21 Feb Joint-By-Joint Approach For Mobility
Have you ever experienced pain at 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 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.
Enhance Your Joint-by-Joint Mobility With [P]Rehab!
We have a dedicated section on our [P]Rehab Programs page solely for mobility. Learn more HERE!
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.
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.
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.
LISTEN: ANKLE DORSIFLEXION WITH [P]REHAB
Do you have adequate ankle mobility? Check it out.
Assess Your Ankle Dorsiflexion
Test DESCRIPTION: The Knee To Wall Ankle Dorsiflexion Assessment is a reliable tool developed and used to evaluate ankle mobility, specifically ankle dorsiflexion range of motion in a closed kinetic chain environment. Please watch the video to get a visual demonstration of how to perform the test and what to be mindful of. Below you will find a description of how to do so.
Test INSTRUCTIONS: Get set up in a half kneeling position near a wall with your foot barefoot on a firm surface. Begin the test by positioning your big toe at least 4-fingers from the wall with your foot facing 12 o’clock. Then, while keeping your heel flat on the ground, try to move your knee directly forward over your toes in attempt to touch the wall. If your knee is able to touch the wall, move your big toe backward, away from the wall, and try again until you find the exact distance that you can just touch the wall with your knee before your heel lifts.
Take a break and perform on the other side, record your score in terms of how far your big toe is from the wall in inches, centimeters, or fingers (whichever you prefer, just make note of it so you remember when it comes time for reassessment).
Some rules to remember with this assessment. Make sure your heel stays on the ground. Be mindful of your arch position, it is ok for your arch to lower a little bit, but don’t completely drop your arch so it is flat on the ground. Be sure to reference the entire video again before performing this assessment again on both sides to improve your performance.
If you find that you are lacking ankle dorsiflexion, here are some exercises that you can implement into your routine!
Ankle Dorsiflexion Distraction
Ankle Dorsiflexion Stretch – Contract-Relax
Ankle Dorsiflexion Dynamic With Kettlebell
Optimize Your Ankle Dorsiflexion!
Ask anyone in the industry, ankle dorsiflexion mobility matters. Without it, you run the risk of exposing other body regions to excessive strain due to compensatory strategies. This program is for anyone looking to improve their ankle dorsiflexion mobility. If your mobility is limited due to an injury/surgery in the past, or you’re just dealing with stiff ankles that are limiting your workouts and athletic performance, this program is appropriate for you as long as you have general workout experience! Learn more HERE!
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.
‘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!
Lunge Hip Flexion Stretch
- 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.
Hip 90/90 External, Internal, and Extension Stretch
Quadruped Lateral Hip Mobilization
Standing Inferior Hip Mobilization
Tight Hips? Learn The Best Exercises For Them!
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!
Thoracic Spine Mobilization
- 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.
Cat Cow Thoracic Spine Bias
Quadruped Thread The Needle To Open Book
Looking For More Thoracic Spine Mobility?
Thoracic spine mobility is a precursor to optimal neck health, shoulder health, and so much more. Yet, the average person is bound to be stiff and limited in this region and the rest of their mid back! We can blame 21st century workplaces and lifestyle habits, but the good thing is the thoracic spine and mid back region respond really well to the right dose of exercises. If your thoracic spine mobility is limited and your entire upper body is paying for it, this program will get you moving better and feeling better! Learn more HERE!
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.
- 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.
About The Author
Dylan Hoz PT, DPT, CSCS
Dylan Hoz is a graduate from the University of Missouri – Columbia. He earned his Bachelors degree in Health Sciences in 2016 and his Doctoral degree in Physical Therapy in 2019. Dylan is currently a practicing Doctor of Physical Therapy and a Certified Strength and Conditioning Specialist in Los Angeles, CA. Growing up playing competitive soccer and having a love for sports, he suffered multiple ACL injuries that led to his interest in Physical Therapy and helping people prevent/rehab injuries. Dylan served an internship as a student physical therapist at the Mexican professional soccer club – Pumas, and worked as a licensed physical therapist for EXOS Sports Performance and Physical Therapy in Kansas City, MO. In his free time, he enjoys spending time with family and friends, watching/playing soccer, and relaxing at the beach.