The Pillars of Dysfunction
When movement dysfunction gets identified, the cause can be traced back to four possible instances — structural impairments (i.e., flat feet), a previous injury not adequately rehabilitated, or a lack of mobility, motor control (stability). Let us explore these four occurrences in greater detail.
Structural impairments are NOT functional impairments. Structural impairments are postural impairments with a skeletal segment of the body. Examples of these include flat-feet, bow-legs, leg-length discrepancy, and scoliosis, which can induce dysfunctional movement. Functional impairments are neuromuscular and include the complete or partial loss of function of a body part. Adapt these terms by imagining the human body as a computer. A computer problem can range from hardware (i.e., structural) or software (i.e., viruses).
Most diagnostic tools with orthopedics are designed to look at your structure, not your function. By comparison, a person has severe low-back pain. A doctor looks at the MRI of the person with low-back pain and concludes because there are no degenerative changes, there must not be anything terrible, so the pain must not be that bad. Wrong! The way the neuromuscular functions can be completely inappropriate (like a software virus) and yet the structure of the body (a computer) still shows well.
There are two ways we should interact with structural dysfunctions, which are protective and corrective. For example, when an athletic trainer or podiatrist puts an orthotic in a shoe, the question must be examined, “Am I protecting the athlete from getting worse because I can do no better due to the structure of the foot? Or am I trying to stimulate neuromuscular feedback so functional foot intrinsics go up to improve the function of the foot? Some athletes get better in an orthotic, making it a protective measure. On the other hand, we can take corrective action and give an athlete the initial orthotic to show them where their foot would be better, get them in a better shoe and then gradually reduce the level of stiffness in the orthotic (rigid → semi-rigid → soft) to give them neuromuscular feedback.
Therefore, the model when engaging structural dysfunctions: did you change something with the active participation of the athlete whether its protective (allows you do something you weren’t able to do) or a corrective (reload a functional movement pattern and get rid of the bad stuff).
When an athlete arrives on campus, we administer the DWMA Screen before we subscribe to any training for the athlete. During this method, we undoubtedly observe mobility and stability dysfunctions in the athlete’s kinetic chain. Commonly, these dysfunctions get traced back to a previous injury despite the athlete having been through rehabilitation and been asymptomatic (no symptoms) at discharge. The reason? The athlete had movement pattern asymmetries and motor control issues not addressed.
As strength coaches, we need to assess athletes on intake and deal with whatever diagnosis the medical staff and athletic trainer present. Unless we screen and determine mobility and stability function in the athlete’s kinetic chain, we are not going to be able to gather the valuable information we need to enhance performance and reduce the likeliness of injury. The number one precursor for an injury is a pre-existing injury, so if limitations exist with mobility or segmental stability, the aim is to improve these dysfunctions via corrective exercises in sequence with coaching, training, and programming.
The corrective exercises consist of a series of flexibility and joint mobility exercises to improve range of motion. Corrective exercises should also involve a series of strength training exercises (Isometrics) to address segmental stability weaknesses within the kinetic chain. The sequence of these corrective exercise models (the mobility-stability continuum) will significantly influence improvement in the kinetic chain’s mobility and stability parameters, thus allowing for an increase in functional movements to occur.
When deducing a corrective exercise strategy for the athlete, ensuring there is no lack of mobility is the first order of business. The reason? You can NOT improve a motor control (stability) problem when restricted mobility is present because it reduces input and imparts disjointed sensory information into the athlete’s central nervous system (i.e., perception and interpretation of movement get skewed). Therefore, limited mobility is not an output problem; it’s an input problem. Until the athlete has a full range-of-motion (ROM) with a functional movement issue, we can NOT call it a dilemma with motor control because environmental perceptions get influenced.
If you see a poor movement pattern, don’t think in the context of “I have to add flexibility training.” Instead, identify what is causing the poor moment pattern, eliminate it, and add a corrective exercise that continues that pattern as active rest between working sets. For instance, an athlete’s squat form isn’t right, but you keep squatting anyway because the athlete needs to get stronger. Instead, manage the integrity of the movement, not the prize (i.e., big squat numbers) by avoiding squats and regressing the athlete down a standing, transitional or developmental movement progression (see below).
Refer to a baby progressing and the milestones they take that eventually lead them to be able to walk upright. They construct a sequence of movement patterns that allows them to improve from turning their head, rolling over, sitting up, crawling, standing, walking, running — all without a personal trainer or being able to communicate or comprehend instruction.
DEVELOPMENTAL MOVEMENT PROGRESSION
Supine Dead-bug → Glute-Ham Bridge → Prone Neck Nodding/Upward Dog → Elbow/Side Plank → Rolling → Quadruped Reach → Bear Crawl →
TRANSITIONAL MOVEMENT PROGRESSION
Tall Kneeling/In-line Chopping → Turkish Get Up
STANDING MOVEMENT PROGRESSION
Lunge → Deadlift → Squat
UPPER BODY MOVEMENT PROGRESSION
When an athlete can’t do a push-up, eliminate it! Instead, do a series of side and prone planks in combination with tall-kneeling and inline chopping. The athlete will eventually develop the reflexive core strength to do a push-up. Recognize the core doesn’t have to move; the athlete’s arms and feet have to act. It’s the same reciprocal action when we crawl, climb, or run.
SHOULDER MOVEMENT PROGRESSION
The rotator cuff holds the shoulder in the socket while you load it with traction or compression. Essentially, we are just asking the shoulder not to drop the weight. An excellent shoulder traction exercise is the farmers carry. Additionally, have the athlete pull or walk backward with a load (i.e., weighted sled drag).
The way our athletes’ train and the movements they perform should improve flexibility. Traditionally though, we add movement progression exercises to a training regimen as supplemental or auxiliary exercises (i.e., sit-ups, leg extensions, lateral shoulder raises). That’s not necessary and is a waste of time. Instead, eliminate that practice and add corrective exercises in that pattern as active recovery between sets. The benefits are the athlete works the pattern while movement integrity is maintained until the athlete gets above a minimum standard to advance UP the movement progression (i.e., lunge → deadlift → squat).
Tracing a mobility problem back to a segment in the kinetic-chain isn’t tricky; however, you can make a part have a greater range-of-motion and still NOT see a functional movement pattern emerge. The reason is the pattern requires motor control, timing, coordination of stabilizers, and prime movers. As a result, motor control problems are NOT part problems; they are pattern problems. The DWMA Screen repeats multiple patterns precisely for this very reason.
If we see a limitation in your DWMA Inchworm, Straight Leg Hip Hinge, and Downward Dog Heel Raise, and trace that back to ankle mobility on the right, then we have seen a consistent issue. And changing ankle mobility may help the athlete improve all three of those patterns. It is equally likely that we see an inconsistency. For instance, the DWMA Inchworm is not limited nor is the DWMA Straight Leg Hip Hinge, but the heel raise of the DWMA Downward Dog is limited. Directly attaching that movement pattern with hamstring mobility doesn’t make sense because all the mobility you needed to hip hinge and do the inchworm got demonstrated. There is something about the heel raise of the downward dog that makes the athlete have awkward alignment and not be able to go through a full range of motion.
In the above sample, limited thoracic spine (t-spine) mobility is the culprit which distorts the heel raise movement pattern due to lack of thoracic extension. Similarly, if this is a rotational athlete (i.e., baseball, tennis, volleyball), avoid doing any rotator cuff training until the athlete’s t-spine is clear; ac joint (acromioclavicular joint) is clear; sc joint (sternoclavicular joint) is clear; upper and lower neck (cervical) is clear. When the athlete has mobility restrictions in the t-spine, then the scapula (shoulder blade) can’t function the way it needs to because the rotator cuff has no anchor.
Recall when the input gets distorted, the output gets distorted. One of the biggest mistakes made when applying corrective exercise protocols is we create mobility and rush right into exercising a pattern without going through the steps to determine if the athlete has adequate motor control in the new range of motion. Instead, apply end range isometric holds in a bilateral comparison. Then go into postural integrity loads before we go into movement patterning loads.
For instance, let’s say we’ve globally screened a team of freshman basketball players and my objective assessment recognized they have limited mobility in the soleus (ankle). My objective examination verifies limited ankle mobility (soleus) limits the team’s ability to perform a back squat. Enacting the ‘Standing Movement Progression’ (Lunge → Deadlift → Squat) I objectively refine movement training from Back Squat to Barbell Reverse Lunge. Next, I incorporate corrective exercise (i.e., myofascial release, soleus stretch) as active rest between sets right up against each other and see if you can improve movement. Then stress it (i.e., end range isometric bodyweight squat) to see if it holds the correction or not. The benefits are the athlete works the pattern while movement integrity is maintained until the athlete gets above a minimum standard to advance UP the movement progression.
When a movement dysfunction issue is present, the primary focus is to dosage the athlete’s training stress with a corrective exercise strategy, so they move better before they leave the weight room than when they entered. If there is no dysfunction, keep the movement quality, re-check with the DWMA as part of your day’s dynamic warm-up, and now your challenging the athlete’s physical capacity.
Utilize these Six Mobility-Stability Continuum arrangements with coaching, training, and programming:
1. Avoid going from stability to movement before you clear mobility. When restricted mobility is present, it reduces input and imparts disjointed sensory information into the athlete’s central nervous system (i.e., a computer virus).
2. Don’t think about stability as a part problem; think of it as a pattern problem. The reason is the pattern requires motor control, timing, coordination of stabilizers, and prime movers.
3. Avoid putting strength in front of stability (motor control) and mobility. Physical capacity (strength) should never exceed the athlete’s ability to stabilize (motor control). If we go straight to physical capacity, we don’t know if the athlete is performing poorly because of limited movement (i.e., dysfunction) or insufficient physiology and performance (i.e., deficient).
4. To improve mobility, utilize self-myofascial release, and PNF stretching also called “active assistive patterning.”
5. Utilize end range and yielding isometrics in bilateral comparison to test the integrity of new ROM developed through relevant PNF applications.
6. Utilize RNT to restore dynamic stability and fine motor control when a dysfunctional pattern arises AND athlete gains mobility.
Let’s explore in greater detail the last three Mobility-Stability Continuum practices and their application in the subsequent chapters.