Designing Effective Corrective Exercise Programs

No matter how fit or deconditioned someone is, we all have some sort of movement dysfunction. Research shows that these dysfunctions can reduce muscle function and are closely related to musculoskeletal pain. Fitness professionals have the professional obligation to assess clients, train them to achieve their health and fitness goals, and take preventative action with appropriate exercise programming. Here, we will explore becoming certified in Corrective Exercise and the elements of an effective corrective exercise program.

If you are a new personal trainer in the field, there is already so much for you to focus on: growing your business, relating to clients, continuing your education, and more. Knowing how to identify improper movement patterns contributing to chronic pain and poor posture will make you more valuable as a personal trainer in addition to keeping your clients healthier and injury-free. In most cases, you will help them with muscle imbalances they didn't even know they had!

Elements of a Corrective Exercise Program

The goal of corrective exercise is to enrich a person's life or sport. This process can be quick, completed in two or three sessions, or lengthy, requiring many modalities of intervention with frequent reassessments over time.

As the fitness professional, you can be reactive or proactive.

• Reactive training - You identified an existing issue in your client and begin to work on correcting it.

• Proactive training - You identified a risk factor that could lead to an issue down the road and begin to address it before it becomes a problem.

In a perfect world, we would always be proactive. However, many clients will arrive with areas of concern you will identify quickly while watching them move.

Train or Refer?

The scope of practice for a personal trainer is broad but limited. When dealing with a client in pain or discomfort, the first step is to determine if the pain is medical pain or a movement pain.

• Medical pain - Potentially from a medical condition that requires a referral to a medical professional.

• Movement pain - Potentially caused by a lack of mobility or flexibility and can be addressed by a corrective exercise specialist.

Carefully assess the risk factors and either refer them to a medical professional or take them on as a client. A good rule of thumb: when in doubt, refer them out. If a medical professional clears them, keep the documentation and begin your corrective exercise protocol.

The PAR-Q

The next element to any fitness program is the Physical Activity Readiness Questionnaire (PAR-Q). This is a list of in-depth questions about health conditions, pain concerns, and health history that gives the fitness professional a deeper look into what may be going on physically with a client.

An added piece to this written assessment is the extremity function scale questionnaires. One for upper body and one for lower body, they ask the client to describe and explain any activities that cause them discomfort or pain.

Keep in mind, these are subjective assessments and are based on the client's honesty in providing answers. Getting to know your clients early on can help you break down any barriers and ensure you are getting correct information from them.

Movement Assessments

With a health history, you can begin movement assessments. These are applicable in sports medicine and with functional exercise clients. You are the exercise specialist, so determine which assessment(s) will be the most appropriate. Some common movement assessments include:

• Overhead squat assessment

• Gait assessment

• Posture and range of motion assessment

• Individual exercise assessment

As you begin, make a list of the dysfunctions you are looking for or expect to find based on the written assessments and speaking with your client. Take clear and detailed notes during assessments to track all parts of the kinetic chain involved:

• Head

• Shoulders

• Hips

• Knees

• Ankles

With the availability of technology and with your client's consent, you can also video the assessments to track progress and refer to later.

Analyze and Develop a Plan

Armed with data, you can now develop a plan of action. Based on what you saw during the assessment, you can pinpoint overactive and underactive muscles. Prioritize the dysfunctions highest to lowest and determine how in-depth the exercise programming needs to be to be effective. In some cases, you will need strictly corrective exercise programming for a period to address the issues. In others, you may simply be able to use corrective exercise techniques during a normal fitness program.

Phases of the Plan: A 4-Step Approach to a Pain-Free Client

1. Myofascial Release (SMR)

Myofascial release is the technique of placing pressure on fascia and muscle tissue to release adhesions (or knots) and promote blood flow to the area. Pressure is applied to a given "trigger point" for 60 to 90 seconds to essentially over-excite the nerves to the point that the overload of neural input causes the tissue to relax.

If clients perform this on themselves with a foam roller, theracane, lacrosse ball, or the like, it is referred to as self-myofascial release. Personal trainers, massage therapists, chiropractors, and physicians can assist and apply the pressure manually to the tissue as well.

This is the first step so the fascia and muscle tissue are as relaxed as possible and will be more pliable.

2. Proper Length-Tension Relationship

Phase two is basically stretching. Once myofascial release starts to break up adhesions in the target tissue, static stretching and simply moving through ranges of motion will continue to loosen tissue and aid muscle fibers in finding the ideal amount of crosshead overlap at the individual level.

3. Recruit the Weak Muscles

Overactive muscles are tight or shortened while underactive muscles are weak and lengthened. You have identified the target joint or muscles and begun to loosen the tissue. Now, using your expertise, you can identify the opposing muscle groups that are typically weakened and begin to strengthen them. This will begin to even out the imbalance.

4. Put It All Together

Finally, you will begin to see the movement dysfunction improve and work toward the proper posture, range of motion, or movement patterns. At this point, you can begin to coach and cue movements correctly. Regular reassessment is the key to tracking progress.

A.B.A. - Always Be Assessing!

A great personal trainer will always be assessing a client's movements no matter how long they have worked with them. Everyday events can lead to muscle imbalances that weren't there yesterday! Extended travel, an acute injury, sleeping poorly, or poor muscle recovery can cause tight muscles and, in effect, change someone's movement patters or cause pain.

Incorporating corrective exercise into allexercise programming is in the best interest of each client. Don't just earn the certification, put it to use! Creating programming that prevents injury and avoids emergency management of pain will protect your client base and garner trust in your knowledge as a fitness professional.

Take the next step and expand your knowledge with the ISSA Corrective Exercise Specialist Certification today!