The Joint by Joint Approach: How to Identify and Address Joint Pain
In today’s modern society, most of us are spending the majority of our day sitting in a car or at a desk. We wake up, commute to work, sit for 8 hours, commute back home, rinse and repeat.
That’s not the case for everyone, and if you’re someone that manages to stay active throughout the day, that’s great. But for many people, this is a daily reality.
Over time, this sedentary lifestyle can lead to a myriad of problems. Chronic joint pain has become way too common in people that are way too young.
So the question is: when the aches and pains start, what do you do to fix it? Common sense might dictate that if something hurts, you should address that area directly.
But that’s where things can get tricky.
Look at your body from the bottom up. You’ll notice a pattern:
- Ankles need to be mobile.
- Knees need to be stable.
- Hips need to be mobile.
- Lumbar spine (lower back) needs to be stable.
- Thoracic spine (mid back) needs to be mobile.
- Scapula (shoulder blades) need to be stable. (and mobile)*
- Shoulders need to be mobile.
Popularized by Mike Boyle and Gray Cook, this is known as The Joint by Joint Approach. This highlights the codependent relationship between the joint segments of the body.
For example, the knee is a stable joint; in order to maintain stability, the ankles must remain mobile — because any joint that is lacking mobility will try to “borrow” it from the joint segment either directly above or below. In this case, if the ankles become tight, they will force the knees to become mobile, and when stable joints are forced to become mobile, the risk of injury increases.
This has caused people to mistakenly pin the blame on certain exercises for their joint pain. Many people will avoid squats because their knees hurt when they do them; they assume the squats must be causing them some kind of “knee problem”.
Often, they don’t have a problem with their knees at all; the root of the problem is their immobile ankles.
Mobile ankles are a prerequisite to a proper bodyweight squat — if yours are tight and locked up, the body will try to steal that mobility from the next link in the chain — the knee — in an attempt to get the job done through the path of least resistance. This will, of course, result in knee pain.
The global effect of joint issues
If one link in the chain is disrupted, the entire Joint by Joint model is inverted. That means problems for your whole body. In order to properly address those problems, we can’t just focus on the health of a single joint; we need to make sure they’re all functioning as they should.
You’ll have some areas that are worse than others; maybe you have good ankle mobility and tight hips, for example. Prioritize those areas first, whatever they are.
Regardless of your particular “problem areas”, the common goal is to get to a neutral posture, and with that in mind, here’s a good, general rule of thumb:
Mobilize the hips, ankles, and shoulders; stabilize/strengthen the core and glutes.
“ Core stability muscles, or postural muscles, are the deep muscles in your abdomen, pelvis and back. They act as a corset or scaffolding holding you together rather than moving your trunk. It is important to have good postural muscles to help maintain a good posture.” — MS Trust
To strengthen the core, there are two main approaches to take:
- #1. Planking variations
- #2. Loaded carry variations (aka “Farmers Walks”. Pick up something challenging and take a walk with it.)
In case you’re wondering why sit ups didn’t make the list — keep in mind that the primary role of the core is to stabilize the spine. Sit up & crunch variations facilitate spinal flexion, and while there’s nothing wrong with including them in your workout — if your goal is to “functionally” strengthen the core, planks and loaded carries are going to be the best bang for your buck.
The glutes work to support proper pelvic alignment. When underdeveloped (as they commonly are), the pelvis gets tilted forward.
The lower back is also called upon to compensate for weak, inactive glutes when performing simple tasks, such as bending over to pick something up. This causes unnecessary shearing on the spine and further contributes to lower back pain.
To stabilize & strengthen the glutes, some good choices are:
- Hip thrusts
- Glute bridges
- Back extensions
- Romanian deadlifts (once you’ve built up the strength)
A good way to test your glute strength: Hold the top position of a 45 degree back extension for as long as possible. Once you’re able to hold the position for 2 minutes, your glutes are catching up to the rest of your body.
Take a two pronged approach with the ankles:
- #1. Utilize a single leg calf stretch variation.
- #2. Roll out the bottom of your foot with a lacrosse ball.
The first, of course, is to address the tight calf muscles directly. But that’s not always enough if everything else surrounding the ankle is immobile as well.
If the fascia (thin connective tissue) on the bottom of the foot is tight, this can result in the entire body being pulled out of alignment.
Work over the bottom of each foot for 1–2 minutes at a time with a lacrosse ball to loosen up the tight fascia.
One of the primary muscles that make up the hip flexors (the psoas) actually originates from the lumbar spine. When it becomes tight, it “pulls” downward on the spine, which leads to back pain and poor posture.
There are plenty of mobility drills out there to address this, but to keep it simple:
Spend 1–2 minutes per day — every day — performing a rear foot elevated hip flexor stretch.
If you stopped reading this article right now and didn’t do anything else but that, reading this was worth it.
As someone that is in a car 8+ hours a day, five days a week — this one move in and of itself has been a game changer for managing lower back pain.
To make a long story short (and effective): hang from a bar.
Orthopedic surgeon, Dr. John Kirsch, notes in the 4th edition of his book, titled “Shoulder Pain? The Solution and Prevention”, that a dead hang from a fixed bar (such as a chin up bar) for intervals of 30 seconds, 3 times a day, effectively increases both mobility and stability in the shoulder joint while increasing the space.
The muscles surrounding them must be strengthened in order to keep the Band pull apart, band dislocate, and face pull variations are also great options, but if you can’t do anything else — taking 90 seconds a day to hang out will pay dividends when it comes to healthy and mobile shoulders.
Putting the plan to action
Give this sample flow a try if you’re someone that’s currently dealing with joint pain.
Sample Mobility/Stability Flow:
- Hang from a bar — 30 seconds
- Shoulder dislocates with band — 10 reps
- Lacrosse ball to bottom of feet — 1 min. per foot
- Single leg calf stretch — 1 min. per side
- Rear foot elevated hip flexor stretch — 1 min. per side
- Front plank — 30 seconds
- Side planks, left and right — 30 seconds per side
- Glute bridge — 10 reps; 20 sec. iso-hold at the top of the last rep
Moral of the story:
I was asked by Richard Mathews what my thoughts were on the best stretches for older people looking to offset the effects of the aging process; my answer to that question would have to be “all of the above”.
Because the truth is, it doesn’t really matter which stretches and exercises you choose — it’s more about getting the joints to move through a full range of motion than it is the particular movements you’re using to get there.
Rather you’re 16 or 60, make joint health a priority and the version of yourself 20 years from now will be thanking you.
- *The scapulae must be mobile so that they can protract, retract, depress, and elevate. The scapular muscles work in concert with the muscles of the rotator cuff to stabilize the shoulder joint while in motion. In this sense, it is a unique area as it must be both mobile and stable.
Thanks so much for reading! If there’s an article you’d like covered in the future, let me know in the comments. New articles are posted weekly, and I’d love to know what you’d like to read about next! — Zack