Mobility and stability have been buzzwords for quite awhile now, but as with any notorious language in the field of movement, it's often bastardized with little regard for solid understanding. In the world of soft tissue therapy, it's pretty important to not only understand their differences intellectually but, also how to identify issues in clinical presentation.

Two names: Gray Cook and Mike Boyle. If you're unfamiliar with these two gentleman, they are two of the most brilliant minds in world of movement and training science. Gray, a world renowned physical therapist and founder of the Functional Movement Screen, and Boyle, one of the foremost experts in the fields of strength, conditioning, and functional fitness brought the concept of joint by joint approach to the field a little less than a decade ago.

The Mobility Vs. Stability Concept

This simplification of viewing the joints as having specific functions and predictable dysfunctions lends itself nicely to evaluating and assessing the clinical needs of those we treat. The concept is straightforward — some joints are designed to be mobile, while others are meant to be stable. The continuum looks like this:

Ankle=mobility
Knee=stability
Hip=mobility
Lumbar spine=stability
Thoracic spine=mobility
Scapular thoracic=stability
Glenohumeral=mobility
Neck=stability

This alternating pattern of mobility and stability is the baseline of mechanical function for the joints and a pivotal shift in how we view injury, pain, and dysfunction presentation. For example, one of the most chronic issues plaguing the majority of the western population is low back pain.

As manual therapists, this demographic is typically the nine to five "desk jockey" that spends an entire day sitting at their desk after which they head to the gym to pay penance for a weekend of bad food and drink choices to then drive home to collapse in front of the television.

The Importance of Range of Motion

Chronically flexed hips much? Or, maybe it's a client suffering from osteoarthritis in the hips. In either scenario, the chronic condition of sitting in a flexed hip position all day, every day or the ailment of osteoarthritis takes what should be very mobile hip joints and suddenly stabilizes them to limit movement.

This creates a cascading problem both above and below the hips and most often presents as low back pain first and then eventually knee pain. Now inevitably there is likely a loss of core function in both of these cases and should be part of the treatment plan however, not many will evaluate low back pain by first looking at hip mobility.

More often than not, the most typical plan of attack is to beat the poor psoas into submission because somehow everything is his fault and then the QLs and erectors are next on the hit list.

All the while, the hips are quietly waiting for someone to notice that they've lost functional range of motion and would simply appreciate some mobility again. The pain in the lumbar spine is often a result of shifting from it's normal state of stability into one of mobility to compensate for the hips that have become stiff. Now this isn't to suggest that every single low back pain complaint that walks through your door is all about a hip issue. Nothing is ever that cookie-cutter and thorough evaluation of possible causation is always called for.

However, this methodology of assessing the mobility and stability of joints is an invaluable road map to guide your assessment rather than just diving straight into myofascial work at the site of pain. If we look at this approach from the ground up, we can easily see how a lack of ankle mobility leads to knee pain. A knee joint that has lost it's stability could lead to achy hips which could lead to low back pain, leading to upper thoracic issues, and more.

Looking at the joints above and below the area of pain often leads to the discovery of some root causes. The graphic above illustrates the alternating pattern of mobility/stability and the common pain complaints associated with dysfunction.

As illustrated above, poor mobility in the ankles often equals knee pain; poor mobility in the hips typically equates to low back pain; a stiff thoracic spine often leads to a tight and painful cervical area.

When an injury occurs, the most immediate side effect secondary to pain is immobility both due to the nature of the event as well as prescribed for healing.  While this immobility serves a purpose for healing, if not addressed it leads to an increased rate of pain and injury in the future. An often overlooked portion of effective treatment is client education.

Movement Education

Teaching proper movement mechanics is arguably the most vital piece of the treatment plan. Explaining the importance of mobility, stability, the "how to's" and the roles within this joint by joint approach can be one of the most powerful tools you pass on to those you treat.

While this concept is simplistic and straightforward, the hip joints are an enigma of duality as it pertains to this instability/immobility dynamic. They can be both. At the same time. For example; if a hip is weak and immobile, excessive adduction and internal rotation will occur at the femur resulting in knee pain as well as low back pain.

In the same vein of thought, if the hip is weak in flexion or extension (psoas and glutes), the lumbar spine will compensate for the lacking range of motion and if the hip is limited in abduction the knee will experience stress levels that will eventually lead to pain. This leads us to the cyclical conundrum of being unstable and immobile at the same time.

The more the lumbar spine takes over movement patterns to compensate for the limited hip strength, the more immobile the hips become. We now have a joint that needs both strength and mobility in multiple planes of motion.

Strength & Mobility

While the lumbar spine needs stability, the thoracic spine needs mobility. As in the case of our "desk jockeys," too often the upper thoracic spine is stiff and governed by a mouse and monitor while the low back is a victim of the office chair.

This whole scenario makes a serious case for 9-5 anarchy and begs to question the validity of our evolution as a higher thinking species. The glenohumeral joint, like its' cousin "the hip" is also in need of some special consideration with the stability / mobility conversation. The shoulder is designed to be the most mobile joint in our body.

Therefore, we need to make sure it's stability game is on point in order to be functional. Understanding the shoulder complex can be a specialty within itself especially as it pertains to successful treatment and training tactics.

However, don't forget one simple thing. If the most mobile joint in the body is attached to a stiff and immobile trunk (the thoracic spine) and an unstable lumbo-pelvic complex with poor core control and activation, that shoulder will eventually suffer a painful overuse injury or tendon / ligament pathology.

A Solid Trunk

In the world of sports, strength and conditioning, it's not uncommon to see athletes with boulders for shoulders and biceps for days, but a prevalence of shoulder injuries that occur under load. It's like trying to fire a cannon from a canoe. If the correct stability and mobility are not present within the trunk and the shoulder complex, something's going to break.

A solid foundation of understanding movement patterns and mechanics is critical if you're going to create a functional treatment plan comprised of accurate assessment in both the static and dynamic planes, soft tissue strategies, and corrective exercise incorporation.

If some of these components fall outside of your scope of practice seek out a qualified movement professional that you can work in conjunction with. Seeking out continuing education in the field of movement science can widen the perspective from which you view the human body in motion and significantly improve your success with those you treat. Understanding the mobility and stability paradigm is essential to moving you in the right direction. Pun intended.