Mend before you strengthen: corrective exercise programming

Before you focus on clients’ strength, you need to work on reconditioning and rejuvenating damaged tissues, writes corrective exercise specialist Justin Price.

With almost 90 per cent of personal training clients experiencing muscle and joint pain, corrective exercise programming should be a mainstay of today’s fitness regimens. Following the rule of gradual progression that underpins all successful program design, clients’ movement imbalances and musculoskeletal deviations should be addressed logically and sequentially. Reconditioning and rejuvenating damaged tissues should be a priority before attempts at dynamic stretching or strengthening movements are made.

When designing a corrective exercise program, incorporate activities that accomplish the following goals in the order listed below:

1. regenerate and release the fascia, muscles and tendons
2. realign and increase blood flow and range of movement to structures
3. strengthen the muscles and challenge the nervous system.

In other words, effective corrective exercise programming should begin with the introduction of self-myofascial release techniques, progress to stretching, and then to strengthening exercises (Price, 2010).

Self-massage

Self-massage regenerates and rejuvenates soft tissues that have become adversely affected by chronic malalignments (Abelson, 2003). These types of exercises are usually easier for clients to perform than more complex, movement-based exercises. Moreover, in addition to promptly reducing painful symptoms, the success clients achieve with self-massage helps build their confidence.

Two popular kinds of self-massage are:

1. self-myofascial release
2. trigger point massage.

Self-myofascial release (SMR) is a massage technique of applying continual pressure to an area of the fascia that contains restrictions or lacks movement. The sustained pressure stimulates circulation to the area, reduces pressure build-up from sluggish blood flow, and restores suppleness to the myofascial tissue (Barnes, 1999). Trigger point massage differs slightly from SMR in that it is intended to target a very specific area of a muscle (or the surrounding fascia). Trigger points are so-called because they trigger a painful response to the surrounding area when stretched, moved, or touched. Both techniques are very effective for preparing the soft tissue structures of the body for movement at the beginning of any corrective exercise program or exercise session.

Teach clients how to use massage aids such as foam rollers, tennis balls, golf balls, squash balls, or trigger point therapy sticks (such as a Theracane®) and electronic massage devices, as well as their hands and fingers, to perform self-massage. Recommend techniques that clients can replicate at home, the office, or anywhere they feel completely comfortable.

An example of a self-massage technique would be using a tennis ball to help recondition the soft tissues of the buttock area (i.e. glutes and hip rotators) (photo 1).

Stretching

Once the self-massage techniques have helped deconditioned soft tissue structures become more fluid and healthy, it is time to use stretching to increase the comfortable range of motion for the muscles, fascia, tendons, ligaments and joints. Stretching involves elongating and lengthening muscle fibres (and their accompanying soft tissues and fascia) in order to restore blood flow and elasticity to those structures (Walker, 2007). Many different types of stretching exercises can help facilitate flexibility/mobility and retrain movement in those parts of the body that have become dysfunctional as a result of chronic malalignment (Alter, 1996).

Three common stretching techniques are:

1. passive
2. active
3. dynamic.

Each technique, which should be used in the order listed above, offers a unique benefit to clients as they prepare for the next stage of their corrective exercise program.

Passive

Passive stretching involves holding a static position for a predetermined amount of time to achieve an increased range of movement around a joint or number of joints. Passive stretches are a good choice to use at the beginning of a stretching program. An example of a passive stretch would be a seated lower back stretch (photo 2).

Active

Active stretching involves a concept known as reciprocal inhibition, which is based around the notion that in order for one muscle group to relax, its antagonist muscle or muscle group must contract (e.g. contracting the quadriceps to enable the hamstrings to relax). A passive stretch, such as a standing calf stretch (photo 3), can be turned into an active stretching exercise by activating the tibialis anterior (i.e. pulling the toes of the back foot up toward the shin).

Dynamic

Dynamic stretching mimics functional movements. It involves the use of concentric activation (i.e. contraction) of certain muscles to move bones while other muscles eccentrically load (i.e. lengthen with tension like a bungee cord) to allow joint motion to occur with minimal stress to the joint. This type of stretching helps clients learn to perform a desired range of movement in a controlled and coordinated manner. An example of a dynamic stretch would be adding a step backward to the calf stretch pictured in photo 3. These types of stretches help clients progress from the stretching to the strengthening components of their programs more successfully.

Strengthening

Once progress has been made toward improving the overall condition of a client’s dysfunctional soft tissue structures, begin incorporating strengthening exercises into their program.

Following are four effective corrective exercise strengthening strategies:

1. isometric
2. concentric
3. eccentric
4. kinetic chain multi-planar/dimensional.

Follow the order detailed above to ensure your clients benefit from each type of strengthening exercise as they progress through their corrective exercise program.

Isometric

Isometric contraction occurs when a muscle becomes activated, but stays the same length (i.e. it does not shorten or lengthen). This is the easiest type of movement for the nervous system to coordinate. Once the nervous system has generated an isometric muscle contraction, it is able to continually keep motor units firing to the muscle(s) involved in that contraction to maintain a state of activation. When a client’s muscles cannot activate correctly, or have shut down as a result of chronic malalignment issues, it is important to get those muscles firing again before attempting to engage them in dynamic movements. An example of an isometric exercise would be instructing your client to stand with their feet abducted and contracting their gluteus maximus to help outwardly rotate their leg (photo 4).

Concentric

Concentric muscle action involves shortening a muscle to bring the origin and insertion points of that muscle closer together, and results in the movement of a joint (e.g. contracting your biceps will bring your forearm closer to your shoulder and flex the elbow joint).

Eccentric

Eccentric muscle action involves the lengthening of a muscle to slow down parts of the body as they move (e.g. the biceps lengthen to slow extension of the elbow joint when lowering a heavy box from shoulder to waist height). Clients unable to perform an eccentric contraction correctly may experience more stress to a joint and/or pain if they attempt an eccentric movement. Therefore, concentric exercises are usually better choices when initially progressing corrective strengthening exercises from isometric to concentric/eccentric.

Both concentric and eccentric strengthening exercises can be performed using a single joint, or many joints (i.e. a multi-joint movement). Begin with single joint movements like a single leg lift exercise (photo 5) that involves using the glutes to lift and lower the leg using just the hip joint (as long as the lower back does not arch and engage the lumbar erectors).

Progress to multi-joint movements when you feel confident your client has control over each joint involved in the sequence (e.g. add an opposite arm lift to the exercise above to incorporate spine extension).

Kinetic chain and multi-planar/dimensional movements

Once a client can control a muscle or group of muscles both concentrically and eccentrically, and the joints those muscles cross, teach them how to use those muscle(s) as part of a kinetic chain (e.g. a series of motions or movements created by muscles working in sequence) (Whiting, 2006). For example, the gluteal complex, which includes the gluteus medius, minimus and maximus, controls hip, leg and foot function (due to attachments of these muscles on the upper and lower leg). When working together as a kinetic chain, these muscles help slow forces to the feet, ankles, knees and hips by transferring the weight of the body to these structures at the right speed and rate, such as in the side lunge with reach (photo 6).

When groups of muscles are working efficiently as part of a kinetic chain, progress to whole-body, multi-planar exercises that move the body in all different directions such as forward and backward (the sagittal plane), side-to-side (the frontal plane) and in rotation (the transverse plane). Performance of these types of exercises correctly and efficiently is the ultimate goal of corrective exercise programs. Clients that have progressed to this highest level should be free from pain, highly functional, and able to execute well-coordinated, dynamic movements.

REFERENCES

Abelson, Dr. Brain and Abelson, Kamali.  Release Your Pain.  Calgary: Rowan Tree Books, 2003.
Alter, M.J. Science of Flexibility (2nd ed.). Champaign, Ill.: Human Kinetics, 1996.
Barnes, J.F. Myofascial Release. In: Hammer, W.I. (Ed.) Functional Soft Tissue Examination and Treatment by Manual Methods (2nd ed). Gaithersburg, Md.: Aspen Publishers, 1999.
Price, J. The BioMechanics Method Corrective Exercise Educational Program. The BioMechanics Press, 2010.
Walker, Brad.  The Anatomy of Stretching.  Chichester, England: Lotus Publishing, 2007.
Whiting, W.C. & Rugg, S. Dynatomy: Dynamic Human Anatomy. Champaign, Ill.: Human Kinetics, 2006.

LISTEN UP!

Click here to listen to Justin Price’s chat with The Fitness Industry Podcast, in which he discusses preventing clients from falling off the fitness wagon, incorporating advanced exercise skills into your PT services, increasing your professionalism and revenue, and the importance of simplicity.

Want to help clients with pain – and earn CECs online?

Justin Price, author of this article, is the creator of The BioMechanics Method Corrective Exercise Specialist Certification powered by Australian Fitness Network (Fitness Australia-approved). The BioMechanics Method is the fitness industry’s highest rated specialty certification with trained specialists in over 70 countries. To find out more about how to become a corrective exercise specialist in The BioMechanics Method so you can help people alleviate their pain, move better and exercise without limitations, click here.

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