What Is Limiting Your Mobility?

In this week’s article, we are talking about “stiffness” or “tightness”. When we feel like we can’t get into a position with ease, whether it be in the golf swing or a back squat, we can expect there to be a tissue extensibility issue, joint mobility issue, or weakness/ motor control issue. It is important on our exam and history we distinguish between these and find which is responsible for the missing range of motion and control. We use joint palpation and end play feel, single joint range of motion, global range of motion testing, and muscle palpation to help determine which issue is truly at hand.

Joint mobility dysfunction

When we determine we have joint mobility dysfunction, exam results will show loss in joint range of motion along with loss of joint play on palpation. Muscle palpation might not show any hypertonicity (tightness).

When addressing a joint mobility dysfunction, we need to mobilize at the deep joint level. A great way to start this process is with chiropractic adjustments of the spine and extremities. The next step would be using banded distraction and dynamic stretching to help get the passive tissues of the joint capsule moving, stretched, and used at their end ranges.

Here are some examples of banded mobilizations for joint mobility dysfunctions.

We also consider the positioning and biomechanics of the skeleton which can inherently limit the expression of range of motion throughout the joint. A great example of this is the notorious anterior pelvic tilt. Not only are there implications from the pressure being put on the low back and the impact it has on the other muscles acting on this joint… but it also impacts the actual positioning of the bones in the joint surfaces (like the hips). When we alter the positioning of the joint like this, we will also alter the amount of space available for range of motion. This can be considered a joint mobility dysfunction.

Here are some example early stage drills we use to address different orientations (like the anterior pelvic tilt and rib flare…) that lead to joint mobility dysfunctions.

Tissue extensibility dysfunction

When the muscles that act on the joint become restricted and stop full expression of range of motion around a joint, then we have a tissue extensibility dysfunction. Here we can work on the muscles directly to influence the missing range of motion. Soft tissue therapy like instrument assisted soft tissue mobilization, pin and stretch, and dynamic stretching coupled with active movement are the best treatment options for this. All of these methods help influence the muscle tissue length and gamma motor tone, again regulating the length of a muscle and the amount of stretch we can get from it before we consciously sense the stretching sensation.

Conclusion

It is vital to assess for the difference between joint mobility dysfunction and tissue extensibility dysfunction when we notice missing range of motion in a patient’s movements. We must also know how to address both tissue extensibility dysfunctions and joint mobility dysfunctions when they present. Beyond this, it is essential we integrate mobility work with the stability, strength, power, and motor control aspects of rehab and performance plans. This is how to we truly address the entirety of the patient in front of us to achieve their health, fitness, and performance goals!

-Dr. Nick DC, TPI, CSCS

If you would like to learn more about your body, pain, and performance, send Dr. Nick an email at contact@integratedrpc.com or call at (585)478-4379, or schedule a FREE discovery visit at Contact.