“…traditional injury prevention strategy of avoiding ‘dangerous’ exercises and excessive loads is inadequate as one is bound to end up in a ‘dangerous’ position sooner or later…”
— Pavel Tsatsouline
Would you say that being more ready for your activity and sport as well as life’s unpredictability is a good thing?
I think we all need a reminder (general public AND movement providers) just how adaptable the human body is. It’s easy to consider how adaptable our muscles are but we forget about our connective tissue structures: tendons, ligaments, cartilage. I have no true data to support this and honestly I don’t want to go down a rabbit hole in finding it; but I would venture to say that over 70% of musculoskeletal injuries are non-muscular in origin.
When it comes to training, rehab, and performance: there is no difference. It’s all in the same bucket. The first question you should ask and answer before any exercise is what is the INTENT behind this exercise.
Some exercises are designed to develop POWER. Some exercises are designed to bias a certain joint or muscle group. Some exercises are designed to resist rotation in the trunk while others are designed to develop rotational power from the trunk. Some exercises target muscle tissue capacity and some target connective tissue capacity.
I used to be the guy that walked into a gym and laughed at the guy doing partial rep squats or deadlifts with an overly flexed spine. BUT, what if the person doing partial rep squats is specifically targeting an area of weakness to provide overload to that area? Being strong through a certain range of motion depends largely on lever arms, which I wont get into in this post, but if you’re curious then I suggest examining this article. (Partial Squats) What if the guy doing deadlifts with an exaggerated flexion biased posture was strategically strengthening his segmental stabilizers so that when he does deadlift max weights his tissues are more resilient to withstand some flexion? Two examples where having context behind the application are critical.
WHEN WE APPLY LOAD TO OUR BODY THERE ARE THREE MAIN EFFECTS.
These are almost always the only considerations we consider when applying load to our body. We lift heavy weights for as many reps as possible in order to promote muscle hypertrophy aka bigger muscles. Other structures adapt as well-tendons, bones, connective tissue. They’re just not as tangient and sexy.
The nervous system also can become more efficient in how in interacts with and responds to load in the way it controls the “structures”. If you’re curious just look more into muscle spindles and Golgi tendon organs. But you’re likely not that curious so save it for a rainy day.
These changes are often left unconsidered and unaccounted for. It’s impossible to separate physiology from psychology. Working against load doesn’t just result in increased strength strength, you also FEEL stronger. As you feel stronger, you perceive the risk of injury to be lower. If your perception of injury is lower then your “alarm system”, consisting of input:threat and output:pain, desire to be used is also lower.
Any injury essentially occurs because the FORCE that went through a TISSUE was GREATER THAN that TISSUES ability to absorb or withstand the force.
Training at END RANGE is something WE ALL need to do more of. If the brain thinks a portion of joint range of motion is not achievable, it has no need to signal our muscles to fire and prevent it. Correct muscle firing patterns and reflexive stability therefore aren’t possible.Perhaps an example will help bring this point to light: If range of motion is limited in, say, lumbar flexion, the brain won’t send the appropriate message to the correct core musculature to kick in and stabilize the spine against it during the deadlift.
Those passive structures: tendons, ligaments, cartilage are passive structures but they still provide feedback to our active structures.
In order to put some context behind these unorthodox movements, lets consider three of the more commonly prescribed and seen movements. The goal with all of these movements is to explore the edges of our ability- safely- with a clear aim, understanding, and purpose.
The Jefferson curl, unlike other posterior chain biased movements; reinforces segmental spinal stabilization. So you can see why this might be a really good accessory exercise for powerlifters, weightlifters, and basically anyone who repeatedly picks heavy objects from the floor. The goal of the exercise IS NOT maximal strength but the combination of 1) controlled range of motion 2) tissue adaptation 3) controlled mobility
How/Why Would I Program in Rehab: A Small Case Study.
Patient is a 28 year old trained weightlifter. Has fear avoidance behaviors with spinal flexion so much so that even bending down to tie his shoe is a task. We can use non threatening and low load movement patterns to reduce threat through ranges of motion AND build his capacity to withstand unpredictable stresses-angles, loads, ranges, leverages in training and everyday life. We might start in a quadruped position and encourage spinal flexion and work towards a tall kneeling position and then into full standing. “Novice” lifters have less window for error than a “trained” lifter, so they make even more sense in that population to extend that window for error.
The Sissy Squat isn’t a very joint friendly in terms of loading to the knee BUT that does not make it a bad exercise. It just means that someone dealing with anterior knee pain or arthritic changes should proceed with caution. After all, training isn’t meant to be entirely friendly. It’s meant to cause adaptation to so called weak points in our movement system.
The movement focuses on quad lengthening through a range of motion. The goal is keep the head, torso, hips, and knee stacked throughout the entire movement.
How/Why Would I Program in Rehab: A Small Case Study
Competitive Weightlifter dealing with nagging anterior knee pain. As you know understanding the activity your client is trying to get back to should be the basis and framework for all your clinical decisions: from exercise application to knowing when to 1) RED LIGHT: STOP, 2) YELLOW LIGHT: SLOW DOWN or SPEED UP if you’re reckless, 3) GREEN LIGHT: GO. Given the upright torso and forward knee position in most of the movements: Front Squat, Clean, and Snatch. Nobody and I mean nobody EVER GOT STRONGER by avoiding something.
We can use the sissy squat and its unlimited regressions and progressions to address tendon healing and adaptation through proper loading. We can address anterior knee capacity to those passive structures: Tendons, ligaments, cartilage: so that when the real work begins at the bottom of a clean his knee is well trained in managing the load and can also stabilize more efficiently.
3) LATERAL ANKLE SQUATS
How/Why Would I Program in Rehab: A Small Case Study
A 17 year old high basketball players comes in with recurring ankle sprains. We have addresses ankle dorsiflexion range of motion, calf strength, ankle stability, and trunk control. The missing piece is building lateral ankle resiliency so that it can withstand forces commonly seen in repetitive jumping with awkward landings. Remember, if we can more consistently train those ligaments to send signals for proper stabilization we can be more ready to get out of that awkward lateral ankle position during a possible ankle sprain mechanism of injury (MOI) event.
Doing non traditional movements with proper intent CAN BE really beneficial in finding new end ranges, increasing the adaptability and capacity of passive structures to withstand more load and more force and be better at mechanoreception(feedback) which results in decreased injury incidence during those key movements specific to your activity.
Don’t let the pendulum swing too far in any one bias when it comes to the human body. We still have no idea how amazing this creation is and we learn everyday. Science is fun. We tweak movements for many different reasons.
Stress certain tissues more others as it relates your goals and training needs.
We have to look beyond structural changes when considering the body’s response to load. Being able to stabilize more efficiently is a response and feeling like you can withstand a load is a response. Nothing can or ever will be able to replace consistent and progressive strength training. But we can fill in the gaps when indicated with unorthodox movements. The goal is to be able to withstand the unpredictable stressors of life and activity. Maybe these can help!