Gray Cook: Expanding on the Joint-by-Joint Approach, Part 2 of 3

Movement: Functional Movement Systems
Gray Cook, Expanding on the Joint-by-Joint Approach, Part 2 of 3

If you did not yet see part one, click here to start at the beginning.

Reviewing the Joints

I often start at the discussion at the foot, where I defer to Todd Wright and Gary Gray. They have great perspective and discussion with respect to the foot. People have always tried to pull me into a top-down or bottom-up argument, but I’m not committed either way. Problems can come from either place and be corrected by either approach. The real question is what do you see.

Here is an example.

Let’s say we do the movement screen and we learn that the active straight-leg raise, shoulder mobility, pushup and rotary stability patterns are great, but in standing, the squat, hurdle steps and lunges are bad. You need to consider the foot. This is because everything was going great until you asked the foot to contribute. It does not imply a foot problem; it simply suggests that perceptions and behaviors are com-promised when the foot hits the ground.

Here’s what I want people to know: The brain and its information pathways work two ways. We’re not just sending information down the spinal cord out to the hands and feet. We’re also uptaking information through the hands and feet.

If the feet are sloppy and the grip is off, not only will the person not activate the right muscles, but he or she is not even up taking the right sensory information. Let me say that again. If there are any mobility or stability compromises between the foot and the brain, it’s like standing on two garden hoses wondering where all the water is. The information pathway is broken two ways… up and down.

The foot is no longer a sensory organ because any information that foot could collect in its normal alignment has to be compromised. The foot has to pronate even more because of a stiff ankle, or maybe the foot has to fire too much throughout the plantar flexors because of a sloppy knee.

The other reason we’ve got to clean up these issue is it’s not just motor pathway down; it’s sensory pathway up. The foot will keep flattening out to grab as much sensation as possible because the brain knows there is a problem. It’s hoping more information will help. If you’ve got bad shoulder positioning in a push or pull movement, you’re going to do things with your grip that are’t as authentic as they could be.

Let’s look back at the foot. The foot needs to be mobile, but it’s inherently set up to be mobile. Look how many bones, how many joints are in the foot. There’s movement all over the place unless there’s arthritis. The muscular role in that foot should be that of stability, and that’s why we have all those intrinsic muscles. These are muscles that dwell within the foot, within the arch of the foot.

Then we get to the ankle. It’s a bony, stable joint. You’re never going to see many people over-dorsiflex or over-plantar flex. But since people know of inversion or eversion sprains or strain, they think the ankle must be trained for stability.

Most of the time, the patient with the rolled ankle will also have restricted dorsiflexion, unless the person stepped on a foot or had a contact injury. There’s a huge prevalence of restricted dorsiflexion in people who present with knee problems, whether MCL or ACL.

When a client can squat to parallel, we often leave that last 10 degrees of dorsiflexion on the table, thinking it’s no big deal. We want the foot to be stable, but that does’t mean the foot has to be stiff. We want a mobile foot to be instantaneously stable at contact and push-off, but also to be relaxed enough to accommodate great range of motion.

The foot has to be adaptable, but it also has to be instantaneously stable. The ankle has to have freedom of movement. You ca’t have ankle restrictions. The ankle also has to be stable, but one of the major problems we see is lack of dorsiflexion. Is it our footwear? Is it the way we train? It’s all that. The muscles attaching around the ankle have great leverage and strength, but the mobility provides the best overall function to utilize the potential strength and power in the ankle.

We need that inherent reflex stability in the foot. We need to have a clear ankle when it comes to plantar flexion and dorsiflexion.

Knees are simple hinge joints. They’re supposed to flex and extend, and when they rotate too much or move valgus or varus too much, we start seeing problems with the knee. Does the knee need to be mobile? Yes, but once it’s mobile, it needs to be stable enough to stay inside the proper plane of movement where its functional attributes are possible and practical.

The rotating joints are the ankle and hip. The ankle does’t just hinge, and the hip does’t just move in one plane. The knee is more of a hinge joint. What we want to see at the knee is once we have the mobility, we need stability.

What are the common problems we see at the hip? Can we see a sloppy hip? Can we see a dislocating hip? Absolutely. But in general, we see a lot more hips that do’t have the full authentic mobility.

• Common problems in the foot: People give up their stability.
• Common problems in the ankle: People give up their mobility.
• Common problems in the knee: People give up their stability.
• Common problems in the hip: People give up their mobility.
• Now we’re at the low back: People give up their stability.

So once again, these aren’t the 10 Commandments, but they’re common tendencies when injury, poor training, unilateral dominance, one-dimensional training, a lack of training or an excess of training occur. These are common defaults the body will go to; they’re not absolutes.

Click here for part three of this three-parter excerpted from Appendix 2 of Gray’s book, Movement.