bioengineering

Article
The Scores and Manner of Performing the Stand and Reach Test
in Girls and Boys of Different Body Weight
Agnieszka Jankowicz-Szymańska 1, * , Justyna Kawa 2 , Katarzyna Wódka 1 , Eliza Smoła 1 , Marta A. Bibro 1
and Aneta Bac 3

1 Section of Physiotherapy, Faculty of Health Sciences, University of Applied Sciences in Tarnow,

33-100 Tarnow, Poland
2 SHARK Swim School, 32-002 Niepołomice, Poland
3 Institute of Applied Sciences, Faculty of Motor Rehabilitation, University of Physical Education in Krakow,
31-571 Krakow, Poland
* Correspondence: jankowiczszymanska@gmail.com

Abstract: Introduction: Flexibility is one of the components of Health-Related Fitness. The range of
flexion has been the participant of numerous publications, but research into the quality of flexibility
is lacking. The aim of the study has been to compare the scores and the quality of the stand and
reach test in both overweight girls and boys and girls and boys with normal body weight. We have
checked whether the forward bend movement is symmetrically distributed over the hip joints and the
lumbar and thoracic spine and how it influences the position of the knee and ankle joints. Material
and methods: 100 girls and 100 boys aged 10–14 years were examined. Flexibility was measured
using the stand and reach test. The quality of the bend was assessed by examining the range of
movement in individual body segments: the range of flexion of the thoracic and lumbar spine (linear
measurements), the range of flexion of the hip joint, and the position of the knee and ankle joints at
Citation: Jankowicz-Szymańska, A.; maximum flexion (angular measurements). The results were subjected to statistical analysis. Results:
Kawa, J.; Wódka, K.; Smoła, E.; Bibro, The participants, especially boys, had poor flexibility. A poor stand and reach test result correlated
M.A.; Bac, A. The Scores and Manner with a lower range of flexion of the thoracic and lumbar spine, greater flexion of the hip and knee
of Performing the Stand and Reach joints, and greater plantar flexion at maximum torso bend position. Although the mean stand and
Test in Girls and Boys of Different
reach score was slightly greater for the girls, gender did not significantly differentiate the way in
Body Weight. Bioengineering 2022, 9,
which the stand and reach test was performed. Being overweight also did not affect the quantity or
538. https://doi.org/10.3390/
quality of the stand and reach test. Conclusions: Limitation of flexibility is common in 10–14-year-old
bioengineering9100538
children and results mainly from limited mobility of the spine. The compensation for this is excessive
Academic Editor: Aurélien movement in the joints of the lower extremities.
Courvoisier

Received: 7 September 2022

Keywords: muscles’ flexibility; forward bending; movement pattern
Accepted: 29 September 2022
Published: 9 October 2022

Publisher’s Note: MDPI stays neutral

1. Introduction
with regard to jurisdictional claims in
published maps and institutional affil-
Flexibility is the ability to move freely through a full range of motion, without pain or
iations. discomfort, necessary to achieve an appropriate level of physical fitness [1]. It is considered
to be one of the basic components of Health-Related Fitness, and many studies emphasize
the need for stretching exercises in physical education lessons as well as a supplement to
training regimens in different sports. Flexibility testing is part of any fitness assessment.
Copyright: © 2022 by the authors. However, there are no publications on the quality of flexibility tests, which consist in
Licensee MDPI, Basel, Switzerland. performing the full possible forward bend. However, it seems that the strategy for doing
This article is an open access article this exercise may be different and depends on many factors. Limitation of flexibility is
distributed under the terms and believed to be a predisposing factor for musculoskeletal disorders, e.g., lumbar spine pain,
conditions of the Creative Commons injuries of the hamstrings, and even excessive muscle tension in the neck [2–5]. On the
Attribution (CC BY) license (https://
other hand, some publications disprove the relationship between the range of motion of
creativecommons.org/licenses/by/
the lumbar spine and hip joint and injuries of the hamstrings [6]. Flexibility, which is
4.0/).

Bioengineering 2022, 9, 538. https://doi.org/10.3390/bioengineering9100538 https://www.mdpi.com/journal/bioengineering

Bioengineering 2022, 9, 538 2 of 9

the subject of numerous scientific reports, is paradoxically a poorly understood trait of

motor skills.
In assessing flexibility, the most frequently used tests are the sit and reach and the
stand and reach tests (also known as the toe touch test). They are used in physical education
lessons, in physiotherapy, in sports and as one of the elements of the evaluation of physical
fitness of people of different ages. These tests are commonly available as they are easy and
cheap to use [3,7,8]. Research shows that these tests are accurate tools, and that their scores
correlate with the range of motion of the lumbar spine, hip joint and the flexibility of the
hamstrings [9]. The comparison between the sit and reach and the stand and reach tests
shows no significant differences, since both tests produce similar results in the assessment
of flexibility. However, surface EMG reveals that the activity of the lumbar spine extensor
is higher in the stand and reach test [10]. In our research, we used the stand and reach test
because it seems to be more functional. The forward bend motion while standing is made
multiple times each day, as opposed to the forward bending motion while sitting.
The aim of the study has been to compare the results and the quality of the stand
and reach test between the girls and boys with normal body weight and those who are
overweight. The objective of the research has been to discover whether gender and body
weight has an influence on the amount and quality of movement. We have tried to
determine whether the forward bend motion in the examined children is symmetrically
distributed over the hip joints and the lumbar and thoracic spine, and how it influences the
position of the knee and ankle joints. We have checked whether any body segments are
hypermobile and require stabilization exercises and hypomobile and require flexibility.

2. Materials and Methods

2.1. Characteristics of the Studied Group
Two hundred students were invited to take part in the study, including 100 girls and
100 boys, aged from 10 to 14 from a primary school in a small town (106,000 inhabitants) in
southern Poland (the number of girls and boys from each age group is given in Table 1).
All students and their parents accepted the invitation and gave their written consent to
participate in the research. The school principal also consented to the study. Participant
recruitment and research were carried out at the beginning of 2020. Patient names and
surnames were coded, and the authors did not have access to them after the data had
been collected.

Table 1. The number of girls and boys broken down into age groups.

Age [Years] Boys Girls All

10 26 12 38
11 19 17 36
12 19 21 40
13 18 27 45
14 18 23 41
All 100 100 200

The inclusion criteria were as follows: no chronic diseases, no congenital or acquired

malformations of the musculoskeletal system (data from the parents), no certificate of
disability (data from the school nurse) and feeling well on the day of the study (information
from the child just before the start of the measurement). Sexual maturity and body propor-
tions were not assessed in the girls and boys, as studies indicate no significant influence of
these features on the results of the flexibility test [2,11,12]. According to the interviews, the
girls and boys participating in the study did not train regularly in any sports club. Their
physical activity was limited to compulsory PE lessons at school and spontaneous sports
activities (walking, cycling, etc.).
The research was conducted in accordance with all the guidelines of the Helsinki
Declaration. All tests and measurements were performed in the nurse’s office by the same
 Bioengineering 2022, 9, x FOR PEER REVIEW 3 of 10

club. Their physical activity was limited to compulsory PE lessons at school and sponta-
neous sports activities (walking, cycling, etc.).
Bioengineering 2022, 9, 538 3 of 9
The research was conducted in accordance with all the guidelines of the Helsinki
Declaration. All tests and measurements were performed in the nurse’s office by the same
experienced person, using the same research tools. When made readable, the results were
experienced person,
read to another using
person theentered
who same research
them intools. When
a table. The made
rangereadable, the results
of hip flexion and thewere
po-
read
sition of the knee and ankle joint in the bend were always read on the left side of the
to another person who entered them in a table. The range of hip flexion and the
position of thebody.
participant’s kneeThe
andmeasurements
ankle joint in the bend
were were
carried outalways
in the read on theThe
afternoon. leftparticipants
side of the
participant’s body. The measurements were carried out in the afternoon. The participants
were dressed in sports clothes, a T-shirt and shorts, and they were not wearing shoes.
were dressed in sports clothes, a T-shirt and shorts, and they were not wearing shoes.
2.2. Research Procedures
2.2. Research Procedures
2.2.1.Determination
2.2.1. Determinationof ofthe
theBody
BodyWeight
WeightStatus
Status
Bodyheight
Body heightand
and weight
weight werewere
the the basis
basis for calculating
for calculating the Body
the BMI. BMI. height
Body height was
was tested
tested
with with a calibrated
a calibrated anthropometer
anthropometer (Alumet,
(Alumet, Warsaw,
Warsaw, Poland)Poland)
from from the Basis
the Basis pointpoint
to theto
the Vertex
Vertex pointpoint
with with an accuracy
an accuracy of 1 mm.
of 1 mm. BodyBodyweightweight was tested
was tested on a TANITA
on a TANITA elec-
electronic
tronic
scale scale (Tanita
(Tanita Corporation
Corporation of America
of America Inc, Arlington
Inc, Arlington Heights, Heights,
IL, USA)IL,withUSA) with an ac-
an accuracy of
0.1 kg. To determine the body weight, we relied on the findings of Cole et al. [13]Cole
curacy of 0.1 kg. To determine the body weight, we relied on the findings of et al.
in which
[13]authors
the in which the authors
propose the BMIpropose
thresholdtheoverweight
BMI threshold overweight
and obesity valuesandforobesity values
girls and boys for
at
agirls
given and boys at a given age.
age.

2.2.2.
2.2.2.Stand
StandandandReach
ReachTest
Test
The first
The first stage before carryingout
before carrying outthethe test
test waswas to mark
to mark fourfour points
points on theonchild’s
the child’s
spine
spine
with awith a marker,
marker, whichwhich were used
were later later for
used thefor thetest
Otto Ottoandtest
theand the Schober
Schober test (seetest
the(see
de-
the description
scription below).below).
Then, Then, the participant
the participant was asked was toasked
standtoonstand on a special
a special step withstep with a
a vertical
vertical measuring bar, onthe
which the ‘0 0 point was at the height of the surface on which
measuring bar, on which ‘0′ point was at the height of the surface on which the partic-
the participant
ipant was standing,
was standing, the positive
the positive values increased
values increased towardstowards
the ground the ground
to 25 cm, toand
25 cm,the
and the negative values increased going upwards to − 35 cm (Figure
negative values increased going upwards to −35 cm (Figure 1). The feet were together, 1). The feet were
and
together, and the
the toes were toes were
aligned with aligned
the edgewith
of thethestep.
edge of participant
The the step. The participant
made made
a free bend a free
forward
bend forward and was asked to keep their legs as straight as possible in
and was asked to keep their legs as straight as possible in the knee joints, the arms hanging the knee joints,
the arms
down andhanging down
straight, andhead
and the straight, and the
as straight ashead as straight
possible. The kneeas possible.
joints were The knee
not joints
stabilized
were not stabilized on purpose to check if the participants would automatically
on purpose to check if the participants would automatically change their position in the change
their
bend.position in the bend.
In the position of theInmaximum
the position of thereach,
forward maximum forward read
the examiner reach,thethe examiner
result of the
read the result of the stand and reach bend, i.e., the value on the measuring
stand and reach bend, i.e., the value on the measuring bar, which the participant was bar, which the
participant was reaching with the tip of their longest finger. Subsequent measurements and
reaching with the tip of their longest finger. Subsequent measurements and tests were
tests were performed in the position described above (Figure 1).
performed in the position described above (Figure 1).

Figure1.1.Measurement
Figure Measurementscheme.
scheme.

2.2.3. Otto Test

The Otto test measures the extent to which the thoracic spine can flex.
Bioengineering 2022, 9, 538 4 of 9

In order to perform the test, before the participant began the bend, in a standing
position, the spinous process C7 was marked with a marker, and then 30 cm down the
spine, another point was marked. In the position of the bend, the distance between the
previously marked points was measured again and it was calculated if the distance was
greater than 30 cm. The normal difference should be between 2 and 4 cm [14].

2.2.4. Schober Test

The Schober test determines the range of the lumbar spine flexion. In order to perform
it, before starting the bend, in a standing position, the spinous process S1 was marked with
a marker, and then the next point was marked 10 cm up the spine. In the position of the
bend, the distance between the previously marked points was measured again and it was
calculated whether the distance was greater than 10 cm. The normal difference should be
5 cm [14].

2.2.5. The Range of Hip Flexion

A goniometer was used to determine the hip flexion angle in the bend position. The
axis of the goniometer was aligned with the transverse axis of the joint on the greater
trochanter of the femur. The movable arm was pointing at the crest of the iliac ala, while the
stationary arm was directed towards the arrow’s head. The result was read in degrees [15].

2.2.6. The Position of the Knee Joint

In order to determine the position of the knee joint in a bend, the axis of the goniometer
was positioned near the arrowhead, parallel to the transverse axis of the joint. The movable
arm of the goniometer was pointing towards the greater trochanter of the femur, while the
movable arm-towards the lateral malleolus. The result was read in degrees. When the knee
joint was in a neutral position (neither flexion nor hyperextension), the goniometer showed
180◦ . Lower values meant flexion, higher values-hyperextension.

2.2.7. The Position of the Ankle Joint

In order to determine the position of the ankle joint in the bend position, the axis of
the goniometer was placed below the ankle. The stationary arm was positioned along the
5th metatarsal bone on the outer edge of the foot, parallel to the ground, while the movable
arm was projected at the arrowhead. The result was read in degrees.

2.3. Statistical Analysis

The collected data was analyzed using the Statistica 13 software. Basic descriptive
statistics and frequency tables were used. The Shapiro–Wilk test was used to ascertain
whether the distribution of variables is normal, and the F test to test the homogeneity of
variance. If the compared independent variables had a normal distribution and uniform
variances, the differences between groups were tested using Student’s t-test for independent
samples. When the distribution of variables deviated from the norm, the Mann–Whitney U
test was used. The relationships between the variables were investigated using Pearson’s
linear correlation. The level of significance was set at α = 0.05.

3. Results
The examined girls and boys did not differ significantly in terms of body weight,
height and BMI (Table 2). Correct body weight was diagnosed in 158 (79%) of 200 children,
including 78 boys and 80 girls. Twenty-two boys and twenty girls were overweight. Obesity
was not found in any of the studied children.
Bioengineering 2022, 9, 538 5 of 9

Table 2. Comparison of the physique of girls and boys (differences were considered significant for
p < 0.05).

Variable Group Mean Min. Max. St. Dev. p

Boys 48.16 32.80 65.00 7.82
Body weight [kg] 0.955
Girls 48.56 35.00 68.00 6.65
Boys 153.95 132.00 175.50 11.82
Body height [cm] 0.631
Girls 153.39 132.00 175.00 10.01
Boys 20.24 16.98 24.34 1.25
BMI [kg/m2 ] 0.101
Girls 20.57 18.67 24.38 1.24
Min.—Minimum; Max.—Maximum; St. Dev.—Standard Deviation.

The overweight and normal-weight children did not differ either in the stand and
reach test scores (which were slightly better in overweight children), or in the range of
flexion of the thoracic (Otto test) and lumbar (Schober test) spine. The position of the hip
and ankle joints in the forward bend also did not differentiate between the groups. The only
examined variable that significantly distinguished overweight children and children with
normal body weight was the position of the knee joint in the bend. Overweight children’s
knee joint was closer to the fully extended position (180◦ ), while children with normal body
weight had greater flexion in the knee joint. The difference was 2.72◦ (Table 3).

Table 3. Comparison of the position of the individual segments of the legs and the spine in the
forward bend.

St. St.
Body Weight Mean Min. Max. p Variable Gender Mean Min. Max. p
Dev. Dev.
Overweight −3.17 −20.00 12.00 5.99 Boys −5.13 −28.00 10.00 7.53
0.150 Stand and reach test [cm] 0.346
Normal −4.69 −28.00 15.00 7.87 Girls −3.61 −28.00 15.00 7.49
Overweight 3.76 1.50 5.00 1.00 Boys 3.67 0.50 6.50 1.13
0.350 Otto test [cm] 0.577
Normal 3.57 0.00 6.50 1.20 Girls 3.55 0.00 5.00 1.20
Overweight 3.58 0.00 7.00 1.43 Boys 3.57 0.00 7.00 1.43
0.320 Schober test [cm] 0.088
Normal 3.77 0.00 7.00 1.30 Girls 3.89 1.20 7.00 1.19
Overweight 115.76 80.00 140.00 11.34 Boys 117.19 80.00 150.00 11.40
0.741 Hip joint position [◦ ] 0.119
Normal 116.85 80.00 150.00 9.55 Girls 116.05 85.00 130.00 8.23
Overweight 177.57 165.00 200.00 6.50 Boys 175.33 160.00 190 5.96
0.010 * Knee joint position [◦ ] 0.986
Normal 174.85 160.00 190.00 5.59 Girls 175.52 164 200 5.83
Overweight 102.50 80.00 125.00 9.89 Boys 102.18 70.00 125.00 9.09
0.576 Ankle joint position [◦ ] 0.245
Normal 103.14 70.00 125.00 8.13 Girls 103.83 85.00 125.00 7.85
Min.—Minimum; Max.—Maximum; St. Dev.—Standard Deviation; *—statistically significant differences.

The girls had slightly better stand and reach test results (the difference was 1.52 cm).
During the forward bend, girls tended to use the flexion of the thoracic spine to a lesser
extent (the difference of 0.12 cm), and the flexion of the lumbar spine to a greater extent
(the difference of 0.32 cm). In the girls’ full bend, the hip and knee joints were less flexed
(difference 1.14◦ and 0.19◦ ), and the ankle joint had greater plantar flexion (difference 1.65◦ )
but the differences were not statistically significant (Table 3).
In the examined children, the quality of flexibility was determined on the basis of the
stand and reach test scores. It was assumed that reaching the surface of the step on which
the child was standing with the tip of their longest finger (value ‘00 on the measuring bar)
means good flexibility, while poor flexibility was diagnosed when the child was unable to
reach this point.
One in four children was diagnosed with good flexibility, of whom girls were found
to have good flexibility slightly more frequently. Among 158 children with normal body
weight, a good stand and reach test result was recorded in 24% of the participants, while
among 42 overweight children, a good stand and reach test result was found in 31% of the
participants (Table 4).
Bioengineering 2022, 9, 538 6 of 9

Table 4. The stand and reach test result in qualitative assessment.

Body Weight Body Weight

Stand and Reach Test-Interpretation Gender Total in Row
Status Normal Status Overweight
Boys 16 7 23
69.57% 30.43% 23.00%
Normal flexibility-the participant
Girls 22 6 28
reached at least the feet support
78.57% 21.43% 28.00%
surface with their fingertips
All 38 13
51
74.51% 25.49%
Boys 62 15 77
80.52% 19.48% 77.00%
Low flexibility-the participant did not
Girls 58 14 72
reach the feet support surface with
80.56% 19.44% 72.00%
their fingertips
All 120 29
149
80.54% 19.46%
Total in column 158 42 200

Children with normal and poor flexibility did not differ in height, weight, or BMI.
In children with normal flexibility, a greater range of flexion of the thoracic and lumbar
spine, less flexion of the hip and knee joints and less plantar flexion of the ankle joint were
observed in the position of a full forward bend (Table 5).

Table 5. Variable values based on good or poor flexibility.

Stand and Reach

Variable Mean Min. Max. St. Dev. p
Test-Interpretation
Normal flexibility 48.67 34.00 62.00 6.85
Body weight [kg] 0.511
Low flexibility 48.26 32.80 68.00 7.40
Normal flexibility 153.83 132.00 173.00 11.12
Body height [cm] 0.912
Low flexibility 153.61 132.00 175.50 10.90
Normal flexibility 20.54 18.12 24.34 1.33
BMI [kg/m2 ] 0.516
Low flexibility 2036 16.98 24.38 1.23
Normal flexibility 3.94 0 5.00 1.26
Otto test [cm] 0.002 *
Low flexibility 3.49 0 6.50 1.11
Normal flexibility 4.67 3.00 7.00 0.89
Schober test [cm] 0.001 *
Low flexibility 3.41 0 7.00 1.30
Normal flexibility 111.92 80.00 125.00 9.85
Hip joint position [◦ ] <0.001 *
Low flexibility 118.23 80.00 150.00 9.47
Normal flexibility 177.68 165.00 200.00 5.65
Knee joint position [◦ ] 0.013 *
Low flexibility 174.65 160.00 190.00 5.77
Normal flexibility 98.92 80.00 120.00 8.00
Ankle joint position [◦ ] <0.001 *
Low flexibility 104.40 70.00 125.00 8.25
Min.—Minimum; Max.—Maximum; St. Dev.—Standard Deviation; *—statistically significant differences.

Significant, though weak, correlations were found between the stand and reach test
results and the mobility of the thoracic and lumbar spine as well as the position of the
hip, knee and ankle joint in the bend. The analysis of the same correlations across gender
groups and body weight status confirmed these observations: a better stand and reach
test score was associated with a greater range of movement of the thoracic and lumbar
spine (positive correlations) and less flexion of the hip joint in the bend position (negative
correlation) (Table 6).
Bioengineering 2022, 9, 538 7 of 9

Table 6. Correlations between the stand and reach test results and the studied variables in groups
distinguished by gender and body weight status.

Body Weight Body Height BMI Otto Test Schober test Hip Joint Knee Joint Ankle Joint
Group
[kg] [cm] [kg/m2 ] [◦ ] [◦ ] Position [◦ ] Position [◦ ] Position [◦ ]
Boys −0.107 −0.151 0.118 0.200 * 0.189 −0.298 * 0.120 −0.174
Girls 0.018 0.050 −0.035 0.326 * 0.275 * −0.243 * 0.236 * −0.195
Overweight −0.155 −0.159 −0.017 0.147 0.327 * −0.259 0.230 −0.280
Normal body weight −0.014 −0.014 0.017 0.271 * 0.228 * −0.282 * 0.154 −0.147
All −0.047 −0.061 0.055 0.257 * 0.237 * −0.276 * 0.178 * −0.172 *
*—statistically significant correlations.

4. Discussion
Girls and boys aged between 10 and 14 had poor flexibility. It was found that the
assessment of the stand and reach helped identify children with limited flexibility, but
additional tests were necessary to assess the quality of the bend. Our research showed
significant differences in the method of performing the bend by children with good and
poor flexibility. Girls and boys with a good flexibility test score used more thoracic and
lumbar spine flexion and held the knee and ankle joints closer to the neutral position. In
children with limited flexibility, reduced flexion within the spine joints, greater flexion of
the hip and knee joints and greater plantar flexion of the ankle joint were noted. Moreover,
it was found that gender and also the body weight status had not an influence on the result
of the stand and reach test and the quality of the performance of the bend.
There was no evidence of an influence of being overweight on the result and quality
of the stand and reach test. Nikoladis’s research also indicates the lack of a relationship
between BMI and body fat and flexibility in adolescents and adults [16]. On the other hand,
Hands et al. [17], different to our study, diagnosed better results of flexibility in teenage
girls compared to boys of the same age.
The average result of the Schober test indicated limited mobility of the lumbar spine
in the examined children. This finding was true for both genders, with the range of lumbar
spine motion being slightly smaller in boys.
According to Kendall et al. [18], the correct range of hip motion in the forward bend (sit
and reach) is around 80◦ (the angle between the sacrum and the horizontal line). Comerford
and Mottram [19] determined the correct range of hip flexion during a forward bend while
standing at 70◦ . Comparing our findings with the conclusions of the above-mentioned
authors, we observed that the examined children used the hip joint excessively. At the
same time, the participants found it difficult to extend the knee joint. The question is: does
this tendency indicate a weakening of the hamstring muscles in the upper segments and
the shortening of these muscles in the lower segments? Perhaps this hypothesis can be
explained by the sedentary lifestyle that is very common today. Of course, our research does
not answer this question, but only motivates the search for the answer. Rakholiya et al. [20]
indicated in their research that a sedentary lifestyle leads to an imbalance of hip extensor.
On the other hand, the influence of the sedentary life on the flexibility of hamstrings is
unclear. One study shows that long-lasting sitting can lead to hamstring tightness [21],
others contradict this thesis [22]. However, the above-mentioned studies investigated the
elasticity of hamstrings as a whole, without taking into account that their proximal and
distal segments, acting on a different joint (as hip extensors or knee flexors), may have
different flexibility.
The stand and reach and sit and reach tests are often used to evaluate the flexibility of
the hamstrings. According to Magnusson et al. [23], the range of the forward bend is a good
measure of the flexibility of these muscles. As Chillon et al. [24] state, the hip angle explains
42% of the sit and reach test result, the lumbar angle-30% and the thoracic angle-just 4%.
The research carried out by Muyor et al. [8] shows, however, that the sit and reach test
correlates poorly or at most moderately with the flexibility of the hamstrings as assessed by
the passive strait leg raise test. It must be remembered that both the sit and reach test and
the stand and reach test are indirect measures and the limitation of flexibility diagnosed by
Bioengineering 2022, 9, 538 8 of 9

one of these tests cannot be a direct indication for stretching the hamstrings [8]. Stretching
the structures that are not shortened leads to hypermobility which, like hypomobility, can
cause injury and reduced sport performance [25].

4.1. Limitations
It seems that in further studies on flexibility, the flexibility of the hamstrings and the
flexibility of the calf muscles should be additionally assessed in an isolated study.

4.2. Clinical Implications

It was our intention that our findings should stimulate further research to seek answers
to the following questions: What is correct flexibility? Is the range or the quality of the
movement more important? How to find a compromise between these features? Should
the approach to stretching exercises change: first the analysis of the quantity and quality of
the forward bend, then individually selected exercises for segmental increase in flexibility
and stabilization of hypermobile segments?

5. Conclusions
1. Children aged from 10 to 14 have poor flexibility.
2. Girls achieve similar results on the flexibility test (stand and reach) than boys at the
same age.
3. Being overweight affects neither the quantity nor the quality of the stand and reach
bend. The only significant difference in the way the bend is done by overweight
children is the more correct (closer to neutral) position of the knee joint.
4. Participants who score poorly in the stand and reach test have a smaller range of
flexion of the thoracic and lumbar spine. When performing the bend, they use the
flexion of the hip and knee joints to a greater extent and place the ankle joint in the
position of greater plantar flexion.

Author Contributions: Conceptualization, A.J.-S.; methodology, A.J.-S. and K.W.; formal analysis,
A.J.-S.; investigation, A.J.-S., J.K. and K.W.; data curation, A.J.-S., J.K., K.W., E.S., M.A.B. and A.B.;
writing—original draft preparation, A.J.-S., J.K. and K.W.; writing—review and editing, A.J.-S., J.K.,
K.W., E.S., M.A.B. and A.B.; visualization, A.J.-S., J.K., K.W., E.S., M.A.B. and A.B.; supervision, A.J.-S.,
J.K., K.W., E.S., M.A.B. and A.B.; project administration, A.J.-S. All authors have read and agreed to
the published version of the manuscript.
Funding: Publication financed under the program of the Minister of Science and Higher Education
under the name “Regional Initiative of Excellence” in 2019–2020. Project number 022/RID/2018/2019
in the amount of PLN 11.919.908.
Institutional Review Board Statement: The study was conducted in accordance with the Declaration
of Helsinki.
Informed Consent Statement: Informed consent was obtained from all subjects involved in the study.
Data Availability Statement: The datasets used and/or analysed during the current study available
from the corresponding author on reasonable request.
Conflicts of Interest: The authors declare no conflict of interest.

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