I am seeing more and more social media rehab and fitness gurus promoting the ‘don’t load a dysfunction’. Personally, I think this mantra displays a complete lack of understanding around the complexities of human movement, the uncertainties and the multifactorial nature of injury, pathology, and pain. Not to mention that no one and I mean no one can tell you with any certainty and even less robust evidence what is a movement dysfunction is.
The main issue I have with this ‘don’t load a dysfunction’ mantra is that it assumes we know what is and what isn’t ‘dysfunctional’ movement. Despite many claims, we have very little evidence that tells us what movements, tasks, or activities are bad, dangerous, harmful, or dysfunctional. When it comes to observing, assessing, and quantifying movement quality “beauty is in the eye of the beholder” meaning that what can look ugly and feel problematic for one person, can look, and feel great to another, and vice versa what looks pristine and perfect to one person can feel like a hot mess to another.
The notion that these so-called ‘experts can tell what is good or bad, normal or abnormal, functional or dysfunctional movement just by observing it is frankly nonsense. This overly simplistic and reductionist way of thinking about and classifying human movement based on individuals’ observation alone needs to be questioned and challenged a lot more.
To put this as clearly as I can… human movement is highly complex and variable due to many factors. Human movement is a dynamical system that is influenced by things, such as, but not limited to:
1) individual factors, such as their age, morphology, genetics, experiences, and so on.
2) the task, such as load, intensity, complexity and so on.
3) the environment they are doing the task in, e.g., is it observed, competitive, poorly lit, smooth, or uneven terrain etc. etc. etc., ad Infinitum.
When assessing any movement, we need to recognize that we are all different shapes, sizes, and have different angulations and lengths of our bones and joints. Because of this, we cannot all move the same. Variations in skeletal structure and geometry such as limb length and joint angulations will influence how someone moves. For example, femoral length, as well as pelvic geometry, affects how an individual squats.
Just because some guru with a touch of hypermobility can fold up like a deck chair when they squat doesn’t mean you will be able to if your bony geometry won’t allow it! Just because someone can reach up between their shoulder blades and scratch the back of their own eyeballs, don’t think you will be able to if your shoulder and thoracic bony geometry won’t allow it.
It is important to recognize that what may look like a ‘dysfunctional’ movement could be due to very non-modifiable genetic and or skeletal factors. This is difficult to determine clinically without a lot of detailed, expensive, and unnecessary scanning and imaging, but it should always be considered, nonetheless.
Of course, more adaptable, and modifiable soft tissues can influence how someone moves, but many movement gurus ignore the non-adaptable, non-modifiable factors when trying to get their so-called ‘dysfunctional’ subjects to work on things they will never be able to achieve. This is clearly not helpful and possibly even detrimental as some can, and do, get highly fixated, frustrated, and disheartened by their lack of progress trying to imitate a flexible guru with completely different anatomy.
Our movement is also largely affected by the task being done, and again this tends to be ignored or forgotten by the movement gurus. For example, how an individual bends over to pick up a box of tissues of the floor will be and should be completely different from how they bend over to pick up a concrete slab or a 150kg barbell from the floor.
Having someone move the same way regardless of the task is simply crazy, yet something I see being promoted by these movement gurus. You simply do not need to bend over the same way to do everything, in fact, this is inefficient and ridiculous.
You do not need to brace your abdominal muscles and pelvic floor, focusing on keeping your spine and pelvis in neutral, setting your scapulae back and down before you reach to pick a box of tissues off the floor.
However, advocates of ‘functional’ movement tend to promote just this, that everyone needs to keep their movements perfectly aligned for everything and anything. Rather than helping people this can and does, make many worse as they become focused, stressed, worried, and even hypervigilant on small, tiny, innocuous things and tasks that are just not something to be worried about.
Some of our most common assumptions about the risk of injury and pain on movements are being challenged more and more, with studies in occupational manual handling showing our postural alignment and lifting advice may not be as helpful as we first thought and may even be harmful.
We need to consider the environment as a factor when we assess movement. As therapists and trainers, we often assess people moving in controlled, constrained, and ultimately false environments. Therefore, any of the so-called movement dysfunctions we may or may not see here, may or may not occur in other settings or environments. We also need to recognize that just the effect of observing a subject move will affect how they move. For example, how normally do you think a patient will be moving when being scrutinized in a cubicle, or gym when they are half undressed and feeling a little anxious or nervous? Do you think you will see the same movement strategy will be used when a subject is asked to perform drop landing off a box whilst being observed compared to when they are on a cold wet football pitch on a Tuesday night in Stoke, jumping for a ball whilst dodging an opposing player?
We also need to recognize that the evidence tells us many of the so-called and believed movement ‘dysfunctions’ we see in people with pain and disability are often seen in those WITHOUT any pain or disability. What we often think are movement ‘abnormalities’ or ‘dysfunctions’ may be optimization strategies in the presence of pain, fear, or a lack of tolerance and capacity. Personally, I think this is one of the most common reasons I see people moving differently or awkwardly and this is what we should be focusing on more.
Often, it’s not the movement that needs to be corrected, it’s the lack of confidence or tolerance to it that does. Therefore, I load and strengthen so-called ‘dysfunctional’ movements. I have come to realize that if I focus more on increasing an individual’s capacity and tolerance to an ugly awkward looking, so-called ‘dysfunctional’ movement, often it soon stops looking as ugly, awkward, or ‘dysfunctional’.
All I’m concerned about is does this movement feel comfortable, natural, and efficient to the person doing it? I don’t care what it looks like that much. As far as I am concerned you can have the ugliest looking movement if you are confident, comfortable, and have the capacity, both physically and psychologically to tolerate it!