Flexibility and Low-Back Health

1. Flexibility and Low-Back Health Chapter

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 5.1Basic 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 5.2The 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 Passivestretching: 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 5.3The spinal column

28. FIGURE 5.4Vertebrae and an intervertebral disk

29. FIGURE 5.5Major 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