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Z-Health and the RKC - a Clinician's View

April 12, 2010 05:25 PM

Over the past few years, a growing number of RKCs have pursued Z-Health certification. With this growing interest, a number of questions have arisen regarding the compatibility and integration of Z-Health principles with the RKC system. As a practicing physical therapist (with a DPT from Duke University), a newly minted RKC, and 4 years experience with Z-Health (R,I,S,T, 9s), I have seen some alarming trends with long term use of some of the Z-Health principles, especially if RKC principles are not rigorously followed. My intent with this article is to give a brief overview of pertinent concepts, introduce some benefits and limitations of Z-Health, and recommend the best use of Z-Health as it pertains to the RKC.

For those of you who are not familiar with Z-Health, it is a neurologically based approach to movement and training for the purpose of optimizing health and wellness. Among the key principles upon which Z-Health is built are the principles of specific adaptation to imposed demands (SAID) and the arthrokinetic reflex (AR). Z-Health defines the SAID principle as "the body always adapts to exactly what you do" and the AR as: "jammed joints cause weak muscles." We will discuss these two principles in a moment.

First, there are many benefits to the Z-Health approach. Most notably, is that it provides a comprehensive lens through which to look at, and assess, human function. Its principles and tools have contributed a great deal to the practical understanding of pain or dysfunction, as well as the practical integration of the bodily systems (such as neural, integumentary, musculoskeletal, circulatory, respiratory, and hormonal, etc.). Z-Health provides an excellent paradigm with which to view and treat patients holistically in the true sense of the word. The most easily recognizable feature of Z-Health is its precise dynamic joint mobility, which, in addition to the mechanical effects of restoring lost joint function, is used as an entry point into the central nervous system to effect rapid systemic changes. There are numerous other tools as well, but they are well beyond the scope of this article.

One of the primary benefits of the Z-Health approach is the ability to reduce or eliminate pain very quickly. Its neurologic "switches," (such as joint mobility combined with visual or vestibular stimulation), can often help reset the pain-processing pathways in individuals with chronic or acute pain problems. This then provides a window of opportunity to address underlying dysfunction. This is great in the hands of a licensed provider. Please note however, that if you are a trainer and do not have a license to "treat" pain, yet you have a client with a painful problem, they should be referred to the appropriate health care provider (MD, PT, etc) for clearance to train and, more importantly, to rule out major problems. One of the most alarming trends I have seen is that because Z-Health's tools work so well to alter pain states, there is often a reluctance to refer clients to mainstream healthcare professionals. Among many Z-Health practitioners, I have seen a general distrust of the medical profession due to the fact that Western medicine often fails to evaluate and treat the "whole person." In addition, because pain can oft be easily altered with a few Z-Health drills, there is a tendency to think that a painful problem has either been "fixed" or is not a major issue. However, a reluctance to refer a client who has pain to a medical professional can have disastrous consequences (such as death)! Mark Toomey had an excellent post on the Dragon Door forum titled "a man's got to know his limitations" regarding a client he referred to an MD for mild but unchanging sub-scapular pain. It turns out that the client had a ruptured aortic aneurysm and would have died had it not been discovered in timely fashion. Thanks to Mark's appropriate and speedy referral, the aneurysm was found and his life saved! What worries me here, is that the primary benefit of Z-Health (its ability to change pain) can also be one of its most dangerous aspects. (Now, I do know that the necessity for appropriate referral is mentioned several times during the certifications. I am speaking here about a general attitude among practitioners that I have seen firsthand rather than what is taught during the certification process.)

After using Z-Health personally and professionally for the last 4 years, (35-40 hours/week with clients, extensive personal practice, and a plethora of one-on-one sessions with Dr. Cobb, the founder of Z-Health), the limitations of the approach are gradually becoming more evident to me. I can already hear the protestations and arguments from the Z-Health crowd as I outline some limitations. I know the arguments well - I used to use them. I will not address these arguments in this article as it is a bit beyond the scope of the current discussion, but maybe some other time . . .

Let's start with its primary underlying principles. Unfortunately, the Z-Health definition of the SAID principle, (characterized by "always" and "exactly"), connotates exclusivity rather than specificity. Although this may seem like just semantics, it sets the stage for some significant issues during training later on, and can be constraining if the concepts which flow out of this theoretical framework are strictly followed. The reality is, that if you buy into the Z-Health definition of SAID, and follow it to its end, transfer of training could not exist. There would be no "what the h** effect." Also, if transfer of training does not occur, then there is no need for auxiliary training or general preparedness. Lack of general preparedness due to misapplication of the SAID principle can lead to poor durability down the road. This is compounded by the following issue.

Another underlying principle emphasized in Z-Health is the AR. The heavy reliance on the AR principle seems to have led to a thought process that disregards the need for the training of movement patterns, (which I believe can be considered a component of general preparedness). For example, it is taught that if joint mobility is fully restored, and under active control of the brain, muscle activity and synergies will automatically function correctly (which incidentally violates the Z-Health definition of the SAID principle). More serious training errors follow this line of thinking. The trend during training becomes a continued emphasis on use of mobility and neurologic tricks to "fix" problems or achieve rapid changes in short term performance, but a failure to maintain consistency and strength in foundational synergistic patterns which are necessary for durability over time. The result is a collection of highly mobile body parts, which literally become "unhinged," paving the way for serious injury, especially under heavy loads. (I have both experienced this myself and seen it happen over time in colleagues and patients.) I have noticed over time, that, in order to perform adequately, there always seems to be something new to "fix," therefore, one ends up always "fixing" things instead of training, and the training threshold eventually starts to decrease. This, in my mind, indicates that the root issue has not been adequately addressed. A serious flaw in an approach that is marketed as a complete and superior system!

The RKC (and the Functional Movement Screen (FMS) to my knowledge) on the other hand, do a phenomenal job of training these foundational movement patterns ? which alone can often resolve many of the underlying patho-mechanics. For example, limited shoulder mobility, asymmetries in trunk rotation or the complete lack of upper-lower or cross-body integration are easily found with the Turkish Get-Up (TGU). Problems with hip flexion and spinal stability are also easily picked up in the deadlift or swing. I myself have made more progress in my own function and rehabilitation in just 2 months of working on various TGU progressions and a few FMS drills than I made in 4 years of Z-Health practice. Could this be error on my part in applying Z-Health principles? Possibly. But, if I, having a doctoral degree in physical therapy from Duke University, and as a former scholarship D-1 volleyball player (I.E.: I am familiar with high level athletic performance), have a hard time interpreting and applying the Z-Health approach correctly to achieve consistent performance gains over time, I imagine a few of you would have the same problem.

Finally, a common source of debate between the Z-Health and RKC communities is the question of "how much tension should be used when training?" The Z-Health line is typically: "only use the right amount of tension to accomplish the goal." This in not an inappropriate answer, but again it leaves the door open for problems down the road. Z-Health, as applied to lifting and loading, relies heavily on joint positioning, bone rhythms, and maintaining space in the joints rather than tension/compression in an effort to avoid triggering the AR. (The argument being that too much tension reduces efficiency and creates too much joint compression, thus inducing the AR over time.) This argument seems sound in theory, but it tends to result in the perception that it is better to use less tension rather than more. Unfortunately, the application of this perception significantly reduces the margin for error during loading or when learning a new skill. (How does one know what the appropriate amount of tension is when learning something new anyway?) It is MUCH safer to error on the side of too much tension than not enough when throwing iron around! Failure to produce enough tension and joint compression creates instability under load and causes excessive shearing forces on tendons, ligaments, and other supporting structures. This can be disastrous to the spine, shoulders, knees, and hips, etc. This is in stark contrast to "Hardstyle" methods, which are characterized by compression (in the right areas and in the right alignment of course). This is not to say that the RKC is all about tension ? it is not. Just take a look at all of the books Pavel has written on mobility, and the use of tension principles to create space and mobility in the RKC manual (such as hip flexor activation in the squat). It appears that the Z-Health community approaches the tension "issue" from one end of the spectrum; the process tends to focus on gaining mobility and decreasing "inappropriate" tension first, then building "appropriate" tension back in. The RKC however, uses tension concepts earlier on (balanced by relaxation principles), then as skill progresses, excessive tension is dialed back. The question then, is which method is safer? In my view as a health care provider, the latter is safer in the long run. Mobility can always be restored as needed using concepts from Super Joints, Resilient, Fast and Loose , or Z-Health R and I phase.

In the end, it is my opinion that Z-health is very beneficial in the rehabilitation setting for treating pain, and is also very useful in stripping away long-standing compensations that accrue over the life span. However, if normal movement patterning is not re-trained after the compensations have been removed, one is left with their weaknesses exposed and "dis-integrated" movement skills. (Whoa-what about I-phase which is all about integration?? Well, actually, when performing I-phase drills, the movements are very isolated movements in an integrated position ? thereby creating a "dis-integration" in what should be an integrated pattern. Does it load fascia in an integrated fashion? Maybe. But it does not necessarily teach coordinated muscular action during movement patterns, which are used by the brain for motor control during function.) My point here, which is worth restating, is that the Z-Health philosophy disregards the need for pattern retraining, and generally relies on isolated mobility work in integrated positions to fix patterning problems. I believe this to be a rather significant and dangerous error in the Z-Health approach as it can lead to instability via loss of synergistic fundamental movement patterns.

So, what is the best way to integrate Z-Health and the RKC? For those who have gone through the Z-Health certifications, my advice is to use its joint mobility work sparingly as rehabilitative, restorative, or recovery work. Concurrently, spend a lot of time using RKC principles to re-learn proper patterning under load. ALWAYS use RKC Hardstyle methods as taught at the RKC when using kettlebells. If you are performing a lot of Z-Health mobility work, watch out for hypermobility problems down the road. In my clinical view as it relates to Z-Health practice, this is characterized by the constant need to "fix" something in order to function properly and a gradual loss of strength over time. (Yes, you will see some immediate and phenomenal strength gains initially, but in the presence of hypermobility you will see a gradual weakening. Unfortunately, by the time you realize it, it is a bit too late.) If at all possible, I would advise getting screened by an FMS or CK-FMS certified trainer to check for any stability, mobility, or patterning issues on a regular basis, to help prevent the aforementioned problems from occurring.

For those of you who are considering the Z-Health certification process, I do believe there are many things to be learned. However, because I feel that Z-Health is more suitable for the health care field (due to its phenomenal pain control aspects), as a trainer it may be more appropriate to pursue the FMS first. In the meantime, master all that the RKC has to offer ? it is simple and effective, and takes care of most of the issues that the general population presents with.

In my opinion, most of the dysfunction in the general training population can be appropriately addressed with RKC principles with a little help from the FMS in the more difficult cases. Joint mobility and general suppleness can be maintained and improved via any of Pavel's resources as well. In closing, although Z-Health is highly beneficial in many respects, I believe the tried and tested methods of the RKC (and FMS) should be used as the primary tools of RKC instructors in their own training and with clients. Z-Health can be used as a rehabilitative and restorative modality when appropriate, but use caution to avoid the pitfalls mentioned in this article. If there is an apparent conflict between Z-Health and RKC principles, use the RKC principles first and foremost, while continuing to honestly explore theoretical constructs methodically and without prejudice.

Courtney Neupert, PT, DPT, RKC is a licensed, practicing physical therapist in a private-practice outpatient clinic. She earned her doctoral degree in physical therapy from Duke University in 2003, and earned her bachelor's degree in exercise science at Rutgers University where she was a Division-1 scholarship volleyball player. She has been Z-Health certified (R, I, S, T, 9s), and earned her RKC in August 2009.