A big issue we see in the health and fitness industry is the assumption that tight muscles always need to be stretched and that tissue stretched or mobilised in one position will correlate with active ranges during movement.
The problem with this idea is that it is purely a mechanical model of thinking and does so without consideration for how the central nervous system controls the structures of the body.
The following study looked at how simple hip mobility drills didn't transfer into functional mobility. http://www.ncbi.nlm.nih.gov/pubmed/23591949%20
The simple matter is if the CNS doesn't feel it has the capability to utilize a range of motion efficiently, it won't allow the body to do so to reduce the risk of perceived injury.
If there is an actual limitation in range of motion that is negatively effecting and individuals ability to perform a functional task then any mobility work should be performed in a way that is...
If not here is a picture that explains why you should. The hip is a ball in socket joint meaning it has incredible access to 3-dimensional movement particularly in dynamic tasks.
For many of our patients and clients however, the actions that they perform in their daily lives and in the workplace are fairly limited and with little variability. The result is a hip complex that lacks the competency for 3-dimensional movement demands. Some of the side effects of this are over use of the same movement patterning of acute injury when the demands of a movement task requires us to use something we aren't well trained in.
At the Movement Assessment Technologies we often use lunge variations to stimulate and stress the hip complex in all three planes of motion. Variations of foot position, arm reaches, different surfaces etc all create different sequences of muscular recruitment to promote competency in many movement variations.
Ever think about how what we do as health care professionals actually work when treating someone who's in pain? Here's our attempt at making a flow chart of some of the processes that can effect whether or not pain as an output can be modulated.
From this chart we can see how hands on techniques such as soft tissue massage, HVLA or even dry needling can have it's place in a neurological frame work by providing sensory input information. This information is modulated centrally and can go someway to desensitizing an individuals response to the question "is there a threat?"
Central influence has also become popular particularly in chronic pain patients. Ideas such as Meditation or Breathing Techniques have long been used to help with pain. Do they fall into this area with other ideas such as Pain Education and other Coping Strategies.
Finally, at the Movement Assessment Technologies, we aim to bring ideas of Movement Training to healthcare particularly for those...
Credit to Lorimer Moseley and the Body In Mind crew for the diagram.
Chronic pain is a complicated multi factorial output of threat from the brain where What You Think (cognition) and What You Do (action) have a big influence of What You Feel (perception). For a while now one of the main approaches to creating positive changes in chronic pain has focused on Cognitive Behavioural Therapy which focuses on educating the patient and changing unhelpful or unhealthy thinking habits, feelings and behaviours around pain.
At the Movement Assessment Technologies we focus on What You Do, using movement interventions to assist in modulating What You Feel through developing movement capacity (strength, power, stamina, range of motion etc) competency (movement skill, precision etc) and variability (different angles, different positions etc) to reduce the potential for experience or perceived threat in movement.
At the Movement Assessment Technologies we use squats daily in the rehabilitation and development of movement competency in our patients and clients. We often modify squats in the position of the feet or upper body to create different stresses and loads through the system depending on what an individuals goal is.
One under utilized modification to the squat is "depth" and knowing what reactions occur through the knee. This little info-graphic may give you an idea on where load can be focused depending on depth. Consider this next time you are rehabilitating a patient or want to develop greater muscular capacity.
Shapour, J. (2015). The Effect of Altering Knee Position and Squat Depth on VMO : VL EMG Ratio During Squat Exercises Journal: Physiotherapy Research International.
Nagura, T. (2002). Mechanical loads at the knee joint during deep flexion. Journal of Orthopaedic Research, 20(4), 881-886.
Caterisano, A. (2002). The effect of back squat depth on the...
Often as therapists we can get hung up with whether an individual has "flat feet" or "high arches". At the Movement Assessment Technologies we believe that this isn't too important as long as we test for how a foot functions. Can it evert/invert, pronate/supinate, load and unload against gravity and ground reaction force in upright function?
At the Movement Assessment Technologies we assess active movement and control of the feet, passive range of joint motion and use quantifiable movement tests such as the Star Excursion Balance Test and Hop Tests in different planes of motion on the M.A.T so we never judge a for by its posture.
When talking to patients and clients about their health sometimes we use the analogy of a bucket with holes in it.
These a holes are the outputs of mental and physical energy in our daily lives whether that be the demands of sport, work or maintaining our relationships etc.
We top up the bucket by nourishing our body with inputs such as sleep, nutrition and other forms of rest and recovery etc.
The aim is to keep the bucket full, it gives us the capacity to handle the stresses that life throws at us biologically, psychologically and socially.
At the Movement Assessment Technologies, we see our role as health and fitness professionals as to help people build a "bigger bucket" by developing movement capacity, competency, variability and confidence through an active treatment approach and education.
If you would like to learn more about how you can help your patients and clients build a bigger bucket check out https://www.matassessment.com/