Issues with Corrective Exercise – What do you do?
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Corrective exercise is becoming an increasingly popular buzz-word, almost along the lines of “functional training”. But what is it and why is it needed?
As more and more people are acknowledging the importance of becoming stronger and moving more often, we have inevitably hit some road blocks along the way, largely in the form of movement dysfunction and the ability to move safe and efficiently.
Whilst many people tout resistance training as dangerous, others endeavour to strive ever onwards, not realising the damage they can do without the proper foundation of understanding how to move.
Due to the thousands of insta-famous fitness gurus explaining “what” should be done, very few understand the mechanics/principles of how. Meaning people have literally dived in to the strength world without first:
- undoing the underlying issues they have in the first place (e.g. poor posture)
- learning the personalization of their own technique.
As a result, corrective exercise has burst onto the scene, with more and more fitness professionals acknowledging that corrective exercise is an essential aspect of physical training. Yet, apart from 1-2-1 training, so few people do as they’re told when it comes to this aspect of exercise.
Learn the science and theory.
It’s largely due to the way corrective exercise is implemented and how we approach the problem.
Stick with the Essentials
Corrective exercises are an essential part of an exercise routine. Although it would be ideal for them to never be needed, even if you are the healthiest, most “movement aware” (if that’s even a term) person alive, unfortunately certain actions/behaviours in society cause us to resort to faulty postures, decrease muscle activation in areas such as the glutes (e.g. sitting for prolonged periods) that ultimately result in acquiring a range of issues when exercising.
When prescribed, performing corrective exercise often results in the loss of fitness. People neglect the exercises that they used to do in place of a bird dog or dead bug and wonder why they are losing their results at a rate they thought impossible.
So why does this occur?
Most people fall on one of two sides: the over and under zealous. Which are you?
Hold Your Horses…
Camp A are hell bent on fixing the problem at hand. So much so that they disregard many of the underlying laws of corrective exercise/rehabilitation due to thinking that determination and grit will get rid of the problem. Unfortunately, when changing a movement pattern (i.e. altering/forming schema in the brain) you must practice the corrective exercise and then have time away in order the body to store this “new found program” and secure it to memory.
In behavioural sciences, this is known as distributed practice and is thought to be far more effective than “cramming” (3), so much so it’s changing the way we teach children in schools.
Furthermore, when aiming to optimise the training response (whether for performance or injury rehabilitation) you must adhere to one of the fundamental laws that is: the dose-response relationship. This refers to the balance between applying a stimulus (whether in the form of manual therapy or rehabilitative exercise) and the body’s ability to recover (1). Wait, that sounds familiar doesn’t it?
As a result, many people perform too much too soon, try and run before they can walk (and however else you want to say it) which means they are forever taking 2 steps forward and then 2 steps back.
On the other side camp B, accept the problem that has occurred and end up questioning their entire place in the universe and the meaning of life itself.
Often, we become so fixated on the problem that it defeats us, in which case we think what’s the point?
Corrective Exercises Are Boring
Elephant in the room here…
I would love to meet the individual who would choose to do a tall kneeling hip hinge or a hip aeroplane over a heavy deadlift. Unless you are a student of movement and can turn the concept of corrective exercise into a fun little puzzle (nerd alert), then chances are you’re going to skip on them because they simply don’t appeal to the fun side of you that enjoys training.
Corrective Exercise Demands more Attention
Unfortunately, it’s human nature to avoid the path of least resistance. From the book “Thinking: Fast and Slow” by Daniel Kahneman (4) has shown that we are inherently and evolutionarily lazy animals; both mentally and physically.
We essentially have a “bank of effort/exertion” that we withdraw from throughout the day and we will always try and save this up just in case anything significant comes our way.
Ever wonder why Mark Zuckerberg always wears the same T Shirts? It’s to remove any unnecessary cognitive load and decision making that can be saved up for a more important task later in the day.
What the hell has that got to do with exercise? Well interestingly, the demand on mental and physical exertion are a lot more closely linked than you may have thought.
Try this mini exercise out.
> Stand up and do 30-50 body weight squats or 20-30 press-ups as fast as possible.
> ½ Through as you start to get out of breath and a bit of a burn.
> Do the following sum: 25 x 78 =
I can guarantee you will at least pause temporarily at this point, as your brain starts to focus on the more cognitive task that has now become the priority.
Although many of us have formed a positive association with exercise, due to the stresses of work and life in general, we often avoid anything that requires cognitive demand. We have now been taught to use exercise as a means of escaping stress and to remove attentive focus from the world around us.
Unfortunately, that manifests itself in one of two ways:
– You stop focusing on the technique in exercises (e.g. bracing your core during a back squat).
– You avoid the corrective exercises that require extra focus and cognitive demand.
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The Bottoms Up Approach
The final issue stems from where corrective exercise was initially developed.
Let’s face it, sport and fitness are relatively young areas of expertise and not so long ago, didn’t even exist. As a result, a lot of our knowledge, particularly in the crossover realm of rehabilitation and health (as oppose to optimal sporting performance) has come from a clinical, medicinal setting. The traditional rehabilitation model is centred around a bottom-up approach.
Most clinicians start by prescribing the lowest demand corrective exercise that can be performed and then gradually increase the intensity from there, steadily building you up back to the movement that caused the pain.
Now don’t get me wrong, this is crucial in the setting of clinical physiotherapy. Post-operative patients often have so many contraindications, along with the increasing number of medical negligence claims, that physios are required to tread as lightly as physically possible…like walking on a frozen lake, hoping to god nothing breaks and you can get to the other side safely.
Gym vs. Hospitals
In the interest of implementing corrective exercise, people in the gym are usually relatively fit. Even if you aren’t a high-level athlete, you still have a much greater capacity to perform exercise than many other people do. As a result, you aren’t starting from the bottom of your fitness potential. If we take you off in a completely different direction to your training with corrective exercises, not only are we wasting time and over-complicating the movement, but we may lose results in the progress.
Unless there has been significant trauma to the area in question, knee valgus during the squat shouldn’t stop you performing any form of loaded lower body exercise until it’s fixed. You just might need to work round it in the meantime.
Take A Top Down Approach
Provided you or your coach has a key understanding of intensity progression and how movement patterns change when challenged, addressing a movement issue or injury within a relatively fit and healthy individual should come from a top down approach.
Corrective exercise doesn’t always have to be lay on a yoga mat, or aiming to increase motor control of your medial arch, but simply an alternative movement that produces the desired effect and fixes the problem at the same time.
That way, you’re performing a task that is slightly more familiar (reducing the cognitive load) and bringing about the change you want.
Below are some common issues in the squat, remedies that are often included as corrective exercises, and some higher intensity progressions that CAN yield similar results.
1) Foot Pronation/Ankle Collapse
> Usual Fix = A whole host of ankle mobility drills
> Easier Alternative = Distribute weight more onto heels* with exercises such as wall overhead squats (photo)
*Although this specific topic will encompass its own article, many people often perform lower body movements with a more forefoot dominant approach, due to poor hip proprioception, core activation and a cocktail of other problems. This significantly increases the demand placed on ankle mobility that shouldn’t be there in the first place.
- Instead, simply stand around a foot away from the wall.
- Arms overhead, brace your core and squat as low as possible without touching the wall.
2) Instability/Poor Knee Control During the Squat
> Usual Fix = Clamshells
> Easier Alternative = Tempo Squats (5 sec, negative and 5 sec position) with an emphasis on rooting feet to the ground and driving your knees out.
Poor knee control often comes from a lack of co-ordination and timing within the movement, more than it stems from significant muscle inhibition.
3) Lumbar Lordosis/Posterior Pelvic Tilt/Butt Wink
> Usual Fix = Hamstring and/or hip flexor lengthening (depending on who you ask).
> Easier Alternative = Learn how to brace your core effectively and perform front squats as part of your warm up with a lighter load.
A lot of issues around the pelvis simply stem from poor abdominal bracing. Due to the change in load position, research has shown the front squat to significantly increase transverse abdominis activation (2), which should help to translate nicely over to a braced, stacked lumbar spine and pelvis when back squatting.
Wait, Wait…Hang on a Minute…
Now don’t get me wrong: corrective exercises that are often complex in nature and address the root of a potentially more serious problem are completely necessary. Sometimes, learning how to root your feet to the ground will involve a whole host of bizarre exercises that genuinely are the cause of your knee pain. In many cases, you may have ankle mobility restrictions that need addressing.
There is also infinite wisdom to be learned from clinical physiotherapy and other medical fields. For example, previous injuries to the spinal column can result in lower demand breathing and postural exercises be necessary prior to lifting anything substantial, even bodyweight.
But the key is to understand where you lie on the spectrum and the scope/magnitude of the problem.
If you are EVER in pain, then you should stop what you’re doing immediately and seek the advice of a professional.
However, if you’re in a bit of discomfort or a joint position occasionally falls out of line; rather than leaping away from the movement issue down onto the floor, stay as close as you can with a variation and save yourself some time and effort.
- Corrective exercises (the way most usually view them) are usually boring and require high cognitive load, reducing the likelihood that you will regularly perform them.
- Change your approach from a more clinical bottom-up approach to a more top-down view. No point in doing something that isn’t intense enough to challenge any aspect of your body.
- Before you dive on a foam roller or yoga mat, try an exercise variation that brings about a similar training response that may also fix the issue.
- If movement dysfunction comes from mobility or muscle weakness (e.g. poor glute activation to maintain ankle, knee and hip alignment during the squat) then you utilise an exercise that still challenges you in a similar way, whilst addressing the problem with other exercises.
*NOTE – This article DOES NOT refer to exercises performed to develop your movement capability. This article simply refers to the way in which we administer corrective exercise and some of the reasons they don’t work. Everyone should strive to improve the way they move. It is also acknowledged that movement is intensely individual and the exercises above may not work for everyone.
- Busso, T. (2003). Variable dose-response relationship between exercise training and performance. Medicine and science in sports and exercise, 35(7), 1188-1195.
- Comfort, P., Pearson, S. J., & Mather, D. (2011). An electromyographical comparison of trunk muscle activity during isometric trunk and dynamic strengthening exercises. The Journal of Strength & Conditioning Research, 25(1), 149-154.
- Dunlosky, J., Rawson, K. A., Marsh, E. J., Nathan, M. J., & Willingham, D. T. (2013). Improving students’ learning with effective learning techniques: Promising directions from cognitive and educational psychology. Psychological Science in the Public Interest, 14(1), 4-58
- Kahneman, D., & Egan, P. (2011). Thinking, fast and slow(Vol. 1). New York: Farrar, Straus and Giroux.