June 2016 Issue

Focus on Fitness: Maintaining Flexibility
By Jennifer Van Pelt, MA
Today's Dietitian
Vol. 18 No. 6 P. 54

Flexibility may be the most neglected component of fitness, ignored by many exercisers and athletes in favor of cardiovascular and strength conditioning or refining specific athletic skills—or, just omitted from workouts due to time constraints. But maintaining and improving flexibility is just as important as cardio and strength training and has many associated benefits, including the following:

• increased joint range of motion (ROM) and muscle length;
• improved release of muscle tension and soreness;
• better circulation due to increased blood supply to muscles and joints;
• enhanced postural stability, coordination, and balance (especially when combined with resistance training);
• reduced lower back, neck, and shoulder discomfort and stiffness;
• stress relief and mental/physical relaxation; and
• decreased risk of injury.1,2

Considering all of these benefits, everyone should add flexibility training to their fitness regimen. The American Council on Exercise (ACE) recommends at least 30 minutes of stretching three times per week for flexibility.2 The American College of Sports Medicine (ACSM) recommends flexibility exercises for each of the major muscle-tendon groups at least twice weekly.1

Recently, the importance of flexibility in fitness has been spotlighted by media coverage of professional athletes who are enhancing performance with yoga and Pilates, two flexibility-based exercise modalities. While adding two yoga or Pilates sessions to weekly workouts is a great way to incorporate flexibility training, 30 to 60 minutes of yoga or Pilates may not fit into the busy exerciser's schedule. Adding just a few minutes of stretching after every workout or at the end of the day can provide benefits and help accumulate the time and effort recommended by ACE and ACSM.

There are several different types of stretching, categorized by movement and position of the stretching muscles and joints.

• Static stretching, the most popular type, involves holding a particular position with the muscle/joint at maximum ROM (the point where mild tension or discomfort, but not pain, is felt) for up to 60 seconds. Props, like a wall, strap, or partner, can be used to assist with static stretches. For many years, it was believed that static stretches should be performed before exercising to "loosen up" or prevent injuries. However, research has demonstrated that using static stretching as a warm-up didn't provide such benefits, and actually may result in muscle injury. But, static stretching when the body and muscles are fully warmed up, such as after a workout or about five to 10 minutes of light activity, provides the most benefits. Static stretching can be active or passive. An active static stretch involves holding the stretch using the strength of the agonist (opposing) muscle; many yoga poses are active static stretches.1 For example, the cat pose in yoga stretches the lower back muscles by contracting the opposing abdominal muscles. In passive static stretching, the stretching position is held with or without the use of a prop or by using gravity.1 An example of a passive static stretch is a seated hamstring stretch with one or both legs extended. While exhaling, slowly bend forward over the leg(s) to maximum ROM, then hold for 30 seconds. A strap can be looped around the balls of the feet and held with the hands, pulling slightly forward to assist with the stretch.

• Dynamic stretching is now recommended as part of a warm-up to workouts or athletic activities. This type of stretching involves the use of continuous, controlled movements performed through a full ROM, and increases ROM and core body temperature. Examples of dynamic stretches include unweighted squatting, single leg alternating lunges, knee lifts or high knee walking in place, pushing and pulling arms with no resistance, full arm circles from the shoulder, arm swinging, and twisting movements through the waist. The most effective dynamic stretches mimic movements in the upcoming workout or sport, serving as a "dress rehearsal" for muscles and joints.1,2

• Proprioceptive neuromuscular facilitation (PNF) stretching methods (also called contract-relax stretching) involve an isometric contraction of a selected muscle-tendon area followed by a static stretch of the same muscle group. Physical therapists or sports medicine professionals commonly use PNF stretching to improve performance and aid in rehabilitation.1

• Ballistic stretching involves bouncing with repetitive movements that take the ROM of the stretch beyond the joint's or muscle's normal ROM.1,2 This type of stretching became very popular in the late 1970s and early 1980s when dance-based aerobics classes were introduced, and stretches were bounced to the beat of music. Because they create too much tension and trauma for the muscles and joints being stretched, ballistic stretches aren't recommended for the average exerciser. However, athletes in sports with ballistic movements may perform supervised ballistic stretching.1

• Myofascial release can be performed with hand or foam roller massage, and is used to release tension from trigger points and help muscles recover after athletic activity. Read more about myofascial release and foam rolling in the October 2015 Focus on Fitness column, "Foam Roller Workouts."

Advice for Clients
Dietitians should recommend flexibility training to all clients, regardless of their fitness level or medical condition. Even those confined to a bed or wheelchair can do some kind of stretching exercises modified for their movement limitations. In general, clients should adhere to the following guidelines when beginning flexibility training:

• Never perform stretching with "cold" muscles. Muscles that aren't warmed up are more easily strained or torn when stretched. Five to 10 minutes of light activity with dynamic stretching should be performed before static stretching. Muscles also may be stretched statically right after a hot bath or shower or moist heating.
• Stretch all the major muscle areas of the body—neck, shoulders, and upper back; arms; legs; lower back; and abdominals. Don't forget some gentle spinal twist stretches to maintain spinal rotational ability and core muscle flexibility.
• Hold static stretches for 10 to 30 seconds. Relax, and then repeat the same stretch two to four times. Older individuals may benefit from longer holds up to 60 seconds.1
• Integrate strength training and stretching into one workout. In between strength exercises, perform dynamic and/or static stretches.
• Always stretch after any cardiovascular or strength training workout. Perform static stretches for all major muscle groups, with extra stretches focused on areas that were worked the most.
• For stress relief, coordinate stretching with long slow exhalations and slow breathing while holding the stretch. Don't hold the breath when stretching—breathe normally or even slower than normal.
• Try yoga or Pilates classes suitable for fitness level. Many beginning yoga and Pilates classes can be physically challenging because instructors assume attendees are in good physical condition but just unfamiliar with yoga or Pilates movements. Clients should let instructors know about any movement limitations and ask for modifications if needed. Any class labeled as "gentle" should be appropriate for all fitness levels.
• Never bounce or "pulse" stretches due to risk of injury. Dynamic stretching shouldn't be confused with ballistic stretching. Dynamic stretches always are controlled, with fuller ROM and no bouncing or pulsing.
• Stretching should never cause pain. If a stretch hurts, reduce the ROM. Clients may feel tension or stiffness, even some discomfort, but never pain.
Flexibility keeps us functional as we age, so remind clients of the importance of incorporating flexibility training into their fitness activities.

— Jennifer Van Pelt, MA, is a certified group fitness instructor and health care researcher in the Reading, Pennsylvania, area.

References
1. Garber CE, Blissmer B, Deschenes MR, et al. American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc. 2011;43(7):1334-1359.

2. Flexibility benefits. American Council on Exercise website. http://www.acefitness.org/fitness-fact-article/2610/flexible-benefits/. Accessed April 12, 2016.