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Posted by on Mar 1, 2015 in Mobility, Rehab

ToM Part III: Bringing Stability to the Region

ToM Part III: Bringing Stability to the Region

 

In the first article of our Trilogy of Mobility (ToM) we found that static stretching has little to no benefit for increasing performance or decreasing injuries and we saw how it may actually hurt our performance if done before training/competition. We also looked at some alternatives to static stretching such as dynamic stretching and eccentric strength training. If you missed that article, here is the link:

http://higherperformancenetwork.com/death-static-stretching/

In the second article we looked at the differences between flexibility and mobility and why mobility is a better approach to take for performance and injury prevention. We also gave you the steps to increasing and maintaining mobility, addressing the soft tissue components surrounding the joint, as well as aspects of joint itself. Here’s a link to that article:

http://higherperformancenetwork.com/rise-of-mobility/

In this third, and final, article of our ToM we’re going to be looking at stability. We’ll look at the definitions of mobility and stability, how they are perpetually intertwined, where in the body we usually need stability training, and how to train it. Along the way we’ll also touch on “hypermobility” and what it means for our body and health. Let’s get to it.

We defined mobility as the ability to move throughout the entire physiologic range of motion for a given muscle or joint. So then what’s the definition of stability? Well, I’m glad that I asked for you. Stability can be defined as having the ability to resist against unwanted movements/forces throughout the entire physiologic ROM for a given joint.  Why is this important to have? If we don’t have stability in a joint we get injured. We can see traumatic injuries like dislocations or torn ACLs, or we can have chronic injuries like patellofemoral dysfunction or shoulder impingement. No matter what, instability will lead us down a path to injury/dysfunction, and along the way our performance will also greatly suffer.

 

The Delicate Dance of Mobility and Stability


yin yang

 

Stability and mobility go together like PB and J, CrossFit and Paleo, yoga and spandex,  etc… They are analogous to yin (stability) and yang (mobility). They are inseparable, and for us to stay healthy and perform optimally, they need to be in balance. We just talked about how a lack of stability invariably leads to aberrant movement patterns and ultimately, injury. In Part II of ToM we looked at how a lack of mobility also ultimately leads to injury and poor performance. The point being, we need them both.

Mobility is always gained before stability. You can’t be stable in a position that you can’t even get into. For this reason, we often see large amounts of mobility without the stability to support it. When this happens, the body can respond by restricting mobility, as sort of a splinting mechanism, thus preventing injury. This comes most often in muscle spasms and chronically overactive muscles, invariably leading to pain and dysfunction. If the body isn’t able to restrict mobility, then we see the injuries.

 

flexibility

 

If there is excessive mobility to beyond the physiologic range, without the stability to support it, we see a stretching of the ligamentous support structure of the joint, lead to hypermobility. This is harder to treat than hypo-mobility as it’s hard, if not impossible, to tighten up ligaments nonsurgically. A classic example of this is the gymnast who can bend over backwards, often-times having much more spinal mobility than stability. These gymnasts are also at a great risk for overextension, causing a lumbar vertebrae to actually move forward and sometimes even off of the disc which it’s supposed to sit on (this is known as a spondylolisthesis injury and can be very dangerous).

The answer in this situation is to create massive amounts of stability in order to keep the body from going to those extreme end ranges of joint motion. The best solution though is to create stability before the mobility becomes excessive and before the ligaments become overly stretched.

While these hypermobility injuries are extreme examples of imbalance between mobility and stability; it’s much more common to have a joint with just slightly more mobility than stability. We see this most commonly in the glenohumeral (shoulder) joint where the rotator cuff muscles (the shoulder stabilizers) are weak in a particular movement pattern such as raising the arm above the head (flexion/abduction) or in external rotation. This results in impingements in the joint and leads to chronic pain and inflammation.

What we also see is that we are perfectly stable in certain movements when the environment is controlled but when we get into sport, where uncertainty is an absolute, our stability breaks down. Along the same line, stability can be present at the beginning of training/competition, but once we get fatigued, stability goes out the window. We’ll get into this more as we look at training stability, but for now let’s look at some patterns that tend to arise with mobility and stability.

 

General Patterns of Mobility/Stability


Hopefully I’ve laid out a fairly clear picture of the relationship between mobility and stability and the fact that one should rarely even be spoken of without bringing up the other. That being said, there is this idea out there that some joints need mobility and some need stability. We’ll get into why I think that this way of looking at things is an oversimplification, but first let’s look at the truths in this idea.

The table below separates the major joints into either the mobility or stability categories:

 

Mobility Stability
Ankle Foot
Hip Knee
Thoracic Spine Low Back
Glenohumeral Joint (Shoulder) Scapulothoracic (Shoulder Blade)
Elbow

As you can see, the requirement of each joint is based on its anatomical structure and its movement pattern. The trend is that the more movements the joint is designed to perform, the more mobility it needs. This makes sense. Vice versa, the less different motions the joint is capable of, the less mobility it needs and the more it requires stability.

You may have also noticed that the pattern goes every over joint. You have one joint, which needs mobility, sandwiched between two joints that are stable. A crane must have a strong base to support the mobile structure. Same with a catapult. Many design features of nature have this balance as well- stability allowing mobility. All of this makes sense from an anatomical and biomechanical point of view, fitting nicely and neatly together. The reality however is that this is a generalization. Each joint is an entire complex of bone, cartilage, ligaments, tendons, blood vessels, nerves, and muscles. Each joint also needs to be able to move small amounts in almost every direction, absorbing force and preventing injury.

658px-Knee_diagram.svg

Take the knee for example. The main motions of the knee are flexion and extension. In these ranges the joint needs vast amounts of mobility. The knee however also moves into internal/external rotation and anterior/posterior translation. These movements require tons of stability as the ranges are much smaller than flexion/extension, but mobility in these ranges is also incredibly important.

As you go even further down the line, the knee also needs to be able to have some mobility to allow absorption of lateral force (valgus and varus stresses). These are only tiny amounts of motion that are necessary, just enough to absorb force and prevent injury, but they are crucial nonetheless and shouldn’t be overlooked.  Mobility contributes as a source of strength just as the pliability of a bamboo stalk makes it incredibly difficult to break.

Now you may be thinking that I’m being nitpicky and you may be right, but these fine nuances of mobility and stability can be the difference between having a great season and spending the season rehabbing an ACL tear or other major injury. I feel that they shouldn’t be swept under the rug. Ok, I’m stepping off of my soapbox…

Principles of Training Stability


Let’s take a look at some of the principles of training stability. One of most important principles of stability is that it needs to be trained in all ranges of motion in which we have mobility. We often times train stability in only one fixed range of motion, which is great when we’re performing in that range, but it doesn’t translate well when we invariably move to a different range of motion.

An example of this would be performing internal/external rotation for shoulder stability. Almost every class on rehabilitative exercise teaches that the upper arm is held close in to the side, scapula down and back, and elbow at 90o. This is great if we want to walk around all day like robots, but what happens to shoulder stability when we our arm isn’t glued to our side, or our scapula gets caught in a different position, or we bend our elbow less or more than 90o? In order for stability to be effective, it has to be present for every movement and throughout the entire range of that movement and thus it has to be trained this way.

The next principle of stability training, and this is true of all training, is that it’s progressive. We start by training stability just with our own body. Once we have stability in basic unresisted positions, then we can add resistance. The resistance should be varied, from bands to body weight to dumbbells. The more different types of resistance we are able to stabilize against, the better off we’ll be. This progression should be slow as increasing our level of stability inherently puts us in ranges and situations where we lack stability, and progressing too quickly can lead to injury.

Once we have a base of stability, the next step is training “reactive” stability. This part of training mostly strengthens the neurological system and may be the most important part of stability. We have to be stable against a wide variety of unexpected forces and the ability of our nervous system to stabilize a joint quickly is often the difference between injury or not. It also plays an incredible role in performance. We see wide receivers who can catch a crazy pass, stay in bounds, and tip-toe their way along the side lines. This too requires incredible amounts of reactive stability.

This sort of training often-times uses uneven surfaces such as a balance board, Bosu ball, or stability ball. Vibration plates are incredible for training stabilizer muscles and reactive stability. Also, having a partner is helpful in creating unexpected situations whether it be small perturbations or tossing a ball that you have to catch, etc… you can get very creative with this style of training.

Another very important aspect of training stability is that we need to be able to do it in a fatigued state. I already wrote an article on this concept (which can be found here http://higherperformancenetwork.com/rehab-injury-prevention-fatigued-state/) so I won’t go too deep into it here, but the basic idea is that when we get tired our form breaks down, predisposing us to injury. We lose stability, particularly reactive stability as our central nervous system becomes exhausted, and the only way to prevent this is to train stability in a fatigued state. Because stability training is often times not too taxing cardiovascularly, a good time to do it is during a break in a workout. Or it can easily be done right after a workout while we’re still tired.

Less Talking, More Doing


Ok so I’m sure by now you are sick of reading about the theories of stability and you want to know how to start creating it. Below I’ve listed a few major areas for stability training, what the focus often times is for the area, and a couple of example exercises for each. I’m just skimming the surface here to get you thinking about stability training. As always, your practitioner/trainer is your best resource and stability training should be done under the direction and close supervision of a well trained practitioner, especially in the initial learning stages.

Ankle

  • Classically known for having stability issues, often times resulting in inversion ankle sprains
  • First focus on strengthening in eversion, inversion, plantar flexion and dorsiflexion
    • 4-way ankle exercises with band resistance
  • Progress to standing and lunges/squats on uneven surfaces
    • Bosu ball, balance board, vibration plate, etc…
  • Perform dynamic, plyometrics-style exercises onto and off of uneven surfaces
    • Should only be performed under supervision and when practitioner/trainer feels you’re ready
  • Walk barefoot as much as possible

Knee/Hip

  • Knee instability often times comes from hip or ankle instability
  • Perform classic lower body compound movements (squats & lunges) with perfect form.
    • Begin with bodyweight and progress to resisted
    • Add as many different variations as possible including uneven surfaces and dynamic/agility training
    • Focus on knees tracking over the 2nd toe and not caving in
  • Hip stability almost always comes down to glute activation and strength
    • Work gluteus medius especially (clams, hip abduction exercises, single-leg bridges)

 Low Back

  • Focus on the traditional “core” muscles
    • Obliques, Rectus Abdominus, Transversus Abdominus, etc…
    • Train correct breathing patterns along with activation of these muscles
  • The mulitfidus muscle is the incredibly important for low back stability
    • Be careful not to over activate these muscles
    • Train with supermans, bird-dogs, bridges, etc…
  • Don’t forget the “other” small muscles of the low back (rotatores, semi-spinalis, intertransversarii, etc…)
  • Don’t forget about the pelvic floor muscles.

Shoulder

  • Need to address scapulothoracic aspect first
    • Shoulder-blades down and back (think opposite back pockets)
    • Rhomboid, lower and middle trap strengthening with row style exercises
    • Classic I’s, Y’s, and T’s
    • Serratous anterior strengthening with push-up+ and in planks
  • Rotator cuff muscles for glenohumeral joint
    • Oscillations of internal/external rotation and forward raises

 

Final Notes on Stability


You may have noticed that stability in one joint is almost always a function of stability in the surrounding joints. For this reason, you can train hip, knee, and ankle stability with the same exercises. A lunge onto a Bosu ball works glutes (hip), quads (knee) as well as all of the muscles of ankle stability, all in one movement. Another important note to make is that once stability is established, the best reinforcement for it is everyday life. Maintaining correct posture and walking/moving correctly will reinforce the stability training, reducing the amount of time that’s dedicated solely to stability training.

Another approach to creating stability is to use kinesiology tape. This tape is not meant for support like athletic tape, but instead can be used to stimulate proprioception in the brain which can lead to increased stabilization of a movement. It can be used to train stability or as a band aid approach during competition, but it should never be thought of as a replacement for adequate stability training. Ask your practitioner about whether or not kinesiology taping might be helpful for you.

Well that sums up our Trilogy of Mobility. This post was a lot longer than I expected, but I hope that it was worth your time and you got something out of it. As you may have figured out, I believe that mobility and stability are two of the most important concepts in athletic performance and staying healthy. I hope after reading some of these articles, you feel the same way. As always, if you have any questions, comments, or disagreements don’t hesitate to contact us at Higher Performance Network, we’ll get back to you as quickly as possible.

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