THE JOINT-BY-JOINT APPROACH

Michael Boyle
Excerpted with permission from Advances in Functional Training:
Training Techniques for Coaches, Personal Trainers and Athletes

If you are not yet familiar with the joint-by-joint theory, be prepared to take a quantum leap in

thought process. My good friend, physical therapist Gray Cook has a gift for simplifying

complex topics. In a conversation about the effect of training on the body, Gray produced one of

the most lucid ideas I have ever heard.

We were discussing the findings of his Functional Movement Screen (FMS), the needs of the

different joints of the body and how the function of the joints relate to training. One beauty of the

FMS is it allows us to distinguish between issues of stability and those of mobility; Gray’s

thoughts led me to realize the future of training may be a joint-by-joint approach, rather than a

movement-based approach.

His analysis of the body is a straightforward one. In his mind, the body is a just a stack of joints.

Each joint or series of joints has a specific function and is prone to predictable levels of

dysfunction. As a result, each joint has particular training needs.

This joint-by-joint idea has really taken on a life of its own, one I certainly didn’t envision. It

seems like everyone’s familiar with it; it’s become so common knowledge people fail to reference

Gray Cook or me as the developers of the idea.

The table in the next column looks at the body on a joint-by-joint basis from the bottom up.

The first thing you should notice is the joints alternate between mobility and stability. The ankle

needs increased mobility, and the knee needs increased stability. As we move up the body, it

becomes apparent the hip needs mobility. And so the process goes up the chain –a basic,

alternating series of joints.

Joint — Primary Need

Ankle — Mobility (sagittal)

Knee — Stability

Hip — Mobility (multi-planar)

Lumbar Spine — Stability

Thoracic Spine — Mobility

Scapula — Stability

Gleno-humeral — Mobility
Over the past 20 years, we have progressed from the approach of training by body part to a more

intelligent approach of training by movement pattern. In fact, the phrase movements, not

muscles has almost become an overused one, and frankly, that’s progress. Most good coaches

and trainers have given up on the old chest-shoulder-triceps method and moved to push-pull,

hip-extend, knee-extend programs.

Still, the movement-not-muscles philosophy probably should have gone a step further. Injuries

relate closely to proper joint function, or more appropriately, to joint dysfunction. Problems at

one joint usually show up as pain in the joint above or below.

The primary illustration is in the lower back. It’s clear we need core stability, and it’s also

obvious many people suffer from back pain. The intriguing part lies in the theory behind low

back pain–the new theory of the cause: loss of hip mobility.

Loss of function in the joint below–in the case of the lumbar spine, it’s the hips–seems to affect

the joint or joints above. In other words, if the hips can’t move, the lumbar spine will. The

problem is the hips are designed for mobility, and the lumbar spine for stability. When the

intended mobile joint becomes immobile, the stable joint is forced to move as compensation,

becoming less stable and subsequently painful.

The Process is Simple

Lose ankle mobility, get knee pain

Lose hip mobility, get low back pain

Lose thoracic mobility, get neck and shoulder pain, or low back pain

Looking at the body on a joint-by-joint basis beginning with the ankle, this makes sense.

The ankle is a joint that should be mobile and when it becomes immobile, the knee, a joint that

should be stable, becomes unstable; the hip is a joint that should be mobile and it becomes

immobile, and this works its way up the body. The lumbar spine should be stable; it becomes

mobile, and so on, right on up through the chain.

Now take this idea a step further. What’s the primary loss with an injury or with lack of use?

Ankles lose mobility; knees lose stability; hips lose mobility. You have to teach your clients and

patient these joints have a specific mobility or stability need, and when they’re not using them

much or are using them improperly, that immobility is more than likely going to cause a

problem elsewhere in the body.

If somebody comes to you with a hip mobility issue–if he or she has lost hip mobility–the

complaint will generally be one of low back pain. The person won’t come to you complaining of
a hip problem. This is why we suggest looking at the joints above and looking at the joints

below, and the fix is usually increasing the mobility of the nearby joint.

These are the results of joint dysfunction: Poor ankle mobility equals knee pain; poor hip

mobility equals low back pain; poor T-spine mobility, cervical pain.

An immobile ankle causes the stress of landing to be transferred to the joint above, the knee. In

fact, there is a direct connection between the stiffness of the basketball shoe and the amount of

taping and bracing that correlates with the high incidence of patella-femoral syndrome in

basketball players. Our desire to protect the unstable ankle came with a high cost. We have

found many of our athletes with knee pain have corresponding ankle mobility issues. Many

times this follows an ankle sprain and subsequent bracing and taping.

The exception to the rule seems to be at the hip. The hip can be both immobile and unstable,

resulting in knee pain from the instability–a weak hip will allow internal rotation and adduction

of the femur–or back pain from the immobility.

How a joint can be both immobile and unstable is an interesting question.

Weakness of the hip in either flexion or extension causes compensatory action at the lumbar

spine, while weakness in abduction, or, more accurately, prevention of adduction, causes stress

at the knee.

Poor psoas and iliacus strength or activation will cause patterns of lumbar flexion as a substitute

for hip flexion. Poor strength or low activation of the glutes will cause a compensatory extension

pattern of the lumbar spine to replace the motion of hip extension.

This fuels a vicious cycle. As the spine moves to compensate for the lack of strength and mobility

of the hip, the hip loses more mobility. Lack of strength at the hip leads to immobility, and

immobility in turn leads to compensatory motion at the spine. The end result is a kind of

conundrum, a joint that needs both strength and mobility in multiple planes.

Your athletes, clients and patients must learn to move from the hips, not from the lumbar spine.

Most people with lower back pain or hamstring strains have poor hip or lumbo-pelvic mechanics

and as a result must extend or flex the lumbar spine to make up for movement unavailable

through the hip.

The lumbar spine is even more interesting. This is clearly a series of joints in need of stability, as

evidenced by all the research in the area of core stability. The biggest mistake we have made in

training over the last 10 years is an active attempt to increase the static and active range of

motion of an area that requires stability.

Physical therapist Shirley Sahrmann in Diagnosis and Treatment of Movement Impairment

Syndromes and James Porterfield and Carl DeRosa in Mechanical Low Back Pain: Perspectives in

Functional Anatomy all indicate attempting to increase lumbar spine range of motion is not

recommended and is potentially dangerous. Our lack of understanding of thoracic mobility

caused us to try to gain lumbar rotary range of motion, and this was a huge mistake.

The thoracic spine is the area about which we know the least. Many physical therapists

recommend increasing thoracic mobility, though few have exercises designed specifically for it.

The approach seems to be ìWe know you need it, but we’re not sure how to get it.î Over the next

few years, we will see an increase in exercises designed to increase thoracic mobility. A leader in

the field, Sahrmann was early to advocate the development of thoracic mobility and the

limitation of lumbar mobility.

The gleno-humeral joint is similar to the hip. The gleno-humeral joint is designed for mobility

and therefore needs to be trained for stability. The need for stability in the gleno-humeral joint

presents a great case for exercises like stability ball and BOSU pushups, as well as unilateral

dumbbell work.

In the book Ultra-Prevention, a nutrition book, authors Mark Hyman and Mark Liponis describe

our current method of reaction to injury perfectly. Their analogy is simple: Our response to

injury is like hearing the smoke detector go off and running to pull out the battery. The pain, like

the sound, is a warning of some other problem. Icing a sore knee without examining the ankle or

hip is like pulling the battery out of the smoke detector. The relief is short-lived.

Excerpted with permission from Michael Boyle

Advances in Functional Training by Michael Boyle