*4.9. Flexibility Training*

14 

Flexibility has been described as the intrinsic ability of body tissue to move a joint through its complete range of motion without causing injury [12]. In practice, it is executed by sports participants and plays a key role in performing the activities of daily living (e.g., reaching, turning). Many factors impact the range of motion, including the distensibility of the joint capsule, whether an adequate warm-up has been used, and muscle viscosity. Moreover, level of physical condition, age, and training parameters also affect flexibility performance [93]. Flexibility training (stretching) is typically recommended 2–3 times a week and should involve the shoulder girdle, neck, trunk, lower back, hips, and legs (Figures 14–17).

**Figure 14.** Upper back stretch. Source: Photos by authors.

Figure 15. Quadriceps stretch. Source: Photo by authors. **Figure 15.** Quadriceps stretch. Source: Photo by authors. Figure 15. Quadriceps stretch. Source: Photo by authors.

Figure 16. Calf muscle stretch. Source: Photo by authors. Figure 16. Calf muscle stretch. Source: Photo by authors. **Figure 16.** Calf muscle stretch. Source: Photo by authors.

130

Figure 17. Hamstring muscle stretch. Source: Photo by authors. **Figure 17.** Hamstring muscle stretch. Source: Photo by authors.

Stretching a chest is contraindicated for a three months after cardiac surgery. There are several types of flexibility exercises (dynamic, static proprioceptive neuromuscular facilitation stretches). Active static stretching is executed by holding a position using the contraction of agonist muscle(s), whereas during passive static stretching the position is held without the involvement of agonist muscles—e.g., using another person or a stretching aid. During dynamic stretching, stretching is performed with a slow movement, and, through repeated movements, a progressive increase in the range of motion is attained. The proprioceptive neuromuscular facilitation technique includes an isometric contraction component (20–70% maximal voluntary contraction held for a few seconds), followed by a 10–30 sec static stretch. During flexibility training, one stretch is typically held for 10–30 s to the point of tightness or slight discomfort [8,12]. Holding a stretch for 30–60 s may be more beneficial in older patients [1,12]. Typically, stretching sessions last Stretching a chest is contraindicated for a three months after cardiac surgery. There are several types of flexibility exercises (dynamic, static proprioceptive neuromuscular facilitation stretches). Active static stretching is executed by holding a position using the contraction of agonist muscle(s), whereas during passive static stretching the position is held without the involvement of agonist muscles—e.g., using another person or a stretching aid. During dynamic stretching, stretching is performed with a slow movement, and, through repeated movements, a progressive increase in the range of motion is attained. The proprioceptive neuromuscular facilitation technique includes an isometric contraction component (20–70% maximal voluntary contraction held for a few seconds), followed by a 10–30 sec static stretch. During flexibility training, one stretch is typically held for 10–30 s to the point of tightness or slight discomfort [8,12]. Holding a stretch for 30–60 s may be more beneficial in older patients [1,12]. Typically, stretching sessions last for 10–15 min. It is important to perform flexibility training after warm-up when the muscle temperature is increased. As stretching may result in an immediate, short-term muscle strength decrease, a flexibility session should not be directly performed prior to resistance training. Regular stretching has been shown to help prevent musculotendinous injuries [94].

131

for 10–15 min. It is important to perform flexibility training after

The ACSM and AACVPR flexibility recommendations are summarized in Tables 37 and 38.


**Table 37.** ACSM flexibility training recommendations [12].

Source: Adapted from [12].

**Table 38.** AACVPR flexibility training recommendations [1].


Abbreviations: AACVPR—American Association of Cardiovascular and Pulmonary Rehabilitation. Source: Adapted from [1].
