Chapter 7: Flexibility Training Concepts Flashcards
flexibility
the normal extensibility of all soft tissues that allows the full range of motion of a joint
extensibility
capability to be elongated or stretched
dynamic range of motion
- optimal control of movement throughout a joint’s entire range of motion
- the combination of flexibility and the nervous system’s ability to control this range of motion efficiently
neuromuscular efficiency
the ability of the nervous system to recruit the correct muscles (agonists, antagonists, synergists, and stabilizers) to produce force (concentrically), reduce force (eccentrically), and dynamically stabilize (isometrically) the body’s structure in all three planes of motion
postural distortion patterns
- predictable patterns of muscle imbalances
- patterns that develop if one or more segments of the HMS are misaligned and not functioning properly
relative flexibility
- the tendency of the body to seek the path of least resistance during functional movement patterns
- aka altered movement patterns
muscle imbalance
alteration of muscle length surrounding a joint
reciprocal inhibition
- the simultaneous contraction of one muscle and the relaxation of its antagonist to allow movement to take place
- a naturally occurring phenomenon that allows movement to take place
altered reciprocal inhibition
- the concept of muscle inhibition, caused by a tight agonist, which inhibits its functional antagonist
- caused by a tight agonist muscle decreasing the neural drive to its functional antagonist
synergistic dominance
the neuromuscular phenomenon that occurs when inappropriate muscles take over the function of a weak or inhibited prime mover
arthrokinematics
the motions of joints in the body
arthrokinetic dysfunction
- altered forces at the joint that result in abnormal muscular activity and impaired neuromuscular communication at the joint
- biomechanical and neuromuscular dysfunction leading to altered joint motion
autogenic inhibition
- the process by which neural impulses that sense tension are greater than the impulses that cause muscles to contract, providing an inhibitory effect to the muscle spindles
- “autogenic” because the contracting muscle is being inhibited by its own receptors
pattern overload
consistently repeating the same pattern of motion, which may place abnormal stresses on the body
Davis’s law
states that soft tissue models along the lines of stress
static stretching
the process of passively taking a muscle to the point of tension and holding the stretch for a minimum of 30 seconds
active-isolated stretch
the process of using agonists and synergists to dynamically move the joint into a range of motion
dynamic stretch
the active extension of a muscle, using force production and momentum, to move the joint through the full available range of motion
what is range of motion dictated by?
the normal extensibility of all soft tissues surrounding it
what is an important characteristic of soft tissue?
it will only achieve efficient extensibility if optimal control of movement is maintained throughout the entire ROM
factors that can influence flexibility
- genetics
- connective tissue elasticity
- composition of tendons or skin surrounding the joint
- joint structure
- strength of opposing muscle groups
- body composition
- sex
- age
- activity level
- previous injuries or existing medical issues
- repetitive movements (pattern overload)
what must individuals have to allow for optimal neuromuscular efficiency?
- proper flexibility in all three planes of motion
- this allows for the freedom of movement needed to perform everyday activities effectively
flexibility requires ___, which requires ___, which requires _____
flexibility requires extensibility, which requires dynamic range of motion, which requires neuromuscular efficiency
flexibility training must use a ____ approach, which integrates various flexibility techniques to achieve optimal soft tissue extensibility in all planes of motion
multifaceted
agonist in a cable pulldown exercise
latissimus dorsi
what does the agonist concentrically accelerate in a cable pulldown exercise?
shoulder extension, adduction, and internal rotation
synergists in a cable pulldown exercise
middle and lowerr trapezius and rhomboids
what do the synergists do in a cable pulldown exercise?
perform downward rotation of the scapulae
stabilizers in a cable pulldown exercise
rotator cuff musculature
what do the stabilizers do in a cable pulldown exercise?
dynamically stabilize the glenohumeral (shoulder) joint throughout the motion
human movement system (HMS)
- also known as the kinetic chain
- comprises the muscular, skeletal, and nervous systems
latissimus dorsi - sagittal movement
must have proper extensibility to allow for proper shoulder flexion
latissimus dorsi - frontal movement
must have proper extensibility to allow for proper shoulder abduction
latissimus dorsi - transverse movement
must have proper extensibility to allow for proper external humerus rotation
biceps femoris - sagittal movement
must have proper extensibility to allow for proper hip flexion, knee extension
biceps femoris - frontal movement
must have proper extensibility to allow for proper hip adduction
biceps femoris - transverse movement
must have proper extensibility to allow for proper hip and and knee internal rotation
gastrocnemius - sagittal movement
must have proper extensibility to allow for proper dorsiflexion of ankle
gastrocnemius - frontal movement
must have proper extensibiltiy to allow for proper inversion of calcaneus
gastrocnemius - transverse movement
must have proper extensibility to allow for proper internal rotation of femur
muscle imbalances lead to ___, which lead to ___, which lead to ___
muscle imbalances lead to poor posture, which lead to improper movement, which lead to injury
what are postural distortion patterns represented by?
a lack of structural integrity, resulting from decreased functioning of one (or more) components of the HMS
what can a lack of structural integrity result in?
- altered length-tension relationships (altered muscle lengths)
- altered force-couple relationships (altered muscle activation)
- altered arthrokinematics (altered joint motion)
maximal neuromuscular efficiency can only exist if what?
all components (muscular, skeletal, and neural) function optimally and interdependently
what is the ultimate goal of the HMS?
to maintain homeostasis (or dynamic postural equilibrium)
what can poor flexibility lead to?
the development of relative flexibility (or altered movement patterns)
relative flexibility example in the squat
- feet externally rotated
- because most people have tight calf muscles, they lack the proper amount of dorsiflexion at the ankle to perform a squat with proper mechanics
- by widening the stance and externally rotating the feet, it is possible to decrease the amount of dorsiflexion required at the ankle to perform a squat using good technique
relative flexibility example in the overhead shoulder press
- excessive lumbar extension (arched lower back)
- individuals who possess a tight latissimus dorsi will have decreased sagittal-plane shoulder flexion (inability to life arms directly overhead), and as a result, they compensate for this lack of range of motion at the shoulder in the lumbar spine to allow them to press the load completely above their head
overactive muscle imbalances
forcing compensation to occur
underactive muscle imbalances
allowing for the compensation to occur
mechanisms that may cause muscle imbalance
- postural stress
- emotional duress
- repetitive movement
- cumulative trauma
- poor training technique
- lack of core strength
- lack of neuromuscular efficiency
muscle imbalances may be caused by or result in the following:
- altered reciprocal inhibition
- synergistic dominance
- arthrokinetic dysfunction
- overall decreased neuromuscular control
example of reciprocal inhibition in the biceps curl
to perform elbow flexion during the biceps curl, the biceps brachii actively contracts while the triceps brachii (the antagonist muscle) relaxes to allow mvoement to occur
example of altered reciprocal inhibition in the hips
a tight psoas (hip flexor) would decrease neural drive of the gluteus maximus (hip extensor)
what does altered reciprocal inhibition alter?
force-couple relationships
what does altered reciprocal inhibition produce?
synergistic dominance
what does altered reciprocal inhibition lead to the development of?
- faulty movement patterns
- poor neuromuscular control
- arthrokinetic (joint) dysfunction
example of synergistic dominance in the hips
if the psoas is tight, it leads to altered reciprocal inhibition of the gluteus maximus, which in turn results in increased force output of the synergists for hip extension (hamstring complex, adductor magnus) to compensate for the weakened gluteus maximus
result of synergistic dominance
faulty movement patterns, leading to arthrokinetic dysfunction and eventual injury (such as hamstring strains)
what can altered joint motion be caused by?
altered length-tension relationships and force-couple relationships, which affect the joint and cause poor movement efficiency
performing a squat with excessively externally rotated feet (feet turned outward) forces what to happen?
- forces the tibia (shin bone) and femur (thigh bone) to also rotate externally
- this posture alters the length-tension relationships of the muscles at the knees and hips, putting the gluteus maximus in a shortened position and decreasing its ability to generate force
- the biceps femoris (hamstring muscle) and piriformis (outer hip muscle) becomes synergistically dominant, altering the force-couple relationships and ideal joint motion, increasing the stress on the knees and low back
with time, what can happen due to arthrokinetic dysfunction?
the stress associated with it can lead to pain, which can further alter muscle recruitment and joint mechanics
neuromuscular efficiency
the ability of the neuromuscular system to properly recruit muscles to produce force (concentrically), reduce force (eccentrically), and dynamically stabilize (isometrically) the entire kinetic chain in all
three planes of motion
what helps to determine muscle balance or imbalance?
mechanoreceptors (or sensory receptors)
what do mechanoreceptors include?
the muscle spindles and Golgi tendon organs
muscle spindles
the major sensory organ of the muscle
what are muscle spindles composed of?
microscopic fibers that lie parallel to the muscle fiber
what are muscle spindles sensitive to?
- change in muscle length
- rate of length change
what is the function of the muscle spindle?
to help prevent muscles from stretching too far or too fast
what happens when a muscle on one side of a joint is lengthened (because of a shortened muscle on the opposite side)?
- the spindles of the lengthened muscle are stretched
- this information is transmitting to the brain and spinal cord, exciting the muscle spindle and causing muscle fibers of the lengthened muscle to contract
- this often results in micro muscle spasms or a feeling of tightness
example - hamstring complex when the pelvis is rotated anteriorly
- the anterior superior iliac spines move downward and the ischium moves upward
- if the attachment of the hamstring complex is moved superiorly, it increases the distance between the two attachment sites and lengthens the hamstring complex
- in this case, the hamstring complex does not need to be statically stretched because it is already in a stretched position
- when a lengthened muscle is stretched, it increases the excitement of the muscle spindles and further creates a contraction (spasm) response
- with this scenario, the shortened hip flexors are helping to create the anterior pelvic rotation that is causing the lengthening of the hamstring complex
- instead, the hip flexors need to be stretched
example - knees adduct and internally rotate during a squat exercise
- the underactive muscle is the gluteus medius (hip abductor and external rotator), and the overactive muscles include the adductors (inner thighs) and tensor fascia latae (a hip flexor and hip internal rotator)
- thus, one would not need to stretch the gluteus medius, but instead stretch the adductor complex and tensor fascia latae, which in this case are overactive, pulling the femur into excessive adduction and internal rotation
where are Golgi tendon organs located?
within the musculotendinous junction (or the point where the muscle and the tendon meet)
what are Golgi tendon organs sensitive to?
- changes in muscular tension
- the rate of tension change
what does the Golgi tendon organ do when a muscle is excited?
it causes the muscle to relax, which prevents the muscle from being placed under excessive stress, which could result in injury
what does prolonged Golgi tendon organ stimulation provide?
-an inhibitory action (called autogenic inhibition) to muscle spindles (located within the same muscle)
what does holding a stretch do?
- creates tension in the muscle
- this tension stimulates the Golgi tendon organ, which overrides muscle spindle activity in the muscle being stretched, causing relaxation in the overactive muscle and allowing for optimal lengthening of the tissue
how long should a stretch be held?
long enough for the Golgi tendon organ to override the signal from the muscle spindle (approximately 30 seconds)
reasons for flexibility training
- correcting muscle imbalances
- increasing joint range of motion
- decreasing the excessive tension of muscles
- relieving joint stress
- improving the extensibility of the musculotendinous junction
- maintaining the normal functional length of all muscles
- improving neuromuscular efficiency
- improving function
what are muscular imbalances often caused by?
muscle imbalances
examples of pattern overload
- baseball pitching
- long-distance running
- cycling
- training the same gym routine repetitively
- a repetitive occupation lifting and loading packages all day
- sitting for long periods of time while working on a computer
what do poor posture and repetitive movements result in?
- dysfunction within the connective tissues of the body
- this dysfunction is treated by the body as an injury, and as a result, the body will initiate a repair process termed the cumulative injury cycle
cumulative injury cycle
tissue trauma > inflammation > muscle spasm > adhesions > altered neuromuscular control > muscle imbalance
what does trauma to the tissue of the body create?
inflammation
how does the body respond to inflammation?
it activates the body’s pain receptors and initiates a protective mechanism, increasing muscle tension or causing muscle spasm
what happens as a result of heightened activity of muscle spindles?
a microspasm
what happens as a result of a microspasm?
adhesions (or knots) begin to form in the soft tissue
what do adhesions in the soft tissue form?
a weak, inelastic matrix (inability to stretch) that decreases normal elasticity
what do adhesions in the soft tissue result in?
- altered length-tension relationships
- altered force-couple relationships
- altered arthokinetic dysfunction
what do altered length-tension relationships lead to?
altered reciprocal inhibition
what do altered force-couple relationships lead to?
altered force-couple relationships
what does arthrokinetic dysfunction lead to?
altered joint motion
what happens if these adhesions are left untreated?
they can begin to form permanent structural changes in the soft tissue that is evident by Davis’s law
what is is soft tissue remodeled with?
an inelastic collagen matrix that forms in a random fashion, meaning it usually does not run
what happens to these inelastic connective tissue fibers when the muscle fibers are lengthened?
they act as road blocks, preventing the muscle fibers from moving properly, which creates alterations in normal tissue extensibility and causes relative flexibility
what happens if a muscle is in a constant shortened state?
it will demonstrate poor neuromuscular efficiency, which will affect joint motion and alter movement patterns
what happens when a muscle is consistently short and moves in a pattern different from its intended function?
the newly formed inelastic connective tissue forms along this altered pattern, reducing the ability of the muscle to extend and move in its proper manner
3 phases of flexibility training within the OPT model (integrated flexibility continuum)
- corrective
- active
- functional
what does corrective flexibility include?
- self-myofascial release
- static stretching
what does active flexibility include?
- self-myofascial release
- active-isolated stretching
what does functional flexibility include?
- self-myofascial release
- dynamic stretching
what is corrective flexibility designed to do?
- increase joint ROM
- improve muscle imbalances
- correct altered joint motion
what principle does self-myofascial release use?
autogenic inhibition to cause muscle relaxation
what principle does static stretching use?
autogenic inhibition or reciprocal inhibition to increase muscle length
what phase of the OPT model is corrective flexibility appropriate for?
the stabilization level (phase 1)
what is active flexibility designed to do?
- improve the extensibility of soft tissue
- increase neuromuscular efficiency by using reciprocal inhibition
what does active-isolated stretching allow the agonists and synergist muscles to do?
move a limb through a full range of motion while the functional antagonists are being stretched
what phase of the OPT model is active flexibility appropriate for?
the strength level (phases 2, 3, and 4)
what does dynamic stretching require?
integrated, multiplanar soft tissue extensibility, with optimal neuromuscular control, through the full range of motion, or essentially movement without compensations
what should the client do if they are compensating when performing dynamic stretches during training?
regress to active or corrective flexibility
what phase of the OPT model is functional flexibility appropriate for?
the power level (phase 5) or before athletic competition
functional movements occur in which plane of motion?
all 3
which plane of motion do injuries most often occur in?
the transverse plane
true or false: exercises that have high levels of neuromuscular demand are preferred
TRUE
what is self-myofascial release used for?
- corrective existing muscle imbalances
- reducing trigger points (knots within a muscle_
- inhibiting overactive musculature
when should self-myofascial release be used?
before or after exercise
what is static stretching used for?
- correcting existing muscle imbalances
- lengthening overactive (tight) musculature
when should static stretching be used?
before or after exercise
what is active stretching used for?
-increasing the extensibility of soft tissues through reciprocal inhibition
what is dynamic or functional stretching used for?
-increasing flexibility with optimal neuromuscular control
when should dynamic stretching be used?
once clients have demonstrated adequate control over motions to prevent injury
true or false: flexibility training is progressive
TRUE
self-myofascial release
a stretching technique that focuses on the neural system and fascial system in the body (or the fibrous tissue that surrounds and separates muscle tissue)
what happens when you apply gentle force to an adhesion or “knot”?
the elastic fiber muscles altered from a bundled position (which causes the adhesion) into a straighter alignment with the direction of the muscle or fascia
what does the gentle pressure applied during SMR result in?
stimulation of the Golgi tendon organ, which creates autogenic inhibition, decreasing muscle spindle excitation and releasing the hypertonicity (tension) of the underlying musculature
requirements for SMR
- find a tender spot (which indicates the presence of muscle hypertonicity)
- sustain pressure on that spot for a minimum of 30 seconds
what triggers the autogenic inhibition response during SMR?
- increase in the Golgi tendon organ activity
- decrease in the muscle spindle activity
should you perform self-myofascial release before or after stretching? why?
before, because breaking up fascial adhesions (knots) may potentially improve the tissue’s ability to lengthen through stretching techniques
how does SMR help restore the body back to its optimal level of function?
by resetting the proprioceptive mechanisms of the soft tissue
static stretching combines ___ force with ___ duration
low, longer
what happens when you hold the muscle in a stretched position for a prolonged period?
- the Golgi tendon organ is stimulated and produces an inhibitory effect on the muscle spindle (autogenic inhibition)
- this allows the muscle to relax and provides for better elongation of the muscle
contracting the antagonistic musculature while holding a static stretch can what?
reciprocally inhibit the muscle being stretched, allowing it to relax and enhancing the stretch
static stretching should be used to ___ the muscle spindle activity of a tight muscle before and after activity
decrease
static stretch - mechanisms of action
autogenic inhibition or reciprocal inhibition (depending on how the stretch is performed)
static stretch - acute variables
- 1-3 sets
- hold each stretch 30 seconds
static stretch - examples
- gastrocnemius stretch
- kneeling hip flexor stretch
- standing adductor stretch
- pectoral wall stretch
what does active-isolated stretching result in?
increased motoneuron excitability, creating reciprocal inhibition of the muscle being stretched
when should you perform active-isolated stretches?
as a preactivity warm-up, as long as no postural distortion patterns are present
when should active-isolated stretching be performed if an individual possesses muscle imbalances?
after SMR and static stretching for muscles determined as tight or overactive during the assessment process
active-isolated stretch - mechanism of action
reciprocal inhibition
active-isolated stretch - acute variables
1-2 sets, hold each stretch 1-2 seconds for 5-10 repetitions
active-isolated stretch - examples
- active supine biceps femoris stretch
- active kneeling quadriceps stretch
- active standing adductor stretch
- active pectoral wall stretch
dynamic stretch - mechanism of action
reciprocal inhibition
dynamic stretch - acute variables
1-2 sets, 10-15 repetitions, 3-10 exercises
dynamic stretch - examples
- prisoner squats
- multiplanar lunges
- single-leg squat touchdowns
- tube walking
- medicine ball lift and chop
examples of controversial stretches
- inverted hurdler’s stretch
- plow
- shoulder stand
- straight leg toe touch
- arching quadriceps
inverted hurdler’s stretch
- believed to place high stress on the inside of the knee
- may cause pain and stress on the kneecap
- should not be performed by anyone with a history of knee or low-back pain
plow
- common posture from yoga (inverted)
- placed high stress on the neck and spine
- may place the spine at risk of injury if not performed correctly
- should not be performed by anyone with a history of neck or back injury, or individuals with high blood pressure
shoulder stand
- common posture from yoga (inverted)
- places high stress on the neck, shoulders, and spine
- should be avoided in patients with hypertension or any history of neck or spine injury
straight-leg toe touch
- one of the most common stretches for the hamstring complex
- may place the vertebrae and the cartilage discs in the low back under high stress
- should not be performed by anyone with a history of herniated discs or nerve pain that runs in the back
- clients with poor flexibility may attempt to hyperextend the knees during this stretch, which may place high stress on the ligaments of the knee
arching quadriceps
- designed to stretch the quadriceps and hip flexors
- places high stretch on the kneecap and the other tissues on the front of the knee joint
- any client with a history of knee injury should avoid this stretch
why would anyone perform controversial stretches if they are dangerous?
- some of these positions are required in certain sports or activities
- others are traditional positions used in martial arts, gymnastics, or yoga
anterior view checkpoints
- feet
2. knees
lateral view checkpoints
- LPHC
2. upper body
feet turn out - overactive muscles
- soleus
- lateral gastrocnemius
- biceps femoris (short head)
feet turn out - underactive muscles
- medial gastrocnemius
- medial hamstring complex
- gracilis
- sartorius
- popliteus
feet turn out - sample SMR and static stretch techniques
- SMR: gastrocnemius/soleus
- SMR: biceps femoris (short head)
- static gastrocnemius stretch
- static supine biceps femoris stretch
feet turn out - sample strengthening exercises
single-leg balance reach
knees move inward - overactive muscles
- adductor complex
- biceps femoris (short head)
- tensor fascia latae
- vastus lateralis
knees move inward - underactive muscles
- gluteus medius/maximus
- vastus medialis oblique (VMO)
knees move inward - sample SMR and static stretch techniques
- SMR: adductors
- SMR: TFL/IT band
- static supine biceps femoris stretch
- static standing TFL stretch
knees move inward - sample strengthening exercises
tube walking: side to side
excessive forward lean - overactive muscles
- soleus
- gastrocnemius
- hip flexor complex (TFL, rectus femoris, psoas)
- abdominal complex (rectus abdominis, external obliques)
excessive forward lean - underactive muscles
- anterior tibialis
- gluteus maximus
- erector spinae
excessive forward lean - sample SMR and static stretch techniques
- SMR: gastrocnemius / soleus
- SMR: quadriceps
- static gastrocnemius stretch
- static kneeling hip flexor stretch
excessive forward lean - sample strength exercises
- quadruped arm / opposite leg raise
- ball wall squats
low back arches - overactive muscles
- hip flexor complex (TFL, rectus femoris, psoas)
- erector spinae
- latissimus dorsi
low back arches - underactive muscles
- gluteus maximus
- hamstring complex
- intrinsic core stabilizers (transverse abdominis, multifidus, transversospinalis, internal oblique, pelvic-floor muscles)
low back arches - sample SMR and static stretch techniques
- SMR: quadriceps
- SMR: latissimus dorsi
- static kneeling hip flexor stretch
- static latissimus dorsi ball stretch
low back arches - sample strengthening exercises
- quadruped arm / opposite leg raise
- ball wall squats
arms fall forward - overactive muscles
- latissimus dorsi
- teres major
- pectoralis major/minor
arms fall forward - underactive muscles
- mid/lower trapezius
- rhomboids
- rotator cuff (supraspinatus, infraspinatus, teres minor, subscapularis)
arms fall forward - sample SMR and static stretch techniques
- SMR: thoracic spine
- SMR: latissimus dorsi
- static latissimus dorsi ball stretch
- static pectoral wall stretch
arms fall forward - sample strengthening exercises
squat to row
shoulders elevate (push/pulling assessment) - overactive muscles
- upper trapezius
- sternocleidomastoid
- levator scapulae
shoulders elevate (push/pulling assessment) - underactive muscles
-mid/lower trapezius
shoulders elevate (push/pulling assessment) - SMR and static stretch techniques
- SMR: upper trapezius (Thera Cane)
- static stretch upper trapezius / scalene stretch
shoulders elevate (push/pulling assessment) - sample strengthening exercises
-ball cobra
head protrudes forward (pushing/pulling assessment) - overactive muscle
- upper trapezius
- sternocleidomastoid
- levator scapulae
head protrudes forward (pushing/pulling assessment) - underactive muscles
-deep cervical flexors
head protrudes forward (pushing/pulling assessment) - SMR and static stretch techniques
- SMR: upper trapezius (Thera Cane)
- static stretch upper trapezius / scalene stretch
head protrudes forward (pushing/pulling assessment) - sample strengthening exercises
-chin tuck (keep head in neutral position during all exercises)
