NASM REVIEW

Define flexibility

Define flexibility

The normal extensibility of all soft tissues that allows the full range of motion of a joint

Define Dynamic Range of Motion

The combination of flexibility and the nervous system's ability to control this range of motion efficiently (Optimal control of moment throughout a joint's entire ROM

Define Neuromuscular Efficiency

The ability of the neuromuscular system to allow agonists, antagonists, and stabilizers to work synergistically to produce, reduce, and dynamically stabilize the entire kinetic chain in all three planes of motion

Define Postural Distortion Patterns

Predictable patterns of muscle imbalances

Define Relative Flexibility

The tendency of the body to seek the path of least resistance during functional movement patterns

Define Muscle Imbalance

Alteration of muscle length surrounding a joint

Define Reciprocal Inhibition

The simultaneous contraction of one muscle and the relaxation of its antagonist to allow movement to take place

Define Altered Reciprocal Inhibition

The concept of muscle inhibition, caused by a tight agonist, which inhibits its functional antagonist

Define Synergistic Dominance

The neuromuscular phenomenon that occurs when inappropriate muscles take over the function of a weak or inhibited prime mover.

Define Arthrokinetic Dysfunction

Altered forces at the joint that result in abnormal muscular activity and impaired neuromuscular communication at the joint

Define Autogenic Inhibition

The process by which neural impulses that sense tension are greater than the impulses that cause muscles to contract, providing an inhibitory effect to the muscle spindles

Define Pattern Overload

Consistently repeating the same pattern of motion, which may place abnormal stresses on the body

Define Static Stretching

The process of passively taking a muscle to the point of tension and holding the stretch for a minimum of 30 seconds

Define Dynamic Stretching

The active extension of a muscle, using force production and momentum, to move the joint through the full available range of motion

When the GTO senses _______ it causes ________

tension, relaxation

when the muscle spindle senses ______ it causes_______

stretch, contraction

Define Davis's law

states that soft tissue models along the lines of stress

Adhesions (contraction knots) form an inability to what?

for the muscle to stretch

What are the 3 phases of flexibility training within the OPT model?

1. Corrective Flexibility

2. Active Flexibility

3. Functional Flexibility

What should you do for Corrective flexibility?

1. Self-Myofascial Release

2. Static Stretching

What should you do for Active flexibility?

1. Self-Myofascial Release

2. Active-isolated stretching

What should you do for Functional flexibility?

1. Self-Myofascial Release

2. Dynamic Stretching

Flexibility techniques should only be performed on what tissues?

Tissues that have been identified as overactive during the assessment process

Self Myofascial Release is a stretching technique that focuses on what two systems in the body?

The neural system and the fascial system (or the fibrous tissue that surrounds and separates muscle tissue)

When using SMR you should find a tender spot and sustain pressure on that spot for a minimum of how long?

30 seconds

Why should you use SMR before stretching?

breaking up fascial adhesions may potentially improve the tissue's ability to lengthen through stretching techniques

How would you use SMR for the Gastrocnemius and Soleus?

1. Place foam roll under mid-calf

2. Cross left leg over right leg to increase pressure (optional)

3. Slowly roll calf area to find the most tender spot

4. Once identified, hold tender spot until the discomfort is reduced (minimum 30 seconds)

How would you use SMR for your TFL/IT Band?

1. Lie on one side, the foam roll just in front of the hip. Cross the top leg over the lower leg, with foot touching the floor

2. Slowly roll from hip joint to lateral knee to find the most tender spot

3. Once identified, hold tender spot until the discomfort is reduced (minimum 30 seconds)

How would you use SMR for your adductors?

1. Lie prone with one thigh flexed and abducted and the foam roll in the groin region, inside the upper thigh

2. Slowly roll the inner thigh area to find the most tender spot

3. Once identified hold tender spot until the discomfort is reduced (min 30 seconds)

How would you use SMR for the performs?

1. sit on top of the foam roll, positioned on the back of the hip. Cross one foot to the opposite knee

2. Lean into the hip of the crossed leg. Slowly roll on the posterior hip area to find the most tender spot

3. Once identified, hold tender spot until the discomfort is reduced

How would you use SMR for the Latissimus Dorsi?

1. Lie on the floor on one side with the arm closest to the floor outstretched and thumb facing upward

2. Place the foam roll under the arm (axillary region)

3. Slowly move back and forth to find the most tender spot

4. Once identified, hold tender spot until the discomfort is reduced

What are the mechanisms of action of a static stretch?

Autogenic inhibition or reciprocal inhibition (depending on how the stretch is performed)

What are the acute variables of a static stretch?

1-3 sets

Hold each stretch for 30 seconds

How do you perform the static gastrocnemius stretch?

1. Stand facing a wall or stable object

2. Extend one leg back, keeping the knee and foot straight and the back heel on the floor

3. Draw navel inward

4. Keep rear foot flat, with foot pointed straight ahead. Do not allow the rear foot to flatten

5. Bend arms and lean forward toward the wall. Keep the gluteal muscles and quadriceps tight and the heel on the ground

   (Make sure the gluteal muscles and quads are activated to keep the knee in full extension. This will enhance the stretch to the gastroc)

How do you perform the Static Standing TFL Stretch?

1. Stand in a staggered stance with the front leg slightly ben and rear leg straight

2. Externally rotate back leg

3. Draw navel inward

4. Squeeze gluteal muscles while rotating pelvis posteriorly

5. Slowly move body forward until a mild tension is achieved in the front of the hip being stretched

6. As a progression, raise the arm (on the same side as the back leg) up and over to the opposite side while maintaining pelvis position

7. Hold side bend position and slowly rotate posteriorly as illustrated

8. Hold for 30 seconds

9. Switch sides and repeat

   (Make sure the gluteal musculature is contracted during the stretch. This will help reciprocally inhibit the TFL, allowing for greater lengthening of the TFL)

How do you perform the Static Kneeling Hip Flexor Stretch?

1. Kneel with front and back legs bent at a 90-degree angle

2. Internally rotate back hip to target the posts musculature or maintain a neutral position to target the rectus femurs

3. Draw navel inward

4. Squeeze gluteal muscles of the side being stretched while rotating pelvis posteriorly

5. Slowly move body forward until a mild tension is achieved in the front of the hip being stretched

6. As a progression, raise arm, side bend to opposite side, and rotate posteriorly as illustrated

7. Hold for 30 seconds

8. (Placing a foam pad underneath the knee may improve comfort for the client, especially if stretching on a hard surface)

How do you perform the Static Standing Adductor Stretch?

1. Stand in a straddled stance with the feet beyond shoulders width apart. Extend one leg back until the toe of the back leg is in line with the heel of the other foot. Both feet should be pointed straight ahead

2. Draw navel inward and posteriorly rotate the pelvis

3. Slowly move in a sideways motion (side lunge) until a stretch in the straight leg's groin area is felt

4. Hold for 30 seconds

   (Be sure to take a wider stance than shoulders width apart to ensure optimal lengthening. This stretch can also be performed from a kneeling position or seated on a stability ball to reduce demand caused by maintaining a static lunge position)

How do you perform the Static Latissimus Dorsi Ball Stretch?

1. Kneel in front of a stability ball

2. Place one arm on ball, with thumb pointed straight up in the air

3. Draw navel upward

4. Posteriorly rotate the pelvis

5. Slowly reach the arm straight out by rolling the ball forward

6. Hold for 30 seconds

   (If this stretch causes any pinching in the shoulder, perform the stretch with the palm down on the ball. To increase the stretch, slightly adduct the outstretched arm across the body)

How do you perform the Static Pectoral Stretch?

1. Stand against an object and form a 90-90-degree angle with your arm

2. Draw your navel inward

3. Slowly lean forward until a slight stretch is felt in the anterior shoulder and chest region

4. Hold the stretch for 30 seconds

   (Make sure the shoulders do not elevate during the stretch. This is an example of relative flexibility and decreases the effectiveness of the stretch)

How do you perform the Static Upper Trapezius/Scalene Stretch?

1. Stand in optimal posture

2. Draw navel inward

3. Retract and depress the scapula on the side being stretched

4. Tuck chin and slowly laterally flex the head, pulling one ear toward the same side shoulder

5. Hold the stretch for 30 seconds

6. Switch sides and repeat

   (As with the pectoral stretch, keep the shoulder of the side being stretched down and retract it by depressing the scapula on the side being stretched. To help accomplish this, one can place the arm on the side being stretched behind the body)

What is the mechanism of action for the active-isolated stretch?

reciprocal inhibition

What are the acute variables for the Active-Isolated Stretch?

1-2 sets

Hold each stretch 1-2 seconds for 5-10 repetitions

How do you perform the Active Gastrocnemius Stretch with Pronation and Supination?

1. Stand near a wall or sturdy object

2. Bring one leg forward for support. Use upper body and lean against object

3. Draw navel inward

4. Keep rear foot not he ground, with opposite hip flexed

5. Slowly move through hips, creating controlled supination and pronation through the lower extremityHold for 1-2 seconds and repeat for 5-10 reps

   (make sure when performing the stretch that the majority of the motion is coming from internal and external rotation of the hip, which in turn causes rotation at the one and eversion and inversion on the foot and ankle)

How do you perform the Active Supine Biceps Femurs Stretch?

1. Lie supine on floor with legs flat

2. Flex, adduct, and slightly internally rotate the hip of the side being stretched while keeping the knee flexed

3. Place the opposite hand behind the knee of the leg being stretched

4. Draw navel inward

5. With hand supporting leg, extend the knee

6. Hold for 1-2 seconds and repeat for 5-10 reps

   (Adducting and internally rotating the hip places ore of an emphasis on the short head of the biceps femoris)

How do you perform the Active Standing TFL Stretch?

1. Stand in a staggered stance with the front leg slightly bent and rear leg straight

2. Externally rotate back leg

3. Draw navel inward and raise arm overhead

4. Squeeze gluteal muscles while rotating pelvis posteriorly

5. Stride forward, in a controlled manner, until a mild tension is achieved in the front of the hip being stretched. Side bend and rotate posteriorly as illustrated

6. Hold for 1-2 seconds and repeat for 5-10 reps

   (as with the static stretch, make sure the gluteal muscles are contracted when going into the stretch. This will help in enhancing neuromuscular efficiency between the hip flexors and hip extensors)

How do you perform the Active Kneeling Hip Flexor Stretch?

1. Kneel with front and back legs bent at a 90-degree angle

2. Internally rotate back hip to target the psoas musculature or maintain a neutral position to target the rectus femoris.

3. Draw navel inward and raise arm overhead

4. squeeze gluteal muscles of the side being stretched while rotating pelvis posteriorly

5. Slowly move body forward until a mild tension is achieved in the front of the hip being stretched. Side bend and rotate posteriorly.

6. Hold for 1-2 seconds and repeat for 5-10 reps

   (internal rotating the back hip targets the posts because this muscle concentrically performs hip flexion and external rotation)

How do you perform the Active Standing Adductor Stretch?

1. Stand in a straddled stance with the feet more than shoulders-width apart. Extend one leg back until the toe of the back leg is in line with the heel of the other foot. both feet should be pointed straight ahead

2. Draw navel inward and posteriorly rotate the pelvis

3. Slowly move in a sideways motion (side lunge) until a stretch in the straight leg's groin area is felt.

4. Hold for 1-2 seconds and repeat for 5-10 reps

   (Make sure to keep the hips level when going into the stretch)

How do you perform the Active Latissimus Dorsi Ball Stretch?

1. Kneel in front of stability ball.

2. Place one arm on ball with thumb straight up in the air.

3. Draw navel upward.

4. Maintaining core control, roll ball out until a comfortable stretch is felt

5. Hold stretch for 1-2 seconds and repeat for 5-10 reps

6. Switch sides and repeat

   (Make sure to initiate the stretch by going into a posterior pelvic tilt. This will take the origin and insertion of the latissimus doors further apart, enhancing the stretch)

How do you perform the Active Pectoral Stretch?

1. Stand against an object and form a 90-90-degree angle with the arm as depicted.

2. Draw navel inward

3. Slowly lean forward until a slight stretch is felt in the anterior shoulder and chest region

4. Hold stretch for 1-2 seconds and repeat for 5-10 reps

   (Retract the scapulae when going into the stretch. This will reciprocally inhibit the pectorals major and minor, enhancing the stretch.)

How do you perform the Active Upper Trapezius/Scalene Stretch?

1. Stand with optimal posture

2. Draw navel inward

3. Tuck chin and slowly laterally flex the head, pulling one ear toward the same-side shoulder while retracting and depressing the same-side shoulder complex

4. Hold stretch for 1-2 seconds and repeat for 5-10 reps

   (If tingling is felt down the arm and into the finger, decrease the range of motion of the stretch. This will take stress off of the nerve. Also make sure the head stays in a neutral position during the stretch. Do not allow the head to just forward)

What is the mechanism of action for the dynamic stretch?

reciprocal inhibition

What are the acute variables of the dynamic stretch?

1-2 sets

10-15 repetitions

3-10 exercises

How do you perform the prisoner squat for dynamic stretching?

1. stand in proper alignment, with the hands behind the head

2. Draw navel inward

3. Lower to a squat position, under control and without compensation (toes straight ahead, knees in line with the toes)

4. Extend hips, knees, and ankles and repeat

5. Perform 10 reps

   (as a progression add a calf raise after extending the hips, knees and ankles)

How do you perform the Multiplayer Lunge with Reach dynamic stretch?

1. Stand in proper alignment with hands on hips and feet straight ahead.

2. Draw navel inward.

3. While maintaining total body alignment, step forward (sagittal plane), and descend into a lunge position while reaching forward as illustrated)

4. Use hip and thigh muscles to push up and back to the start position

5. Perform 10 reps

6. Repeat on opposite leg

7. Progress to side lunges with reach (frontal plane), followed by turning lunges with reach (transverse plane)

How do you perform the Single-Leg Squat Touchdown dynamic stretch?

1. Stand on one leg in optimal posture, keeping raised leg parallel to the standing leg. Imagine the floating leg is resting on an imaginary phonebook

2. Draw navel inward

3. Squat, in a controlled manner, bending the ankle, one, and hip while reaching the opposite hand near the standing leg toe

4. While maintaining drawn-in maneuver and gluteal activity, return to starting position

5. Perform 10 reps

6. Repeat on opposite side

   (Make sure the knee is tracking in line with the second and third toes. Do not allow the knee of the squatting leg to move inside the foot)

How do you perform the dynamic stretch of Tube Walking: Side-to-Side?

1. Stand with feet hip-width apart, knees slightly bent, and feet straight ahead

2. Place tubing around lower leg.

3. Draw navel inward

4. Keep feet straight ahead and take 10 small steps sideways, without allowing knees to cave inward.

5. Repeat in the opposite direction

   (Make sure the toes stay straight ahead and do not turn the feet out when stepping. This exercise is very effective for improving gluteus medium and core activation)

How do you perform the dynamic stretch Medicine Ball Lift and Chop?

1. Stand with feet hip-width apart, knees slightly bent and feet straight ahead

2. Grasp a medicine ball with both hands and keep elbows fully extended

3. Draw belly button inward

4. Starting from optimal posture, initiate the rotational movement from the trunk outward, lifting the medicine ball from a low position to a high position

5. Allow the hips to pivot on the back foot as the motion nears end range

6. Perform 10 reps

7. repeat on opposite side

   (Allow for the hips to rotate during both portions of this exercise (chop and lift). This will improve arthrokinematics through the lumbo-pelvic-hip complex)

Why is the Plow a controversial stretch?

-the head is lower than the hips and places high stress on the neck and spine

Why is the shoulder stand a controversial stretch?

it is inverted like plow and places high stress on the neck, shoulders, and spine

Why is straight-leg toe touch a controversial stretch?

it may place the vertebrae and the cartilage discs in the low back under high stress. Also, clients with poor flexibility may attempt to hyperextend the knees during this stretch, which may place high stress on the ligaments of the knee

What is the arching quadricep stretch controversial?

it paces very high stress on the kneecap and the other tissues on the front of the knee joint

What are probably overactive muscles when your feet turn out?

Soleus

Biceps femoris (short head)

Lateral Gastrocnemius

What are probable underactive muscles when your feet turn out?

Medial gastrocnemius

Sartorius

Gracilis

Medial hamstring complex

Popliteus

Sartorius

What are two sample SMR techniques to use when your feet turn out?

gastroc/soleus

biceps femoris (short head)

What are two sample static stretches to use when your feet turn out?

gastroc stretch

supine biceps femoris stretch

What is a sample strengthening exercise to use when your feet turn out?

single-leg balance reach

What are probable overactive muscles when your knees move inward?

Adductor complex

Vastus lateralis

TFL

Biceps femoris (short head)

What are probable under active muscles when your knees move inward?

gluteus medius/maximus

vastus mediales oblique (VMO)

What are two SMR techniques to use when knees move inward?

1. adductors

2. TFL/IT band

What are two static stretches to do when your knees move inward?

1. supine biceps femoris stretch

2. standing TFL stretch

what is a good strength exercise to do when your knees move inward?

tube walking side to side

If you have excessive forward lean, what muscles are probably overactive?

1. Soleus

2. Gastrocnemius

3. Hip flexor complex (TFL, rectus femoris, psoas)

4. Abdominal complex (rectus abdomens, external oblique)

If you have excessive forward lean, what muscles are probably under active?

1. Anterior Tibialis

2. Gluteus maximus

3. Erector Spinae

If you have excessive forward lean, what are two SMR techniques you should use?

1. gastroc/soleus

2. quadriceps

If you have excessive forward lean, what are two static stretches you should use?

1. gastroc stretch

2. kneeling hip flexor stretch

If you have excessive forward lean, what strengthening exercise should you use?

1. Quadruped arm/opposite leg raise

2. Ball wall squats

If your low back arches, what muscles are probably under active?

1. Gluteus maximus

2. Hamstring complex

3. Intrinsic Core Stabilizers

If your low back arches, what two SMR techniques should you use?

1. Quadriceps

2. Latissimus Dorsi

If your low back arches, what two static stretches should you use?

1. Kneeling Hip Flexor Stretch

2. Latissimus Dorsi Ball Stretch

If your low back arches, what strengthening exercise should you use?

1. Quadruped arm/opposite leg raise

2. Ball wall squats

If your arms fall forward, what muscles are probably overactive?

1. Latissimus Dorsi

2. Teres Major

3. Pectoralis major/minor

If your arms fall forward, what muscles are probably under active?

1. Mid/lower traps

2. Rhomboids

3. Rotator Cuff

If your arms fall forward, what two SMR techniques should you use?

1. Thoracic Spine

2. Latissimus Dorsi

If your arms fall forward, what two static stretches should you use?

1. Latissimus Dorsi Ball Stretch

2. Pectoral Wall Stretch

If your arms fall forward, what strengthening exercise should you use?

Squat to row

If your shoulders elevate during the pushing/pulling assessments, what muscles are probably overactive?

1. Upper Traps

2. Sternocleidomastoid

3. Levator Scapulae

If your shoulders elevate during the pushing/pulling assessments, what muscles are probably under active?

Mid/lower traps

If your shoulders elevate during the pushing/pulling assessments, what SMR technique should you use?

Upper trapezius (thera cane)

If your shoulders elevate during the pushing/pulling assessments, what static stretches should you do?

Static stretch upper trapezius/scalene stretch

If your shoulders elevate during the pushing/pulling assessments, what strengthening exercise should you do?

Ball cobra

If your head protrudes forward during the pushing/pulling assessments, what muscles are probably overactive?

1. Upper trapezius

2. Sternocleidomastoid

3. Levator scapulae

If your head protrudes forward during the pushing/pulling assessments, what muscles are probably under active?

Deep cervical flexors

If your head protrudes forward during the pushing/pulling assessments, what SMR technique should you use?

Upper trapezius (thera cane)

If your head protrudes forward during the pushing/pulling assessments, what static stretches should you do?

Static stretch upper trapezius/scalene stretch

If your head protrudes forward during the pushing/pulling assessments, what strengthening exercises should you do?

Chin tuck (keep head in neutral position during all exercises)

Biomechanics

the science concerned with the internal and external forces acting on the human body and the effects produced by these forces.

Length-Tension Relationships

the resting length of a muscle and the tension the muscle can product at this resting length.

Force-Couple Relationship

muscle groups working together to produce movement around a joint.

Muscle Levers

Joint motion caused by pulling on bones. Bones are levers, Muscles create the motion, and resistance can be body weight or object weight.

3 kinds of levers

1st class: fulcrum in the middle, like a seesaw. Ex. nodding the head

2nd Class: resistance in the middle. like a load in a wheelbarrow. Ex. full body push ups or calf raises

3rd Class: effort in the middle (MOST LIMBS IN THE HUMAN BODY ARE 3RD CLASS) Ex. human forearm during bicep curl. (fulcrum=elbow, effort=bicep, load=dumbbell)