Practical Science on Movement and Pain
Practical Science on Movement and Pain
There is a lot of much needed skepticism on the internets these days in regard to the idea that we can diagnose movement “dysfunction” and prescribe movement “correction.” A lot of this debate centers on the FMS and other systemic approaches to improving quality of movement. I think a lot of this discussion is useful and productive.
I also think that the level of skepticism sometimes goes too far, veering into what I call “movement relativism” – the idea that one movement will work just as well as another for a given purpose, or that we don’t have the slightest idea how to tell whether one way of moving is better than another.
Of course, most skeptics would not go this far. And, don’t get me wrong, I like the skeptical position, and have written posts from that perspective here and here. Some of the major points from these posts and elsewhere are that:
Despite the validity of these points, I think the skeptical view goes too far when it is expressed in statements like:
“We don’t know what movements are right.”
“There is no right way to move.”
In fact, some of my favorite bloggers like Greg Lehman have used similar language. Now this is a semantic point for sure because I think Greg and I are probably in almost complete agreement on all the substantive issues here. I also think Greg is one of the best sources of information on how much evidence we really have about our ability to assess dysfunctions and make useful corrections. That being said, semantics matter to me (hey I used to be a lawyer.) So here is why I don’t like to hear “we don’t know how people should move” or “there is no right way to move.”
These phrases sound (a little!) like what I call “movement relativism” - the idea that one way of moving is just as good as another for a given purpose or person. Or they sound like “movement agnosticism” – the idea that we don’t have any idea at all about how people should move.
Although we definitely need to be humble about our knowledge of human movement, its not like we know nothing. We know quite a bit, even if some of it is pretty obvious. For example, we can be sure that it is less stressful and faster to run on our feet than our hands. This is of course an absurd example, but there’s a latin phrase called reductio ad absurdum which, when placed in italics, gives me the solemn right to use absurd examples to illustrate a point. The point is that not all movements are created equal in their safety and efficiency, and we certainly have at least some ideas about what movements work better than others.
People with the highest levels of function have a lot in common in the way they move. For example, even though runners will always have some individual differences in their gaits, a group of elite runners will show less variance than novices. As Tolstoy said: “Happy families are all alike: every unhappy family is unhappy in its own way.” This is true to some extent about happy movers – they share certain essential qualities in common. Measuring these qualities objectively might be difficult, as discussed in some of the recent criticisms of the FMS made by Stu McGill and others. But that doesn’t mean these qualities don’t exist.
I live near a lake in Seattle which attracts a lot of novice runners for some reason. If you have taken a walk around Greenlake, you will notice some serious diversity in running style. To be frank, you will see some straight up bizarre shit sometimes. Not that there’s anything wrong with that.
On the other hand, if you watch a group of elite runners, there is much more uniformity. Everyone is pretty much doing the same thing, because even though there are a million ways to run slow, there’s only a few ways to run fast. Sure if you watch a slow mo video of Haile Gebreselassie, you can find little flaws or peculiarities. He has a surprising amount of pronation, and does a funny thing with his left arm.
But for the most part he is adhering to a very strict formula for running success. He may not have learned how to run this way from a coach, and maybe technical instruction would not have helped him much. But watching the smoothness of his gait should leave no doubt that there are right and wrong ways to run, and that guys like Haile are doing something right. Similarly, watching the average runner at Greenlake will make it equally clear that most people have some serious room for improvement!
So is there a right way to move? For a given person, functional goal and context … of course! For my body, and my goals, and my injuries, and my physiological state, there are right and wrong movement solutions to motor problems. Sure there might be a couple solutions that basically tie for first place, but there is a very obvious hierarchy among the different options.
Are there any actual movement relativists out there that would deny this? Maybe not, but just in case any show up, we’ll know what names to call them.