E70 | Keep It Real #15: Mobility & Stability

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On today's episode, Greg, Doug and Trevor #KeepItReal while talking mobility and stability.

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Episode Transcription: Welcome to the Resilient Performance Podcast, this is Keep It Real episode 15. Uh, we had a question come in on Instagram yesterday. Um, Is the mobility and stability approach too simplistic? And does it relate to performance? Uh, we were kind of talking briefly beforehand. We can kind of take it on a bunch of different directions with this one, but Doug, why don't you take it and get started? Yeah, I mean, I think the answer to that as a too simplistic is yes and no, like, like any other model, right? Like the mobility stability. Model para-dime way of thinking about things because it's a model and it's, you're trying to explain complex phenomenon, trying to explain reality into words. It is simplistic as, as any model, but it doesn't mean that the model is necessarily not without some kind of merit. So that's the short answer. The long answer is we have to kind of define the terms like with anything else. Now, I think the mobility stability kind of continuum. Model that the question alludes to tends to define mobility and stability and maybe in different ways than how other people would define those terms. So I think that the way that model is typically defined or constructed is to mean that mobility is more synonymous with range of motion. So there's this idea that like, you know, if you have too much range of motion, let's say then that can make a joint unstable because. You are, you're unable to control that range of motion, assuming you have too much. So it's basically taking range of motion to the extreme. Is that, is that a problem or to someone in that spectrum line more towards the, the range of motion side of things, stability would, would mean that, you know, the, the ability to control that range of motion, kind of like more synonymous with motor control. Um, so the, the extreme of that will be someone who's just like. Super super stiff has, you know, very like limited range of motion. Maybe can't hit certain key positions that they need for their life or their sports or their job. So like, you know, in a lot of cases, looking at the extreme scenarios can be enlightening as leads you more towards somewhere in the middle. So you don't want to have an athlete or a patient that is like, just so stiff that they can't demonstrate important ranges of motion and it key positions. You don't want to have somebody that does. So much range of motion that they have a hard time controlling it because now maybe like in sports, they take their joints to an end range position where they're there, where it's maybe putting the joint in a compromising position. But I've also heard of people depending on like where the either school of thought defined mobility as the ability to control a joint through its range of motion. So if you define mobility that way, then you can actually never have too much mobility because mobility always. You, you, you can't have a building without control orange emotion without control. So if you're defining mobility to mean that you have to be able to have range of motion and control it, then in theory, you can never have too much mobility because you can't separate the range of motion from the stability component. So again, it comes to, you're only really limited by like your anatomy, right? So it would come down to, you know, uh, in the more traditional model we're talking about range of motion versus. Versus stability or, or control that's one scenario. The other scenario is if you're saying that mobility always requires you to be able to control range of motion, then you can never have too much of it. So it depends on what we're talking about and how we're defining those terms, I think. And outside of the Symantecs and like in real life, like, yes, I think that the, the first model where we're talking about range of motion versus. More, um, you know, stability or motor control. Like I have worked with people where immediately, you can tell a bit there, they lie more towards the range of motion side of the spectrum, and they need more like, almost like isometric work, slowly centric work. And these are the people that, you know, like your, your baseball rowers, right? And like where, what, what makes them good is also what puts them at risk for injury, because now, like they need to have a freaky amount of external rotation. In the cocking phase to be able to throw harder. Um, and if they didn't have that range of motion, they wouldn't be able to throw hard, generate velocity through a longer range of motion, but because they can put their shoulder in that end range position, they're more likely to put that joint at risk, whether it's like, you know, the labrum anterior shoulder bicep, tendon. That kind of thing. And those are the kinds of athletes where they hate doing isometric work. They hate doing slow work because they're always relying on their range of motion, their elasticity to be able to produce force. And so they're off like with other athletes as well, like weightlifters or gymnast, um, the more, the more flexible types. Right. And then you've got like, maybe the, um, like again, stereotyping, but like the basketball player, who's just like, they can jump out of the gym because they're super stiff, but they have a hard time, like getting really low into a defensive position. They can't bend, but they're so used to relying on these very like, kind of short range of motion, rapid movements and generate force. And that's oftentimes why they're so genetically gifted it's because they have that utilize city, but they don't like producing force through longer ranges of motion. They're the ones who, because you know, our, our kind of philosophy is we want to give the athletes what they don't have. And like, we're not gonna, we're not going to take someone who has a 40 inch vertical leap and make them more explosive per se, but from like a, a general health and an injury standpoint, we can even make them more robust by giving them more general qualities. So like that, that more like hypermobile looking athlete, the baseball pitcher, like they're going to benefit from a general instinct for training standpoint with more like isometric East centric. You know, just control type things. Whereas like the stiff springy athlete might, you know, like they might benefit from like being able to access more ranges of motion, learning how to access and control that and producing force, you know, with more of like a muscular type effort, then an elastic effort. So it's more, like I said, when you get rid of submit, it's finding what the athlete. Doesn't do well and getting them to do it, but, you know, even in the same athlete and that's where we talk about the joint by joint approach. Like you can have an athlete thriller, for example, that has really freaky range of motion in their shoulder, but they have, let's say like really poor. Um, internal rotation and their lead hip, or like a stiff lead hip. And you could speak better than I can to this Greg. Like, I think there's been some data showing that like, you know, pitchers throwing out the two black lead lead lead hip, internal rotation, or more likely to have like elbow problems or Tommy John problems as an example. So just because somebody demonstrates, leans more towards the, um, the range of motion or the motor control end at one joint doesn't mean they're going to have the same relationship. And every other joint. So again, short answer, the question is like, yes and no, there's, it's, it is overly simplistic, but I think it can also be a useful paradigm to kind of, you know, um, put athletes at the buckets, but just realize the limitations of it. Like any other model. Yeah, I think what you just said there, Doug is like, just because it is simplistic, doesn't mean that it's not useful at all. And I think like you just gave like 10 great examples of how we can take that, that paradigm and the continuum of mobility and stability and apply it to so many different populations to be able to help us choose more appropriate interventions for the person that we're working with in front of us. I think that's the whole goal that we want to have with like any sort of model and even like the drone by drone approach. Would you just mention as well as like, how can we actually take. Take some of those, uh, the principles of it and apply it to, to populations because just the idea of like Mobilians ability does seem kind of simple, but when you kind of peel away the layers, you can get a lot deeper into it and, and understand that, um, there was a lot of complexity within that simplicity that has a lot of really good use for us as therapists and coaches to help again, make, make positive changes and positive impacts with the people that we work with. Yeah, definitely then thinking about the joint by joint approach. Like for me as a first-year strength coach years ago, like that was an awesome start. Like that was where somebody should start when they're they're green and they're, they're newer to the, some, some of this stuff. And I think I had just heard it from Mike Boyle. And then like, you know, just being introduced to all the things that Mike Boyle does, like it does some awesome stuff and it's very, you could call it like simplistic, so to speak, but like it, it gets the job done and it's a great foundation. Um, so I think that's important to understand too, is like, yeah, maybe it's not the right thing for, um, You know, someone who has worked in the field for 20 years and has developed a more complex model that they're able to adapt to the needs of their clients, whether they're training or more patients. Um, so that's, that's one way that I think it is a very important and useful model. Um, also is like, If that's the model that we're, we're talking about, like in a physical therapy setting, it might not matter as much because we're dealing with some, a lot more context potentially than someone who's in a, in a healthy situation and just kind of training to be an athlete and get stronger. Um, so it depends on what type of professional you are and what, like, what way you're working and in what capacity you're working. Um, and then one other thing too, is like, It's, you know, we talk about it like an either or, but it's not like, just because you increase, somebody's like mobility that they're then teetering on the edge of being unstable and they're going to fall apart. So, um, you know, we tend to, like you said, Doug, like, we tend to bucket people and if you're somebody who's like this loosey goosey, like touch your thumb to your forearm person and like, Put your palms on the floor. Like it's probably going to benefit you if we can kind of tighten you up a little bit. And you're not just all of a sudden gonna be too Steph and not be able to move. Um, and it's all about just building a range for somebody to operate in and giving them things that they don't necessarily have, uh, already. Yeah. And I would say that's one of the reasons why, why I think that, that, that idea is so useful is because it is, we talk about all the time. What we do with most of the clients is give them the things that they don't have. And then we can bucket people into just a simplistic category of mobile or overly stable. I think stable is almost the wrong word. It's like. Kind of replace stable with rigid and stable seems like a good quality read to sounds like not as good of a quality. So if you have mobile and rigid, it's like people who are mobile, we want to make them a little bit more stable. So kind of move them toward the, towards the end of the continuum towards like rigidity and somebody who's really rigid. We want to bring them back to the middle where they are a little bit more mobile. So I think just, you know, it helps us understand, like, all we're trying to do ultimately is give people some of the qualities that they don't necessarily have. Um, Like compared to some other qualities that they may kind of happen in space. Just give them, give them, expose them to things that they're not as good at. Yeah. Where it gets tricky. As, I mean, sometimes it's, it's hard to differentiate. Like what's a motor control or a stability problem from like a pure range of motion or like what, what I think they might call that model like a tissue extensibility problem. Cause like you can take, for example, Like a pitcher, right? Right-hand a pitcher. You test them on the table. They have very limited shoulder internal rotation, but if they truly had a Mo like a tissue centric problem or a range of motion problem, You would need to like, do you need to do like some kind of like low, low, and long duration stretching? We basically, you wouldn't get, you wouldn't get a change in range of motion. It would take you months to get a true change in range of motion. But like there's a lot of different neuro tricks and neuro hacks you can do to, to get range of motion. So for example, like a Commonwealth pitchers, right? As you just. They're right. Handed pitcher, press down on their left rib cage. Haven't breathed a couple of times. And if they double their shoulder internal rotation, then what, what is that? Is that a mobility problem within a stability problem? So sometimes like what's written off as a, a mobility or range of motion. Problem is really because. It's that joint or that body part, trying to stabilize for something else. And then when you give the body like stability proximately in the case of, you know, like, like even people who do like, let's say a bear exercise, you get them to feel their abs. Now they have better shoulder flection, better shoulder internal rotation that you, you could call that a stability problem. Whereas. Some of, some of the models of this stuff is based on what originally dismissed the shoulder internal rotation, you know, as like a, like a tissue problem or like a range of motion problems. So I think that the most simplistic way to look at this and sending, using even mobility and stability is just look at the athlete and their sport. Look at their life demands, figure out like how much range of motion do they need and whatever range of motion they need, they should be able to control. So you're never really differentiating, but that, that sounds like saying you can never have too much mobility because now for taking mobility and we're saying mobility, we're defining it by saying mobility is the ability to control, whatever range of motion you have. What's problematic about that definition. Is that, where do you draw? Like how much rain, how much range of motion does somebody need? Because like, you can, you can say, well, you can never have too much mobility. I think you can, because. To, to, to, to develop the ability to control a joint through extreme ranges of motion takes an investment in your training time. And like, I don't, I don't mean like an athlete to be able to control, let's say like 90 degrees of hip internal rotation. If they get 30 to 45 and they can control it and they can demonstrate strength. I'm happy with that. So I do like the idea of saying like any range of motion that somebody has, it should be able to control. And if you want to call that mobility, that's fine. But. Not everybody needs to have extreme range of motion and be able to control it. Even if somebody can access extreme range of motion, as long as they don't find themselves getting into a crazy position, we don't need to keep developing that if it's not going to help them for their life or their sports. So I think again, the most simplistic way of looking at it is do a needs analysis. How much mobility does somebody need a range of motion to be a human being? How much do they have to have to play their sport? And then give them a little bit of a buffer, but they don't need to have a huge buffer. It's like saying. If, uh, if an offensive lineman needs to be able to squat 400 pounds to play the position, well, maybe getting them to four 50 is good. They have a buffer, but they don't need to squat 700 pounds and be a power lifter because that investment in getting to 700 pounds is going to detract from other things they need. So maybe that's an easier way to look at it, but I still think there's some merit to the mobility, stability continuum. Just realize what the limitations are and where it falls apart. Like any other model. Yeah, definitely. I definitely feel like I, I realize like some of the people who are more mobile or like flexible and bendy. Like, they're the ones that seem to enjoy doing more mobility stuff. Like they're the ones that are like, ah, it feels good to stretch or like they want to do this because like, they feel like they want to feel a stretch or they want to feel something at end range. Um, and meanwhile, like they're not the ones that need to be doing it because like you said, Doug, like more doesn't necessarily mean better. It's just a matter of like, if you have enough, uh, if you have enough to do your sport and then a little bit more, like that's probably where we would want you to be for. Any joint, um, and then, or, or any physiological quality, really just to have that buffer. Um, and then, uh, yeah, like you said, like it's going to take an investment to continually like work on controlling some sort of extreme end range of motion when, who knows, who knows if that's really like, it's probably not going to benefit your sport if you've already got what you need and then some, um, so that's sort of like, A tricky thing where like, you then need to like convince the person that they've done enough of that. And like, let's do more ISO. Is that in rain? You know, like do something else, uh, do some temporal work or whatever it is. Um, and that's, I don't know. It just, for some reason, it got me thinking about CrossFitters in. Um, whenever we have somebody who's into that style of training, I tend to, I find that I'm giving them more like ISOs and tempos. Cause they're just like flying through range of motion. Yeah. Like often not oftentimes, but a lot of their joints are like pretty flexible just because they've kind of like banked through them or whatever. Um, yeah. Or maybe like they have one joint that's stiff and then to make up for it, like another one that's hyper mobile. So, um, it tends to be in like a rehab situation. I'm kind of asking them to. Do the opposite of what their workouts are telling them and go slow and, and hold position. So that was just something that popped into my head. That's why I like the, a urinal. Did you give an RMS dog of like the alphabet? I think if you can think of things in that approach, like, do you have enough. Do you have enough range of motion because that is ultimately what my ability kind of, kind of comes down to is to a certain degree, is like, do you have enough to do the things that you need to be able to do and that, why are we going to spend tons of resources chasing other things when there's other qualities that you probably need? And I think that. I was one of the, keep it real from a while ago where we talked about like, like now, like, you know, probably three, four years ago, if I had somebody super flexible who talks about how they love stretching, I'd be like, Oh, you don't need to stretch, stop stretching. You don't need it nowadays. I'm like, if you like it, it feels good. Like go for it. But it's just kind of sprinkle in and some of the things that you probably do need as well, rather than trying to take away something that the person enjoys and probably does make them feel good. This is a different, it's a different, you know, somebody can get an range. Position and it causes them pain and yes, we want them to stop doing it, but there's plenty of people who, yeah. They don't maybe need to spend time doing it, but if, if it makes them, if it makes them feel good that they can kill, still get into these funky positions and stuff, then yeah. I'll let them keep doing it, but they didn't get him to try to get them. Some of the more things that I think they actually need to, like we've talked about before, just give them what they don't have to get them doing things that they don't normally do. And maybe if we're talking about like, Being able to control the range of motion you have just looking to make sure that there isn't a huge discrepancy between their like, you know, passive range of motion and active range of motion. We don't need to keep driving more range of motion. But obviously, if someone is like demonstrates a ton of mobility, passive range of motion passively, but then can't, you know, get into that position actively or can't control it very well. Then maybe that is a problem because now you've got an athlete who's capable of getting into an extreme position, but they don't really know how to get out of it. That doesn't mean that we didn't necessarily need to give them more, more and more, more range of motion to keep chasing more end range, but whatever their end range is, make sure that they can control it. And then if it's not sufficient for the sport, then we keep trying to increase the end range while also developing the ability to control it, or, you know, demonstrate strength. And at that end range position. Okay. It's like personality types. I mean like no one, nobody in psychology, nobody totally adheres to like a very strict personality type and in different situations, people's personalities might change, but, you know, as a, as a heuristic, like. You can, when you're around somebody long enough for like, Oh, well, this person is really, really like compassionate and accommodating. This person's kind of stubborn, you know, like even among ourselves, like as far as that range of motion, stability continuum, like I would lean more towards the, like the rigid or the stiff side, you know? Um, I, I don't wanna speak for you guys. Like Trevor's probably more in the middle. You know, um, but they, they, these things do have merit, but even once you type cast somebody and say, you're this well, that's great. You've labeled them. You diagnose them, but what are you going to do about it? So ultimately again, this stuff is kind of semantics because they need range of motion. They've got to be able to control it. So how are you developing range of motion? Are you developing control? That's the more fun conversation than kind of like talking about the abstracts. Because the models are great, but even with the, with the models, like you have to apply the model, what does that model look like in practice? How do you determine when somebody has too much of something or not enough? And then how do you develop it? That's why we like sharing programs because we could say, well, we had a hypermobile athlete. We could say this was hyper mobile athlete. Great. But what do you do with that person? How do you, how do you cue, how do you coach the exercises? How does that change for the quote unquote hyper mobile athlete for the stiffer athlete? Or do you have just a standard of what you think looks good and you make sure that they. Adhere to that, to your movement model. So, um, there's a lot of things that play into this. Have either of you guys had like an athlete that you think was. They're kind of bucket them and just kind of one of these two categories, either too mobile or too stiff, too rigid for their sport. Cause I have one that kind of comes, comes to mind for myself. I got, I don't know if you guys kind of have one that as you can think of, like, like mine was one of the, it was a high school basketball player who was, uh, six, 10. I started working with him 10. 10 or 11 months after his initial surgery and then ended up having like a microfracture surgery, like two months after his ACL surgery and things like that. But, um, like he came in, he's a big, strong kid, super, super, you know, like very incredibly rigid. And he had to, to be able to do the things that he needed to do on the court. Like he was still missing probably 15 to 20 degrees of knee flection by the time he got to me. So that was something we're always chasing. You could see that. Um, that stiffness and the rigidity in his knee effect is, is his running gait. Um, and then like the number one, I would say overly rigid joint that he has was his ankles. He had like, no, not joking, probably like five degrees of dorsiflexion. So anytime he would try to get into the deepest stance, like Doug had mentioned earlier, the shuffle to change direction, you would see just. How much that limited him in his movement capacity. Um, so I, you know, that's why I think it's like, yes, this model is simplistic, but every now and then you do kind of see like the black and white of it. Um, but I think oftentimes it is the gray where people need some sort of combination of both. Um, but like this athlete, if I had got, gotten to work with them longer, I would have just spent. Tons and tons of time, really trying to chase and, and improve just his, his ankle range of motion and getting his full knee flection back. Cause I think he had all the strength and power in the world, but, but he just couldn't get into the positions that would allow him to use what his true strengths actually were. Yeah. And I think, um, I'm thinking of a couple swimmers that, uh, to answer your question. Seemed to be like too loose for their own good. Um, these weren't like post-op where we had to sort of chase range of motion, increase it or anything, but it was just sort of like, they generally lacked some, some sort of stiffness that at joints to, to be powerful and strong and, and range where. And it, it tends to be, I'm thinking of two, two swimmers who were, who had shoulder issues. And they were just kind of like floppy all over the place. And a lot of the things we did were very much like static tempo, um, like armbar, screwdriver type things. Um, definitely just to try and control movement a little bit. So that was one thing that popped in my head. Yeah. The swimmer is interesting case because you could, you could argue that a swimmer because they're in the water and the water is kind of supporting them. Maybe they don't need to have a ton of whatever you're calling stability, but the problem is less swimmers, whether or not the pool, a lot of their dry land training, they try to make look like swimming. So now they don't have the water supporting them, but they're getting into these crazy end range positions on land. And they've never, now you've taken that stability of the water away from them. It's another benefit. So I think a swimmer probably when they're on land is better off doing things that look nothing like swimming. And just training more in a mid range. And then that's why, like a lot of the strength work that we do with people tends to be more in the mid range. And that's really going to benefit both classes of athletes, if you want to typecast them. Because the quote unquote like hypermobile athlete, they don't know what mid range looks like. All they know how to do is get good to end range and kind of like almost impinge a joint. So getting them at mid range, like teaches them. Oh, like I don't need to go to the end to feel like I'm safe. And then if you have a really like stiffer or rigid athlete, What looks like a mid range position for a normal person is like, that's like their end range. So getting them into a mid range, it's like, that's like flexibility to Frank for them, but they're also, you know, there's an external loads. They're getting a strength benefit from it too. So that's why like good training. A lot of times it's just a fixed for regardless of how you want to typecast the athlete. If you have an idea of what you want a movement. So look like, and like it passes the eye test. It's probably going to benefit both classes of athletes because both like either class of athletes, like they're going to, they're going to gravitate towards one of the extreme of the other, like the really rigid athletes doing a deadlift might not be able to pull from the floor in a good position. So you just get them to pull from whatever, you know, from the blocks or from the pins, whatever it looks good. The, the more, you know, range of motion dominant athlete. Like, they're going to have to be really, you're gonna have to get them in a really good initial setup position. So they don't go to an end range where they're like, you know, a lot of those, those kinds of athletes will want to like go into immediate, like just full lordosis, like end range spinal extension, because they don't know how to use their hips. They don't know what mid range looks like. So good training. And this is like another mic will point. Like Mike Boyle talks about for like ACL prevention is good training. Like whether the athlete is, you know, the, the, um, The mobility of the stability, dominant athlete, getting them to train well in good positions is going to benefit both of them. And then like, you know, then you can get really specific with what do these people need. Like that's different than everybody else, but the big rocks, the 80% is still going to be good training. Right? Um, like if you have a stiff athlete and they can't hit key positions, well maybe you're going to have more range of motion work and your warmup to help prepare them to hit those positions. Whereas the more like range of motion dominant athlete, Like if I've got someone that I consider like hyper mobile, warm up as like, basically just doing more sets of the first exercise. Cause they don't need a ton of that exposure to range of motion. But a lot of times like the, just like with anything else, like a baseball player versus a football player, like a lot of their program is the same, you know, they're still doing just the basic strength movements. They're still jumping and sprinting, but maybe like, you know, 30% of the program is different too, to account for their individual and their sport differences. I think that's a great point. I think it's like from a programming standpoint, if you have somebody like, unless they're like super, super extreme ends of the continuum, then may be the majority of the program does look different, but if you're not, you know, the 1% at each end, if you're kind of in the middle of, within one standard deviation of the middle, it's like, okay, 80% of the program is going to be the same. It might be the kind of beginning and end type stuff. And maybe some excessive work that might be a little bit different, but the stuff that is going to get you the most bang for your buck is going to be the same, regardless of where you kind of fall within the continuum. Because again, ultimately like people have to be able to do. The same things relatively, and they got pit, they need some of the same physiologic qualities. And when you program well, it's like, those are the qualities that you're always programming for that you're always trying to train is whether you are good or bad at them. Like we're always training for those qualities. Awesome. I think if, if there's nothing else to say, I think we'd beat that one up nicely. It was a good question though. And it's. It's nice. Cause it's like, uh, like, like, like the question, the question implies it's simplistic, but we feel like it's important to talk about. Cause it's so it's so often talked about and poorly defined potentially between professionals and there's a lot of different ways you can look at it in different contexts. You can think about it. So I think that's, that was a great question. So keep them coming and uh, that'll wrap up this. Keep it real episode. Thanks guys. Thanks everybody.