Flexibility DR SAHAR M ADEL Flexibility FLEXBILITY DEFINITION

Flexibility • DR: SAHAR M. ADEL

Flexibility

FLEXBILITY DEFINITION is a joint's ability to move freely through a full and normal range of motion. The capacity to perform movement over a broad range is known as flexibility, or often mobility, and is significant in training. It is a prerequisite to performing skills with high amplitude and increases the ease with which the athlete can perform fast movements.

The success of performing such movements depends on the joint amplitude, or range of motion, which has to be higher than that required by the movement. Thus, there is a need for a flexibility reserve, which the athlete must develop to be on the safe side.

Factors that affect flexibility include Internal influences 1. the type of joint (some joints simply aren't meant to be flexible) 2. the internal resistance within a joint 3. bony structures which limit movement 4. the elasticity of muscle tissue (muscle tissue that is scarred due to a previous injury is not very elastic)

5. the elasticity of tendons and ligaments (ligaments do not stretch much and tendons should not stretch at all) 6. the elasticity of skin (skin actually has some degree of elasticity, but not much) 7. the ability of a muscle to relax and contract to achieve the greatest range of movement 8. the temperature of the joint and associated tissues (joints and muscles offer better flexibility at body temperatures that are 1 to 2 degrees higher than normal)

External influences • the temperature of the place where one is training (a warmer temperature is more conducive to increased flexibility) a movement's amplitude increases following a normal warm up because progressive physical activity intensifies blood irrigation of a muscle, making its fibers more elastic. 2. the time of day (most people are more flexible in the afternoon than in the morning, peaking from about 2: 30 pm 4 pm) 3, the stage in the recovery process of a joint (or muscle) after injury (injured joints and muscles will usually offer a lesser degree of flexibility than healthy ones)

Flexibility varies accordance to the time of day. The highest amplitude of movement seems to be between 10: 00 AM. and 11: 00 AM. , and 4: 00 P. M. and 5: 00 P. M. , and the lowest likely occurs earlier in the morning (figure 13. 1). The explanation lies with the continuous biological changes (CNS and muscle tone) that occur during the day (Ozolin 1971). )

4. age (pre adolescents are generally more flexible than adults) 5. gender (females are generally more flexible than males) Age and sex affect flexibility to the extent that younger individuals, and girls as opposed to boys, seem to be more flexible. Individuals reach maximum flexibility at 15 or 16 years of age (Mitra and Mogos 1980).

6. one's ability to perform a particular exercise (practice makes perfect) 7. one's commitment to achieving flexibility 8. the restrictions of any clothing or equipment

An inadequate development of flexibility, or no flexibility reserve, may lead to various deficiencies, suggested by Pecht (1982) as being the following: • Learning or perfecting various movements is impaired. • The athlete is injury prone. • The development of strength, speed, and coordination are adversely affected. • The qualitative performance of a movement is limited. (When an individual has a flexibility reserve, he or she can perform skills more rapidly, energetically, easily, and expressively. )

The capacity of a muscle fiber to stretch increases as a result of flexibility training. Flexibility is often limited regardless of the amount of training invested if the antagonistic muscles are not relaxed, or if there is a lack of coordination between contraction (agonists) and relaxation (antagonists). It is not surprising, therefore, that individuals with poor coordination, or an inability to relax the antagonistic muscles, may have a low rate of flexibility development.

By the time the athlete performs flexibility movements, the muscle temperature has increased, thus facilitating the muscle fibers to stretch without causing harm. Strength and flexibility are compatible because the first depends on the cross section of the muscle, and the latter depends on how far a muscle can stretch. These are two different mechanisms and, therefore, do not eliminate each other.

Gymnasts who are both strong and flexible are proof of this concept. An incorrect methodology of developing strength or flexibility may lead to questionable results. Consequently, strength training has to be concurrent with flexibility training.

Fatigue and the emotional state affect flexibility performance significantly. A positive emotional state has positive influence on flexibility compared with depressive feelings. Similarly, flexibility is affected by fatigue (Mitra and Mogos 1980), be it a general state of exhaustion or fatigue accumulated toward the end of a training lesson.

The good news is that with training (stretching), degree of flexibility can be increased. Other benefits of stretching include: • Reduces muscle soreness • Reduces the risk of injury • Improves relaxation (both physical and mental) • Reduces stress

Flexibility Training Methods to Develop Flexibility 1. The active method, comprised of a static method and a ballistic method 2. The passive method 3. The combined method, or proprioceptive neuromuscular facilitation (PNF) developed by Kabat in 1958

Active Method The active method is a technique whereby an individual achieves maximum flexibility of a joint exclusively through muscular activation. This method refers to the extent to which the agonistic muscles flex, as well as the relaxation and yielding to such a force by the antagonistic muscles.

When using the static method, the athlete flexes two segments of a limb to the utmost point of flexibility and holds the position for 6 to 12 seconds. The athlete performs the ballistic method through active swings of one segment of a limb that is mobile, against another limb that is still.

Passive Method The passive method achieves maximum flexibility through the assistance of a partner or by employing a weight. A partner holds or presses a limb toward its maximum point of flexibility without the subject's active involvement. This method is applicable for the following joints: ankle, hip, vertebral column, shoulder, and wrist.

Using weights (barbells, dumbbells) for improving ankle, knee, and shoulder flexibility. do not suggest this for the hips or vertebral column, because the weight may exceed the athlete's pain tolerance or may press two segments of a joint to bend beyond their limits, resulting in eventual muscle pulls. In any case, the weight has to be low, carefully applied, and progressively increased. Always do such training under close supervision.

Combined Method The combined method (PNF) requires the athlete to actively flex the limb to the joint's limit, then execute a maximum isometric contraction against the resistance of a partner.

The athlete may perform the isometric contraction for 4 to 6 seconds, with as many repetitions as he or she can physically tolerate and that are methodologically necessary. Many coaches and athletes prefer the static method, fearing that the ballistic method may lead to muscle pull. Although PNF has some limitations in its application, that is, it is applicable only to the hip and shoulder joints, coaches often prefer this method.

The area of training methodology refers to two types of flexibility, general and specific. General flexibility refers to the idea that each athlete has to have a good mobility of all bodily joints, irrespective of specific requirements of a sport or event. Such flexibility is a requirement in training, and it assists the athlete in training tasks and performing substantial unspecific exercises or elements from related sports.

Specific flexibility implies the quality that is sport or joint specific (Le. , specific flexibility of a hurdler differs drastically from that of a butterfly swimmer). Because developing flexibility is easier at a young age, it has to be part of the training program of each young athlete irrespective of sport specialization.

If the athlete achieves a desired degree of flexibility, it does not mean that you should neglect flexibility training. On the contrary, from this point on, flexibility programs must maintain the achieved level. Incorporate flexibility exercises in the warm up part of a training lesson. As already indicated, precede flexibility exercises by a general warm up (jogging and calisthenics) of at least 10 minutes.

• Relate the selection of exercises and their complexity and difficulty to the athlete's preparation level and the specifics of the sport. • The athlete must perform each selected exercise in 3 to 6 sets of 1 to 15 repetitions (or up to a maximum of 60 90 repetitions per lesson). • During the rest interval, consider relaxation exercises (shake the group of muscles that have performed or execute a light and short massage).

Increase the amplitude of an exercise progressively and carefully throughout the performance. At first, the athlete performs exercises with an amplitude that is not challenging, then progressively increases up to the limits. From this point on, each repetition should aim to reach this superior limit and further it.

For the ballistic method, there is a high variety of exercises, flexions, extensions, and swinging. As suggested by Bompa, and Zivic (1981), An athlete can achieve flexibility by employing free exercises, medicine balls, stall bars, and benches. Using medicine balls (i. e. , flex the hips while holding the ball with arms extended) increases the leverage of a limb. It also accentuates the momentum, which results in more effective development of flexibility.

For both the static and PNF methods, the athlete tries to position the joints to enhance the sought flexibility. Then the performer statically maintains the position for 6 to 12 seconds (6 10 sets), for a maximum total of 100 to 120 seconds per training lesson for the chosen joints. The athlete can build up such time requirement progressively over 10 to 18 months. Throughout the performance of static flexibility, the performer should relax the antagonistic muscles so they will yield to the pull of the agonists, thus reaching a more acute angle between two limbs.

For the periodization of flexibility, you must achieve most of it during the preparatory phase. Regard the competitive phase as a maintenance period, when the athlete directs the energy and strain on muscle groups toward specific training. In either case, however, flexibility has to be part of an everyday training program and the athlete should perform it toward the end of the warm up. Athletes attained best results when they trained flexibility twice a day (Ozolin 1971).

Even athletes performing four to six training lessons per week still may develop flexibility during early morning training, thus ensuring an adequate flexibility.

ACTIVE FREE EXERCISE Active free exercise is performed by the patient without any assistance or resistance other than gravity and the weight of the extremity or segment involved in the exercise. The patient must have sufficient strength to perform the activity against the resistance performed by gravity. The position of the patient will affect the resistance provided by gravity. You can demonstrate to yourself how the effect of gravity is altered by attempting the same exercise while supine, sitting, standing, or prone.

SCAPULAR ABDUCTION AND UPWARD ROTATION (Serratus anterior) Position of Patient (All Grades): Short sitting, over end or side of table. Hands on lap. Position of Therapist: Standing at test side of patient. Hand giving resistance is on the arm proximal to the elbow. The other hand uses the web space along with the thumb and index finger to palpate the edges of the scapula at the inferior angle and along the vertebral and axillary borders. Test: Patient raises die arm to approximately 130° of flexion with elbow extended Instructions to Patient: "Raise your arm forward above your head. "

SCAPULAR ELEVATION (Trapezius, upper fibers) Position of Patient: Short sitting, over end or side of table. Hands relaxed in lap. Position of Therapist: stand behind patient. Test: Patient elevates shoulders through range of motion (Fig. 77). Instructions to Patient: "Raise your shoulders toward your ears" OR "Shrug your shoulders. "

SHOULDER ABDUCTION Position of Patient: Short sitting with arm at side and elbow slightly flexed. Position of Therapist: Stand behind patient. One hand may stabilize the shoulder. Test: Patient abducts arm to 90°. Instructions to Patient: "Lift your arm out to the side to shoulder level. "

SHOULDER ADDUCTION HORIZONTAL Position of Patient: Supine. Shoulder at 90° of abduction and elbow at 90° of flexion. Position of Therapist: Stand at test side. Test: Both Heads: Patient horizontally adducts extremity across chest in a straight pattern with no diagonal motion (Fig. 85). Clavicular Head: Direction of motion by the patient is diagonally up and inward. Sternal Head: Direction of motion is diagonally down and inward. Instructions to Patient: "Move your arm across the chest. "

ELBOW FLEXON Position of Patient: Short sitting with arms at sides. The following are the positions of choice, but it is doubtful whether the individual muscles can be sepa rated when strong effort is used. The Brachialis in particular is independent of forearm position. Biceps bracbii: forearm in supinarion. Brachialis: forearm in pronation. Brachioradialis: forearm in midposition between pronation and supination. Position of Therapist: Stand in front of patient to ward the test side. One hand applies counterforce by cupping the palm over the anterior superior surface of the shoulder. The elbow is cupped by the examiner's hand. Test (All Three Forearm Positions): Patient flexes elbow through range of motion. Instructions to Patient (All Three Tests): "Bend your elbow. "

FOREARM SUPINATION Position of Patient: Short sitting; arm at side and elbow flexed to 90°; forearm in pronation. Alternatively, patient may sit at a table. Position of Therapist: Stand at side or in front of patient. One hand supports the elbow. Test: Patient begins in pronation and supinates the forearm until the palm faces the ceiling (Fig. 90). Instructions to Patient: ''Turn your palm up. Keep your wrist and fingers relaxed. "

WRIST FLEXION Position of Patient: Starting position with forearm supinated and wrist neutral. Position of Therapist: Support the patient's forearm under the wrist. Test For Both Wrist Flexors: Patient flexes the wrist straight up without resistance and without radial or ulnar deviation. For Flexor carpi radialis: Patient flexes the wrist in radial deviation For Flexor carpi ulnaris: Patient flexes the wrist in ulnar deviation

HIP FLEXION Position of Patient: Short sitting with thighs fully supported on table and legs hanging over the edge. Patient may use arms to provide trunk stability by grasping table edge or with hands on table at each side. Position of Therapist: Standing next to limb to be tested. Test: Patient flexes hip to end of range, clearing the table and maintaining neutral rotation. Instructions to Patient: "Lift your leg straight up off the table. "

HIP ABDUCTION Position of Patient: Side lying with test leg upper most. Start test with the limb slightly extended be yond the midline and the pelvis rotated slightly for ward. Lowermost leg is flexed for stability. Position of Therapist: Standing behind patient. The hand used to palpate the Gluteus medius is just proximal to the greater trochanter of the femur. Test: Patient abducts hip through the complete avail able range of motion without flexing the hip or ro tating it in either direction Instructions to Patient: "Lift your leg up in the air. " Figure (105)

Hl. P EXTERNAL ROTATION Position of Patient: Short sitting. (Trunk may be supported by placing hands flat or fisted at sides). Position of Therapist: Sits on a low stool or kneels beside limb to be tested. One hand is contoured over the lateral aspect of the distal thigh just above the knee. Test: Patient externally rotates the hip. Instructions to Patient: "Turn your leg out. "

KNEE FLEXION Position of Patient: Prone with limbs straight and toes hanging over the edge of the table. Position of Therapist: Standing next to limb to be tested. (Illustration is deliberately incorrect to avoid obscuring test activity. ) One hand is placed over the hamstring tendons on the posterior thigh (optional). Test: Patient flexes knee while maintaining leg in neutral rotation Instructions to Patient: "Bend your knee. "

ANKLE PLANTAR FLEXION GASTROCNEMIUS AND SOLEUS TEST Position of Patient: Patient stands on limb to be tested with knee extended. Patient is likely to need external support; no more than one or two fingers should be used on a table (or other surface) for balance assist only. Position of Therapist: Standing or sitting with a lateral view of test limb. Test: Patient raises heel from floor consecutively through full range of plantar flexion Instructions to Patient: Therapist demonstrates cor rect heel rise to patient. "Stand on your right leg. Go up on your tiptoes. Now down. " Repeat test for left limb.

SOLEUS ONLY Position of Patient: Standing on limb to be tested with knee slightly flexed. Use one or two fingers for balance assist. Position of Therapist: Standing or sitting with clear lateral view of test limb. Test: Patient raises heel from floor through full range of plantar flexion, maintaining flexed position of knee. Instructions to Patient: Therapist demonstrates test position and motion. "Stand on your right leg with your knee bent. Keep your knee bent and go up and down on your toes. " Repeat test for left leg.

FOOT DORSIFLEXION AND INVERSION Position of Patient: Short sitting. Alternatively, patient may be supine. Position of Therapist: Sitting on stool in front of Patient with patient's heel resting on thigh. One hand is contoured around the posterior leg just above the malleoli. Test: Patient dorsiflexes ankle and inverts foot, keep ing toes relaxed Instructions to Patient: "Bring your foot up and in. "

FOOT EVERSION WITH PLANTAR FLEXION Position of Patient: Short sitting with ankle in neu tral position (midway between dorsiflexion and plan tar flexion). Test also may be per formed with patient supine. Position of Therapist: Sitting on low stool in front of patient or standing at end of table if patient is supine. One hand grips the ankle just above the malleoli for stabilization. Test: Patient everts foot with depression of first metatarsal head and some plantar flexion. Instructions to Patient: "Turn your foot down and out. "