Stretching Into the 21st Century: Part Two

Developing specific flexibility programs that fit your classes or personal training clientele.

Flexibility is one of the five health-related components of physical fitness (along with muscular strength and endurance, cardiorespiratory endurance and body composition). Some of our most common orthopedic injuries can be partially attributed to poor flexibility. Approximately 80% of the U.S. population will experience back pain sometime in their lifetime. In the workplace, back injuries are the number one problem, and overuse injuries in the upper extremities such as carpal tunnel syndrome are number two. Among athletes, common complaints include back pain, leg pain and various shoulder problems. In all of these situations, too much or too little flexibility can contribute to poor body mechanics which increase the risk of injury.

Ignoring the flexibility component of fitness is like not maintaining your car but continuing to regularly drive it. Over time, the chances of your car having problems will increase. It could be as simple as being unable to start your car or getting a flat tire. It could be as bad as having a serious accident because your brakes don't work. If you don't maintain your body by including all five health-related components in your fitness program, your likelihood of having health problems is greatly increased as you get older.

In reality, most people have some areas of hypomobility (decreased flexibility) and hypermobility (flexibility that is beyond normal). Lack of flexibility means your muscles may work harder to perform an activity, you may be substituting one movement for another or performing movement with poor body mechanics. As an example, if you have tight hip flexors, when you walk your hip extensors have to work harder to propel your body forward. This is most obvious in the last phase of walking when you push off with the back leg. It is not uncommon for people with tight hip flexors to substitute hip extension with lumbar hyperextension while pushing off with the back leg. Additionally, tight hip flexors can also lead to increased internal rotation of the hip during activities that use the legs. The increased internal rotation can compromise the body mechanics of any of the joints in the lower body including the hips, knees, ankles and feet.

Conversely, it is also possible to be too flexible. Injuries are more likely to occur when you do not have the strength and endurance to protect your joints throughout their available range of motion (ROM). A joint that has more ROM than expected is called a hypermobile joint. There are many sports, such as gymnastics, swimming and pitching, in which increased flexibility can create some mechanical advantages. Flexibility coupled with strength in the upper body can help athletes excel in all of these sports. However, due to the nature of the activities, upper body overuse injuries can also be found. In the case of an overuse injury, there is often a lack of functional flexibility.

Flexibility looks at the ROM available in a joint. Functional flexibility means you can use this ROM correctly when you need it. In other words, it means having the correct combination of flexibility, strength, endurance and coordination to perform everyday activities with proper body mechanics. For example, if someone cannot reach overhead, and you only work on increasing their shoulder flexibility, then you haven't worked on all the components of functional flexibility. Everyday activities that usually require reaching overhead include combing your hair, hanging clothes in a closet and getting a cup out of an overhead cabinet. Most people have the flexibility to reach overhead with both arms. However, most of us do not have the functional flexibility to easily comb our hair, hang our clothes in the closet or get a cup out of an overhead cabinet with our non-dominant arm. This is because most people never practice these activities with their nondominant arm.

The ideal flexibility program includes more than the static stretches typically found in most warm-ups and cooldowns, although they are still important to make sure a person has the necessary ROM available to do their activities. Some form of dynamic stretching generally helps address the combination of flexibility, strength, endurance and coordination. As an example, someone with tight hip flexors will benefit from doing static stretches that isolate the iliopsoas and rectus femoris. For functional flexibility, they could work on getting full hip extension while doing various aerobic activities like walking, running or taking step classes.

Before starting clients on a functional flexibility program, assess their available ROM in a static position. Use static stretches to help any areas of inflexibility. Once clients have the ROM in a static position, you'll figure out how to incorporate the use of it through dynamic stretching activities.

Screening for Flexibility

Following are some basic screening tools for common areas of inflexibility. Test both sides of the body. Even with the spine, it is possible for the muscles on one side to be tighter than on the other side. Because we are testing functional flexibility rather than maximal flexibility, it is not necessary for the client to warm up before these screenings. The client should demonstrate his or her pain-free range. Any range that is uncomfortable or requires an extensive warm-up will probably not be used in normal circumstances and therefore isn't usually a functional ROM for everyday activities.