The Flexibility Myth
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I see it every day in the clinic - patients told that their musculoskeletal pain, wherever it may be, is due in large part to lack of flexibility. Furthermore, they are being told that increasing flexibility will be beneficial for their health in the long run, and will decrease their risk of future injury. A classic example is someone with low back pain who is given the rehabilitation goal of increasing lumbar flexion range of motion - gotta be able to touch those toes or you will live a life of misery.
The above scenario is pretty common - flexibility for the sake of flexibility. It's easy to see how any doctor or therapist can get caught in the flexibility trap. We are all taught the "normal" ranges of motion for any joint, with the rule that anything outside of these norms needs to be fixed. In fact, most medico-legal cases demand improvements in range of motion as a marker of success in therapy. So what are we to do?
Looking into the research, there is no evidence that decreased range of motion in the spine or most other joints in the body leads to an increased risk for injury (extreme cases aside). In fact, just the opposite has been found. It is the individuals with great range of motion that are more susceptible to injury. Why is this?
Let's start with discussing flexibility vs. mobility. Flexibility is simply the ability to move a joint, either actively or passively, to a certain end range of motion. We are lead to believe that increasing this range of motion will not only improve our health, but will also improve performance in sport. This is interesting because when you look at elite athletes, very often their joint range of motion, medically speaking, would be considered disabling. So how is it that they are able to perform at such a high level, and without constant injury? That brings us to mobility.
Mobility is a much more functional assessment of joint range of motion. It is not simply a Euclidian measure of range, it is a measure of strength and motor control through a given range of motion. This is where ultimate performance and health lives, and should be the goal of any good therapy or performance training program. It is essential to look deeper than simple measures like range of motion - we need to look for dysfunctions in movement patterns, especially when asymmetries exist - it is here that we see the greatest potential for injury if not corrected. So what are some strategies for correcting these dysfunctions?
Assuming you are pain free (never train a painful movement pattern), mobility comes from increasing tissue extensibility combined with adding strength through the complete range of motion. Let's look at a case study of a golfer as an example. On assessment, the golfer tests poorly for lumbar spine stability and core muscular endurance, combined with limited thoracic mobility and shoulder extensibility dysfunction with poor shoulder girdle motor control. This is a fairly common presentation for the average golfer. In this case we would start with the spine, working on lumbar stabilization, thoracic mobility, and shoulder mobility using a combination of strength/endurance training and soft-tissue therapy/joint manipulation. Once we achieve proper stability and mobility, specific motor-pattern training is added to the rehabilitation program for the shoulder girdle and hip complex. This will ultimately give the golfer a mobile, yet powerful swing range of motion as opposed to a flexible but unstable swing range.
The moral of the story here is to look through the surface to find the deeper, root causes of dysfunction. This is what will truly lead to decreased risk for injury and increased performance.
Dr. Adam Meisenhelder is a Sports Chiropractor in Beaverton, Oregon specializing in working with injured runners and endurance athletes. Learn more at http://www.mybeavertonchiropractor.com
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