Inside The Huddle: Pattern Recognition

The central point of my work is movement pattern recognition. It does not take the place of anatomical knowledge or technical expertise in exercise, however it is equally important.

I am still amazed that we are asked to discuss exercise programs without a preliminary movement inspection. The toe touch pattern is a timeless example for me, as you might have noticed from my last article.

Please consider this as you read Don Reagan’s thoughts about our working relationship, and how movement patterns are a central part of the work we do.

Gray Cook

Inside The Huddle: Pattern Recognition
Don Reagan, Mountain River Physical Therapy

SFMA toe touch

Since starting my apprenticeship with Gray Cook at Mountain River Physical Therapy & the FMS Headquarters, I’ve learned exponentially, and have grown as a professional, particularly in the area of pattern recognition. I’ve learned to efficiently diagnose a problem using qualitative movement analysis with objective criteria in mind.

Gray will often say to a client, “I’ve seen this problem many times before,” and immediately explain the etiological factors of the pain or dysfunction in a lucid and captivating way. Obviously, movement screening and assessment was part of this process, but his ability to quickly and accurately come to a conclusion on why a person is experiencing pain or is moving poorly is astonishing.

This creates a client’s sense of confidence in Gray. He’s made a clear decision regarding the client’s problem. Watching him made me vow to recognize a problem sooner the next time I see a client with a similar presentation. Furthermore, if another movement issue is present, it’s my job as a holistic practitioner to accost it, and educate the client about it.

The clinical example that comes to mind is an adolescent ectomorphic male with bilateral knee pain. He didn’t have any structural damage, but rather had a movement issue. His primary complaint was that both knees hurt while attending a technical school where he was required to wear large work boots. The client’s rationale was the pain increased because he was standing for hours on a concrete floor in heavy boots.

However, Gray pointed out that the young man was very thin and the problem was not his body weight loading his knees, but rather the immobilization of his ankles, which was placing greater demands on his knees. After performing some techniques to accost his pain, I was to teach him the posterior weight shift needed to perform a deadlift and eventually a hip-dominant squat.

After a few visits, Gray observed me coaching the client’s deadlift, using different strategies to improve his quality of movement, but without much success. The client simply wasn’t getting it.

That’s when Gray came over and asked if I’d cleared his toe touch.

I thought for a moment and realized I’d observed his forward bending pattern and noted it was limited to mid tibia, but had forgotten to fix it. I’d been focused on strengthening his deadlift pattern due to his thin stature. Ironically, the pattern I missed was the most important one. The client needed a respectable toe touch before he would have the requisite movement ability to hip-hinge.

Think about it.

Snip from the new Key Functional Exercises You Should Know DVD
filmed August 2012, Perform Better Long Beach

From the pelvis down and from the sagittal view, the toe touch and deadlift look very similar. With both, there’s a significant posterior weight shift, full hip flexion, and they both require good posterior tissue extensibility. Having a full toe touch is the prerequisite to the invaluable universal athletic position. After attaining the toe touch, the deadlift can be added to facilitate power development.

I immediately went to the toe touch progression and then back to the deadlift in the same session, with much better results. The client later learned to deadlift with weight and then progressed to pain-free goblet-style squatting.

The next time you’re teaching someone to hip hinge and are not seeing improvement no matter how much patterning you do or how high you elevate the starting position, consider looking at the forward bending pattern.

Trust me, I won’t forget this lesson.

Don Reagan
Mountain River Physical Therapy

You can see more clips from the new Key Functional Exercises DVD,
get the content description or order the DVD here.

What’s in a Toe Touch?

Gray Cook
with Don Reagan

When I entered the Perform Better lecture tour a long time ago, I thought it was very important to discuss movement, because most of the questions concerned exercise and exercise progressions without first qualifying what the exercise was supposed to change in movement. We talked about exercise in the way of muscle development, sort of a kinesiological map, if you will. But we didn’t discuss the way movement patterns are affected by a particular exercise. We failed to realize that right when we finish an exercise, there’s a window of opportunity where hopefully the brain has become more efficient.

Brad Thompson toe touchBrad Thompson, on stage with Gray at Perform Better Long Beach, August 2012

Furthermore, the first part of strength gains is initially attributed to neural factors. This means when we introduce a new exercise there’s not a lot of tissue change, but rather a more efficient nervous system. We call this motor control. Motor control is really a fancy term for timing, stabilization and coordination, resulting in a higher level of proficiency.

In almost every movement we do, there’s room for improvement. If you’re an expert at a certain movement, the room for improvement is very small, but if you’re new to a movement or new to doing a movement correctly, there’s a lot of room for improvement.  Most of the improvement won’t be muscle bulk or hypertrophy. It might not even be in energy systems, but the reason endurance and strength continue to escalate is because we become more efficient.

On my first pass through the Perform Better lecture circuit, I wanted to demonstrate how movement could change much quicker than we thought. I ended many of my early presentations by finding someone who couldn’t touch his toes, and bringing him on stage. Now obviously, I wouldn’t ask somebody to come on stage if the toe touch limitation was due to pain. I wasn’t trying to perform a rehabilitation trick on stage, and I don’t advise anyone to try this.

However, when people have generalized stiffness and an inability to cleanly touch their toes, we could identify that as movement dysfunction. These are the people I brought on stage to do a few quick techniques.

These techniques don’t involve stretching. They don’t involve putting my hands on anyone. They don’t involve soft tissue mobilization. These are simply exercises to keep the neurological system from putting on the brakes during the toe touch.

Much of the posterior chain tension people feel if they can’t touch their toes is literally putting on the brakes. This is due to a number of reasons.

•    The rhythm of the lumbar spine and pelvis could be out of sync—the hips and pelvis should be the first part of flexion, and the spine should be the second part of flexion.
•    They may not feel comfortable with the posterior weight shift required as the hips go back and the trunk comes forward.
•    They may not be comfortable bending the lumbar spine along with the hips in a rhythmical fashion.

As I started doing the toe touch progression and a few other techniques that improve a toe touch in less than a minute, people started to understand I wasn’t trying to change muscle length or core stability. I was simply giving the brain permission to subconsciously adopt a more efficient pattern.

Snip from the new Key Functional Exercises You Should Know DVD
filmed August 2012, Perform Better Long Beach

The brain for some reason compounds a problem by putting fitness on dysfunction. The problem could perhaps be due to a previous injury that wasn’t completely resolved, bad training habits, an imbalance of training such as too much anterior chain musculature training as opposed to posterior, or the lack of full range of motion training, among many possibilities. All of these can reduce one’s natural ability to touch the toes.

Many of the people we’re training don’t have adequate movement. Corrective strategy can be a painless process that doesn’t take a lot of time to do if done correctly. As people started doing the toe touch, it made a good platform for the Functional Movement Screen.

Unfortunately, this is when things spun out of control. People put way too much emphasis on the volume of corrective exercise, and not nearly enough emphasis on the quality.

My point was the opposite. I had changed a person’s toe touch in a matter of minutes. On this better toe touch, I planned to do programming that hopefully would not reduce the toe touch, which I could verify by rechecking the baseline. I wanted the programming cause the person to work within the new range of motion to require more stability.

As I said, things spun out of control and mistakes were made.

First, people became obsessed with corrective strategy and forgot that the purpose of corrective strategy is to get back to performance and fitness training to ultimately make us healthier and more resilient. This allows us to combat our sedentary lifestyle and gives us an outlet for much of the tension we store in our bodies.

Corrective strategy, when practiced by an expert, is a temporary sidetrack, not a six-month program. This is not to say some people are not so dysfunctional or so involved that they won’t need continued corrective strategy, but hopefully, we’ll know exactly what’s driving that.

Maybe we’ll have the consultation of a physician, physical therapist, chiropractor or some other medical professional who can help navigate when people have a permanent restriction or disability. For these people, it’s okay to have continued corrective strategy as part of a program. Otherwise, it would probably be more appropriate to introduce a corrective strategy that works, and then become aggressive in trying to remove and replace it with more functional programming.

Another misconception is that the toe touch was inherently hazardous. We’re not supposed to round our backs; spine flexion is bad, or so the thinking is. I don’t even know where to start with this.

Spine flexion is not bad. Spine flexion under load is bad. We flex our spines all the time. A pitcher flexes his spine in his follow-through movement. A pole vaulter rounds and extends the spine going over the bar. Sprinters flex their spines in the start. Jockeys and cyclists flex their spines to assume an aerodynamic position.

But when we’re lifting, pushing and pulling heavy loads or doing ballistic or plyometric activities, it’s better to adopt a stable spine. We do this not through stiffness, but by vigilant motor control, or what we can call reflex stabilization.

Reflex stabilization doesn’t mean the loaded back is stuck in a stiff and extended position, diligently prepared at all times to do a squat. The best spines move when they need to move and are stable when they need to be stable, thereby demonstrating the highest level of motor control: adaptability.

Then people started reciting a rule that has been somewhat misconstrued, ‘Aren’t we supposed to have stability before mobility?’

The answer is an emphatic no. That breaks all natural laws. We’re supposed to have mobility before stability. We’re supposed to have stability before we have movement.

What they should be saying is we should have stability before movement, but somewhere along the line, ‘movement’ was replaced by ‘mobility.’

Mobility is simply the available motion within normal limits, the potential to move, and the lack of restriction. Once we have a lack of restriction and have the ability to stabilize, we naturally adopt the ability to control motion. Once we can control motion, we should then seek opportunities to move.

The rule is this—Mobility before stability; stability before movement; and movement before strength.

This is why the Functional Movement Screen is not a performance measure. It has some testing that exploits symmetrical mobility—active straight leg raise  and shoulder mobility—some testing that exploits low-level motor control and stability—rotary stability—and some testing that exploits high-level motor control and stability—trunk stability pushup, long before going to standing to look at closed-chain movement, which is the inline lunge, hurdle step and overhead squat.

Note how we look at the leg raise, shoulder mobility, rotary stability and the pushup before we worry about lunging, stepping or squatting.

The rule is embedded in the Functional Movement Screen. If it’s not clearly understood, I will own that mistake and issue the statement in clearer terms.

Episode Twenty-Three of Gray Cook Radio:

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What does Gray mean when he says, “If you can’t touch your toes, don’t deadlift”?

Now, let’s see if we can apply this lesson.

I often work with athletes and patients who have a history of low back pain. They’re commonly given ubiquitous trunk stabilization exercises without anyone exploring their potential for movement. Without mobility, how can we check stability? What we could be checking is stiffness. If we ask you to hold a position and you’re stuck there, are you really holding the position or are you just hanging out on stiffness? Perhaps there is inappropriate tone of stabilizing muscles creating stiffness?

When I evaluate an individual, the basic mobility patterns I look at is a leg raise and a toe touch. If the leg raise is normal, but toe touching is abnormal, there must be something happening when standing that doesn’t allow movement through the full range of motion. When restricted in both movements, there must be a restriction regardless of whether loaded or not.

Either way, it’s extremely important to normalize the toe touch before teaching a hip hinge, deadlift, swing or squat.

A hip hinge ultimately spares the spine and loads the hips so the hips do most of the dynamic work. The spine statically, without movement, transmits the energy to the upper body. The spine can only be stable if the hips are mobile. If the hips are not mobile, the spine cannot be stable.

However, there’s another ingredient. The spine must also be mobile so it can feel and adjust when it’s out of position.

As we enhance the mobility of body segments, one of the first things we do is enhance the proprioception of the area. The deep multifidus muscles that travel along the entire spine have a significant number of muscle spindles, which allow them to be excellent sensory organs since they’re close to the joint. By being close to the joint, they transmit information about subtle changes in the spine to the brain that can then be acted upon by the larger muscles with the larger lever arms, such as the obliques and spinal erectors.

What I usually see with these patients is a lack of toe touch because the spine and hips are too stiff to move. Yet if I put the same patients in a position to deadlift even a small amount of weight, the initial movement is to round the back. They would rather round the spine than load the hips because it’s been so long since they properly loaded the hips. It is an option that’s not available, and sadly they have limited awareness of that option.

Conversely, some people are unwilling to round the back in a toe touch. Yet they are more than willing to allow rounding of the back and poor loading of the hips in a deadlift. They round the spine when they shouldn’t, and consciously or unconsciously hold the back stiff when they try to touch their toes.

What we try to do is flip the scenario by giving them permission to bend, rotate, turn and flex the spine when moving through space. This allows the spine to have more input and more sensory information. The movement stimulates mechanoreceptor activity.

Mechanoreceptor activity then becomes more and more aware of the external environment and the loads, so we create a toe touch to create spine mobility. Then we coach spine stability and allow it to naturally occur in movements like the deadlift.

The biggest misconception is that I give people permission to round the spine under load. Once again, there’s a part of the population who would rather embrace absolutes than think on their own.

Rounding the spine in a toe touch is okay. Rounding the spine in a deadlift is a recipe for disaster. Not rounding the spine in a toe touch is a demonstration of significant dysfunction, because normal weight shifting, body mechanics and alignment have been distorted.

In addressing this, we reset the toe touch to create a better environment to teach the deadlift.

Before you make a decision on how you feel about this, I want you to realize this is only my opinion. However, my opinion is based on over 20 years of working with this very situation. I’m not asking you to invest 20 years playing with this, but at least investigate the scenario.

Don’t find a person with back pain. Find somebody who can’t show you a clean toe touch, and teach the proper deadlifting mechanics and watch what happens. Then do what you can do to help the person achieve a toe touch.

If you don’t know how to do this, we have plenty of ideas. The best place to start is a Functional Movement Screen, because there may be multiple reasons why a person can’t do a toe touch. Visit the exercise article library on functionalmovement.com to learn our suggestions for most of those reasons.

Either way, try to teach someone how to deadlift without first clearing the toe touch. Then teach someone to deadlift by clearing the toe touch first. Pull some repetitions before you comment. I think you’ll be surprised.

Here’s a couple-minute snip from the live demonstration of deadlifting instruction segment from my new DVD. This is how we teach this.

You can see more clips, get the content description or
order the new Key Functional Exercises You Should Know DVD here.

You can also listen to more about the toe touch in this audio lecture.