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Just move it & that’s it

Simple, easy, exploratory movement is the best basic therapeutic exercise. No philosophical, spiritual, and cultural baggage. No gurus or teachers or best-selling books. No fads or controversies. Just get moving.

Mobilize!

Dynamic joint mobility drills are an alternative to stretching that “massages you with movement”

5,500 words, published 2004, updated 2012
by Paul Ingraham, Vancouver, Canada bio
I am a science writer, the Assistant Editor of ScienceBasedMedicine.org, and a former Registered Massage Therapist with a decade of experience treating tough pain cases. I’ve written hundreds of articles and several books, and I’m known for sassy, skeptical, referenced analysis and a huge bibliography. I am a runner and ultimate player, and live in beautiful downtown Vancouver, Canada. • full bioabout SaveYourself.ca

Mobilizations are basically active or “dynamic” stretches and rhythmical movements that “massage” your muscles and joints with movement — wiggle therapy. The currently sexy technical term is “dynamic joint mobility drills,” but I prefer my simpler term mobilizations. By any name, it involves a lot of moving a joint through its full range, without resistance — an easy exercise.

“Mobs” can warm you up gently, gradually expand your comfort zone, relieve tension and perhaps muscle knots, and facilitate healing. Mobilizing is an extremely easy form of therapeutic exercise, easily fine-tuned for anyone, which can be used to efficiently stimulate specific tissues with just the right amount of activity — not too much, but enough to facilitate healing. “Motion is lotion,” as the old rhyme goes.

A great deal of scientific evidence suggests that movement, especially early in healing, is a crucial part of recovery from injuries and surgeries. This is known in the rehab business as “early mobilization.” I also routinely prescribe mobilizations for:

These additional applications are all somewhat unconventional and generally unproven, although the rationale is sound and the exercises are free and safe. In this article, I will explain why you should mobilize, and of course how.

Motion is lotion.

— timeless wisdom

The origin and ultimate reason for the brain’s existence is not to help us think or feel or create art, but to control the movement of the body.

Todd Hargrove of BetterMovement.org, nicely paraphrasing Daniel Wolpert’s TED talk, The Real Reason for Brains

Table of Contents

Early mobilization — a critical rehab concept

In 1966, in Vietnam, my father was shot in the leg, a terrible wound that shattered his femur from hip to knee. A progressive young doctor insisted that he start walking as soon as the bone could take it — a direct contradiction to the orders of a more senior physician, a doctor who was actually famous for inventing the traction equipment my father was strapped into. My father followed the younger doctor’s advice, and experienced a remarkable recovery. We can never know for sure if early mobilization was as decisive a factor for him as it seemed to be, but for the last thirty years orthopaedics has evolved decisively in that direction. Today, doctors often won’t put a cast on a fracture if they can avoid it — fractures heal faster when they aren’t completely immobilized.12

My father in traction

After a bullet shattered his femur, a young physician encouraged my father to get moving as soon as possible. Here he is visiting with actor Jackie Cooper. Early in the war, Vietnam veterans were treated like heroes.

My father in traction

After a bullet shattered his femur, a young physician encouraged my father to get moving as soon as possible. Here he is visiting with actor Jackie Cooper. Early in the war, Vietnam veterans were treated like heroes.

Acute low back pain has been shown to respond much better to normal activity than to bed rest.34 Achilles tendon ruptures have been shown to heal faster with early mobilization after surgery.5 Whiplash victims recover much faster if they get moving right away after their accident, rather than wearing a collar.6

For all the evidence that early mobilization is a crucial concept in rehabilitation, the prescription is easy: just do as much as you can, as soon as you can, and let the pain be your guide. It’s not a type of exercise, just a sensible idea, no different than it was in 1966 — it’s just “let’s get you moving as soon as possible.” It didn’t seem like common sense forty years ago, when “bed rest” was the first thing physicians recommended for practically everything, but it does seem straightforward these days.

Bourne concentrated on rest and mobility. From somewhere in his forgotten past he understood that recovery depended upon both and he applied rigid discipline to both.

The Bourne Identity, by Robert Ludlum, p137

But mobilizations — the way I usually prescribe them — do not exist in mainstream rehabilitation theory, and exactly how and why to do them needs to be spelled out. It’s not exactly radical, but it’s not exactly obvious either. What is it? And why am I recommending something that doctors and other physical therapists do not?


Good for prevention, too!

Mobilizations aren’t just for rehab — they are also good for keeping you from needing rehab in the first place!

For one athletic season, over a thousand female footballers — that’s “soccer” to many of us — participated in a warm-up routine.8 Their goal was to “improve strength, awareness, and neuromuscular control” — coordination practice, basically. Many of the exercises were similar in principle to the kind of mobilizations I teach.9

Several hundred other players did no such exercises.

The difference between the groups was remarkable. The athletes with the coordination-o-centric warm-up had fewer traumatic injuries, and fewer overuse injuries, and the injuries they did have were less severe. This evidence strongly suggests that mobilizations specifically are generally a useful tool for preventing athletic injury. Another large project led by the same scientist, published a couple years later in 2010, found that “the risk of overall and acute injuries was reduced by more than a third” by good participation in a warm-up program,10 specifically the 11+ warm-up regimen recommended by FIFA — more intense than mobilizations, but otherwise quite similar in spirit.

Massaging with movement

Mobilizations as a therapeutic exercise system are best understood as “massaging with movement.” That phrase neatly summarizes most of this article. Feel free to skip down to the practical sections now, if you don’t need to read all the details. “Active stretching” or “dynamic stretching” is a similar concept.

Mobilizations are an easy, cheap, safe, efficient way of stimulating tissue — and stimulating tissue has many benefits. I prescribe mobilization exercises extensively to treat just about all kinds of pain problems, even in cases of pain where there is no reason to expect any significant relief by any method. Mobilization is still useful, I think, even then.

I prescribe mobilizations for just about all kinds of pain problems.

Unfortunately, there is little direct scientific evidence to support that opinion, although I suspect that it will emerge steadily over the next twenty years. Evidence is already emerging around the edges. Just as it is now more or less established that early mobilization is an important part of rehabilitation, it will probably also be established that it is more broadly beneficial. For instance, if you do mobilizations, to some extent you are also doing a kind of therapeutic exercise recommended by many physical therapists, neurodynamic mobilizations, which is similar in spirit but more specific,11 and has some scientific support.

Meanwhile, a sound rationale will have to suffice … and the indirect evidence. And both are pretty good.

The Goldilocks principle

We know from research that regular moderate activity is generally a good thing,1213 tissue stagnancy is bad news, and that overexertion is dangerous to healing tissues.1516

That pretty clearly implies a need for some kind of in-between exercise intensity, something not too easy nor too hard, but a Goldilocks “juuuust right.”17

But conventional therapeutic and rehabilitative exercise tends to hit only the extremes. For serious injuries, there are the gentlest of exercises, such as pain free range of motion (PF-ROM) exercises, like dangling and swinging your arm in a six-inch circle when you’re recovering from a shoulder dislocation. That’s your only option when you can barely move your shoulder. But what if you have more or less normal use of your arm, but have nevertheless had chronic, nasty shoulder pain for three years?

The therapeutic intensity mobilizations is not too easy nor too hard, but a Goldilocks “juuuust right.”

That’s when your physiotherapist will almost inevitably prescribe endurance or strength training exercises — which are often too intense, and aggravate the problem or simply don’t help it, even while your continuing difficulties are interpreted as a sign that you “really need” the exercise. What you “really need” is a compromise. You need mobilizations! This is where they fit into the scheme of rehabilitative exercise:

Spectrum of intensity of rehabilitative exercises
RepetitionsLoadingChallenge
PF-ROM Exercises 25–100 extremely low painless
Mobilize! 25–75 low mild discomfort
Endurance Training 12–50 low to moderate moderate exertion discomfort
Strength Training 6–12 moderate to high strong exertion discomfort

Mobilizations fill in the gap in conventional rehabilitation exercise between PF-ROM and endurance training. They are ideal for a wide range of patients, the neglected masses of people who are not exactly acutely “injured,” but not exactly feeling good either:

These are enormous groups of suffering people for whom PF-ROM may be too gentle and endurance training too much.


Sick muscle syndrome

Muscle pain is an extremely common human experience. Still a medical puzzle, we call spots sensitive, tight-feeling muscle “knots” or “trigger points.” They come up all over SaveYourself.ca because it’s safe and cheap to experiment with self-treatment, often worthwhile, and also because muscle pain has an exasperating tendency to “get involved” in many other painful problems. More specifically, trigger points may cause, complicate, and/or replace other pain problems. And yet doctors and physical therapists of all kinds tend to be unaware of the potential clinical significance of muscle. So it’s a nice opportunity for helpful public education.

I have a book all about muscle pain, so see that for (a lot) more information. But it’s important to say a few words about it here, because mobilizations and muscle knots were made for each other.

I call myofascial pain syndrome “sick muscle syndrome,” because muscle knots are a muscular dysfunction that makes muscles weak and quick to fatigue. They ache and feel kinda gross. Overstimulation or overexertion in the form of strength training, endurance training, or even stretching can both help or irritate them, and it’s impossible to predict.18 And yet they will also typically be aggravated by stagnancy. Life in a chair, for instance, may be one of the primary causes of myofascial pain syndrome.19

For most people with pain, most of the time, it makes sense to compromise with a mild to moderate exercise intensity (Goldilocks principle), and also to work with a good variety of movements — not too much of any one thing. Mobilizations to the rescue! Mobilizations are a great way to work cautiously through muscle pain — or at least to get some tolerable exercise while afflicted.

It is simply unknown if a lot of mild-mannered contraction actually “fixes” muscle pain, but it certainly might. Even if it doesn’t, it is still a sensible coping activity — the best you can do in a bad situation.


How to do mobilizations

Mobilization exercises are easy to invent for yourself! One of the main reasons that I am enthusiastic about mobilizations is that nearly anyone can do them with only a small amount of instruction.20 To create a mobilization exercise, you need the following elements:

Mobilizations depend on movement to get the job done. Choose a joint, perhaps one closest to the pain if your pain is in a specific location, and begin to explore its range of movement. Which directions can you move it? How far? See, you’re already mobilizing!

Start to move back and forth in the joint’s range. Visualize the muscles attached to it: are they shortening and lengthening? The muscles do not have to contract hard, but they do have to contract, enough for metabolic activity. Imagine the muscle being squeezed out like a sponge every time it contracts. Picture the bones “stirring” your muscles.

Is it easy? If you are injured or in pain, usually there is some limitation to the movement. Find the “edge” of your range. Approach your limits, feel the edge, and retreat. You don’t have to test it hard. Achieve results with repetition, not intensity.

How much repetition? Quite a lot …


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Mobilizations demo

Gifs are big files. Zoom for the full size one: 1.7MB!

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Mobilizations demo

Gifs are big files. Zoom for the full size one: 1.7MB!

Repetition, repetition, repetition, repetition, repetition, repetition, repetition …

The real power of mobilizations is in the repetitions. Every repetition of a movement is like a message to the body, asking it to function, to do its job, to learn how to move like that and be okay with it. The message is mild-mannered, but persistent. Repeat it enough, and the body will start to respond. Most pain and stiffness will yield sooner or later if you justkeepasking.

Most pain and stiffness will yield sooner or later if you justkeepasking.

How many times should you repeat the exercise? Lots. Enough that you should be thinking, near the end, “Wow, this is really quite a lot of these.” Once you have found a satisfying movement, you should repeat it approximately 25–75 times in a single set, and you should do approximately 1–3 sets per day. For example:

There is one really important thing to avoid with repetitions: don’t try to split up a large batch of mobilizations into pieces over the whole day. Remember, every movement is like a message to your tissues. The message must be repeated, or the body seems to “forget” what you were asking for. If you split your mobilizations up into three smaller batches at breakfast, lunch and dinner, then your body won’t get the message at breakfast, won’t get it again at lunch, and still won’t get it at dinner. The purpose of the exercise is to “learn” the movement — to learn that it can be done without pain, in particular — and that learning process probably requires some concentrated exposure to the stimulus, for the same reasons that a piano student who practices for a single 20-minute session per day is probably going to learn better than a student who does a bunch of 2-minute sessions per day.

Of course, unlike a suffering piano student, you're perfectly free to listen to music or have the TV on while practicing…

Very generally speaking, most people’s bodies don’t seem to start to respond to the “message” until somewhere between 25–50 … and definitely on the higher end of that for older and more severe problems.


Troubleshooting: make it easier!

A common mistake is to give up instead of just making it easier.

If mobilizing feels exhausting to your muscles, make it easier.

If you start to tighten up, make it easier.

If it hurts too much, make it easier.

Make it as easy as necessary to allow lots of repetitions! If you’ve tried this and a mobilization still feels like a Bad Thing in any way — or just pointless — then please listen to your instincts and stop. Mobilizations aren’t good for every situation, just most of them.


Trust your instincts (or “The Squirming Method”)

Although a knowledge of anatomy is required for cooking up the very best mobilizations for certain problems, most worthwhile mobilizations are obvious, intuitive, almost instinctive

The body abhors stillness.21 Most of us tend to start mobilizing by instinct. Everyone squirms when they are uncomfortable, when we’ve been sitting for too long. Wrenching the neck or rolling the head in a circle, swinging the arms, opening the chest in the morning, swinging the hips, a quick toe touch … these are all common, natural “mobilizations.”

But these movements tend to be brief, and are often negative, even desperate if you are in chronic discomfort. Instead of mobilizing, people try — often unconsciously — to squirm, wriggle and wrench their way free of pain and stiffness. They rarely do more than take the edge off, at best.

To convert these anxious movements into therapeutic mobilizations, simply make them more deliberate, positive, and thorough. Don’t just pull your neck to the side once or twice: do it ten times, or a hundred times. Convert the instinct into an exercise! Watch for how you tend to squirm, and use it as the basis for a mobilization.

Mobilizations versus squirming
Squirming Mobilizations
instinctive rational
desperate optimistic
takes the edge off therapeutic
1–3 repetitions 10–50 repetitions

Use your favourite stretches as inspiration

Mobilizations are probably more therapeutic than stretching. Todd Hargrove puts it well:

Joint mobility drills have several advantages over static stretching. First, they involve movement, which is good, because you probably want to get better at moving, not just staying still with your limbs splayed out. Second, most of the work in a static stretch is done at end ranges of motion that don’t get used very often. By contrast, joint mobility drills usually involve movements through the middle ranges of motion where most of life and sport occur. So they promise to have more applicability to real world tasks. Healthy athletic movement at most joints has far more to do with quality of motion than quantity of motion.

But let’s not throw the baby out with the bathwater. If nothing else, your favourite stretches are a good source of inspiration: any stretch can be converted into a mobilization simply by entering and leaving the stretch rhythmically.

People tend to “accidentally” mobilize when they meant to stretch anyway: impatient with slow stretches and craving the stimulation of more movement, stretchers often hold their stretches only briefly, and then repeat them haphazardly trying to “scratch the itch” of stiffness. All that is needed to turn this kind of stretching into a more effective mobilization is simply to make it more rhythmic and deliberate. You can even think of mobilizations as a kind of stretching, or as “dynamic stretching.”22

And, of course, static stretching may have some value as well. It’s a bit dubious, but holding a stretch often feels so good that I recommend including it in your mobilizations. Simply pause the mobilization in a stretched position for as long as you like, and then resume moving when you are ready.

But bear in mind that classic slow or static (still) stretching is physiologically boring — not much happens. Indeed, evidence and reason show that stretching cannot achieve the goals that people usually have in mind for it.23 It is possible that stretching may be useful for relieving some stiffness and pain caused by trigger points, but probably not much in most cases.24

Meanwhile, mobilizations are more stimulating, and almost certainly affect more tissue, more efficiently. They probably have both significant general benefits, as well as a more direct effect on trigger points.


Not a life sentence

Mobilizations aren’t into “commitment.” They’re great — but partly they’re great because you don’t have to take them too seriously. The goals are relatively modest, so it’s not all that hard to achieve them. Precision and discipline need not apply.

That’s quite different from the physical therapy standard, which tends to be rather heavy-handed: multi-week recovery regimens that often take pages to outline and a substantial commitment that almost anyone would consider tedious, and few people can actually stick to…

Differences between mobilizations and typical physiotherapy prescriptions
1–5 exercises 3–20 exercises
a few minutes per day will do it commonly at least a 30-minute daily commitment
a few days is usually sufficient several weeks of regular exercising is often considered normal
not a life sentence kind of feels like one …

The advantage of mobilization is that it is relatively easy to prescribe just a few relevant exercises that efficiently address the tissues in need. And there is little need to do them without knowing if they are doing any good: the benefits should be reasonably obvious within three days at the most. If there are no obvious benefits, just let it go. (If the benefits are obvious, it won’t matter much to you whether it takes three days or three weeks.) But in any case, mobilizations generally shouldn’t be continued for long. They should be performed in relatively concentrated batches as needed — whenever you feel like, and until you feel done.

Unless, of course, you just like them …


Mobilizing for pleasure … and prevention

Like stretching, mobilizing just feels good, and mobilizing regularly is an ideal way to maintain musculoskeletal health as well as restore it. A set of your favourite mobilizations can easily be the meat of a pleasing daily regimen — like a little yoga ritual, but more dynamic and less about stretching, or like taijiquan but without all the tradition and demanding technique.

Mobilizations are most of all like qigong, Chinese “calisthenics,” but are much more Western in style: practical, efficient, “just do it.”

Mobilizing can be a lot like taiqi … but without all the tradition and demanding technique.

If you’re not actually trying to fix something, mobilizations do not have to be done in large batches. “Small batch” mobilizations are more useful for maintenance and prevention, primarily because you can quickly do a wider variety of mobilization exercises. This is better for body awareness and distributes stimulation more evenly throughout your body and your day.


Microbreaking

Probably no group of people can benefit more from regular, small batches of mobilizations than chair-bound office workers, followed closely by cashiers and others who are more or less stuck in one position and/or activity while working.

For all of you, “microbreaking” — taking small, regular, stimulating breaks — is the most important new concept in ergonomics. Stop worrying as much about how your workstation is arranged, and start thinking about how you use it!

Mobilizing is an ideal way to spend your microbreaks. Three or four times an hour, even if it’s only for thirty seconds or a minute, you should not just be getting up and changing your position, but dousing your nervous system and cranky muscles with movement.

See Microbreaking: Prevent low back pain and neck cricks with lots of little breaks.


Conclusion: one more time, why and how in just a few words

Let’s wrap up by condensing this whole article into one brief explanation:

The most efficient exercise method for helping muscles and joints heal is to “massage them with movement,” providing just enough stimulation to facilitate healing, but not so much to aggravate. Mobilizing as soon as possible is proven to reduce recovery time from injury and surgery, and these benefits probably extend into recovering from chronic pain problems as well, especially those that involve muscle knots (which is most of them).

To do it, simply move rhythmically, shortening and lengthening muscles — basically, stretch one way and then the other, neither fast nor slow, pushing hard enough to be interesting but not hard enough to make anything worse. This is very much like squirming when stiff, only more repetitive and optimistic. The following numbers are roughly appropriate for most rehabilitation:

For maintenance and prevention, smaller and more frequent batches of mobilizations are ideal.

Oh, and one more thing …


My favourite mobilizations!

The possibilities are literally infinite, and nearly any kind of rhythmic movement is useful. Nevertheless — with decades of practice, clinical experience, and knowledge of anatomy — I have cooked up some pretty good mobilizations! A complete reference to mobilization exercises for many common conditions is published in Appendix C. But here are four favourites, great examples of “feel good” mobilizations that I always look forward to doing …

Have fun!

Deep Gluteal Mobilization — Starting from a seated position, place your ankle on the stretch side over your knee on the other side. Let your lifted knee relax downwards for a moment, and then begin to lean forward from your pelvis. Avoid simply slumping forward, which is useless. Visualize pushing your belly button between your legs. Now do this on the other side, to even yourself out, even if you have symptoms only on one side. Now, to complete the mobilization for both sides, place your feet widely on the floor, and drop your knees straight down towards the floor.

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Stick-Yer-Bum-Out — This unusual mobilization reaches the low back and gluteus maximus in a way that no other exercise can, stimulating that hard-to-reach spot in the very bottom “corner” of the low back, just above the dimple. Stick your bum out as though you are going to sit down on a stool that is well behind you and off to one side. Your knees must bend. Round your low back like the top of a ball, lean your torso in the other direction (i.e. bum goes left, torso goes right), and twist your shoulders to face back towards the middle. (The further you lean and twist, the further the stretch will “reach” into your upper back.) To conclude, stand up and lean back a bit, clenching your gluteal and low back muscles firmly. Now alternate from side to side: left, clench, right, clench, left, clench, etc.

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Forearm Mobilizations, seated — Sit on the edge of your bed or any other firm surface where there is space to put your hands down on either side of you. Stretch the hand back by placing the palm face down with your fingers towards you. Lean into it a bit and then release. Repeat this on the other side. Now go back to the first hand again and do the opposite: place the back of your hand downwards, fingers still pointing towards you. Lean into it for a moment, and then switch to the other side. Now just rhymically move back and forth: right, left, right, left, and so on. Keeping your elbows locked helps.

(No diagram for this exercise yet, I’m afraid. It’s on the to do list. Somewhere.)


Chest Opening and Closing Mobilization — This exercise duplicates a familiar natural stretch that most of us do automatically in the morning or after getting up from a lot of sitting: spread your arms way back and lift your chest up. Now, to turn it into a mobilization, simply reverse the movement: reach your arms strongly across your chest and go “hunchbacked.”

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About Paul Ingraham

I am a science writer, former massage therapist, and assistant editor of Science-Based Medicine. I have had my share of injuries and pain challenges as a runner and ultimate player. My wife and I live in downtown Vancouver, Canada. See my full bio and qualifications, or my blog, Writerly. You might run into me on Facebook and Google, but mostly Twitter.

Appendix A: The Chinese influence

I have been practicing taiqi and qigong since I was fifteen years old, when I first took lessons from an unlikely teacher, Prince George’s Sam Masich. Not much older than I was at the time, just twenty or so, Sam had recently returned from China, where he had won an international competition. Prince George, despite being a bit of a red-necked, backwater place, has a surprising way of producing talented people!

I am grateful to Sam for getting me off on the right foot with taiqi. I learned early that taiqi was practical as well as artful. Sam loved the martial aspects of taiqi, and would gleefully demonstrate how various poses related to the fighting stances of kung fu. To this day, I still notice how practically every taiqi student — they can often be seen on downtown Vancouver’s waterfront — still overextend themselves, reaching and leaning much too far, not realizing that taiqi is all about balance and grounding.

Taiqi is also all about movement. The Chinese really get the idea of “use it or lose it.” In fact, taiqi is just one ingredient in a vast stew of ideas called “qigong,” which is basically “Chinese calisthenics.” Mobilization is qigong: gentle, rhythmic exercise.

The Chinese really get the idea of “use it or lose it.”

Qigong, less well-known in the West, is extremely popular in China. The Chinese do it because it is a really smart form of exercise: stimulating enough to be useful, gentle enough to be useful into old age.25 While I was still in school, I recognized the similarity between qigong and the “early mobilization” of acute injury rehabilitation. Yet the Chinese don’t just use qiqong for recovery from recent injuries: they also use it as preventative medicine, to treat chronic health problems (which traditional Chinese medicine is so generally adept at treating), and as a lifelong constitutional26 with the intention of extending longevity.27

I started prescribing qigong exercises as soon as I was in practice, in 2000, but I didn’t call them qigong exercises. I just took the Eastern mysticism out of it — there is plenty of “woo woo” in qigong! — and started selecting exercise that specifically stimulated the joints and soft tissues I felt were most relevant to the pain problems and injuries my clients were bringing to me.


Appendix B: Case study of mobilizing a “neck crick”

Let’s look at the case of a neck crick in a little more detail. Why mobilize a neck crick? Neck cricks are caused by a combination of joint and muscular dysfunction, and usually respond well to stimulation. Neck range is limited by definition, and almost invariably increases with repeated gentle neck circles.

For a fresh, 2-day old severe neck crick, I would prescribe multiple large sets of neck circles each day, probably 3 sets of 80 (40 in each direction), with a good prognosis: based on my clinical experience, most people should be feeling much better after the first day of mobilizing, and will be almost completely recovered by the third day of mobilizing.

Most people will be almost completely recovered from a neck crick by the third day of mobilizing.

Is that actually any better than normal recovery time? It’s true, neck cricks generally do resolve on their own. However, it’s extremely common for them to bother people for three weeks, so getting that down to three days is a pretty good deal.

The neck circle is one of the simplest of all mobilizations: rolling the head around is pretty easy! I caution patients about the back of the circle, because the neck can feel uncomfortably crunchy in extension. But if it’s not distressing, it’s not a concern.

The trick is just to get the right intensity. If you only have 20˚ of right side bending … then that’s all you do. With every circle, you just nudge the edge of that range. Somewhere between thirty and forty turns, that range will probably increase to 25˚, if not on the first set, then on the second; if not on the first day, then on the second.


Appendix C: Mobilization Exercises Reference Chart

The following chart summarizes 21 mobilization exercises I commonly prescribe to my clients, and what they are best used for (other than mild pain and stiffness in the area, which is obvious).

Mobilizations Reference
MobilizationSummaryThis mobilization is especially good for …
Abdominal LiftBlow your breath out, and then suck your gut in strongly while holding your breath. More …
  • stress
  • constipation
  • mild digestive disturbance
  • practicing good diaphragmatic breathing
  • Cats and DogsStraight from yoga: flex and extend your back while on your hands and knees. More …
  • low back pain
  • Chest Opening and Closing MobilizationSpread your arms wide — a classic “good morning” stretch — and then collapse and give yourself a hug. More …
  • low back pain
  • upper back pain
  • chest tightness
  • Chest RotationsRoll your chest in a slow-motion hoola hoop movement. This one is difficult for the coordination-challenged, but rewarding. More …
  • low back pain
  • upper back pain
  • tight chest
  • Deep Gluteal MobilizationSit, cross one leg over the other, and lean forward. Then spread the feet and push the knees in and down. Far superior to a common physiotherapy stretch prescribed for sciatica and piriformis syndrome. More …
  • low back pain
  • sciatica
  • piriformis syndrome
  • Doorway Pectoralis Major MobilizationAlternately stretch and contract the pectorals with the help of a doorframe. More …
  • chest tightness
  • Foot CirclesJust roll the feet in circles. Simple, surprisingly difficult, and helpful for a wide variety of lower leg and foot problems. More …
  • plantar fasciitis
  • splints
  • Forearm Mobilizations, seatedSit on the edge of a bed and alternately bend your wrists forward and back on the mattress, with locked elbows. A deliciously stimulating sensation for computer users and cashiers. More …
  • tennis elbow
  • typists
  • Forearm Mobilizations, standingBend your wrist back and forth with a locked elbow. Not as satisfying as the seated version (see Forearm Mobilizations, seated) but often more convenient. More …
  • tennis elbow
  • typists
  • Iliopsoas MobilizationAlternate between flexing and internally rotating the hip, and then doing an ordinary lunge with the back foot turned in. Great for chair-bound office workers especially. More …
  • excessive sitting
  • low back pain
  • Iliotibial Band MobilizationThis is a complex walking stretch derived from taiqi. Far superior to other iliotibial band stretches! More …
  • iliotibial band syndrome
  • Neck CirclesRoll your head in a circle. Incredibly useful for a huge array of common upper back, shoulder, neck and headache problems. More …
  • neck cricks
  • tension headaches
  • Neck Flexor MobilizationsAlternate between pulling the chin towards one side of the chest, and then tilting the head backward and to the opposite side. Sort of … More …
  • tension headaches
  • neck cricks
  • Pelvic CirclesSwing the hips in a circle. This is a simple but powerful mobilization for low back pain and sciatica. More …
  • low back pain
  • iliotibial band syndrome
  • Rotator Cuff MobilizationsRotate the humerus back and forth in the shoulder joint with a complex alternating motion. A complex but important mobilization. More …
  • frozen shoulder
  • arm pain
  • Spinal Twist MobilizationWhile standing, turn your upper body back and forth, twisting the spine. More …
  • low back pain
  • Standing Forward BendStraight from yoga: touch your toes and then stand up with a rolling motion of the spine. More …
  • low back pain
  • iliotibial band syndrome
  • tension headaches
  • Stick-Yer-Bum-OutStick your bum backwards and out to one side while twisting the spine. This reaches deep into one side of the low back. Then reverse the motion, and do the other side. More …
  • tension headaches
  • low back pain
  • iliotibial band syndrome
  • sciatica
  • Supine Lumbar TwistsLying down, roll your pelvis and shoulders in opposite directions, back and forth. Supine lumbar twists are really pleasant, almost luxurious. More …
  • low back pain
  • iliotibial band syndrome
  • Wide Arm CirclesSwing the arms in wide circles. One of the simplest of all mobilizations, and very helpful for many shoulder problems. More …
  • tension headaches
  • rotator cuff injuries
  • Wrist CirclesRoll your wrists around in circles. Just like ankle rolls, this is surprisingly tiring! More …
  • carpal tunnel syndrome
  • tennis elbow

  • Further Reading

    Notes

    1. Consider a modern example:

      One of my clients broke her arm, and was told by her doctor: “Look, I can put this in a cast and it will be nice and safe, or we can leave it out and it will heal three weeks faster if you can protect it properly until then.” My client chose to skip the cast, and was simply very careful with her arm for a little while. Sure enough, the wound was healed in excellent time. Even though she was very careful with it, the gentle stresses of gravity and slight movements alone were enough to stimulate accelerated healing.

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    2. Oldmeadow et al. No rest for the wounded: early ambulation after hip surgery accelerates recovery. ANZ J Surg. 2006. PubMed #16813627.

      From the abstract: “Early mobilization after hip fracture surgery accelerates functional recovery and is associated with more discharges directly home and less to high-level care.”

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    3. Hagen et al. The updated cochrane review of bed rest for low back pain and sciatica. Spine. 2005. PubMed #15738787.

      From the abstract: “For people with acute low back pain, advice to rest in bed is less effective than advice to stay active.” There is even “high quality evidence” that bed rest leads to more pain.

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    4. Vroomen et al. Lack of effectiveness of bed rest for sciatica. New England Journal of Medicine. 1999. PubMed #9971865.

      In this sciatica study, researchers “randomly assigned 183 subjects to either bed rest or watchful waiting” for two weeks and found that “bed rest is not a more effective therapy than watchful waiting.” Nor is it less effective. The results were exactly the same. If that sounds like no big deal, consider the difference in the lives of those patients! Two weeks of bed rest? Compared to two weeks of going about your business!

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    5. Sorrenti. Achilles tendon rupture: effect of early mobilization in rehabilitation after surgical repair. Foot & Ankle International. 2006. PubMed #16764795.

      From the abstract: “Surgery combined with early mobilization reduces range of motion loss, increases blood supply, and reduces the degree of muscle atrophy that typically occurs after Achilles tendon rupture, thereby decreasing the time to resumption of normal activities.”

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    6. See Mealy, Vassiliou, McKinney, and Schnabel. BACK TO TEXT
    7. Lamb et al. Mechanical supports for acute, severe ankle sprain: a pragmatic, multicentre, randomised controlled trial. Lancet. 2009. PubMed #19217992.

      It’s been in vogue in physical therapy for a long time now to “mobilize” injuries as quickly as possible — probably too much in vogue. In the zeal to get people on their feet again ASAP, serious sprains — which are worse than fractures in some ways — are almost never put in a cast. Turns out that’s a mistake. A 2009 experiment published in the Lancet presents clear evidence that a full cast for a severe ankle sprain is superior to the almost universal practice of using braces and tubular compression bandages. The editors write, “This elegant study highlights the need for trials to address common problems.”

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    8. Soligard et al. Comprehensive warm-up programme to prevent injuries in young female footballers: cluster randomised controlled trial. British Medical Journal. 2008. PubMed #19066253. BACK TO TEXT
    9. There were also undoubtedly many differences, and the research I’m citing is certainly not perfectly applicable to mobilizations. However, it’s definitely somewhat applicable — nearly any moving warm-up counts as some kind of mobilization. BACK TO TEXT
    10. Soligard et al. Compliance with a comprehensive warm-up programme to prevent injuries in youth football. British Journal of Sports Medicine. 2010. PubMed #20551159. BACK TO TEXT
    11. “Mobilizations” as I have described them here are a more general, accessible concept than neurodynamic mobilization, but both techniques share rationales and assumptions. I assume that whatever benefits are provided by neurodynamic mobilizations are probably somewhat encompassed by the technique I recommend. If you do mobilizations the way I prescribe them, you are going to be doing some neurodynamic mobilizations as well. Of course, NMs may be more specifically chosen to address more specific pathologies. BACK TO TEXT
    12. For instance: Puetz et al. Effects of chronic exercise on feelings of energy and fatigue: a quantitative synthesis. Psychol Bull. 2006. PubMed #17073524.

      From the abstract: “Chronic exercise increased feelings of energy and lessened feelings of fatigue …”

      And of course there are countless other kinds of research showing an incredible variety of exercise benefits. BACK TO TEXT
    13. Or consider the enormous body of cultural and medical wisdom that constitutes the foundation of taiqi and qigong in China. See Appendix A for more. BACK TO TEXT
    14. Hopefully it’s perfectly obvious the healing tissues are threatened by overexertion! More important, and less obvious, is that tissues harbouring myofascial trigger points are at risk. Trigger points are easily sustained and aggravated by overexertion. Given their clinical importance — their tendency to cause, complicate or even replace virtually any other musculoskeletal problem — the risk of irritating them with therapeutic exercise is not trivial. See Simons. BACK TO TEXT
    15. link to audio “Exorcizing Myths about Exercise” an audio recording from Quirks & Quarks (CBC Radio One).

      This excellent radio segment discusses recent scientific evidence that debunks several exercise myths, showing that stretching isn’t as useful as you might have thought, that working out exclusively on the weekend may actually be dangerous, and response to aerobic and strength training may depend on your genes.

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    16. See The ‘Use It Or Lose It’ Principle for a more detailed discussion of this topic. BACK TO TEXT
    17. See Strength Training Surprises and Stretching for Trigger Points. BACK TO TEXT
    18. The Trouble with Chairs BACK TO TEXT
    19. This is actually really important in rehabilitation: a lot of clever rehabilitation and therapeutic exercise concepts look great on paper, but fail miserably when you ask real people to do them. The actual ease of usage of mobilizations is one of their strongest benefits. BACK TO TEXT
    20. It’s a morbid example, but consider the effectiveness of immobilization as a torture method. Victims suffer terrible agony and degeneration surprisingly swiftly. Strange as it may seem to bring this up, consider the physiological implications: why does being still hurt so much? Physiologically? I assume it’s because we are hard-wired in many different ways to avoid stagnancy, because it’s actually dangerous. Even trying to sit still for meditation soon causes pain. BACK TO TEXT
    21. I remember having a debate with a colleague about the difference between stretching and mobilizing, only to discover that there was no difference between his kind of stretching and my mobilizing. He simply thought of mobilizations as the “correct way to stretch” — as a kind of stretch. Which, of course, they are. However, I consider mobilizing to be sufficiently different from stretching to deserve its own classification. BACK TO TEXT
    22. The case for this is thoroughly explored in Quite a Stretch. Considerable scientific evidence is presented. It’s a difficult article to read without wondering why anyone ever bothered stretching in the first place. BACK TO TEXT
    23. This possibility is considered in the article Stretching for Trigger Points. BACK TO TEXT
    24. See note 9. BACK TO TEXT
    25. Cohen. The Way of Qigong. 1997. BACK TO TEXT
    26. There are numerous studies suggesting general systemic benefits to meditation and meditative exercise like taiqi, qigong and yoga. It’s not all that important to my point, so I won’t review them here. BACK TO TEXT