The Limitations of Mobility

iStock_foamrollersmallAmong CrossFitters and athletes, “mobility” has become all the rage.

The general idea is to systematically and specifically mobilize, or loosen areas of restriction with an attempt to find the root cause of movement dysfunction. Mobility combines stretching with tools like foam rollers, lacrosse balls and large rubber bands for purported improvements in functional movement.

I’m actually a fan, when properly applied. But this post is about where the usefulness of mobility ends, and what to do when we get there. Because “just mobilize it” has its limitations. In fact, I will argue that mobility is only one part of root cause analysis when it comes to identifying and fixing movement faults. (Just as I did when I positively reviewed Becoming A Supple Leopard!)

From the outset, I want to point out that this piece will be read by a diverse group of people. From exercise enthusiasts with no scientific training or background what-so-ever, to the most seasoned and trained chiropractors, physical therapists and coaches. Satisfying both groups with an article of this kind is next to impossible. If I go too heavy on the science, I lose the first group, and if I skirt sound principles and verbiage altogether, I make a fool of myself in front of the latter.

So I ask kindly that you bear with me as I navigate those tricky waters.

There’s no such thing as a “tight” muscle
Muscle tone is controlled by a complex combination of feedback and communication between the body and the central nervous system (CNS). There are proprioceptors, mechanoreceptors and other devices that sense your body’s environment and send that (sensory) information back to the CNS. Then there is the efferent (motor control) information from the CNS to the muscle. Thus, the tone of any given muscle at any given time is automatically determined by the ebb and flow of this feedback loop.

For more on proprioception, please check my post “Your Shoes Are Starving Your Brain.”

So when someone has “tight” hamstrings, the appropriate response should not be “just mobilize it.” Anyone who’s had this issue for a long time will tell you, they stretch and stretch and it rarely gets any better. The appropriate question is; “why is the body up-regulating tone to these muscles, causing them to shorten and feel tight?”

Instead of “tight”, think of muscle as being facilitated. Facilitation means the body is automatically increasing tone (also shortened muscle length) for a purpose. We could also call this presentation hypertonicity. Many times the body is initially responding to an environment that requires stability and rigidity. However, this hypertonicity becomes problematic when it becomes chronic.

Secondarily, this chronic muscle facilitation is made worse by our physiologically incongruent environmental input. To be plain – we sit too damn much. From the age of 5 we start school and don’t stand up or squat fully for another 16 years. I doubt I need to get on my “sitting is the new smoking” soapbox. But it’s true.

There’s no such thing as a “weak” muscle (sort of)
Too many patients have blamed injuries and movement faults on just needing to strengthen a certain muscle group.

The flip side of the facilitation coin is inhibition. If a muscle is neurologically inhibited (or shut off), then no matter how strong an athlete is, the biomechanics will be unsound and prone to injury. These inhibitions are caused from a number of different things. Past injuries, repetitive motion, biomechanical faults, and inactivity – just to name a few.

Ever sprained an ankle? Had a concussion? Fell down stairs as a kid? The list is endless. All of which can leave us with neurologic imbalances, compensatory problems and improper force absorption.

Take IT-Band (ITB) tendonitis for example. The ITB feels tight. And it is hypertonic. But it is secondary to the real problem which is often a neurologically inhibited gluteal muscle group. You can foam roll the hell out that ITB, but until your get your hip muscles firing properly, you’re probably just causing yourself unnecessary pain.

What to do?
First recognize that you can stretch and mobilize forever, but if the CNS is facilitating or inhibiting muscle tone, it’s not going to be very effective.

What I find most effective is to address the neuro-motor control element in conjunction with condition specific mobilizations. To reiterate – many times the thing that feels like it needs to be mobilized isn’t the problem at all.

I can’t tell you how many clients I’ve worked with that have frustratingly stretched a known movement limitation, only to get nowhere. “I stretch and roll out my hamstrings and low back everyday, but they’re still tight!”

There’s that word again.

One more example
In CrossFit, and Olympic lifting, the most common problem I see is shoulder pain, immobility and/or fixation in overhead squat/snatch position.

There is no way I can get into every detail of this complex problem in a mere blog post. But to be clear – it is much more complex than a generalized band & lacrosse ball mobility protocol will solve. The one problem I want to highlight is the role of the subscapularis muscle in this position. In addition to being a powerful internal rotator of the arm, the subscapularis, when properly firing, also has the task of stabilizing the gleno-humeral joint (shoulder ball & socket) in overhead position. In fact, it has the unenviable task of keeping the ball from migrating to far superior (up) and impinging on the socket in overhead reaching. (See diagram of Rotator Cuff Muscles).Rotator Cuff

We used to call this swimmer’s shoulder. Many swimmers and triathletes present with pain on the top of the shoulder. It presents as a classic impingement of the supraspinatus tendon due to a neurologically inhibited subscapularis. And this is exactly what I’ve seen in CrossFitters galore. Like whoa!

So the question follows: Will mobilizing the shoulder fix the pain and impingement?

NO!!!

You must FIRST get the body to recognize that the subscapularis is not firing properly, and fix that motor control problem.

HOW???

You come see me, or one of the many wonderful providers out there that also understand these principles.

Bummer.

I’m sure you were hoping for some easy self care take home point. But there are some things I just can’t teach you to do yourself. I can’t teach you how to do a specific neurological check, render the appropriate treatment and evaluate the efficacy of that treatment.

That’s what I’ve spent 15 years learning (and continuing to learn) how to do. In my office I assess, detect and correct the neurological imbalances that are causing improper muscle tone and faulty movement patterns.

Then and only then will I prescribe the appropriate mobility exercises for any residual restrictions.

In my opinion, anything else is putting the cart before the horse, chasing the wind and throwing mobility darts.

Feedback: Do you have a long standing movement fault that hasn’t responded well to mobility/stretching?

Yours in health signature


7 thoughts on “The Limitations of Mobility

  1. Aimee

    Great article! Yes! I have a “spot” that I can’t seem to fix (or even figure out where that “spot” really is)! It feels like my right hip or glute. It’s “tight”, hurts when I sit too long & I can’t squat very well (inhibited gluteal muscle group?). I have “Becoming a Supple Leopard” & I also follow Katy Bowman’s work, but I’m so overwhelmed that I don’t know where to begin. I stretch, roll, I walk, move…
    But maybe it’s coming from somewhere else?!?! Where? I’d love to find out!!

    Reply
    • scottamillsdc Post author

      Hey thanks for weighing in Aimee. Check out Kelly’s work in BASL on the hip – especially consider the piriformis muscle which externally rotates the femur. See if that move (sort of a figure four position) gets the spot – but yes, if you’ve worked on this for a while and it’s still a problem – there is likely a neuro-motor control issue to deal with. I actually see this mostly with hip flexor (or psoas) inhibition. You could check this easily by lying on your back lifting one leg, and having someone press down with firm resistance. Then check the other leg. If one feels sluggish – that could be the culprit.
      -Gluck!

      Reply
  2. Andrea @ pencils and pancakes

    I have a serious instability problem in my hips and pelvis. The dr diagnosed as SI joint dysfunction in the left hip but since then I’ve had other nagging problems on the other side as well…..my abductor and knee getting referred pain and my low back constantly feeling ‘tight’. I’ve been able to keep this all in check with my Supple Leopard book and self massage and muscle release, but it never gets better, just stays manageable. Damn I wish you were near me! The only dr I found that knew what he was talking about did ART and he is in Buffalo almost 2 hours away.

    Reply
  3. Nick

    hi my subscap isn’t firing just like what you wrote above. I can lift my arm and then it just stops. No pain. No feeling of tightness or pulling. Just doesn’t move. Can be pushed easily with no pain or stretch either. Just won’t go on its own.
    Been like this for weeks.
    Desperately need some advice on how to tell my body that this is happening to get the nerve muscle relationship back on track. Have tried Osteo and physio and had X-ray and ultrasound. Running out of options! Live in Sydney. Seriously grateful for any pointers.

    Reply
    • scottamillsdc Post author

      Nick – hey there…actually what your describing sounds more like an Accessory Nerve (Cranial Nerve XII) problem causing the trapezius to be inactive. You can check pretty easy…just have someone observe your trapezius muscles as you lift one arm through abduction (lateral raising). Compare your good side to the bad. Typically, you’ll see a classic compensation in the arm not able to fully reach overhead as you try to lift your torso instead moving through the shoudler. The fix is an upper cervical adjustment. Best bet is to find a NUCCA (upper cervical) chiropractor. -Dr. Scott

      Reply

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