New Dimensions in Flexibility: What the Research is Finding and Missing by Charlie Hoolihan (2011)


Round three everybody, welcome to round three. Thank you if you are here for round three. You are great endurance athletes; I appreciate you being here, if you are here for the first time, thank you for coming and investigating it. If you are brand new here, I am a recovered swim coach now personal trainer, and I am honored to be here and speaking to ASCA and all you guys who have dedicated yourself to improving kids, and making them better people. It’s tremendous, and I know that when all the dust shakes off from budget cuts, they will for sure raise teachers and coaches salary.

My talk is on flexibility, flexibility is something that is pretty heavily researched, and is also heavily misinterpreted. And what I want to do, is at least bring a little clarity to some of that as best as I can, being an English major who just started reading a lot and investigating research projects after I got involved in training. I want you to think of this as, just like with the core training, as your own guidelines to do your own research project. By enlarged, research is done on things that are being done. So if Coach Bower develops cruise intervals, they will do research on cruise intervals to see how effective they are. If you develop a program producing Olympic caliber athletes, they will do research on the components of your program. This discussion is to head you in that direction. Especially personally, because everyone is different in terms of physiologic makeup and everyone needs to think of him or her as their own personal research project.

We have known about flexibility for a long time, everyone had done or talked about it in some frame or fashion. There are goals of flexibility, the goals as I see it, are to improve motion and the length tension relationship in muscles and joints. What that means is the relationship between how much tensions you can handle, how long your muscles are, and how far apart they are. Another goal is to improve a neural stretch response, how are you stimulating the proprioceptors and golgi tendons in your joints to respond better to motion. In order to do a stronger motion, there are all types of sensors in all of your joints, which need to be stimulated. The final goal is to improve posture, alignment, and overall function and movement. So, for example, if you are a breaststroker trying to get your foot everted better and gets the range of motion needed to get into the right position.

Lets see how it works. What I would like you to do is stand up, and we are going to do a couple of examples. First, we are going to breathe, and what I want you to do is put your hands under your chin, and you are going to pretend that your lungs are attached to the outside of your elbows. Now I want you to raise up your elbows as you inhale, then exhale out, practice that a few times. Do you feel relaxed? What you just did is stretched all of your breathing muscles. When you are exhausted you use more muscles to breathe, you use your shoulder and intercostals. The stretch we just did opened up the lungs, and put you in a posture that allowed those muscles we do not realize we use while we breathe to effective aide in breathing.

Now, lets talk about posture, and what it does to your ability to move. So what I want you to do, is slump your shoulders down, and raise up your shoulders as high as you can. That does not feel too good, right? It makes you feel all tense and pulled and stressed at the shoulder. Imagine if you were a swimmer, who swims like this, and look at your swimmers and see how many are slouched. Now straighten up, doesn’t that feel better, there is not as much tension in your shoulders. Let’s slouched down again, this time I want you to turn and look at your right hand. Without taking your eye off your finger, I want you to rotate as far as you can to the left. Come back to center, and then stand up tall. Do the same rotation I just had you do, and you will notice that you will get further towards the wall. That is something that is very important, if we are talking about flexibility in the shoulder and upper spine. If you are a swimmer and you’re slumped trying to reach you will notice that you have impingements in the spine and shoulder, which is not very healthy. If you want your swimmers to have good rotation, and not have that rotation bang into areas that are not supposed to be banged into repetitively, you want their shoulders in the upright position, you want them flexible.

The next thing we are going to do, has very little to do with swimming, it has more to do with coaching and walking on the pool deck. Close your eyes, and I want you to think of the bottom of your feet and where do you feel your foot pressing into the ground. Open your eyes, and I want you to keep that feeling in your head. Now I want you to walk around, and feel the pressure of your foot going into the ground. Do that until you have a good picture of where your bodyweight is being pushed into the ground. Keep that feeling in your mind. Now I want you to lay on your back, bend your knees, and grab your hamstring. Twirl your foot twenty times clockwise and counterclockwise, then you want to point and flex your foot twenty times, repeat with your other foot. If your shins burst into flames, you are doing it correctly. Once you have finished that, hop up and walk around, see if you notice any change. Where is the pressure on your foot now? Is it the same place? What is the most dominate feeling in your foot? What normally occurs is you feel more balance, instead of feeling all the pressure in one area. For those that are runners, you should do this all the time. So what you did is nothing flexible, or stretching, what you did is stimulated muscles that are typically weak. Those muscles were stimulated so now they can be more involved while you are standing there. So if you are a breaststroker who typically walks on the outside of your feet, you will probably feel more balanced, as apposed to Daffy Duck. Part of the message is that we have some muscles that are weak that do not need to be stretched, they might be over stressed, and we have tight areas that need to be stretched.

For this next demonstration, you need to find a partner. I want you to bend at the waist, keeping your spine straight, and try to reach as low as you can, mark that spot and notice how it feels. Once you have figured that out I want you to lay on the ground to complete the next few exercises. For the first exercise, you are going to lay on your stomach, arch your back driving your hips down, and get your head back. Hold that position for two minutes. When you are done with that, rotate onto your back, bring your knees towards your chest, keeping you legs parallel to one another roll your legs to the right, you will spend a minute on the side then roll to the other side and spend a minute on your left. For the last exercise you want to get into your hands and knees, you are going to alternate from a arching your back and collapsing your back making sure you are moving your hips when you do each motion, repeat twenty of each. Once you have completed all three exercises you want to retest your ability to bend down and reach towards the ground. Did you get more range of motion? What the exercises you did, did not stretch your hamstrings, the aided in hip and spinal mobility and rotational capacity.

Now you are going to actually stretch, we will start with a hip flexor stretch. Once again there are three separate motions, the first motion you will put your foot behind you on a chair, and jump forward until you feel a little tug, raise your hands up as high as you can, and I want you to feel a stretch from you fingers all the way to your toes, then you want to gently lean to the right, then to the left, then rotate. Once you have done that, walk around and compare a stretched leg to an un-stretched leg. Can you feel a difference? After you have compared them, go ahead and stretch the other leg.

Okay, you cannot see this, but I can, it is a book by 14 different authors, talking about the anatomy of optimal range of motion. The one that is probably the most near and dear to swimming is I’ve got an extreme of 55 degrees of internal rotation, to 95 degrees of internal rotation, as the authors recommended range of motion for that joint. A difference of 40 degrees, I am not a geometrist, but that is a lot of degrees. When we talk about research coming up, that is some of the stuff researchers are coming up with. Range of motion is life; it is not a stretch put into a singular position. If somebody has tight calves, it does not necessarily mean that is the issue. Range of motion is how the whole body moves when we stretch a particular way. What’s happening here with this is that we have got hip extension and flexion, spinal rotation flexion, knee flexion, knee extension, shoulder abduction, shoulder adduction, dorsal and plantar flexion, each time an athlete is hitting the floor, that is the type of range of motion that is going on. Do you think a research project is finding that? No. In swimming, they are going through these ranges of motions without ground force, which is kind of a good thing. I asked an expert a long time ago, why do swimmers swim so much and track athletes don’t train as much? Her answer was that swimmers could get away with it, you can train a 50 freestyler 2 hours a day and get away with it, you can not train a 100m dash runner for 2 hours a day nonstop and get away with it. You get away with it in swimming because you do not have the ground force reaction. We need more range of motion, and to achieve more range of motion or effective range of motion, we need to understand the purpose of what our stretch is. Just because you can grab a pull up bar and bring you legs through that pull up bar then all the way through and then let go, does not you have to or should do that, that is not a normal range of motion. You have to understand that active and passive motions are two different things. When we did the stretches, we took you through 4 or 5 different motions that had a relative aspect to what you would that you would do in hip flexion and extension. When I run, when my leg comes here, my stretched leg is here but I am rotating here.

If I just do this stretch here, and that is it, I am ignoring 5 or 6 different ranges of motion that I am trying to stretch and get ready to do. It is the same thing with shoulders, if you just stretch this way, and not come up here, your ignoring different ranges of motion that occur within the shoulder, and different directional challenges that are presented to the muscle. You want to understand what the end ranges of motion are, how far is a normal end range of motion? What is getting in the way of that end range of motion? If I was going to do a foam roll, what you are doing here when you are using a foam roll, what happens is that if you have a trigger point and this is your muscle out here, and there is a knot in the muscle, and you just do a normal stretch, you are stretching up to that knot, and then you are going to the other side of that knot and you are stretching that side. You still have the knot, but if you get a foam roll, and you press into the foam roll into your back, what you do is you release the knots and kinks that were in your back that were preventing you from doing a motion.

What we did, is we took the kink out of the shoulder. The area of pain is the area that is jammed up. You think about the shoulder, and you think about the way the muscles of the shoulder are, they are linear, they go in different directions, but the area that is going in different directions is linear. There are all kinds of pulling things happening when you swim. What is happening is there is something going on in the shoulder that is not in alignment. In doing that, we are releasing some of that tension.

Male Speaker 1: Exactly what kind of a ball are we using?

Hoolihan: It is called a trigger point ball, but you can use a softball or a medicine ball. If you do it this way, you are releasing the muscles in different ranges of motion.

Male Speaker 2: (Inaudible 43:22)

Hoolihan:: When we talk about fascia, he asked if I got pain here, and then it wrapped around to back here, it is muscle fascia, it is the muscles adjoined by this sheath of fascia from your toes to your fingers, and when you disrupt that fascia in a different area, and start pulling in the wrong direction, you are going to get pain. If I have effective motion with my shoulder square, what happens with people who have internal rotation, every single swimmer in the country has internal rotation, so what happens is that if you can open that up and release that and bring the fascia up out of that rotated position, then you are not banging at it. The shoulders are suppose to be on top of the body, their shoulders are suppose to be in front of the body pointing straight. Unfortunately though, they are down and in because of the way we live, swimmers are desperately susceptible to this because as we talked in the core work, here is your force, you are driving the force in here. If I am a runner, all it is doing is making me a slow runner because I am running like this. If I am a swimmer, it is causing me to bang into the joints and tendons more than it should.

Hoolihan: If you have issues you should roll everything everyday, before you do anything. I am running out of time, it took us two minutes to do the foam roll. If you get down and you learn how to do rolling, you can do it in 15 minutes. If you have an issue, you do it proactively before hand. I have a shoulder issue, everyday before I lift weights, I roll my lat and right shoulder, because my right shoulder is the one that bothers me. Remember when we talked about in the core thing, the shoulder that you are more likely to have a problem with, is the one that you overuse. When I begin my workout with the rolling, my right shoulder does not have any pain. If I get out there and start doing anything, even swimming, and I don’t stretch my lats, I am going to get pain in my shoulder. So it is proactive, especially if you have issues. For those of you that are triathletes, you should live on this thing. With the amount of jamming up in your body, the upright position that is important is pretty amazing.

Male Speaker 3: These are expensive right?

Hoolihan: Ya

Male Speaker 3: The benefit of a kid bringing a tennis ball is that going to provide adequate (inaudible 47:00)

Hoolihan: Not a tennis ball, but a softball or a small basketball. What you can do is, get them to do their shoulders and lats.

Hoolihan: Yes there is, we will do it after probably because we are going to run out of time. Let me kind of move on from this and we will take questions after. So what about research, I have seen studies that say that stretching is ineffective, a waste of time, increases injury, decreases strength and power, that certain types or stretching are worse than other types, there are also different opinions on the length of time you should do a stretch. There are a ton of different opinions. The research of the research says that, even though there is conflicting information about stretching, there is not any evidence that you should discontinue it or throw it away as a modality. There is evidence that says we should change what we are doing. We saw everyone get more range of motion from doing this. We saw more people get more range of motion on their toe touch without stretching. We saw some of the guys with shoulder issues feel a little better when we did this press on the shoulder. This is stuff that has not been researched, but is stuff that every trainer in the country that is practicing this, is getting tremendous results. So you are going to see research that is conflicting.

Male Speaker 5: Charlie, swimmers have been told for years that swimming backstroke is going to help their shoulders more than any other stroke, do you believe in that?

Hoolihan: I do, because if you always swim internally rotating, you have to balance it out by externally rotating like you do in backstroke.

Common sense tells you that when you stretch it feels good. Nowhere in the research shows that if you do that in the middle of a run you are going to feel better. We all kind of know that the kid that is like this is the one that is injured more. Or the breaststroker that is trying to run gets shin splints, ankle pains, or knee issues, because they have no range of motion. What makes them talented in breaststroke screws them for any kind of land-based activity, because they do not have this ability. That ability in running is critical, you cannot stay to the outside of your feet like that. So maybe the research is not measuring the right thing, maybe the stretches are bad. Research on the research concluded the out of twenty flexibility tests that twelve out of twenty and eight out of twenty stretch protocols were reliable, less than half for female, and almost half for male. Another one found that less than 78% of twenty methalogical practices in the research study was flawed. Not to mention they are all conflicting.

One examination of flexibility and running economy, same thing, found that improved flexibility is desirable for enhanced running economy. The other one found out that inflexibility in certain areas of the muscular skeletal system may enhance running economy. What? You just said the same thing. Another set of research says that sprinters have more hip extension range of motion, than marathon runners. Here is a really cool study, this gets to the point of when we are talking about the dog and cat stretching we did earlier, this study researched injuries in hamstrings and what they did is agility, core stabilization, and icing. They had ten times the improvement in hamstring than the one that had static stretching and hamstring exercises. They considered the entire body, and this isn’t even little stuff, the standard guys returned to sports in 37 days while the nontraditional guys returned to sports in 22 days. Two weeks later the standard guys 54% of them were injured again, with the nontraditional core stabilization multi level muscle groups, 0% were re-injured. One year late 70% were re-injured in the standard group and 7% were re-injured in the non standard group. It found that strengthening the core reduced hamstring issues. So I think the answer here is that you need mixed modality to do that, if you stretch that hamstring and your hips are knocked out in an anterior tilt position, you are pulling your hamstrings up. They are tight because they are over active and over stretched. So you need to stretch your hip flexors because they are the ones pulling your hips up. Once again it is a mixed modality thing, you need to roll those hamstring, release and relax them. You need the multi plane stretching, just like we did. If you are a swimmer, and we have talked about internal rotation, what are we stretching right here. I am stretching to get more range of motion in internal rotation. I am also stretching muscles in my back that are already overactive and stretched, and they are in too much trouble right now.

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