I am seeing more and more social media rehab and fitness gurus promoting the ‘don’t load a dysfunction’ message and it annoys the hell out of me. Personally, I think this mantra displays a complete lack of understanding around the complexities of human movement, the uncertainties and the multifactorial nature of injury, pathology and pain. Not to mention that no one and I mean no one can tell you with any certainty and even less robust evidence what is a movement dysfunction actually is.

I also think this message has negative and even harmful ramifications for many people who exercise and even more annoyingly creates unnecessary barriers and restrictions to those who don’t exercise. So I want to spend the next 10 minutes explaining why I think these influential well known, and highly respected therapists and trainers are barking up the wrong tree with this message, and make the case for why I think we should actually load so-called dysfunctions.

Loading Dysfuntion

The main issue I have with this ‘don’t load a dysfunction’ mantra is that it assumes we know what is and what isn’t ‘dysfunctional’ movement. Despite many claims, we actually have very little evidence that tells us what movements, tasks, or activities are bad, dangerous, harmful, or dysfunctional.

When it comes to observing, assessing and quantifying movement quality “beauty is in the eye of the beholder” meaning that what can look ugly and feel problematic for one person, can look and feel great to another, and vice a versa what looks pristine and perfect to one person can feel like a hot mess to another.

The notion that these so-called ‘experts’ can tell what is good or bad, normal or abnormal, functional or dysfunctional movement just by observing it is frankly nonsense. This overly simplistic and reductionist way of thinking about and classifying human movement based on individuals observation alone needs to be questioned and challenged a lot more.

To put this as clearly as I can… human movement is highly complex and variable due to many factors. Human movement is a dynamical system that is influenced by things, such as, but not limited to, 1) individual factors, such as their age, morphology, genetics, experiences, and so on. 2) the task, such as load, intensity, complexity and so on, and finally, 3) the environment they are doing the task in, eg is it observed, competitive, poorly lit, smooth or uneven terrain etc etc etc, ad Infinitum.

The Individual 

When assessing any movement we need to recognise that we are all different shapes, sizes, and have different angulations and lengths of our bones and joints. Because of this, we can not all move the same. Variations in skeletal structure and geometry such as limb length and joint angulations will influence how someone moves. For example, femoral length, as well as pelvic geometry, affects how an individual squats (ref, ref).

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Just because some guru with a touch of hypermobility can fold up like a deck chair when they squat doesn’t mean you will be able to if your bony geometry won’t allow it! Just because some Supple Leopard can reach up between their shoulder blades and scratch the back of their own eyeballs, don’t think you will be able to if your shoulder and thoracic bony geometry won’t allow it (ref, ref).

It is important to recognise that what may look like a ‘dysfunctional’ movement could be due to very non-modifiable genetic and or skeletal factors. This is difficult to determine clinically without a lot of detailed, expensive, and unnecessary scanning and imaging, but it should always be considered nonetheless.

Of course, more adaptable and modifiable soft tissues can influence how someone moves, but many movement gurus ignore the non-adaptable, non-modifiable factors when trying to get their so-called ‘dysfunctional’ subjects to work on things they will never be able to achieve. This is clearly not helpful and possibly even detrimental as some can, and do, get highly fixated, frustrated and disheartened by their lack of progress trying to imitate a flexible guru with completely different anatomy.

The Task

Our movement is also largely affected by the task being done, and again this tends to be ignored or forgotten by the movement gurus. For example, how an individual bends over to pick up a box of tissues of the floor will be, and should be completely different from how they bend over to pick up a concrete slab or a 150kg barbell from the floor.

Having someone move the same way regardless of the task is simply batshit crazy, yet something I see being promoted by these movement gurus. You simply do not need to bend over the same way to do everything, in fact, this is inefficient and ridiculous.

You do not need to brace your abdominal muscles and pelvic floor, focusing on keeping your spine and pelvis in neutral, setting your scapulae back and down before you reach to pick a box of tissues off the floor.

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However, advocates of ‘functional’ movement tend to promote just this, that everyone needs to keep their movements perfectly aligned for everything and anything. Rather than helping people this can and does, actually make many worse as they become focused, stressed, worried, and even hypervigilant on small, tiny, innocuous things and tasks that are just not something to be worried about.

Movement variation is actually something a lot of movement gurus don’t understand or feel comfortable with. This is a shame as movement variation, within reason, and depending on the task and the load is far more useful in most circumstances than movement restriction (ref, ref).

This is NOT to say that we should NEVER give people any movement constraints, or that we just recommend they move around like headless chickens whenever they want. In some situations, in some circumstances, it can be very helpful to coach and constrain some movement variations and advise an individual how to more ‘efficiently’ during some tasks.

However, some of our most common assumptions about the risk of injury and pain on movements are being challenged more and more, with studies in occupational manual handling showing our postural alignment and lifting advice may not be as helpful as we first thought, and may even be harmful. (ref, ref, ref, ref)

The Environment

Finally, we need to consider the environment as a confounding factor when we assess movement. As therapists and trainers, we often assess people moving in controlled, constrained, and ultimately false environments. Therefore any of the so-called movement dysfunctions we may or may not see here, may or may not occur in other settings or environments. We also need to recognise that just the effect of observing a subject move will affect how they move.

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For example, how normally do you think a patient will be moving when being scrutinised in a cubicle, or gym when they are half undressed and feeling a little anxious or nervous? Do you think you will see the same movement strategy will be used when a subject is asked to perform drop landing off a box whilst being observed compared to when they are on a cold wet football pitch on a Tuesday night in Stoke, jumping for a ball whilst dodging an opposing player?

It’s not that simple!

So hopefully I have highlighted how movement is based on many factors and what we think may be abnormal or dysfunctional could be normal and even advantageous due to the individual, the task, or the environment.

We also need to recognise that the evidence tells us many of the so-called and believed movement ‘dysfunctions’ we see in people with pain and disability are often seen in those WITHOUT any pain or disability. Things such as lumbar spine lordosis, thoracic kyphosis, scapula dyskinesis, knee valgus, femoral head CAM deformities, are all seen in many people without any pain or pathology.

We also need to recognise that what we often think are movement ‘abnormalities’ or ‘dysfunctions’ may actually be optimisation strategies in the presence of pain, fear, or a lack of tolerance and capacity. Personally, I think this is one of the most common reasons I see people moving differently or awkwardly and this is what we should be focusing on more.

Why I load ‘dysfunctions’

Often it’s not the movement that needs to be corrected, it’s the lack of confidence or tolerance to it that does.

This is why I load and strengthen so-called ‘dysfunctional’ movements. I have come to realise that if I focus more on increasing an individuals capacity and tolerance to an ugly awkward looking, so-called ‘dysfunctional’ movement, often it soon stops looking as ugly, awkward or ‘dysfunctional’.

I didn’t improve this dysfunctional movement with any specific motor control drills or fancy coaching techniques, I just gave confidence and reassurance to the individual to keep trying and built up their capacity and tolerance to that movement. I let their experience and neuromuscular system gradually self organise and find its most efficient and preferred strategy to get the job done.

However, I have also found that the ‘ugliness’ of a movement often does not change with continued experience and exposure, but that also doesn’t really matter to me either. As I said at the beginning ‘beauty is in the eye of the beholder’ and who am I to say what is an ugly movement or not.

All I’m concerned about is does this movement feel comfortable, natural, and efficient to the person doing it? I don’t care what it looks like that much. As far as I am concerned you can have the ugliest looking movement as long as you are confident, comfortable, and have the capacity, both physically and psychologically to tolerate it!

Summary 

So that’s my two cents on why I load ‘dysfunctional’ movements and why I disagree with many of the social media ‘movement’ gurus on this topic. Remember that there is little evidence to say what is and what isn’t a dysfunctional movement despite what these gurus say, and for me, the most functional movement anyone can do is one you don’t have to worry about.

As always thanks for reading

Adam