Female Mobility Case Study

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This “Mobility Case Study” is on my pal, the beloved Tamara. Many of you know who she is because she posts on the internet at least 37 times a day. I think some of you misunderstand her because you think she’s a pain in the ass. In any case, she likes me because I’m a pain in her ass (figuratively, not literally).

Tamara has a host of mobility issues that I can sum up in saying that she’s “jacked up”. Not in that “she’s so muscular” kind of way, but more along the lines of “she moves like James Harrison was getting paid to hurt her” kind of way. Let me show you:



In this picture you can see her toes out, knees tracking in, left knee shifting medially, and her right knee pushed forward inside of her right foot (with the assumed collapsed arch in the feet). Nonetheless, she’s decently strong for a 36 year old woman with a history of knee problems and only lifting for a couple of years. Tamara is primarily an Olympic weightlifter who front squats and low bar squats a lot. Recently she hurt the radial ligaments of her right wrist while missing a clean. As a result, she can’t rack a front squat without pain and has been using safety bar to squat. This flared up her peroneals (lateral portion of the shin) on her right leg. She also has a pretty crappy bottom position in the snatch.

Here are some videos of a heavy clean, snatch, and front squat — you can see how the mobility limits her. She’s losing a lot of her force application due to the inefficiency. In other words, all of her strength is not being applied to the specific movement of each lift.

This stuff is hard to talk about in text, so I made a video that analyzes Tamara’s faults and provides a “mobility prescription” on what she needs to improve. There is a short and long version. The short version is just the intro and the summary; the long version shows all of the elaborations on what she needs to do (it’s specific to her, but will apply to everyone else).

Short video:

CONTINUE READING

Long video:


Tamara’s chronic positional issues need to be rectified if she’s going to improve her lifting efficiency. She can address the specific acute instance of peroneal pain by working on the peroneals, but she needs to address the underlying cause by improving her mobility in her hips, knees, and ankles. I recommend that she:

– work on her external rotators with a lacrosse ball (while keeping the hip in flexion, like the bottom of a squat) for at least two minutes each side, every time she trains

– use anterior joint distraction at her hip with a band for 1 to 2 minutes each side (and each leg), contracting and releasing her glute and “exploring the joint capsule” (as Kelly says) to find her tight spots. She can also contract the glute and then a) sink the hips forward or b) rotate the torso to find her end ROM

– use the two couch stretch variants after doing the joint distraction. This will free up the muscle belly of the quadriceps so that the couch stretch opens them up better. There are two variants: a) keeping hands on floor, torso horizontal and sink the hips forward with contracted glute and b) posting up so that the torso is vertical, which will open everything up from the hip to the knee. In both variants, keep the lower abdominals tight to avoid anterior hip rotation.

– Tack and stretch the supra-patellar pouch of the distal quadriceps (right above the knee and patella). This helps alleviate tension at the knee from the superior aspect (above it).

– Anterior and posterior joint distraction at the ankle while going into dorsiflexion and lightly pushing the shin lateral with respect to the foot

– Lacrosse ball work to free up the foot arches while using foot strengthening exercises to help establish the arch integrity over time.

Tamara has a lot of stuff to work on. Typically these things are important for everybody, but they are more important for her since her lack of mobility is causing problems in other places. In this case, her lack of hip/knee/ankle mobility is causing peroneal pain due to the weird knee torsion that occurs. If she works on them diligently, we can expect her to improve her overall ROM and subsequently the efficiency in her lifting.

43 thoughts on “Female Mobility Case Study”

  2. Tamara we have alot in common.

    A)similar lifting numbers
    B)mobility issues
    C)both screamers :-)

    Nice lifts. I’m working like crazy on my mobility as well. Look forward to seeing your progress.

  3. There you go Tbone. Get after it!

    Nice Post. Question about mobbing, since it’s related. I’ve looked around, but without bands it seems like a bitch to get enough leverage to successfully work on ankle mobility with actual weight. Any suggestions for achieving this without ordering from rogue/jumpstretch?

  5. Looking forward to the videos….after I go heavy with front squats/cleans, I have really bad pain in the peroneals for a couple days. To the point where I can hardly bend over/squat at work(which I need to do a lot), as the pain is so intense. I quit squatting as frequently due to this issue…

    I’d be surprised if you didn’t have something similar to Tamara going on where the knee tracks inside the toes and is forward with a collapsed arch. If the ankle is in forced eversion, this would not only put the peroneals in contraction when they shouldn’t be, I could see how it would pinch down on the proximal peroneal nerve (posterior and lateral aspect of the knee).

    –Justin

  6. I forgot to add, that randomly my left leg will go somewhat numb from the knee down, on the peroneal side…it can vary in time and is quite annoying.

  9. Wait, that hit by Harrison wasn’t clean?

    Interesting stuff on foot angle while walking. My right foot kicks out and I’ve been trying to correct it for years- tough to do.

  10. angdesj and TBone: I’m a grunter, not a screamer.

    Unnecessary/unrelated: I’m seeing more tanks at my gym these days. No soffes, though. LAME.

  12. Next Monday dedicated to screaming,shrieking,yelling,grunting and other vocally related weightlifting videos.

    I gots tons of them. Likely compete with a tennis player in that arena.

  14. All those problems can be and usually are caused by weak glutes. Those soft tissue recs will help acutely but not long term and not as significantly as proper glute strengthening would.

    This is very common with right handed people, left leg is stronger but inhibited right leg is weaker and is strained trying to keep up with the left.

    Good glute activation will fix all that quick.

  16. @dmichell are you suggesting she begin including Glute leg lifts or Glute ham raises as accessory work. @Justin would it also help if she start hanging out in the bottom of the squat or do the squat against the wall with a band stretch that really helps me to loosen my hip capsule in order to reinforce that qood positioning

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  18. Nice post Justin. I suffer from the same mobility issues with my knees and foot arch collapsing, although only really in the snatch. I’ve been mobbing, but I will add that lacrosse ball to the external rotators today.

    One thing I might add is to address adductor tightness if there is any. It’s a big limiting factor for me. I use the squat with feet up against a wall and band for joint approximation. Another K-Star favourite. Some soft tissue work with a barbell to the medial thigh is also pretty effective.

    @enlightenedsnipe The guys over at California Strength do this stretch where they get into a squat position and hold a barbell on top of their knees so that the weight carries the knees over the toes. It is their recommended ankle stretch. If you go to their website, there is a video of it.

    Tom

  19. About 2mins in to this vid for the adductor stretch.

    http://www.youtube.com/watch?v=703zuQptNRU&list=FL1cjH5sfbIZgItl6ccT68eg&index=10&feature=plpp_video

    @enlightenedsnipe here’s the stretch video

    http://www.californiastrength.com/videos/viewvideo/50/cal-strength-exercises/flexibility-exercises-for-the-lower-body-in-olympic-weightlifting

    On the topic of mobility, this blew my mind the other day. A 190kg squat jerk from a 69kg Chinese lifter. Go to about 8.30.

    http://www.youtube.com/watch?v=OQ625YEQqlI&list=FL1cjH5sfbIZgItl6ccT68eg&index=1&feature=plpp_video

    That’s the kind of mobility I want when I grow up

  21. Saying glute strength should be examined, would bet on a significant weakness right vs left side.

    There is no mobility problem, all those problem areas will disappear with some good quadraped glute activation progressing to glute bridging.

    Right glute weakness will cause the body to look elsewhere for strength, deep external rotators are strained, quads are strained, it band is strained, peroneals are strained and even feet. All those areas are fine just glute weak. If you think about it, it makes sense. What are the odds of all these individual problems on the right side, makes more sense one very large problem.

    This is my thought, I could be wrong, often am.

    You’re suggesting that these problems will suddenly go away if she starts doing glute bridges…? Yes, that is wrong.

    If she is incapable of externally rotating properly (for a variety of reasons), then her gluteals won’t receive the force distribution like they are supposed to. I guess you didn’t watch the video to note her positional problems, as well as the probable anatomical assymetry from her childhood that allow or help her bad positioning. In other words, if a person cannot achieve a proper position to use their gluteals most efficiently due to a lack of mobility at the hips (in this case on the anterior and lateral aspects), “strengthening them” with glute bridges (which would be a poor way to strengthen them anyway) isn’t going to fix the problem.

    I’m beginning to think “muscle weakness” people are looking at the wrong end of the barrel.

    –Justin

  22. Great post. Really good information in the videos. I felt kind of bad for her after reading the first 2 paragraphs, but then it came around.

    @enlightenedsnipe I like the ankle MOB where you drop into a squat and rest a barbell on your knees to force more dorsiflexion. I’ve seen it on Cal Strenght and some Catalyst Athletics articles.

  24. I know, im saying the exact opposite, all the soft tissue people are looking at the wrong end of the barrel.

    I guarantee you that glute is weaker not because of positional issues but because its just weaker.

    Your approach that thorough with no activation work at all?

    Ive had several clients with the same issue, its always the right leg.

    And its not really that her right leg is weak, just weak relative to the left.

    I agree getting the soft tissue stuff out of the way is key but if you go lift after that your just going to create the same issue all over again.

    Soft tissue, mobilize, activate the glute properly then lift, and probably take the weight down a bit while getting the glute strength and activation to improve, she needs to stick with a weight that does not exacerbate her problems for at least a few weeks.

  26. I don’t understand the glute mumbo jumbo that you guys are discussing, but I have a hard time believing that my right leg is weaker than my left in the way you are describing.

    My right knee turns in. That is something I was born with and was in a brace for as a toddler (which did not resolve the issue). I am right leg dominant, played competitive soccer and used that leg much more, have previous torn cartilage in that knee as well as a host of other knee and ankle injuries primarily to my right leg in about 15 years of soccer.

    Two years ago, I tore my left hamstring tumbling. That side was significantly and noticeably weaker for over a year. I can do a pistol on my right leg – at one point when I was a psycho CrossFitter, I could do many – but I don’t think I have ever managed to do a pistol on my left leg.

    And, my lack of ankle flexibility was the first thing that was noticed by every single person who had coached me in weightlifting as well as my physical therapist. Working on ankle flexibility immediately made a difference in my bottom position, which used to be much, much worse than it currently is.

    Just some background.

  27. In competitive soccer you kicked with your right leg planted with your left. Your left leg dominant because it is what your body chooses to plant with, but that doesn’t mean it functions better just that it is stronger all things being equal. If you had to jump off one leg you would use your left.

    Tearing your left hamstring is indicative of improper recruitment patterns. The hamstring in that situation may have taken on stress meant for the glute, ive had the same issue myself as a basketball player.

    When you go to do a pistol, you need good access to your glute, your right, while weaker, has better access to the glute, the left is stronger but has improper movement patterns using the hamstring instead making a pistol much harder. Your IT band is also tighter on your left side making it harder to place stress on your glute.

    But the pistol is asking function at least in your case, strength doesn’t seem to be the issue with a pistol for you. How else do you explain being so much stronger on your right except when pushed to your limit on two legged compound exercises? That left side is an issue too with its inhibition, you need glute activation work on both sides.

    Its funny, everyone has a story about why their legs function the way they do. I was in a car accident, I was kicked by a horse, I broke my leg as a teenager, thats the side I carried my baby on etc… but in my experience those traumas and actions never seem to change the fact that with per our most primitive of midbrain functions. Right arm and left leg go forward, left arm and right leg go back.

    If you are a true righty, you are left leg dominant. Don’t confuse function with strength.

    Do you have or have you ever had any shoulder problems?

  28. If right arm and left leg go forward, then why do I jerk with my right leg forward? Or is that different in your world?

    Tearing my hamstring is indicative of tumbling (read: gymnastics) totally cold when you are over 30. You’re an idiot if you think otherwise.

    I am not trying to explain shit other than the actual facts of what has happened to me in my life: brace, previous knee and ankle injuries, etc.

    You watched about 30 seconds of video on me, and yet, you think you know more about my movement patterns than people who have worked with me for a long time. I am not saying anyone is right or wrong. Who the fuck knows? But, Justin has surely spent more time talking to me about all of this and has watched a lot more of my lifts than you have. And, my PT has worked with me on lifting specific issues for over a year now.

    The only shoulder problem I have ever had was messing up my shoulder from kipping muscle ups when I was a CrossFitter. But, I would love to hear how glute activation played a role in that.

  29. In any case, Justin, thanks for doing this. I hope the video is helpful for other people. Now that I am out of the wrist splint, I am back to low bar squats instead of the SSB. My peroneal nerve is not feeling like utter and complete shit anymore. As I start adding front squats back in, we shall see what happens. It is probably going to be a while before I am racking heavy snatches and cleans, but I hope to have an even better bottom position by then, of course.

  30. Gotcha. Not trying to start trouble, but if the route I’m mentioning hasn’t been tried, it wouldn’t hurt to. One last question, which shoulder did you hurt?

  31. I am not saying that I am not going to try other options to improve my lifts. But, you also have to realize that this isn’t something I sit around obsessing about every single day. Justin and I were talking about something completely unrelated, and I happened to mention that my peroneal nerve had flared up due to the SSB. He is a super dork about this kind of stuff, and he ran with it.

    Why don’t YOU tell ME which shoulder I hurt, what the MRI said was wrong, and why that shoulder was injured in particular…

    If you can answer that, you will be the SAVIOR OF CROSSFIT. No more shoulder injuries due to kipping! Think about it. That could mean big money for you.

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  33. I was just curious… could be reasons for either… Or could be traumatic injury nothing to do with anything… I like to connect the dots, but it doesn’t always work out.

    Right shoulder. Supraspinatus.

  34. Left shoulder. Probable SLAP tear according to MRI done without contrast. And, since I never had an MRI with contrast or exploratory surgery, it shall remain a mystery…

  35. Damn. Oh labral tear.. I see.. I didn’t really think I could figure out the shoulder injury BTW just took a stab. Dont want you to think I’m psychotic. B

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