posture assessment

What I learned in 2013

Each year I like to reflect back and summarize some of the ideas or concepts that I have learned over the course of the year.  Realistically, most of these are evolutions of my thoughts rather than brand new concepts, but regardless, represent some of my current thoughts and things I am teaching on how I approach rehabilitation and performance training.

Here are a some of the concepts that I think were important to me in 2013.


Alignment First

One of the key concepts that I discussed in Functional Stability Training of the Lower Body was that alignment is important, and in fact, likely one of the most important things to first consider when designing your programs.

In fact, earlier in the year I wrote about the old debate of “which comes first, mobility or stability” where I openly felt the best answer was “neither!”  If I had to order my priorities, I would say it would be “alignment, then mobility, then stability.

Realistically, mobility and stability should likely be developed in tandem, but alignment always comes first.  If not, you risk encouraging compensations and training the wrong areas by working on mobility out of alignment.  In this posture photo below, you can see that there are several deviations from neutral and symmetrical alignment.

posture assessment

Unfortunately, most of the exercises and stretches we use are built using the cardinal planes of motion, however, our bodies are not neutral or symmetrical.  As an example, stretching the hamstrings in the sagital plane is fine if, and this is a big “if,” your pelvis is neutral and symmetrical.  It likely isn’t.

While we have done a great job as a profession moving away from machine based exercises that lock the body in a specific plane of movement, you have to also wonder if double limb exercises like barbell bench press and back squats are too restrictive and force the body to move both limbs with the assumption neutrality and symmetry.

There is always going to be a great time and place for exercises like these, I’m not saying not to squat!  But this concept strengthens the idea of assuring that single limb exercises are a major component of your programs as well.


If You Focus on Movement Quality First, Everything Gets Easier

This concept is something that I have been following for over a decade now, but is something that I wanted to focus on sharing more through my education this year as I am seeing young professionals continue to miss this point.

Don’t get caught up on designing programs based on focusing on muscles.  Rather focus on our body’s basic movement patterns – squat, lift, push, pull, carry.  Many of our professions greats, like Dan John, Alwyn Cosgrove, Mike Robertson, and many more have driven this point home well in their educational programs.

But one thing I would add is that you also work on movement quality in all of these movement patterns rather than just strength in these planes.  As Gray Cook always says, don’t put strength on top of dysfunction.  Don’t just pick exercises to get these movement patterns strong, add self-myofascial release, dynamic warm up, manual therapy, and corrective exercises to improve each of these movement patterns as well.

For those working with people in pain, worry first about enhancing movement rather than reducing pain.  If you have a huge loss of shoulder mobility, as an example, you can treat the shoulder pain all day but will find little improvement without also focusing on the things like soft tissue quality, glenohumeral arthrokinematics, and thoracic mobility.


Design Your Manual Therapy to Enhance Movement and Your Corrective Exercises

I have been pretty open about the fact that I think I really missed the boat very early on in my career regarding soft tissue and manual therapy.  My mentors and background were based on exercise science and biomechanics.  While this background is fantastic and effective, enhancing my manual therapy skills every year has really improved my outcomes.

I use soft tissue techniques and manual therapy to enhance movement quality.  That is a really important concept.

I am not just “massaging” someone as a fluff treatment, my intent is to help them move better with less pain and restriction.  This is why I may be working areas throughout the kinetic chain that are far from the location of symptoms.

This goes for both manual therapy and other tissue quality techniques like self-myofascial release.  Trust me, I know there is no way that rolling on a foam roll releases your fascia, realize it is just a popular “name.”  However getting someone actively engaged, reducing tone, and decreasing any perceived threats with movement are all great reasons to use things like foam rollers.

Think of manual therapy and self-myofascial release techniques as ways to enhance movement and your corrective exercises.


You Still Really Need to Know How to Treat a Joint

Here is the flip side to the above point regarding focusing on movement quality.  At the risk of contradicting myself, I also am seeing another new wave of young professionals.

These are those that have gone to every trendy continuing education course to learn a new system like FMS, SFMA, DNS, and PRI.  Don’t get me wrong, I have gone through these courses myself and have really benefited from these concepts and recommend them all.  However, I really feel like some of the younger professionals are getting a little too caught up at times and may miss the boat.

I think it is great you are trying to stimulate the diaphragm or working on enhancing breathing patterns for someone with shoulder pain, I do too.  However there is one very important concept I would add to that:

You have to know how to treat a joint!

Don’t forget this simple fact and get caught up in the latest trend.  Integrate all these great new concepts into your thought process but don’t forget the fundamentals.


I hope these few things that I have reflected on will help you also reflect on what you learned this year.  In fact, I want to hear what key concept your learned this year that has really influenced you, perhaps you’ll teach me something that I can include in next year’s article!



7 replies
  1. Dillon Smith
    Dillon Smith says:

    Another great article. I am one of those young professional who did get caught up in what new “trend” can I learn next. I have been following you for the past few months and just by reading your articles and doing more research I am finally starting to hone my skills as an athletic trainer. I am also a big believer in manual therapy. I was with a professional football team and most of the stuff we would do would be fluff, “feel good” and was mostly a waste of time. I thank you for what you do in guiding people to evidence based practices and giving options.

  2. DrNotley
    DrNotley says:

    Great article Mike. I’ve gone full circle in my clinical experience from using exercises as a form or rehab to soft tissue/manual therapy and back to exercise but this time as a form of corrective exercise.


    Interesting round up Mike. I especially relate to your latter comments about the potential for over focusing on one particular system. The old saying that there are many ways to skin a cat becomes more and more evident as one’s career develops.
    In the UK, the ‘market’ for osteopaths and chiropractic in certain parts of the country is becoming saturated and the temptation is to specialise as soon after graduation as possible! No substitute for learning, reasoning and time. Excellent post.

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