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Have you ever experienced pain in a joint and/or muscle? Well, you are not alone. It is pretty safe to say that everyone at some point in their life will experience some sort of musculoskeletal pain. Traditionally, we are quick to blame the affected body part and address it in a localized fashion. What if I told you that your bad knees, shoulder, low back, etc. are only the victims of a dysfunction elsewhere in your body? Treating the ‘painful’ body part can potentially improve your symptoms, but ultimately this remedy is destined to only be temporary, as the dysfunction elsewhere in the body is left untreated. Think of it as having a flat tire in your car and trying to fix the steering wheel for not working properly. Learn how to independently understand, identify problems, and improve your body's mobility. Consequently, learn how to address pain anywhere in your body with a more promising and lasting approach! In this article, we are going to show you the joint-by-joint approach for mobility to enhance your movement patterns!
What is the Joint-by-Joint Approach?
It is no secret that human movement is extremely complex. Walking alone requires essentially every muscle in your body to either move or stabilize a body segment, working in harmony, to deliver a ‘simple’ step. Needless to say, attempting to dissect human movement can be overwhelming. Thankfully, Mike Boyle and Gray Cook created a simple, yet revolutionary concept explaining why movement dysfunctions and consequent injuries occur.
Boyle and Cook suggested that the body could be seen as “just a stack of joints” with each having a main function that alternates between the need for mobility and stability, starting from the bottom-up. Explaining that if a deemed ‘mobile’ joint lacks the necessary mobility, the ‘stable’ joint above or below will have to compensate for this deficit, which could result in pain and/or injury.
Mobility refers to the ability of a joint in the body to move through its full and expected range of motion without interference, not to be confused with the flexibility (stretch tolerance of a muscle). On the other hand, stability refers to the ability of a joint segment to adequately allow controlled movement or willingly limit it at a specific body part.
Dealing With Stiff Hips? Gain Better Hip Mobility With Our Program!
The powerhouse of the movement system: the hip. With all of the force is can generate and without purposeful attention this joint can start to feel pretty stiff. It's a ball and socket joint by design meaning it was made to move in all planes of motion. If you want to optimize your movement system hip mobility is a great choice!
Significance of Joint-by-Joint Approach to Daily Life
Whether you are a professional athlete, weekend warrior, or avoid athletic activity at all costs, movement is inevitable. As society and technology continue to evolve, sedentary lifestyles become much more prevalent, creating an array of movement dysfunctions in the process. The problem with movement dysfunctions is that they can often be masked by a lack of symptoms, but much like a tight pair of pants, it’s a matter of time before they break.
Unfortunately, it is not until pain shows its ugly face that people seek a remedy. Although Physical Therapy is certainly effective at treating pain, it is also incredibly effective at preventing it. Regardless of your current physical condition, pain or painless, I encourage you to learn how to identify your movement dysfunctions and treat them independently.
Guidelines for Treatment
As previously mentioned, lack of mobility can cause a lack of stability, which in turn can lead to pain and/or injury. Following that logic, the first step is to identify and fix the existing mobility deficits, as they are usually the root of your problem. Just like weeds in your garden, pulling out the roots is necessary to get rid of them.
For the purposes of this blog, we will discuss how to identify and address decreased mobility, as it is the more commonly occurring issue. However, it is also true that one can have ‘normal’ or even ‘hyper’-mobility with the inability to adequately control it. Meaning lack of stability is the underlying cause of the overall movement dysfunctions.
Ankle Mobility
The foot and ankle are the base of our entire body when standing. Lack of mobility at this joint, more specifically dorsiflexion, can force the rest of the body to compensate and make up for it elsewhere. Directly affecting the ‘stability’ joints up the chain. Activities as simple as walking, sitting down, squatting, and jumping can be affected by a lack of mobility at the ankle.
‘Stability’ Joints Compromised
Knee: To put it simply, the knee was made to bend and extend in one direction only. It has minimal rotational or side bending abilities. However, if the ankle is not moving as it should, the knee is left with the task of dissipating the stress that the ankle passed upwards. Obligating it to move in those ways it was not designed to move. A common example of this would be the infamous ‘knee valgus’, which undoubtedly could lead to injury.
READ: HOW TO PREVENT KNEE VALGUS
Lumbar spine (low back): An easy way to visualize the interconnectedness of the ankle and the spine is by performing a squat. If the ankle’s dorsiflexion comes to a halt during the descending portion of a squat, meaning the knees are simply not allowed to continue moving forward. Then the body will compensate by rounding the low back in order to maintain balance and reach further depth. Needless to say, repetitive bending of the spine under load can certainly create problems. Now try another squat, but this time with your heels lifted on a slanted surface (as in wearing heels or lifted shoes). Was it easier to do? That is because your ankle did not need to dorsiflex as much.
Do you have adequate ankle mobility? Check it out.
Exercise 01 of 06
Exercise demonstration
Knee To Wall Ankle Dorsiflexion Assessment
View exercise instructions
LISTEN: ANKLE DORSIFLEXION WITH [P]REHAB
If you find that you are lacking ankle dorsiflexion, here are some exercises that you can implement into your routine!
Exercise 02 of 06
Exercise demonstration
Ankle Dorsiflexion Distraction - Band
View exercise instructions
- HOW: Anchor a band close to the ground. In a seated position, place your ankle inside the loop of the band and have it wrapped underneath the side ankle bones. Cross the bands over the top of your foot as you bring your foot up creating a tension that pulls your ankle towards the anchored band. Loop a towel around the balls of your feet and pull back with both hands. Hold that for as long as prescribed.
- FEEL: You should feel a stretch in your ankle joint and your calf muscle.
- COMPENSATION: Make sure the band is looped around your ankle and foot properly to get the best stretch.
Hip Mobility
The hip is a complicated joint segment because it is designed to be one of the most mobile joints in the body, but to function effectively it also requires a high level of stability. Unfortunately, as we age the hip tends to lose its mobility, and living a sedentary lifestyle speeds up this process. Furthermore, loss of mobility at the hip feeds into consequent loss of stability at the same joint, in addition to the one above and below.
Exercises For Tight Hips
‘Stability’ Joints Compromised
Lumbar spine (low back): If the hip lacks flexion and internal rotation mobility, the spine will have to bend forward to make up for it. Try to touch your toes while keeping your back straight, do not worry, not succeeding is completely normal in this case. More than likely at some point during the movement, you had to bend your back to reach further down. Conversely, if the hip lacks extension and external rotation, the back will have to bend backward to account for the loss of mobility. Now place your hands on your hips and try to bend backward at the hip while keeping your back straight. Much like in the other example, your spine will have to bend backward to continue moving, which is also completely normal. With that being said, if the hip lacks adequate mobility while performing activities as common as walking, running, squatting, jumping, etc. the low back will have to compensate for it.
Knee: This most commonly occurs due to lack of stability at the hip, from improper activation of the hip abductors, external rotators, and extensors. Furthermore, the low back can also be directly affected for the same reasons. Nonetheless, restoring hip mobility first is still paramount before addressing stability. The goal of addressing mobility first is to position the hip in correct alignment, allowing it to function adequately. Then, we can train stability by teaching the muscles to fire as needed.
Do you need more hip mobility? Check out these exercises!
Exercise 03 of 06
Exercise demonstration
Lunge Hip Flexion Stretch
View exercise instructions
- HOW: Begin in a runner's stance position. Lower your body as if you are reaching the elbow towards the heel of the leg in front. Really sink down as far as you can. With each exhale sink a bit deeper.
- FEEL: You should feel a butt and groin stretch on the foot that you take a step forward with as well as a hip flexor and groin stretch on the back leg.
- COMPENSATION: Do not excessively round your upper back when in this position. You can use a yoga block to hold you up if you are limited.
Exercise 04 of 06
Exercise demonstration
Hip 90/90 External, Internal, and Extension Stretch
View exercise instructions
- HOW: Begin on the ground with one leg out in front of you with one knee bent to the inside. Your other leg should be out to your side with your knee bent. The first stretch is rotating towards the leg out to the side. The second part is leaning straight forward over the front leg. Then, position yourself into a lunge position with the front knee down on the ground and the leg that is out to the side up with your foot flat on the ground. Shift your weight forward to feel a stretch in the front of your hip.
- FEEL: You should feel a stretch all around your hip.
- COMPENSATION: Make sure your legs are in the proper starting position. Keep your chest up as you lean to each side.
Thoracic Mobility (Mid and Upper Back)
This joint complex is frequently under-evaluated and undervalued, considering its importance for posture and human movement. Who has not spent hours slumped in a chair staring at a phone? I know I have. Unfortunately, sustaining the mid and upper back in a forward bent or ‘rounded’ posture for extended periods of time, for years on end, has potentially negative consequences. Through time, the mid and upper back adapts to this position and adopts it. Consequently, losing its mobility in the process.
‘Stability’ Joints Compromised
Neck: With the mid and upper back in a ‘rounded’ position, the neck is forced to extend (bringing the chin up), in order to not stare directly at the ground. Not only could this posture stress the vertebrae in the neck, it also tenses the upper back muscles as they are tasked with maintaining the head looking up.
Lumbar spine (low back): Similar to the neck, with the mid and upper back ‘stuck’ in a ‘rounded’ position, it has lost its ability to fully extend (straighten). Therefore, the low back is now obligated to extend to maintain a ‘fake’ upright posture. This problem is aggravated by misalignments at the hip previously mentioned. No different than in the neck, this maintained posture also affects the lumbar vertebrae and places increased stress towards the low back muscles in order to maintain an over extended posture.
Scapulae (shoulder blades): More often than not, a ‘rounded’ mid and upper back, will result in rounded shoulders as well. Consequently, the shoulder blades are now protracted (slide forward) and upwardly rotated (top of shoulder blade rotates towards spine, bottom rotates away from the spine). As you would expect, this affects the length and tension of different surrounding muscles. Additionally, the aforementioned motion of the shoulder blades (protraction and upward rotation) must occur during the act of raising your arm overhead. However, this motion has already occurred by maintaining the ‘rounded’ back posture. Try it for yourself, sit in and maintain a slumped posture and try to lift your arm above your head. Now sit upright and do it again. Your shoulder should have been able to move better when you were sitting upright. Like a domino effect, lack of mobility at the mid and upper back leads to lack of stability at the shoulder blade, subsequently causing lack of mobility at the shoulder. Evidently, this can cause pain and/or injury at the shoulder.
Are you lacking adequate thoracic spine mobility? Check out these awesome exercises to improve your mid back motion!
Exercise 05 of 06
Exercise demonstration
Thoracic Spine Mobilization - Swissball
View exercise instructions
- HOW: Sit back on your heels with your knees on the ground and your toes pushing into the ground. Rest your arms in front of you on a swiss ball. Roll the ball out with your arms as you take your chest to the ground. Hold that stretch when you can’t roll the ball out any further for the prescribed amount of time.
- FEEL: You should feel a stretch in your mid back.
- COMPENSATION: Don’t roll to either side, roll the swissball out straight in front. Stay seated on your heels to get the best stretch.
Exercise 06 of 06
Exercise demonstration
Cat Cow Thoracic Spine Bias
View exercise instructions
- HOW: Get set-up on your hands and knees, hinge back at your hips until your butt and heels are touching or close to it- this will round your low back slightly. While keeping the rest of your body still, round your mid back followed by slowly arching your mid back. Repeat
- FEEL: When you round your back, you should feel like you’re pushing your chest away from the ground by pushing through your hands. You should also be performing a posterior pelvic tilt with rounding your back, thus your back looks like a cat. When arching your back, you should feel like your chest is dropping towards the ground, but you don’t want to bend at your elbows, keep your arms straight. You should also be performing an anterior pelvic tilt with arching your back, thus your back and head make the shape of a camel.
Closing Thoughts
Lacking mobility anywhere in the body can lead to breakdowns and compensations elsewhere in the body, potentially causing pain. Treating the painful area in your body in a localized fashion can help reduce symptoms. However, chances are this will only function as a temporary relief, as the dysfunctional area and culprit for your pain is left untreated. Identifying and addressing mobility deficits in the body by utilizing the joint-by-joint approach is the first step to permanently fixing your pain.
Take Your Hip Mobility To A New Level With Our Programming
The powerhouse of the movement system: the hip. With all of the force is can generate and without purposeful attention this joint can start to feel pretty stiff. It's a ball and socket joint by design meaning it was made to move in all planes of motion. If you want to optimize your movement system hip mobility is a great choice!
References
- Cook, Gray. Movement: functional movement systems: screening, assessment, corrective strategies. On Target Publications, 2018.
- Boyle, Michael. "A Joint-by-Joint Approach to Training." T Nation. 20 June, 2007. https://www.t-nation.com/training/joint-by-joint-approach-to-training. Accessed 15 Jan. 2021.
- Horschig, Aaron. The Squat Bible: the ultimate guide to mastering the squat and finding your true strength. 2017.
- Wilkins, Tyler. "Mapping EXOS Rehab Methodology: movement-based therapy concepts and clinical reasoning across the continuum." EXOS. Volume 2. Feb. 2020.