EXCI252Ch10AssessingFlexibilityF2023 (2).pptx

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