Welcome to another article written by intern Marvin Perkins during his mentorship at ReVITALize Rehab Club. The topic at hand is to determine which factor is important during your physical therapy rehabilitation or sports medicine performance enhancement experiences. This complex but crucial topic was meaningful for Marvin since he was dealt with a common but under-managed sports injury. As a collegiate sports athlete, we felt it was fitting for him to learn more on building movement from a foundation of mobility and stability.
Hope you enjoy his article. Share your thoughts about your injury.
Medicine is often viewed as a parts-based system. While that may be true to a certain extent, in reality, patterns often play as large, or a larger factor in medicine than most individuals realize. What does that mean? I will explain it. On the day to day, medical professionals see athletes or individuals come in with all sorts of complaints. It can be seen they are well versed in the anatomical parts that are creating the issue for them. However, when it pertains to function, they are less educated.
For example, a woman might come into the office and say, “Hey Doc, I am having pain in my knee, I think it is just deteriorating due to all my years as a powerlifter.” In my case, I once strained my quadricep during a track meet in the spring of 2019. I went to a Physical Therapist for rehabilitation, but I did not fully understand what he was doing concerning my therapy.
When we have pain, there is a tendency to point to the part as the main issue or focus. While in some instances that may have some merit, often it can be a misleading idea. Let’s go back to the powerlifter example, she is complaining of knee pain, but the imagery shows her knee is normal. The actual problem is that she suffers from poor hip stability, which is perpetuating that knee pain. In discussing my quad, when I was attending therapy, I expected that my PT would be focusing solely on that area, which was not the case. He had me performing rehab exercises that focused on my hips, ankles, and feet.
The point is that patterns of movements created from multiple areas largely contribute to the function of a part. Primarily people are uneducated about this aspect to misguide their thinking regarding what is wrong with them. Using a parts based perspective will not yield the desired results. On the other hand, investigating with a pattern-based perspective provides the most efficient method in seeking a part.
What is, do you think of when you hear the word “pain”?
Is it the thought of stubbing your toe on the dining room table? I know this to be the case for me sometimes! People define pain in many different ways. The dictionary says pain is defined as “physical suffering or discomfort caused by illness or injury.” However, did you know that pain can be a potential cause of injury? This personal anecdote will tell you how. During my freshman year of track & field, I was doing a workout then began feeling pain in my foot. Due to the problem, I started running differently to compensate for it. As a result, I suffered deep bruising on my metatarsals, which sidelined me for weeks. The pain caused me to alter my running form’s motor controls, which lead to the eventual injury. How pain can affect motor control can be unpredictable.
When we suffer an injury, our bodies elicit a response that has a short term benefit but comes with long term consequences. Our body will protect itself from the pain by using other muscles to slow the movement down in the short term. Another way to think of this is our brain sending a signal to pump the brakes. For example, after my quad injury, I could not walk normally without a high amount of pain. To move without pain, I had to limp with a slight hunch in my back gingerly. My body could not utilize all of the muscles; it usually would when walking correctly. In response, other muscles were used to slow the movement down as well as to avoid pain.
I could tell that I was using the muscles not normally fired when I was walking normally because I would experience soreness. Mainly from in my back because I had to have a slight hunch to be comfortable moving. While this short-term response serves to benefit us by limiting the pain, it also can lead to long-term consequences. Say the pain that you are feeling lasts for a while, and your body continues to respond in the same way to preserve itself.
When the pain disappears, what do you think will happen?
We become so accustomed to moving in that particular manner that we continue to move when we become pain-free using the non-primary muscles for that action. In other words, we have created a dysfunctional movement where the wrong muscles for the motion are firing. It took about 4-6 weeks just for me to be able to walk pain-free. After the pain had dispersed, I would catch myself walking with a limp even though there would be no pain present. Since I was walking unproperly for that length of time to avoid pain, it became natural for my body to do so even without the pain. Shortly after, I was able to return to my normal functional movement. However, this is not always the case for others. They may have that dysfunctional movement for so long they do not even recognize it as improper.
Now that we have discussed patterns and pain, we can transition to mobility and stability. As you go from different practitioners, you might find various definitions of mobility and stability. The explanation I will be using is defined by the Selective Functional Movement Assessment (SFMA). Mobility can be defined as the joint’s range of motion, while stability can be defined as the joint’s motor control. These two phenomena play essential roles concerning one another; however, it is necessary not to interchange them. The relationship between mobility is displayed in the Joint by Joint Approach, which was popularized by Gray Cook and Mike Boyle. They employ us to think of our body’s framework as a stack of joints on one another.
Joint by Joint theory.
Every joint has a particular function that it serves within our body and is susceptible to certain deficiencies. With that being said, each joint has certain developmental needs. From the bottom up, our joints alternate from emphasizing mobility to an emphasis on stability. For example, we would want optimal mobility in our ankle and optimal stability in our knee. This relates to training and assessment because this theory turns the focus to movement-based patterns rather than parts.
With this approach, instead of a coach using the dated method of focusing on body parts in a training session, the focal point shifts toward doing certain movements such as a push-pull. We can also see that injuries play an important role in joint dysfunction because if there is a problem at one joint, one will likely experience pain in one above or below it. One illustration is that if you lose mobility in your ankle, you will likely suffer pain in your knee. Although the quadricep muscle is not a joint, I definitely can tell you that my hip mobility suffered when it was injured. When an individual is put through the SFMA breakouts, the instructor uses movement patterns to identify whether he or she has a mobility or stability problem.
Why this is important.
As you can see, everything that has been discussed has built upon one another. Looking at an individual’s complaint from a pattern-based perspective will always yield results about their pain rather than looking from a parts based perspective. We see how pain can be a cause of injury and can negatively affect those movement patterns that we discussed beforehand. In the short term, it is protection from your body, but in the long term, your movement is compromised. Finally, we see the roles mobility and stability play with not only one another but also regarding the Joint by Joint Theory.
The Joint by Joint Theory brings this full information circle, as it highlights how this approach is applied to movement pattern assessment. What gets this process started? The athlete’s or individual’s explanation of pain! An example is the SFMA top tier test, along with the breakouts for each movement. The goal is for the movement to bring out the pain that the person is describing. Once that occurs, the movement is broken down until the instructor can deduce whether the individual is suffering a mobility or stability problem. As I started this journey, I kept my quad injury in mind to see how it could relate to the discussion.
Now that I am concluding, I can say that it would’ve been beneficial to know this information and its relation to each other. I thought the issue was solely about my quadricep during my injury, but now I can see that was not the case. I understand now why my PT had me performing rehab exercises to strengthen my hip mobility. As I train, the work we have been doing is based on movements, not parts! I will leave you with this; remember, medicine is meant to have a pattern-based perspective. The next time you suffer an injury or discomfort from pain, remind yourself not to settle looking at the anatomical part. Widen your vision and think about the things we have discussed here today because it is not about the part; instead, it is about the movement pattern!