How to Tap the Flexibility Fountain of Youth

Flexibility is essential to both athletic performance as well as good health. The Spine Engine Theory postulates that a significant amount of the power that drives human locomotion comes from stretching and releasing fascia rather than from direct muscle contraction and extensions. In addition, loss of flexibility makes us more susceptible to injury as our bodies start shifting movement elsewhere in search of compensation for lost flexibility in our joints. The chart below shows the results of an extensive study of over 7,000 participants measuring flexibility by age. Not surprisingly we see a drop in flexibility with age.

Interestingly, there is a substantial difference in the decline by joint. Around age 30, the elbows and knees start to show separation from other joints in maintaining more flexibility. At age 45-50, trunk and shoulders begin to lose flexibility precipitously relative to other joints. When isolating the shoulders, the worst joint in terms of loss of motion, numerous studies show the greatest loss of motion is external shoulder rotation. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3824991/

It is not a surprise that external shoulder rotation is highly impacted. The picture below shows some of the impact of poor desk posture. We can see clearly how this posture can cause the shoulders to become rounded forward.

A study published in 2015 used combined radiological and histological procedures to investigate changes in rotator cuff muscles. The study included 294 patients without rotator cuff tears and 109 patients with rotator cuff tears. The study found a pattern with aging: the supraspinatus, a muscle located on the upper back, and suprascapularis, a muscle located on the upper chest, significantly declined with aging. This is not a surprise because one of the impacts of sitting at a desk all day is elongated upper back muscles and shortened upper chest muscles.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4686609/

Sports which rely on external shoulder rotation include:
 • Baseball Hitting
 • All throwing motions (Football, Baseball, …)
 • Tennis Serve and Forehand
 • Golf Swing

The chart below from a study on golfers range of motion by age shows the rapid decrease in external shoulder rotation.  Of all the motions in the shoulder, greatest reduction was in dominant side external shoulder rotation.

https://www.jospt.org/doi/pdf/10.2519/jospt.2003.33.4.196

Beyond reducing us to an embarrassing fast ball speed or golf drive, lack of flexibility in shoulders can lead to a variety of injuries including:

– Frozen Shoulder
– Rotator Cuff Tears
– Bursitis
– Tennis Elbow and Golfer’s Elbow

Fortunately, we are not stuck living with our flexibility dissipating year by year.  There are numerous studies showing soft tissue mobilization with other methods of treatment can produce rapid improvement in overall shoulder external rotation range of motion.  Soft Tissue mobilization techniques include Advanced Release Therapy, Graston Technique, and Dry Needling.  No Soft Tissue Mobilization should be undertaken before confirming with your physician that

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4242960/
https://www.jospt.org/doi/pdf/10.2519/jospt.2003.33.12.713

The pictures below are of a 54 year old who went through Advanced Release Technique for his right shoulder and no therapy for his left shoulder.  Both shoulders started relatively comparable.  This was after 4 treatments of 30 minutes each.  We estimated approximately 16 degrees of incremental gain in external shoulder rotation.