EXCI252Ch10AssessingFlexibilityF2023 (2).pptx
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Chapter 10 Assessing Flexibility EXCI 252 1 Flexibility Important, yet often neglected component of health-related fitness. Adequate levels are needed for maintenance of functional independence. performance of activities of daily living (ADL). Flexibility tests have been includ...
Chapter 10 Assessing Flexibility EXCI 252 1 Flexibility Important, yet often neglected component of health-related fitness. Adequate levels are needed for maintenance of functional independence. performance of activities of daily living (ADL). Flexibility tests have been included in most healthrelated fitness batteries because it has been long thought that lack of flexibility is associated with musculoskeletal injuries & low back pain. EXCI 252 2 Flexibility Research Minimal. Few studies substantiate its importance to health-related fitness. Limited evidence that a greater than normal amount of flexibility decreases injury risk. Suggests individuals with ankylosis or hypermobility are at higher risk than others for musculoskeletal injuries. Fails to support an association between lumbar or hamstring flexibility & the occurrence of low back pain. EXCI 252 3 Flexibility Research Hypermobility Olga Korbut, a Russian gymnast representing the Soviet Union, performing a chest roll on the beam during the 1972 Olympic games in Munich, West Germany. Photograph: Graham Wood/Getty Images EXCI 252 4 Flexibility & Joint Stability are highly dependent on: joint structure, strength & number of muscles spanning the joint, strength & number of ligaments spanning the joint. EXCI 252 5 Definitions & Types of Flexibility Flexibility is the ability of a joint, or series of joints, to move through a full ROM without injury. Static Flexibility is a measure of the total ROM at the joint. is limited by the extensibility of the musculotendinous unit. Dynamic Flexibility is a measure of the rate of torque or resistance developed during stretching throughout the ROM. EXCI 252 6 Joint Range of Motion Depends on morphological factors such as: Joint geometry (structure) Joint capsule Ligaments Tendons Muscles. EXCI 252 7 Joint Classification by Structure & Function Type of Joint Rotation Axes Movements Gliding Nonaxial Gliding, sliding, twisting. Intercarpal, intertarsal, tarsometatarsal. Hinge Uniaxial Flexion, extension. Knee, elbow, ankle, interphalangeal. Pivot Uniaxial Medial & lateral rotation. Proximal radioulnar, atlantoaxial. Condyloid & Saddle Biaxial Flexion, extension, abduction, adduction, circumduction. Wrist, atlanto-occipital, metacarpophalangeal, first carpometacarpal. Ball & Socket Triaxial Flexion, extension, abduction, adduction, circumduction, rotation. Hip, shoulder. EXCI 252 Examples 8 Soft Tissue Structures that Limit Flexibility Relative contribution of soft tissue structures to the total resistance encountered by the joint during movement (Johns & Wright, 1962). Soft Tissue Structure Relative Contribution Joint Capsule 47% Muscle & Its Fascia 41% Tendons & Ligaments 10% Skin 2% EXCI 252 9 Soft Tissue Structures that Limit Flexibility Joint Capsule & Ligaments composed predominantly of a nonelastic connective tissue called collagen. Muscle & Its Fascia composed of an elastic connective tissue called elastin. most important structures in terms of reducing resistance to movement & increasing dynamic flexibility. EXCI 252 10 Muscle-Tendon Unit The tension within this unit: affects both static flexibility & dynamic flexibility. is attributed to the viscoelastic properties of connective tissues, degree of muscular contraction from the stretch reflex. EXCI 252 11 Muscle-Tendon Unit Elastic deformation of the muscle-tendon unit (MTU) is proportional to the load or tension applied during stretching. Viscous deformation of the MTU is proportional to the speed at which the tension is applied during stretching. During fixed length static stretching the tension (tensile stress) within the MTU decreases over time, which is called viscoelastic stress relaxation. A single static stretch sustained for 90 s produces a 30% increase in viscoelastic stress relaxation. decreases muscle stiffness for up to 1 hour. EXCI 252 12 Factors Affecting Flexibility Body Type Age Gender (Sex) Physical Activity Level Warm-Up Amount of Stretching & Flexibility Training EXCI 252 13 Body Type Bodybuilders large hypertrophied muscles. may score poorly on ROM tests. Obese Individuals excessive amounts of subcutaneous fat. may score poorly on ROM tests. EXCI 252 14 Age Increased muscle stiffness. Lower stretch tolerance. Decline in physical activity. a primary cause of age-related flexibility loss. Development of arthritic conditions. a primary cause of age-related flexibility loss. EXCI 252 15 Gender Generally, females are more flexible than males at all ages. This gender-related flexibility difference is attributed to: gender differences in pelvic structure, & hormones that may affect connective tissue laxity. EXCI 252 16 Physical Activity Level Habitual Movement Patterns & Lack of Physical Activity are apparently more important determinants of flexibility than age, gender, & body type. Habitual Movement Pattern May restrict ROM because of the tightening & shortening of muscle tissue. Examples Moving the joints & muscles in a repetitive pattern. Jogging. Maintaining habitual body postures. Office worker that sits behind a desk for long periods. EXCI 252 17 Physical Activity Level Lack of Physical Activity is a major cause of inflexibility. Disuse due to a lack of physical activity or immobilization. produces shortening of the muscles & connective tissues. EXCI 252 18 Warm-Up Warm-Up Alone does not increase ROM. Active Warm-Up + Dynamic Stretching Static Stretching or more effective than stretching alone for improving ROM. EXCI 252 19 Amount of Stretching & Flexibility Training Hypermobility often observed in certain athletes. e.g., gymnasts. leads to joint laxity or instability. may increase the risk of musculoskeletal injuries. EXCI 252 20 Assessment of Flexibility Static Flexibility is assessed in field & clinical settings. tests measure ROM directly or indirectly. Dynamic Flexibility testing is limited to the research setting. tests measure the increase in resistance during muscle elongation. equipment is expensive. EXCI 252 21 General Guidelines for Flexibility Testing General warm-up Static stretching before test Performance of the test Administer 3 trials of each test item Select the best score Obtain a flexibility rating from norms Identify weaknesses that need improvement EXCI 252 22 Methods of Measuring Static Flexibility Direct Methods Indirect Methods Goniometer Universal goniometer Digital goniometer Sit-and-Reach Tests Modified Schober Test Electrogoniometer Skin Distraction Test Flexometer Inclinometer EXCI 252 23 Universal Goniometer is a protractor-like device with 2 steel or plastic arms that measures the ROM as the difference between the joint angles in units of degrees at the extremes of a movement. Measuring the ROM at the knee joint. EXCI 252 24 Digital Goniometer Provides a digital ROM. Measuring the ROM at the elbow joint. EXCI 252 25 Electrogoniometer is composed of 1 or 2 flexible potentiometers, or strain gauges, between 2 end-blocks. Measuring the ROM at the elbow joint. EXCI 252 26 Electrogoniometer Advantages of Electrogoniometers Over Goniometers & Digital Goniometers Are flexible. Easier to use because the technician’s hands are free. Measurements can be made in 2 planes simultaneously when using a 2-channel electrogoniometer. EXCI 252 27 Leighton Flexometer is a device composed of a weighted 360-degree dial & weighted pointer that measures the ROM for a given joint in relation to the downward pull of gravity on the dial & pointer. Measuring the ROM at the elbow joint. EXCI 252 28 Inclinometer is another type of gravity-dependent goniometer that measures the angle between the long axis of the moving segment & the line of gravity. Double inclinometer technique used to measure lumbosacral flexion. EXCI 252 29 Inclinometer is easier to use than the flexometer & universal goniometer because it: is held by hand on the distal end of the moving body segment during the measurement. doesn’t have to be aligned with specific bony landmarks. EXCI 252 30 Average ROM Values for Healthy Adults EXCI 252 31 Validity & Reliability of Direct Measures of ROM The validity & reliability of devices such as goniometers & inclinometers that measure ROM directly are highly dependent on: the joint being measured, & technician skill. Radiography: is considered to be the best reference method for establishing the validity of goniometric measurements (universal goniometers & double-inclinometer technique). EXCI 252 32 Validity & Reliability of Direct Measures of ROM The intratester & intertester reliabilities of goniometric measurements are affected by: Difficulty in identifying the axis of rotation, & Palpating bony landmarks. Measurements of upper extremity joints Generally, more reliable than ROM measurements of lower extremity joints. EXCI 252 33 Validity & Reliability of Direct Measures of ROM Intertester reliability of inclinometer measurements is variable & joint specific: Lumbar extension (reliability coefficient = 0.48) Subtalar joint (reliability coefficient = 0.96) Knowledge & skills required to obtain accurate & reliable ROM measurements: Knowledge of anatomy Knowledge of standardized testing procedures Training & practice EXCI 252 34 Sit-and-Reach Test is included in most health-related fitness test batteries. Why? The belief that lack of flexibility is associated with low back pain & musculoskeletal injuries. EXCI 252 35 Sit-and-Reach Test provides an indirect, linear measurement of the ROM. used to evaluate the static flexibility of the lower back & hamstring muscles. however, research indicates it is not a valid measure of low back & hamstring flexibility. has poor criterion-related validity. is unrelated to self-reported back pain. should be limited to identifying individuals at the extremes of flexibility who may have a higher risk of muscle injury: Hypermobility, Lack of flexibility in the hamstring muscles. EXCI 252 36 CSEP Sit-and-Reach Test Protocol Warm-up before the test: Perform the modified Hurdler’s stretch. Twice on each leg, hold the stretch for 20 seconds. Measurement: Sit-and-Reach box with a zero point = 26 cm. Client sits on floor with legs fully extended, without shoes. Balls of the feet rest against the upper crossboards. Inner edge of the feet must be 6 inches apart. With legs fully extended, arms evenly stretched with palms down & hands together, clients bend & reach forward to push the sliding marker forward along the scale with the fingertips as far as possible. EXCI 252 37 CSEP Sit-and-Reach Test Protocol Measurement: The flexed position must be held for 2 seconds. Instruct clients to concentrate on pushing the sliding marker forward & to lower the head & exhale to maximize the distance reached. If the knees flex, the trial is not counted. Do not attempt to hold the knees down & do not allow the client to use a bouncing or jerking motion. Record both trials to the nearest 0.5 cm & use the highest score to determine the Health Benefit Rating. If the client is unable to reach the mark on the flexometer, measure the distance from the fingertips to the ‘0’ mark. This can be used later in goal setting: e.g., to reach the mark upon re-assessment. (McHugh et al., 2010; CSTF, 1987) EXCI 252 38 CSEP Sit-and-Reach Test Health Benefit Rating Age Rating Male Fema le Age Rating Male Femal e 1519 Excellent Very good Good Fair Poor ≥ 39 34-38 29-33 24-28 ≤ 23 ≥ 43 38-42 34-37 29-33 ≤ 28 4049 Excellent Very good Good Fair Poor ≥ 35 29-34 24-28 18-23 ≤ 17 ≥ 38 34-37 30-33 25-29 ≤ 24 2029 Excellent Very good Good Fair Poor ≥ 40 34-39 30-33 25-29 ≤ 24 ≥ 41 37-40 33-36 28-32 ≤ 27 5059 Excellent Very good Good Fair Poor ≥ 35 28-34 24-27 16-23 ≤ 15 ≥ 39 33-38 30-32 25-29 ≤ 24 3039 Excellent Very good Good Fair Poor ≥ 38 33-37 28-32 23-27 ≤ 22 ≥ 41 36-40 32-35 27-31 ≤ 26 6069 Excellent Very good Good Fair Poor ≥ 33 25-32 20-24 15-19 ≤ 14 ≥ 35 31-34 27-30 23-26 ≤ 22 EXCI 252 39 Sit-and-Reach Tests Test Equipment Stretch Start Standard Box Both legs simultaneously 26 cm V or YMCA Yardstick Both legs simultaneously 38 cm Modified Box Both legs simultaneously Relative Back-Saver Box One leg at a time 26 cm Modified Back-Saver Bench One leg at a time 26 cm Chair Folding Chair One leg at a time NA EXCI 252 40 Sit-and-Reach Tests Test Test Appropriateness Modified Used to account for a bias due to limb-length differences. Back-Saver Devised to relieve some of the discomfort caused by the compression of the anterior portions of the vertebrae during the performance of the Standard, Modified, & V Sit-and-Reach tests. Modified Back-Saver Some participants may complain about the uncomfortable position of the untested leg when performing the Back Saver Sit-and-Reach test. Chair This test is intended for many older individuals that have difficulty performing sit-and-reach tests because functional limitations prevent them from getting down to & up from the floor. EXCI 252 41 Modified Sit-and-Reach Test A yardstick is placed on top of the box with the zero end toward the client. The relative zero point is established for each client. EXCI 252 42 Back-Saver & Modified Back-Saver Sit-and-Reach Tests Back-Saver Sit-&-Reach Test Modified Back-Saver Sit-&-Reach Test EXCI 252 43 Alternatives to the Sit-and-Reach Test Double-Inclinometer Technique assesses low back fitness. measures lumbar ROM directly. Modified Schober Test & Skin Distraction Test assesses low back fitness. measures lumbar ROM indirectly. EXCI 252 44 Skin Distraction Test Midline of lumbar spine. 15-cm mark 0-cm mark Assesses low back flexibility. EXCI 252 45 Flexibility Testing of Older Adults Senior Fitness Test developed by Rikli & Jones (2013). includes 2 measures of flexibility for older adults: Chair Sit-and-Reach Test Back Scratch Test EXCI 252 46 Chair Sit-and-Reach Test Assesses lower body (hamstring) flexibility. EXCI 252 47 Back Scratch Test Assesses upper body (shoulder joint) flexibility. EXCI 252 48 Lumbar Stability Tests Lumbar instability increases the risk of developing low back pain. Primary muscle groups responsible for stabilizing the lumbar spine: Trunk extensors (erector spinae), Trunk flexors (rectus abdominis & abdominal oblique muscles), & Lateral flexors (quadratus lumborum). EXCI 252 49 Lumbar Stability Tests Sorensen Test Measures isometric endurance of trunk extensors. V-Sit Test Measures isometric endurance of trunk flexors. Side Bridge Test Measures isometric endurance of lateral flexors. EXCI 252 50
