Wednesday, November 18, 2009

Exercise Corrective

There has been some very good answers to my Just Questions... post. What I was hoping to do was ignite some thinking, especially regarding the corrective exercise stuff that seems to be the latest way to make money in the health and exercise industry.

My biggest issue with the corrective exercise stuff, as all the bright folks who responded to the post also stated, is that any movement/exercise can be corrective. I think too many of the "experts" have been spewing too much pseudo rehabilitation stuff and now everyone is over-thinking/over-correcting symptoms and playing the role of therapist. I thought exercise in general was theraputic and pro-active. What about true expert coaching of basics and allowing these basic gross movement patterns to do the correcting?

It's important to not settle for average technique and try to patch everything up with "corrective" work. Let's allow for individuals to access their motor learning capacities. Language, quality demonstration, and effective coaching cues are important here. Using language with a little emotion goes a long way as well. Watch a group getting an energetic talk about correct lifting posture. What do you notice? The audience begins to straighten-up.

I have dumped much of the activation/prehab/rehab work from most if not all the programs I write now, and have had hardly any issues because of it. I've been demanding in the correct technique of the major barbell and dumbell lifts and bodyweight movement. I also make sure to leave the weightroom as a place to develop strength and power, and have done as much as I can to get more time of our training sessions outside the weightroom for movement/speed/agility work. What's been amazing is how "corrective" good quality movement training and basic strength and power lifts can be. Repetition and patience is important... the athlete needs practice and time, and it's amazing what happens when it is given.

The major point here is, if one gets much better at coaching the basics and has a thorough understanding of the mechanics and physiology of basic exercise, it becomes much easier to spot problems that need correcting/adjustments. Now every moment spent with an athlete or client becomes an assessment and less time needs to be spent on specific assessment sessions and filling an athletes time and energy with more exercises than needed. Every individual only has a finite capacity for attention and energy. Let's put it to use with the most effective methods.

Obviously there is a time and place for "corrective" type work, but let's not make and lead everyone to believe they are a patient.

Move.
AS

14 comments:

Putting Health Back into Fitness said...

Great Post, Aaron. I agree that "corrective" exercise is a poor term, for one, and an overblown marketing gimmick to sell more product-a way to establish value when good quality, "regular" exercise becomes unsexy.

I agree that any exercise can be corrective with a knowledge and understanding of the person's body performing the exercise.

I'm also a little concerned with certain fitness gurus who state that certain exercises are "bad" because they break the body down over time. For example, some coaches don't like the back squat and opt instead for single leg work, because they believe that the back is a poor force transducer. Although single leg work is important, it's silly to think that the back squat is to blame for back problems, when it is likely the person performing the back squat that is the issue not the exercise itself.

If more people, coaches, athletes, trainees, were informed and educated about how their body works and what it can and cannot do, then one can stop blaming exercises for their lack in performance or injury. It's easier to blame exercises, but harder to look inward at our own abilities. I think it's human nature to blame these external factors for things that can be remedied by identifying and working within oneself.

The other problem with the corrective exercise folks is the fear mentality. Like Josh said on the previous blog on this topic, when you label it "corrective" exercise, you are psychologically telling the person that they are broken and need fixing. Corrective exercise Trainers fall into this trap all the time and often spend their entire workout doing esoteric corrective exercises for fear of being thrown out of balance in traditional exercises. This often results in missing the mark on reaching weight loss and performance goals because the focus is too much on trying to correct.

The solution?

To start, we can identify-WITH the athlete present-the movement limitations that exist, give them homework to do on off days, and then hit it hard in the gym emphasizing IMPECCABLE form. To me, this is just great coaching, pure and simple. But it starts with the athlete/trainee owning their health and dedicating themselves to understanding how their body works and how it moves in space.

jleeger said...

Aaron, you've summed this up incredibly well!

I have dumped much of the activation/prehab/rehab work from most if not all the programs I write now, and have had hardly any issues because of it. I've been demanding in the correct technique of the major barbell and dumbell lifts and bodyweight movement. I also make sure to leave the weightroom as a place to develop strength and power, and have done as much as I can to get more time of our training sessions outside the weightroom for movement/speed/agility work. What's been amazing is how "corrective" good quality movement training and basic strength and power lifts can be. Repetition and patience is important... the athlete needs practice and time, and it's amazing what happens when it is given.

"if one gets much better at coaching the basics and has a thorough understanding of the mechanics and physiology of basic exercise, it becomes much easier to spot problems that need correcting/adjustments...every moment...becomes an assessment."

YES! YES! YES!

I also agree with Charlie. Some folks need "homework" to get over habitual/long-standing deviations. Probably not most of the population you work with (and I, similarly, don't have any clients right now who are really messed up physically), but some of the "regular (non-athlete) population" have serious deviations that need constant attention.

That being said, I think that more HEAVY LIFTING WITH CORRECT FORM/POSTURE is the ultimate corrective. Reason being, you can do as many "breathing squats" or yoga poses as you want, but when you stand back up, and gravity starts pulling on you, your weak muscles will fail. And there you'll go, back into slouch-dom. Somatic awareness is great, and correcting alignment just prior to lifting or exercise is awesome, but without heavy lifting to cement those adjustments, what's the point? Your life becomes constant adjustment. And then, again, you're always "ill." Screw that.

Further, people just don't lift heavy stuff anymore. I mean, generally. The days of the farmboy/girl are gone for the most part. Industrial agriculture has killed that. All of the real heavy (and dangerous) factory-type work has been roboticized or moved out of this country. The only guys who do any heavy lifting anymore are construction workers, movers (of any sort), and package-delivery folks.

More, Charlie mentions this, and you mention the cure for it. I am beginning to wonder more and more about the cultural assumptions behind our activities. Because, ultimately, they inform us of what is possible/impossible, right/wrong. So they'll tell us why trainers and trainees are taking this expert/non-expert role in communication (what I mentioned before, and Charlie mentioned here), and how to communicate through/past that obvious barrier to success (what you said)...

Great post man! Awesome, thoughtful, simple!

Aaron Schwenzfeier said...

Very good stuff comrades!

Charlie, I like this statement:
"But it starts with the athlete/trainee owning their health and dedicating themselves to understanding how their body works and how it moves in space."

Josh, I totally agree that heavy lifting with correct technique can be completely corrective. Plus I think heavy lifting WAKES SHIT UP in a person's body. We have too many weaklings walking around today. Getting stronger most definitely does not bring one closer to death.

I also think that some stuff should absolutely be homework, but also thing some of the homework 'assignments' should be subtractions from what one is currently doing.

In society, we are already 'overloaded' with excess of everything, and reduction of the unnecessary might relieve stress, change perception, and add energy to ones self. And renewed energy and less stress creates an improved internal environment, which leads to better external output... and posture and movement are not excluded from these possibilities.

Or assign going for a brisk walk in the park versus some corrective work. Not only is the walk nice low-intensity movement, but a little 'fresh' air and sunlight go a long way.

Again fellas, always love the insights, thanks.

Brett Jones said...

I commented below as well - some repeat here...

There are some things that I agree with here -
blaming exercises instead of the movement patterns we bring to the exercise is a big issue.
I'm not sure that "any"/all exercise can be corrective but i would say that if it hits a "weak link" then yes it can help - the question becomes how do you define/validate that.
yes - athletes and clients should be "empowered" and able to say "when".

I do not agree that you get better movement by enforcing technique - instead you typically get better at compensating around your restrictions and asymmetries.

Performance does NOT equate to movement quality!

If you have a consistent baseline you know what effect exercise is having and you can find the weak links before they are an issue.

TPI (Titleist performance institute) can show conclusively on comparison of 3-D swing analysis and movement screening of 1000's that certain swing faults correlate with movement restriction and asymmetry - You cannot coach these people into a good golf swing as long as the movement restriction is present.

Why not recommend 5 miles of walking?
Because if the person has reduced ankle mobility or lacks hip extension (which most people do) then they are going to get injured - not healthy.
Clear the movement restrictions and now you can walk to health.

You have dumped the prep work etc... but are these the same athletes that were with you when you did perform these preps etc......
and remember that performance does not equal durability.

Does heavy lifting have a place - absolutely! But with a proper movement base.

Brett

i am Susan said...

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6. We are a Functional Food, not a juice!

Aaron Schwenzfeier said...

Brett, I thank you for taking the time to come on here and post your thoughts...

"I do not agree that you get better movement by enforcing technique - instead you typically get better at compensating around your restrictions and asymmetries."

So by coaching better technique with something like a deadlift, in which the athlete initially had an unsafe amount of spinal flexion, possibly an anterior weight shift in foot pressure, etc.; does not technique correction, of fixing spine position, foot pressure, head posture, teaching the athlete to 'hinge' through the hips, improve one's movement in that particular exercise? Which now maybe has the potential to do some correcting???

I agree that performance does not necessarily equate to movement quality; which is why good coaching goes a long way. Proper instruction can lead to "top-down" learning...

"TPI (Titleist performance institute) can show conclusively on comparison of 3-D swing analysis and movement screening of 1000's that certain swing faults correlate with movement restriction and asymmetry - You cannot coach these people into a good golf swing as long as the movement restriction is present."

... interesting. I wonder what the age of the subjects averaged with this research. Obviously time and 'sheer' repetition in something such as asymmetrical as a golf swing can probably indeed wreak some havoc on ones tissues and motor patterns. But does form follow function, or function follow form?

"Why not recommend 5 miles of walking?
Because if the person has reduced ankle mobility or lacks hip extension (which most people do) then they are going to get injured - not healthy.
Clear the movement restrictions and now you can walk to health."

What would happen with someone who had a desk job, or student who spent the majority of their time in a seated position and then started adding 40 minutes to 1 hour of walking each day?

What if they decided to start walking to work or class? Would they get injured?

Is corrective exercise the ONLY way?

Does improvement to some systems of the body such as internal physiology have no positive effect on motor output? Does the body not have any inherent wisdom that only "man and science" can correct after years of disuse?

If all of a sudden we became a communist country and mandated 5 miles of walking every day for everyone, would this undermine the system and kill our health care because now everyone is getting injured?

Would 5 miles of outdoor walking in sunlight go further for improving overall health and performance than corrective work?

Does the body have inherent wisdom that when exposed to the correct "environment" will help "correct" itself?

I know these are all far-fetched questions, but ones I seriously consider.

Thanks again Brett,

Aaron

jleeger said...

There's something odd in that Brett originally supported the deadlift and the Turkish getup as "corrective exercises."

A review of Brett and Gray Cook's RKC course:
http://www.begin2dig.com/2008/08/ck-fms-you-gotta-do-this-its-about.html
"...we looked at the revised Turkish Get Up as both a confirmation of improvement and as a complementary diagnostic tool...We've looked at the deadlift and presses in the same way: both as corrective strategies and to note progress or issues that correlate with the screen."

So it's very strange that he's so negative in his comment with regard to this particular issue.

Brett, did you stop believing/practicing this?

He's also oddly disconnected. What's the sudden jump (other than being a "plug"/advertisement) to the Titleist statement?

Last but not least - he's wrong.

First, no one has "dumped" prep work or even corrective exercise. Every session starts with prep work and "corrective" work. However, what is that prep/corrective work based on?

The question is whether or not we might be wrong in thinking only minute/fine adjustments/manipulations of the body, or that minute/fine motor patterns are "corrective."

The second question is whether or not minute/isolated motor-pattern training has any effect when the organism goes back into activity with full-body demand in an unpredictable environment.

What is a "proper movement base" if it is not good form/technique through as complete a range of motion as the individual is capable.

Walking is corrective exercise. A person with limited ankle flexibility (unless it is pathological - that is, caused by actual breakdown or deformity in the body) can improve that flexibility by walking with proper technique.

The first step is to get people to understand how their body works optimally. Joint alignment, levers, etc. The second step is to help them to put that understanding into practice so that they can then go on and do whatever they want to without you. "Teach them to fish."

Keeping people locked down in minutiae leads to dumb individuals with dumb bodies.

Brett Jones said...

Aaron,
As far as coaching technique - yes all of your coaching cues are good - but the athlete/individual will be able to access those coaching cues better if they are not fighting roadblocks like lack of a toe touch, or a bad ASLR.

Your questions on walking - I still stand my saying that an ankle restriction or hip extension issue will simply cause compensated walking patterns - I base this on my 20 years of seeing people begin a walking program for health only to end up with plantar fascitis or knee pain etc....

The age of people evaluated at TPI was pretty varied from youth golfers to pros to executives.

Aaron - have you been through an FMS workshop?

Brett Jones said...

jleeger,
Have you seen any of my and Gray's products?

Have you seen Kettlebells from the Ground Up
or Secrets of Core training - the backside
or Secrets of the Shoulder?

Until you have seen them then don't assume what I do or think because we approach all of these products and the related exercises with Screening and corrective drills to ensure safe and proper execution without compensation.

In KBs from the Ground Up there are specific things we are looking for at each step and specific drills to help correct issues at each step. It is the Right to Left appraisal that Get-ups, Presses and single leg deadlfts provide and we capitalize on.

I am not wrong and I have not changed my mind on anything - you simple don't know what you don't know.
That was not a Plug for Titleist - it is simply a source of information - i am not certified by or hired by titleist and even if I were what difference would that make? The data they have collected is solid.

The movement base I recommend is the FMS - Have you been through an FMS workshop?

The FMS deals in fundamental movement not minutia.
I am a huge fan of lifting heavy and technical excellence in the lifts - if you actually knew anything about me you would know that.

So what is your experience with the FMS?

jleeger said...

Hey Brett...send me a copy of your DVD's and I'll watch them:
290 Division St
San Francisco CA 94103

I don't buy into "functional movement" most of the time. I usually find the term is used as a catch-phrase to sell a system (that is, limited knowledge).

I've seen the FMS. I don't find it to be especially functional. I'm sure it's good for some, but I'd rather watch the individual all the time. Every second is an assessment. I'm not interested in their performance on tests.

I understand your statement about walking. If someone has a true limitation that coaching can't get them past, you're right. But it goes way beyond movement at that point, to soft-tissue work, and psychology as well.

Send me a copy of your DVD's and I'll gladly watch them. You're right, I don't have context to discuss your work. I was just confused because you came across as very strongly against the idea that strength training movements could be considered corrective, but have promoted that in the past...

jleeger said...
This comment has been removed by the author.
Brett Jones said...

jleeger,
I'll see what I can do but it will be a couple of weeks before I can get anything in the mail (I am recovering from Ventral Hernia surgery). Or you could order them through dragondoor.com and take advantage of their one year money back guarantee.
The Get-up is one of those rare exercises that can clear up a lot of movement patterns - KBs from the Ground Up covers all of this. However - self screening is similar to self surgery - something is bound to be missed.

If Gray could go back in time and change the name of the movement screen he would call it the Fundamental Movement Screen - since the moves in the FMS come from developmental sequencing, PNF, Othopedic evaluation and rehabilitation etc...
I agree that the term "functional" has lost much if not all of it's meaning.

You said you would rather watch the individual all the time - inferring that the screen is a one time thing and then nothing follows it. Not so - the screen is a starting point to find restriction and asymmetry before they become issues and as you progress through the corrections you move on to higher level activities with lots of coaching etc...

Mike T Nelson said...

Good discussion guys.

I dropped almost all standard "corrective type" of exercise about 2.5 years ago. This does NOT mean I allow my athletes to move like dog poo. Quite the opposite. We work to get their movement quality high, and then load them in an appropriate way with as close to perfect form as possible.

Intensity will burn in adaptations faster. I know for myself, that if I miss heavy lifting, it takes more mobility work to keep me from adapting to my laptop position (silly dissertation).

The missing key is biofeedback--was a squat good for that athlete on that day? If not, find a way to make it good (mobility work) or do something different. The exercise MUST be good for the athlete at that time for optimal adaptation.

Rock on
Mike T Nelson Phd(c)
Extreme Human Performance

Don Banker said...

Mr. Jones

"I am recovering from Ventral Hernia surgery".

How did this happen? Are you doing anything unique in rehab? Would love to see a holistic approach.