I’d like to introduce you all to Mitch Hauschildt, MA, ATC, CSC. Mitch is a great friend but also one of the best clinicians I have ever met. Hands down. Mitch is the Rehab Coordinator for Missouri State University and is the Founder of Maximum Training Solutions. You can reach him at firstname.lastname@example.org. Here is Mitch’s take on Mobility vs. Stability!
Both are needed for proper movement and function. Without both, authentic movement will never be achieved and injury risk will rise as a result.
Let’s break it down a little bit further…
Mobility has been defined as “the ability to produce a desired motion” (via Bill Hartman). The key word in that basic definition is “ability.” If someone doesn’t have the ability to produce or reproduce a specific movement pattern (due to lack of range), then they are inherently immobile.
Stability has been defined as “the ability to resist movement.” Without the ability to resist poor movement, one will never be able to create truly authentic movement and will always have compensatory patterns.
Be careful with this, however, because it can be very easy to confuse joint stiffness with joint stability. They are 2 very different things according to the nervous system. If someone only has joint stiffness, at some point they will be stretched to the end of their limited range and they will collapse and sustain and injury because they don’t have true stability.
So, how do we train mobility and stability? Gray Cook makes it very clear that you ALWAYS train mobility before stability. That is to make sure that you avoid the joint stiffness scenario that we just discussed.
I agree with Gray on this point almost all of the time when we are talking about relatively healthy individuals with relatively “normal” mobility (whatever that is). I have found that there are some occasions where it make sense neurologically to challenge the body via stability training within an available range of motion as you continue to improve their mobility. There are also some instances where it works well to improve both mobility and stability simultaneously. As with all situations, the rules are the rules, but they can be broken from time to time.
There is one area where this rule cannot and should NEVER be broken. That is the post surgical rehab patient. Mobility and joint range of motion MUST always be the first priority immediately following a surgical intervention. Without full range of motion, performing simple ADLs becomes problematic for patients.
Neurologically, activation patterns are significantly altered with poor range of motion. Because the nervous system controls every aspect of the body, the ripple effect that poor range of motion has on the body is immeasurable.
First, joint stability will never be realized with a limited range of motion. When muscles only work in a shortened position, they lose their mechanical advantage and can’t create the appropriate torque needed to keep a joint stabile in an unstable environment.
This leads to larger issues elsewhere. When the local stabilizers can’t keep a joint centrated, prime movers take over because they are typically larger muscles that are in a position to greatly improve joint position, even though that is not their intended role. This leads to decreased performance, especially if they are an athlete, because the prime movers are tied up performing stabilizing duties instead of moving the body. For the same reasons, this will also lead to overuse injuries.
These same poor activation patterns also impact other joints in the body. For example, the rotator cuff is specifically tied to grip strength. It is a protective mechanism that is used by the brain to protect a damaged shoulder. Thus, if the rotator cuff can’t work correctly due to a limited range, that person’s grip will be compromised.
Going further, that same patient with a poor functioning shoulder will have problems in the lower extremity. It is rather obvious that the Lats play an important role with the shoulder joint. Many people forget that the Lats are directly tied to the Gluts in a crossing pattern in the low back. Thus, if one Lat isn’t working well (because of a compromised shoulder), the opposite glut won’t function properly. This can lead to knee pain because the Gluts are a powerful external rotator of the femur, keeping it in an advantageous position for the patellofemoral joint.
Continuing on down the chain, when that glut doesn’t work, it will likely be correlated with an anterior pelvic tilt. An anterior pelvic tilt is associated with a number of issues, including an ankle dorsiflexion restriction. This can lead to ankle and foot problems. And, I can keep going…
Moving away from activation patterns, we also have to keep in mind that a poor functioning joint will have other effects on the joints around them. Looking at the joint-by-joint approach (Cook and Boyle), we understand that the human body is simply a series of stacked joints which alternate between needing joint mobility and joint stability. So, if you lose joint mobility in one joint, you are going to be asking another joint to make up for it. The body will find the motion somewhere. Unfortunately, the motion will have to come from a joint that is intended to provide stability.
As an example, if an ankle patient doesn’t regain full range of motion, they will develop knee or back pain. This is because the knee and low back are intended to be stable joints, but when presented with a lack of mobility below them, these joints become unstable and painful. It is consistent and predictable.
Honestly, these examples are just the tip of the iceberg. As you read this, you may be thinking to yourself, “I know Mitch, this is common sense.” And you are right. Unfortunately, I can’t tell you how many young athletes come into my practice from other therapists who are cleared to return to play missing 10, 20, sometimes 30 degrees of motion. Then, I get to tell the kid and their parents that they can’t play because they aren’t ready and then I get to spend the next few months fixing what should have been done early in the rehab process.
It’s honestly not about me though. None of us got into this profession for us. We love our patients and want the best for them. So, lets start doing just that. Give them the best treatment available. Today. Tomorrow. Next week. Next year.
Mobility precedes stability in the post surgical patient. ALWAYS!!