Mobility - Fad or Fallout?

Mobility is a common factor cited and addressed in physical rehab by athletic therapists, physiotherapists, chiropractors, and the like. Like always, however, 'mobility' didn't become a mainstream word until personal trainers and other fitness professionals started throwing it around, and today it's the current hot-word that everyone uses to sound smart and grab attention. There are misconceptions about what mobility actually is, however, and the proper ways to address it.

So what is mobility? A lot of people use it interchangeably with "flexibility", which is understandable but incorrect. Mobility refers to the range of motion at a joint itself. For example, flexion at the shoulder joint (lifting your arm up in front) to reach over head is a range of motion. When we speak of flexibility, we are only talking about the muscles of the joint being able to lengthen and stretch. While flexibility contributes to mobility, the stiffness of a muscle is not the only factor that can affect a joint's range.

Mobility Is More Than One Factor

The joint itself has several structures that can cause limitations. Fascia covers all muscles, and while it's often considered to be part of the muscle itself, it exists as its own separate structure. There's the joint capsule, which is ligament-like bands that encompass the joint, and ligaments themselves that support the area. There are bursae, fluid-filled sacs that buffer impact and friction, which can become inflamed and limit range of motion. There's cartilage and the bone surfaces themselves, which can hinder mobility if there's damage or degeneration. (ie: meniscus tears or arthritis) Synovial fluid, which lubricates a joint, can increase or decrease based on joint health. Bone surfaces can also be incongruent and may be sitting improperly on one-another. (ie: a "stuck" rib) With all that in mind, mobility is a multi-faceted picture, and when you're trying to increase it, you're addressing all of these physical factors, not just the flexibility of the muscle.

If it was as simple as "the arm bone is connected to the hand bone", then we could just publish a "For Dummies" manual.

Now, one problem that I run into a lot is that people think that they need to aggressively mobilize every joint in their body in order to attain proper or optimal function. The fitness industry is starting to become bad with this, and even personal trainers are often over their heads when attempting to prescribe mobility exercises. This is where injury, of course, follows suit. If someone is new to exercise and can't fully flex their arms overhead, should we really be getting them into aggressive dowel-circles with the goal of having them overhead squat? Of course not! Those shoulders are unstable!

A Cyclic Relationship

Here's the word that should have accompanied "mobility" as it's partner-in-crime hot-word: Stability. Stability and mobility are directly paired, and one cannot exist without the other. In fact, in the absence or loss of one, the other will typically decrease as well. This isn't the body rubbing salt in a wound, however. In fact, when mobility decreases in response to poor-stability, this is the body creating a protective response.

Every joint in the body needs to have a certain degree of muscular stability in order to properly protect the area and prevent injury to structures. However, when stability is lacking, such as when spinal stability is lost due to inactivity and a weak core, the human body has a fantastic compensation method in order to ensure that injury and pathology can still be minimized. Hypomobility is the result. Muscular structures will increase in tension and become tighter, joint capsules become restricted, fascia will be adhesed and glued, and synovial fluid production can drop. Think of it as a loose hinge on a machine that's too stripped to repair, and so it's welded tight instead. Less movement can occur, but the structural integrity is spared.

Never compromise your integrity!

With this in mind, it should hopefully be easy to understand why aggressive mobilizing can result in injury. If the shoulder's stabilizing muscles are weak, then drastically increasing mobility is just going to cause a person to move their arms into a position that your muscles can't support, and damage will ensue.

Two types of practitioners that I often see falling into this trap are chiropractors and yogis (without trying to say that neither field has its place). Chiropractors, specifically those who are treatment-based only and favour the "crack" or other quick and aggressive techniques, definitely do the job that they're paid for by releasing a joint. However, by not taking the time to correct for the instability of the joint - the reason for why the joint became hypomobile in the first place - it sets up for the return of that client quite often once the body finishes responding to the instability by restricting the area again. On the other side of the professional field, yogis tend to do the same thing, albeit in a more conservative way. True, they do a lot of isometric bodyweight strengthening, but many individuals will not find pain-relief from the activity. When the main focus is elongating the body's muscles and maximizing range of motion and flexibility, complementary weight-training is very often a necessity in order to stabilize the body in order to compensate.

The Solution

The solution is clear. Stop being so aggressive when mobilizing clients! It doesn't matter if you're a physiotherapist, personal trainer, or witch doctor. We all need to stop removing a base of joint support without offering anything to replace it. My philosophy is as follows:

• In educated practice, mobilization is done slowly and gradually. Ideally, it should never be the goal to try and entirely mobilize a severely restricted joint in one session. 
• In clinical practice, joint glides and muscle energy techniques are supplemented with gentle self-mobilization homework and stabilization exercises. Even massage is best when paired with exercise.
• Ie: For the back,  a gentle mob, a cat-camel mobilization exercise, and some core strengthening will likely show much better efficacy than a quick crack.

• Mobilization should never hurt save for the Grade 5 (the crack) and even that's debatable. Whether the client is receiving a mobilization technique or doing a mobilization exercise, a look of excruciation on their face is a definite sign to stop.
• Above all, if you're recommending mobilization to someone, know what you're doing! Be specific in your aims and know the limitations of your client (and you're insurance coverage). If you're throwing darts and hoping that stressing an end-range repeatedly is going to result in good health, your client is in for a nasty surprise, sooner or later.

We'll likely to continue to see mistakes concerning mobility for years to come until a new trend hits the fitness media and takes over. Until then, education is important. In failure of that, I could just start hanging out at Crossfit gyms and hand out business cards.