Do you use corrective exercise?
If you do, are you confident that you aren’t just wasting your client’s time?
Most clients think this kind of “exercise” is boring. And if you’ve only got 30 minutes with a client, are you really going to spend that much time on it? What’s left to address their actual goals?
We’ve put together this post–one of our most thorough–to help you pick an exercise or two that will help your client correct imbalances, gain mobility, and, ultimately, augment their training. It includes:
- a why do you need this introduction,
- a short lecture video of training theory,
- a lab demonstration video of exercises and cues to use, and
- a downloadable assessment sheet for you to use with your clients
When someone says they prescribe “corrective exercise”, I start to wonder…
- Is this the best use of your time?
- Are you aware of the anatomy you’re affecting?
- Do you know the actual cause of the dysfunction you’re diagnosing?
- Is it really even a dysfunction to begin with?
- Are you giving them just general mobility drills?
- Or are you actually prescribing something for a specific solution?
Trainers everywhere prescribe shoulder rotations and hip circles and whatever else, but these exercises either
- have no purpose, or
- are based off of poor reasoning
Honestly, I don’t even like the term “corrective exercise”. It’s not specific enough for me. I only use it because it’s familiar.
A common example: banded shoulder IR/ER to “strengthen the shoulder”
These types of exercises can be useful. I use them. But I only use them once the bigger issues have been resolved. When people come to me complaining of shoulder pain or some sort of mobility restriction, I always make sure to clear up their thorax position first.
Because the shoulder sits on the thorax. If your ribs can’t move, then you’ll compensate somewhere else (e.g. the shoulder blade, the shoulder joint, the elbow, the wrist).
I’m not going to sugar coat this: prescribing good corrective exercise is not easy. There’s a lot of anatomy, physiology, and psychology to consider.
Overview of this post
My goal with this post was to make prescribing corrective exercise as simple as possible. There are three main tests, in a specific order, and suggested exercises to prescribe. We go through the rationale behind the tests so that you can even think up your own exercises on the fly when you start experimenting with your clients.
To simplify things even further, we’ve included a Google Sheet that will guide you through the whole process.
Short summary of upper body mobility limitations
The 3 major restrictions that you want to look for:
Poor diaphragm position
Sternum pump handle up, wide lower rib cage = wide infrasternal angle, insufficient external obliques, overactive internal obliques and pectoralis major, diaphragm is descended, don’t put them in quadruped position, do put them in shoulder flexion positions, look like a gorilla
Limited upper chest breathing ability
Sternum pump handle up (maybe), narrow lower rib cage = narrow infrasternal angle, ribs straight, diaphragm is descended, overactive external obliques, inhibited internal obliques and transversus abdominis, traps air when exhaling, use a quadruped exercise, look like a dog, often has pelvic floor issues and hypermobility
Limited upper back breathing ability
Sternum pump handle down, pooch belly, flat chest, no abdominal muscle tone
Clear the tests in this order:
Infrasternal angle around 90 degrees
Shoulder IR around 90 degrees
Upper back expansion on inhalation without shoulder shrug
Follow this treatment algorithm:
Get lower rib cage position first
Then upper chest expansion
Then posterior rib cage expansion
This post is heavily based off of the Mechanics of Respiration series of videos.
If you’re a total newbie when it comes to breathing mechanics, you may enjoy reading Anatomy of Breathing. It’s an easy and painless read.
Okay, almost time to get into the videos. But first, let’s get you the assessment sheet.
Part 1 – The assessment process
In part one, we discuss…
- Why are rib cages shaped differently?
- How people with longer torsos look
- How people with shorter torsos look
- What muscles pull the ribs outward?
- What muscle pulls the ribs inward?
- Where the inspiratory intercostals are located
- What kinds of positions are best for people with wide lower rib cages
- What kinds of positions are best for people with narrow lower rib cages
- Which type of client needs more help with their pelvic position
- What’s going on with your clients who have pooched bellies and flat chests
- What to do when your client’s rib cage is asymmetrical (like Lance’s)
- Shoulder Hang
- Supine Overhead Reach activities
- Walkout from Knees
- Rollout on Swiss Ball
- PNF Diagonals
Part 2 – Picking the right corrective exercises
In part two, we discuss…
- How you can use familiar exercises to see clients in a different light
- What changes you should be looking for in these exercises
- When to use the Wall Press Abs exercise and how to do it
- How to progress and regress the Wall Press Abs exercise
- When to use the Supine Pullover exercise and how to do it
- How to progress and regress the Supine Pullover exercise
- How the Wall Press Abs and Supine Pullover exercises are different
- When to use the Band Diagonal exercise and how to do it
- How to progress and regress the Band Diagonal exercise
- An example exercise for people with a wide infrasternal angle (get the arms overhead!)
- An example exercise for people with a wide infrasternal angle and asymmetric rib cage (use PNF diagonals!)
- An example exercise for people with a narrow infrasternal angle (put them on their hands and knees)
- An example exercise for people with a narrow infrasternal angle and asymmetric rib cage (use quadruped PNF diagonals!)
- How to progress and regress these exercises for your stronger and weaker clients
- Why a tall client is at a disadvantage for controlling their thorax
- How we progress someone to standing (spoiler: get them down on one knee!)
- How to CORRECTLY cue your client in this half kneeling position (it’s easy to cheat)
- When is your client ready to alternate unilateral exercises from side-to-side (and why it’s important… evolution!)
- Side bar on how to address your female clients who worry about growing too big and bulky
- What happens to the ribs when the shoulders internally rotate
- When you should ABSOLUTELY NOT use a side plank with a client
Want more practice? Quiz yourself!
[su_lightbox src=”https://docs.google.com/forms/d/e/1FAIpQLScBgYiwoSmg5NfbKoZTd6kLIWRCt1d12Omrs17ffJicecumIQ/viewform?embedded=true”] [su_button size=”10″ background=”#cc1414″ style=”soft”] Click here to take the quiz [/su_button] [/su_lightbox]
Q: How frequently do you see a superior T4 syndrome with someone with a narrow ISA? Also, how might that change the course of the treatment? Would you still start in quadruped but then avoid right arm overhead activity early on?
A: In general, I put narrow ISA clients in a variation of quadruped to start as it bends the ribs to promote restoration of the full excursion of the lower ribs as my first goal. In many cases, reaching overhead does not restore the full respiratory excursion of the lower rib cage. You can test this by having the client in supine, reach overhead, and inhale as you monitor the ISA. When is does not widen, you’ll have confirmed the narrow ISA.
Can you think of any other exercises? Leave them in the comments below and maybe you’ll jog someone else’s creativity.
Give that assessment sheet a shot.
As always, if you found this helpful, send it to someone else!