Data To Live By (Part III: Mobility Assessment)

The typical seated office worker has more musculoskeletal injuries than any other industry sector worker, including construction, metal industry, and transportation workers.
— Dr. Kelly Starrett, author of Becoming a Supple Leopard

At a certain point in our lives, whether from underuse, overuse, injury or neglect, we lose flexibility, mobility and range of motion in one or more of our joints and the muscles which collaborate to animate those joints. If unchecked, this diminishing range of motion can lead to discomfort, susceptibility to injury, loss of vigor and chronic pain.

The Health Warrior Way applies several different, complementary interventions to combat this loss of suppleness in our muscles and diminishing flexibility in our joints. Interventions like self-massage and foam rolling help prepare the muscles for stretching or yoga by disentangling muscle fibers that have become "glued" together over time. We can also consciously activate muscles that are dormant during our normal, workaday lives. These strategies help prepare the body for movement by circulating blood to the muscles, warming them up. It’s only at this point that you can really reap the full benefits of a dynamic stretching routine or yoga class.

I speak from experience. For many years, starting in my early 20s, I suffered from intermittent, debilitating lower back pain, which only got worse after I sustained a powerlifting injury in my early 40s. It was at this point that I became increasingly – and alarmingly – fragile. Something as innocuous as a sneeze could take me out of rotation for weeks. Chiropractors could offer me relief from the acute pain (only after the muscle spasms subsided) but I eventually grew tired of treating the symptoms and went searching for the root cause. Here's what I found:

  1. I had misaligned core strength balance: more specifically, my anterior core (my “abs”) was stronger than my posterior core (my lower back), undoubtedly caused by decades of sitting at a desk. This imbalance meant that my vertebrae weren't aligned (stacked) and I wasn't standing up straight. I was lacking functional strength in my lower back to support my active lifestyle and my other (secondary and tertiary) muscles, which are smaller and weaker, had to compensate. This put me at constant risk of injury.
  2. My posterior chain was chronically tight: too much sitting, the enemy of mobility, had shortened the muscles up and down the back of my body. From my heels to the base of my skull, I was like a rubber band pulled taut. Literally every link in my posterior chain was weaker than the next, including my Achilles tendon and calf muscles (gastrocnemius and soleus), the backs of my legs (hamstrings and gluteus maximus), my hip flexors (especially my hip flexors!) and my mid and upper back (quadratus lumborum, erector spinae and trapezius).
  3. I was losing hip rotation mobility, fast: my external hip rotator muscles (the piriformis and quadratus femoris, primarily) were not sufficiently flexible and they pulled on my lower back, flattening out the natural curvature of my spine. This created pressure in my lumbar discs If I stood for too long. Once again, sitting -- and not enough stretching -- was the cause.

Once I self-diagnosed my back issues and learned the muscular anatomy interactions that were causing them I was able to develop stretching, mobility and strengthening exercises in an effort to correct the deficiencies. This remains part of my self-care regimen to this day. It’s what I do, every day or three, to ensure that I’m maintaining if not improving my flexibility and mobility, even as I’m developing strength and building lean muscle mass. I haven't had the need to see a chiropractor in over 4 years.

Developing a self-care regimen to maintain or improve flexibility, mobility and range of motion as we age is a core HWW strategy. A regular focus on mobility enables you to stay active while simultaneously mitigating the risk of injury. It's also a significant contributor to quality of life insofar as it can help address chronic pain caused by musculoskeletal imbalances and anatomical misalignment.

Before developing a self-care regimen, however, we have to assess baseline biomechanics to identify impingements, imbalances and limitations in range of motion. The following section -- the Health Warrior Way Mobility Assessment -- provides an overview of the approach used to assess flexibility, mobility and range of motion limitations in the key muscle groups. The ultimate goal is to design a program of targeted, efficient interventions to restore maximum functional movement and alignment as quickly as possible.

GEEK ALERT: as with the HWW Strength Assessment the descriptions can get fairly technical anatomically. I hope you're not too bored. I've included a muscular anatomy chart in case you really want to geek out, as well as links to helpful references.


The Health Warrior Way Mobility Assessment

The HWW mobility assessment is designed to measure the mobility of nine muscle groups. Where applicable, these tests are performed unilaterally, on individual units (e.g., one leg at a time), and bilaterally, on paired units (e.g., both legs at the same time) to better ascertain mobility deficiencies in isolation. Photos are taken during each test to create a visual record of baseline mobility to visually gauge incremental progress (intuition is for the experts; the rest of us rely on data).

Assessing the flexibility of these areas enables us to develop mobility, flexibility and strengthening interventions to preserve or regain as much flexibility and functionality as possible

The Feet and Toes

Foot mobility can affect your posture and your gait (walking or running). Over time, limited mobility in soft foot tissue (plantar fascia is the surface connective tissue running the length of the foot, from the heel to the ball) can cause reflected pain in your knees, hips and back. Limited toe range of motion can impact athletic performance and can make prolonged standing or walking uncomfortable.

The Ankles

Ankles are very susceptible to injury, especially in athletes where repeated trauma to the soft ankle tissues (ligaments and tendons) can cause scarring and chronic stiffness, leading to limited range of motion. Lateral flexibility of the ankle is assessed (eversion and inversion), as is dorsiflexion and plantar flexion (pointing the toes up and down).

The Calves

Our calf muscles (the gastrocnemius and soleus muslces, which both anchor into the heel bone via the Achilles tendon) do a lot of work. Part of the posterior chain of muscles and connective tissue, the calves provide much of the necessary force required to propel our bodies through space (walking, running and jumping) and they also provide the stabilization required to maintain balance in all upright positions. Chronically tight calf muscles limit the power we can generate with our lower legs, forcing other muscles to compensate and eventually causing lots of untoward side-effects (like collapsed ankles and balky knees).

The Knees

The knee is a complex joint with lots of moving parts that must work in harmony to enable range of motion and stability. There's a lot going on in there: there are four ligaments which connect the femur to the tibia and fibula (the bones of the lower leg) and the patella (the kneecap) to the tibia; there are also tendons which anchor the powerful muscles of the upper leg (the quads) to the patella, and which anchor the patella to the front of the shin (the tibia); there's also a lot of soft connective tissue (bursas, meniscus, synovial membranes and cartilage) which under normal circumstances provide smooth, gliding surfaces for the bones. This complexity comes at a price, however, as knees are very prone to injury and age-related and activity-generated deterioration (i.e., wear and tear). Restoring full knee range of motion should be a priority for anyone that is looking to maintain an active lifestyle.

The Hamstrings and Quads

The three large muscles (semitendinosus, bicpes femoris, semimembranosus) that comprise the hamstring group connect the pelvis to the lower leg bones (tibia and fibula). The hamstring is to the leg what the bicep is to the arm. Flexing (contracting) these muscles elevates the heel to the butt (a curl), while extending (stretching) them enables us to fold into a forward bend (Uttanasana, in yoga), reaching our fingers toward our toes. A sedentary lifestyle, including too much sitting, can result in chronically shortened hamstring muscles and seriously compromised posterior chain flexibility.

The four large muscles (vastus lateralis, vastus medialis, vastus intermedius, rectus femoris) on the front of the thigh that form the quadriceps are the leanest and strongest muscle group in the body. The quadriceps is to the leg what the tricep is to the arm. Contracting (flexing) these muscles locks the knee and extends the leg straight, while extending (stretching) them enables range of motion in the knee. Tight, chronically shortened quads can't perform, tug on the patella (the kneecap) and are at constant risk of injury.

The hamstring and quad muscles have an agonist/antagonist relationship. That is, when the hamstring is flexed (contracted) it is known as an agonist (or prime mover). The opposite quad muscle, or antagonist, must relax to allow the prime mover to contract.

The Hips, Glutes and Adductors

The hips are a marvel of engineering. They are the portal through which we enter this world, they cradle and protect the literal seeds of human life (our reproductive organs), they transfer power from our lower body to our upper body, making whole-body movement possible, and they enabled our evolution into animals that could stand upright.

Hip mobility is therefore crucial to maintaining functional movement and an active lifestyle, enhancing our quality of life. 

Assessing hip mobility involves testing the range of motion of four adjacent muscle groups:

  • the adductor group (the muscles on the inside of the thighs that connect the pelvis to the inside of the femur bone) help rotate the hips internally, pulling the thighs in toward the midline of the body (resulting in a stretch of the external hip rotator muscles, as antagonist).
  • the glutes (gluteus medius, gluteus minimis and gluteus maximus, the largest and most powerful muscle in the human body) are one of the structural features which enabled humans to adapt to two-legged locomotion.
  • the external hip rotators (including the piriformis and quadratus femoris) enable us to open our legs wide (which results in a stretch of the adductor group as antagonist).
  • the hip flexors (psoas major and iliacus) are the only muscles connecting the trunk of the body to the legs; they enable the abdomen to act as the main flexor of the hip joint.

Tightness in any of these muscle groups will likely result in chronic, reflected pain in the lower back and/or knees and, over time, compromise posture and full-body functionality.

The Core (Lower Back and Abdominals)

The anterior abdominal wall is comprised of three layers of muscle. The deepest layer is the transverse abdominus; the middle layer is the obliquus internus abdominus; the outermost layer is obliquus externus abdominus. External to these three layers is the rectus abdominus, which runs vertically along either side of the abdomen midline. These muscles are crucial to correct posture and everyday, functional movement; they enable a back bend (rounded back) as in the yoga cat pose.

The lower back muscles include the quadratus lumborum and the erector spinae muscle group (the set of muscles which run vertically along the spine and anchor at the pelvis via the iliocostalis lumborum). These muscles also support good posture and enable spinal flexion (a back arch, or hollow back, as in the yoga cow pose).


The Shoulders

Shoulder mobility relies on the interaction of several complementary (antogonist and agonist) muscle groups:

  • the rotator cuff muscles, which act exclusively on the shoulder joint and which connect the scapula (shoulder blade) to the humerus (the upper arm bone) and which include supraspinatus, infraspinatus, teres minor and subscapularis
  • the anterior shoulder and chest muscles (pec major and the anterior deltoid), which help internal rotation of the shoulder, must relax in order to enable rotation of the shoulders externally
  • the posterior shoulder and back muscles (lattisimus dorsi and the posterior deltoid), which help external rotation of the shoulder, must relax in order to enable rotation of the shoulders internally

A sedentary lifestyle, if left unchecked, will usually result in a "shoulder-forward" position characterized by rounded shoulders and chronic pain in the mid back (from overstretching). Identifying and correcting shoulder imbalances will improve functional strength and reduce or even eliminate chronic pain.


The Forearms and Wrists

Lack of elbow or wrist flexibility usually starts in the forearms, which shorten and then stiffen as they adapt to a life spent with hands hovering over a keyboard. Developing interventions which target the extensors (the muscles of the posterior forearm, which enable us to extend our fingers and wrists) and flexors (the muscles on the anterior forearm which enable us to make a fist and grasp objects as well as flex wrists and elbows) will help restore range of motion to the wrists and elbows.

Awesome Resources!

Take ownership of the recovery and restoration of your mobility with the help of the following resources:

MobilityWOD: "Optimize your Mobility. Prevent Injury. Train Smarter. Recover Better. Treat Your Own Pain & Injuries. Enjoy Performance Gains. Understand Your Physiology." Kelley Starrett is smart as hell and a true innovator. His book "Becoming a Supple Leopard" is the bible of mobility self-treatment.

Yoga poses by anatomy (Yoga Journal): "Find yoga poses for specific parts of your body, from your lower back to your hamstrings and more." Yoga is complementary to so many things, including cycling, which is my main source of cardiovascular exercise. I credit yoga with helping to keep me out of the chiropractor's office for the past four years (and counting).

Muscular Anatomy: Biodigital's 3D rendering of the human body lets you "dissect" the over 600 skeletal muscles in the body to reveal their functions (actions) and anatomical details like origin and insertion points. Select Anatomy by Systems, then Male or Female Musculoskeletal System. Highlight a muscle to reveal its description; click on "Read more" to dive into details. Click Edit to access the dissection tool, which lets you peel away muscle and soft tissue layers to access the deeper tissues. Have fun!

musc anat.PNG