The Mobility Stability Model for Low Back and Knee Pain

Hey clinicians, before we start, I'm going to draw your attention to the premium version of the podcast that we have that we released back in January. It's going very well. It releases once a week and it's all the stuff that you care more about than some of the general conversation you might get in some of these free version podcasts. So it's about 15 minutes long. We do case presentations, all of the stuff that we tried, things that work, things that didn't work, and a little bit more specific to you and the things that you wish might be in there too. It's very affordable. You can quit at any time. There's a link in the description below.

Go check it out. You'll love it. Now onto the podcast. You're listening to the Restoring Human Movement podcast, where movement experts discuss the latest evidence-based practices to help you and your clients move with mastery. And now, your host, Dr. Sebastian Gonzales. Hey guys, this is Sebastian, your host with the Restoring Human Movement podcast. Thanks for joining the Movement Movement. Here's the first time on the show. Welcome. You've missed a lot of podcasts before. It's about 250, 60 different episodes where we've covered things from hips to low back to hip flexor to sciatica, foot pain, knees, you name it, any part of the body. We've covered a lot of different things. So we've had guests on. There's some solo podcasts just as such as the one today. Today, we're going to cover something called the mobility stability continuum or the mobility stability approach to training or even rehabilitation. There is a lot of information out there on this. I'm not going to pretend this is the first podcast or article that's ever been created on this because it's not original information. However, it's something that I think when we help people understand a little bit more so about how their body functions roughly from a mechanical perspective, then they get a little bit more empowered and understanding why doing more than just a local approach to something like a knee or a foot might actually be helpful. So this podcast is about a 30, 45 minute long type of format. It's intended for lay public. This is not clinical information and it's also not medical information for you guys. You should always be examined by someone who's qualified. As always, you can come see us if you want to. We're in Coastmates, California.

Love to see you. For clinicians out there, there is a premium version of the podcast where we go over things like clinical reasoning, orthopedics tests, neurological findings, why we choose what we choose, and basically how to rehab someone back into a normal life or a very active life, hopefully. So if you're looking for all the nitty gritty stuff, then it's right there. You just have to get access to it. It's all the way down to your podcast player. But lay public and actually probably new docs. This is probably going to be really good information for you. For strength coaches out there, if you haven't heard it before, it's good information. Now, years ago, I was familiarized with this concept that there was an alternating series of mobile and stable joints in the body. This is a very, very basic way of looking at the body. And I'm not going to say it's set in stone. And there is flaws in theory, but for the most part, it actually makes good sense. And so if you consider the areas of high mobility in the body, then you got to consider things like ball and socket joints, which are the easiest to think about when we're considering like, well, what is a mobile joint?

A mobile joint is one that has high capacity to move in different planes of movement. Um, there's three planes, generally three planes of movement. There's forward, backwards, there's side to side, and there's turning. Uh, you can recognize that when you bend forward and touch your toes and then twisting, like you're doing the twist and shout. And then like the lean side to side is if you're kind of leaning back and forth, like you're, uh, I guess you're maybe the boogeyman or, or the person under the bed who you'd kind of shuffle in like, you know, scare like your, your nephew or your niece. And so that's the frontal plane. And those are three planes of movement.

Now the body as a whole has ability to do a lot of ranges. It has a lot of what we call movement availability. And you might notice that like, so I have a new puppy. She's super mobile. She's like, Oh, I call it a wiggle worm. Like she just looks like almost when she runs to you, it's almost like her tail wags her. It's almost like she's just a snake. Um, she has, she does somersaults. Uh, when you kind of grab her on the bum, she turns around and puts her nose right on your, on your hand. Um, so she can chase her tail, grab her tail. Um, and she can probably lick every part of her body except for the area behind her neck and her ears. So she's extremely mobile, but all of that motion doesn't come just from one joint. It comes from multiple series. And if we consider back into just basic physics is that to produce movement, you need to have a stable area to move from, I'm going to say it again, to produce movement, you need to have a stable area to move from. Something has to be stable. That's the basics of it. And as I'm sitting here doing this podcast now, uh, I'm kind of in a scenario where I usually show some of our clients, uh, what I mean by this is whatever's more stable will not move. Whatever's less stable will move. And so I have this little rolly desk that I'm on, or actually probably the easiest thing is imagine I'm in a, um, so I'm in a little rolly chair, like, um, you know, like a regular chair, but with rollers on the bottom.

And so usually I'll go up to the wall and actually, sorry, I'll go up to, I have another rolly. It's like a standup desk. It rolls too. So we both roll the desk and the, and I roll. And so I'll push the table and I'll say, who's more stable, me or the table? And they say, well, you are, cause the table moved. The table is actually pretty small. And so then I'll scoot up next to the wall and I'll push the wall and I'll move. And I'll say, who's more stable, me or the wall. And they'll say the wall. And so stability is relative. Okay. Mobility happens when something else is more stable than it. And so this whole alternating series of mobile and stable segments in the body actually helps out.

And it helps out with your ability to move other joints of interest better. And you can move them better if you can create more relative stiffness in an area. Now the concept of stiffness has been actually the, I don't want to say the concept of stiffness has been kind of watered down, but like, there's like this stigma of stiffness. It's like, well, we need you to create some more stiffness. Well, I don't want to be stiff. I want to be mobile. It's almost like, you know, like when you kind of paint the picture of, I feel like it's, it's a lot of people in their thirties and forties, it's like, well, you know, what do you want out of, like, what do you want out of like physical activity?

Well, I want to be more flexible. You know, it's like, they're stereotypical, like the look at yoga and it's like, I need to do that. And I'm not quite sure why people will feel that way. I would imagine it's because they have some stiffness in their body that's uncomfortable, but stiffness is not always uncomfortable. Stiffness is actually helpful to actually increase mobility in the areas where they have stiffness. I'm going to say that again. So creating stiffness in the right areas will help out to reduce stiffness in other parts of the body where you might be having pain or injury. So I'll give you an example. It's really common to have piriformis pain or hip flexor pain or gluteal region pain, uh, kind of deep down in the back of the hip or in the front of the hip. And so a lot of times a really good starting point for rehabilitation is isometric core work or stiffness work of the core area around the spine, which a lot of these muscles, specifically the hip flexor, let's use the hip flexor because the best example in this, uh, the hip flexor is attached to the spine and it also attaches to the femur. It attaches to the thigh bone. Um, if you contract the muscle, depending upon which side is stiffer, it'll produce movement on the other one. So if it, if it, if it, if it's resides on the spine and the spine is not stiff in the leg area is stiffer than the spine, then the spine will move. But I think the reason why you probably want to, you, you probably won't, uh, want to address your hip flexors because it hurts when you actually bring your knee up or when you're walking and lifting your leg. So it might be easiest to create some decreased stiffness in the hip flexor muscle, decrease your pain overall in discomfort by creating more stiffness in the area of the body that actually is better equipped to produce stiffness, not necessarily the hip joint. Uh, now I should probably look up, I'll look this up here and I'm going to do a Dr. Google real quick, mobility, stability, uh, joints of the body and mobility versus stability joints. So I'm just going to click on Google images. I do encourage you guys to do the same. Um, so there's technical versions of this and there's not technical versions of this. Um, but you'll see a bunch of pictures and there's different areas that are kind of circled and some are mobile, some are stable, but I want you to notice is, um, there's one, this was a, by the way, this is created by Mike Boyle and great cook, I believe was a part of it. Um, but Mike Boyle is, uh, one of the contributors to it for sure.

And so there's pictures of the spine where you'll see circles of mobile and circles of stable. The easiest way to look at this is first from a spinal perspective. So if you look at the picture, which I do encourage you to pause this podcast and look at a picture, you'll notice that the upper neck is generally mobile. Uh, I apologize. There is a, uh, gardener getting closer and closer here, which you can never really tell when these guys are coming by, but, uh, I'll be, uh, I'll be a funny dude, but, uh, this is a free podcast. I do my very best to, uh, uh, actually, uh, he's getting closer and closer. Uh, yeah, I actually have a really good mic and even in the old office where I had the, uh, formal studio, I had a whole closet decked out as an actual studio that had foam on the walls and stuff like that. Even then, like it was really hard to control when fire trucks went by and stuff like that. So this ain't Joe Rogan's podcast. So I'm going to do my very best guys.

So the area of the spine, uh, especially the neck that is the most mobile of all of the neck areas is the upper few segments. And so if you see on one of these pictures, you'll see this little area right underneath the skull, which is circled, which is mobile. Uh, this is where I think of the estimate is 50% of your neck rotation and looking up and down comes from 50%. And there's a lot, there's, there's more than two of these segments. There's 70 segments in the neck. And so the remainder of the segments will come or remainder of the rotation and bend will come from those segments as well as other parts of the body. So let's just do the rough math here. Two segments do half the movement and the other five segments do the remainder of the half of the movement.

Well, we're going to classify the first two segments as generally mobile. They do have stability characteristics and properties, but they're generally mobile because they do a lot more mobility than the other areas. Now the other five segments just below it, just as it kind of inserts into the rest of your body, those ones are generally stable because they, they're sharing the load amongst a little bit larger area and they're just, they, they don't move quite as much. Um, especially in this triplanar movement. Triplanar means three, by the way. Um, if you go down, you'll see the mid back right around the rib cage, which actually has a lot of movement properties. Um, this whole mid back thoracic spine area is known to be, um, uh, an extremely mobile area. I think it's 45 degree rotation on either direction. Um, and if you look at the architecture of the spine, by the way, a lot of these will, um, the mobile state, uh, mobile stable types of, um, categorization is kind of based upon the architecture of the, of the, of the joints in the area. And so the architecture leads us to believe as well as movement testing people that the mid back area is extremely, extremely mobile below that is the low back, which is the area around the lumbar spine where people get disc herniations and all that kind of stuff. Um, that area is stable. And so I'm sure a lot of you have probably heard the term core stability. This is kind of what we're talking about. Um, this area of the spine should generally be stable. If it becomes too mobile, then it will start to become painful in those areas. Uh, I mean, it hurts when it becomes painful. So by no means do we really want this area to become too mobile.

So, um, the next areas we go down, which were kind of out of the spinal area, but, um, there is a conundrum, which is the SI joint pelvis area, which I'm not really going to go into today because it's kind of like a, uh, an area that doesn't really give, um, it kind of is a hole in this, in my opinion, um, because it's, uh, it's kind of skipped as you'll know. And the SI joint actually, um, has a little bit of play into it, but the area below it is a ball socket. It's a hip, it's a mobile joint, uh, in this area moves a lot. And actually there was a interesting, uh, um, presentation I saw where it was talking about the stability of the joint and are you able to dislocate it and stuff like that. And so they basically took a cadaver that took someone who was no longer alive and they put a ton of force through the ball socket joint of the hip. And when they take it out, you hear a, there's almost like a negative pressure in there. It's like a gasket and it's tough. So it's generally pretty mobile, but also has some stability properties into it too. So considering this before I go on too far down the rabbit hole, just consider that we have upper, upper neck, which is mobile. We have mid to lower neck, which is stable. And then we have mid back, which is mobile. And I guess we can break that into segments if we wanted to, but generally let's say mobile. We have a low back, which is stable. And then we have the hips that are mobile. And you see how these things are alternating at this point, hopefully, especially if you have a picture in front of you, uh, next, you go down to the knees. Those are generally stable because they don't move a lot in multiple directions. They move generally a lot into one direction, which earlier I mentioned that triplanar type of approach, the three joint, the three movements, um, or the three planes of movement. Uh, this is a simple hinge joint. So it does move a lot forward, backwards. I'm not going to disagree with that, but it does not move a lot in the other directions. And when it moves a lot in the other directions, people tend to have problems like meniscal tears, meniscal irritation, ACLs, and so on. And then you get down into the ankle, which is generally mobile because there's a lot of joints. Um, this is, um, not a single joint in there. There's many plain joints and so on. There's a lot of them which slip inside on each other. Uh, and there's a lot of movement in the ankle, generally speaking with people who have normal ankles. Uh, and then there's the foot, which is stable. Uh, if you went up into the shoulders, the shoulder blades are stable, the ball socket GH or glenohumeral joint, the actual shoulder itself is mobile. The elbow is just like the knee. It's stable because it moves a lot in one direction, but not the others. And then there's the wrist and so on, which is basically, you can almost mirror image like the ball sockets of the shoulder and the hip and just kind of put the hip or sorry, put the lower limb on the, on the arm. And then it's kind of the same thing. It's just different part of the body. So as you see, or hopefully as you see, there's a, there's an alternating series here, roughly no joint is specifically mobile or only mobile or only stable. And I'm not saying by any means that you don't need to, that you shouldn't produce any movement in your back at all or your lower back at all. Um, I'm just saying it might not be a good idea to always stretch it. So a lot of times people will end up having things like low back pain or knee pain, uh, or shoulder blade pain where they just end up stretching it a bunch. And according to this model, we have a need to stabilize the area, which can actually dramatically help out with local pain. I'll give you an example again. So we have that low back, which might respond better to a core stability approach. Uh, I think the foundation of pretty much most structured low back programs is to create some support. The multifidus, the QLs, the obliques, the abdominal wall, the internal hoop, which is like the hoop of the core, even internal pressure, the pelvic floor, the pelvic diaphragm, all these muscles are important to create stability within the area. Um, there is a need for things like tissue work sometimes or mobilization in certain segments, but generally speaking, um, if we were taking mobile and stable segments, if we said a mobile area became too stable, you might want to grease it up with a little bit of WD-40. If you had an area like a stable stable air, which became too loose, then you might want to put some duct tape on it. And so, uh, I mean, you kind of say like MacGyver can fix anything with WD-40 or duct tape. The same kind of, kind of approach can happen from something like a rehabilitation perspective. Back pain can be rehabbed very simply by just giving, uh, a corrective exercises and, um, other types of movement approaches. It doesn't require surgery, medications, injections, or even tissue work for that matter. Um, it might in some circumstances and not everybody's the same, but generally speaking, if we can create some stiffness or duct tape up the area that is not necessarily stiff anymore, then you might actually find some dramatic change. Now we have to consider the possibility of what the surrounding joints will do to the area. So if we have our stable joint, which has become painful, then we might have to actually offload some of those movement requirements by making other areas around it move better. Let me explain that a little bit. So if your hip had arthritis or say it was kind of not working or you had an injury to it a while back and it's just not working well, or it's not strong, then movement that was supposed to happen at your hip will start to move in other areas such as your knee or your low back. It'll kind of spread the load out because movement will happen. Kind of like if you're reaching up to grab a bag, uh, um, grab a box of cereal over your refrigerator and your shoulder didn't work, you would find some way you'd twist your body, you'd shrug your shoulder and you would get it right. Cause no one wants to starve movement will happen. And so the ways we can reduce pain is number one, stabilize the areas which are big have that need stability, but are no longer as stable as they should be. And the second thing is, is you can improve mobility in areas that need that, that, that are not moving well. We call these non-painful dysfunctional areas because the hip doesn't always hurt in the case of back pain, but it certainly typically helps if you add movement to the hip and you shift some of the responsibility back to the hip versus making the back work so hard. Um, that is the nutshell of low back and hip, um, ways that we can do this exercises that we really like with low backs are bird dogs, side planks or side bridges and, uh, things like hard style planks. Um, um, Stuart McGill did really great work in regards to, um, stabilization of the core area. And if you read some of his work, he has actually a great white paper on, uh, I think called it super stiffness, just type up Stuart McGill, uh, stiffness, and you'll find this PDF that pops up, which is really great. It's, uh, it's written in a really easy terminology to understand. Uh, and it basically goes over how some people can create a lot of super stiffness in the area and actually helps out with athletic athletic performance, but creating stiffness where stiffness is not really there can actually help out reducing back pain quicker than you ever thought possible.

Now ways that we usually will improve the hips movement is, uh, to decrease back pain is that we do things like banded glute bridges, which is why a lot of research over the years has found that glute stuff probably helps out with back pain, uh, disc, disc injuries, um, facet pain, um, nerve root pain, sciatica. A lot of these things will improve, uh, based upon this approach with small tinker, uh, tinkering points. Um, we also use things like split squats. Actually, this is why things like deadlifting or squatting can actually be a very critical part of getting you back into a point where you can do a lot of things that you want to do.

Teaching the body to use the hip again, especially with some load can really help out with creating, um, movement patterns that have been past compensated. Now, another example we can go through is the knee. This one has a little bit more of a, uh, well, actually let me default back really quickly into the mid back. It's actually really common for people with some low back pain that goes into the upper glute, the sacrum, or it just generally feels stiff. If there's nothing really wrong with the hip, which is on one side of it, you can actually deflect some of the movement back up into the mid back. A lot of times when people sit a lot, they have that mid back round.

I'm not saying the mid back round has necessarily has to change to make them feel better, but you meet, you might need to get more movement possibilities back into the mid back. And that simply comes back with exposure. And so you can just arch or bend over the back of your chair. So where your mid back starts to extend a little bit, which might help out with deloading some of the low back. And so that's another way we can kind of skin this. And so you can go up or below the area of interest for low backs. Now let's move on to knee because the knee is a really common one to, uh, um, it's, it's challenging for people to understand, which I totally get. Um, sometimes trauma is related to these, which, uh, there's usually something that will set the stage. Um, we kind of a saying that normal things that are normal circumstances won't necessarily hurt. Uh, abnormal things under normal circumstances will sometimes hurt and abnormal things under abnormal circumstances will probably hurt.

And so let's just say if you're doing something like running, you ran five miles and your right knee starts to hurt, but your left one doesn't, you might well, you might say, well, like it's probably the running. Well, the running was okay on the other side, right? It's the same amount of steps. It's the same amount of mileage. And so there was something else which predispose this to create that type of pain. Now, even ACLs, like there's a lot of predisposing factors, especially when women's sports, which can go all the way up into things like, um, hormones, um, uh, strength, cue angle, there's all these different things that are contributing factors. But generally if someone were to jump up and down a bunch of times and then their left knee started to hurt, there is, there's other things that are not necessarily painful, but are things that might be able to be, um, uh, addressed to decrease the possibility of that coming back again. Um, now once you have an actual structural problem, like say, say we're talking about the low back, if you have a low back disc herniation, not a big deal. It's really not that big. It doesn't need surgery typically, but if there's something like an extrusion or a larger level one, or it's actually created something like Caudi Aquinas syndrome, uh, or there's something like a, uh, spondyloptosis, uh, movement into, uh, like the vertebra actually physically sliding on each other. Um, or there's, uh, even sequestration sometimes of a disc. I think it's actually that those ones may actually resolve on their own. So there's things that at some point, the structure of the stable area might become compromised to the point where you might need surgical intervention, but that's not always the case. We see a lot of people with low back disc herniations and we've been seeing people with some extrusions, protrusions, uh, and things like that where actually they respond really well. Um, there's only a few things in history and exam that will guide us into, okay, this person needs surgery pretty quickly. And if they don't fall into those categories and won't necessarily do it, we'll rehab them first. And we'll take this mobility, stability, joint by joint approach to help out to decrease pain very quickly, decrease swelling very quickly. Um, and then deload the area and incorporate normal movement patterns back and get the air to be strong again, get the body to be strong again. Now let's go back into knee. I apologize to jump around a little bit. Now with knee, we can also talk about those structures that might need some surgical interventions, like an ACL that's been completely ruptured or a PCL or something like that. Like then, yeah, that might be something that has to be readdressed. Even large meniscal tears, um, are ones that might need to be readdressed. It's probably important to note there's many different types of meniscal tears or meniscal phrase. And sometimes the meniscus is just generally sensitive.

Sometimes swelling can be things like from chondromalacia patella or wearing underneath the kneecap, um, that just creates some irritation and local swelling within the knee. Um, typically if you don't feel a big pop and then immediate swelling, usually it's something lower grade, like a meniscus or something like a, uh, like a chondromalacia, like chondromalacia patella runner's knee type, if you will. So, um, it's important to note that most knee cases are actually rehabilitation, rehabilitation cases until, until, uh, proven otherwise. Imaging as well as with the low back. With the knee, it's important only if it's important and it provides extra information, which is helpful, but it's not a smoking gun either way either. The indication for having surgery typically comes along with history and exam findings, not necessarily with an image. Um, I, I, it's one of my pet peeves about people getting images done and then deciding surgery based upon an image. Um, there is stuff in the image, which can be very revealing, but very rarely is it something where like, okay, it's no need to do it. We need to do it right now. You know, um, things like infection, uh, and tumors and things like that. Like those certainly those are, you got to address those very quickly, but usually for just like a basic need that, which is has ups and downs. It has, has days where it has pain or swelling. Then there's days where it doesn't, uh, there's things that bother it. Like walking is okay, but bending it fully is not okay. Um, going down onto your haunches, like you're, you're, you're kind of like on the ground with like a puppy and then your heels are to your butt. That hurts, but it, it, it feels better when you shake it off. Like with those fluctuations, typically it means there's not a pure inflammatory aspect to the problem, but there is a mechanical aspect. And so we can do something similar to like what we did with the low back is we can create stability locally around the knee or synthetically, uh, synthetically or internally. And then we can also offload the knees movements that we don't want it to do too much of at the moment, especially in the directions where it's not tolerant of anyways, and doesn't have a lot of movement availability, such as, um, the side to side and the turning. And we can shift those movement requirements back into areas that might be deficient. Um, you can actually have even a trainer assess some of your movements into your hips and ankles with something like simple, like a functional movement screen, uh, physical exam can do it as well. But if there's movement lacking in an area like a hip or an ankle, or even the opposite side, then you're still going to continue to put movements into areas of the knee that aren't tolerant of it. And it's going to be very hard for it to resolve because you keep poking the bear ways that we can stabilize the knee come in a few situations is we can provide external support, which is something like taping, uh, tab taping, or even things like, uh, even a knee brace. Uh, they do this with post-op ACLs and they give them those robo knees. That is knee stabilization. Uh, it's external obviously, but they will remove it to provide some internal, uh, yourself stabilizing the area within a rehabilitation setting. Typically, I believe they'll start with isometrics, non-movement contractions and find a range of motion that really doesn't bother your knee, but then load the musculature around it. Cause the whole point of the musculature around it is to help stabilize the area and produce some movement. But again, this is a sliding paradigm, um, stable, more, it's more stable than mobile, generally speaking. Now that is a way to stabilize the knee, but only stabilize, stabilizing the knee is just part of the puzzle. If you only stabilize the knee, you're not going to get everything you need to out of this. It's, it might come back. As I mentioned before, you did the same amount of mileage on one leg versus the other. So why this knee? So it's better to figure out the dysfunctional, non-painful areas that might be contributing to that knee working so much anyways.

And the hip and the ankle on the same side are the first things you should look at. And the opposite side are the other things you should look at. By the way, if your knee didn't swell, you might consider actually that it might be coming from the spine. In that case, a nice common ground is that hips. That's a really great starting point. So, um, I'm trying to think of a good, easy way to, to, to show this. I know I do, I do have a YouTube video on it where we talk about a knee collapse. Oh, you know, actually I know a really good way. Uh, I want you all to stand up and if you're not already, and I want you to actually then sit down. Um, just notice standing up, sitting down, and how your knees kind of track on their own. Do they go inward? Do they go outward? Does one go in and one stays tracking norm, uh, kind of like front and center? Uh, and then I want you to actually bring your knee inward, stay seated, bring your knees together and notice what happens to your hips. They move, right? Notice what happens to your ankles. They move, right? And so the movement inward, the caving of the knee, we call this a valgus collapse, um, couples with also failure to keep, um, stable or, uh, failure, failure to keep position in the hip and the ankle. And so a lot of times when you see people with like have big injuries of the knee, like ACLs and things like that, um, soccer thing, uh, soccer and volleyball, basketball, you'll see this horrific, uh, knee inward kind of turning thing where you're like, Oh gosh, that's, that's a bad thing. And so if you consider it, obviously there are circumstances where people get fallen on, but most ACLs and knee injuries in this fashion are, they're non-traumatic. The person does it just by landing or turning.

Um, so think about if those areas above and below could have kept integrity, would this collapse have happened? Would the structure itself had to, had to do that much work that would the ACL or the meniscus had to do that much work with the knee have to do that much work to keep its, uh, itself together if the other areas would have done their jobs? Probably not. Everything in the body, everything in earth has this load tolerance. Uh, there's a, there's a door in front of me. If I kick through it at some point, if I kick hard enough, I'm going to go through it. It has, it's fine how it is, but under abnormal circumstances, it's going to fail. And just as I mentioned earlier, uh, normal things under normal circumstances are fine. This door will be here for a very long time.

Abnormal circumstances with even normal structures will make it. So they will fail or make may fail because enough kicks might finally get through it. I remember the shining, like they came through with a, he had to hit the, hit it with the ax quite a few times and then it failed. Um, but if I had a broken door in the first place or it hadn't like rot in it, I'm pretty sure a very nominal kick or an ax would probably take it down. So if you have a limb that is under abnormal circumstances or it's abnormal because there's areas like the hip or the ankle, which you're not working well, then your knee, which might be completely normal might start to fail. But if the knee itself had a predisposed problem, like you heard it in high school and now it's a thing, uh, you, it's kind of like been a week for a long time, an abnormal hip and abnormal ankle and an abnormal knee together is probably going to be a problem. Now we can do our best to rehab the area by stabilizing the knee. But again, I'm going to say it over and over again, you need to address the hip and the ankle. And the cool thing is if we go back to the very first thing that I mentioned in the podcast, or at least one of the first things was I talked about physics, whatever's more stable will allow the other area to produce movement better. And so if our goal of the knee is to locally stabilize the knee, but also to get better movement in areas above and below it, such as the hip is above it. How do we get better movement in the hip? How do we get better function in the hip? Well, it has to have a mobile, a stable area to, to move from, which is the core. Right? So there's a saying, the body's one unit because the body's one unit.

It's very hard to isolate down. Like we're just only going to do knee or only going to do back or only going to do shoulder rehab. If you don't address the areas around it, you need to address the areas around it. And this might look like things like you go into a rehab facility where you have knee pain and they start with your low back core. And you're like, why are we doing this? It's because they're starting from a stable point and to produce movement, better movement or support in the hip and to produce, or I take that back there. They're, uh, starting with core stability so they can help with hip function so they can help reduce triggering events on the knee. It's as simple as that. And the cool thing is, is that core work will help out with hip stuff. Uh, core work can help out with, um, neck stuff. It can help out with knee. It can help out with groin. It can help out with a bunch of things, especially if it's spinal referred like things like sciatica, hamstrings, quad strains, it can help out with a lot of it. So, um, it's a little bit hard sometimes as a healthcare provider or trainer to go into all the weeds. Cause this would have been already a 30, 40, 40 minute, uh, discussion before we actually physically do anything in your session. So I hope this is a good introduction into how the body works and why you might actually find people like your trainer, your strength coaches, your, uh, exercise coaches, your personal training. I think I said personal trainers, but you're a physical therapist or chiropractors or whoever you're working with might be starting with an area that doesn't completely make sense to you, but hopefully if they can say, look, it all starts here. Either number one, your option is the number one, trust them. Or the second option is to kind of understand some of the basics of how the body works together.

The body is one unit. So the mobility stability approach by Mike Boyle is, is well published out there. Strength does come into this paradigm as well. You need to have strength in the body as well. Having just a mobile or just, just a stable body is really cool until you the wind hits you and then your house of cards. So you need to be able to keep the stability and the mobility when under load or stress as well. Um, I like to think of this as a, um, uh, I love the movie Ford versus Ferrari. Uh, they made a really great Ford vehicle, the Shelby. And so he took it on the, on the, uh, the backstretch and he took it over red line. Now that's considered load. The areas of the body, which need mobility and stability are all good until you put load on them. So sometimes you need to train for load and the body will start to adapt. So I'm sure the car was fine tuned, but it wasn't really tested in the load, which is why that was a challenging part of the movie is because we didn't know what was going to happen. So if you want to expect more things out of your body, like being able to run, being able to do triathlons, lift weights, um, play baseball again, then you're going to have to possibly load test it. And that is the value of having somebody like a strength coach or someone coaching movements with you. I'd love to say it's, um, physique. It's not, it comes down to function. If your goal is to actually be someone physically active, it should come down to function, not physique. So I hope this was helpful to everybody. Um, this, this principle can be applied to multiple parts of the body. It just wasn't in the context of the, um, of the podcast today. Uh, I do have some videos on YouTube about this. Just go on to our, um, uh, just go on to YouTube and put in performance play sports care.

Uh, if you go under our channel, there's a search bar and just look up things like, uh, uh, mobility stability, and you'll find a bunch of, uh, videos that I've created on this room for multiple different topics. So hope that was helpful to you guys subscribe to the podcast and, uh, hopefully we'll see you next time.