Mobility, stability, inhibition and
compensation. These seem to be the biggest buzz words in the
fitness/strength/healthcare professions at the moment, with guru like figures
regularly feeding us tit bits of information that tantalize us into purchasing
tickets to seminars hoping to acquire other worldly knowledge of the nervous
system and human movement. We are all, including myself, suckered into this
trap looking for a "magic pill" to help us "unlock the power of
the nervous system" or become a "supple leopard" or some manor
of other beast.
This stuff interests us, it also sells
well; Personal trainers are more and more commonly giving out mobility
prescriptions as part of their packages, we are rolling around on foam rollers
and digging lacrosse balls into what we assume are trigger points. I hope to
clear up some of this recent confusion as well as challenging some of these
dangerous, naive viewpoints that seem to be taking hold in people that should
know better.
I'm going to try to convince you that 90%
of this is marketing sensualism and in reality most topics are pretty simple to
understand when you apply some basic biomechanical logic.
The biceps flex the elbow. The triceps
extend the elbow. The infraspinatus externally rotates the humerous. All of
these statements are irrefutably true, and you will be taught every single one
of these in any biological science and you probably always will be, but let me
challenge this for you.
Mr Richardson comes into my office, he has
a rotator cuff tendonosis which he has had for months. We find that the
external rotators have switched off, what do we do ? Prescribe 3x10 external
rotations with a theraband, for the end of time, or until the pain fades and
you stop being bothered. So what has been accomplished here? All we can hoped
to have done is increase the body’s ability to perform an external rotation
with a theraband, this follows the famous SAID principal (specific adaptations
to imposed demands). We have not changed the speed of contraction, the global
stabilization, the mobility in the thoracic spine or the stabilization in the
transverse abdominis.
We have in effect done nothing to prevent
his problem from reoccurring; he may as well have taken ibuprofen and waited.
"The biggest predictor of injury is
previous injury"
Someone is messing up here? We have
chiropractors, osteopaths, strength and conditioning coaches, physiotherapists,
and rehabilitation specialists. We have a new buzz word every couple of years,
core strength, functional fitness, dynamic stability. Nothing is working,
people are still getting injured over and over again, patients once out of pain
are discharged and sent back to the gym, only to represent weeks/months later.
So what are we missing?
Pain is the last thing to appear and the
first thing to disappear, dysfunction is deviation from the ideal ROM/a lack of
stability and far more pertinent to us as athletes. Mike Boyle and Gray cook
have created a joint by joint approach to mobility and stability that clears up
many issues for us as powerlifters/athletes.
I'll stick to the upper body as that was
the example used earlier
Lumbar spine - stable
Thoracic spine- mobile
Scapulae - stabile
Glenohumeral - mobile
Elbow - stable
Wrist- mobile
Makes sense right? So let's apply this to
Andrew and his rotator cuff - Andrews thoracic spine is stiff, which throws off
the stability in the scapula allowing his shoulders to round which locks up his
Glenohumeral joint ramming his supraspinatus tendon into his acromioclavicular
arch. Now when we apply those theraband external rotations we can see they are
doing pretty much nothing at all to solve the patient’s problems on a larger
scale. Until the thoracic spine starts to move the scapulae will always try to
compensate for it by moving in excessive and unnecessary ways never giving the
Glenohumeral joint a chance to do its job.
So once I've treated Andrew I would
endeavor to check that he has sufficient motion/stability patterns before
discharging him back to his sporting activity, this way I know I've done the
best job possible with regards to banishing the injury long term.
This concept is fantastically elaborated on
my Gray cook in "movement". Gray has developed a functional movement
screen which encompasses some basic movements, including a lunge, squat, hurdle
step, straight leg raise, and shoulder mobility, alongside a few others. These
patterns are observed and given a quantitate score reflecting the quality of
the movement.
The author is quick to establish that this
is not about spotting a "tight psoas" when viewing a lack of
unilateral hip extension while lunging. This would of cause be our first
thought, we may even go as far as diagnosing an "inhibited" glute,
which to our clients sounds very technical and leads us onto a nice easy
corrective prescription of glute bridges. However the unilateral lack of hip
extension wasn't picked up on in any other movements, why? Because the glute is
not inhibited and would probably test strong if we were to isolate hip
extension, so why the poor patterning in the lunge? The issue is normally an
asymmetry in the perceived neuromuscular stability while in a split stance,
most likely causing the body to clamp down by locking up the psoas. Less easy
to say and less easy to prescribe correctives for!
Finally with regard to powerlifting
specifically I'll hit a few FAQ’s. Let's start with the most common pain -
elbow pain. You should all know that if you load your wrist in extension you’re
going to explode your flexors... So I'll skip over that. "Low bar squat
position gives me bad elbow pain" "take your hands out further
then" or sort the issue out and keep that desired upper back tension. So
elbow pain: First we try to smash the it apart with balls, massage, ice,
anti-inflammatories and general broscience, but it's not worked and you’re
still getting pain. You buy a copy of ‘Becoming a Supple Leopard’, you read it
cover to cover, genius it's my subscapularis, aggressive stretching of your
internal rotators commences increasing the mobility at the Glenohumeral joint…
great; but again it comes back. Until we chase all the way up the kinetic
chain, right into the thoracic spines mobility problem, or occasionally as far
down as the lumbar spine’s stability then we will never sort this elbow pain
out.
As you can see applying our basic
biomechanical principals that are frequently neglected in healthcare/personal
training can yield amazing results.
Information contained within this entry was
taken from Gray cook’s movement, Mike Boyle and Evan Osar’s corrective exercise
for the hip and shoulder.
Disclaimer: I have never treated Andrew for
a rotator cuff issue!
Written by Dr Luke Thomas Neal MChiro
Chiropractor at North Down Chiropractic Clinic, Bangor . Luke frequently treats a number of
local elite level power lifters in his clinic as well as members of the general
public.
Luke's clinic: http://www.northdownchiro.co.uk/
I hope you all enjoyed reading this article. There will be more guest articles from now on and especially from Luke. I personally believe it is good to expand your own viewpoints and interpretations of a topic through learning off other fields of work such as Chiropractor's, Physiotherapists etc.
Thank you Luke for an enjoyable read
Andrew Richardson, Founder of Strength is Never a Weakness Blog
I have a BSc (Hons) in Applied Sport Science and a Merit in my MSc in Sport and Exercise Science and I passed my PGCE at Teesside University.
Now I will be commencing my PhD into "Investigating Sedentary Lifestyles of the Tees Valley" this October 2019.
I am employed by Teesside University Sport and WellBeing Department as a PT/Fitness Instructor.
My long term goal is to become a Sport Science and/or Sport and Exercise Lecturer. I am also keen to contribute to academia via continued research in a quest for new knowledge.
My most recent publications:
My passion is for Sport Science which has led to additional interests incorporating Sports Psychology, Body Dysmorphia, AAS, Doping and Strength and Conditioning.
Within these respective fields, I have a passion for Strength Training, Fitness Testing, Periodisation and Tapering.
I write for numerous websites across the UK and Ireland including my own blog Strength is Never a Weakness.
I had my own business for providing training plans for teams and athletes.
I was one of the Irish National Coaches for Powerlifting, and have attained two 3rd places at the first World University Championships,
in Belarus in July 2016.Feel free to email me or call me as I am always looking for the next challenge.
Contact details below;
Facebook: Andrew Richardson (search for)
Facebook Page: @StrengthisNeveraWeakness
Twitter: @arichie17
Instagram: @arichiepowerlifting
Snapchat: @andypowerlifter
Email: a.s.richardson@tees.ac.uk
Linkedin: https://www.linkedin.com/in/andrew-richardson-b0039278
Research Gate: https://www.researchgate.net/profile/Andrew_Richardson7