Hamstring | Glutes or Adductor | Hip Flexor | Iliotibial Band | Ankle
Shoulder: Transverse Abduction / Extension | Flexion | External Rotation | Internal Rotation
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 under an significant workload. Also see Active Insufficiency.
- Examples of affected exercises:
- Example assessments
- Example preventative/corrective exercise:
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.
- Examples of affected exercises:
- Example Assessments
- Example preventative/corrective exercise:
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.
- Examples of affected exercises:
- Military press (standing)
- Decline Sit-up
- Lunge (rear leg)
- Lever Back Extension (fulcrum near hip)
- Example assessments
- Example preventative/corrective exercises:
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).
- Example of affected exercises:
- Example assessments
- Example of preventative/corrective exercises:
Shoulder Flexion
Inability to raise arm forward overhead or undue exertion required position arm in vertical position.
Examples of affected exercises:
- Dumbbell Shoulder Press
- Cable Shoulder Press
- Overhead Triceps Exercises
- Overhead Squat
- Power Clean
- American Swing
- Example assessments
- Shoulder mobility (open hands)
- Shoulder mobility (closed hands)
- Prone Shoulder Flexion
- Overhead Deep Squat
- Shoulder Flexion ROM
- Example of preventative/corrective exercises:
- Bent-over Lat Stretch (on chair or bench)
- Wall Lat Stretch
- Overhead Squat
- Dumbbell Shoulder Press
Shoulder External Rotation Inflexibility
- Examples of affected exercises:
- Behind Neck Shoulder Press
- Lever Shoulder Press (torso upright facing away from lever)
- Rear Pull-down
- Lever Fly (on pec deck)
- Overhead Squat
- Snatch
- Example assessments
- Example preventative/corrective exercises:
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
- Example assessments
Shoulder laxity can further exacerbate to over compensate for the following conditions:
- Winged Scapula Condition
- Protracted Shoulders
- Serratus Anterior Weakness or fatigue (Tovin 2006)
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.
- Examples of affected exercises:
- Upright Row (narrow grip)
- Sumo Deadlift High Pull
- Example assessments
- Example preventative / corrective exercises:
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 2000).
- Examples of affected exercises:
- Example assessment
- Example preventative / corrective exercises:
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 (Kim 2015) and leg press exercises in full range of motion. If the range of motion of the ankle is limited, knee flexion can be inhibited and hip flexion may be exaggerated which can inadvertently increase thoracic and lumbar spine flexion (List 2013, Campos 2016). Also see Butt Wink. To maintain normal range of motion in both the hip and knee, the heel may have a tendency to leave the floor or platform.
- Examples of affected exercises with suggestions for affected individuals until range of motion is restored
- Example Assessments
- Example preventative / corrective exercises:
Plantar Fasciitis & Foot Dorsiflexion Inflexibility
High 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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