Thoughts on mobility training

Mobility is a buzz word in the fitness community right now. Everyone understands it’s important (joints have to be mobile in order to create movement). However, how much mobility the average person needs is a hotly debated topic, and, I am going to argue, for some, maintaining higher levels of mobility might affect more than just the physical state.  What is mobility and how does it differ from flexibility? Todd Hargrove distinguishes between the two in his book, “A Guide to Better Movement,” by defining flexibility as the range of motion at a particular joint, or more simply how far it passively moves from point A to point B. Mobility, on the other hand, is how much control a person has over end range motion. For instance, say a client can place a strap around the ball of his foot and pull his hip into 110 degrees of flexion. Once the strap is removed and the individual has to actively hold his hip into flexion, his leg drops to 80 degrees of hip flexion. The first is an example of his flexibility, while the second is an example of his mobility. 

This idea of controlling end range and developing strength in various joint angles is important for good quality movement. There are some that tend towards having quite a bit of mobility and are considered “hypermobile.” On the opposite end of the spectrum are individuals experiencing an idea Joanne Elphinston calls functional rigidity. This occurs when a person undertakes higher stability or balance challenges than he can control. The nervous system, in an effort to protect the body from injuring itself, creates stability by increasing muscle activity, partially immobilizing a series of joints (Elphinston, 2015). This is where relaxing the nervous system, via breathing techniques, Feldenkrais, specific types of yoga, or other restorative modalities can cause a dramatic improvement in mobility without stretching by essentially calming the system down. These modalities don’t necessarily translate to improved movement quality and efficiency, but they are effective at helping a person understand when he is overworking. (It could be argued one of the first steps to moving well is increasing movement awareness).

Another factor that can cause a sense of rigidity in a person’s movement is the startle response (Keleman, 1985). During the first stage of the startle response, the spine straightens out or arches and the spinal extensors contract. The upper body braces and is alert, prepared for stress to the system. This can become a habituated postural pattern, resulting in similar movement patterns as functional rigidity; things are locked down to provide stability and control. (There are other progressions of the startle response, but for the purpose of this blog, I am just going to write about the initial response). This is also called “preparatory set” in the literature (Payne and Crane-Godreau, 2015). Again, the startle response or preparatory set posture prepares us for action, allows us to focus our attention on the situation at hand, and isn’t necessarily a bad thing, as long as the organism rebounds back to a calm state. The ability to do this is supported by a number of factors, including the interplay between efficient breathing and efficient posture.

What in the world does all of this have to do with mobility training? I promise I am getting there. But first, consider the individual that wants to begin training. She doesn’t have any major mobility goals, other than she wants to get stronger and be more fit. She is in her early 30s, and has a rigid, braced way of moving with far less mobility than you expected to find upon the initial evaluation. She has dabbled in group classes and exercise off and on throughout her adult life, and played soccer in high school. Her neck muscles jut out a little bit, and her upper traps feel like a rock. Where do you start?

The beauty of this kind of client is by focusing on gentle, restorative movements during the warm-up, encouraging slow, controlled movement during the workout, and finishing with restorative work during the cool-down, mobility will improve significantly in a short period of time without too much actual “work.” This doesn’t mean all of the joints will move independently, or the mobility will be optimal for all of the exercises you are hoping to do with her. There will still be work to be done. It does, however, give you a more accurate starting point in terms of which areas need attention. If during this period you have the client perform an exercise that is slightly out of her comfort zone or ability, one of two things will happen. Either practice will eventually give the person the motor control and skills needed to accomplish the task well or the system will go back to a state of bracing due to a perception of threat. 

This is true if the client perceives an emotional threat as well, either real or imaginary (Lelard, et.al, 2013). Research indicates emotional states affect how motor tasks are accomplished, in part by altering posture. Let’s say you have been training the individual above for four months, she is doing really well and is holding herself in a more relaxed manner, but at the beginning of the fifth month her dog dies. Chances are high you might notice a bit of the initial rigidity she came to you with when she comes in to train. Her mobility might decrease and, unless she is able to reconcile her emotional distress, at least for a brief moment, during her session, it might be a rough training day in terms of quality. If the emotional issue is something bigger, like a divorce or a death of a family member, it is possible mobility training might not be the most effective choice while the person processes what she is experiencing. (Or it might. Everyone is different. The point is the physiological response to an emotional threat is difficult to “train” out of a person. This is what therapists are for, not to train the response out, but to help a person move forward).

Back to the ideal world where the client has no extra stress and has made improvements in mobility simply by decreasing sympathetic tone through breathing exercises, mindful exercise, joint articulations, and a non-threatening environment. Though she has not expressed the need to do any specific athletic feats, such as the splits or a forward fold with her nose on her knees, you wonder if her mobility is adequate for her athletic goals. Which brings us to an appropriate question: how much mobility does a person need?

Like all things, it depends. Different tasks require different amounts of mobility. For instance, research performed by Schache et.al (2000) demonstrated that the act of running requires a degree of both anterior pelvic tilt and hip extension in order to propel the body forward. And, shockingly (insert sarcasm here), the Thomas test was not indicative of the ROM actually used during running. The researchers advise against making statements regarding dynamic sagittal plane movements of the hips and pelvis based on what a passive test shows.

This of course, makes sense. We are beginning to understand and embrace the fact mobility training should be dynamic in nature in order to give us more strength at end range. In fact, when adolescent soccer players are compared to their non-soccer playing peers, hip flexor force was higher in the soccer players (Hoshikawa, et.al, 2012). While this study didn’t compare hip flexor mobility between groups, I would guess dynamic ROM would be higher in the soccer players as well; not only was their ability to generate force higher, the cross sectional area of the psoas major was greater in the soccer players. They utilize hip flexion regularly in a dynamic way. This tends to lead to greater mobility. In fact, I would also suggest the adolescent soccer players studied probably have greater dynamic hip flexion ROM than the distance runners mentioned above. The distance runners don't need to generate high forces in hip flexion in order to move forward. The two groups require different amounts of mobility to adequately meet the motor challenge.

Back to the client at hand. If she has adequate mobility for the work you are doing with her and for the things she is doing in her everyday life, she is pleased with her progress, and she is pain free, do you need to do intense mobility training with her?

Payne and Crane-Godreau (2015) propose the following theory for the preparatory set posture I mentioned earlier. Pretend there is a short-term threat. There is an appropriate response via the sympathetic nervous system, including the preparatory set posture, the appropriate action is taken, the parasympathetic nervous system rebounds, and sympathetic activation returns to baseline. This includes a change in muscle tone and breathing back to resting levels. This cycle is good. It builds resiliency and leads to a stronger physiological system. (Think the normal recovery after exercise).

Sometimes, the situation doesn’t resolve quickly, so the PS response becomes prolonged and possible chronic. In extreme situations where the threat is much higher (think the television show Blacklist), ideally the same cycle outlined above occurs (PS occurs, once threat is removed and everyone is safe, levels return to baseline. When this doesn’t happen, a disorganization of the physiological system occurs. This equals trauma. 

What I am suggesting is dynamic posture and mobility patterns are sometimes related to something bigger than lack of mobility. This goes back to Keleman’s work which I referenced earlier. There can be a rigidity with the long term perception of threat. Perhaps this rigidity gives the person experiencing the trauma sense of control. When there are less degrees of freedoms available for movement, there is a sense of stability. I speak from experience. I had a, for lack of a better word, a tumultuous childhood. This translated to my physical self. I was always the tightest one in PE; touching my toes wasn’t really an option, The flip side of this is I was quite strong. Over time, as I continued to perform movements that were outside my DOF grade (see functional rigidity), I felt tighter and tighter, until eventually everything hurt. 

Enter lots of breathing, restorative work, and interoception/proprioception work. I suddenly felt amazing. An entire new way of moving and being opened itself up to me.  Nothing hurt, I could move in the manner I wanted, and things were great. This is not to suggest I was “flexible.” Not compared to the bendy movement people and yogis of instagram. But that was okay. I could do what I wanted, when I wanted.

And then my goals changed. I found myself in the midst of a really rewarding physical training program that required mobility beyond what I currently had. The obvious solution was to do active mobility work. So I did. And as new ranges of motion opened up to me that had never been there before, not even as a child, I found myself consistently talking myself off of an anxiety cliff. “You are fine. It’s okay to be able to move your shoulder/hip this far. People do it all of the time. Just because you feel like your body is completely disconnected, doesn’t mean it is. You are doing this intelligently, with strength. And your sleep will balance itself out, and the incessant worry you are finding yourself plagued with will go away. Because this is temporary while you adjust.”

It’s not terribly surprising this was my experience. Research demonstrates a link between anxiety and hyper mobility (Bulbena, et.al, 2015). Based on my limited experience with suddenly accessing more mobility than I am used to, it makes perfect sense that not knowing where your body is located in space on a regular base would be anxiety producing. Again, there is a lack of control over your movements, and for many, control is fundamental to feeling stable. 

So what about for our hypothetical client? If mobility work is indicated to achieve specific goals, I suggest working on one thing at a time. Give the body and mind time to adapt and adjust to the new ranges of motion. Once there is a sense of ease in her movement at the new end range, move on to a different area. I personally wouldn’t work more than two mobility drills at a time with this type of individual. You don’t know if this woman suffers from anxiety, you don’t know if she has experienced trauma, and you don’t know if she will have a momentary panic attack when she realizes she is moving in a foreign way. (Or even if it’s a foreign way. Again, protective rigidity is multi-faceted). 

Fortunately for me, the anxiety was temporary. But the nine days it lasted were rough. As I adapted to the new ranges, my anxiety calmed. Amanda Gore writes in her blog,* “the link between body and mind is now proven beyond dispute.” Just like increasing strength builds a sense of confidence, a sense of resilience, improving mobility beyond the individual’s sense of “normal” will cause a shift in perception. Respecting this mental shift can help guide programming. It also should provide a moment’s pause as you ask yourself, “why am I having the person do this? What overall purpose does it serve to enhance the quality of her life?” And remember: passive mobility tests aren’t reflective of dynamic mobility.

Yours in health and wellness,
Jenn

References:
Elphinston, J., (2014). Stability, Sport and Performance Movement: Practical Biomechanics and Systematic Training for Movement Efficacy and Injury Prevention. North Atlantic Books: Berkeley.
Keleman, S., (1985). Emotional Anatomy: The Structure of Experience. Center Press: Berkeley.
Payne, P., & Crane-Godreau, M.A., (2015). The preparatory set: a novel approach to understanding stress, trauma, and the bodymind therapies. Frontiers in Human Neuroscience, 9(178). (Full text here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4381623/).
Schache, A. Blanch, P., & Murphy, A., (2000). Relation of anterior pelvic tilt during running to clinical and kinematic measures of hip extension. British Journal of Sports Medicine, 34(4), 279-283.
Hoshikawa, Y., Iida, T., Ii, N., Murumatsu, M., Nakajima, Y., Chumank, K., & Kanehisa, H., (2012). Cross-sectional area of psoas major and hip flexion in youth soccer players. European Journal or Applied Physiology, 112(10), 3487-3494.
Bulbena, A., Pailhez, G., Bulbena-Cabre, A., Mallorqui-Bague, N., & Baeza-Velasco, C., (2015). Joint hypermobility, anxiety and psychosomatics: two and a half decades towards a new phenotype. Advanced Psychosomatic Medicine, 34, 143-157.

*This line came from a great blog on “Thought Viruses,” which can be found here: http://amandagore.com/thought-viruses/