Patterns and systems

As human beings, we look for patterns. Patterns help us explain things. They make it easier to make decisions, and they serve as a reference point, allowing us to draw from past experiences to rapidly assess the current situation. Some scientists argue humans possess a superior pattern processing ability (SPP). SPP is believed by some to be the foundation for intelligence, imagination, language, and invention (1). 

The problem with patterns is the anomalies. If the patterns that we are accustomed to dictate our decisions, eventually we will find ourselves stuck, unsure of how to proceed. Let’s take a closer look at this in the world of fitness and wellness.

Body types:
When I was in college, many moons ago, I learned about the idea of somatotypes. Somatotyping is a way to classify individuals based on body type. There are three main categories: ectomorphs, mesomorphs, and endomorphs (2).  Ectomorphs are classified as naturally thin, delicate, and wiry. Mesomorphs are athletic, put on muscle easily, and have thick skin. Endomorphs are round, have trouble losing weight, and soft. When I searched PubMed, 332 articles on somatotype research were available, the most recent an article in The Journal of Strength and Conditioning Research published in July of 2017 on “somatotype and body composition in young soccer players according to the playing position and sport success.” 

For those of you that are wondering, goalkeepers tended towards a meso-endomorphic somatotype while forwards were generally meso-ectomorphs. (3). It makes sense specific body types are better suited for the athletic requirements of specific sports. Again, it’s a pattern and a generality we expect. It’s also possible that participating in something regularly will lead to muscular adaptations to meet the task. Obviously, a six foot three, 280 pound linebacker is never going to look like a five foot four, 145 pound gymnast, but what if the 280 pound, six foot three individual had chosen gymnastics instead? I imagine his body shape and composition would look different than it would as a football player. Does body type really dictate our athletic abilities? And can one’s somatotype be altered with the right stimulus? How do you feel if the pattern doesn’t fit?

Posture:
A long time ago, a physician and physiotherapist named Vladmir Janda noticed postural patterns he believed was directly related to movement dysfunction and pain (4). He applied rehabilitation concepts to the patterns he observed in a clinical setting, eventually placing these postural dysfunctions into one of three categories: upper crossed syndrome, lower crossed syndrome, and layer syndrome. Upper crossed syndrome visually looks like forward head posture, lower crossed syndrome looks like a lumbar extension pattern and layer syndrome is a combination of the two. “Upper crossed syndrome” resulted in 54 results on PubMed. The most recent was an article in the “Journal of Physical Therapy Science” published last year examining the effects of middle and lower trapezius strength exercises and levator scapulae and upper trapezius stretching on forward head posture, aka upper crossed syndrome (5). 

Again, for those of you wondering, yes, strengthening the mid back and stretching the upper back resulted in a decrease of a head that looks like it’s forward. It is worthwhile to note none of the subjects in the study had pain. Did they suffer from movement dysfunction? And if they didn’t have pain during the time of the study, isn’t it reasonable to speculate maybe their tissues adapted to the position of their head and they weren’t destined to a life of pain? 

Exercise systems:
An even longer time ago, a man named Joseph Pilates declared the “curvature of the spine, protruding stomach, stooped-shoulders, hollow chest, hollow back, bow legs, and knocked-kneed conditions” were postural issues related to pain and dysfunction (6). He developed an exercise system to correct these issues that is still widely used today. A PubMed search on Pilates turned up 334 results, one of which was a 2016 literature review of Pilates for low back pain. The authors concluded (after a thorough database review) Pilates is more effective than doing nothing for low back pain; however, there is no evidence that Pilates is superior to other exercise interventions (7). One of the things that stood out about the effectiveness of both Pilates and the exercise interventions studied is consistency mattered. At least a three month intervention, cumulating in 20 hours or more of physical activity was advantageous for reducing pain. 

A 2014 review on lumbo-pelvic kinematics and low back pain concluded increased lordosis and anterior pelvic tilt were not contributing factors to developing pain (8). However, people with low back pain did consistently have reduced range of motion in the lumbar spine and reduced proprioception. Pilates addresses spinal mobility and increases body awareness making it an effective intervention for low back pain, though not for the postural reasons originally suggested by Mr. Pilates. 

Systems are based on observations. It is natural to want to explain the why behind what we do, so we do research to prove our hypothesis and rationalize interventions. However, the problem with humans is they don’t always fit perfectly into a specific pattern. If our scope of understanding human movement or behavior relies solely on one system, eventually as practitioners, we will get stuck. Someone won’t respond like we expect or won’t present with a body type or movement pattern that fits one of our categories or sub-categories. And if you are a teacher that tries to explain to the student what he’s doing and why he’s doing it, it might not resonate with the student. Broad generalizations based on experience works most of the time, but when it doesn’t, the person to whom you are educating will feel isolated because he doesn’t fit the general rule. If you are trying to help someone with pain, this breakdown of understanding and communication can have detrimental effects in terms of the efficacy of treatment.

The square peg in the round hole:
Let’s look at the Meyers Briggs personality test for a moment. It’s a well known test used in businesses and the military to help people understand behavior. It was also widely criticized for its lack of consistency, suggesting the idea that people routinely and consistently fall into one of sixteen personality categories is unrealistic (9). In fact, the category people end up in on Tuesday might change on Thursday, suggesting many of us either suffer from multiple personalities or that the test isn’t an accurate indicator of personality. 

I have taken the Meyers Briggs several times over the last 20 years. The first time I was a teenager in high school. I remember reading through the questions, finding myself conflicted over which answer best represented me. Sometimes I liked to be with people; other times I liked to be by myself. Usually, I analyzed things to death; sometimes, though, I went with my gut instinct. Usually I am thoughtful, sometimes I am emotional. How was I supposed to know which was the best representation of me when any of the options could represent me depending on the situation?
 
By the time I had finished and tallied up the scores, I was an INTJ, but just barely; I was almost split in two of the categories, and the other two weren’t exactly clear favorites.

This trend continues today; usually, I am an INTJ, sometimes, I am an INSJ, and I think once I was even an INTF. Though I am a fairly consistent person and I don’t suffer from mood swings, my opinion regarding my actions varies. 

As much as it would be nice to believe we all live in a state of homeostasis, where there is a consistent baseline we all return to that keeps us behaving and feeling the same way every day, that’s not the reality of human existence. Our moods vary. Our beliefs, if we are a thoughtful person, can be altered. Our movement patterns are no different- we might walk up the stairs on Monday one way, but on Wednesday, after a really hard workout and a long walk, we walk up the stairs a different way. Variation is normal and it challenges the idea that our movement patterns behave in a predictable way. 

This isn’t to say that the systems which have been designed to explain the processes of human movement and/or posture are wrong; they can be a good starting point to begin to understand basic generalities. However, if the systems you study and explore movement under are your only vantage point, eventually you will be stumped. Someone will show up with an issue or a way of moving that sits in your blindspot. You can try to explain it, but the reality is the person doesn’t fit. Or, at least, the person doesn’t fit into a specific category that day.

Variability:
If you were to take an elite runner and video his foot strides, you would notice that while they look similar, there would be subtle variations between steps. If there were a lot of variation between steps, this would waste energy and the runner wouldn’t be elite, but the subtle variations are how the runner’s neuromuscular system figures out the most efficient way to deal with the environment while moving as quickly as possible. If the runner were a machine, there would be no variation- each step would perfectly replicate the one before it.

In fact, a small study published this month found foot strike variability during downhill trail running led to a decrease in neuromuscular fatigue (10). Variability might not only be normal, but in certain situations it might be optimal.

Another small study looked at how the back muscles worked while they repetitively lifted an object (11). The subjects with low back pain had very little variation in low back muscle activity. The pain free group, on the other hand, had a shift in the distribution of muscle activity as the lifting activity went on. If you watched the pain free subjects, it wouldn’t look like they were wildly changing their strategy to lift the object each time, but small micro-changes are being made while the brain takes the feedback from the muscles to improve the lifting strategy each repeition.

The point is, we do have a fair amount of consistency in our thoughts, actions, and movements when things aren’t fatigued, the system is feeling non-threatened, and life is moving forward in a predictable way. The tiny deviations we experience are generally a way to maximize output with as little effort as possible. But everyone, at some point, will experience deviations from their baseline and these deviations don’t always fit into a defined box. Sometimes normal doesn’t fit into a defined box either. 

The first time you watch someone move, you are left with a snapshot, a selfie that may or may not be indicative of reality. The incomplete picture makes it difficult to make blanket statements or assumptions regarding the person’s patterns or how the person fits in a specific system. Over time, consistencies reveal themselves. The first meeting with a new client, the client is figuring you out and trying to please you, while you are watching, assessing how she moves. It’s a recipe for potential performance anxiety. And if you begin vocalizing the assumptions you make on a one time assessment, you may very well scar the person for a long time. 

Labeling is one of those things we tend to do to better understand a person’s habits, but labels are fluid and don’t always stick. Plus, they don’t instill self confidence, encouraging a more fixed mindset rather than a growth mindset. If our goal is to set our clients and students up for success, avoiding labels or language the indicate, in some way, the person is broken or dysfunctional should be avoid. Things like, “your transverse abdominis doesn’t fire/your glutes are weak/you overly pronate,” don’t serve any purpose coming from a fitness professional, other than to make the client feel like there is something wrong with him. 

If you study a system that resonates with you, know it well. Know it forwards, backwards, and upside down so that when someone walks in that doesn’t fit, or doesn’t respond like you expect, you recognize the anomaly and you either refer out or you change your perspective. I went on a search several years ago for the perfect system. While perfection eluded me, my journey did hone my observation skills, enable me to discover new ways of approaching exercises and movement, and add perspectives to my toolbox I wouldn’t have otherwise. I am stronger, more flexible, and a better practitioner from everything I have studied. I continue to study different modalities and receive coaching because at the end of the day, as long as the stimulus is a little bit more than what you did yesterday, you will get stronger and more mobile; if it’s interesting in some way, you are more likely to stick with it. As a healthy, pain free adult, that’s all I am looking for. 

I am also a little bit weary, because for every system that promises to cure people’s posture or low back pain, there is someone for whom it doesn’t work. My solution is to study anatomy, motor control, biomechanics, and psychology. To be an effective practitioner, especially if you are working with special populations, it takes more than understanding what the system says to look for; it requires knowing what you are looking at and being able to ascertain joint movement, integrated movement, and a lack of coordination or understanding at a specific area. Perhaps most importantly, it requires listening to the person in front of you. Strength matters; so does the ability to move freely. Establishing a way to check your work and confirm your impressions is critical, but so is the ability to re-route your plan when it isn’t working. Use your system, but more importantly, think critically.

My latest online course on shoulder anatomy, function, and integration is finally finished! Check it out here: https://vimeo.com/ondemand/shoulderworkshop

References:

1. Mattson, M.P., (2014). Superior pattern processing is the essence of the evolved human brain. Frontiers in Neuroscience, 8(265). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4141622/
2. Perroni, F., Vetrano, M., Camolese, G., Guidetti, L., & Balderi, C., (2015). Anthropometric and somatotype characteristics of young soccer players: differences among categories, subcategories, and playing position. Journal of Strength and Conditioning Research, 29(8), 2097-2104.
3. Cardenas-Fernandez, V., Chinchilla-Minguet, J.L., & Castillo-Rodriguez, A., (2017). Somatotype and body composition in young soccer players according to the playing position and sport success. Journal of Strength and Conditioning Research, doi: 10.1519/JSC.0000000000002125.
4. Page, P., Frank, C.C., & Lardner, R., (2010). Assessment and Treatment of Muscle Imbalance: The Janda Approach. Human Kinetics: Champaign, IL. 
5. Bae, W-S., Lee, H-O., Shin, J-W., & Lee, K-C., (2016). The effect of middle and lower trapezius strength exercises and elevator scapulae and upper trapezius stretching exercises in upper crossed syndrome. Journal of Physical Therapy Science, 28(5), 1636-1639.
6. Pilates, J., (1934). Your Health: A Corrective System of Exercising that Revolutionizes the Entire Field of Physical Education. Presentation Dynamics. 
7. Lin, H-T., Hung, W-C., Hung, J-L., Wu, P-S., Liaw, L-J., & Chang, J-H., (2016). Effects of pilates on patients with chronic non-specific low back pain: a systematic review. Journal of Physical Therapy, 28(10), 2961-2969. 
8. Laird, R.A., Gilbert, J., Kent, P., & Keating, J.L., (2014). Comparing limbo-pelvic kinematics in people with and without back pain: a systematic review and meta-analysis. BioMed Central Musculoskeletal Disorders, 15, 229.
9. Pittenger, D.J., (1993). Measuring the MBTI…and coming up short. http://indiana.edu/~jobtalk/Articles/develop/mbti.pdf
10. Giandolini, M., Horvais, N., Rossi, J., Millet, G.Y., Morin, J.B., & Samozino, P., (2017). Effects of the foot strike pattern on muscle activity and neuromuscular fatigue in downhill trail running. Scandinavian Journal of Medicine and Science in Sports, 27(8), 809-819.
11. Falla, D., Gizzi, L., Tschapek, M., Erlenwein, J., & Petzke, F., (2014). Reduced task-induced variations in the distribution of activity across back muscle regions in individuals with low back pain. Pain, 155(5), 944-953.