Training with approach to the joints
September 19, 2020
"We grow old very quickly, but we grow wise very slowly" (Swedish Proverb)
The physical therapist Gray Cook he has a knack for simplifying confusing issues. I admire his ability to take a complex thought process and make the idea seem quite simple.
In a recent seminar I attended on the effect of training on the body, Cook expressed one of the most enlightening thoughts I had heard. Gray discussed the findings of the Functional Movement Screen (FMS), the needs of different joints in the body, and how joint function is related to training.
One of the beauties of functional motion control is that it allows us to separate the issues of stability and mobility.
Cook's thoughts were simple and made me realize that the future of training may be a joint-based rather than movement-based approach.
Gray's analysis of the body was clear, the body is a stack of joints. Each joint or group of joints has a specific function and is prone to specific, predictable levels of dysfunction. Each joint has specific training needs.
The table below examines the body by joints from bottom to top
Deep seat (DeepSquat) with full mobility
The initial approach to joint training starts with ankle joint mobility, knee stability, hip mobility (polyaxial joint), lumbar spine stability (LMS), thoracic spine mobility. The first thing that is noticed is that the joints alternate between stability and mobility.
The ankle joint requires increased mobility.
The knee joint requires stability
As we move up the body, it is obvious that the hips require mobility. And so the process goes up the chain.
Over the past 20 years, we've progressed from the silly approach of training one body part (sorry bodybuilders), to a smarter training approach per movement pattern. In fact, the phrase "movements not muscles" has been over-used and frankly that's progress.
I think most good coaches have given up on the old chest – shoulders – triceps process and they have moved forward in the push-pull-hip-knee process.
Interestingly enough, I now believe that the "movement not muscles" process should probably be taken a step further. I believe that injuries are closely related to proper joint function or more properly joint dysfunction.
Are you confused? I will try to explain it to you.
Dysfunction of one joint leads to dysfunction of individual joints. Hips require mobility.
The simplest example is the waist (OMSS), many people suffer from lower back pain. It is clear, based on the progress of the last decade, that we need core stability. More interesting is the theory behind lower back pain.
My theory as to why: Loss of hip mobility. Reduced mobility of the hip joint (lower joint) affects the function of the OMSS (upper joint). In other words, if the hips can't move, the spine will. The problem comes when we know that the hips require mobility and the spine requires stability. When the supposedly mobile joint is immobilized, the stable joint is forced to move and thus becomes less stable with painful results.
The process is simple: – reduced ankle mobility – knee joint pain reduced hip mobility lower back pain reduced chest mobility neck and shoulder (and lower back) pain.
Examining the body based on the joints, starting with the ankle, this thought process makes sense.
Reduced ankle mobility causes the "landing" pressure from a jump to shift to the upper joint (knee).
In fact, I believe there is a direct correlation between the stiffness created by the basketball shoe and/or the use of a bandage or support tape and the likelihood of developing patellofemoral pain syndrome in basketball players.
Our desire to protect the unstable ankle comes at a high cost. We have found that many athletes with knee pain have issues with ankle mobility. Many times this is consequential ankle sprain and eventually using bandages and tapes.
The exception to the rule seems to be in the hips. The hips can be both immobile and unstable, resulting in knee pain from instability (a weak hip will allow internal rotation and adduction of the femur) or low back pain from immobility. How a joint can be both immobile and unstable is an interesting question. It appears that hip weakness in either flexion or extension it forces the spine to work compensatory, while when the weakness is in abduction (or more accurately, preventing adduction) it causes pressure on the knee.
Weakness or poor activation of the psoits and iliacus cause lumbar flexion patterns as a substitute for hip flexion. Weakness and/or poor activation of the glutes will cause a substitute pattern of spinal extension and attempt to substitute hip extension. Interestingly enough, this creates a vicious circle. As the spine moves to replace the lack of strength and movement in the hips, the hips lose their mobility.
It seems that lack of strength in the hips leads to immobility and immobility in turn leads to dysfunctional movement of the spine.
The end result is a puzzle: A joint that needs both strength and mobility in multiple designs. The spine is even more interesting.
The spine requires stability
It is clearly a series of joints that need stability, taking into account the function of the SS. It's pretty weird, but the biggest mistake we've ever made in coaching in the last ten years is committing to a drastic effort to increase the static and dynamic range of motion (ROM) of an area that obviously needs stability.
I believe that most if not all rotational exercises done for the spine are done with the wrong instructions. Sahrmann (Diagnosis and treatment of motor disability syndromes) and Porterfield & DeRosa (Mechanical low back pain: perspectives on functional anatomy) show that attempting to increase range of motion of the spine is inadvisable and potentially dangerous. (Is rotation a good idea after all?)
I believe that the lack of understanding of motor behavior of the thoracic spine has led us to try to gain rotational range of motion in the lumbar spine, this is a big mistake.
The thoracic spine is an area we don't have much information about. Many physical therapists recommend thoracic mobility, though few know exercises that are specifically designed for chest movement. The approach seems to be as follows:
"We know we need it, but we're not sure how to achieve it». I think in the next few years we will see an increase in exercises that are specifically designed to increase thoracic mobility. It is very interesting that in the diagnosis and treatment of motor disability syndromes, physiotherapist Shirley Sahrmann advocated the theory of developing thoracic mobility and limiting lumbar mobility.
The glenohumeral joint is designed for mobility
The glenohumeral joint (shoulder) they are similar to the hips.
The glenohumeral joint is designed for mobility and as it happens with the hips it should be trained for stability. I think the need for stability in the glenohumeral joint presents an opportunity for exercises such as push ups with a stability ball or BOSU as well as exercises with dumbbells on one side (alternating)
The inability of the joints to function normally leads to pressures on the individual joints. In the book Ultra Prevention – (actually a nutrition book) – the authors perfectly describe our current method of responding to injury.
Our reaction to injury is like hearing the smoke detector go off and running to pull out the battery. Pain, like noise, is a warning of some other problem. Putting ice on a sore knee or hip without examining it is like taking the battery out of a smoke detector.
What we need to understand is what is stated in the introductory phrase, “we grow old fast, but we get smart very slowly". Every day I learn more and more about the body. Everything I learn allows me to become a better coach and a better trainer.
Often what I learn is contrary to what I previously believed. Remember, they once thought the earth was flat!
Scientific article by Nikos Vlachos
Nikos Vlachos, MA Sports Science, Athletes Performance Specialist, Functional Trainer Specialist, Athletic Trainer, Sport Rehab & Therapy Trainer fitness trainer and rehabilitation consultant
Medical Fitness Center, Michail Psellou 11, Kifisia-Thessaloniki, info@medical-fitness.gr