The Joint by Joint Approach to Stability and Mobility
At Crossfit North Atlanta we are embarking on a 40 Days to Awesomeness challenge to focus on our health. The challenge covers four main categories: 1. Training, 2. Nutrition 3. Recovery, and 4. Community. I am writing this guide as a resource for CFNA members (as well as anyone else) as part of the Recovery category to the challenge. I hope this will help guide your mobility and stability work to stay healthy so you can train hard and stay injury free!
I am sharing with you the approach I use when evaluating patients and the approach you can use when doing mobility work. It’s a concept called regional interdependence and it is visualized as the joint by joint approach. It was developed by Vladamir Janda, a pioneer in the manual therapy field, and later expanded upon by Michael Boyle and Gray Cook. The joint by joint approach starts at the ankles and alternates from mobile to stable as you move up the kinetic chain. Here is what it looks like:
Ankles: Mobile
Knees: Stable
Hips: Mobile
Pelvis/Sacrum/Lumbars: Stable
Thoracic Spine: Mobile
Shoulder Blades: Stable
Glenohumeral joint (shoulder joint): Mobile
Elbow: Stable
Wrist: Mobile
Lower Cervical Spine: Stable
Upper Cervical Spine: Mobile
This model essentially says, if you are immobile in the areas you are supposed to be mobile in, or if you are unstable in the areas that you are supposed to be stable, you are putting yourself at risk for future injury. When you perform your warm up at the gym before a WOD, target the green areas with mobility drills as they relate to the exercises you will be doing that day. For instance, banded hip and ankle mobility drills before a squatting day, or foam rolling the lats, thoracic spine, and pecs before a push-press day. In the same instance, you should target the blue circles with exercises to ensure stability in those areas. An unstable lumbar spine can result in low back pain and injury with some of the lifts that cross fitters perform such as dead lifts, or back squats.
Likewise an unstable shoulder blade will almost guarantee a shoulder injury down the road doing movements like thrusters or overhead squats. Its also important to avoid training a stable area with something reserved for mobility. For example, try and limit stretching and foam rolling your low back. It may feel good at the time, but over-doing it in this area will ultimately contribute to unstable lumbars rather than stable ones.
Below are some examples of mobility and stability drills as they relate to the joint by joint approach:
Banded Ankle Distractions (Mobility)
Hold at different angles for 30 seconds to 1 minute
Banded ankle distractions. Repeat this from multiple angles for greatest effect.
Banded Hip Distractions (Mobility)
Hold at different angles for 30 seconds to 1 minute
Dead Bugs (Lumbar Stability)
Starting Position: Hold hips and knees at 90 degrees.
Position 2: Slowly lower right leg to almost parallel with the floor
Position 3: Slowly bring right leg back into starting position and repeat the same for the left side.
Bridges (Pelvis and Lumbar Stability)
Basic Version. Try and keep a straight line from your knee through your torso
A little more challenging with the banded variation around the thighs. This version adds activation to the glute medius
Single Leg Variation: Adds more challenge to the downside glutes and hamstring
Bird Dog (Lumbar and Pelvis Stability)
Alternate left arm and right leg, trying to keep your limbs and trunk parallel
For a greater challenge, try performing while balancing a PVC pipe across your midline
Cat Camel (Lumbar Warmup)
Alternate arching and rounding your lumbar spine with slow concise movements for 3-4 minutes.
Thoracic Spine Foam Roll and Open Book Stretch (Thoracic Mobility, extension and rotation)
Start at T12 (midway down your spine) and roll up to the base of your neck while supporting your head in your hands. Do this 3-4 times slowly.
Next, start from T12 again, keep your butt on the ground and traction yourself backward over the roller. Hold for 10 seconds, roll up your spine half an inch and repeat. Do this until you reach the base of your neck.
Next lie on your side with your arms folded in front of you and your hips and knees stacked.
Keep your hips and knees stacked and rotate your trunk with the goal to touch your shoulder to the ground on the other side. This one takes some work!
Prone Lift Offs (Scapular Stability)
Lie facedown with arms out stretched holding a PVC Pipe
Lift the pipe off the ground and hold for 5-10 seconds. This will make your upper back muscles scream!
Banded Overhead Squat (Scapular Stability)
Standing upright, hold a set of resistance bands over your head
Go into a deep squat while keeping the bands over head and shoulders back
Y Press (Scapular Stability)
Start with arms out to the side, holding bands
Externally rotate arms
Lift arms straight upward
This should give you a great start and a good base of knowledge for mobility and stability work. There are literally thousands of different exercises and ways you can mobilize or stabilize a joint. As always, if in doubt, consult your local sports chiropractor or physical therapist. This post is meant to give you a good jumping off point, but by no means does it replace the opinion of an expert. Please feel free to reach out with any questions or comments!
- Dr. Drew