A client that I see occasionally came in recently. “What would you like to work on?” I asked.
“My shoulders,” she immediately responded. After a little more questioning, I discovered her shoulders felt tight and a little cranky. She’s quite active and had stepped up her intensity over the last few weeks.
I frequently get asked what it is, exactly, that I do. “I am a personal trainer,” I reply. “No,” people tell me, “it’s not like traditional personal training. It’s something else.”
Fortunately, I think the personal training industry is slowly changing. Many of the techniques I use are regularly implemented in clustered geographical locations across the country. I individualize my approach depending on the person in front of me, which means I put together the various techniques I study in a way that will help the person in front of me move more efficiently in that moment in time.
Before I give an example of how I do that, I think it’s important to note that I look at things underneath the framework of “does the person understand what I am asking? If yes, does the person have the strength/mobility to perform the task? If yes, where can the person be more efficient?”
To break this down further, I start with motor control, move into joint differentiation, and finish with integrated movement.
These three things, of course, all play off of each other. Improving motor control will increase strength and mobility; improving specific joint mobility and strength will improve motor control; effective coaching for global motor patterns will improve motor control, strength, and mobility.
Within those specific components, there are things to look for. Where is the person’s sense of center? If you have ever worked with someone that is blind in one eye, missing a limb, has suffered a serious fall, or had a foot or leg in a boot or brace you know that a person’s sense of center can be seriously altered.
Motor control researchers believe the center of mass for most individuals is in front of the second sacral vertebra, or a little below the belly button (1). This becomes our center point for movement- everything rotates around this place.
However, sometimes a person’s sense of center is more to the left. Or to the right. Or higher up and to the right. Or lower down and to the left. And so it becomes my job to help the person re-establish a center point.
There are things that can’t be changed. Congenital scoliosis isn’t going to be altered by the neuromuscular exercises and strengthening exercises that I do, but it can be improved upon. We all have room for improvement, if we are exposed to the proper stimulus.
A brief note about neuromuscular training….
It’s just motor control training, with a fancy title. It often utilizes isometric contractions so, if done over time, results in improvements in strength and coordination. The changes that occur right after the exercise has been performed won’t stay unless the person is repeatedly exposed to the exercise. There are no magic tricks, unfortunately, Just doors that can be opened and training that can be performed within that window to reinforce new self awareness. Sometimes, miraculous things happen, like pain diminishing or disappearing, or a new experience with movement, but it’s what happens with a thoughtful program after eight weeks that really makes a more permanent difference in a person’s life.
One more note about sympathetic drive…
There is a thing called sympathetic tone. We generally have periods of the day where we are a little more alert and our sympathetic nervous system is a little more active and periods of the day where we are winding down, not quite as on guard, and our parasympathetic nervous system is a little more active. Nervous system activity influences how we hold ourselves and our muscular tone (2). Occasionally, a person will be out of balance, with the sympathetic nervous system more active more often than it needs to be. When this happens, the nervous system can be wound tight, like a screw that’s tightened so much it’s difficult to loosen without breaking the screwdriver. The individual’s experience of specific muscles in this situation is a little bit like the screw- no matter what he does, he can’t get it to loosen. As a result, he holds himself in a more rigid way.
This can happen even with hypermobile individuals, While their limbs might look like they are all over the place, if you look closely, you will see specific areas that don’t budge at all. It has been my experience that with these individuals, you need to figure out how to tap into a sense of stability before you layer on complexity in the form of complicated motor control exercises or isolated joint work. I usually use a combination of things, as you will see below, but I start with calming things down. Fortunately, the breathing exercises that create more SNS/PNS balance also strongly activate the sensation of work in the deep abdominal region. When muscles contract, proprioceptors in the muscle spindles inform where the body is located in space. For a person with a lot of mobility, this essentially kills two birds with one stone- nervous system is regulated and the increased proprioception makes it easier to figure out where center actually is.
So back to my client. What did I do with her?
I started her in supine, with her hands by her sides. I asked her to slide her shoulders up by her ears and down. Her shoulders moved up a couple of inches, but barely moved down. As I watched her breathe, I noticed her chest was lifting and there was no movement behind her ribs. I moved her on to her hands and knees and immediately saw her ribs pulling away from her shoulder blades and her shoulders moving subtly up and down, every breath.
So, I had her flip back over, and started a lively string of exercises that included exercises and influences from: ELDOA, PRI, DNS, Feldenkrais/gymnastics training, traditional strength and conditioning, GMB, and MovNat. I also included a few things I made up (though nothing is new. I simply haven’t seen these things before), and finished with Mabel Todd’s hissing breath. She stretched, breathed, isometrically contracted, moved, rolled, strengthened, and down regulated. All in the course of 55 minutes. “How are your shoulders feeling?” I asked, at the end of the session.
“Oh my God. I can’t even tell you. I feel like a different person. I was having neck pain, jaw pain, and felt locked in my mid-back. I didn’t even associate that the problem was my breathing. I feel like I just got a massage, only better.”
I spent a total of 4 minutes on breathing specific exercises. Much of what I did was put her in situations where her normal pattern wasn’t an option. By changing the context, I was able to increase her awareness and offer alternatives that she could feel and repeat.
Understanding how to implement the tools available to you is critical. If people are paying to work out and they spend 35 minutes in isometric contractions and doing focused breath work, they aren’t going to come back. However, if you understand the why behind various techniques well enough and you understand sequencing and progression, it becomes relatively easy to organize a workout that addresses specific habits, offers alternatives for those habits, and then provides strength and coordination in positions that support the alternative habits. Moving well and being pain free don’t have to be complicated endeavors, but they do sometimes require a bit of critical thinking. Whatever lens you look at movement through, don’t forgot there are many different shades. Try on a different pair once in a while. It might make your vision a little more clear.
- Yang, F., & Pai, Y-C., (2015). Can sacral marker approximate center of mass during gait and slip-fall recovery among community-dwelling older adults? Journal of Biomechanics, 47(16), 3607-3812. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4469384/
- Navegantes, L.C.C., Baviera, A.M., & Kettelhut, I.C., (2009). The inhibitory role of sympathetic nervous system in Ca2+- dependent proteolysis of skeletal muscle. Brazilian Journal of Medical and Biological Research, 42(1), 21-28. http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0100-879X2009000100005
- van Ark, M., Cook, J.L., Docking, S.I., Zwerver, J., Gaida, J.E., van den Akker-Scheek, I., & Rio, E., (2016). Do isometric and isotonic exercise programs reduce pain in athletes with patellar tendinopathy in-season? A randomized clinical trial. Journal of Science and Sports Medicine, 19(9), 702-706.