Unit 1 - Anatomy and physiology for heath and exercise - Flexibility and stretching

Question 1

Name 3 definitions that can be used when referring to flexibility.

Answer 1

• a measure of the range of motion (ROM) available at a joint or a group of joints
• the ability to move the joints in the needed range of motion demanded by the sport
• the ability to readily adapt to changes in position or alignment; may be expressed as normal, limited, or excessive

Question 2

Name 10 benefits of flexibility.

Answer 2

• increased range of motion
• reduced muscle tension and increased physical and mental relaxation
• reduced risk of joint sprains or muscle strains
• reduced risk of back problems
• decreased muscular soreness (DOMs) associated with other exercise activities
• decreased muscle viscosity, causing contractions to be easier and smoother
• improved coordination by allowing for greater ease of movement
• improvement and development of body awareness
• improved capability for circulation and air exchange
• improvements in posture

Question 3

How does flexibility work bring for interaction between the client and the trainer?

Answer 3

Those forms of passive stretching that rely on the personal trainer directing, and physically moving the client into stretch positions, demand a great deal of the trainer’s communication and general client care skills.

This, therefore, is an opportunity to win client confidence and to demonstrate skills.

Question 4

What factors affect flexibility?

Answer 4

• Age: Young people are normally more flexible than older people. As we get older, muscle contractility remains, whilst elasticity is lost, resulting in tighter, stiffer muscles.
• Gender: Studies have shown females to be more flexible than males in most joints and to remain so throughout adult life. Reasons may be attributed to the structural or anatomical differences or different activities and training experiences of boys and girls early in life.Small levels of relaxin are constantly present, and will fluctuate slightly throughout a normal menstrual cycle
• Temperature: An increase in temperature due to either direct heat or the weather can increase the range of motion and elasticity of muscle and tendons. Conversely, a decrease in temperature can result in a decrease in flexibility of as much as 20%
• Exercise and resistance training: Active people tend to be more flexible than those with a sedentary lifestyle.
• Heredity: Flexibility can be an inherited characteristic. Some people are born with naturally excessive ROM. This can create a greater potential for injury (e.g. joint dislocation) and it may be necessary to concentrate on strengthening the muscles acting over the joint in order to increase stability
• Fashion: Female clients who constantly wear high heels may find that the muscles of the lower limb (gastrocnemius, soleus, peroneals) adaptively shorten over a period of time

Question 5

Because of what to the muscle spindles and Golgi tendon organs (GTOs) have an influence on flexibility and stretching?

Answer 5

Because of the reflex actions that they stimulate.

Question 6

Where are muscle spindles located and what is their main function?

Answer 6

Muscle spindles are located within muscle fibres and their main function is to send messages back from the muscle to the central nervous system to inform about its state of stretch.

If the muscle is stretched, distortion of the muscle spindle causes the myotatic reflex (automatic contraction) to come into play, thus avoiding damage through over-stretching.

This muscle spindle activation (muscle contraction) is felt as the tension of the stretch.

Question 7

What happens when the stretch is faster and more forceful?

Answer 7

The amount and rate of contraction elicited from the stretch reflex are proportional to the amount and rate of stretching.

Hence, the faster and more forceful the stretch, the faster and more forceful the reflex contraction of the stretched muscle; therefore, the greater the likelihood of the muscle tearing

Question 8

What are GTO’s and where are they located?

Answer 8

GTOs are sensory nerves located near the musculotendinous junction.

Question 9

How are GTOs activated?

Answer 9

They are activated by a contraction in a muscle and help prevent excessive tension occurring within the muscle, or the tendon of that muscle.

Question 10

What is the inverse stretch reflex?

Answer 10

In contrast to the muscle spindles, stimulation of the GTOs will cause a reflex relaxation of that muscle (the inverse stretch reflex).

This resulting relaxation is important for certain stretches because the inhibition of the muscle in which they are located will allow muscle fibres to lengthen and stretch further.

Question 11

What is autogenic inhibition and how is it achieved?

Answer 11

The relaxation that occurs in the same muscle because of GTO activation is called autogenic inhibition.

This is achieved by contracting a muscle immediately before passively stretching it.

The contraction will increase GTO activation, thus increasing the subsequent muscle relaxation during the stretch.

Reciprocal inhibition is the relaxing effect that occurs in a muscle when the antagonist is contracting. This occurs to allow an easier contraction of the antagonist.

Hence, contracting the antagonistic muscle will allow for a greater stretch in the muscle being elongated

Question 12

Name several methods of stretching muscles with examples.

Answer 12

• Active stretching → Static, Dynamic, Ballistic → Standing chest stretch, Leg swings, Toe touches
• Passive stretching → Static, PNF → Wall chest stretch, Supine partner hamstring stretch

Question 13

How is active stretching accomplished?

Answer 13

Active stretching is accomplished using antagonist muscles and without assistance from an external force or object.

It involves actively contracting one muscle or muscle group in order to stretch its opposing muscle group.

For example, pectorals actively contract to stretch posterior deltoids and tibialis anterior actively contracts to stretch gastrocnemius.

Question 14

Why is active stretching important for athletes?

Answer 14

This type of stretching is very important for athletes because it is an essential aspect of dynamic flexibility and thus has a greater correlation with sports performance than passive stretching.

Question 15

How is passive stretching done?

Answer 15

This is where another body part or external factors, such as a wall or a partner, is used to facilitate the stretch.

For example, a lying hamstring stretch where the hands are held behind the thigh or on the calf.

It increases joint range and muscle length.

Question 16

How can a trainer assist in a passive stretch and what are the precautions?

Answer 16

A trainer partner can assist by gently pressing parts of the subject’s body through the full range.

Great care and communication are required between partners using this method and so it is not recommended for beginners.

Applying the external force incorrectly, excessively or too quickly may cause the stretch reflex to initiate, perhaps causing injury.

However, it can be beneficial if the agonist is too weak and will provide a greater ROM than active stretching

Question 17

Name 4 different types of stretches.

Answer 17

• Ballistic: involves quick, repetitive bouncing or bobbing actions. It is undertaken in order to increase the stretch beyond the muscle’s normal range using momentum and body weight
• Dynamic: This is similar to ballistic stretching, however, the limb movements do not end with bouncing or jerky movements, but instead, are performed under control. These stretches should mimic the movements of the following sport or activity and act as a kind of rehearsal → perform 10-15 repetitions of each stretch under control, gradually increasing the ROM
• Static maintenance: is where the muscle is taken to the end of its normal range and held without bouncing. These are short stretches, held for 10-15 seconds and are used to maintain the normal length of the muscle
• Static developmental: These stretches are used in flexibility training to develop the length of the fibres themselves, thereby increasing range of movement at a joint

Question 18

What are the guidelines for static developmental stretches?

Answer 18

• take the stretch to the ‘point of bind’, maintaining good alignment and posture
• hold for 10 or more seconds, until the tension within the muscle has reduced
• relax and passively increase the ROM of the stretch until tension is felt again
• again hold for 10 or more seconds, until the tension within the muscle has reduced
• again increase the ROM of the stretch until tension is felt again
• hold until the tension reduces, then slowly return the limb to its normal position
• repeat the stretch if desired

Question 19

What is Muscle energy techniques (METs)?

Answer 19

MET is a form of passive stretching from the world of osteopathic technique. It targets the soft tissues primarily, although it also makes a major contribution towards joint mobilisation.

Question 20

Where did the Muscle Energy technique evolve from?

Answer 20

The technique itself evolved from the rehabilitative technique known as proprioceptive neuromuscular facilitation (PNF), developed by Herman Kabat in the late 1940s and early 1950s.

Question 21

What type of contraction is used in the muscle energy technique?

Answer 21

Like PNF techniques, MET commonly uses an isometric contraction of the target muscle before the stretch is applied.

MET, unlike PNF (which uses near-maximal muscle contractions), uses only minimal force during the isometric phase.

The stretching phase is generally, though not always, done passively.

Question 22

What is perhaps the main form in which MET is applied?

Answer 22

post isometric relaxation (PIR)

Question 23

Give the example of a hamstring stretch, utilising PIR.

Answer 23

• under the trainer’s instruction the client should adopt a comfortable and manageable position
• the trainer explains to the client what is to be done and how the technique is to be carried out
• the trainer lifts the leg into hip flexion and takes the passive stretch to the point of bind, maintaining good alignment and posture throughout
• the trainer holds the limb at the point of bind for 10 or more seconds, until the tension within the muscle has reduced
• the client performs an isometric contraction of 20-30% maximum force and holds this for 6-8 seconds. The trainer should direct the client to begin slowly and progressively build the level of contraction
• the client relaxes (this can be aided by a deep inhalation followed by an exhalation as the stretch is administered) while the trainer passively increases the ROM of the stretch (increase hip flexion) until tension is felt again
• this cycle is repeated 2-3 times, always finishing with a stretch and not a contraction
• the trainer slowly returns the limb to its normal position

Question 24

What happens by isometrically contracting the target muscle against the trainer during a PIR stretch?

Answer 24

The client will activate the GTOs in that muscle and stimulate an autogenic inhibition response. This will create the necessary level of relaxation in that muscle to allow it to be stretched.

Question 25

When are PIR based techniques best applied?

Answer 25

In the post-exercise period.

This will allow the trainer to stretch out the muscles worked during the main session and provides a relaxing ‘wind down’ for the client after their exertions. A good passive stretching session, performed by a competent trainer really embodies the personal, one-to-one nature of personal training.

Question 26

When do apply what type of stretch.

Answer 26

Although always advocated after a warm-up, stretching can be performed at any time of the day, appropriate to the client.

• Warm-up: Static stretching, Dynamic stretching, Ballistic stretching
• Cool-down: Static stretching, Developmental, Muscle energy techniques (METs)

Question 27

Guidelines for flexibility training. (14)

Answer 27

• ensure correct position, posture and alignment prior to and during the stretch
• take the stretch to a point of mild discomfort and do not strain or passively force a joint beyond its normal ROM
• ensure correct breathing patterns are maintained and try to breathe calmly and rhythmically
• exhalation during increases in ROM will aid whole-body relaxation
• closing the eyes, where applicable, may aid relaxation, focus and awareness
• do not force a stretch whilst holding the breath
• do not bounce or spring whilst statically stretching
• wait until the stretch reflex has subsided, and the muscle has ‘relaxed’ before attempting to increase ROM during developmental stretches
• unilateral stretches should be performed on both sides, where required
• emphasise stretching the weight-bearing muscles and in particular, the multi-joint muscles
• stretch towards the end of each workout as a minimal requirement, to prevent any unwanted adaptive shortening. The muscles should be very warm and receptive to extension, thus promoting recovery and relaxation
• stretching in either a sitting or reclining position may aid relaxation for corrective and post-exercise stretching
• concentrate and communicate when working with a partner
• come out of a stretch as carefully as going into it

Question 28

Precautions for flexibility training.

Answer 28

• decrease the stretch intensity or stop if the client experiences any local or radiating pain, or any loss of sensation
• any mild soreness following stretching should last no longer than 24 hours. If the soreness is prolonged, then the stretching was too aggressive
• use extreme caution when stretching any hypermobile joint, and question if developmental stretching is necessary
• avoid excessive or aggressive stretching of recently immobilised tissues (casting). These tissues can become dehydrated and lose tensile strength
• stretch with caution when working with any individuals with known or suspected osteoporosis (loss of bone integrity)

Question 29

Contraindications for flexibility training

Answer 29

• any developmental, excessive, uncontrolled or ballistic stretching should be avoided during pregnancy, due to the softening effects of relaxin
• if the movement is limited by a bony block
• avoid stretching a fracture site for approximately 8-12 weeks post-fracture
• any sharp pain occurring during a stretch
• any uncontrolled muscle cramping occurring during a stretch
• any infected joint or nearby tissue
• any acute inflammation, except for the majority of arthritic clients
• a local haematoma (bruise), resulting from an overstretch injury
• a client suffering from certain vascular or skin diseases

Question 30

Design and perform a cool-down stretching routine using PIR techniques and suitable for use at the end of a general whole-body muscular endurance workout

Answer 30

Example(repeat all 3 times, at the end always return to resting position slowly):

1. upper trapezius PIR (in a seated position, the trainer behind the client, flex neck and turn head in ipsilateral position (trapezius work exactly opposite, giving about neck extension and contralateral rotation). In this position lift the same side shoulder slightly. Tell the client to flex neck back and rotate to contralateral while you hold everything in position, giving you about 20% strengths. Hold for ten seconds, breath in and as the client breathes out, relax and trainer pushes neck a bit further to widen the stretch. Repeat.
2. elevator scapula. Same initial position of client and trainer. As the elevator scapula, as it contracts, causes head extension and ipsilateral rotation, the PIR stretch will be exactly opposite (similar to upper trapezius, but turning the nose aways) - so flexing of the neck and turning the nose to the opposite side. Lift shoulder slightly and tell the client to lift the head back and tilt to the opposite direction, giving about 10-20% force, while trainer holds. Hold for 10 seconds, breath in as the client breathes out, stretch the head further down to the new barrier of resistance.
3. Pectoralis Major: client lies supine, arms stretched out to either side, the trainer presses down until mild stretch is perceived. Hold the stretch, have client take a deep breath and hold it while pushing against the trainer with about 25% force, hold for another 10 seconds, as client breathes out, push arms closer to the mat, until new barrier.
4. Latissimus Dorsi (Lats): client lies on side, trainer takes arm by holding at the humerus and placing arm under theirs, stabilize the pelvis. stretch shoulder in adduction superior until mild stretch in latissimus Doris. Ask the client to contract latissimus dorsi with about 20% force, hold 10 seconds and as the client relaxes, bring about further adduction.
5. Hip flexor stretch. The client lies on back and flexed one knee and places the foot onto the trainer’s chest, leaving other leg and arms relaxed. (It is best to do this on a massage bed, trainer standing at the edge). Here the trainer can see, how much the other leg is elevated of the floor. Now, the trainer will push onto the free knee while client pushes upwards for about 10 seconds, deep breath in and as client breathes out, push knee further down to new barrier of resistance.
6. Hamstrings: the client is lying supine, Lift one leg up from ankle until the client feels a mild stretch. Trainer positions in front, placing leg upon the shoulder and places both hands on distal thigh. the client takes a deep breath in, holds and pushes the leg back into the trainer with about 25% strength. Hold for 10 seconds, as the client breathes out, intense the stretch to the new barrier.
7. Quadriceps: client lies face-down. The trainer takes one leg up by the ankle until client feels mild stretch. Measure the gap with the hand between ankle and glutes. Trainer will hold leg in position while client pushes with about 20-25% strength against the grip. Hold for 10 seconds, when breathing out, relax and push the leg closer to the body to the new barrier of resistance.
8. Gluteus Maximus: client lies supine and takes one knee into their hands and pulls knee in until mild stretch. Trainer places hands on knee and holds position while client pushes against the hands with about 20% strength, holds for 10 seconds and as relaxes, trainer pushes knee closer to body.
9. Piriformis Muscles: supine, one leg up and foot facing to opposite hand until mild stretch. Appy force to brace the position while client pushes the leg outwards. after holding for 10-15 seconds, release and rotate the leg further for the foot to look inwards.