Welcome to this week’s episode of AHA. I’m your co-host Coach Ken. Each week we will discuss practical health/fitness strategies and topics to help you regain, maintain, or improve your health and movement practice. Ultimately our goal is empower you to create a personal movement practice that will support your activities of daily living, make you fall resistant, and living independently for as long as possible.
Show Content: Episode Overview Episode #7
Movement Practice Concept: Understanding the Alternate Arrangement of Mobility and Stability Joints in the Body
As you know, the title of this program is Active Healthy Aging. In an attempt to be somewhat cleaver I created the acronym AHA or simply “aha” because in my journey as a fitness professional there have been many “aha” moments. In my opinion we have collectively done a very poor job of physically educating the public. I have been a competitive athlete for most of my life and yet it wasn’t until I became a fitness professional that I really started to understand how the body actually works.
I have been fortunate enough to be exposed to some incredible mentors, coaches, physical therapists, and other fitness professionals. Just about every time I start to dive into a topic, whether it’s a familiar subject or something brand new, I usually have at least one “aha” moment as I’m learning.
In today’s topic, we will be recognizing that our body’s prime mover joints are arranged in an alternating pattern by function of being either stability or mobility joints. Gray Cook, physical therapist, author, and presenter was the first person that I knew of to point this anatomical reality out. I hope that as I explain this concept that you will grasp the significance of this concept and that you are then able to apply this information to your own body.
So let’s take a look at the arrangement of our prime mover joints, starting at our head.
The neck or cervical spine is made up of 7 vertebrae, these are obviously classified as “mobility joints” as we actively use them to move our head.
Before we move down the spine, let’s take a short detour to our shoulder blades or scapulae. This is a somewhat paradoxical classification because even though we want and need full scapular movement, our shoulder blades are actually classified as a ”stability joints.” Here’s why, even though we know the scapula must rotate upwardly during an overhead press for example, it is its ability to offer the shoulder joint a solid platform from which to bring the arms up over head that requires stability. So the scapula is classified as “stability joint” and the shoulder joint itself, is the “mobility joint.” Indecently, the shoulder joint, being one of our most mobile joints in the body, is also one of the most unstable joints. Unfortunately with all that mobility or range of motion, it also makes it one of our most vulnerable joints when it comes to injury. There isn’t a deep socket for the head of the humorous or upper arm bone to sit in but rather imagine a golf ball on a golf tee, there’s just not much contact surface area there. Hence, it’s very easy to dislocate this joint or more commonly, tear one of the little rotator cuff muscles that try to hold the humeral head or upper arm in place.
OK, let’s review where we are on this alternating joint journey: The neck or cervical spine is a mobility joint. The scapula is a stability joint and the shoulder joint is a mobility joint.
Now, returning back to the neck and moving down the spine, we have our thoracic spine, made up of 12 vertebrae. These segments are designed to move. They allow us to flex forward, bend backwards, bend sideways, and rotate our upper body. Ironically, most people do not move their thoracic spine regularly through these ranges of motion and thus they become stiffer as we age. I will offer you a strategy in the regeneration section for helping you mobilize these mobility segments.
Moving down the spine we come to the lumbar spine. This is where the majority of back pain is experienced. This segment of the spine consists of 5 vertebrae and they are classified as “stability joints.”
While they are designed to move a few degrees, their primary function is to stabilize the low back. There are two common practices that most of us are doing everyday that feeds into low back pain. Most notably sitting. In short, we sit too much and sitting especially slouching in a chair puts tremendous shear force on L4 and L5 vertebrae. Sitting up straight will help a little but better yet start being creative about sitting less.
The other common practice that can feed into a back “pull or spasm,” is twisting your upper back without allowing your hips to move with them. For example, imagine a golfer taking a swing by rotating his upper back but failing to allow his hips to rotate as well. This is a recipe for injuring your low back. A more common movement fault is forward flexion of the spine (bending forward) and then rotating to the side. Say you dropped a small object on the floor, off to the side. You bend over at the waist and then twist to your left or right to pick up the object….Wham followed by ouch!
If you don’t remember anything else in this show please remember that your shoulders and hips ALWAYS need to move together.
So, your lumbar spine is a stability segment, next the hip. After the shoulder this is probably our second most mobile joint. Remember the analogy of a golf ball on a tee to illustrate the vulnerability of the shoulder joint? Well the hip, as most of you know, has a deep socket, so the risk of dislocation is greatly reduced.
If you only have a little time or desire to work on mobility, please consider working on and maintaining your shoulder and hip mobility. One other quick note, why are we seeing an almost epidemic of hip and knee replacements? I believe, there is a direct coloration between sitting too much and poor sitting and standing posture. Since most folks rarely squat anymore they not only have lost hip strength, the seated posture shortens the hip flexors, which attach to and pull on the lumbar spine.
These chronic poor posture positions can lead to a loss of optimal joint centration or the joints ability to stay centered in it’s socket and thus feeding into wear and tear on the hip joint.
Moving down from mobile hips we arrive at the knee joint. The knee joint is a stability joint. It does freely allow knee flexion and extension but as you probably know, doesn’t like lateral or rotation forces.
In a very broad sense the knee joint, a stability joint, is sandwiched between two mobility joints (hips above and ankles below).
The genesis of most knee pain is poor mobility or strength of the hip and/or the ankle. Usually, when the knee hurts, there is a problem in the hips above or the ankles below. I’m obviously excluding situations where there has been a blunt trauma to the knee itself. This why if you go to a physical therapist for knee pain they will likely evaluate your hip and ankle first. Think of it this way, the knee (a stability joint) is stuck in the middle, if the alignment or strength of the hips or ankles are poor, it can go straight to the knee joint.
Hang in there we are almost to the bottom of the mobility/stability continuum. So, we identified the knee as a stability joint, the next segment down is the ankle, our final mobility joint. The ankle/foot is a very complex group of structures and suffice it to say, if your ankle structures aren’t allowing you to walk, run, ride a bike, or jump efficiently and without pain you know you have a problem. Probably one of the biggest contributing factors to ankle/foot immobility is wearing shoes. Now don’t touch that dial yet, hear me out. I’m not suggesting that you throw away your shoes but perhaps spending a little focused time working on your ankle/foot mobility and maybe wearing the least amount of shoe you can at times could help. If your ankles can’t bend, flex, extend, and twist within recommended ranges of motion it can effect the joints above (knees, hips, low back etc). In the next section I’ll offer some general mobility practices you can try to keep you moving free and easy.
Movements of the Week: Some basic Mobility examples (ankles, hips, GH, and thoracic spine.
Well we made it down the body from head to toe illustrating how the prime mover joints are arranged in an alternating fashion. You hopefully have a sense that there’s some practical value to maintaining adequate joint mobility.
Before I go into some specific mobility drills for your mobility joints I need to address the idea of “hyper-mobility.” Physical therapist are taught to measure joint angles or ranges of motion.
There are fairly specific degrees of motion that are considered safe for each joint segment. Excess mobility can be as problematic as restricted mobility. Remember, the body is always working hard to stay in balance, whether it’s blood volume, hormone levels, or how far we should take a joint during movement practice.
So without belaboring the point, just because you can take a joint to extreme ranges, doesn’t mean you should. If your sport or recreational activity requires more than normal joint range of motion then I suggest you work with a physical therapist or fitness professional to make sure you are also developing the stabilizing muscles that will help accommodate these ranges of motion and keep you moving safely.
Now on to some mobility drill examples for each of the mobility joints we just discussed. Keep in mind these are just examples, there are many ways to mobilize your various joint segments. Also, as you explore these drills there should be no joint pain! If you try these and experience joint pain stop and get evaluated by a health care professional.
Cervical spine (neck): Lay on your side, on the floor with your neck supported on a foam roller or make a towel roll to support your neck (something firm). Pull your knees up into a 90/90 position (like sitting), extend your bottom arm out to the side. Place your other hand on your forehead and gently roll your head from side to side, letting your neck gently roll from side to side across the roller.
Shoulder Joint: Stand with your back to a wall, heels out away from the wall 6-8 inches. While maintaining contact with your tailbone, spine, shoulder blades, and back of your head against the wall, slowly raise both arms up overhead, trying to touch the wall behind you with your thumbs. This will require both some upper back (thoracic extension) and shoulder flexion as you raise your arms up.
Thoracic Spine: Assume the same side-laying position as in the neck mobility dill above, 90/90 knees and both top and bottom arms extended away from you. Now glide your top arm forward an inch or two and then slowly raise your arm up in a arching motion, following your arm movement with your head and eyes. Your knees will want to come apart but don’t let them. You can use a pillow or yoga block between your knees. Keep tracking your arm up and across your body. Focus on getting the movement out of your upper back (thoracic spine) not cranking on your shoulder. Only go as far as you can keep your knees together and then return to the start position and repeat.
Hips: Probably one of the most effective hip openers you can do is a supported deep squat position. Simply hang onto a counter top, doorjamb, or bar about waist height, at arms length. Push your hips back, push your knees outward and try to drop all the way down. Once in this bottom position try to remain there for 30 seconds to a minute. Eventually you may be able to start sitting in this 3rd world sitting position when you are performing daily tasks like working your garden.
Ankles: Standing facing the right side of a doorjamb, place your right foot about 4 inches from the doorjamb. Step your left foot forward past the doorjamb and place your hands on the doorjamb for balance. Then keeping your right heel on the floor, bend your right knee and try to touch the doorjamb with your kneecap. If you can’t touch, then move forward a little, if it’s too easy move back a little. Average ankle mobility should allow you to be back about 6 inches from the doorjamb and still be able to touch.
Wellness Concept of the Week: “Just because you can doesn’t mean that you should.”
I mentioned this earlier but I think it bears repeating within the context just about everything we do related to our health and fitness. We have access to so much information these days on any subject that it is really a challenge to know what is accurate or appropriate for us. This is where I believe we each need to turn up our critical thinking caps.
Let’s look at a few examples:
You just watched a video featuring some buffed out male or female telling you that if you take this supplement and do this exercise routine you will lose your belly fat overnight and look just like them.
I understand that we are all vulnerable to the marketing that supposedly offers a solution to our personal issues, whatever they may be but hopefully you can take the emotional charge out of this and critically analyze the facts.
In terms of exercises, we see examples of this all the time. There are endless You Tube videos showing some pretty crazy stunts. While these can be entertaining, most of us would be wise to avoid attempting them. As an extreme example, performing a barbell squat while standing on a stability ball comes to mind.
Perhaps a quick risk to benefit assessment could save us from ourselves in this situation.
So consider using this litmus test to keep yourself healthy and safe in all aspects of your life and remember: Just because you can doesn’t mean that you should.
Wellness Quote of the Week: From Walt Whitman
“Re-examine all you have been told at school, church, or any book, dismiss whatever insults your own soul.”
A good reminder to keep our critical thinking capacity turned up.
Regeneration Strategies: Pamper your feet
While this could include having a pedicure I’m actually going for something a little more practical to keep your feet structures happy. Our feet are composed of 26 bones (1/4 of your skeleton), creating 33 joints. Most of these joints are articulated, meaning they connect several bones just like an articulated bus that has connected segments allowing it to bend in the middle. Many of these foot joints not only hinge but they need to be able to slide and glide with one another.
Some of the root causes of common foot ailments can be traced back to wearing restricting or over-correcting shoes. One of the easiest and most effective ways to keep your feet happy is to roll a tennis ball or spiky ball under your bare foot. Simply sit down, place your foot on the ball and begin to roll the ball from the base of your toes to the back of your heel. Apply as much pressure as you can reasonably tolerate. You can also roll side to side and in little circles. Over time your feet should be able to accept more pressure, keeping the fascial tissue, muscles, and joints of the feet supple and pain free. This technique can also help prevent plantar fascitis, a common debilitating condition of the feet.
So roll those dogs frequently, they will thank you.
Fitness Truths, Half-Truths, and Lies:
Today I’d like to debunk a fitness myth that older adults should not do deep squats.
First, my cautionary disclaimer. Of course if you have known degenerative changes in your knees/hips/ankles such as Osteoarthritis or Rheumatoid arthritis, then full/deep squats may not be appropriate.
I have found that most adults that come to my classes, are often concerned about squats hurting their knees. Usually the issue is that they don’t know how to squat correctly and thus can experience joint pain. If we clean up the squat technique, they are usually able to start performing at least assisted or modified squats without pain.
Keep in mind that I’m talking about just body weight squats. The effective functional depth of a squat needs to be roughly where the top of the thigh is parallel to the floor. Once the form is good and they are pain free, we can explore deeper ranges until they are able to squat in a free standing position and drop into a deep squat position.
This deep squat sitting position has a number of health benefits:
• It is an excellent way to traction out or stretch your low back, even if you need to hang onto a bar or railing at first.
• It is a great hip mobility movement, especially if we push our knees outward as we drop down.
• Finally, if we can maintain the ability to come out of a deep squat or even a parallel squat for the remainder of our days, we will likely have the strength to keep living as independently as possible.
Fitness Fun Fact: Medicine Balls
You’ve no doubt seen these weighted balls at the gym. Some are designed to be bounced or thrown for rebound effect, others are called dead med balls, that do not bounce and just plop when you slam them into the floor, and finally there are weighed balls attached to ropes for a variety of swinging and chopping motions.
The best known origin of the term medicine balls dates back to the father of modern medicine, Hippocrates, around the same time in ancient Greece, where he is said to have stuffed animal skins with sand to create a weighted object for “medicinal purposes.” Similar objects where used in the Middle East around the same time period.
Medicine balls are very popular tools in functional training movements. By adding just a little weight to the arms while the lower extremities are performing a movement like a lunge, we can really challenge balance, core stability, and strength all at the same time.
As with any tool, if you aren’t familiar with how to use them, get some instruction from a qualified coach or fitness professional.
The information and opinions expressed on this show are for informational and entertainment purposes only and are not intended to be a substitute for professional medical advice, diagnosis, and/or treatment. Always seek the advice of your physician or health care provider regarding any medical issue you may be experiencing
Thanks for listening and as always,
BE WELL …BE FIT