Corrective Exercise in Our Lectures
Corrective exercise tips gleaned from our lecture series
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“There are two reasons why a mobility problem can persist despite many attempts to remedy it. The mobility problem is either reinforced by a behavior or it is not challenged at all. If it is reinforced, it has no reason to go away. If it is not challenged at all, it becomes part of the background and goes unnoticed for years.
“Somebody who’s been extremely sedentary and has avoided physical activity could have numerous mobility problems. Unless those mobility problems were the result of a permanent structural change, a change in the activity level and in the environment should beg for a change in the organism—the physical presence of more mobility, more function and more movement.
“However, we often see attempts to restore mobility eroded by the lifestyle that created the problems in the first place. If we cannot challenge these mobility problems to go away and replace the mobility with something else, they will return.
“A reinforced mobility problem, in my opinion, is the default mechanism of a body that lacked integrity or motor control at one time.
“When we lose our primary stabilization, our primary motor control, the body can easily create a restriction that keeps us out of an area where we have unpredictable responses. We don’t know what our shoulder is going to do anymore, so why not freeze it up? We don’t know what our hip is going to do any more so why not lock it down? We don’t know what’s going to happen in that ankle but we sure don’t want to roll it again, so let’s tighten it up.
“In the presence of limited motor control, when that perfect action-reaction loop created by the minute adjustment of signals from the sensory receptors in the body and the signals from the brain blend together is no longer there, then, biologically, we default to stiffness.” ~ Gray Cook
“Your body will use restriction of mobility as a locking mechanism to try to make you stable, but there’s also a central cohesive reason why mobility restrictions occur.
“When we look at movement, mobility is basically the ability to move. You have to have the ability to get movement in motion, but after that you’re going to have to be able to control that movement.
“The control of that movement, especially under changes of position and changes of environment—emotional and physical—is called stability. You can have all of the mobility you want, but if you don’t lock that in with stabilization to control it, it doesn’t matter how much mobility you have.” ~ Perry Nickelston
“You don’t need 1,000 corrective exercise drills. You need corrective exercise drills and their variations that allow you to quickly target someone’s dysfunctional or restricted movement pattern and help improve that movement pattern.
“You don’t need to do any corrective exercise that hasn’t shown improvement of a person’s restrictions or asymmetries. You might have the world’s favorite corrective exercise, but it’s not going to work for everybody. You have to be willing to be adaptable and give exercises that are most effective for the individual with whom you’re working.” ~ Brett Jones
“What is joint centration? Think about joint centration as a ball and socket joint. The ball fits into the socket and when it’s centered within that socket, there’s an optimal axis of rotation with optimal congruency of the joint surfaces.
“There is not too much wear and tear on the joint because there’s an optimal axis of where it can rotate. The muscles around the joint, the ligaments and the joint capsules are set up to control the joint when things are functioning properly.
“Within the components of centration, there are two fundamental components to achieve a centrated joint position. We must be able to stabilize the joint and we must be able to dissociate.
“We must be able to have a functional control of that joint through all ranges of motion, whether we’re statically controlling the joint or whether we’re performing a more dynamic movement. The axis of rotation must be maintained to ensure integrity of the joint.
“We must be able to centrate our joints and stabilize the femoral head within the acetabulum, for example, but still dissociate it when we need to create functional movement. Centration is the ability to stabilize and dissociate appropriate joint surfaces.” ~ Evan Osar
“The sagittal plane is really good for flexion and extension. You can see the facet joints of the lumbar spine compared to the thoracic spine, compared to the cervical spine—each section really has a difference in what it’s able to do. The cervical spine is really built for a lot of rotation. The thoracic spine is in all three planes—transverse, coronal and sagittal—so it can do a good job as far as rotation, flexion and extension, as well as side-bending. When we get down to the lumbar spine, it is really built for flexion and extension and really not for other things.
“The thoracic spine is oriented in all three planes—in the transverse, the sagittal and the coronal plane—so it can do rotation, flexion and extension, as well as side-bending. Even though the vertebrae are set up for side-bending, the connection between the rib and the vertebrae blocks that side-bending, meaning there isn’t a lot of side-bending at the thoracic spine. This is not because the vertebrae cannot handle it, but because of the connection between the rib and the vertebrae.
“You can get a lack of mobility between the vertebrae. You can get a lack of mobility at the transverse spine. If someone’s thoracic spine gets “locked up,” for lack of a better phrase, they have to find mobility from somewhere else, to get it from the lumbar spine. This ends up being why we have so many issues with the lumbar spine and with low back pain.” ~ Sue Falsone
“With corrective exercise, the goal is to get off the correctives. If your form is bad in your exercise, there’s no permanent way to get off of it. There’s no corrective for a bad technique. If you’re practicing an exercise with poor technique, it necessitates corrective exercise. In essence, you create your own dependency on that fix.
[bctt tweet=”There’s no corrective for a bad technique. ~ Mark Cheng” via=”no”]
“If your form takes a detour for the better, it’s interesting to see how good form de-necessitates those corrective exercises because it’s corrective in and of itself. If you’re observing proper form and if you’re hitting all those points you need to hit, it’s amazing how much that actually feeds into better hip mobility, thoracic spine mobility and shoulder stability. It’s a beautiful thing.” ~ Mark Cheng
“Within corrective exercise, there are a few key concepts we touch on. The first key concept is to ‘remove the negative.’ This actually cuts two directions in the corrective exercise concepts. ‘Remove the negative’ obviously means to remove the weakest link. ‘Remove the negative’ also cuts in a second direction. It also means remove those exercises or activities that are challenging a dysfunctional asymmetrical pattern.
“If you’re trying to correct an active straight leg raise, for example, but you’re still running, deadlifting, performing hip hinges or activities that challenge the active straight leg raise pattern, changing the pattern is going to take about four times as long as it should. This is because you’re constantly undoing the good you’ve accomplished with your corrective exercise.” ~ Brett Jones
“There are two steps I will always take before I ask you to reload a new pattern. I’ll try to reset the situation. I’ll try to identify the bad habit you’ve been doing. I’ll try to break that bad habit with some clinical expertise, and I’ll try to reinforce the breaking of that bad habit when you leave my presence.
“I’ll try to do some tape, lifestyle management, a brace or something that will continue the therapy, even though you and I are no longer beside each other. At some point, if I can manage the breaking of a bad habit or a bad movement pattern, I can introduce a better movement pattern.” ~ Gray Cook
“The brain is a giant emergency brake. One way to define the brain is that it exists so you don’t hurt yourself. Part of what makes us different than animals is that animals don’t feel the things we do. Their brain is different because they live in an environment where they must continue to be physical to live, to find their shelter and to find their food. We don’t have to do that. We can be more cerebral. Our brain is probably more cultured in that realm and it keeps the emergency brake on so that we’re not the same as animals.
“For certain people, this can release that emergency brake, not just descending in a squat in an overspeed eccentric. You’ve heard of taking the brakes off as we attempt to pull down the kettlebell on the descent of an overhead kettlebell press. We then release the emergency brake so we can press it harder and faster on the subsequent repetitions.” ~ Charlie Weingroff
“Mobility needs to happen down to T4 in order to simply rotate your head to either side, and mobility needs to happen down to T6 in order to lift your arm up over your head. This area does need mobility.
“Other things that are going to affect this region are lat dominance or at shortness and stiffness. It can really begin to affect the posture and decrease that thoracic outlet, putting pressure on those neurovascular structures and giving issues all the way down the upper extremity.
“Stability facilitates movement. We know we need proximal stability for distal mobility. We’ve already talked about that with the relative rigidity of the upper thoracic spine in relation to the lower cervical spine. We have to have more rigidity in the upper thoracic area for the upper extremity to be able to move. We need stability to create movement.” ~ Sue Falsone
“A large majority of our clients’ postural and movement strategies don’t suffer from the inability to do the task we’re asking them to do. It’s the level of effort they’re using to perform a task that’s not as appropriate as it could or should be. It doesn’t mean our clients are not effective.
“In order to differentiate yourself from your colleagues, to be the leader in this industry and to be the expert people come to for help in solving postural and movement-based problems, you must teach your clients how to adopt a more efficient stabilization and movement strategy.
“A client’s strategy is defined as how an individual’s nervous system organizes sensory information to achieve appropriate motor responses related to accomplishing a task. It literally means does your client use the right muscles at the right time in a manner appropriate for accomplishing the task?
“While we’re discussing having an efficient thoracic stabilization strategy, we’ll be defining this as using the optimal amount of effort required to achieve a functional goal, while minimizing the stress placed on the soft tissue and bony structures. Is your client able to use the right muscles at the right time to stabilize the thorax in an optimal manner required to accomplish the functional task while placing the least amount of stress upon the soft tissue, bony and joint structures?” ~ Evan Osar
“Neural edge training is really based on what the brain does and how we’re programmed as human beings. There are certain things that always happen regardless of whether we want them to or not. That’s kind of laid down in our subconscious—the things that happen and we don’t know why.
“When you’re working with clients, there are several rules you want to follow. First, you don’t want to do any harm. As a fitness professional or healthcare provider, your job is to make sure you don’t hurt a client.
“Then, you want to make them adaptable to whatever situation they’re in, as well as be able to improve it, and to increase durability. Durability is giving clients the ability to do what they love better, longer and to not get hurt. You want them to be in a situation where they’re more resilient to injury, and help take their performance and adaptability to another level.
[bctt tweet=”Durability is giving clients the ability to do what they love better, longer and to not get hurt. ~ Perry Nickelston” via=”no”]
“Neural edge training is based on a body needing to fail in order to learn. You let your clients make mistakes, but not too big or not too many. The body can then adapt to the outside stress you’re putting on it. The underlying goal is for us to figure out what we can do, and regress back in order to help our clients get to their goals faster.” ~ Perry Nickelston
“Instead of going headstrong into your preferred activities and then having to clean up the movement dysfunction in the path of your activity, why not adopt some activities that force you to maintain your mobility, stability and movement patterns? Even though you might train in one special direction, the variety of activity you have in another direction somehow naturally maintains your balance of power.
“Originally, this was the definition of cross training, but somehow we lost that message. The amount of dosage it takes not to have detriment from specialization should be cross training. Every one of us wants to specialize in something. We have things we like to do—golf, triathlons, lifting heavy weight. However, your cross training, if done correctly, is a certain dosage of activity that undoes the detriments specialization may cause.
“Some of the detriments specialization may cause are neglect of a certain movement pattern, limitation in a movement pattern or left-right asymmetry. If we could inject natural activities alongside some of our favorite activities and those natural activities were somehow self-limiting, they would basically keep us in a highly adaptable state.” ~ Gray Cook
“The primary function of the tertiary muscles is to increase inspiratory volume when necessary by lifting the rib cage. With pathological breathing, the pattern is an inhibition of the sternal and costal fibers of the diaphragm, the abdominal obliques, the pelvic floor and the transverse abdominis. These tertiary muscles of respiration become dominant. These muscles are not intended to lift the rib cage for any extended period of time—they’re assisters. They’re not there to do all the work.
“This pathological breathing is the most faulty movement pattern in the body. From the resulting consequences, we have a relatively stiff rib cage. This makes expiration a passive motion. It is far more efficient to drop the diaphragm than it is to elevate the resistant rib cage. When we’re evaluating an individual and taking a history, we should be observing breathing patterns posturally and, of course, functionally.” ~ Tom Solecki
“We often see a tight and restricted diaphragm, especially in this anterior pelvic tilted position. The diaphragm can arguably be the most dysfunctional muscle in the body. The diaphragm is the neural driver for so many different things in the body, and when it’s not functioning well, a lot of other things aren’t going to function well.
[bctt tweet=”The diaphragm can arguably be the most dysfunctional muscle in the body. ~ Mitch Hauschildt” via=”no”]
“Another dysfunction is how the pelvis correlates to the lower extremity when it’s anteriorly rotated. When it rotates forward, it automatically causes the femur to internally rotate, which carries down to the knee and tends to put that into valgus. This leads to tibial internal rotation and eventually pronation of the foot, so it has this huge ripple effect down the lower leg.” ~ Mitch Hauschildt
“When your subconscious and the subtle timing of your stabilizers create joint integrity, joint alignment and fascial tension balance the forces around the joint, maintain the axis of the joint and simply juice integrity of the system, the prime movers have no choice but to perform better.
“The best way to optimize a prime mover is to put it in an environment where it can do what it does better. Long before a prime mover gets hypertrophy or changes its size to accommodate a new workload, it will optimize itself and become efficient.
“How can it become efficient when it’s not working with joint alignment or a perfectly aligned joint axis at every degree of range of motion, the supportive fascial tension and the contribution of the synergistic and stabilizer muscles? Why are we trying to optimize a prime mover when we haven’t gone to the foundation of all the things that prime mover needs and made sure that foundation is adequate?” ~ Gray Cook
“I want to distinguish between what infant reflexes are. Those I believe are what we would call primitive patterns—things that are reflexive behaviors that occur in an infant.
“As an infant matures, these behaviors are reflexive actions that are pre-programmed in the central nervous system, such as rooting or feeding reflexes, clearly gripping with a hand grasp, stepping, the asymmetrical tonic neck reflex and other things.
“Those are things that all disappear or regress as the infant develops into normal maturation patterns and normal patterns of mobility and stability that are very clearly outlined in the development of an infant. I believe in the sequencing of the central nervous system and its interaction with anatomical development that occurs very predictably in infants as they age.” ~ Barb Hoogenboom
“Almost every muscle in the body that crosses a few different joints stabilizes one end while it moves the other end. Sometimes when we switch from an open- to a closed-chain activity, the muscle immediately assumes a different role. This is based on circuitry in the brain—the brain doesn’t care about the individual muscle. The brain realizes this is a completely different movement pattern. It’s a completely different signal sequence.
“Muscles work as a proprioceptive sequencing sender—a sending unit telling us about tension in the body—but then they also take action on movement and work on signals.
[bctt tweet=”Just because a muscle can contract adequately doesn’t mean it will in all of the different positions where it’s going to contribute. ~ Gray Cook” via=”no”]
“Many times in physical therapy, I’ve had to almost ‘jump-start’ a muscle. Once that muscle is ‘jump-started,’ though, it is back on the circuit board. It’s back within the natural circuitry. But just because a muscle can contract adequately, it doesn’t mean it will in all of the different positions where it’s going to contribute.” ~ Gray Cook
“If a person came in without need for much corrective work, traditional movement preparation worked beautifully in preparing the body because there were no fundamental issues that needed to be addressed. We could go in and activate. We could actively elongate. We could do some integrated marching and skipping, and bang! Ready to go. We were ready to go because there were no major movement efficiency issues to deal with.
“However, we found that nearly everybody had some weak link or some type of movement efficiency issue that needed to be addressed. So we came up with movement preparation for movement efficiency. Instead of thinking of movement preparation as preparing for the demands of the sport or of the training session, we decided to look at what the individual’s needs are, what the individual’s movement pattern needs are.” ~ Joe Sansalone
“Let’s talk about what breathing does from a pure physiology standpoint. Breathing is an exchange of gas that brings oxygen into our body and gets rid of CO2 with exhalation. Breathing is fundamental in making sure our brain is operating as efficiently as possible.
“Imagine now that we’re trying to coach a skill with one of our clients, athletes or patients and they’re not breathing effectively. They’re reacting from their emotional center. If the task is difficult, will they really benefit as much as they could if they were breathing properly or even worse if they’re in the fight, freeze or run mode and the lizard brain is turned on? Are we really coaching proper motor control sequences at this point?
“By incorporating some very simple techniques to teach people how to diaphragmatically breathe, we can tap into the sympathetic and parasympathetic nervous system. We can slow down the heart rate. We can help to enhance cognitive function, which gives us a much better chance of coaching the way that we want to for our clients, athletes and patients.” ~ Jason Green
“When people encounter people who can’t touch their toes, they assume they know why they can’t touch their toes. It must be those tight hamstrings, because that’s exactly what they complain of on a toe touch. Whether your hamstrings are the problem or not, you’re always going to feel your hamstrings on a toe touch. They’ll feel tight, but isn’t a muscle that’s contracting at the same time it’s stretching always going to feel tight?
“What if your weight shift is inappropriate? What if you lean too far forward and don’t have a posterior weight shift backward? Wouldn’t it be the job of your hamstrings to say, “If we let you go all the way down, you’re going to wind up busting your nose on the floor. We’re going to contract even though you would prefer we didn’t because we’re going to save you from a mild concussion.”
“Inappropriate weight shifting, even if you don’t know how to weight shift—posterior translation of the hips, so the trunk can go anterior—your subconscious balance system will keep you from falling at all costs, even if that means not letting you have flexibility you’ve earned. Your hamstrings may be long enough for you to touch your toes, but you still can’t. Your hamstrings contract as a way of applying a parking brake to a movement pattern that’s poor.
“There are other reasons you can’t touch your toes—a stiff lower back, or increased tension and tone in your plantar flexors, mainly your gastrocnemius, which crosses both the knee and the ankle joint. However, you’re almost always going to feel it in your hamstrings unless there’s a pain associated with it, but that doesn’t necessarily imply the hamstrings are the problem.” ~ Gray Cook
“I’m not a fan of having people lie on the lateral structures of the IT band. I can appreciate that’s what people are doing and there are very well respected people doing that. That’s just not the way I like to approach it. My feeling is that the greater trochanter and the bursa in that area anatomically are too superficial and delicate.
“As we know, and as Thomas Myers has helped us understand, the tensor fasciae latae in the iliotibial complex isn’t limited to the pelvis and the lower leg. It’s definitely integrated into the fascia of the torso and so forth. If there is real noxious stimulus or discomfort in that area, I think we really do alter that in a way that’s not as favorable.” ~ Stacy Barrows
“One thing I can guarantee is, if you do not tape properly and you don’t create corrective exercises properly, you can absolutely do harm to a person. That’s obviously counterproductive. We don’t want to just tape someone to tape someone. We want to have a reason for why we’re taping.
“We want to have a reason for why we’re having them doing on-the-ground rolling patterns. We want to have a reason for why we’re doing glute activation exercises or why we’re doing half-kneeling. Have a reason for why you’re doing these techniques.
“You’re going to get to your ‘why’ component by assessing and reassessing the person. Every patient who walks through my door gets reassessed every time they return. They may not realize they’re getting reassessed, but you can bet I’m reassessing as I watch them walk into the clinic.
“That’s going to be the key, because if you don’t reassess people every time they come in, you’re not going to be able to develop the proper correctives.” ~ Rick Daigle
“External respiration refers to the movement, the anatomy and the way that we use our physical bodies during the act of breathing. It has to do with using muscular contraction, posture, alignment and all these things that go along with everything else we talk about with biomechanics to facilitate the internal respiration.
“Once we start talking about anatomical external breathing, we can split that and subdivide it into two different categories again. These are costal breathing and diaphragmatic breathing.
“Costal breathing has to do with using the rib cage and the structures associated with the rib cage to inhale, to exhale and to perform the movement of breathing.
“Diaphragmatic breathing refers to using the diaphragm, which is the big mushroom or umbrella-shaped muscle that attaches to the underside of the rib cage. It can move independently of the rib cage. Diaphragmatic breathing refers to using the diaphragm as the primary method of breathing.” ~ David Whitley