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5 Reasons Why I Don’t Use the Sleeper Stretch and Why You Shouldn’t Either

Ah, the sleeper stretch.  Pretty popular right now, huh, especially in baseball players?  Seems like a ton of people are preaching the use of the sleeper stretch and why everyone needs to use it.  It’s so popular now that physicians are asking for it specifically.

I don’t like the sleeper stretch and I rarely use it, in fact I haven’t used it in years.  I don’t think you should use it either.

There, I said it, I felt like I really had the get that off my chest!

Every meeting I go to, I see more and more people talking like the sleeper stretch is the next great king of all exercises.  Then I get up there and say I don’t use it and everyone looks at me like I have two heads!  Call me crazy, but I think we probably shouldn’t be using it as much as we do.

In fact, I actually think it causes more harm than good.

 

5 Reasons Why Shouldn’t Use the Sleeper Stretch

I haven’t used the sleeper stretch in over a decade and have no issues restoring and maintaining shoulder internal rotation in my athletes with safer and more effective techniques.

If you have followed me for some time, you know that I rarely talk in definitive terms, as I always strive to continue to learn and grow.  I know my opinions will change and things aren’t black and white.  However, over the years my stance on NOT using the sleeper stretch has only strengthening.  As I learn more and grow, I actually feel more strongly that we shouldn’t be using this common stretch.

So why don’t I use the sleeper stretch?  There are actually several reasons.

 

It’s Often Performed for the Wrong Reason

The sleeper stretch is most often recommended for people with a loss of shoulder internal rotation.  When a person has a loss of internal rotation, it can be from several reasons, including:

  1. Soft tissue / muscular tightness
  2. Joint capsular tightness
  3. Joint and boney alignment of the glenohumeral joint and scapulothoracic joint
  4. Boney adaptations to repetitive tasks, such as throwing a baseball and other overhead sports

You must assess the true cause of loss of shoulder motion and treat accordingly.

Of the above reasons, you could argue that only joint capsular tightness would be an indication to perform the posterior capsule.  But see my next point below…

Performing the sleeper stretch for the other reasons could lead to more issues, especially in the case of boney adaptations.  The whole concept of glenohumeral internal rotation deficit (GIRD), is often flawed due to a lack of understanding of the normal boney adaptations in overhead athletes.

I can’t tell you how many people think they have GIRD that I evaluate and that they in fact do NOT have GIRD.  Click here to learn more about how I define GIRD.

 

It Stretches the Posterior Capsule

If you have heard me speak at any of my live or online courses, you know that I am not a believer in posterior capsule tightness in overhead athletes.  Maybe it happens, but I have to admit I rarely (if ever) see it.  In fact, I see way more issues with posterior instability.  Please keep in mind I am talking about athletes.  Not older individuals and not people postoperative.  They can absolutely have a tight posterior capsule.

But for athletes, the last thing I want to do is make an already loose athlete looser by stretching a structure that is so thin and weak, yet so important in shoulder stability.

Urayama et al in JSES have shown that stretching the shoulder into internal rotation at 90 degrees of abduction in the scapular plane does not strain the posterior capsule.  However, by performing internal rotation at 90 degrees of abduction in the sagittal plane, like the sleeper stretch position, places significantly more strain on the posterior capsule.

Based on the first two points I’ve made so far, if you have a loss of shoulder internal rotation, you should never blindly assume you have a tight posterior capsule.

Assess, don’t assume.

But be sure you know how to accurately assess the posterior capsule.  Many people perform it incorrectly.  Click here to read how to assess for a tight posterior capsule.

 

It is an Impingement Position

This one cracks me, check out the photos below, if you rotate a photo of the Hawkins-Kennedy impingement test 90 degrees it looks just like a sleeper stretch.  I personally try to avoid recreating provocative special tests as exercises.

sleeper stretch impingement reinold

 

This is a provocative test for a reason, by performing internal rotation in this position, you impinge the rotator cuff and biceps tendon along the coracoacromial arch.  If you actually had a tight posterior capsule, you’d get subsequent translation anteriorly during this stretch and further impingement the structures.

So based on this, even if you have a tight posterior capsule, I wouldn’t use the sleeper stretch.  I would just perform joint mobilizations in a neutral plane.

 

People Often Perform with Poor Technique

So far we’ve essentially said that people often perform the sleeper stretch for the wrong reasons and can end up torquing the wrong structure (the posterior capsule) and irritating more structures (the rotator cuff and biceps tendon).

Even if you have the right person with the right indication, the sleeper stretch is also often performed with poor technique, which can be equally as disadvantageous.

People often roll too far over onto their shoulder or start in the wrong position.  If you are going to perform the sleeper stretch, at least follow my recommendations on the correct way to perform the sleeper stretch.

 

People Get WAY too Aggressive

Despite the above reasons, this may actually be the biggest reason that I don’t use the sleeper stretch – people just get way too aggressive with the stretch.  The whole “more is better” thought process.  Being too aggressive is only going to cause more strain on the posterior capsule and more impingement.  You may actually flare up the shoulder instead of make it better.

I always say, if you have a loss of joint mobility, torquing into that loss of mobility aggressively is only going to make it worse.

 

When the Sleeper Stretch is Appropriate

There are times when the sleeper stretch is probably appropriate.  But it’s not as often as you think and it’s most often not in athletes.  The older individual with adhesive capsulitis or a postoperative stiff shoulder may be good candidates for the sleeper stretch.  But I honestly still don’t use it in these populations.  There are better things to do.

But of course, there are good ways to perform the sleeper stretch and there are bad ways, technique is important.

For more information on some alternatives to the sleeper stretch, check out my article on sleeper stretch alternatives.

 

6 Hip Mobility Drills Everyone Should Perform

Recently, I have seen dozens of social media posts with “advanced” hip mobility drills that made me stop and think…

Should we actually be seeking to perform these advanced variations?

I would argue most people still need the basics, and should incorporate just a handful of more simple drills as the foundation of their mobility drills.

The internet is famous for sensationalizing the drills that look “fancy” rather than the ones that are likely the most effective.  It’s probably another case of the Pareto Principle, where 80% of the drills seen online should only be performed 20% of the time, and conversely, 20% of the drills seen online should be performed 80% of the time!  Heck it may be even less than that when it comes to hip mobility.

To make matters worse, the more advanced hip mobility drills are probably inappropriate for most people.  In my experience, limitations in hip mobility seem to be more related to the individuals unique anatomy, boney adaptations, and alignment rather than simple soft tissue limitations.  So, forcing hip mobility drills through anatomical limitations is just going to cause more impingement and issues with the hips, rather than helping.

Sometimes less is more.

 

My Favorite Hip Mobility Drills

I wanted to share my favorite hip mobility that I use with most of my clients.  I think you should really focus on these hip mobility drills before proceeding to more advanced variations.  If these don’t do the trick, it’s probably best that you seek out a qualified movement specialist to assess the reason behind you hip mobility limitations, rather than forcing more drills.

 

Quadruped Rockbacks

The first drill is a quadruped rockback.  This is one of my favorite drills for the hips, and feels great to loosen up the adductors and hip joint into flexion.  Plus, I do these barefoot to get more dorsiflexion and great toe extension.

 

Adductor Quadruped Rockbacks

The adductor quadruped rockback is a variation of the rockback that involves straightening out one hip.  This takes away a little bit of the hip flexion benefit, but enhances the effect on the adductors.  Performing this on both sides is the best of both worlds.

 

True Hip Flexor Stretch

The true hip flexor stretch is probably the most fundamental hip mobility drill we should all be performing.  I started calling it the “true” hip flexor stretch because the more common versions of this do not lock in the posterior pelvic tilt and just end up torquing the anterior capsule.

 

Posterior Hip Stretch

The posterior hip stretch feels great on the glutes and hits the posterior hip area, which is often tight.  Many people feel like the can get into a hip hinge much better after this drill.

 

Figure 4 Stretch

The posterior hip is a complicated area of muscles, I often pair the figure 4 stretch with the posterior hip stretch above to get different areas.  For me, I simple go by the feedback from my client on what feels more effective for them.

 

Spiderman

The Spiderman hip mobility drill is likely the most advanced of this list, which is why I have it last.  This is something I don’t always perform right away, but is a goal of mine to integrate with everyone eventually.  This requires more hip mobility that the others, so acts as a nice progression to put these all together.

 

How to Get Started with Hip Mobility Drills?

So wondering how to get started?  Start with the quadruped rockbacks and hip flexor stretch.  Those two are very foundational and will be the most impactful for most people.  Once you get those down, progress to the posterior hip stretch and figure 4 to hit more of the posterior aspect of the hip.  Lastly, progress to the Spiderman drill.

I honestly don’t think you need much more than that, and if you seek to get too aggressive with hip mobility drills, you often make things worse.

 

 

How to Stabilize the Scapula During Shoulder Elevation

One of the most common compensations we see with people with limited overhead shoulder elevation is lateral winging of the scapula.  Anytime you have limited glenohumeral joint mobility, your scapulothoracic joint is going to try to pick up the slack to raise your arm overhead.

This is common in postoperative patients, but also anyone with limited shoulder elevation.

Stabilizing the scapula during range of motion is often recommended to focus your mobility more on the shoulder than the scapula.  As with everything else, as simple as this seems, there is right way, a wrong way, and a better way to stabilize the scapula during shoulder elevation.

In this video, I demonstrate the correct way to stabilize the scapula, and show some common errors that I often see.

 

How to Stabilize the Scapula During Shoulder Elevation

 

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The True Hip Flexor Stretch

The hip flexor stretch has become a very popular stretch in the fitness and sports performance world, and rightly so considering how many people live their lives in anterior pelvic tilt.  However, this seems to be one of those stretches that I see a lot of people either performing incorrectly or too aggressively.  I talked about this in a recent Inner Circle webinar on 5 common stretches we probably shouldn’t be using, but I wanted to expand on the hip flexor stretch as I feel this is pretty important.

I’ve started teaching what I call the “true hip flexor stretch.”  I call it the true hip flexor stretch as I want you to truly work on stretching the hip flexor and not just torque your body into hip and lumbar extension.  When performing, most people say they never felt a stretch like that before, hence the name “true hip flexor stretch.”

 

True Hip Flexor Stretch

 

Key Points

  • There is a difference between a quadriceps stretch and a hip flexor stretch.  When your rationale for performing the stretch is to work on stretching your hip flexor, focus on the psoas and not the rectus femoris.
  • Keep it a one joint stretch.  Many people want to jump right to performing a hip flexor stretch while flexing the knee.  This incorporates the rectus and the psoas, but I find far too many people can not appropriately perform this stretch.  They will compensate, usually by stretching their anterior capsule too much or hyperextending their lumbar spine.
  • Stay tall.  Resist the urge to lean into the stretch and really extend your hip.  Most people are too tight for this, trust me.  You’ll end up stretch out the anterior hip joint and abdominals more than the hip flexor.
  • Make sure you incorporate a posterior pelvic tilt.  Contract your abdominals and your glutes to perform a posterior pelvic tilt.  This will give your the “true” stretch we are looking for.  Many people wont even need to lean in a little, they’ll feel it immediately in the front of their hip.
  • If you don’t feel it, squeeze your glutes harder.  Many people have a hard time turing on their glutes while performing this stretch, but it is key.
  • Guide your hips with your hands.  I usually start this stretch with your hands on your hips so I can teach you to feel posterior pelvic tilt.  Place your fingers in the front and thumbs in the back and cue them to posterior tilt and make their thumbs move down.

true hip flexor stretch

  • Progress to add core engagement.  Once they can master the posterior pelvic tilt, I usually progress to assist by curing core engagement.  You can do this by pacing both hands together on top of your front knee and push straight down, or by holding a massage stick or dowel in front of you and pushing down into the ground.  Key here is to have arms straight and to push down with you core, not your triceps.

 

I use this for people that really present in an anterior pelvic tilt, or with people that appear to have too loose of an anterior hip capsule.  This works great for people with low back pain, hip pain, and postural and biomechanical issues related to too much of an anterior pelvic tilt.  Give the true hip flexor stretch a try and let me know what you think.

 

 

5 Common Stretches We Probably Shouldn’t Be Using

5 Common Stretches We Probably Shouldnt Be DoingThe latest Inner Circle webinar recording on the 5 Common Stretches We Probably Shouldn’t Be Using is now available.

5 Common Stretches We Probably Shouldn’t Be Using

This month’s Inner Circle webinar was on 5 Common Stretches We Probably Shouldn’t Be Using.  Don’t get me wrong, I do perform stretches with people, but I think we often over utilize them as well.  Here are 5 stretches that are pretty common, why I think we overuse them, and what to do about it.

 

To access the webinar, please be sure you are logged in and are a member 0f the Inner Circle program.

Does Stretching Really Decrease Performance?

Static stretching has really taken a beating over the last several years after the publication of several studies that showed a reduction in strength, power, speed, and athletic performance.  Many in the strength and fitness communities took this info and ran with it, condemning stretching before athletic competition.

As with any research, though, a careful assessment of the literature will show you that the concept of stretching before competition isn’t that simple.  Saying that “stretching” causes something, either good or bad, is too simplistic without carefully describing the type of stretching and subjects that were in included in studies, and other similar variable.

 

Does Stretching Really Decrease Performance?

does stretching really decrease performance

Image by Istolethetv

Conflicting reports only further complicate the issue, with a recent review showing that 69% of studies on stretching have reported no significant reduction in strength, power, or speed.

Recent studies and meta-analyses have been conducted to look at the this concept more closely and determine, does stretching really decrease performance?  The results are certainly interesting, and it appears that there may be a time and a place for static stretching in our pre-event warm-up, especially considering the research that static stretching can help reduce muscle strain injuries.

 

Duration of Stretch is Important

One of the biggest factors behind reduced performance after stretching appears to be related to the duration of the stretch.  A recent study published in Medicine and Science in Sports and Exercise performed a meta-analysis of 106 published studies to specifically look at the impact of stretch duration on performance.

When carefully breaking down the results of studies based on the duration of stretch, it appears that stretching for less than 30 seconds does not correlated to decreased performance, while stretching for more than 60 seconds does decrease performance.

The authors report that only 14% of studies reported a significant decrease in performance when stretching for less than 30 seconds, and 61% when stretching for more than 1 minute.  You can see a large difference and what I would consider a relatively low risk when stretching is performed for shorter durations.  Still, when stretching over 1 minute, results do not indicate that stretching reduces performance 100% of the time.

 

Timing of Stretch is Important

Another potential factor in decreased performance is the timing between a session of static stretching and the start of athletic competition.  Many of the commonly published studies have looked at the immediate response to stretching, but how often do we stretch and then immediately run out onto the field and play?

Timing is an issue and this has led some authors to recommend a 5 minute period of time between stretching and the initiation of competition.  This makes sense to me and something that I recommend.

 

Integration of Static and Dynamic Stretching is Important

After the initial knee jerk reaction to some of the stretching studies, many people immediately shifted to dynamic stretching instead of static stretching before sports.  This led to the development of better dynamic warm up routines, which is certainly a good thing.  But recent research has shown that combining the two may also be beneficial.  In fact, the negative effects of static stretching were absent when combining both static and dynamic stretching.

It is hard to tell if the dynamic warmup was the factor that led to the change in findings in this study or simply just the 15-minute duration that occurred between the static stretching and testing protocol.

Regardless, I feel this is a great reason to include both static stretching and dynamic stretching, as this combination may be effective or at the very least it allows more time between static stretching and competition.

 

How and Why You May Want to Perform Static Stretching

In light of all the combined information above, it appears that there may be a proper way of incorporating static stretching into our routines if this is something you want to include.  In my mind there are two different reasons where I would want to perform static stretching.

The first is for someone who obviously has a restriction that would benefit from stretching.  Another major limitation to the stretching research is that it is predominantly performed with healthy individuals.  But what about someone who has a past injury or deficits?  In this situation we need to assess if addressing the restriction is more important than the potential risk of decreased performance.

I think static stretching is needed for these individuals and a part of a proper injury prevent program in this group.  That doesn’t mean a global generic stretching routine, but rather focus on what needs to be stretched.  However, I would still us the above principles in regard to duration, timing, and integration with a dynamic warm up.

The other scenario that I use static stretching before a competition is when an athlete just feels stiff or sore from past games, especially when in a sport that plays 162 games in 180 days, for example.  Add some bus trips, flights, bad hotels, and plenty of overuse to the mix and our athletes are going to feel pretty stiff.  Heck, I feel stiff and I’m not even playing.

In this scenario, I am not aggressively holding a static stretch for the intent of elongating tissue.  Rather, I am just trying to neuromodulate tone and the athlete’s perceived stiffness.  I often perform 3-5 reps of a stretch with holds between 3-5 seconds and essentially just pick up the tissue slack without torquing into end range motion.

I also don’t want running, throwing, or jumping during competition to be the first exposure the athlete’s body gets to the dynamic movement so just getting them lightly moving is helpful at times, I’ve discussed this briefly in the past.

I simple refer to this as a “fluff” stretch.  In all honestly, I can’t remember the last time I held a stretch for 30 seconds let alone great than a minute.  In my experience we stretch our athletes, many of which are already loose, too often and aggressively.  I almost always prefer to stretch less.

Perhaps the best approach is to combine the two scenarios by stretching only what is needed and fluffing the rest?

I’m not sure the best answer but it does appear that if you hold static stretches for less than 30 seconds, include a dynamic warm up, and assure that at there is some time between stretching and competition that stretching will not decrease performance.  (Click Here to Tweet This)

Regardless, I don’t think we need to fear and avoid static stretching before athletic competition is performed correctly and in the right scenario.

 

 

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5 Principles of Treating the Stiff Shoulder

5 Principles of Treating the Stiff Shoulder

The latest webinar recording for Inner Circle members is now available below.

5 Principles of Treating the Stiff Shoulder

This month’s Inner Circle webinars discussed several principles of treating the stiff shoulder.  We’ll cover:

  • The several types of “stiff shoulders”
  • Are we seeing shoulder stiffness more than we realize?
  • How to completely understand the anatomy and biomechanics of the glenohumeral capsule
  • Know when to push motion (and when not to!)
  • What should people with stiff shoulders do at home between sessions

To access the webinar, please be sure you are logged in and are a member of the Inner Circle program.

Ankle Mobility Exercises to Improve Dorsiflexion

ankle mobility exercises to improve dorsiflexionLimitations in ankle dorsiflexion can cause quite a few functional and athletic limitations, leading to the desire to perform ankle mobility exercises.    These types of mobility drills have become popular over the last several years and are often important components of corrective exercise and movement prep programming.  Considering our postural adaptations and terrible shoe wear habits (especially if high heels), it’s no wonder that so many people have ankle mobility issues.

Several studies have been published that shown that limited dorsiflexion impacts the squat, single leg squat, step down activities, and even landing from a jump.  These are all building blocks to functional movement patterns, so the importance of designing exercises to enhance dorsiflexion can not be ignored.  While I will openly admit that I believe that the hip has a large influence on ankle position and mobility, it is still important to perform ankle mobility exercises.  I will discuss the hip component in a future post.

There are many great ideas on the internet on how to improve dorsiflexion with ankle mobility exercise, but I wanted to accumulate some of my favorite in one place.  Below, I will share my system for assessing ankle mobility and then addressing limitations.  I use a combined approach including self-myofascial exercises, stretching, and ankle mobility drills.

 

How to Assess Your Ankle Mobility

Before we discuss strategies to improve ankle mobility, it’s worth discussing how to assess ankle mobility.  I am a big fan of standardizing a test that can provide reliable results.  One test that is popular in the FMS and SFMA world is the half-kneeling dorsiflexion test.

In this test, you kneel on the ground and assume a position similar to stretching your hip flexors, with your knee on the floor.  Your lead foot that you are testing should be lined up 5″ from the wall.  This is important and the key to standardizing the test.

From this position you lean in, keeping your heel on the ground.  From this position you can measure the actual tibial angle in relationship to the ground or measure the distance of the knee cap from the wall when the heel starts to come up.  An alternate method would be to vary the distance your foot is from the wall and measure from the great toe to the wall.  I personally prefer to standardize the distance to 5″.  If they can touch the wall from 5″, they have pretty good mobility.  I should note that my photo below has my client wearing minimus shoes, but barefoot is ideal.

Ankle Dorsiflexion Mobilty

 

This is a great position to assess your progress, and as you’ll see, I’ll recommend some specific drills you can perform from this position to you can immediately assess and reassess.

 

Ankle Mobility Exercises to Improve Dorsiflexion

As I mentioned previously, I like to use a 3-step process to maximize my gains when trying to enhance ankle dorsiflexion:

  1. Self-myofascial release for the calf and plantar fasica
  2. Stretching of the calf
  3. Ankle mobility drills

I prefer this order to loosen the soft tissue and maximize pliability before working on specific joint mobility.  Also, I should note that I try to go barefoot during my ankle mobility exercises.

 

Self Myofascial Drills for Ankle Dorsiflexion Mobility

One of the more simple self myofascial release techniques for ankle mobility is foam rolling the calf.  This has benefits as you can turn your body side to side and get the medial and lateral aspect of your calf along the full length.  I will instruct someone to roll up and down the entire length of the muscle and tendon for up to 30 seconds.  If they hit a really tender spot or trigger point, I will also have them pause at the spot for ~8-10 seconds.

What is good about the foam roller is that you can also add active ankle movements during the rolling, such as actively dorsiflexing the foot or performing ankle circles.  This gives a nice release as well.  Don’t forget to roll the bottom of your foot with a ball, as well, to lengthen the posterior chain tissue even further.  There is a direct connect between the plantar fascia and Achilles tendon.

Some people do not feel that the foam roller gives them enough of a release as it is hard to place a lot of bodyweight through the foam roller in this position.  That is why I often use one of the massage sticks to work the area in addition.  You can use a massage stick in a similar fashion to roll the length of the area and pause at tender spots.  I often add mobility in the half kneeling position as well, which gives this technique an added bonus.

 

Stretches for Ankle Dorsiflexion Mobility

Once you are done rolling, I like to stretch the muscle.  If moderate to severe restrictions exist, I will hold the stretch for about 30 seconds, but often just do a few reps of 10 seconds for most people.  The classic wall lean stretch is shown below.  This is a decent basic exercises, however, I have found that you need to be pretty tight to get a decent stretch in this position.

I usually prefer placing your foot up on a wall or step instead, as seen in the second part of my video below.  The added benefit here is that you can control the intensity of the stretch by how close you are to the wall and how much you lean your body in.  I also like that it extends my toes, which gives a stretch of the plantar fascia as well.  For both of these stretches, be sure to not turn your foot outward.  You should be neutral to point your toe in slightly (no more than an hour on a clock).

 

Simple Ankle Mobility Exercises

I like to break down my ankle mobility exercises into basic and advanced, depending on the extent of your motion restriction.  There are several basic drills that you can incorporate into your movement prep or corrective exercise strategies.

The first drill involves simple standing with your toes on a slight incline and moving into dorsiflexion by breaking your knees.  Eric Cressey shows us this quick and easy drill that you can quickly perform:

Tony Gentilcore shows another simple ankle mobility drill, which is essentially just a dynamic warmup version of the ankle mobility test we described above:

Kevin Neeld shows a great progression of this exercise that incorporates both the toes up on the wall, essentially making it more of a mobility challenge and stretch.  If you look closely, you’ll see that he is also mobilizing in three planes, straight neutral, inward, and outward:

 

Advanced Ankle Mobility Exercises

Jeff Cubos shares a video of the half kneeling mobilization with a dowel.  The dowel is an important part of the ankle mobility drill.  You begin by half kneeling, then placing a dowel on the outside of your foot at the height of your fifth toe.  Now, when you lean into dorsiflexion, make sure your knee goes outside of the dowel.  You can add the dowel to many of the variations of drills we are discussing:

Chris Johnson shared a nice video using a Voodoo Floss band to assist with the myofascial release and position the tibia into internal rotation:

For those that have a “pinch” in the front of the ankle of tight joint restrictions of the ankle in general, Erson Religioso shows us some Mulligan mobilizations with movement (MWM) using a band.  In this video, he has his patient put the band under his opposite knee, however you could easily tie this around something behind you.  In this position you step out to create tension on the band, which will move your talus posteriorly as you move forward into dorsiflexion:

As you progress along with your mobility, you may find that variations of these drills may be more effective for you.  You can combine many of these approaches into one drill, such as Matt Siniscalchi shows us here, combining the MWM with the dowel in the half kneeling position:

As you can see, there are many different variations of drills you can perform based on what is specifically tight or limited.  You may have to play around a little but to find what works best for each person, however these are a bunch of great examples of ankle mobility exercises you can choose to perform when trying to improve your dorsiflexion.