Joint Space & Stability
Today we’re going to talk about your joints. How to get them out of pain most quickly and efficiently.
If you’ve been around Z for any period of time, one of the things you know is we spend a lot of time talking about joint mobility and how joint mobility impacts the brain and also movement and pain.
Now, one of the things I want to cover with you is a very important concept that we share in some of our more advanced trainings because at the initial stages of working with people with let’s say shoulder pain.
Joint Space & Stability – Which Does Your Body Need?
One of the first things we say is it’s probable or likely that that joint has been closed down and it needs to be opened up a little bit in order to be healthier.
If you think about most of your joints as joining together and then being covered in a sock, that sock is what’s called a joint capsule, and sometimes that joint capsule can become too tight. The joint surfaces are held together, so when we start doing exercises, very often we’re trying to actually separate the joint surfaces a little bit in order to decrease pain symptoms or pain from movement particularly.
Now, in some cases however, that doesn’t work because if you think about a shoulder that’s been badly injured and it’s had tearing in the capsule or ligament tears, etc., it’s possible that what that joint actually needs is more stability as opposed to more space being created.
What’s very cool about understanding that is once you understand it, every joint issue that you have in your body, you can figure out a way to test this to see well, what would do best for me? Because we are always trying to get people to understand that you have to individualize your exercises for your issues to make yourself move better and feel better.
So I’m going to show you a couple of examples of this with regards to the shoulder and how I would work with people particularly that need the opposite of space being created, but instead actually need some compression being created to get them out of pain.
Joint Space & Stability – Starting With the Basics
So to start this, let’s make sure we understand the basics.
When we work with people who are having pain issues, assuming they’ve been cleared with their doctor and we know that there’s nothing bad going on, the next thing we want to figure out is how to make you experience one pain-free repetition of whatever the issue is. For instance, if I have a shoulder issue and it always hurts every time I come to this range of motion and this movement, my job is to go, “Hey. How can we get you to here without pain? Or to here without pain?”
If we can get one pain-free rep to occur, we know that it’s possible.
So we start off pain relief with possibility because we believe it’s very important for your brain to understand that it can happen.
Now, imagine that I have right shoulder issues and I have pain every time I come to this range of motion. Super common. We see it all the time. Maybe it’s because I’ve overdone certain types of exercises or other stuff. I have nerve issues. So it’s a whole host of things that may go into this, but right now we’re talking specifically about the joints.
If I have pain here, one of the first things that I would probably test with a person with this type of issue is okay, if we create a little bit of space in that joint, can you go a little bit further with less pain or no pain?
In our I-phase, which is our level two movement series, one of the things that we teach is called shoulder distraction. So the basics of this, if you can see my arm, my arm is just sitting here. I’m kind of in this supposedly painful range. If I was testing this with someone, what I would do is I would go, “Where does it hurt?” “Here. Ow.” I go, “Okay, well let’s not go there. Let’s go a little bit lower.” Now what we would do is we say, “We want you to keep your shoulder blade back, but punch your fist forward.”
Keep your shoulder blade back, punch your fist forward. It’s a small motion that happens, but what’s basically occurring is because I’m stabilizing my shoulder and then moving my humerus forward, I’m creating a small amount of space in the joint. So I could … Shoulder blade back, punch the fist forward. Now move up into that range that was painful previously.
Now in a lot of cases, and I would say probably 75% of the time, when we create that little bit of space, as long as they’re not super inflamed or anything, they will go, “Oh, wow. I feel better. I can go further and I have less pain.” Then that tells us that what they need is a lot of mobility drills, but particularly mobility work and some strength work to create space in that joint. We’ll talk a little bit about that here in just a second.
Joint Space & Stability – Next Steps
If I know that, what do I do? About 25% of the time, what we see is this. We go, “Okay. Where’s your painful range? Let’s move out of that. Shoulder blade back, create space,” and they go, “Ow.”
They have pain immediately as soon as more space is being created in the joint. So as soon as I see that, I go, “Okay. It’s possible that instead of needing to create more space, you need less.”
This is very sensible, because a lot of people know that they feel better if they have a brace on things. “I have knee pain.” I put a brace on it. I get some compression. The joint has more control because of that brace. It feels better.
if you know that you already need that or you show up here with braces, you probably need some compression when you’re doing your movement drills.
The way that I would then approach this with that client is say, “Okay. We’re going to do a couple of tests.” Because in general, what we’ll see is if they need some compression and they have pain like this, they will usually have pain in this kind of range of motion as well.
The simple test I will do with them is I go, “Okay. Let’s go over to the wall,” and in this case, I’m just going to use our gladiator wall here. I will get them into a comfortable position. Again, if they have pain here, I’ll say, “Lets come below that,” and I will have them do a range of motion. So maybe an internal or external rotation or whatever bothers them the most. In this case, let’s say it’s internal rotation, which is where my hand’s going down and in.
That’s the most common position for people to have pain, anyway. Now what I would have them do is actually lean into the wall. As I lean into the wall, that’s pushing the shoulder closed a little bit. If they keep the shoulder closed and then they repeat the range of motion, and maybe they should add a little more pressure to it, very often they will go further and they will have less pain.
So now we’ve both learned something. We’ve learned that if we give your joints some compression, you’ll feel better, and we can maybe get that one pain-free rep.
Now it becomes a question of how do I train a joint to be a little bit more compressed?
Joint Space & Stability – How To Train With Compression?
That’s where bands come in. For instance, let’s again say we’re working on my right shoulder. We’ve done our test. We know that create space hurts. Compressing the joint doesn’t hurt and actually makes things move better.
Now what I want to do is start to include some mobility and strength work in their exercise program but in a way that keeps that joint somewhat more compressed, makes it feel better to the brain, decreases pain.
In this case, what I would tend to do is I would have them use a band, and we would then push the band out away from the wall using both hands so that we don’t stress this one out. Their first job is once they are in this position, is to learn how to let the joint close. I’m trying to exaggerate it, but right now, I’m saying, “Hey, imagine there’s a wall behind your shoulder blade so it can’t move backwards, and simply let the joint between the arm and the shoulder blade close.”
So basically this big bone is moving backwards but not the whole shoulder.
Joint Space & Stability – Your Mental Model
So hopefully you can see the difference.
This would be wrong. This is correct.
Once that’s nice and stable, we will then have them start doing some nice simple shoulder circles in each direction, basically only in the plane of the bands. In this case, the band is directly straight out in front of me. I’ve closed the joint. I do some really small circles letting the band assist in keeping the shoulder compressed.
To make sure you have a visual of this, let’s just look at it from the side. Again, we’re imagining that this is the shoulder that needs some compression. Let’s say I have a band attached over here, and the band’s pushed out.
Here’s what I want. I want to imagine there’s a wall behind this shoulder blade so that the band is simply doing that motion. It’s just allowing this joint to be compressed back utilizing the elasticity of the band. That’s the correct version.
A lot of people when they’re first doing this, because they have that awareness, they will do this motion, where the entire arm and shoulder blade are rolling backwards. It’s a subtle difference. That’s correct. That’s incorrect. If you can get that figured out, you might have to use a mirror or an assistant, but that’s really going to be the key in making sure that you are doing this correctly.
That would be step one. Once we’ve done that, we retest. Most of the time, in that 25% group, what we’re going to see, better range of motion, decreased pain. If that works well for them, this is going to become part of their work. In previous blogs I’ve talked a lot about different shoulder exercises that you can do, particularly making sure that you are working in different ranges of motion.
You can combine this information from this blog with isometrics and shoulder mobility exercises from other blogs but using bands to keep it in a compressed position. This is one of the most effective tools I’ve found in quickly screening people to go,”Hey, what is it that you need?”
Joint Space & Stability – A Body-Wide Concept
This same idea can be applied to the knee and the foot and the hip. A little bit more complicated as you get into big stuff about how to load it and how to compress it, but I want to make sure that we have at least talked about this in the upper body, for the elbow, wrist, hand, and shoulder, because ultimately, like I said, about 25% of the people that we work with need the opposite of more mobility. What they actually need is some stability while they’re also maintaining good motor control. So it’s basically stabilized mobility. Let’s leave it that way.
This is the basics. If you have this issue, you have shoulder issues, make sure to do this test. Give this a try at home. One of the big things that you start figuring out is this is a small range of kinesthetic awareness because we’re not moving anything very far.
You will have to play with it, but this is one of the most valuable tools that I’ve found, particularly working with people that have had significant injuries. Maybe they’ve had surgeries or other repairs. They’ve done okay with their rehab and therapy, but they still have some nagging pain issues.
If that’s you, give us a shot.
Let me know how it works.