IOL Strength and Conditioning

by Gray Cook
Excerpted from
Movement: Functional Movement Systems—Screening, Assessment and Corrective Strategies

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—

1. 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.
2. 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.
3. 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.
4. 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.
5. 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.
6. 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.
7. The middle and lower cervical regions have a tendency toward sloppiness and therefore could benefit from greater amounts of stability and motor control.
8. The upper cervical region has a tendency toward stiffness and therefore could benefit from greater amounts of mobility and flexibility.
9. 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.
10. 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.

I was interviewed on this topic after it became popular, and many of my comments regarding the joint-by-joint discussion have been transcribed for you ­here.
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-by­joint 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?

Click here for part two of this three-parter excerpted from Appendix 2 of Gray’s new book, Movement. In that segment, he begins to expand on the joint segments and discusses how he clears the larger joint regions.

What was very likely the most influential concept in physical training in the past five years occurred during a casual conversation between Gray Cook and Michael Boyle. Gray produced the idea, and Michael brought it to the masses. In this excerpt from Michael’s book, Advances in Functional Training, he explains the joint-by-joint concept. Click here for part one of Gray’s expanded explanation, excerpted from his forthcoming book, Movement.
This stuff’s brilliant; we owe these guys a bundle. ~Laree

by Michael Boyle
Excerpted from Advances in Functional Training
Training Techniques for Coaches, Personal Trainers and Athletes

If you are not yet familiar with the joint-by-joint theory, be prepared to take a quantum leap in thought process. My good friend, physical therapist Gray Cook has a gift for simplifying complex topics. In a conversation about the effect of training on the body, Gray produced one of the most lucid ideas I have ever heard.

We were discussing the findings of his Functional Movement Screen (FMS), the needs of the different joints of the body and how the function of the joints relate to training. One beauty of the FMS is it allows us to distinguish between issues of stability and those of mobility; Gray’s thoughts led me to realize the future of training may be a joint-by-joint approach, rather than a movement-based approach.

His analysis of the body is a straightforward one. In his mind, the body is a just a stack of joints. Each joint or series of joints has a specific function and is prone to predictable levels of dysfunction. As a result, each joint has particular training needs.

This joint-by-joint idea has really taken on a life of its own, one I certainly didn’t envision. It seems like everyone’s familiar with it; it’s become so common knowledge people fail to reference Gray Cook or me as the developers of the idea.

The table in the next column looks at the body on a joint-by-joint basis from the bottom up.

The first thing you should notice is the joints alternate between mobility and stability. The ankle needs increased mobility, and the knee needs increased stability. As we move up the body, it becomes apparent the hip needs mobility. And so the process goes up the chain–a basic, alternating series of joints.

Over the past 20 years, we have progressed from the approach of training by body part to a more intelligent approach of training by movement pattern. In fact, the phrase movements, not muscles has almost become an overused one, and frankly, that’s progress. Most good coaches and trainers have given up on the old chest-shoulder-triceps method and moved to push-pull, hip-extend, knee-extend programs.

Still, the movement-not-muscles philosophy probably should have gone a step further. Injuries relate closely to proper joint function, or more appropriately, to joint dysfunction. Problems at one joint usually show up as pain in the joint above or below.

The primary illustration is in the lower back. It’s clear we need core stability, and it’s also obvious many people suffer from back pain. The intriguing part lies in the theory behind low back pain–the new theory of the cause: loss of hip mobility.

Loss of function in the joint below–in the case of the lumbar spine, it’s the hips–seems to affect the joint or joints above. In other words, if the hips can’t move, the lumbar spine will. The problem is the hips are designed for mobility, and the lumbar spine for stability. When the intended mobile joint becomes immobile, the stable joint is forced to move as compensation, becoming less stable and subsequently painful.

The Process is Simple

Lose ankle mobility, get knee pain
Lose hip mobility, get low back pain
Lose thoracic mobility, get neck and shoulder pain, or low back pain

Looking at the body on a joint-by-joint basis beginning with the ankle, this makes sense.

The ankle is a joint that should be mobile and when it becomes immobile, the knee, a joint that should be stable, becomes unstable; the hip is a joint that should be mobile and it becomes immobile, and this works its way up the body. The lumbar spine should be stable; it becomes mobile, and so on, right on up through the chain.

Now take this idea a step further. What’s the primary loss with an injury or with lack of use? Ankles lose mobility; knees lose stability; hips lose mobility. You have to teach your clients and patient these joints have a specific mobility or stability need, and when they’re not using them much or are using them improperly, that immobility is more than likely going to cause a problem elsewhere in the body.

If somebody comes to you with a hip mobility issue–if he or she has lost hip mobility–the complaint will generally be one of low back pain. The person won’t come to you complaining of a hip problem. This is why we suggest looking at the joints above and looking at the joints below, and the fix is usually increasing the mobility of the nearby joint.

These are the results of joint dysfunction: Poor ankle mobility equals knee pain; poor hip mobility equals low back pain; poor T-spine mobility, cervical pain.

An immobile ankle causes the stress of landing to be transferred to the joint above, the knee. In fact, there is a direct connection between the stiffness of the basketball shoe and the amount of taping and bracing that correlates with the high incidence of patella-femoral syndrome in basketball players. Our desire to protect the unstable ankle came with a high cost. We have found many of our athletes with knee pain have corresponding ankle mobility issues. Many times this follows an ankle sprain and subsequent bracing and taping.

The exception to the rule seems to be at the hip. The hip can be both immobile and unstable, resulting in knee pain from the instability–a weak hip will allow internal rotation and adduction of the femur–or back pain from the immobility.

How a joint can be both immobile and unstable is an interesting question.

Weakness of the hip in either flexion or extension causes compensatory action at the lumbar spine, while weakness in abduction, or, more accurately, prevention of adduction, causes stress at the knee.

Poor psoas and iliacus strength or activation will cause patterns of lumbar flexion as a substitute for hip flexion. Poor strength or low activation of the glutes will cause a compensatory extension pattern of the lumbar spine to replace the motion of hip extension.

This fuels a vicious cycle. As the spine moves to compensate for the lack of strength and mobility of the hip, the hip loses more mobility. Lack of strength at the hip leads to immobility, and immobility in turn leads to compensatory motion at the spine. The end result is a kind of conundrum, a joint that needs both strength and mobility in multiple planes.

Your athletes, clients and patients must learn to move from the hips, not from the lumbar spine. Most people with lower back pain or hamstring strains have poor hip or lumbo-pelvic mechanics and as a result must extend or flex the lumbar spine to make up for movement unavailable through the hip.

The lumbar spine is even more interesting. This is clearly a series of joints in need of stability, as evidenced by all the research in the area of core stability. The biggest mistake we have made in training over the last 10 years is an active attempt to increase the static and active range of motion of an area that re-quires stability.

Most, if not all, of the many rotary exercises done for the lumbar spine were misdirected. Physical therapist Shirley Sahrmann in Diagnosis and Treatment of Movement Impairment Syndromes and James Porterfield and Carl DeRosa in Mechanical Low Back Pain: Perspectives in Functional Anatomy all indicate attempting to increase lumbar spine range of motion is not recommended and is potentially dangerous. Our lack of understanding of thoracic mobility caused us to try to gain lumbar rotary range of motion, and this was a huge mistake.

The thoracic spine is the area about which we know the least. Many physical therapists recommend increasing thoracic mobility, though few have exercises designed specifically for it. The approach seems to be “We know you need it, but we’re not sure how to get it.” Over the next few years, we will see an increase in exercises designed to increase thoracic mobility. A leader in the field, Sahrmann was early to advocate the development of thoracic mobility and the limitation of lumbar mobility.

The gleno-humeral joint is similar to the hip. The gleno-humeral joint is designed for mobility and therefore needs to be trained for stability. The need for stability in the gleno-humeral joint presents a great case for exercises like stability ball and BOSU pushups, as well as unilateral dumbbell work.

In the book Ultra-Prevention, a nutrition book, authors Mark Hyman and Mark Liponis describe our current method of reaction to injury perfectly. Their analogy is simple: Our response to injury is like hearing the smoke detector go off and running to pull out the battery. The pain, like the sound, is a warning of some other problem. Icing a sore knee without examining the ankle or hip is like pulling the battery out of the smoke detector. The relief is short-lived.

by Mike Nichols, MD

Dr. Mike Nichols has been a friend and advisor since the late 1980s. We trust him with our lives… literally. I’ve done heart-rate training since the mid-’90s, but had not heard of some of his markers, and asked for permission to reprint this article from his site, WhenYouAreSerious.com. When you finish reading, click on over to his site to read the next four segments, and be sure to listen to the video lectures. Then subscribe to the updates (right sidebar subscription box) so you’ll get an email notice of his new articles. Each one leaves me pondering, considering changes I need to make, and they’ll do that to you, too. ~Laree

Warning: Be sure your heart is ready for serious training!

I’ve had the good fortune to train some very fine athletes—national and international class across several different sports. You will also know that my doctor’s heart is given to those who are ill, sick with diabetes, coronary artery disease and the like.

Those who were at Tempus Clinic will remember the fuss we made of getting your heart rate data downloaded and studied. As I’ve lately been working directly as a trainer with patients and not just the jocks, I’ve realized afresh how much information I derive from heart rate-based training as a guide to healthy training. I knew it. but had not lately, so directly, so intimately, seen how important the information can be.

Let me initiate you into the Polar Priesthood! Of course, the monitor need not be Polar; any will do, however you should have a way to download and examine each workout.

When examining your heart rate profile download, look for these basics:

• How tightly does the heart rate profile map onto the actual work done?

• Is there an overshoot at cessation of exercise; does the heart rate come down immediately or seconds later?

• Is there a shoulder just off-peak where the heart rate ‘hangs’ for some period of time? Peaked at 170, and then stuck at 145 for 15 seconds for example?

• How long is the tail of elevated heart rate after you have completed the workout? For example, you started with a resting heart rate of 60, had a good shark-tooth workout with ascending mean heart rate throughout, and then your heart rate stayed at 110 for 12 minutes after the workout.

To understand what each of these means, let me tell you that a rested, well-trained heart in a healthy young athlete has no overshoot, shoulders or tails, and his heart rate maps very tightly onto the actual work load.

Each of these very visible shapes to the heart rate profile as a graph has specific information about your heart, your sympathetic and parasympathetic tone, your underlying metabolism, how well you slept the night before the workout and how well and what you have been eating. Maybe of more immediate concern, this kind of information can point directly at various kinds of heart disease. Notice that last part; important clues to heart disease can be found here as well.

To unpack each issue revealed in your heart rate profile would take a book. Short of that, begin to familiarize yourself more with your heart rate response to exercise. Know that this is one of the more important feedback loops to help track your health and your training.

Click on over to Mike’s site for part two, part three, part four & part five.