Theories on Movement
Hello Everybody!
In this SOAP Note, I’d like to just offer up my thoughts on the human body. I’ve tried to research and understand as many different interpretations of the body and movement as I can find. In doing so, I have collected in this article many of what I consider to be the most effective philosophies regarding the body. Some of those who have influenced my understanding include; Tom Myers, Gray Cook, Mike Reinold, Douglas Heel, Kelly Starrett, and Mike Boyle just to name a few. I’m sure you recognize some of those names if not all of them, and if any are unfamiliar to you I would encourage you to check them out. I don’t want to use this article to just describe the theories presented by all of these brilliant men, instead I am going to talk about some of the similarities I have found or adaptations I use.
A mentor of mine from my days as an undergrad AT student once told me that mobility = flexibility + strength. In other words, range of motion (flexibility) requires control within a range of motion (strength) to be able to own your range of motion and produce force (mobility). This is a very basic equation to consider but I find it to be the basis of any training protocol. There is really one common goal for sport coaches, strength coaches, athletic trainers, and physical therapists. The goal is to create and allow for optimal athletic movement. Sport coaches provide skill training. Strength coaches train the athlete to increase force production and the endurance required to maintain that production. Athletic trainers and physical therapists restore movement to injured athletes and they promote efficient movement as prehab for healthy athletes. Replace movement with mobility and you can easily see how that simple equation relates to everything we do. The equation can be manipulated to explain injuries too. I believe injuries most often occur within a range of motion where we have decreased control. In other words, when there is a difference between range of motion and control of that range we become vulnerable (or flexibility - strength = potential for injury). When stress is introduced to the body it is either controlled or uncontrolled. Controlled stress is accomplished through weight lifting, therapy, or rehab with the intent of influencing a target tissue. For the equation, controlled stress would look like (flexibility + stress) + (strength + stress) = enhanced mobility. Uncontrolled stress is how injuries happen because the stress moves to unintended structures that are unprepared to withstand it. That equation would look like this, flexibility + strength + stress = injury. Keep this equation in mind as we discuss other views of the body and movement.
Gray Cook talks about how we use our body for two things; to move around in space and to interact with our environment, locomotion and manipulation respectively. During an interview with Central Virginia Sports Performance, strength coach Brijesh Patel mentions there are two things the body has to do to survive. He says the body will always find a way to breathe and to move. When I considered both of these ideologies I came to the conclusion that our body is meant to interact with our environment (manipulation) by any means necessary.
What do I mean “by any means necessary”? Well it’s easier to just apply this to an athletic movement, so let’s consider a tennis player running to return a ball. The goal of movement for him/her is to get to the ball and hit it back to the other side, if the ball is about to bounce a second time the athlete might need to use an unconventional swing to hit it back like between the legs. Hitting the ball with the racquet is interacting with the environment, aka manipulation. In the process of hitting the ball back from between the legs, the forearm will do most of the work instead of the shoulder or back. This is not because the forearm can generate more force than the shoulder or back, it is because of the angle and position required to return the ball from between the legs. The goal here is a movement with a specific outcome and the body will find a way to achieve the outcome even if that means using a non-optimal movement pattern. In the course of a tennis match (or anything for that matter) the body will need to breathe. Recent research has shown that ideally those breaths will be driven by the diaphragm but that doesn’t always happen. The body will always find a way to move and to breathe, so if the diaphragm isn’t doing the job the scalenes might need to help elevate the rib cage or maybe the upper traps will lift the shoulders to allow for easier rib cage expansion. So in this example of returning a tennis ball we see the interaction with the environment and how the body prioritizes motion and breathing to accomplish the necessary manipulation.
In his Be Activated series, Douglas Heel sections the body into three zones. The zones resemble a target with zone 1 over the center of the body zone 2 is a little bigger and zone 3 the biggest to include the outer extremities. I combined this image of the body with the joint-by-joint description of stable and mobile joints presented by Mike Boyle. I did not make any significant discoveries by combining these images, but I do believe these two methods can help explain many musculoskeletal issues. The three body zones from Douglas Heel I find to be very effective at explaining compensation patterns especially when combined with Tom Myers’ thoughts on the myofascial system (more on compensation patterns in another article). The joint-by-joint approach also helps to identify compensation patterns when it comes to the physical requirements of a joint. I believe between the two ideologies we can observe and predict most musculoskeletal injuries when evaluating an athlete’s quality of motion.
At the end of the day I have found these approaches to align with my own understanding however, I firmly believe there is not one way to explain anatomy and movement. It is important to consider all of these theories and others together to truly begin to conceptualize the complicated system that is the human body. So, what do you all think about human movement? Who are some of your influencers and how do you view the body?
More next time,
Mark D.
@MarkDomATC
Mark,
ReplyDeleteI think correct movement can go a long way to decrease chronic pain and improve athlete performance. Referring to the equation you outlined above (flexibility-strength= potential for injury) throughout a competitive season an athlete will see daily changes in both flexibility and strength. Severe changes could increase that likelihood of injury. While I am an advocate in therapies to increase flexibility (stretching, foam rolling, massage, etc) I think it is vital that if the treatment goal is to increase flexibility the athlete must have adequate strength at the newly established ROM. This is a concept that I think is accepted with surgical rehabs, but sometimes is not considered with short term rehab or maintenance/ corrective rehab. Ian Markow and Kinstretch are some resources I have used to grow my thoughts on the subject. No matter the sport our athletes participate in there will be times that they ask their bodies to exceed the flexibility that they are comfortable with, I think it is our responsibility to increase their strength at these vulnerable ranges of motion. An example I like to use, is when a weightlifter is competing in the snatch or clean and jerk they will likely see a full depth squat on their catch. If that is a motion they are not familiar with or have the required strength to get out of without loading over 100kgs then how can we expect them to do it safely with 100+kgs at their chest of above their head. What techniques have you used to try and control the stress athletes endure to decrease risk of injury?
Thanks for the comment and well said! You were able to get to the heart of what I was trying to say with that specific adaptation of the equation you pointed out. When we have ROM but no strength to control in that range we are susceptible to injury. This could be a weak point within a range or at the end-range of a motion. I have a future article that further addresses injury prevention methods and gets a lot more into what we are talking about, so stay tuned!
DeleteI have used some Kinstretch techniques with some of the baseball pitchers I work with, I find it is a great way to mobilize the wrist with muscular activation at end range to really open up their flexors. I really do think quality movement can help to counter act injury risk. My interpretation of quality movement would include the example you provided of the snatch. If an athlete can't get under the bar in a snatch (as Gray cook would say) with integrity, then you can assume 100+kgs is going to break something along the kinetic chain. The next question is how do we enable this athlete to accomplish his training of lifting 100+kgs? There are many options, Kinstretch as you mentioned might help to gain better control at end-range. FMS/SFMA works well to identify limitations and isolate them both as an evaluation tool and an exercise prescription. Really the answer to this question is whatever your method of prehab might be.
Hope this was what you were looking for! Thanks!
Hi Mark,
ReplyDeleteI think this is a really good review of many different theories of movement of the body and the connections within it. When I think about movement and what it entails, I too refer to some of these influences, such as Thomas Myers and specifically the relationships between force couples and fascia lines. I think that when it comes to human movement the sport really does make a huge difference, particularly working with overhead sports. Especially with your sport of baseball, the demands on the athlete are very difficult when repetitively having to produce large range of motion + strength and velocity in an unstable and unnatural position/motion. However, I think often times we may place too much focus on the throwing arm strength and motion. For example, in baseball specifically, the "weighted ball" is all the rage in current training programs to build rotator cuff strength and firing velocity. A recent article I read by Mike Reinold revealed data that discourages this exercise with the exception of elite pitchers with nearly perfect biomechanics across the kinetic chain. This is just another feather in the cap of the kinetic chain theory, and having to improve mobility not only at the joint in concern but those surrounding it. I think above all, the thing that interests me most as a clinician is the individuals that do not display "textbook" biomechanics (sometimes rather ugly) and are asymptomatic AND effective. For example, a Chris Sale, Hunter Pence, Shawn Marion, or a Lonzo Ball (although not as effective as of late). These athletes are not the ideal picture of the "proper way" to pitch, swing, shoot, etc., but if they are asymptomatic and effective, is it wise to make adjustments to prevent injury and improve biomechanics/mobility?; Or on the contrary take the position of, as the saying goes, "If it ain't broke, don't fix it!"?
- Harrison Kuehn
Harrison,
ReplyDeleteI know of the article by Reinold you mentioned, he does a great job presenting the information. I thought his study he did was a little too broad he measured many variables with many different skill levels and different weighted balls. I don’t dispute his data but the underlying thought is that we don’t yet know enough about weighted ball programs to use them efficiently!
I agree with what you said about movement being sport specific. The demands of baseball are vastly different than soccer. However, movement efficiency has to be the base we build on. If you take two athletes, one soccer and one baseball, and neither can properly perform an overhead squat for whatever reason. That will have hugely different interpretations for either athlete. If the issue is lack of shoulder/T-spine mobility, the soccer player might never notice an issue but that would lead to major shoulder problems for a baseball player. So yes, the demands of sport vary greatly but we need to agree on the basics first.
The third thing you mentioned that was interesting was the very last quote you used. I totally agree, and this is part of a broader topic that gets debated over and over again. Baseball is a sport that massively favors asymetry from one side of the body to the other. Studies have shown that muscular asymetry is a big risk factor for injury. So, do we try to balance out the asymmetries of a baseball athlete to reduce injury risk? Or do we seek to enhance those asymmetries to develop their sport skill and increase their chances of going pro? I don’t know the right answer. I do believe the answer is circumstantially based, meaning it will vary emensely from one case to the next.
Thanks for the comment!! Stay tuned for future articles!
-MD