On my first clinical rotation as a Physical Therapy Student, I was lucky to work under a clinical instructor who not only looked at a single joint for answers, but also examined the joints surrounding the injury site. During one of my first days on clinical he recommended that I read “A Joint-by-Joint Approach to Training” by Mike Boyle. I haven’t viewed movement the same since.
In 2007, Mike Boyle wrote this blog on T-Nation. He recounted that his friend, and legend in this field, Gray Cook, helped him to simplify why movement dysfunctions and subsequent injuries occur. In perhaps one of the most influential blogs ever written, Boyle suggested that “The joints simply alternate between the need for mobility and stability as we move up the chain.” When we lack mobility at a supposed mobile joint, the stable joint above or below will compensate for this deficit by becoming more mobile, which can lead to pain or injury.
Fundamental Movement and Gait
The principles illustrated in “A Joint-by-Joint Approach to Training” have withstood the test of time. Since its publication, this simple concept has been presented in numerous books and blogs. Rather than continuing to discuss how the Joint by Joint Approach relates to the weight room, I want to give a different perspective. I want to discuss how the Joint by Joint Approach relates to Fundamental Movement.
In Physical Therapy School, we are taught that the stance phase of the gait cycle can be further divided into five distinct phases:
· Heel Strike (Initial Contact)
· Foot Flat (Loading Response)
· Mid-Stance
· Heel Off (Terminal Stance)
· Toe Off (Pre-Swing)
With Fundamental Movement, the stance phase of the gait cycle can be further broken down into just two phases:
· Absorption
· Propulsion
The absorption phase of Fundamental Movement, or front side mechanics of gait, includes heel strike and foot flat. During this phase the ankle dorsiflexes; the hip flexes and internally rotates; the thoracic spine flexes and rotates towards the flexed hip; and the shoulder internally rotates and extends.
The propulsion phase of Fundamental Movement, or back side mechanics of gait, includes heel off and toe off. During this phase the ankle plantarflexes; the hip extends and externally rotates; the thoracic spine extends and rotates away from the extended hip; and the shoulder externally rotates and flexes.
The mid-stance phase of the gait cycle can be thought of as the amortization phase. In simple terms, the amortization phase is the transition period between the absorption and propulsion phases.
Every time we walk, run, jump, or cut, the absorption and production of force occurs. As the velocity of these movements increases, so too does the amplitude, or range of motion at each joint. This means that athletic movements at high rates of speed require greater ranges of motion at these mobile joints.
The Movement Pyramid
If we circle back to the Joint by Joint Approach, we are able to see how taking 10,000 steps in a given day with limited hip mobility can lead to low back pain. A mobility restriction at the hip can lead to increased mobility at the supposed stable lumbar spine. If we take this same hip mobility restriction and apply it to an individual who is being asked to sprint or change directions at a high rate of speed, you could imagine that pain or injury might manifest itself at a much faster rate.
Gone are the days of looking solely at the injury site for answers. In order to find the true culprit, we must take a global approach to truly understand why pain and injury have occurred in the first place. Enter the movement pyramid.
The movement pyramid can be broken down into three components. At the top of the pyramid is skill. An example of a skill would be a crossover in basketball. Below skill is performance. Performance qualities include the ability to jump, shuffle, cut, accelerate, or run at top end speed. Sticking with the basketball crossover example, we can extrapolate that an athlete would need to be able to execute a shuffle as a prerequisite to performing the crossover.
At the base of the pyramid is fundamental movement. Fundamental movement, as discussed earlier, is the ability to absorb and produce force. During the shuffle, an athlete plants the outside leg, dorsiflexing the ankle along with flexing and internally rotating the hip. When they go to push off that same leg, they plantarflex the ankle and extend and externally rotate the hip. We can appreciate that if an athlete lacks the ability to dorsiflex the ankle it will impact their ability to absorb force during a shuffle, which will subsequently impact the crossover in basketball. This inability to dorsiflex the ankle could lead to increased demands placed on the knee, which, over time, could manifest itself as a knee injury.
Fundamental movement is the foundation for all subsequent movement. A lack of mobility locally can lead to a supposed stable joint becoming mobile.
When an individual comes to us with a pain complaint they will typically provide a story related to the top two tiers: skill or performance. “My knee hurts when I perform a crossover.” It is our job to identify the movement dysfunction at a fundamental level in order to restore function and ultimately improve performance and skill acquisition.
References:
1. Boyle, Michael. “A Joint-by-Joint Approach to Training.” T NATION, 20 June 2007, www.t-nation.com/training/joint-by-joint-approach-to-training.