There are certain things in life that you just go through the motions. You have created your own progress for getting things done. You don’t have a written guide or anything, but you know what you’re doing. You just get into your rhythm, and go! Like driving your kids to school everyday, it’s routine, you don’t have to think about it. Sometimes I feel like that when I am working with patients. I have this system that I am using to strategically draw out what is going on in the body that is causing pain. It is almost routine to me! Okay, so maybe the driving to school thing is a bad example because every human body is different and each problem someone has is unique, but if I really simplify the process of what I look at it comes down to 3 things: Mobility, Muscle recruitment, and Strength.
Mobility
Okay, brace yourself for this: I am not a huge fan of stretching. *Gasp* Yes, I know, I said it. Let’s be honest though, you are not going to make your muscles longer by bending over and touching your toes for 10 seconds. It just isn’t going to happen. Nor does it need to happen! You can have normal muscles that are at a certain length, and that is totally okay. Did you know you actually have to hold a muscle in a stretched position for 15 minutes to see any change in tissue length? Are you doing that, because I am not! Not to mention, stretching for that long will actually make the muscle weaker, so is it really worth it? I say no, but you do need to have good mobility. By this I mean your joints need to be able to move unrestricted and independently; your muscles need to be able to slide under your skin and across each other; your nerves and tendons need to be able to slide though their sheaths and between muscles and boney structures without getting caught up, and all of this should be happening without pain.So, if stretching is not going to do the trick what should you do instead? Well, stretching is not necessarily bad. I just don’t want you to have the wrong impression that its purpose is to make your muscles longer. Instead, use your stretch time to explore your body and find out where the end range of your muscles are so that you can utilize all of that range when you are strengthening later. Stretch to create internal heat, which makes the tendons and muscles more pliable and less likely to get injured. When it comes to improving mobility there are a couple of things that I focus on the most: one is joint mobility, the other is trigger points. If your joints are stiff and painful, then you are not going to be able to fully lengthen or strengthen your muscles. Think about it like doing a squat to a chair. If your hips can only move as far down as the chair before they are too stiff, then you are going to be weak below that level because you cannot physically move into that lower range. You need to be able to move in order to use all of the muscle, and you need to be able to use all of the muscle in order to get even stronger. Trigger points {tender actively contracted areas of a muscle that are painful to the touch} can do the same thing by limiting the ability of a muscle to fully lengthen. They can pinch down on nerves causing referral pain and weakness which further limit mobility. For this, I do a lot of dry needling to relax the muscles. Not being able to move does not necessarily stop people, but this is where it gets tricky. In order to keep going, we compensate, which leads to injury and pain.
Cat-Cow is a spine mobility exercise to prepare for core strengthening exercises
2. Muscle Recruitment
This is weird right? Muscle recruitment basically means, knowing how to contract the muscles you are trying to work out, and contracting them in the right order. Stay with me. Your musculoskeletal system is actually a big series of levers and pulleys. Your muscles attach to your bones through tendons. Your bones connect to each other through joints and ligaments. You do not have just one muscle that connects to one bone, but multiple muscles that connect to each bone, pulling at different angles. If your muscle timing is off, then you have a problem. Sometimes this means that the muscles that reach out from your body contract before the muscles that stabilize your joints, which can cause increased friction and compression in those joints. This is where we see meniscus and labral tears. A muscle can contract prematurely and take the brunt of whatever activity you are doing, leading to inflammation in the form of tendonitis or bursitis. With correct muscle timing, the joints spaces will stay open or will be properly stabilized in order to take on the activity you are doing. With correct muscle recruitment, a singular tendon will not be overworked to the point of inflammation, and you will find that you are more efficient at the exercise you are doing. Think about setting up for a lift, or getting in place for a tennis serve. If you do not have the mechanics set from the beginning, then the outcome will not be as successful. You’ll either not be able to complete the lift, or you’ll miss your target with your serve. So it is muscle recruitment.
3. Strength
Now, let’s pull all of this together: making those muscles stronger! If you have good mobility, then you can bring your joints and muscles through their full available range of motion. If you have good muscle timing and recruitment, then you can move without compensatory patterns that cause inflammation. Now, we can properly strengthen the muscles. I will not go on and on about this because this is where it is going to branch off into what you like to do as far as fitness goes, but I do want to cover a couple different things about strengthening.
A muscle voluntarily contracts a couple of different ways. Concentrically, which means the muscle is contracting and shortening like doing a biceps curl, and eccentrically which means it is contracting and elongating, like when you control the weight back down. An eccentric contraction puts more load on a muscle than a concentric muscle contraction, because it is stretching and contracting at the same time. Both kinds of contraction are important and should be trained because in real life situations, we use both! Where many people get stuck at is they only train the muscles a specific way, and then they get over worked, or they do not strengthen though a full range of motion. Take squats for example: if you have hip and knee joints that are healthy and moving properly, you should be strengthening down low into your squat through your full range of motion. By getting your hips sunk down between your ankles, you are going to be able to load up those glutes and really be able to get them stronger, instead of staying shallow and pretty much just working the quads.
So why is strength training so important? There are a lot of good answers to this, but I will just name a couple. One, your muscles have water in them and are one of the most important shock absorbers for your joints. If you aren’t strength training and are having joint pain, ditch the elastic knee brace, ditch the shoes with 5 inches of padding, and get yourself in the gym and lift some weights. Putting bandaid on your problem is only going to prolong the inevitable. Did you know that regular exercise is one of the only things proven, through research, to effectively eliminate chronic low back pain? When done properly, strengthening saves joints, not destroys them. Number two, loading the muscles and bones with weight helps with bone density. Osteoporosis is hereditary people! If your mom has it, your grandma has it, you have it. How do you combat this besides medication? Loading up the muscles. Pressure helps the bone to absorb calcium. This is why, if you have increased friction in an area you can develop bone spurs, like in your shoulder or your foot. Again, done properly strengthening is so good for your skeletal system.
Conclusion
Now that you have a better idea of what to look for, test some of these out on your own. Play around with movement. Do you notice tightness or limitation in your squat? Trying to touch your toes? Trying to push the bar overhead? Do your shoulders hike up to your ears when you reach into the cabinet for a plate? Do you feel weak when you try to reach back to grab that toy that your kid is whacking the other one in the head with? Do you think you are doing that lift right, but you just cannot get past a certain weight? These are all indications that some part of those 3 things is missing.
When I am working with patients, we talk about the problem you are seeing me for to lay down ground work for what I need to further assess. I watch you move so that I can see if you are moving normally or abnormally to determine what tests I need to do to rule diagnoses in or out. Some tests are for specific diagnoses like a rotator cuff tear, impingement, etc, while other tests are to determine the mobility, muscle timing, and strength. All of this together, is how I diagnose the issue, as well as develop the plan of care that you need in order to get better.
I have been posting a series in Instagram to give you some ideas for working on mobility, muscle recruitment, and strength in some of the most problematic areas of the body. See the link below to access the series for yourself. If you know something is off, don’t wait until you get injured! Seek out a professional to diagnose your movement and set you on the right path.
Dr. Ashley Romine, DPT
Owner / Physical Therapist
Athlete’s Mechanic, LLC
Are you struggling with pain that is stopping you from working out? Let’s get to the root of the problem by scheduling an evaluation today!