Flexibility and Mobility Programming

Flexibility and mobility are critical components of functional fitness for older adults. Age-related changes in connective tissue, joint structures, and muscle tissue can significantly impact range of motion and movement quality. This lesson covers assessment and programming strategies to maintain and improve flexibility and mobility in the senior population.

Understanding Flexibility and Mobility

Definitions

Flexibility: The ability of soft tissues (muscles, tendons, ligaments) to lengthen and allow movement through a range of motion. Flexibility is typically passive—how far you can be moved or stretched.

Mobility: The ability to move freely and easily through a range of motion with control. Mobility is active—how far you can move using your own muscular effort.

Joint Range of Motion (ROM): The extent of movement available at a joint, determined by joint structure, flexibility, and mobility.

Both flexibility and mobility are important for older adults, but mobility (active control through range of motion) is often more functionally relevant.

Why Flexibility and Mobility Matter

Functional implications:

• Reaching overhead (cabinets, dressing)
• Bending to floor (picking up items, tying shoes)
• Turning to look behind (driving, awareness)
• Rising from chairs and beds
• Walking with normal gait pattern
• Maintaining balance

Health implications:

• Reduced risk of muscle strains
• Better posture
• Decreased low back pain
• Improved circulation
• Enhanced relaxation

Age-Related Changes Affecting Flexibility

Connective Tissue Changes

• Collagen becomes less elastic and more rigid
• Cross-linking of collagen fibers increases stiffness
• Elastin content decreases
• Water content in tissues decreases

Joint Changes

• Cartilage thinning and degeneration
• Synovial fluid production decreases
• Joint capsule stiffening
• Osteophyte (bone spur) development

Muscle Changes

• Muscle fiber stiffness increases
• Increased intramuscular fat
• Reduced muscle extensibility
• Altered muscle-tendon unit properties

Posture Changes

• Increased thoracic kyphosis (rounded upper back)
• Forward head posture
• Hip flexor tightness from sitting
• Ankle stiffness affecting gait

Assessment of Flexibility and Mobility

Common Tight Areas in Older Adults

Upper body:

• Shoulder flexion and external rotation
• Thoracic spine extension and rotation
• Cervical rotation

Lower body:

• Hip flexors
• Hamstrings
• Hip internal/external rotation
• Ankle dorsiflexion

Trunk:

• Lumbar flexion/extension
• Thoracic rotation

Simple Assessment Tests

Chair Sit-and-Reach (Lower body flexibility):

• Measures hamstring flexibility
• Part of Senior Fitness Test
• See previous lesson for protocol

Back Scratch Test (Shoulder flexibility):

• Measures shoulder rotation and reach
• Part of Senior Fitness Test
• See previous lesson for protocol

Thoracic Rotation:

• Seated or standing
• Measure rotation range to each side
• Note asymmetries

Hip Flexor Assessment:

• Thomas test (modified for safety)
• Note if thigh stays elevated when opposite hip is flexed

Ankle Dorsiflexion:

• Knee-to-wall test
• Measure distance from wall when knee touches

Functional Movement Screen

Observe quality of:

• Squat pattern (depth, alignment)
• Reaching overhead
• Turning/looking behind
• Stepping over obstacles
• Rising from floor (if appropriate)

Types of Flexibility Training

Static Stretching

Holding a stretch position for an extended period.

Protocols:

• Hold 30-60 seconds (60 seconds may be more effective for older adults)
• 2-4 repetitions per muscle group
• Mild discomfort, not pain
• Breathe normally

Best timing:

• After warm-up or exercise
• Not recommended before strength/power activities
• Can be done as separate flexibility session

Examples:

• Hamstring stretch
• Quadriceps stretch
• Calf stretch
• Chest stretch
• Shoulder stretch

Dynamic Stretching

Controlled movements through full range of motion.

Protocols:

• 10-15 repetitions per movement
• Controlled speed
• Gradually increasing range

Best timing:

• During warm-up
• Before any physical activity
• Can be part of cool-down

Examples:

• Leg swings
• Arm circles
• Trunk rotations
• Walking with high knees
• Walking lunges (if appropriate)

PNF Stretching (Proprioceptive Neuromuscular Facilitation)

Combines stretching with muscle contraction.

Contract-relax technique:

1. Stretch to mild tension
2. Contract muscle isometrically (6-10 seconds)
3. Relax and stretch further
4. Repeat 2-4 times

Considerations for older adults:

• More effective but more demanding
• Requires partner or fixed object
• Blood pressure considerations (avoid excessive strain)
• May be too intense for some clients

Active Isolated Stretching

Short-duration stretches with active movement.

Protocol:

• 2-second hold
• 10-12 repetitions
• Use opposite muscle group to create stretch
• May use rope or strap to assist

Myofascial Release

Self-massage using foam rollers or balls.

Considerations for older adults:

• Softer foam rollers may be more appropriate
• Focus on less bony areas
• Avoid areas with osteoporosis risk
• May need alternative positions (standing against wall)
• Not appropriate for all clients

Mobility Training

Joint-by-Joint Approach

Different joints have different needs:

Joints needing mobility:

• Ankle
• Hip
• Thoracic spine
• Shoulders

Joints needing stability:

• Knee
• Lumbar spine
• Scapula

Mobility work should focus on joints that commonly lose mobility while maintaining stability at adjacent joints.

Mobility Drills

Ankle mobility:

• Seated or standing ankle circles
• Calf stretches with knee bent and straight
• Knee-to-wall dorsiflexion

Hip mobility:

• Seated hip circles
• 90/90 stretches (modified as needed)
• Hip flexor stretches with glute activation
• Supine figure-4 stretch

Thoracic mobility:

• Seated thoracic rotation
• Thread the needle
• Cat-cow variations
• Foam roller extension (if appropriate)

Shoulder mobility:

• Wall slides
• Shoulder circles
• Open book stretch
• Doorway stretches

Programming Guidelines

ACSM Recommendations

• Flexibility exercises 2-3 days per week minimum
• Daily stretching provides greater benefits
• Hold static stretches 30-60 seconds
• Repeat each stretch 2-4 times
• Stretch all major muscle-tendon groups

Integration Strategies

Option 1: Part of warm-up/cool-down

• Dynamic mobility in warm-up (5-10 minutes)
• Static stretching in cool-down (5-10 minutes)

Option 2: Dedicated flexibility sessions

• 15-30 minute stand-alone sessions
• 2-3 times per week
• Focus on problem areas

Option 3: Daily flexibility routine

• Brief (5-10 minute) daily routine
• Morning to reduce stiffness
• Focus on most limited areas

Sample Flexibility Program

Daily Morning Routine (5-10 minutes):

1. Neck rotations (gentle)
2. Shoulder rolls
3. Seated trunk rotations
4. Cat-cow (if floor accessible) or standing pelvic tilts
5. Calf stretches
6. Hip flexor stretch

Post-Exercise Cool-Down Routine (10-15 minutes):

1. Walking until heart rate settles
2. Standing quadriceps stretch
3. Seated hamstring stretch
4. Figure-4 hip stretch
5. Chest stretch in doorway
6. Shoulder cross-body stretch
7. Triceps stretch
8. Deep breathing

Weekly Dedicated Session (20-30 minutes):

1. General warm-up (5 minutes light movement)
2. Dynamic mobility circuit (5 minutes)
3. Static stretches for all major muscle groups (15-20 minutes)
4. Relaxation (2-3 minutes)

Special Considerations

For Osteoporosis

• Avoid loaded spinal flexion stretches
• No aggressive twisting of the spine
• Emphasize hip mobility over spinal flexion
• Standing or seated stretches preferred
• Extension-based stretches are generally safer

For Arthritis

• Gentle range of motion exercises
• Heat application before stretching may help
• Avoid overstretching inflamed joints
• Movement is important—don't completely rest joints
• Water-based stretching can be helpful

For Joint Replacements

• Follow surgical team's guidelines
• Certain positions may be contraindicated initially
• Progress gradually post-rehabilitation
• Lifetime precautions may apply for some replacements

For Pain

• Never stretch into sharp pain
• Mild discomfort is acceptable, moderate pain is not
• Avoid bouncing or forcing range
• Address underlying issues if pain persists

Common Mistakes to Avoid

1. Bouncing: Use controlled, sustained stretches
2. Holding breath: Breathe normally throughout
3. Stretching cold muscles: Always warm up first
4. Overstretching: Mild tension, not pain
5. Inconsistency: Regular practice yields results
6. Neglecting weak areas: Address the areas that need it most
7. Only static stretching: Include mobility work for function

Progress Monitoring

Objective Measures

• Joint range of motion (goniometry)
• Sit-and-reach distance
• Back scratch test distance
• Functional reach tests

Functional Measures

• Ease of daily activities
• Quality of movement patterns
• Posture improvements
• Reports of stiffness

Realistic Expectations

• Improvements may be slow
• Consistency is more important than intensity
• Some limitations may be structural and unchangeable
• Focus on functional improvements

Key Takeaways

1. Both flexibility and mobility are important for older adult function
2. Age-related changes make regular stretching more important, not less
3. Static stretching is most effective after warm-up or exercise
4. Dynamic mobility is appropriate during warm-up
5. Frequency matters—daily stretching provides greater benefits
6. Hold stretches longer for older adults (60 seconds)
7. Address individual needs based on assessment findings
8. Consider chronic conditions when selecting techniques
9. Consistency over intensity—gentle, regular practice wins