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 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 complex did not tighten 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, counteracting 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 would not understand the purpose and nature of fascia and you would 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 has over 2,000 lbs of durability needed to even stretch 1%, that durability is what helps to make walking gait and running far more efficient, it has to be tense! 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 upgrade from a foam roller, to a bumpy roller, to a PVC roller etc,  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) that gives you the illusion of tissue change but is actually an endogenous modifier of nociception and nocifensive behavior such as tissue guarding. Keep ignoring it 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” – 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 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.

I haven’t updated in a while due to time devoted to opening a new clinic called Generation Care Performance Center.

However, I felt compelled to make a quick, blunt, review of Todd Hargrove’s: A Guide to Better Movement: The Science and Practice of Moving With More Skill And Less Pain. Simply put, this book is the most important book on movement in the last 20 years, possibly in existence up to this point. It will become a required reading for every movement professional to truly understand movement and pain. I have made pitiful attempts to touch on some of the concepts of this book in the past, but Todd has so elegantly written words which convey a clear understanding of the integration of movement in the Neuromatrix, that  I don’t know if I could ever add to it (but will foolish try at some point!). This book is fully accessible to both the clinician and the patient/client. Thank you Todd for your efforts, your clarity, and how incredibly affordable you have made this knowledge in an age of academic inflation. If you don’t buy this book, you are doing a disservice to your patients, and yourself. Buy it now!

Furniture sliders are extremely inexpensive (less than $10 at Lowes) and extremely versatile. I was inspired by Ross from Ross Training to experiment with these tools. One of my favorite exercise progressions is a multi-planar single leg squat. The slider is a great cue to promote mobility and stability as well as adding flow to a sequence of movements. It easily allows progressions and regressions based on the needs of the individual.

Ground based rope climbs are great space saving full body pulling exercises. However, the top of the climb ends up being the easiest part of the exercise. Some heavy chain is a great way to maintain resistance throughout the climb. Just be sure to pad the support chain you wear well!

 

This is part 2 of a series of posts reflecting on some highlights in learning about movement that I experienced in this last year. In part 1, I addressed my experience with Applied Functional Science / Chain Reaction™ Biomechanics and presented an application of this approach using hip internal rotation. In this post, I will discuss how my strength and conditioning beliefs have changed in 2012.

I still believe in heavy sagital plane lifting. Power/explosive lifts, deadlifts, squats, various forms of pressing have important places with strength and conditioning in a number of sports. Gary Gray provides good reasoning to support the idea that athletic development does not gain a great deal from these lifts unless they are a competitive weight lifter. However, standardized tests improved by these lifts have been shown to be related to athletic success in research1,2 and professional experience does show these lifts cross over into training. It is possible these improvements may  be related to changes in coaching over the career of an athlete but it doesn’t change the fact that intense overloads over time result is associated with athletes becoming stronger, more powerful, and faster. The carry over effects might not be driven purely by hypertrophy and increased neuromuscular drive, it could be endocrine related (increasing load is associated with increases in GH, testosterone, etc) and it could even be largely related by the mental discipline it takes to safely and properly lift increasingly difficult loads. The argument that he and others make is that there are other ways to accomplish this carry over and provide more specific tissue and neurological adaptation to sport. That may be the case, but it has not had the sheer volume and history of success as heavy sagital plane loading. There are certainly some sports I could see the value in dumping this type of loading today, but I think we might lose something, or cause a new problem, if we drop it all together.

So what about the multiplanar, multi-joint, functional training, corrective exercise realm? This is where I started my journey into movement through attending a seminar at Perform Better in 2003. At that time and many years looking forward, I just wanted to collect exercises and categorize them for individual purposes. I rode the anti-heavy lifting bandwagon for a good 4 years before I realized there was a value in it and put it back in my own system. I juggled the balance between the use of bigger lifts and the use of mobility/stability/sport specific power/strength development. I also began to realize how stability and mobility training was being scarred by the functional training movement. People see individuals squatting on stability balls and doing bicep curls on BOSUs under the claim of being “functional” when in fact, quite the opposite, they’re producing movements which simply do not exist in typical function unless they have some sort of odd circus specialty as a career.

Squat on ball

In fact, for many the idea of stability training automatically seems to perceived as being on an unstable surface, which could not be further from the truth. Worse yet, when they are not on some sort of unstable surface they are frequently isolated and cued to be worked under artificial constraints of stability. Everyone is given at least 5 cues to tighten one muscle, loosen another, fire this muscle, not that one. These cues have a place when someone is painful or are early in a rehabilitation protocol, but they do not belong in an athlete’s prehab or conditioning program in the long term except if they have another exacerbation of symptoms. They do not allow the athlete the freedom of motion to develop control in multiple planes of motion. Stability is a joint by joint function specific task. Stability is not simply the ability to hollow, brace, or maintain perfect hip hinge technique (go ahead and tell any strong man competitor fully flexed over atlas stone that his spine is unstable while lifting).

Atlas_Stone

Nor is stability hip abduction and external rotation strength and endurance which keeps this hip, knee, and ankle in a perfect sagital position. Stability is also nearly impossible to tease away from mobility. When mobility with load and force are only practiced in one plane of motion (IE: sagital plane heavy squatting, dead lifts, etc.), mobility will not improve in other planes of motion unless loaded in those planes of motion. Which brings me to our next topic, mobility needs training, not just stretching (dynamic or static):

I believe we can incorporate loaded and body weight exercises into general strategies for improving mobility which I think is more beneficial than a stretching regimen alone. We now know that long term static stretching flexibility improvements are primarily related to stretch tolerance, not tissue change. We are beginning to see that long-term resistance training with full ROM have similar flexibility improvements. 3,4 My belief is that incorporating more full body multiplanar movements with appropriate loading will therefore make more lasting changes in mobility in ways which are more functionally applicable than stretching because they reinforce active patterns of movement. Furthermore, performing these mobility exercises in weight bearing may theoretically promote joint stability at these newly acquire ranges of motion.

Finally, addressing the concern of timing of implementing all of these exercises into anyone’s program. Overall, I see some effectively implementing multi-planar/multi-joint mobility and stability into supplement work for their heavy sagital plane work. Some incorporate into into their metabolic days. To some extent, I will acknowledge it is possible that the advent of diverse multi-planar dynamic stretching prior to every session is already adequate to address my concerns. However, I still wonder if these are enough to make long standing changes in freeing up movement patterns, in particular in the transverse planes. Simply peppering a couple of mobility exercises from time to time may not be enough.

I began this year developing a program meant to complement existing training programs rather than replacing anything. It started first as a way to implement many of the old school strong man training and unconventional training techniques popular these days: focusing on grip strength and lifting and moving diverse objects into a dedicated session, as a way to expand motor patterns for force generation and just to mix up training. Some of this was just for entertainment and variety. Ultimately, after my exposure to the AFS approach and some of the group training at Shoreline Sport & Spine, this progressed to include a variety of multiplanar activities to promote mobility and stability. I now call these the “Mix” sessions, with the idea being utilize full body movements, lift and move diverse objects which require multiple forms of grip and body positioning, and integrate multiplanar/3D mobility and stability to complement an existing training plan.

The idea behind having these as separate sessions rather than integrated into existing sessions was that although I wanted some mild/brief fatigue from a metabolic style warm-up and a finisher at the end, I wanted to not have neuromuscular fatigue be so great prior to, or during, the session as to prevent the body from learning new movement it might not be familiar with.

I put together a video of some the exercises used in group sessions over the last year as this thought process evolved. This video is not the best representation of everything involved in a mix session or the balance of single plane vs. multi-plane diversity. I still have a large number of sagital plane based exercises, but it still demonstrates how the movement is changed by using objects other than barbells and how freedom of motion is promoted throughout. Of additional note, these sessions were designed for group sessions, the exercises recorded below were primarily for non-competitive athletes, these are different than a competitive athlete and the sessions can be customized be more “general sport specific”, but they are inherently limited in the ability to address an individual’s functional needs.

And if I’m completely honestly, it is just fun to have an entire dedicated session to experiment with movements that are different than what are traditionally used. Sometimes a little change is all that we need to move forward.

1.) Hansen, Keir T., et al. “Do Force–Time and Power–Time Measures in a Loaded Jump Squat Differentiate between Speed Performance and Playing Level in Elite and Elite Junior Rugby Union Players?.” The Journal of Strength & Conditioning Research 25.9 (2011): 2382-2391.

2.) Gonzalez, Adam M., et al. “Performance Changes in National Collegiate Athletic Association Division I Women Basketball Players During a Competitive Season: Starters Vs. Nonstarters.” The Journal of Strength & Conditioning Research 26.12 (2012): 3197-3203.

3.) O’Sullivan, Kieran, Sean McAuliffe, and Neasa DeBurca. “The effects of eccentric training on lower limb flexibility: a systematic review.” British Journal of Sports Medicine 46.12 (2012): 838-845.

4.) Morton, Sam K., et al. “Resistance training vs. static stretching: effects on flexibility and strength.” The Journal of Strength & Conditioning Research 25.12 (2011): 3391.

Sometimes I forget how long the debate over abdominal hollowing (drawing in) vs. bracing has been going on. We’re close to 20 years on this topic. A year and half ago I started writing a clinical commentary on a herniated lumbar disc rehabilitation protocol which included addressing this very topic. A recent resurgence in interest regarding core stability (I guess it never really goes away) made me want to pull an excerpt from the article before it is published. I believe there is a time and a place for abdominal hollowing and abdominal bracing, but there is also a time for neither. The “neither part” has further been bolstered by my experience with Gary Gray’s Applied Functional Science (See Learning about Movement – Part 1). Here is the excerpt:

“Selective recruitment of the TA and multifidi utilizing “abdominal hollowing” or “drawing in” has been described in the literature and is widely practiced. (88,90) In contrast, the simple “abdominal bracing” exercise is another common exercise which not only emphasizes TA and multifidi recruitment, but has demonstrated recruitment of other musculature of the abdominal wall including the internal and external obliques.(89,91) Hodges et al.(85) have demonstrated, using an in vivo porcine model, some increased intervertebral stiffness utilizing TA activation by replicating “hollowing”, more recently, authors have demonstrated that this increased stiffness from “hollowing” is significantly less than during “abdominal bracing” due to decreased activation of the remainder of the abdominal wall musculature. (91,92) When sudden posterior trunk perturbations are introduced, abdominal bracing yielded significantly greater cocontraction of the trunk musculature, increased trunk stability, and better resistance to lumbar displacement than abdominal hollowing.(93) It also appears that the greater the conscious effort utilized to activate the muscular wall, the greater the decrease in spinal stability.(94) Abdominal hollowing has been shown to cause sufficient inhibition of the erector spinae and other musculature to decrease anterior pelvic during hip extension.(95) Inhibition of the erector spinae may have specific therapeutic and treatment benefits in addressing potential muscular imbalances, however they are valuable contributors to stable functional movement, which may result in decreased pelvic control if inhibited.

Although cocontraction of the TA and multifidi has been perceived as vital for muscular stabilization of the lumbar spine, their attempted selective activation may decrease anteroposterior trunk stability,(91-94) theoretically placing rotational trunk stability at risk through decreased activation of the external obliques in comparison to abdominal bracing.(89,91) Despite this, utilizing “hollowing activity” in the early in treatment phases of treatment can provide some symptom relief, kinesthetic awareness, motor control education, and provide some early activation of the TA and multifidi during the acute phase. However, once an individual progresses to postures that involve weight bearing, utilization of bracing may be better to enhance multiplanar stability.

Ultimately, conscious efforts towards bracing and/or hollowing do not contribute toward functional stability, rather, focus should be redirected towards addressing specific motor patterns utilizing multiple muscles in order to develop comprehensive spinal stability.(96) Moreover, from a theoretic functional perspective, consciously constraining movement in any region of the body over an extended period of time may alter the demands placed upon numerous other regions of the body. This may be best illustrated with the influence of external fixation, such as the use of a spinal orthosis for reducing pelvic mobility,(97) single segment spinal fusion influencing segmental motion around it,(98) and the increased risk of degeneration above and below the segment of lumbar fusion.(99) Although these examples entail extreme measures of stabilization beyond the level produced consciously by an individual, it serves as a reminder that a balance between mobility and stability is necessary to enable responses to the dynamic demands during movement of the human body.”

85. Hodges P, Kaigle Holm A, Holm S, et al. Intervertebral stiffness of the spine is increased by evoked contraction of transversus abdominis and the diaphragm: In vivo porcine studies. Spine (Phila Pa 1976). 2003;28(23):2594-2601. doi: 10.1097/01.BRS.0000096676.14323.25.
88. Richardson CA, Jull GA. Muscle control – pain control. what exercises would you prescribe? Manual Therapy. 1995(1):2-10.
89. Richardson CA, Snijders CJ, Hides JA, Damen L, Pas MS, Storm J. The relation between the transversus abdominis muscles, sacroiliac joint mechanics, and low back pain. Spine (Phila Pa 1976). 2002;27(4):399-405.
90. Hides J, Wilson S, Stanton W, et al. An MRI investigation into the function of the transversus abdominis muscle during “drawing-in” of the abdominal wall. Spine (Phila Pa 1976). 2006;31(6):E175-8. doi: 10.1097/01.brs.0000202740.86338.df.
91. Grenier SG, McGill SM. Quantification of lumbar stability by using 2 different abdominal activation strategies. Arch Phys Med Rehabi. 2007;88:54-62.
92. Stanton T, Kawchuk G. The effect of abdominal stabilization contractions on posteroanterior spinal stiffness. Spine (Phila Pa 1976). 2008;33(6):694-701. doi: 10.1097/BRS.0b013e318166e034.
93. Vera-Garcia FJ, Elvira JL, Brown SH, McGill SM. Effects of abdominal stabilization maneuvers on the control of spine motion and stability against sudden trunk perturbations. J Electromyogr Kinesiol. 2007;17(5):556-567. doi: 10.1016/j.jelekin.2006.07.004.
94. Brown SH, Vera-Garcia FJ, McGill SM. Effects of abdominal muscle coactivation on the externally preloaded trunk: Variations in motor control and its effect on spine stability. Spine (Phila Pa 1976). 2006;31(13):E387-93. doi: 10.1097/01.brs.0000220221.57213.25.
95. Oh JS, Cynn HS, Won JH, Kwon OY, Yi CH. Effects of performing an abdominal drawing-in maneuver during prone hip extension exercises on hip and back extensor muscle activity and amount of anterior pelvic tilt. J Orthop Sports Phys Ther. 2007;37(6):320-324.
96. Kavcic N, Grenier S, McGill SM. Determining the stabilizing role of individual torso muscles during rehabilitation exercises. Spine (Phila Pa 1976). 2004;29(11):1254-1265.
97. Konz R, Fatone S, Gard S. Effect of restricted spinal motion on gait. J Rehabil Res Dev. 2006;43(2):161-170.
98. Schwab JS, DiAngelo DJ, Foley KT. Motion compensation associated with single-level cervical fusion: Where does the lost motion go? Spine. 2006;31(21).
99. Putzier M, Hoff E, Tohtz S, Gross C, Perka C, Strube P. Dynamic stabilization adjacent to single-level fusion: Part II. no clinical benefit for asymptomatic, initially degenerated adjacent segments
after 6 years follow-up. Eur Spine J. 2010;19(12):2181-2189. doi: 10.1007/s00586-010-1517-4.

This is part 1 of a series of posts reflecting on some highlights in learning about movement that I experienced in this last year. I hope to be able to do this on an annual basis as a record of self-reflection and hopefully provide some value to others out there on the same journey.

Applied Functional Science / Chain Reaction™ Biomechanics

SKBK_WuShu_Aerial_R

I have previously discussed my interest in going more in depth into multiplanar movement with my posts on 3D stretching as well as regional interdependence. I have used the FMS and SFMA off and on for a few years and felt they were both efficient and useful for their respective purposes, and I love that the research community is actively exploring the validity and reliability of these tests. I will still utilize components of these tests from time to time. However, I have personally found I need to change to a more customized approach to evaluation. In the past, I have found that in the middle of testing, I would break out of the protocols established trying to “tease” out something that did not fit cleanly into any of the tests. Part of this is just my nature, I have a difficult time adhering to standardized procedures and the way I do things just kind of evolves and varies depending by how I perceive something is presented to me. As these breakout sessions grew in complexity, I knew that for me personally I needed to explore some other philosophies which probably have figured out things I have yet to even think to ask about. Gary Gray’s Applied Functional Science (AFS) was the first approach that peaked my interest after that point. Gary Gray arguably pioneered much of the functional training movement, with Gray Cook stating publicly he has been strongly influenced by Gary Gray’s thought process. However, getting to the point of wanting pursue learning about the AFS approach has been a 4 year journey. When I first watched videos of Gary demonstrating and discussing his thought process, I completely disregarded it because my bias at the time of what I was seeing was an awful amount of poor quality movement with no regard for what is currently considered stability, in particular with movement of the spine. But over time, I could not deny that this freedom of motion looked more useful than I had first thought. I finally bit my lip and jumped in, eventually realizing I need to at least give it a try. It was probably one of the best decisions I could have made and now has significantly influenced how I view movement and exercise prescription.

I was given the opportunity to be exposed to the AFS approach through a nine week clinical rotation at Shoreline Sport & Spine in Spring Lake, MI. There are currently 6 Fellows of Applied Functional Science™(FAFS) at this location. A FAFS has completed a 40 week fellowship through Gary Gray’s Applied Functional Science (AFS) approach. The clinicians at Shoreline have integrated AFS with a wide variety of manual therapies and other interventions which was a fantastic eclectic experience that allowed me to explore a number of ways to integrate this philosophy.

Before presenting on this topic, I must first acknowledge that these are my personal reflections on the experience, and if they are in error, they should not reflect upon the excellent clinicians at Shoreline Sport & Spine. I am certain more than one FAFS will perceive I might have missed the boat on key points, and to that, I respond that I plan to formally take a Chain Reaction™ course in the future to see what else I might have missed. Furthermore, I am commenting on but a drop in the ocean of what the AFS system entails. The “Functional Nomenclature” alone requires a 44 page manual to address simply the language and fundamental principles. That being said, here are some key things I learned from this experience:

“Drivers facilitate chain reactions throughout the body”

This was the earliest, most applicable, concept I learned from my exposure to the AFS/Chain Reaction model. It may seem like a simple statement but it is incredibly profound when broken down even a small amount. Rather than simply thinking about one joint moving on another and leaving it at that, the Chain Reaction model demands that every joint be examined from a proximal on distal and distal on proximal perspective, what are the joints above and below doing, and what planes of motion (sagital, frontal, transverse) all of the joints are moving in during any musculoskeletal action. Central to this is the concept that during movement, a driver leads the movement and the joints above and below follow that same movement, but at different speeds as they progressively move in the direction dictated by the driver. This delay in speed/timing of a bone following another bone is the Chain Reaction explanation for much of what we understand about arthrokinematics. When bones move on top of each other in multiple planes of motion in the various representations of roll, glide, spin, etc.,  they are doing so according to the congruencies afforded to them to allow them to follow the next bone and joint as led by the driver.

In most of our manual therapy courses, we examine relative motion of one joint on another and addresses joint movement in various planes of motion based on arthrokinematics. Traditionally, looking at joints this way was left to the manual therapy realm and not the exercise prescription realm. Oddvar Holten likely made the earliest attempt to merge the manual therapy perspective with exercise prescription with his Medical Exercise Therapy (MET – Not to be confused with muscle energy technique) which focused on utilizing various apparatuses to isolate spinal segmental levels and extremities and then focusing on patient induced movement into one or more planes of motion specific to the desired outcome determined in the manual therapy diagnosis. The Chain Reaction approach more broadly addresses this by including concepts more similar to regional interdependence and primarily using the patient’s own body and extremities to control the levels of segmental or joint emphasis through prepositioning such as: Holding on to a stable or unstable support, modifying the weight bearing surface (wedges, angles, instability), conscious prepositioning, etc. It then utilizes another joint or point of the body above or below (could be FAR above or below) to facilitate movement at the joint in the plane, or planes, desired. This approach is both a diagnosis and a treatment, which is the focus of the AFS approach. It integrates extremely well with existing manual therapy interventions, or in Gary’s opinion, independent of traditional manual therapy models, resulting in him developing his own manual therapy system specific to the AFS called Functional Soft Tissue.

Getting back to the idea of a “driver”. A driver is anything which “drives” motor behavior. This could be any part of the upper extremity, lower extremity, trunk, neck, head, eyes, sense organs, and/or even fears and beliefs. The driver itself has numerous variables which can be applied to it: Is it open or closed chain based? What action is performed? What is the direction of movement? What is the speed? What are the force demands? Etc. etc.. This is just a small list amongst many other variables, not even addressing fears and beliefs.  The entire process can get very complex, very quickly, when broken down in the nomenclature which requires looking at every movement from the perspective of:

  • What environment is it occurring in (given available, or specified with certain controls on stability)?
  • What is the beginning position (upright, seated, kneeling, prone, supine, sidelying)?
  • What exactly is the driver (hand, knee, foot, pelvis, trunk, shoulder, etc)?
  • What is the triangulation (direction/target)?
  • What is the action (squat, lunge, reach, pull, etc)?
  • What is the ending position?

I am not qualified to go into that sort of detail, so instead I will provide a broad overview with a contemporary example. Many of us are already applying general versions of this thought process, but do not realize how far we can take it. I will use the example of a kettlebell swing.

 Kettlebell Swing

If you give a new client a kettlebell and only cue them to swing the kettlebell, they will instinctively “drive” the motion using the arms and shoulders, not their hips as you may have originally intended. They do this because you just gave them a cue which facilitates a motor pattern to accomplish the goal in the simplest way the brain understands, which is to swing their arms to swing the kettlebell, rather than to accomplish the exercise prescription goal you had intended, which was likely hip extension. If you change the cue to “Drive the hips forward”, you changed the driver of the motion to the hips, rather than the arms. Now in order to produce the force to swing the kettlebell, the individual will use a hip extension strategy. You just changed the entirety of the neuromuscular patterns utilized, even though you had the exact same exercise setup. Change the driver and the motor behavior changes.  Now, if you expand this to joint by joint, things get really interesting.

Take for example working mobility and stability of hip internal rotation. There are a handful of non-weight bearing activities which involve the femur actively or passively internally rotating on the pelvis.

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We may begin with a manual therapy intervention to address mobility, then provide a mobility exercise, then a stretch, then we prescribe an exercise for stability, then we address another joint which may be associated, and we give it a mobility exercise, and a stretch, and a stabilization exercise, on and on we go. We may end up providing a large amount of exercises, all of which take time, with very specific cues and details to remember. Now with AFS, if we apply the concept of a driver along with any number of subtle changes, or “tweaks” as Gary likes to call them (the process is called “tweakology”), we can tailor a custom exercise specific to our patient needs across multiple joints with reduced need for extensive cuing and details. This can be done with fewer exercises overall because we can integrate mobility, stability, and movement across multiple joints, in multiple planes of motion, into simple exercises which require less time for the patient perform. Progression and regression are simple to teach because you are using movement patterns the client/patient already knows, you simply tweak one or two components to make changes towards the movement you want to improve.

As I am already far over my target word count for this post, I will finish with a video in which I discuss some basic strategies to emphasize hip internal rotation in weight bearing and function:

Movement “flows” are a popular trend in the personal/fitness/strength and conditioning realm these days. “Flows” are a sequence of movements or exercises put end to end and performed in a continuous fashion.  These movements are performed continuously for the desired amount of time or repetitions.  To some extent, they have existed for 1,000 of years in martial arts in patterns of movements called “forms” which paired together martial arts techniques in both short and extremely long sequences (I have learned forms over 10 minutes in length in various styles over the years, and some forms of Tai Chi can be even longer). These grew and evolved to include many acrobatic techniques as well. The value of any these forms are debatable, but for those who enjoy them, they are worthwhile. Similarly, for those who are looking for something different, the current trend of movement flows are worthwhile. After all, movement in life is varied and diverse, not confined to singular patterns. Not to mention that flows can be quickly fatiguing through a variety of changing movements rather than the need to do a high volume of the same exercise.

Over the last few months, I have been toying with the idea of incorporating movement patterns and exercises that I think are generally beneficial to overall movement into standardized flow. As it stands, I have developed two sequences which I have been putting through trials with a variety of victims (read: clients and friends) with positive response. Therefore, I have decided to throw these out to the public for others to try. These flows are great for a warm-up or a stand alone exercise and can be blended together for a physically, and sometimes cognitively, challenging exercise.

Dynamic Principles Basic Flow #1 emphasizes mobility and stability for the hips and shoulders, trunk control, and multiplanar movement driven by both the upper and lower extremities.

Dynamic Principles Basic Flow #2 emphasizes dynamically lengthening the frontal and lateral anatomy lines, multiplanar spinal mobility, and multi-angle hip extension

As always, thoughts and opinions are welcome!

The discussion about the value of a dynamic warm-up in movement preparation is fairly focused on dynamic stretching these days. If you need a brief primer on pre-exercise dynamic stretching, please visit this old write-up of mine here. Now debates occasionally arise regarding what the “optimal” dynamic warm-up or movement preparation approach is. Tons of articles, books, and even training programs encompass very specific “functional” activities as a part of the warm-up. While I personally think that some degree of specificity is needed for each individual sport, there may be times we get a little excessive in this vein. A recent article from  Sander et al. sparked my interest on this topic. In their study, they took a group of elite youth soccer players (making some limitation of the practicality to 13-18 years olds), split them into two, one with a very generic warm-up (although they did include various running drills which are functionally specific to sprinting) and a second which did the generic warm-up plus additional “functional exercises”.  They found that for linear sprints and change of direction sprints, no significant difference was noted between the two groups. In other words, besides just “getting warmed up”, some of the classic “functional dynamic warm-ups” did not add any additional benefit to the performance of a sprint task. This leaves a great deal of room for argument regarding how this would apply to the broad scope of movements of sports beyond sprinting, but it still shows you don’t have to spend 15-20 minutes doing a complex dynamic warm-up to be able to a physically demanding task such as sprinting.

This was interesting to me because I have been playing around with the use of an intervals for movement preparation in recent months as method of making shorter warm-ups, and the feedback I have received so far has been positive.  Intervals have been extremely popular in recent years for “metabolic training” and fat loss programs based on various interpretations (some grossly inaccurate) of the original Tabata protocol and other historical interval/circuit training research. However, another possible use for intervals are as a generic/semi-specific warm-up.

When performing an interval for a warm-up, the intensity is perceived as high, but the rest intervals, exercise selection, and exercise order prevents early overwork and burn out. Time is saved from the exclusion of a general warm-up, and the movement specific components can be incorporate as a part of the interval model (although more will be necessary if full sport participation is planned).

Currently, I use 30 seconds on, 10 seconds off, for 10-20 rounds  (5-10 mins of actual work) depending on the demands for the session. In these 10-20 rounds I select a matching number of alternating light, moderate, and higher intensity full body exercises which generally involve the primary movers and stabilizers for most sports. Typically, I use a number general low risk contemporary exercises which can be easily graded for intensity, such as heavy ropes, kettlebell deadlifts, hand walk ups on unstable surfaces, farmers walks, etc. If limited equipment is available (on field, etc.) most of the intervals are body weight.

Although I can’t state there are unique physiological benefits from an interval model, theoretically it shares the same benefits of increasing heart rate, blood flow, increased neuromuscular recruitment, provide the ROM demands of the activity, and most importantly, being interesting and challenging enough to get the central nervous system fired up and therefore “wake” the athlete up for training. If I’m honest, it’s not really much different than most dynamic warm-ups except earlier increases in intensity and using a timer rather than reps and sets. But that’s what makes it different from a psychological perspective. Just having the warm-up “be different” is valuable to me, because after nearly 10 years of sets and reps of rather low intensity progressive dynamic warm-ups, sometimes you just want something different, and often times, so do your athletes.

Below is a video of a sample interval warm-up for a small group training session. Since the goal of the warm-up was to prepare for some backyard strength training, no sport specific components were a part of the training session. This session was shorter than what I typically use, consisting of 7 rounds for 3 minutes and 30 seconds of actual work. But it was still more than adequate to warm-up everyone to be able to do what they needed to do in the proceeding training session, showing how the interval model can save quite a bit of time in compressed training sessions.

Sample Interval Breakdown

**Note: With groups, it is more difficult to grade intensity of exercises since an individual starts at any station, so every exercise has to be selected as if it can be tolerated as the athlete’s first exercise if they were “cold”.

  • Weighted stair/box stepping – Hip extension patterning, unilateral & quick heart rate elevation
  • Kettlebell deadlift – Hip extension patterning, requires less spine/hip flexion than tradition DL & much lower load, and some core activation.
  • Floor mover reaches – Scapular/RC activation, some core, and mobility.
  • Floor mover mountain climbers – Quick heart rate elevation, and mobility.
  • Heavy rope battling ropes – Heart rate elevation, scapular/RC activation, and some core activation.
  • Sandbag hand walk-ups – Core activation and scapular/RC activation.
  • Isometric grip strength – This was partially a rest station, but was also to prepare for the gripping components of the training session for the day.

P.S. Yes, I love to keep it classy by shooting these videos in my trashed basement gym. The record has been a small group of 10 victims squeezed in here.

Eric Cressey put out a great post a few months ago regarding the possible risk of doing excessive amounts of heavy pull-ups/chin-ups. Eric also made a good point that perhaps for some individuals, we should be doing a cost-benefit analysis regarding whether they should even be doing the exercise. Since then, I have seen a number of individuals post their concerns regarding excessive chinning/pull-ups. Along with many of these posts came the suggestion of complimenting, supplementing, or possibly replacing pull-ups/chins with rowing and other pulling techniques. Although this isn’t exactly a new idea, many coaches are attempting to balance between the two motions, it just hasn’t had as wide of recognition as it should have because so many people hold the pull-up/chin as a sacred cow which cannot be degraded or changed in any shape or form. Needless to say, I still love pull-ups/chins, but I have found myself drifting more towards doing variations of heavy rope climbing as my primary grip, arm, and back strengthening exercises. For this post, I put together video of my favorite rope climbing progressions as a supplement to, or replacement for pull-ups/chin-ups.

This is a basic rope climbing progression toward climbing single and double ropes without leg assistance. Rope climbing is an excellent grip, arm, and back challenge that demands strong functional muscle synergies in order to complete each pull. This progression is designed for rope lengths between 7-10 feet, such as those attached to a power rack/squat rack or a low ceiling. At this distance, climbing up and back down equals 1 rep. As each unweighted progression becomes easy (3 sets of 10 reps easy), you progress to the next technique, or skip around as you see fit. Treat the “no leg” climbs like a heavy lift, aiming for sets of 5. If you can get to the point of doing 5 sets of 5 reps with the no leg technique, you are solid and should either strap on some weight or find a place to use a decent height rope (20+ feet).

**Caution: Although I really enjoy the suspension strap assisted climbs, there is a risk of getting yourself tangled up and coming down without your legs to protect you. If you can’t safely bail out with just your arms at this height, don’t use this technique.