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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
1
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”.
2
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
3
7
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
4
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.
5
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
6
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.
7
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.
8
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.
9
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.
10
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.