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Improving Movement to Decrease Pain


As a personal trainer, you are tasked with leading your clients through fun, functional, and rewarding workout sessions. You are also responsible for addressing movement and/or muscle dysfunction when you see it to alleviate and prevent pain and/or injury. This combination of improving movement while decreasing pain is a challenge that many trainers find difficult. This article will outline a strategy for helping you assess, target and correct specific areas of the body that may be causing movement dysfunction and pain. That way, you can safely provide your clients with exactly what they are looking for – movement-based, fun and pain-free workouts.

Looking for Clues

In order to help a person alleviate pain when they exercise, you have to assess what is going on with his or her body. However, assessing a client’s movements as they exercise can be challenging. There are many body parts you must observe as they move, sometimes at great speed, as you try to pinpoint the source of your client’s movement dysfunction and the possible cause(s) of the aches and pains. On the other hand, looking at something when it is stationary is a much less daunting task. For example, if you see a parked car that has mud splattered down the side of its doors, you can assume that it has been off-roading or at least been driven down a muddy road. You don't need to actually see the car getting muddy to be able to infer what the car has been doing. You can apply a similar principle to looking at the human body when trying to assess and improve movement. If you know where and how to look at your client’s body when they are standing still (e.g. posture), you can make inferences about the way they move.

The position and condition of someone’s feet, ankles, knees, hips, back, shoulders, neck and head give you many clues as to how that person moves. Most importantly, these clues can direct you toward strategies you can employ to help recondition a client’s dysfunctional parts. When the dysfunctional areas have been addressed, you can then integrate those parts back into functionally correct and coordinated whole-body movements that minimize the potential for injury.

Here is an example of how to interpret the clues of a common musculoskeletal problem that most trainers have encountered: overpronation. Simply put, overpronation is characterized by the foot and ankle collapsing too much toward the middle of the body. The presence of overpronation, which is assessed at the feet and ankles, can tell us a great deal about how a person moves. Since the problem appears at the foot, many trainers assume that overpronation is a problem with the foot and ankle complex. As such, they recommend orthotics or exercises to strengthen the foot and ankle as the solution. While overpronation is an important indication that the feet and ankles have issues, it also reveals that other parts of the body may not be effectively or efficiently slowing down the external forces of gravity and ground reaction forces (such as impact) as they pass through the body. In essence, the person’s inability to dissipate these forces causes the foot to overpronate (collapse) under the load of gravity placed on it from above. Therefore, if you perform a static structural assessment and find that a client overpronates you can safely conclude they may have other systems in their body that are not working effectively.

NOTE: Techniques for conducting a full body structural/postural assessment can be found on Personal Training on the Net in the three articles by the author, which are also published in the new ACE Personal Trainer Manual (Fourth Edition), pages 136 – 146:

Pieces of the Puzzle

In order to determine how movement is affected by a structural or postural imbalance you need to evaluate all the elements, muscles, and/or systems that relate to that imbalance. Since overpronation was used in the previous example, we will consider the muscles in the body that control pronation and how they may contribute to this imbalance: the gluteus maximus, the hip flexors and the erector spinae group.

Gluteus Maximus

When a person is engaged in weight-bearing activities (e.g. running walking, etc.), the foot begins to pronate when it comes into contact with the ground. This is a normal function of the foot and it helps with the transfer of force (such as body weight, gravity, and ground reaction forces). As the foot pronates, the entire leg rotates toward the midline of the body over the foot. This inward rotation of the leg moves the insertion of the gluteus maximus (on the outside of the upper and lower leg) away from its origin (near the base of the spine and back of the pelvis), thereby lengthening the muscle and creating tension in it like a bungee cord (Golding & Golding, 2003).

One of the main purposes of this tension is to help slow down the internal rotation of the leg and the subsequent pronation of the foot. However, if the gluteus maximus is unable to lengthen under tension effectively, the leg will rotate inward too quickly and with too much force and the foot will overpronate as a result. Therefore, training the gluteus maximus to lengthen under load may help reduce overpronation.

Hip Flexors

When a person is running or walking, the foot comes in contact with the ground and the leg then travels behind the pelvis into extension as the person steps forward with the other foot. The internal rotation of the leg and pronation of the foot that begins when the foot strikes the ground continues as the leg and hip moves into extension. It is the job of the hip flexors to lengthen to help slow down hip/leg extension, internal rotation of the leg, and ultimately, pronation of the foot. However, as is the case with the gluteus maximus, if the hip flexors are restricted in any way and can not lengthen efficiently, the foot will overpronate and the body will experience more stress. Therefore, retraining the hip flexors to lengthen under load effectively will improve performance and decrease aches and pains (McGill, 2002).

Erector Spinae Group

It’s not just ineffective lower body muscles that can contribute to overpronation. There are many other soft tissue structures in the body that help control dissipation of force as the foot makes contact with the ground. For example, the erector spinae muscles in the upper back can play a part in causing overpronation. Here’s how. One of the primary functions of the erector spinae group is to slow down forward flexion of the spine during movements such as reaching and bending down and forward (Gray, 1995). If these muscles have become chronically lengthened (or over stretched) in the thoracic spine due to excessive thoracic kyphosis they may not work effectively to slow the body’s mass as it moves down and forward. In order to maintain balance, the weight of the body is transferred to the foot in an uncontrolled manner. The resultant stress at the foot and ankle can cause overpronation. Therefore, retraining the erector spinae muscles in the upper back may help prevent problems at the foot.

As you can see, there are many muscles or systems that can contribute to the appearance of a structural imbalance. Performing a series of simple structural assessments or static postural evaluations on the major areas of your client’s bodies (i.e., feet and ankles, knees, hips, pelvis, spine, shoulders, head and neck) before they exercise will help you understand which body parts may experience more stress when they actually move and why. It will also help you know which muscles or groups of muscles need addressing with your corrective exercise strategies to help improve movement and decrease pain.

Putting the Pieces Together

With the results of your static structural assessments and soft tissue evaluations at hand, you are now better equipped to pinpoint the source of your client’s movement dysfunction. Let’s go back to the car example from earlier to help illustrate this. You know from looking at a parked car that has dirt caked on the doors that it must have been driven through mud. If there is more mud splashed down the left side of the car than the right, you might surmise that this might be due to a front wheel imbalance or a missing mud flap on the undercarriage. As such, you could likely predict that if driven down a muddy road again, in the same condition, the car would get mud splashed on its doors with more on the left-hand side. You can use the findings of static structural assessments in the same way to make assumptions about what will happen when a client moves.

For example, if your assessment results indicate that a client has an excessive anterior pelvic tilt and excessive lumbar lordosis, you can assume that certain types of movements that require the use of muscles or systems that attach to the pelvis, spine, hips and/or torso may be impaired (Kendall, 2005). Now, imagine this person is performing a dynamic, integrated movement, such as a squat with ViPR where they first reach under their legs and then stand up quickly to press the ViPR over their head (i.e., “Squat Thread the Needle” in ViPR language). Every time they reach over their head they experience pain in their lower back. Having previously identified the client’s structural deviations you can safely assume two things: 1) that their lower back area has experienced excess strain over time, and 2) since the pain occurs when the client raises their arms overhead, the muscles that attach or insert to the front of their pelvis and lumbar spine (i.e., hip flexors and abdominals) may not be working effectively to help the client slow down the forces to their hips and lower back as they move into extension. These two pieces of information can help you predict that any type of movement that requires extension of the hips and lower back will likely cause this client pain if the imbalances are ignored. However, if you train the affected muscles to lengthen under load effectively it would take stress off the client’s lower back and decrease their pain during future movements that require extension of the hips and spine.

Solving the Puzzle

Once you have performed a structural assessment on your client and can pinpoint the possible structures in their body that may not be functioning correctly, the strategies you can employ to help correct the problem are relatively easy to follow and implement. If a soft tissue structure(s) is not lengthening under load as it should (like a bungee cord) utilize self-myofascial release (SMR) techniques to recondition and rejuvenate the problematic muscle(s)/fascia (Rolf, 1989). (You should always begin addressing movement dysfunction with SMR. It’s the same concept as chewing gum before you attempt to blow a bubble; you need to massage the tissues before they can stretch effectively.) After your client has performed the necessary SMR exercises, move them on to stretching exercises that will teach the target muscles to lengthen more effectively. Finally, integrate the newly massaged and stretched structures back into a more dynamic movement (i.e., integrated strengthening exercise) to teach them how to move in conjunction with the rest of the body.

Let's look at an example of how you could use these exercise protocols to help the client discussed above perform the ViPR squat to overhead press without pain. Please watch the following video clip to see the author demonstrating and explaining the rationale for each of the exercises shown below:

SMR for hip flexors SMR for abdominals Stretch for hip flexors and abdominals Back step with arm raise

Helping clients improve their movement capabilities is the secret to decreasing their pain. A client who can move without pain is able to enjoy exercise more frequently and for longer periods of time. Obviously, for fitness professionals this is an important aspect to having a healthy business chock full of happy clients. The use of structural assessments and functional anatomy knowledge combined with a logical order of exercises (i.e., SMR, stretching, strengthening) in your training sessions will enable you to get clients moving better and keep them feeling great.

References

  1. American Council on Exercise. (2010).  ACE Personal Trainer Manual (Fourth Edition). American Council on Exercise.
  2. Golding, L.A. & Golding, S.M. (2003). Fitness Professional’s Guide to Musculoskeletal Anatomy and Human Movement. Monterey, CA: Healthy Learning.
  3. Gray, H. (1995). Gray’s Anatomy. New York: Barnes & Noble Books.
  4. Kendall, F.P. et al. (2005). Muscles Testing and Function with Posture and Pain (5th ed.). Baltimore, MD.: Lippincott Williams & Wilkins.
  5. McGill, Stuart. (2002). Low Back Disorders: Evidence Based Prevention and Rehabilitation. Champaign, IL: Human Kinetics.
  6. Rolf, I. P. (1989). Rolfing: Reestablishing the Natural Alignment and Structural Integration of the Human Body for Vitality and Well-Being (revised edition). Rochester, VT: Healing Arts Press.

Additional Resources

  1. Myers, T. 2001. Anatomy Trains. Myofascial Meridians for Manual and Movement Therapists. Edinburgh: Churchill Livingstone.
  2. Rolf, I. P. 1989. Rolfing: Reestablishing the Natural Alignment and Structural Integration of the Human Body for Vitality and Well-Being (revised edition). Rochester, VT: Healing Arts Press.