Movement Checklist for Dysfunctions

This a a guest post by Dean Somerset.

If someone comes into me for training and they say they want to get stronger, but have no issues with previous injuries, trauma, or whatever, I could screen them and come up with all types of numbers, then design corrective strategies as to how to fix problems they weren’t aware of, but in most instances, those won’t translate well into getting stronger unless we address a couple of key components behind them.

For instance, let’s say we assess someone’s ability to squat, and it winds up looking like a rusty hinge. The person is in their early thirties, with no history of trauma, so degenerative changes and osteoarthritis shouldn’t be a limiting factor, so what gives? Should we load it up and see whether more weight helps clear it up? That’s an option that typically (about 99% of the time, anyway) produces terrible adaptations.

Ironmen

Now let’s say we screen them and then set up in a corrective sequence based on what we think is going on, spend 10 weeks working on it, then re-test and see…the exact same squat pattern. did the person get stronger?

Absolutely. If you give them stressors that they have to adapt to, they’re going to adapt and get stronger. However, if the issue being corrected wasn’t the main affect against the individual doing a squat pattern, it won’t help.

Simply put, corrective exercises should correct something. The aspect that should be corrected should be something that gets measurable improvements in a relatively short period of time.

Now let’s say you get someone who doesn’t respond to a corrective exercise in any noticeable manner. What gives? Is the exercise broken? Are you doing it wrong? Maybe, but most likely, it’s not the right approach for that individual, and the reason they’re seeing some form of restriction is probably found elsewhere.

Today I wanted to break down a simple check list I use to determine the causative factors behind any movement restriction, and then show some ways to make them better.

#1: Structural Restrictions

We always assume everyone has the same bones and joints, muscles and attachment points, and lever lengths when it comes to exercise. We know this isn’t true, but it doesn’t stop us all from making the same assumptions. If it were the case, we wouldn’t have centres in basketball, and the Mountain would only be 5’10” and 200 lbs, not a 6’9″ 420 pound half-dead monster from Iceland.

basketball

The femur as it inserts into the hip joint can have a couple of different variations. The first is in the vertical angle of the femoral neck. The three major positions can provide a massive variation from one end of the spectrum to the other. The second aspect is the anterior-posterior variation of the femur. The third aspect to look at is the positioning of the acetabulum and whether it sits more anterior, posterior, or vertical. There’s 27 potential combinations of femur and acetabular alignments, which means there’s potentially 27 different “optimal” positions for people to find their best squat pattern, or that could resist performing a squat.

bones

When two bones get close to each other, they compress any kind of tissues that can be in between them. Try this out: Make two fists and press them together as far as possible. You’re only going to be able to press into contact so far before either physically you can’t do it any more or pain prevents further movement from happening. If you want to go further, you’re going to damage something. For the squat, the bones of the femoral neck and the ridge of the acetabulum come closer together, and eventually, they can’t get any further without creating bone to bone contact, and further movement in that position will either cause pain or other problems.

The ankle is very similar. If you were to go into the operating room and get a dose of anaesthesia from a qualified health professional (not some back alley salesman with a gold tooth and a shifty glare), your ankle will most likely flop around like a dead fish. If you have a history of ankle injuries or some form of degenerative change, your ankle will be pretty stiff. I’ve rolled my right ankle more times than I can count (I run out of fingers after 10 and then counting gets dodgy), so my mobility, specifically through dorsiflexion and internal rotation is minimal.

The end result of all this is to say, is there something anatomically that’s holding you back, or that you need to adjust?

From a structural perspective, if they have more than enough range of motion through passive means like these, the realistic conclusion could be that they have the structural ability to get through the movement. If these passive movements are restricted, they could have structural issues, or potentially soft tissue issues, guarding tension, or other problems keeping them from doing the movement.

Essentially…

Passive mobility is the available range of motion that you could theoretically use actively.

If you can get your knee to your chest and dorsiflex your ankle, all while having your hamstrings touch your calves, that’s a squat range of motion. Another way to view this is through a simple rock back with the ankles in dorsiflexion. This is essentially a horizontal squat. If they can do that, the structure and soft tissue aren’t restricted enough to prevent the squat from happening vertically.

Now if this issue is related to structural alterations or possible degeneration or dysfunction, you’re stuck between a literal rock and a hard place. You can’t stretch out bone to bone contact. You can’t foam roll joint space narrowing. You can’t use manual therapy or acupuncture to release arthritis. You can use all of those modalities for other things, but if the structure is the limiting factor, the only thing that will fix that is surgery to alter the bone shape and alignment. That’s what happens with joint replacements. The only way someone with severe osteoarthritis will regain their range of motion in their locked up knee will be to get a bionic new one made of titanium and kevlar, maybe even some adamantium with optional sunroofs.

knee-brace

If someone can’t get to a full depth squat due to structural limitations, that’s fine. We can use what they have available to use as best as possible. Box squats, assisted squats, and working towards their tolerance is still applicable, but they won’t be able to get to what would be considered “optimal” because their joints don’t let them get there.

Occasionally this can be adjusted by simply altering the set up, or the foot positioning. Some people get much better results from taking a wider stance, some by turning their toes out, and some others by simply altering whether they press through their heels or toes. For me, I can usually have better depth with a wider toe out positioning, but I can still do it with my heels relatively close. When my knees come in, my heels have to go out a little wider.

Changing position just changes how the bones come together, giving some additional range of motion or limiting it further, so playing with positioning you can see some significant alterations in whether you can hit depth or not. If you play with positioning and suddenly find a new range of motion, cool. That’s your new position. Use it, and get after it. If changing positioning doesn’t alter your ability to squat, and you have restricted passive mobility, it could be a structural issue. It could be a soft tissue issue. It could be a guarding issue. Right now, we just know it’s restricted. Let’s look further.

#2. Soft Tissue Restrictions

Foam rolling has been shown to help improve range of motion in both clinical and research settings when applied appropriately. I’ve had people do a standing toe touch, get to their knees, roll out their feet and re-test the toe touch and all of a sudden hit the floor with both palms. Similarly, I’ve had clients who couldn’t squat roll out their adductors, swear bloody hell and make some interesting faces, then squat to the floor without restriction. The re-test validates the application.

Soft tissue work through foam rolling or other self-myofascial release, manual therapy like ART, or massage, as well as tool-assisted mechanisms like Graston, acupuncture, or other forms of medieval torture can provide some significant increases in available range of motion, most likely through an alteration in resting neural tone and decreasing guarding tension through the region. If the body is saying “HANG ON!!!” that tissue will stay tight. Moving into tight muscles and other tissues will present some restriction, and it will take some effort to push through, much like trying to push water up hill.

This tension is a good thing when lifting heavier loads, as it prevents you from dropping through to the bottom of your movement and decreasing your power output, as well as preventing you from getting into an end-range of motion where you may not be used to existing, and therefor reducing your likelihood of getting pain from some sort of injury. It’s a necessary adaptation, but typically means you have some weakness at the end range of motion, and that you’re trying to not get there.

Reducing the neural tension driving the muscles to be tight is a good idea before you train a range of motion, but it should be used when you’re looking to train a range of motion, not when you’re just simply going back to work. I’ve worked with a couple of really skilled manual therapists and scheduled training sessions immediately following their treatments, so as soon as they have that new range of motion we could get them into the gym and train their new mobility, while also reinforcing stabilization through the system. It seems to work well.

So if you’re looking to use soft tissue alterations in your assessment, here’s what you do. Check passive range of motion. Check their movement quality and depth. Do soft tissue work, either through manual therapy if you’re a manual therapist or through foam rolling on some areas like the adductors, glutes, IT bands, and calves, then re-test both passive and active patterns. If you see a remarkable difference, cool. The person needs to do soft tissue work before each workout. Odds are 3-8 minutes of rolling on those key areas will show some significant improvements, so make sure you’re keeping a couple minutes of rolling in their warm ups. If they don;t see a difference, cool. That just means we need to look elsewhere.

#3: Stability

This is a pretty easy one to check and can give you some pretty immediate feedback as to how to proceed. Let’s say someone tries to do a squat free without any support or weight and they wind up barely breaking their knees and quarter squat the hell out of themselves, thinking they’re doing something good. They’d barely be able to sit onto a bar stool, let alone a dining room chair. Let’s say you give them something to hang on to and all of a sudden they drop it like it’s hot with next to no effort.

mens-health

Going from a 2 point base of support to a 4 point supportive system can help to reduce the amount of force through the legs, which is beneficial if the person isn’t strong through that range of motion, and also help them to balance to find their groove easier than with a smaller base with only two points of contact. Much of it can be psychological, with some people finding new depth with only finger tip pressure on a supportive structure. You’re willing to try something new and difficult if you have a safety net, so providing something to hang on to is a massive benefit.

Another way to check this is to give the person a dumbbell to hold in front of them in a goblet position. This moves more weight in front of their centre of gravity, giving them more leeway to sit back into the movement and find a better point of balance than if they didn’t have it. This is especially valuable for those who feel they have to stretch their arms and shoulders out in front of them like they’re reaching for the last burrito on earth.

The funny thing about stability is that the person could have all the mobility, structural accommodations, and strength through the full range of motion, but if they always feel like they’re going to fall over, they won’t ever get to depth. Finding the sense of balance and centration to the movement can be a massive impediment to getting into the movement, and typically can just take altering their centre of mass or through simple practice.

#4: Movement Competency

When people approach any movement, if it’s something they’ve never done before or where they sense a potential danger like falling over, they will automatically tense up more than optimally to do the movement in a guarding or bracing manner. This helps to keep them from being injured while experiencing the movement for the first time, or while going through a new range of motion where they aren’t familiar, but it doesn’t help them to explore the full extent of the movement.

This is all to say that if it’s the first time someone is doing a movement, especially if they think there’s a pass or fail criteria while being observed by a relative stranger, they won’t perform all that well. The novelty of the movement and fear of failure will be too high, so their performance won’t be unrestricted. Sure, they could have all the mobility and strength to do it, but the pattern isn’t there yet.

When we’re young, our body starts laying down motor engrams in our brain that we can call up automatically as we do different things. Think about the kids who grew up in gymnastics and can still do funky things when they’re 30 like front levers and splits. Then look at the kids who were in swimming or badminton and can go for ever without getting tired, but who can’t even hope to get into the same positions without falling on their faces. Then look at the kids who played football and hockey and try to help them count past 5.

concussion

Most kids in western society don’t spend that much time in a squat position through school, recreation or anything for that matter. As a result, the adults lose the ability to squat at an early age and it becomes increasingly difficult to get it back as they age. If someone is 50 and the last time their calves felt their hamstrings was 40 years ago, odds are they will have some difficulty today getting into a full deep squat while breathing normally and not falling on their butt.

Competency for the movement comes down to how comfortable they are with the position and movement to get into that position. It usually is dictated by a lack of pain, the structure to get there, and the ability to maintain balance without freaking out about it. Also, are they breathing deep and slow or are they looking like they’re about to black out at any moment? Are they holding their breath and really straining to get it in and out? Probably not a good sign.

This is all to say that if you’re used to a movement, you’ll do better than if you’re not used to it. For novices, they’re almost always going to suck, and the more advanced the test the harder it will be to succeed. I don’t use an overhead squat assessment for many people for this very reason: the barrier to success is too high for most of my clients.

Sure, I could still use it on everyone, but the end result is I would have to regress each test to find the limiting factors, so I just start with a regressed version which is a body weight squat, and then peel it back from there as needed. If they can hit a bang on perfect body weight squat for depth, sure, I’ll get them to try an overhead version, but if they can’t do a simple bodyweight squat, they definitely won’t be able to do a more advanced overhead squat. That’s like Little Timmy failing on his arithmetic because he can’t figure out why 4 x 5 equals 20, but then asking him to do calculus.

#5: Mobility-Stability Mismatch

Let’s say you have a weak core, or at the very least it’s not “awake” in that it isn’t feeling too strong, reactive or snappy. As a result, your hips wind up getting a little bit more stiff and tight, and they try to create some tension through the fascial networks that envelope the spine. You could try to squat, but the end result won’t be too great. You stretch, roll, and mobilize, but the hips just won’t give.

Maybe try working on some core reactivity to get the hips to loosen up.
If the core muscles become a little more charged up, the hips won’t have to tense up to donate stability to the spine, and they’ll reflexively relax on their own, allowing that range of motion to occur without issue. No stretching, rolling or mobilization required.

I wrote about how core reactivity can impact hip mobility HERE, so check it out to see what I’m talking about.

So here’s how you can determine if it’s a mobility-stability mismatch:

1. Have the person squat and observe it’s overall poopiness
2. Have the person either front plank or side plank
3. Re-test to see if it improved their squat
4. Fist pump for your success.

If you noticed an immediate improvement in their squat, you have a potential answer, and something you should work into their programming on a regular basis.

So that’s the simple 5-point check list I use to determine the underlying causes of any movement restriction. You can use it for pretty much any movement in the body, and just have to follow the steps. Here it is in a fancy graphic format.

potential-cause

This is a very oversimplified overview of the process of assessing movement, but it’s distilled down to the bare essentials. You can add more if you like, or just stick with this. If you have something that works better for you, give ‘er. This is what I have found to be able to apply to a lot of the people walking through the door without some obvious trauma or pathology, and seems to hold up well across the age spectrum. It goes out the window when the person has had something like a traumatic musculoskeletal injury, sarcoma, or other odd event that makes the body not follow the same rules.

It works for most, but not for all. It still offers a good framework for a lot of people though. Hopefully you enjoy it.

Complete

Dean and Tony Gentilcore are coming to Vigor Ground Performance April 9-10 to present “Complete Shoulder & Hip.” Dean just showed what he knows with the hip, and this is just a simple blog post, so imagine spending a full day going through everything from assessments to corrective options and strength training for the hip. Tony Gentilcore is a co-founder of Cressey Sport Performance, one of the premier baseball training facilities in the world, and has helped hundreds of high school, collegiate and professional baseball players keep their shoulders strong and healthy through the very challenging demands of the sport.

This is a great chance to learn from 2 of the best in the industry about what they do best. The early bird pricing for the workshop is still on until Sunday evening at midnight, so get on it to save $100 on registration and earn continuing education credits as well.

FINAL NOTE

hm_seaparator
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