Why Mobility Exercises Don’t Work, And What To Do Instead

Man with great mobility doing yoga with laptop

You don’t wake up one day suddenly stiff, it only feels like that.

Mobility, like most skills, exists on a “use it or lose” basis.

Unfortunately, for most of us adults, our daily lives don’t incorporate much “using it”, so we end up “losing it”.

The best way to maintain mobility if your life doesn’t have you climbing trees and crawling around on a daily basis is through exercise, but, if you have already lost a large amount of mobility, then you’ll have to work specifically to regain it, exercise alone is often not enough.

If you ask google “how to increase mobility”, the top 5 results say roughly the same thing: stretch, foam roll, perform dynamic “joint mobility” and “activation” exercises.

These are valid, but incomplete strategies.

The reason being, lack of mobility is usually not a true range of motion issue – I could lie you down on a treatment table and passively move your joints through a much greater range of motion than you can demonstrate – but rather, a stability issue.

Instability is perceived as a threat by the central nervous system, so protectively, it shuts down range of motion so you can’t cause yourself any harm.

Thus, the underlying cause of limited mobility is neurological.

So, in order to improve mobility in the real world, you must go deeper than foam rolling and targeted stretching/joint exercises and “release the brakes”.

If you don’t, you will just end up spinning your wheels, because when improperly applied, mobility exercises don’t work.

This is because you can’t force the body to do anything, it will resist in an effort to maintain equilibrium.

Now, there are definitely cases where there are physical changes to soft tissues and joint structures that limit mobility, but, outside of diseases and trauma, these physical changes usually occur as a result of the limited mobility caused by the nervous system (use or lose it principle).

So, if you have lost mobility over time, how do you get it back? There are many ways, this is the process I’ve found effective and use with my patients:

Osteopathic Manual Therapy

Being an osteopath, I like to start with manual therapy, but not for the reasons you might think.

Manual therapy doesn’t change tissue length, nor does it “put you back into place” or “re-align” you.

What manual can do, and in the hands of a skilled practitioner, does very well, is provide the body with a chance to change.

Movement, or motor output, is the result of complex co-ordination that takes place in the brain, based in part, on sensory information provided by the peripheral nervous system.

Nociception, the transmission of “danger” signals to the brain and spinal cord from nerves located throughout the body can inhibit motor output.

Nociception is related to, but not the same as, pain. You probably know that if something hurts, it usually doesn’t work well. This can also happen when that something doesn’t necessarily hurt, but the nerves are hyper-active anyway.

Because the body functions as a whole, when one area isn’t moving properly as a result of this increased nociception, then there is a chain reaction throughout the rest of the body.

By using manual therapy, we can inhibit nociception, change motor output and affect a change throughout the rest of the body – often decreasing pain and increasing mobility.

Often manual therapy alone is enough, especially if the issue is relatively new or minor, and new, dysfunctional patterns have not had time to become ingrained. If the problem has been around longer, or is not responding to manual therapy alone, we can move to the next step.

Restore Reflexive Stability

Reflexive stability is the term physiologists give to the near instantaneous adjustments that take place when we move.

This allows us to move safely and effectively, and usually efficiently.

With disuse and pain, this response is dulled, and one of the results is an increase in stiffness, which is designed to protect us in the absence of true stability.

To restore this, you have to go back to fundamental movement patterns, progressing to the next only when you have reached mastery each position/stage.

As mentioned earlier, most stiffness is the result of instability, rather than a true range of motion issue. With this in mind, regaining lost reflexive stability is an effective way to improve mobility by addressing the underlying cause.

Reflexive stability exercises are by nature, whole body movements, performed in progressively more challenging positions/postures.

For the vast majority of people, a combination of manual therapy and reflexive stability exercises will improve most mobility deficits.

For an example of reflexive stability in action, try this simple test:

Perform a squat, noting your depth and the amount of tension involved in achieving it.

Now, get down on your hands and knees and perform 60 seconds of quadruped rocking (below):

After 60 seconds, get up and retest your squat.

If you notice an improvement, then you just witnessed the benefits of reflexive stability. If it was the same for you, then either you don’t have a deficit, or your deficit is elsewhere.

Maintaining Reflexive Stability

After you have gone through the progressions, moving from ground based to upright, the easiest way to maintain your reflexive stability and build your health is by walking properly and walking regularly.

Walking is largely reflexive – a lot of the control occurs at a spinal, not brain level – which means that once you have restored your reflexes, maintaining them simply requires using them.

Now, any old shuffle won’t do, what you want in order to reap the benefits, is to walk with a contra-lateral arm swing, looking up. Ambling down the street with your phone in your hand and your eyes on your phone isn’t going to help you, it’s only going to re-inforce the issues the caused you stiffness in the first place.

For most people, especially those of you who don’t exercise, these two steps alone are enough to restore the mobility you need to go about your daily living.

If you are exercising and/or you want to take things even further, then we can add a few more steps.

Active Stretching and Functional Movement

If you have addressed potential issues with manual therapy and general (reflexive) stability work, but you’re still not getting the specific mobility improvements you want, it is time to begin more targeted work.

One form of targeted mobility work I like to use is “active stretching”.

Active stretching is probably just another name for PNF (Proprioceptive Neuromuscular Facilitation) stretching, but it’s simpler for my patients to understand, so I prefer that.

Active stretching is where you are stretching a muscle group whilst simultaneously activating opposing or synergistic muscle groups – essentially adding stability to the newly explored range of motion.

I’ve found this to be far more effective than passive static stretching, and it really helps people “get” what a joint position is supposed to feel like.

If you then use this increased joint range of motion in more demanding, functional tasks, then you “teach” the body that this range is okay to use, because you are adding strength/stability to a previously weak/unstable position.

This results in an increase in mobility.

In the following example I shared on Instagram, I’m using an active hip flexor stretch, followed by an isolated glute activation exercise before reinforcing the new pattern under load with a barbell squat:

If the problem was at the ankle instead/as well as at the hips, another sequence might involve an active calf stretch (demonstrated below), followed by a dynamic mobilisation of the ankle joint before squatting.

Again, these exercises are not only addressing range/length of a joint/tissue, but improving stability, which, as we discussed, is often the real driver of joint mobility.

The functional exercise then reinforces the pattern, and once repeated enough times, in correct fashion, it is usually enough on its own to maintain the improvements in mobility.

Whilst I demonstrated the example with a barbell squat, this isn’t necessary, you might simply perform a full squat position, as millions of people around the world do on a daily basis, in order to maintain mobility.

As always, the execution will depend on your needs and wants, but the underlying principles remain the same.

An Aside On Exercise Technique

In the examples above, the active stretching is then reinforced by the high demands imposed by the squat.

However, if you are squatting with poor form, then you are undoing the effects of the active stretching.

Good form is easy to spot – it is controlled, stable and smooth. Whilst everyone has different body shapes and sizes, thus the execution of movements will look different, the ability to perform controlled movement should be universal.

It’s also important to understand that if you skip straight to exercise, without addressing the stability issues first, then your body will simply “survive” the exercise by using whatever movement pattern is strongest, optimal or not.

Once you have addressed these issues, using optimal exercise technique reduces the need for continuing mobility work – once you’ve got it, maintaining it is easy – this is why in countries where people continue to squat throughout their life, mobility deficits are less common.

Maintaining Mobility

Maintaining mobility is relatively simple: use what you have got.

If you are coming to this article with restrictions, then it is still simple: regain what you’ve lost, then use it to keep it.

If you go to all the effort and expense of getting treatment and performing the work to regain mobility, only to continue with the lifestyle that got you needing treatment in the first place, then chances are, you’ll end up back where you started, given a long enough time frame.

Because we don’t have many (any) physical demands to survive anymore, we have to deliberately perform tasks that challenge us physically, including our range of motion.

This goes against human nature, which is to conserve as much of our energy as possible – it’s wired into our brains to do this – so, what I recommend is to build mobility maintaining activities into your day.

Examples of mobility maintaining activities are:

  • Walking properly (as discussed earlier) instead of driving short distances
  • Sitting on the floor to watch TV instead of on a couch
  • Squatting instead of bending to pick things up from the ground

Whilst these activities are not going to prepare you for a Cirque de Soleil audition, they will help with your activities of daily living (ADL) and your quality of life.

Beyond this, exercise, particularly full range of motion strength training, in all its forms, is the best way to maintain, and even improve mobility.

Conclusions

Mobility exercises need to be used in context. If you use them when you have an underlying stability issue, either at the stiff segment or elsewhere in the body, they will not be effective.

Used in a sensible, principle based approach, like the one I outlined above, they can play a valuable role in regaining mobility.

Once you have restored lost mobility, it’s much easier to maintain. This can be done by incorporating activities into your day that require you to use extra mobility.

Walking is one of the best general exercises, if you do it well, and can help maintain good health, including mobility.

For more focused efforts, full range of motion strength training is probably the best way to maintain and even improve joint mobility, once you are moving correctly.
This blog post was written by Dr Nick Efthimiou (Osteopath), founder of Integrative Osteopathy.

This blog post is meant as an educational tool only. It is not a replacement for medical advice from a qualified and registered health professional.

 



 

References

Nociception and motor function

Cutaneous afferent regulation of motor control

Feed forward control and movement stability

Physiological basis of functional joint stability

Training the Core

Lower motor function, Lederman, E., The Science and Practice of Manual Therapy, pp 99-100

Exercise For Low Back Pain

Fit girl lift weights at fitness gym center. Deadlift workout.

Any article about exercise for pain needs to cover one important fact before it goes on:

The body will tend towards self-correction/health/resolution, if, and that’s a big if, the right conditions are present.

The biggest challenge facing an osteopath, or any other therapist, is finding, or more likely, stumbling upon, the right conditions for the individual seeking help.

Whilst there are general guidelines to abide by, every one of us has a unique set of experiences, thus different stories, explanations, treatment techniques and movements are required to facilitate a recovery; not to mention all the environmental factors that come into play.

This article intends to discuss the general principles that should underpin your actions when exercising for/with low back pain.

Where Most Back Pain Exercise Programs “Go Wrong”

Most back pain exercises or exercise programs are based on the notion that pain is the result of specific factors, and that these factors can be specifically identified and then specifically addressed.

There are a variety of factors that can contribute to low back pain, but aside from a history of previous episodes of low back pain, nothing drastically stands out as being identifiable. (1)

As an aside, this perhaps points the finger at us, therapists and rehab professionals, who are not doing a good enough job in the first place (on a population, not individual level).

It is also highly important for sufferers of low back pain to understand, as many people decide to cease treatment/rehab as soon as their pain is gone, rather than concluding the full course of treatment and restoring “lost” function.

Unfortunately, it is very difficult to specifically assess and as a result, address them with targeted exercises.

So knowing that specific factors may be hard to identify and treat, it seems more important to build resilience with a complete mobility, strength and conditioning program.

Take home point number 1: exercise programs for low back pain should not attempt to be specific, but rather improve all physical qualities.

There Are No ‘Good’ And ‘Bad’ Exercises

Another misconception surrounding exercise for low back pain is the concept of ‘good’ and ‘bad’ exercises.

Generally, if you are reading a fitness article, the concept of “neutral spine” is mentioned quite a lot. Lifting should always take place with a neutral spine, regardless.

If you are reading a rehab article, limits might be imposed on external loading, as in, any lifting above 10 kg is bad, and must be avoided.

Or you might read a medical article which mentions you should simply avoid things that hurt.

All of these comments have a place, and are neither right or wrong without any context to define them.

A ‘good’ exercise is one that you can do safely, is suitable for your current ability, is able to be gradually progressed and fits in with your needs and wants (aka your goals).

Take home point number 2: blanket statements and absolutes do more harm than good. There are times when a moderate approach doesn’t work and more extreme action needs to be taken, but it is rarely either or. Exercise selection is based on your needs and wants, not an arbitrary definition of good and bad.

Self-Limiting Movements

This is a concept that was popularised by American physical therapist Gray Cook, in his book Movement.

Self limiting movements/exercises are those that have an inbuilt “coaching mechanism”, meaning doing them forces you to increase your awareness with movement, and often times with these type of movements you can only perform them correctly, or not at all.

Utilising self limiting movements as part of an exercise program for low back pain allows you to safely challenge your body and brain, leading to improvements, without the risk of overdoing it.

There are many different examples of self-limiting exercises. The specifics are not as important as being able to move with increased awareness and a low risk. This is a big focus of our exercise programming for low back pain, especially in the early stages.

Take home point number 3: a good exercise program will provide both a challenge and the option to “fail safely” – thus reducing the fear associated with facing more demanding movement challenges.

Our Approach To Programming

There is no one way to program exercise for low back pain. As long as the programming is underpinned by sound principles, and not “technique based”, then it should be sufficient.

We strive for more than sufficient, we strive for optimal.

As such, over the years our approach to exercise programming for low back pain has been refined to what it currently is. Chances are, in another 5 years it will be further refined, but the vast majority will be consistent, as it is all principle based.

First, we consider the body as a whole. We don’t only do “low back” or “core” exercises, but rather we devise a total body program. This is the underpinning principle of osteopathy, and is also applicable to exercise programming.

Second, we ensure that of physical qualities are developed in the right sequence.

If we start with osteopathic manual treatment in the consultation room, we then progress to mobility and flexibility exercises.

These will usually start on the ground, as this provides the most stable environment, thus is the least threatening.

Considering pain occurs when there is a perception of threat by the brain (if you haven’t already, have a read of Pain Basics), this is one of the best ways to regain movement and avoid inefficient compensation patterns taking over.

From there you are looking to build “motor control” – this is simply the ability to control movement well.

We can call this stability, but that implies static positions and discounts the movement component. This is actually achieved simultaneously with improving movement/mobility/flexibility.

We can consider mobility as “end range strength”, and we are simply progressively challenging you so that both qualities improve.

Once you have achieved adequate movement and control (adequate is based on your individual needs), if you want and/or need, we would add load. This might be in the form of external resistance, increased leverage challenge or even changing the tempo.

Only when you are moving competently under load do we add a conditioning component – that is, more volume of work. This is the challenge of fatigue to your new found movement abilities, and if done correctly, is the difference between breaking down when the going gets tough and being able to withstand (almost) anything.

Take home point number 4: whole body, principle based programming that utilises appropriate methods of progression yield the best long term outcomes (based on clinical experience and research) (2) for sufferers of low back pain.

Conclusions

There is a well worn quote:

Methods are many, principles are few. Methods always change but principles never do.

This served as inspiration for this post – there is no point showing you how to do an exercise with no context as to whether it is appropriate for you or not.

Rather, it is important to have an understanding of why you are doing something – even if you only care about the “what”.

This understanding means you will not chop and change based on the latest article in your newsfeed.

It means you will take the time to get things right, knowing that making progress is all the matters, even if it is “slow”.

It also means that you have a better chance at a good outcome and are less likely to become a statistic of low back pain recurrence.

Reducing the article to four sentences, we would end up with something like this:

  1. Do something you enjoy doing, that has intrinsic reward – there are no “good” or “bad” exercises.
  2. Ensure you take a “whole body” approach to exercise. Don’t simply focus on “low back exercises”.
  3. Start slowly, progress gradually.
  4. Vary the stimulus over time, but not too much or too often (or you won’t elicit adaptations).

 

This blog post was written by Dr Nick Efthimiou (Osteopath), founder of Integrative Osteopathy.

This blog post is meant as an educational tool only. It is not a replacement for medical advice from a qualified and registered health professional.

 



 

References

(1) Incidence and risk factors for low back pain: http://www.ncbi.nlm.nih.gov/pubmed/24462537

(2) Resistance training and low back pain in active males: http://www.ncbi.nlm.nih.gov/pubmed/20093971