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by Rebekah Grube
Published on June 1, 2018

If you want to lift heavier, squat deeper, run faster or push past plateaus, are you doing all of the necessary things to get you there? If you are prone to injury, have you considered that you don't prepare your joints well enough for the 'workout of the day'?

Most people know that they should warm up prior to physical activity, yet it’s surprising just how few do it or if they do, how little effort they put into it. Personally I’ve never liked the term, “warm-up”. To me, a “warm-up” makes it sound like all you need to do is get your blood pumping and increase your heart rate a little. If this is your perception of what a warm-up’s purpose is, you are missing the point and likely downplaying the importance, probably going about it with careless, unfocused movements or worse, you might be skipping it altogether. Unfortunately, this mindset has been a factor in leading many of my patients towards injury.

During an initial consultation with a new patient, I will typically question them about their activity level and ask them to describe what their warm-up looks like, including any mobility work or stretching that they do prior to a training session. Recently, I met with a patient who had been suffering with chronic shoulder issues for the previous year and a half. He couldn’t remember injuring it, yet with increasing frequency over the last year, he had experienced pain and weakness when performing certain lifts in the gym. The problem progressed to the point where he couldn’t lift the loads he used to and occasionally experienced a “dead arm” sensation.

As a clinician, when someone comes to you in pain without any associated trauma or injury, your thinking start to look towards mobility dysfunctions or other adverse compensations of the musculoskeletal system. Instead of asking “what happened?”, we start investigating behaviors that could have led to the issue at hand. During my conversation with this patient, when I inquired about his warm-up and what he did for movement and joint prep on his lifting days, he admitted that his warm-up consisted of just a few minutes on the elliptical and doing some arm circles.

Listen to me…if this is what you deem an appropriate way to prep your body heading into a high intensity or strength training session, you are just asking for an injury to happen sooner or later. It might not be a traumatic injury like a muscle tear or joint dislocation; rather, it might be in the form of chronic pain that slowly increases over time and ultimately debilitates you.

So why is it so important to take your warm-up more seriously?

As I eluded to at the beginning of this blog, I stated that I don’t love the term, “warm-up”. I think movement prep or joint prep more accurately describes what this period of time preceding the bulk of our training sessions should be called. There are several reasons for implementing a good warm-up…many of which you’ve probably heard before, but the one I’d like to discuss is joint preparedness.

For any movement to occur with the least amount of stress on your body as possible, your joints must be functioning optimally. This means that the hardware of your body – which consists of ball-and-socket joints, hinge joints, mortise joints, etc. – must have minimal restrictions and maximal usability. The majority of restrictions and tension we feel in our joints are due to physical changes in the dense, fibrous connective tissues surrounding the joints; this is referred to as the joint capsule.

The capsule is extremely adaptive to postures, positions and repetitive movements we do day after day and can thicken or become fibrotic in certain areas while concurrently thin out and weaken in others. Even if you exercise, you may not be incorporating enough variability in your movements to prevent a joint capsule from becoming dysfunctional. Doing the same repetitive movements like running or cycling day after day or never changing up your routine - ie. doing the same 12 strength training exercises - week after week WILL result in tissues adapting to those movements and those movements only. This is bad because as these adaptations progress, they will slowly start to alter how your bones rotate, spin and glide upon each other and eventually lead to pain, inflammation or worse, injury.

If you begin a training session with less than optimal joint tissues and you do not then adequately prepare them, that joint will NOT move in an optimal way and therefore will alter the way in which you can perform a specific movement. For example, if you have a chronically tight shoulder and you never do anything about it, over time the ‘ball’ of the joint won’t be able to fully rotate inside the socket. I see this all the time and unfortunately when people head to the gym and do something like an overhead shoulder press with a shoulder that can’t get into the proper position, something else WILL compensate. What once was a smooth, pain-free shoulder press is now becoming an ‘arch-the-back so you can stay upright because your arm can’t get straight overhead all by itself anymore movement’. Oh…and it’s now painful. Joint restrictions can be subtle – and just a few millimeters of motion lost in a joint can translate into pain or result in huge adaptations of other areas of the body not prepared for the unexpected loads newly placed on them.

Now that I’ve covered WHY movement or joint prep is necessary, I’ll briefly explain the three primary methods I try to include before a strength training session.

1. Controlled articular rotations (CARs). Like I’ve stated, stimulating the deepest layers of tissue around a joint should be prioritized. We do this with CARs which are slow, purposeful movements of the joint at the outer limits of a joint’s range of motion. Think of arm circles or hip circles but slower, much more controlled and isolated to the joint WITHOUT compensations or movements of other parts of your body. I’ve attached an instructional video below for you to get the idea. You can do these rotations in every major joint of the body. I typically do 2-3 rotations in each direction, increasing the intensity of my effort and expanding the ‘circle’ with each other. Once I’ve completed the rotations, my warm-up will take on a different look depending on the movements I plan to train that day. If I’m doing squats, I will place more focus on spine and ankle mobility as well as hip external rotation. If I plan on deadlifts, hip and spine mobility is key but so are my shoulders. Latissimus recruitment is essential with deadlifts after all. View this link for examples.

2. Isometric contractions at the end ranges of motion are the best way to maximize motor unit activation and to teach cells what lines of stress to realign tissue fibers in (directionality). Muscle fibers which are arranged in parallel bundles and free of fibrosis or scar tissue respond the best to loads placed on them. Here is a couple of videos demonstrating isometrics for internal rotation of the shoulder.View this link for examples.

3. Movement ‘play’ where you explore joint and whole body movements isn’t very structured in nature but encourages moving joints throughout their ranges of motion with increasing complexity. Not only is it a great way to prepare for complex and functional movements but in doing so, you’re also providing yourself valuable feedback about the readiness of your body that day. The more that you become attuned to how your body feels and responds on any given day, the more specific you will be able to direct your training. Some days you might need more time for preparation and some days less. Some days you’ll be pleasantly surprised and realize a GREAT training day is upon you and other days, your warm-up will tell you that your body isn’t functioning optimally enough to do the training you intended and you need to readjust. Here's a short video demonstrating how I prepared my hip joints for squats one day. View this link for examples.

I used to be that person that jumped right into my training sessions without adequately preparing my body. Pressed for time, I thought that it didn’t matter and that it was more important to get in all my intended exercises for the prescribed sets and reps.

Besides, I wasn’t in pain so what did it matter anyways? Now that I have made this a more intentional part of my training, I see that the benefits extend even into my performance. No longer am I distracted or limited by the stiffness or achiness of my joints. With healthier joints moving as they should be, my muscles are freed up to do the work THEY are supposed to do. I can actually FEEL my muscles working and I’m lifting heavier loads with MUCH less effort than I used to be. If you want your body to functional optimally during your training sessions, begin with just five minutes of joint prep and you’ll start to see your entire body move better and perform better.

Those precious 10-15 minutes at the start of your workout should be focused on exposing your joints to end ranges, to get you more balanced and to get you moving in ways that you otherwise wouldn't be moving. Long-term, doing those things is going to get you to squat better, lift heavier, run faster so that in the future you will be able to do all the things that you're currently unable to do. A warm-up isn't always going to consist of things you WANT to do but it offers you the opportunity to work on the things you NEED to do ultimately teaching you to WANT to do it.

If you would like routines for how to prepare specific joints or regions of your body, you can enroll in one of the Motion Health Workshops found on Healthe at Cerner Portal. Navigate to Register for Wellness Classes. Under My Progress & Plan, scroll down to Wellness Workshops and click on Manage Workshops. Scroll to Motion Health workshops where you can choose from five different workshops available. You can also reach out to me or one of the ATC's on my team for ideas of how to warm-up for your training.

Move well and move often, my friends!

-Rebekah