STRETCHING ANATOMY arnold G. nelson Jouko kokkonen Illustrated by Jason m. mcalexander human kinetics Library of Congress Cataloging-in-Publication Data Nelson, Arnold G., 1953- Stretching anatomy / Arnold G. Nelson, Jouko Kokkonen. p. cm. Includes index. ISBN-13: 978-0-7360-5972-5 (soft cover) ISBN-10: 0-7360-5972-5 (soft cover) 1. Muscles--Anatomy. 2. Stretch (Physiology) I. Kokkonen, Jouko, 1950- II. Title. QM151.N45 2007 613.7'182--dc22 2006013908 ISBN-10: 0-7360-5972-5 (print) ISBN-10: 0-7360-7936-X (Kindle) ISBN-13: 978-0-7360-5972-5 (print) ISBN-13: 978-0-7360-7936-5 (Kindle) ISBN-10: 0-7360-8084-8 (Adobe PDF) ISBN-13: 978-0-7360-8084-2 (Adobe PDF) Copyright © 2007 by Arnold G. Nelson and Jouko J. Kokkonen All rights reserved. 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Printed in the United States of America 10 9 8 7 Human Kinetics Web site: www.HumanKinetics.com Australia: Human Kinetics United States: Human Kinetics 57A Price Avenue P.O. Box 5076 Lower Mitcham, South Australia 5062 Champaign, IL 61825-5076 08 8372 0999 800-747-4457 e-mail: [email protected] e-mail: [email protected] New Zealand: Human Kinetics Canada: Human Kinetics Division of Sports Distributors NZ Ltd. 475 Devonshire Road Unit 100 P.O. Box 300 226 Albany Windsor, ON N8Y 2L5 North Shore City, Auckland 800-465-7301 (in Canada only) 0064 9 448 1207 e-mail: [email protected] e-mail: [email protected] Europe: Human Kinetics 107 Bradford Road Stanningley Leeds LS28 6AT, United Kingdom +44 (0) 113 255 5665 e-mail: [email protected] contents Introduction v 1 neck . . . . . . . . . . . . . . 1 c h a p t e r  shoulders, back, c h a p t e r and chest . . . . . . . . 9  arms, wrIsts, c h a p t e r and hands . . . . . .   lower trunk . . . .  c h a p t e r  hIps . . . . . . . . . . . . . 9 c h a p t e r  knees and c h a p t e r thIGhs . . . . . . . . . . . 91  feet and c h a p t e r calves . . . . . . . . . . 11 Stretch Index 141 About the Authors 145 About the Illustrator 147 iiiiii E3469/Nelson/5.01a/274110/JasonMc/R1 IntroductIon G ood flexibility is known to bring positive benefits in the muscles and joints. It aids with injury prevention, helps to minimize muscle soreness, and improves efficiency in all physical activities. Increasing flexibility can also improve quality of life and functional inde- pendence. Good flexibility aids in the elasticity of the muscles and provides a wider range of motion in the joints. It provides ease in body movements and everyday activities. A simple daily task such as bending over and tying shoes is accomplished better with flexibility. Unfortunately, flexibility is generally not a focus of people wanting to start a fitness pro- gram. In fact, many times it is minimally addressed or neglected altogether. While the benefits of regular cardiovascular and strength training exercise are well known, few people realize that flexible joints and regular stretching are also essential for optimum health and activity. Recently, many whole-body fitness and wellness programs, such as yoga and Pilates, which incorporate some flexibility training, have increased in popularity. While these programs may improve the flexibility of individual body segments, their emphasis is not specifically aimed at improving the range of motion of all of the major joints. Yoga emphasizes balance in all areas, seeks to strengthen all muscle groups equally, creates balance between the mental and physical, and encourages moderation in everything. Yoga involves holding static poses while exploring breathing, physical feelings, and emotions. The increase in flexibility comes from holding the body in the desired poses. Pilates, on the other hand, is an exercise program that encourages the use of the mind to control the muscles. It emphasizes strengthening the postural muscles that help keep the body balanced and provide support for the spine. In contrast to traditional strength training programs that involve multiple sets and repetitions of a single exercise, a Pilates workout stresses few repetitions of each exercise and empha- sizes doing these movements with precise control and form. The increases in flexibility are primarily accomplished from the ballistic movements used to increase strength. How much stretching should a person do every day? Usually, most stretching tends to be a very brief routine concentrating on the muscle groups of the lower body. The total time spent in a stretching routine hardly ever exceeds 5 minutes; people tend to stretch a particular muscle group for no more than 15 seconds. Additionally, the stretching usually occurs at the start of the exercise session. Even in sport training, stretching is given minor importance in the overall training programs. An athlete might spend just a little more time stretching than the average person. This is usually because it is part of a warm-up routine. After the workout, however, most athletes are either too tired to do any stretching or simply do not take the time to do it. To be the most effective, however, stretching should be performed both during warm-up before a workout routine and as part of a cool-down after the workout. For any person, whether an athlete or not, a regular stretching routine can bring some interesting benefits. Research studies on hamstring injuries have shown that those people with the lowest flexibility have the greatest chance of injury. Interestingly, the type of increased flexibility needed for reducing injury did not come from doing stretching exercises right before the activity. Rather, the increased flexibility required for fewer injuries came only from doing weeks of stretch training. Additional research has shown that regular, intense stretching for a minimum of 10 minutes will bring some major beneficial changes in the neuromuscular–tendon units. Increased strength and endurance gains have been reported as well as improved flexibility and mobility.  i introduction Types of Stretching In general, any movement that requires moving a body part to the point at which there is an increase in the movement of a joint can be called a stretching exercise. Stretching can be done either actively or passively. Active stretching occurs when the person doing the stretch is the one holding the body part in the stretched position. Passive stretching occurs when someone else moves the person to the stretch position and then holds the person in the position for a set time. The four major types of stretches are static, proprio- ceptive neuromuscular facilitation (PNF), ballistic, and dynamic. The static stretch is used most often. In static stretching, one stretches a particular muscle or group of muscles by slowly moving the body part into position and then holding the stretch for a set time. Since the static stretch begins with a relaxed muscle and then applies the stretch slowly, static stretching does not activate the stretch reflex (the knee jerk seen when the tendon is tapped with a mallet). Activation of the stretch reflex causes the stretched muscle to contract instead of elongate. This contraction of the muscle is directly opposite of the intent of the exercise. PNF stretching refers to a stretching technique in which a fully contracted muscle is stretched by moving a limb through the joint’s range of motion. After moving through the complete range of motion, the muscle is relaxed and rested before resuming the procedure. The combination of muscle contraction and stretching serves to relax the muscles used to maintain muscle tone. This relaxation allows for increased flexibility by “quieting” the internal forces in both the muscles that assist and the ones that oppose the movement of the joint in the desired direction. Ballistic stretching uses muscle contractions to force muscle elongation through bobbing movements where there is no pause at any point in the movement. Although the bobbing movement quickly elongates the muscle with each repetition, the bobbing also activates the stretch reflex (or knee jerk) response. Since the stretch reflex stimulates the muscle groups to contract after the stretch is finished, ballistic stretching is usually discouraged. Dynamic stretching refers to the stretching that occurs while performing sport-specific movements. Dynamic stretching is similar to ballistic stretching in that both use fast body movements to cause muscle stretch, but dynamic stretching does not employ bouncing or bobbing. Additionally, dynamic stretching uses only the muscle actions specific to a sport. Practically speaking, dynamic stretching is similar to performing a sport-specific warm-up (that is, performing the movements required for the activity but at a lower intensity). Benefits of Stretching The following are several chronic training benefits gained from using a regular stretching program: • Improved flexibility, stamina (muscular endurance), and muscular strength. The degree of benefit depends on how much stress is put on the muscle. Medium or heavy stretches are recommended. You can do this by building up to doing long stretches of high intensity (see the next section for a detailed explanation of light, medium, and heavy stretching). • Reduced muscle soreness, aches, and pains. Use only very light stretches if muscle soreness prevails. • Improved flexibility with the use of static or PNF stretches. Medium or heavy stretches are recommended. • Good muscular and joint mobility. • More efficient muscular movements and fluidity of motion. introduction ii • Greater ability to exert maximum force through a wider range of motion. • Prevention of some lower back problems. • Improved appearance and self-image. • Improved body alignment and posture. • Better warm-up and cool-down in an exercise session. General recommendations • Try to include all the major muscle groups in any stretching program. • Do at least two different stretches for each joint movement. • Before any physical activity, use light stretches as part of the warm-up. • After an exercise routine, cool down with medium-intensity stretches. • If muscles are sore after exercising, use only light stretches two or three times with a 5- to 10-second hold for each stretch performed. • If muscle soreness persists for several days, continue using light stretches two or three times with a 5- to 10-second hold for each stretch performed. • The majority of the stretches should be static. Stretching Programs The following programs can be prescribed for anyone who is interested in improving flex- ibility, strength, and strength endurance. To make changes to any of these areas, you need to be involved in a regular stretching program, preferably as a daily routine or as close to that as possible. Changes will not come in a day or two but rather after a dedicated effort of several weeks. You can incorporate these programs with or without any other kind of exercise routine. According to the latest research, heavy stretching, even without any other exercise activity, can bring about changes in flexibility, strength, and muscular endurance. As in any other exercise program, progression is an integral part of a successful stretch- ing program. The stretching progression should be gradual, going from a lighter load with less time spent on each stretch to a heavier load with more time spent on each stretch. For the programs outlined in this introduction, you should begin with the initial program, or level I, and then progress through to level V. However, you may customize this program according to your current level of experience and flexibility. Generally, working through each level at the recommended speed will result in meaningful and consistent workouts. After such workouts, you will find improved flexibility in the muscles you worked as well as the satisfaction of having done something beneficial. Intensity is always a critical factor when you want changes and improvements to come from an exercise program. In a stretching routine, intensity is controlled by the amount of pain associated with the stretch. Using a pain scale from 0 to 10, initial pain is light (scale of 1 to 3) and usually dissipates as the time of stretching is extended. Light stretching occurs when you stretch a particular muscle group only to a point where you feel the stretch with an associated light pain. Moderate stretching (scale of 4 to 6) occurs when you start to feel increased, or “medium,” pain in the muscle you’re stretching. In heavy stretching (scale of 7 to 10), you will initially experience a moderate to heavy pain at the start of the stretch, but this pain slowly dissipates as stretching continues. Research studies have shown that heavier stretches rather than lighter stretches provide greater improvements in flexibility and strength. Thus, you are the key to your own success, and how well you are able to monitor stretch intensity and tolerate the pain level determines how quick and large the improvements will be. iii introduction Because of the complexity of muscle attachments, many stretching exercises simultane- ously affect a variety of muscle groups in the body and stretch the muscle groups around multiple joints. Thus, a small change in body position can change the nature of a stretch on any particular muscle. To get the maximal stretching benefit in any muscle, it is helpful to know joint movements that each muscle can do. Putting the joint through the full range of each motion allows for maximal stretching. You can customize the exercises in this book, which will allow for numerous stretch combinations. Also, this book illustrates only a portion of the available stretches. You are encouraged to experiment with these stretches by following the explanations provided. Information is also provided to enable you to explore a variety of positions in order to stretch the muscle by slightly altering the angles and directions of the various body positions. Thus, you can adapt the stretching exercises to fit your individual needs and desires. For example, if you have soreness in only one of the muscles or just a part of the muscle, you can adapt each exercise to stretch that particular muscle. If the explained stretch or particular body position does not stretch a particular muscle as much as you want it to, then experiment by slightly altering the position. Keep making alterations in the position until you reach the desired level of stretch (using a pain scale rating). In the programs that appear in the following section, specific instructions are given relating to the time to hold the stretch and time to rest between each stretch, as well as the number of repetitions you should do. You should follow these instructions in order to get the benefits described. For example, if the instructions indicate that you should hold a stretch position for 10 seconds, time (or count out) the stretch to ensure that you hold it for the recommended time. Also, you should incorporate only two to four heavier stretching days in each week and have a lighter stretching day in between each of the heavier stretching days. Finally, for any stretch involving sitting or lying down, you should do the stretch with a cushion underneath you, such as a carpet or athletic mat. Cushioning makes the exercises more comfortable to perform. However, the cushioning should be firm. Too soft of a cushion will reduce the effectiveness of the stretches. Recommended PRogRams The following programs are specific stretching recommendations and are based on your initial flexibility. In addition to following the programs listed, you should follow the general recommendations listed previously. Stay on each level for two to four weeks before going to the next level. Level I • Hold the stretching position for 5 to 10 seconds. • Rest for 5 to 10 seconds between each stretch. • Repeat each stretch two times. • Use an intensity level on the scale from 1 to 3, with light pain. • Duration is 15 to 20 minutes each session. • Stretch two or three times per week.