Guest Post by Kevin Neeld
Over the last few years I’ve been fortunate to spend a lot of time at continuing education courses. Each weekend I leave with a fueled curiosity for the complexity of human performance (and optimizing movement), a lot of questions, and a few ways to change our assessment and programming process.
My first course with the Postural Restoration Institute (PRI) was paradigm shifting, as I hadn’t ever been exposed to the inherent asymmetries humans possess in terms of our anatomy, sensory systems and movement tendencies. Maybe more importantly, the athletes at our facility with the most obvious limitations in the PRI tests were also the ones that seemed to constantly be fighting nagging injuries. Having now sat through over 100 hours of PRI courses, I have a new perspective on movement that has changed our entire training process.
As a quick aside, I’m a firm believer that people should move well before they move more often, further, faster, or under load. That said, I understand that there is more to performance than movement quality. I’ve heard Patrick Ward describe three buckets of human performance as: 1) Fitness; 2) Stress Resistance/Tolerance; and 3) Movement Quality. Each of these will be influential in how an athlete or client performs. From a coaching perspective, this also provides a framework for what we need to assess and monitor to put our clients in the best position to succeed. While the goal is to maximize each of these buckets depending on the functional needs/goals of the individual, the reality is that many people will succeed by being great in one or two, as long as the others don’t fall below a critical threshold. In recognizing this, the goal is really to maximize the buffer zone between an individual’s capacity and the requirements of their sport/activity.
This is a somewhat theoretical discussion, but it has applicable implications. Simply, it’s important to have a system of assessment/screening and management for each bucket in order to ensure that progress is being made or maintained. From a movement quality perspective, the hierarchical process we use for accomplishing this is:
4) Integrated Movement
The Mobility -> Stability -> Integrated Movement order was one I learned at an FMS Level 1&2 course a few years ago. The neutrality component comes from PRI. Without diving too deep into the specifics of the common patterns PRI discusses, the idea is to first ensure that we’re assessing mobility from the correct starting position. For example, if an individual presents with a pelvis that is rotated to the right, it would be undesirable for that person to have symmetrical hip external and internal rotation on each side, as it would likely be an indication of overstretched muscles or ligaments on one or both sides. In contrast, if the individual presented in a non-neutral state, but with a slight shift in hip rotation (e.g. Left ER: 45, Left IR: 40; Right ER: 40, Right IR: 45), this would actually be desirable, because it indicates that they have the same total motion in both hips; it’s just shifted slightly. Restoring them to a neutral position will likely restore symmetrical rotation in both hips. From a stability perspective, if an individual is heavily biased toward an extension pattern, his/her spinal stability strategies are likely to be dysfunctional. Both of these examples highlight the importance of ensuring the individual starts from a neutral position, which allows for the most optimal assessment and expression of mobility, and better movement and stabilization strategies.
“The appearance of full mobility in this absence of neutrality is often indicative of pathology”
Within the mobility bucket, it’s important to recognize that limitations can be both structural (not modifiable) and functional (modifiable). For example, if hip flexion range of motion is limited, is it because of posterior stiffness (modifiable) or because the individual has femoroacetabular impingement (FAI), which is simply a bony overgrowth of the femoral head/neck junction or the acetabular hood.
Understanding the source of the limitation will help determine whether you add corrective work to help improve the restriction (e.g. self-myofascial release to the posterior hip structures, and posterior hip mobility work), or simply change how you teach exercise technique to that individual (e.g. have them squat to a higher box, deadlift from elevation, not lunge as low and/or place a pad under their back knee in half kneeling exercises).
As I alluded to earlier, the goal with this process is to ensure that the individual doesn’t present with any red flags. A 3° shift in hip rotation because of a mild loss of neutrality probably won’t have a significant impact on how that individual feels unless they have significant limitations in hip rotation. In other words, a 3° shift in someone with an 80° arc probably won’t be significant, but a 3° shift in a 40° arc may be. In contrast, a 10°+ shift may be very significant and warrant taking steps to restore a more neutral position.
Following this process with our athletes/clients has allowed me to:
1) Identify individuals with significant restrictions or asymmetries
2) Develop a simple system of corrective exercises based on a short list of effective exercises, which allows us to address the most modifiable limitation/dysfunction without eating up an entire training session.
3) Know which individuals will need to modify exercise technique based on their structure
4) Have a means of continually reassessing/monitoring so we can track progress over time
Going through this process is a lot of work, but in the end, I think it gives us a better system to assess and monitor the individuals we train at our facility, and puts them in a better position to develop physically while simultaneously minimizing injury risk. That, in my mind, is what it’s all about.