weakness and dysfunction

When is it dysfunction, and when is it just being weak? Fact: there are many people in gyms with a history of serious injuries and health conditions who are stronger, fitter and with better joint mobility than many "healthy" beginners.

It's often said in physical training that we should not apply load to dysfunction. For example, if someone does a bodyweight squat and as they rise they always swing their hips to the right, there is some sort of imbalance there that needs to be dealt with before we put even a 20kg barbell on their back. When you add load to an imbalance, the imbalance is amplified.

But what's the cause of that imbalance? There could be a previous injury like a hip dislocation, or a condition like scoliosis. Obviously these should be looked at and considered, a competent trainer or coach will know about this in their lifters, and work with medical professionals to help the person. 

But what if the person's just weak? Few of us stand with the weight evenly distributed between both feet, usually we'll shift our weight to one side, and usually it's almost always the same side. This then leads to a muscle imbalance left-right, and something like that could cause the person's hips to shift to the right as they come out of a squat. We don't need a medical professional for that, we just need some proper training, lots of one-legged work to balance things up. 

This is something that's rarely talked about in physical training and medicine, the line between injury or condition and ordinary weakness. There's a guy at my gym, I've seen him do around 5 wide-grip pullups, benching around his bodyweight - and deadlifting his bodyweight. He has a below-knee amputation with a prosthetic, you don't get any more imbalanced than the limb being missing! But despite his medically-caused imbalances he works out hard and with good results.

And yet at the same gym there are guys who say they can't squat deep because it hurts their knees, and beginners whose posture resembles that of a gorilla say that they can't deadlift because it's bad for their back. And when you look at their squats or deadlifts you see why, their movements are imbalanced and rough. Their ordinary weakness is worse than a medical issue. 

A one-legged guy deadlifts 80kg and does wide-grip pullups with added weight, and is called "disabled." Another guy cannot deadlift with correct form, and cannot pull 60kg from the ground, and is called "healthy." 

Of course there are people in between, for example someone might break an ankle, it's in a cast for six weeks so gets weak and stiff, after that they tend not to use that foot as much, it's usually not a medical problem but twenty years later when they squat that ankle is less mobile and strong. However, if it's bad enough it might be a medical problem. Maybe to strengthen the ankle we put the person on a one-legged leg press, and they get shooting pains up and down the sides of their calves. 

Thus the issue of where a medical problem ends and simple weakness begins can be a muddled one. Trainers are usually pretty bad at dealing with medical issues, it goes beyond our scope of practice, and too many will get all butch and tell people to work out despite injuries or conditions, "everyone needs to barbell squat," etc. But medical professionals are pretty bad at dealing with simple weakness, being overcautious about proscribing movements, "just rest." 

The vast majority of people don't have any real medical issues preventing them from doing particular movements in the gym, however they will find lots of things very hard, and will have all sorts of funky muscle imbalances going on. These are usually dealt with by teaching correct movement rather than focusing on individual muscles, and simple verbal cues will often do a lot to balance things up.