Sunday, August 1, 2010

Bendy bits should bend in full range of motion, speed and control, right? So what's this mobility/stability dichotomy?

Mobility/Stability. I confess i don't get what's meant or how this increasingly popular distinction between mobility and stability came to be seen as useful. I'm prepared to believe it's my problem, and sometimes as writing helps me work out such issues, forgive me while i lay out where the gaps seem to be in my understanding of the framing of movement as mobility/stability rather than simply a notion of movement, and ability to control ranges of motion at ranges of speed.

Here we go: Of late i've seen a number of intelligent people assert with what seems like good reasons that some joints are seemingly a priori meant to be "stable" while others are meant to be "mobile." Consider the fist article in this set kicked off by Mike Boyle,  a well respected and established trainer, called A Joint by Joint Approach to Training. In this pieces, and many related articles, work by Stuart McGill on the low back is cited: in particular, McGill's findings that flexion is the root of most low back evils, and that sitting is the worst place to be of all. This is pretty compelling stuff. Seems to make sense.

But then there are seeming contradictions within this: in his discussion of the knees, not the back, Boyle sites McGill's reason for low back pain that it isn't perhaps so *much* flexion, but overuse. When other stuff  - like the hips - get stuck, the back pays.  So in that sense - the lumbar spine and knees should be stable, but the hips should be mobile?

The problem i find in this is that the arguments seem to suggest that pretty much all the time the lower spine should be stiffened up and the thoracic spine and hips loosened up - for instance. Mike Boyle goes so far as to ask "is spinal rotation even a good idea" He quotes a lot of work by a physical therapist name of Shirely Sharman who in her view suggests that the abs are there to stop so much rotation of the lumbar spine then that's what they should be doing.  Boyle's issue seems to be that too many trainers concentrate on lumbar stretching when, citing Sharman "rotation is even dangerous" at the lower spine. He points to sprinter coach Bob Ross who did isometric work with his spinters in the abs, abandoning other forms of spinal movement work and how that was a positive thing for results.

Ok, but what do most sprinters do? Run. In pretty much straight lines. So maybe holding the spine in line and upright for 10-30secs is a good idea. In that case. That particular sport-specific constraint doesn't come up.

Rather, Boyle says he's chucked a lot of exercises designed to extend trunk range and seems to find less complaints of low back pain in clients since doing so. And that's cool. I'm not sure, however, that that means that that work  has made his client's backs more stable - it just may mean that stretching a body part beyond its comfortable range of motion is painful or causes neuroligical shut down by pushing inappropriately, and that stopping doing something that hurts will reduce pain?

In other words, i'm just not sure that eliminating a set of kind of questionable stretches is therefore "decreasing mobility" or "increasing stability" - it may just be avoiding inducing threat.

And as for rotational work, surely the lack of it is one of the greatest weakness of most of us who train especially or exclusively at lifting heavy things? We tend to stick to pretty a given plane of motion for a movement, and forget about diagonal and especially rotational movements.

Pavel Tsatsouline demonstrating the
Full Contact Twist in Bullet Proof Abs
One of the funest ab exercises is surely the russian twist (seated) or the Full Contact Twist with the bar stuck in the corner on the floor and the other end in the athlete's hands, arms extended, arc'ing back and forth?

Pavel Tsatsouline writes of the FCT in Bullet Proof Abs:
The best exercise for transferring the hip power into the shoulder, with a high interest yield, is the Full Contact Twist. This exercise was originally developed in the Soviet Union for shot put conditioning.
The then-nameless twist came to kickboxers' attention when a famous Russian shot putter failed to talk his way out of a mugging. This mild mannered man got annoyed when one of the attackers cut him with a blade. He ruptured the punk's spleen with a single punch.
Igor Sukhotsky, M.Sc., formerly a nationally ranked weightlifter and an eccentric sports scientist who took up full contact karate at the age of fort-five, popularized the twist among Russian fighters. This renaissance man noticed that the twist not only had increased his striking power, but also had toughened his midsection against blows by toning it up. Sukhotsky was so impressed with the Full Contact Twist, that he added it to his super abbreviated strength training
routine which consisted of only four exercises: squats, bench presses, deadlifts,
and good mornings.
It's interesting that Sukhotsky came to the value of rotation - moving across planes of motion - in moving from a more linear sport of weighlifting to the more richly plane-crossing Karate. It's also intriguing that it is a life event - a mugging - that fostered interest in this movement.

So for truly "functional" movement, isn't it better to train strength in rotation, as well as across a range of movement planes? In other words, why not focus on building strength across the entire range of motion of the joints so that we can be - as pavel puts it - bulletproof? And that bulletproofness seems to mean being able to rotate, bend and recover as needed - and as the joints give us the degrees of freedom to accomplish that movement?

The Kneee/ACL injury- not about stability or mobility? The ACL (and MCL) are the ligaments most often torn (or pop) in knee injuries. One might say that that's because the knees are not stable enough. Indeed, again Mike Boyle tends to make this case in his Joint by Joint article. But he also seems to move away from actually saying the knee needs stability by deeking out to say the problem is that the knees pay for lack of hip mobility. I'm not sure what the bottom line is here? He digresses into back pain rather than a discussion of the knee.

Gray Cook comes in to help in his Expanding on the Joint-by-Joint approach saying,
"The knee has a tendency toward sloppiness and therefore could benefit from greater amounts of stability and motor control. This tendency usually predates knee injuries and degeneration that actually make it become stiff."
He also states
Knees are simple hinge joints. They’re supposed to flex and extend, and when they rotate too much or move valgus or varus too much, we start seeing problems with the knee. Does the knee need to be mobile? Yes, but once it’s mobile, it needs to be stable enough to stay inside the proper plane of movement where its functional attributes are possible and practical.
Now Gray Cook is a knowledable phyiscal therapist who knows a lot about movement and how joints operate. He's also worked with a ton o' athletes and helped them restore function when others were ready to cut them open and write them off. So it's with respect that i wonder what's meant by 'mobility" with a "simple hinge joint"? What does a stable knee joint mean? That the femur stays attached to the tib/fib bones on the minisci? That it doesn't slide off to one side when it goes to bend? What?

I'm not making a joke here or being sarcastic. I'm really not sure what "the knees have a tendency towards slopiness" means in terms of real movement. All those ligaments are actually loose? Or does that mean one's leg muscles in say a squat aren't firing so the knee comes in (the Valgus knee). That's not really a knee issue though, is it? That's poor form such that the person hasn't been taught to work a better squat pattern, or hasn't worked on what may be inhibiting a good squat movement? And so they're putting strain on their knees by failing to keep good position. Too much load, and absolutely perhaps issues in the ankle and hip and upper back that need to be addressed.

But i'm not really thinking about such a static movement as the squat. Really I'm thinking of the mighty number of girls who have ACL injuries in sports in the states these days. One theory (gathering momentum) has it that the girls who have ACL injuries showing up in basketball don't have a way to balance their increasingly higher (as going through puberty) center of balance. Intriguingly, the comments from the researchers is not to increase strength training (for more core or knee stability) but to increase their prorioceptive (body awareness) training.

The suggestion is not unlike studies on sensory-motor balance training with athletes to see if progressive balance work could help reduce ankle injury - another common problem for field and track athletes. They found that, effectively, progressively training for the sprain through this program helped the nervous system not go into panic, and predicted injuries would be less.

To take a lessen from martial arts as well where one practices for the fall pretty regularly, how much attention is given to working with an athlete on end range of motion work - not just balance work but what might be loaded balance work at the place where we rarely go in our training - that end range where recovery from a sudden lapse or accident is hard and where injuries occur? Is that augmenting mobility, stability or does it matter? 

I go back to Boyle and Cook on the knees and back to their facesaying that these joints tend towards slopiness, and yet McGill (quoted by Boyle) saying no no, the low back in people with pain have stronger extensors than those without. So there's a lot of muscular strength around the low back already. The spine is *not* weak here (and by extension, one would say not sloppy if so much strength can be turned on?)

What's Going On? Where is this taking me? I'm hoping that Gray Cook's new book Movement will anser a lot of these queries. I'm looking forward to getting it, because right now the mobility/stability dialectic seems more problematic than helpful - at least to me. Here's why - and here's where i struggle with this as a model.

All the joints in the body have a pretty much well-scoped ranges of motion, right down to what the usual degres of movement are in each one. So why not simply be able to move all of these joints in these ranges of motion with strength and control as demanded by whatever that movement is - especially at the most vulnerable end ranges of motion?

Movement vs Mobility/Stability? Why not talk, therefore, just about "movement" (as Cook's book title suggests) rather than "mobility/stability." Is the question not really can one, for instance, hold a position for one particular movement or relax it for another? The knee needs not only to support the hinge with strength and power in say a basketball jump shot, but also needs to support the roll in with equal aplomb from standing to the ground - either when making a lunging tennis shot, or losing one's footing on a football pitch or simply getting pushed or in a fight getting from standing to knees to grapple quickly?

Perhaps there's an historical context i'm missing - Boyle talks alot about the "last decade" with too much stretching going on in the trunk and so life got too caught up on flexibility? Dunno, as i own i missed that part of the discussion not being in the space at that time. But maybe that's not it, either, as Paul Chek's Movement that Matters and his "primal patterns" seems to have been in play since at least 1999 (ie the last decade, plus), and that is likewise focused i think on movements?

Mobile when? Stable when? But again, i'm not claiming expertise of that period - it's a genuine question - it's just that i can't find the value add in framing our bodies as there's supposed to be stability here and mobility there, and if we get this thing more stable and that thing more mobile (implicit seems to be "all the time") then everything is Functional. Mobile when? Stable when? Are we talking averages? That on average of all possible movements, these joints are more often than not needing to be stable rather than mobile? And so we need to train for the average use case, rather than the range of uses?

Can you see why i'm a wee bit flustered? It's not a dichotomy that helps me when i'm working with clients to talk about stability or mobility because i guess i'm not sure what they really mean when put in operation. Our model reflects our practice, i guess, and i'm struggling with the mobility/flexibility as a model.

For me, mobility seems pretty good on it's own: mobility is the ability to voluntarily and actively control a given range of motion. For me, in my practice, it seems pretty important simply that we be able to control that movement through all ranges of motion, and all speeds, equally. If folks have restricted ankle mobility, not only does that potentially need to be opened up but strengthened as well. Strength and ROM seem to work together.

It then seems pretty important that if there's a gap somewhere we have the tools to be able to help find a way to address that weakness. And as Cook also notes, since the site of an issue is not necessarily  the source of the issue, the source of a weakness may be, as we've seen above, proprioceptive rather than musclo-skeletal, too. In other words, mobility and enhancing control of mobility seems sufficiently descriptive of the kinesthetic. And beyond this, if we do accept the site is not the source of an issue necessarily, it seems we need to take into account whatever other systems may be operating on us. From somato-sensory, to affect, to nutrition to, anything that plays on the 11 organ systems in our body.

For a bit of context, beyond the CSCS, RKC and Z-Health Certifications, i hold both the FMS qualification and the CK-FMS certification. One has to pass the FMS exam before getting to the CK-FMS quals. It's a fascinating course, and i'm looking forward to doing it again this fall because Gray Cook is teaching it with Brett Jones, and i'm sure two years after taking it initially, it will have evolved, and i certainly know a bit more than i did then, and Gray Cook has a lot of cool things to say. I am keen to learn more about this physiological piece. I confess anatomy is, to use Cook's phrasing again, the weaker link in my chain.

So i recognize i would benefit by being more au fait with kinesiology/physiology (hence more recent posts exploring things like the amazing shoulder, and kinesiology books used to assist practice with willing folk).

This article is not meant as a criticism of Boyle or Cook. I'm just saying, right now, i'm not grokking the mob/stab distinction. It seems to me both too extreme - these joints need to be mobile; these stable - and too unspecific - generally? specifically? Now maybe we're both saying the same things: have full range of motion and be strong in all ranges of motion and so be able to control all ranges of motion at all speeds. That would be cool. Then again, i'd say why not just say that? Since mob/stab can start to be heard as prescriptions: the thoracic spine MUST be mobile the lumbar spine MUST be stable.

I'm also saying that i agree with neurologists who talk about the somato-sensory system, and how that's just as improtant to be integrated into any discussion of movement, too.

So, as said, i'm perfectly prepared at this point to believe that the misapprehension is mine. That we are all on the same page. Just putting out there where i'm struggling. Perhaps some of y'all can relate, or have passed through this vale and come to a conclusion on the other side with more knowledge and insight. Look forward to meeting you there.



Unknown said...

I got a lot out of Mike Boyle's Strength Coach 3.

I've actually started doing a session a day that's based around his approach ...

1. massage (MFR) above and below each of the joints he suggests should be 'mobile'.

2. Do flexibility, mobility &/or activation work at said joints.

I'm into my second month (I usually try things for six months). So far so good. I can now do a2g overhead squats without 'tucking' my tail under and with great ROM in the shoulders. And I can now shin kick at head height without any 'lean back' (maintaining a reasonably vertical upper body).

(Incidentally, I've been following a modified GYM movement program for the first six months of the year ... and, despite focusing on 'the best ROM I can do at any given time for each exercise' and hoping for gradual improvement, I was unable to gain any significant ROM increases ... I got strength and conditioning improvements, just no ROM increases)

From my perspective, the whole mobility/stability approach seems to be an attempt to make complex issues a little easier for laymen (like myself) to understand ...

For example (using Boyle's joint-by-joint & compensation concepts) ... Most muay thai guys I know can shin kick to the head ... But many have poor mobility through the hips and compensate at either the 'joints' above or below (or both) and consequently they get knee or lower back injuries ...

So Boyle's given me a simplified way of understanding what's going on and a comprehensive way of fixing it.

So far so good, but I'm interested to see 'how much' of an improvement I can gain following his basic ideas.

Incidentally, I also train with an MMA dude who specializes in 'rubber guard' (a very 'bendy' style of BJJ made famous by Eddie Bravo). At any rate, I've shown him the basic approach and he's all ready made significant ROM gains through his hips ...

Interestingly, he's also had knee problems in the past ... I think it may have been caused by the continual compensation he had to use in order to get the locks and positions he needs for his style of grappling. It won't surprise me if his knee problems start to clear up. But, once again, we'll wait and see what happens :)

At any rate, I'll let you know how things turn out after six months if you like.

Cheers :)


dr. m.c. said...

Jura baby,
that is super that you took the time to write about all your experiences here. It's awesome you've found something that connects with you and got you spending quality time on some of your bendy bits.

1) really cool and dandy. which joints? ankles, hips, thoracic and anything else?

2) ROM is about so many things from strength to arthrokinetic reflex effect, to proprioceptive signaling to all wrapped up in threat modulation that sure some stuff will help because it gets at what we need and some stuff just won't. why i like assessments as that can help zero in a lot faster on what an individual needs to get going.

3) great that you've been able to help other athletes with the work some bendy stuff approach. makes total sense. if we all did that, folks would perform better to some level of better immediately

no doubt that if your colleague's hips and ankles and upper back are moving better that takes the pressure off the knees. If something somewhere is not functioning right, something else pays.

so none of these improvements for you or your folks are surprising if what you're saying is that you and the folks you work with are doing movement drills at least at key joints that should move and don't.

5) it's great that boyle's approach works for you. My sense is that we need to try to test and refine our models all the time. So isn't

simpler than Boyle's explanation but less intriguing is - joints are designed to move; but our bodies are plastic: what we don't move that is supposed to move starts to fail. and when it fails there are costs elsewhere in the body. if hips don't move, knees or low back can pay; if ankles/feet don't move, muscles can go all tight. SO moving joints through their ROM daily is a good thing to do."

nothing about stiff needs to be mobile; mobile needs to be stuff. it's just joints are designed to move; be sure to move them.

and if you don't have time or desire to do all joints, at least get the classically stiff-in-the-west ones going: feet, ankles, hips, thoracics and you'll feel and move better in no time.

seems that's kinda what you're doing?

6) so this is about getting stuff that should move to move, is it not? and learning to work with that? that makes sense to me.

it's great that you like to test stuf out too. It would be cool if at some point you considered adding in mobility work for all the other joints too. Feel even better-er - even for the knees.

Lots of folks i know who - some who are football players working on their kick, others just wanting to feel better, when asked to do a closed chain knee circle to work that simple hinge joint that actually supports lateral/medial tilting as well to allow rotation, get stuck at different points. They lose the smooth circle of the ROM there. Get that going they move so much more beautifully. Or they get headaches or stiff shoulders. Turns out there's poor control or stiffness in what seems a very bendy area already - the neck.

i guess i'm saying working all the bendy bits has huge benefits but the Top Four is an excellent place to start, to be sure.


also, it's great to have so many ways of getting out that movement is important.

Boyle's model has reached you and is making a positive difference. That's great.

And again, thanks for taking the time to share, kiddo. much obliged.


Joe Berne said...

I feel a bit presumptuous speaking for Boyle and Cook, but I think that the thrust of Boyle's mobility/stability contrast is that he's pointing out tendencies that sometimes contradict many strength coach's assumptions. If you see a player with knee pain, it's often a lack of mobility at the hip or ankle, not a problem at the knee itself.

Don't forget that he's usually training 10-20 athletes - an entire team - at the same time, so they don't all get individual assessments and treatment the way a z-health client would. A lot of his writing is aimed at an audience of coaches working in the same situation. So he's telling the football and hockey coaches of the world that they need to focus on mobility at the hip and ankle and stability at the knee and lumbar areas when designing programs and warmups for the teams as a whole, because on average that's going to be where their athletes' needs are. I've heard Cook say in podcast interviews that individual athletes can have different needs, that he's seen clients with hips that aren't stable enough, for example.

As far as rotation of the lumbar spine goes, I think Boyle's point is that the focus of an athlete's program should be on anti-rotational exercises where the lumbar spine isn't loaded at the ends of its range of motion. Think of that exercise where you do a situp with dumbells in your hands and throw punches at the top across your body - lots of spine rotation. Contrast that with heavy medicine ball throws where the back is kept braced - you're working your anti-rotational muscles but the spine isn't (or shouldn't be) actually moving all that much. I know my back feels better when I use those exercises - training the core to resist/transfer force and not so much to create movement - but, you know, n=1.

btw I love your blog :)

Steven Rice Fitness said...

A wee bit of opinion is that the stability exercises actually do involve movement, just not much. Perhaps anti-rotation should be called "very little rotation"

Recall that the muscle will be weakest at full extension, also that strength is built beyond the range worked in an exercise, my very fuzzy memory says 30%. Finally my fuzzy memory also says lumbar rotation is only about 5 deg. Put these together and holding the midsection immobile while transferring a lot of force through it does look like safe, full range of motion strength training.

Steven Rice Fitness said...

I should have written "trying to hold the midsection immobile"

dr. m.c. said...

Joe, thanks for dropping by and for the thoughts, Steven really like "with very little rotation" as opposed to anti-rotation.

i think this must be my own model/bias shaping up to say there's ROM; movement seems to be about the way we can control that ROM, but to control it we have to have it.

Based on a neural/threat modulation perspective, ROM and strength go together. ROM opens up the safer the body feels to perform. Sometimes that's building strength to enable better movement. sometimes it's just practicing the ROM in related joints.

just riffing. thanks guys.


dr. m.c. said...

This comment emailed from Jen to post

"I've read Boyle's article, but I don't think I've read the Cook items you reference. I agree with Kira that I suspect it may be a way to try to simplify things for laypeople.

I just keep going back to "if it wasn't meant to move, it would be a bone." You are right, the joints have well-established ranges of motion. I think everything else from there is a way to put it in to context for a specific group.

Unknown said...

Thanks fora very stimulating article - lots to think about.

However,Gray Cooks' comment does worry me somewhat. If he truly believes that the knee joint, (probably the 2nd most complex joint in the body after the shoulder), is a "simple hinge", I'm not sure that I can trust his understandsing of the incredibly complex compound motion of this joint.

Unknown said...

"which joints? ankles, hips, thoracic and anything else"



Yes. The 'take home' messages I got from Strength Coach 3 was this ...

1. Improve tissue 'quality'.

2. Develop optimal ROM for each joint, which may involve increasing ('mobility') and decreasing ROM ('stability').

3. Improve movement patterns (by taking advantage of improved ROM).


I have tried 'intu-flow' by Scott Sonnon for six months. I got a lot of improvement in ROM in the elbows, wrists & ankles. Less so through the hips and shoulders. I still do some of the exercises when I think I need them.

I am considering trying some z-health stuff in the future.

Incidentally, one thing I have found (which I didn't expect) involves foam rolling/MFR ...

In the past I've done MFR (six months) and got some modest improvements.

Boyle suggests MFR is a waste of time UNLESS you do flexibility work along with it (and vice versa).

And, so far, I've had much better improvement by doing both together i.e. I massage above and below a joint AND then stretch (and do activation exercises if needed).

Gotta go.


Kira :)

dr. m.c. said...

thanks kira.
i'm not sure what "tissue quality" is or how that's assessed?

i hope at some point you'll try another combo, kira: just the mobility work and drop the stretching and the foam roller. Foam rollers are an awfully big hammer for what may be optimal. Likewise stretching.

If we were working together, i'd be doing a lot of testing with you in the context of your practice to check on the right combo for you right in that session, and you'd learn how to do likewise. My sense in working with folks is that the roll and stretch are often above and beyond what's optimal.


yes i found that kinda funny myself.
i confess i'm not aware of too many "simple hinges" that not only flex and extend but also slide and rotate.

there's an expression attributed to einstein something to the effect of make things simple but not too simple.

all the best folks, and thanks very much for the thoughtfulness of your comments.



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