Gray Cook: Expanding on the Joint-by-Joint Approach, Part 1 of 3
Movement: Functional Movement Systems
Gray Cook, Expanding on the Joint-by-Joint Approach, Part 1 of 3
The original conversation between Mike Boyle and I regarding the joint-by-joint approach to training was more about the thought process than about physiological facts and absolutes. This has been the topic of lots of discussion, but here is the pearl: Our modern bodies have started developing tendencies. Those of us who are sedentary, as well as those of us who are active, seem to migrate to a group of similar mobility and stability problems. Of course you will find exceptions, but the more you work in exercise and rehabilitation, the more you will see these common tendencies, patterns and problems.
A quick summary looks goes like this–
- The foot has a tendency toward sloppiness and therefore could benefit from greater amounts of stability and motor control. We can blame poor footwear, weak feet and exercises that neglect the foot, but the point is that the majority of our feet could be more stable.
- The ankle has a tendency toward stiffness and therefore could benefit from greater amounts of mobility and flexibility. This is particularly evident in the common tendency toward dorsiflexion limitation.
- The knee has a tendency toward sloppiness and therefore could benefit from greater amounts of stability and motor control. This tendency usually predates knee injuries and degeneration that actually make it become stiff.
- The hip has a tendency toward stiffness and therefore could benefit from greater amounts of mobility and flexibility. This is particularly evident on range-of-motion testing for extension, medial and lateral rotation.
- The lumbar and sacral region has a tendency toward sloppiness and therefore could benefit from greater amounts of stability and motor control. This region sits at the crossroads of mechanical stress, and lack of motor control is often replaced with generalized stiffness as a survival strategy.
- The thoracic region has a tendency toward stiffness and therefore could benefit from greater amounts of mobility and flexibility. The architecture of this region is designed for support, but poor postural habits can promote stiffness.
- The middle and lower cervical regions have a tendency toward sloppiness and therefore could benefit from greater amounts of stability and motor control.
- The upper cervical region has a tendency toward stiffness and therefore could benefit from greater amounts of mobility and flexibility.
- The shoulder scapular region has a tendency toward sloppiness and therefore could benefit from greater amounts of stability and motor control. Scapular substitution represents this problem and is a common theme in shoulder rehabilitation.
- The shoulder joint has a tendency toward stiffness and therefore could benefit from greater amounts of mobility and flexibility.
Note how stiffness and sloppiness alternate. Of course, trauma and structural problems can break the cycle, but it is a present and observable phenomenon producing many common movement pattern problems. It also represents the rule in orthopedics evaluation of always assessing joints above and below a problem region. It would be illogical to expect to improve knee stability in the presence of ankle and hip mobility restrictions. Likewise, it would be impractical to assume that a recent improvement in hip mobility would not return to stiffness if improved stability were not also created in the lumbar and knee regions. Chronic sloppiness would always be more convenient to use than new mobility.
When Mike and I first discussed this layering of opposites, he did a great job of developing the topic to discuss a more comprehensive approach to exercise program design.
The point in the joint-by-joint approach is not so much the 10 Commandments of Mobility and Stability: Make the ankle mobile. Make the knee stable. Make the hip mobile. Make the low back stable. We’ll find a person every now and then whose ankle has too much mobility or who’s sloppy in the hip. We use the words mobility or stability to implicate a segment of the body that should be moving better or have more control. The whole point is to practice with a systemic approach to clear the joints above and below the one with the problem.
When we talk about the ankle, we’re talking about the ankle joint, the inverters, the everters, the dorsiflexors, the plantar flexors and all of the other stabilizers that control that ankle. We’re not just talking about a joint–we’re talking about a complex. Same thing with the knee; same thing with the hip; same thing with the back, the Tspine, and so on up the chain.
When you’re about to do knee stability training or lumbar stabilization and you take the classic kinesiology approach of training all the muscles around the knee or all the muscles around the core, you’re going to make a mistake nine times out of ten. You’re assuming when you train the knee that the ankle and hip are contributing like they should, as much as they should. That’s hardly ever the case.
It’s the same is true with lumbar stability. Some of the people producing lumbar stability research today are very well intentioned about the muscles they want us to fire and the muscles on which they want us to focus our exercises. I don’t have a problem with stability research or stability suggestions. All I ask is that the authors use a qualifying statement in front of their core stabilization talks: These statements about stability have been made assuming that you know how to clear the hips and clear the T-spine and other regions where mobility will actually compromise stability. These regions should be considered as potential reasons for loss of stability and compensation behavior.
Logically we must make sure these areas are mobile, because if the hips and T-spine aren’t mobile, the lumbar stability we create is synthetic. It is not real. We develop enough stability and strength to do a side plank, but we don’t authentically stabilize in natural environments. The central point of the joint-by-joint discussion is to assure we’re working on what we think we’re working on. Most of us make the mistake by assuming sloppy knee, stiff ankle, stiff T-spine without considering the potential problems above and below.
What would be a reason for the T-spine to become stiff? Probably there’s a lack of stability somewhere else. Often if you don’t have the necessary core stability, the T-spine will get stiff and this also works in reverse. If the T-spine is too stiff, the core stability will be compromised. It can work either way. It’s not about finding what came first, the chicken or the egg–you have to catch both or you can’t manage either.
The takeaway from a joint-by-joint discussion is this: Instead of trying to memorize how everything is supposed to be in a perfect world, ask yourself these questions–
- I’m getting ready to train mobility or stability in this segment.
- I either want this segment to move better or I want this segment to be more stable.
- Have I truly cleared the joints above and below that can compound the problem?