Book Review  |   February 2009
Flexibility: A Concise Guide to Conditioning, Performance Enhancement, Injury Prevention, and Rehabilitation
Author Affiliations
  • Thomas Wesley Allen, DO
    1987–1998, JAOA—The Journal of the American, Osteopathic Association, Chicago, Ill, Clinical Professor Emeritus of Family and Sports, Medicine, University of Oklahoma College of Medicine, Tulsa
    Editor in Chief
Article Information
Book Review   |   February 2009
Flexibility: A Concise Guide to Conditioning, Performance Enhancement, Injury Prevention, and Rehabilitation
The Journal of the American Osteopathic Association, February 2009, Vol. 109, 104-105. doi:
The Journal of the American Osteopathic Association, February 2009, Vol. 109, 104-105. doi:
Of the three generally accepted components of physical fitness—cardiopulmonary (ie, aerobic) capacity, muscular strength and endurance, and flexibility—the latter component generates the most controversy. 
Does stretching enhance flexibility and, if so, what type of stretching is most effective? Is stretching best done before or after exercise or at both times? Does it enhance or diminish athletic performance? Can one prevent injury with the use of stretching? 
Dozens of clinical studies published in the scientific literature during the past several decades have drawn varying conclusions in attempting to answer these questions. 
In Flexibility: A Concise Guide to Conditioning, Performance Enhancement, Injury Prevention, and Rehabilitation, the authors address these and other questions based on their cumulative years of work in this area. 
Laurence E. Holt, PhD, longtime professor (now retired) in the School of Health and Human Performance at Dalhousie University in Halifax, Nova Scotia, is the book's senior author. 
The coauthors of the book are Thomas W. Pelham, MS, a physical therapy researcher in Nova Scotia, and Jason Holt, PhD, an assistant professor in the School of Recreation Management and Kinesiology at Acadia University in Wolfville, Nova Scotia. In the preface, Dr Pelham is credited with the clinical applications presented in the book while Dr Jason Holt is credited with the literature reviews that shaped the authors' critical assessment of previous research. 
Flexibility: A Concise Guide builds on the “Scientific Stretching for Sport” (3S) concept that Dr Laurence Holt described in his 1973 work on the reversal of antagonists. The 3S concept is based on techniques of proprioceptive neuromuscular facilitation (PNF). 
Readers familiar with the early research of Irvin M. Korr, PhD, regarding the facilitated spinal segment as the basis for the manual techniques of muscle energy, Strain-Counterstrain, and myofascial release will appreciate the description of PNF in this book. Through nervous system inhibition or facilitation, these manual techniques restore normal muscle function. 
Flexibility: A Concise Guide opens with an introduction proposing a new definition of flexibility: 

Flexibility is the disposition of body tissues to allow, without injury, excursions at a joint or set of joints.

The authors argue that a new definition is necessary to better conduct and interpret research in this area. However, I believe that an inordinate amount of verbiage is used to propose and explain this revised definition. But, perhaps they are right. 
The rest of the book is composed of two main parts: Part I, “Practical Considerations” (chapters 1-6), and Part II, “Theoretical Considerations” (chapters 7-10). 
The opening chapter of Part I, “Stretching Techniques and Exercise Prescriptions,” is a concise yet complete description of various forms of stretching techniques. Yoga, slow and static stretching, dynamic stretching, and PNF are described and compared, and the 3S technique is introduced. This chapter is helpful as a review. 
The remaining five chapters in this part of the book cover stretching techniques for the major muscle groups of the lower limbs, upper limbs, and trunk and neck, as well as advanced 3S exercises for figure skaters, gymnasts, divers, and dancers, with applications to sports, fitness, and dance. 
Each chapter is well written and nicely illustrated with photographs demonstrating practical applications of the various stretching exercises for the different muscle groups. I especially appreciated the photographs depicting a step-by-step, progressive application of each method. I found the specific applications to figure skating, gymnastics, diving, and dancing interesting and helpful. 
Part II opens with a chapter titled “Flexibility and Exercise,” on factors that influence flexibility. Although the authors admit there is conflicting evidence regarding the possible benefits of flexibility training, they attempt to focus on “more or less generally accepted findings and less controversial claims.” Brief discussions of such factors as age, sex, time of day, anatomic constraints, disease, injury, and posture are informative. The conclusions are supported by references to existing literature. 
I was a bit frustrated in attempting to locate the authors' sources. At the conclusion of each chapter, a numbered list of authors referenced in the text is provided—but only by surname and date. Thus, I had to refer to the bibliography at the end of the book to find the complete references. Perhaps the authors were trying to be helpful, but I found this aspect of the book annoying. 
The remaining three chapters of Part II cover “myths” about stretching, clinical concepts and applications, and mechanisms of flexibility enhancement. In the chapter about myths, the authors attempt to counter recent clinical studies questioning the benefits of stretching. 
In these chapters, the tone of the authors' critique is often dismissive, especially when conclusions presented in the literature are at odds with the authors' own clinical experiences. I leave it to readers to draw their own conclusions as to the validity of the authors' arguments. 
Helpful features in Part II include a number of tables and diagrams, such as a table with contraindications and precautions for therapeutic stretching and diagrams depicting models of the muscle-fascia-tendon complex. 
The concluding section of the book features a number of appendices. Among the items in this section are a glossary, a table of applied anatomy 3S stretches, photographs of machine and solo 3S exercises, and a list of recommended exercises for special activities. 
My pique regarding the tone of the authors' research critique notwithstanding, I found Flexibility: A Concise Guide informative and helpful. I recommend this book to practitioners who wish to increase their understanding of flexibility and the application of stretching techniques. 
 By Laurence E. Holt, PhD; Thomas W. Pelham, MS, PT, CSCS; and Jason Holt, PhD. 162 pp, $69.95. ISBN: 978-1-60327-105-9. Totowa, NJ: Humana Press; 2008.
 Editor's Note: Corrections to this article were published in the July 2009 issue of JAOA—The Journal of the American Osteopathic Association (2009;109:388). The corrections have been incorporated in this online version of the article, which was posted December 2009. An explanation of these changes is available at: