8.14 Flexibility training

CHAPTER 8: Fundamental Laws for Training and Periodization 8.14 Flexibility training

An important component of an exercise programme is flexibility training, providing improvements and maintenance in range of motion of the joints and surrounding tissues. ACSM classifies stretching as flexibility training (ACSM, 2020). The importance of flexibility training should not be underestimated, playing a key role in neuromuscular injury prevention and rehabilitation from injuries. Similar to other exercise training components, flexibility programmes require careful consideration and construction in order to reach optimal levels of performance (Matharoo 2015). This chapter will provide an overview of flexibility training, from benefits to the application.

Flexibility is the ability to move muscles, joints, and bones through an unrestricted, pain-free range of motion

Flexibility is the ability to move muscles, joints, and bones through an unrestricted, pain-free range of motion (ROM). Improving ROM can improve performance. Although flexibility varies widely from person to person, minimum ranges are necessary for maintaining joint and total body health. Many variables affect the loss of normal joint flexibility including injury, inactivity or a lack of stretching. The range of motion will be influenced by the mobility of the soft tissues that surround the joint. These soft tissues include: muscles, ligaments, tendons, joint capsules, and skin. A lack of stretching, especially when combined with activity can lead to a fatigue-induced soft tissue shortening over time.

Inadequate flexibility will have a negative effect on the body in 3 significant ways (UC Davis, 2023):

Joints require movement through a full range of motion to maintain the health of cartilage and other structures within the joint with increased blood supply and nutrients to joint structures with increased quantity of synovial joint fluid (oil in the crankcase). This effect can be particularly noticeable in weight bearing joints such as the hips and knees.
Muscles that are inflexible tire more quickly, causing opposing muscle groups to work harder. Muscle fatigue can lead to muscular injuries and the inability of the muscles to protect joints from more severe injuries. For example, the hamstrings play a role in stabilizing the knee and preventing ACL tears.
Decreased flexibility may also lead to abnormal stress on structures and tissues distant from the initial site of inflexibility. One example of this is that tendonitis in the knee can be related to calf tightness.

Benefits of a regular stretching routine (UC Davis 2023, Matharoo 2015):

Maintaining or increasing ROM
Enhanced performance
Decreased risk of injury
Posture and muscle symmetry may improve
Increased blood supply and nutrients to joint structures
Increased quantity of synovial joint fluid (oil in the crankcase)
Increased neuromuscular coordination
Muscle soreness: may reduce muscle soreness after exercise
Muscular cramps: cramps caused by involuntary skeletal muscle contraction may be alleviated
Reduced muscular tightness and increased joint mobility
Return of muscle to natural resting state
Modifying blood pooling, re-circulation

Range-of-motion continuum

Similar to other forms of exercise training, flexibility should follow a structured path for optimal progression. In flexibility training, this is called the range-of-motion (ROM) continuum. Personal trainers should understand the importance of a systemic flexibility programme in order to achieve optimal results without increasing the risk of injury. There are three progressive phases within the continuum: corrective, active and functional flexibility (Matharoo 2015).

Corrective flexibility enhances joint motion and improves muscular imbalances via self-myofascial release and static stretching.

Active flexibility incorporates self-myofascial release and active stretching. This progression encourages improved neuromuscular efficiency and extensibility of soft tissue.

Functional flexibility is the final phase of progression, involving dynamic flexibility and self-myofascial release. Characteristics of this phase are soft-tissue extensibility throughout the range of movement and optimal neuromuscular control.

Types of Flexibility Exercises

Basic classification of flexibility exercises (stretching) is dynamic and static.

Dynamic stretching

Dynamic stretching involves active body movements and momentum to take muscles through their full range of motion, promoting increased power, flexibility, and range of motion without exceeding the static range of motion (ROM) and increasing the risk of injury. It differs from static stretching, which involves holding a stretch for a certain amount of time. Dynamic stretching is often used as a warm-up before physical activity and as a cool-down after activity to increase recovery time. By mimicking the controlled movements of an activity, dynamic stretching gradually and safely increases ROM. An example is a hamstring stretch where the leg is swung upward in a kick, with each pass gradually increasing the height of the kick (Behm et al., 2016).

An example is doing a hamstring stretch where your leg is swung upward in a kick through its range of motion. With each pass, a gradual progression in height is being reached.

Static stretching

Static stretching involves stretching a muscle or group of muscles to its farthest point and holding that position for a period of time, usually between 15 to 30 seconds, with repetition if needed.

Inadequate flexibility will have a negative effect on the body in 3 significant ways (UC Davis, 2023):

Joints require movement through a full range of motion to maintain the health of cartilage and other structures within the joint with increased blood supply and nutrients to joint structures with increased quantity of synovial joint fluid (oil in the crankcase). This effect can be particularly noticeable in weight bearing joints such as the hips and knees.
Muscles that are inflexible tire more quickly, causing opposing muscle groups to work harder. Muscle fatigue can lead to muscular injuries and the inability of the muscles to protect joints from more severe injuries. For example, the hamstrings play a role in stabilizing the knee and preventing ACL tears.
Decreased flexibility may also lead to abnormal stress on structures and tissues distant from the initial site of inflexibility. One example of this is that tendonitis in the knee can be related to calf tightness.

Benefits of a regular stretching routine (UC Davis 2023, Matharoo 2015):

An example is a shoulder stretch, where the arm is brought across the chest and held in place using the opposite forearm.

Stand tall, feet slightly wider than shoulder-width apart, knees slightly bent. Place your right arm, parallel to the ground across the front of your chest. Bend the left arm up and use the left forearm to ease the right arm closer to your chest. You will feel the stretch in the shoulder.

Static stretching is often used to improve flexibility and range of motion and can be done before or after exercise, but is more commonly performed after exercise as a cool-down to prevent muscle soreness and promote recovery (Behm et al., 2016).

Methods for training flexibility

Stretching exercises can be further categorized into active and passive forms. Active forms can be further divided into active and active-assisted flexibility exercises, whereas passive forms can be divided into passive and passive-active techniques. Selecting the right technique(s) depends upon the level of flexibility, activities the athlete is involved with, availability of a training partner and/or equipment, and individual goals.

Active stretching is one where you assume a position and then hold it there with no assistance other than using the strength of your agonist’s muscles. For example, bringing your leg up high and then holding it there without anything to keep the leg in that extended position. These stretches are performed by a person herself, without the assistance of a therapist or trainer.

Active stretching increases active flexibility and strengthens the agonistic muscles. Active stretches are usually quite difficult to hold and maintain for more than 10 seconds and rarely need to be held any longer than 15 seconds.

Passive stretching is also referred to as relaxed stretching. A passive stretch is one where you assume a position and hold it with some other part of your body, or with the assistance of a partner or some other apparatus. For example, bringing your leg up high and then holding it there with your hand. The split is also an example of a passive stretch. The most common durations of a passive stretch are 15 seconds increments up to 60 seconds, but around 30 seconds on average.

Slow, relaxed stretching is useful in relieving spasms in muscles that are healing after an injury. Obviously, you should check with your doctor first to see if it is okay to attempt to stretch the injured muscles.

Relaxed stretching is also very good for “cooling down” after a workout and helps reduce post-workout muscle fatigue, and soreness.

Other types of stretching are also ballistic stretching which uses the momentum of a moving body or a limb in an attempt to force it beyond its normal range of motion. This is stretching, or “warming up”, by bouncing into (or out of) a stretched position, using the stretched muscles as a spring which pulls you out of the stretched position. This type of stretching is not considered useful and could lead to injury. It does not allow your muscles to adjust to, and relax in the stretched position. It may instead cause them to tighten up by repeatedly activating the stretch reflex.

Isometric stretching is a type of static stretching (meaning it does not use motion) which involves the resistance of muscle groups through isometric contractions (tensing) of the stretched muscles. The use of isometric stretching is one of the fastest ways to develop increased static-passive flexibility and is much more effective than either passive stretching or active stretching alone. Isometric stretches also help to develop strength in the “tensed” muscles (which helps to develop static-active flexibility), and seem to decrease the amount of pain usually associated with stretching.

The most common ways to provide the needed resistance for an isometric stretch are to apply resistance manually to one’s own limbs, to have a partner apply the resistance, or to use an apparatus such as a wall (or the floor) to provide resistance.

Resistance stretching involves using an external force, such as a band or a partner, to provide resistance against the muscle being stretched while moving through a range of motion. This method utilizes eccentric contractions. Most often it is performed with a partner. This method is less about a contraction at the end range, and more about a loaded controlled eccentric contraction throughout the entire range. For example, using a band to stretch your hamstring while performing leg swings is a form of resistance stretching.

PNF Stretching is currently the fastest and most effective way known to increase static-passive flexibility. PNF is an acronym for proprioceptive neuromuscular facilitation or muscle energy technique (MET). It is not really a type of stretching but is a technique of combining passive stretching and isometric stretching in order to achieve maximum static flexibility. PNF refers to any of several post-isometric relaxation stretching techniques in which a muscle group is passively stretched, then contracts isometrically against resistance while in the stretched position (usually around 6-10 seconds), and then is passively stretched again through the resulting increased range of motion. PNF stretching usually employs the use of a partner to provide resistance against the isometric contraction and then later to passively take the joint through its increased range of motion. It may be performed, however, without a partner, although it is usually more effective with a partner’s assistance.

Techniques for Proper Stretching

Proper stretching is an essential component of any fitness routine, as it can improve flexibility, range of motion, and reduce the risk of injury. To stretch correctly, it is important to follow the basic principles of exercise science. The gradual progressive overload (GPO) principle applies to flexibility training as much as it applies to strength training.

It is essential to warm up your muscles with a few minutes of light cardio exercise such as jogging, cycling, or jumping jacks before stretching. This helps increase blood flow and prepares your muscles for stretching. The way to stretch correctly is to avoid the pain threshold.

Here are some techniques to follow:

Before stretching, warm up the muscles either actively (a few minutes of light cardio exercise such as jogging or cycling) or passively (e.g., moist heat packs) to increase blood flow and prepare the muscles for stretching.
Focus on major muscle groups such as hamstrings, quads, calves, and shoulders. These muscles tend to be the most tight and prone to injury. Each major joint area should be included (e.g. shoulder girdle, chest, neck, trunk, lower back, hips, legs and ankles).
Avoid bouncing or jerking movements when stretching.
Gradually increase the intensity of stretching over time, starting with light stretching and avoiding pushing too hard too quickly to prevent injury.
Listen to the body and stop stretching if any pain or discomfort is experienced.
Incorporate stretching into daily routines, even on rest days, to maintain flexibility and reduce the risk of injury.
All stretch methods mentioned above can be used:
- Static stretches should be held for 10-30 seconds (although older adults may have greater benefits if static stretches are held for 30-60 seconds).
- Active stretches should be held and maintained for 10 – 15 seconds.
- PNF stretching should include 3-6 seconds of contraction followed by 10-30 seconds of assisted stretching.
Complete 60 seconds of total stretching for each exercise by means of repetition of exercises two to four times (ACSM, 2014).

Static stretching has been found to cause acute reductions in muscle performance, including maximal strength, power, and speed-dependent performance. However, the negative effects of stretching depend on the duration of the stretch. One review found that stretches lasting less than 45 seconds had the smallest negative impact, while longer stretches had a more significant effect. Although the impairment is moderate, it may still be practically relevant for competitive athletes, but for recreational exercisers, the mild alterations are likely, not meaningful (Bushman, 2016).

If you only stretch at one time, the better time is at the end of your workout. Post-workout stretching may minimize spasms, promote relaxation of the muscles (and mind and nervous system), and speed recovery by alleviating or minimizing the stiffness and soreness of workouts.

Yoga is considered a form of stretching; however, the emphasis on stretching can vary depending on the style of yoga being practiced. Overall, yoga can be a great way to improve flexibility and mobility.

Stretching the lower limb

The lower legs and feet carry the whole body’s weight when standing or walking. This can result in soreness around the soles of the feet, ankles, calves, or shins. Sitting down and gently stretching the feet can significantly relieve this discomfort. For athletes, especially runners, it is vital to keep the lower legs strong and supple to absorb the shock of running and avoid suffering a twisted ankle or repetitive strain injury such as plantar fasciitis (Williamson 2017).

Ankles

The ankle joint experiences four primary movements: plantarflexion, dorsiflexion, inversion, and eversion. To enhance range of motion (ROM), clients should engage in all four exercises, including ankle circles, heel and toe rocking, pointing, and flexing.

In the case of an ankle sprain, only active stretching is recommended for sub-acute ankle sprains; all forms of stretching are contraindicated for acute ankle sprains.

Because four ankle movements should be restored (dorsiflexion, plantar flexion, eversion, and inversion), the clients should gently start with gentle dorsiflexion and plantar flexion with the foot elevated (figure 1). Later, add the eversion and inversion (figure 2).

Dorsiflexion and plantar flexion are the easiest ankle movements. Movements of eversion and inversion are harder for most clients to perform, yet they are important to include at some stage of the rehabilitation process because they will help restore ROM of the joint (Johnson 2012).

Achilles and calves

The calves at the back of the lower leg feature two main muscles: the larger gastrocnemius, which bulges visibly in those with well-defined calves, and the smaller, flatter muscle soleus, which lies underneath. Both connect with the Achilles tendon, which extends down to the heel. Calf stretching is vital for people who favor sports with repetitive movements, such as runners or hikers, or athletes doing sudden explosive movements like jumping or lunging (Wiliamson 2017).

Standing tows-up stretch, standing achilles stretch, high lunge is recommended, as well as below mentioned step stretch and soleus stretch.

An example of an active stretch is a step or stair stretch, which can be performed on a step or a stair using a handrail for support. This position results in eccentric loading of the calf muscles, which is supposed to be beneficial (figure 3).

An example of a passive stretch is a soleus stretch in the prone position. This stretch increases the stretch to the soleus muscle but may not be appropriate for clients who are unable to line prone or for those who have problems with the knee (figure 4).

In a case of Achilles tendinopathies both active and passive stretches are recommended (either for sub-acute or chronic achilles tendinopathies), but are contraindicated in the acute stage (Johnson 2012).

Stiff ankle

Many people suffer from stiff ankles. This condition may result from a sedentary lifestyle or direct immobilization of the lower limb due to surgery. Both active and passive stretches are recommended: besides dorsiflexion and plantar flexion also standing calf stretches (figure 5) are recommended. If a client finds this stretch easy, they can try step stretch or the passive soleus stretch (above).

Calf muscle strains, if not acute, should be treated the same as sub-acute ankle sprains (only active stretching). The same routine is recommended for cramps in the calf.

You can modify active stretches (dorsiflexion and plantar flexion) with clients sitting on the floor, gently doing stretches. Some clients can help themselves with a towel or a band, hooked around the toes (figure 6 below). Standing calf stretches (figure 5 above) are also beneficial.

This active stretch is also beneficial for sub-acute hamstring strain. Passive stretches are not recommended!

Stretching is also not recommended for an acute hamstring strain.

Hamstrings stretch

A hamstring stretch is vital for preserving flexibility and range of motion in the hamstrings, contributing to injury prevention, specifically hamstring strains. Maintaining flexibility and strength in the hamstrings can also help reduce the risk of lower back pain.

The hamstrings, a group of three muscles located at the back of the thigh, play a crucial role in daily activities such as walking, running, and jumping. Tight or weak hamstrings can negatively impact athletic performance and overall mobility. Incorporating hamstring stretches into your exercise routine promotes better flexibility and muscle balance in the lower body.

Regular hamstring stretching can benefit individuals with sedentary jobs or lifestyles, as sitting for long periods can cause the hamstrings to shorten and become tight. Additionally, athletes and fitness enthusiasts can benefit from hamstring stretches, as they help improve performance and reduce the risk of muscle imbalances, which can lead to other injuries.

In the cases mentioned above, both active and passive stretching is helpful (Johnson 2012).

Apart from dorsiflexion and plantar flexion another recommended active stretch is the lying hamstring stretch (figure 7). A client should lie on the floor in a supine position supporting one leg with arms behind the knee. Starting with the knee bent, a client should attempt to straighten the knee until a comfortable stretch is felt in the back of the thigh. Similarly, leg-up chair stretch is performed.

Remember that the hamstrings are hip extensors, so taking the hip into flexion will also stretch these muscles (see figure 8). In this picture, the hamstrings of the left leg are being stretched because this is the hip that has been taken into flexion.

Clients who do not wish to do their stretches on the floor could simply try placing one leg on a stool and leaning forward to stretch the hamstrings of that limb.

Passive soft tissue release works well with the client in the prone position and is easy to apply. One simple stretch is holding the client’s leg in the position shown in Figure 9, facilitating a stretch in the tissues of the posterior thigh (Johnson 2012).

Groin and inner thigh

The groin and inner thigh stretch targets the adductor muscles in the inner and hip regions. These stretches are essential for enhancing flexibility and range of motion, minimizing tightness, improving posture, and decreasing the likelihood of injury.

Tight adductor muscles can negatively impact posture and contribute to muscle imbalances, potentially leading to injuries such as groin strains or hip issues. By incorporating groin and inner thigh stretches into the exercise routine, muscle balance and flexibility can be maintained, which are crucial for overall mobility and performance.

Improved balance and coordination are additional benefits of these stretches, as the hip and adductor muscles stabilize the pelvis and coordinate leg movements. This improved stability can enhance athletic performance and reduce the risk of falls in older adults or those with limited mobility. Additionally, regular groin and inner thigh stretching can help alleviate stress and tension in the lower body. This can improve overall muscle function, reduce discomfort, and improve movement patterns.

Groin pain can be caused by many things, including tight, weak groin muscles (adductors) or groin pulls or strains. It also can be caused by hip injuries and even osteoarthritis. Stretching should be conservative to prevent reinjury to muscles not yet fully healed and should be avoided in the early stages of tissue repair (Johnson, 2012). Passive stretches are not recommended.

One of the best-known examples of groin stretch is the butterfly stretch.

Your client should sit down and place the soles of his or her feet together. Then, either clasp the hands around the feet, hold onto the ankles, and sit taller. Keep the back straight and lean your upper body forward to move deeper into the stretch.

If a client cannot sit cross-legged, he or she should start lying on the floor, gently abducting the legs (with the knees extended). If this is tolerable, a client should then progress to sitting cross-legged (figure 10), gently pushing the knees towards the floor. Once this is tolerable, a client could progress to figure 11 (Johnson 2012).

Similar to the butterfly stretch is also “the diamond” and “the tortoise” stretch.

A dynamic version of Butterfly exists whereby the legs are bounced (or wings flapped) rapidly. Such a sharp, quick movement is likely to trigger a contract response in the muscles of the groin and inner thighs – the exact opposite to the slow muscular release we want. Instead, hold the stretch steady, breathe deeply through the nose and wait for the inner thigh muscles to relax. Over time, the legs will drop closer to the floor (Williamson 2017).

Stretching adductor muscles is beneficial for those who engage in sports activities such as running, swimming and football and is also beneficial for those who walk a lot. Adductors may become tight after periods of immobility, leading to muscle imbalance in the pelvis and lower limbs (Johnson 2012).

Active stretches for groin strains (figures 10 and 11 above) are also helpful for combating tight adductors. Another helpful stretching exercise is the side lunge. This stretch can be performed both standing (figure 12) or, where balance is the problem, in the kneeling position (figure 13). Standing side lunges are a type of stretching that works multiple muscles, such as the quadriceps, abductors, glutes, adductors, and hamstrings.

Quadriceps stretch

The quadriceps stretch is a crucial exercise for enhancing flexibility in the quadriceps muscles, consisting of four large muscles at the front of the thigh. This stretch not only increases joint range of motion and alleviates tightness in the thigh area but also helps to minimize pain and improve knee stability.

The quadriceps muscles are responsible for basic movements like walking, running, squatting, and jumping. Therefore, maintaining their flexibility is vital for overall mobility and athletic performance. Regularly stretching the quadriceps can help prevent muscle imbalances and tightness that may lead to knee pain or other lower-body injuries.

In addition, stretching the quadriceps can contribute to better knee stability, as these muscles help control the movement of the kneecap and provide support during various activities. Improved knee stability benefits athletic performance and daily functioning, reducing strain on the knee joint and surrounding structures.

By incorporating regular quadriceps stretches into the exercise routine, the risk of injury can be decreased, and promote better muscle function in the lower body.

While there is a huge range of hamstring stretches, there are fewer ways to access the four quadriceps or ‘quads’ located at the front of the thigh (Williamson 2017).

The quadriceps can be actively stretched both in the lying (figure 14) or standing (figure 15) position. The client should stand tall with her feet hip-width apart, then slowly bend one of her legs and reach around to hold the foot with her hand. The knee should be pointing downward. Those who have poor balance, they can position themselves against a wall or hold a chair. A client should push her hips forward. Repeat on the other side.

Other recommended quad stretches are also a low lounge and dynamic quad stretch (the same as the static standing position above, just add movement of the leg by alternately pointing the knee forward and drawing it back. Repeat on the other side, 4 times).

Stretching the trunk

Stretches for the back and sides

Stretching the back and sides is essential for enhancing flexibility and range of motion in the spine and surrounding muscles. This can reduce tension and tightness, improve posture, and improve spinal health. Incorporating back and side stretches into an exercise routine can alleviate pain and minimize the risk of injuries related to the spine and back muscles.

The muscles of the back and sides play a crucial role in maintaining proper posture and providing support during daily activities and exercises. Regular back and side stretching can aid in relieving stress and promoting relaxation. The physical act of stretching can help release tension that accumulates in the muscles due to stress, leading to a greater sense of well-being and relaxation.

Stretching these muscles can help address muscle imbalances and prevent postural issues, such as rounded shoulders or a forward head posture, which can contribute to pain and discomfort in the neck, shoulders, and lower back.

Back pain is also called the “disease of the century” because around 80% of the population will suffer back pain at some point in their lives. The term back pain encompasses numerous problems, such as chronic low back pain, sciatica and disc herniation, all with one element in common: pain is localized in the spine.

Back pain can be caused by an incorrect posture held for a long time, excessive muscle tension due to psychophysical stress, it could be a consequence of overweight and sedentariness and also of cold, humidity, muscle tears, excessive efforts etc.

With regularly practicing back stretching techniques, the pain could be reduced and mobility of the back gained back.

Recommended stretches are standing twist (twisting upper body to the left and letting the arms swing around, then return to the center and twist to the right), full body stretch (a client should stand with his feet hip-width apart and then sweep his arms up overhead and interlink his fingers. Press the palms towards the ceiling and remain here. Lift the arms up, but relax the shoulders), standing back band and standing side bend (a client should stand his feet hip-width apart, then sweep his arms up overhead and interlink his fingers. Then he should simply lean to the side aiming not to tip forwards or backwards. Repeat on the other side) and others.

In a case of a low back strain, keep in mind that both active and passive stretches are contraindicated in the acute stages of back strain.

If the pain is sub-acute and a client is experiencing spasming in muscles such as erector spinae, he or she should start with simple stretches, for example lying on the floor with legs on a higher position (figure 16). A rest in this position will gently traction the extensor muscles and associated fascia. Another active stretch is pelvic tilting in supine position (gently tilting pelvis into the posterior tilt position, flattening the back against the floor or hugging one or both legs, see figure 17). Both actions help stretch the lumbar extensors, thus facilitating lumbar flexion (Johnson 1965).

If the whole back just feels tight with no specific area to stretch, a client should try decompressing the back. This can be as simple as clasping the top of a doorframe and bending the knees to lengthen the muscles of the back while keeping the feet on the floor. Another option is the 90-degree Chair Stretch, placing the hands on the back of a chair and tipping the body into a 90-degree position (Williamson 2017). Also recommended are the cat stretch, puppy stretch and child’s pose.

Head and neck

Head and neck stretch is vital in maintaining the health and function of the cervical spine and surrounding muscles. These stretches help to enhance flexibility, alleviate tension, and increase range of motion in the neck area, contributing to pain reduction and improved posture. Incorporating head and neck stretches into an exercise routine can decrease stiffness, prevent injuries, and promote overall neck health.

The head and neck muscles are responsible for various movements and support the head during daily activities. Tight or imbalanced neck muscles can lead to postural issues and discomfort, including tension headaches, neck pain, and even shoulder pain. Regularly stretching these muscles can help address these problems and reduce the risk of injury.

In addition to the physical benefits, head, and neck stretches can also improve circulation in the area, promoting nutrient delivery and waste removal. This increased circulation can contribute to better muscle function and overall health in the neck region.

Furthermore, head and neck stretching can help reduce stress and promote relaxation. The act of stretching can release tension stored in the muscles, leading to a greater sense of well-being and relaxation.

Stiff neck is caused when maintaining a static posture for too long or with sports involving repetitive head turning and overarm movements (such as tennis, swimming etc). Stress can also trigger neck and shoulder tension.

Simple warming-up stretches to begin with are head roll (semi-circle movement with the head), head turn (rotating the head to the right, back to the center and over to the left) and head nod (dropping the head down, tucking the chin in towards the upper chest and then lifting the head and looking slightly up).

Another movement that should be encouraged is performing cervical rotation – each time a client looks over his or her shoulder, they should try to look further behind.

Neck stretches should be performed for 20 seconds approximately. Take care not to overstretch the neck muscles as this may result in increased, rather than decreased, tightness (Williamson 2017).

Stretch the neck by adding gentle overpressure in lateral neck flexion – assisted side neck stretch (figure 18) or a passive stretch where a Personal trainer should passively stretch the lateral neck flexors by gently depressing the shoulder and simultaneously easing the head and neck into lateral flexion (figure 19).

As an active stretch simple retraction of the head is recommended. This movement may be practiced regularly throughout the day and helps stretch tissues of the cervical region quite differently from neck extension, which compresses (rather than stretches)tissues of the posterior neck.

Stretching the upper limb

Stretching the upper limb

Most commonly performed are stretches for shoulders, elbows and wrists.

Shoulder stretch

Shoulder stretches are essential for maintaining the health and function of the shoulder joint and surrounding muscles. By incorporating these stretches into an exercise routine, flexibility can be improved, range of motion enhanced, and alleviated muscle tension in the shoulder area can increase. These benefits contribute to a reduced risk of injury, better posture, and stress relief.

The shoulder joint is one of the most mobile joints in the human body and is responsible for various movements. Regular shoulder stretching can help prevent muscle imbalances, tightness, and inflammation, leading to common shoulder issues such as rotator cuff injuries, impingement, and frozen shoulders.

Improved posture is another benefit of shoulder stretching, as it can help to address muscle imbalances and tightness that contribute to rounded shoulders or a forward head posture. These postural issues can result in pain and discomfort in the neck, shoulders, and upper back.

In addition to the physical benefits, shoulder stretches can also help to increase circulation in the area, promoting nutrient delivery and waste removal. This improved circulation can contribute to better muscle function, reduced inflammation, and overall shoulder health.

Furthermore, shoulder stretching can help reduce stress and promote relaxation, as stretching releases tension stored in the muscles.

Some effective shoulder stretches include the cross-body shoulder stretch, overhead triceps, shoulder stretch, and the doorway stretch.

With shoulder and triceps stretch, a client should cross one arm over the body at shoulder height and use the opposite arm to hug into the chest. Keep the trunk facing forward (figure 20).

The upper back and posterior shoulder stretch are similar, where both hands reach around the body to grab shoulder blades. Crawl fingers further around the back to increase stretch (figure 21).

Elbow stretch

Elbow stretches are crucial for maintaining the health and function of the elbow joint and surrounding muscles. Incorporating these stretches into an exercise routine can enhance flexibility, mobility, and range of motion in the elbow area. These benefits contribute to a reduced risk of injury, improved circulation, and overall better elbow health.

The elbow joint is essential for various arm movements, including flexion, extension, and rotation. Regular elbow stretching can help prevent muscle imbalances, tightness, and stiffness, leading to common elbow issues such as tennis elbow, golfer’s elbow, or other overuse injuries.

In addition to the physical benefits, elbow stretches can help improve strength, coordination, and balance in the arm and upper body. By maintaining flexibility and range of motion in the elbow joint, one can perform daily activities and exercises more effectively and with less risk of injury.

Improved circulation is another benefit of elbow stretching, as it promotes nutrient delivery and waste removal. This enhanced circulation can improve muscle function, reduce inflammation, and improve elbow health.

Some effective elbow stretches include the forearm flexor stretch, forearm extensor stretch, and triceps stretch.

Overuse of extensor muscles in the wrist (tennis elbow) can be treated with a forearm flexor (active) stretch where your client stretches the wrist extensors, keeping the elbow extended (figure 22). Performing the stretch with the elbow flexed is less powerful.

Overuse of flexor muscles in the wrist (golfer’s elbow) can be treated with a forearm extensor (active) stretch where your client stretches the wrist extensors, keeping the elbow extended (figure 23). These stretches can be easily modified so that a client rests his or her pal against a wall or a table.

Wrist stretch

Wrist stretches are crucial for maintaining the health and function of the wrist joint and surrounding muscles. These stretches help to enhance flexibility, prevent injury, and alleviate pain caused by overuse. Incorporating wrist stretches into an exercise routine can improve the range of motion and circulation in the hands and wrists, promoting overall wrist health.

The wrist joint plays a vital role in various hand and arm movements, including flexion, extension, and rotation. Therefore, regular wrist stretching can help prevent muscle imbalances, tightness, and stiffness that may lead to common wrist issues such as carpal tunnel syndrome, tendonitis, or other repetitive strain injuries.

In addition to the physical benefits, wrist stretches can also help to improve circulation in the area, promoting nutrient delivery and waste removal. This enhanced circulation can improve muscle function, reduce inflammation, and improve wrist health.

Some effective wrist stretches include the wrist flexor stretch, wrist extensor stretch, and the prayer stretch. To maximize the benefits of these stretches, practice proper form and technique, holding each stretch for 15-30 seconds and repeating as needed. It is essential to perform these stretches gently and avoid overstretching, as the wrist joint and surrounding structures can be susceptible to injury.

Wrist stretching is not recommended for acute wrist sprains and should be avoided. Active stretching of the wrist helps to regain ROM. There are four movements to maintain: flexion and extension (figure 24) and radial and ulnar deviation (figure 25). Stretching of the wrist and fingers also consist of the interlinking of the fingers and gently pushing.

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