Sunday/10/14/2012

Readings:

Flexibility, Static and Dynamic Stretching, and Warm-Up

NSCA text: Chapter 12 pp 251 260, 266274 Course web site:

Supplemental optional reading articles on course web site discussed and cited in lecture notes

Flexibility, Static and Dynamic Stretching and Warm-Up

Flexibility, Static and Dynamic Stretching and Warm-Up

Introduction
Flexibility, Stretching and Warm-Up are all interrelated, and opinions vary on their relationships, proper applications and effects Understanding these topics can help you design effective Stretching and Warm-Up based on your clients needs

Flexibility
Flexibility is a measure of range of motion (ROM) about a joint (or series of joints, e.g. spine) Goal in flexibility is:
The ability to move a joint freely through the normal, and necessary, ROM

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Flexibility
Static flexibility is the range of possible movement (ROM) about a joint during a passive movement Dynamic flexibility is the available ROM during active movements and therefore requires voluntary muscular actions to produce the movement through the ROM
Dynamic flexibility may be less than static for the same joint movement direction. Example of this?

Benefits of an Appropriate Level of Flexibility

Efficient movements of joints though the desired and normal ROM for a task
w/o this, tissues associated with the joint in question, or a nearby one, may be at increased risk of injury (acute or chronic)
E.g. you do not have the shoulder ROM to reach over your head, every time you do you strain extended shoulder tissue E.g., because your hip is not flexible enough to move though the needed ROM for the squatting motion, the lumbar spine flexes, and strains lumbar tissues
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Flexibility, Static and Dynamic Stretching and Warm-Up

Benefits of an Appropriate Level of Flexibility

Therefore
Optimal levels of flexibility exist for each activity Injury risk may increase outside this range
For ROM too low (above examples)

Benefits of an Appropriate Level of Flexibility

For ROM too great
Injury risk may increase, or efficiency may decrease, due to decreased joint stability
E,g, see website article Stretching Before Exercise:

AND

For ROM too great (next)

Increased flexibility is important for some sports such as ballet, gymnastics and swimming, but it may decrease running economy and may be inappropriate for line play in American football and for certain other sports where joint stability is critical.
Runners with less flexibility are actually more efficient at running (Jones 2002 Running economy is negatively related to sit-and-reach test
performance in international-standard distance runners. Int J Sports Med. 23(1):40-3)

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Benefits of an Appropriate Level of Flexibility

McGill text pg 13 3rd ed. Loose joints without precisely controlled strength are unstable. This decreases performance and increases risk of subsequent injury. Do all athletes need stretching? Some do and some dont. Rather than simply stretching stretching to correct asymmetry has a foundation
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Benefits of an Appropriate Level of Flexibility

Lesson to learn

Dont just assume everybody should stretch to increase ROM of many joints as part of an fitness or sports training program!
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Factors Affecting Flexibility

Joint Structure
Elbow versus hip

Factors Affecting Flexibility

Connective Tissue = MAJOR STRUCTURE LIMITING ROM
Ligaments, tendons, joint capsule, connective tissue within muscle Elasticity of connective tissues affect ROM (continued)

Age and Sex

Decreases from childhood onward Females tend to be more flexible than males (esp. trunk, hips, ankles) (continued)

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Factors Affecting Flexibility

Temperature
Increased temp, increased ROM (hence warm-up)

Warm-Up
Warm up is an activity that raises total body temperature, including muscles, to prepare the body for exercise Warm up is not just static stretching

Activity Level
An inactive person tends to be less flexible than an active one, due to:
Limited ROM with inactivity leads to less pliable connective tissue Increased fat may restrict ROM

Muscle Bulk
Extremely large muscles may impede joint movement E.g. huge pects or biceps
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Warm-Up Benefits
Lowered viscous resistance in muscles (to enhance ROM) Improved oxygen delivery due to the Bohr effect (higher temperatures facilitate oxygen release from hemoglobin and myoglobin) Increased blood flow to active muscles Enhanced metabolic reactions

Types of Warm-Up
Passive: e.g. warm pads on muscles
Saves energy, but no CV system activation, not always practical

General (active): gross motor activities (e.g., jog, cycle) Specific (active): movements that are part of the subsequent activity (e.g., jog before running,
move arms before upper body weight lifting)
Dynamic stretching (discussed more later) is an example of specific active warm-up

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Warm-Up Guidelines
A general warm-up period may consist of 5 to 10 minutes of slow activity A specific warm-up period may involve 8 to 12 minutes of dynamic stretching Increasing intensity and/or duration as fitness increases

Types of Flexibility Training

Ballistic: rapid, jerky, bouncing
Stretches muscles to maximum ROM rapidly DO NOT DO THIS DUE TO INJURY RISK!

Static Dynamic Proprioceptive Neuromuscular Facilitation (PNF)

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Static Stretching (hows..)

Relax and lengthen target muscle to max ROM = point of minor discomfort Hold for 15 - 30 secs (longer not more effective) Source also: website article Stretching Before Exercise Static stretches to do, see:
NSCA text examples (2 follow) Web site articles:
ACSM basic stretching program Lower extremity stretching for endurance runners Static streching/flexibility (James Madison University)
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Static Stretching (hows..)

Step Stretch

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Static Stretching (hows..)

Side Bend With Bent Arm

Dynamic Stretching (hows..)

Allows fast movement Involves movement & ROM specific to sport or activity to follow

Does not bounce of end of ROM

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Dynamic Stretching (hows..)

May be quantified in time, reps, yards, steps, as appropriate to task Amount to do?
Up to 12 minutes, or more, depending on fitness of individual and intensity of task to follow

Dynamic Stretching (hows..)

Dynamic stretches examples (many different
examples and preferences of trainers and client/athletes):

NSCA text examples (a few follow) Web site articles:

Dynamic stretching/flexibility (James Madison University) Eight Mobility Drills Everybody Should Do (Micheal Boyle) Dynamic Stretching Exercises (brainmac) Core flexibility

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Dynamic Stretching (hows..)

Lunge Walk

Dynamic Stretching (hows..)

Lunge With Twist

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WHEN to include Dynamic Stretching, Static Stretching & Warm-Up into exercise program
Opinions Vary..

WHEN to include Dynamic Stretching, Static Stretching & Warm-Up into exercise program

NSCA text:
Static stretching before dynamic activity may decrease performance (pg 274)
also see article brief on website: Stretching before

sprinting concluding performing passive stretching exercises before sprinting activities can result in a significant decline in sprinting speed. also see website article Stretching Before Exercise stating[Static] stretching just before exercise may cause temporary strength deficits.

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WHEN to include Dynamic Stretching, Static Stretching & Warm-Up into exercise program

WHEN to include Dynamic Stretching, Static Stretching & Warm-Up into exercise program

Accordingly Static stretching BEFORE exercise, as part of warm-up, is not recommended, by many sources
article on website Static streching/flexibility (James Madison University) stating : Flexibility Development (not to be used as a warm-up) a stretching protocol should be included in the training program. The ideal timing in which to include this stretching protocol is subsequent to the training session
http://www.brianmac.co.uk/stretchpaper.htm

Accordingly Static stretching BEFORE exercise, as part of warm-up, is not recommended, by many sources
Strength and Power Hour podcast 09-05-24, Dr. Kramer and host views. 545

Strength and Power Hour podcast 09-05-24, Dr. C Denegar, PhD, PT, ATC view. 141

NSCA Essentials of Strength and Conditioning Text (pg 297, 3rd ed) the use of static stretching in warm-up needs to be questioned.
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WHEN to do Static Stretching?

Following practice and competition
Post practice stretching facilitates ROM improvements because of increased muscle temperature.

BUT Doesnt Static Stretching Before Exercise Prevent Injury?

NSCA text:
Static stretching before dynamic activity has not been demonstrated to prevent injuries (pg 275)
also see article on website: Stretching Before

As a separate session
In this case, stretching should be preceded by a thorough warm-up to allow for the increase in muscle temperature necessary for effective stretching. This type of session can be especially useful as a recovery session.

Exercise - Core Performance stating there is little scientific evidence that such [static stretching] routines can improve exercise performance, reduce delayed onset muscle soreness, or prevent injuries.

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BUT Doesnt Static Stretching Before Exercise Prevent Injury?

Shrier I. Stretching before exercise does not reduce the risk of local muscle injury: a critical review of the clinical and basic science literature. Clin J Sport Med. 1999 Oct;9(4):221-7. The basic science literature supports the epidemiologic evidence that stretching before exercise does not reduce the risk of injury. Small K et al., A systematic review into the efficacy of static stretching as part of a warm-up for the prevention of exercise-related injury. Res Sports Med. 2008;16(3):213-31. There is moderate to strong evidence that routine application of static stretching does not reduce overall injury rates. There is preliminary evidence, however, that static stretching may reduce musculotendinous injuries.

So what does a warm-up consist of?

NSCA text: A general warm-up period may consist of 5 to 10 minutes of slow activity (e.g., jog, cycle) A specific warm-up period may involve 8 to 12 minutes of dynamic stretching Increasing intensity and/or duration as fitness increases

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So what does a warm-up consist of?

www.brianmac.co.uk/warmup 5 to 10 minutes of jogging 10 to 15 minutes of dynamic stretching 10 to 15 minutes of general and event specific drills
E.g., for runner:
Lower leg drills Leg drills Technique drills

So what does a warm-up consist of?

McGill text (pg 45) Overall characteristics: prepare but not tire, 10 15 min routine, General Preparation: easy walking, progressing to jogging and calisthenic exercise Specific Preparation: ROM exercises may enhance active flexibility and may or may not include specific stretches.
E.g., jumper & running performers progress to acceleration runs, lifters elicit potentiation by lifting unloaded bar and progress to some heavy exertions
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BUT some experts do include static stretching as part of a warm-up

The Static Stretching Renaissance, Michael Boyle
(on course web site)

BUT some experts do include static stretching as part of a warm-up

The Truth About Stretching
Source: http://www.thestretchinghandbook.com/archives/stretchingtruth.php (This .com source recommended in NSCA Strength and Conditioning Text)

5 min foam rolling (like a massage) Static stretching (muscle is stretched cold, stretch all areas) Dynamic warm-up

Dynamic stretching preferred before competition Static stretching can be used as part of training warm-up, may slow down athletes for an hour The best way to increase flexibility is to static stretch with 30 sec holds performed away from events requiring peak performance

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BUT some experts do include static stretching as part of a warm-up

McGill text Should stretching be incorporated into a warm-up routine? Not always. (pg 13)
= sometimes yes, sometimes no

Proprioceptive Neuromuscular Facilitation (PNF) Stretching. What is it?

Proprioceptive neuromuscular facilitation is a technique developed several decades ago by physical therapists to FACILITATE the contraction of muscles
E.g., contracting the shoulder and chest muscles can facilitate a stronger contraction of hip or knee extensors in a patient having difficulty activating the leg muscles
Many other patterns of muscle contraction facilitation techniques exist in the rehabilitation PNF literature today

Muscle warm-up is necessary, but rarely includes deliberate stretching, particularly when dealing with the back (pg 45)

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PNF Stretching. What is it?

People in the EXERCISE world adapted the technique, and borrowed the name, to develop PNF STRETCHING

PNF Stretching. What is it?

Some studies find PNF stretching techniques to produce greater short term (acute) and long term (chronic) increases in joint ROM compared to static stretching,
Sady SP, et al. Flexibility training: ballistic, static or proprioceptive neuromuscular facilitation? Arch Phys Med Rehabil 1982;63(6):261-263 Wallin D, et al. Improvement of muscle flexibility. A comparison between two techniques. The American journal of sports medicine 1985;13(4):263-268

Contracting a muscle to facilitate a greater stretch Requires a partner trained in PNF procedures

and others do not

Decoster LC, et al. The effects of hamstring stretching on range of motion: a systematic literature review. J Orthop Sports Phys Ther 2005;35(6):377-387. Marek SM, et al. Acute Effects of Static and Proprioceptive Neuromuscular Facilitation Stretching on Muscle Strength and Power Output. J Athl Train 2005;40(2):94-103.

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PNF Stretching. How does it work?

PNF stretching is typically explained as invoking the Golgi tendon organ &/or spindle stretch reflexes to induce muscle relaxation, producing greater ROM
BUT a reflex role for producing muscle relaxation in PNF stretching has been demonstrated to be an incorrect concept
Chalmers G. Re-examination of the possible role of Golgi tendon organ and muscle spindle reflexes in proprioceptive neuromuscular facilitation muscle stretching. Sports biomechanics / International Society of Biomechanics in Sports 2004;3(1):159-183

PNF Stretching. How to do it?

Various procedures
with different names possible for the same or similar procedures, depending on what source you are reading

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PNF Stretching. How to do it?

Target muscle contract procedure (e.g., for Hamstrings)
1. 2. 3.

PNF Stretching. How to do it?

Opposing muscle contract procedure (e.g., for Hamstrings)
1. 2. 3. 4.

4. 5.

Subject relaxes and partner stretches target muscle to full ROM Hold position 10 secs Strong isometric contraction of target muscle against fixed resistance (i.e., partner) (or shortening contraction of target muscle against high resistance) Relaxation of target muscle Partner attempts to push target muscle to greater length, and joint to greater ROM

Subject relaxes and partner stretches target muscle to full ROM Hold position 10 secs Strong contraction of ANTAGONIST to target muscle Relaxation of ANTAGONIST muscle (this step does not exist in some
variations of the this technique)

5.

Partner attempts to push target muscle to greater length, and joint to greater ROM

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PNF Stretching. When to do it?

NSCA personal training text says:
PNF stretching can be dangerous. WHY?
Requires a skilled stretching partner

Assisted Stretching. What is it?

A stretch performed by a subject alone until a limit is reached, at which point a partner assists to gain a further stretch. This type of stretching should be performed with care. The partner must be competent and well trained, and must have established good communication and trust with the subject to prevent overstretching

Takes more time, than static stretching Is not always superior for producing ROM increases, compared to static stretching Personal training clients can usually develop the ROM needed for their activities by static stretching PNF methods have limited application in personal training settings

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Conclusion
Flexibility, Stretching and Warm-Up are all interrelated, and opinions vary on their relationships, proper applications and effects Understanding these topics can help you design effective Stretching and Warm-Up based on your clients needs

Conclusion
Who needs to do static stretching to increase joint ROM?

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Conclusion
Who is likely to need to do static stretching to increase joint ROM?

Conclusion
When should a person do static stretching to increase joint ROM?

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