All human movement is patterned and organized. It has predictable, repeatable elements such as those we see in gait. This article defines and describes three movement patterns essential to bipedal stance and locomotion that can contribute to assessment and program design in the fitness setting.
To illustrate this topic, I’m going to start with a little story about movement patterns I wrote some years ago. 1
What do they mean when they say “it’s all in your head”?
A friend broke her ankle and spent the required time with cast and crutches. Her fracture healed in due time: the bones had knitted, the swelling was gone. But she continued to limp. They said, “Just walk normally,” but she couldn’t so they said, “It’s all in your head. “Let me try to understand this,” she said. “What are the possibilities?”
- It’s my imagination and I’m just not thinking the right thoughts.
- I’m doing this to myself—punishing myself for getting injured, or malingering to avoid my responsibilities, or to get sympathy.
- Something is seriously wrong and they’re not telling me.
- None of the above.
“But if I’m not limping because I want to or need to, why am I limping? It’s all in my head, isn’t it?”
How can we explain this phenomenon? My friend’s habit of limping is a movement pattern. These patterns are stored in the central nervous system, so the problem really is in her head (and spine). But it’s not about being crazy or imagining things. By having pain or even fearing pain we construct adaptive patterns so that when we move, it hurts less. In this way, we teach the nervous system a different way of moving (e.g., limping), which the CNS remembers even when the reason for limping is gone.
The CNS is goal oriented. It is designed to answer a need: the mover’s intention. Whenever we want to do something, the CNS is there for us directing our muscles and joints. However, if there is a barrier, such as pain, the CNS fulfills our intention by choosing alternative muscle use. Unfortunately, the pattern is not necessarily efficient, normal or pain-free, but it keeps us on our feet. My friend may have limped but she got around, all because of this goal-oriented aspect of the CNS. To change the limp she had to change the pattern by working with a therapist or trainer who could assess the situation and guide her toward normal function.
In the fitness setting we work with sedentary people who have not had to use their bodies very much. People sit too much because they cannot stand comfortably. They cannot stand comfortably because they have poor hip muscle function. Clients who are unstable on their feet will lift and tighten their shoulders, because their lower body support is insufficient. These behaviors are a product of poor movement patterns that cannot be corrected with strength training alone.
Many clients just want to lose weight; others want to tone and shape. Few are aware how the form of their bodies is a factor of how they use them.
Even in exercise, form follows function – and movement patterns are about function. Thus movement patterns have an impact on the body shape.
What is a Movement Pattern?
A movement pattern is a specific sequence of muscle activation. Any movement can be described as a pattern, normal or abnormal. For example, in normal shoulder abduction (lateral arm raise), the supraspinatus initiates the movement and the deltoid completes the arm raise to 90 degrees. If deltoid/supraspinatus is not fully active, some other muscle, such as the ipsilateral upper trapezius, will perform the movement. This is a dysfunctional, poor or abnormal pattern. The optimal pattern would use a clear initiation and follow through by the supraspinatus/deltoid with no lifting of the shoulder or other additional action.
As shown in the limping story, any pattern is developed through habitual use and stored in the CNS as a model. Practicing poor muscle activation results in a poor pattern in the CNS; a good pattern results in a good model. The CNS does not evaluate; it only stores. Unless there is some effort to change a dysfunctional pattern, it will continue to be used. In shoulder abduction, for example, coaching the client not to use the upper trapezius doesn’t work because she doesn’t have a choice. The CNS chooses whatever path is available. If the deltoid isn’t up to the job, some other muscle group will be used.
What is Normal in a Pattern?
There is a rather large gap in the literature regarding what is normal in a movement pattern. We are used to judging movement by joint range of motion but this is not enough to determine if the pattern is functional. Specific, correct muscles must also participate. “Function is not limited to passive joint mobility but implies also active, i.e., muscular activity and, of course, the central nervous regulation of motion producing the movement patterns.”
Dr. Vladimir Janda (1928-2002), a Czechoslovakian physiotherapist and physiatrist, pursued the question “What is normal in a movement?” Physical therapist, Irmgard Bartenieff (1900-1981) wrote in 1970 that among the various movement and rehabilitation disciplines, she found no one set of terms for defining that which is "normal." About the same time, Janda was developing his view of the motor system as a whole and the importance of recognizing the role of central nervous regulation in movement patterning. Part of his research involved establishing the norms for certain movement sequences using EMG technology and then working out ways of recognizing, facilitating and reinforcing efficient patterns of movement in the clinic.
Janda discovered that people would use "trick" movements to accomplish a given movement when the proper muscle groups were not functioning. Bartenieff called this "muscling through" the movement. Neither Janda nor Bartenieff thought it acceptable to merely reproduce the gross features of the desired movement; how the movement was done was important. It had to be performed with the correct muscles working in the right sequence.
Three Patterns of the First Order
Janda identified three “first order” patterns: shoulder abduction, hip abduction and hip extension. These patterns occur in the three dimensional, proximal joints of the limbs. I will describe each pattern and how it presents in the fitness setting.
Shoulder Abduction (lateral arm raise)
The movement is a lateral arm raise to 90 degrees with elbow flexed (to eliminate the biceps brachii) and the palm faces the floor. Client may be seated or standing.
What to look for in a normal pattern:
- Recruitment in the deltoid/supraspinatus muscles
- Ease of movement in the arm raise: no stiffness, halting or apparent heaviness
- No involvement of ipsilateral upper trapezius
- No lateral shift in the torso away from the movement (i.e., leaning left to raise the right arm)
If the pattern is poor, the client may be overusing the upper trapezius as a substitute and have done so for some time. This overuse creates tightness and soreness in that muscle, a common complaint. The problem is not improved with resisted lateral arm lifts because it is not a question of weakness but one of available resources (muscles) by the CNS. When shoulder abduction is poor there may also be problems in the joints and limb segments distal to the shoulder such as tennis elbow or carpal tunnel syndrome. Overuse of the upper trapezius may also be a contributing factor in headaches. Any of these problems may have an impact on the client’s fitness commitment/regime/program as well as ADL.
When the pattern is normal, avoid loading to the maximum in resistance work. The long hand-to-shoulder lever is very sensitive to too much weight.
The client will be forced to recruit muscles other than deltoid/supraspinatus compromising the pattern. Instead, use a lighter weight with many repetitions to improve strength and maintain a good pattern. For improved muscle definition, coach your client to lift distally (from the hands) rather than proximally (from the shoulders). When fatigue sets in or the form deteriorates, rest or change the exercise.
The movement is a lateral leg raise from a side-lying position. The top hip is being tested and must be extended 10 to 15 degrees; the bottom hip/knee are flexed. To test, raise the leg no higher than the hip.
If tight hip flexors restrict hip extension, this will compromise the test position. Stretch them in advance of the test.
What to look for in a normal pattern:
- Active recruitment of the gluteus medius/minimus
- Ease in the leg raise with no appearance of effort, heaviness or strain
- Leg remains in the same plane throughout the lifting/lowering movement (i.e., no hip flexion occurs)
- No activity in the quadratus lumborum
- No raising of the pelvis toward the ribs
If the pattern is poor, the client may substitute the quadratus lumborum, the tensor fasciae latae, rectus femoris, iliopsoas or abdominals to raise the leg. Remember, the CNS is goal-oriented and intention-driven. It only wants to do our bidding. However, these substitutions create their own problems. A poor hip abduction pattern, over time, will produce lumbar strain, sacroiliac, knee or ankle pain. These stressed areas will be overused to supply the stability that should come from the hip abductors.
When the pattern is normal, clients will be able to stand on one foot easily with eyes open or closed and will improve their endurance in standing, walking and running, weight-shifting and changing levels (using stairs, crouching). In many clients, improving hip abduction is also a saddle-bag solution. When the gluteus medius and minimus are working properly, the shape above and below the greater trochanter becomes more defined.
A side-leg raise with the hip in extension may be used to keep the hip abductors working well. The leg raise should be slow, the foot should be relaxed and there should be a rest between each raise. Do not add ankle weights. The extended hip/knee provides adequate resistance. When fatigue sets in or the form deteriorates, change sides. Forcing the movement will encourage substitutions and a poor pattern. Hip abduction resistance machines used in a seated position do not improve the pattern because the flexed hip position recruits an insufficient number of abductor fibers.
The movement is a prone thigh raise to about 15 degrees of hip extension with knee flexed and ASIS on the mat.
What to look for in a normal pattern:
- Recruitment of gluteus maximus
- No rotation in the pelvis to either side
- No initiation of movement from the back extensors
If the pattern is poor, recruitment will be absent or insufficient in the prime mover, in which case the client will find the thigh/leg too heavy to raise or will hyperextend the lumbar spine as a substitute. The client may experience lumbar strain as well as difficulty using stairs or inclines.
When the pattern is normal, the gluteus maximus will have a rounded shape, even at rest, and will quickly contract on demand. The leg weighs 22 to 25 percent of the body weight and needs these large muscles to lift such weight and to transport the body against gravity; the leg provides its own resistance. Do not use ankle weights. A prone thigh raise is a useful exercise to maintain active use of the gluteus maximus. The thigh raise should be slow, the foot should be relaxed and there should be a rest between each raise. When fatigue sets in or the form deteriorates, change sides. Forcing the movement will encourage substitutions and a poor pattern.
Patterns in the Fitness Setting
A faulty pattern is not a question of isolated muscle weakness that can be corrected by strengthening. It is a choice made by the CNS as a result of poor usage, trauma or injury and insufficient variety of movement, or as Chaitow says, "overuse, misuse or abuse." The result is abnormal muscle activation/recruitment and/or impairment of tissue. Attempting to improve a poor pattern through resistance training only teaches the CNS new ways of getting around the problem.
In most cases, poor patterning doesn't mean people are not moving, but they will have difficulty in performance, reduced endurance and adaptability to change; they will fatigue quickly and the form of the movement will deteriorate early in the movement trial. What is interesting is how effective the CNS is in finding substitutes for poor patterns.
Working with Patterns in the Training Setting
An understanding of these patterns and their roles in basic body movement enhances fitness assessment and program design. Review your anatomy. Then practice looking at the patterns on a partner. There are only a few muscles involved in these patterns but their use is specific and precise. Working with patterns demonstrates their importance in the hierarchy of change and their inter-relationships within the body. If the client cannot stand and walk well (based on good hip abduction and extension), the upper body will not be free to use weights and sports equipment efficiently. Upper body movement is facilitated with support from the lower. Support from the lower comes from good grounding and the sense of security that comes from good hip patterns.
Good patterns support the body and its activities from simple walking and standing to high jumping, skating or pitching a baseball. Good patterns are the basis of excellent performance because they provide optimal use of the body as a bipedal organism in gravity. Pattern observation is part of a good assessment and will help plan an effective training strategy. Listen to your clients and to their comments about low back, sacroiliac or shoulder pain. Poor patterns may be the source.
When patterns are corrected, the trainer can observe the difference in ease and accuracy of the tested movement. The client experiences a lighter limb, a quicker response to a movement intention, less binding and restriction across the joint. Standing and walking become more comfortable. Working with these three first-order patterns also teaches the trainer to recognize patterning in all movement. Good patterns form the basis of a successful training strategy.
This article is for information and should not be considered a training vehicle. Patterns and the process of altering patterns are best learned in a hands-on setting.
- A version of this story first appeared in Health Innovations, a Med-fit Specialists Newsletter, Fall, 1999.
- A first order pattern is stereotypical (the same for everyone) and is anatomically fixed. The three patterns described in this article are the basis of bipedal stance, locomotion and prehension. Janda also recognized second order patterns. They occur within those of the first order, that is, they are not separate patterns but individual qualities in a person's movement. Second order patterns are idiosyncratic and are responsible for our individuality of movement.
- Bartenieff, I (1970). Laban space harmony in relation to anatomical and neurophysiological concepts. In Four adaptations of effort theory in researach and teaching. NY: Dance Notation Bureau.
- Chaitow, L (1997). Muscle energy techniques. NY: Churchill Livingstone.
- Janda, V (1982). Muscles as a pathogenic factor in back pain. Proceedings of IV IFMOT Conference, Christchurch, NZ.