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Stability and mobility. Best friends….

At Cor-Kinetic one of our foundational concepts is that of the relationship between stability and mobility.

Stability is a component part of mobility. The body needs to move in a mobile AND stable manner. Stability without mobility is RIGIDITY. Rather than a sign of functionality of the system I would see it more as a sign of dysfunction. The inability of our motor system to effectively control movement will create a rigidity in the system as the body chooses stability over mobility and closes down the system's ability to move.
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The TvA. Does it matter and why are we obsessed with it?!

Whenever we run a Cor-Kinetic course for physio's and other health care professionals the same subject always comes up, the TvA and lower back pain (LBP). This inspired me to write a blog on the subject!
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Throwing injuries-A case study in deceleration, the forgotten end of the throw part 1!

I had an interesting case this week involving a water polo player who was experiencing shoulder pain when throwing. This pain was only occurring however when he put maximal effort into the throw. Now I do not get to see many water polo players so this was a challenge. I decided to put aside the fact that ground reaction forces would be different as well as having two different resistances on the upper and lower parts of the body (air and water friction) as this would present even more challenges to the assessment!
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Is your movement giving you what you need?

So its been a while since I last wrote a blog. Been pretty busy moving house and working hard so had very little time.

This blog is all about the movements that we give our patients/clients to perform and how we may need to pay closer attention to how they do it for maximum impact on the system.

One of the things we look at heavily during the Cor-Kinetic Mentorship program is the reaction created by the movement we perform. Just because we believe that a movement we prescribe will enhance our clients movement does not mean that this movement will give us the reaction we desire.

Understanding the authentic biomechanical movement that we need in the first place is only one half of the battle. If it was as simple as that then very few people would be in pain. How much of that movement does some one tolerate is the question, and to find the answer we need to look at their movement threshold.

If we have too large a movement into an area that lacks the required movement then you will get a compensatory movement from the body. It is as simple as that. The response you thought you would get will not occur. In fact it could be this compensation that is causing the pain you are trying to eliminate. This is why it can be hard prescribing corrective exercises. You don't know if you are feeding the compensation beast or correcting a movement! The more we go towards end range the more the variability of the response becomes. As the demand/stress increases so does the bodies need to find an alternative pathway.

Along with patient adherence this has always been the problem with corrective exercise prescription for the client to go away and perform on their own. This is where the science of the body meets the art of the practitioner. As the body is not a linear system and does not follow a set pathway every time it moves we have to be able to interpret and control movement at the moment it occurs and be able to adapt movement for a favorable reaction. Not always and easy thing to do but hugely powerful once you can start to implement this thought process.

To guarantee that the reaction we need to find the threshold of success. This is a concept borrowed from the great Dr David Tiberio of the Gray institute. The threshold is the point that the movement can still have a positive reaction the vast majority of the time and will remain pain-free. The more we go over the threshold and suddenly the movement becomes unsuccessful as the body tries to find another pathway or creates pain to reduce the sub optimal movement created. The key is feed the body a little more demand each time. Inching over the threshold bit by bit until we have a consistent positive reaction. Understanding the range, angle and speed of the movement can help you increase and decrease the variables to be able to have full control over the patients/clients success and being able to increase it. It maybe that the threshold we have in terms of range will decrease the faster we get. This maybe of great importance for a sports player who has to increase their movement speed.

An example of this process would be a lunge for increased pronation of the foot. If we were stepping with the right foot then we would want to step across to the left half of an imaginary semi-circle in front of me (somewhere around 45 degrees left would be good!). If the body cannot get this movement under increased force then it will try to decrease the impact on the system. A couple of ways it may do this is simply to roll to the outside of the foot or adduct the foot (turn it in). In these ways it reduces the demand on the structures that would get eccentrically stressed during pronation (Tri plane-dorsi flex, abduction, eversion) . We need to be able to find the threshold or angle that decreases these compensatory reactions and progress slowly until we have the angle and reaction we need/desire. A better angle to start at maybe 10 degrees gaining a consistent reaction before moving to 20 and so on and so on. When the reaction becomes less consistent we can come back to success and start inching over the threshold degree by degree. It may sound time-consuming but is actually a quick process when you learn to control it!

In this way we can regress and progress the movement to create continued success. The more the body feels and interprets this success the more we can feed the neurological system to allow the continued success to become a predominant pathway of movement. It is not always the movement we give but the way in which we give the movement!

As the great Gary Gray says "The test is an exercise and exercise is a test". In this way we can interpret the success of any movement we perform and constantly evaluate the success of the individual we are training/assessing/treating.

A purely academic/biomechanical approach to functional movement may lead us just to understand what movement is required and give as much as possible. This is something I have seen many times with a fairly low-level of success. The variability in the creation of the desired movement is high. At Cor-Kinetic we don't see that as the answer. In fact in this scenario more can actually lead to less, the path to success is in the way that you do it. Our tag line is "Evolving movement" both our students understanding of movement and our clients movement potential.

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Power of the capsule!

At Cor-Kinetic we appreciate the power of the hip capsule and specifically the capsule ligaments. How to stimulate the capsule forms a component part of what we teach both academically and also in terms of technique.

We find that the powerful effect that capsule stimulation has on the muscles surrounding the hip-joint means that it is an area of the body under recognized when looking to create motion and stability around the hip and subsequently the body as a whole.

Anatomy

The three extrinsic capsule ligaments are arranged in a helical structure. This means that each ligament may respond to motion in any of the three planes of movement. The illiofemoral ligament is the largest and strongest. In fact it is the strongest ligament in the human body!

Why?

Ligaments are highly proprioceptive. This means when placed under tensile forces they send lots of information back to the CNS (central nervous system) and also surrounding musculature. If we get into a scenario where the hip muscles restrict motion around the joint then the capsule stops becoming stimulated. This is a bit of a catch 22 because if the capsule stops getting stimulated then it will not in turn play its role in stimulating the muscles surrounding the hip. This leads to a 'locking down' of motion in this area. As an area of huge mobility and freedom in the body (as a ball and socket joint allows) it can then impact on areas such as the lumbar spine, sacroiliac joints and general lower back area that rely on the motion and force dissipation of the hip and associated muscles for correct sequencing of movement and healthy operation.

Research

Solomonow (2003) has documented much of the research into the proprioceptive ability of ligaments. Multiple anatomical studies have shown the presence of Pancinian, Golgi and Ruffini mechanoreceptors within ligaments. This means that through stimulation or lack of stimulation the capsule ligaments can create reflex activation or inhibition of the associated musculature. As far back as 1900 (Payre) it has been suggested that a reflex arc exists between muscles that may directly or indirectly modify the load imposed on a ligament. In this way the body can create a synergistic activity of ligaments and muscles for joint stability/mobility. The indirect nature of this reflex arc also shows the functional inter-connectedness of the body that we often miss with a joint-by-joint isolation approach.

This reflex arc has not just been noted in the hip. The stimulation of the medial collateral ligament of the ankle results in activation of the intrinsic muscles of the foot (Solomonow 2002). This again shows the power of the functional chain as many of these muscles do not cross the ankle joint! As we already know, during the pronation cycle rotation around the STJ (subtalar joint) is accompanied by rotation at the MTJ (midtarsal joint). This motion at the MTJ will also help decelerate lower limb motion preventing excessive motions at the knee and hip.

Traditional lengthening of muscles may not be the answer to create more motion at the joint to create more stimulation of the capsule. As muscles get towards end range they become stiffer (more resistant to lengthening), similar to what would happen when we stretch an elastic band. This would mean that the stress (force divided by area) applied would not result in strain deformation of the tissue or more simply put lengthening. This may mean that the capsule ligaments, which would be stimulated more towards the anatomical end range, may get reduced input. Both muscles held towards end range and muscles held shortened could display increased stiffness. Gadjosik (2002, 2003, 2005) has performed research into stretching and increased muscular stiffness.

Method

Our methodology, especially around the hip, to create more capsule stimulation involves creating a passive shortening of the muscle in the transverse plane. At Cor-Kinetic we believe the transverse plane is responsible for a lot of the intrinsic stability in the body. Much like the ropes of a ship's mast, when we rotate or 'wind' a longitudinal oriented structure/muscle (also longitudinal orientation of the individual fibres), we create a passive tension. This tension is created quickly in a plane (such as the transverse in a longitudinal muscle) that lacks much range. This range would be much larger and therefore more movement before a stiff response if deformed longitudinally rather than rotationally. This would mean the stiffness/tension and resultant stability on offer would take longer to access.

To avoid this lengthening and resultant stiffness we instead 'unwind' the transverse plane by externally rotating. As we know from our anatomy lessons there are many more external rotators around the hip than internal rotators. We tend to rely on gravity for internal rotation during functional movement!

We can further reduce stiffness by creating stability. Instability tends to create rigidity (increasing stiffness) around a joint therefore reducing movement and capsule stimulation. Simply pre-positioning our bodies towards the anatomical end range will also help create capsule ligament stimulation.

So our three golden rules of capsule stimulation at Cor-Kinetic are to shorten the transverse plane to reduce stiffness, create stability to reduce stiffness and preposition further towards end range. By changing body position and drivers of movement we can emphasis motion in the individual ischiofemoral, iliofemoral and pubofemoral ligaments. This should result in more stimulation of the highly proprioceptive capsule ligaments for reflexive stimulation of the associated musculature.

Simply not enough!

Stimulation of the capsule however is only one part of the story. Following this muscular activation 3D mobility must then be restored to the joint. This mobility must then be integrated into our movement. To much mobility maybe shut down by the body as it could be beyond the perceived range of the proprioceptive system. By introducing dynamic and integrated movement we can teach the body to understand this motion and create stability and strength in its new-found range and therefore integrate this motion into its everyday movement patterning.

This maybe why manual therapy techniques can be short-lived as we do not teach the body to stabilize the new-found joint mobility and mobility is perceived as instability. This is why mobility must be integrated into actual movement to create stability. Gary Gray has coined the phrase "mostability" to describe this process.

We teach a 3 stage 3 dimensional mobility/stability process on our two-day courses along with assessment techniques to determine which areas need to be focused on!

For more information on our courses please click this link Cor-Kinetic education.

As always this is our take on complex subjects and merely opinion back up with a smattering of research.

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