Showing posts with label ck-fms. Show all posts
Showing posts with label ck-fms. Show all posts
Sunday, August 1, 2010
Bendy bits should bend in full range of motion, speed and control, right? So what's this mobility/stability dichotomy?
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Mobility/Stability. I confess i don't get what's meant or how this increasingly popular distinction between mobility and stability came to be seen as useful. I'm prepared to believe it's my problem, and sometimes as writing helps me work out such issues, forgive me while i lay out where the gaps seem to be in my understanding of the framing of movement as mobility/stability rather than simply a notion of movement, and ability to control ranges of motion at ranges of speed.
Here we go: Of late i've seen a number of intelligent people assert with what seems like good reasons that some joints are seemingly a priori meant to be "stable" while others are meant to be "mobile." Consider the fist article in this set kicked off by Mike Boyle, a well respected and established trainer, called A Joint by Joint Approach to Training. In this pieces, and many related articles, work by Stuart McGill on the low back is cited: in particular, McGill's findings that flexion is the root of most low back evils, and that sitting is the worst place to be of all. This is pretty compelling stuff. Seems to make sense.
But then there are seeming contradictions within this: in his discussion of the knees, not the back, Boyle sites McGill's reason for low back pain that it isn't perhaps so *much* flexion, but overuse. When other stuff - like the hips - get stuck, the back pays. So in that sense - the lumbar spine and knees should be stable, but the hips should be mobile?
The problem i find in this is that the arguments seem to suggest that pretty much all the time the lower spine should be stiffened up and the thoracic spine and hips loosened up - for instance. Mike Boyle goes so far as to ask "is spinal rotation even a good idea" He quotes a lot of work by a physical therapist name of Shirely Sharman who in her view suggests that the abs are there to stop so much rotation of the lumbar spine then that's what they should be doing. Boyle's issue seems to be that too many trainers concentrate on lumbar stretching when, citing Sharman "rotation is even dangerous" at the lower spine. He points to sprinter coach Bob Ross who did isometric work with his spinters in the abs, abandoning other forms of spinal movement work and how that was a positive thing for results.
Ok, but what do most sprinters do? Run. In pretty much straight lines. So maybe holding the spine in line and upright for 10-30secs is a good idea. In that case. That particular sport-specific constraint doesn't come up.
Rather, Boyle says he's chucked a lot of exercises designed to extend trunk range and seems to find less complaints of low back pain in clients since doing so. And that's cool. I'm not sure, however, that that means that that work has made his client's backs more stable - it just may mean that stretching a body part beyond its comfortable range of motion is painful or causes neuroligical shut down by pushing inappropriately, and that stopping doing something that hurts will reduce pain?
In other words, i'm just not sure that eliminating a set of kind of questionable stretches is therefore "decreasing mobility" or "increasing stability" - it may just be avoiding inducing threat.
And as for rotational work, surely the lack of it is one of the greatest weakness of most of us who train especially or exclusively at lifting heavy things? We tend to stick to pretty a given plane of motion for a movement, and forget about diagonal and especially rotational movements.
One of the funest ab exercises is surely the russian twist (seated) or the Full Contact Twist with the bar stuck in the corner on the floor and the other end in the athlete's hands, arms extended, arc'ing back and forth?
Pavel Tsatsouline writes of the FCT in Bullet Proof Abs:
So for truly "functional" movement, isn't it better to train strength in rotation, as well as across a range of movement planes? In other words, why not focus on building strength across the entire range of motion of the joints so that we can be - as pavel puts it - bulletproof? And that bulletproofness seems to mean being able to rotate, bend and recover as needed - and as the joints give us the degrees of freedom to accomplish that movement?
The Kneee/ACL injury- not about stability or mobility? The ACL (and MCL) are the ligaments most often torn (or pop) in knee injuries. One might say that that's because the knees are not stable enough. Indeed, again Mike Boyle tends to make this case in his Joint by Joint article. But he also seems to move away from actually saying the knee needs stability by deeking out to say the problem is that the knees pay for lack of hip mobility. I'm not sure what the bottom line is here? He digresses into back pain rather than a discussion of the knee.
Gray Cook comes in to help in his Expanding on the Joint-by-Joint approach saying,
I'm not making a joke here or being sarcastic. I'm really not sure what "the knees have a tendency towards slopiness" means in terms of real movement. All those ligaments are actually loose? Or does that mean one's leg muscles in say a squat aren't firing so the knee comes in (the Valgus knee). That's not really a knee issue though, is it? That's poor form such that the person hasn't been taught to work a better squat pattern, or hasn't worked on what may be inhibiting a good squat movement? And so they're putting strain on their knees by failing to keep good position. Too much load, and absolutely perhaps issues in the ankle and hip and upper back that need to be addressed.
But i'm not really thinking about such a static movement as the squat. Really I'm thinking of the mighty number of girls who have ACL injuries in sports in the states these days. One theory (gathering momentum) has it that the girls who have ACL injuries showing up in basketball don't have a way to balance their increasingly higher (as going through puberty) center of balance. Intriguingly, the comments from the researchers is not to increase strength training (for more core or knee stability) but to increase their prorioceptive (body awareness) training.
The suggestion is not unlike studies on sensory-motor balance training with athletes to see if progressive balance work could help reduce ankle injury - another common problem for field and track athletes. They found that, effectively, progressively training for the sprain through this program helped the nervous system not go into panic, and predicted injuries would be less.
To take a lessen from martial arts as well where one practices for the fall pretty regularly, how much attention is given to working with an athlete on end range of motion work - not just balance work but what might be loaded balance work at the place where we rarely go in our training - that end range where recovery from a sudden lapse or accident is hard and where injuries occur? Is that augmenting mobility, stability or does it matter?
I go back to Boyle and Cook on the knees and back to their facesaying that these joints tend towards slopiness, and yet McGill (quoted by Boyle) saying no no, the low back in people with pain have stronger extensors than those without. So there's a lot of muscular strength around the low back already. The spine is *not* weak here (and by extension, one would say not sloppy if so much strength can be turned on?)
What's Going On? Where is this taking me? I'm hoping that Gray Cook's new book Movement will anser a lot of these queries. I'm looking forward to getting it, because right now the mobility/stability dialectic seems more problematic than helpful - at least to me. Here's why - and here's where i struggle with this as a model.
All the joints in the body have a pretty much well-scoped ranges of motion, right down to what the usual degres of movement are in each one. So why not simply be able to move all of these joints in these ranges of motion with strength and control as demanded by whatever that movement is - especially at the most vulnerable end ranges of motion?
Movement vs Mobility/Stability? Why not talk, therefore, just about "movement" (as Cook's book title suggests) rather than "mobility/stability." Is the question not really can one, for instance, hold a position for one particular movement or relax it for another? The knee needs not only to support the hinge with strength and power in say a basketball jump shot, but also needs to support the roll in with equal aplomb from standing to the ground - either when making a lunging tennis shot, or losing one's footing on a football pitch or simply getting pushed or in a fight getting from standing to knees to grapple quickly?
Perhaps there's an historical context i'm missing - Boyle talks alot about the "last decade" with too much stretching going on in the trunk and so life got too caught up on flexibility? Dunno, as i own i missed that part of the discussion not being in the space at that time. But maybe that's not it, either, as Paul Chek's Movement that Matters
and his "primal patterns" seems to have been in play since at least 1999 (ie the last decade, plus), and that is likewise focused i think on movements?
Mobile when? Stable when? But again, i'm not claiming expertise of that period - it's a genuine question - it's just that i can't find the value add in framing our bodies as there's supposed to be stability here and mobility there, and if we get this thing more stable and that thing more mobile (implicit seems to be "all the time") then everything is Functional. Mobile when? Stable when? Are we talking averages? That on average of all possible movements, these joints are more often than not needing to be stable rather than mobile? And so we need to train for the average use case, rather than the range of uses?
Can you see why i'm a wee bit flustered? It's not a dichotomy that helps me when i'm working with clients to talk about stability or mobility because i guess i'm not sure what they really mean when put in operation. Our model reflects our practice, i guess, and i'm struggling with the mobility/flexibility as a model.
For me, mobility seems pretty good on it's own: mobility is the ability to voluntarily and actively control a given range of motion. For me, in my practice, it seems pretty important simply that we be able to control that movement through all ranges of motion, and all speeds, equally. If folks have restricted ankle mobility, not only does that potentially need to be opened up but strengthened as well. Strength and ROM seem to work together.
It then seems pretty important that if there's a gap somewhere we have the tools to be able to help find a way to address that weakness. And as Cook also notes, since the site of an issue is not necessarily the source of the issue, the source of a weakness may be, as we've seen above, proprioceptive rather than musclo-skeletal, too. In other words, mobility and enhancing control of mobility seems sufficiently descriptive of the kinesthetic. And beyond this, if we do accept the site is not the source of an issue necessarily, it seems we need to take into account whatever other systems may be operating on us. From somato-sensory, to affect, to nutrition to, anything that plays on the 11 organ systems in our body.
For a bit of context, beyond the CSCS, RKC and Z-Health Certifications, i hold both the FMS qualification and the CK-FMS certification. One has to pass the FMS exam before getting to the CK-FMS quals. It's a fascinating course, and i'm looking forward to doing it again this fall because Gray Cook is teaching it with Brett Jones, and i'm sure two years after taking it initially, it will have evolved, and i certainly know a bit more than i did then, and Gray Cook has a lot of cool things to say. I am keen to learn more about this physiological piece. I confess anatomy is, to use Cook's phrasing again, the weaker link in my chain.
So i recognize i would benefit by being more au fait with kinesiology/physiology (hence more recent posts exploring things like the amazing shoulder, and kinesiology books used to assist practice with willing folk).
This article is not meant as a criticism of Boyle or Cook. I'm just saying, right now, i'm not grokking the mob/stab distinction. It seems to me both too extreme - these joints need to be mobile; these stable - and too unspecific - generally? specifically? Now maybe we're both saying the same things: have full range of motion and be strong in all ranges of motion and so be able to control all ranges of motion at all speeds. That would be cool. Then again, i'd say why not just say that? Since mob/stab can start to be heard as prescriptions: the thoracic spine MUST be mobile the lumbar spine MUST be stable.
I'm also saying that i agree with neurologists who talk about the somato-sensory system, and how that's just as improtant to be integrated into any discussion of movement, too.
So, as said, i'm perfectly prepared at this point to believe that the misapprehension is mine. That we are all on the same page. Just putting out there where i'm struggling. Perhaps some of y'all can relate, or have passed through this vale and come to a conclusion on the other side with more knowledge and insight. Look forward to meeting you there.
Best,
mc Tweet Follow @begin2dig
Here we go: Of late i've seen a number of intelligent people assert with what seems like good reasons that some joints are seemingly a priori meant to be "stable" while others are meant to be "mobile." Consider the fist article in this set kicked off by Mike Boyle, a well respected and established trainer, called A Joint by Joint Approach to Training. In this pieces, and many related articles, work by Stuart McGill on the low back is cited: in particular, McGill's findings that flexion is the root of most low back evils, and that sitting is the worst place to be of all. This is pretty compelling stuff. Seems to make sense.
But then there are seeming contradictions within this: in his discussion of the knees, not the back, Boyle sites McGill's reason for low back pain that it isn't perhaps so *much* flexion, but overuse. When other stuff - like the hips - get stuck, the back pays. So in that sense - the lumbar spine and knees should be stable, but the hips should be mobile?
The problem i find in this is that the arguments seem to suggest that pretty much all the time the lower spine should be stiffened up and the thoracic spine and hips loosened up - for instance. Mike Boyle goes so far as to ask "is spinal rotation even a good idea" He quotes a lot of work by a physical therapist name of Shirely Sharman who in her view suggests that the abs are there to stop so much rotation of the lumbar spine then that's what they should be doing. Boyle's issue seems to be that too many trainers concentrate on lumbar stretching when, citing Sharman "rotation is even dangerous" at the lower spine. He points to sprinter coach Bob Ross who did isometric work with his spinters in the abs, abandoning other forms of spinal movement work and how that was a positive thing for results.
Ok, but what do most sprinters do? Run. In pretty much straight lines. So maybe holding the spine in line and upright for 10-30secs is a good idea. In that case. That particular sport-specific constraint doesn't come up.
Rather, Boyle says he's chucked a lot of exercises designed to extend trunk range and seems to find less complaints of low back pain in clients since doing so. And that's cool. I'm not sure, however, that that means that that work has made his client's backs more stable - it just may mean that stretching a body part beyond its comfortable range of motion is painful or causes neuroligical shut down by pushing inappropriately, and that stopping doing something that hurts will reduce pain?
In other words, i'm just not sure that eliminating a set of kind of questionable stretches is therefore "decreasing mobility" or "increasing stability" - it may just be avoiding inducing threat.
And as for rotational work, surely the lack of it is one of the greatest weakness of most of us who train especially or exclusively at lifting heavy things? We tend to stick to pretty a given plane of motion for a movement, and forget about diagonal and especially rotational movements.
 |
| Pavel Tsatsouline demonstrating the Full Contact Twist in Bullet Proof Abs |
Pavel Tsatsouline writes of the FCT in Bullet Proof Abs:
The best exercise for transferring the hip power into the shoulder, with a high interest yield, is the Full Contact Twist. This exercise was originally developed in the Soviet Union for shot put conditioning.
The then-nameless twist came to kickboxers' attention when a famous Russian shot putter failed to talk his way out of a mugging. This mild mannered man got annoyed when one of the attackers cut him with a blade. He ruptured the punk's spleen with a single punch.
Igor Sukhotsky, M.Sc., formerly a nationally ranked weightlifter and an eccentric sports scientist who took up full contact karate at the age of fort-five, popularized the twist among Russian fighters. This renaissance man noticed that the twist not only had increased his striking power, but also had toughened his midsection against blows by toning it up. Sukhotsky was so impressed with the Full Contact Twist, that he added it to his super abbreviated strength trainingIt's interesting that Sukhotsky came to the value of rotation - moving across planes of motion - in moving from a more linear sport of weighlifting to the more richly plane-crossing Karate. It's also intriguing that it is a life event - a mugging - that fostered interest in this movement.
routine which consisted of only four exercises: squats, bench presses, deadlifts,
and good mornings.
So for truly "functional" movement, isn't it better to train strength in rotation, as well as across a range of movement planes? In other words, why not focus on building strength across the entire range of motion of the joints so that we can be - as pavel puts it - bulletproof? And that bulletproofness seems to mean being able to rotate, bend and recover as needed - and as the joints give us the degrees of freedom to accomplish that movement?
The Kneee/ACL injury- not about stability or mobility? The ACL (and MCL) are the ligaments most often torn (or pop) in knee injuries. One might say that that's because the knees are not stable enough. Indeed, again Mike Boyle tends to make this case in his Joint by Joint article. But he also seems to move away from actually saying the knee needs stability by deeking out to say the problem is that the knees pay for lack of hip mobility. I'm not sure what the bottom line is here? He digresses into back pain rather than a discussion of the knee.
Gray Cook comes in to help in his Expanding on the Joint-by-Joint approach saying,
"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."He also states
Knees are simple hinge joints. They’re supposed to flex and extend, and when they rotate too much or move valgus or varus too much, we start seeing problems with the knee. Does the knee need to be mobile? Yes, but once it’s mobile, it needs to be stable enough to stay inside the proper plane of movement where its functional attributes are possible and practical.Now Gray Cook is a knowledable phyiscal therapist who knows a lot about movement and how joints operate. He's also worked with a ton o' athletes and helped them restore function when others were ready to cut them open and write them off. So it's with respect that i wonder what's meant by 'mobility" with a "simple hinge joint"? What does a stable knee joint mean? That the femur stays attached to the tib/fib bones on the minisci? That it doesn't slide off to one side when it goes to bend? What?
I'm not making a joke here or being sarcastic. I'm really not sure what "the knees have a tendency towards slopiness" means in terms of real movement. All those ligaments are actually loose? Or does that mean one's leg muscles in say a squat aren't firing so the knee comes in (the Valgus knee). That's not really a knee issue though, is it? That's poor form such that the person hasn't been taught to work a better squat pattern, or hasn't worked on what may be inhibiting a good squat movement? And so they're putting strain on their knees by failing to keep good position. Too much load, and absolutely perhaps issues in the ankle and hip and upper back that need to be addressed.
To take a lessen from martial arts as well where one practices for the fall pretty regularly, how much attention is given to working with an athlete on end range of motion work - not just balance work but what might be loaded balance work at the place where we rarely go in our training - that end range where recovery from a sudden lapse or accident is hard and where injuries occur? Is that augmenting mobility, stability or does it matter?
I go back to Boyle and Cook on the knees and back to their facesaying that these joints tend towards slopiness, and yet McGill (quoted by Boyle) saying no no, the low back in people with pain have stronger extensors than those without. So there's a lot of muscular strength around the low back already. The spine is *not* weak here (and by extension, one would say not sloppy if so much strength can be turned on?)
What's Going On? Where is this taking me? I'm hoping that Gray Cook's new book Movement will anser a lot of these queries. I'm looking forward to getting it, because right now the mobility/stability dialectic seems more problematic than helpful - at least to me. Here's why - and here's where i struggle with this as a model.
All the joints in the body have a pretty much well-scoped ranges of motion, right down to what the usual degres of movement are in each one. So why not simply be able to move all of these joints in these ranges of motion with strength and control as demanded by whatever that movement is - especially at the most vulnerable end ranges of motion?
Movement vs Mobility/Stability? Why not talk, therefore, just about "movement" (as Cook's book title suggests) rather than "mobility/stability." Is the question not really can one, for instance, hold a position for one particular movement or relax it for another? The knee needs not only to support the hinge with strength and power in say a basketball jump shot, but also needs to support the roll in with equal aplomb from standing to the ground - either when making a lunging tennis shot, or losing one's footing on a football pitch or simply getting pushed or in a fight getting from standing to knees to grapple quickly?
Perhaps there's an historical context i'm missing - Boyle talks alot about the "last decade" with too much stretching going on in the trunk and so life got too caught up on flexibility? Dunno, as i own i missed that part of the discussion not being in the space at that time. But maybe that's not it, either, as Paul Chek's Movement that Matters
and his "primal patterns" seems to have been in play since at least 1999 (ie the last decade, plus), and that is likewise focused i think on movements?Mobile when? Stable when? But again, i'm not claiming expertise of that period - it's a genuine question - it's just that i can't find the value add in framing our bodies as there's supposed to be stability here and mobility there, and if we get this thing more stable and that thing more mobile (implicit seems to be "all the time") then everything is Functional. Mobile when? Stable when? Are we talking averages? That on average of all possible movements, these joints are more often than not needing to be stable rather than mobile? And so we need to train for the average use case, rather than the range of uses?
Can you see why i'm a wee bit flustered? It's not a dichotomy that helps me when i'm working with clients to talk about stability or mobility because i guess i'm not sure what they really mean when put in operation. Our model reflects our practice, i guess, and i'm struggling with the mobility/flexibility as a model.
For me, mobility seems pretty good on it's own: mobility is the ability to voluntarily and actively control a given range of motion. For me, in my practice, it seems pretty important simply that we be able to control that movement through all ranges of motion, and all speeds, equally. If folks have restricted ankle mobility, not only does that potentially need to be opened up but strengthened as well. Strength and ROM seem to work together.
It then seems pretty important that if there's a gap somewhere we have the tools to be able to help find a way to address that weakness. And as Cook also notes, since the site of an issue is not necessarily the source of the issue, the source of a weakness may be, as we've seen above, proprioceptive rather than musclo-skeletal, too. In other words, mobility and enhancing control of mobility seems sufficiently descriptive of the kinesthetic. And beyond this, if we do accept the site is not the source of an issue necessarily, it seems we need to take into account whatever other systems may be operating on us. From somato-sensory, to affect, to nutrition to, anything that plays on the 11 organ systems in our body.
For a bit of context, beyond the CSCS, RKC and Z-Health Certifications, i hold both the FMS qualification and the CK-FMS certification. One has to pass the FMS exam before getting to the CK-FMS quals. It's a fascinating course, and i'm looking forward to doing it again this fall because Gray Cook is teaching it with Brett Jones, and i'm sure two years after taking it initially, it will have evolved, and i certainly know a bit more than i did then, and Gray Cook has a lot of cool things to say. I am keen to learn more about this physiological piece. I confess anatomy is, to use Cook's phrasing again, the weaker link in my chain.
So i recognize i would benefit by being more au fait with kinesiology/physiology (hence more recent posts exploring things like the amazing shoulder, and kinesiology books used to assist practice with willing folk).
This article is not meant as a criticism of Boyle or Cook. I'm just saying, right now, i'm not grokking the mob/stab distinction. It seems to me both too extreme - these joints need to be mobile; these stable - and too unspecific - generally? specifically? Now maybe we're both saying the same things: have full range of motion and be strong in all ranges of motion and so be able to control all ranges of motion at all speeds. That would be cool. Then again, i'd say why not just say that? Since mob/stab can start to be heard as prescriptions: the thoracic spine MUST be mobile the lumbar spine MUST be stable.
I'm also saying that i agree with neurologists who talk about the somato-sensory system, and how that's just as improtant to be integrated into any discussion of movement, too.
So, as said, i'm perfectly prepared at this point to believe that the misapprehension is mine. That we are all on the same page. Just putting out there where i'm struggling. Perhaps some of y'all can relate, or have passed through this vale and come to a conclusion on the other side with more knowledge and insight. Look forward to meeting you there.
Best,
mc Tweet Follow @begin2dig
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Friday, May 7, 2010
Muscle Cramps in Calves when Running in Vibram FiveFingers: what is it, what causes it and what can be done about it?
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Runners Cramp - Calves cramping - it's AWFUL. In talking with folks who run in VFF's it seems that one usual side effect initially at least is that, when picking up the pace in VFF's (perhaps especially up hill), calves may start to cramp up. Guaranteed, if we keep going with this run, once that cramp starts, the calf or calves will turn to unyielding, painful rock. What can be surprising is how quickly into a run this seize up can happen. What the heck is going on, and what might help stop it from happening.
There could be lots going on, so i'm not trying to be comprehensive and exhaustive - not sure that's possible. The goal of this post is to look at pain generally, muscle cramps in particular and what's hypothesised about causes, introduce a newer model not seen in web discussions of cramp, and propose a refinement for that model. Finally, some practical suggestions of getting out of that cramp while heading to barefoot running freedom.
Pain is a signal for Change
Based on work in pain, and as summarized in work by David Butler like the plain language Explain 
Pain
, pain is a signal for change; pain does not necessarily, however, equal injury, and the site of pain is not always the source of pain; treating the site of pain therefore can be a losing proposition.
I've used the analogy of a car oil gauge regularly reading low. One solution is to top up the oil in the engine so that the gauge reads the right level. That level will only last short term and needs to be repeated regularly - and in the interim, what related problems might be developing from such regular loses?
Another solution is to do a diagnostic to find out what else might be going on - like a leak in the engine block where actually a bolt may simply need to be tightened (or an entire gasket in the block replaced - can you tell i'm having flashbacks of stripping the head of an engine in the middle of the bush on an old carola. never mind; i digress). The point is, getting away from site = source often leads to better results.
In the car analogy, finding a more fundamental issue, performing a wee tweak and testing if that tweak will work means that the oil level stays where it's supposed to be for as long as it's supposed to be there. Both approaches are a kind of solution; the benefits on the system and the wallet are better in the latter case.
What's a Cramp in the Calves Anyway?
So taking the above pain thesis into account, what does this mean for the calves rock effect?
What's a Cramp? A cramp is an involuntary and intense contraction of a muscle. What causes a cramp is a subject of much discussion, and poorly understood. A quick check on the web doesn't get at too much about why this contraction occurs.
WHy a cramp? The usual checks: electrolytes, hydration, low carbs, tight muscles to begin with are offered up not as reasons, but of things somehow thought to be related to cramping. Here's an examplary summary of that kind. In this model, the thesis seems to go, the muscles don't have the chemical materials needed to fire in that working limb properly so they effectively rigor mortis up. This rationale for cramp has been more or less tossed out as demonstrated here in 04, and as summarised in this recent BMJ review article. First, on dehydration:
Here's another view of cramps by Luke Hoffman that could be written for VFF runners:
The above describes what might be called "voluntary contraction" - not quite the same as involuntary. If we take the above council about voluntary cramps to bear, however, what should be the case is once a cramp starts, we should stretch it out, and wait for the fatigue to pass from that contraction, and recover, and really stop doing what we were doing - running on the forefoot. Consequently, Pose & VFF runners who run on the forefoot should be cramping all the time. And if we believe work in barefoot running, this is rather how we're designed to run. So, hmm, maybe not.
None of these explanations therefore is complete it seems, to explain cramping we see in the calves that comes on unexpectedly, as lots of well fed, well hydrtated, well electolyted people who stretch still get cramps, and these weird cramps in VFF's in particular.
So why does this cramp only happen *some* of the time - especially if all the typical niceities of cramp avoidance are observed? For me, for instance, it happened first when i started practicing actually bringing the heel of the foot down more (extending the calf) when running, rather than staying up on the forefoot. So, maybe it's not (entirely) about the calves?
Altered Neuromuscular Control. In the research one of the explanations around cramp is: maybe the muscle is just not strong enough to do what is being asked of it, for the duration it's being asked to operate at this level - hence fatiguing - and it's that fatigue that is setting up EAMC: exercise-associated muscle cramping. This hypothesis, also known as "altered neuromuscular control" was first proposed in 1996, so that's how new this stuff is. A key part of this model is that the neuromuscular control issue is located in the SPINE, not at the site of the issue - the site is paying for what's going on at the source.
So in the Pain as Signal to Change perspective, cramps are painful; they are a signal to change. The altered neuromuscular control model suggests, stretch it out and recover. Related work suggests, improve strength/stamina to reduce fatigue and reduce this muscle cramp response. Both have in common that fatigue is causing neural level loss of appropriate control.
Wildly Hypothesising? What's going on when this particular response occurs well before one would think a muscle used to running for miles and miles starts to go all crampy?
In
work pionered by LeDoux in the nineties
, he showed that the brain processes emotional responses like fear/threat without the conscious brain being involved. It happens fast, at a low level, without cognitive involvement and has immediate chemical consequences in the system (nice review of this and related work here by Ohman, 2005). In other words, perhaps there's some other *thing* happening in the sensory-motor exerperience that is saying "not good" and the result is this fatigue-like chemical messaging system that sets off early light cramp signals - that if ignored will just get louder until one is forced to change patterns.
In Z-Health, Eric Cobb translates this fear response into the nervous system's job to perceive threat or no threat: if there's a perception of threat, the system starts to shut down (example in arthrokinetic reflex). What might be the threat ocuring in VFF ocaisional calve cramping? The system may be literally putting on the breaks to what it perceives as a threatening to it's well being practice.
It's easy to see that if the nervous system perceives that the task - going at a particular speed in a particular way - is causing part of the system to be over-taxed, it's going to respond to that as a threat or non-optimal situation, and if it takes pain to get change, well, whatever it takes.
Personal Experience. Taking a Z-Health approach to this experience, i think i've learned to become more alert to any pain signal my bod sends up in an athletic effort. So in this case, if and when these cramps begin, they usually start with a very mild "uh oh" twinge of "about to turn to rock if you don't respond."
There are two simple things that z-health suggests for rehabbing a movement with the cue of "never move into pain:"
Guided by the Nose: run to pace inhalation. Another technique i've been using and coaching to help head off cramps and adapt to barefooting generally is to explore gaiting running speed with ability to stay breathing in through one's nose. If running at a clip where i have to mouth breath, i slow it down (i find if i hit that level, it's pretty hard to get it back to nose inhaling). This approach is just one way at least some of the time to practice running reps quality rather than overdriving the other parts of the system.
Deeper Tune Up: Starting from the Source
So we've seen one theory in the research is around muscular fatigue inducing EAMC; getting stronger in those areas where muscles cramped seemed to help. In one study. That's great. Another possibility - that can lead to faster fatigue - is if there's some kind of issue in one's movement that is causing perhaps other muscles to compensate for other weaknesses, and causing fatigue/pain/signaling in the calves faster that should happen for that group. So while a solution may be to do extra strength work, maybe a faster solution may actually be to look at one's movement as a whole.
In other words, the calves may be plenty strong IF everything else is firing up appropriately, but they may be being asked to super compenate for other stuff, that if those other movement issues were addressed, wouldn't cause the problem.
There's value therefore in (a) having a movement assessment and (b) practicing dynamic joint mobility and sensory-motor work to ensure great movement, and ability to maintain great, clean movement.
Summary: Avoiding Running Cramps in VFF's
Based on the latest research, EAMC cramps are about temporary loss of clear neuromuscular control. The best model so far to explain this effect is fatigue. A known way to work out a cramp is to lengthen the muscle. There may however be other approaches that just haven't been researched that also seem to work. The hypothesis here is that these approaches are dealing with neurological signaling, too, taking advantage of the sensory-motor system.
Some pragmatic responses therefore if cramp occurs are:
During a Run: Assuming one is not dehydrated, de-electrolyted, or have squirrels biting their calves while running,
And before That
Consider a movement assessment to check for what Gray Cook calls "weak links" so as not to build strength on top of dysfunction.
Let me know what works for you.
Citations
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Runners Cramp - Calves cramping - it's AWFUL. In talking with folks who run in VFF's it seems that one usual side effect initially at least is that, when picking up the pace in VFF's (perhaps especially up hill), calves may start to cramp up. Guaranteed, if we keep going with this run, once that cramp starts, the calf or calves will turn to unyielding, painful rock. What can be surprising is how quickly into a run this seize up can happen. What the heck is going on, and what might help stop it from happening.
There could be lots going on, so i'm not trying to be comprehensive and exhaustive - not sure that's possible. The goal of this post is to look at pain generally, muscle cramps in particular and what's hypothesised about causes, introduce a newer model not seen in web discussions of cramp, and propose a refinement for that model. Finally, some practical suggestions of getting out of that cramp while heading to barefoot running freedom.
Pain is a signal for Change
Based on work in pain, and as summarized in work by David Butler like the plain language Explain Pain, pain is a signal for change; pain does not necessarily, however, equal injury, and the site of pain is not always the source of pain; treating the site of pain therefore can be a losing proposition.I've used the analogy of a car oil gauge regularly reading low. One solution is to top up the oil in the engine so that the gauge reads the right level. That level will only last short term and needs to be repeated regularly - and in the interim, what related problems might be developing from such regular loses?
Another solution is to do a diagnostic to find out what else might be going on - like a leak in the engine block where actually a bolt may simply need to be tightened (or an entire gasket in the block replaced - can you tell i'm having flashbacks of stripping the head of an engine in the middle of the bush on an old carola. never mind; i digress). The point is, getting away from site = source often leads to better results.
In the car analogy, finding a more fundamental issue, performing a wee tweak and testing if that tweak will work means that the oil level stays where it's supposed to be for as long as it's supposed to be there. Both approaches are a kind of solution; the benefits on the system and the wallet are better in the latter case.
What's a Cramp in the Calves Anyway?
What's a Cramp? A cramp is an involuntary and intense contraction of a muscle. What causes a cramp is a subject of much discussion, and poorly understood. A quick check on the web doesn't get at too much about why this contraction occurs.
WHy a cramp? The usual checks: electrolytes, hydration, low carbs, tight muscles to begin with are offered up not as reasons, but of things somehow thought to be related to cramping. Here's an examplary summary of that kind. In this model, the thesis seems to go, the muscles don't have the chemical materials needed to fire in that working limb properly so they effectively rigor mortis up. This rationale for cramp has been more or less tossed out as demonstrated here in 04, and as summarised in this recent BMJ review article. First, on dehydration:
A careful review of the literature did not identify a single published scientific study showing that athletes with acute EAMC are more dehydrated that control athletes (athletes of the same gender, competing in the same race with similar race finishing times). In contrast, there is evidence from four prospective cohort studies showing that dehydration is not associated with EAMC.And on electrolytes (and dehydration):
In summary, dehydration and electrolyte depletion are often considered together (and recently together with muscle fatigue) as the ‘‘triad’’ causing EAMC. The key components of this hypothesis (fig 1) are that electrolyte (mainly sodium) depletion through excessive sweat sodium loss together with dehydration causes EAMC. However, results from prospective cohort studies consistently show that athletes suffering from acute EAMC are not dehydrated, neither do they have disturbances in serum osmolality or serum electrolyte (notably sodium) concentrations. Furthermore, sweat sodium concentrations measured during exercise in 23 reported cases with a past history of EAMC are not higher than those reported in many other studies. Both electrolyte depletion and dehydration are systemic abnormalities, and therefore would result in systemic symptoms, as has been observed in other clinical conditions. However, in EAMC, the symptoms classically are local and are confined to the working muscle groups. Thus, the available evidence to date does not support the hypotheses that electrolyte depletion or dehydration cause EAMC — therefore an alternate hypothesis for the aetiology of EAMC has to be considered.And here's another typical "it's because you didn't stretch right" response - but you'll note the article doesn't raelly say *why* stretching prior to running does or does not do anything for cramp reduction. Indeed, when it comes to running and stretching, the current scene seems to suggest that a stretching program - not necessarily something done prior to running, but just putting this into one's routine - helps running mechanics. That's different. And has nothing to do with a pre-run routine to reduce cramps; as we'll see, stretching is used to respond to a cramp; not prep for one.
Here's another view of cramps by Luke Hoffman that could be written for VFF runners:
According to current theory in the sports science literature (as of 1997), skeletal muscle cramps during exercise probably happen when muscles that are shortened (for example, a calf muscle when your toe is pointed) are repeatedly stimulated. This can happen if your foot is extended, toe pointed, and you keep extending it further. You can actively do this by, for example, running on your toes or doing lots of toe-raises without going down to extend the muscle. What appears to happen is that the muscle gets fatigued, and it doesn't relax well. There is a reflex arc -- made up of the muscle, the nerves carrying signals to the central nervous system (CNS) and the nerves carrying signals from the CNS back to the muscle -- that keeps carrying contraction signals from and to the muscle. This appears to lead to a sustained contraction in the muscle, also known as a cramp.
Stretching (in this case, grabbing your toe and stretching the calf) is about the only thing that breaks this reflex arc signal and stops the cramp when it comes to exercise-induced cases. But the muscle is still fatigued, and the cramp process is easy to re-trigger until the muscle rests for a while. The fatigue-cramp process seems to happen most often in muscles that cross two joints, such as the calf muscle (which crosses the knee and ankle), since the muscle is easy to shorten and continue contracting.
The above describes what might be called "voluntary contraction" - not quite the same as involuntary. If we take the above council about voluntary cramps to bear, however, what should be the case is once a cramp starts, we should stretch it out, and wait for the fatigue to pass from that contraction, and recover, and really stop doing what we were doing - running on the forefoot. Consequently, Pose & VFF runners who run on the forefoot should be cramping all the time. And if we believe work in barefoot running, this is rather how we're designed to run. So, hmm, maybe not.
None of these explanations therefore is complete it seems, to explain cramping we see in the calves that comes on unexpectedly, as lots of well fed, well hydrtated, well electolyted people who stretch still get cramps, and these weird cramps in VFF's in particular.
So why does this cramp only happen *some* of the time - especially if all the typical niceities of cramp avoidance are observed? For me, for instance, it happened first when i started practicing actually bringing the heel of the foot down more (extending the calf) when running, rather than staying up on the forefoot. So, maybe it's not (entirely) about the calves?
Altered Neuromuscular Control. In the research one of the explanations around cramp is: maybe the muscle is just not strong enough to do what is being asked of it, for the duration it's being asked to operate at this level - hence fatiguing - and it's that fatigue that is setting up EAMC: exercise-associated muscle cramping. This hypothesis, also known as "altered neuromuscular control" was first proposed in 1996, so that's how new this stuff is. A key part of this model is that the neuromuscular control issue is located in the SPINE, not at the site of the issue - the site is paying for what's going on at the source.
There is a growing body of evidence to suggest that the mechanism for muscle cramping has a neuromuscular basis. Firstly, as has been discussed, voluntary muscle contraction or stimulation of the motor nerve can reliably cause muscle cramping. Secondly, there is evidence from experimental work in human subjects that stimulation of the 1a afferents through electrical stimulation or using the tendon tap (activating the 1a afferents) can induce cramping. Thirdly, it has repeatedly been shown that the most effective treatment for cramping induced in this manner is muscle stretching.
[WHY stretching?] An increase in tension in the Golgi tendon organ during stretching, which will result in increased afferent reflex inhibitory input to the a-motor neuron, is a plausible mechanism to explain why stretching is an effective treatment of cramping. [see Bertolasi and Co., '93]
[...]
There are other possible mechanisms that could alter neuromuscular control at the spinal cord level, and therefore may contribute to the development of EAMC. The first of these is the possibility that muscle injury or muscle damage, resulting from fatiguing exercise, could cause a reflex ‘‘spasm’’, and thereby result in a sustained involuntary contraction. The second possibility is that increased or decreased signals from other peripheral receptors (such as chemically sensitive intramuscular afferents, pressure receptors or pain receptors) could elicit a response from the central nervous system that can alter neuromuscular control of the muscles. These other mechanisms have not been investigated in athletes with EAMC, but would be important to explore in the future.
So in the Pain as Signal to Change perspective, cramps are painful; they are a signal to change. The altered neuromuscular control model suggests, stretch it out and recover. Related work suggests, improve strength/stamina to reduce fatigue and reduce this muscle cramp response. Both have in common that fatigue is causing neural level loss of appropriate control. Wildly Hypothesising? What's going on when this particular response occurs well before one would think a muscle used to running for miles and miles starts to go all crampy?
In
work pionered by LeDoux in the nineties, he showed that the brain processes emotional responses like fear/threat without the conscious brain being involved. It happens fast, at a low level, without cognitive involvement and has immediate chemical consequences in the system (nice review of this and related work here by Ohman, 2005). In other words, perhaps there's some other *thing* happening in the sensory-motor exerperience that is saying "not good" and the result is this fatigue-like chemical messaging system that sets off early light cramp signals - that if ignored will just get louder until one is forced to change patterns. In Z-Health, Eric Cobb translates this fear response into the nervous system's job to perceive threat or no threat: if there's a perception of threat, the system starts to shut down (example in arthrokinetic reflex). What might be the threat ocuring in VFF ocaisional calve cramping? The system may be literally putting on the breaks to what it perceives as a threatening to it's well being practice.
It's easy to see that if the nervous system perceives that the task - going at a particular speed in a particular way - is causing part of the system to be over-taxed, it's going to respond to that as a threat or non-optimal situation, and if it takes pain to get change, well, whatever it takes.
Personal Experience. Taking a Z-Health approach to this experience, i think i've learned to become more alert to any pain signal my bod sends up in an athletic effort. So in this case, if and when these cramps begin, they usually start with a very mild "uh oh" twinge of "about to turn to rock if you don't respond."
There are two simple things that z-health suggests for rehabbing a movement with the cue of "never move into pain:"
- reduce the range of motion
- reduce the load
Guided by the Nose: run to pace inhalation. Another technique i've been using and coaching to help head off cramps and adapt to barefooting generally is to explore gaiting running speed with ability to stay breathing in through one's nose. If running at a clip where i have to mouth breath, i slow it down (i find if i hit that level, it's pretty hard to get it back to nose inhaling). This approach is just one way at least some of the time to practice running reps quality rather than overdriving the other parts of the system.
Deeper Tune Up: Starting from the Source
So we've seen one theory in the research is around muscular fatigue inducing EAMC; getting stronger in those areas where muscles cramped seemed to help. In one study. That's great. Another possibility - that can lead to faster fatigue - is if there's some kind of issue in one's movement that is causing perhaps other muscles to compensate for other weaknesses, and causing fatigue/pain/signaling in the calves faster that should happen for that group. So while a solution may be to do extra strength work, maybe a faster solution may actually be to look at one's movement as a whole.
In other words, the calves may be plenty strong IF everything else is firing up appropriately, but they may be being asked to super compenate for other stuff, that if those other movement issues were addressed, wouldn't cause the problem.
There's value therefore in (a) having a movement assessment and (b) practicing dynamic joint mobility and sensory-motor work to ensure great movement, and ability to maintain great, clean movement.
Summary: Avoiding Running Cramps in VFF's
Based on the latest research, EAMC cramps are about temporary loss of clear neuromuscular control. The best model so far to explain this effect is fatigue. A known way to work out a cramp is to lengthen the muscle. There may however be other approaches that just haven't been researched that also seem to work. The hypothesis here is that these approaches are dealing with neurological signaling, too, taking advantage of the sensory-motor system.
Some pragmatic responses therefore if cramp occurs are:
During a Run: Assuming one is not dehydrated, de-electrolyted, or have squirrels biting their calves while running,
- As soon as a cramp (pain) starts, change something - gait, speed, whatever; if that doesn't work, stop what you're doing.
- consider rather than (just) stretching, doing mobility/sensory-motor work.
And before That
Consider a movement assessment to check for what Gray Cook calls "weak links" so as not to build strength on top of dysfunction.
Let me know what works for you.
Citations
Schwellnus, M. (2008). Cause of Exercise Associated Muscle Cramps (EAMC) -- altered neuromuscular control, dehydration or electrolyte depletion? British Journal of Sports Medicine, 43 (6), 401-408 DOI: 10.1136/bjsm.2008.050401
OHMAN, A. (2005). The role of the amygdala in human fear: Automatic detection of threat Psychoneuroendocrinology, 30 (10), 953-958 DOI: 10.1016/j.psyneuen.2005.03.019
Bertolasi L, De Grandis D, Bongiovanni LG, Zanette GP, & Gasperini M (1993). The influence of muscular lengthening on cramps. Annals of neurology, 33 (2), 176-80 PMID: 8434879
Wagner, T. (2009). Strengthening and Neuromuscular Reeducation of the Gluteus Maximus in a Triathlete With Exercise-Associated Cramping of the Hamstrings Journal of Orthopaedic and Sports Physical Therapy DOI: 10.2519/jospt.2010.3110
Caplan N, Rogers R, Parr MK, & Hayes PR (2009). The effect of proprioceptive neuromuscular facilitation and static stretch training on running mechanics. Journal of strength and conditioning research / National Strength & Conditioning Association, 23 (4), 1175-80 PMID: 19528850
Schwellnus, M. (2004). Serum electrolyte concentrations and hydration status are not associated with exercise associated muscle cramping (EAMC) in distance runners British Journal of Sports Medicine, 38 (4), 488-492 DOI: 10.1136/bjsm.2003.007021
Schwellnus MP (2007). Muscle cramping in the marathon : aetiology and risk factors. Sports medicine (Auckland, N.Z.), 37 (4-5), 364-7 PMID: 17465609Related Sources
Schwellnus, M. (2008). Cause of Exercise Associated Muscle Cramps (EAMC) -- altered neuromuscular control, dehydration or electrolyte depletion? British Journal of Sports Medicine, 43 (6), 401-408 DOI: 10.1136/bjsm.2008.050401
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Wednesday, April 21, 2010
Ankle Sprains: Tape, Bracing - doesn't matter finds research - but how'd we get so busted up in the first place?
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A recent paper has presented the results of a bunch of trials looking at interventions for ankle sprains. Main result? if someone's had an ankle injury - like a sprain - then tape or brace doesn't seem to show a difference: both seem to cut down reinjury. What's troublesome on a metalevel, is first how sort of accepted the notion of this level of injury seems to be, and second how nascent in the approach described here is the model that for folks who haven't been injured - as a preventitive - they maybe should be immobilised too. Aren't there other questions to ask - perhaps especially about the injury free staying injury free - rather than whether incapacitating natural function is a Good Idea? But perhaps more fundamentally, how did we get to this point where someone is so beaten up their joints are written off as so dysfunctional they must be immobilized to perform?
Here's the abstract:
So what's going on here that this is even considered a useful strategy?
Apparently, there's a lot of functional instability, mechanical and proprioceptive factors are also considered in some of the studies to be impaired. Mechanical instability (lax joint) can be a cause of functional instability. These effects build up from - you guessed it - repeated ankle injuries. Where reflexes get slower, joints can get hypermobile, funtional loss of static and dynamic support of the joint has gone way down. Effectively, the ankle for a potential variety of reasons, is so beaten up and abused, it can no long function as an ankle, so, a greater degree of immobility is preferable to too much.
Um. what happened that a person gets to this point of so MANY repeated injuries they're beyond the pale of recovering normal function? Ah right: this is sport, not health.
Intriguingly, there's a claim that some bracing helps proprioception:
There are alternatives approaches: perhaps we should ask, as indicated, what's causing these injuries in the first place? Is it a skills-on-the-field problem? turning skills? cognitive processing for field awareness skills? Is it lack of ankle flexion or hip/pelvis restrictions? Is it a sensory-motor disconnect with shoes or other gear killing proprioceptive awareness of foot placement?
Folks like Gray Cook working with NFL football teams have been looking at athletic mobility/stability. Eric Cobb has been looking more at sensory-motor approaches, and cognitive stress for field performance that's more effective and injury free.
Any solution assumes a model for which that solution is appropriate. The solutions proposed by these authors seems to presuppose a model where (a) the amount of reinjury that leads to such horrible dysfunction is taken as a given and seems to be ok such that (b) further bodily immobilization seems like a good idea to enable athletic movement seems problematic to me on a number of levels.
Strategies to understand why the injuries are so high in the first place - never mind acceptable - seems to be a more humane way to begin strategizing about enabling athltetes to play ball, no?
Related Posts
Citation
Dizon, J., & Reyes, J. (2010). A systematic review on the effectiveness of external ankle supports in the prevention of inversion ankle sprains among elite and recreational players Journal of Science and Medicine in Sport, 13 (3), 309-317 DOI: 10.1016/j.jsams.2009.05.002 Tweet Follow @begin2dig
A recent paper has presented the results of a bunch of trials looking at interventions for ankle sprains. Main result? if someone's had an ankle injury - like a sprain - then tape or brace doesn't seem to show a difference: both seem to cut down reinjury. What's troublesome on a metalevel, is first how sort of accepted the notion of this level of injury seems to be, and second how nascent in the approach described here is the model that for folks who haven't been injured - as a preventitive - they maybe should be immobilised too. Aren't there other questions to ask - perhaps especially about the injury free staying injury free - rather than whether incapacitating natural function is a Good Idea? But perhaps more fundamentally, how did we get to this point where someone is so beaten up their joints are written off as so dysfunctional they must be immobilized to perform?Here's the abstract:
Epidemiological studies have shown that 10–28% of all sports injuries are ankle sprains, leading to the longest absence from athletic activity compared to other types of injuries. This study was conducted to evaluate the effectiveness of external ankle supports in the prevention of inversion ankle sprains and identify which type of ankle support was superior to the other. A search strategy was developed, using the keywords, ankle supports, ankle brace, ankle tapes, ankle sprains and athletes, to identify available literature in the databases (MEDLINE, PubMed, CINAHL, EMBASE, etc.), libraries and unpublished papers. Trials which consider adolescents and adults, elite and recreational players as participants were the study of choice. External ankle supports comprise ankle tape, brace or orthosis applied to the ankle to prevent ankle sprains. The main outcome measures were frequency of ankle sprains. Two reviewers assessed the quality of the studies included using the Joanna Briggs Institute (JBI Appraisal tool). Whenever possible, results were statistically pooled and interpreted. A total of seven trials were finally included in this study. The studies included were of moderate quality, with blinding as the hardest criteria to fulfill. The main significant finding was the reduction of ankle sprain by 69% (OR 0.31, 95% CI 0.18–0.51) with the use of ankle brace and reduction of ankle sprain by 71% (OR 0.29, 95% CI 0.14–0.57) with the use of ankle tape among previously injured athletes. No type of ankle support was found to be superior than the other.This is when it's nice to have the whole article, because you'd think it just stops there, right? For previously injured, folks who were taped didn't seem to get reinjured. How does one predict the future like that? Well that's the toughie: only one study had a control group - so did they just get reinjured that many more times than the athletes who braced? No, it's of the populations taped or braced, how many did NOT have a recurrence in a given period.
So what's going on here that this is even considered a useful strategy?
Apparently, there's a lot of functional instability, mechanical and proprioceptive factors are also considered in some of the studies to be impaired. Mechanical instability (lax joint) can be a cause of functional instability. These effects build up from - you guessed it - repeated ankle injuries. Where reflexes get slower, joints can get hypermobile, funtional loss of static and dynamic support of the joint has gone way down. Effectively, the ankle for a potential variety of reasons, is so beaten up and abused, it can no long function as an ankle, so, a greater degree of immobility is preferable to too much.
Um. what happened that a person gets to this point of so MANY repeated injuries they're beyond the pale of recovering normal function? Ah right: this is sport, not health.
Intriguingly, there's a claim that some bracing helps proprioception:
"they restrict range of motion to a certain degree and enhance proprioception of the injured ankle making them more useful in the prevention of possible re-injury."Wow, that's wild. How does that work? And can that awareness be re-trained rather than delivered only through a device? Where's it coming from? But there's not a lot of interest in the article in looking at say other strategies like rehab, movement assessment. Why not? There's a model here that says once injured, you're toasted:
As mentioned earlier in the discussion, after a sprain, structural damage occurs to the ligamentous tissues, nervous and musculo- tendinous units in the ankle joint. Functional and mechanical instability arise. For these reasons, the risk of injury to a pre- viously injured ankle is increased. his is the point where external ankle supports play an important role.And that may have informed the authors' decision simply to look at what type of bracing is better to reduce re-injury, rather than to wonder if
- training that can find movement or other sensory-motor issues that may be related to WHY a person roles their ankles
- investigation of the stupid shoes that may be killing proprioception necessary to reduce ankle sprains
- anything else that may help the athlete perform with less likelihood of injury, better performance
This review provides good evidence for the use either ankle taping or ankle braces to prevent lateral ankle sprains among previously injured players. However, for those with- out previous ankle injuries this still needs to be proven. There is no evidence on which external ankle support is better than the other. Each has its own advantages and disadvantages.You see it? These folks with this model of the weakness of the ankle - where "10-28%" of all athletic injuries occur - are already thinking MAYBE - we don't know yet - but maybe if we just brace the ankle up from the get go, we'll keep more ankles from being sprained.
There are alternatives approaches: perhaps we should ask, as indicated, what's causing these injuries in the first place? Is it a skills-on-the-field problem? turning skills? cognitive processing for field awareness skills? Is it lack of ankle flexion or hip/pelvis restrictions? Is it a sensory-motor disconnect with shoes or other gear killing proprioceptive awareness of foot placement?
Folks like Gray Cook working with NFL football teams have been looking at athletic mobility/stability. Eric Cobb has been looking more at sensory-motor approaches, and cognitive stress for field performance that's more effective and injury free.
Any solution assumes a model for which that solution is appropriate. The solutions proposed by these authors seems to presuppose a model where (a) the amount of reinjury that leads to such horrible dysfunction is taken as a given and seems to be ok such that (b) further bodily immobilization seems like a good idea to enable athletic movement seems problematic to me on a number of levels.
Strategies to understand why the injuries are so high in the first place - never mind acceptable - seems to be a more humane way to begin strategizing about enabling athltetes to play ball, no?
Related Posts
Citation
Dizon, J., & Reyes, J. (2010). A systematic review on the effectiveness of external ankle supports in the prevention of inversion ankle sprains among elite and recreational players Journal of Science and Medicine in Sport, 13 (3), 309-317 DOI: 10.1016/j.jsams.2009.05.002 Tweet Follow @begin2dig
Monday, May 4, 2009
A Movement Assessment: what is it and why should i have one?
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Getting rid of the Parts Model of Human Pain and Performance.
Folks on various health forums will often post "i have a weak knee; what exersises can i do to strengthen it?" or "my hamstrings are tight and it's affecting my deadlift; what can i do to loosen them up?" or "my shoulder keeps bugging me; what's good for shoulder rehab?"
All of these questions, it seems, tend to consider the site of the problem to be the source of the problem.
Folks who reply often share that perspective with proposals like "sore shoulder - here's a great book/dvd/blog on shoulder rehab." or "tight hamstrings? foam roll 'em out. it's great. do that anytime before you deadlift that'll loosen 'em right up."
But what if the site of the problem isn't the source of the problem?
Then all we are providing are classic band aid solutions where the problem will just keep coming back. We know about this in any kind of mechanical situation: the car engine is leaking oil.
If all we do is keep pouring in oil to top it up, we're not dealing with the problem. The problem may require a simple tweak on a part we're not familiar with, or it may need some more serious work. We don't know; we don't have the expertise. So we get an assessment of what the problem is, and what it will take to fix it.
We know enough to do this for a mechanical machine, and yet when it comes to our far more complex organism - our bio-electrical-mechano-organic selves, we seem to take a far cheaper attitude. Perhaps because we're so resliant; perhaps because the trad. medical establishment has let us down. And how successful - in the long term - is our tire patch/band aid approach?
Avoid Frankensteining Body Work
Here's another analogy: Pavel Tsatsouline famously decries the "frankenstien monster" approach to strength/body building that treats muscles in isolation. Frankensteining the body referring to assembling parts that are shown off as parts rather than integrated elements. Many of us have experienced the benefits of compound movement work to create powerful integrated, athletic strength and power.
Ok, so why then why then when we have a tweak, a pain, a weakness, do we suddenly move exactly to that body part, isolationist, frankensteining approach for how to make ourselves better?
Alternatives to the Parts Model approach to
Perceived Human Performance Problems
A movement assessment sees pain as a symptom only and respects the complexity of the body. As a result it may indeed be less interested in causes for a particular expression of the Whole Body saying HELP, and more interested in looking at and addressing movement patterns. A finding that's shocked and delighted me is how much improved movement/addressing movement reduces pain - many many varieties of pain.
Isn't that what Doctors Do?
Now, you might say well heck isn't that what a physio or a chiro does or even a doctor does?
The answer is yes and no: yes, if that physio or manual therapist of whatever stripe is hip to the notion of movement and how everything is connected in the body, possibly; if that physio person hears you say "i have sore shoulder" and goes right to assessing your shoulder - like site = source, then more likely no. The last time i went to see a doctor about a sore back i was prescribed muscle relaxants. Perhaps you have similar experiences?
The Movement Approach Difference:
Seeing a Whole Body in Motion; not bunches of parts.
While we tend to think of ourselves as a sore back, weak knee, tight hamstring. Or as strong biceps, weak shoulders, great back, our bodies are not so isolationist. The connections througout are rich and legion. Joints and muscles are connected with all sorts of tissue in all sorts of ways throughout the body such that "anything can affect anything." Really. Take a look at a book like Anatomy Trains for an incredible illustration of this point. A headache may be more tied to a tightness in the foot than a pain in the neck, as it were.
One of the best ways to see this interconnection manifest itself, it seems, is when we do what our bodies are designed to do: move.
When the body is in movement, it calls into play so many inter-related parts that when watched
via a skilled assessor or via a good screen, show off just how well our highly integrated systems are working together - or not - and provide clues of what may need to be addressed to get us moving optimally. Consider walking: we are not only moving limbs and counterbalancing tensions; we're balancing and orienting ourselves in space. Our central nervous system is, as Z practitioners (overview of zhealth)and others learn, "always on" too, always connecting all systems. I've written before about the power of the arthrokinetic reflex and how a crinked neck cuts strength in a deadlift.
The emphasis is on movement. Address the movement and other good things follow.
UPDATE: what are examples of what happens in a screen (motivated by question on DD)
Movement assessments say "let me see you move" - and based on watching you move, a certified screener/assessor can see where there are weaknesses/problems in that pattern. They then have a set of corrective strategies that map to tackling that issue. They work through these with you and retest that sore point (where the symptom is tweaking) to check for improvement, and iterate to narrow down on the best set for you.
So you may come in with a sore shoulder, and be asked for a history of your health, and then, in Z someone may say "let me see you walk" - to check for those patterns.
The issue doesn't have to be pain; it may be a plateau in a lift, or problem with part of a move. same thing. Let's look at how you move, assess, drill, retest that move that's your concern.
Here's another example for an assessment that you can step through:
on the Functional Movement Screen site, there's an overview that describes/shows the 7 screens of that assessment.
You go through each screen, each side of your body and get scored. Based on those scores, the person screening you suggests drills to address any asymmetry (differences in left/right side performance) or weakness. The foundational principle of the FMS is first address asymmetries, then improve performance.
In ZHealth (and here's an overview), there's a variety of assessments, but the fundamental one is to watch you walk. Given that, you may be given mobility drills (like those in the Rphase DVD) to address what's found.
Can i Just Screen Myself?
yes and no.
It's tricky because it's hard to see yourself from vary many angles. i can watch myself walk forward, but need a video to watch me from behind, which is really important. so ya maybe with video, if you know what you're looking for.
That said, Gray Cook's Atheletic Body in Balance had a shorter version of what was to become the FMS for this kind of self-assessment - better perhaps than a kick in the head.
More recently, Gray and Brett and Mark's work on the TGU in the Kalos Sthenos DVD has been proposed as "a screen" - in fact we've been talking about how the TGU compares with the FMS. SO if you rigorously checked yourself against the spec of the TGU on the DVD, at each of the 7 parts of that move, you could get a very good idea of where your weak link may be - Brett would be quick to say though that that may only show you where your weak link is in the TGU - we're not clear yet how well it generalizes as a diagnostic.
What one could do is say
One more point for consideration on the self-check - this is exactly what a lot of us do when checking out our own form in a mirror for the swing or the snatch, right? but if you've had the pleasure of being observed by someone trained to teach these moves, they'll see one little thing we might miss, tweak that and in two minutes it's as if we've gone to movement heaven.
So yes, it's very good to get body awareness, and in particular movement awareness. This is what something like the ZHealth Rphase/Neural WarmUp vids help build and what the KS DVD helps build from slightly different perspectives.
The benefit of then going to a certified trainer to have the assessment is like going to an RKC to watch your hard style swing or snatch to tweak it, or to an ikff ckt for your GS. Another pair of eyes; another depth of experience.
Isn't this an expensive luxury? I just have a tight hamstring...
That's a good question.
Let's qualify a tight hamstring first and then expensive.
In keeping with the view of our body as an integrated system - and not just a machine with replaceable parts, a tight hamstring could be caused by just about anything. Indeed, to quote Eric Cobb of ZHealth, anything can cause anything. What if it's just a signifier of something in your shoulder or foot that if it isn't addressed, that hamstring issue will keep coming back, and perhaps bring some of its friends and pump up the volume. The arthrokinetic reflex is just one example of how something happening in one part of our system has profound consequences *through out* the system.
So, if you take away one thing from this post i hope it's that a pain signal or perception of weakness may be a signal of a systems issue, and checking the system (in this case with a movement screen) is a good way to address that signal.
Note i'm not saying that we have to check the system to find the CAUSE of the problem - who knows what the cause is, and is that important? What we can do is check for what's happening in the movement, address that, and see the positive effects.
Now as to expense, it's unfortunate that movement assessment isn't part of medical insurance. But until it is, yes it's a choice as to how you spend your hard earned cash.
A qualified/certified trainer may well cost you as much as going to see a chiro or related therapist for an assessment. As with other disciplines/services, you get what you pay for, so a question may be:
Likewise, seeing a pro movement specialist and trainer for 30-60mins can give your performance a huge boost that well pays for itself in terms of time taken to make these strides (and ability to make them without pain).
And there's other options:
with the CK-FMS (overview of cert), folks need to do a case study: they need someone they can see usually at least twice to assess and follow up. Search for a ck-fms in training and offer to be their case study. Some folks will also trade services for services, or have student rates. So ask. Packages are a great way to get even more value from your session. More on this next.
Optimizing the Benefit of a Screen: buyer's market.
There are a ton of personal trainers available - all dying to train YOU.
A growing number of smart trainers are adding movement assessment certifications to their tool box. You can look around for trainers that have such qualifications to go with your training - and you can check out what you think of those screens.
The RKC has hooked up with Gray Cook and Brett Jones to extend the Functional Movement Screen Certification to the CK-FMS. This cert material goes well beyond what's offered at an FMS cert, and is only available to RKC's - so with a CK-FMS, you have a top hard style kettlebell trainer and someone who knows how to run the FMS and who has done at least one deep case study on how to apply this approach from diagnostic to corrective strategies for that client.
Likewise, you'll find an increasing number of RKC's (and others) who (also) have Z-Health training. That trainer has a range of movement assessment tools and strategies available to them, too.
Both the FMS and ZHealth sites list certified trainers at least by location if not by name as well. It's relatively straight forward to check for someone who looks good via google and see what all their qualifications are, along with that particular cert, and see if that person looks like a match for your intersts.
What i like about the ZHealth listing for instance, is that you'll find physio's, rolfers, chiropracters, at least one MD, who care about fitness training, and have done advanced level Z certification, too. So what's your comfort level? if you want someone with a medical background also trained in movement assessment, you have choices.
So whether you're looking for kettlebell trainers or certified strength and conditioning coaches, or physical therapists, or chiropractors to help you with your fitness performance and health and well being, really the choice is yours. One of my most popular requests is for a movement assessment combined with a kettlebell movement check/tune up. I love that. It's a great package and a great way to optimize your training dollar/pound/euro/etc.
What does a movement assessment get someone, really?
In the FMS, Gray Cook talks about identifying your weakest link in order to address this link so as not to build function or strength on top of dysfunction.
In Z-Health, Eric Cobb talks about efficient, pain free movement.
The motivation in each case is similar:
- when you take away "the site is the source of the problem" perspective, you start to see a body in motion - not a collection of parts that can be assessed in isolation, but complex connected interrelated components.
From this perspective, the bod's really complicated: anything can cause anything. So an optimal way to look at the body is not at one part that may be saying something (on behalf of everything else), but at a whole organism in motion. The pragmatic consequence is a movement assessment that:
So if you have a tweak or a perceived weakness in a limb or have hit a plateau, consider these as signals not just to poke at a part, but as a call from your body to look at your whole self, and a great way to look at your whole physiological self is when it's in movement.
Guaranteed if you do this for yourself you'll be happier and healthier for it. And you'll find most trainers do offer guarantees of satisfaction, too. Tweet Follow @begin2dig
Folks on various health forums will often post "i have a weak knee; what exersises can i do to strengthen it?" or "my hamstrings are tight and it's affecting my deadlift; what can i do to loosen them up?" or "my shoulder keeps bugging me; what's good for shoulder rehab?"
All of these questions, it seems, tend to consider the site of the problem to be the source of the problem.
Folks who reply often share that perspective with proposals like "sore shoulder - here's a great book/dvd/blog on shoulder rehab." or "tight hamstrings? foam roll 'em out. it's great. do that anytime before you deadlift that'll loosen 'em right up."
But what if the site of the problem isn't the source of the problem?
Then all we are providing are classic band aid solutions where the problem will just keep coming back. We know about this in any kind of mechanical situation: the car engine is leaking oil.
If all we do is keep pouring in oil to top it up, we're not dealing with the problem. The problem may require a simple tweak on a part we're not familiar with, or it may need some more serious work. We don't know; we don't have the expertise. So we get an assessment of what the problem is, and what it will take to fix it.
We know enough to do this for a mechanical machine, and yet when it comes to our far more complex organism - our bio-electrical-mechano-organic selves, we seem to take a far cheaper attitude. Perhaps because we're so resliant; perhaps because the trad. medical establishment has let us down. And how successful - in the long term - is our tire patch/band aid approach?
Avoid Frankensteining Body Work
Here's another analogy: Pavel Tsatsouline famously decries the "frankenstien monster" approach to strength/body building that treats muscles in isolation. Frankensteining the body referring to assembling parts that are shown off as parts rather than integrated elements. Many of us have experienced the benefits of compound movement work to create powerful integrated, athletic strength and power.
Ok, so why then why then when we have a tweak, a pain, a weakness, do we suddenly move exactly to that body part, isolationist, frankensteining approach for how to make ourselves better?
Alternatives to the Parts Model approach to
Perceived Human Performance Problems
A movement assessment sees pain as a symptom only and respects the complexity of the body. As a result it may indeed be less interested in causes for a particular expression of the Whole Body saying HELP, and more interested in looking at and addressing movement patterns. A finding that's shocked and delighted me is how much improved movement/addressing movement reduces pain - many many varieties of pain.
Isn't that what Doctors Do?
Now, you might say well heck isn't that what a physio or a chiro does or even a doctor does?
The answer is yes and no: yes, if that physio or manual therapist of whatever stripe is hip to the notion of movement and how everything is connected in the body, possibly; if that physio person hears you say "i have sore shoulder" and goes right to assessing your shoulder - like site = source, then more likely no. The last time i went to see a doctor about a sore back i was prescribed muscle relaxants. Perhaps you have similar experiences?
The Movement Approach Difference:
Seeing a Whole Body in Motion; not bunches of parts.
While we tend to think of ourselves as a sore back, weak knee, tight hamstring. Or as strong biceps, weak shoulders, great back, our bodies are not so isolationist. The connections througout are rich and legion. Joints and muscles are connected with all sorts of tissue in all sorts of ways throughout the body such that "anything can affect anything." Really. Take a look at a book like Anatomy Trains for an incredible illustration of this point. A headache may be more tied to a tightness in the foot than a pain in the neck, as it were.
One of the best ways to see this interconnection manifest itself, it seems, is when we do what our bodies are designed to do: move.
When the body is in movement, it calls into play so many inter-related parts that when watched
via a skilled assessor or via a good screen, show off just how well our highly integrated systems are working together - or not - and provide clues of what may need to be addressed to get us moving optimally. Consider walking: we are not only moving limbs and counterbalancing tensions; we're balancing and orienting ourselves in space. Our central nervous system is, as Z practitioners (overview of zhealth)and others learn, "always on" too, always connecting all systems. I've written before about the power of the arthrokinetic reflex and how a crinked neck cuts strength in a deadlift.The emphasis is on movement. Address the movement and other good things follow.
UPDATE: what are examples of what happens in a screen (motivated by question on DD)
Movement assessments say "let me see you move" - and based on watching you move, a certified screener/assessor can see where there are weaknesses/problems in that pattern. They then have a set of corrective strategies that map to tackling that issue. They work through these with you and retest that sore point (where the symptom is tweaking) to check for improvement, and iterate to narrow down on the best set for you.
So you may come in with a sore shoulder, and be asked for a history of your health, and then, in Z someone may say "let me see you walk" - to check for those patterns.
The issue doesn't have to be pain; it may be a plateau in a lift, or problem with part of a move. same thing. Let's look at how you move, assess, drill, retest that move that's your concern.
Here's another example for an assessment that you can step through:
on the Functional Movement Screen site, there's an overview that describes/shows the 7 screens of that assessment.
You go through each screen, each side of your body and get scored. Based on those scores, the person screening you suggests drills to address any asymmetry (differences in left/right side performance) or weakness. The foundational principle of the FMS is first address asymmetries, then improve performance.
In ZHealth (and here's an overview), there's a variety of assessments, but the fundamental one is to watch you walk. Given that, you may be given mobility drills (like those in the Rphase DVD) to address what's found.
Can i Just Screen Myself?
yes and no.
It's tricky because it's hard to see yourself from vary many angles. i can watch myself walk forward, but need a video to watch me from behind, which is really important. so ya maybe with video, if you know what you're looking for.
That said, Gray Cook's Atheletic Body in Balance had a shorter version of what was to become the FMS for this kind of self-assessment - better perhaps than a kick in the head.
More recently, Gray and Brett and Mark's work on the TGU in the Kalos Sthenos DVD has been proposed as "a screen" - in fact we've been talking about how the TGU compares with the FMS. SO if you rigorously checked yourself against the spec of the TGU on the DVD, at each of the 7 parts of that move, you could get a very good idea of where your weak link may be - Brett would be quick to say though that that may only show you where your weak link is in the TGU - we're not clear yet how well it generalizes as a diagnostic.
What one could do is say
- hmm my shoulder's bugging me,
- i'm going to do the ahtletic body in balance screen on myself and see what comes back,
- and even if it doesn't show a shoulder issue, i'm going to run the pattern for whatever comes back in my test
- do the corrective drills for the weak bits,
- and retest my shoulder, see if it feels better.
One more point for consideration on the self-check - this is exactly what a lot of us do when checking out our own form in a mirror for the swing or the snatch, right? but if you've had the pleasure of being observed by someone trained to teach these moves, they'll see one little thing we might miss, tweak that and in two minutes it's as if we've gone to movement heaven.
So yes, it's very good to get body awareness, and in particular movement awareness. This is what something like the ZHealth Rphase/Neural WarmUp vids help build and what the KS DVD helps build from slightly different perspectives.
The benefit of then going to a certified trainer to have the assessment is like going to an RKC to watch your hard style swing or snatch to tweak it, or to an ikff ckt for your GS. Another pair of eyes; another depth of experience.
Isn't this an expensive luxury? I just have a tight hamstring...
That's a good question.
Let's qualify a tight hamstring first and then expensive.
In keeping with the view of our body as an integrated system - and not just a machine with replaceable parts, a tight hamstring could be caused by just about anything. Indeed, to quote Eric Cobb of ZHealth, anything can cause anything. What if it's just a signifier of something in your shoulder or foot that if it isn't addressed, that hamstring issue will keep coming back, and perhaps bring some of its friends and pump up the volume. The arthrokinetic reflex is just one example of how something happening in one part of our system has profound consequences *through out* the system.
So, if you take away one thing from this post i hope it's that a pain signal or perception of weakness may be a signal of a systems issue, and checking the system (in this case with a movement screen) is a good way to address that signal.
Note i'm not saying that we have to check the system to find the CAUSE of the problem - who knows what the cause is, and is that important? What we can do is check for what's happening in the movement, address that, and see the positive effects.
Now as to expense, it's unfortunate that movement assessment isn't part of medical insurance. But until it is, yes it's a choice as to how you spend your hard earned cash.
A qualified/certified trainer may well cost you as much as going to see a chiro or related therapist for an assessment. As with other disciplines/services, you get what you pay for, so a question may be:
- What is your pain free movement worth?
- What is a strategy that will help reduce the likelihood of the next injury worth?
- What's your ability to train optimally worth?
- or simply to get through the day without sore shoulders and/or a headache worth?
Likewise, seeing a pro movement specialist and trainer for 30-60mins can give your performance a huge boost that well pays for itself in terms of time taken to make these strides (and ability to make them without pain).
And there's other options:
with the CK-FMS (overview of cert), folks need to do a case study: they need someone they can see usually at least twice to assess and follow up. Search for a ck-fms in training and offer to be their case study. Some folks will also trade services for services, or have student rates. So ask. Packages are a great way to get even more value from your session. More on this next.
Optimizing the Benefit of a Screen: buyer's market.
There are a ton of personal trainers available - all dying to train YOU.
A growing number of smart trainers are adding movement assessment certifications to their tool box. You can look around for trainers that have such qualifications to go with your training - and you can check out what you think of those screens.
The RKC has hooked up with Gray Cook and Brett Jones to extend the Functional Movement Screen Certification to the CK-FMS. This cert material goes well beyond what's offered at an FMS cert, and is only available to RKC's - so with a CK-FMS, you have a top hard style kettlebell trainer and someone who knows how to run the FMS and who has done at least one deep case study on how to apply this approach from diagnostic to corrective strategies for that client.
Likewise, you'll find an increasing number of RKC's (and others) who (also) have Z-Health training. That trainer has a range of movement assessment tools and strategies available to them, too.
Both the FMS and ZHealth sites list certified trainers at least by location if not by name as well. It's relatively straight forward to check for someone who looks good via google and see what all their qualifications are, along with that particular cert, and see if that person looks like a match for your intersts.
What i like about the ZHealth listing for instance, is that you'll find physio's, rolfers, chiropracters, at least one MD, who care about fitness training, and have done advanced level Z certification, too. So what's your comfort level? if you want someone with a medical background also trained in movement assessment, you have choices.
So whether you're looking for kettlebell trainers or certified strength and conditioning coaches, or physical therapists, or chiropractors to help you with your fitness performance and health and well being, really the choice is yours. One of my most popular requests is for a movement assessment combined with a kettlebell movement check/tune up. I love that. It's a great package and a great way to optimize your training dollar/pound/euro/etc.
What does a movement assessment get someone, really?
In the FMS, Gray Cook talks about identifying your weakest link in order to address this link so as not to build function or strength on top of dysfunction.
In Z-Health, Eric Cobb talks about efficient, pain free movement.
The motivation in each case is similar:
- when you take away "the site is the source of the problem" perspective, you start to see a body in motion - not a collection of parts that can be assessed in isolation, but complex connected interrelated components.
From this perspective, the bod's really complicated: anything can cause anything. So an optimal way to look at the body is not at one part that may be saying something (on behalf of everything else), but at a whole organism in motion. The pragmatic consequence is a movement assessment that:
- looks at you as a whole person who moves, and seeing that whole person move, help assess and improve that movement so that it's at its best. The usual consequence of this is improved overall performance and reduced pain.
- provides you with strategies to address any movement issues to help improve your movement performance, and again the results of this are better overall movement; less pain; reduced risk of injury.
So if you have a tweak or a perceived weakness in a limb or have hit a plateau, consider these as signals not just to poke at a part, but as a call from your body to look at your whole self, and a great way to look at your whole physiological self is when it's in movement.
Guaranteed if you do this for yourself you'll be happier and healthier for it. And you'll find most trainers do offer guarantees of satisfaction, too. Tweet Follow @begin2dig
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