Stretching, M.

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Stretching: Kinesiological Aspects

(By Mark Bailey, PhD, CSCS, NSCA-CPT)

Flexibility as a component of physical fitness has received more attention

recently since the publication of the updated ACSM positional statement
on fitness and flexibility 1.

The inclusion of recommendations for flexibility exercise in this position

stand is based on growing evidence of its multiple benefits including;
improving joint ROM and function and in enhancing muscular
performance. (Guidelines, 2000 ,p 984)

Regular stretching has also recently been associated with a lower incidence of
painful muscular cramps associated with exercise 2. In fact, regular
stretching has been suggested as a more effective preventative than
attention to electrolyte and fluid imbalances.

Caveat: It is nevertheless important to note that the scientific data needed for
precise exercise prescription for health related flexibility are still lacking. It is
generally agreed that a lack of flexibility in the pelvic region (hamstrings, hip
flexors, lower back) is associated with a higher incidence of back problems.
However, patterns in areas such as the shoulders are more elusive. It makes
intuitive sense that tight shoulders may predispose to shoulder problems and a
lack of evidence may not mean a lack of an effect in this case.

On a basic level, stretching is done to both chronically enhance flexibility and

also to acutely enhance joint range of motion (ROM) for performance. The basic
types of stretching include:

I. Ballistic vs Static

A. Ballistic, or stretching with a bouncing, bobbing or ballistic motion.

Ballistic stretching probably will enhance flexibility.

1. In sports with rapid ballistic movements, many argue that the final
stretches should be ballistic.

2. On the other hand, there are arguments against ballistic stretching.

For one thing, injury is more likely; the more rapidly tissue is
stretched, the higher are the chances of it rupturing.

1
ACSM Position Stand on the Recommended Quantity and Quality of Exercise for Developing and
Maintaining Cardiorespiratory and Muscular Fitness and Flexibility in Adults. Med Sci Sports
Exerc,
Vol 30(6): 975-991.
2
Schwellnus, MP, Derman, EW, & TD Noakes. (1997). Aetiology of skeletal muscle cramps during
exercise: a novel hypothesis. J. Sports Sci. Vol 15(3): 277-285.
Stretching, M. Bailey, PhD 2
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3. Secondly, it engages the stretch reflex causing an increase in
muscle tension in the agonist which is counter to obtaining the best
stretch. If used, ballistic stretches should be graded; start easily and
slowly increase speed and intensity.

B. Static, in which a stretch is done slowly and held (often for 10 to 30

seconds). There is general agreement that such stretching is safer and
more effective for the optimal enhancement of range of motion.

1. Disciplines such as Hatha Yoga have used static stretching for

centuries (unfortunately, some of their stretching movements are
questionable).

2. Gradual static stretching should also slowly increase tension in the

muscle tendons eventually stimulating the Golgi Tendon Organs to
fire, relaxing the muscle being stretched and possibly causing the
antagonist to contract, both of which should increase the stretch
efficiency.

3. However, some advocate one caution; it is claimed that in sports

with ballistic actions one should not do static stretches to the total
exclusion of ballistic stretches.

II. Passive vs Active Stretching

A. Passive stretching/flexibility describes a situation in which an individuals

limb or body segment is moved through the range of motion by an
external force, such as another athlete (or presumably even
themselves), or a device, and not by muscular contractions as in sport
movements. This is often seen in sport situations in which athletes
stretch each other out. A greater ROM is achieved with passive
stretching than active stretching.

B. Active stretching/flexibility is defined as the stretching of muscles

through muscular contractions and actual use in motion. Since athletic
events rarely use passive stretches, active stretching is better correlated
with athletic performance.

1. Apparently when there is large difference between passive and

active stretch
ROM, the chances of injuries in activities are increased.

2. Resistance training exercises maximizing joint ROM should reduce

the differences between active and passive stretch ROM.

3. Passive and active stretch and full ROM resistance training can
therefore be profitably combined for performance.

III. Proprioceptive Neuromuscular Facilitation or PNF.

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A. This involves the use of several neurophysiological sensory

mechanisms (such as the muscle spindles and Golgi Tendon Organs)
and associated reflexes.

B. Although the literature describes at least nine different variations of PNF

stretching, most use some kind of alternating contraction and relaxation
of the agents and antagonist. Its refinement is generally attributed to
research by physical therapists for use in clinical rehabilitation.

C. However, it has been gradually adapted to training athletes with

excellent results. The three most popular (NSCA) are described below
and will be demonstrated in lab.

PNF Methods: There are three basic methods:

1. Hold-relax
A. A passive prestretch is administered by the partner and held for 10
seconds.
B. Athlete isometrically contracts against partners resistance for 6
seconds.
C. Athlete relaxes and a second passive stretch is performed and held for
30 seconds.
* Autogenic inhibition should allow a greater passive stretch.
2. Contract relax
A. A passive prestretch is again administered by the partner and held for 10
seconds.
B. Limb extended against resistance through the entire ROM.
C. Athlete relaxes and a second passive stretch is performed and held for
30 seconds.
* Autogenic inhibition should allow a greater passive stretch.
3. Hold-Relax with agonist contraction. First two portions identical to #1.
A. A passive prestretch is administered by the partner and held for 10
seconds.
B. Athlete isometrically contracts against partners resistance for 6
seconds.
C. Partner applies second passive stretch while athlete contracts agonist .
Extra stretch here is from;
* reciprocal inhibition, primarily
* autogenic inhibition, secondarily
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American College of Sports Medicine Guidelines recommend the following:

Type: A general stretching routine that exercises the major muscle

and/or tendon groups using static or PNF techniques.

Frequency: A minimum of two to three days per week.

Intensity: To a position of mild discomfort.

Duration: 10 to 30 seconds for static; 6 second contraction followed by 10

to 30 seconds assisted stretch for PNF.

Repetitions; 3 to 4 for each stretch.

Preparation/Timing for Stretching

One "dogma" the public has heard for years has been to be certain to stretch
before an exercise session.

1. While there was no data to support this, it seemed to be common sense.

2. As evidence began to accumulate, confusion resulted. In fact, a recent study

(University of Hawaii) looked at 1,500 marathon participants and found no
difference in injury rates at all between stretchers and non-stretchers.

3. One suggestion was that cold stretching (stretching without a prior warm-up)
could result in enough injuries as to cancel out any possible benefits from
stretching before exercise.

4. One soon began to see on the market "how-to" books for jogging which
cautioned in one chapter to "always stretch before jogging" and yet in another
chapter to always "warm-up" before stretching with a light jog. Essentially the
reader was instructed to stretch before they jog, and jog before they stretch!!

5. The most recent ACSM Guidelines makes more sense. It is stated that
stretching can be done either before or after (or both), provided that a warm-
up is done before stretching.

6. The key is to realize that stretching in health related fitness is not for the acute
effects during one exercise session so much as for the long term flexibility
benefits.
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Your instructor's opinion would be as follows;

1. Recommend light stretching after recreational exercise (when the body temp is
up). This in line with the ACSMs Current Comment statement on the
placement of stretching in a fitness routine (found on the website).

* If clients wish to stretch before exercise, this is fine but suggest that they
warm-up to the point of a light perspiration beforehand.

2. There should be more vigorous stretching/warm-up for athletes in sports with a

high ROM and/or explosive power moves prior to practice. This is for
performance related fitness.
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Selected Stretching Exercises

The following are by no means the final word on stretching. They simply
represent examples of stretches for various areas.

(1) Hamstrings:

1. Sitting comfortably bend forward slowly at the hip, keeping the back straight.
2. Lower until hamstring tension is felt, hold briefly.

(2) Hamstrings: assisted

1. With the leg on the spotter's shoulder, gently press forward until hamstring
tension is felt.
2. Be certain to obtain feedback from the partner. PNF stretching could be used
here.
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(3) Hamstrings & Hip:
Grabbing the ankle and the knee, gently press the leg toward the chest.

(4) Hip Flexors/Quads:

1. Lie comfortably on side, grab ankle and slowly pull leg/thigh rearward.
2. It is important to avoid extreme knee flexion; try to maintain the knee at least
the angle seen above.
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(5) Hip Flexors/Gluts (Single Leg Hug)

1. Start in hook lying position. Pull one leg in toward the chest as tightly as
possible.
2. Slowly straighten the other leg lowering the back of the knee toward the mat.

(6) Lower Back:

1. Sit upright in the chair

2. Relax and extend the torso while bending at the waist and slowly lowering
the stomach onto the thighs; hold it for a moment.
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(7) Back:

1. Kneel on all fours, toes backwards.

2. Inhale, contract the abs and arch the back.
3. Relax the abs, exhale and return to flat back position.

(8) Lower Back & Gluteals:

1. Client can alternate positions. Start in hook lying position, contract gluteals
and raise hips up and arch back slightly.
2. Relax, return hip to ground, curl up knees to chest and hold.
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(9) Backroll

1. With slow, controlled motion, roll backwards contacting each point of the
back.
2. In the second, right hand grabs the left toe or vice versa.

(10) Back and Hip:

Rotate the trunk while pressing the bent knee across the body, and finally rotate
the shoulders more.
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(11) Abdominal/Back stretch:

1. Relax on stomach with hands on the floor under shoulders.

2. Press up in a slow, relaxed way keeping the pelvis on the ground.

(12) Adductors:

1. Once seated, bring the heels and soles of the feet together.
2. Grab the ankles and after placing the elbows on the inside of the thighs,
push downward to stretch the adductors.
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(13) Adductors:

1. Assume the position indicated.

2. Exhale and slowly lower the chest toward the ground.
3. Hold the stretch briefly. Do this with caution the first time. It places great
stretch on the adductors.

(14) Calves:

1. This method will allow stretching and strengthening of the calves. As shown,
first contract upward in plantar flexion.
2. Lastly, lower downward and stretch.
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(15) Calves

1. This will probably be a more effective stretch if performed in bare feet.

2. Maintaining the rear heel in contact with the ground tilt the lower leg forward.
The rear knee can be allowed to bend slightly.

(16) Back/shoulder stretch

1. Drop a towel over the back and grab it with the lower hand.
2. Slowly work the lower hand up until the hands can touch.
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(17) Shoulder/deltoid stretch

1. Gently pull the arm inward toward the middle of the back
2. If you cannot reach the elbow, hold the wrist.

(18) Triceps/shoulders

1. Gently pull and stretch the triceps.

2. This stretch will especially hit the long head of the triceps.
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(19) Lats/Triceps

1. Gently pull arm and stretch all heads of the triceps.

2. While stretching, attempt to keep shoulder of stretched arm low.

(20, a & b) Chest

(a) Clavicular Pec (b) Sternal Pec

1. On 15 (a-c), find a door way and place the hands as desired.

2. Form your upper arms and body in a T-shape.
3. Exhale and lean forward to stretch.
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(15c) Chest (16) Chest

On 16, self-explanatory.
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(21) Chest: Cat Stretch

1. Once on a mat, place the hands over the head and stretch the body out.
2. Lean the chest downward toward the mat and stretch.

(22) Lateral Trunk Stretch

Slowly and carefully stretch laterally using the other knee for support if needed.
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Potentially Harmful Stretches

(Review by M. Bailey, PhD)

Sometime in the mid 1980s Corbin and others started the practice of listing
certain exercises and targeting them as potentially dangerous. Some have
called these lists exercise hit lists. While it is unquestionably useful to be able
to know which exercise movements the public should and should not be doing,
personal trainers, etc., should also be taught how to properly use the lists.

First of all, there is rather widespread agreement on many of the movements

noted, given the fact that both national injury statistics and kinesiological
analysis support the proposition that the exercises are potentially harmful. With
respect to the general public, these movements should probably be avoided.

On the other hand, the student should also be aware that there is disagreement
(occasionally heated) among equally knowledgeable and well-intentioned
experts on some exercise movements and statements are made (often implied to
be proven fact) which are clearly based more on simple opinion. For one thing,
there is the distinct possibility that certain individuals may be predisposed to an
injury from a certain movement while the vast majority of the public would not be.
If we have only case studies of individuals to work with, it could be very difficult
to precisely know which movements were so affected and the safe route would
be to err conservatively and proscribe the movement for everyone.

In addition, the student should keep in mind that in virtually all cases we are
dealing with probabilities and not certainties. Some people could do a harmful
movement for years (or even a whole lifetime) and have no problems. In fact, the
majority of healthy adults probably would not be injured doing most of these
movements. However, since in almost all cases effective and safe alternative
movements can be found, the matter becomes academic; performing the
unsafe versions becomes unnecessary.

The point to be made is this: as a professional, be aware of these movements,

but do not become extremely rigid or over-zealous in prohibiting clients
(especially in adult fitness programs) from doing the movements if they strongly
wish to do one or more of them. Simply apprise them of the potential problem
and advise caution. (I mention this because I have seen personal trainers,
although certainly well meaning, brandish these lists like a club and generally be
a pain in the posterior to all around).

A coaching situation can be even more complex. The coach must ask
themselves why the movement is to be used, if there are alternatives, etc.
He/she must weigh the potential risks to the benefits for the athletes. Quite
frankly, careers and jobs generally depend more upon athletic performance (or
aesthetic appearance) than how safely athletes are doing exercises. Even if a
movement could cause long term problems (over years), but is known to produce
short term performance enhancement, it may have to be used. Some hit-listed
exercises may not be much of a problem if only done during an athletic season
and not daily over years. In addition, it is conceivable that in some training
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situations it may be more dangerous to exclude a black-listed exercise than to
include it. An excellent example is the wrestlers bridge. While dangerous in
general, wrestlers simply must do this movement since it is performed violently
during the sport itself and they must be conditioned for it. Another example
concerns ballistic stretches. While these are not recommended for the general
public, as noted previously, some strongly recommend at least some ballistic
movements in sports or activities using ballistic movements for training
specificity.

The well-trained exercise professional should eventually be able to give an

intelligent opinion on the safety of a movement simply by seeing it performed.
For example, if the movement is substantially outside of the joints normal
movements, it may be a problem; the hero stretch twists the joint outside of the
sagittal plane of motion and transverse axis that knee flexion and extension are
performed in. Or, if the movement is in the correct plane and axis of motion but
goes well beyond the joints normal ROM, it may be a problem; hyperextension
of the elbow is an example. Common sense can also be used
with great success.
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Questionable Exercises
Lets look at stretching movements that are controversial. The illustrations
include a wide variety of such movements. Lets start on the first couple pages of
Corbins hit list and discuss the suggested reasons for possible harm in those
where it is not readily apparent.

1-3 Plough plough shear, and shoulder stand: Excessive pressure on the
cervical region of the spine can potentially affect blood flow of the vertebral
artery to the brain. In addition, the pressure could compress cervical spinal
nerves
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4. Back arching/neck arching: The main problem here is seen to be strain to
the cervical area. If the leg is high enough there could also be slight strain in
the lower back. Butt burners, as these are occasionally called, are felt to
be safe if one goes to a straight back position only.

5. Back arching/abdominal stretch: There is excessive stress on the articular

facets of the vertebrae. This is not necessarily a problem movement if the
extreme neck hyperextension is eliminated.

6. Same as in #4&5. Back hyperextension: This movement may compress

the lumbar vertebrae, especially irritating articular facets.
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7. Neck hyperextension: Strain to the cervical area of the spine. It should be
noted that some reputable authorities do not see a real problem here if the
movement is done slowly and with control.

8. Standing toe touch: Besides the chance of lower back strain, locking the
knees could strain structures in this area as well.

9. Ballet bar stretch: Many feel that the leg should not be raised over a 90
degree angle or there is a chance of sciatic nerve irritation through rubbing

against the femur.

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10. Standing shin and quadricep stretch: The first concern is that when the
knee is flexed excessively, cartilage could be torn or ligaments stretched. In
an older population or anyone with knee problems, the entire body weight
should not be held in this manner with only one leg. If the knee gives out, the
person could fall forcefully. This could be done safely in those with good
knees by gently stretching the quad out at more of a 90 degree angle.

11. The hero: This tends to place abnormal stress on the medial collateral
ligament, tending to lengthen (and loosen) it. It also stresses knee cartilage
and may strain the groin. There is no argument on this position.

12. Knee pull-down: There is a small fear of knee ligament strain since the
knee joint is flexed well beyond 125 degrees. This could be done safely for
hip flexors simply by grasping under the lower thigh and not the knee, thus
removing pressure from the knee.

13. Hurdlers stretch: Again, the collateral ligaments may be stressed. This is
the majority opinion. That said, it should be noted that there is some
disagreement here. A few feel that if the toes and foot are not turned out
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and are aligned in a straight line with the lower leg, it may be relatively safe.
In this view, the picture on the left would be OK and the inner knee stress
minimized.

14. Wrestlers style head bridge: This may seriously compress the cervical
vertebrae.

15. Full splits: These may unduly place stress on the medial collateral ligament
and the medial meniscus since the body weight could tend to force the
knees inward.
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16. Yoga cross-legged sitting: This can put stress on the internal knee

ligaments.

Miscellaneous Exercise Movements:

1. Hands behind the head sit-ups: An excessively forceful pull on the head
could strain structures in the neck. Also, the iliopsoas muscle complex (hip
flexors) are trained
excessively.

2. Double leg list (leg raises): This will work the hip flexors muscle
excessively, pulling on the lumbar area of spine excentuating lordosis.
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3. Deep knee bends: Few if any authorities dispute this one. In any extreme
flexion of the knee (anywhere beyond 125 to 135 degrees depending upon
the person), the knee ligaments (especially the posterior cruciate) can be
stretched due to a wedging apart of the femur and tibia caused by the
occlusion of the soft tissue masses (the calf and hamstrings) around the
knee. Such exercises may also predispose to chronic synovitic or arthritic
changes. (Interestingly, in archeological sites of people who used deep
squatting often during life, there is a very high incidence of knee arthritis
seen in the skeletal remains). Knee bends are excellent for firming the thighs
and hips, but should never be performed with the knee flexed much beyond
the so-called thigh parallel (to the ground) position. Much beyond this and
flexion could go beyond the recommended maximum angle. (A few suggest
using 1or 2 inch heel lifts to aid balance during knee bends: be aware that
such lifts will slightly increase the possibility of such tissue occlusion.

4. Knee sitting: This will clearly stretch the knee ligaments through tissue
occlusion and eventually produce joint instability. It is especially dangerous
in those with pre-existing knee problems. This posture is frequently used in
martial arts as a resting position and is of greater concern here given the
fact that the student generally has little or no choice in the matter if the
instructor asks for the students to assume this position. (It is unfortunate that
in many clubs, the ability to take the discomfort of the position for long
periods of time without complaint is deemed admirable).