The best corrective exercise

Posted by Hans Lindgren DC on 24 September 2016 | 0 Comments

Tags: Exercise, Functional Rehabilitation

The best corrective exercise is to do the exercise correctly

The rehab and fitness industries often provide information on how to perform corrective exercises. There might be advice on how to strengthen the gluteal muscles for individuals who cannot control their hips when performing squats or lunges, or how to improve the strength of the scapular stabilization muscles for those who cannot do exercises without scapular elevation or winging.

The problem with this approach is that the focus is on individual muscles that are considered to be weak, and by strengthening them the problem will be corrected. Unfortunately, it doesn’t work like that because it is not a question of weakness, but an inability to use the muscle when required.  Often it’s the stabilization function that is dysfunctional and so training the muscle in a phasic function is not going to have any effect.

Faulty movement patterns are not due to individual muscle weaknesses, but rather a lack of coordination and activation of a proper stabilization pattern. The brain is for some reason substituting the ideal stabilization pattern with one less effective.

Let’s look at an orchestra made out of the world’s best musicians. What would happen if all the musicians only practised by themselves and played whatever music they wanted?  Once we put the members of the orchestra together for a symphony, it would probably sound awful even though the individuals played well. However, if the musicians had practised together under a skilled conductor it would sound magnificent.

Another comparison could be a Football team. It would not matter how skilled the individuals in the team were, unless they practised playing together they would not win any championships.

Instead of focusing on individual muscles we should concentrate on the movement of each joint. If it is properly stabilised there will be good centration of the joint throughout the entire range of the movement.

To be able to evaluate the quality of movements, we have to be aware of what the ideal patterns look like.

The most effective way of correcting a faulty stabilization pattern is to first identify exactly where in the movement sequence the dysfunction appears and then activate the correct pattern in that position. The resistance applied and the range performed has to be adapted for each individual.  By moving the joint back and forth with an ideal stabilization pattern, the correct stereotype gets grooved in. Once the individual can perform the movement with a good stabilization, training can be performed unsupervised. It is very important to improve the individual’s proprioceptive awareness of the correctly stabilized movement. Methods involved in this proprioceptive training phase can include asking the individual to perform the correct or the incorrect movement on demand, working with closed eyes, or using mirrors to see the movement. Once the awareness of the movement has been improved it is time to increase the resistance and range of movement, but never more than with what can be performed using correct stabilization.

So if we have someone who cannot lift their arms to the side without elevating the shoulders it is not hard to guess that the solution is to practice lifting the arms without shrugging, using only as much resistance and range as can be handled with perfect form.

Key points in correcting faulty movement patterns:

• Identify the dysfunctional part of the movement.
• Establish proper Joint centration – sometimes manual positioning is required
• Perform partial movement- back and forth across the dysfunctional phase
• Improve proprioceptive awareness- Feel the movement- Separate right from wrong
• Apply Isometric, concentric and eccentric loading
• Gradually increase the range of movement
• Never exceed the ability to stabilize correctly
• Not training muscles- training the brain to use the muscles correctly

The brain is the conductor of the orchestra and the coach of the Football-team

Once the ideal pattern is established – the “weak” muscles will automatically be activated and the “tight” ones will be relaxed and elongated. Muscle tightness is just a compensation derived from insufficient stabilization of a joint.

All movements can be illustrated by a series of snap-shots where perfect position should be observed in every single one. Imagine filming a movement and going through it in slow-motion to see if there are any deviations from ideal stabilization. The solution is to find the flaw, correct it and introduce the corrected pattern back in to the movement sequence.

Overload injuries are not caused by moving joints too much – they are the result of moving them incorrectly.