Flexibility and Low Back Health

1. FlexibilityandLow Back Health Chapter 5

2. Physical Activity Pyramid

3. Lecture Objectives Define flexibility. Explain benefits of flexibility. Discuss factors that influence one’s level of flexibility. Describe the stretch reflex. State F.I.T.T. principle for flexibility and compare to F.I.T.T. principles for other components of fitness. Explain the three types of stretching and which are recommended for which reasons. Explain what can cause poor posture and low back pain and how to improve poor posture and low back pain.

4. Facts About Flexibility Flexibility is the component of fitness most often neglected Flexibility is joint specific Flexibility is enhanced if the body is warm Engaging solely in a flexibility program will not help shed body fat

5. Definitions Flexibility The ability of a joint to move through its full ROM. Stretch Moving the joint beyond the accustom range of motion (ROM).

6. Benefits of Flexibility and Stretching Exercises Joint health Increase ROM Prevention of low-back pain and injuries Can be performed at anytime and anywhere Lifetime wellness benefits Other potential benefits? Temporary reduction of post-exercise muscle soreness, known as delayed-onset muscle soreness (DOMS) Relief of aches and pains and muscle cramps Improves coordination by allowing for easier movement Improved body position and strength for sports Maintenance of good posture and balance RelaxationTemporary reduction of post-exercise muscle soreness, known as delayed-onset muscle soreness (DOMS) Relief of aches and pains and muscle cramps Improves coordination by allowing for easier movement Improved body position and strength for sports Maintenance of good posture and balance Relaxation

7. What Influences Flexibility? Genetics Joint structure / muscle elasticity and length Lack of use Injury Disease Gender Age

8. Effect of Stretch on Connective Tissue

9. Stretch Reflex Maintaining stretch for 15-30 seconds will allow the stretch reflex to subside and permit gains.

10. Assessment of Flexibility Sit & Reach Test Trunk Rotation Back Extension Use of a Goniometer/Flexometer (Kroeger & Kroeger, ACSM)

11. Creating a Successful Program to Develop Flexibility Applying the FITT principle Frequency: 2 – 3 days per week Intensity: 10% beyond ROM (Mild discomfort. Stretching should not be painful.) Time: 15 – 30 seconds and performed 2 – 4 times Type: stretches should focus on major joints (and muscles)

12. Frequency A minimum of 2 – 3 days per week (5 – 7 days/week is ideal) Stretch when muscles are warm Do not stretch before a high-performance activity

13. Intensity 10% beyond ROM (point of slight tension or mild discomfort)

14. Type Static PNF Ballistic

15. Static Stretching Widely recommended Stretch slowly until tension Active / passive assistance Hold stretch for 10-30 sec. Relax the muscle Increase stretch a bit more(developmental stretch)

16. Proprioceptive Neuromuscular Facilitation (PNF) Most effective Combines methods (active and passive) Promotes increase in strength

17. Ballistic Stretching Dynamic movement Uses momentum May be important for athletes Specificity of movement

18. What are the advantages and disadvantages of the different types of stretches? Static stretching Adv: less change of injury; better ROM retention Disadv: more time consuming Ballistic stretching Adv: good for dynamic flexibility Disadv: momentum increases chance of injury; more soreness; increases stretch reflex thus reducing static ROM PNF Adv: makes the best use of proprioceptive information from muscles Disadv: need qualified assistant to perform (Kroeger & Kroeger) Static stretching Adv: less change of injury; better ROM retention Disadv: more time consuming Ballistic stretching Adv: good for dynamic flexibility Disadv: momentum increases chance of injury; more soreness; increases stretch reflex thus reducing static ROM PNF Adv: makes the best use of proprioceptive information from muscles Disadv: need qualified assistant to perform (Kroeger & Kroeger)

19. Recommendationsfor Stretching Relax Breathing Move slowly into the stretch and simultaneously exhale Be aware of posture Concentrate Do not overstretch muscles (Andes, McMillian, ACSM, Fahey)

20. Modified Stretching Programs Variations and the use of equipment/tools can be effective in the improvement of flexibility: Physioball Jump rope, dynaband, exercise pole Foam Roller Yoga/Pilates Movement Prep (Verstegen, Curtis, ACE)

21. Flexibility in Relationto Posture When poor flexibility happens to good people: Increases likelihood of injury Restricts body movement Reduces overall balance and muscular stabilization Contributes to body asymmetry and bad posture Increases risk of low-back pain (Fahey, INOVA)

22. Minimal stress on the vertebral joints and supporting ligaments.Body segments balanced around the center of gravity

23. Flexibility, Posture, & Back Pain Short and tight muscles cause poor posture which leads to back pain

24. Long and strong muscles keep the body in good alignment and reduce risk of back pain

25. Causes of Poor Posture Heredity Poor fitness (muscle strength & endurance) Environmental Influences (work environment) Bad Habits/ Body Mechanics

26. Function of the Spine Structural support Surrounds and protects spinal cord Supports body weight Attachment site for muscles, tendons, ligaments Allows movement of neck and back in all directions

27. Vertebrae andIntervertebral Disk

28. Impactfrom “bad exercises” Certain exercises or movements put the back at risk and should be avoided

29. Common Errors ofBody Mechanics Lifting Carrying Pushing/Pulling Reaching Sitting Posture Sleeping Posture Entering/Exiting Vehicles Picking up objects from low heights

30. Protecting Your Back

31. What can you do to prevent and manage low-back pain? Strengthen the abdominal, lower and upper back, and leg muscles at least 3 days per week Emphasize muscular endurance Do not do full range of motion spine exercises early in the morning Engage in regular endurance exercise Be patient and stick with your program Lose weight, stop smoking, and reduce emotional stress Avoid sitting, standing, or working in the same position for too long Use a supportive seat and a medium-firm mattress Warm up thoroughly before exercise Progress gradually when improving strength and fitness Incorporate “core stabilization” into exercise routine Focus on proper body mechanics during daily activities Strengthen the abdominal, lower and upper back, and leg muscles at least 3 days per week Emphasize muscular endurance Do not do full range of motion spine exercises early in the morning Engage in regular endurance exercise Be patient and stick with your program Lose weight, stop smoking, and reduce emotional stress Avoid sitting, standing, or working in the same position for too long Use a supportive seat and a medium-firm mattress Warm up thoroughly before exercise Progress gradually when improving strength and fitness Incorporate “core stabilization” into exercise routine Focus on proper body mechanics during daily activities

32. Managing Acute Back Pain Sudden back pain usually involves tissue injury Symptoms Treatment Symptoms: Pain, muscle spasms, stiffness, inflammation Treatment: Ice, then heat OTC medication (ibuprofen or naproxen) Moderate exerciseSymptoms: Pain, muscle spasms, stiffness, inflammation Treatment: Ice, then heat OTC medication (ibuprofen or naproxen) Moderate exercise

33. Managing Chronic Back Pain Considered chronic if lasts longer than 3 months Symptoms Treatment Symptoms: Stabbing or shooting pain, steady ache accompanied by stiffness, pain that is localized or that radiates to other parts of the body Treatment: medication, exercise, physical therapy, massage, acupuncture, education, and surgerySymptoms: Stabbing or shooting pain, steady ache accompanied by stiffness, pain that is localized or that radiates to other parts of the body Treatment: medication, exercise, physical therapy, massage, acupuncture, education, and surgery

34. Lecture Summary Define flexibility. Explain benefits of flexibility. Discuss factors that influence one’s level of flexibility. Describe the stretch reflex. State F.I.T.T. principle for flexibility and compare to F.I.T.T. principles for other components of fitness. Explain the three types of stretching and which are recommended for which reasons. Explain what can cause poor posture and low back pain and how to improve poor posture and low back pain.