FREE MOBILITY EBOOK REHAB-U REHAB-U.COM Free Mobility eBook Mobility has been a hot topic in the fitness industry for many years now. Search online and you will find all kinds of mobility specialists, systems and tools. After all, everyone wants to get more mobile and as therapists and personal trainers, our role is to help people move better. Yet, many things are still being done with the intention of improving mobility that aren’t actually creating lasting changes in the way our clients move. Much of this is likely due to all the confusion around mobility and how to improve it. In the fitness industry, there is a nasty habit of living in absolutes. A method or intervention is ultimately bad or ultimately good. For example, stretching (particularly static stretching) has gotten a bad rep over the years. We literally went from using it as a go-to for joint health and injury prevention to touting it as useless or even worse, as capable of increasing the risk of injury. In reality, it is likely the outcomes of stretching tissues wrongly or approaching mobility from a limited point of view that creates much of the confusion around the terms. • This eBook is intended to: • Redefine mobility and how we improve it • Help you create learning-driven changes in movement capacity Provide you with a full body mobility program that is unique in its kind REHAB-U.COM Meet Mai-Linh Mai-Linh Dovan is a Certified Athletic Therapist and leading industry expert in functional rehabilitation. She holds a Bachelor’s degree in Athletic Therapy and a Master’s degree in Exercise Science from Concordia University, where she worked in collaboration with the Department of Psychology and the Centre for Research in Human Development. With over 20 years of experience in clinical rehabilitation and strength and conditioning, she has developed a comprehensive and unique functional training approach with integrated rehabilitation. She uses this approach with a diversity of athletes and clients from bodybuilders, powerlifters, CrossFit athletes, as well as athletes from various sports. She is the Head Therapist of the Académie Baseball Canada where she oversees the rehabilitation and reconditioning of Québec’s baseball elite. REHAB-U.COM Redefining Mobility Interestingly enough, if you do a “similar words” search for mobility you will find flexibility, and vice versa. I would hope that this would start to cue you that they are intricately linked, even though our industry has given flexibility, and anything remotely attached to it like static stretching, a bad rep. Mobility is a combination of range of motion, motor control and strength. To improve mobility, you have to be able to move efficiently. Limitations in range of motion that stem from poor soft-tissue quality need to be addressed if we hope to move more efficiently. Flexibility, then, is a component of mobility, because lack of flexibility can limit range of motion. There are many factors and reasons for reduced joint range of motion, one of which is muscle tightness. Muscle “tightness” results from an increase in tension from active or passive mechanisms. Passively, muscles can become shortened through postural adaptation or scarring; actively, muscles can become shorter due to spasm or contraction. Both of these are responsive to mechanical forces, like various forms of stretching, foam rolling and other soft-tissue mobilization techniques. REHAB-U.COM Should people stretch then? The bottom line is, what is it we are trying to accomplish? Whether we are trying to acutely increase range of motion or lower the excitability of a facilitated muscle, applying a stretch or other soft-tissue method makes sense if you have a specific task in mind that will benefit from the response. This is something I discuss at length in my blog article Is Stretching Good or Bad? If you’re more of a listener than a reader, there is also a video in the article and on our YouTube channel. All that said, remember that there is also an active component to mobility. Regaining muscle function, active range, control and strength requires active participation that passive modalities do not provide. What the passive modalities do provide is the potential range of motion. But it doesn’t stop there! In order to translate the effect of passive tissue mobilization to mobility we need to apply intentional force into the newfound range Simply put, we need to work within that range to create that fine balance between range of motion and motor control in order to have a lasting effect on mobility. This is Why Foam Rolling Alone Doesn’t Improve Mobility. Want to learn to build effective mobility programs for your clients? LEARN MORE The mobilitystability continuum If mobility is a combination of range of motion, motor control and strength, what about stability? From a purely anatomical (structural) standpoint, we tend to view mobility and stability as opposite ends of the same spectrum: some joints have a structure that affords more mobility, such as the shoulder, while some have a structure that affords more stability, such as the knee. Mobile joints have a bony geometry that is conducive to more movement but less structural stability, and vice versa. REHAB-U.COM However, from a functional point of view, the opposite of mobility is not stability, because mobility can be demonstrated in stable states. In addition, hypomobility can also result in instability demonstrated by a decreased capacity to generate force. Individual joints, as well as the entire kinetic chain, require a combination of mobility and stability that is balanced and extends as far as possible across the range between rigidity and laxity (the extremes), as depicted in the figure below, which I discuss in this video: Watch the Mobility-Stability Continuum video and don’t forget to subscribe to our YouTube channel! Both hypermobility and hypomobility can result in instability. Hypomobility often manifests as an inability to produce a desired movement, whereas hypermobility often manifests as an inability to control a desired movement or an inability to resist an undesired movement. For example, a hypomobile shoulder can result in an inability to lock out the arm in an overhead position. With a hypermobile shoulder, one may have difficulty stabilizing the end range of the lockout or prevent excessive movement at the end range. REHAB-U.COM Mobilize to allow movement In my practice, I use the word “mobilization” rather than “mobility”. To IMMOBILIZE is to make immobile, to prevent use or reduce movement. As such, to MOBILIZE is the exact opposite: to make mobile, to allow use or increase movement. Mobilization refers to the action of making something more capable of movement. The objective of mobilization should be to address the various factors that can affect movement capacity or quality in order to make the individual more capable of movement. As such, the objective of Mobilization should be to address any of the following elements that are susceptible to limit movement capacity: • • • • • address soft tissue limitations and/or joint restrictions down regulate facilitated muscles improve joint dissociation capacity improve proprioception address autonomic state Mobilization can be aimed at improving any of the different components of mobility: range of motion, motor control and strength, depending on the individual needs of the client. What about hypermobility? Knowing what we know about mobility and stability, we can appreciate that even the hypermobile client can benefit from a well thought out intervention including appropriate mobility work. To see what kind of intervention is effective for the hypermobile client, head to my blog article: “Managing Functional Instability in the Hypermobile Athlete”. Want to learn to build effective mobility programs for your clients? LEARN MORE REHAB-U.COM You can direct mobilization to be more passive or more active, depending on the client you are working with: PASSIVE SMR (foam roller, lacrosse ball, Tiger tail, etc) Self-mobilization MOBILIZATION Active-assisted ROM ACTIVE Active ROM Flows PNF stretches Long duration passive stretching Loaded stretching Definitions: SMR (self-myofascial release): soft-tissue mobilization using a foam roller, lacrosse ball, tiger tail, tool or other implement Self-mobilization: joint mobilization techniques performed with assistance and/or movement such as, for example, thoracic spine extension performed with the elbows on a bench Long duration passive stretch: static stretch held for over 1 minute Active-assisted range of motion: moving actively through full range of motion with additional passive motion at end range using a band or other form of assistance PNF stretch: hold-relax or contract relax stretch Active range of motion: moving actively through full range of motion Flows: combination of active range of motion exercises and or other movements in a continuous circuit Loaded stretching: contracting a muscle while it is in a stretched position As you can see, there are many different tools that you can use. The key is to become better at identifying the right tool for the right client, because not every client will benefit from the same tool. That is the difference between your tools and you practice. Don’t confuse your tools with your practice REHAB-U.COM Breathing and Mobility Breathing is probably the simplest and perhaps most under-used form of mobilization. Among other benefits, it can bring you into a parasympathetic state which helps to alleviate muscle tension, reduce rigidity and facilitate movement. As such, it is a great way to mobilize the nervous system, as explained in this must-watch YouTube video. With every breath we take comes a natural mobilization of the spine, moving into extension on inhalation and flexion on exhalation. I discuss the link between breathing and thoracic mobility in this blog article: Read article Breathing and Thoracic Mobility Breathing is also a fundamental competence for core stability. An effective breathing pattern is the necessary foundation on which to build the core and then, movement. Current literature suggests that diaphragmatic activity can help stabilize the core, unlocking more mobility for the extremities. If breathing is shallow or inefficient, the secondary breathing muscles become hypertonic: scalenes, pec minor, sternocleidomastoid and levator scap. Hypertonicity of these muscles can impact function of the scapula and shoulder girdle leading to mobility deficits. Mouth breathing also leads to a decrease in the amplitude of diaphragm movement which results in a decrease in thoracic expansion and increased tone in the secondary breathing muscles. This excessive tone and elevation of the thorax further inhibits the diaphragm and perpetuates the cycle of inefficiency. Sub-optimal breathing can also impact the hip complex, as the body will look for stability from the psoas, hamstrings and pelvic floor. Learning to breathe and implementing para-sympathetic breathing can alleviate muscle tension and help unlock mobility. REHAB-U.COM The Program This full body mobility program is unique in its kind. The goal is to improve mobility by targeting various passive and active components that can affect movement potential of the shoulder and hip complex. The program includes soft-tissue and joint mobilization exercises, but also various active exercises meant to apply intentional force within range of motion. The mobilization strategies utilized in the program extend far beyond passive stretching and soft tissue release, focusing on the active components of mobility. The benefits touch not only on performance, but also on injury prevention and robustness. EXERCISE SETS REPS NOTES BREATH MOBILIZATION A. Crocodile breathing 1 3 mins Nasal breathing - 5-sec inhale, 5-sec exhale SOFT-TISSUE MOBILIZATION A. Lats PNF stretch 3 6 sec Stretch - contract x 6s - release and stretch - Repeat 3 times B. Foam roll quads + Foam roll hamstrings 1 2 mins Foam roll for a total of 2 mins REHAB-U.COM EXERCISE SETS REPS NOTES SHOULDER COMPLEX A. Seated chin tuck 2 10 Hold tuck position 2 seconds B. Prisoner T-spine rotation 2 8/side Inhale on rotation C. Tall sitting shoulder dislocates 2 8 D. Wall walk-out hold 1 2 mins Complete total 2 mins in as few sets as possible HIP COMPLEX A. Active-assisted straight leg raise 2 8/side B. Low cat-camel 2 10 C. Active thread the needle 2 8/side Hold end range 2 seconds D. Globet squat loaded stretch 1 3 mins Light weight – Total 3 mins isometric hold bottom Hold stretch 2 seconds Online Mobility Course Your clients are going to move based on the resources they possess. If you want them to move differently, you need to give them access to more resources. Want to learn the strategy to build effective mobility programs for your clients? The Mobility Fundamentals for Prehab and Performance Online Course provides you with the know-how to build an individualized targeted intervention aimed at making learning-driven changes in movement behavior. This online course provides you with unlimited lifetime access to over 4 hours of video content allowing you to learn at your own pace and in the comfort of your home. The course also includes access to a 200+ video exercise library, two 12-week purposeoriented mobility programs and access to a private Facebook Community for questions and extra support. Want to learn to build effective mobility programs for your clients? LEARN MORE Disclaimer: The information contained in this document is presented to improve movement, not treat medical conditions. This information is not a substitute for medical advice or treatment of specific medical conditions.
