The following is the second in a series, which is the basis for Anthony Carey's seminar Before the Core: Posture and Motor Learning.
What do a 73-year-old grandmother and a 26-year-old professional athlete have in common?
They both need corrective exercises.
This article will address the need for corrective exercises to be used with all of your clients regardless of their level of fitness or physical accomplishments. Corrective exercises are the foundation for positive changes in motor learning. Bypassing this critical step is a common and costly error by many health and fitness professionals. What I hope to convey in this article is the need for you, as an integral part of the health community to assess what you assess. Not that you are assessing the wrong things, but that you may not be assessing everything that requires evaluation. Of course how you interpret that information and the intervention you provide is the key to successful exercise programming.
Traditionally in the fitness setting, the components of assessments have emphasized cardiovascular related characteristics such as heart rate, blood pressure, VO2 max (or predicted values) and body composition. In addition, a 1 RM strength test and flexibility measurements may be included. The primary reason why there is an emphasis on cardiovascular related characteristics is that you don't want your client to die from exercise!
Another excellent reason to assess cardiovascular parameters is to establish a baseline from which to gauge progress. This is because if you don't measure it (i.e. body composition), you can't manage it. "Measuring it" refers to the assessment and "managing it" refers to your exercise prescription or intervention. After establishing your baseline, you must reassess at pre-established intervals to determine the effects of your exercise intervention.
In the previous article, Before the Core Part 1 we discussed some of the problems with making the terms "core training" and "functional training" mutually exclusive. In that article, we identified some of the major pitfalls of applying exercises considered to be core-strengthening exercises universally to all of your clients. The critical differentiation made was that a complete functional training progression must include core training and stabilization. However, core training and stabilization do not always equate to "functional". Underlying motor system dysfunctions and inappropriate progressions are some of the primary reasons for this.
When assessing your clients musculoskeletal system, there are several accurate and effective ways to gather the necessary baseline information. There are static, quasi-static (stabilizing in a static position) and dynamic assessments. Some fundamental examples of each are:
- Static: Standing posture
- Quasi Static
- Single leg balance
- Squat with arms in overhead press
- Dynamic: Gait
Ultimately, as your skills in assessment progress you would want to assess your client both statically and dynamically. Initially, you must be able to master a static assessment before you begin attempting to observe your client under dynamic conditions. The simple reason for this is because it is much easier to become familiar with the structural deviations that the human body can present when you are looking at it standing still then while it is moving. One can observe the details of a photograph much easier then the details of real time video footage. It has been my experience in the numerous courses that I have taught on postural evaluations that many professionals have jumped to the quasi-static and dynamic assessments too soon. This is evident in their inability to accurately identify and interpret what they see in a static postural evaluation. Just as I will outline how your clients' motor learning will be a progression, so should your learning and application of assessment techniques be a progression. In addition, movement assessments are not a substitute for a postural assessment. Both are essential to a complete biomechanical profile of your client. As Shirley Sahrmann PhD., PT, noted author, clinician and researcher states: "Postural alignment is the basis of movement patterns, thus optimal movement is difficult is alignment is faulty". She goes on to say, "Ideal alignment facilitates optimal movement. If alignment is faulty before motion is initiated, correction is necessary to achieve the ideal configuration that must be retained throughout the motion". (1)
From static posture alone, we can assess the four key components of the client's neuromusculoskeletal system: Muscle balance, mechanical efficiency, neuromuscular coordination and proprioceptive awareness (2).
- Muscle balance. The relationship between agonist and antagonist muscles around the joint(s) they act on and how they will effect joint position and segmental alignment.
- Mechanical efficiency. The muscles act on the bones, which serve as levers to create movement or overcome resistance. If muscles that move the bones are at disproportionate lengths to one another, the length-tension curve is affected negatively. Compared to a "normal" muscle, a posturally shortened muscle's ability to generate maximal tension will occur in a smaller range of motion. Compared to a "normal" muscle, a posturally lengthened muscle will have to be in a lengthened position before it can generate maximal tension. See Figure 1.
- Neuromuscular coordination. This refers to the manner in which the CNS coordinates the activity of the muscular system to produce or reduce force or stabilize against force. This includes the timing, degree and efficiency of the necessary contractions.
- Proprioceptive awareness. Processing of the individual’s internal and external feedback mechanisms to determine spatial relationships, joint positions and muscular lengths and tensions. This serves as a reference value for creating movement.
The rationale for assessing is the same whether you are experienced and use several different forms of screening, or you are a beginner labeling basic postural distortions. That rationale is to have a baseline to measure your progress and to identify what interventions are needed. Unfortunately, it is with the intervention where trainers of all levels will make the same mistake. And that mistake is disregarding the fundamental motor learning principles necessary to create changes in their client's structure and function. It is similar to putting a young child on an adult-sized, two wheeled bicycle without training wheels, and letting him go all the while shouting instructions to him. You have skipped the preliminary motor learning that begins first on a tricycle and then on a child’s bike with training wheels.
What I am referring to here is the motor skill complexity and load that is being applied immediately following the assessment in an attempt to create change in posture and movement patterns and at the same time impact the client’s fitness level. Typically, the trainer will overload the client's neuromuscular system with variables (i.e. load or balance requirement) and their need for cognitive processing (i.e. verbal instructions). We must understand that if the nervous system detects a reduced capacity of a muscle or muscle group to generate force, it will recruit more motor neurons. This will come from recruiting more motor units from an uninjured or facilitated part of a muscle or from other muscles capable of compensating with a similar task (3). Therefore, if you are asking too much of your clients in the name of functional training without addressing their motor learning process, you may very well be perpetuating their movement dysfunctions.
For example, a client is assessed with having excessive flexion in their thoracic spine and concomitant protracted scapuli. The trainer instructs the client to "pinch their shoulder blades together" while performing a dumbbell chest press on a physio-ball. This is an attempt to improve their scapular stabilization. (Note: the scapuli must abduct to some degree during a chest press. The purpose of adducting the scapuli is to begin the movement from a biomechanically correct position. The rhomboids and middle trapezius are then eccentrically loaded through the movement.) Let's break down this exercise and see a sample of what this client has to handle while trying to establish a new motor program for the shoulder girdle.
Dumbbell Chest Press on Physio-Ball
|Reorientation of the vestibulo-occular reflexes from lying supine (gaze fixation)
||Keep the shoulder blades together
|Projection of center of gravity (COG) between 3 bases of support (two feet and the shoulders on the ball)
||Keep the wrist over the elbow
|Stabilizing the COG on an unstable surface (ball)
||Straighten the elbows at the top of the movement
|Gravitational force acting on the dumbbells
||Keep the weights over your chest
|Independent stabilization of both upper extremities to move the weight
||Remember to breathe
|Independent directional control of both upper extremities moving the external resistance (dumbbells) to the desired location
||Don’t lift your head off of the ball
The point of laying the information out in such a way is to illustrate how futile it is to attempt to "teach" your client a new motor strategy when two or more of their current neurological, musculoskeletal, cardiovascular or intellectual capacities are all being exceeded simultaneously. The body will have a hierarchy of responses based on survival (or in this case safety). Those that will occur first, are those that require the least amount of processing and are based on reflexes (3). Let’s say for example, during our dumbbell chest press the ball begins to roll on this same client. His COG starts shifting as he presses the dumbbells over his chest. What do you think his body will give priority to - adjusting his feet to reestablish stability of his COG or keeping his shoulder blades together? Obviously to protect himself he will shift his feet to get stable. If the degree of perturbation was not too great, he may even have finished the press. But he would have done so using a strategy with which he was efficient or “strong” at. A common substitution pattern in this case might involve utilizing the cervical flexors and slightly lifting his head off of the ball. This would promote thoracic flexion and scapular elevation, essentially eliminating any chance of maintaining scapular adduction because scapular adduction would have required higher level processing. Therefore, scapular adduction would place low on the level or importance as it related to the disturbance of his COG.
When the learning variables are too many, your client will not be able to disassociate related movements (compensations) to those that you wish to reinforce. If you are attempting to reinforce scapular stabilization during shoulder abduction, then the client must disassociate scapular elevation or shrugging (4). Keep these consequences in mind as you prepare your exercise programs following your assessments. And understand that verbal instructions alone, will not overcome an established motor engram your client currently possesses. I like to refer to it as asking your client’s body to cash a check it does not have the funds for.
In the next part of this series, we will explore some of the principles and goals of the corrective exercise process. Remember, Function First, everything else follows.
For information on the remaining 2003 dates and locations for Anthony Carey's seminar Before the Core: Posture and Motor Learning, check out : www.anthonycareyinc.com/page/page/562278.htm
- Sahrmann, S. (2002). Diagnosis and Treatment of Movement Impairment Syndromes. St. Louis, MO: Mosby
- Luttgens, K., Wells, K (1982). Kinesiology: Scientific Basis of Human Movement. Philadelphia, PA: Saunders College Publishing.
- Schmidt, R. (1988). Motor Control and Learning. A Behavioral Emphasis. Champaign, IL: Human Kinetics Publishers, Inc.
- Edgerton, VR., Wolf, SL., Levendowski, DJ., Roy, RR. (1996). Theoretical basis for patterning EMG amplitudes to assess muscle dysfunction. Medical Science in Sports and Exercise 28: 744-51.
- Liebenson, C. (2002). Functional reactivation for neck pain patients. Journal of Bodywork and Movement Therapies 6: 59-66.