Common Orthopedic Flexibilities Issues

Hamstring | Glutes or Adductor | Hip Flexor | Iliotibial Band | Ankle

Shoulder: Transverse Abduction / Extension | External Rotation | Internal Rotation

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Hamstrings Inflexibility

Increased risk of lower back injury during hip extension activities when knees are straight. If hip flexion (eccentric phase of hip extension), is inhibited by hamstrings inflexibility, the lumbar spine may compensate by flexing more than usual. The risk of injury is increased if the lumbar spine is not accustomed to this movement or workload. Also see Active Insufficiency.

Gluteus Maximus or Adductor Magnus Inflexibility

Increased risk of lower back injury during hip extension activities when knees are bent. After complete flexion of the hip (eccentric phase of hip extension), the lumbar spine will flex if movement is continued. The risk of injury is increased if the lumbar spine is not accustomed to this movement and workload. Until flexibility can be restored, recline leg press back support to furthest position and base hip flexion range of motion criteria just before hips tilt. Also see Full Squat Flexibility Q&A.

Hip Flexor Inflexibility

Increased risk of lower back injury during hip flexion and extension and overhead standing activities. During extension activities, the lower back can hyperextend more than usual if the hip cannot fully extend. During hip flexion activities, the Iliopsoas can hyperextend spine during hip flexor activities. Risk is compounded when hip flexor inflexibility is combined with abdominal weakness.

Shoulder Transverse Abduction / Transverse Extension Inflexibility

Typically due to insufficient flexibility of pectoralis muscles. Results in decreased range of motion during chest exercises. High risk for behind the neck exercises, particularly when combined with external shoulder rotation inflexibility. Exacerbated and often accompanied by protracted shoulders girdle. Excluding cases with particular orthopedic problems (e.g.: infraspinatus weakness), participants should be encouraged to perform chest exercises through THEIR full range of motion; shoulder transverse extension / hyperextension until a slight stretch is felt. Since the shoulder can typically hyperextend further than it can transverse extend, the exerciser performing a bench or chest press will be able to bring bar closer to body when elbows are positioned closer to body (shoulders more abducted).

Shoulder Flexion

Inability to raise arm forward overhead or undue exertion required position arm in vertical position.

Prone Shoulder FlexionExamples of affected exercises:

Shoulder External Rotation Inflexibility

Passive Shoulder External Rotation AssessmentIncreased risk of shoulder injury during activities involving external rotation of the shoulder. Risk is compounded with a winged scapula condition or kyphosis. Until full range of motion is restored, individuals with external rotation inflexibility should be advised to perform pull-downs and shoulder press with bar in front of head. Those with more severe cases should perform overhead presses with angled back support (eg: 100-110° incline bench).

Excessive Shoulder External Rotation

Shoulder range of motion is typically greater in swimmers and overhead athletes by acquiring anterior glenohumeral laxity. This allows for excessive shoulder external rotation, but places greater demand on the rotator cuff and the long head of the biceps to reduce humeral head elevation and anterior translation.

Weak or fatigued rotator cuff and scapular stabilizers may permit excessive humeral head migration, thereby increasing stress on the tendons.

  • Example of affected activities
    • Swimming (during the pulling motion of swimming)
    • Baseball Pitching

Shoulder laxity can further exacerbate to over compensate for the following conditions:

Shoulder Internal Rotation Inflexibility

Increased risk of shoulder injury during activities involving internal rotation of the shoulder. When the shoulder is flexed and internally rotated, pressure can be created between the insertion of the supraspinatus and acromion or coracoacromial ligament. Incidentally, pain in this position can be indicative of impingement or rotator cuff tendinitis (Hutton & Julin 1997). Tight internal rotators can contribute to protracted shoulders.

Iliotibial Band Tightness

Increased risk of lateral knee injury during knee extension activities. Iliotibial band friction syndrome (ITBFS) is a cause of diffuse tenderness over the lateral knee. While weight bearing during knee flexion, the Tensor Fascia Latea contracts to assist the other hip abductors stabilize the pelvis from lateral movement and the Gluteus Maximus extends the hip for forward locomotion. Both the Tensor Fascia Latea and the Gluteus Maximus can place tension on the Iliotibial tract, which produces repetitive friction on the lateral epicondyle. Furthermore, hip abductors weakness can exacerbate this pull on the Iliotibial tract by allowing the hip to sag slightly when standing on a single leg or during locomotion (Fredericson, et. al. 2000).

Ankle Dorsiflexion Inflexibility

Dorsiflexion flexibility is required during the lower phases of the squat and leg press, so Ankle Dorsiflexion inflexibility can make it difficult to perform squat and leg press exercises in full range of motion. If the range of motion of the ankle is limited, hip flexion may be exaggerated and knee flexion is often inhibited. To maintain normal range of motion in both the hip and knee, the heel may have a tendency to leave the floor or platform.

Plantar Fasciitis & Foot Dorsiflexion Inflexibility

Seated Plantar Fascia StretchHigh incidences of plantar flexion strength deficits and dorsiflexion range of motion limitations are associated with Plantar Fasciitis. Plantar Fasciitis is a common overuse syndrome occurring in runners and walkers. This syndrome is associated with microtears in the plantar fascia at its insertion into the calcaneus. If allowed to progress to the point when bone spur (calcium deposit) forms on the underside of the calcaneous (heel bone), surgery may be required. Individuals with excessive pronation (feet rolling inward), flat feet, or knocked knees have increased risk for plantar fasciitis. These conditions force the plantar fascia to stretch more during weight bearing activities, placing increased pressure where it attaches to the heel bone. High arches are also associated with plantar faciitis.

Examples of affected exercises

Example Preventative Exercises


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