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3 Layer Injury Screening for PT’s:

How Can You Know If Your Client Sucks at Functional Movement Training Part 3 – Bad Movement Habits

Ulrik Larsen

APA SPORTS PHYSIOTHERAPIST

CEO REHAB TRAINER GROUP

   

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Are you getting the point of this 3-part series yet? The point

is that you need to have a really good handle on

Dysfunctional Movements in order to be good at Functional

Movement Training! Its not enough to use a VIPR or

Kettlebell or Battling Rope, or be able to prescribe the most

relevant exercises for a particular client – they will most

probably do it poorly (with the odd exception :).

A client is guilty of Dysfunctional Movement, until proven

innocent, I say! They will have some Pain somewhere

creating havoc, they are likely to have a Biomechanical

Blockage from an old injury, and lastly what we look at today:

they are possible going to be guilty of ….

Part 3: BAD MOVEMENT HABITS

Of the three elements that create dysfunctional movement,

this is the least likely to directly cause injury. Many people

with poor posture alone never suffer pain, even have knees

that move medially during squats, or some winging of the

scapula – yet don’t get injured or suffer pain.

However, this is also the easiest way to screen Dysfunctional

Movement from a distance, and secondly if there is pain or

injury, it is also the first place to begin what we call “Injury

Prevention Coaching”.

   

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Genetics 8

You see, we all move with patterns that become ‘habitual’

through repetition. So many of us are affected quite early on

in our biomechanical development by any number of less

than optimal events or elements that then progressively set

us up for dysfunctional movement. What are these less

severe but quite compounding underlying causes of bad

movement habits? The more you understand them, the better

you will be able to keep a sharp eye on which clients have a

higher risk of future injury.

Let’s count down from #8 to #1 to discover the most

powerful life elements that contribute to Bad Habits of

Movement, with #1 being generally accepted as the greatest

contributor and also the strongest predictor of future injury.

Here we go, starting with the

least troubling ingredient:

Very few of us are not

born with some genetic

(also termed ‘structural’)

deviance from the average. We

may be born with a slight

scoliosis, increased scapular

   

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winging, knee valgus (medial position) or a flat back. We

adapt to these unique elements, and they in themselves

rarely give us any trouble unless our environment changes

through injury or new lifestyle ingredients. Most genetic

elements are bilateral and therefore the body can adapt to

them extremely well.

Not all clients are created equal in terms of their

ability to feel, perceive and understand their own

movement, and therefore some may drift into bad habits

without any recognition. They may be very tight in certain

areas and have learnt how to move in a very small range of

motion; or genetically hypermobile. Those with hypermobility

often have poor proprioception because of the increased

‘play’ in the joints, and need extra training in this area. Think

of the client with hyperextending elbows doing push-ups…

how hard it can be for them to train those elbows to not lock

out! In either case they may be without pain, but due to

unawareness be very prone to, and difficult to teach out of,

bad movement habits.

Client’s Body Awareness

   

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5 Work

6 Long term Sports

Long seasons of any sports will slowly create bad

habits of movement even while we are becoming

more skilled, fit, flexible or whatever else. This is due

to the nature of focusing so heavily on one activity. Hockey

will cause increased lumbar flexion with all the forward

bending; netball easily allows for medial knee jarring; tennis

leads to poor push/pull movements such as winging of the

scapula, and so on. Even complex, high-level sports like

gymnastics sees young athletes riddled with subtle bad

movement habits that lead many to quit early due to multiple

niggling injuries.

Long hours, potential for stress, and increasing

demands on the body will be more problematic than

sports. It will strengthen and tighten arms, legs or

the trunk in certain imbalanced ways like sports do. Think of

the security guard standing all night with their ‘sway back’

posture, or the plumber always kneeling on the knee, or the

waitress always carrying multiple loaded plates on her left

arm. We get lost in our work, and those Bad Habits get locked

in deep into our neuromuscular system.

   

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Training Errors 4

Remember Case Study 3 from Part II?

The computer geek with stiff thoracic

spine will normalise poor pull movement

as she is positioned in increased

kyphosis, will protract her chin, and

demonstrate increased lordosis in the

lumbar spine during overhead

movements. Excessive training of abdominal curls or poor

warm up of thoracic spine that is stiff from the work day, will

exacerbate this.

While somewhat debatable and controversial, we

understand that certain exercises, if taught

excessively or in isolation, will actually cause dysfunctional

movement. These faulty movement choices that are taught to

clients as ‘functional’ may easily result in overtraining

because they require the body to unlearn natural movements

or learn unnatural movements.

Examples of exercises or techniques that promote bad habits

of movement include:

+ Bench press (restricts scapular movement and

overloads the supraspinatus),

+ Overhead squat (forces the client to learn the

unnatural element of pushing overhead while

   

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descending into the deep squat – multiple problems

may result),

+ Push/pull movements with no scapular movement

(‘keep shoulders back and down’ the whole time),

+ Squats where knees are kept behind the line of the

toes (poor quadricep activation, poor dorsiflexion,

lumbar spine overload result),

Remember Case Study 1? The small ankle sprain we

discussed earlier causes the brain to avoid pure ankle

dorsiflexion, which over time becomes the new normal during

closed kinetic chain movement. Instead there may be

increased posterior tilt at the pelvis, and quite a few training

environments, clients are taught not to take their knees

beyond the line of the toes, which would support the client’s

inability to do so due to poor dorsiflexion, and lead to long-

term imbalanced movement patterns.

+ Overhead press where arm is kept in internal rotation

at the top of the movement (increased shoulder

impingement risk)

+ Poor breathing timing or rhythm.

   

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3 Left/Right Dominance

Loading with excessive fatigue and insufficient recovery can

also be deemed ‘training error’ and is a recipe for

dysfunctional movements as clients struggle to move well

due to fatigue, tightness or DOMS.

Finally, training errors extend to poor equipment choices

such as poor shoe selection or excessive wear on shoes,

which again result in bad movement habits.

A normal genetic preference for arm or leg use may

become more prominent through any of the above

elements (which sport they play, work they do, or a

new exercise they have been trained in, or simply poor body

awareness). When normal mild dominance of right or left

becomes more pronounced, overload and compensation can

be the result. This increased dominance then will overload

structures and any mild bad movement habits that are

present through genetics, sports or work.

   

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2 Asymmetry When dominance, sports or work-related preference

for a side, genetics, training error, and poor body

awareness begin to join forces we get an increase in

asymmetry beyond the point of healthy. Here the risk of

injury climbs steeply as the compounding nature of doing it

much more heavily on one side leads to structures becoming

overloaded, injured and compensated for, and bad habits of

movement become much harder to overcome.

You could argue that this is more relevant to the legs than

the arms as the arms work quite separately to each other;

the legs, however, easily compensate for each other and

should possible be understood as a complete unit flowing

from foot through the pelvis to the other foot - where you are

always coaching clients towards 50/50 loading.

   

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1 Past Significant Injuries And, finally the Grand Master of factors that will create bad

habits of movement:

Injuries are by far the most powerful dictator of

movement changes. The brain shuts down certain

movements that cause pain and works around them through

compensation. The brain then slowly becomes used to such

patterns, which are normalised through repetition. Any other

factors will be sidelined immediately as there is no more

powerful destroyer of movement patterns than pain, the need

to protect the body from that pain, and then from further

harm.

Remember Case Study 2? The tennis player with shoulder

impingement learns to over-extend in his wrist, and to

protract his chin further. He may increasingly demonstrate

poor pull and push movement as his shoulder is gradually

unable to do full and strong scapular retraction and

protraction. Use of the bar in back squats will contribute to

this becoming normal, where the restrictions in scapular

movement will require increased wrist extension and chin

protraction.

   

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Many human systems never fully recover from significant

injuries, carrying deformities, asymmetry, on-going pain and

weakness for the rest of their lives. These ingredients will

continue to drive bad habits of movement, and can be

extremely hard to coach out of a client. But…the plasticity of

the brain still remains our hope that even those in their later

stages of life, given enough motivation can retrain and move

more efficiently and freely.

Visit www.rehabtrainer.com.au for video tips, courses and more resources.