Many people suffer from aches and pains while doing their best to get and stay fit. More than 50% of Americans have musculoskeletal ailments costing our healthcare system an estimated $420 billion—more than any other chronic condition. Furthermore, according to the World Health Organization, people with musculoskeletal health concerns are at higher risk of developing mental health issues.
It can be frustrating and worrisome for people to feel pain when trying to work out. These aches and pains are often ignored and categorized as a "normal" part of working out. People move through them until they've progressed, causing an injury that our society then likes to label. Once we get a label or diagnosis, we are led down a series of treatment protocols for that particular condition. This is the epitome of reactive care.
This reactive musculoskeletal (MSK) care lands in the hands of orthopedic specialists, from MDs to therapists to athletic trainers and exercise physiologists. These experts have been trained to understand and treat MSK conditions for their particular domain. They are very impressive and do a great job.
But…how come these MSK professionals are best known to react to an injury versus prevent one? Why don't they utilize screens to "early detect" musculoskeletal injuries like other specialists for chronic lifestyle diseases like diabetes and stroke?
Unfortunately, the answer to these questions is likely linked to the infamous "follow the money" phrase. And perhaps related to the fact that pain is motivating. Unless a person is injured and in pain that interrupts their daily life, they are less likely to work on preventing one from occurring.
A Proactive Solution
A pattern we've recognized at Juniper Physical Therapy and Fitness is clients coming in to see us when they are in pain and then discovering how much more we can do to prevent their pain from returning. They experience how effective and helpful preventative care for MSK conditions can be.
We perform a movement screen on the first day we see someone or as soon as they can. This screen gives a lens into what may have led to their pain or injury. We treat the pain, of course, but we also start working on restoring movement patterns through corrective exercises for long-term results. We want to ensure that when our clients return to their daily activities and fitness routine, they are ready and able to move well.
What are Mobility Exercises?
Some of the most important corrective exercises we prescribe are described as "mobility." We love to complement our client's usual workout routine with a few mobility exercises tailored to their body's needs. These exercises help warm up and move their joints while prepping their muscles for work. They often include a combination of general or specific joint movements and activation of particular muscles.
A Client Example with Knee Pain
Recently, I evaluated a 52 y/o female Cross Fit athlete with a 2-month history of very localized right inside knee pain. This pain came on gradually without any specific injury. She had already been to an orthopedic MD and an athletic trainer. X-rays were "normal," and an MRI wasn't justified based on her symptoms. She was given an anti-inflammatory and some general leg exercises. She was not given an explanation for her symptoms and didn't notice any improvement in her pain.
I performed a movement screen and a local knee evaluation. She has been seen for one additional follow treatment session so far. During the evaluation, I noted a lack of ability to flex her lower spine (sacrum) when reaching for the floor. I also discovered that three knee muscles were linked to her symptoms. Various manual therapy techniques were performed, and after this treatment, she no longer had pain with walking or going up and down stairs.
Her home program was to avoid overloading her hamstrings, continue her usual exercises that did not cause pain, and self-massage the muscles we worked on. My plan for her upcoming sessions is to continue with pain reduction as needed while investigating why she cannot flex her spine correctly while trying to touch her toes. Although this may seem unrelated, this dysfunctional movement may be the root cause of her knee pain.
I aim to create a customized mobility warm-up routine (that includes prescriptive muscle activations) she can do before her Cross Fit workouts. This is the ultimate in preventive care to avoid future injury.
Do Mobility Exercises Prevent Injury?
When we dive into the scientific literature, we find conflicting statements about mobility and injury prevention. The correlation between mobility exercises and injury prevention is unclear.
This 2021 study demonstrates no difference between strength training and stretching in preventing injury. While this 2016 study found no relationship between mobility/proprioception and injury risk but did correlate strength asymmetry with injury risk. Yet this 1996 study concluded that a preseason flexibility program might reduce injury risk for collegiate male athletes.
Most of these studies have been on static or passive stretching vs. mobility. The most significant difference between mobility and stretching is the active movement and activation of specific muscles performed when doing mobility work. Therefore, we aren't comparing apples to apples when we use these studies as a reference. Hopefully, greater distinction and more work will be made on the effect of actual mobility work.
Currently, we do not know if mobility work prevents injury. What we do know, however, is that those who move better have less injury overall. When our MSK system works better, we feel better. Our muscles are responsible for moving our joints. We can't move well if our muscles aren't firing optimally and our joints are stiff. It just makes logical sense to work on improving the mobility of our joints and muscles, regardless of what the studies say.
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