The Rubber Band Syndrome—Why Stability Matters

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Stability is a tried and true fitness buzz word.  You hear it all the time, “You need stability during exercise! If someone asked you why stability is important, could you answer?” In this article I will tackle the concept of stability, why it matters, how poor stability can lead to pain or injury and most importantly, how to train it.

First, the reality of human movement—everyone is born with a body that is a professional cheating machine. It is fine-tuned to quickly find the path of least resistance and the movement of least effort. Your body is made of tissues that can contract and those that can’t. Contractile ability is important because this will determine how your body stabilizes itself— actively or passively. Active stabilization encourages your body to optimally share the forces placed on it. Passive stabilization is used when muscles aren’t doing their fair share and the rest of the non-contractile tissues have to pick up the slack.

Let’s quickly review some anatomy and physiology to better understand this concept. Active stabilization occurs when muscle contractions are used to produce movement and contribute to joint stabilization. Passive stabilization occurs when the body uses non-contractile components of muscle tendons, ligaments, joint capsules, and bony surfaces to stabilize itself. Even muscles contain non-contractile connective tissues. Epimysium, perimysium and endomysium are a fascial support structure wrapping around and within muscles to help support them and they aren’t able to contract to produce force. However, the body can still use these connective tissues to help support movement and generate force because they are a primary source of a muscle’s resistance to stretch. Translation- you can use your connective tissues like giant rubber bands! You can hang on them when you’re tired and bounce off them to produce an easier movement during activity and exercise.

By Pedrohms – Own work, FAL, https://commons.wikimedia.org/w/index.php?curid=12155042

Passive stabilization is the underlying mechanism of the Rubber Band Syndrome—poor movement execution when you don’t have sufficient muscle strength or control. Let’s go over some examples.

One of the most commonly cited abnormal movement patterns in the athletic arena is dynamic knee valgus- described as a combination of hip adduction, hip internal rotation and tibial (leg) abduction. This movement pattern has gained attention because of its association with non-contact ACL injury risk.1-6, 8-11 Dynamic valgus is also seen in other lower extremity conditions such as patellofemoral pain syndrome12-16, gluteal tendinopathy17 as well as other leg, ankle and foot injuries.18-23

We already discussed how the body will chose the path of least effort to accomplish a movement task. We also reviewed how active stabilization encourages your body to optimally share the forces placed on it. Now let’s dive in a little further to understand why dynamic valgus can be problematic and tie these concepts together.

To prevent injury, the impact imposed on the body should be absorbed throughout the lower extremity joints to create optimal loading. Biomechanical data has shown that knee valgus increases the impact forces on the knee and reduces the ability of the hip to help absorb these forces.24 Although much of this data comes from studying landing and deceleration tasks we can draw reasonable assumptions about the importance of knee alignment during heavy weight lifts.

So, here’s a question- if this position doesn’t allow optimal force absorption throughout the lower body, why do people do it? The answer—Rubber band syndrome! At the lower depths of a squat the gluteus maximus contributes less muscle force to hip extension26. This causes the hamstrings and adductor magnus25 to play a large role during the upward squat phase, drawing the knees inward. This movement is also advantageous because it allows the lifter to utilize tightened gluteal tendons and knee structures like the MCL and patellar tendon to create passive tension during their lift. This passive tension can be used as a rubber band to bounce off of—aiding to propel the body upward.

Another example of rubber band syndrome is scapular winging. For this example, we will assume there is no neurologic injury and that the winging is due to a simple muscle imbalance. When the periscapular muscles—serratus anterior, rhomboids, middle trapezius and lower trapezius, have inadequate muscle strength and control, the shoulder, elbow, wrist and hand have to pick up the slack. When a fast or heavy upper body lift is performed, the scapula is the critical link in the kinetic chain that allows the transfer of energy from the core to the overhead moving arm. Proper utilization of this kinetic chain allows multiple body segments to optimally contribute to the performance or execution of the specific lift.

Think of your shoulder blade as a stud in the wall. If you want to hang heavy objects on your wall, you need to find a stud. If you try to hang a heavy object on drywall, it will tear through due to inadequate stabilization. The arm is very similar. If you don’t have good scapular stability this can lead to excessive wear and tear on the shoulder joint and its supportive muscles. Abnormal scapular motions have been identified in populations with shoulder impingement, rotator cuff tendinopathy, rotator cuff tears and shoulder instability.27-29

By Connexions – OpenStax College. Anatomy & Physiology, Connexions Web site. http://cnx.org/content/col11496/1.6/, Jun 19, 2013., CC BY 4.0, https://commons.wikimedia.org/w/index.php?curid=29624320

Now that we have reviewed a few examples let’s talk about training! To train stability, you need to understand the different planes of movement. The body moves in three cardinal planes—transverse, sagittal and coronal. For most activities, including sports, the sagittal plane dominates. Training the body in all three planes is critical for stabilization. Understanding anatomy is also essential to training stabilization. Check out the list below to see commonly underactive or weak muscles associated with pain and reduced stabilization. This is not an exhaustive list but what you should know is nearly every major joint in the body can have pain as a result of poor stabilization.

Shoulderserratus anterior, lower trapezius, middle trapezius and rhomboids, supraspinatus, infraspinatus, teres minor, subscapularis
KneeGluteal complex, quads
HipGluteal complex, TFL
ElbowExtensor carpi radialis brevis, rhomboids, lower trapezius
AnkleTibialis posterior, peroneus longus and brevis, gastrocnemius

Now, on to the training! When discussing exercises, I find video demonstrations much more helpful than written descriptions. Find the following four posts in my Instagram feed below for exercise instructions and parameters. These exercises train some of the most common problem areas seen in athletes.

You should now understand stability, why it matters and how poor stability can lead to pain or injury. If you watched my videos—you should also have some new exercises to train common problem areas. As always, all the research used in this article is referenced below for readers wishing to dive further into their learning. Enjoy the training and share the knowledge!

References

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