Designing Programs for Flexibility and Low Back Care

1. chapter11 chapter 11 Designing Programs for Flexibility and Low Back Care Author name here for Edited books

2. Objectives • Apply training principles to flexibility programs • Understand issues of safety and efficacy of stretching • Identify guidelines for design of flexibility programs • Individualize flexibility programs based on client goals, starting values, and abilities • Understand low back syndrome and methods to prevent it • Identify exercises useful for low back care

3. Principles of Flexibility Training • Flexibility training is a systematic program of stretching exercises designed to progressively increase the range of motion (ROM) of joints over time. • Flexibility programs should be individualized to address the needs, abilities, and physical activity interests of each client.

4. Training Principles • Specificity: Flexibility is joint specific. • Overload: Stretch muscles beyond normal resting length but beneath point of pain. • Progression: Increase duration of each stretch or increase repetitions. • Interindividual variability: Point of pain in ROM, stretch tolerance, and perception of stretch and pain vary by individual.

5. Stretching Methods Three methods historically used to improve ROM: • Ballistic: fast, jerky, bouncing • Static stretching: slow, sustained, muscle lengthening • Proprioceptive neuromuscular facilitation (PNF): isometric or dynamic of target (agonist) and opposing (antagonist) muscle groups followed by passive stretching of agonists; requires a knowledgeable assistant

6. Stretching Techniques Pros and cons for each stretching technique: • Active: Client moves body part without external assistance. • Passive: Client relaxes target muscle group as assistant moves the body part. • Active assisted: Client moves body part to end of its active ROM; assistant then moves body part beyond its active ROM.

7. Table 11.1

8. Types of PNF Stretches • Contract-relax (CR): Client isometrically contracts target muscle group; follows immediately with slow, passive stretching of target muscle group. • Contract-relax agonist contract (CRAC): Initially identical to CR except that client assists CRAC stretching phase by actively contracting opposing muscle group; improves ROM more effectively.

9. Figure 11.1a

10. Figure 11.1b

11. Theories of PNF-Induced Increases in ROM • Neurophysiologic modifications such as inhibition of stretch reflex and Golgi tendon organ (GTO), reflex in target muscles • Voluntary antagonist contraction during CRAC stretching explained by reciprocal inhibition (as the opposing muscle group is voluntarily contracted, the target muscle group is reflexively inhibited)

12. Designing Flexibility Programs: Exercise Prescription • Identify joints and muscle groups needing improvement. • Select appropriate stretching method and specific exercises for the exercise prescription. • Include one stretch per major muscle group. • Select exercises for problem areas; include more than one exercise for these muscle groups. • Workout should take 15 to 30 minutes. (continued)

13. Designing Flexibility Programs: Exercise Prescription (continued) • Familiarize yourself with stretches to avoid— those causing stress for low back and knees. • Intensity is to the point of mild discomfort; below pain threshold. • ACSM recommends 15 to 60 seconds duration for each stretch. • ACSM recommends 4 reps per stretch initially. • For clients with lower flexibility, use shorter stretch duration (10-15 sec) and higher reps. (continued)

14. Designing Flexibility Programs: Exercise Prescription (continued) • Progress the stretch by changing either the stretch duration (10-30 sec) or the number of repetitions so that the total time in stretched position gradually increases. • Gradually increase the total stretching time for each exercise in order to ensure overload and further improvements in ROM. (continued)

15. Designing Flexibility Programs: Exercise Prescription (continued) • Recommended stretching program is minimum of two times weekly (preferably daily) for 10 minutes total per session. • Stretch after moderate to vigorous exercise program. • Stretching is a good cool-down routine from a strength or cardio workout. • Stretching is not a good warm-up; it may actually hinder performance or strength. (continued)

16. Designing Flexibility Programs: Exercise Prescription (continued) • Vibration may be a promising method for increasing ROM beyond what is obtainable with static stretching. • Stretching improves ROM in older adults, especially if a stretch is held for 60 seconds. • Caution is urged using PNF stretches with older adults—they have lower stretch tolerance. • Individualize the stretching program, regardless of client age!

17. Designing Low Back Care Exercise Programs • No best way yet to prevent and rehabilitate low back injuries. • Select method that matches client’s needs and goals: • Traditional approach: Focus is spinal alignment • Alternative approach: Focus is lumbar stability

18. Traditional Approach to Low Back Care • Improve ROM by strengthening and stretching hip flexors, hamstrings, and low back extensors. • Strengthen abdominal muscles. • Some programs include exercises to increase the strength and endurance of both the abdominal and low back extensor muscles. • Strengthening the low back (lumbar extensor) muscles requires pelvic stabilization. (continued)

19. Traditional Approach to Low Back Care (continued) • Strengthening abs requires exercises that maximize abdominal muscle activation while minimizing compression (load) on lumbar vertebrae. • Minimize influence of psoas muscle to reduce lumbar vertebrae compressive load.

20. Alternative Approach to Low Back Care • Muscle endurance is more protective than muscle strength for reducing low back injury. • Lumbar mobility is directly related to low back injury. (continued)

21. Alternative Approach to Low Back Care (continued) • Brace lumbar spine during activity by isometrically co-contracting the abdominal wall and low back muscles. • Maintain a neutral spine during activity. • Avoid fully flexed or extended ROM positions of trunk while lifting or exercising. • Perform exercises emphasizing endurance rather than strength.