Mobility Before Stability? Not So Fast! | Modern Manual Therapy Blog - Manual Therapy, Videos, Neurodynamics, Podcasts, Research Reviews

Mobility Before Stability? Not So Fast!

A colleague of mine who is a lead instructor for RedCord asked me over the weekend, "What do you say to those who preach mobility before stability?"

If you have not used RedCord, check out my review here. Essentially, he was asking because he works on "stability" a lot with RedCord assisted/resisted motor control exercises, and what appeared to be "mobility" issues turned out to be stability.

It turns out this is only partially right, but mobility and stability need new operational definitions.

Mobility = true issues in the tissues, actually takes 4-5 weeks or more to actually change length (Slow Responder) - click here to learn why you cannot improve true issues in the tissues quickly

Stability = neurophysiologic lockdown on an area due to pain/perceived threat, can be improved rapidly with novel inputs (Rapid Responder)

Back to the original question, it is a good one! Like anything, it's best not to follow any rules that imply never or always. Remember, never trust anyone who says never, and always be weary of people who say always. A good rule to live by!

Anyway, I've taken FMS 1, and SFMA 1 and 2, and been exposed to some very excellent instructors and thought leaders. When anyone who says "Mobility before Stability," my modern take on that means
  • use manual or other modulatory means to improve mobility prior to working on strength or stabilization exercises
  • those who do this probably get faster results than those who simply prescribe general strengthening exercises to any body part in pain

Before Moseley started down the Pain Science route, he studied pain and its effects on motor control, and thus we have research that is often cited when people say pain alters motor control. This is why you should probably mitigate threat; in doing so, reduce or abolish pain prior to performing ANY movement based treatment including
  • repeated motions
  • corrective exercise
  • general strengthening and conditioning

If your goal is to improve movement patterns for symmetry and/or efficiency, it will probably take you much longer if you have having your patients hammer away at movements that are associated with pain/threat. Those who tend to use a more manual based approach sometimes have more rapid results due to the dissociative effects of removing threat associated with certain movements or positions. Combine this with modern pain science that challenges beliefs of hurt equaling harm and you have a lethal combo!

However, let's redefine Mobility before Stability in a more modern way. Mitigate threat first. Heck make it a hashtag! #mitigatethreat1st - In order for this to happen, the beliefs that pain is directly related to
  • alignment
  • core strength
  • disc bulges
  • stuck facets

have to be addressed in the greater medical community as well as the public eye. That is not easy, but my goal in every Eclectic Approach seminar is to reach at least 1-2 people so they can spread the word. As for the ill informed, do not call them dinosaurs or look down on them, after all we all got into this profession to hopefully heal people first and feed our families second - in other words they mean well, no need to be a jerk. No one likes a contrarian who is one just for the sake of it, or a self proclaimed "arse."

Interested in live cases where I apply this approach and integrate it with pain science, manual therapy, repeated motions, IASTM, with emphasis on patient education? Check out Modern Manual Therapy!

Keeping it Eclectic...

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