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Elements of successful corrective exercise programs

This is an excerpt from BioMechanics Method for Corrective Exercise-2nd Edition, The by Justin Price.

Chronic imbalances can affect the health and condition of all musculoskeletal structures, including the bones, joints, muscles, fascia, tendons, and ligaments. Therefore, the corrective exercises you recommend must first promote the rest, recovery, and rejuvenation of all structures you identified as problematic during the assessment process. You must then help these areas regain function, health, and suppleness by introducing corrective exercises to retrain, reinforce, and strengthen them to improve the overall health of the musculoskeletal system and curtail future problems.

Many things factor into the selection of appropriate corrective exercises for your clients’ programs. In addition to choosing safe and effective techniques, you must also address clients’ practical and emotional needs and abilities, and the exercises you recommend should build their confidence (Price and Bratcher 2010). You must also know how to introduce corrective exercises in a logical sequence so clients can achieve the greatest possible benefits in the least amount of time.

Building Client Confidence

When clients first come to you to discuss their goals or the musculoskeletal issues they are experiencing, understand that they have probably been concerned about them for some time. As a result, they may have lost confidence in their ability to perform certain activities, especially those that require the use of the affected or painful areas (Bandura 1986).

Bearing this in mind, it is important to build clients’ confidence when you first introduce them to corrective exercise. This is best done by taking the time to listen to their concerns and answering their questions honestly, avoiding the use of technical jargon. Proceed slowly at first, and use different teaching approaches as you explain each technique and the corrective exercise process in general. If you notice that a client appears confused, is not asking questions, or is simply agreeing with everything you say—or if they seem overenthusiastic—do not assume they understand (Fuller 2004). These types of responses often indicate just the opposite. Clients who lack confidence in their abilities are less likely to tell you when they do not understand. Learning to recognize when a client is feeling anxious or overwhelmed allows you to address these issues as they arise; gain the client’s trust; and build a positive, long-lasting relationship (Whitworth et al. 2007).

In addition to addressing clients’ concerns about their physical condition, you can boost their confidence by choosing easy-to-perform exercises at the outset of the program. When they can try and successfully perform a new corrective exercise, their self-confidence increases. This motivates them to repeat the action (i.e., it increases their adherence), and it makes them more likely to try the next exercise you ask them to perform (Feltz 1992; Rejeski 1992).

Remember, the guiding principle of corrective exercise programming is the same as that of traditional fitness programs: gradual progression (Bryant and Green 2010). This strategy applies from both a mental and a physical standpoint. Introducing concepts and exercises at a manageable pace improves the likelihood that your clients will adhere to their programs and reach their goals.

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Go to the online video to watch video 14.1, where Justin provides tips for building client confidence.

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Order of Exercises

Successful corrective exercise programs must address a client’s imbalances and deviations in a logical and sequential format. Structures that have been damaged and stressed must first be allowed to rest and regenerate before any attempts at retraining through stretching or strengthening can be made (Price and Bratcher 2010). Therefore, when designing a corrective exercise program, use activities that achieve the following goals in the order listed:

1. Let inflamed joints rest while incorporating techniques for rejuvenating and regenerating the fascia, muscles, and tendons.
2. Increase blood flow and range of movement.
3. Strengthen the muscles and challenge the nervous system.

In other words, every corrective exercise program should begin with self-myofascial release techniques, then progress to stretching, and ultimately advance to strengthening exercises.

• Self-myofascial release. The term myofascial comes from “myo” meaning muscle and “fascial” referring to fascia. This technique of self-massage is used to restore and rejuvenate soft tissues that have become adversely affected by chronic musculoskeletal imbalances (Myers 2008; Rolf 1989; Travell and Simons 1992). Self-myofascial release also helps clients feel better by reducing aches and pains that accompany excessive soft tissue stress. Always start each exercise session and each program with some form of self-massage that clients can also do between sessions at home, at the office, or anywhere they feel completely comfortable.
• Stretching. As the soft tissue structures become more fluid and healthier with the regular performance of self-myofascial release exercises, the next step in the corrective exercise process is to increase flexibility of the muscles and fascia and to increase the range of motion of the joints. Many different types of stretching exercises can be used to increase safe ranges of motion and retrain movement in those parts of the body that have become dysfunctional or impaired because of chronic musculoskeletal imbalances (Walker 2011).
• Strengthening. Once a client has begun to improve the condition of specific soft tissue structures, add strengthening exercises to the program. These fortify the soft tissue structures and increase the client’s confidence about movements that were previously difficult. Strengthening exercises are also used to reeducate the client’s body so it can eliminate musculoskeletal imbalances and movement impairments (Price and Sharpe 2009).

The appropriate application and progression (or regression, when appropriate) of self-myofascial release, stretching, and strengthening exercises are vital to the design of corrective exercise programs. Each of these modalities is discussed in greater detail in later chapters.

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Go to the online video to watch video 14.2, where Justin talks about The BioMechanics Method corrective exercise program design process.

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Evaluating Exercises

Selecting effective corrective exercises involves determining whether the techniques you recommend are both effective and practical. Clients are unlikely to adhere to exercises that call for equipment they cannot easily obtain. Therefore, you should always evaluate both the usefulness and the practicality of an exercise before choosing it for inclusion in a client’s program.

The following SIMPLE exercise evaluation process can help you determine the suitability of an exercise by identifying the target structures; the imbalances or impairments being addressed; the clients’ ability to do the exercise; practicality; and possible alternatives, regressions, and progressions.

• Structure. What structures (muscles, fascia, joints, bones) are targeted with this exercise?
• Imbalance. Which musculoskeletal imbalance(s) or impairment(s) are you addressing with this exercise?
• Mechanics. What are the correct mechanics of the exercise (so the imbalance or impairment is addressed and not exacerbated), and can the client perform it correctly?
• Practical. Will the client perform this exercise effectively and regularly? (Are the constraints of the exercise reasonable, and are the equipment needs practical?)
• Level. Can this exercise be progressed or regressed for a greater or lesser challenge to meet the client’s needs?
• Exercise alternatives. Is there a similar exercise that targets the same imbalance or impairment that is more likely to increase client adherence—that is, an exercise the client likes better or that can more easily be incorporated into their daily routine?

Use this SIMPLE procedure to evaluate every corrective exercise you recommend to ensure that you meet each client’s needs.

More Excerpts From BioMechanics Method for Corrective Exercise-2nd Edition, The

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