There is an epidemic of movement professionals emphasizing outcomes without understanding “why” they are seeing the things they are seeing in human movement. Whether a rehabilitation profession, a strength and conditioning coach, or personal trainer, just because something changes, doesn’t mean that it had anything to do with the specifics of what you did, there are many factors involved in movement behavior change, most more powerful than the direct effects of your prescribed exercise! The “why’s” that are frequently touted tend to be focused on rigid structure, failed understanding of tissue strain curves and plasticity, and a fallacy of some sort of predictable patterns which must be re-organized like a puzzle piece or molded like a piece of putty. There is rarely a basic analysis of the underlying physiology that creates the measurable change that is occurring. Failure to investigate the most studied mechanisms for the changes we see, limits significant potential for improving prescription strategies and may also increase risk of harm of the client for which the plan was made. In fact, the education we use to describe our movement strategies may negatively impact the potential of that movement strategy, or even harm the client’s beliefs about themselves and their potential. Furthermore, a failure to understand how psychology, social factors, and culture are tightly interwoven into the physiology of human movement has long term implications of movement across a lifespan.

Below are 8 examples of strong basic scientific concepts related to movement which are vital to understand for anyone who observes and prescribed movement interventions

  1. Flexibility and Mobility
    • Muscles, tendons, and other soft tissues are not independently operating tissues of the body, they cannot become “tight” or “stiff” on their own, they require a nervous system, immune system, and endocrine system (infact there is growing evidence muscle is a an important endocrine organ!) to be able to do anything including how willing they are to move and be lengthened. To understand flexibility, range of motion, and “mobility” you must understand nociception in contexts other than pain. You must understand that nociception does not equal pain and plays a vital role in many areas of human function. If nociception was pain and if we have “pain fibers” and “pain signals” in the body, then we’d all be screaming in pain as we explore our available range of motion, because how nociception is processed is what predominantly regulates your flexibility and your ability to change it. Your nervous system is the primary driver of how willing your muscles and tendons are to lengthen, if it feels you shouldn’t lengthen that tissue, no amount of stretching will change it unless you can “play with processing” to see if it will behave in another manner. Fundamentally, if the term stretch tolerance is new to you, you missing out on the most basic fundamental science of stretching and mobilization, stretch tolerance the cornerstone physiology of range of motion works in humans.  (here, here, here, here, here to start) Furthermore, by understanding stretch tolerance and knowing that nociception is both peripherally and centrally facilitated and modulated means you need to understand a persons thoughts and emotions are going to regulate how much the muscle will resist lengthening. (see here) The amount of time wasted on stretching and mobility activities emphasizing an area that doesn’t want to move is ridiculous. Odds are very good there is a reason the tissue is behaving the way it is, and efforts to try and change it may counteractive to the functional benefits of it being “tight”, perhaps the behavior could even be protective! We see this very clearly with running, if the gastrocsoleus and achilles tendon complex did not stiffen with increased volume of running, you would lose a tremendous amount of passive tissue energy reserve which reduces strain and effort throughout the body. Yet here thousands of runners waste their time “stretching” their calves, or thinking they are mobilizing their talus with a band, fighting against a very useful and performance enhancing adaptation. Worse yet, and depending on the area emphasizes, this excessive time spent on mobility and flexibility may contribute to unhelpful compulsive behavior and potentially result in tissue injury in the long term. Remember, it doesn’t require a fancy technique or tool to change mobility, just play with context and processing and see what happens, look here for an example.
  2. Strength and Durability of Soft Tissues
    • To fail to understand the high tensile strength, adaptability, resiliency of connective tissues and normal connective tissue changes such as scar tissue, means to not understand the purpose and nature of fascia and to not understand tendon/fascia skeletal muscle interface as related to movement.  (here, here, here, here, here)  Fascia really has two primary purposes, it’s a firewall to protect the spread of infection to deeper tissue, and to conserve energy. Take for example the IT band, which requires over 2,000 lbs of tensile force to lengthen a measly 1% in length, that tensile strength is what helps to make walking gait and running far more efficient, it has to be tense! Let alone the basic science of physics clearly indicate you as a clinician could not lengthen it (or any other piece of fascia) even if you wanted to! Over emphasizing and/or under appreciating these fundamental concepts of soft tissue leads to many common time-wasting strategies, promotion of negative self-beliefs, obsessive behaviors, and possible injury to neurovascular structures. Clinically it is not that uncommon I see athletes who regularly “roll their IT band” end up with significant sensitization of the lateral femoral cutaneous nerve, which can sometimes take a very long time to calm down. The warning signs are common, if you find yourself upgrading from a foam roller, to a bumpy roller, to a PVC roller, to a steel pipe and beyond,  because you can’t get your targeted area to “mobilize” like it used to, you are starting to experience some change in nociceptive processing, you are experiencing less the DNIC effect. (Diffuse Noxious Inhibitory Control) DNIC is part of what gives you the illusion of tissue change but is actually an endogenous modifier of nociception and nocifensive behavior such as tissue guarding (see #1 above). Keep ignoring the growing sensitization and thinking the tissue just needs to be “Beat-up more” to be “mobilized” and the problem could expand into something else.
  3. Regional Emphasis on Mobility
    • This is one my most frustrating things to see on social media and I’m equally guilty for previously propagating this misunderstanding in the past.
      • “Focus on dorsiflexion to improve your squat” – No, you don’t need to, dorsiflexion only influences one aspect of a squat, the ability to go past the toes, which you may want if you want more quad work. It’s based on the idea that there is some form of “good” squat form, there is not, you squat the way your body is built, you don’t force your body into a particular squat. The key is, you can still get a great squat with less dorsiflexion, there are thousands of other ways to squat to and past parallel, and ways to work your quads more, all while meeting the ability of your anatomy safely and appropriately. Squat to your anatomy, not into it, or past it!!
      • “Your hip flexors limit your squat” – No, they don’t, look at the anatomy and follow the osteokinematics with the origin and insertion. No, they don’t, please look at the anatomy. Please stop.
      • “Your psoas is too tight and pulling on your back keeping you out of neutral spine during your squat” – No, it isn’t, no it can’t. See above. And no you can’t keep a neutral spine, see below.
      • “Mobilize those hips to get this very specific angle of hip width/ER/flexion in your squat that you must have to protect your spine” – Your hips can only move in the way your anatomy was built. Human hips have a great deal of femoral acetabular variation, it is common and many factors influence it. (see here) Even a form of the “dreaded”  Femoral Acetabular Impingement (terrible name for a normal variant of the body) exists in some manner in up to 67%  of asymptomatic individuals (here) Odds are if you keep pushing hips into a direction where two bones get really close to each other, your body might start to guard or get angry. See topic 1 above for consideration.
  4. Keeping a Neutral Spine
    • Human bodies cannot keep a neutral spine while squatting, even in highly trained Olympic lifters. No matter what, 40-50 degrees of lumbopelvic flexion always occurs during efforts of “maintaining neutral” while squatting or picking something up (see here). If you are worried about spinal flexion and spinal discs, perhaps it’s best to realize we are all “doomed” and maybe that doesn’t matter. Or perhaps our understanding of the biomechanics of the spinal discs is that in weight bearing flexion is not that of a jelly donut, and might protect the spinal cord and nerve roots in comparison to neutral or extension. (see here)
  5. Stabilization and Muscle Activation Exercises
    • Guilty as charged, I sadly even wrote articles to perpetuate this limited concept without fully questioning many of the authors and clinicians thinking. This is the problem when you expect “leaders in the field” to do the critical thinking for you rather than delving into it yourself to make sure what they are saying makes sense. The fundamental problem is there are no specific “stability” motor control patterns written into the body that can be assessed or that need to be trained, there are a number of very fundamental aspects of humans with spines that are commonly missing from the dialog, in particular, the role of context in posture and movement. Rather than “stability” motor programs in the human body; there is a “keep from tipping over”, “don’t drop that thing”, and “don’t get squashed” contextually derived dynamic postural-righting behavior that is heavily influenced by your emotions and your thinking in real-time. (start here and here) Many of the smaller muscles of the spine are spending a good chunk of their time as sensing organs while other portions of their time fine tuning movement with other larger and smaller muscles, sometimes they’re even allowing the passive structures to do work, and that’s normal and needed for the health of the spine articulations and structure – Gasp!  Any effort to train them is an exercise in futility. Every study that has examined this belief shows there is no change in actual muscular behavior when doing specific exercises; doing those exercises might make a person feel better for a number of other reasons, but nothing changed with how the muscles function. (here, here, here, here, here, here to start) Furthermore, things like specific order of activation of muscles, do not exist, I’ll let Greg Lehman take it from here and here. We can’t program motor behavior with exercise prescription, they’re not programmable, you can condition the muscles but their motor behavior is dynamic, not static, and the amount of factors involved in that dynamic state, let alone the infinite numbers of contexts they are changing in, is impossible to predict and accommodate for with a deliberate exercise. Specific “Stability exercises” are not only a waste of time but may reinforce pain related behaviors by reducing variability of the trunk in response to context, which may be detrimental in the long term by creating a virtual “movement prison” (thanks to Jarod Hall for that term).
  6. Emotions and thoughts in Movement
    • If you fail to recognize the vital importance of emotions and thoughts in the human movement, you fail to understand motor behavior in a meaningful way, motor control and coordination does not exist in a sterile environment, in fact their very development is dependent on emotions and cognition. (here, here, here, here,). Trying to make someone selectively “turn-on” (since when was it off??) or emphasize an muscle when they have significant stress in their life is not just a futile effort, but it’s essentially impossible for them to do in that context of their life in that moment. Their motor circuitry is overloaded by their emotional state which no cognitive cue is going to override. Fear results in massive co-contraction of the TVA, multifidi, IO/EO, rectus, and ES! That corset is already there, the problem is, they don’t know how to do anything BUT brace their core at that moment.
  7. Posture is Biopsychosocialcultural
    • If you fail to understand the psychological, social, and culture roles of how humans hold themselves, you do not understand posture, it is not just a bunch of bones stacked on each other. (see previous post on this here)
  8. Injury Prevention is Non-specific
    • There are many “injury prevention” and “bullet-proofing” programs out there by a number of gurus. Some of those gurus were hired by professional sports organizations, how do you think those teams are doing? (here, here, here to start.). When looking at specific vs. general programs of preventing injury, no specific strength, flexibility, or neuromuscular control strategy stood out amongst the rest (here). Simply doing something different than current sport while participating in your sport seems to help, and the slow burn recognition that the most predictive return to sport after injury are psychosocial factors is slowly making it into daylight.

If these concepts are new to you, please take the time to struggle with them. I started this journey toward understanding movement 21 years ago for my own benefit and then began trying to help others 5 years later and I’m still processing this stuff on a daily basis to make sure I can best take care of myself and my clients. There are a lot of unknowns in movement, but as described above there is a strong scientific basis for shifting the way we look at human movement through a Biopsychosocial lens and not getting caught up in this illusion of a “movement system” that operates like a machine. We are not simple cars, we are so much more than machines.

1 reply
  1. Irene Diamond
    Irene Diamond says:

    Excellent perspective to focus the topic on movement rather than pain relief.

    The ability to move with ease to carry out ADLs, hobbies, life‘s joys is a bio psycho social cultural goal of people all over the world.

    Thanks for the well-written article.

    Reply

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