Designing Programs for
Flexibility and Low Back Care
Chapter 11
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.
Lifestyle assessments (see appendix A.5, p. 326) can
help identify muscle groups and body parts with limited
joint mobility caused by habitual body postures (e.g.,
sitting at a desk for long times at work) or repetitive
movement patterns during exercise (e.g., jogging).
TRAINING
PRINCIPLES
Specificity: Flexibility is joint specific.
Overload: Stretch muscles beyond normal resting
length but not to point of pain.
Progression: Increase duration of each stretch and/or
increase repetitions.
Interindividual variability: Point of pain in ROM,
stretch tolerance, and perception of stretch and pain
vary by individual.
STRETCHING
METHODS
Three methods historically used to improve ROM:
1.Ballistic: fast, jerky, bouncing
2.Static stretching: slow, sustained, muscle lengthening
3.Proprioceptive neuromuscular facilitation (PNF):
stretching techniques involve maximal or submaximal
contractions (isometric or dynamic) of target (agonist) and
opposing (antagonist) muscle groups followed by passive
stretching of the target muscles
STRETCHING
TECHNIQUES
Pros and cons for each stretching technique:
1.Active: Client moves body part without external assistance.
2.Passive: Client relaxes target muscle group as assistant
moves the body part.
3.Active assisted: Client moves body part to end of its active
ROM; assistant then moves body part beyond its active ROM.
Table 11.1 summarizes the advantages and disadvantages of
stretching methods. (see next slide)
TABLE 11.1
TYPES OF PNF STRETCHES
Contract-relax (CR): In the CR technique, your client
first isometrically contracts the target muscle group;
this is immediately followed by slow, passive stretching
of the target muscle group.
Contract-relax agonist contract (CRAC): The first
two steps of the CRAC and CR techniques are
identical except that the client assists the CRAC
stretching phase by Actively Contracting the opposing
muscle group. (see figure 11.1 for example, next two slides)
To stretch the pectoral muscles, the client sits on the floor and
extends the arms horizontally. The client isometrically contracts the
pectoral muscles as the partner offers resistance to horizontal
flexion…
CRAC
Following the isometric contraction, the partner slowly stretches the
pectorals as the client actively contracts the horizontal extensors in
the upper back
CRAC
THEORIES OF PNFINDUCED 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)
GENERAL RECOMMENDATIONS FOR
PERFORMING PNF STRETCHES
The following steps are recommended for
performing PNF stretches to increase ROM:
■ Stretch the target muscle group by moving the joint to the
end of its ROM.
■ Isometrically contract the stretched muscle group against
an immovable resistance (such as a partner or wall) for 5 to
10 sec.
■ Relax the target muscle group as you stretch it actively or
passively
■ For the CRAC technique, contract the opposing muscle
group submaximally for 5 or 6 sec to facilitate further
stretching of the target muscle group. (with a partner) to a
new point of limitation.
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.
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.
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.
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.
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!
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
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.
• 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.
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.
• Brace lumbar spine during activity by isometrically cocontracting 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.