Episode 1790 - When to be picky about movement

Dr. Cody Gingerich // #ClinicalTuesday // www.ptonice.com In today's episode of the PT on ICE Daily Show, Extremity Division lead faculty member Cody Gingerich discusses how to know when to challenge or change movement patterns vs. when to be ok with more freedom of movement Take a listen to the episode or check out the full show notes on our blog at www.ptonice.com/blog . If you're looking to learn more about our Extremity Management course or our online physical therapy courses , check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. EPISODE TRANSCRIPTION CODY GINGERICHGood morning PT on ICE Daily Show. My name is Cody Gingerich. I'm one of the lead faculty with the extremity division and I'm jumping on here today to talk about when to be picky about movement. So, The last several years in PT, there has been kind of this shift in differing opinions on how specific do we need to correct every tiny little movement fault that we see in people, all the way to like, hey, however they move, this is just kind of how this person moves and we can just get strong in whatever positions that they feel comfortable with. And so I want to talk about a little bit of the like, finding that middle ground and there's a time when yes, we need to just let somebody potentially move how their body is going to naturally move versus also, hey, that moving pattern doesn't look good, isn't efficient, could be leading to the injury that they're dealing with and how should we and when should we correct that? So the old adage kind of, uh, that I like to use in that like thought process is it doesn't matter until it does, which is basically saying nothing other than, um, there are gonna be points in time where you have to understand that person moving in front of you and understand where their pain is coming from and then is that movement pattern the problem for their pain, okay? And so the number one thing is that there is no way without any context behind the person in front of you. Like if you just see a video of somebody that you have never met and you watch them move and you say, oh yeah, we need to correct that, that would be not a time where you can fully say that. Okay. And so I would encourage you to, to kind of get rid of that out of your brain of like, if you don't have any context behind that person moving and you just think, well, that movement pattern is incorrect and we would definitely need to fix that. I would argue that that wouldn't be the correct mindset going into that. However, if you have that same person and you see their movement pattern and you understand the sport or the activity that they're doing, and potentially if they are dealing with pain, then all of a sudden we can have that conversation of, is that movement pattern creating some of the issues? Are we putting undue stress on different tissues because of the way that they're moving? Okay, and so a couple examples of this, a lot of times this is going to be if we talk about patient population. If we're dealing with someone who is an older adult and they have a very low movement standard already, like they have not really done much moving and they are generally deconditioned and just need to create any type of strength adaptation as possible. Of course we want to teach them how to hip hinge and teach them how to squat and do some of that, but does it need to be the cleanest, prettiest squat or hinge that you've ever seen? Arguably no. Okay, right now we need to just get all of their muscles moving together in whatever capacity they can in order to just start that strength training process, change their their homeostasis change their overall body structure so that they can move one thing to another. Okay. And so with that population, I would say, go more on the air of how they're moving is not quite as important as what they're doing and what they're moving. Okay. Of course, changing from a squat to a hinge or whatever pattern you're wanting to look at a lunge, a step up those type of things. But if their knee shifts a little bit one way or the other, or they have a bit of like a hip shift when they're squatting, or it's not the prettiest hand you've ever seen, like their chest isn't quite upright, like all of those things, you want to try and work towards them, but you don't want to limit their ability to do that movement because it doesn't look perfect. Additionally, if you're dealing then, if we flip the coin and we talk about more high level athletes, If we talk about high level athletes and you are just watching them move and don't have any context yet, and you see them and they say like, potentially this is like top of the top, right? They have potentially created adaptations and movement standards and movement positions that create the proper adaptation for whatever sport they are doing. So if you think more unilateral sports, I've been watching the Olympics the last couple weeks, right? There are some incredible, incredible athletes. Those people are not going to be symmetrical. So if you think about a shot put thrower, like those people are incredible. Both men and women like throwing those weights incredible distances. They are not doing that on both sides. So they're going to naturally have one of their their push off leg and they're throwing arm is going to be stronger. And so when they do then bilateral movements, there is a chance that that might not look exactly the same every time. But if they are not dealing with any pain or discomfort, then maybe that's not really a big deal at all. And that's actually helpful for them. When we want to start looking at actually diving into some of those, like, hey, we need to really adjust how you're moving and pay really close attention is going to be when A, either that same athlete that I just talked about is dealing with pain and it's more of a unilateral thing, or B, if potentially the way they're moving is inefficient for the sport that they're doing, right? So sometimes when we think about, especially our fitness athletes, When the clock is going, their body just says, hey, I need to get from point A to point B as fast as possible. And a lot of times, as fast as possible does not necessarily mean as efficient as possible, and they end up overloading one joint, one muscle, something, because that is the way their body has just started to adapt, because there is a weakness lying somewhere. Okay, so then in those moments when there is actually pain involved, that's when without that context, you're not going to have any idea. But with context, we can start teasing out, are there weak points? Are there mobility deficits? Are there different reasons why they're moving in these poor movement patterns? Okay. And so a lot of times that's where just a poor movement pattern, but if you end up looking at it and say, well, everything is moving or everything is strength wise, pretty equal. Their mobility is pretty equal. Now we're dealing with something a little bit differently, but if there is a weakness leading to a movement restriction or a mobility leading to a odd movement pattern that ends up overloading those tissues, Now we need to start looking at, well, we need to potentially strengthen that area of weakness or improve that area of mobility. And then that freedom of movement can increase. And now we have a little bit less stress taken off of the tissue that's irritated and the other potential tissues can take up some slack as we build them up. So as opposed, this is kind of going backwards again. So in our heads, when we're watching movement patterns, think more so, is this something where we are creating an overload of a tissue that is unnecessary and creating pain? And what is weak that is trying to make that happen? And sometimes the weakness area can be the thing that's irritated or sometimes you could actually have that stronger side or stronger tissue area be the thing that is just constantly being used repetitively, repetitively, repetitively. So with the example of our fitness athletes, think one of those athletes that does, if they're doing burpees and they do like to do step back or step up burpees and they like one side over the other, okay? A lot of times that is not a problem at all. And they just continue to build some strength there and they might have side to side issues. But then all of a sudden, if that starts to show up in their squat and they have a big shift when they're trying to get out of the hole, that is now their body trying to utilize that stronger side to do a lot of that work. And it's going to start showing up in other areas over time. And then if they develop pain along that whole route, these is the context that you want with movement patterns. Now, all of a sudden, we need to build up that strength at the other side, maybe clue them into, hey, when you're doing burpees, I need you to alternate legs every single time so you're not just repeatedly lunging on one side or the other. Okay. And so at that moment, now we are adjusting movement patterns and then working on their squat patterns. So it might, we might need to say, okay, we need a pause and we need to make sure that when we drive out of that hole, we aren't getting any type of shifting this side to side, and we're not overloading that one hip or that one quad that you feel dominant in. Okay? So that's where, with this, when does it matter versus when does it not? Okay? When we're talking about our lower level athletes, people who have not necessarily moved in a long time, those first six months potentially, of course we're building into, like, we want to still coach good movement patterns, but don't limit their ability to move weight and get stronger just because it isn't exactly perfectly correct. Still allow them, still you're always fighting for good movement patterns, but keep letting them build some strength just as they're naturally growing. And then as that starts to build up, now we can hone in on some of those nuances. As an elite athlete, if they potentially need those differences in movement patterns, but in the absence of any type of pain, or anything like that, don't just automatically assume they need to really change how they're moving or that asymmetry in their squat or their deadlift or something like that is a problem. It might be an adaptation that they literally need. When we need to start changing and looking a little bit more closely and honing in on very specific movement patterns, think more so if pain comes on board, with any of those movement patterns or you notice a big mobility deficit or a big strength deficit that causes that shift or that change in movement pattern and if you can then either coach that out or change their strength or mobility, that's then when we can start teasing out some of these nuances in movement. In the extremity course, we talk a lot about extrinsic versus intrinsic cueing. Our extrinsic meaning not saying, hey, squeeze your lats, squeeze your glutes. Those are more intrinsic things that people think about. But instead, it's like, hey, I want you to drive your head through the ceiling. Okay, so doing something like that, I want you to punch that bar through the ceiling, or I want you to drive, like break a board under your feet when you're standing up out of the squat, something like that, where you're going extrinsic cueing. And that's gonna be more so, can you cue some of these movement patterns out? If we notice more of that weakness or a mobility type of deficit, that's when we need to really hone in on, are we really thinking about moving in the right patterns and using the correct tissues and muscles that we want? And can we get a little bit more specific? If you're noticing, hey, that lateral hip is a little bit weak or their quad is a little bit weak, Now, all of a sudden, if you're doing more specific movement patterns, you can start thinking, hey, I really need your brain at your quad and you can like tap the quad, you can have some kind of stimulus at the quad, I really need your brain focusing in on this quad. And that's where at the out of the bottom of that squat, I need you squeezing that really, really hard. or I really need you thinking like that muscle that we just got burning from a leg lifter or doing the side steps like that's that area in your hip that I really need you honed in on. And that's going to create some of those movement pattern shifts as well. So utilize both our extrinsic coaching and or intrinsic cueing in order to change some of those movement patterns. If you have determined like you have that context with your patient, you understand like there needs to be some nuance to this movement pattern that's going to be more efficient for that person. And they have been working around something for a very long time and their muscles have adapted to that. And now it's getting to a point where it needs to be addressed. Okay, that's what I've got for you today. Hope y'all have a wonderful weekend. We have an extremity course coming to you next weekend. I believe Lindsey's going to be up in Bozeman, Montana. So as far as if you're trying to find a late last minute jump into a course, we'd love to see you out there. Otherwise, hope everybody has a great day. OUTROHey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.