The Functional Continuum

by Dr. Rob Orr |   Date Released : 25 Oct 2009
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Dr. Rob Orr

About the author: Dr. Rob Orr

Dr. Rob Orr joined the Australian Army in 1989 as an infantry soldier before transferring to the Defence Force Physical Training Instructor (PTI) stream. Serving for 10 years in this stream, Rob designed, developed, instructed and audited physical training programs and physical education courses for military personnel and fellow PTIs from both Australian and foreign defence forces. Rob subsequently transferred to the physiotherapy stream where his role included the clinical rehabilitation of defense members and project management of physical conditioning optimisation reviews. Serving as the Human Performance Officer for Special Operations before joining the team at Bond University in 2012, Rob continues to serve in the Army Reserve as a Human Performance Officer and as a sessional lecturer and consultant. Rob is also the co-chair of Tactical Strength and Conditioning (TSAC) – Australia.

Rob’s fields of research include physical conditioning and injury prevention for military and protective services from the initial trainee to the elite warrior. Generally focussing on the tactical population, Rob is actively involved in research with the Australian and foreign defense forces, several police departments (both national and international), and firefighters.

The results of Rob’s work and academic research have been published in newspapers, magazines and peer-reviewed journals and led to several health and safety awards. In addition, Dr. Orr serves as the section editor for the Australian Strength and Conditioning Journal – TSAC Section and the shadow editor for the National Strength and Conditioning Association (NSCA) TSAC Technical Report. Rob is regularly invited to deliver training workshops and present at conferences both nationally and internationally.

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Comments (6)

Orr, Dr. Rob | 08 Apr 2010, 20:26 PM

Hi Robert.

Thank you for the question. I must admit when teaching courses these are my favorite questions – they show progression past the basic concepts into more advanced thought processes – Following the key philosophy taught to me – ‘Not WHAT to think – HOW to think.’
The basic concept in looking at the number of joints involved – in this article - are broad, looking at Isolation versus Compound, versus Kinetic Link (Complex and Multi-plane). As you have noted however, both the Lateral Raise and the Squat are compound movements…so where to from here?

I will try and answer succinctly but will have to attack the question from a few directions. Firstly, for me (and I appreciate many will vary) functional is simply the ability for my patients to perform ADLs (Activities of Daily Living), and for my more advanced clients, sports / activity specific training (and counter-functional training). If we look at basic ADLs like dressing we can see that many joints and planes of movements are involved and are impacted on by external factors: (Balance for example). So with this in mind, the number of joints does have an impact on how to make a movement more functional – yep you know that - Isolation versus Compound, versus Kinetic Link (Complex and Multi-plane). Now with this in mind, let us apply the number of joints involved in a movement against a given movement. Take your example of the Lateral Raise – to make this movement more functional –the number of joints being moved can be increased by adding elbow flexion and ulnar deviation – the result – an Upright Row with movement now across not only the Coronal Plane but also the Sagittal plane – aahh a key movement pattern for lifting e.g. groceries out of a car, large objects onto a table. Now you can add more joint movement and progress from a Compound movement to Kinetic Link movement by adding a semi – squat (and you have the makings of a deadlift to high pull). So the next key focus regarding the number of joints involved in a movement and its functionality is how to increase movement across the number of joints for A GIVEN MOVEMENT rather than cross compare the number of joints involved in two totally different exercises. Secondly, as you noted, ‘… the definition for functional includes the number of joints …’ The number of joints involved forms part of, but is not the sole focus of, a functional movement. Consider the example at Figure 4, all the squats have the same number of joints involved but the balance requirements are progressively greater, thus an unstable Squat CAN be more functional than a stable smith machine squat. There is however a point where functional is not functional – consider a Deadlift on a Fitball with a barbell – How is this functional? It may be functional to a helicopter Load Master or a Crab fisherman moving crab pots in rough water but for someone looking to increase basic strength or someone who cannot even perform a safe squat/deadlift, hmmm. This leads back to the underlying concept of the paper – FUNCTIONAL FOR WHAT. In answer to your question I would say that the Squat is more functional – to improve Sit-To-Stand movements and basic parallel lift movements. But wait. I would say the Lateral Raise is more functional for a client with poor scapulothoracic rhythm as faulty scapulothoracic movement will impact on almost all upper limb movements – Furthermore, if recovering from a shoulder injury (eg Rotator cuff) there is a tendency for patients to hitch their shoulder to produce momentum to pass the first 15-20* of shoulder abduction in order to bypass the role of the weakened Supraspinatus – a pattern that needs to be unlearned and the movement (and muscles) retrained. So they are both functional if used in the right context and for the right reasons. Hope this helps. Fun In Training, Rob (PS Here is another one to crack your brain on – How is it that both the Hamstrings and Quadriceps can contract at the same time to produce movement in a Squat when one is an antagonist to the other and antagonists are meant to relax when agonists contract? Enjoy - Rob)

Treece, Robert | 05 Apr 2010, 02:58 AM

Rob, the main problem I have with the functional training model is that most exercise practicioners throwing this jargin around don't understand what they themselves mean when assessing the probability of an exercise being "functional" Now from the previous respones and article you seem like a smart guy, so I am eager for you to tell me which of these 2 exercises are most functional why or why not;

1. DB Coronal Plane Humeral Abduction
2. Body Weight Free Squat

Here is my perspective. Obviously a squat seems like much more of a global movement. We have isometric spinal extension, Hip Extension, Knee Extension and Plantar Flexion, (I know you got this, just clarifying so we're on the same page). However in looking at the Arm Abduction, or lateral raise, most people would see only GH motion. So diving further into shoulder mechanics, we have motion not only at the GH, but SC, Scapulo- Thoracic and a non mobile joint the AC all of which are in the motion. If the definition for functional includes the number of joints involved its easy to see we have an issue. Both exercises have 4 joint points that are involved, and depending upon the definition, one could argue the definition being inaccurate.

Overall this is an extremely well written article and I appreciate your expertise, I just have my issues with the functional model being incomplete and over marketed with questionable value.

Orr, Dr. Rob | 12 Feb 2010, 13:31 PM

Hi Victoria, Great question. Firstly, when prescribing a program I avoid thinking in terms of muscles (Eg Chest, Back etc) if possible. Rather I think in terms of movement: Push, Pull, Lift, Bend, Twist, Gait etc. I base and design these movement patterns on the client's needs, be they hypertrophy, power, healthy lifestyle or rehabilitation. Eg If they sit at a desk all day typing, I ensure I include more pulling and lifting exercises (extension based movements) and focus (as I do with all exercises) on a strong functional posture. I might also modify the push to finish in an open chest position (like the forward hand position when holding a bow and arrow) rather than a closed position. The reason I approach training programs from movement patterns are: a) simplicity - due to the complexity of muscle interactions and b) "The brain doesn't know muscles - the brain knows movement". As an example I have included Day 1 of a three-alternate day full body program that can be done anywhere with a set of hand weights.

EXERCISE 1. Push up and Row (Do a push up with hands gripping dumbbells and after each push up perform a one arm row- alternating arms after each push up rep). MOVEMENT PATTERNS: Push / Pull. PLANES OF MOVEMENT: Sagittal / Coronal / Tranverse. Joint Motions (muscles) for the Push – Horizontal Shoulder Flexion (Pectoralis Major, Anterior Deltoid, Coracobrachialis), Scapula Abduction (Serratus Anterior, Pectoralis Minor), Elbow Extension (Triceps Brachii, Anconeus). Joint Motions (muscles) for the Pull – Horizontal Shoulder Extension, (Latissimus Dorsi, Posterior Deltoid, Infraspinatus, Teres minor), Scapula Adduction, (Middle Trapezius, Rhomboids Major/Minor), Elbow Flexion (Biceps Brachii, Brachialis, Brachioradialis, Pronator Teres, ECRL, Flexor Carpi Radialis & Ulnaris, Palmaris Longus )

EXERCISE 2: Lunge with one arm upright row (with a slight forward lean to include lifting specific movements) MOVEMENT PATTERNS: Lift / Bend / Pull. PLANES OF MOVEMENT: Sagittal & Coronal. Joint Motions (muscles) for the Lift – Hip extension (Gluteus maximus & medius (posterior), hamstring group, adductor magnus (inferior), piriformis), Knee extension (Quadriceps), Ankle plantarflexion (Gastrocnemius, Soleus, Tibialis posterior, Flexor Hallucis & Digitorum longus, Peroneals, Plantaris). Joint Motions (muscles) for the Pull – Shoulder Abduction (Medial deltoid, Supraspinatus). Scapula Upward Rotation to 90* (Trapezius, Serratus Anterior), Scapula Depression (Lower Trapezius and possibly Pecs and Lats Dorsi?). Clavicle elevation (Upper Trapesius): Elbow Flexion (Biceps Brachii, Brachialis, Brachioradialis, Pronator Teres, ECRL, Flexor Carpi Radialis & Ulnaris, Palmaris longus). Joint Motions (muscles) for the Bend - Lumbar spine extension (Lumdorum group, Multifidus)

EXERCISE 3: Squat with one arm overhead press. MOVEMENT PATTERNS: Lift / Push. PLANES OF MOVEMENT: Sagittal. Joint Motions (muscles) for the Lift – Hip extension (Gluteus maximus & medius (posterior), hamstring group, adductor magnus (inferior), piriformis), Knee extension (Quadriceps), Ankle plantarflexion (Gastrocnemius, Soleus, Tibialis posterior, Flexor Hallucis & Digitorum longus, Peroneals, Plantaris). Joint Motions (muscles) for the Push – Shoulder Flexion (Pectoralis Major (clavicular), Anterior Deltoid, Coracobrachialis, Biceps Brachii (long head)), Scapula Abduction and Upward Rotation 90-180* (Serratus Anterior, Pectoralis Minor, Trapezius), Elbow Extension (Triceps Brachii, Anconeus).

EXERCISE 4: Trunk twist (Full Sit up with twist). MOVEMENT PATTERNS: Twist / Bend. PLANES OF MOVEMENT: Sagittal / Transverse / Coronal. Joint Motions (muscles) for the Bend - Trunk flexion (Rectus Abdominus, Internal / External Oblique Abdominus, Psoas, Major / Minor, Illiacus).Joint Motions (muscles) for the Twist - Trunk Rotation (Internal Oblique Abdominus (ipsilateral), Miltifidus, Rotators Lumborum, External Oblique Abdominus (contralateral))Joint Motions (muscles) for the Trunk Twist/ Flexion Couple - Trunk lateral flexion (Lumdorum group, Internal / External Oblique Abdomius, Psoas Major).
As you can see a lot of muscles are involved in these actions - and I have just listed the agonists and synergysts [consider that in Exercise 1: The cervical extensors and deep neck flexors are activated and focused on to remove forward head posture; the Transverse Abs, Pelvic Floor Group, Multifidus, Diaphragms and Psoas are activated to maintain trunk rigidity].
Furthermore, the muscles move in complex and complimentary patterns. So choosing one muscle to counter another may be a fruitless task as while sometimes these muscles are antagonists with each other at other times they are synergysts or even agonists. For example Lats Dorsi (Back) is a horizontal shoulder extensor and Pec (Chest) is a horizontal shoulder flexor but both are shoulder internal rotators and adductors. Likewise Rhomboids (Back) are scapula retractors while the Pec Minor (Chest) is a scapula protractor but both are scapula downward rotators. The Lower Trapezius (Back) is a scapular upward rotator while the Pec Minor (Chest) is a downward rotator but both are scapula depressors. To add further complication, the entire kinetic movement could see one muscle indirectly couple with another muscle. During a high incline press for example the Pecs (Chest) et al., would be used to perform the Horizontal Shoulder Flexion and Shoulder Flexion while the Serratus Anterior would protract the scapula and couple with the middle and Lower Tapezius to add some upward rotation. What is needed is to correctly position the joints then continue to move in natural movement patterns and couples.

With your example I would look for a dysfunction (eg Poor posture = testing = tight restrictive Pec Minor, Lats Dorsi and Upper Traps, winged, elevated and protracted scapula), then look at how to treat the dysfunction while training the client (So active posture engaging the Middle Rhomboids and Lower Traps to reposition the scapula may be a good start - with coaching this will deactivate the Lats [which often will globally activate to try and draw the scapula down and in] as well as reciprocally inhibit Upper Traps and Pec Minor)…then once they can hold this position move into a complimentary exercise that would counter the cause of this restriction - eg too much sitting in a flexed position = increase extension and external rotation patterns for the upper limbs and extension patterns for the lower limbs - if they are really restricted you can add flexor stretching into the movement pattern by performing a modified stretching regime of agonist contraction, antagonist stretch (ie adding a stretch to the tight muscles that have been reciprocally inhibited by the agonistic muscle contraction).

In conclusion, look for postural and movement patterns to counter any concerns and enhance the overall physical status of the body. As a basic start use Figure 2 and shade in the movements mostly performed by your client in ADLs (Activities of Daily Living) and in training (sport or personal fitness work) - Do some areas appear to be dominant?

I have tried to keep this short and succinct (so I left out rehabilitation specific stuff like Isolate and Integrate), let me know if this clears up your question. In closing this may have raised more questions - which is great - because the one thing I have found is that the more I learn - the more questions I have. So, if you have more questions please ask. Fun In Training. Rob

Hillman, Victoria | 30 Jan 2010, 22:22 PM

Hi Rob

you have discussed in your article that most programs include chest and back exercises but they don't actually help to counter-balance those muscle groups. Grateful if you could give some examples of what exercises you prescibe to counter-balance the use of the chest muscles (I'm thinking use of the posterior deltoid & lower traps??). Thanks Victoria

Orr, Dr. Rob | 30 Oct 2009, 21:48 PM

Hi Callum, Thanks for the comments. Regarding the rational regarding the plank – my key point is ‘why is it prescribed?’ Is it prescribed as a core exercise? I hope not as there is little evidence that it is actually training the core (esp in large groups without a trained physiotherapist providing constant feedback) – remember stability and rigidity are not the same. As mentioned in the article, ‘more often than not, the plank does NOT train the core. In fact, for many if not all people, the plank/prone hold detrains the core. Holding the position is too intense for the core muscles, and as such, the obliques and even rectus are often employed in a long phasic contraction.’ When assessing some fitness clients using real time ultrasound in a physio clinic we found that the external obliques and rectus abdominals would contract strongly and the transverse abdominals in some patients (esp back pain patients) would not even contract – thereby teaching a pattern that we try to avoid as phasic muscles try to take on a tonic role by holding a long phasic contraction. Unfortunately, the phasic contraction contracts too strongly (as these muscles are designed to generate force) and the muscles fatigue rapidly, leaving the back unprotected. Watch anyone holding a plank exercise for a period of time, the majority will ‘break’ at the hip and the hips will sag or bridge as the phasic muscles can no longer hold the position and the position is too intense for the transverse muscles (and even multifidus which must pick up the load to prevent a translation of the vertebral segments)…this leads us back to the ‘why us it prescribed?’ Rigidity does have its place. The exercise is very useful in improving push up ability in the military as often the soldiers have weaker trunk rigidity than actual upper body weakness and by improving their ability to maintain the correct ‘flat’ position for the push up, they can complete more push ups. As for the ‘not finding much support for dropping this exercise’ there are still people who prescribe shoulder press behind the head and loaded pec decs which was generally considered as a potentially harmful exercise in the late 90s, there are also coaches who still perform knee and neck rotations, which were considered as potentially harmful in the late 80s early 90s. Another point to remember is that often the general floor knowledge of the fitness industry is around 5 to 8 years behind the research. A research paper will take around a year to write, another year to publish, 3 – 4 years to make it into the latest text books and another couple of years to make it into teaching manuals-and this if the course providers are proactive and up to date. Finally, I don’t believe there is a need to drop the exercise, as I mentioned I do still prescribe it for military soldiers, what I do believe is that it needs to be prescribed for the right reason. Hope this helps the thought process. Fun In Training. Rob

Martin, Callum | 29 Oct 2009, 22:59 PM

Interesting article with some good thinking and ideas but I'm unlcear on the rationale regarding not using the plank. I can not find much support out there for dropping its use.

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