Optimizing Training For The Unstable Client

Take a step back and think about your most challenging client….

Not the one who struggles to change poor habits or lacks consistency, and not the client who refuses to take constructive feedback.

I’m talking about the client who shows up every day, works hard, but struggles to make consistent progress.  They have a hard time getting stronger, trouble putting on lean mass, and their ability to generate power is virtually non-existent.  They’re seemingly stuck in third-gear with no real ability to access their full potential.

Despite their efforts—and yours—nagging injuries always keep them from doing as much as you’d like them to, and often prevents them from seeing the time they want on the playing field.

Does the above situation sound familiar? If so, then there’s a strong likelihood that you’re training an unstable client.

This article will help you to identify if you’re dealing with an unstable client and, if so, how to safely and intelligently design your program for their particular circumstances. 

Identifying The Unstable Client 

Instability can present itself in several different ways, some of which aren’t always apparent at first look.  I’ve always found the simplest and most reliable method of evaluating instability is by following the Beighton Laxity Scale, a graded test for joint hypermobility.  With the Beighton Scale, you check whether or not eight different joints can hyperextend and if your client can palm the floor.  The client is given one point for each joint movement.  A score above 4/9 classifies you as hypermobile. 

Using this screen is helpful, but it doesn’t give you the entire picture. The Beighton Scale informs you if there is laxity in the connective tissue around a particular joint, but does not inform you if the client is able to call on active stabilizers to control ranges of motion.  Remember, joint stability happens by a combination of both passive support structure (ligaments) and active, or dynamic ones (muscle).

In the most extreme cases of hypermobility I often see a commonality.  My client’s with the most joint laxity, and highest Beighton scores, stand in a position of near end-range anterior pelvic tilt, bilaterally.

I recently began a course from the Postural Restoration Institute where I started to put two and two together.

Picture a client who has a pelvis that rests near end-range anterior tilt. The majority of their weight is pushed forward and they have no choice but to maximize end-range positions for support.

Visualize the pelvis tilting anteriorly as stove burners turning on. The more it tilts forward; the hotter the stove gets. Now imagine end-range positions as the burners turned up all the way.

HYPERMOBILITY=BURNERS ON HIGH

In this position you rely on joints and ligaments for stability because your muscles are not in a position to function.

 

A client like this may have trouble FEELING exercises.

Over time, ligamentous integrity may become compromised and pathology may develop.  This client can now do things they shouldn’t be able to do given their anatomic position.  But, some of these clients have pushed their anteriorly-tilted pelvis so far forward, so chronically, that they have actually weakened the Y-ligaments that provide anterior hip support—like a leather belt being held under tension over months and years. 

Just because you have a client that presents in this manner does not mean that they need to be put in a bubble.

Although hypermobile people have a greater likelihood of being unstable, they don’t have to remain that way. Whether this laxity is acquired or a combination of acquired and congenital, it is important to alter one’s training accordingly.

It takes smart programming and coaching to put your unstable client on a path towards becoming a monster in the weight room and a beast on the playing field by simply finding ways to turn the burners on the stovetop down.

Here are a few strategies when working with an unstable client.  

Optimize Position

Use the warm-up as an opportunity to acquire optimal position.  When an unstable client optimizes their anatomical position, they put their muscles in a better position to function.  Start with the position of the core and pelvis; and by learning good breathing mechanics and the use of the internal obliques, transverse abdominis, adductors, and hamstrings your unstable client will be able to extend the pelvic inlet and get their ribs down.

Below is a similar sequence of exercises that I may use with an unstable client. Also, understanding what muscles are needed to make up for lax ligaments becomes extremely important.

Modified All Fours Belly Lift

Standing Un-Resisted Wall Reach

*It can also be helpful to reach and press into a table or box here to give more sources of external feedback to aid in turning on the abs.

90-90 Supported Alternating Cross Over w/ IO/TA

Don’t Rush Through Your Anterior Core Progressions

Once you enter the resistance-training portion of your workout it is crucial to master sagittal plane control of the pelvis and lumbar spine before introducing transverse and frontal plan activities. Client’s who are unstable have a difficult time controlling the above variables.

Many times we’re too quick to jump to half-kneeling, tall kneeling, and standing abdominal exercises when your unstable client may be relying on their hip flexors, calves, neck, and other stabilization strategies rather than their anterior core muscles.

Do your clients a favor and spend plenty of time with supine-based exercises? It will be much easier for someone to FEEL their abs when they have more points of external feedback (more areas of the body touching the ground).

Core-Engaged Leg Lowers

Deadbugs

3-Month Position KB Pullover

Increase Time Under Tension

When progressing to larger, compound movements these clients need to learn to control their vast ranges of motion. An unstable client is accustomed to quickly going through their exercises, in an uncontrolled manner, hanging out on ligaments and bouncing off of their joints.

Increasing time under tension can be done by slowing down the concentric and eccentric portions of the exercise and using isometric holds. All of the above will give the client more of an opportunity to:

– Improve proprioception and body awareness.

– Learn to use active support and create tension within specific ranges of motion

– More opportunities to FEEL exercises in the appropriate muscles

Goblet Squat with Pulse (Controlled Eccentric)

Offset Bottom’s Up KB Split Squat Iso Hold

Use Partial Ranges of Motion

This may seem counterintuitive, but similarly to finding more external reference points when training the anterior core; creating more reference points during compound movements can be helpful for an unstable client to learn where their body is in space. It will allow them to develop active stability in smaller ranges of motion before venturing to near end-range positions.

Goblet Squat to Box

1-Arm DB Floor Press

Add Perturbations to Shoulder and Core Exercises

Perturbations can be a fun way to challenge your client’s ability to dynamically stabilize while a joint is in a particular position. This type of exercise has gained the most notoriety in the world of shoulder rehabilitation in order to train the rotator cuff to stabilize the shoulder joint, but adding perturbations to core exercises can present a challenge to more advanced clients during anterior core exercises.

Quadruped Rhythmic Stabilizations

Push Up Iso Hold w/ Perturbations

What to do Now?

Step 1: Place a premium on position & ligamentous muscle
Step 2: Master sagittal plane control of the pelvis and spine
Step 3: Slow down larger movements and learn how to create tension and feel the exercise in the appropriate muscles.
Step 4: Don’t be afraid of partial range of motion exercises
Step 5: Incorporate perturbations to improve co-contraction of dynamic stabilizers in certain joints or positions. 

Be patient when training an unstable client. It can be frustrating and quite a challenge. Begin to incorporate the above steps and your unstable clients will start to see the results they desire. 

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