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Mobility progressions for rehab: What we learn from Functional Range Conditioning
@curatedmobility
Dive into the dynamic world of Functional Range Conditioning (FRC) in the latest Sportsmith expert article!
From isolating joint capacities to rehabilitating athletes, explore the nuanced balance between strength and mobility. Discover how FRC techniques in the can shape rehab strategies to match an athlete's unique needs.
Navigating the early, mid and late phases of rehab, @curatedmobility teaches us how to reacquire movement options and how this helps in building resilient athletes who move better than ever before.
Don't miss out on redefining mobility in the realm of training systems!
Link in bio.
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Throughout the reconditioning process, graded exposure can be implemented in various different ways depending on how we want to dial up stress to the target tissue or to the system as a whole. Earlier on, we may need to be much more selective with how we stress the system, but as we progress further towards building resiliency, or even antifragility, in said system, it becomes more important to ensure it’s ability to handle, or thrive under whatever stressors that may appear.
Constraints that we leverage whilst selecting exercise can play a role in influencing how we amplify stress towards the system. Are we placing the system back in a position/context in which injury previously occurred? Are we reaching a level of failure we have yet to perform under? Are we placing stricter temporal constraints such that we have to generate force quickly? Are we demanding an overall increased level of force production? All of these, among others, are considerations we should make in the reconditioning process.
In this example, isolated tissue specific inputs can help us funnel loading more directly towards intended targets. Setup for the LLLD PAILs is versatile in that while it places us directly in symptomatic positions, we can slowly progress towards max effort and/or ballistic PAILs. A continuous tension input, and an end range velocity input both allow the system to experience sport demands in a more constrained environment. Creating these affordances first in clinic, before we build them for the mats.
Rehab for knee injuries often starts out the same, but the end goal is different depending on the athlete in front of you.
Josh (@curatedmobility ) is a master at applying the systems of staged rehab combined with sport-specific joint range of motion.
“I’ve started referring to those three steps as a “create, curate, cultivate” framework”
He goes into more detail about this framework and applying it to grappling athletes.
Full article on the HanPhysio website - link in bio.
#jiujitsu #physio #aclrehab #grappling #jiujitsujourney #kneeinjury #kneerecovery
Especially in earlier stages of rehab/ training, goals often revolve around restoring/building movement competency and availability. When selecting inputs with said goals in mind, and even more so when pain is present, the main driver is often consistency instead of intensity. As such, CARs are often a valuable tool in the toolbox to provide the system with a means to safely explore joint workspace as we work to rebuild movement optimism and movement capacity. Laying down foundational steps early on in the process and learning to competently isolate joint movement also allows us to more specifically apply our training inputs later down the line. The better we can isolate our target joint/tissue, the more surgically we may be able to load said joint/tissue.
In the case of the knee, while we’ll often see knee motion occur in conjunction with hip motion in many of our commonly seen movement tasks, if our initial goal is to isolate joint motion whether for assessment, pain modulation, or rehab purposes, we should at least ensure that we can truly isolate tibial motion. This coupling of hip and knee motion is quite often seen in the knee CAR, often due to an absence of cueing around strict tibial motion. Depending on setup as well, we may also notice that we’re unable to fully explore into the extremes of either flexion or extension due to length tension limitations or environmental limitations instead of due to injury related capacities. If this is the case, understanding our intention with the CAR in our current phase of rehab allows us to more effectively modify our setup.
As always, variables can be adjusted depending on intended adaptation.
Another year, another weekend full of gems at the @sportsmithhq injury prevention conference. Always a great opportunity to connect with practitioners around the world and touch on current best practices. Interesting to gain insight on application at the highest levels within @psg systems as well.
Looking back to a couple years ago at the first time I attended the speed conference in Pittsburgh it’s incredible to see how much this has grown!
When looking at injury rehab around inert structures especially the collateral ligaments of the knee and elbow we often see loading of nearby joints as a potential aggravating factor due to increases in “stability” demand of said structures. Conceptualizing one of the roles the knee and elbow plays in global movement being that of energy transfer from our core out to the external environment, we can see the importance of rebuilding load bearing capacity in these ligamentous structures.
While not an absolute necessity for all cases of medial ligamentous stress injuries in the knee, for physical demands involving heavy rotational loading through the lower extremity it may be necessary to ensure tolerance to said stresses.
Particularly when looking at more bent knee positions in the case of MCL, we’ll often see loading options that would normally be seen as primarily affecting hip (especially hip rotation) become aggravating factors for medial knee. Following our commonly seen hierarchy of restoring peak force capacity and then funnelling towards long and/or rapid exposure, we can begin to build out late stage loading options for MCL in this bent knee subcategory.
Today we’ll look at several exercise selection options in the case of later stage MCL rehab. As per usual, our needs dictate our selection. Are we looking more for an exploratory “priming” type of stimulus? Maybe we’re looking more towards the speed end of our length-loading continuum? Is impact tolerance something we need to consider? Do we want something that allows us to accumulate longer time under tension at maximal effort? Like always these are just some of many potential loading considerations.
When considering exercise selection during the reconditioning process for muscles like the hamstring group, we’re presented with a whole host of additional needs and options due to its biarticular nature. With such muscles crossing at and influencing two joints, we’re able to play with more complexity when it comes to affecting length tension relationships on target tissue. Our simple loading framework categorizing inputs into either lengthened, middle, or shortened positions still applies, we just now need to consider both target joints, and attempt to match loading positions with factors such as injured region, mechanism of injury, and pain provocation. Once we’ve nailed down position, we can start to address desired physical quality that we’re looking to draw out with our loading input.
Aside from looking at state of lengthening with our exercise categorization, we can also simply break down into two subgroups: bent and straight knee options. We can still look to layer in shortened/lengthened/mid-position considerations here if such detail is needed, otherwise this straight and bent knee division lets us ROUGHLY break down loading vectors into primarily vertical and horizontal. This then allows us to either ensure we’re touching on both, or focus on one depending on individual need or return to sport time allowance.
Looking at our straight knee options then, as early as the middle stages of rehab where range of motion is mostly restored and force capacities are beginning to come back, we can look to address needs along our length-loading continuum and along our velocity spectrum. From here, we can refer to dynamic correspondence as a way to dial up specificity to injury/sport needs. Our exercise selection from here looks to answer a specific question in regard to our needs analysis. Are we looking at mainly force production? Maybe we need to funnel into speed/power/impact? Perhaps we’re just looking to explore movement/loading in said positions? Having clarity with what we’re trying to achieve with an exercise input allows us to more effectively match our programming to our intended outcome.
A common presentation we’ll see in cases of extension intolerant low back pain is the more flexible individual who has often had access to these greater ranges of motion for much of their life and tend to lean into these movement extremes as their primary movement strategy. One such strategy we’ll see is a significant hinge point through the lower lumbar spine (often in or around the symptomatic segment). We can then hypothesize that much of our movement into spinal extension (and sometimes hip extension) just occurs through that one hinge point instead. This observation becomes relevant especially in a situation where extension intolerant pain is actively flared up as it can be a direct aggravating factor and potentially something we’re looking to offload. As always, this is solely a clinical observation and not to be taken as a statement of cause and effect.
Understanding this, our CARs being our ever-present Swiss Army knife can be used not only as a way to explore “safe” pain-free motion, but in this case also as a way to learn how and where to start to divert movement towards adjacent motion segments along the spinal column. Naturally, some individuals will be able to lock in on these alternative movement strategies just with some cueing as shown here, others may require a more constrained input in order to isolate and build awareness through these alternative strategies.
Posture remains a hot topic in the fitness and movement world with some claims that static posture is a cause for pain/injury still present. As such, we’ll also see claims that certain exercises will drastically change static posture long term. While many of these views are beginning to fall out of favour as the understanding that correlation between posture and pain is less and less significant, and that we’re unlikely to have a significant change to static resting postures with a single five minute “routine”, there may still be importance in considering our more postural biased tissues depending on goal.
One consideration we’ll make when looking at posture then is our ability to access relevant positions and eventually our ability to find effective movement in/through these positions.
Using our typical posture example with the upper back, regions of interest include the thoracic spine and shoulder girdle (scapular and glenohumeral joints). Here we’ll look at an exercise input that allows our system to explore glenohumeral motion while coordinating static muscular effort through the remaining relevant joints. Options like this provide slightly wider environments in which our system can work to coordinate multi-joint actions through a variety of surrounding musculature compared to more hyper-isolated options which may be more suited for funnelling higher doses of stress to target tissue.
In most other injury situations, we understand the importance of addressing any relevant deficits and maintaining/rebuilding movement and force capacities as early as safely possible. With rib injuries however, common consensus still seems to be “there’s nothing we can do about it, just wait for it to heal”. While it’s true that like in most other injury cases, some form of relative offloading will likely be necessary in order to initial insult to settle and for early healing to begin, a complete rest approach is often both unnecessarily long and ineffective in actually facilitating a safe return to activity.
When considering loading options for rib injury rehab then, typical planes of motion we’ll notice as our primary limiting or aggravating factors are related to spinal rotation. Early stage options might then look to isolate, restore, and rebuild rotational load capacity. Once these are restored we’ll typically be in a stage where day to day pain provocation is no longer a concern and priorities shift towards fully restoring capacities in conjunction with terminal task needs.
It’s in these states where we can begin to funnel in increased complexity via multiplanar loading, or increased intensity via external load or via speed/power/impact demands. All of these variables will likely be relevant depending on sport.
Groin Strain Rehab Options
When considering exercise selection, whether in the world of rehab or strength and conditioning, the discussion is often around “what’s the BEST exercise for ___” be it a condition or a muscle group. While it’s not hard to understand why we always seek out these one size fits all approaches, the complexities associated with human movement often make it so that this one size fits all approach doesn’t realistically exist.
Instead, a better consideration around exercise selection might be “what question am I trying to answer with this exercise and how can I best answer it?”. As one will eventually see when we dig far enough into this side of the internet, establishing a needs analysis and allowing said needs analysis to guide exercise selection in this way is often a more effective approach than memorizing a list of exercises that match with certain conditions and force feeding them to anyone and everyone with said condition.
Let’s use the example of a groin strain and the following rehab journey to dive into this. Throughout the entirety of any rehab process, we’ll naturally see our rate limiters change and thus our more prioritized buckets of need will change as well. As a generalization however, we’ll typically go from resolving pain, restoring movement capacity, and exploring the spectrum of force/velocity with some overlap throughout this progression.
Understanding what these specific needs are and what boxes we’re trying to check off with our loading option allows us to build a more robust reconditioning program and avoid situations where we neglect glaring needs or have multiple exercises trying to achieve the same thing.
For example, in our early stages, perhaps we’re looking through our menu for an option that addresses pain, and then an option that begins to explore range of motion. Maybe in our mid-stages we’re still looking to refine end range, but priorities shift towards multiplanar force production and multi-segment coordination/integration. Perhaps in our late stages we’re looking to push speed capacities especially in an already fatigued state.
Reaching into later stages of the reconditioning process, goals often switch from pain/movement focused more towards reducing risk of reinjury when exposed to a similar mechanism. Unfortunately, there are many cases where these stages are not well addressed, or altogether neglected. This is what often leads us down a cycle of reinjury and a belief that we’ll never be able return to meaningful activity.
One of the components of this later stage rehab is ensuring that the individual (both physically and psychologically) is able to tolerate exposure to previously injurious positions. In the case of lateral ankle instability, this will be our inversion ankle sprain position. While a lot of work can be done and a lot of benefit can be gained from working to RESIST inversion, in the chaos of life/sport, we will naturally find ourselves in suboptimal positions.
Another common consideration in our later stages of rehab will be the question of readiness for return to speed, especially in and around our aforementioned danger zones. We’ve likely restored our slower force capacities at this point but are we able to withstand the high force, high velocity exposures seen in sport?
Here we’ll explore several options for this lateral instability. As always, our exercise selection looks to answer specific questions. Are we looking for a more extensive exposure to address prolonged stiffening demands? Are we looking for a higher intensity singular exposure in an isolated or integrated fashion? Or are we looking to zoom out a bit and explore our ability to transition between vertical and lateral momentum?
