Mobility Training

Mobility drills beat static stretching for joint health

Anthony advocates daily mobility drills — circular joint movements that increase synovial fluid circulation — over static stretching, noting they eliminated his joint pain and made him feel 20 years old again.

"the moment I started doing mobility drills on a daily basis, like I felt like I was 20 years old again, like no pain, no nothing. So that's why that's a reason I am a big advocate of mobility drills."

One day per week of deep stretching makes your strength training dramatically better

The hosts explain from personal experience that dedicating one day per week to deep stretching and mobility work leads to noticeably better strength training performance because range of motion improves and you simply feel better. They emphasize this is one of the most overlooked ways to augment muscle-building.

"say the sauna, I notice my strength trainings better because my range of motion is better and I feel better. It's a good introduction to those knee ranges of motion."

Specific mobility and yoga outperform strength training for increasing range of motion

While strength training can improve functional flexibility, the hosts acknowledge that dedicated mobility training and specific forms of yoga are simply better at increasing range of motion in a shorter timeframe. Each modality has its strength, and combining them produces the best results.

"functional flexibility with strain training you can? But are there other forms of exercise that specifically for those things are a little better? Like yeah, cardio will get you stamina faster. And there are forms of mobility, specific mobility training, specific forms of yoga, if you want to have like something that you can put a label, like they're better at increasing ranges of motion"

Even if it's 5% or 7%, or whatever percent

And also, on the freeing yourself of going beyond all postures' period, working with the postures you have, but towards a posture less way of doing things. So this is something interesting to work when people work with movements, but finally are able to go into movement.

"even if it's 5% or 7%, or whatever percent. And also, on the freeing yourself of going beyond all postures' period, working with the postures you have, but towards a posture less way of doing things. So this is something interesting to work when people work with movements, but finally are able to go into movement. And this magic starts to happen. And then the techniques fall apart and something appears. And it's a phase change."

Mobility Training: I mean, a lot of people don't realize that's

I mean, a lot of people don't realize that's actually why we do this, it's to capture more sound waves, right? The localization of sound is based on a simple brainstem calculation of interoral time differences, the time in which something, the brain intuitively just knows, because it's a pretty hard

"I mean, a lot of people don't realize that's actually why we do this, it's to capture more sound waves, right? The localization of sound is based on a simple brainstem calculation of interoral time differences, the time in which something, the brain intuitively just knows, because it's a pretty hard-wired circuit, that if a sound arrives first to this year, then that year, that it's likely coming from over here,"

Mobility Training: Actually, an anticipation of you arriving here

Actually, an anticipation of you arriving here today, I noticed that as I was going up and down the stairs in this house, that I was injecting a little bit of playfulness in the way that I might have many, many decades ago, but haven't for a very long time.

"Actually, an anticipation of you arriving here today, I noticed that as I was going up and down the stairs in this house, that I was injecting a little bit of playfulness in the way that I might have many, many decades ago, but haven't for a very long time."

A holistic movement, smooth movement

And yet, I think for most people, because we think in words often, some of those categories can be useful. So let's say I was going to embark on a movement practice, or that child was going to embark on a movement practice, either throughout the day or for a dedicated period of time.

"And yet, I think for most people, because we think in words often, some of those categories can be useful. So let's say I was going to embark on a movement practice, or that child was going to embark on a movement practice, either throughout the day or for a dedicated period of time. What are the sorts of categories of movement that I might want to think about? A holistic movement, smooth movement."

Overdeveloped Abs Causing Back Pain: The Counterintuitive Culprit

Sahrmann reveals that overdeveloped abdominal muscles -- common in serious exercisers -- can increase spinal compression and contribute to back pain. She prescribes a simple test: measure rib cage expansion from full exhale to full inhale. If it's less than 2.5-3 inches, the abdominals may be too stiff. She recommends arms-overhead breathing and lateral side bends through the thoracic spine to elongate them.

"You know, it makes some intuitive sense, but it's not something you hear many people talk about. I know, I know. Even within the community of physical therapists, people are really exercising big time. I mean, high-intensity exercise is super popular. I'm all for it because it'll increase our patient load. But one of the things that happens when your abdominals are overdeveloped, because what happens when muscles hypertrophy, they become stiffer and muscles are like springs. So they have a, I mean, I'm using the mechanical word of stiffness. And so when the abdominals get to be too much, they increase the compression on your spine. And so the way you can check me out on this is if you look to see if you take a deep breath, if you go from maximum exhalation to maximum inhalation, you should be able to change the circumference of your rib cage about two and a half to three inches. And if you can't really do that, then it means that the stiffness of your abdominal muscles is so much it's adding to the compression and then if you have any kind of asymmetry if for example if you put your hands on your iliac crest and one iliac crest is slightly higher than the other then you're basically your your spine is in a side bend and if it's in a side bend and you're squeezing on your vertebrae, they're not happy because they aren't lined up as optimally as possible. Do you see what I mean? I do. Absolutely. Okay. So that's the ballpark idea. That also reflects how we're looking at these problems. What is it about the way you move? What is it about the way you've exercised or done things that cause the symptoms? I would love to spend more time on this, selfishly, of course, because the reason I am sitting and not standing for this interview is because of this lower back pain. So it's worse when you're standing than when you're sitting? It is worse when I am standing. Now, I do have, I guess we can jump right into the weeds. I have a transitional segment if I'm using the right terminology in my lumbar. So I do have quite a bit of excessive lower back sway or atypical lower back sway. When you say sway, do you mean an increased curve? Increased curve. Yeah. Like lordosis and kind of guts hanging. And with that anterior pelvic tilt, right? Standing and slow walking, say walking through a museum, tend to aggravate it the most. My brother has the same thing. Although in the last six months or so, when I sit on a very hard surface, like a hard bench or something like that, it also causes this pain. I have had imaging, but maybe we could talk about imaging, how you see some people who look like they've gone through a mulcher on their back MRI, but they're asymptomatic. And then you have the opposite. That's the whole point. So I do have some stenosis around like L4, L5, but the pain feels to me localized around the SI joint. The relief, if this is helpful, I know we're getting a little technical for some folks, but the relief that I've had in the last week was actually from seeing a chiropractor. There's a high degree of variability with chiropractors, but he works with a lot of athletes. And he put me on a machine that provided some traction. And he said, I think it's actually that you may have a disc pressing on a nerve that runs past the SI joint. So you're misattributing the cause to the SI. And I've had quite a bit of relief, but to answer your question, standing, slow walking combined with standing, like going through a museum or a cocktail party, sitting on hard surfaces, those are the three things that hurt. Brisk walking does not hurt. And actually that type of, and this is a primitive interpretation, but sort of repeated stretching of the hip flexors, if I'm getting enough terminal hip extension, feels really good to the back. Those are a few of the things. Have you put your hands on your pelvis to see when you're walking, if it rotates? I have not. I would love to know how to do that properly. It's not rocket science. You know where your pelvis is, you know where your hands are. Just because very often when your hip flexors are not even just not short, just stiff, stiffer than your back, as you walk, it rotates your pelvis and that's where you're going to be getting your symptoms from. And evidently, when you go fast enough, you're not staying static, and you're causing enough equal movement, but that would be the big thing. When you stand up and you're in this anterior tilt, can you contract your abdominals enough to get out of the tilt? I can, yeah. And then does that decrease your symptoms? It does decrease my symptoms. So if my back is bothering me, I'll very often do basically a forward fold or a full squat and then round my back and get into that flexed position. The flexed position and even mild extension does not bother the back. If I do a compression test, like a heel drop test, or I pull myself into a chair, it's standing straight up and with compression that shows that type of intolerance. And I get that pain kind of directly on the lower spine. The other thing to try, Tim, is when you stand up, put your feet apart, separate them out and see if that changes your symptoms. What is that doing? Number one is this little thing I referred to before. If one iliac crest is higher than another, and it's a test for what we call relative stiffness. So one of the big hip flexors that's problematic is called the tensor fasciae latae iliotibial band. And it's an abductor. So if you put your feet apart, so your hips are abducted, it takes the stretch off of that band. And any kind of asymmetry that you would have, particularly with a transition vertebrae, would be playing into the symptoms. Do you see what I mean? I do. And then if you put them together and your symptoms increase, then you would know that that's what's playing a role in doing this. So I'll add a few more things, just because this is a rare opportunity to get to talk with you about this. So my TFL tends to be very tight and sensitive. Yeah, that's right. The piriform is also very tight. A piece of this that may or may not be helpful, but what gives my back also some release is working on the, very specifically, the iliacus and then some of the adductors so on the inside of the thigh now i don't know how you do that tell me what that means well having someone really dig uh into the abdomen to have me say okay extend the leg it's not you working on it somebody else's no it's somebody else working on it um and then it's not very pleasant for people who are listening and And then some of my adductors, I don't know if it's Magnus Longus or whatever, but also very tight and seemingly potentially weak. But to come back to the height, maybe the asymmetry of the iliac crest, my right side seems to get hiked up a lot and doing wall sits to try to press them maybe back into some symmetry seems to alleviate some of the symptoms as well. I don't know if any of this makes any sense. You've just confirmed one of my thoughts is that if your right iliac crest is higher than your left, but then I would also bet that your right TFL is stiffer than your left. So if that's playing a role, then when you put your feet apart, your iliac crest should level out. That should help with your symptoms. So historically, when I've been recording podcasts, I basically end up in that really wide stance. And so I think I'm... Now is that... I mean, that's useful for maybe temporarily relieving the symptoms if I'm recording a podcast in terms of corrective measures. Let's just say using your... Have you ever tried anything where you're in the quadruped position? I have actually, a long time ago, I did a lot of movement in quadruped position, but I would be curious to hear what you have in mind. Part of what happens when one iliac crest stays higher than another, and I'm not, to be perfectly honest with you, I haven't quite figured it all out yet, but there's some adaptation of the other hip muscles. And I've just found that if you do this in quadruped, you just rock back. Often it will improve the asymmetry. So basically being on hands and knees? Hands and knees, right. And let your hips drop to about 90 degrees. You don't have to go back all the way. You just need to go back a little bit and go back by easily pushing with your hands. Because otherwise, if you activate your hip flexors, it could pull it, contribute to your problems. Okay. And then, can you tolerate prone? Yeah, I can tolerate prone. And then you need to just do, like, just flex your knee. And then you need to laterally rotate your hips. So you're letting your knee flex to 90 degrees, and then let your foot go in towards the other leg. That's lateral rotation. Yep. And that kind of motion will help to elongate the TFL ITD. Interesting. And you're doing that leg by leg? Yeah, one leg at a time. One leg at a time. Okay. Yeah, by bilaterally yeah okay very interesting so you can try those try those things let me know i will i will do i will do both of this so let's if we zoom out just for a moment thank you for that by the way we may come back to it how would you describe the movement systems syndromes approach so the MSS approach? What would the sort of lay description of that be? In 2013, the American Physical Therapy Association adopted the movement system as its identity. And to me, what's really important about all of this is that it's a way of trying to say to the public that there is a body system called the movement system. And it's not like the traditional anatomically defined systems like the cardiovascular system or the musculoskeletal system or the nervous system. It's a system of systems. But that's just like, in my mind, the immune system, which nothing is more important in medicine these days than the immune system. And it's a system of system. It uses many of the different organs in its function. Metabolic system is the same way. And so when you think of it as running from subcellular all the way up to how do you move in your environment, movement is critical. When movement stops, everything stops. And so I think in some ways to me it's like a parallel to the nutrition system because we take for granted doing it. And yet there's right ways and there's wrong ways. And so the whole idea of this is to realize that their movement does involve a system. And just like we were talking about before, movement, if you have a lesion in a system, like you have rheumatoid arthritis or something, or you have a stroke, then you've got pathology in your movement. But as I indicated, movement can also induce pathology. In fact, we know if people don't move enough, they develop the metabolic syndrome and other kinds of things because for lack of movement."

Systemic issues like vitamin D affect back pain

Medications, nutrient deficiencies, and under-reported injuries often contribute to back pain more than structural issues on imaging.

"Do you know if this person is wildly deficient in vitamin D or they have adequate magnesium levels? There can be so many different places where things can kind of go off the rails systemically that I think it's just so important to always start with a conversation and also get a feel for their history with exercise and in some cases, rehabilitation. What's worked, what hasn't, what's made you feel better. All right, you felt great with dry needling, but not with something else. Those are all things that can kind of give you a clue into the clinical puzzle, so to speak. Yeah, totally. If somebody is, let's just say a jujitsu player and they're constantly in guard, that's going to be very different from say a surfer who spends 90% of their time paddling in that extension. So you have the conversation. What happens after that? I always go to a static postural assessment and there's a lot of, I guess, debate over posture and it doesn't perfectly predict injury or lack thereof, but it does give us some clues into where people at least start. And then there are schools of thought that are heavily focused on alignment. The idea being if you're in a good alignment, it's going to increase the likelihood that you're going to be in a better position once you actually wind up somewhere else. I look at it much more as how's gravity working on this body? What are the shapes that they're in? And it starts to give me some clues on, hey, if you've got really, really low shoulders, you got this downslope shoulder blade like crazy and you have anterior shoulder pain, I'm probably thinking that when we get to movement, your scapular upper rotation, what's taking place when you take your arms overhead, probably is going to be less than ideal just because you're starting 10 yards behind the starting race. The other fly in the ointment for me is that I have congenital transitional vertebra. Well, I should say vertebrae. What is the plural? Vertebra is the singular, I guess. So I have one transitional segment, which means for people who may wonder, if you're looking at my lumbar spine, so my lower back on an MRI from the side, the segments of the spine should, and I'm simplifying here, but look kind of rectangular. And in my case, I have one vertebra in the lower back that is more like a wedge. It's like a door wedge. So I have a lot of lower back lordosis, right? I have sway back, basically. I used to have kyphosis, which was that hunchback look. Thankfully, fixed that. But that is also another aspect to this whole thing, which has led it to be a problem for decades. It's true for my brother as well. But then, whatever it was, 12 weeks ago, suddenly everything just got put into acceleration mode from a pain perspective. and it's really been mystifying. And it's made me really sympathize for people in chronic pain because it seems to be such an elusive problem for so many people. So you look at the static posture. What comes next? I mean, to your point, everybody's invincible until they're not, right? And I think that's a line I tend to use quite a bit. But you might have that conversation about, hey, I have a congenital variant in some way. Some people we see in the structure of their hips or could be a number of different things, but what you also have to do is you have conversations with doctors, with physical therapists to see if their symptoms actually correlate with where that may take place. And that's something I should emphasize is that I work as part of a comprehensive team. I have physical therapists one door down and massage therapists. And we refer out to a lot of orthos on the regular. But once we've done that postural screen, you know, for me, I will go into a collection of like, I guess, classic orthopedic range of motion tests. We may do some manual muscle testing. And then we actually get them up and move them around in more general screens. Things like overhead squats, overhead lunge walks, pushups, toe touches, shoulder abduction, slash flexion, all these different screens that are, I guess, collectively general screens. So you want a collection of both general and specific screens that you're not necessarily missing things. I got it. So general screen, but you're also doing specific screens that might relate to the lower back assessment. Yeah. And those are your gateways, right? In my world, those are sometimes just the things that I need to know on whether, hey, we need to refer this out. Because you're going to have people that walk in with low back pain that just, they trained like idiots. They either choose the wrong exercises. Who are you calling an idiot? Or they go in the wrong patterns or whatever it is. So some people just need good coaching and maybe a little break. Maybe they need a discussion about like, hey, the volume in your program is just inappropriate. We need to find some different kind of variability for you. And then other people, they kind of scream, this is something much more clinical. We need to escalate this. We need to get it to the hands of somebody who could do some imaging for it and maybe get a better diagnosis. Or we may in-house do some kind of test retest where it's, Hey, let's do some manual therapy here and let's see if they get some symptomatic resolution. And if we do create some kind of a transient change, whether it's in the context of their range of motion or in their reduction of symptoms, what are some things on the exercise side of things that we can do to follow it up to make those changes stick? Is there a resource or a book, anything that people could check out to become familiar with some of these movement screens? Long time ago, I talked about FMS in the four-hour body. There are probably many other variants of that type of screen. With the understanding that you should work with a professional, are there any other resources you might recommend? Yeah, for sure. And I think the crew at FMS has done a good job. And the selective functional movement assessment is kind of a little bit more of a clinical add-on to that, that I think they've done a good job with that. If you walk in and look at our screen, it's really a collection of different philosophies all melded together. So I think my response would probably be very different for people in the health and human performance industries asking versus like a general population folk. With that said, I know Kelly and Juliet Starrett in their new book have kind of talked about some stuff. He was a recent guest, just things that people should be able to accomplish in terms of activities of day living and tasks. I do think that's a little maybe a good proactive screen that people could use. Built to move for people. Great read. Just finished it. So people could start there. Let's continue to go down the rabbit hole of lower back pain. So I'm looking at some research that I gathered for this conversation. Could you speak to maybe some of the ingredients in the cocktail that can produce lower back pain or exacerbate lower back pain? So I have a number of things here. I didn't want to read them in depth. maybe you have revised your thinking on this, but I have a whole list of things here. Left AIC, right BC patterning. No idea what that is. Poor motor control and strength of the glutes, poor hip rotation and mobility in general, thoracic spine mobility, et cetera. Are there any usual suspects that in, not necessarily sedentary folks, but let's just make this personal because that's the easiest way to have a conversation. You have a former competitive athlete, me, and I've done a fair amount of extension and flexion, but I'd say probably more flexion just from wrestling and so on. And I have not competed in a long time, but I've continued with the weight training and sometimes more methodical than other times. What are some of the ingredients that you would want to consider as part of the cocktail that is producing the lower back pain? I can't remember when I wrote that, but it's a good find in the archives. I think the big things that I would say is all those things come back to probably two things. It's loading aberrant patterns. So, you know, an example of the left AIC, right BC patterning, that speaks to the Posture Restoration Institute. And they talk about a very predictable pattern of asymmetry, you know, right hips that are shifted out, low right shoulders. And so there can be some compensatory things when we start to load that. What does that mean? Left AIC? It's just an abbreviation for the pattern that they talk about. I see. But basically that's the way they define it. And you will see it very commonly. If you go to any major league baseball game, you'll see every shortstop standing between pitches, like in the exact same position, they'll be stuck in their right hip with a low right shoulder. And their mindset has always been that we'd rather breathe well and move poorly than move well and not be able to breathe. It's a survival instinct. And to some degree, these patterns that we account for are how we maintain our line of sight and our ability to breathe the way that we want to. So these are normal asymmetries, right? We have a heart and we have a vena cave on one side and a liver on the other side. But when we get into trouble is where these things may become excessive and we load on top of them and we lose the variability that we count on to have long-term successful movement."

Push-ups and landmine presses protect the spine

Cressey favors push-ups, cable presses, and landmine presses as spine-friendly alternatives to heavy barbell pressing.

"Whenever possible, I try to emphasize things like push-ups, cable presses. I love landmine presses."

How to find good orthopedic practitioners

Ask local sports teams for referrals to their preferred orthopedic specialists rather than searching blindly.

"If you're in any decent-sized city, you don't have to find someone from the Yankees. Any sports team can give you a referral to their favorite ortho."

Mobility as a fundamental vital sign for durability

Starrett describes mobility as a compounding investment that serves as a vital sign for physical resilience, applicable from world championship athletes to children growing up durable.

"Is there anything, are there any cues that they can have at their desk, any movements they can do, any little stretches they can do whilst on a call where the video maybe isn't on? Um, that can besides quit your job. Yeah, right. You can't quit your job, I have to feed my family. Correct. So, one of the ways I think is useful to think about this is that you're not fragile and you can sit all day long and go ahead and jump on a red eye, take a long flight, you know, go to a conference. You'll see that it's fine. But what we can start to say is, I think if we can give people some vital signs, so the book, for example, is kind of, you can divide it into two categories. The first category is, here are some vital signs. And when I say vital sign, like we'd say like blood pressure. If I say 120 over 80, everyone's like, well, that's not very good blood pressure, but it's not bad blood pressure either. It's sort of like, hey, I should pay attention to this. So, when we give people objective values, objective experiences where they can say, okay, I'm above or below that, then we can start to ask what the next question is. And what we can, what we can strip out one of my favorite ways of talking about training, and this came out of some of the work we did with Premier Soccer, is Premier Footy."