While joint flexibility may decrease with age, with the

potential to affect normal daily function, older adults do

maintain the ability to improve flexibility through
stretching exercises
Why is flexibility important for seniors?
As we age, staying limber and flexible becomes more and more important.
Flexibility helps us increase our range of motion so we can easily complete
everyday tasks like bending down to tie your shoes or reaching to get a
dish from a shelf.

Neurological System
Normal, nervous system with flexibility

Spine
The spinal column is the conduit of the entire nervous system. It is composed of 22 bones and
multiple joint surfaces between each, as well as muscles surrounding all sides. The spine
protects and promotes the flow of conscious and unconscious control of our entire body: the
motor nerves that make our arms and legs work, as well as the autonomic nerves that control
breathing, heart rate, digestion, and all other components vital to running.

People may understand muscle and joint flexibility, but few recognize the vital importance of
spinal mobility. While it is a strong, resilient ‘organ,’ the spine is extremely sensitive to changes
in mobility. Stiffness can cause significant dysfunction to those systems.

Nerves
The nervous system consists of continuous, interconnected tissue that begins in the brain and
spans out to the tips of our fingers and toes. Because nearly every nerve emanates from the
brain and travels down the spinal column, the entire system is one continuous piece of tissue.
That said, since the nerves that travel to the feet pass through the upper neck, it is possible–and
uncannily common–for a neck issue to affect the legs. Indeed, ‘it’s all connected’ through the
nervous system.

The nervous system can lose mobility when any part of the spinal column becomes stiff, or any
tissue through which the nerve runs–including muscle, fascia (the protective and
power-enhancing muscle covering), or even skin–becomes stiff or injured.
Nervous tissue is highly sensitive. When they lose mobility, nerves can become very painful or
create tension in muscles, tendons, and joints in order to protect themselves. Conversely, the
nervous system may weaken other muscles to protect vulnerable nerves.

This nerve tension is the most important tissue mobility. Trying to stretch a tight muscle or
joint–without first addressing nerve tension–is a losing strategy, as the brain will always protect
a tense nerve through muscle tightness.

A classic example of nerve tension is ‘hamstring flexibility:’ the sciatic nerve–the pain nerve
powering the posterior and lower leg–runs its course from the posterior pelvis to the back of the
knee. Stiffness anywhere in the spine–from the ears to the tailbone, and everywhere in
between–can create tightness in the hamstrings that is unrelenting to any hamstring stretching.
People who complain of ‘tight hamstrings’ or achiness in the posterior thigh are experiencing
sciatic nerve tension. And more often than not, the problem is coming from somewhere in the
spine.

All that said, the nerves drive all flexibility in our bodies. For this reason, a mobile nervous
system is extremely important.

Performance Flexibility: Joint, Spine, And Nerve Mobility For Runners

https://movementum.co.uk/journal/2019/5/30/stretching

Ageing
● Somatic motor cortex
○ Around 35% of people over the age of 70 years have gait problems; while there
are many contributing factors, including age-related changes to muscles and
joints, the nervous system is also implicated. The somatic motor cortex – located
in the frontal lobes of the brain – controls the movement of muscles involved in
walking. From middle age onwards the neurons in this region show signs of
atrophy (Manini et al, 2013), which can contribute to gait problems, potentially
reducing mobility in older people (Rosso et al, 2013).
● Brainstem and autonomic function
○ The autonomic function of the brain does decline with age and this can
compromise the body’s ability to respond quickly to internal and external
environmental changes (Hotta and Uchida, 2010). Both branches of the
autonomic nervous system (ANS) – the parasympathetic and sympathetic
branches – are compromised with age (Parashar et al, 2016).
○ These changes can negatively affect older people. For example, the blunting of
baroreceptor responses increases the risk of postural hypotension, so standing
up suddenly can lead to falls and injury.
● The loss of myelin slows the conduction of peripheral nerve impulses by around 5-10%
(Joynt, 2000). In health, this reduction in conductivity causes few problems, but in older
people with diabetes it may contribute to, and exacerbate, diabetic neuropathy.
Damaged peripheral nerves are not repaired as efficiently in older people as in their
 younger counterparts, and some of these nerves are never repaired. This can contribute
to reduced sensation and motor control.
● Reaction time
○ The progressive loss of neurons, reduction in impulse velocity and minor
changes in the spinal cord lead to a slowing down of reaction times (Spirduso,
1995). This can create problems, particularly when a fast reaction is essential (for
example, to step out of the way of oncoming traffic).

Normal - Flexibility
When flexibility is carried out normally, it helps improve blood circulation, makes the body less
stiff, improves the mood, and many other things.
https://www.healthline.com/health/why-does-stretching-feel-good#benefits
https://movementum.co.uk/journal/2019/5/30/stretching
https://www.reposelifestyle.com/2018/04/flexibility-isnt-what-we-think-it-is/

Ageing - Flexibility
No such research has been conducted → But the same principles can be applied → over time
through the ageing process, it can be assumed that the body will become less stretchable. The
body loses its flexibility over time.

This article has more stuff on flexibility in older adults - But not sure about neurological stuff.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3703899/
https://www.physio-pedia.com/Physical_Activity_and_Neurological_Conditions

Exercise Modification: (Hold onto something all the time, to avoid losing balance)
● Easier, repetitive exercises -- because elder patients forget easily.
● Slow increments of the stretches → Because they might pull something
● Stretching to improve their posture, improve their gait and improve their balance.
● Stretching to improve coordination → and reaction time
● Bending over and standing up flexibility exercises to avoid head rush and blood pressure
problems.
● Reduce blood pressure and stress → by stretching as it is said to release endorphins
and improve circulation.
● Swimming, or even just getting into a pool, moving around and doing exercises
and stretching is a great way to improve flexibility. Although it will not be as
effective as doing set stretches, yoga or Pilates, tai chi, swimming is a great way
to lengthen the muscles.

https://ioraprimarycare.com/blog/stretching-exercises-for-seniors/
https://www.youtube.com/watch?v=eHXbj2Uq8mM

Cardiorespiratory
Normal

Ageing
Pectoral muscles may become shortened as a result of the forward lean position
include stretches that aim to maintain the length of the pectoral muscles and in doing so this may improve
posture

Loss of muscle mass particularly occurs in immobile individuals or in those who lead a sedentary
lifestyle, as inactivity promotes muscle wastage and weakness (Nigam et al, 2009).

With age, the intervertebral discs gradually become desiccated, less robust and more compressed under
the weight of the body. Age-related curvature of the thoracic spine causes a narrowing of the spaces
between the vertebrae and between the ribs; this progressively reduces the volume of the rib cage
(Lowery et al, 2013).
Thoracic flexibility training (TFT) is a spinal exercise that focuses on thoracic spine extension, which
results in increased respiratory rate by reducing tension in the intervertebral discs and surrounding
tissues Park D, Won J, Roh J, Ko E, "Effects of the thoracolumbar exercise program on static standing balance and pain in low back pain patients," Orthopaedic Physical
Therapy Practice, V. 24, No. 2. (2012), pp. 78- 84. [11] Heo M-Y, Kim K, Hur B-Y, Nam C-W, "The effect of lumbar stabilization exercises and thoracic mobilization and exercises
on chronic low back pain patients," Journal of Physical Therapy Science, V. 27, No. 12. (2015), pp. 3843-6.

Normal CV responses to flexibility training: Flexibility training can elicit hemodynamic responses.
Mechanoreceptors are activated through the stretch in muscle fibers which can help with parasympathetic
withdrawal and sympathetic activation.

Ageing CV responses to flexibility training: As a result of ageing, there is a decrease in elasticity of

blood vessels and in particular arterial walls. In arterial walls, there is a thickening of the tunica intima and
tunica media, decreasing the lumen size and thus, reducing arterial elasticity (Marieb and Hoehn, 2015).
Specifically in flexibility training.
Compared to the younger population, the heart rate and stroke volume decrease during exercise. This is due to
the structural change in shape of the heart, caused by an increase in remodelling and redistribution of cardiac
muscle mass ( Lakatta, 1990).
An increase in blood pressure due to reduced elasticity and narrowing of the lumen diameter which results in
increased level of vasoconstrictor ( Angiotensin II)

Modifications: Skeletal muscle stretching is a low intensity form of exercise recently shown to elicit
significant cardiovascular responses in all populations (Kruse & Scheuermann, 2017).
Musculoskeletal

Normal responses to flexibility training -

Roles of structures in humans
Skeletal muscles:
● Produce movement and maintain posture via contractions
● Support cardiovascular system by aiding venous return to the heart
● Create heat to sustain normal body temperature

Bones:
● Provide support and protection
● Allow for the mechanics of movement via joints/levers
Free of severe degeneration, illness and disease
(Knight and Nigam, 2017)
For the body to conduct the necessary functions of the skeletal muscles and bones, there must be
adequate flexibility at each joint. There are two types of flexibility in humans, static flexibility and dynamic
flexibility. Static flexibility is the range of movement available at the joint, whereas dynamic flexibility is
how easily the muscles will allow the joint to achieve this range of movement. (Gleim and McHugh, 1997),
without flexibility the skeletal muscles and bones will not be able to function efficiently and safely.
There are many factors that can influence both flexibility and increases in range of motion with training
including the degree of physical condition, age, training specificity as well as training variables including
the number of sets, repetitions, order of exercises and rest periods. Stretching exercises in particular will
improve flexibility in a population. (Simao et al., 2011)

Ageing and flexibility - Changes occur in the collagen and elastin of ligaments in older adults. - This
reduces the elasticity of the ligaments in turn reducing the mobility and increasing joint stiffness (Knight
and Nigam, 2017)
Intervertebral disc (IVD) degeneration occurs with age - involving a reduction in disc height. This alters
the mechanical properties of the IVD, resulting in reduced flexibility and mobility at the spine. (Boros and
Freemont, 2017; Galbusera et al., 2014; Sung, 2016)
Loss and erosion of articular cartilage - structural and functional failure of synovial joints, alteration of
subchondral bone, a synovial inflammatory response and pain and disability - leading to reduced range of
motion at a joint. But movement , including stretching can increase joint circulation, thereby providing
nutrition to the articular cartilage; (ii) strengthen muscles; (iii) improve joint stability; and (iv) preserve and
possibly improve joint function and range of motion (ROM) (Forsyth et al., 2011)
Postural changes - can occur with age due to conditions such as osteoporosis , that can cause Muscle
“tightness” can result from this passively as they become shortened for being in that position
continuously. (Page, 2012)

Acute effects of stretching: decreased muscle stiffness through visoelastic deformation of the muscle
tissue (transient and short lived), Increased muscle length through serial addition of sarcomeres
(improves muscle length, increase stretch tolerance (Kubo et al., 2001).

Modifications:
-Pilates method has previously been used incorporating an exercise ball (ball adds support and allows to
only stretch to individual limits) - (Geremia et al., 2015)
- Assisted passive stretch with longer hold (60 Seconds) in older population shown to give larger increase
in ROM (Feland et al., 2001)