PT on the Net Research

Corrective Exercise Is Functional - Part 1


"The only thing that interferes with my learning is my education." - Albert Einstein

As the evolution of the fitness industry continues, perhaps one of the greatest benefits to emerge is the “discussion” it has generated. With all of the gains in research that have expanded our understanding of human anatomy and physiology, there are still vast differences in the interpretation and application of the available information. And this is understandable, since that is the nature of research meeting practical application.

Perhaps no other topic has created more “discussion” than that of function and functional training. And with the overwhelming varieties in human bodies and what they are used for, is it any wonder?

Corrective exercises are of growing interest in the fitness industry, and they are part of this discussion on function. This three part article will attempt to provide a clear understanding of what corrective exercises are and demonstrate the vital role they play in the functional continuum.

The approach and application of corrective exercises I use and teach are often quite different than the perception many professionals have on the topic. This article will further differentiate the functional contribution this approach and application has to optimal health and performance.

I am a proponent of and use all forms of what most consider functional training. This includes but is not limited to multiplanar movements using multiple segments as well as unstable surfaces. But perhaps instead of calling it functional training, we should call it training for function since function is ultimately defined by the individual. This may seem like pure semantics, but it is not. Functional training implies a specific mode of training. Training for function implies an objective.

Corrective Exercise vs. Post Rehab Exercise

It may be useful to first draw a distinction between corrective exercise and post rehabilitative exercise. Corrective exercises are not dictated by symptoms or a current pathology. They are based purely on positively influencing the neuromusculoskeletal system. Exercises will always involve areas of the body far removed from the site of pain or past injury. In a symptomatic client such as those I work with, the symptoms do not dictate what we do. They only place certain limitations on what we do because we do not want to exacerbate the symptom(s).

Post rehabilitation exercises are dictated by a specific objective related to prior treatments by a licensed medical provider following an injury or medical intervention (e.g., surgery). Technically, a fitness professional should not be doing post rehab without directives from the treating professional. Post rehab is most commonly a continuation of the medical providers’ treatment plan.

Post rehabilitative exercises are often body part or quadrant specific. For example, post rehabilitative exercises for a knee procedure would include attention to the quadriceps and hamstrings. And then ideally, it would include the joints above and below the effected knee (ankle and hip).

As the outcomes of the post rehab plan are met, it would be prudent to move on to a more global corrective exercise strategy, realizing that any disruption to the motor system will have consequences far removed from the site of the procedure or pathology.

Whose Function?

Two questions that always drive my training paradigm are: “For whom?” and “For what?” When we ask these two questions, differing philosophies on function inevitably move closer to common ground. Once we’ve answered these two questions, in order for our training approach to be functional, it must be transferable to the unique characteristics and needs of that client/athlete.

To further expand and perhaps cloud the discussion on function, I’ll use one of my clients with chronic lower back pain as an example. This woman can not sit for more than 15 minutes and can no longer work. For her session, I dance around her in a dimly lit room waving incense and singing The Smiths’ song “Girlfriend in a Coma.” She finishes our session with no back pain and proceeds to drive for two hours to Los Angeles still pain free. Was that a functional training session? If you asked my client, she wouldn’t care. She had a functional outcome.

And that may be a critical point: function is determined by output and not necessarily input. In the hypothetical example, the client’s back pain would not be gone long unless it was completely psychosomatic. Therefore, an appropriate functional exercise program would follow.

But what is functional for this client and at this point in her progression? Here is where the divergence occurs in philosophies. One end of the spectrum might involve floor work that is purely cognitive driven motor re-education. We’ll call this the Far Left (FL) of the spectrum. The other end of the spectrum would include completely vertically loaded multi planar exercise including squats and lunges. We’ll call this the Far Right (FR) of the spectrum. Which is “right” or more effective?

I believe they both are. I believe that they are not mutually exclusive and are both in fact part of the total functional continuum. The goal ultimately is to minimize cognitive input and move to the far right of the continuum as quickly as the client is capable. “Capable” means the client has demonstrated a level of competency (quality of movement, stability, endurance, etc.) that justifies moving her to the next stage in the continuum.

There are many practitioners who would agree with me on this, and this approach is supported by many researchers (including McGill, O’Sullivan and Lee) in the area of spinal rehabilitation. But what many practitioners don’t realize is that the continuum I am speaking of does not necessarily span weeks or months. It spans minutes.

Why Corrective Exercise?

When used with specific functional objectives in mind, corrective exercises can be progressed to multiplanar and/or proprioceptively challenging exercises within a given one hour session. This is what I do every day. I use corrective exercises to create an environment where the client can be most successful, performing exercises that are vertically loaded, multiplanar and/or on labile surfaces.

The body is cued to move differently through the stimulus of the corrective exercises. The corrective exercises are ascended, progressively linking together more complex movements. Even as the program is progressed to movements of the FR, we continue to apply exercises that challenge the client’s individual functional needs versus generic multi planar exercises. By following this programming strategy, we facilitate changes to the individual’s biomechanical constraints and motor control strategies.

Corrective exercises are applicable to every client and athlete. They are not limited to clients currently experiencing pain. We can be reasonably confident that most, if not all, of your clients have been in pain at some point in their lives. Show me a client or athlete older than 15 years of age who has never had an injury that created pain avoidance, and I’ll show you someone with a very short memory.

Pain is the single greatest stimulus to enter our body. Through resulting changes in the central nervous system (CNS), the influence of pain is reflected in biomechanical characteristics. Even if pain is no longer present, its effects are. To quote Doctor Janet Travell, the former White House physician and pioneer in trigger point work: “Tissues heal, but muscles learn. They readily develop habits of guarding that long outlast the pain.”

Pathological or disrupted proprioceptive information from the periphery (skin, muscles, joints, tendons, connective tissue) results in functional, adaptive processes through the whole motor system. The symptoms might be felt locally, but the response is experienced globally.

Far Right (FR) on the Functional Continuum

The FR approach has its basis in stimulating the proprioceptive system through “natural” movements that most often require eccentrically controlling gravitational forces. This elicits an appropriate concentric contraction to overcome gravitational forces such as in walking or to produce acceleration and power for a movement such as throwing. The mass and momentum of various body segments are manipulated through verbal instruction from the trainer or therapist to dynamically produce desirable biomechanical reactions of other muscles and joints. For example, changing the orientation of the trunk in a lunge relative to the gravity vector will alter the muscular and joint responses throughout the body.

For these reasons, the FR approach elicits a more integrated and higher level of musculoskeletal function than a floor based, cognitive approach that is to the far left (FL) of the continuum. Assuming the client’s existing biomechanical constraints have responded to the designed stimulus (exercises), the CNS is able to assimilate a more comprehensive catalog of improved movement strategies.

The FR approach assumes, however, that the proprioceptive system will respond in a predictable manner and thereby produce the desired biomechanical response. In the case of the client currently experiencing pain or with pain events in her health history, the proprioceptive system may be “rewired.” And even in cases where the dysfunction is pre-pathological, adaptations/compensations are already underway that will eventually lead to exceeding tissue tolerance and manifesting as regional symptoms.

It can also be argued that exercises from the FR actually use more cognitive processing than the appropriate application of corrective exercises. The complexities of many of the multiplanar, multi joint exercises are completely foreign to many people’s motor systems and are therefore novel movements. This unfamiliar exercise requires a higher level of cognitive processing to both understand and execute than a corrective exercise would. The more complex the unfamiliar movement is, the more likely it will initially produce inefficient co-contractions at many joints, potentially blocking degrees of freedom at those joints. This results in stiff and awkward movement patterns. 

Even if the desired proprioceptive response is produced in the CNS, the body must still deal with any possible biomechanical constraints (myofascial adhesions, trigger points, scar tissue, osseous obstructions, etc.). Excitation of the motor nerve from the spinal cord determines how frequently the muscle is excited, but how it actually contracts and relaxes is determined by the properties of the muscle tissue.

Stay tuned for Part 2 of this fascinating series... coming soon!

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