功能性柔韧：将复杂简单化

是否在高尔夫，足球、棒球或者其他任一项目的训练中，很多运动员都会意识到力量训练的好处，却很少有人能意识到柔韧性训练的重要性。柔韧性是我们的基础！实际上，没有柔韧性，机体将不会表现出最佳状态的爆发力、力量、肌耐力以及心血管健康。

柔韧性是预康复、运动表现和损伤预防的基石。然而，柔韧性练习在实际训练中似乎很少见，最可能的是这样一些原因——一项研究显示了导致这种困惑的几种观点。

1.当回顾隐匿在大多数研究背后的原则时，就很容易理解为什么会有这些观点。作为专家，重要的是我们选择什么样的技术（手法）是根据一些原则性的方法来决定的，而这些方法是针对每一个人的需要制定的，而不是随意设计出的所谓准则。为了帮助大家决定选择什么样的技术（手法），我们将首先推出三大准则，而这些准则是应该应该予以考虑并要遵循的一个策略——去评估和定位你的病人或客户的功能性柔韧。

功能性柔韧的三大准则：

1. 个体化和所要执行的任务

2. 三维空间

3. 灵活性/稳定性系统

功能性柔韧是使我们去更好发挥功能的柔韧性。它让机体在执行任务时能最优化和有效化。

2.精确的功能就是个体化和所要执行的任务。

3.所以，一般根据肌肉起止点所设计的拉伸技术不能给我们提供最佳的功能性输出。相反，医师在工作中必须重视肌肉的功能。也就是说，肌肉怎样工作是由所要执行的任务来决定而不是教科书中所描述的。这不是说教科书的作者是错的，他们对于姿势、动作功能的概括在特定的情况下是正确的。

当身体改变了角度，姿势等的时候，它的功能也随之发生了改变；这就是为什么为了使柔韧性功能化，这些手法看起来就必须追求所要达到的功能。所以，我们需要理解在精确工作时，肌肉、筋膜、肌腱、韧带、神经、关节囊和关节是如何在三维空间内运动的；不仅要看动作的运动幅度，还要看怎样的运动方式更好。对于个体（不是教科书）和想要达到的任务（所有的任务需要不同水平的运动-稳定性）而言，在三维空间内需要适当的运动程度和适当的稳定性程度，这就是灵活性-稳定性的原则。

为了使得这个复杂的原则简单化，我们将分享一个应用于我们三大原则的实战策略。这个策略将会在你接下来的评估或评价中被实际应用。

首先最重要的是，清楚每一个不同的个体和任务。一旦你清楚了个体目前的条件、限制因素、担忧和他们想要做的，你就可以尽可能地评价你所要完成任务的真正功能。关键就是明白他们想要或需要去做的，以及当下他们究竟该怎样做才能成功完成。在这里，我们创建一个策略去引导他们(医师)，使其沿着正确的方向尽可能迅捷且安全地解决问题。举例来说，正如每一个体和每个任务所需要的，需从步骤一开始，只能推进到步骤二和三。

步骤一：任务专项化。评估完成这个精确任务的能力。例如，走，弓箭步，下蹲、转动、迈步、触够、跑、平衡、抓起特定的目标，坐着的同时举起右手等等。是否做这些动作时产生了疼痛、不适或者缺少信心，产生了一个可靠地支撑去协助任务的完成。例如，一个人两腿开立，可能向前够到膝关节高度时，会感到后背部很紧。

你是否将高度调整到触及腰部呢？是同样还不舒服还是会感觉好一点呢？如果感觉好一点，是不是在第一次评估时后背和髋部不允许后背在那个范围内活动呢？在达到所要完成的任务之前，要让自己象侦探一样通过改变身体的角度、姿势、高度、驱动（注：所谓“drivers”在这里应该是主动发力还是被动发力的意思）、范围等等来查找原因。找到他们获得成功（这里的成功是指所想要执行的任务，如做一个动作等）时所想要或需要做的是什么。如果这个失败了，那么进入水平二（尽管看起来水平二跟水平一的步骤很相像）。

步骤二：完成任务的外在支持。轻微地增加外在支撑或者稳定的支点来达到预想的功能。以我们为例来说，如利用拉伸练习器或门道进行简单地增加外在支撑。外在支撑将使你的病人或客户置于特定的范围或区域，然后再应用可靠地驱动。伴随他们的起始运动，用你的触诊技术去评估整个链式的反应，以此来寻找弱链。这就是运动-稳定原则的应用。假如问题在那里的话，机体将会觉察稳定性，它会以灵活性的形式表现出来。如果有人怀疑灵活性不在那里，而想评估结构组织的质感，张力水平，那么步骤三则能提供有关所怀疑问题结构的信息（而不是精确地功能）。

步骤三：具体的结构。为结构的评估提供一个环境，如底座或是桌子。如果想获得功能，那么就要弄清楚偏离真正功能任务的原因，因为一个偏差或者结果将与功能具有相关性和统一性。

在过去，很多手法的实施是从症状或者结构的僵硬开始进入步骤三，最终回到步骤一。在这个范式的迁移里，我们要让精确的功能去判断功能与孤立组织的差距有多大。这个策略节省了时间，但是更重要的是给了你的病人和客户希望——“功能反应功能”。

由于功能总是变化的特性，所以被认为是复杂的。我们可以通过简化下一步的功能来简化功能。用病人和客户的话说，他们经历过什么，通过你的健康指导就能有怎样移动。当我们应用实用功能科学的这个原则时，柔韧性就被赋予新的意义。功能柔韧性是将个体看做一个整体的。一旦你理解了动力学的所有内容，至少在原则上，你将会获得一种能力以及各部分之间相互作用的动作模式。

FUNCTIONAL FLEXIBILITY: Complex Made Simple

by

Lenny Parracino PT, FAFS

Whether training for golf, football, baseball, or any sport, most athletes realize the benefits from a strength training program, yet rarely recognize the importance of a flexibility program. Flexibility is the foundation of what we do! In fact, without flexibility the body will not exhibit optimal levels of power, strength, cardiovascular fitness, or muscle endurance. Flexibility is the cornerstone of rehab, performance, and preventing injuries. However, flexibility programs seem to be less popular, most likely for a variety of reasons – one being research shows mixed reviews which often leads to confusion.1 When reviewing the principles (or lack thereof) behind most research it is easy to understand why the mixed reviews exist. As professionals, it is important that our decisions on what technique to choose be determined by a principle-based approach that is specific to each person’s intended need, not an arbitrarily designed guideline. To assist in determining what technique to choose, we will first explore three primary principles that should be considered, followed by a strategy to assess and address your patient’s / client’s functional flexibility.

Three Primary Principles of Functional Flexibility:

1. Individual and Task Dependent

2. Three-Dimensional

3. Mobility / Stability System

Functional flexibility is flexibility that allows us to function better. It allows one to perform tasks optimally and efficiently.2 The exact function is individual and taskdependent. 3 Therefore, general stretching techniques designed for muscle origininsertion will not provide us with an optimal functional outcome. Instead, the practitioner must appreciate the function of the muscles during the task. In other words, what a muscle does is task driven not textbook driven. This doesn’t make the textbook authors wrong, their right relative to the position, motion in which they concluded function at that time. When the body changes angles, positions, etc., its function changes; this is why for flexibility to be functional the techniques must look like the intended function. Therefore, we need to understand how the muscles, fascia, tendons, ligaments, nerves, joint capsules, and joints are moving three-dimensionally during the exact task; not only how much motion but also how well. This is the principle of mobility-stability, the right amount of motion with the right amount of stability in all three planes specific to the individual (not textbook) and intended task (all tasks require different levels of motion-stability).

To help simplify this complexity, we would like to share a practical strategy applying our three principles. This strategy can be used practically during your next assessment / evaluation…

First and foremost, understand each unique individual and task. Once you understand the individual’s current condition, limitations, concerns, and what they want to do, assess the intended task with as much authentic function as possible. The key is in understanding what they want / need to do and what they currently can do successfully. From here build a strategy to lead them in the right direction as quickly and safely as possible. For example, start with level one and only move to level two and three as needed per individual, per task.

Level One: Task specific. Assess the ability to perform the exact task. For example, walking, lunging, squatting, pivoting, stepping, reaching, running, balancing, picking up a specific object, sitting while reaching with right hand, etc. If this produces pain, discomfort, and/or lack of confidence, create authentic support to assist in the task. For example, one may reach forward at knee height from a split standing stance and feel low back stress. What if you changed the height of the reach to waist height? Same discomfort or less? If less, is it the back or the hips inability to allow the back to be successful from the range first assessed? Become a detective by changing body angles, positions, heights, drivers, ranges, etc. before leaving the intended task. Figure out a way to gain success in what they want/need to do. If this fails, progress to level two (although level two will look like level one).

Level Two: Task with outside support. Subtly add outside support or points of stability to the intended function. Using our example, simply add outside support such as in a True Stretch or a doorway. The outside support will allow you to position your patient / client in a specific range or zone to then apply authentic drivers. As their driving motion, use your palpation skills to assess the entire chain reaction searching for the “weak-link.” This is the application of the motion-stability principle. Then the body perceives stability it will exhibit mobility, providing it’s there. If one suspects the mobility is not there and desires to assess structural tissue texture, tension level three can provide information regarding the suspected structure (not exact function).

Level Three: Structure specific. Provides an environment for a structural assessment such as a plinth or table. This deviation from the exact functional task must be understood as a deviation and the results then correlated and integrated back into function, if function is the desired outcome.

Traditionally many techniques have been taught to start from the symptom or structural tightness to level three eventually getting to level one. In this paradigm shift, we allow the exact function to dictate how far away from function and into isolated structure we go. This strategy saves time but most importantly gives hope to your patient / client – function feeds function. Although function is complex due to its always changing nature, we can simplify function by simply following function. Use what your patient / client is saying, what they have experienced, and how they are moving as your guide to improving their wellbeing. When we apply the principles of Applied Functional Science (convergence of physical, biological, and behavioral science), flexibility takes on a new meaning. Functional flexibility recognizes the individual as a whole. Once you understand the dynamics of the whole, you derive, at least in principle, the properties and patterns of interactions of the parts.

1 Journal of Bodywork and Movement Therapies (2003) 7(1),1

2 Gray G: Functional Video Digest. Functional Flexibility Enhancing Life. V2.11

3 Gray G: Fast Function. Flexibility, Mobility. 2006​​​