Here is a great Z Health email I got the other day from a local trainer

I just got done doing (KB) snatches today and the 32kg's are just flying up! Unbelievable how much more power I have now that my glutes and hammies are actually working properly. My back is feeling great and I also did arm bars and gained mobility in my shoulders and hips too.

Awesome!

Mobility, even in the lumbar region?

Aright. I did it this time. This will get my banned off Eric Cressey's Christmas card list, pull Dr. McGill away from his study of belly dancers--seriously, I did not make that part up, check the reference), and send most "personal trainers" running for the hills (cue the Iron Maiden music).

Yep, I am talking about LUMBAR FLEXION and EXTENSION. Holy crap, I just suggested that you should move your low back and for some of you (not the readers of this blog--way too bright for that) are thinking that I have lost my friggin’ mind now and confirmed that really am out on a weekend pass from the funny farm.

Here is why I believe you should move your lumbar spine.

1) I am paraphrasing Geoff Neupert here, "If you were not supposed to move it, there would be a BONE there instead of a joint" The premise is that you were designed with a joint there, so you move it!

Now, one of the rules of the Z Health system is that you never move into pain, but pain free movement is good! Maybe this means you need to move slower, cut the range of motion or in extreme cases cut the loading (work in a pool for example). Either way, the body was designed for movement.

Living systems are built up with use, and ATROPHY with disuse.

This is the direct opposite to anything else. If you built a bridge and stuck it in a vacuum, it would last forever. Shoot someone up into space, confine them to bed rest, or severe the nerve supply to muscles and they will atrophy like crazy. Countless studies show that one of the WORST things is space flight (due to zero gravity and the unloading effects) and bed rest!

What is normal?
There is a debate about what is considered a "normal" ROM (range of motion) for the lumbar (low back) area. Zigler, J et al. (15) stated, “a normal ROM at the implanted level (for L3–L4 and L4–L5 between 6° and 20°; for L5-S1 between 5° and 20°).

Herp et al (14) compiled a nice table or range of motion in degrees in 20-30 year old from 5 different studies. Click here for the study

Denoziere, G et al. (1) stated "The rotational mobility offered by the device is limited to 12° in flexion, extension, lateral bending and is not limited in axial rotation.” This study was done to investigate the normal ROM for a computer model.

The take away is that none of them said ZERO for a ROM. Strike 1

What else you got?

An extreme case would be zero ROM and lots of ROM. Well, that type of well controlled study is hard to find, but if you look in the biomedical engineering literature you can find some neat stuff.

Zigler, J et al. (15) did just that in a prospective, randomized, multicenter (all good words for studies!) FDA (Food and Drug Administration) investigational device of a disc replacement versus fusion for the treatment of 1-level degenerative disc disease. So we have one case with some movement (artificial disc) and another case with no motion (fusion). Not the best since we have to jam this foreign object into someone’s back, but it is a start.

Keep in mind, that for this study what they define as “success”. “By the FDA definition in this study, ROM success required greater motion at 24 months than at preoperative baseline for investigational patients. Using this analysis, 89.5% of investigational patients were clinically successful." (15) We all know that it just not as simple as a ROM test 2 years later, but in the realm of this study, it is a “success”

To get a new medical device approved, you need to show that your new widget is better than the FDA approved widget/therapy at that time. In this case that is spinal fusion!

The study (15)showed a trend towards less pain (done by VAS--Visual Analogue Scale pain score) in the disk group, but the patients were still in a fair amount of pain at 24 months with a small (although statistically significant) reduction. Hmm, slightly better ROM and still in pain after 24 month—welcome to state of the art! Realistically, this just shows that pain is a huge, really complicated area.

Spinal Proprioception?
There is also a hypothesis that spinal proprioception may play a role in modulating protective muscular reflexes that prevent injury or facilitate healing. That would make sense that the body would want to protect the spine at all costs.

Feipel et al. and others (2, 9-11) has shown a loss of proprioception in patients with chronic low-back pain, although not conclusive (5) I saved you a diatribe on each study, but some very fascinating stuff.

2) Mechano vs noci (what the hell is he talking about now?)
As the spine gets more “locked down” and approaches a more fusion type state, there is evidence to support the idea that there will be an increase in the number of nociceptors and a decrease in the number of mechanoreceptors. I remember Dr. Cobb mentioning this at the last I Phase training. So why do you care?

Mechanoreceptors are little guys (ok, not really but go with me on this) that live in the joints (and muscle) to monitor mechanical forces. Now there are all sorts of flavors of them, but we will keep it general for now and just call them mechanoreceptors.

Nociceptors are little guys that monitor noxious (bad) stimuli. Now, a noxious stimulus may or may NOT be painful; but it’s generally viewed as bad and can lead to pain. Remember, pain lives in the brain and that part get complicated really fast.

So, if the mechanoreceptors are going down we get less info about the environment and the nociceptors are going up there is an increased chance of noxious stimulation. Sounds cool in theory, but are there any data?

Roberts, S et al. (13) at first glance looks like a killer study, but there were no controls; so the data is not really useful—drat. McLain, RF et al (6-8) has completed some interesting studies looking at concentrations of mechanoreceptors around the spine and shown that there are more in the cervical area than any other area. That makes sense, look how much more you can move your head than your lower spine! As Mc Lain, RF (6) states “The predominance of receptors in the cervical spine is consistent with its greater mobility, the need to accurately position the head in space, and the need for coordinated muscle control for protection and posture.”

We have a bingo!
Onodera T et al (12) did a great study looking at the density and distribution of neural endings in rabbit lumbar facet joints after anterior spinal fusion and to evaluate the effects of intervertebral immobilization. The author states, “These results suggest that immobilization of the intervertebral segment causes a reduction in the number of mechanoreceptors in the facet joint capsules because of the reduction in mechanical stimulation. Moreover, in the upper adjacent facet joint there may be neural sprouting caused by nociceptive stimulation.” This is further evidence (in an animal model) that the body will remodel in a possibly negative way to immobility. Is that really that far of a reach?

Now, one study does not “prove” anything and neither does a collection of studies, but it goes give us evidence toward the right direction as long as we are asking the correct questions.

What if everyone is talking about the same thing?
Johansson, H et al (3, 4) have found a close relationship between activation of joint mechanoreceptor and stimulation of the gamma efferents (to sensitize the spindles) which results in increases in muscles "stiffness" and joint stability. Now the work of Johansson was done on knees, but the same principals probably apply.

So maybe our end result is more muscle “stiffness” but we need to TRAIN MOBILITY to get there?

Mc Lain, RF states (7) “Previous studies have suggested that protection muscular reflexes modulated by these types of mechanoreceptors are important in preventing joint instability and degeneration”

In English, this means you should move your lumbar spine! Please discuss.

Rock on
Mike N

References

1. Denoziere G., D. N. Ku. Biomechanical comparison between fusion of two vertebrae and implantation of an artificial intervertebral disc. J Biomech. 39(4):766-775, 2006.

2. Feipel V., C. Parent, P. M. Dugailly, E. Brassinne, P. Salvia, M. Rooze. Development of kinematics tests for the evaluation of lumbar proprioception and equilibration. Clin Biomech (Bristol, Avon). 18(7):612-618, 2003.

3. Johansson H., P. Sjolander, P. Sojka. Receptors in the knee joint ligaments and their role in the biomechanics of the joint. Crit Rev Biomed Eng. 18(5):341-368, 1991.

4. Johansson H., P. Sjolander, P. Sojka. A sensory role for the cruciate ligaments. Clin Orthop Relat Res. (268)(268):161-178, 1991.

5. Koumantakis G. A., J. Winstanley, J. A. Oldham. Thoracolumbar proprioception in individuals with and without low back pain: intratester reliability, clinical applicability, and validity. J Orthop Sports Phys Ther. 32(7):327-335, 2002.

6. McLain R. F. Mechanoreceptor endings in human cervical facet joints. Spine. 19(5):495-501, 1994.

7. McLain R. F. Mechanoreceptor endings in human cervical facet joints. Iowa Orthop J. 13:149-154, 1993.

8. McLain R. F., J. G. Pickar. Mechanoreceptor endings in human thoracic and lumbar facet joints. Spine. 23(2):168-173, 1998.

9. Newcomer K., E. R. Laskowski, B. Yu, J. C. Johnson, K. N. An. The effects of a lumbar support on repositioning error in subjects with low back pain. Arch Phys Med Rehabil. 82(7):906-910, 2001.

10. Newcomer K., E. R. Laskowski, B. Yu, D. R. Larson, K. N. An. Repositioning error in low back pain. Comparing trunk repositioning error in subjects with chronic low back pain and control subjects. Spine. 25(2):245-250, 2000.

11. Newcomer K. L., E. R. Laskowski, B. Yu, J. C. Johnson, K. N. An. Differences in repositioning error among patients with low back pain compared with control subjects. Spine. 25(19):2488-2493, 2000.

12. Onodera T., Y. Shirai, M. Miyamoto, Y. Genbun. Effects of anterior lumbar spinal fusion on the distribution of nerve endings and mechanoreceptors in the rabbit facet joint: quantitative histological analysis. J Orthop Sci. 8(4):567-576, 2003.

13. Roberts S., S. M. Eisenstein, J. Menage, E. H. Evans, I. K. Ashton. Mechanoreceptors in intervertebral discs. Morphology, distribution, and neuropeptides. Spine. 20(24):2645-2651, 1995.

14. Van Herp G., P. Rowe, P. Salter, J. P. Paul. Three-dimensional lumbar spinal kinematics: a study of range of movement in 100 healthy subjects aged 20 to 60+ years. Rheumatology (Oxford). 39(12):1337-1340, 2000.

15. Zigler J., R. Delamarter, J. M. Spivak, et al. Results of the prospective, randomized, multicenter Food and Drug Administration investigational device exemption study of the ProDisc-L total disc replacement versus circumferential fusion for the treatment of 1-level degenerative disc disease. Spine. 32(11):1155-62; discussion 1163, 2007.

I have always thought back mobility played a part in overall physical health. Now I have Mike (scary smart) backing me up, cool!

So, all those back bends I do in my yoga practice actually help the rest of my body to get stronger by stimulating the neuromuscular pathway?

Scary Smart strikes again! I especially like all the lit. references. (That quote about bone at the beginning wasn't half bad either...;])

More posts like this please.

Wow! With your 15 references, you are redefining the use of internet blogs.

Scary Smart? No shit. And you write well, too, in a way that's engaging to read. You should have a regular column if you don't already.

ok, you are over my head, but I'm trying to keep up. I was looking at some of your older posts - you sir, are WAY to excited about cadavers! lol

Mike,
I have a blog today because of this blog - great stuff and great information - I think the concept of all joints should have stability within their full and natural range of motion is the way to go.

And there is a difference between enjoying stability within the full range of motion (which we should all train and have) and experiencing range of motion in the spine during a squat with 500 pounds on your back? yes??

Mobility, stability...it is much simpler...
coordination!

Good movement is not just the ability to move in any structurally sound way (mobilize), it is the ability to not move (stabilize- maintain position)
Basically, coordination gives you the choice to move or not move.

Any movement is some combination of moving some parts and not moving others....
which are both made possible through coordination.

This makes the focus of ALL movement practice obvious - coordination.

Your body is already coordinating everything. You might as well be conscious of it as well as precise.

Fantastic stuff Mike,
Your desire to pursue the science of this stuff is both amazing and much appreciated. I can understand it but have lost interest. I just want to do what works!

Brett, I think you've got it. Like Geoff says, if it wasn't s'posed to move, there wouldn't be a joint there! (wait 'til you wanna talk about the skull with my Biodynamic Cranial work friends!)

But of course how, how much and under what loads, position, etc. al l are critically important questions to answer regarding joints and loads, and the spine is probably a special case - heck in it's own way every joint could have special case situations.

Great stuff overall. I really enjoy and appreciate applied science, esp. when it involves the body acting in life! I would also love to see it continue.

Oh yeah Fawn,
I think you are also right on the money. The spine is our core and like with some bridges (the kind we drive on, not the exercise), if the core isn't strong and you try to use it, bad things happen.

That's why things like yoga and Z and KBs are so good for you, IMO. They demand the core function optimally (so then the peripherals can also do the same) and train & condition it to do so.

Thanks for all the wonderful comments everyone. It is much appreciated.

If I were to simplify it down, Frankie hit the nail right on the head--it is all about coordination. That is why I never like those charts stating that that the knee needs stability, the ankle needs mobility, etc. Most people need MOBILITY in order to get better coordination, in my opinion.

Great discussion as always too!
Rock on
Mike N

Yes everyone needs mobility but are you telling me:
A: that if the arch collapses that the ankle will not lose mobility? (which is the purpose of charts like that to provide a starting guide - yes anything can cause anything - but these are likely candidates)
and
B: Would you agree that for every bit of mobility gained there must be a corresponding increase in stability/control to go along with it.

I get the coordination part and agree but for increases in mobility there must be subsequent increases in stability (repeating myself but hey it sounds good - and with the fatigue you and Geoff are experiencing - Do you think that could be part of the neural switching? Your stability and firing patterns are catching up with your increases in mobility?
Just an idea...

Brett,

"...if the arch collapses that the ankle will not lose mobility? (which is the purpose of charts like that to provide a starting guide - yes anything can cause anything - but these are likely candidates)"

Yes, particular parts of the foot/ankle complex at particular vectors through particular ROM will lose aspects of their mobility.

"Would you agree that for every bit of mobility gained there must be a corresponding increase in stability/control to go along with it?"

Yes, for every amount of COORDINATION gained there is a corresponding increase in stability & mobility to go along with it - although - it may not be directly proportionate to the joints being coordinated. It could have a distal efffect.

Something everyone needs to be reminded of is that with every new or reawakened coordination pattern, we effectively have a new body. This new body does not immediately have the local endurance or resilience. It appears those qualities are somewhat easily acquired perhaps faster than we think possible.

As for "neural switching," the mechanisms at work I don't believe to be directly related to SMA being shed but rather SMA being acquired.

I thought your blog about stability/mobility was better and more accurate than how Boyle portrayed it. It works well for the squat. Other movement patterns can be described quite differently - take any throwing or striking movement pattern for example.

The problem with most movement assessments is that they are based on exercises rather than more "primal" movements - so to speak. While they can tell part of the story, other assessments offer a fuller picture. Of course, no one particular assessment tells the entire story nor does any movement - only the body with all of its movements - from intracellular to musculoskeletal.

There isn't an unimportant movement skill. Coordination seems to be the most general yet precise term to encompass any movement skill.

Thanks for the comments Frankie!

The body is not so simple that complex movements can be summed up in a nice neat little chart. Don't get me started on only looking above and below the joint either. I understand the idea behind it though.

Also, you need full ROM first in every joint to help get rid of any SMA and any arthrokinetic reflex; which ultimately makes you weaker.

Thanks for the comments!
Mike N

Thanks Frankie,
That helps (and thanks for the positive comments on the mobility/stability thing) - I agree that the difference between exercises and assesments (the FMS uses what are considered to be primal movements made "difficult" in order to catch mistakes).

It seems to me that coordination is the culmination of the effective patterning of the mobility/stability stuff. Unlocking or bring back into the "normal" ranges would have to result in the "relearning" you were referring to.

I am excited to learn the Z-health assesment and be able to target the drills effectively.

Mike,
The chart is simply a beginning guide for those that do not have the background and knowldge to apply - remember that the general fitness industry has many people entering that have no background in anatomy, kinesiology etc...
It is useful and does help people.

Looking forward to Z.

Brett,

One reason why I shy away from the mobility/stability map or metaphor is that so few people characterize it accurately and leads to most people being confused.

I like to think of the process of coordination as purposefully moving some parts while not moving others.

As it turns out, having the choice to not move a particular part of your body often comes after purposefully moving that same part.

The purpose of movement retraining is to make all movement or non-movement purposeful instead of unconscious or incidental.

It will be interesting to see if you come away from Level 1 Certification with a set of new tools or a new perspective from which to use all of your tools.

While Z itself is still just a map, it changes everything. Yes, it will be very interesting to see what changes for you.

We shall see Frankie - it will be interesting.

Geez louise! This is some serious stuff Mike! Very impressive!

I would agree for the most part. Joints are designed to move, that is why they are called joints. I think there are periods of time, especially with the client who comes in with segmental hyper mobility in various segments of the lumbar spine where increasing mobility is a BAD IDEA. For example, if a client has degenerative disc disease at various levels and their is a severe loss of disc height. This causes the spinal ligaments to loosen thus creating ligament laxity and a hypermobile segment. Would teaching this client how to move out those segments be a wise choice?

Especially if there is a hypomobile joint above or below it.Wouldn't getting the hypomobile joints to move be better?

I think to generically claim that all lumbar spines must move through their full range of motion sounds great on paper, but in reality doesn't always make the best approach. That should be the end range goal, to restore as much pain free ROM as possible. But some people that just ain't gonna happen.

Now I agree that most people are just too tight in most of their body, but with lumbar disc issues I have not had alot of success with flexion. Extension generally seems to be better and easier to restore, even easier than side flexion and rotation. I am not saying I have all the answers but initially it seems that some sort of stabilty or stiffness needs to be addressed with many of these types of clients.

Personally I have worked with Dr. Cobb on my lumbar spine and I think it was just too unstable. This is not an attack on Eric at all, but my back did not respond well to the mobility work. It did respond well to medium weight deadlifts, swings, snatches and some Swiss Ball Stability work(of course not at high intensities).

Great post!

Thanks for the great comments Franz and sharing your experiences. Very interesting.

Yep, you are absolutely correct that everyone is different and each has to be treated on an individual case, esp. to not create pain. The nice part about using a form of evaluation (like gait) is that you can check to see if you helped them or not. Personally, I would much rather know what drills NOT to do since the first goal is to not make them worse!

The other key (as you know) is that with some athletes it is hard to get them to move their lumbar without creating added tension, loosing long spine, or moving into pain. This where some Z opposite joint work can come in handy at times.

How is your lumbar area now Franz? Did you alter your form on DLs and swings or anything else? Just curious.

Take care and thanks for the comments!
Mike N

Mike,

my lumbar spine is much better. My last disc herniation pretty much pancaked my disc so I can feel when I am getting a little unstable. The instability starts to cause some weird pain and dysfunction.

As long as I keep it stable and strong and don't abuse heavy loads, I feel AMAZING. Best I have felt ever in my life in that area, although if I abuse it I can feel it.

Being conservative is the key, especially since I am on my feet 8 + hour per day.

Thanks for the comments!

AWESOME that it is feeling better now! Good stuff.
Mike N

Mike, I'm glad I clicked over here, really good post.

I have a bit of a compass of simplicity. I love the observation that if we weren't meant to move at the spine, we'd have a bone rather than a joint. All my life I've argued that if we have a ROM it should be strong. That lead me to such insane activities as squatting as low as mobility would allow. Of course my knees got better rather than worse, they didn't explode as some would have me believe back in the nineties.

My point, I agree with your post, mobility is one of the keys. But to be fair to McGill (I like his work), he supports mobility too. He writes about stability first, mobility second. In fact the goal of his spine exercise progressions is mobility. And as a fella who has more adrenaline fuelled injuries than most, I have experienced great improvement by insuring I was statically strong before dynamic. But, I've also gone the reverse order, gained mobility first, then worked on strengthening the entire ROM, and that worked as well... maybe more enjoyable too.

In the end, I must conclude that I like your position best, which seems to be, move pain free and get better at it, and that is as common sense simple as I can get!

p.s. I have been doing well with some Z-Health movements you suggested, thanks.

Thanks for the comments and glad to see you here Roland!

I hear ya on the adrenaline fueled injuries--busted ankle, completely ripped out shoulder, seperated the other shoulder, wrist and various sprains, blah blah blah.

There is no doubt McGill is a bright guy, but I vote for mobility first in full ROM and then load it slowly.

Take care!
Mike N

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