Five Elements of Movement Rehabilitation

What do I mean by movement rehabilitation?

 

In a movement rehabilitation session, I work with a person who is hoping to improve their experience moving in the world. Usually, people seek out a session with me because they are experiencing pain while performing certain movements. Other times it’s because they feel stiff and want more mobility tools or they are feeling uncomfortable but can’t quite pinpoint why. 

Whatever the case, when putting time and energy into movement rehabilitation we are essentially trying to optimize performance in 5 key areas: Coordination, Position, Stability, Mobility, and Strength. Any movement can be compromised if one of these attributes is lacking. Also, an individual may excel in one area and be able to cover up their weakness in another. I define these elements as follows.

 

The Five Elements

 

Coordination

Every movement involves more than one muscle or tensional line. Coordinating these structures to fire is key to efficiency and success. Sequencing is very important for complex movements like walking, squatting or jumping. For most movements, the core should be stabilized and braced first.  If you swing your leg forward before your push into the back leg your gait will be ineffective and jarring. If you bend your knees before you send your hips back in your squat you will overload your knees and underload your hips which can lead to pain and degeneration of the knee. Likewise, if any muscle is not firing and well, other muscles will have to work harder.

Focusing on the onset and release of muscular engagement is particularly important. If a movement is well coordinated in the beginning and end you don’t usually have to worry about the middle. A movement that is usually uncoordinated may feel more effortful during the coordination process but once the brain has rearranged its firing pattern that movement will feel easier. 

Position

Truly coordinating your movements well is not possible if the movements are moving through bad positions. When you look at a photograph of a person performing any activity, even though it is just a single image, you can learn about their movement quality due to the positions of their joints. Any activity can be done better with excellent alignment whether it’s running, scrolling your phone, baking, or gardening. Setting yourself up in a good position will load your shoulders and hips and not your intervertebral joints. It will take advantage of your resilient and elastic connective tissue instead of muscular contraction whenever possible thereby increasing biomechanical efficiency. 

Stability

Being able to find a good position is better yet when you can hold it steady. Every joint in your body is controlled and supported by the soft tissue around it. Each joint is designed to be moved in certain pathways and not others. Although each joint can be forced into positions that may damage them and the brain will do it’s best to protect them. Loading your joints with adequate torque and strengthening their optimal pathways is a crucial component of improved movement quality. 

Mobility 

Mobility is the amount of control that you have at the end of your range of motion. A baseline of functional mobility is imperative to maintaining a good position. A great example is taking your arm overhead. If you have reason to bear weight overhead being able to flex the shoulder so your arm is in alignment with your ear without raising your ribcage or sending your head forward will optimize how that weight transfers to your core. If you are struggling against a mobility restriction a movement is also likely to be less stable.

There is an important distinction between mobility and flexibility. Essentially flexibility is passive and mobility is active. Extending your passive ROM usually decreases joint stability. Joint stability is usually maintained while increasing active ROM. You can read more about this distinction in my article, The Mobility Uprising.

Strength

All of these elements will be compromised while under load if there is not sufficient strength to bear that load. Strength and stability go hand and hand. If a base level of strength is not present even simple movements will become unstable. Also, if a movement is already unstable, special awareness is needed to strengthen it. Adding a load to a wobbly pathway can be very beneficial and increase stability and strength but, adding too much can cause aberrant deviations and stress out the brain as well as the tissues it is controlling.

Adding a load to a movement is essential for taking it out of the gym into real-world situations. Bodyweight squats are essential for getting in and out of a chair but deadlifts are fundamentally the same as picking up a heavy tote or a bag of groceries. Not only do we want to move around, but we also want to affect the world around us. Developing physical strength increases an individual’s potential to do just that.

 

Putting it all together

 

If any of these elements are underdeveloped in a particular movement pattern it can lead to a pain alert or awkward compensations. Sometimes eliminating pain is as simple as engaging the transverse abdominis as you flex your hips or externally rotating your arms as you lift up your arm.

When I am working with a client I will use a variety of different techniques depending on what element is compromised. I cue movements that work on good positions with a coordinated onset and release of tension. I use manual techniques to apply pressure, tension, slack or load to movements to support, stabilize and mobilize them. I also use tools like lacrosse balls, lightweights and Therabands to support repatterning new or old movements. If you have any other questions about what a movement rehabilitation session looks like, send us a message or book an appointment!

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