Chapter 16 Guidelines for Designing Flexibility Programs PDF

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Preparation for the ACSM Certification for Personal Training...

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CHAPTER 16: GUIDELINES FOR DESIGNING FLEXIBILITY PROGRAMS FLEXIBILITY- Degree to which a joint moves throughout a normal, pain free range of motion (ROM) ACSM recommends adults stretch major skeletal muscle groups 2 to 3 times per week DETERMINANTS OF FLEXIBILITY Several factors including: 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 AGE ● As one gets older, the ability to move through full ROM becomes compromised with an overall loss of flexibility of approx. 25 to 30% by age 70 ● Was determined that 30% loss in hamstring flexibility from age 20-29 to 70+ years, 15% loss in shoulder flexion from age 20 to 29 to 70+ years REASONS FOR DECREASED ROM WITH AGE - tighter cross-linkage within and between collagen fibres - reduction of elastin - deterioration of cartilage, ligaments, tendons, synovial fluid & muscles with age -decreased physical activity MALE FLEXIBILITY VS. FEMALE FLEXIBILITY - females are overall more flexible due to different patterns of skeletal architecture (ex/ females have broader pelvic regions) & connective-tissue morphology & certain hormonal differences EX: Females generally have a greater range of extension in the elbow because of a shorter upper curve of the olecranon process of the elbow than males. Also, have greater potential for flexibility in trunk flexion after puberty b/c of a comparatively lower center of gravity and shorter leg length

PHYSICAL ACTIVITY HISTORY ● Can impact on his/her joint TOM

● Studies prove that an individual physically active is also more likely to have a greater ROM than a sedentary individual ● Volleyball players exhibited greater flexibility in wrist extension than sedentary individuals, elite field hockey players greater hip ROM than sedentary individuals ● Found that more active older women had significantly greater flexibility in the hip and spine than moderately active and sedentary older women

BENEFITS AND RISKS OF FLEXIBILITY TRAINING BENEFITS IMPROVED ROM IN SELECTED JOINTS ● Long term study on effects of flexibility exercise on shoulder and hip ROM found that flexibility program used produced significant increases in shoulder extension (5.7%), shoulder transverse extension (10.4%), hip flexion (13.3%), and hip rotation (6.3%) ● A minor improvement (5.5%) observed in shoulder flexion ● Improvements can be seen in a relatively short amount of time ● It has been recorded improved ROM values in both static and dynamic hip extension when participants followed the program twice daily for 10 weeks ● Found improvements in spinal ROM and greater hamstring flexibility after subjects followed a 3-month program IMPROVED PERFORMANCE FOR ACTIVITIES FOR DAILY LIVING ● Extent to which individuals can live independently depends on ability to perform basic daily tasks (self-care and essential household chores) termed as “Activities for Daily Living” (ADL) ● Ability to perform ADLs have been highly correlated with joint mobility; easier to perform when an individual possesses an acceptable ROM within the joint. ● Significantly increase aid in balance, postural stability, particularly when combined with resistance exercising RISKS JOINT HYPERMOBILITY- “Congential Laxity” of ligament joints.Characterized by extreme ROM accompanied by mild to moderate intensity pain ● Although it is suggested that certain individuals or athletes (gymnasts) may possess extraordinary joint ROM, there is insufficient scientific evidence to link hypermobility to flexibility training DECREASED STRENGTH ● Some evidence to suggest that static stretching may contribute to decreased muscular strength

● Recent study found that muscle strength and endurance performance reduced after shortterm static stretching in physical education college students ● Found similar results after prolonged stretching of the ankle plantar flexors. This voluntary strength deficit persisted for up to an hour after stretching. ● In addition, it has been demonstrated that stretching prior to the execution of one repetition maximum decreased the performance of the left ● A review by McHugh and Cosgrave indicates that acute participation stretching will decrease the ability to generate a maximal force, but if these stretches are part of other activities used in a warm-up, then performance is not seriously affected ● Activities such as gymnastics that require large ROM movements, it’s necessary to perform pre participation activity to achieve the required ROM for the performance ● It’s possible that if pre performance stretching is accompanied by other warm up movements, performance is not negatively impacted ● However, because flexibility exercises may acutely reduce power and strength, it’s recommended that flexibility exercises be performed after exercise and sports where strength and power are important for performance INEFFECTIVE FOR PREVENTING INJURY ● Research doesn’t show a consistent link between performing regular flexibility training and a reduction in musculotendinous injuries ● Review published regarding injury prevention and flexibility have generally been unable to conclude whether or not stretching before or after exercise contributed to injury prevention among competitive or recreational athletes ● Has been suggested that there is some evidence that pre-participiation stretching may reduce the incidence of muscle strains, but that it doesn’t prevent overuse injuries ● Concluded that type of sport activity in which an individual participates is critical when determining the value of flexibility training to reduce injury. They found that the more explosive the skills involved in an activity, the more likely stretching may be needed to decrease injury

TEMPORARY EFFECTS ● Duration of time that increased flexibility lasts after stretching may not be as long what Personal Trainers may think ● Increased flexibility following acute stretching is extremely short lived ● Study recruited 30 male subjects and found that improvements in knee ROM following static stretching of the hamstrings lasted less than 3 minutes

● Authors suggest that athletes who statically stretch and then wait longer than 3 minutes before activity can expect to lose ROM gained as a result of preceding bout of stretching ● Another test 30 male subjects using proprioceptive neuromuscular facilitation (PNF) on the hamstring muscles and found that ROM improvements lasted only 6 minutes after the stretching protocol ended. ● A recent study by Sainz de Baranda and Ayala indicated that hip flexion passive ROM (pROM) was significantly increased after 12 weeks of stretching. They used a randomized controlled trial on 122 men and 51 women to determine the effects of different stretch techniques and durations on pROM of the hip ● ACSM flexibility training recommendations are effective for improving hip flexion ROM. Although it seems as though stretching has a little acute impact, it may be that longer duration training is effective for increasing ROM EVALUATING FLEXIBILITY - Assessing of clients’ ROM is an essential component of developing their exercise program which includes: ● ● ● ●

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

3 TYPES OF STRETCHING Three types of stretching that can be performed using active or passive techniques: Static, Dynamic, PNF

STATIC STRETCHING----Performed actively and passively and consists of slow movements into position and holding the position for a few seconds at peak tension ● Method used most commonly to improve flexibility ● Despite its popularity, little agreement has been reached among experts with respect to how long the static stretch should be held at peak tension ● ACSM suggests a hold range of 10 to 30s

● Other researchers’ data supports this recommendation when they concluded that static stretches of 30s, 3 days a week, for 6 weeks, significantly improved hamstring flexibility in high school-aged males than in unstretched controls ● Others argued that no particular single duration (15,30, or 45 s) of static stretching was better with regard to its effect on ROM ● Personal Trainers should advise their clients to hold static stretches for 10 to 30s ● ACSM recommends stretches be repeated 2 to 4 times to accumulate a total of 60 s for each flexibility exercise (if each stretch is held for 15 s, each would be repeated 4 times) PROPRIOCEPTIVE NEUROMUSCULAR FACILITATION- Involves both the stretching and contraction of the targeted muscle group. ● ● ● ●

Both active and passive techniques designed to improve ROM Several muscle groups can be trained when used properly Requires an experienced Personal Trainer and a cooperative client Should be performed only by competent and trained practitioners, as overstretching is possible if technique not properly understood ● Involves a dual process where an isometric contraction is followed by a static stretch in the same muscle/tendon group (contract-relax) ● Commonly believed to elicit a relaxation response from the neuromuscular system. This response can occur in the prime mover (agonist), synergist, and antagonist muscles across a particular joint ● With a stretch-induced reduction in muscle tone, joint ROM increases during subsequent stretches and eventually during physical activity ● However, a review refutes this rationale and points to studies that suggest that PNF improves PNF improves ROM mainly b/c of changes in the ability to tolerate stretching and/or changes in the viscoelastic properties of the stretched muscle ● While the mechanism for ROM change with PNF continues to be studied, it’s clear that PNF techniques have long been shown to increase joint ROM CONTRACT-RELAX- Most common technique of PNF stretching. The muscle is isometrically contracted for 6 Seconds, relaxed for 2-3 seconds, then moved to the final stretch for 10-30 seconds 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. (boxer warming up with jabs and hooks) ● Should be performed only as active stretches ● Built into every mode of exercise and physical activity ● Been characterized dynamic stretching as being very similar to a sport-or-function specific warm up

● Goal: to move the specific joint in a controlled manner within a normal ROM in order to minimize the risk of injury ● Important to progressively introduce dynamic stretches into the stretching program, particularly if the client is not accustomed to this type of stretching ● Begin gradually with a small ROM progressing to a larger ROM, repeating each activity 5 to 12 times EX: Arm circles; begin with small, slow circles and gradually progress into larger and faster circles until a full ROM is reached for the shoulder joint ● Ideally, dynamic stretches incorporate movements that are specific to sport movement of interest, but excellent dynamic stretches can also be developed on the basis of the flexibility needs of the medically cleared population at large ● Sometimes confused with “Ballistic Stretching” BALLISTIC STRETCHING- 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 EX: A client seated upright on the floor could extend his/her arms forward in an effort to reach the toes. By moving slowly into that position and holding for a few seconds at peak tension, the client would be performing an active static stretch. However, if in an attempt to touch the toes the client pushed forward repeatedly with short, successive, bouncing flexions at the hip, he/she would be performing a ballistic stretch BALLISTIC STRETCH ● Controversial because it’s often considered “contraindicated” movement, but if performed properly, ballistic stretching done safely in adults, basketball players. ● Equally effective as static stretching in increasing joint ROM

RATIONALE FOR FLEXIBILITY TRAINING ● Justification for certain flexibility techniques is controversial ● Little scientific evidence exists to support either continuing or discontinuing most common stretching habits designed for injury prevention ● Causes confusion with Personal Trainers APPROACH TO PROBLEM: conducting a thorough fitness assessment of the client to determine the extent to which inflexibility limits sport and/ or general physical performance

● Should ROM deficiencies be evident in the client, then the Personal Trainer is justified in prescribing the basic stretching techniques ALL 3 STRETCHES ARE MOST COMMONLY KNOWN TO IMPROVE FLEXIBILITY. IT IS REASONABLE TO EMPLOY THESE TECHNIQUES AND CONTINUE TO MONITOR THE FLEXIBILITY NEEDS OF THE CLIENT WHILE AT LEAST ONE EARLY STUDY FOUND SIGNIFICANT IMPROVEMENTS IN FLEXIBILITY WITH ALL 3 METHODS. PERSONAL TRAINERS ARE ENCOURAGED TO SELECT AN APPROACH THAT BEST SUITS THE NEEDS, LIMITATION, AND ABILITIES OF THE CLIENT, WHILE CONTINUING TO MONITOR JOINT ROM AND ITS ULTIMATE IMPACT ON SPORT AND PHYSICAL ACTIVITY PERFORMANCE. DESIGNING A FLEXIBILITY TRAINING PROGRAM WARMUP ● Although stretches can be performed at the start, in the middle, and/or at the finish of the workout, it’s common to precede stretching with a brief, aerobic exercise warm-up ● Found that active warm up reduces the resistance to strecth ● Established that increasing the temperature of a muscle increases the elastic properties or the ability to stretch- warm muscles tissue responds less stiffly than cold muscle tissue ● Little evidence suggest that the exercise warm up should be altered to accomodate flexibility training exclusively. Typical warm up exercises include stationary cycling, treadmill walking/ running, or rowing. ● Often recommended that stretching be done at the end of the workout after the muscles are warm

BREATHING ● Proper breathing techniques are often helpful in relaxing the client and allowing movement into position more comfortably ● Flexibility training is no time to perform a Valsalva maneuver( air expiration against a closed glottis) ● 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 POSTURE

● Personal Trainers must know the proper positioning of the stretch to target the appropriate muscle group ● Focus on maintaining proper body alignment during the execution of the exercises EX: Posture can be greatly improved by using the “free hand” (the hand not grasping the ankle) to hold a railing or the back of a chair to maintain balance. The Personal Trainer should emphasize that one should avoid pressing the elevated foot to the gluteals( hyperflexion at the knee) or leaning into the stretch for additional force development. REMINDERS FOR CORRECT POSTURAL ALIGNMENT: ● 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. PRECAUTIONS FOR INDIVIDUALS WITH HEALTH CONCERNS ● Little reason to avoid flexibility training in a healthy individual ● Several common health conditions that require special attention and may present challenges to the Personal Trainer in regard to flexibility training. 1) Arthritis 2) Muscular imbalance 3) Osteoporosis 4) Hip fracture/ replacement

ARTHRITIS-inflammation of a joint resulting in damage to the joint structure ● According to the US National Center for Chronic Disease Prevention and Health Promotion, 50 million Americans suffer from arthritis or other joint pain and inflmmation ● Believed to limit physical activity in nearly 21 million adult Americans ● More than 100 different types of arthritis, with 2 most common types being osteoarthritis and rheumatoid arthritis OSTEOARTHRITIS-Chronic degenerative condition that develops over time and is believed to result from abnormal or excessive wear on normal cartilage or normal wear on abnormal cartridge.

RHEUMATOID ARTHRITIS-Classified as an autoimmune disease in which the body attacks and destroys joint surface ● In either case, individuals with arthritis tend to limit movement because of pain and stiffness, which may result in an increased loss of flexibility and joint motion. Fortunately, flexibility and joint range can be improved in an individual with arthritis GUIDELINES WHEN FLEXIBILITY TRAINING AND INDIVIDUAL W/ ARTHRITIS ● Avoid strenuous exercises during acute flare ups and periods of inflammation. However, it’s appropriate to gently move joints through their full ROM during these periods ● 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 ● If the client experiences greater joint pain following a training session, the session may have been too intense and may need to be modified ● Avoid overworking individuals who have taken anti-inflammatory medications (aspirin, ibuprofen, and naproxen sodium); these drugs can temporarily lessen musculoskeletal pain and make it possible for a client to do too much MUSCULAR IMBALANCE ● Which may create postural alignment issues and injury ● Repetitive movements, poor posture, and weak or tight muscles can cause these muscular imbalances (Baseball/tennis player consistently trains and plays with joint dominance) ● When the body experiences an imbalance in muscular forces on opposite sides of a joint, ROM of that joint may be affected ● Obvious goal to correct the muscular imbalance would be to strengthen the weak muscles and stretch the shorter muscles if ROM is compromised OSTEOPOROSIS-disease in which bone mineral density (BMD) is reduced, bone microarchitecture deteriorates and the bone becomes fragile and very susceptible to fracture ● Afflicts more than 50% of the population aged 50 and older ● Both men and women lose bone steadily after about age 35 ● At menopause, women often have an accelerated loss of bone due to hormone changes MOST COMMON SITES FOR BONE LOSS: Spine, hips, and wrists ● Flexibility exercises for those w/ osteopenia(low bone mass) or diagnosed osteoporosis should be designed to minimize the chance for fracture. ● When possible, it may be helpful to have the client use a chair or handrail for support when needed. Examples of exercises to avoid include those that involve twisting, bending, or compression of the spine or those that stress the wrists or hips

SPECIFICALLY, AVOID THE FOLLOWING ● Bending forward (forward fold pose) ● Supine spinal rotation or twists ● Plough pose ● Back extension( cobra pose)

RECENT HIP FRACTURE OR REPLACEMENT RECOMMENDED TO AVOID FLEXIBILITY EXERCISES THAT INVOLVE EXCESSIVE: ● 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)

FLEXIBILITY PROGRAM DEVELOPMENT ● ACSM recognizes that joint ROM is important and can be improved by engaging in flexibility training ● Programs should follow the same FITT-VP (Frequency, Intensity, Type, Time, Volume, and Progression) of exercise prescription as resistance training or cardiorespiratory endurance ● Exercises are most effective when the muscles are warm, thus low-to-moderate intensity warm up activities should be done preceding all stretching FREQUENCY ● Currently recommended that stretches be performed at least 2 to 3 days a week, but stretching exercises are most effective when performed daily, including 2 to 4 stretch repetitions per muscle group ● Researcher found no increase in hamstring flexibility in 93 female and male subjects when the frequency of stretching was increased from 1 to 3 times per day ● Little research exists to refute the practice of stretching daily wheth...