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Do We Really Need Corrective Exercises?

This past weekend, I was speaking at the Elite Training Workshop that we hosted at Champion PT and Performance in Boston on the topic of Integrating Corrective Exercises with Performance Enhancement.  As I was going through my slides, I actually tweaked it a bit and added one new slide with a simple statement:

 

Stop Trying to Correct and Start Trying to Enhance

Do We Really Need Corrective ExercisesAt the beginning of the talk, I discussed what some people would use to define the term “corrective exercise.”  I even asked around the room.  In general most people refer to corrective exercises as an exercise designed to improve poor mobility, strength imbalances, and altered motor control.

But there are some people that still refer to corrective exercises as exercises designto “fix” someone or “reduce pain.”  I would argue, this is not what corrective exercises are supposed to be utilized for within a training program.  Fixing injuries uses rehabilitation exercises, not corrective exercises.  They are different.

This may be why you see people doing a squat on an unstable surface and calling it a “corrective exercise.”  What are you trying to correct with that exercise?

One of the major components of using corrective exercises is a thorough assessment.  Without an assessment you are just taking a stab at something.  Without a through assessment, you are looking at an incomplete picture.  This may be OK to try on some people, but will be ineffective with many people, and could actually be detrimental with people in pain.  I’ve talked about this before in what I call The Corrective Exercise Bell Curve.

corrective exercise bell curve

I would define corrective exercises more like this:

Corrective exercises are designed to enhance how well you move and perform.  [Click Here to Tweet This]

 

So Do We Really Need to Use Corrective Exercises in the Fitness and Performance World?

I still think we do, but perhaps we should really change our focus.  Corrective exercises shouldn’t be used to “fix” people.  That implies there is a problem.  Don’t think of it as taking someone that is below their baseline capacity and getting them back to baseline, think of it as enhancing someone’s baseline and raising their capacity.

“Corrective exercise” is probably not the best terminology, perhaps that is part of the problem.  Incorporate corrective exercises to help enhance people.   Again, I’ll go back to that original phrase from my new slide:

Stop trying to correct and start trying to enhance.  [Click Here to Tweet This]

Use corrective exercises to enhance someone’s mobility, or improve someone’s movement pattern, or to add a strength emphasis to an area that is weak.  In this last example, if someone is quad dominant, has poor glute strength, and overuses their low back instead of their hips to hips, a “corrective exercise” may be a deadlift variation!  That doesn’t seem like rehab to me, that seems like performance enhancement, doesn’t it?

 

Learn How I Integrate Corrective Exercises with Performance Enhancement

 

If you are interested in learning how I integrate corrective exercises into our performance enhancement programs at Champion, I have an Inner Circle webinar on the topic.  In the presentation, I discuss:

  • What corrective exercises really focus on
  • How to  classify corrective exercises into specific components
  • My system for determining which corrective exercises to perform
  • What you can do to maximize the effectiveness of your corrective exercises
  • How and when to integrate corrective exercises into your rehabilitation, fitness, or performance enhancement program

To access the presentation:

 

 

Anterior Pelvic Tilt Influence on Squat Mechanics

anterior pelvic tilt influences squat mechanicsI feel like we’ve been discussing anterior pelvic tilt lately in several articles and an Inner Circle webinar on my strategies for fixing anterior pelvic tilt.  I wanted to show a video of a great example of how a simple assessment really tells you a lot about how pelvic positioning should influence how we coach exercises such as squats and deadlifts.

If you haven’t had a chance to read my past article on how anterior pelvic tilt influences hip range of motion, you should definitely start there.

In this video, I have a great example of a client that has limited knee to chest mobility and with boney impingement.  However, if we abduct the leg a bit, it clears the rim of the hip and has full mobility with no impingement.

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As you can see, because he is in anterior pelvic tilt, he is prepositioned to start the motion in hip flexion, so therefor looks like he has limited mobility.  I have a past article on how anterior pelvic tilt influence hip flexion mobility, which discusses this a little more.

While you are working on their anterior pelvic tilt, you can work around some of their limitations.  I hate when people say there is only one way to squat or deadlift.

Our anatomy is so different for each individual.

Some need a wider stance while others need more narrow.  Some need toes out while some need more neutral.  Do what works best for your body, not what the text book says you are supposed to look like.

 

 

Updated Strategies for Anterior Pelvic Tilt

The latest Inner Circle webinar recording on the Strategies for Anterior Pelvic Tilt is now available.

Updated Strategies for Anterior Pelvic Tilt

strategies for anterior pelvic tiltThis month’s Inner Circle webinar was on Strategies for Anterior Pelvic Tilt.  This is actually an update on one of my most popular webinars in the past.  I am doing a couple new things and wanted to assure everyone has my newest thoughts.  In this webinar I go through my system of how I integrate manual therapy, self-myofascial release, stretching, and correcting exercises.  To me, it’s all how you put the program together.  My system builds off each step to maximize the effectiveness of your programs.

Great Exercise to Enhance Posterior Shoulder Strength, Endurance, and Overhead Stability

I wanted to share an exercise I have been incorporating into my programs lately to develop posterior shoulder strength, endurance, and overhead stability.  I call it the ER Press as it combines shoulder external rotation in an abducted position with an overhead press.  When performed with exercise tubing, it provides an anterior force that the posterior musculature must resist during the movement.  The key is to resist the pull of the band while you press overhead.

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I use this drill a lot with my baseball players and overhead athletes.  I think it’s a great drill that hits many of the areas that I focus on when training a strong posterior chain of the trunk and arm.

It’s also becoming a favorite of my Crossfit and olympic lifting athletes, who are reporting that they feel more comfortable overhead and have more stability with their snatches and overhead squats.

There are numerous progressions that can be performed by simply changing the position the athlete is in, including tall kneeling, half kneel, and split squat stances.  You can also perform some rhythmic stabilizations at the top range of motion once to increase the challenge.

 

Functional Stability Training for the Upper Body

My latest educational program with Eric Cressey, Functional Stability Training for the Upper Body, is now available!  

FST for the Upper Body is the third program in out Functional Stability Training system, adding to the popular Core and Lower Body programs.  When Eric and I started to brainstorm what we wanted to teach with these programs, we wanted to share our approaches to rehabilitation and performance training, but more importantly how we integrate the two together.  This makes the FST products a great resource for any rehabilitation, fitness, or performance specialist.

 

Functional Stability Training for the Upper Body

Functional Stability Training for the Upper BodyIn order to function properly, our body needs to be strong and mobile, but control and stabilization of this mobility is often less than optimal.  Unfortunately, stabilization is often overlooked in the design of rehabilitation and performance programs.  Traditional program design relies too much on mobilizing what is tight and strengthening what is weak.  We are missing the boat on stabilization and it’s effect on enhancing optimal movement patterns.

Proper function of the upper extremities is complicated and requires the arm to work in conjunction with the scapula, thorax, cervical spine, and core to provide mobility, strength, and power to the entire body.  Any deficits in stability throughout the body’s kinetic chain can lead to injury, dysfunction, and a decrease in performance in the upper body.  FST for the Upper Body aims to help formulate rehabilitation and training programs designed to optimize how the upper body functions.

By addressing alignment, strength, mobility, and dynamic motor control, you can maximize your rehabilitation and training programs to reach optimal performance.

Think about a few of these:

  • Can the lumbopelvic and thoracic regions impact shoulder function?
  • Can the cervical spine impact the elbow?
  • Can scapular position decrease shoulder performance?

The answer to all of these questions is ABSOLUTELY!  Functional Stability Training for the Upper Body discusses all this and more, showing you exactly how you can assess and correct issues within the kinetic chain to optimize stability and performance of the upper extremity.

Here is an outline of the presentations and lab demonstrations that we perform.  Eric and I combine presentations with real life examples so you can see how we both manage specific individuals based on our assessments.  You get to see Eric and I at work together working with people:

  • How posture and position influence upper extremity function
  • Understanding and managing joint hypermobility
  • Understanding the elbow: functional anatomy, common injuries, and conditions
  • Elbow injuries: evaluation and management
  • Assessment and management of thoracic mobility restrictions
  • Assessment and management of muscles imbalances of the shoulder and scapula
  • Assessment and management of scapular position
  • Assessment and management of elbow epicondylitis

 

Optimal Shoulder Performance

For those that are familiar with Eric and I’s other education program Optimal Shoulder Performance, Functional Stability Training for the Upper Body takes this information to the next level by showing how we integrate the entire body to optimize upper body function.  

FST for the Upper Body integrates the concepts learned from FST for the Core and FST for the Lower Body, and serves as the sequel to their previous educational program, Optimal Shoulder Performance.  FST for the Upper Body is perfect as a stand alone program, but also builds off Optimal Shoulder Performance to help take your knowledge to the next level.  Putting the information from all of these products together will give you a complete understanding of how we approach our integration of rehabilitation and performance.

We had great reviews from the live filming of this program:

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Special Sale Price This Week Only

Functional Stability Training for the Upper Body is available now and is on sale for $20 off to celebrate the launch.  

If you haven’t purchased any of the other FST products in the past, you can get all three FST programs for the Upper Body, Core, and Lower Body together in one bundle and save another $20.

These special sale prices are for this week only and end Sunday May 18th at midnight EST.  Click below to learn more and order before this sale price ends!

 

large-ordernow

 

Yoga Stability Push Up

yoga stability push upI’ve recently been playing around with a variation of the yoga push up on an unstable surface.  The yoga push up exercise integrates a push up with a plus with the downward dog yoga position.  You can also perform this exercise on an unstable surface, such as a stability ball.

 

How to Perform the Yoga Stability Push Up

Here are a few of my coaching cues during the yoga stability push up:

  • Place the stability ball up against a wall.  The instability provided the ball is plenty, having the ball mobile isn’t needed and may not be safe.  Also, don’t perform this on turf as it is sometimes hard to keep the feet from slipping.
  • Start at the beginning plank position at the top of the push up.  In this position prep you body by finding neutral spine and performing a mild abdominal brace.  Keeping the core stable with enhance the mobility benefits at both the shoulders and hips.
  • Perform a push up but on the push back up focus on your hands pushing up and out above your head to drive your hips up high.  Protract your shoulders to perform a “push up with a plus.”  Be sure to keep your core stable and hinge at your hips.  You should feel both your abdominal area and glutes engage.

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Benefits of the Yoga Stability Push Up

There are many benefits of incorporating the yoga stability push up into your routine.  The three big things I am looking to improve with this exercise are:

  • Shoulder and scapular stability.  Performing a push up on an unstable surface has been shown to enhance scapular muscle activity compared to a traditional push up.  This can also be said for the rotator cuff muscles.
  • Serratus anterior activity.  The push up with a plus includes both upward rotation and protraction of the scapula, the two motions of the serratus anterior that when performing together have been shown to enhance serratus activity.
  • Hip mobility.  By adding the downward dog yoga hip hinge portion of the exercise, you drive more elevation of the arms, but also help facilitate a hip hinge pattern.

 

 

 

Strategies for Anterior Pelvic Tilt

The latest Inner Circle webinar recording on the Strategies for Anterior Pelvic Tilt is now available.

Strategis for Anterior Pelvic Tilt

strategies for anterior pelvic tiltThis month’s Inner Circle webinar was on Strategies for Anterior Pelvic Tilt.  I go through my system of how I integrate manual therapy, self-myofascial release, stretching, and correcting exercises.  To me, it’s all how you put the program together.  My system builds off each step to maximize the effectiveness of your programs.

 

To access the webinar, please be sure you are logged in and are a member 0f the Inner Circle program.

Is Resting Scapular Position Important?

Scapular posture assessmentA common component of any shoulder or neck evaluation is observation of scapular position and motion.  Posture assessment is popular and attempts to identify any asymmetries between sides.

As our understanding of the mechanics of the shoulder and scapular improve, the reliability and validity of assessing resting scapular position have recently been challenged.  Many authors believe that we may be overassessing and assuming dysfunction based on resting scapular position, which would imply that many corrective exercise strategies for the scapula may be either ineffective or inappropriate.

I have really changed how I assess and treat scapular dysfunction over the last decade.  My research has led my change in thought process, but other studies have also been reported in the literature.

 

Does Poor Scapular Position Correlate to Poor Scapular Mobility?

My exploration of scapular asymmetries and dyskinesis led me to first assess scapular position.  In baseball players, asymmetries of scapular position are common, and perhaps a normal adaptation.

While these resting static asymmetries were noted, I started to observe that these asymmetries seemed to become much less obvious during active movement.  As an example of this, we noted that the resting static position of the scapula on the throwing side was 14mm lower, which was statistically significant.  However, when the arms were abducted in the scapular plane to 90 degrees of elevation, the scapula was now symmetrical with the nonthrowing shoulder.

Scapular position

This really made me start thinking about the validity of resting static scapular posture.

To further evaluate this, we then looked at 3D electromagnetic tracking to see if poor static posture correlated to poor scapular mobility, or dyskinesis.  We looked at this in a few studies and found that resting static position does not correlate to poor movement patterns.

Several studies have shown that these scapular asymmetries are common in the general population too, so I consider my findings in the overhead athlete relevant to any population.  In my experience these same results occur in other populations.

 

Does Scapular Position Correlate to Injury?

The validity of static resting posture of the scapula has come into recent debate as tests such as the Lateral Scapular Slide Test, described by Kibler, has been shown to find asymmetries in both symptomatic and asymptomatic people.  Static postural tests like this have been shown to have both poor reliability and validity, meaning that we are not sure how accurate they are or what these tests actually measure.

Probably more importantly, however, is the finding that static tests have been unable to identify people with and without shoulder injuries, such as in this systematic review from the British Journal of Sports Medicine.

in a 2-year prospective study of over 100 recreational athletes, a recent study in the International Journal of Sports Medicine showed that static resting scapular position did not correlate to the future occurrence of shoulder pain.  They did note that the people who developed shoulder pain demonstrated decreased scapular upward rotation at 45 and 90 degrees of elevation, further suggesting that dynamic mobility is more important that static.

These studies are difficult to conduct but it appears that scapular asymmetries are common in the general population and do not correlate to injury.  That does not necessarily mean they do not feed into dysfunction, but the correlation may not be as factual as many think.

 

Recommendations

So what do we know about resting scapular position?

Based on our current understanding of scapular posture, it is hard to place a lot of emphasis on static posture as it does not appear to be reliable, valid, correlate to injury, or correlate to poor movement patterns.

I think one of the worst things you can do is assume dysfunctional movement will occur based on a posture assessment.  For example, you would not want to cue excessive scapular movement during arm elevation just because the person is resting in a certain scapular position.  You have a very large chance of just further facilitating your compensatory pattern by forcing the motion instead of finding the underlying cause.

People often seem to forget one VERY important fact:

The scapula is part of the scapulothorax joint.  The position of the thorax and spine will greatly influence the position of the scapula.  [Click to Tweet]

Perhaps an anterior pelvic tilt is causing increased thoracic kyphosis and scapular anterior tilt.  Perhaps a forward head posture is causing shortness of the levator scapula and causing downward rotation of the scapula.  Cueing movement without addressing the alignment, soft tissue restrictions, and other real issues is going to make this a lot worse.

These are just two examples but hopefully demonstrate the complexity of assessing scapular position and mobility.

To learn more about my approach, I have a recorded webinar for Inner Circle members that reviews how I assess and treat scapular dyskinesis, click here to learn more about my Inner Circle.

Scapular Dyskinesis

 

 

Do I still look at posture and scapular position?  Sure.  I start there, but realize that dynamic movement is likely much more important to assess.  I would not recommend that you apply corrective exercises based solely on resting scapular position.