December 2020
What Is Functional Movement?
Functional movement means moving in ways that mimic the everyday things we need to do, such as walking, lifting, carrying, pushing, pulling, sitting and standing, bending, or getting on and off the floor. Functional movements involve moving the body as a whole, not just as isolated parts. It involves using multiple muscle groups, and often in more than one plane of movement. Functional movement often includes weight-bearing through the upper and lower extremities, as well as resistance strengthening throughout your body, both of which are important for bone growth and health. (See my Blog on Bones: https://www.brainbodysynergy.com/post/bones).
Move Like The Animal You Are, Play Like The Child You Were
Even before becoming a physical therapist, I have always exercised and loved being physically active. I even wanted to be a professional wrestler at one point (I sent an audition video in to MTV’s Tough Enough competition). However, it was when I started practicing kung fu that I was introduced to new ways of moving the body. We focused not only on different movements associated with kicking, punching, and blocking, but also the many animal styles that are part of our system, including snake, crane, tiger, eagle, leopard, golden rooster, and monkey. Many of these styles involve movements that we also perform as humans, as we are, after all, animals too, including rolling, crawling, squatting, lowering and rising. Animals perform whole body movements to accomplish specific tasks, such as obtaining food, or escaping from a predator, not to sculpt their quads. They even perform whole body stretching, or pandiculation, which involves contracting a set of muscles, slowly lengthening them, and then contracting them again to a rest position, and often involves yawning (which is also a form of pandiculation). Many of us have seen our cats and dogs perform it (think of downward dog), and it is actually performed in all mammals and most vertebrates, such as birds.
Dog: German Shepherd
Cat: Leopard
Bunny:
Chipmunk:
In addition, these are also movements, positions, and activities that we performed as kids, such as rolling from our stomachs to our backs, pushing up to elbows on our stomach (planks?!, push-ups?!), deep squatting to play with objects on the ground, crawling before we walked, walking before we ran, kicking or throwing a ball, riding a bicycle, and hopping, which is also involved in skipping and galloping. These are all movements and activities that engage the whole body and require coordinated effort by multiple muscle and nerve groups in the body. They are a complex set of skills that we learn as we develop and age; however, as we get older, a lot of us lose the ability to perform some of these motions and actions. The main reason some of us can’t do some of these any more is because we stop doing them.
Why Is Functional Movement Important? Use It or Lose It. Train For What You Want To Be Able To Do
Use it or Lose It. That phrase applies to most things in the body, including strength, range of motion, balance, and cognitive function, to name a few. As we get older, our lifestyles change, which often involves more sedentary behavior due to school and work, and less play, for many reasons, including increased work, lack of time, injury or disability. Over time, we can slowly lose the ability to get into or out of certain positions, because we stop doing them. However, if we keep doing these activities, positions, and movements, or start doing them again once we’ve stopped, we improve our ability to keep doing them, which in turn continues to improve our overall strength, mobility, health, and function.
Train for what you want to be able to do. As many athletes know, if you want to be good at a specific task or skill, you need to practice doing that task or skill, in varying conditions, speeds, and positions. It is the same principle for being able to do, and continue to do, the things in your life that you enjoy, such as taking a walk, hiking, running, skiing, gardening, picking up your children or grandchildren, and even the things you may not want to do but have to, such as household chores, taking out the garbage, or shoveling snow. There are other actions we do on a regular basis, such as lifting something heavy overhead, yard work (think raking, sweeping), or moving furniture, that also require sufficient stability and mobility to be able to perform with ease and without injury. If you participate in a sport, such as tennis, golf, soccer, cycling, or rowing/kayaking, practicing the types of movements that make up these activities improves the ease (and fun) with which you do them. Working on maintaining, or improving these skills helps ensure that we will continue to be able to do them. You can hone these skills not only by practicing them with good technique, but also by incorporating these movements into your workouts.
To improve and maintain our ability to move properly and functionally, we need not only strength, but also range of motion, and balance. Even seemingly simple activities that we may take for granted, such as sitting and standing, can deteriorate in quality, for example not being able to get out of a low chair, or lower yourself to a low toilet with control. I often hear people say that they avoid doing squats, or think that they are not capable of performing them, however sitting and standing, actions we perform all day long, are actually functional squats, and learning to perform daily activities with control improves muscular strength and endurance, as well as motor control and balance. Being able to get on and off the floor may not seem like a big deal, until or unless you are not able to do it, and then it can become a source of fear. Literally practicing getting on and off the floor improves your ability to do it safely, while strengthening the whole body at the same time. Move It or Lose It also implies to our bodies, across the age spectrum.
Sit to Rise Test
As mentioned above, being able to get on and off of the floor is an important skill we may take for granted until it actually becomes difficult for us. In fact, inability to get on and off the floor is related to risk of falling. There is a functional assessment test, the Sit to Rise Test, which looks at a person’s ability to sit on the floor criss-cross style and rise back up again, including how they perform this task. The test is out of 10 points; you get 5 points if you are able to sit without using any support (hand, forearm, knee, or side of leg) and 5 points if you are able to rise without using any support. One point is subtracted for use of each support.
There is a study from 2012 that has gotten a good amount of attention over the years regarding this test. A Brazilian physician and researcher in exercise and sports medicine found that participants with a score in the low range (0-3), had an associated 6-fold higher all-cause mortality. This is a rather drastic, and perhaps anxiety-inducing conclusion, as it indicates that your ability to perform this test well is associated with your lifespan. An article from The Washington Post that came out in 2019 took a deeper dive into this topic, discussing limitations of the study – most of the people who scored the lowest were between 76-80 years old, a group that generally experiences decreased mobility and coordination. Additionally, the 2012 article did not reveal the causes of the 159 deaths during the follow up period, thus they could have passed away from other causes, such as complications from falling, cardiovascular disease, or cancer, to name only some. They discussed that, as many of us are aware, correlation does not equal causation – for example, having a bad knee or shoulder does not mean that you are going to die soon. They also highlighted some of the other measures physicians and clinicians use to assess health. These include a study from 2019 that found that the ability of middle-aged, active male firefighters to perform 40 push-ups (compared to less than 10) in a 10 year span decreased their risk of cardiovascular disease. They discussed 2 studies showing that walking speed has been correlated with lifespan – the faster you walk, the longer you live, as well as risk of death from cardiovascular disease – again, faster is better. Another study showed that decreased hand grip strength (measured by a dynamometer) is linked with higher percentages of dying from any cause, including heart disease, stroke, and heart attack.
So what is the take away? If you cannot perform the Sit and Rise Test with a perfect 10, do not fear; chances are it does not predict your eminent death. However, it is never too late to start practicing. If the method used in the Sit to Rise Test is too difficult or painful to perform now, try performing it in a different way that feels more comfortable and appropriately challenging, such as moving onto your side, then hands and knees, then kneeling, then standing. With practice, you can improve the ease with which you perform it, how many times you can perform it, and how you comfortable you feel performing it. Being able to lift and control your own body weight, which is at the heart of functional movement, is a vital life skill not only for safety, but pleasure.
Think About Your Workouts Differently
There is nothing wrong with wanting to sculpt and tone your muscles so that they look nice, and it’s not bad to do bicep curls, or tricep extensions, or leg presses. However, most machines at the gym were designed to strengthen one specific muscle or muscle group, and often not in the ways that we actually use these muscles functionally. If you are not already doing so, it is a good idea to start to incorporate at least some functional movements into your exercise routine, in order to strengthen and mobilize your body for the activities you want to do. In my humble opinion, I also think they are more fun, because they get the body moving, blood pumping, and nerves firing more than single body part targeted exercises, and you don’t need much or sometimes any additional equipment other than your own body to perform them.
According to the fitness world, there are 7 “Functional Movements.” I will discuss them below (the first seven listed), as well as some other key movements I think are important; however, functional movements are not limited to these. As discussed above, any movement that involves the whole body moving in ways that mimic everyday things we do, is considered functional. For each type of movement, I will briefly describe what it is, how it relates to everyday life, and a few examples or variations of exercises.
Squat: A squat is essentially bending your hips and knees with feet hip width apart, as if sitting down. Squats strengthen the muscles in your hips, glutes, and legs, including quads and hamstrings. Sitting and standing are the prime examples, including standing from a low position, getting up from a low couch or chair, or sitting on a low surface with control.
Examples: Air squat (only body weight), front squat (holding a weight or bar in front of your body/against your chest), back squat (holding a bar behind your body/upper back), one-legged squat, sit to stands, one-legged sit to stands
Lunge: A lunge involves placing or stepping one foot forward/backward/laterally and slowly lowering the body with control, bending both knees. Lunges strengthen the muscles in your hips, glutes, and legs, including quads and hamstrings. Unlike squats, lunges are performed one leg at a time, thus are a good way to improve single leg strength, balance, and coordination. We perform lunge-type activities such as lowering the body to pick something off the floor, such as groceries or laundry, and raising the body up from a kneeling position.
Examples: Stationary lunge, forward lunge, reverse lunge, lateral lunge, walking lunge
Hinge / Bend: There are many variations of hinges or bends, and when done properly, they predominantly strengthen the muscles in your posterior chain, including the back, glutes, and hamstrings. It is important to keep the knees bent, the abdominals and gluteals tight/engaged throughout the motion, and to “hinge” from the hips, not round the back. Throughout the day, we bend over for various reasons, such as getting something out of the fridge or a low cabinet, picking up or putting down a light object from/on the floor, even picking up or putting down our children. A majority of the time, we simply round the back and fold forward with straight/locked knees to perform these motions, as it is easier and doesn’t require much thought. This type of movement, especially when performed quickly, can strain tissues in the low back, leading to pain. Learning to move properly and strengthen the correct muscles that are meant to perform these actions can prevent or improve injury.
Examples: Romanian deadlift, bench hip thrust (weighted bridge on bench), kettlebell swing
Push: There are many different types of exercises that involve pushing with the muscles of our upper extremities and upper body. We also do many activities throughout the day that involve pushing, such as pushing open a door, pushing a cart or stroller, moving household items, even vacuuming. When it comes to exercise, it’s a good idea to think about working in both the horizontal and vertical planes. Additionally, though these are upper extremity dominant exercises, it is important to also stabilize with and utilize strength from the core and lower body.
Examples: Horizontal: Push-ups, planks, straight punches; Vertical: Overhead shoulder press, wall balls
Pull: As with pushing, there are many different types of exercises that involve pulling with the muscles of our upper extremities and upper body, and many daily activities that involve pulling, such as pulling a door closed, pulling a trash bag up from the ground, pulling a heavy yard waste bin to take out to the curb. And as with pushing, think about working in both the horizontal and vertical planes and don’t forget to incorporate the core and lower body.
Examples: Horizontal: Seated row, bent over row; Vertical: Pull-ups/chin-ups, active bar hang, lat pulldowns
Twist: While excessive twisting, especially when carrying a heavy load, can put increased stresses on structures in the body, including the spine, many of our daily activities involve some degree of twisting, such as reaching or looking into the back seat of the car, turning to pick something up or lower something to the ground. Learning to perform these motions with proper control and stabilization not only improves your strength and movement, but can also reduce risk of injury.
Examples: punch twist (moving a weight from one side of the body to the other in a seated position with knees bent), standing resistance band rotation, standing bar twist, bicycle crunch
Walk / Carry: Walking and carrying are sometimes grouped together, as in order to carry, you need to be able to walk. I recommend working on walking as its own skill, and carrying as another skill, as you can focus on different aspects of the task more pointedly.
Walking: Our bodies were designed to be energy efficient, and it takes extra cognitive and physical energy to think about and change the way you walk. However, with a little extra effort, you can improve your technique and feel better during and after walking, as well as get the brain and body juices flowing. Tips to think about while walking:
· Heel-toe: Make sure to pick up your toes when you walk, i.e. avoid shuffling. In the gait pattern, we strike first with the heel, which gives the brain and body important information about the surface you are walking on, then lower the toes to get ready for push-off. Picking up your toes also decreases your risk of tripping/falling.
· Arm swing: Most people have at least a little bit of natural arm swing. This helps propel the body, keep our trunk upright, and improve our balance. Increased arm swing can also improve blood flow and cardiovascular benefits of walking.
· Upright trunk / postural awareness: Gravity is always pulling us down, thus we need muscular control and endurance to help keep us upright. Postural muscles are not just in our abdomen, but all along our spine. I often teach my patients to think about a plumb line pulling you straight up – this helps engage all the postural muscles throughout your body
Carrying: As with pushing and pulling, there are many variations of exercises that involve carrying. We carry things all day, light and heavy, and even carrying light objects without proper stabilization can lead to imbalance throughout the body and sometimes pain. Additionally, due to the sometimes awkward shape or nature of what we are carrying, we carry things in different positions. Learning how to carry weights of different sizes and in different positions helps improve our strength and balance for when we have to use them in real life.
Examples: Farmer’s walk/carry (holding weights in both arms down by sides), suitcase carry (holding weight in one arm down by side), racked carry (holding a weight at shoulder height), waiter’s walk (carrying a weight above your head), sled pulls/pushes
Beyond the Fitness 7: A Physical Therapist’s Insight
Rolling: You may not roll on the floor much; however as a baby, you used to roll a lot. Rolling as babies helped develop the muscles and coordination needed for future skills, such as getting off the ground. Given the right surface, you can start rolling again! Rolling involves rotation of the trunk and body, weight shifting in our lower body, and coordinated movement of the head, neck and upper body. Working on rolling can help improve skills for rotationally-based sports such as golf, throwing, and tennis, and twisting-based sports such as dance, gymnastics, and skating.
Crawling: Crawling is another skill we mastered as babies, and may not perform significantly as adults; however you may have found yourself crawling on the floor to find something that rolled under the bed or couch, or as you clean your floors by hand (does anyone but me do this?). Crawling is thought to be the foundation of our gait (walking) pattern, and helps tones muscles throughout the body, as well as improves core stability as well – think of a plank with movement.
Step Ups/Downs: When given the option, take the stairs! Not only do we go up and down stairs throughout a typical day, but also curbs, ramps, hills, and mountains if you hike. Improving your ability to elevate and lower your body with a single leg is an important functional skill and a great strength builder. Performing step ups and downs more slowly is more difficult, but also improves motor control, balance, and can decrease chances of discomfort in the knees.
Hopping/Jumping: Hopping and jumping are also skills we learned as children, including skipping and galloping. Jumping improves coordination, which can also help reduce your risk of injury, and promote cardiovascular health and bone density. If you have osteoporosis or another condition that increases your risk of fracture, you want to avoid high-impact activities. Examples include jumping jacks, jumping rope, high skips, hopping over an object with one or both feet at a time.
Swimming: Not everyone lives near a body of water, thus swimming may not be an essential life-skill for everyone. However as humans, swimming is an activity we perform for fun, and sometimes, hopefully rarely, if ever, for life-saving needs. Swimming is a great whole body, functional exercise. Swimming is predominantly a cardiovascular exercise, like running, though the resistance of the water can provide some strengthening effects.
Where to begin? Pick a few of these movements that seem the most fun or easy to start with. You don’t have to perform all of these movements every day, though hopefully they provide some food for thought to spice up your exercise routines. We tend to like to do what we are good at, and we are definitely creatures of habit. It is important to challenge not only our bodies with our workouts, but also our brains, so that they both grow, which involves learning new skills and movement patterns. What is it that you want to be able to do better, or be able to do again? Start slowly and simply, and with time, you can move like the animal you are, and play like the child you were!
References:
6. https://geriatrictoolkit.missouri.edu/srff/deBrito-Floor-Rise-Mortality-2012..pdf (Ability To Sit and Rise From the Floor As A Predictor of All-Cause Mortality)
7. https://www.washingtonpost.com/lifestyle/wellness/this-anxiety-inducing-fitness-test-purports-to-tell-you-how-long-youll-live-we-investigated/2019/03/18/0a1d06fe-4035-11e9-9361-301ffb5bd5e6_story.html?outputType=amp (This Anxiety-Inducing Fitness Test Purports To Tell You How Long You’ll Live)
13. https://www.insider.com/benefits-of-jumping-rope
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