It’s not uncommon for a member of my training studio to have some type of limitation. They may have an issue, such as a knee or shoulder, that has structural problems which bring along contraindications. The person with the shoulder problem may have poor thoracic (upper-back) spine mobility, which then effects their alignment in overhead presses. Our approach is to eliminate overhead pressing until they can display adequate range of motion of the scapulae, and we substitute pressing with t-spine mobility drills. It’s an easy fix. The person with the knee issue may have poor patella tracking and lateral stability. When they take a step to lunge, for example, they feel pain. They don’t have enough integrity and strength at the knee to decelerate when performing that exercise. In that case, we eliminate the step and have them remain in a static position and use the TRX suspension trainer for assistance. They can work on strength through a full range of motion without pain. These are common fixes we use at the studio. They are also common protocols used in physical therapy.
I’m not a physical therapist and I don’t walk around claiming to be one. I’m a personal trainer and a strength coach. My focus is on helping people to maintain and improve their mobility, improve strength, and, if desired, help them to reduce body-fat. That’s a simplified description to a complicated process. I always address someone’s movement competency or mobility when I’m working with them. My recipe for mobility is:
Joint range of motion + joint stability + motor control = Mobility
I share this definition with many professionals in strength and conditioning. That is the personal performance goal I’m currently working towards with my knee. Last week, I had a knee arthroscopy. The doctor used a small keyhole to put a scope into my knee joint. I had apparently torn my meniscus years ago and was grinding away at my knee joint. My line of work accelerated the degeneration of my knee. My joint range of motion had greatly diminished due to lack of joint stability. I was able to overcompensate with strength of the hamstring, but this created faulty compensations. Now I have the job of re-teaching, or re-booting, the motor control of my leg. I have to shut down muscles that were overused and turn up the engagement of muscles that were underused due to the injury. As my motor control improves, I should gain better range of motion at the joint and overall mobility of the knee. I consider that mobility work and strength training, but some may consider that physical therapy.
Dry needling, acoustic wave therapy, electric muscle stimulation (EMS), cold/heat treatment, and blood flow restriction (BFR) therapies are all treatments used in physical therapy. I wouldn’t recommend using any of them, outside of the cold/heat treatment, if not monitored by a therapist. Each requires the usage of a tool or machine, that needs to be used in an exact format. These techniques are all used to promote healing and to decongest an area or reduce inflammation. The EMS and BFR both promote muscle stimulation to an area using minimal load. One-week post-op, I’m currently using them both.
In dealing with injuries and limitations, there is a time when you need to minimize force to an area of the body for promotion of healing. On the other side of the sliding continuum, there is a time you need to apply force in a controlled manner to stimulate an adaptation. In my world, the adaptation is commonly a strength improvement. I think one of the most overlooked steps is having a clear diagnosis of the problem. Imaging such as MRIs and x-rays are great tools that eliminate the guess work. They allow you determine the appropriate protocol. After fighting denial for years, it was a simple x-ray of my knees a few months ago that dictated I needed surgery. There wasn’t an exercise or therapy technique that could fix my dilemma. The structural integrity of my knee had been compromised. I want to recommend that if you have a nagging pain that isn’t going away, go see a doctor and get it assessed. Once you get that done, you can map out a strategy on how to get that area of your body stronger, because what you may need, in the long run, is strength.
I’ll see you at the studio.