Chapter 6 – Flexibility
Improving Range of Motion
Dawn Markell and Diane Peterson
Joint ROM results from a combination of factors, which are classified as either internal or external. Internal structures relate to the physical structures of body materials and tissue. External factors are non-structural and include gender, age, excess fat mass, muscle mass, environmental temperature, and restrictions in clothing or equipment.
Internal factors include joint structure/joint mechanics and the connective and soft tissue surrounding the joint. Because muscular actions, such as muscular contractions and stretching, are controlled by the nervous system, another internal factor can be attributed to the neuromuscular system and how the stretching and tension is managed.
Joint Structure
A joint is defined as a location on the skeletal system where two or more bones intersect and interact. For example, the humerus (upper arm) intersects with the radius and ulna (lower arm) at the point of the elbow. The bony formation of each joint structurally limits its ROM. For example, the shoulder joint, which is structurally a ball-in-socket joint, can rotate in multiple directions, giving it a wide range of motion. However, the knee joint is a modified hinge joint, which is limited to essentially a forward-backward direction of movement.
Additionally, ROM may be limited by excessive fat mass or even large muscle mass surrounding a particular joint. Although the amount of muscle mass and fat mass surrounding a joint can be altered by diet and activity levels, joint structure is permanent. As a result, little can be done to improve flexibility in this area.
Not only is range of motion related to the joint structure, but flexibility exercises are joint-specific. Stretching the hamstring will not improve flexibility in the shoulders. Likewise, flexibility in the shoulders may be excellent while fingers or ankles remain “stiff.” As such, a complete and effective stretching program includes multiple stretches for various joints.
Connective and Muscle Tissue
Joints are surrounded and connected by muscles, tendons, ligaments, and skin. The head of the humerus fits into a small cavity to create the shoulder joint. However, those bones cannot remain in that position without the muscles, tendons, and ligaments that keep the joint tight and hold it in place. In addition, muscle tissue is surrounded with connective tissue, primarily collagen and elastin. As a joint moves through its normal range of motion, all of this soft tissue must stretch to accommodate the movement. Therefore, static and dynamic flexibility is probably most limited by the flexibility of the surrounding soft tissue, specifically the connective tissue.
Neuromuscular System
Modern cars come equipped with a central computer and sensors to troubleshoot problems with the vehicle. Sensors in the engine monitor temperature. Sensors on the wheels gauge tire pressure while sensors in the gas tank alert the driver when fuel is low. Much like a car, our bodies are equipped with sensors, called proprioceptors, that help us manage movement and prevent injury.
Muscles have two specific types of proprioceptors that determine the length and tension of the muscle. These proprioceptors are called muscle spindles and Golgi tendon organs (GTOs).
Muscle spindles lie parallel to the regular muscle and help determine the length of muscles when they are being stretched. When a muscle is stretched, it sends signals to the central nervous system causing the stretched muscle to contract. This resistance to the stretch, called the myotatic or stretch reflex is generated by the nervous system’s reflexive stimulus sent to the stretching muscle. That same signal also causes the antagonist, or opposing muscle to relax, called reciprocal inhibition. As such, when the upper thigh muscles (quadriceps) are stretched, the hamstrings (antagonist to the quadriceps) relax.
The GTOs are located near the musculotendon junction, the end points of the muscle, and relay messages to the central nervous system regarding muscle lengthening and tension of the muscle. When activated, these signals will override the stretch reflex causing a sudden relaxation of the stretching muscle. This is called autogenic inhibition or the inverse myotatic reflex. This inhibitory reflex can only occur after the muscle has been stretched for 5 seconds or longer. This is why, to effectively stretch, movements must be sustained for long, slow increments of time. Otherwise, the resistance encountered from the stretch reflex will not be overridden and lengthening cannot occur. Whether signaling the muscles to contract or relax, the neuromuscular system manipulates the stretched muscle, presumably as a protective mechanism to prevent injury.