2Test your knowledge Stretching exercises should be performed At the start of a warm-upFirst thing in the morningAfter endurance exercise or strength trainingC. it’s best to do stretching exercises when your muscles are warm. Stretching muscles before exercise may temporarily reduce their explosive strength and interfere with neuromuscular control.
3Test your knowledgeIf you injure your back, it’s usually best to rest in bed until the pain is completely gone. True or False?FALSE. Prolonged bed rest may actually worsen back pain. Limit bed rest to a day or less, treat pain and inflammation with cold and then heat, and begin moderate physical activity as soon as possible.
4Test your knowledgeIt is better to hold a stretch for a short time than to “bounce” while stretching. True or false?TRUE. “Bouncing” during stretching can damage your muscles. This type of stretching, called ballistic stretching, should be used only by well-conditioned athletes for specific purposes. A person of average fitness should stretch slowly, holding each stretch for 15 – 30 seconds.
5FlexibilityAbility of a joint to move through its normal, full rage of motion.2 types:Static flexibility ability to hold an extended position at one end or point in a joint’s range of motionDynamic flexibility ability to move a joint through its range of motion with little resistance. Involves strength, coordination and resistance to movement.
6What determines flexibility? The flexibility of a joint is affected byStructureMuscle elasticityLengthNervous system regulation
7Joint structure Joint capsule Cartilage Synovial fluid Ligaments Provides support and stability to the jointCartilageSynovial fluidCushions the bones and reduces frictionLigamentsFound on both inside and outside the joint capsuleServe to strengthen and reinforce the joint.
8Joint structureHinge jointBall – and – socket joint
9Muscle elasticity and length Soft tissues limit the flexibility of a jointSkin, muscles, tendons, and ligamentsMuscle tissue is the key to develop flexibilityConnective tissue: provides structure, elasticity and bulkCollagen: white fibers, provide structure and supportElastin: yellow fibers, provide elasticity and flexibilityRegular stretching contributes to flexibility by lengthening muscle fibers through the addition of contractile units called sarcomeres.
10Nervous system regulation Proprioceptors: nerves that send information about the muscular and skeletal systems to the nervous system.Control the speed, strength and coordination of muscle contractions.Proprioceptors adapt very quickly to stretching (or lack of stretching). Frequent training is beneficial for developing flexibilityStretches than involve rapid, bouncy movements can cause injury.Performing a gradual stretch and then holding it allows the proprioceptors to adjust to the new muscle length and to reduce the signals sent to the spine, allowing muscles to lengthen and over time to become more flexible.
11Benefits of flexibility and stretching exercises Joint healthPoor joint flexibility can cause:Abnormalities in joint lubricationJoint deteriorationExpose joint to abnormal stressesGood joint flexibilityPrevents arthritisLessens painIncreases balance and stability
12Benefits of flexibility and stretching exercises Prevention of low-back pain and injuriesLow-back pain is related to poor spinal stabilityStrength and flexibility in the back, pelvis and thighs may help prevent this type of pain.Good hip and knee flexibility protect the spine from excessive motion.Overstretching may decrease the stability of a joint, increasing the risk of injury
13Benefits of flexibility and stretching exercises Relief of aches and painsRelief of muscle crampsRelated to increase electrical activity within the affected muscleImproved body position and strength for sports and life.Lets you assume more efficient body positions and exert force through a greater range of motion.Maintenance of good posture and balanceContributes to body symmetry and good postureRelaxationReduce mental tension, slows breathing rate, reduces blood pressure.
15Creating a successful program to develop flexibility Your goal should be to attain normal flexibility in the major joints.Extreme flexibility causes joint instability which can lead to pain in the back, hips, shoulders and knees.Balanced flexibility provides joint stability and facilitates smooth movement patterns.
16Apply the FITT principle Frequency2-3 days a week – ideally 5-7 days a weekStretch when your muscles are warmPre-exercise stretching decreases muscle strength and performance and disturbs neuromuscular control.
17Intensity and timeSlowly stretch your muscles to the point of slight tension or mild discomfort.Hold the stretch for 15 – 30 secondsTry to stretch a little bit fartherDuring the stretch try to relax and breath easilyRest 30 – 60 seconds between each stretchDo 2-3 repetitions of each stretchA complete flexibility workout usually takes about min.
18Types of stretching techniques Static stretchingEach muscle is gradually stretched and the stretch is held for 15 – 30 seconds.Ballistic stretchingThe muscles are stretched suddenly in a forceful bouncing movement.Recommended only for well trained athletes
19Types of stretching techniques Dynamic (functional) stretchingInvolves moving the joints through the range of motion used in a specific exercise or sport in an exaggerated but controlled manner.
20Types of stretching techniques Proprioceptive neuromuscular Facilitation – PNFUses reflexes initiated by both muscle and joint nerves to cause greater training effectsContract – relax stretching: the muscle is contracted before it is stretched.Contract – relax – contract stretching: begins with the contraction of the muscle to be stretched, then relaxing it and then contracting the opposing muscle (antagonist), finally relaxing the first muscle.
21Types of stretching techniques Passive vs. active stretchingPassive stretchingAn outside force or resistance provided by yourself, a partner, gravity or a weight helps your joints move through their range of motion.Active stretchingA muscle is stretched by a contraction of the opposing muscle
22Exercises to improve flexibility Warm up 5-10 minutes or following an endurance or strength training workoutStretching exercises for major jointsSample programExerciseAreas stretchedHead turns and tiltsNeckTowel stretchTriceps, shoulders, chestFrequency: 2-3 days/week; 5-7 days/week idealIntensity: stretch to the point of mild discomfort, not pain.Time: 15 – 30 seconds, 2-4 timesType of activity: stretching exercises that focus on major joints.Across –the-body and overhead stretchesShoulders, upper back, back of armUpper-back stretchUpper backLateral stretchTrunk musclesStep stretchHip, front of thighSide lungeInner thigh, hip, calfInner thigh stretchInner thigh, hipHip and trunk stretchTrunk, outer thigh, hip, buttocks, lower backModified hurdler stretchBack of thigh, lower backAlternate leg stretcherBack of thigh, hip, knee, ankle, buttocksLower-leg stretcherCalf, soleus, Achiles tendon
23Remember… Improper stretching does more harm than good Understand the different types of stretching exercises and how they affect muscles.Do stretching exercises statically.Do not stretch to the point of pain.Relax and breathe easily as you stretchPerform all exercises on both sides of your body.Increase intensity and duration gradually over time.Stretch when your muscles are warm
24Preventing and managing lower-back pain Back pain can result from sudden traumatic injuries but it is more often the long-term result of weak and inflexible muscles, poor posture, or poor body mechanics during activities like lifting and carryingAny abnormal strain on the back can result in pain.
25Function of the Spine Provides structural support for the body Surrounds and protects the spinal cordSupports much of the body’s weight and transmits it to the lower bodyServes as an attachment site for a large number of muscles, tendons and ligamentsAllows movement of the neck and back in all directions.
26Structure of the Spine Vertebrae Nerve rootVertebraeVertebral body: carries stress of body weight and physical activityBony processes: joints to adjacent vertebrae and attachment sites for muscles and ligaments.Invertebral disks: absorb and disperse the stresses placed on the spine, separate vertebrae from each other.InvertebraldiskVertebralarchVertebralbody
27Structure of the Spine Vertebrae 4 curves 7 cervical 12 thoracic 5 lumbarSacrumCoccyx4 curvesCervicalThoracicLumbarSacral
28Core muscle fitnessMuscles in the abdomen, pelvic floor, sides of the trunk, back, buttocks, hip and pelvis29 musclesStabilize the spine and help transfer force between the upper body and lower bodyDuring dynamic exercise, core muscles work together to produce movement and stabilityWhen specific core muscles are weak or tired, the nervous system steps in and uses other muscles producing abnormal stress on the joints, decreased power and an increase in the risk of injury.
29Causes of back pain Being greater than 34 years Degenerative diseases such as arthritis or osteoporosisFamily or personal history of back pain or traumaSedentary lifestyleLow job satisfactionLow socioeconomic statusSmokingExcess body weightPsychological stress or depressionPhysically hard work: frequent lifting, twisting,bending, standing up or straining in forcedpositionsHigh concentration demands (computerprogramming)Vibrations (truck driving)
30Underlying causesPoor muscle endurance and strength in the core musclesExcess body weightPoor posture and body position when standing, sitting or sleepingPoor body mechanics when performing actions like lifting and carrying or sports movements.
31Symptoms Numbness in the back, hip, leg or foot Radiating pain Loss of muscle functionDepressed reflexesMuscle spasm
32Preventing low back pain Lose weight, stop smoking, reduce stressAvoid sitting, standing or working in the same position for too long.Use a supportive seat and a medium-firm mattressUse lumbar support when drivingWarm up thoroughly before exercisingProgress gradually when attempting to improve strength or fitness.
33Managing back pain Cold treatments Heat treatments AcuteChronicCold treatmentsHeat treatmentsNonsteroidal anti- inflammatory medicationImmediate rest following the onset of back painLimit bed rest to one day and begin moderate physical activity as soon as possibleSee your physician if acute back pain doesn’t resolve within a short time.Low-back pain is considered chronic if it persists for more than 3 monthsPrescription medicationsExercisePhysical therapyMassage, yoga or chiropractic careAcupuncturePercutaneous electrical nerve stimulationPsychological therapy
34LAB ACTIVITIES Assessing muscular endurance for low back health Posture evaluation