The Corrective Exercise Bell Curve
I’m going to admit something that may come as a surprise to you. Corrective exercises don’t always work for me. There, I said it, I feel liberated now!
Corrective exercises are one of those things that have seen a recent rage in popularity, in both the rehab world but probably even more so in the personal trainer world. Everyone is now assessing biomechanics and movement patterns and trying to prescribe corrective exercises to address what they see. This is fantastic.
I recently co-authored an article with Jon Goodman from the Personal Trainer Development Center on how physical therapy and personal training can collaborate more effectively. We discussed this concept a little bit. Jon took more of a hard stance against personal trainers performing assessments, for several reasons that he discussed. I don’t feel as strongly Jon on the subject and welcome the development of systems like the Functional Movement Screen that all of us can use to look at movement patterns and communicate better between professions. Anything we can do to individualize someone’s programming is awesome in my mind. But there is a caveat…
There is a dirty little secret that I don’t hear a lot of people talking about – corrective exercises don’t always work.
This has almost become like the story of the Emperor’s New Clothes, where people are a little afraid to admit that corrective exercises don’t always work. Perhaps they think they aren’t skilled or intelligent enough to make the corrective exercises work! Well, I am here to make you feel better. Corrective exercises don’t always work for me, either, and understanding why they “don’t work” is just as important to understanding why the “do work.”
The Corrective Exercise Bell Curve
To better illustrate the spectrum of corrective exercise efficacy, I have developed the corrective exercise bell curve. The corrective exercise bell curve explains why some people don’t respond to corrective exercises. I am not 100% certain of the exact percentages, this is just a model, but a starting point for discussion at least.
In this diagram, you can see that there is a certain percentage of people who are going to respond very favorably (and often rapidly) to corrective exercise. These are the all-stars that we all love to work with, call them the rapid responders!
Conversely, there is a certain percentage of people who just aren’t going to respond to corrective exercises at all. For these people, something is not allowing the correctives to work. Perhaps its pain, pathology, malalignment, biomechanical, structural abnormalities, or even neurophysiological. These people essentially need more than corrective exercises.
Then there is everyone else in the middle. These are the people who may respond to corrective exercises, but it probably isn’t going to be a quick fix. These people are going to take some time.
Applying the Corrective Exercise Bell Curve
This is all important to understand so you can begin to classify the people you screen. If you are a personal trainer that just performed a movement screen, programmed some corrective exercise, and was able to clean up some poor movement patterns, congratulations! That is awesome, you did a great job for your client and maybe even saved our healthcare system some money in the future!
For people who do not respond to corrective exercises, this is where I really see the benefit of personal trainers and physical therapists collaborating. We can do much greater things together than alone!
For the smaller percentage that is never going to respond to corrective exercises alone, they need a full physical therapy evaluation and will need a combination of treatments including things like manual therapy techniques, neuromuscular motor planning techniques, and eventually corrective exercises.
But here is the really cool group to work with – everyone else! This is the gray area that we could really collaborate well on to help people achieve their goals. Notice in the middle group, I stated that corrective exercises MAY work or may take LONGER to work. In this situation, if physical therapists and personal trainers collaborated more, we could really make a difference in a lot of people.
Physical therapy can work in tandem with personal training to help people achieve their goals faster by combining things like manual therapy with their workouts.
I’m lucky, throughout my career I have worked side by side with some of the best strength coaches and personal trainers, people who have made me better at why I do. This is by far my ideal work environment and why I always try to team up with a multidiscipline group of people.
To better illustrate, let me come up with a a couple of examples. Perhaps you notice someone has pretty poor squat mechanics. Corrective exercises aren’t working. This is a perfect person to collaborate with a physical therapists. Perhaps their hip capsule is tight or their hips are not aligned well (just a couple of examples, it could be several things). All they may need is just a kick start in the right direction with specific manual therapy and they may be good to go.
Or how about you screen someone with really poor shoulder mobility on one side. They don’t really have many symptoms other than a general ache in their shoulder from time to time, but the corrective exercises don’t seem to be working. I was actually referred a patient just like this last week from one of the personal trainers I work with frequently. That specific patient had very specific glenohumeral capsular tightness that wasn’t going to get better with corrective exercises alone.
I do this all the time and can often times clean up someone’s patterns in a few sessions, sometimes even less, by using the right manual therapy techniques to address their concerns while they continue to train. To me, that is fun. Helping people achieve their goals faster through collaboration.
So next time you feel like your corrective exercises are not working, don’t feel bad about it. You are not alone. If you are a physical therapist or personal trainer, find a respective partner to collaborate with and remember the corrective exercise bell curve.