the targeted muscle group. Although there are several ways to employ PNF, the most common technique is termed contract-relax. Following the preliminary passive stretch, the muscle is isometrically contracted for 6 s, relaxed for 2- 3 s, and then passively moved into the final stretch which is held for 10- 30 s. This method is most effective with the use of a trainer to assist the client through the stretch. All major muscle groups should be targeted at least 2- 3 d ∙ wk − 1. A 3- to 6-s muscle contraction at 20%- 75% maximum intensity is followed by 10- 30 s of assisted stretching. A total of 60 s of stretching time should be achieved per targeted muscle group.

PNF definition

Proprioceptive neuromuscular facilitation or PNF involves both active and passive techniques designed to improve joint ROM. techniques involve a dual process where an isometric contraction is followed by a static stretch in the same muscle/ tendon group (i.e., contract- relax). PNF improves ROM mainly because of changes in the ability to tolerate stretching and/ or changes in the viscoelastic properties of the stretched muscle.

Benefit of breathing

Purposeful and controlled breathing that accompanies relaxing exercise may help reduce stress levels and decrease voluntary muscle tension. Remind exercisers to exhale slowly as they move toward the end point of a stretch and inhale as they return to the starting position.

Passive Stretching

The client is not actively involved in this type of stretching. The client assumes a position and then either holds it with some other part of the body (i.e., arm) or with the assistance of a partner or some other apparatus (i.e.,stretching strap). The goal is to slowly move the client into the stretch in order to prevent a forceful action and possible injury. Exercise design would follow the static stretching protocol.

Ballistic stretching

This approach involves a bouncing or jerky type movement to reach the muscle's ROM limits. This bouncing motion may produce a powerful stretch reflex that counteracts the muscle lengthening and could possibly lead to tissue injury. Although ballistic stretch is not common practice for the general population, its use in training and rehabilitation of athletes where explosive movements are critical, it may have a justifiable role. Exercise design would be determined by activity-specific needs on an individual basis. Not appropriate for the general population; may be suitable for athletes involved in ballistic sport skills

Flexibility program development: time

active stretch 10-30s PNF 3-6s active contraction then 10-30s PNF older adults 30-60s

Examples of dynamic stretching

arm circles pendulum leg butt kicks high knees dynamic foot ROM soldier walk

Flexibility program development: frequency

at least 2- 3 days a week, but stretching exercises are most effective when performed daily, including two to four stretch repetitions per muscle group.

Osteoporosis is a disease in which

bone mineral density (BMD) is reduced, bone microarchitecture deteriorates, and the bone becomes fragile and very susceptible to fracture. Osteoporosis afflicts more than 50% of the population aged 50 years and older (22). Both men and women lose bone steadily after about age 35 years; however, at menopause, women often have an accelerated loss of bone due to hormone changes

Causes for loss of ROM with age

connective tissue collagen fibers increase regidity reduction in elastin and deterioation of cartilage, ligaments, tendons, synovial fluid and muscles decreased physical activity

There are generally three types of stretching that can be performed using active or passive techniques to improve flexibility:

static, dynamic, and proprioceptive neural facilitation or PNF.

The more ______ the skills involved in an activity, the more likely stretching may be needed to decrease injury.

explosive

Dynamic stretching is a form of stretching that

incorporates movement along with muscle tension development. Progress from small ROM to larger ROM

_______ can contribute to hypermobility or excessive ROM in a joint.

injury, disease, and poor soft tissue integrity

Exercises to avoid for osteoporosis

involve twisting, bending, or compression of the spine or those that stress the wrists or hips. Bending forward (e.g., forward fold pose) Supine spinal rotation or twists Plough pose Back extension (e.g., cobra pose)

Hamill, Knutzen, and Derrick (35) suggest that several factors determine flexibility. These factors include

joint structure, health of soft tissue around the joint, length of antagonist muscles, and temperature of the tissues being stretched in addition to the viscoelastic (" rubber band-like") properties of the tissues surrounding the joint.

Flexibility program development: Progression

low- to moderate-intensity aerobic activities be done as a warm-up or that moist heat packs or hot baths be used to passively warm the area prior to stretching. flexibility exercises be performed after any exercise or sport where strength and power are important for performance.

The existing science of flexibility training often presents fitness professionals with

more questions than answers regarding the benefits and risks of stretching.

An active warm-up benefit

reduces the resistance to stretch (64). It has been established that increasing the temperature of a muscle increases the elastic properties or the ability to stretch

Flexibility program development: type

should involve the major muscle and tendon groups of the body. only Personal Trainers who have advanced training and practice should attempt employing PNF

goal to correct the muscular imbalance would be to

strengthen the weak muscles and stretch the shorter muscle if ROM is compromised

Flexibility refers to

the degree to which a joint moves throughout a normal, pain-free range of motion (ROM).

Ballistic stretching refers to

to the use of the momentum of the moving body segment to produce a bouncing or jerky movement that is done to obtain a peak muscle tension or stretch.

There are three preliminary training guidelines unique to the design of flexibility programs. These involve

warm-up, breathing, and posture.