FREE MOBILITY EBOOK
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About
Mai-Linh
Dovan
Mai-Linh Dovan is a Certified Athletic Therapist and leading
industry expert in functional rehabilitation. She holds a Bachelor’s
degree in Athletic Therapy and a Master’s degree in Exercise
Science from Concordia University, where she worked in
collaboration with the Department of Psychology and the Centre
for Research in Human Development. With over 20 years of
experience in clinical rehabilitation and strength and conditioning,
she has developed a comprehensive and unique functional
training approach with integrated rehabilitation.
She uses this approach with a diversity of athletes and clients
from bodybuilders, powerlifters, CrossFit athletes, as well as
athletes from many sports and recreational lifters struggling with
various problems: recovery from cervical and thoracic fractures,
low back and shoulder dysfunction, dysfunctional movement
patterns. It has led many to unleash their full performance
potential.
It is using this innovative approach rooted in clinical strategies
and geared towards prevention and performance that Mai-Linh
developed the Movement Optimization for Prehab and Performance
Course. This course provides the principles to effectively assess and
identify movement dysfunction as well as strategies, means and
methods to build a rehabilitation- integrated intervention.
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What is
Mobility?
Mobility can be defined as the ability
to move or be moved freely and
easily. To reinforce efficient movement
patterns, you have to be able to
move efficiently. In the fitness industry,
we often see mobility expressed as
various forms of soft-tissue release.
Limitations in movement that come
from poor soft-tissue quality and/or
mobility are a significant barrier to
movement quality and need to be
addressed if we hope to move more
efficiently. Most mobility programs
involve foam rolling, lacrosse ball
rolling, even massage guns and the
likes. However, these are not the only
components of an effective mobility
program.
Addressing soft-tissue limitations
opens up a window of opportunity, as
it removes these barriers to movement.
There is an active component to
mobility that needs to be addressed,
because mobility and stability are
intrinsically linked. Once we have
opened up range of motion, it is
imperative to work within that range
to gain awareness and control. This is
what true mobility is.
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The mobility-
stability continuum
From a purely anatomical (structural) standpoint, we tend to view mobility and stability
at opposite ends of the same spectrum: some joints have a structure that affords more
mobility, such as the shoulder, while some have a structure that affords more stability,
such as the knee. Mobile joints have a bony geometry that is conducive to more
movement but less structural stability, and vice versa.
Cook & Boyle’s joint by joint theory explains that our joints are stacked and function to
alternately provide mobility and stability:
What is true from a structural standpoint is not always demonstrated from a functional
standpoint. Mobile joints may tend to become “sloppy” as Cook & Boyle put it, which we
can define as mobility expressed without stability.
On the other hand, joints that are intended to be mobile may become stiff, and often this
can be attributed to the joint above and/or below not providing the stability it is intended
to provide.
As you can see, both hypermobility and hypomobility can result in instability.
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Hypermobility often manifests as an inability to control a desired movement
or an inability to resist an undesired movement, while hypomobility often
manifests as an inability to produce a desired movement.
For example, a hypomobile shoulder can result in an inability to lock out
the arm in an overhead position. With a hypermobile shoulder, one may
have difficulty stabilizing the end range of the lockout or prevent excessive
movement at the end range.
For optimal function and movement, individual joints, as well as the entire
kinetic chain, require a combination of mobility and stability that is balanced
and extends as far as possible across the range between rigidity and laxity,
as depicted in the figure below:
Muscles
and joints
Soft-tissue release will have an effect on muscles, but mobility also involves joints. While
releasing muscles may increase joint range of motion, until we work within that range to
create that fine balance between mobility and stability, we will not have a lasting effect
on mobility.
The intricate relationship between joints and muscles is well summarized by
Dr. John M. Mennell (Mennell, John. Joint Pain., Little Brown and Company, 1983.):
1. When a joint is not free to move, the muscles that move it are not free to move.
2. Muscles cannot be restored to normal if the joint which they move is not free to move.
3. Normal muscle function is dependent on normal joint movement.
4. Impaired muscle function perpetuates and may cause deterioration in abnormal joints.
An effective mobility approach needs to involve muscles and joints with consideration to
the intricate relationship between the two.
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Mobilize to
allow movement
I often use the word “mobilization” instead of “mobility”. To IMMOBILIZE is to make
immobile, to prevent use or movement. As such, to MOBILIZE is the exact opposite: to
make mobile, to allow use or movement. The objective of mobilization is to improve the
individual’s ability to move, to make more mobile, to improve the quality of the movement.
As such, mobilization can include any of the following:
- alleviate muscle tension / improve soft-tissue integrity
- improve the length-tension relationship of antagonistic pairs of muscles
- downregulate facilitated muscles
- optimize joint range of motion in adjacent regions
- improve dissociation capacity
- promote proximal stability for distal mobility
- create stability for better joint centration
As you can see, it can be as much about mobility as it can be about stability, depending
on the individual needs of the client, so there is much more to it than foam rolling and
smashing. This means that even the hypermobile client can benefit from a well thought
out mobility intervention. To illustrate what kind of mobility work can be effective for the
hypermobile client, read my blog article: “Mobility work for the hypermobile shoulder”.
Mobilization can be more passive or more active, depending on the client you are working
with and on where within your programming you want to include your mobility work.
PASSIVE MOBILIZATION ACTIVE
SMR (foam roller, lacrosse Active-assisted ROM Active ROM
ball, Tiger tail, etc)
Self-mobilization PNF stretches Flows
Long duration passive Loaded stretching
stretching
Definitions: REHAB-U.COM
SMR (self-myofascial release):
soft-tissue mobilization using a foam roller, lacrosse ball, tiger tail,
tool or other implement
Self-mobilization:
joint mobilization techniques performed with assistance and/or
movement such as, for example, thoracic spine extension performed
with the elbows on a bench
Long duration passive stretch:
static stretch held for over 1 minute
Active-assisted range of motion:
moving actively through full range of motion with additional passive
motion at end range using a band or other form of assistance
PNF stretch:
hold-relax or contract relax stretch
Active range of motion:
moving actively through full range of motion
Flows:
combination of active range of motion exercises and or other
movements in a continuous circuit
Loaded stretching:
contracting a muscle while it is in a stretched position
Individualizing
mobility
Whenever possible, mobility work should be individualized, as with any other training
intervention. There are many different types of people ranging generally from intense
and hyperactive to anxious and quiet. Some people are somewhere in between. People
who are more intense tend to like to be challenged and feel like they are working. More
active mobilization techniques from the list above may be better for these types. On the
other hand, people who are anxious and quiet may benefit from more passive forms of
mobility work, as well as parasympathetic breathing.
In a group context, the challenge will always be that some individuals will be hypomobile
while some others might be hypermobile. When building a generic mobility intervention,
it is preferable to use more active methods. That way, both the hyper and hypomobile
clients will benefit. For example, working through active range of motion will create space
for the hypomobile client and awareness and stability for the hypermobile client. These
should be your exercises of choice if you are building an intervention for a group.
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Breathing
and mobility
Breathing is an integral part of mobility. With every breath we take comes a natural
mobilization of the spine, moving into extension on inhalation and flexion on exhalation.
I discuss the link between breathing and thoracic mobility in this blog article:
Read article Breathing and Thoracic Mobility
Breathing is also a fundamental competence for core stability. An effective breathing
pattern is the necessary foundation on which to build the core and then, movement.
Current literature suggests that diaphragmatic activity can help stabilize the core,
unlocking more mobility for the extremities. If breathing is shallow or inefficient,
the secondary breathing muscles become hypertonic: scalenes, pec minor,
sternocleidomastoid and levator scap. Hypertonicity of these muscles can impact function
of the scapula and shoulder girdle leading to mobility deficits. Sub-optimal breathing can
also impact the hip complex, as the body will look for stability from the psoas, hamstrings
and pelvic floor.
Para-sympathetic breathing can alleviate muscle tension. Ideally, we should be able to
slow breathing down to a rate of 6 breaths per minute (5-second inhale and 5-second
exhale). I suggest you use an app such as Respirelax+ that allows you to set the duration
of the inhalation and exhalation and breathing time. I use it regularly with my clients as
part of their mobilization strategy.
The
program
This program is unique in its kind. The goal is to improve mobility by targeting many of the
different muscles, joints and regions that can affect movement at the shoulder and hip
complex.
The mobilization strategies utilized in the program extend far beyond passive stretching
and soft tissue release, instead focusing on active movement to improve both mobility
and stability. The benefits touch not only on performance, but also on injury prevention
and robustness.
Mobilization REHAB-U.COM
METHOD/ REP
EXERCISE SET NOTES
TEMPO RANGE
SHOULDER COMPLEX
Slow and hold = Hold light
Slow and
A. Seated chin tucks 2 10-12 reps pressure at end range of
hold motion for max 2-3 sec
Fully closed grip on dowel,
Tall sitting shoulder
B. Slow 2 10-12 reps keep torso upright, head
dislocates
looking forward
T-spine extension Slow and hold = Hold light
Slow and
C. on bench, on 2 10 reps pressure at end range of
hold
elbows motion for max 2-3 sec
Slow and hold = Hold light
Prisoner T-spine Slow and 6-8 reps /
D. 2 pressure at end range of
rotation hold side motion for max 2-3 sec
HIP COMPLEX
Low Slow and Slow and pause = Slight pause
E. 2 6-8 reps
cat-camel pause at end ranges
Slow, Slow, assist and hold = Assist
Active-assisted 8-10 reps/
F. assist and 2 with band/strap at end range
straight leg raise side
hold and hold for max 2-3 sec
Slow and hold = Hold light
Active thread Slow and 8-10 reps/
G. 2 pressure at end range of
the needle hold side motion for max 2-3 sec
Push and Hold = Press toes
Multiplanar ankle Push and into the ground while keeping
H. 2 10 reps
dorsiflexion hold heel down, hold end range of
motion for max 2-3 sec
Thanks for taking the time to go through
the Rehab-U Free Mobility eBook!
We hope this eBook provided you with
some new tools for your practice.
We’d love to hear about your feedback!
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Disclaimer: The information contained in this document is presented to improve movement, not treat medical conditions.
This information is not a substitute for medical advice or treatment of specific medical conditions.
