Strengthening dysfunctions…

Recently I have seen many of the social media movement gurus promoting ‘don’t load a dysfunction’ message and it frustrates and annoys the hell out of me. Not only do I think this message is utter bollocks said by those who don’t have a fucking clue about human physiology and kinesiology. I also think it has some potential negative even harmful ramifications. So I want to spend the next 10 minutes explaining why I think we should strengthen and load dysfunctions.

The main issue I have with all these messages from the gurus above is that it promotes a false belief that they, or anyone else, knows what is and what isn’t ‘dysfunctional’ movement. Despite many claims, the truth is we have very little robust evidence or science that tells us what is a bad, dangerous, harmful, dysfunctional movement.

As the old saying goes, when it comes to observing, assessing and qualifying movement “beauty is in the eye of the beholder” meaning what looks ugly and feels problematic for one person can look and feel great to another.

The notion that these so-called ‘movement experts’ can tell what is good or bad, normal or abnormal, functional or dysfunctional movement by observing it is again utter bollocks. This overly simplistic and reductionist way of thinking about human movement needs to be questioned and challenged a lot more, especially from these influential gurus muppets.

To put this as clearly as I can… ALL human movement in EVERYONE is highly variable due to MANY factors. Human movement is a complex dynamical system that is influenced by things, such as, but not limited too, an individual’s anthropometric factors, the task they are doing, and the environment they are doing it in.

The Individual 

When assessing movement we need to recognise that not all of us are built the same with different angles of bones, joints and limb ratios. Therefore we can not all move the same. Variations in skeletal structure and geometry such as bone length and angulation will hugely influence and affect how someone moves. Just as one example, femoral length, as well as pelvic geometry affects how an individual can squat (ref, ref).

 

 

Just because some Functional Range Conditioning guru with a touch of hypermobility can fold up like a cheap piece of furniture when they squat don’t think you will ever be able to if your bony geometry won’t allow it!

This is no different in any other area such as the shoulder girdle. Just because some Supple Leopard can reach up between their shoulder blades and scratch the back of their own eyeballs, don’t think you will ever be able to if your shoulder and thoracic bony geometry won’t allow it (ref, ref).

It is important to recognise that what may look like a ‘dysfunctional’ movement could be due to very non-modifiable skeletal factors. This is difficult to determine clinically without detailed, expensive, and unnecessary scanning and imaging, but it should always be considered none the less.

Of course, modifiable and adaptable soft tissues will also influence how someone moves, but many of the movement gurus forget or ignore the non-modifiable factors getting their so-called ‘dysfunctional’ subjects to work on things they will never be able to achieve. This is clearly not helpful and possibly even detrimental as some people can and do get frustrated and disheartened by their lack of progress trying to imitate a guru with completely different anatomy

The Task

Human movement is also affected by the task being done, and again this tends to be ignored or forgotten but the movement gurus. For example, how an individual bends over to pick up a box of tissues of the floor will be vastly different from how they bend over to pick up a heavy object from the floor.

Having someone move the same way regardless of the task is simply batshit crazy, yet often promoted by these batshit crazy movement gurus. You just do not need to bend over the same way to do everything, in fact, this is inefficient, ridiculous and just… batshit crazy. You just do not need to concentrate on bracing your abdominals, keeping your pelvis in neutral, or setting your scapulae back and down before you reach for something on the floor.

 

However, the advocates of ‘functional’ movement tend to promote that everyone needs to keep their movements perfectly correct and aligned for everything and anything. Rather than helping people this message can actually make many hypervigilant and focused on small, tiny, innocuous things that are just not important or an issue, and tends to detract away from the things that are.

Movement variation is actually something a lot of movement experts don’t understand or feel comfortable with. This is surprising and a shame as movement variation, within reason, and depending on the task and the loads is far more useful in most circumstances than movement restriction and correction (ref, ref).

This is NOT to say that we should NEVER give people any movement constraints or guidance and we can just let them move around like flaying headless chickens. In some situations, in some circumstances, it can be very helpful to advise a patient how they can move differently, more ‘efficiently’ during some tasks.

However, some of our most common assumptions about movement an risk of injury and pain are being challenged, with some studies in occupational manual handling showing that our postural alignment and lifting advice may not be as helpful as we first thought, and may even be harmful. (ref, ref, ref, ref)

The Environment

Finally, we need to consider the environment as a confounding factor when we assess movement. As clinicians, we often assess people move in controlled, constrained, and ultimately false environments. Therefore any of the so-called movement dysfunctions we may or may not see, may or may not occur in other settings or environments. We also need to recognise that just the effect of observing a subject move will affect how they move.

 

For example, how normally do you think a patient will be moving when being scrutinised in a cubicle, or gym when they are half undressed and feeling a little anxious or nervous? Do you think you will see the same movement strategies used when a subject is asked to perform drop landing off a box whilst being videoed, compared to when they are on a cold wet football pitch trying to jump for a ball whilst dodging an opposing player?

Of course not! As for everything we do and see in life the context always matters!

It’s not that simple!

So as I have hopefully highlighted how someone moves is based on many factors and what we think are abnormal or dysfunctional movements may actually be normal, beneficial, even advantageous due to the structure, the task, or the environment.

We need to recognise that the evidence tells us that many of the so-called movement or postural ‘dysfunctions’ we see in people with pain and disability are often seen in those WITHOUT any pain or disability. Things such as lumbar spine lordosis, thoracic kyphosis, scapula dyskinesis, knee valgus, femoral head deformities,

What we often think are movement ‘abnormalities’ or ‘dysfunctions’ may actually be optimisation strategies in the presence of pain, fear, or a lack of tolerance and capacity. Personally, I think this is the bigger issue, and this is what we should be focusing on more.

Often it’s not the movement that needs to be corrected, its the lack of tolerance to it that does.

This is why I load and strengthen so-called ‘dysfunctional’ movements. I have come to realise that if I focus more on increasing an individuals capacity and tolerance to a painful, ugly looking, so-called ‘dysfunctional’ movement, often what was a painful, ugly, and ‘dysfunctional’ soon isn’t anymore.

I have found that the ‘ugliness’ of a movement often does not change with my rehab, but I don’t really care. As I said at the beginning ‘beauty is in the eye of the beholder’ and who am I to say what is an ugly movement or not.

All I am concerned about is does the movement feel comfortable, natural, smooth, efficient to the person doing it, fuck what I or anyone else thinks it looks like. As far as I am concerned these days you can have the ugliest looking movement as long as you are happy, comfortable, and have the capacity, both physically and psychologically, to tolerate it!

Summary 

So that’s my two cents on why I load so-called ‘dysfunctional’ movements and why I disagree with many of the social media functional movement gurus on this topic.

Remember that despite what these knobheads say we have little idea or evidence to say what is and what isn’t a dysfunctional movement. Also don’t fall for these gurus before and after pictures of subjects which are often rigid, and finally be aware that labelling people dysfunctional just isn’t helpful.

Asking people to try and achieve some so-called ideal alignment or movement strategy is often unattainable, unrealistic, and often detrimental as they start to feel demoralised, frustrated, and hypervigilant that they can’t do it.

For me, the most functional movement anyone can do is one you don’t have to think or worry about.

As always thanks for reading

Adam

11 thoughts on “Strengthening dysfunctions…

  1. Hi Adam, interesting post as always. Whilst I agree with the majority of what you have said, I think that it’s worth making reference to the population that you are working with. The majority of the ‘movement guru’s’ on social media are working with an athletic population, seeking movement efficiency/performance/optimal biomechanics. Therefore their content should not be taken out of context and applied to an average joe with no desire to AMRAP a deadlift at 2 x their bodyweight. I think that some of their messages are important, for example, how many physiotherapists in the U.K. are coaching (and loading) a hip hinge pattern properly? Not specifically to pick up a tissue, but a heavy toddler maybe if that is their LBP trigger.

    I think that it’s great that more physio’s are talking about coaching/cueing/movement, just need to make sure that clinical reasoning is applied and the individual is taken into consideration.

    All the best.

    be taken in to context with the

    • Hi Harry, thanks for the comment! To be honest I dont think it matters who you are working with, the rules of assessing movement that I mention still apply regardless if your a couch potato or an olympian. Movement is a dynamical system and we can not say what is good or bad due to so many variables and confounders! Thats my point. Cheers Adam

  2. Couldn’t agree more! I always find it interesting that when you improve someone’s strength/endurance the “dysfunction” either improves or the pain disappears.Begs the question “should you correct a ‘dysfunction’ in the absence of any pathology …… my answer to this would be No – leave it alone. They’ve probably loaded their body with that pattern since being a toddler.

  3. “the presence of pain, fear, or a lack of tolerance and capacity.” are surely why movement patterns are important. Anyone can see if somebody has a limp, without having to be a Guru, does that mean you would load up a heavy squat, or deadlift for that person without understanding the reasons behind their limp? If someone is in pain, you would load that pain to make it disappear? Most people when they watch for arguments sake, athletics, can without being a physio, or Pt, tell if someone is moving well. They might not be able to tell you why, or how, but they can identify good or bad movement. I agree don’t fix what’s not broken. If any movement is acceptable, why are you assessing movement? Why not just count reps?

  4. Hi Adam…

    Nice reading, thanks for sharing you thoughts….  
    I definitely share many of the thoughts about “dysfunctional movements” you present here.. ..

    Though – I don’t agree completely with this;

    “What we often think are movement ‘abnormalities’ or ‘dysfunctions’ may actually be optimisation strategies in the presence of pain, fear, or a lack of tolerance and capacity. Personally, I think this is the bigger issue, and this is what we should be focusing on more”….

    Maybe sensations and emotions like pain and fear do have the potential to influence movement behavior/strategies in an non-optimal manner. At least sometimes..? If these factors influences movement strategies negatively, it seems (to me) reasonable to focus on this as part of a “multidimensional, BPS intervention” like P. O’Sullivan et al (2018) in this text about Cognitive Functional Therapy; https://www.ncbi.nlm.nih.gov/pubmed/29669082

    Fx;
    “Exposure with control is a process of behavioral change through experiential learning, in which sympathetic responses and safety behaviors that manifest during painful, feared, or avoided functional tasks are explicitly targeted and controlled”.

    Maybe things aren’t so black and white – but more greyish..
    Maybe this is what we should be focusing on more….?

    Well, just a thought.
    Again, thanks for the post.
    Regards
    Jeppe

  5. I recently left a professional sports environment where the desire was for the ‘perfect / optimal functional movement pattern’ as determined by specific non-modified tests regardless of size or shape. I think that after 10 years of testing they’re still searching!
    Now i find myself in a kind of occupational role at a factory – they too teach one movement pattern for all lifting tasks, reinforced by hundreds of reminder posters on walls so not to be forgotten.
    Both environments – young, fit, healthy, v older, deconditioned, sedentary – have a high percentage of back pain patients.
    I fought and lost against the S&C ‘experts’ now running all sports but slowly changing opinions here in the real world – we are what we train – unrealistic demands of perfection causing break down, or years of heavy manual work that demands some compensatory adjustments.
    So, yes, I agree – load what you have, it’s capacity to perform that matters.

    Always a good read Adam

  6. I fully concur with your comment. We have a similar problem in neurorehabilitation where a generation of physios has been trained to re-educate “abnormal movement patterns” and discouraging any form of compensation (e.g., abnormal synergy). The problem with this approach is that we are throwing the baby with the water, as compensations, are often a major contributing factor to achieve functional goals in patients (e.g, post-stroke; see a recent review by Jones 2017). Sometimes, we (as physios) behave as we know better than the CNS how to achieve motor goals, to paraphrase an excellent opinion paper By Anson and Latash (1996, a must-read for anyone interested in the problematic of “normality” in motor control). We should be a bit more humble and accept the notion that variability is not a nuisance but an essential characteristic of motor behaviours.

    Ref.
    Jones TA (2017) Motor compensation and its effects on neural reorganization after stroke. Nat Rev Neurosci 18:267-280 doi: 10.1038/nrn.2017.26
    Latash, M. L., & Anson, J. G. (1996). What are “normal movements” in atypical populations?. Behavioral and brain sciences, 19(1), 55-68.

    • Hi Francois… many thanks for that earlier paper of Latash’s… I missed that and what a fantastic read. It is however disheartening to see he wrote that nearly 20 years ago and not much has changed in the world of physiotherapy thinking and movement. Will it ever???

  7. I love understanding operant conditioning and seeing this with “movement expert” PTs! They tell a pt how they should really move, the pt moves to the PTs liking at every visit because if they don’t the PT won’t be happy, the pt walks out of the clinic and reverts to “bad” form and the PT thinks they completely changed someones “bad” movement and fixed the problem. 😂

  8. Hey Adam, great post!
    I guess people who are posting those subjective statements, about the perfect movement, whatever it is, have never worked with amputees or people suffering from brain or spinal cord injuries. People are simply moving their own way.

    Regards,
    Matt

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