Chapter 6
Flexibility
Copyright © 2010 American College of Sports Medicine
Flexibility
y
The functional capacity of the joints to move through a full
range of motion (ROM)
Gold standard
standard—laboratory
laboratory assessment of the ROM of a
specific joint
Copyright © 2010 American College of Sports Medicine
Range
g of Motion Terms Defined
• Active Range of Motion
• Passive
P
i
R
Range off Motion
M i
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Unique
q
Assessment Principles
p
• Comprehensive assessment is
impossible—too many joints
• M
Measurementt off each
h joint
j i t is
i
unique
– Eliminates the possibility of
a singular test
• Warm-up—necessary before
assessing flexibility
– Whole-body aerobic
exercises
– Passive stretching and
ROM exercises
i
Copyright © 2010 American College of Sports Medicine
Methods of Measurement
• Visual measurement
• Changes
Ch
in
i distance
di
• Device measurement—assess ROM
– Goniometer—most common device
used
Copyright © 2010 American College of Sports Medicine
Visual Measurement
• Largely inaccurate
• Good
G d ffor gross deficiencies
d fi i
i and
d gains
i
• May be observed at very large or small joints
• Especially useful for locations where a goniometer would
not work easily
– Spine
– Fingers
– Toes
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Distance Tests:
Sit-and-Reach Test
• Most widely used flexibility test in physical fitness
programs
• Theorized association of poor flexibility with low-back
pain and injury
Copyright © 2010 American College of Sports Medicine
Distance Tests:
Sit-and-Reach Test
Procedures for the YMCA sit-and-reach test
1.Starting
1
Starting at 15
15-inch
inch mark,
mark participant sits with legs
extended. Heels should touch the edge of the taped line
and be about 10–12 inches apart
2.The
2
Th participant
ti i
t reaches
h slowly
l l fforward
d with
ith b
both
th h
hands,
d
holding the farthest position approximately 2 seconds.
Hands should be even at all times
3.The score is the most distant point (in centimeters or
inches) reached with the fingertips. The best of two trials
should be recorded
Copyright © 2010 American College of Sports Medicine
Distance Tests: Sit-and-Reach Test
• Using a Sit-and-Reach Box
Copyright © 2010 American College of Sports Medicine
Distance Tests:
Assessment of Lumbar Flexion
• Seated with pelvis stabilized
• Tape is positioned with zero
at the spinous process C7
• Measure down the SI
• Lumbar flexion performed
until first sign of resistance
• Average healthy range: 4inch increase
Copyright © 2010 American College of Sports Medicine
Distance Tests:
Assessment of Lumbar Extension
• Same body and tape position
as for flexion assessment
• Lumbar extension is
performed until first sign of
resistance
• Average healthy range: 2inch increase
Copyright © 2010 American College of Sports Medicine
Range
g of Motion
• The amount of available motion, or arc
of motion, that occurs at a specific
j i t
joint
• Assessed with body at anatomic start
p
position:
– Body set at 0 degrees of flexion,
extension, abduction, and
adduction
– Can be assessed actively or
passively
• HRPF assessments are always
l
active
Copyright © 2010 American College of Sports Medicine
Range
g of Motion
Factors influencing flexibility
• Age
A
(tendency
(
d
to decrease
d
with
i h age in
i adults)
d l )
• Gender
• Previous joint injury
• Specific diseases (e.g., arthritis)
Copyright © 2010 American College of Sports Medicine
Range
g of Motion: Goniometers
• Fulcrum centered to
identified anatomic landmark
• Stabilization arm remains
fixed (establishes the start
p
position)
)
• Movement arm moves in
relation to client’s movement
(establishes the ending
position)
Copyright © 2010 American College of Sports Medicine
ROM Assessment
Before beginning
• Provide
P
id the
h client
li
with
ihad
demonstration
i
off an ROM test
• Position the goniometer
– Locate the fulcrum at the joint axis or hinge point
• Where the axis of rotation occurs for the two body
segments
– Place the stabilization and movement arms
• Centered along each body segment
Copyright © 2010 American College of Sports Medicine
ROM Assessment
Goniometry is an accurate measure if:
• All anatomic
t
i llandmarks
d
k are id
identified
tifi d
• Joint axis point has been clearly defined
• Body is stabilized in proper alignment
• Client is instructed to move slowly through the proper ROM and
the goniometer is properly aligned
• Test administrator is familiar with normal ROM for each joint
• Observation of whether ROM assessment is pain free occurs
Copyright © 2010 American College of Sports Medicine
ROM Tests
For each assessment, locations of the goniometer for the
following three points are specified:
1. Axis
2. Stabilization arm
3 Movement arm
3.
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Structure: The Shoulder
Movement: Flexion
Goniometer position
Stabilization
1. Fulcrum: Lateral aspect of
greater tubercle
• Client is in good posture with
a stabilized scapula
(retracted) thoracic,
(retracted),
thoracic and
lumbar
2. Stabilization arm:
Perpendicular to the floor
3. Movement arm: Align with
the midline of humerus and
reference the lateral
epicondyle
• Stabilize scapula to prevent
tilting rotation
tilting,
rotation, or elevation
Copyright © 2010 American College of Sports Medicine
Structure: The Shoulder
Movement: Flexion
Starting/ending body position
•
Seated with glenohumeral in 0
degrees of flexion, extension,
abduction,, or adduction
•
Head is in neutral position
•
Palm of hand facing body
•
Elbow completely extended
•
Client performs glenohumeral
flexion until the first sign of
resistance
i t
Average range: 0–180 degrees
Copyright © 2010 American College of Sports Medicine
Structure: The Shoulder
Movement: Extension
Goniometer position
Stabilization
1. Fulcrum: Lateral aspect of
greater tubercle
• Client is in good posture with
a stabilized scapula
(retracted) thoracic,
(retracted),
thoracic and
lumbar
2. Stabilization arm:
Perpendicular to the floor
3. Movement arm: Align with
the midline of humerus and
reference the lateral
epicondyle
• Stabilize scapula to prevent
tilting rotation
tilting,
rotation, or elevation
• Place towel under humerus
to stabilize and align with
acromion process
Copyright © 2010 American College of Sports Medicine
Structure: The Shoulder
Movement: Extension
Starting/ending body position
•
Client is prone on table with
glenohumeral in 0 degrees of
flexion,, extension,, abduction,,
or adduction
•
Head is in neutral position
•
Palm of hand facing the body
•
Elbow is extended completely
•
Perform glenohumeral
extension untill the
h ffirst sign off
resistance
Average range: 0–60 degrees
Copyright © 2010 American College of Sports Medicine
Structure: The Shoulder
Movement: Internal Rotation
Goniometer position
Stabilization
1. Fulcrum: Olecranon process
of the elbow
• Client is in good posture with
a stabilized scapula
(retracted) thoracic,
(retracted),
thoracic and
lumbar
2 St
2.
Stabilization
bili ti
arm:
Perpendicular to the floor
3. Movement arm: Align with
lateral midline of ulna and
reference the ulnar styloid
• Stabilize scapula to prevent
tilting rotation
tilting,
rotation, or elevation
• Place towel under humerus
to stabilize and align with
acromion process
Copyright © 2010 American College of Sports Medicine
Structure: The Shoulder
Movement: Internal Rotation
Starting/ending body position
•
Client is supine on table with
humerus abducted at 90
degrees
g
and elbow is flexed at
90 degrees.
•
Elbow is at 0 degrees of
supination and pronation
•
Client performs glenohumeral
internal rotation until the first
sign of resistance
Average range: 0–70 degrees
Copyright © 2010 American College of Sports Medicine
Structure: The Shoulder
Movement: External Rotation
• Goniometer position and stabilization are the same
as in internal rotation of the shoulder
• Starting position is the same, but the client performs
external rather than internal rotation until signs of
resistance occur
• Average range: 0–90 degrees
Copyright © 2010 American College of Sports Medicine
Structure: The Hip
Goniometer position
Stabilization
1. Fulcrum: Greater trochanter
of the lateral thigh
• Client is in good posture with
a stabilized scapula,
thoracic, lumbar spine, and
pelvic
l i area
2. Stabilization arm: Lateral
midline of the pelvis
3. Movement arm: Lateral
midline of the femur, using
the lateral epicondyle as a
reference
• Pelvis should not rise off
table
• Opposite leg not being
assessed should have knee
flexed and foot flat on table
for added stability and
protection for the back
Copyright © 2010 American College of Sports Medicine
Structure: The Hip
Movement: Flexion (Testing Leg Fully Extended)
• Client is supine on table with
hip in 0 degrees of flexion,
extension, abduction,
adduction, and rotation
• Testing leg has knee fully
extended
• Client performs hip flexion
until the first sign of resistance
or until the pelvis rotates or
knee breaks extension
Average range: 0–90 degrees
Copyright © 2010 American College of Sports Medicine
Structure: The Hip
M
Movement:
t Flexion
Fl i
(Testing
(T ti
K
Knee and
d Hi
Hip Fl
Flexed
d att 90
Degrees)
Starting/ending body position
•
Client is supine on table with
knee flexed at 90 degrees and
hip flexed at 90 degrees; hip is
in 0 degrees of abduction,
abduction
adduction, and rotation
•
Knee is flexed to reduce
contraction of hamstrings
•
Client performs hip flexion until
the first sign of resistance or
until the pelvis rotates
Average range: 0–120 degrees
Copyright © 2010 American College of Sports Medicine
Structure: The Hip
Movement: Extension (Testing
(
Leg Fully
ll Extended)
d d)
Starting/ending body position
•
Client is prone on table with
hip in 0 degrees of flexion,
extension, abduction,
adduction and rotation
adduction,
•
Testing leg has knee fully
extended
•
Client performs hip extension
until the first sign of resistance
or until the pelvis rotates
Average range: 0–30 degrees
Copyright © 2010 American College of Sports Medicine
Structure: The Hip
Movement: Abduction
Goniometer position
Stabilization
1. Fulcrum: Locate at the ASIS
(anterior superior iliac
p
)
spine)
• Client is in good posture with
a stabilized scapula,
thoracic, lumbar spine, and
pelvic area
2. Stabilization arm:
Imaginary horizontal line
connecting axis point ASIS
to the other
othe ASIS
• Stabilize for lateral trunk
flexion on both sides
3. Movement arm: Anterior
midline of the femur, using
the midline of the patella as
a reference
Copyright © 2010 American College of Sports Medicine
Structure: The Hip
Movement: Abduction
Starting/ending body position
•
Client is supine on table with
hip in 0 degrees of flexion,
extension, and rotation
•
Testing leg has knee fully
extended
•
Client performs hip abduction
until the first sign of resistance
or lateral trunk flexion occurs
on either side
Average range: 0–45 degrees
Copyright © 2010 American College of Sports Medicine
Structure: The Hip
Movement: Adduction
Goniometer position
Stabilization
1. Fulcrum: Locate at the ASIS
(anterior superior iliac
p
)
spine)
• Client is in good posture with
a stabilized scapula,
thoracic, lumbar spine, and
pelvic area
2. Stabilization arm:
Imaginary horizontal line
connecting axis point ASIS
to the other
othe ASIS
3. Movement arm: Anterior
midline of the femur, using
the midline of the patella as
a reference
• Opposite leg not being
tested should be abducted
fully to allow for testing hip
to be assessed
Copyright © 2010 American College of Sports Medicine
Structure: The Hip
Movement: Adduction
Starting/ending body position
•
Client is supine on table with
hip in 0 degrees of flexion,
extension, and rotation
•
Testing leg has knee fully
extended
•
Client performs hip adduction
until the first sign of resistance
or lateral trunk flexion or pelvic
rotation occurs
Average range: 0–30 degrees
Copyright © 2010 American College of Sports Medicine
Summary
y
• Flexibility is an important component of
health related physical fitness
health-related
• Basic measurements can be taken in a
relatively
elati el short
sho t period
pe iod of time and with
ith
inexpensive equipment
Copyright © 2010 American College of Sports Medicine