Chiropractic is not simply about pain relief, adjusting subluxations and restoring spinal health. Your obligation as a frontline health care professional is to educate, teach, mentor and transition your patients to an all-inclusive healthy lifestyle. Optimizing healthy living through a systematic program of care ranging from pain relief to rehabilitation, corrective exercise and fitness should be your goal.
Bridging the gap between rehabilitation and physical fitness can be a slippery slope if you are not familiar with the underlying principles of corrective exercise strategies. Ultimately, you want clients to demonstrate functional movement patterns with balance between proper mobility and stability before they engage in strenuous activities.
Without optimum balance and symmetry, you are introducing a degree of compensation patterns with increased risk of injury. I am often quite surprised at how few health care professionals actually use corrective exercise in their practice. The exercise obtained by patients from performing everyday activities and functions is often inadequate. Many conditions treated by chiropractic adjustments could greatly benefit from exercise, as thousands of traumatic low back pain cases are treated annually by exercises alone.
What It Is
Corrective exercise is a form of exercise that strives to bring the body back into perfect postural position. As you know, the body is designed to perform at its most advantageous level when it is in a position of ideal posture and bilateral symmetry.
Corrective exercise is designed to undo mobility and stability imbalances, thus guiding the body to work in synchronization without pain. Through corrective exercise, you will be working toward re-educating the body to move as it was designed so that it can function at its best.
Specific movements improve body biomechanics and remove negative micro-traumatic stresses that have led to dysfunction. Corrective exercise reintroduces proper function, which restores correct structure. When the body stops compensating for imbalances, clients are able to move freely without restrictions and pain eventually disappears. It all comes down to movement!
Each doctor will develop their own preferred way to look at movement issues with specialized methods to arrive at solutions based on their practice paradigm. Unfortunately, highly specialized isolated movement examinations have been one of the biggest errors in assessing global patterns of compensation. This isolationist thought process is then carried over into rehab, exercise and fitness.
The body functions as a whole. The anatomy books have it wrong. The body does not simply function with action from an origin to insertion point. Everything is interconnected and one area of dysfunction will cause a compensation and a myriad of symptoms somewhere else.
Correctives combine the scientific principles of biomechanics, physics, motor control and human physiology to correct the cumulative stress of life. Even very small structural changes, if they occur over time, alter the muscles' and joints' ability to perform properly. This is because no muscle works alone; each is connected to another part of the body. Because corrective exercise focuses on fixing the cause of pain, instead of just addressing symptoms, it works where many other remedies fall short. So, even if you've tried everything else to help a client feel better, now is the time to introduce an effective strategy for pain relief.
Health care and fitness practices often neglect fundamental movement, paying too much attention to the superficially obvious. Weakness and tightness are often attacked with isolated and focused strengthening and stretching protocols that don't work.
The majority of musculoskeletal pain syndromes, both acute and chronic, are the result of cumulative micro-trauma from stress-induced by repeated movements in a specific direction or from sustained misalignments. The body develops a motor learning pattern for improper movement.
Without corrective exercise designed to teach the proper motor control patterns, patients will often develop bad technique from inferior neuromuscular coordination and compensation behavior. For example, when someone complains of chronic knee pain, we are quick to find solutions to treat, rehab, and exercise the knee. However from a corrective exercise perspective, we want to address movement in the entire kinetic chain: ankle, hip, core, thoracic spine and bilaterally symmetry. This is a much more all-inclusive, full-body system for exercise and the long-term benefits of functional movement.
[pb]The Missing Link
The number-one risk factor for musculoskeletal injury is a previous injury, implying that current rehab standards are missing something. Current medical and rehabilitation programs can manage the pain and symptoms resulting from an initial injury, but they have less ability to influence the likelihood of a recurrence. Don't let this be you.
According to Gray Cook, MSP, "Your commitment should be not only to manage the painful episode, but also [to] target and contain the risk factors. It is important to separate pain with movement from movement dysfunction. It is possible to move poorly and not be in pain, and it's possible to be in pain and move well. A licensed health care professional experienced in musculoskeletal evaluation and treatment should address pain with movement regardless of fitness ability."
Corrective exercise is the great equalizer. It allows you to do exercise with clients in non-painful dysfunctional areas to help alleviate their pain. Above all, we must remember that the muscle holds the skeleton in place. Many conditions, both chronic and acute, cannot be permanently cured unless and until the damaged, distorted or weak muscle is built up to normal strength and tone.
Many professionals do have an appreciation of function, and yet they still persist in an anatomical approach to exercise by training body parts instead of movement patterns. Choosing exercises based on symptoms is not alleviating the true cause. This is in agreement with the entire chiropractic paradigm of taking care of the whole body, rather than simply isolating painful regions. When it comes to corrective exercise and movement dysfunction, not everything is as it appears. You cannot make assumptions about what the body is trying to tell you simply by looking on the surface. You must think further outside of the proverbial box.
For example, what you see on evaluation as weakness may be muscle inhibition. So strengthening the weakness will make no lasting change in function. If anything, you might worsen the condition.
There are always two sides to every coin. What you see as poor function in an agonist may actually be problems with the antagonist. If positive changes are not made within several visits, flip the coin and look on the other side.
Weakness in a prime mover might be the result of a dysfunctional stabilizer. Don't be so quick to blame the big muscles that are always in spasm. Look deeper at the underlying stabilizer culprits. A prime example is constant spasm in the upper trapezius from lack of stability in the scapulae.
Tightness and stiffness may be a neurological protective mechanism of the body to increase tone for stabilization. Stretching stiffness will often lead to further tightness and injury. The body will increase tightness as a guarding mechanism or due to inadequate muscle coordination. Those hamstring muscles that are always tight is a classic case of stiffness due to lack of stability elsewhere.
Getting Started
The following are some essential paradigm components to understanding corrective exercise.
Exercise Examples
Let's take a look at some brief examples of the corrective exercise thought process in action.
Shoulder pain: Performing the obligatory internal and external rotator-cuff resistance exercises will do little to enhance shoulder stability. Instead focus on thoracic spine rotation and scapular stability.
[pb]Knee pain: Knee extensions and hamstring curls are the pinnacle of isolation movements. Instead, focus on hip and ankle mobility. Pay special attention to hip stability and glutei muscle activation with rotational vector patterns.
Neck pain: Active range- of-motion exercises will only get you so far. Instead, zero in on thoracic spine extension and rotation patterns. Focus on pelvic rotation determining if there is an anterior or posterior shift compromising the kinetic chain. Inner core exercises are paramount. And don't forget the diaphragm.
Back pain: There's more to strengthening the back than just working the abdominals. Hip function is paramount to back mechanics. If you lack mobility and stability in the hips, your back will pay the price. Check the joints above and below for proper functional control during basic patterns of movement.
Also: All corrective exercise for the back should involve the hip and glutei.
Principle Action Steps
Prioritize restoring and maintaining lumbopelvic stability. If you don't, the adaptations up and down the kinetic chain will persist no matter what exercises you use with patients. Many times you will have to start simply with floor exercises in supine, quadruped and side-lying to teach clients how to recruit the core musculature, especially the external oblique, and hold pelvic position / neutral lumbar spine.
Most core exercises tend to be rectus abdominis dominant. This dominance often gets ignored because everyone wants strong abs and the faulty pattern gets reinforced. Emphasize the posterior chain since it is often a neglected component of movement. Deadlifts, low cable pullthroughs and even back extensions can have corrective properties if proper movement patterns such as hip extension are reinforced. Don't be afraid of deadlifts, either. When implemented at the right time and with proper coaching of hip hinging, a deadlift is one of the most effective exercises for injury prevention.
Split-stance exercises like split squats, Bulgarian split squats and reverse lunges allow patients to work on hip mobility in hip flexion and extension, as well as improving stability. Asymmetrical loading is a great way to enhance trunk stiffness and pelvic stability that you'll need to gain hip extension mobility. Also include a little single-leg-stance activity. It's not about getting incredibly strong on a single leg, but more about increasing stability. Your primary exercises should be double-leg, yet single-leg movements add a nice, unstable training variable.
Start focusing more on function as opposed to structure. Karel Lewit, MD, said, "The first treatment is to teach the patient to avoid what harms him." Begin laying your foundation for corrective exercise from the very first patient visit by noting history, work habits, activities of daily living and current fitness level. All of these components will be critical to the design matrix of your corrective exercise strategy.
Remember ,the brain thinks in terms of movements, not individual muscles, so become attune to each patient as an individual. No cookie-cutter exercise program will work for you in the world of corrective exercise, so take the necessary steps to learn proper application.
Resources
Continuing to impress the advertising and marketing world, The Foundation for Chiropractic Progress (F4CP) has again been recognized by industry organizations for its excellence in educating consumers on the benefits of chiropractic, this time through social media, newsletters, and demonstrating thought leadership by promoting holistic well-being.
Dr. Louis Sportelli received the Lee-Homewood Chiropractic Heritage Award during the annual conference of the Association for the History of Chiropractic (AHC). During his nearly 60-year career, Dr. Sportelli has embodied the spirit of the award, given to “living individuals who have made outstanding contributions to the chiropractic profession.”
Presently there is no consensus on the best treatment for Achilles tendon rupture; and its management is still controversial. The treatment options are conservative treatment and surgical repair. With either treatment, be it conservative or surgical, Achilles tendon tears necessitate prolonged recovery and rehabilitative management.
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