Flexibility programs play an important role in athletic success

By Scott Huelskamp

Ask athletes to pinpoint the most important aspect of a prepractice or pregame routine, and you're bound to get a long list of answers.

Check the equipment one more time. Eat a carbohydrate-heavy meal. Review the game plan. Visualize what you want to happen on the court. Tighten the shoelaces.

Addressing flexibility and stretching may not even make the top 10. But it should. In fact, it should be right at the top.

Unfortunately, few athletes identify flexibility and stretching as an integral part of the process. Rather, they see it as an afterthought, something that has to be completed to get to the good stuff–the dunks, jumps, sprints or hits that comprise the more glamorous aspects of athletic competition.

But one step precipitates the other. And a deficiency in one phase—preparation—prevents success in the second phase—the competition. In fact, Scott Pensivy, PT, ATC, estimates that 90 percent of the athletes he treats are tight in some areas and should be on a flexibility program. An athlete who can touch his toes may think his hamstrings are flexible, but it doesn't necessarily mean all his lower extremity muscles have comparable capabilities.

The goal of any flexibility program is simple: Give the joints freedom of motion to prepare athletes for activities they're going to perform. But even if teams at high school, college or professional levels pay attention to flexibility, they may not adhere to the right movements or activate the appropriate muscles, spindles and fibers, say experts.

A big contributor to that problem, Pensivy said, is a strong focus on strengthening programs, at the expense of flexibility and stretching routines. If an athlete doesn't adhere to a flexibility program, but insists on only strength training, "you're just going to strengthen the deformity," said Pensivy, co-owner of Soder-Pensivy Orthopedic Rehabilitation Therapy Sports (S.P.O.R.T.S.) in Las Vegas.

Obviously, strength training has its place. Big and bulky looks good, but aside from football players, it's not the most important component toward continued success in sports such as tennis or golf, or even baseball and basketball.

The theory that flexibility is an innate quality is, for the most part, a myth. Gymnasts' bodies aren't born to sustain pretzel-bending twists. And high jumpers can't automatically contort their backs into a U-shape to clear a 7-foot-high bar. Instead, proficiency is learned, developed, nurtured and maintained, said Pensivy, just like shooting free throws or dribbling a soccer ball.

In time, flexibility produces a list of benefits, such as resistance to muscle injury, soreness and lower back pain, and better posture, joint mobility and circulation. Lack of flexibility, on the other hand, creates a greater susceptibility to overuse injuries, postural stress, pattern overloads and cumulative trauma. In addition, when muscles falter, so do technical skills, core strength and neuromuscular control, said Pensivy.

Joe Dowdell, CSCS, CPT, said stretching actually "resets the nervous system," with range of motion exercises that focus on muscle spindle length, neuroadaptations and tissue compliance. That means balancing muscle mobility with stability, he said.

Developing Flexibility

Athletes usually equate tightness with a lack of flexibility. However, sports medicine clinicians are starting to view poor flexibility as being related to the weakness of the muscles that bring an athlete into a certain joint position, rather than the muscles that prevent it from obtaining that position, said Dowdell, owner of Peak Performance Strength & Conditioning Center in New York City.

For example, some athletes continually stretch their hamstrings, yet never seem to improve flexibility. "If you're trying to improve mobility, then you must make sure the athlete has strength in newly developed ranges of motion," he said, which also means focusing on the strength and stability of the hip flexors and rectus femoris.

A common mistake athletes make is stretching in only one plane—the sagittal plane. But muscles actually work in three planes—sagittal, frontal and transverse—during sports activity. Therefore, sports medicine clinicians must attack the muscle in all three planes during flexibility training.

Even addressing two planes, such as moving the leg forward and backward, isn't good enough because it fails to address the sideward motion (transverse), said Craig Klos, PT, ATC, which is where most injuries occur. "If you're going to ask a muscle to go through three planes, you have to prepare it for three planes," said Klos, co-owner of Sports Rehabilitation and Physical Therapy in Overland Park, KS. (The effectiveness of the three-plane approach, said Klos, was verified through the functional rehabilitation research of Gary Gray, PT, and David Tiberio, PhD, PT, OCS.)

For example, a soccer player may stretch his hamstrings by placing a foot on a bench and moving his chest, head and trunk toward the knee. But to achieve triplanar motion, suggested Klos, he also must rotate the foot and leg inward and outward. This activates the muscles and joints that will be required for sharp cuts and quick starts on the soccer field.

It revolves around functional flexibility to loosen the joints, he added, and knowing why you're doing a specific type of stretch. For instance, athletes may use a common groin stretch, such as sitting with the feet together and leaning forward. But that's not accomplishing much, since it doesn't adequately stretch the muscles in the three planes that are required for the activity, Klos said.

Instead, an athlete should stand with one foot on a bench and the other foot on the ground, with the foot turned outward. The athlete should lean forward and backward, then move his pelvis side to side, and finally rotate the trunk, thus incorporating all three planes of movement to the groin muscles.

Stretches fall into two categories: dynamic (movement) and static (holding a position) flexibility exercises. These two components should be melded into a daily athletic continuum. The typical pathway should start with a light aerobic warm-up, followed by dynamic stretching, then sport-specific activity. Static stretches should cap the activity.

Dynamic Stretching

Dynamic stretching–or dynamic functional motion and movement–involves motion. Typical dynamic stretches put muscles through increased range of motion to gradually warm up body tissues, while simultaneously lengthening them, said Thomas Dompier, MS, ATC, CSCS, a research assistant at Michigan State University in Lansing.

Aerobic activity, such as riding an exercise bike or doing light callisthenics, preps the system for dynamic stretches. Dynamic movements are more applicable for pre-activity and should always follow a warm-up, since warmer tissues are going to be more compliant to impending stretches.

Moving a person dynamically through movements that elongate the muscle in a partially loaded state is more effective to prepare joints and soft tissue for sports activities, said Michael Mullin, PTA, ATC, a staff therapist at HealthSouth in Portland, ME.

Other categories further subdivide these dynamic flexibility activities.

Active stretches. With active stretches, athletes use their own muscle action to bring them into the range, and exceed the static range to strengthen the agonistic muscles. For example, during a supine straight leg raise, activating the rectus femoris and hip flexors will reciprocally inhibit the hamstrings and allow the extremity to move through a greater ROM, said Dowdell.

Some sports medicine clinicians prefer progressive dynamic exercises, in which an athlete gradually increases the speed and difficulty of an exercise. For instance, track athletes can begin with a jog, then move to slow running and cutting, and eventually increase to faster, more complex actions, such as a careoke run (criss-crossing the legs while moving sideways). However, be careful not to fatigue the body during this stage, cautioned Pensivy, since tired muscles have less elasticity and can decrease the ROM used in movements.

For overhead athletes, such as baseball players, dynamic stretching would include moving the arm in a windmill motion. This better prepares the shoulder musculature for throwing motions, said Pensivy.

These microprogressions are also applicable to strength training workouts, said Dowdell, and can gradually increase an athlete up to a workload. Running on a treadmill wouldn't accomplish the necessary warm-up, he said, because it lacks specificity to the workout.

Instead, it's wiser to do three repetitions of leg squats using just the body weight, thus "teaching" the body about the activity and taking it through the range of motion. Then, after moving an athlete to the squat rack apparatus, gradually increase the resistance and have the athlete perform several sets of one to three repetitions until he can reach the predetermined workout load. "You're prepping the body for the chosen range of motion, path of motion as well as progressively teaching it that it's going to be exposed to increasing loads," Dowdell said.

Ballistic stretching. Ballistic stretches use passive momentum, such as repeated bouncing, to exceed the static range of motion. Although commonly used by martial artists, sprinters and ballet dancers, ballistic stretches—and their quick bouncing motions—place excessive pressure on the joints, which is why most sports medicine professionals don't recommend them. They can be effective, however, if the bounces are done slowly and athletes gradually warm up, suggested Dowdell.

Although it places great stress on the tissues, ballistic motions stimulate stretch receptors to counteract the stretch, Dompier said, which prepares the muscles for explosive athletic movements. The potential for rapid flexibility gains exists, but only for people who already have sufficiently high levels of control of the stretch reflex and need greater flexibility during activity. A ballet dancer with her leg up on a barre bouncing down toward her knee will be able to control the motion much better than a 300-pound football player.

Ballistic stretches make it possible for hurdlers to blast out of a starting block and fold their bodies over 3-foot-high barriers. But most recreational athletes have no business even attempting ballistic stretches, said Dowdell. People must remember "that what many athletes are required to do for their sport isn't necessarily good for the general public," said Dowdell.

Proprioceptive neuromuscular facilitation. PNF is more applicable in rehabilitative settings under the watch of a therapist or certified athletic trainer. PNF, originally developed as a method of rehabilitating patients with stroke, focuses on the contract-relax and hold-relax mechanisms to strengthen and stretch muscles. It's a two-person activity, in which one person holds the leg, for example, to elongate the muscles.

PNF enlists the neurological system to decrease the re-activity of the stretch receptors, said Dompier. It's appropriate for joint mobilizations, knee and shoulder rehabilitation, and hamstring injuries. The whole premise, said Dompier, is to use functional motions that incorporate angular as well as rotational components of motion, to put athletes through more normal ROM.

With PNF, a muscle group is passively stretched, then contracted against resistance while in the stretched position. It's then passively stretched again though increased range of motion. This stretch usually requires a partner to provide resistance against contractions and take the joint through increased ROM.

For example, during a contract-relax motion to stretch hamstrings, an athlete lies on his back and brings his leg up to full ROM, then contracts the hamstrings for five to 10 seconds, said Dompier. Then he relaxes the hamstrings and contracts the quadriceps and hip flexor. A PT or ATC helps the athlete bring the leg up into greater hip flexion.

Static Stretching

Static stretches, such as hamstring stretches and splits, are called static-passive stretches. Although they're the traditional mainstay of stretching programs, static stretches don't tax the muscle in a way that mimics activity, said Mullin, which is why these flexibility exercises are more appropriate for cooling down after activity.

However, athletes and teams may make the common mistake of exclusively employing static stretches before participation, creating a false sense of security. With static stretches during pre-game routines, athletes "obtain range of motion but no strength and control," said Dowdell. "They go running down the field with extra range of motion, go to plant and blow a hamstring."

Research theorizes that static stretching before performance can have a negative effect on outcome because "it reduces peak force production of the muscle, reduces rate of force development and may interrupt the afferent loop and lead to injury," Dowdell said.

The gains of static stretching usually last an hour, before the muscles return to baseline levels, Dompier said. Therefore, static stretches aren't effective when a football team goes on the field to stretch 90 minutes to two hours before kickoff, said Dompier.

Static stretches can be as simple as a hamstring stretch or putting a rope around the instep of the foot, pulling and holding in a position. In addition, gravity-assisted static stretches use the body's own weight to accomplish a stretch, such as letting the arm hang off a bench to stretch the pectoral muscle.

However, elite athletes must strive for greater gains and excursion of movements during static stretching, said Klos. For instance, a pro soccer goalie who needs to kick the ball farther than a high school goalie will have to be more diligent with a flexibility program, especially since muscles lose elasticity with age.

But too much flexibility isn't always a good thing. Athletes with exceptionally loose or limber joints, such as dancers, usually don't have the strength and stability to provide adequate support. Excessive flexibility can create hypermobility of a joint, resulting in injury. Therefore, you will have to focus on strength and stability first during recovery, he added.

Also be wary of stretching programs for children, especially pre-teens and adolescents. With young children, be careful not to irritate growth plates while the skeletal system is developing. Between the ages of approximately 6 and 12, children are growing, and their bones and joints are beginning to set and prepare the body for the teen years. Growth plates are still active, and tendons are gradually attaching to bones.

At different points in children's growth, they're going to be more flexible, said Dompier. Most of the time, they're most flexible before a growth spurt or during early adolescence. Therefore, it's safer to focus more on static-passive stretches that cater to a young athlete's own comfortable level of ROM, he said. You also can incorporate dynamic functional movements that focus on fun activities, Klos suggested, such as careoke movements, leg swings and running around cones.

Regardless of age, sports medicine experts should use flexibility and stretching programs to create healthier, more limber athletes. Once athletes see the results and feel less residual stiffness after activity, then they understand the importance of flexibility and stretching, said Dowdell. It doesn't take much to convince athletes. Golfers can drive the ball farther. Marathon runners can lower their time. And tennis players can crank up the speed on a serve.

"All you can hope with your training is to try to maintain the body and prevent it from getting hurt," said Dowdell, "and ultimately give it the necessary tools to improve performance in your sport."

Scott Huelskamp is on staff at ADVANCE and can be reached at shuelskamp@merion.com.

Mobilizing the Nervous System

With their delicate splits and bounding leaps, gymnasts seem to display the perfect balance of flexibility and strength. This balance is essential to all exercise programs, said former gymnast Linda Termine, PT, ATC.

"When you have too much strength without flexibility or vice versa, you put yourself at risk for injury," she explained, noting lower back pain as a common problem.

Those seeking strength and flexibility can turn to Pilates. A blend of Eastern and Western philosophies, Pilates consists of a series of fluid body conditioning movements that concentrate on core strength. Yet, it also simultaneously develops spine flexibility.

Many people have stiff lower backs or extra lodorsis, said Termine, a New York Guild Pilates instructor and owner of Personal Best and Fitness Foundations in West Mount, IL. They can't round their lower back, for instance, when doing a straight leg sit-up. Even worse, traditional exercise methods don't show them how to do so properly. But Pilates, she said, teaches them to peel one vertebrae off the floor at a time when rolling up. This method helps restore normal spine mobility–a vital factor for healthy living.

Pilates helps improve muscle health by teaching people to engage in active stretching, said Termine. This, ultimately, offers more benefits than passive stretching. When you push against the hamstring in therapy, she said, you're stretching the hamstring and sciatic nerve. But when clients stretch the hamstring themselves, she adds, they're also using their quadriceps, which helps lengthen the hamstring even more. "They're coordinating their muscles with one another," Termine explained, "which is how we function in life."

Pilates also offers clients an effective way to stretch out painful, postoperative scar tissue. If a patient has surgery to correct a herniated disk, leftover scar tissue often will stick to the nerves, resulting in excruciating pain. To get rid of it, said Termine, clients need an exercise program that will loosen the scar tissue. Pilates, she said, does the trick. In fact, she said, "Pilates quite eloquently mobilizes the entire nervous system."

–By Tisha Nickenig