Corrective Exercises: No Magic Fixes

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I once thought of corrective exercise as a magic ritual that would instantly fix pain. I believed a Z-Health drill, an FMS glute bridge, NSCA balance exercise, exotic kettlebell move, or some specific stretch or core activation routine would instantly change something so that I could move freely without pain—and without thinking about it. That’s magical thinking and now I think otherwise.

Corrective exercise is only corrective if the movement skills or sensations learned during the exercise transfers to the “real-life” activity for which the correction is sought. This process entails diligent thinking and crucially, it requires awareness. A corrective exercise should promote awareness of how to use certain muscles and/or how to move or stabilize a limb in a new, more effective way.  Here’s an example:

At a recent running-related clinic conducted by running coach and physical therapist Jay Dicharry. we discussed a common problem among runners in which forward propulsion comes from too much lumbar spine extension and not enough hip extension. This is inefficient and may cause low-back pain, knee pain, and other problems. We learned several strategies to run in neutral posture while extending the hip. More specifically, we used the abs to bring the ribs down toward the pelvis, reducing lumbar extension, while simultaneously contracting the glutes to drive the leg backward. Several exercises helped us gain awareness of glute contraction, hip extension, and ribcage positioning. We didn’t stop with exercises. We took the awareness created by the exercises to the act of running. We had to think and pay close attention to what we were doing.

In the context of corrective exercise, my job is to facilitate habit change in my clients. I must select the exercises that help my client move and feel better. The exercises should have adequate similarity to the activity in which my client wants to improve. I must use cues that resonate with my client, that help them understand and feel the proper movement pattern.

This process may require using several exercises that link to the activity itself. For running, we may start with a simple exercise to simply feel a muscle, the glutes for example. We may start with some sort of bridge, lying supine on the ground. We may progress from lying on the ground to kneeling, to standing on two legs to standing on one leg, and then to running. All the while, I must use the right cues and instructions to keep the client focused on the task at hand. Finally, I must ensure my client repeats the new movement pattern. Repetition is essential for learning.

The corrective exercise process is fundamentally about habit change. It’s about focused learning to create and allow new, different movement. The new movement process must be practiced and ingrained so that it replaces the old, painful movement. Corrective exercise is not about an automatic fix.

Awareness: Half-Kneeling

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I’m very much into the idea of awareness so I’m going to continue the conversation.  I feel like many of us aren’t fully aware of how to do a lot of things and as a result we’re weak, slow, and/or in pain.  We aren’t aware of our spinal position and stability (or lack there of) as we move.  We’re not aware of our scapulas as we use our arms.  We’re not aware of our glutes as we do all kinds of things.  We’re not aware of our pelvic position…  In general, we’re not aware of our inabilities, our instabilities, and our weaknesses.  So if we think we’re going to function well, be strong, and move fast without awareness then we are very mistaken.

More specifically, I’ve become very keen on improving the rotary stability portion of the Functional Movement Screen (FMS.)  I’ve realized that rotational stability is sort of a hidden weakness and an under-appreciated ability. Rotational forces are acting on us all the time and we often don’t know it. If we don’t control rotational forces correctly then we’re at risk of injury and poor performance.

Part of this process includes the half-kneeling position.  You can use this position as both a test and an exercise.  The interesting thing about this process is either you do it correctly and you succeed or you do it wrong and you fail.  Unlike say, a bench press where you can make the bar move up and down in a multitude of ways that may or may not be safe and effective, staying upright in the half-kneeling position equates to the one and only way to do the exercise correctly. Thus, the test is the exercise and the exercise is the test.

I discussed the half-kneeling position with Denver-area PT Mike Kohm.  He’s worked with a lot of runners and cyclists including some pros.  He says it’s not uncommon to put a strong, capable athlete into a half-kneeling position and they instantly become an unbalanced clod with no idea how to stabilize his or her body.

Why is this and why does it happen?

By going into the half-kneeling position we’re taking the legs out of the equation and putting a lot more work into the hips and trunk–aka the core.  Mike suggests that many athletes have very strong legs that can compensate for an inefficient core.  Why not go ahead and get a competent core?  Gain awareness.  Shore up the weakness.  Get really fast/strong/mobile, etc.

The first video goes into the half-kneeling process.  The second video is from Gray Cook; it covers the lift and chop which are often done in the half-kneeling position.  Finally, if you’re interested in expanding on exercises to improve rotary stability, check out Can’t Turn This by Brett Contreras at TNation.com. It’s full of several very effective exercises that should help you improve the very under-appreciated ability to resist rotational forces.