Corrective Exercise

Preface: This blog will likely piss some people off (although possibly not to the extent my 80/20 blog did.) If you’re the easily offended type I suggest backing out now.

Ok…..

Based on observation trainers are making at least two major errors when it comes to Corrective Exercise.

1) The Trainers failure to understand their scope of practice.
2) The Trainers failure to understand what Corrective Exercise actually is,where it fits in a training continuum and what it is they’re looking at.

I have education in corrective exercise. In the interest of transparency I’ll say I failed forward into it after being wrongly billed as a “Corrective Exercise Specialist.”  My manager at the time knew NASM’s Certified Personal Trainer course heavily covered anatomy and had roots in Physical Therapy based approaches.

I figured to make things right I needed to live up to my billing and educate myself on the topic. One thing that I am decently good at is learning ,and being able to practically apply new information rather quickly. This was a need and expectation while I served in the military and I have two decades worth of practice doing it.

Corrective Exercise wasn’t something I would have volunteered for. Due to the fact that I was certified by NASM (and depressingly one of the few certified trainers on staff) I became the “resident expert on all things corrective exercise” by default.  Based purely on a comparative basis this may have been true, but in reality this was far from the case. There were both positive and negative consequences to holding that (at least partially) undeserved reputation.

Being blunt, my molehill of corrective exercise knowledge was a mountain compared to everyone else.  Problem is people don’t trip over mountains.

In hindsight I’m glad I did it. It opened up an entirely new area which I previously held no interest and added tools to my training repertoire that could be broadly applied. I stand by my opinion that the NASM CES is acceptable for learning the concepts of elementary level rehab exercise and does a very good job of teaching practical anatomy. Like any area of study, the exam only indicates a minimum level of knowledge as defined by the organization. It is on the trainer to continue learning and improving their skills.

The key words are elementary level. The NASM CES, good course that it is,really only scratches the surface of things. If you only read one book you’re limited to that level of knowledge no matter how many times you read it.

I’ve gone on to learn more corrective exercise and screening strategies over the years and two constants has remained the same.  My approach continues to simplify and I’m quicker to refer out.  What I do now bears near zero resemblance to what I was initially taught, although some fine details and lines of thinking remain intact.  I don’t even use the word “dysfunction”

I encountered a situation recently where a trainer stated he had an enlarged Sternocleidomastoid  (SCM) muscle along the left side of his neck which has become uncomfortable and is accompanied by pain shooting down his left arm. He wanted to know what corrective exercises could be applied to remedy this situation.

The Sternocleidomastoid muscle (Left) and all the neat stuff surrounding it.

When I read things  like this my  first thoughts are “what’s the worst things this could be?” Once again the military mindset reveals itself.  The person could be right and it could be a muscle imbalance of some sort, but then again he could be very wrong.

The presence of pain shooting down the left arm alone suggests the person visits their primary care manager. Enlargement of the SCM,presupposing it is the SCM and not something else.at my level of understanding and sight unseen of the person could indicate a number of things that CES won’t help.

CES trainers need to refer out clients for medical evaluations and treatment plans when things exceed their depth.

NASM’s Corrective Exercise Specialist (Left) and the Functional Movement Systems (FMS) are two of the larger and more established screening and correctives approaches. NASM states that diagnosis does not fall under the CES scope of practice and does not require a college degree if the candidate already holds an accredited Certified Personal Trainer credential. The FMS states explicitly where the FMS trained practitioner must refer to the higher level SFMA practitioner (Selective Functional Movement Assessment). SFMA holders are medically credentialed professionals.

Unless the CES course has radically changed over the last few years, it focused only on biomechanical issues that might lead to pain or some type of “dysfunction” BioMechanical issues are only one possibility when it comes to these things. One glance at the SCM images above shows we are pretty complex creations. CES doesn’t cover the other things that could be a factor such as neurological,endocrinological, disease state,structural et al…. the very same things that are outside of a trainer’s scope of practice and that no amount of Corrective Exercise will “fix”

Truthfully several CES recommendations can make matters worse. The otherwise innocent looking and popular foam roller for example is contraindicated in multiple conditions and thats not taking the more hardcore approaches into account.

CES has a place for clients that have been cleared of the more serious possibilities and for whom biomechanics have been determined as the main cause. Someone with a Dr title makes that call,a person with a deeper toolbox,imaging resources, understanding of many common health issues and ihow to  properly work with them.

 

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