Should you mobilize or strengthen a painful joint: the Stable/mobile model of the body
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Should you mobilize or strengthen a painful joint: the Stable/mobile model of the body

August 16, 2019

– Hello, and welcome
to the next installment in the Fix Your Squat workshop. Today we’re gonna be
going over that question, if you have a painful joint, should you be mobilizing it, or should
you be strengthening it? And to help me with those decisions we’re gonna go through the
stable-mobile model of the body. This is again on my lunch
break, so as a heads up, the lunch van hasn’t arrived yet so if you hear some interesting
music in the background that will be the lunch van arriving. And I’m gonna be sipping away on my soup as we go through this one. So that question about
when something is painful and people trying to work out, well, am I meant to be mobilizing the joint, or am I meant to be strengthening it? Is something we get asked a lot in clinic, and actually, using this model, it’s really quite simple to work out where to start at the very least. So the stable-mobile model
of the body just works on this really nice principle
that the joints alternate so that we have one stable
joint followed by a mobile joint followed by a stable
joint, so in this example we work through the arm. We should have nice mobile
fingers and a stable hand, and that’s important in stuff
like hand balancing stuff. Mobile wrist, stable
elbow, mobile shoulder, stable shoulder blade,
mobile thoracic spine. You’ll have exactly the same alternation of joints in the lower leg,
so toes should be mobile, foot should be stable, so
particularly that arch, it should be stable,
ankles should be mobile, and knees should be stable,
hip should be mobile and lower back should be stable. Now, how is this at all useful for working out firstly that question of should you strengthen
or should you mobilize, and also how is it relevant
for when we actually get pain in the first place? Well, very simply put, a
stable joint is something that is designed to move just through smaller ranges of motion
or fewer ranges of motion. So if we take the elbow, it’s
a fairly simple hinge joint, we’ve got a small extra movement here, but fundamentally, we flex and extend. So it’s designed, and this is sort of how the knee will work too, to just have this simplistic motion through here. So we call that stable joint
because we’re not trying to do this circumduction,
rotation, side-flexion, and these joints, so if we use the example of the knee or the elbow,
perform much better when they work in these stable planes. So that’s why we’ll cue you in squatting to keep the knee out and level, and that’s why you typically will get pain when the knee starts to move around a lot. So when a stable joint is
being asked to be too mobile, so move around in that squat, that’s when we can then
get pain and discomfort. Conversely, mobile joints,
the best example for this is shoulders or hips, so that’s
a ball and socket approach. Their strength comes
from being a mobile unit, and actually, if you find
that you lose range of motion so it becomes more
stable, so more restricted in its movement, that’s
when a mobile joint like the shoulder or the hip becomes
painful or uncomfortable. So the structure of the
joint will dictate whether it’s a stable joint or a mobile joint, and then we’ve got this really nice model of the alternating system, so again, knee stable, hip mobile,
lower back stable. So when we’ve got that question of, well, should we be strengthening or should we be mobilizing the joint,
well first of all, you can just look at
this model and work out, is the joint meant to be a mobile joint? So is it in that system of
alternation where it’s mobile, so like the shoulder or the wrist? In which case start with mobilizing them, or is it meant to be a stable joint, so stable elbow, stable
hand, and in which case, start with strengthening them. Now, with a stable joint, you’ll get pain when it starts to move too much, so what we really want to be looking at is first of all strengthening here, so in this case getting the elbow position where we want to, so things like bench, making sure the elbow
is underneath the bar, but we can also look at when
you are trying to mobilize, we’re gonna mobilize above and below. So if you are painful in a stable joint, so those stable joints are feet, knees, lower back, shoulder blades, elbows, if you’re painful in any of those joints, what you’re gonna do is
mobilize the joints around it, so above and below, and
you’re gonna then work on strengthening that
joint to stabilize it more. If you’ve got pain in a mobile joint, so things like the shoulder, the wrist, the thoracic spine or the
hips, then what we’re gonna do is look to strengthen that
area around it so that we can then get more mobility
through the mobile area. The simplest way is going
back to that original approach first, is it stable or mobile? Stable, strengthen, mobile, mobilize. And then if you’re still having problems, then look at the joints above and below, are they performing their
function properly or not? Let’s just have a quick look on here. The only other thing that’s really useful if somebody’s got for the mobile joints and working out whether
it’s mobilized or not, test it first, if you can’t determine whether it’s restricted in its movement or whether it’s because
the joints around it aren’t stable enough,
test your range of motion. And we’ve got a range
of videos to do that. I’ll try to put some
links in the notes below. But test, mobilize a mobile joint, and then strengthen a stable joint. The cheat sheet for today’s
one has got a really nice clear example of what the joints are so you’ve got that kind
of reference point. But refer back to that model, should you mobilize,
should you strengthen? Well, is it a mobile joint
or is it a stable joint? I will look forward to
seeing you next week. Next week’s title is gonna be on whether you should wear a lifting belt or not, what they do, and when you
shouldn’t wear a lifting belt. All right, take care guys, bye bye.

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