It must have been the summer of ’93, maybe ’94. I was 14 years old and playing basketball a lot. And I really mean a lot. Just shooting some hoops, playing little 3 on 3 games, jumping a lot (forever trying to do my first slam-dunk) and generally hanging around the court. But we also practiced purposefully and mindfully at some times, mimicking moves our NBA idols used in their play. Or at least we were trying.
But most certainly we were learning. And learning in the most natural way. Mimicking expert models, exploring different options, getting feedback from friends on how it looked, getting feedback from the result, sometimes literally falling, but getting back up and trying again, and again and again. For an outsider it could have been seen as hard work, which sometimes it was, but for us, it was play. And as I said, we learned a lot. Some new moves, new ankle breaking dribbles, a no-look-pass, a fade-away-jumpshot from the baseline. But we also learned what was not possible, what was out of our reach (at least temporary, we thought…).
I did not know anything about motor learning and motor control, about biomechanics, about anatomy, about muscle physiology … But I still changed my motor patterns and got better. Then came a time to go to university, and study all those subjects with great interest, but (almost) forgetting what I knew from basketball practice:
If you want to change your movement patterns, you must change your movement patterns! *
This seems like a very stupid thing to say, and actually it is, but it in physical therapy it is a necessary thing to say. Let me give you an example:
I have been using these pictures for my students to make a point. Michael Jordan, arguably the best basketball player ever, probably one of the best athletes of all time and Shaquille O’Neal, giant, rapper, entertainer and superstar basketball player. Take a more careful look at their pictures and more specifically their shooting style.
Michael Jordan has his elbow right under his hand, which, when I was younger and playing basketball, was the correct way of taking a shot. If you look at Shaq, you see that his elbow is not really under the ball. For those who are not familiar with basketball, Shaq was not famous for his amazing shooting skills…
If my basketball coach saw me taking a shot like Shaq, what would his advice have been? If the elbow is too much to the outside, what would be the appropriate strategy to correct this pattern? I can tell you what his cue was: keep your elbow under the ball!!! I you do something that is not correct, then don’t do it!
Again, for some readers, this may seem very obvious, which of course it is. But let us now take another example. Somebody does a squat, or a lunge, or a step-up, or a drop vertical jump, and you see his knee going to the inside of the foot, which you consider to be less than ideal. How are you going to change this pattern? Think about it for a second.
In physical therapy circles, the answer often is somewhere along these lines:
– “Oh, the posterior m. gluteus medius is weak, so we should do some leg raising exercises in sidelying.”
– “No, it is not weak, it is insufficient in that range because it is too long, so we should train it with inner range holds for 10 times 10 seconds.”
– “Ok, but I think this exercise is better for addressing that problem.”
– “Yes, but, I could also be the m. tensor fascia latae that is dominant, so I would look for triggerpoints and treat them manually.”
– “Hmm, you could also dry needle them.”
– “Actually, have you tried foam rolling, because that is my preferred method, or even better, with a lacrosse ball.”
– “Still, my favourite glut med exercise is a supine bridge with one leg, where the pelvis has to be horizontal, it addresses all the core muscles at once.”
– “Ok, but I think we should not forget the m. transversus abdominis and the lumbar multifidi.”
– “Yes, and the pelvic floor…”
You get the gist. All of the suggestions from above have some merit, but what would my basketball coach say? Don’t do it! Don’t let that knee go medial. Simple as that.
Can you imagine a basketball coach change the shooting style by the following?
– “Let us look at the strength of you shoulder adductors and do some butterfly exercises.”
– “I would choose for an inner range hold exercise, to change the length of the m. pectoralis major.
– “Or we could do some scapular stabilisation work on a bosu ball.”
– “Let us not forget the m. longis colli…”
So again, if you want to change a movement pattern, then change the movement pattern, directly!
Now, I must say, many physical therapists do use this principle, but maybe not enough. They change a faulty squat pattern, or a bad lunge. But do they change the general movement behaviour? If a runner has knee pain while running, and if you change his bad squat and lunge, will this change his pain? Because then you assume a transfer of skill, from squatting and lunging to the running skill.
We can be short about that; it probably is not going to happen. I’ll get to that in the next blog, putting some science to back up my claims.
So, if you want to change a movement pattern, then change that movement pattern, as directly and specifically as you can. Try to forget about all the muscles, think in movement patterns. And do not only change the squat and lunge, but change the gait, running pattern, and sport specific movements.**
Thanks for reading and look out for more on this in the next blog,
* ‘If’ is an important word here. I’m not saying that we always have to change movement patterns (although I think that we ought to do this a lot). It is not so easy to say if a motor pattern is faulty. I don’t even like to use the words ‘right’ and ‘wrong’ for movement, I prefer ‘biomechanically smarter of safer’ for ‘right’. And some movement patterns can be wrong for most people, but for that person, in that situation, it can be the best option there is. It is useful to think of movements in terms of adaptation: is that movement adaptive or maladaptive (hat tip to Peter O’Sullivan and Wim Dankaerts)
** The subject of this blog is something I’ve been doing and teaching for a longer time, but I’ve been inspired for writing it down now by a presentation of a colleague and PhD student Bart Dingenen, who’s been doing some great work.