Flexibility Assessment Notes

Assessing Flexibility

What Is Flexibility?

  • Flexibility is the ability to move through a full Range of Motion (ROM).
  • Types of flexibility:
    • Static flexibility
    • Dynamic flexibility

Joint Classification by Structure and Function

  • Gliding Joints
    • Axes of rotation: Nonaxial
    • Movements: Gliding, sliding, twisting
    • Examples: Intercarpal, intertarsal, tarsometatarsal joints
  • Hinge Joints
    • Axes of rotation: Uniaxial
    • Movements: Flexion, extension
    • Examples: Knee, elbow, ankle, interphalangeal joints
  • Pivot Joints
    • Axes of rotation: Uniaxial
    • Movements: Medial and lateral rotation
    • Examples: Proximal radioulnar, atlantoaxial joints
  • Condyloid and Saddle Joints
    • Axes of rotation: Biaxial
    • Movements: Flexion, extension, abduction, adduction, circumduction
    • Examples: Wrist, atlanto-occipital, metacarpophalangeal, first carpometacarpal joints
  • Ball and Socket Joints
    • Axes of rotation: Triaxial
    • Movements: Flexion, extension, abduction, adduction, circumduction, rotation
    • Examples: Hip, shoulder joints

Factors Affecting Flexibility

  • Joint structure
  • Soft tissue tightness
  • Body composition
  • Age
  • Sex
  • Physical activity
  • Muscle temperature

Excessive Flexibility

  • Hypermobility
  • Joint laxity
  • Subluxation or dislocation

Assessing Flexibility

  • Dynamic flexibility
    • Measures resistance during muscle elongation
    • Considered impractical and typically used in lab tests
  • Static flexibility
    • Direct measures of ROM
    • Indirect measures of ROM

Direct Measures of Static Flexibility

  • Measure joint ROM in degrees
  • Measurement devices:
    • Goniometer
    • Electrogoniometer
    • Smartphone apps

Electrogoniometer

  • Advantages over goniometer:
    • Flexible
    • Hands-free operation
    • Ability to measure in two planes simultaneously

General Guidelines for Flexibility Testing

  • Flexibility is joint-specific.
  • Perform three trials and take the average of the three measurements.
  • Compare results to established norms.
  • Identify areas in need of improvement.

Validity and Reliability of Direct Flexibility Measures

  • Dependent on:
    • Joint being measured
    • Technician skill
  • Tester requires the following skills:
    • Knowledge of anatomy
    • Knowledge of standardized procedures
    • Training and practice

Indirect Measures of Static Flexibility

  • Sit-and-reach tests
    • Moderately related to hamstring flexibility
    • Poorly related to low back flexibility
  • Skin distraction test
  • Back scratch test

Sit-and-Reach Test Variations

  • Standard: box, 26 cm start
  • V-sit or YMCA: yardstick, 15 in. (38 cm) start
  • Modified: box, start relative to arm length
  • Back-saver: box, single leg, 26 cm start
  • Modified back-saver: bench, single leg, 26 cm start

Skin Distraction Test

  • Low back flexibility assessment
  • Procedure:
    • 0 cm mark: lumbar spine at the level of posterior superior iliac spine
    • 15 cm mark
    • Maximal trunk flexion
    • Measure the new distance between the marks

Back Scratch Test

  • Start standing
  • Test:
    • One hand: client reaches over the shoulder and down the back
    • Other hand: client reaches up the middle of the back
  • Score: measure from middle finger to middle finger
    • Overlap is indicated as +
    • Gap is indicated as –