Flexibility
Flexibility
Some people are naturally extremely flexible whereas others struggle to touch their knees. Flexibility is the ability of a joint or series of joints to move through an unrestricted and pain free range of motion. Your flexibility depends on various factors.
What factors influence flexibility?
Connective tissue
Connective tissue is a term given to several different tissues of the body that connect, support and help bind other tissues in the body. Connective tissue can further be broken down into three categories: loose connective tissue, dense connective tissue, and specialized connective tissue. Dense connective tissue is what makes up fascia, tendons and ligaments and consist of a higher density of collagen fibers. The elasticity and length of your connective tissue determine how flexible you are.
Age and gender
With aging, connective tissues lose water content and the collagen in ligaments and tendons can become thicker and less flexible. This is why your flexibility naturally decreases as you get older. Because of bone structure, females tend to be more flexible than males, despite how old they are. With aging, we see an increase of degenerative changes in the joints. This can negatively affect the arthrokinematics of the joint, meaning that it doesn’t move as far as it used to. Just as with strength and endurance, flexibility can be increased at any age with training and proper stretching.
Muscle bulk
Strength training with heavy weights shortens the muscle belly. Without stretches to compensate for this, the flexibility of a joint can decrease due to shortened muscles. In extreme circumstances the muscle mass itself can also reduce flexibility because it gets in the way.
Nerve mobility
Neurodynamics refers to the movement of different parts of the nervous system and how it is connected to the musculoskeletal system. It has been shown that nerves move independently from other tissues. Restrictions in the neural mobility can cause restrictions in the range of motion
What if you are not flexible enough?
If a joint becomes less flexible this is often compensated for by other joints. Sometimes this is a great way to maintain function but it can cause overload in the compensating joints. It is important to determine if the inflexibility is a permanent change or a temporary one that is expected to improve with the right treatment and training.
What if you are too flexible?
Hypermobility (joints that move further than normal range), can be caused by connective tissue disorders. Hypermobile Ehlers-Danlos syndrome (EDS) is a hereditary connective tissue disorder that is caused by defects in the collagen proteins. This is generally characterized by not only joint hypermobility but joint instability with subluxations and/or dislocations, scoliosis and other joint deformities, skin hyper- stretchability and abnormal scarring amongst other structural weaknesses.
Some people have joint hypermobility, joint instability, injury and pain in their joints and muscles. However, they do not have other connective tissue problems like skin, gums, bowel, and blood vessel rupture. In this situation where there is no other explanation for hypermobility, instability, and joint and muscle injury, the term hypermobility spectrum disorder (HSD) is used.
The Beighton score is a popular screening technique for hypermobility. This is a nine – point scale and requires the performance of 5 maneuvers.
- Rest palm of the hand and forearm a flat surface with palm side down and fingers out straight. Can the fifth finger be bent/lifted upwards at the knuckle to go back beyond 90 degrees? If yes, add one point for each hand.
- With the arm out straight, the palm facing down, and the wrist then fully bent downward, can the thumb be pushed back to touch the forearm? If yes, add one point for each thumb.
- With arms outstretched and palms facing upwards, does the elbow extend (bend too far) upwards more than an extra 10 degrees beyond a normal outstretched position? If yes, add one point for each side.
- While standing, with knees locked (bent backwards as far as possible), does the lower part of either leg extend more than 10 degrees forward? If yes, add one point for each side.
- Bend forward, can you place the palms of your hands flat on the floor in front of your feet without bending your knees? If yes, add one point.
Total …/9. A score of 0-3 is seen as normal and a score of 4-9 as representing ligamentous laxity.
How can physiotherapy help?
Both hypermobility and hypomobility come with an increased risk of injury. To mitigate this, a physiotherapist will look what areas of your body are affected, what the underlying factors are and how they affect your personal goals. With this information a tailored plan can be made. This could for example involve manual therapy, strengthening and/ or flexibility exercises, proprioception and active stability training. Often this is accompanied by a home-based exercise program. This way we work together to improve your quality of life.
By Ellen Keijsers – Physiotherapist
