Functional Flexibility

FUNCTIONAL FLEXIBILITY: Complex Made Simple
by
Lenny Parracino PT, FAFS

Whether training for golf, football, baseball, or any sport, most athletes realize the benefits from a strength training program, yet rarely recognize the importance of a flexibility program. Flexibility is the foundation of what we do! In fact, without flexibility the body will not exhibit optimal levels of power, strength, cardiovascular fitness, or muscle endurance. Flexibility is the cornerstone of rehab, performance, and preventing injuries. However, flexibility programs seem to be less popular, most likely for a variety of reasons – one being research shows mixed reviews which often leads to confusion.1 When reviewing the principles (or lack thereof) behind most research it is easy to understand why the mixed reviews exist. As professionals, it is important that our decisions on what technique to choose be determined by a principle-based approach that is specific to each person’s intended need, not an arbitrarily designed guideline. To assist in determining what technique to choose, we will first explore three primary principles that should be considered, followed by a strategy to assess and address your patient’s / client’s functional flexibility.

Three Primary Principles of Functional Flexibility:

1. Individual and Task Dependent
2. Three-Dimensional
3. Mobility / Stability System

Functional flexibility is flexibility that allows us to function better. It allows one to perform tasks optimally and efficiently.2 The exact function is individual and taskdependent. 3 Therefore, general stretching techniques designed for muscle origininsertion will not provide us with an optimal functional outcome. Instead, the practitioner must appreciate the function of the muscles during the task. In other words, what a muscle does is task driven not textbook driven. This doesn’t make the textbook authors wrong, their right relative to the position, motion in which they concluded function at that time. When the body changes angles, positions, etc., its function changes; this is why for flexibility to be functional the techniques must look like the intended function. Therefore, we need to understand how the muscles, fascia, tendons, ligaments, nerves, joint capsules, and joints are moving three-dimensionally during the exact task; not only how much motion but also how well. This is the principle of mobility-stability, the right amount of motion with the right amount of stability in all three planes specific to the individual (not textbook) and intended task (all tasks require different levels of motion-stability).

To help simplify this complexity, we would like to share a practical strategy applying our three principles. This strategy can be used practically during your next assessment / evaluation…

First and foremost, understand each unique individual and task. Once you understand the individual’s current condition, limitations, concerns, and what they want to do, assess the intended task with as much authentic function as possible. The key is in understanding what they want / need to do and what they currently can do successfully. From here build a strategy to lead them in the right direction as quickly and safely as possible. For example, start with level one and only move to level two and three as needed per individual, per task.

Level One: Task specific. Assess the ability to perform the exact task. For example, walking, lunging, squatting, pivoting, stepping, reaching, running, balancing, picking up a specific object, sitting while reaching with right hand, etc. If this produces pain, discomfort, and/or lack of confidence, create authentic support to assist in the task. For example, one may reach forward at knee height from a split standing stance and feel low back stress. What if you changed the height of the reach to waist height? Same discomfort or less? If less, is it the back or the hips inability to allow the back to be successful from the range first assessed? Become a detective by changing body angles, positions, heights, drivers, ranges, etc. before leaving the intended task. Figure out a way to gain success in what they want/need to do. If this fails, progress to level two (although level two will look like level one).

Level Two: Task with outside support. Subtly add outside support or points of stability to the intended function. Using our example, simply add outside support such as in a True Stretch or a doorway. The outside support will allow you to position your patient / client in a specific range or zone to then apply authentic drivers. As their driving motion, use your palpation skills to assess the entire chain reaction searching for the “weak-link.” This is the application of the motion-stability principle. Then the body perceives stability it will exhibit mobility, providing it’s there. If one suspects the mobility is not there and desires to assess structural tissue texture, tension level three can provide information regarding the suspected structure (not exact function).

Level Three: Structure specific. Provides an environment for a structural assessment such as a plinth or table. This deviation from the exact functional task must be understood as a deviation and the results then correlated and integrated back into function, if function is the desired outcome.

Traditionally many techniques have been taught to start from the symptom or structural tightness to level three eventually getting to level one. In this paradigm shift, we allow the exact function to dictate how far away from function and into isolated structure we go. This strategy saves time but most importantly gives hope to your patient / client – function feeds function. Although function is complex due to its always changing nature, we can simplify function by simply following function. Use what your patient / client is saying, what they have experienced, and how they are moving as your guide to improving their wellbeing. When we apply the principles of Applied Functional Science (convergence of physical, biological, and behavioral science), flexibility takes on a new meaning. Functional flexibility recognizes the individual as a whole. Once you understand the dynamics of the whole, you derive, at least in principle, the properties and patterns of interactions of the parts.

1 Journal of Bodywork and Movement Therapies (2003) 7(1),1

2 Gray G: Functional Video Digest. Functional Flexibility Enhancing Life. V2.11

3 Gray G: Fast Function. Flexibility, Mobility. 2006

Low Back Pain - Treatment considerations

The Low Back

The low back (lumbar spine) is perhaps the most dysfunctional and weakest musculoskeletal link in the body. It is one of the leading reasons for visits to the emergency room. And anyone who has had a bout of back pain will tell you it affects everything they do throughout the day. It is active in nearly every functional activity of the body and its proper function is integral to most of our movements in every day life.
Interestingly, the low back is rarely the first to move. If you take a swing in golf, first your arms move, then your upper back, and then your low back moves then hips. If you step forward and bend down to pick something up, first your foot moves then your leg and hip then your sacroiliac joint and then your low back moves. This is a very important point, because the low back relies on proper communication from the rest of the body in order to function properly. Thus, any therapy for low back pain should integrate the rest of the body and promote proper communication between the low back and the upper and lower body.
What does communication to the low back mean? It means the ability to transfer triplane (sagittal, frontal and transverse) motion into triplane stability. The low back is designed to move really well in the front to back motions (sagittal plane); it has some movement in the side to side (frontal plane motion) and very little motion in rotation (transverse plane). The limitation in rotation allows the lumbar spine to be stable enough to transfer rotational motion between the upper and lower body. As a practitioner I consider how the body functions in its transformational zones between two stages of motion. The load and the unload. Loading is the preparation for a movement. The unload is performance of a specific movement. Let’s look at an example.
I recently treated a person who was training for her first marathon that was to take place in 3 weeks. She had been having right low back pain for the last 2 months of her training and had just recently started to get right knee pain and swelling. She was unable to run or even go from sitting to standing without pain.
I started her evaluation by observing her walk. I immediately noticed that she walked on the outside of her right foot, her right foot turned out more than the left and her heel came off the ground early. My next step was to get more specific and see how her right foot moved in all three planes of motion and when she was doing a balance reach exercise she lacked balance in the frontal and transverse planes. In response to this unbalance she said, “I do remember spraining my ankle about a year ago”. Next I assessed her hip function on the TrueStretch which allowed for a stable environment to look at triplane motion. It quickly became evident that she lacked sagittal, and more importantly, transverse plane motion of her right hip. “Yeah, but what does this have to do with my back”, she asked me. Next I set out to re-gain motion in her right ankle and hip by facilitating these motions in a pain-free range of motion and then I followed up with triplane functional lunges to activate some sleeping muscles. Within one and a half weeks, this patient was back to pain-free running.
Although the patient’s original complaint was right low back pain and knee pain, I believe the true cause of pain and dysfunction was rooted in the foot/ankle and hip. Since the low back only has a nominal amount of rotation to begin with, there is not much it can do to compensate for lack of motion in other parts of the body. Therefore those restricted parts of the body must be evaluated and treated in order to have a truly successful and lasting resolution of back pain.

Preventing injuries by improving foot function

As spring is becoming more evident, many of us are starting to venture outside more often. If you plan to start a new workout program or simply move your current workout from the treadmill to the trails you should be aware of proper foot mechanics.Outdoor surfaces can be uneven, too hard, too soft, too bumpy and unpredictable.Your foot needs to be able to adapt to all of these changes.

As your heel strikes the ground it needs to move down and in (pronate) to unlock the foot joints and make the foot a flexible adaptor so it can react to uneven surfaces.When the heel is about to come off the ground the joints of the foot should lock so your foot has something rigid to propel off of. If these things don’t happen you could be setting yourself up for an injury.When the foot pronates too much or for too long it puts more stress on the fascia of the bottom of the foot which can lead to plantar fascitis, tendonitis, bunions, and other foot pain and tingling symptoms.If the foot does not pronate enough it won’t absorb shock like it should which could lead to metatarsalgia and stress fractures of the foot and leg.

In addition, the motion of the heel bone allows the lower leg to internally rotate which allows the upper leg to internally rotate and allows for several other reactions up the chain. This internal rotation of the leg "turns on" or stimulates the powerful butt muscles to contract which in turn slows down the internal rotation and eventually moves the leg into external rotation for proper lift "off".

This is a very important concept that must be addressed with all foot/leg/ and spine injuries. If it is not addressed many injuries will heal improperly or you will be set up for the same injuries over and over again.

So as you are outside enjoying a spring workout and enjoying the spring foliage pay special attention to your feet and thank them for working properly.If you feel that your feet need some help, remember that I am here for you.

Kevin Colling, DC

Foot Function

The heel is the key that turns on the machine. At heel strike the calcaneous (heel bone) must dorsiflex, evert and externally rotate in order to allow the rest of the leg and body to properly react. The motion of the heel bone allows the lower leg to internally rotate then the upper leg to internally rotate and allows for several other reactions up the chain. This internal rotation of the leg "turns on" or stimulates the powerful butt muscles to contract which in turn slows down the internal rotation and eventually moves the leg into external rotation for proper lift "off"

This is a very important concept that must be addressed with all foot/leg/ and spine injuries. If it is not addressed many injuries will heal improperly or the person will be set up for the same injuries over and over again.

It's know coincidence that the term "Achilles Heel" is so well known. Proper heel function is essential for proper walking and running biomechanics.

Kevin Colling, DC

Little Benefit to Knee Surgery for osteoarthritis

A recent article in the Sept 11th, Los Angeles Times, from the associated press reported that, "Arthroscopic knee surgery for arthritis - performed hundreds of thousand of times a year - does not reduce joint pain or improve knee function, according to new research released Wednesday[Sept 10,2008]"

This is a case where a treatment is applied to a symptom instead of to the cause of the symptom. Although surgery may help by removing cartilage fragments, it does nothing to prevent the same damage from happening in the future.

For all types of knee pain it is imperative to find out what is causing the pain and to treat the cause as well as treat the symptom. Some people have restrictions of movement in their foot, some have restrictions in their hip, or thoracic spine. These restrictions whether they are caused by muscle, joints or ligaments can all lead to knee pain. In fact, something as seemingly trivial as a big toe that doesn't bend enough can easily cause knee pain and knee degeneration.

Proper evaluation and management of the knee should rule out internal derangement such as ligament tears and should find the limiting factors in motion from the ground up and the top down in order to come up with the best results.

Chiropractic manipulation, kinesiotaping, leukotaping, Graston Therapy and three plane stretching are all services provided by Colling Chiropracitc that can help knee pain. The key is where, when and how to apply them.


Kevin Colling, DC

Sports injury - knee pain