Common Orthopedic Inflexibilities

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Hamstrings Inflexibility Increased risk of lower back injury during hip extension activities when knees are straight. If hip flexion (eccentric phase of hip extension), is inhibited by hamstrings inflexibility, the lumbar spine may compensate by flexing more than usual. The risk of injury is increased if the lumbar spine is not accustomed to this movement or workload. Also see Active Insufficiency. Examples of affected exercises: Straight Leg Deadlift Good Morning Barbell Bent-over Row Example assessments Active Lying Knee Extension Test Passive Lying Leg Lift Test Example preventative/corrective exercise: Seated Hamstrings Stretch Lying Hamstrings Stretch Gluteus Maximus or Adductor Magnus Inflexibility Increased risk of lower back injury during hip extension activities when knees are bent. After complete flexion of the hip (eccentric phase of hip extension), the lumbar spine will flex if movement is continued. The risk of injury is increased if the lumbar spine is not accustomed to this movement and workload. Until flexibility can be restored, recline leg press back support to furthest position and base hip flexion range of motion criteria just before hips tilt. Also see Full Squat Flexibility Q&A. Examples of affected exercises: Leg Press Squat Single Leg Squat Example Assessment Deep Squat Test Example preventative/corrective exercise: Glute Stretch Adductor Magnus Stretch Hip Flexor Inflexibility Increased risk of lower back injury during hip flexion and extension and overhead standing activities. During extension activities, the lower back can hyperextend more than usual if the hip cannot fully extend. During hip flexion activities, the Iliopsoas can hyperextend spine during hip flexor activities. Risk is compounded when hip flexor inflexibility is combined with abdominal weakness. Examples of affected exercises: Military press (standing) Decline Sit-up Lunge (rear leg) Lever Back Extension (fulcrum near hip) Example assessments Lunge Test Thomas Test Example preventative/corrective exercises: Kneeling Hip Flexor Stretch Quadriceps Stretch Shoulder Transverse Abduction / Transverse Extension Inflexibility Typically due to insufficient flexilibility of pectoralis muscles. Results in decreased range of motion during chest exercises. High risk for behind the neck exercises particularly when combined with external shoulder rotation inflexibility. Exasperated and often accompanied by protracted shoulders girdle. Excluding cases with particular orthopedic problems (e.g.: infraspinatus weakness), participants should be encouraged to perform chest exercises through THIER full range of motion; shoulder transverse extension / hyperextension until a slight stretch is felt. Since the shoulder can typically hyperextend further than it can transverse extend, the exerciser performing a bench or chest press will be able to bring bar closer to body when elbows are positioned closer to body (shoulders more abducted). Example of affected exercises: Bench Press Chest Press Chest Flies Behind Neck Shoulder Press Rear Pull-down Example assessment Passive Chest Flexibility Assessment Example of preventative/corrective exercises: Straight Arm Chest Stretch Shoulder External Rotation Inflexibility Increased risk of shoulder injury during activities involving external rotation of the shoulder. Risk is compounded with a winged scapula condition or kyphosis. Until full range of motion is restored, individuals with external rotation inflexibility should be advised to perform pull-downs and shoulder press with the bar in front of the head. Those with more severe cases should perform overhead presses with angled back support (eg: 100-110° incline bench). Examples of affected exercises: Behind Neck Shoulder Press Lever Shoulder Press (torso upright facing away from lever) Rear Pull-down Lever Fly (on pec deck) Example assessment Passive Shoulder External Rotation Assessment Example preventative/corrective exercises: Subscapularis Broom Stick Stretch

Shoulder Internal Rotation Inflexibility Increased risk of shoulder injury during activities involving internal rotation of the shoulder. When the shoulder is flexed and internally rotated, pressure can be created between the insertion of the supraspinatus and acromion or coracoacromial ligament. Incidentally, pain in this position can be indicative of impingement or rotator cuff tendinitis (Hutton & Julin 1997). Tight internal rotators can contribute to protracted shoulders. Examples of affected exercises: Upright Row (narrow grip) Example assessment Passive Shoulder Internal Rotation Assessment Example preventative / corrective exercises: Infraspinatus Broom Stick Stretch Iliotibial Band Tightness Increased risk of lateral knee injury during knee extension activities. Iliotibial band friction syndrome (ITBFS) is a cause of diffuse tenderness over the lateral knee. While weight bearing during knee flexion, the Tensor Fascia Latea contracts to assist the other hip abductors stabilize the pelvis from lateral movement and the Gluteus Maximus extends the hip for forward locomotion. Both the Tensor Fascia Latea and the Gluteus Maxiums can place tension on the Iliotibial tract which produces repetitive friction on the lateral epicondyle. Furthermore, hip abductors weakness can exasperate this pull on the Iliotibial tract by allowing the hip to sag slightly when standing on a single leg, or during locomotion (Fredericson, et. al. 2000). Examples of affected exercises: Lunges Step-Ups Example assessment Ober's Test Example preventative / corrective exercises: Tensor Fasciae Latea Stretch Gluteus Maximus Stretch Lever Seated Hip Abduction Ankle Dorsiflexion Inflexibility Dorsiflexion flexibility is required during the lower phases of the squat and leg press, so Ankle Dorsiflexion inflexibility can make it difficult to perform squat and leg press exercises in full range of motion. If the range of motion of the ankle is limited, hip flexion may be exaggerated and knee flexion is often inhibited. To maintain normal range of motion in both the hip and knee, the heel may have a tendency to leave the floor or platform. Examples of affected exercises with suggestions for affected individuals until range of motion is restored Leg Press: place feet higher on the platform Squats: wider stance or elevate heels slightly on board or weight plates Range of motion may need to be restricted so heels do not raise at lower portion of exercise Example Assessments Deep Squat Active Bent Knee Foot Raise Test Example preventative / corrective exercises: Gastrocnemius Stretch Soleus Stretch Calf Raise Calf Press Plantar Fasciitis & Foot Dorsiflexion Inflexibility High incidences of plantar flexion strength deficits and dorsiflexion range of motion limitations are associated with Plantar Fasciitis. Plantar Fasciitis is a common overuse syndrome occurring in runners and walkers. This syndrome is associated with microtears in the plantar fascia at its insertion into the calcaneus. If allowed to progress to the point when bone spur forms, surgery may be required. Individuals with excessive pronation (feet rolling inward), flat feet, or knocked knees have increased risk for plantar fasciitis. These conditions force the plantar fascia to stretch more during weight bearing activities placing increased pressure where it attaches to the heel bone. High arches are also associated with plantor faciitis. Examples of affected exercises Walking (particularly upon awakening) Running Jumping Example Preventative Exercises Seated Plantar Fasciitis Stretch Can Foot Roll

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