Why You Can't Fix You

Over the course of the last few years we have seen a swell of information as it pertains to treating your own injuries, increasing the ever elusive 'mobility' and basically just how to become a bad ass. How is it possible with all of these gurus and programs out there like Kelly Starrett's, Mobility Wod (www.mobilitywod.com), everyone making sure they have their Gray Cook, Functional Movement Screen (www.functionalmovement.com) and getting Gumby-like with all the rest of the YouTube mobility Bob Vila's, does a guy like me still have a job? Well, because you are only getting part of the story.

First of all before I get trolled on this, I'm absolutely not knocking on any of these guys or the techniques they use, I use something from each one of these practitioners each and every day. In fact, I consider them mentors. That being said, I think somewhere along the line the general public has been coaxed into the belief that a foam roller can 'cure' IT band syndrome, or gaining more mobility through your lumbopelvic complex with admonish chronic low back pain. 

...beating back pain and diabetes with mobility since 1896.

That's not the case though, in fact musculoskeletal injuries are still on the rise. Of course this in part due to a large aging population, more involvement in recreation activities nationwide and various other reasons. If we are all becoming mobility, self-treatment ninjas though, shouldn't this offset at some point? Well Kelly Starrett does state that every human being should be able to handle approximately 95% of their own injuries, but there are always going to be those injuries/issues which we will need practitioner assistance with. 

In my opinion, there are two major reasons that we are not able to fully self-treat most of our issues with the tools we currently possess.  The first reason is what I call 'The Movement Blackhole', which is basically our general lack of movement which is perpetuated by poor movement once we decided to actually get our lazy butts off the couch. This will be discussed further in a future blog. The second reason is because most techniques, methods or tools only address one issue or at least one issue at a time.

What do I mean by that?

Well we can foam roll a muscle until the cows come home, but that doesn't mean that CNS knows what to do with the change in tissue tone/neurologic input. I can perform an extremely conscientious movement flow sequence, but who is to say that I had the prerequisite mobility to move in and out of positions without compensation. Here is the first bubble burster of this blog...humans are compensation machines. We are the only 'machine' (speaking from a biomechanics standpoint) that can compensate rapidly and effectively on the fly. The problem with being excellent compensatory machines is that there is no survival benefit to getting back to moving optimally. Our body and more importantly our brain will always take the path of least resistance, which is fantastic for short term, but absolute rubbish for long term musculoskeletal health and injury limitation.

So what to do? Burn the foam roller? Stop stretching completely? Just keep the ibuprofen on drip? It all starts with a proper assessment, I don't know who first said it but, "if you ain't assessing then you're just guessing". True words may never have been spoken. So if you are out there practicing your Lamaze breathing on a foam roller, stop what you're doing and find a competent practitioner, trainer, etc... I've seen many patients that have worked on 'tight hips', 'my plantar' or you name it until they are blue in the face, with no real measurable change. If you don't know what the issue is, how do you expect to change.

Mission: Identify the Culprit

I don't care what method is used to identify the issue, we just need to make sure that everyone's time and effort is directed appropriately.

Now hopefully we know what issue/issues are (and we're not talking about that bad break-up) and we can get to work. Here is where most of us miss the boat...we focus on only one part of the equation. Let's take an example of a bilateral ankle dorsiflexion restriction...because THAT NEVER HAPPENS! So what do we do...

  • Use a foam roller, kettlebell handle or some other torture device to 'mash' your calves
  • Stretch your calf endlessly or maybe you have an advanced degree in self-treatment and you are mobilizing the joints in your ankle through various techniques

...alas after weeks on end you are either still dealing with a plantar fascitis issues or Achille's tendinosis or you just can't bottom out that squat. 

What gives??? You might be saying to yourself this seems...

 

The human organism is a beautifully complex beast and when trying to self-treat an issue or gain more active mobility/flexibility we have to address all aspects of the system...and it is a system, which means that all parts needs to be addressed as interconnected and dependent on one another. So here are the basics of what need to be addressed for ANY...ANY...ANY...CAN I GET AN 'ANY' injury, neuromotor or mobility issue.

  • The nervous system - remember trolls this is for the general public - we are taking an immensely complicated system and acknowledging that it need be addressed, let's leave it at that for right now. Your CNS and PNS rule the road on permitting any soft tissue changes to actually be integrated into the system. This includes neural tension in soft tissue structures, recruitment patterns and joint centration, etc... Tremendously important part of the system here.
  • Skin/fascia/muscular/nerve/bone interface - how tissues slide and glide against one another will ultimately determine the ability to get to end ranges of joint complexes. Below is probably the best video out there on why we need to some sort of general 'mobility' work as it applies to fascia. When talking tissue in the body, we also have to realized that the changes that occur are neurologic but also histologic in nature.
  • Work load capacity - you could call this a couple of things: strength, endurance, etc... for the purposes of this article let's think about this in terms of what your system can withstand before the tissues or more commonly the nervous system fatigues which results in  compensation patterns and possibly injury. 

Now that we have outlined the parts of the system, how do we address an issue. This is where the R.I.P.L. system comes in to play. 

Reset - any intervention such as foam rolling, myofascial release, mobilizations, adjustment, etc...something that introduces a change to the tissue or joint.

Integrate - allowing the nervous system to accept the reset through proper recruitment patterns, breathing and joint kinematics.

Pattern - at this point we need to get permission from the CNS to allow this new tissue change or mobility to be used in a functional pattern.

Load - last but not least, we need to hit the SAVE button, by applying a load, repetitions or both...the tissues, joints and ultimately CNS will be able to reproduce this movement/pattern in a pain and compensatory free manner in the near and distant future.

Just like the ripples on a pond from a single single pebble being dropped in, we are not only trying effect the area of issue or complaint, but change the whole system over time.

In order to bring this all together, let's use the ankle dorsiflexion restrction scenario.

Assess!

Reset - calf rolling, myofascial release, joint mobilizations, etc...the following are some examples.

 

Integrate - dynamic mobilizations

Pattern - using a squat pattern to reinforce the ankle dorsiflexion AROM. 

- When patterning it is usually beneficial to assist the pattern at hand in order to allow the nervous system to adapt appropriately.

 

Load 

- for this portion you could simply go in to a workout that consisted of any dorsiflexion dependent pattern, i.e. squats, rowing, pistols, etc...or simply just grab a kettlebell or small child and do some high quality squats

With the R.I.P.L. system you can lay the framework on how to tackle almost any injury or mobility issue, now in my humble opinion any injury should start with a trained professional just to keep things safe, but also to probably speed things along. 

In conclusion, if you have been dealing with a chronic injury or long term mobility issue and you aren't seeing any progress, maybe it's time to rethink the process.