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On the Web - Concept 09

Web9-01: Clinical Assessments of Flexibility

Web9-02: Proprioceptive Neuromuscular Facilitation - PNF

Web9-03: Maintenance of Flexibility

Web09-04 Movement Disciplines Related to Flexibility

Web9-05: Foam Rollers

Web9-06: Flexibility Assessments

Web9-07: Web Resources

Web9-08:Supplemental Readings

Web08-09 - Web Resources

Web9-01: Clinical Assessments of Flexibility

Flexibility can be reflected by the range of motion in joints. Physical therapists use goniometers and inclinometers to help them measure a patient's range of motion. The therapist uses the goniometer by lining up the arms with the patient's bones that surround the joint they are wanting to assess. Generally, the joint must be assessed at both ends of the range of motion (ie. fully flexed and fully extended).

Unlike the goniometer, the inclinometer does not require the therapist to align the device with the joint. To use the inclinometer, a therapist places the device in a predetermined starting position and zeros the device. The therapist then instructs the patient to move the joint through the full range of motion. The inclinometer then measures the final degrees of the range of motion of that joint.

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Goniometer	Inclinometer

Web9-02: Proprioceptive Neuromuscular Facilitation - PNF

Proprioceptive neuromuscular facilitation (PNF) stretching is an advanced stretching technique that has been shown to maximize stretching gains. The images and text below reveal the basic concept behind (PNF). In this example, the trainer has an individual perform an active contraction against resistance (Step 1). This contraction causes a reflex relaxation of the muscle that the individual is trying to stretch (hamstring). By applying a passive assist, the trainer is able to facilitate the subsequent stretching of the hamstring (Step 2).

It is important to point out that there are a variety of PNF techniques. Because they involve some passive movements they should not be done without proper training, supervision, or assistance.

Web9-03: Maintenance of Flexibility

Flexibility doesn't get the same attention given to other dimensions of fitness but it is increasingly being found to be important for maintaining good functional movement and independence among the elderly. While the limitations of flexibility are more apparent in old age it is important to develop and maintain a flexibility program throughout your life to reduce risks of problems later on.

Click here to get tips on how to incorporate flexibility exercise into your normal workout routine. Some other helpful flexibility websites are listed below.

Flexibility training: http://www.sport-fitness-advisor.com/flexibilitytraining.html
Time for fitness: http://www.timeforfitness.com/flexibility/

Web09-04 Movement Disciplines Related to Flexibility

Several movement disciplines related to flexibility have gained increasing popularity with classes being taught at most health clubs and fitness centers. Yoga, Tai Chi, and Pilates are all great forms of exercise that will help improve flexibility, strength and balance. Yoga combines stretching, strengthening, breathing, and meditation. Tai Chi began in China as a form of martial arts, and it includes a series of postures with meditation. Pilates involves movements that are performed in a specific order for maximum stretching and strengthening.

American Yoga Association: http://www.americanyogaassociation.org/general.html
Yoga Journal: http://www.yogajournal.com/
Tai Chi Association: http://www.tai-chi-association.com/taichi/
Tai Chi Magazine: http://www.tai-chi.com/
History of Pilates: http://www.pilatesmethodalliance.org/whatis.html
Pilates: http://www.pilates.com/

Web9-05: Foam Rollers

Foam rollers are cylinder shaped foam pieces of varying densities that are now being widely used as exercise equipment as well as for rehabilitation. These rollers are used to improve flexibility, balance, and strength. They are becoming increasingly popular in yoga and pilates classes, fitness centers, and rehabilitation clinics. Some foam rollers even come with their own DVD for instructions and use at home.

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Below are links to several companies that carry foam rollers:

PTMart: http://www.ptmart.com
Power Systems: http://www.power-systems.com
Exertools: http://exertools.stores.yahoo.net
Perform Better: http://www.performbetter.com
Nefitco: http://www.nefitco.com

Web9-06: Flexibility Assessments

A variety of assessments are available for assessing flexibility. The following descriptions provide additional detail and suggestions for the assessments used in lab 10A

Modified Sit and Reach (Flexibility Test of Hamstrings)

1. Remove shoes and assume the position for the "backsaver toe touch'', except place the sole of the foot of the extended leg flat against the box or bench seat, and place the head, back, and hips against a wall; 90 degree angle at the hips.
2. Place one hand over the other and slowly reach forward as far as you can with arms fully extended; head and back remain in contact with the wall. A partner will slide the measuring stick on the bench until it touches the fingertips.
3. With the measuring stick fixed in the new position, reach forward as far as possible, three times, holding the position on the third reach for at least two seconds while the partner reads the distance on the ruler. Keep the knee of the extended leg straight.
4. Repeat the test a second time and average the scores of the two trials.

Zipper (Shoulder Flexibility)

1. Raise your right arm, bend your elbow, and reach down across your back as far as possible.
2. At the same time, extend your left arm down and behind your back, bend your elbow up across your back, and try to cross your fingers over those of your right hand.
3. Measure the distance to the nearest half-inch. If your fingers overlap, score as a plus; if they fail to meet, score as a minus; use a zero if your fingertips just touch.
4. Repeat with your arms crossed in the opposite direction (left arm up). Most people will find that they are more flexible on one side than the other.

Hamstring and Hip Flexor Flexibility

1. Lie on your back on the floor beside a wall.
2. Slowly lift one leg off the floor. Keep the other leg flat on the floor.
3. Keep both legs straight.
4. Continue to lift the leg until either leg begins to bend or the lower leg begins to lift off the floor.
5. Place a yardstick against the wall and underneath the lifted leg.
6. Hold the yardstick against the wall after the leg is lowered.
7. Measure the angle created by the floor and the yardstick using a protractor. Your score is the angle measured for each leg. The greater the angle, the better your score.
8. Repeat with the other leg.

Note: For ease of testing, you may want to draw angles on a piece of posterboard. If you have goniometers, you may be taught to use them instead.

Trunk Rotation

1. Drop the left arm and raise the right arm to the side, palm down, fist closed.
2. Rotate the trunk to the right as far as possible
3. Have a partner read the distance reached with a yardstick

Web9-07: Web Resources

Orthopedic Physical Therapy Products (source for stretching ropes) - www.optp.com
The Physician and Sports Medicine - www.physsportsmed.com

Web9-08:Supplemental Readings

References new to 7e/14e

Shrier, I. 2004. Does Stretching Improve Performance?: A Systematic and Critical Review of the Literature. Clinical Journal of Sport Medicine: Volume 14(5):267-273

Sherman, K.J. et al., 2005. Comparing yoga, exercise, and a self-care book for chronic low back pain: a randomized, controlled trial. Annals of Internal Medicine 143(12):849-56.

Rererences from Past Editions

• Alter, M.J. The Science of Stretching. 2nd ed. Champaign, IL: Human Kinetics Publishers, 1996.
• Basmajian, J.V. Therapeutic Exercise. 5th ed. Baltimore: Williams & Wilkins, 1990.
• Beighton, P.H. "Dominant Inheritance in Familial Generalized Articular Hypermobility." Journal of Bone and Joint Surgery 52B(1970):145-47.
• Brodie, D.A., et al. "Joint Laxity in Selected Athletic Populations." Medicine and Science in Sports and Exercise 14(1982):190.
• Colucci, D., et al. "Comparison of Static versus PNF Stretching on Shoulder ROM in Intercollegiate Baseball Players." Athletic Training 24(1989):116.
• Cornelius, W.L. "PNF Ankle Stretching: Partner/No-Partner Procedures." National Strength and Conditioning Association Journal 13(1991):59-63.
• Fomby, E. W. & M. B. Mellon, M. B. Identifying and Treating Myofascial Pain Syndrome. The Physician and Sports Medicine. 25(2) (1997):67.
• Gleim, G.W., et al. "Influence of Flexibility on Economy of Walking and Jogging." Journal of Orthopaedic Research 8(1990):814-23.
• Godges, J.J., et al. "The Effects of Two Stretching Procedures on Hip Range of Motion and Gait Economy." Journal of Orthopaedic and Sports Physical Therapy 11(1989):350-57.
• Golding, L. A. (1997). Flexibility, Stretching, and Flexibility Testing. ACSM's Health and Fitness. 1(1)(1997):17.
• Grahame, R., & J.M. Jenkins. "Joint Hypermobility-Asset or Liability." Annals of Rheumatic Disease 31(1972):109.
• Hardy, L., and D. Jones. "Dynamic Flexibility and Proprioceptive Neuromuscular Facilitation." Research Quarterly for Exercise and Sport 57(1986):150.
• Hoeger, W., & D. Hopkins. "Assessing Muscular Flexibility." Fitness Management 6(20):34-36, 42, 1990.
• Hoeger, W., & D.R. Hopkins. "A Comparison of the Sit-and-Reach and the Modified Sit-and-Reach in the Measurement of Flexibility in Women." Research Quarterly for Exercise and Sport 31(June 1992):191-95.
• Hopkins, D.R., & W. Hoeger. "A Comparison of the Sit-and-Reach Test and the Modified Sit-and-Reach Test in the Measurement of Flexibility for Males." Journal of Applied Sport Science Research 6(1992):7-10.
• Knudson, D. Stretching: From Science to Practice. Journal of Physical Education Recreation and Dance. 69(3)(1998):38.
• Knudsen, D.V., Magnusson, P., and McHugh, M. (2000) Current issues in flexibility fitness. Presidents Council on Physical Fitness and Sports: Research Digest, 2(10), 2000.
• Knudsen, D.V. Stretching during warmup: Do we have enough evidence? JOPERD, 70(7)(2000) 24-27,5.
• Pope, R.P., Herbert, R.D., Kirwan, J.D. et al., A randomized study of pre-exercise stretching for prevention of lower limb injury. Medicine and Science in Sports and Exercise 31(2)(2000), 271-277.
• Rider, R.A., & J. Daly. "Effects of Flexibility Training on Enhancing Spinal Mobility in Older Women." Journal of Sports Medicine and Physical Fitness 31(1991):213-17.
• Roberts, M. "The Well Done Stretch." U.S. News and World Report (Mar. 5, 1990):65-67.
• Sady, S.P., et al. "Flexibility Training: Ballistic, Static or Proprioceptive Neuromuscular Facilitation." Archives of Physical Medicine and Rehabilitation 63(1982):261.
• Taylor, D.C., et al. "Viscoelastic Properties of Muscle-Tendon Units: The Biomechanical Effects of Stretching." American Journal of Sports Medicine 18(1990):300-309.