What is it?
Flexibility is the ability to move muscles and joints through a completely normal range of motion (ROM). Flexibility aids performance and posture, promotes efficient movements, prevents improper body alignment, maintains proper muscle length and balance, and also reduces the risk of injury.
Types of flexibility:
1. Static: Ability to assume and maintain a position with full range of motion about a joint. Static-active is unaided; static-passive is supported.
2. Dynamic (functional): ability to perform full ROM of the joints during movement
For athletes, flexibility can improve performance in sport-specific skills.
Factors that influence flexibility
• Joint structure: determines how much room the joint has to move.
• Muscle Imbalance: An imbalance in muscle strength and length will reduce flexibility due to uneven pull of antagonist muscles.
• Muscle control: Lack of strength to control the working muscle during certain movements can limit flexibility.
• Age: Flexibility decreases with age due to changes in connective tissue.
• Gender: Women tend to be more flexible due to structural, hormonal and anatomical factors.
• Connective tissue: tendons, ligaments, fascia and joint capsules influence flexibility. That is why complete training and rehabilitation of connective tissue is important.
• Muscle mass: Muscle hypertrophy can limit flexibility if the muscle-building regimen does not have a corresponding stretching plan.
• Resistance training: Limiting full ROM during strength training can reduce flexibility.
• Activity level: Active people tend to have more flexibility.
Sports medicine evaluation and treatment
A sports medicine doctor will determine your flexibility level and create an activity or exercise prescription with specific exercises and stretches to improve your flexibility. It is important to discuss injuries and rehabilitation with your doctor to achieve safe and effective stretching regimens. Physical examination to assess the degree of flexibility will be assessed in clinic.
If there is a clinical cause causing decreased flexibility during evaluation, further testing may be considered to identify any musculoskeletal problems that may be preventing you from maintaining or improving your flexibility. The doctor will also examine whether there are signs of hypermobility or joint laxity that may appear as increased flexibility but could pose a threat to possible injury in the future.
Flexibility and stretching programs can maximize sports performance and improve athletic ability to sustain physical activity.
Types of Stretching Exercises to Improve Flexibility and Performance:
1. Static: Hold a single position for at least 15-20 seconds. Perform this stretch after exercise or after the muscles have warmed up.
2. Dynamic: Stretching through movements during warm-up. Can be changed to be sport specific.
3. Ballistic: Stretching during explosive or jumping movements. There are mixed reviews about the real benefits of this form of stretching.
4. Proprioceptive neuromuscular facilitative stretching: includes concentric, eccentric and isometric muscle movements with passive stretching. This type is good for neuromuscular training.
Prevention of injuries
To improve flexibility and reduce injuries, stretching is most effective and safe after the muscles have warmed up. Stretching with cold or stiff muscles may be less helpful in improving flexibility. Proper stretching can be done alone, with a partner, or formally with a trained medical professional (i.e., physical therapist, athletic trainer). The doctor works closely with the medical team to create individualized plans to help improve flexibility in strength, injury prevention and coordination. With hypermobility, strength and conditioning regimens can be developed to improve the muscles surrounding a joint and reduce the chance of injury.
Return to play
Evaluating flexibility after an injury will help the medical team personalize rehabilitation goals for each athlete. The goal is to return to play at full capacity with basic movement, strength and flexibility to reduce the chance of re-injury.
Authors who are members of AMSSM
Tu Dan Kathy Nguyen, MD and Mark Chassay, MD
References
1. Ratamess NA. ACSM's foundation for strength training and endurance training. Chapter 10: Warm-up and flexibility. Philadelphia. Wolters Kluwer Health/Lippincott Williams & Wilkins; 2012.
2. Jeffreys I. Warm-up and stretching. In: Baechle TR, Earle RW, editors. Basics of strength training and conditioning. 3rd edition. Champaign (IL): Human Kinetics; 2008. p. 295324.
3. Alter, M.J. (1996). Science of flexibility (2nd ed.). Champaign, IL: Human Kinetics
