Course Review: Functional Range Conditioning (Nov 30 – Dec 1, 2013)

I have been following Dr. Andreo Spina’s work for some time now and I decided to take his Functional Range Conditioning (FRC) course this past weekend. Overall, I thought it was a great course! I wanted to write some of the important things I got from it before they slipped out of my mind, so here goes:

First, some background information. You might be thinking, what the heck does “Functional Range Conditioning” even mean?? Seems like a lot of buzz words put together! To put it simply, FRC is a system of improving mobility, mitigating injury, and optimizing joint function based on Dr. Spina’s interpretation of the existing scientific literature. It is intended to be a part of the rehabilitation continuum to progress someone from rehab to training.
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Before I get into the course stuff, I also just wanted to say that I quite enjoy and respect Dr. Spina’s approach to teaching. He is open to admitting that he doesn’t know the answers (none of us do) and that really, we all know very very little about how the human body functions. Everything that he teaches is based on his interpretation of the existing literature and if new literature contradicts what he teaches, he will be sure to make the appropriate changes. Another aspect I liked is that there were references on almost all his theoretical knowledge slides so that we can look up the literature ourselves; in fact, he encouraged us to read the original literature ourselves rather than to just believe him! I really like this because I think I’m the type of person who can’t 100% believe something until I look at the original evidence myself and see if I come to the same conclusions (though I realize there is a bit of confirmation bias with this). So, if any of you would like references to what I will be talking about below, feel free to contact me and we can track down the original source(s) to see if we come to the same conclusions.

In no particular order, these are some of the major concepts I took away from this course:

  1. Mobility vs Flexibility

  • I suppose this is a matter of semantics and different people may call it different things but as defined by FRC…
  • flexibility = the ability to passively achieve an extended range of motion (ROM)
  • mobility = the ability to actively achieve an extended ROM = flexibility + strength
  • being flexible does not necessarily mean you are mobile but you do need to have flexibility to be mobile
  • mobility implies control over your ROM
  • mobility training is an attempt to capture passive/”useless” ROM and to make them active so that they are functional/”useful”

  2. When there is limited direct evidence for your goals (e.g. acquiring mobility), look at other literature to form indirect evidence –> this is the basis of FRC!

  3. We should always explore different explanations for why certain techniques work and question existing theories. Why? Because different theories may imply different methods to obtain the same goal. Using a more accurate theory to develop your methods may result in a more efficient attainment of your goal.

  • Example 1: a common explanation for increases in flexibility over time when stretching consistently is muscle “lengthening” due to the viscoelastic properties of tissue
      • However, while these viscoelastic effects do occur, they are short term effects and it’s been shown that long term stretching (3 – 4 weeks) lead to improvements in ROM with no change in the actual structure of the muscle!
  • Example 2: the use of the reciprocal and autogenic inhibition reflex to explain why proprioceptive neuromuscular facilitation (PNF) stretching – aka contract-relax, muscle energy techniques, etc – work
      • however, Dr. Spina pointed us to some evidence showing that muscle activity actually increases during PNF stretching (i.e. during the “relax” part of a contract-relax technique, there is greater electrical activity of the stretched muscle)
      • as well, unilateral PNF stretching has been shown to improve ROM on the opposite unstretched limb (you would not expect this if increases in ROM were due to reciprocal inhibition)
      • if you’d like to watch Dr. Spina talk about this, watch this video
  • Based on the evidence, it seems that neither the viscoelasticity theory or the theory of reciprocal inhibition hold true as mechanisms behind increases in ROM after repeated stretching in the long term
  • A possible underlying theory is that ROM increases in the long term are due to neural adaptations via an increase in the stretch tolerance –> i.e. by stretching repeatedly, your central nervous system “allows” the ROM to occur
  • The amount of limitation is based on our previous experiences and our muscles’ abilities to function at a particular range… thus, a technique to increase ROM would target these two items rather than the viscoelastic properties of connective tissue or the reciprocal inhibition reflex –> this implies the need for a modification in the techniques we use!
  • One of the techniques that we learned in FRC (PAILs/RAILs) looks very similar to PNF except that, when using them to increase ROM, maximal isometric contractions are used rather than sub maximal (I think they told us 10 – 20% in school when doing PNF stretching?)
  • The reason for this is that maximal isometric contractions will increase the muscle’s ability to function at the end range (isometric contractions shown to increase strength at that specific angle +/- 10 deg) and thus reduce the limitations your nervous systems puts on how much of your potential ROM you can access

  4. Systematic approach to improving mobility

  • I took Ido Portal‘s shoulder and hip mobility courses a couple years ago and as inspiring as they were, I felt like I was “given the fish but not taught how to fish”
  • I found Dr. Spina’s approach to be the opposite, which I really like because I feel like I can progress/regress myself based on the system that was taught
  • There are no “right” exercises or stretches to do –> with the FRC system, you mobilize what you find limiting for yourself and this will be different for everyone, but the underlying principles are the same

  5. Training mobility vs training movement

  • Dr. Spina made it very clear that his course is not meant to train people how to move and that there are many people, such as Ido, who can do a much better job of that
  • FRC trains mobility, which is a prerequisite for movement and proportional to movement potential

  6. Injury mitigation vs injury prevention

  • The purpose of FRC is not just to help people be more mobile but also to “bulletproof” their tissues
  • Injuries occur when applied load exceeds capacity of tissues to absorb load… so why not increase capacity?
  • There is no such thing as injury prevention, only injury mitigation –> “Shit happens” all the time and the only thing we can control is how our tissues respond when shit does happen (e.g. training our tissues so that when we roll our ankles, it’s a grade 1 sprain instead of a grade 2 or 3 sprain)
  • This idea of “joint prep” is not new – you’ve probably heard of it before if you’ve ever been on Gymnastic Bodies or are familiar with Ido Portal’s work – but it was nice to see some science behind why it works and it’s the most systematic approach I’ve seen so far

Whew, congrats if you read all that. And I didn’t even get to talking about the system! As always, if you have any questions, comments, or concerns, I would love to hear from you! Feel free to leave a message below or send me an email :).

Thanks for an engaging course, Dre!

Thanks for an engaging course, Dre!

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12 comments to this article

  1. Olivier

    on December 4, 2013 at 8:05 am - Reply

    Great post!

    One question though. What is meant by PAILs/RAILs?

    Thank you for sharing.

    Olivier

    • VeeWong

      on December 4, 2013 at 5:06 pm - Reply

      Thanks for reading!

      PAILs/RAILs are the name of a technique that Dr. Spina showed us. PAIL = progressive angular isometric loading, RAIL = regressive angular isometric loading. Basically they are isometric contractions in either a lengthened position (PAIL) or a shortened position (RAIL). They can be used as a training tool to increase neural drive to the muscles at the end range and thus increase ROM (if you believe the alternate theory that increases in ROM are due to changes in the nervous system’s stretch tolerance and that stretch tolerance can be altered by increasing the muscle’s ability to function at end range).

      I think Dr. Spina discusses PAILs/RAILs in some of his videos. I found one that talks about it: http://www.youtube.com/watch?v=Sj-oH0qamY8&list=PL92990613EFF9182D&index=2

      Hope that helps clarify things!

  2. Allison

    on December 4, 2013 at 10:18 am - Reply

    Great post!
    I was also at this course over the weekend and I think this review really summarizes the concepts well. Glad to hear you enjoyed the weekend too!
    Allison

  3. Jeff Wong

    on December 5, 2013 at 3:21 am - Reply

    Didn’t know you had a blog Vee. PRetty good article, keep it up!

    • VeeWong

      on December 5, 2013 at 11:49 am - Reply

      Thanks! I just started it not too long ago :).

  4. David

    on December 5, 2013 at 10:33 am - Reply

    When doing PAILS/RAILS, you mention maximal contraction being used. Is that just internally driven and/or is there an external force being applied by practitioner? When applied from a practitioner, would you resist in all directions once positioned?

    Thanks

    • VeeWong

      on December 5, 2013 at 11:58 am - Reply

      Hi David,

      It can be internally driven or someone else can be applying an external force.

      For example, with a supine straight leg stretch for the hamstrings, the practitioner would apply an external force pushing the patient’s foot towards their head while the patient resists that motion for PAILs and then the opposite for RAILs (i.e. practitioner applies external force pushing the patient’s foot away from their head while patient resists that motion and tries to pull themselves further into the stretch).

      For them to do an internally driven maximal contraction, they’d probably need something to push against when doing PAILs (e.g. wrap a towel around their leg and push against that while they’re holding on the towel) and for RAILs, they would just be pulling themselves further into the stretch using their hip flexors as much as possible (i.e. thus increasing neural drive to those muscles in a shortened position).

      Hope that makes sense!

  5. PTStudent

    on June 2, 2016 at 9:01 pm - Reply

    I’m a current PT student in my first year thinking of taking this course. I’ve followed Dr. Spina as well for a little while and his stuff is great. The courses are, however, very pricey. Do you think it’s worth it for this broke student to shell out nearly $1000 next year to attend? And do you have any info on the FR courses? Those are available to me sooner but I wonder if I need more background in orthopedics (only have 1 placement under my belt so far) or if the FRC course teaches some prerequisite skills that I should build on before taking FR. As of now, all I got are the basic manual treatment skills from clinical labs! Thanks for the insight.

    • VeeWong

      on June 5, 2016 at 5:01 pm - Reply

      Hi there PTStudent!

      Thanks for reading. It sounds like you’re pretty motivated to learn more!

      I think there is a lot of important information in his FRC course that we are not taught in school (if anything, are mis-taught). That being said, if you already follow his work, you might already know a decent chunk of it. If you’re strapped for money but want to take a course, I would recommend Greg Lehman’s Reconciling Biomechanics with Pain Science (I wrote a course review if you want to learn more). Much more reasonable price and I think you’d get much more out of it. He’s someone who also really explores different explanations for why certain techniques work and questions existing theories.

      I took FR upper limb after FRC but as far as I know, FRC is not a prerequisite for FR. Sometimes you don’t need much more than the basics :). Again though, I’d recommend taking Greg’s course before anything else.

      Hope that helps! Feel free to email me at veronica@veewong.com if you’d like to chat in more depth.

      Veronica

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