1. FEXIBILITY AND LOW-BACK HEALTH
Chapter 9

2. Test your knowledge Stretching exercises should be performed
At the start of a warm-up
First thing in the morning
After endurance exercise or strength training
C. it’s best to do stretching exercises when your muscles are warm. Stretching muscles before exercise may temporarily reduce their explosive strength and interfere with neuromuscular control.

3. Test your knowledge
If you injure your back, it’s usually best to rest in bed until the pain is completely gone. True or False?
FALSE. Prolonged bed rest may actually worsen back pain. Limit bed rest to a day or less, treat pain and inflammation with cold and then heat, and begin moderate physical activity as soon as possible.

4. Test your knowledge
It is better to hold a stretch for a short time than to “bounce” while stretching. True or false?
TRUE. “Bouncing” during stretching can damage your muscles. This type of stretching, called ballistic stretching, should be used only by well-conditioned athletes for specific purposes. A person of average fitness should stretch slowly, holding each stretch for 15 – 30 seconds.

5. Flexibility
Ability of a joint to move through its normal, full rage of motion.
2 types:
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. Involves strength, coordination and resistance to movement.

6. What determines flexibility?
The flexibility of a joint is affected by
Structure
Muscle elasticity
Length
Nervous system regulation

7. Joint structure Joint capsule Cartilage Synovial fluid Ligaments
Provides support and stability to the joint
Cartilage
Synovial fluid
Cushions the bones and reduces friction
Ligaments
Found on both inside and outside the joint capsule
Serve to strengthen and reinforce the joint.

8. Joint structure
Hinge joint
Ball – and – socket joint

9. Muscle elasticity and length
Soft tissues limit the flexibility of a joint
Skin, muscles, tendons, and ligaments
Muscle tissue is the key to develop flexibility
Connective tissue: provides structure, elasticity and bulk
Collagen: white fibers, provide structure and support
Elastin: yellow fibers, provide elasticity and flexibility
Regular stretching contributes to flexibility by lengthening muscle fibers through the addition of contractile units called sarcomeres.

10. Nervous system regulation
Proprioceptors: nerves that send information about the muscular and skeletal systems to the nervous system.
Control the speed, strength and coordination of muscle contractions.
Proprioceptors adapt very quickly to stretching (or lack of stretching). Frequent training is beneficial for developing flexibility
Stretches than involve rapid, bouncy movements can cause injury.
Performing a gradual stretch and then holding it allows the proprioceptors to adjust to the new muscle length and to reduce the signals sent to the spine, allowing muscles to lengthen and over time to become more flexible.

11. Benefits of flexibility and stretching exercises
Joint health
Poor joint flexibility can cause:
Abnormalities in joint lubrication
Joint deterioration
Expose joint to abnormal stresses
Good joint flexibility
Prevents arthritis
Lessens pain
Increases balance and stability

12. Benefits of flexibility and stretching exercises
Prevention of low-back pain and injuries
Low-back pain is related to poor spinal stability
Strength and flexibility in the back, pelvis and thighs may help prevent this type of pain.
Good hip and knee flexibility protect the spine from excessive motion.
Overstretching may decrease the stability of a joint, increasing the risk of injury

13. Benefits of flexibility and stretching exercises
Relief of aches and pains
Relief of muscle cramps
Related to increase electrical activity within the affected muscle
Improved body position and strength for sports and life.
Lets you assume more efficient body positions and exert force through a greater range of motion.
Maintenance of good posture and balance
Contributes to body symmetry and good posture
Relaxation
Reduce mental tension, slows breathing rate, reduces blood pressure.

14. ASSESSING FLEXIBILITY
Lab 9.1
ASSESSING FLEXIBILITY

15. Creating a successful program to develop flexibility
Your goal should be to attain normal flexibility in the major joints.
Extreme flexibility causes joint instability which can lead to pain in the back, hips, shoulders and knees.
Balanced flexibility provides joint stability and facilitates smooth movement patterns.

16. Apply the FITT principle
Frequency
2-3 days a week – ideally 5-7 days a week
Stretch when your muscles are warm
Pre-exercise stretching decreases muscle strength and performance and disturbs neuromuscular control.

17. Intensity and time
Slowly stretch your muscles to the point of slight tension or mild discomfort.
Hold the stretch for 15 – 30 seconds
Try to stretch a little bit farther
During the stretch try to relax and breath easily
Rest 30 – 60 seconds between each stretch
Do 2-3 repetitions of each stretch
A complete flexibility workout usually takes about min.

18. Types of stretching techniques
Static stretching
Each muscle is gradually stretched and the stretch is held for 15 – 30 seconds.
Ballistic stretching
The muscles are stretched suddenly in a forceful bouncing movement.
Recommended only for well trained athletes

19. Types of stretching techniques
Dynamic (functional) stretching
Involves moving the joints through the range of motion used in a specific exercise or sport in an exaggerated but controlled manner.

20. Types of stretching techniques
Proprioceptive neuromuscular Facilitation – PNF
Uses reflexes initiated by both muscle and joint nerves to cause greater training effects
Contract – relax stretching: the muscle is contracted before it is stretched.
Contract – relax – contract stretching: begins with the contraction of the muscle to be stretched, then relaxing it and then contracting the opposing muscle (antagonist), finally relaxing the first muscle.

21. Types of stretching techniques
Passive vs. active stretching
Passive stretching
An outside force or resistance provided by yourself, a partner, gravity or a weight helps your joints move through their range of motion.
Active stretching
A muscle is stretched by a contraction of the opposing muscle

22. Exercises to improve flexibility
Warm up 5-10 minutes or following an endurance or strength training workout
Stretching exercises for major joints
Sample program
Exercise
Areas stretched
Head turns and tilts
Neck
Towel stretch
Triceps, shoulders, chest
Frequency: 2-3 days/week; 5-7 days/week ideal
Intensity: stretch to the point of mild discomfort, not pain.
Time: 15 – 30 seconds, 2-4 times
Type of activity: stretching exercises that focus on major joints.
Across –the-body and overhead stretches
Shoulders, upper back, back of arm
Upper-back stretch
Upper back
Lateral stretch
Trunk muscles
Step stretch
Hip, front of thigh
Side lunge
Inner thigh, hip, calf
Inner thigh stretch
Inner thigh, hip
Hip and trunk stretch
Trunk, outer thigh, hip, buttocks, lower back
Modified hurdler stretch
Back of thigh, lower back
Alternate leg stretcher
Back of thigh, hip, knee, ankle, buttocks
Lower-leg stretcher
Calf, soleus, Achiles tendon

23. Remember… Improper stretching does more harm than good
Understand the different types of stretching exercises and how they affect muscles.
Do stretching exercises statically.
Do not stretch to the point of pain.
Relax and breathe easily as you stretch
Perform all exercises on both sides of your body.
Increase intensity and duration gradually over time.
Stretch when your muscles are warm

24. Preventing and managing lower-back pain
Back pain can result from sudden traumatic injuries but it is more often the long-term result of weak and inflexible muscles, poor posture, or poor body mechanics during activities like lifting and carrying
Any abnormal strain on the back can result in pain.

25. Function of the Spine Provides structural support for the body
Surrounds and protects the spinal cord
Supports much of the body’s weight and transmits it to the lower body
Serves as an attachment site for a large number of muscles, tendons and ligaments
Allows movement of the neck and back in all directions.

26. Structure of the Spine Vertebrae
Nerve root
Vertebrae
Vertebral body: carries stress of body weight and physical activity
Bony processes: joints to adjacent vertebrae and attachment sites for muscles and ligaments.
Invertebral disks: absorb and disperse the stresses placed on the spine, separate vertebrae from each other.
Invertebral
disk
Vertebral
arch
Vertebral
body

27. Structure of the Spine Vertebrae 4 curves 7 cervical 12 thoracic
5 lumbar
Sacrum
Coccyx
4 curves
Cervical
Thoracic
Lumbar
Sacral

28. Core muscle fitness
Muscles in the abdomen, pelvic floor, sides of the trunk, back, buttocks, hip and pelvis
29 muscles
Stabilize the spine and help transfer force between the upper body and lower body
During dynamic exercise, core muscles work together to produce movement and stability
When specific core muscles are weak or tired, the nervous system steps in and uses other muscles producing abnormal stress on the joints, decreased power and an increase in the risk of injury.

29. Causes of back pain Being greater than 34 years
Degenerative diseases such as arthritis or osteoporosis
Family or personal history of back pain or trauma
Sedentary lifestyle
Low job satisfaction
Low socioeconomic status
Smoking
Excess body weight
Psychological stress or depression
Physically hard work: frequent lifting, twisting,
bending, standing up or straining in forced
positions
High concentration demands (computer
programming)
Vibrations (truck driving)

30. Underlying causes
Poor muscle endurance and strength in the core muscles
Excess body weight
Poor posture and body position when standing, sitting or sleeping
Poor body mechanics when performing actions like lifting and carrying or sports movements.

31. Symptoms Numbness in the back, hip, leg or foot Radiating pain
Loss of muscle function
Depressed reflexes
Muscle spasm

32. Preventing low back pain
Lose weight, stop smoking, 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.

33. Managing back pain Cold treatments Heat treatments
Acute
Chronic
Cold treatments
Heat treatments
Nonsteroidal anti- inflammatory medication
Immediate rest following the onset of back pain
Limit bed rest to one day and begin moderate physical activity as soon as possible
See your physician if acute back pain doesn’t resolve within a short time.
Low-back pain is considered chronic if it persists for more than 3 months
Prescription medications
Exercise
Physical therapy
Massage, yoga or chiropractic care
Acupuncture
Percutaneous electrical nerve stimulation
Psychological therapy

34. LAB ACTIVITIES Assessing muscular endurance for low back health
Posture evaluation