Proximal stability for distal mobility:

There are many times I can think of when a new client comes in and is complaining of stiffness in the hips or shoulders, or their calves are tight. When I ask them what they’ve been trying to do in order to correct this issue, I usually hear something like this…

“I stretch it occasionally. You know, just try to loosen it up so it doesn’t bother me”.

After assessing and screening these individuals, I often find that they lack core/spinal stability. Tissues may be “tight”, but it’s imperative to find out WHY they’re tight to begin with.

What these poor souls don’t realize is that aside from possibly having some true tissue stiffness, they also possess a lack of core stability. What needs to be understood is that a lack of stability in the core has an impact on the other joints (hip, shoulder, neck, ankle, ect).

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What happens over time is that these joints basically “pick up the slack” for the lack of core/spinal stability, and in turn the body creates an artificial stability by “locking down” the tissues at that joint. That joint becomes unable to proficiently transfer any sort of load or force back towards the core because the body realizes that the core can’t handle it. This can happen up and down the kinetic chain.

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…Nerd alert!

If we take a look at how each of us develops from an early age, you’ll see that we are born with mobility. It’s through exploring movement as infants, trial and error and a LOT of reppetition that we gain our stability. Gray Cook explains this very nicely in the video below. I especially like how he talks about kicking your kid so that he or she has to keep getting back up to truly gain the ability to stand and eventually, walk.

Here is an image of the progression of gross motor control. Remember the good ol’ days?

Started from the bottom, now we here.

Life has a funny way of changing this. As we age, we pick up bad movement habits, we sit more and we move less. The body is incredibly good at finding alternatives and adapting when something in the chain isn’t working properly. This brings me to my next point, which is… Stretching is NOT always the answer when stiffness/tightness is present.

You can stretch and foam roll all you want, but if that joint is unstable, or there’s an unstable joint in one of your myofascial lines (Thomas Myers anyone?), your body is going to b**** slap you right back to where you were before – TIGHT, WEAK & UNSTABLE.

For example. I routinely see people with “tight shoulders” who also present very poor scapular control/stability. I have them perform exercises that focus on joint centration and stability and the tension may subside. Of course this isn’t always the case, and things aren’t typically that simple. This is why it’s imperative that we look elsewhere for issues that may be contributing to the problem. The point is that stretching should not be your go-to whenever tension is present. Investigate, assess and correct.

Kettlebell training can be especially beneficial if executed correctly for shoulder stability. The turkish get-up is one of my absolute favorite exercises for this. Of course, whether or not they are safe for you or a client is subjective, but when learned correctly they are an invaluable tool for shoulder health and performance. Bottoms-up kettlebell variations are also a simpler alternative for working shoulder stability.

Turkish Get-Up:

Bottoms-up Kettlebell Carry:  Eric Cressey

“Failure of the rotator cuff and the scapular stabilizers to maintain the humeral head in the glenoid fossa can lead to excessive humeral head migration and either increased tensile stress on the tendons 10, 15 or compression of the tendons from abutment of the humeral head on the undersurface of the acromian.” (1)

External rotation much?!

 

Eric Cressey on anterior humeral glide in a common rowing motion:

So, to quickly recap:

  • If your core is weak/unstable, surrounding joints/tissues can & will pick up the slack and create tension at those joints/tissues
  • Unstable joints are sloppy joints. They under perform and can often cause discomfort or pain for the individual depending on the severity
  • Working on joint centration and stressing osteokinematics as well as arthrokinematics is vital to your joint health & overall performance

Osteokinematics:

  • Gross movements of bones at joints
  • Flexion / extension
  • Abduction / adduction
  • Internal rotation / external rotation

Arthrokinematics:

  • Small amplitude motions of bones at joint surface
  • Roll
  • Glide (or slide)
  • Spin

 


 

References:

(1)  Tovin BJ. Prevention and Treatment of Swimmer’s Shoulder. N Am J Sports Phys Ther. 2006;1(4):166-75.

 

Pick up something heavy.

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Why the floor beats the Bosu: A look at “balance training”

So, I originally wasn’t going to write about this, but a recent “discussion” came up between a few individuals and myself on the use of “balance training” in the gym setting. Mainly the use of a Bosu trainer or foam pad. For those of you who may not be familiar with the Bosu, it’s essentially half of an exercise ball with a flat plastic surface underneath. There is a legitimate time and place for using unstable surface training, and it’s typically in the rehabilitation setting. Lets take a simple look at how balance works. Mechanoreceptors are sensory organs found throughout the body that respond to mechanical stimuli such as tension, pressure and displacement. Proprioceptors are receptors within the body (specifically in our muscles, tendons, joints, and inner ear) that detects motion or position of the body or the limbs by responding to the stimulus within the organism. Proprioception is defined as “The unconscious perception of movement and spatial orientation arising from stimuli within the body itself. In humans, these stimuli are detected by nerves within the body itself, as well as by the semicircular canals of the inner ear”(1).

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Observe the evil that is the Bosu…

So, what started off as a healthy discussion quickly became a somewhat heated debate. The argument for utilizing the Bosu or balance training went something like this… “I use the Bosu because my elderly clients benefit from the proprioception and core activation that comes with Bosu/balance training. They fire muscles they haven’t used in years when they’re on an unstable surface”. Sounds good, right? It would make sense that training on an unstable surface would offer increases in balance, proprioception, and coordination. The thing is, it DOES – but its biggest benefit is for those who have lost most of their proprioception, strength, and stability. One study (2) conducted on institutionalized elderly individuals found that introducing wobble board training for 9 weeks increased their standing balance. That’s great, but again, we typically don’t come across elderly clients who are in need of being institutionalized.  Although, I’m sure some trainers DO come across this population from time to time, but again – this type of training and population is found in the rehabilitation setting. Typical “balance training” that we see in the gym, or as I like to call it, “Swiss ball circus maneuvers” is best used for those of us looking to join the Ringling Brothers.

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They wanted me to go to rehab, so I said yes yes yes…

My stance or “mantra” has always been to work as hard as you can within the confines of your ability/physicality. This doesn’t mean I’m going to have a 70-year-old severely kyphotic man deadlift 600Lbs – although that would be awesome. Instead, we do what we can with what we have, and try to improve to the best of our ability. So, with this mindset my argument against the overuse/overly prescribed Bosu/Swiss ball training was to utilize other means of creating instability while operating on a stable surface. Stability, balance, and core activation can be improved by standing on both feet while on a stable surface. The main benefit from working on a stable vs a non stable surface is that force production increases while on a stable surface. A study (3) was conducted comparing the activity of the muscles of the core in 12 trained men. Each participant performed the back squat, deadlift, overhead press, and curl lifts on stable ground and on a Bosu. Guess what? They concluded that core activation was greater in the group that performed the exercises on a stable surface. Floor wins, your move Bosu… Another study – free PDF download (4), showed that when stable and unstable environments were used to test unilateral balance on healthy individuals, that the stable surface produced greater gains in balance (See page 6, figures 3-6).

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Goblet Squat…On the floor…FTW.

Simply put, there are better ways to improve stability and balance without having to stand on a Swiss ball or Bosu. Trust me, you weren’t really cut out for the circus life anyway. Instead, try offsetting the load and performing exercises such as: suitcase deadlifts, bottom-up kettlebell variations, in-line chops/presses, and pallof presses. I love the supine pallof press shown here by Tony Gentilcore (5) (He’s awesome, and you should read his stuff if you aren’t already). You can improve proximal and distal stability, core strength/stability, and total body strength. In doing so you will be – strong and stable!

So the next time you see someone squatting on a Bosu or curling 2.5lb dumbbells while kneeling on a swiss ball, just remember. You have better options available to you. Offsetting loads and performing Squats, deadlifts,  and overhead presses are all great ways to build stability and balance throughout the entire body. When performing these exercises on a stable surface, your force production and core activation increase, and you can lift more weight (6). I don’t know about you, but that sounds pretty great.

Pick up something heavy.

References:

(1)  proprioception. (n.d.). The American Heritage® Stedman’s Medical Dictionary. Retrieved January 13, 2014, from Dictionary.com website: http: dictionary.reference.com/browse/proprioception

(2) Ogaya S, Ikezoe T, Soda N, Ichihashi N. Effects of balance training using wobble boards in the elderly. J Strength Cond Res. 2011;25(9):2616-22.

(3) Willardson JM, Fontana FE, Bressel E. Effect of surface stability on core muscle activity for dynamic resistance exercises. Int J Sports Physiol Perform. 2009;4(1):97-109.

(4) Journal of Sports Rehabilitation, 1993. Copyright 1993 Human Kinetics Publishers Inc. Unilateral balance training of noninjured individuals and the effects on postural sway. Emily D. Cox, Scott M. Lephart, and James J. Irrgang: https://www.google.com/url?q=http://www.pitt.edu/~neurolab/publications/1992-1996CoxED_1993_JSportRehab_Unilateral%2520balance%2520training%2520of%2520noninjured%2520individuals%2520and%2520the%2520effects%2520on%2520postural%2520sway.pdf&sa=U&ei=sSLUUqKMM6OiyAH42oCQAw&ved=0CAUQFjAA&client=internal-uds-cse&usg=AFQjCNFoVKS604QDgb8uQbkPwxEBjNi5pQ

(5) Tony Gentilcore: http://www.tonygentilcore.com/blog/exercises-supine-pallof-belly-press/

(6) Kohler JM, Flanagan SP, Whiting WC. Muscle activation patterns while lifting stable and unstable loads on stable and unstable surfaces. J Strength Cond Res. 2010;24(2):313-21.