One of the topics that regularly comes up in our courses is how relevant are more static/clinical tests to our everyday dynamic and function related movements. We have decided to address this in this blog.
I thought I would have a bit of a Jerry Maguire moment with my latest blog post!
Over the last few months I have certainly gone through a period of change with regards to how I understand the human body. Anybody who regularly reads my blog may have sensed that! I have begun to appreciate the brain as the command centre for all that we do, moving away from a more functional/biomechanical approach I had previously. This has been facilitated by some pioneering characters around me who I am thankful to for opening my eyes, even if it can feel sometimes that they don't want others to come along for the ride! I have certainly suffered my own bouts of cognitive dissonance along the way.
So I have seen various variations on Gary Gray’s view that muscles are reactors. I think this is spot on. Muscles ARE reactors.
I think what Gary meant by this was that generally we see muscles as concentric force producers. Actually during movement we tend to need to decelerate motion by eccentric contraction first. Think walking first we flex to attenuate gravity, ground reaction forces, mass and momentum before creating force to move. So we are reacting to forces acting on the body before we create concentric force.
What a great question. Firstly I am not really sure that there is a definitive answer so let me say sorry in advance. The word functional seems to mean a lot of different things to a lot of different people so lets look at the Cor-Kinetic interpretation.
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.
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!
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.
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!
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.
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.
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.
I have been reading The Talent Code this week by Daniel Coyle and have enjoyed it immensely. One passage in the book stood out to me. It describes the difference between how we teach football and how we teach musical instruments, specifically the violin.
"The ideal soccer circuit is varied and fast, changing fluidly in response to each obstacle, capable of providing a myriad of possible options that can fire in liquid succession: now this, this, this and that. Speed and flexibility are everything; the faster the more flexible the circuit, the more obstacles can be overcome, and the greater that players skill"
Now that sounds pretty cool. So if we want to help improve someones soccer (football) circuit then our training for that sport should help increase the sphere of the players movement, speed and flexibility. To be dynamic, variable and increase the brain/body connection would seem prerequisite for such an activity. This would be a functional approach to training!
BUT in fact Coyle goes on to talk about how we teach people to play instruments, in this case the violin.
"This circuit is not a vinelike tangle of improvisation but rather a tightly defined series of pathways designed to create-or more accurately, recreate-a single set of movements"
This struck me as a more accurate description of how we teach people to exercise in the gym. A set way of performing a movement not to be deviated from. A series of movements that lack the variability of any sporting or movement skill that we may want to enhance, in fact a completely different skill set.
When we build neural circuits and fire them repeatedly they get larger, stronger and after time and repeated use through practice they get myelinated. The Myelin insulates the circuit allowing the signals to travel faster and more efficiently. These circuits are specific to the practice or training the we do. Playing the violin does not increase my skill or ability to move or produce force for football.
The generic nature of exercise and strength training in particular would lead us to believe that strength and movement are generic. By practicing a defined pathway movement such as a squat this will enable me to improve the incalculable movement and strength/force production variations involved with football. The deadlift and bench press, movements that do not move my centre of mass away from the vertical, will enable me to explode in various directions and apply my force against another body in the horizontal plane. Studies have shown very limited crossover from training one specific movement to another specific movement!
The variables involved in applying your force against a moving external object are huge. From the foot positions taken to the change in position of the opposite body and the angle both bodies are moving in.
During a specific functional activity the feedback loop from the nervous system will define the appropriate response in terms of movement and ability to apply force. If the circuit is not variable then can it respond to a varied input?
Mel Siff states:
"The rate and number of fibres firing depends on voluntary and involuntary processes....the involuntary ones to the feedback of the proprioceptive system"
Involuntary would be more subconscious processes that are involved in sporting activities. They would also apply to the stretch reflexes involved with eccentric before concentric contraction! Something else involved with sporting force production.
Siff also states:
"there will usually be changes in centre of gravity, moments of inertia, centre of rotation, centre of percussion and mechanical stiffness of the system that will alter neuromuscular skills required in the sport"
If we believe that the mechanical/neurological skill process is vital to specific functional force production or strength and that during sport this is a constantly changing and evolving landscape then to train for this process we must involve variability. It must be more like teaching someone to play football than the violin. More variable than defined.
We must allow the body and mind to process information and create a response based on that information. Instead we try to create a robotic series of defined motions that offer a limited response. Even worse at an elite level of training we have created governing bodies that advocate training protocols with exceptionally limited variation in exercise. None of which ever come away from the vertical, none of which involve rotation. Sound like sport?, look like sport? Seems to me it is more like playing the violin than football!
How many sports only involve moving the centre of mass in the vertical? The ability to decelerate and accelerate in the horizontal plane is pretty much sport! Throwing, kicking and hitting all involve rotation. They also all involve strength, flexibility, speed, stability and power during the same split second periods of play! Not as individual components.
A similar rationale maybe applied to the world of rehabilitation from injury also. Do we want to prepare our clients for a limited range of specific movements or the variability of the world that we function in. This would be a personal choice.
On a final note, Malcolm Gladwell in his book 'Blink' describes a complex war game in which he felt the protagonists over analyzed the scenario in front of them.
"They were so focused on the mechanics and the process that they never looked at the problem holistically. In the act of tearing something apart you lose its meaning"
I believe that this can happen in our approach to the body. By reducing it to components we lose the magic of integration that creates movement. This also leads us to understand why injury site and source may be different! If we focus solely on the injured component then the cause will never become apparent. This is in part why we have chronic problems.
As usual this is my own take on a complex subject. More opinion than fact! Although with supporting evidence.
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