1. Flexibility Optimal musculoskeletal function requires that an adequate range of motion be maintained in all joints.

2. Flexibility After assessing your client’s flexibility, you must identify those joints and muscle groups which are in need of improvement and select an appropriate exercise mode and specific exercises for the flexibility program.

3. Flexibility The specificity and progressive overload principles apply to the design of flexibility programs.

4. Flexibility Flexibility is highly joint-specific; therefore, to increase flexibility of a particular joint, select exercises that stretch the appropriate muscle groups.

5. Flexibility To improve ROM at the joint, your client must overload the muscle group by stretching the muscles beyond their normal resting length - but never beyond the pain-free range of motion.

6. Flexibility Periodically your client will need to increase both the amount of time the stretched position is maintained and the number of repetitions of the exercise to ensure the overload required for further improvement.

7. Flexibility Of particular importance is maintenance of flexibility in the lower back and posterior thigh regions.

8. Flexibility Lack of flexibility in this area may be associated with an increased risk for the development of chronic lower back pain.

9. Flexibility Lack of flexibility is prevalent in the elderly among whom this condition often contributes to a reduced ability to perform activities of daily living (ADL).

10. Flexibility Accordingly, exercise programs for the elderly should emphasize proper stretching, especially for the upper and lower trunk, neck, and hip regions.

11. Flexibility There are different types of stretching techniques (e.g., static, ballistic, and PNF) that can be performed.

12. Flexibility All three types of stretching are effective in increasing the ROM.

13. PNF PNF stretching increases ROM by inducing muscle relaxation through spinal reflex mechanisms.

14. PNF Using the contract-relax technique, your client first performs an isometric contraction of the muscle group being stretched, and then proceeds with the slow, static stretching (relaxation phase) of the muscle group.

15. PNF This technique is based on the concept of reciprocal inhibition.

16. PNF Theoretically, the isometric contraction of the antagonists (muscle group being stretched) induces a reflex facilitation and contraction of the agonist during the slow, static stretching phase.

17. PNF The isometric contraction of the antagonists also stimulates the Golgi tendon organs, resulting in a reflex relaxation of the same muscle group.

18. PNF Another type of PNF stretching is the contract-relax with agonist contraction (CRAC) technique.

19. PNF This method is identical to the contract- relax technique except that the stretching is assisted by a submaximal contraction of the opposing (agonist) muscle group.

20. PNF Theoretically, the voluntary contraction of the agonists induces additional inhibitory input to the antagonists (muscles being stretched) through reciprocal inhibition.

21. How are PNF Stretches Performed? The following steps are recommended when using PNF stretching techniques to increase static flexibility: Stretch the target muscle group by moving the joint to the end of its ROM.

22. How are PNF Stretches Performed? Isometrically contract the pre-stretched muscle group against an immovable resistance (such as a partner or wall) for 5 to 6 seconds.

23. How are PNF Stretches Performed? Relax the contracted muscle group as you or your partner statically stretch the muscle to a new point of limitation.

24. How are PNF Stretches Performed? With the contract-relax agonist contraction technique, the opposing muscle group, (agonist) contracts submaximally for 5 to 6 seconds to facilitate relaxation and further stretching of the target muscle group.

25. Why is slow, static stretching safer than ballistic stretching? Many exercise specialists recommend using slow, static stretching rather than ballistic stretching because there is more chance of injury and muscle soreness resulting from jerky, rapid movements.

26. Why is slow, static stretching safer than ballistic stretching? The ballistic technique uses a relatively fast, bouncing motion to produce stretch.

27. Why is slow, static stretching safer than ballistic stretching? The momentum of the moving body segment, rather than external force, pushes the joint beyond its present ROM.

28. Why is slow, static stretching safer than ballistic stretching? This technique appears to be counterproductive for increasing muscle stretch. Muscle spindles signal both changes in length and speed of contraction.

29. Why is slow, static stretching safer than ballistic stretching? The spindle responds more to the speed of movement than to the muscle’s length or position. In fact, muscle spindle activity is directly proportional to the speed of movement.

30. Why is slow, static stretching safer than ballistic stretching? Thus, ballistic or dynamic stretching evokes the stretch reflex, producing more contraction and resistance to stretch in the muscle group being stretched.

31. Why is slow, static stretching safer than ballistic stretching? This places strain on the muscle-tendon unit and may cause microscopic tearing of muscle fibers and connective tissue.

32. Why is slow, static stretching safer than ballistic stretching? In slow, static stretching, your client stretches the muscle with the joint positioned at the end of its ROM.

33. Why is slow, static stretching safer than ballistic stretching? While maintaining this position, the client slowly applies torque to the muscle to stretch it further. Because the dynamic portion of the muscle spindle rapidly adapts to the lengthened position, the spindle discharge is decreased.

34. Why is slow, static stretching safer than ballistic stretching? This lessens reflex contraction of the muscle and allows the muscle to relax (viscoelastic stress relaxation) and to be stretched even further.

35. Is PNF stretching better than slow, static stretching? Limited research. It may, but it produces greater feelings of being uncomfortable.

36. Is PNF stretching better than slow, static stretching? A major disadvantage of the PNF technique is that the exercises, in some cases, cannot be performed alone.

37. Is PNF stretching better than slow, static stretching? A partner is needed to resist movement during the isometric contraction phase and to apply external force to the muscle during the stretching phase.

38. Is PNF stretching better than slow, static stretching? Thus, the amount of time required for both individuals to complete the flexibility exercises is increased.

39. Exercise Prescription for Flexibility A well-rounded program includes at least one exercise for each of the major muscle groups of the body.

40. Exercise Prescription for Flexibility Use the results of the flexibility tests to identify specific muscle groups with relatively poor flexibility, and include more than one exercise for these muscle groups.

41. Flexibility A general exercise prescription for achieving and maintaining flexibility should adhere to the following guidelines:

42. Flexibility F = At least 3 days/week, preferably daily. I = To a position of mild discomfort. T = 10 to 30 secs. for each stretch. S = 3 to 5 reps for each stretch. Perform static stretches with a major emphasis on the lower back and thigh area.

43. Risky Exercises? Hyperextension Hyperflexion

44. Safe Intensity? The joint should not be stretched beyond its pain-free range of motion. Some mild discomfort will occur.

45. Duration of Stretch? ACSM recommends holding the stretched position only as long as it feels comfortable (usually 10 to 30 seconds).

46. Number of Repetitions? Beginners should start with 3 reps of each exercise. As flexibility improves, they may increase the reps to 5.

47. Client Guidelines Warm-up before stretching to increase body temperature and ROM. Stretch all major muscle groups, as well as opposing muscle groups.

48. Client Guidelines Focus on the target muscle involved in the stretch, relax the target muscle, and minimize the movement of other body parts.

49. Client Guidelines Hold the stretch for 10 to 30 seconds. Stretch to the limit (endpoint) of the movement, not to the point of pain.

50. Client Guidelines Keep breathing slowly and rhythmically while holding the stretch. Stretch the target muscle groups in different planes to improve overall ROM at the joint.