Isolation or Integration?

Lately within the fitness industry, there has been a shift towards functional exercise and rehabilitation programming. This has resulted in some very positive changes to how we look at exercise.

In the past, many physical preparation programs utilized bodybuilding principles, which may be fine for bodybuilding but were of questionable value to anyone else. While this paradigm shift is encouraging to see, we must realize that rehabilitation and functional exercise programs can differ greatly in exercise techniques and application for many reasons.

In the early stages of rehabilitation programming, isolation exercises or isolated parts of integrated exercises may be used, with neuromuscular isolation being one of the primary objectives.

In contrast, functional exercises use coordinated, integrated movements that may - depending on the exercise - result in improvements in neuromuscular integration, static or dynamic stability, strength and power.

Techniques used in isolated exercises aren't necessary directly applicable to integrated exercises. It seems a number of fitness educators throughout the industry have mistakenly confused these concepts by using isolation techniques while teaching integrated exercises.

One such technique is adducting the scapulae fully before pulling in rowing movements. It has been suggested to keep the scapulae fully adducted throughout the repetition and, in some instances, the entire set. This is not only kinesiologically unsound but has the potential to greatly increase your client's risk of pain or injury.

Adducting the scapulae fully before pulling creates a faulty pull pattern. Why?

The scapulo-humeral and scapulo-thoracic musculature should work synergistly, with both sets of muscles contributing to the movement. The elbow and scapula should have the same approximate relative timing with a simultaneous conclusion at the end ROM, effectively sharing the load.

During rowing exercises, adducting the scapulae fully first while stabilizing the scapula shifts the load fully onto the scapulo-humeral muscles to produce the required movement. This can overload the scapulo-humeral muscles, creating trigger points. Also altered length, length tension curves and force couples acting on the joints may ensue.

While adducting the scapulae in isolation can have its place in certain rehabilitation or isolation programs, this does not make it appropriate technique for the general population involved in functional integrated exercises. Efficient movement shares load over multiple joints, while segmented movement can overload a joint or muscle.

Teaching clients to adduct the scapulae fully first and keeping them adducted throughout the movement (thus creating a faulty pattern) will take a tremendous amount of work to repair. Bear in mind that it may take as little as 300 repetitions to reach the stage of automicy in a facilitated movement pattern. And to repair a faulty facilitated pattern, it can take as many as 5,000 repetitions.

As Paul Chek says, it doesn't take anymore effort to do it the right way, "So do it right the first time."

One argument stated for using this technique is, "If scapula stabilization is not initiated prior to other joint movements, the mid trapezius and rhomboids key postural muscles are often ineffectively targeted and strengthened." Muscular recruitment not scapula stabilization is the real issue as to why these muscles are ineffectively targeted.

An initial approach to get "key postural muscles" to strengthen could be to emphasize them with isolated exercises where necessary and only if necessary, then progress them to fully integrated exercises, correctly following the principles of both rehabilitation and functional exercise programming.

It is important to remember that faulty patterns can create or are a by-product of muscle imbalances. Stretching tight muscles out prior to exercise is essential. Tight facilitated muscles can alter recruitment patterns; examples in this case could be the upper trapezius, levator scapulae, scalenes, pec minor and latissimus dorsi, to name a few.

Failure to stretch facilitated muscles prior to exercise results in the facilitated muscles trying to take over the function of synergistic and antagonistic muscles, with the end result being little effect on improving muscle imbalances while further increasing the potential for overuse injuries.

Techniques as simple as stretching facilitated muscles, combined with palpation of the muscles you want to recruit (thereby exciting them) would be a better approach, rather than incorrectly using isolated exercise techniques with integrated exercises.

The advice to adduct the scapulae prior to movement has not been limited to rowing exercises but also to various lat pull-down type exercises. This advice also creates faults in the pull pattern and, considering the intricacies of the scapulo-humeral rhythm, opens Pandora's box.

Let's look at scapulo-humeral rhythm:

The motion of the scapula, synchronous with motion of the humerus, allows for approximately 150-180 degrees of motion into flexion or abduction with elevation.

Although there is a considerable degree of variance amongst individuals, it's commonly accepted to be 2:1 overall motion (2 degrees of gleno-humeral motion to 1 degree of scapula rotation).

During the setting phase (0-30 degrees of abduction or 0-60 degrees of flexion), motion occurs primarily at the gleno-humeral joint. During the mid-range, the scapula has greater motion, approaching a ratio of 1:1 with the humerus and then later in the range the gleno-humeral joint again dominates the motion. It is this synchronous motion of the scapula that allows the muscles moving the humerus to maintain good length-tension relationships throughout the movement, while helping to maintain good congruency between the humeral head and the fossa and reducing shear forces.

The scapula rotates to alter the position of the overhanging acromium and coracoacromial ligament away from the rotating humeral head and it's greater tuberosity, maintaining the optimum lengthening of the deltoid muscles in the abducting process. It is the coordinated movement, coupled with proportional rotation of the humerus, that results in physiologic arm motion.

Janda determined that optimum shoulder abduction should have the following muscular firing pattern in order: supraspinatus, deltoid, infraspinatus, middle and lower trapezius and contralateral quadratus lumborum. Realizing this, it is easy to see how the advice to adduct the scapulae fully before pulling has great potential to alter efficient physiologic movement, creating an array of faulty movement patterns and increasing injury potential. Maintaining the adducted position throughout the entire set may have serious consequences on the integrity of the whole shoulder complex.

Exercise prescription should be kinesiologically sound. Consider the advice to adduct fully before pulling. If we related it to the squat, does that mean we need to fully flex the hips, then flex the knees?

In summary, although industry education is advancing in the field of exercise prescription, it is imperative to remember that isolation and integration exercises can have differing applications. With the complexities of human movement, the use of inappropriate techniques during exercise can have lasting ramifications on the health and function of the musculo-skeletal system.

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