What is it?

Flexibility is the ability to move muscles and joints through a full normal range of motion (ROM). Flexibility helps performance, posture, promotes efficient movement, prevents incorrect body alignment, maintains appropriate muscle length and balance and also decreases injury risk.

Types of flexibility:

1. Static: Ability to assume and maintain a position at full ROM around one joint. Static-active is unassisted; static-passive is assisted.

2. Dynamic (functional): Ability to perform full ROM in the joints during movement

For athletes, flexibility may increase performance in sports specific skills.

Factors effecting Flexibility

• Joint Structure: Dictates how much ROM the joint has.

• Muscle Imbalance: Muscle strength and length imbalance will reduce flexibility due to unequal pulls from antagonistic muscles.

• Muscle Control: Lack of strength to control the working muscle in certain movements can limit flexibility.

• Age: Flexibility decreases with age due to changes in connective tissue.

• Gender: Women tend to be more flexible due to structural, hormonal, and anatomic factors.

• Connective Tissue: tendons, ligaments, fascia, and joint capsules affect flexibility. Therefore, full training and rehabilitation of connective tissue is important.

• Muscle Bulk: muscle hypertrophy can limit flexibility if muscle-building regimen does not have a corresponding stretching plan.

• Resistance Training: limiting full ROM in resistance training can reduce flexibility.

• Activity Level: active people tend to have more flexibility.

Sports Medicine Evaluation & Treatment

A sports medicine physician will determine your level of flexibility and form an activity or exercise prescription with specific exercises and stretches to improve your flexibility. It is important to discuss injuries and rehabilitation with your physician to obtain safe and effective stretching regimens. Physical examination to evaluate level of flexibility will be assessed in clinic.

If there is a clinical reason that is causing decreased flexibility during evaluation, further studies may be considered to identify any musculoskeletal problems that limit you from maintaining or improving your flexibility. The physician will also evaluate for signs of hypermobility or joint laxity that can present as increased flexibility, but pose as a threat for possible injury in the future.

Flexibility and stretching plans can maximize sport performance and improve athletic ability to maintain physical activity.

Types of stretching to improve flexibility and performance:

1. Static: Holding a single position for at least 15-20 seconds. Perform this stretch post-exercise or after the muscles have been warmed up.

2. Dynamic: Stretching through movements during the warmup routine. Can modify to be sport specific.

3. Ballistic: Stretching during explosive or bouncing-type movements. There are mixed reviews on the true benefits of this form of stretching.

4. Proprioceptive Neuromuscular Facilitation Stretching: Incorporates concentric, eccentric, and isometric muscle movements with passive stretching. This type is good for neuromuscular training.

Injury Prevention

To improve flexibility and reduce injuries, stretching is most efficient and safe after the muscles have been warmed up. Stretching with cold or stiff muscles may be less helpful for improving flexibility. Stretching properly can be done alone, with a partner, or formally with a trained medical provider (i.e. physical therapist, athletic trainer). The physician works closely with the medical team to form individualized plans to help improve flexibility for strength, injury prevention and also coordination. With hypermobility, strength and condition regimens can be developed to improve the muscle surrounding a joint to reduce chances of injury.

Return to Play

Evaluation of flexibility post-injury will help the medical team personalize rehabilitation goals for each athlete. The goal is to return to play at full capacity with baseline motion, strength and flexibility to reduce the chance for re-injury.

AMSSM Member Authors
Tu Dan Kathy Nguyen, MD and Mark Chassay, MD

References
1. Ratamess NA. ACSMs Foundations of Strength Training and Conditioning. Chapter 10: Warm-Up and Flexibility. Philadelphia. Wolters Kluwer Health/Lippincott Williams & Wilkins; 2012.
2. Jeffreys I. Warm-up and stretching. In: Baechle TR, Earle RW, editors. Essentials of Strength Training and Conditioning. 3rd ed. Champaign (IL): Human Kinetics; 2008. p. 295–324.
3. Alter, M. J. (1996). Science of flexibility (2nd ed.). Champaign, IL: Human Kinetics