A Closer Look

Rehabilitation and fitness professionals often assign morality to human movements. Some are deemed “good” while others are deemed “bad.” This often leads to the notion that there is a “correct” way to move.

However, even experts completing a motor task have some sort of variability in their movements, that this variability stems from an almost infinite number of degrees of freedom, and that this variability isn’t necessarily negative. Additionally, the body adapts.

Closer Look #1:

Michael Shacklock, through ultrasound, shows that scapular elevation, often deemed “bad” because it puts the shoulder in an awkward position can actually can do something “good” by relieving pressure off the brachial plexus.

For reference, here are some pictures. This is the clavicle and the first rib.

auckland anatomy

Here is the brachial plexus.

plexus 2

Here it is labeled in the ultrasound picture.

brachial plexus intro

This is a screenshot from his website.

ezgif.com-video-to-gif

I would highly recommend watching the presentation Shacklock gave at the San Diego Pain Summit. He has more ultrasound examples of the plexus being given more space in traditionally “bad” positions, like scapular protraction, and the plexus being compressed in traditionally “good” positions, like stretching the pec minor.

Closer Look #2:

Here is a demonstration of the complicated relationship between pain and movement. The following is from a presentation given by Greg Lehman, also from the San Diego Pain Summit.

giffy 1

An orthopedic surgeon notices a “weird” movement of the boy’s scapula.

giffy 2

He asks if the boy feels discomfort. The boy says yes. The surgeon proceeds to explain how this scapular “dysfunction” is causing the pain problem. He then proceeds to “fix” it.

giffy 3

Turns out the pain was on the “normal” side of the body. Whoopsie!

I love how Todd Hargrove puts it:

“Pain science does not overrule the basic laws of physics, and therefore it is obvious that moving with bad technique under heavy load can cause injury. But the question remains whether we are likely to get chronic pain from everyday habitual movement patterns in low load activities like sitting, standing, breathing, bending, or reaching. Do these cause repetitive stress and injury, or do we simply adapt to handle the stresses we encounter regularly, just as we do with exercise stress.

Movement patterns that are commonly alleged to be “dysfunctional” are not correlated with pain or increased injury risk. Treatments aimed at correcting specific dysfunctions often work no better than general exercise. Corrective methods may create good results even when no “correction” occurs, suggesting these methods work by some other mechanism.

The lesson here is that the connection between movement and pain is complex. There’s no doubt that exercise can reduce pain, improve function, and help to prevent injury. But we should be very skeptical about claims concerning the assessment and correction of “dysfunctions” and their relevance for pain in everyday movements.”

Instead of being Jesus, raising all the movement “sinners” from their imminent kyphotic death, or playing Nostra-dumb-ass and predicting injuries and pain problems in a sea of ambiguous noise, it may be more intellectually defensible to accept normal anatomical and movement variations as… something human.

Personally, I think we should respect people and ALL of their anatomical quirks.

brave vs fix