To folks in the who have met me, it should come as no surprise whatsoever that I consider myself to be quite the nerd in regards to human movement, performance, and rehabilitation.
Similar, yet different.
Recently, myself and a colleague were discussing the various strategies we use to get our athletes and patients out of pain and moving/performing more effectively. By the end of this discussion, we had come to an illuminating realization. Nearly everything that we do for our athletes and patients can be categorized into two domains; improving variability and improving capacity. If this seems a touch esoteric, bear with me.
Hopefully not that esoteric.
Injury and pain are simply the result of too much stress being applied on a certain area of the body. Discs bulge, labrums shred, and ACLs tear when they’re asked to do more than their structure allows for. This can happen acutely (car accident, football tackle, mauled by a grizzly) or chronically (overuse during running, a lifetime of lifting hay bales, an afternoon of picking up squirmy grandchildren). What can we do to prevent or treat these injuries? Well, one option would be to improve an individual's movement variability; the number of different positions (at all joints) that a person can utilize. By improving this, we’d hope to take stress off of previously injured or irritated structures so that other tissues can better “share the load” during activity. When the hips and mid back can move freely during a deadlift, that troublesome low back disc won’t be as prone to herniating because it isn’t being exposed to loads it can’t handle. Another option to treat or prevent injuries would be to improve a person’s capacity; the ability to load a single position or pattern repetitively before something bad (injury) happens. When an athlete has sufficient strength in her hip and legs muscles to control leg position, her ACL won’t be as likely to tear because it isn’t being stretched to the max with every take off and landing.
As a younger practitioner, I likely would have given the terms “flexibility” or “mobility” to what I am now describing as variability. Deficits in the ability to get one (or both) arms overhead, rotate the trunk freely in both directions, and touch one’s toes- just to name a few- are indicative of deficits in movement variability. For fellow movement nerds out there, limited unilateral or bilateral hip internal rotation is also a dead giveaway that systematic movement variability likely needs to be restored. Tight muscles, restricted joints, and faulty breathing strategies can all contribute to these deficits (and are all effectively improved via physical therapy). Therefore, rehabilitative activities to restore variability typically center around muscle relaxation and deep breathing, while emphasizing certain joint positions.
"That's right, exhale all your pain into this balloon"
Restoring variability might also mean manual techniques such as joint mobilization, spinal manipulation, or dry needling. Once the ability to elongate certain muscles or move certain joints differently has been restored, we can teach a person to use their newfound ranges of motion in a variety of different functional movements- squatting, lunging, pushing, pulling, walking, running, karate in the garage, etc…
Did we just become best friends?
Long ago, I would have given the terms “strength” or “endurance” to what I’m now calling capacity. Assuming you have the required movement variability/flexibility/mobility to obtain the positions you need to, do we have enough capacity of the muscular, aerobic, and cardiovascular systems to do “work” without breaking down and relying on the ligamentous or skeletal systems for stability? Are we baseline aerobically fit enough that we don’t have to use our necks and backs to “pull” extra air into our lungs during a walk around the block? Are our hip and thigh muscles strong enough to let us use our legs, and not our backs, to pull a load off the ground? Can the muscles of our trunk create enough “stiffness” to let us effectively transfer force from our legs to our arms when delivering a fastball? All of these are questions of capacity. We improve this quality via well-designed, well-coached, and well-executed strength and conditioning activities that look far more like classic “exercise”.
Like this, but in color.
In treating and preventing injury we must seek to optimize capacity- improving a person’s aerobic fitness and muscular strength to such a degree that they can espouse consistently high movement quality, be it on the final repetition of a workout or the last hour of a grueling work day.
What are some of your strategies for improving your ability to move in varied ways? What are some of your favorite ways to build capacity? Are you having trouble moving the needle in a positive direction with one or both? Comment below or contact me directly.
Dr. Tim