What Is Your Movement Perspective? Part 3

Perspective 1: Physical activity is a prescribed routine to maintain and/or improve physical capacity.
Perspective 2: Physical activity is a continuous education process to help one experience improved functional movement capabilities and quality of life beyond original expectations.

An individual has the opportunity to experience a “new world” of physical capability when training for “movement quality”, as compared to utilizing a prescribed routine of “exercise” for maintaining and/or improving physical capacity. This factor may sound confusing at first glance, so I will use an example to further clarify. The American College of Sports Medicine recently released “Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory, Musculoskeletal, and Neuromotor Fitness in Apparently Healthy Adults: Guidance for Prescribing Exercise”1.  This position stand’s purpose was to provide guidance to professionals who counsel individualized exercise to apparently healthy adults of all ages. Although thorough and well researched, these guidelines treat exercise (not functional movement) as a medication to be prescribed, as opposed to a process of exploration of human movement potential. As I see it, the problem we are facing as a nation in regards to physical activity is not what we are not doing (exercising enough), but why we are not able to maintain it consistently. Treating physical activity like a pill to cure health related problems, has not proven to be effective in getting individuals to comply. The above mentioned “guidelines” prescribe routines for cardiorespiratory, resistance, flexibility, and neuromotor training individually, not taking into account that most activities of daily living incorporate a combination of these elements. Functional training was specifically classified under neuromotor training, neglecting the notion that one can train all elements of fitness by building skill in functional movements. This systematic breakdown of fitness categories, overcomplicates physical activity, leaving underactive individuals overwhelmed. An individual seeking out a fitness professional doesn’t need someone who can quote research protocols but instead needs someone who knows how to teach movement. Teaching a “movement practice” instead of prescribing a plan to follow can inspire individuals to view physical activity as something inherent to being alive and therefore develop a mindset that not be active is limiting one’s potential to live a high quality life. If one is taught to move well, he/she will want to move more often. This inspiration creates a continuum that carries training over to daily life, blurring the line between exercise and living.

Reference:
1. Garber CE, Blissmer B, Deschenes MR, et al. American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc. 2011;43(7):1334-59.

What Is Your Movement Perspective? Part 2

PERSPECTIVE 1: Physical ACTIVITY is risky and often a cause of injury; therefore, it is safer to be physically INACTIVE.
PERSPECTIVE 2: Physical INACTIVITY is risky and often a cause of injury while physical ACTIVITY is a way of making the body more resilient.

    These two perspectives speak to an individual's understanding of risk. Does one believe that he/she is reducing risk of injury by not partaking in activities that may be complex and therefore challenging to master, or does one believe that putting forth the effort to become proficient in these movements will decrease his/her risk of injury by making him/her more resilient to activities encountered daily? It is an important concept to consider, as an individual's mindset towards risk of injury will often dictate his/her willingness to take the time to learn proper execution of complex functional movements. In my experience as a physical therapist, more musculoskeletal injuries are developed gradually overtime from routinely moving or positioning oneself inefficiently, than from being acutely injured from a specific movement. Moreover, individuals with views aligned with perspective 2 tend to have a better prognosis for recovery when injured versus those that adopt perspective 1. I believe this to be true for two important reasons:


1. Individuals with perspective 2 tend to have an improved understanding of how to use their bodies efficiently, and therefore are better able to safely stay active around the injury. This allows for less deconditioning and improved full body circulation; therefore, quicker healing/recovery.
 2. Individuals with perspective 2 tend to view pain/symptoms as the result of moving inefficiently as opposed to the result of performing a dangerous movement. In this way, the pain acts as feedback for them to make adjustments to their technique or programming. This is important, because it gives individuals a sense of control over what causes symptoms/injury, and therefore, decreases fear of injury.

Current research1,2,3 seems to support my clinical observations in regards to the power of fear-avoidance in determining an individual's response to intervention in the face of injury. Wertli et al, concluded in their systematic review that  “evidence suggests that Fear-Avoidance Beliefs (FABs) are associated with poor treatment outcome in patients with low back pain (LBP)”, and therefore recommended early treatment, including interventions to reduce FABs, as to avoid delayed recovery and chronicity. The authors further stated that “patients with high FABs are more likely to improve when FABs are addressed in treatments than when these beliefs are ignored”.  One can easily see how adopting perspective 2 falls in line with the above scientific conclusions.

References:
1.Wertli MM, Rasmussen-barr E, Held U, Weiser S, Bachmann LM, Brunner F. Fear-avoidance beliefs-a moderator of treatment efficacy in patients with low back pain: a systematic review. Spine J. 2014.
2. Rainville J, Smeets RJ, Bendix T, Tveito TH, Poiraudeau S, Indahl AJ. Fear-avoidance beliefs and pain avoidance in low back pain--translating research into clinical practice. Spine J. 2011;11(9):895-903.
3. Vlaeyen JW, Linton SJ. Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain. 2000;85(3):317-32.

What's Yout Movement Perspective: Part 1


Perspective 1: Complex movements are inherently dangerous and are not part of a healthy exercise regimen
    Let's look at some common examples of perspective 1: Squatting and lunging are bad for the knees. Deadlifting is dangerous for your back. Overhead pressing is bad for your shoulders. You should NEVER squat past parallel. Olympic lifting should only be attempted by high level athletes.
    Individuals with this perspective tend to be unfamiliar with the progressions necessary to become proficient in these movements. They also demonstrate a lack of confidence in the ability of human beings to LEARN movement tasks and set artificial limitations on human movement. Moreover, these individuals tend to view exercise progression as increasing resistance and volume with simple movements, as opposed to moving from simpler to more complex movements.

Perspective 2: All people have the capability to develop competency in complex movements by going through appropriate progressions
    Although, pain and injury does occur when performing functional movements such as those mentioned above, it is inappropriate to jump to the conclusion that these activities are the CAUSE of pain. That line of thinking is similar to saying that since many people have knee pain with walking, walking must be the cause of knee pain, and therefore should not be practiced due to the stress it applies to the knees. This example sounds ridiculous but is really the same line of thinking as not training other functional movements due to fear of injuring oneself. The problem with the training of complex movements is not the movements themselves but the quality of the execution, and most importantly the understanding of proper progressions in training. 
    Let’s look at a common example: An individual that does not have the ability to get into a full proper squatting position using his/her own body weight would not be appropriate to squat with load (i.e. weighted back squat, front squat, etc.) or at high volumes (i.e.  sets of 50 air squats). In this case the primary focus should be to work on the fundamental positions and transitions involved in squatting and only when that is adequate, should that movement be utilized in order to focus on strength and conditioning.
    It is my opinion that the primary duty of any professional that deals with human movement, is to have a thorough understanding of how to teach progressions of functional movements ranging from the fundamental mobility/stability necessary to get into/maintain a position to the use of heavy loads and high velocities needed to strengthen and condition the movement. As far as pain/injury is concerned, it should be considered a warning sign that something needs to be adjusted in training. Positions/movements causing symptoms should immediately be assessed for dysfunctional patterns, and adjustments should be made to eliminate pain. If pain can not be eliminated with movement modification, referral to an appropriate health care practitioner is warranted. However, intermittent pain that is abolished with appropriate movement corrections can be utilized as useful feedback indicating improper technique.