1. Flexibility and Low-Back Health
Chapter
Flexibility and Low-Back Health

2. Flexibility and Low-Back Health
Types of Flexibility
What Determines Flexibility?
Benefits of Flexibility
Assessing Flexibility
Creating a Successful Program to Develop Flexibility
Preventing and Managing Low-Back Pain

3. KEY TERMS AND DEFINITIONS
Flexibility – the ability of a joint to move through its normal, full range of motion – is important for general fitness and wellness

4. Types of Flexibility
Range of motion: The full motion possible in a joint
Static flexibility: Ability to hold an extended position at one end or point in a joint’s range of motion
Dynamic flexibility: Ability to move a joint through its range of motion with little resistance

5. Joint Structure
Flexibility of a joint depends partly on nature and structure of the joint
Hinge joints
Ball-and-socket joints
Joint capsules: Semielastic structures, composed primarily of connective tissues; surround major joints

6. FIGURE 5.1 Basic joint structures

7. Muscle Elasticity and Length
Soft tissues: Tissues of the human body that include skin, fat, linings of internal organs and blood vessels, connective tissues, tendons, ligaments, muscles, and nerves
Collagen: White fibers that provide structure and support in connective tissue

8. Muscle Elasticity and Length
Elastin: Yellow fibers that make connective tissue flexible
Elastic elongation: Temporary change in the length of muscles, tendons, and supporting connective tissues
Plastic elongation: Long-term change in the length of muscles, tendons, and supporting connective tissues

9. Nervous System Regulation
Proprioceptor: Nerve that sends information about the muscular and skeletal systems to the nervous system
When they detect changes in position or force of muscles and joints, they send signals to the spine and brain
The brain sends signals back to coordinate muscle action to protect muscles and tendons from injury

10. Nervous System Regulation
Proprioceptors control speed, strength, and coordination of muscle contractions
Small movements that only slightly stimulate these receptors cause small reflex actions
Rapid, powerful, and sudden changes in muscle length stimulate receptors and can cause powerful reflex muscle contractions
Proprioceptive neuromuscular facilitation (PNF) stretching

11. Joint Health
When muscles and other tissues supporting a joint are tight, the joint is subject to stresses that can cause deterioration
Poor joint flexibility can cause abnormalities in joint lubrication, leading to deterioration of the cartilage cells lining the joint

12. Prevention of Low-Back Pain and Injuries
Poor spinal stability puts pressure on the nerves leading out from the spinal column and can lead to low-back pain
Good hip and knee flexibility protects the spine
People with either high or low flexibility seem to have an increased risk of injury
Stretching programs are important for older adults and people who play high-power sports, who have brief but intense exertion, and who sit for long periods

13. Additional Potential Benefits of Flexibility
Relief of aches and pains
Relief of muscle cramps
Improved body position and strength for sports and life
Maintenance of good posture and balance
Relaxation
Improving impaired mobility

14. Assessing Flexibility
There are no tests of general flexibility
The sit-and-reach test rates flexibility of muscles in the lower back and hamstrings

15. Applying the FITT Principle
Frequency
ACSM recommends stretching exercises be performed a minimum of two or three days a week
Intensity and time (duration)
Slowly apply stretch to your muscles to point of slight tension or mild discomfort
Hold the stretch for 10 to 30 seconds
As tension subsides, stretch a bit farther
Rest 30 to 60 seconds; do 2 to 4 repetitions

16. FIGURE 5.2 The FITT principle for a flexibility program

17. Creating a Successful Program to Develop Flexibility
Types of stretching techniques
Static stretching: Technique in which a muscle is slowly and gently stretched and then held in the stretched position
Ballistic stretching: Technique in which muscles are stretched by the force generated as a body part is repeatedly bounced, swung, or jerked

18. Creating a Successful Program to Develop Flexibility
Types of stretching techniques
Dynamic stretching: Technique in which muscles are stretched by moving joints slowly and fluidly through their range of motion in a controlled manner; also called functional stretching
Proprioceptive Neuromuscular Facilitation (PNF): Uses reflexes initiated by both muscle and joint nerves to achieve greater training effects

19. Creating a Successful Program to Develop Flexibility
Types of Stretching Techniques
Passive stretching: Technique in which muscles are stretched by force applied by an outside source
Active stretching: Technique in which muscles are stretched by the contraction of the opposing muscles

20. Flexibility Exercises
Head Turns and Tilts
Towel Stretch
Across-the-Body and Overhead Stretches
Upper-Back Stretch
Lateral Stretch
Step Stretch
Side Lunge
Inner-Thigh Stretch
Hip and Trunk Stretch
Modified Hurdler Stretch (Seated Single-Leg Hamstring)
Leg Stretcher
Lower-Leg Stretch
Single-Leg Deadlift

21. Making Progress
Judge progress by noting body position while stretching
Should see some improvement after two to three weeks of stretching
May take two months to attain significant improvements

22. Exercises to Improve Flexibility: A Sample Program
Flexibility program should include exercises to work major joints of the body by stretching associated muscle groups
Hold each position 15 to 30 seconds for 2 to 4 repetitions
Use proper technique

23. Preventing and Managing Low-Back Pain
Low-back pain afflicts more than 85% of Americans by age 50
Second most common ailment in the U.S.
Often result of weak and inflexible muscles, poor posture, or poor body mechanics when lifting or carrying

24. Function and Structure of the Spine
Spine provides structural support for the body
Surrounds and protects the spinal cord
Supports much of the body’s weight
Serves as attachment site for muscles, tendons, and ligaments
Allows movement of the neck and back in all directions

25. Function and Structure of the Spine
Spinal column has 7 cervical, 12 thoracic, 5 lumbar vertebrae, and 9 fused vertebrae that form sacrum and coccyx
Vertebrae: Bony segments of the spinal column that provide structural support for the body and protect the spinal cord

26. Function and Structure of the Spine
Intervertebral disk: An elastic disk located between adjoining vertebrae consisting of a gel- and water-filled nucleus surrounded by fibrous rings; it serves as a shock absorber for the spinal column
Nerve root: Base of one of the 31 pairs of spinal nerves that branch off the spinal cord through spaces between vertebrae

27. FIGURE 5.3 The spinal column

28. FIGURE 5.4 Vertebrae and an intervertebral disk

29. FIGURE 5.5 Major core muscles

30. Core Muscle Fitness
Core muscles: The trunk muscles extending from the hips to the upper back
29 muscles attach to ribs, hips, spine and other bones in the trunk of the body
Core muscles stabilize spine and help transfer force between the upper body and lower body

31. Core Muscle Fitness
During any dynamic movement, core muscles work together
Some shorten to cause movement, others contract and hold to provide stability, lengthen to brake movement, or send signals to the brain about the movements and positions of the muscles and bones
Best exercises for low-back health care are whole-body exercises that force core muscles to stabilize the spine in many different directions

32. Causes of Back Pain Lumbar area most common area of pain
Poor muscle endurance and strength in the core muscles
Excess body weight
Poor posture or body position
Poor body mechanics
Physical stress can cause disks to break down and lose some of their ability to absorb shock

33. Preventing Low-Back Pain
Maintain healthy weight
Stop smoking and reduce stress
Avoid sitting, standing, or working in the same position for too long
Use a supportive seat and a medium-firm mattress
Use lumbar support when driving
Warm up thoroughly before exercising
Progress gradually when attempting to improve strength or fitness

34. Managing Acute Back Pain
Sudden back pain usually involves tissue injury
Applying cold and then heat may reduce pain and inflammation
Bed rest immediately following the onset of pain may help
See physician if acute back pain doesn’t resolve within a short time
Back pain that lasts more than 3 months is considered chronic

35. Managing Chronic Back Pain
Different people benefit from different treatment strategies including:
Medications
Exercise
Physical therapy; acupuncture
PENS
Education and advice
Surgery

36. Exercises for the Prevention and Management of Low-Back Pain
Perform low-back exercises (3 days per week)
Emphasize muscular endurance
Don’t do full range of motion spine exercises early in morning
Engage in regular endurance exercise
Be patient and stick with your program
Forget the adage ‘no pain, no gain’
Emphasize stabilization exercises