corrective exercise Archives

What’s the Difference Between Corrective Exercise and Physical Therapy?

Justin Price/7 June 2023/ All MFN blog/

Both physical therapists and corrective exercise specialists help clients alleviate muscle/joint pain and improve their movement capabilities. However, the manner in which these professionals enter a client’s health and fitness journey is very different, and the procedures employed when working with clients are often dissimilar. Physical therapists are licensed health care professionals whose services are typically used by clients to treat a medical diagnosis, physical trauma, or specific injury (e.g., Achilles tendinitis, plantar fasciitis, rotator cuff tear, post-surgery rehabilitation, etc.). Physical therapy is also prescribed as an alternative means to orthopedic surgery, with therapists teaching patients how to prevent or manage their medical condition(s), often lessening the need for prescription drugs and painkillers.(1)

The job of a corrective exercise specialist is quite different. These types of professionals do not (and should never) diagnose and/or treat a medical condition. Instead, their specialty skills consist of assessing and evaluating a client’s musculoskeletal system for soft tissue and movement restrictions, imbalances, habitual patterns, and muscle dysfunction that may affect that person’s ability to move well, exercise effectively and/or perform daily activities (e.g., restriction of the lumbar erector muscles accompanying an anterior pelvic tilt, prolonged seated postures promoting excessive thoracic kyphosis, etc.). This specialized knowledge regarding the musculoskeletal system helps corrective exercise specialists design and implement corrective exercise programs to assist clients in beginning, resuming and/or continuing a fitness program without experiencing muscle and joint pain or movement limitations. (6) When a client’s musculoskeletal issues are not able to be addressed solely with appropriate exercises, or fall beyond a corrective exercise specialist trainer’s scope of practice, the client is referred out to medical experts for treatment.

Corrective Exercise Specialists are Not Physical Therapists

As a corrective exercise fitness professional, it is important that you clarify your role with clients from the outset with regard to assisting them with their musculoskeletal health and not step beyond your professional bounds. In addition to laws dictating that any professional must remain within their bounds of experience, education, training, and demonstrated competencies, confusing your role with that of a physical therapist, and working outside your scope of practice, can harm your standing with clients and reputation within the fitness industry. (5) Aside from it being a requirement, the primary benefit of working within your boundaries as a corrective exercise fitness professional is that it enables you to practice, perfect and promote the unique talents you have with regard to evaluating the musculoskeletal system for imbalances, and assessing and correcting a client’s movements during physical exercise and activities.

Increased Referrals as a Corrective Exercise Specialist

Doctors, physical therapists and other licensed health practitioners are always looking for qualified fitness professionals to whom they can refer patients that need guidance with exercise.(3) According to recent research, two out of the top three reasons patients visit their doctor is for assistance with conditions that could be greatly improved by participation in a program of regular exercise.(4) Unfortunately, these medical professionals are often reluctant to refer patients with musculoskeletal conditions out of a concern that their clients’ problems might be made worse by an unskillful personal trainer. However, when you have specialty qualifications and knowledge in musculoskeletal assessment and corrective exercise, and work within your scope of practice, medical professionals will feel confident in your abilities, which provides an opportunity for you to build strong networking and referral relationships with them.(2)

As you begin incorporating corrective exercise procedures more regularly into client programs, it is highly recommended that you obtain a Corrective Exercise Specialist (CES) credential from a recognized and approved provider. This will advance your skills and can also result in more referrals from medical professionals. As your business network grows, you will also find that holding a reputable CES qualification makes it easier to refer clients to other specialists when their condition lies beyond your scope of practice.

The Future of Fitness

Fitness professionals qualified as corrective exercise specialists know how musculoskeletal malalignments and imbalances of any kind can create pain, injury, and dysfunction throughout the body. They also know how to use the results of individual consultations and assessments to pinpoint clients’ exercise needs so they can start or return to a regular fitness program successfully. In short, knowledgeable and qualified corrective exercise specialists have the skills to competently meet clients’ musculoskeletal restoration needs, and represent perfectly the fitness professional of the future.

MedFit Network (MFN) members receive 20% off The BioMechanics Method Corrective Exercise Specialist certification. Members can get their discount coupon here.

Justin Price is one of the world’s foremost experts in musculoskeletal assessment and corrective exercise and creator of The BioMechanics Method Corrective Exercise Specialist certification (TBMM-CES). The BioMechanics Method is the fitness industry’s highest-rated CES credential with trained professionals in over 70 countries. Justin is also the author of several books including The BioMechanics Method for Corrective Exercise academic textbook, a former IDEA Personal Trainer of the Year, and a subject matter expert for The American Council on Exercise, Human Kinetics, PTA Global, PTontheNET, TRX, BOSU, Arthritis Today, BBC, Discovery Health, Los Angeles Times, Men’s Health, MSNBC, New York Times, Newsweek, Time, Wall Street Journal, WebMD and Tennis Magazine.

References

American Physical Therapy Association. (2018). Who are physical therapists. Retrieved from: http://www.apta.org/AboutPTs/
Bryant, C.X., & Green, D.J. (2010). ACE personal trainer manual: The ultimate resource for fitness professionals (4th ed.). San Diego, CA: American Council on Exercise.
DiNubile, N.A., & Patrick, W. Patrick. (2005). FrameWork: Your 7-step program for healthy muscles, bones, and joints. New York: Rodale.
Huffington Post. (2013). Most common reasons for seeing a doctor revealed in new study. Retrieved from: https://www.huffingtonpost.com/2013/01/17/common-reasons-see-a-doctor-skin-disease_n_2497424.html
Howley, E.T., & Thompson, D.L. (2016). Fitness professional’s handbook (7th ed.). Champaign, IL: Human Kinetics.
Price, J. (2018). The BioMechanics method for corrective exercise. Champaign, IL: Human Kinetics.

Leg Length Discrepancy: Is it Causing Your Pain and Dysfunction?

Justin Price/15 June 2022/ All MFN blog/

In order to design effective corrective exercise programs that both alleviate pain and improve function, fitness professionals must understand their clients’ strengths, limitations, and weaknesses.[1] This includes having an awareness of common structural imbalances such as leg length discrepancies (i.e., when one leg is shorter than the other). While it is not within a fitness professional’s scope of practice to diagnose a leg length discrepancy (LLD), it is extremely important that personal trainers and fitness instructors understand the ramifications of this imbalance and how it can affect a client’s musculoskeletal system.

Types and Prevalence of LLD

There are two types of leg length discrepancies: functional and anatomical. A functional leg length discrepancy refers to a musculoskeletal imbalance where any number of structures (or muscles) in the body are not working as they should. This results in parts of the skeleton being pulled out of alignment making it appear as though one leg is shorter than the other. Alternatively, an anatomical leg length discrepancy occurs when the bone(s) in one leg are actually shorter/longer than those in the other.[2] As the possible cause(s) of a functional leg length discrepancy are wide and varied, this article will focus on anatomical leg length discrepancies and how they affect your client’s body.

Anatomical, also known as true, leg length discrepancies have been found in as much as 95% of the population.[3] However, significant leg length discrepancies of more than one centimeter are found in about 1 out of 4 people.2 True leg length discrepancies affect the entire musculoskeletal system and play a substantial role in the health, function and experiences of pain for your clients.[4]

How LLDs Affect the Body

The body is designed to be dynamic and can adjust incredibly well to varying movements and positions. However, a true leg length discrepancy (that is left untreated) causes bones and joints to shift out of alignment, soft tissue structures like muscles, tendons, ligaments and fascia to compensate/overwork and can lead to pain and injury over time.[5] Some major areas of the body that are affected by a LLD discrepancy are the lower back, hips, feet and ankles.

LLD and the Lower Back

The pelvis forms the base of support for the spine. Therefore, a level and well-balanced pelvis is critical for spine health and optimal lower back function. In order to comprehend how an LLD can affect the spine and lower back, it is imperative to understand the structural anatomy of this area. Either side of the pelvis is made up of three bones (i.e., the ilium, ischium and pubis) that are fused together.[6] However, independent movement of each side of the pelvis is possible due to two important joints located in the pelvis. One of these joints is called the sacroiliac joint (SI joint). The SI joints are located on either side of the back of the pelvis where the top of the pelvis (i.e., the ilium) meets the base of the spine (i.e., the sacrum). The other joint is located on the front of the pelvis where the pubic bones (i.e., pubis) meet (i.e., the pubic symphysis) (see picture below).[6] Since the base of the spine articulates with each side of the pelvis via the sacroiliac joint, movement of the pelvis affects movement and function of the spine.

In addition to interacting with the spine, each side of the pelvis also articulates with the corresponding leg via the hip socket. From a skeletal point of view, the height of each side of the pelvis is governed, in part, by the length of the leg on that side of the body. If one leg is longer than the other then the pelvis will likely also be higher than that same side (see picture below).[2]

If the left side of the pelvis is higher due to a leg length discrepancy, then the base of the spine (i.e., the sacrum and coccyx) will shift toward that side also causing a compensatory shift in the rest of the spine all of the way up to the neck and head.[2] Therefore, a leg length discrepancy can cause pain and irritation to the joints of the pelvis, the intervertebral discs of the spine and the muscles and other soft tissues that help stabilize and mobilize these areas.

LLD and the Hips

The relative length of each leg also affects the position and function of the hip socket. As one side of the pelvis elevates in compensation for a longer leg, the hip socket shifts laterally toward the longer side.[2] Consequently, the hip of the longer leg will shift to a position outside of the foot/leg (see picture below).

These compensation patterns in the hip/leg can cause various aliments for clients such as greater trochanteric bursitis, iliotibial band syndrome, tracking problems of the knee, and sacroiliac joint dysfunction.

LLD and the Feet/Ankles

Leg length discrepancies can also affect the function of the feet and ankles. Pronation, or a flattening out of the arch of the foot, is a common compensation for clients with an LLD to effectively shorten a longer leg by reducing the height of the arch. Conversely, supination effectively lengthens a shorter leg by increasing the height of the arch. As such, a common compensation pattern for someone who presents with a LLD is to overpronate on the side with the longer leg and over supinate on the shorter side. These imbalances in the feet typically display with compensatory shifts in the ankles as well. Overpronation is usually accompanied by an ankle that rotates in too much, while a supinated foot is accompanied by an ankle that rotates out too much.[5] These misalignment issues in the feet and ankles can lead to ankle sprains, Achilles tendinitis, plantar fasciitis, ankle impingement and a whole host of other painful problems.

How to Help a Client with a Suspected LLD

Being aware of the signs and symptoms of a suspected LLD will help you know when to make appropriate referrals to a licensed medical professional who can diagnose a client’s condition with the help of advanced imaging techniques (i.e., x-rays and CT scans). Developing a professional referral network that you can turn to for help with issues that fall out of your scope of practice allows you to provide a more comprehensive service for your clients. It also enables you to create long-lasting relationships with like-minded professionals who will act as a referral stream for your business.[7]

Once the appropriate referral and LLD diagnosis has been made, your allied medical professional will develop a treatment plan that may include a shoe lift. Your role, as an expert in muscles and movement, is to design corrective exercise strategies that help your client adapt to the shoe lift and the resultant new position of their head, neck, pelvis, spine, hips, feet and ankles. The golden rule of any exercise program – gradual progression – should govern every aspect of your client’s LLD treatment. Encourage clients to introduce their lift gradually when acclimatizing to their new leg length and follow the underlying doctrines of corrective exercise program design: utilize self-myofascial release strategies in the initial stages of adapting to the lift; progress to stretching and only conservatively add strengthening exercises after the client has had at least six months to a year to get used to their new leg length.

References

Bryant, C. X., & Green, D. J. (2010). ACE Personal trainer manual: The ultimate resource for fitness professionals (4th ed.). San Diego, CA: American Council on Exercise.
Knutson, G. A. (2005, July 20). Anatomic and functional leg-length inequality: A review and recommendation for clinical decision-making. Part I, anatomic leg-length inequality: Prevalence, magnitude, effects and clinical significance. Chiropractic & Osteopathy, 13(11). doi:10.1186/1746-1340-13-11
Pappas, A. M., & Nehme, A. E. (1979). Leg Length Discrepancy Associated with Hypertrophy. Clinical Orthopaedics and Related Research, &NA;(144). doi:10.1097/00003086-197910000-00034
McCarthy, J. J., MD, & MacEwen, G. D., MD. (2001). Management of Leg Length Inequality. Journal of the Southern Orthopaedic Association, 10(2). Retrieved July 01, 2016, from http://www.medscape.com/viewarticle/423194
Price, J. (2020). The BioMechanics Method Advanced Corrective Exercise Mentorship. The Biomechanics.
Gray, H., Williams, P. L., & Bannister, L. H. (1995). Gray’s anatomy: The anatomical basis of medicine and surgery. New York: Churchill Livingstone.
Price, J. (2018). The BioMechanics Method for Corrective Exercise. Champaign, IL: Human Kinetics.

Benefits of Being a Corrective Exercise Specialist

Justin Price/27 September 2021/ All MFN blog/

Research shows that 90% of people report painful and limiting musculoskeletal conditions affecting the success of their workouts. (4) In response to this need corrective exercise is booming with fitness professionals becoming educated about musculoskeletal assessments, movement analysis and corrective exercise to help both themselves and their clients feel and function better. Becoming a specialist in corrective exercise and integrating these strategies into your fitness business has many advantages.

Attract More Clients: Latest research indicates the number one reason people seek the help of a fitness professional is to assist them with muscle/joint pain. (4) If you are qualified to address these problems, you will attract more clients.
Increased Revenue: Having a sought-after specialty qualification in corrective exercise has been shown to increase your income by as much as 50%. (1)
Utilize Fool-Proof Assessments: When a client comes to you with pain or complains of pain during their workout, you can take a strategic and active approach to assessing and correcting the underlying cause of their problem.
Use Proven Methods: The corrective exercise strategies contained in well-recognized corrective exercise certifications like The BioMechanics Method have been tried and tested on real clients and produce unbelievable results.
Design Better Workouts: A better understanding of functional anatomy and movement can not only help you get clients out of pain, but it can also assist you in designing more effective exercises. This enables you to create high-performance programs for both weekend warriors and professional athletes.
Accelerate Client Results: Injuries and movement dysfunction limit the types and intensity of workouts clients can perform. Helping clients feel better so they can perform better, both in and out of the gym, lets them realize goals sooner.
Keep Clients Coming: When clients get injured, they drop out. Addressing your client’s muscle imbalances and movement dysfunction at the outset of their program decreases the likelihood they will experience pain or injuries and ensures they can continue working with you.
Increase Word of Mouth Referrals: The ability to help clients get out of pain and achieve their goals is marketing gold. They will confidently refer friends, family and colleagues to you for help. You will also be able to successfully network with health professionals who need a trusted, qualified corrective exercise specialist to whom they can refer patients.
Get Ahead at Work: Latest research indicates that advanced qualifications weigh heavily in an employer’s decision when looking to promote a staff member. (2)
Edge out the Competition: Statistics show that 89% of clients are looking for a fitness professional to help them alleviate their aches and pains. Yet only 56% of personal trainers offer corrective exercise services.4 The knowledge and skills you obtain by earning a corrective exercise qualification could provide you with a major competitive edge in the fitness arena.

Helping clients overcome aches and pains can be a profitable and rewarding experience. A sound understanding of biomechanics will allow you to develop and use your practical corrective exercise skills. It also provides an outlet for you to market your unique services and become one of the industry’s most sought-after professionals.

MedFit Network (MFN) members receive 20% off The BioMechanics Method Corrective Exercise Specialist certification. Members can get their discount coupon here.

References

NASM. 2015. Annual NASM-CPT Survey. Chandler, AZ: National Academy of Sports Medicine.
National Federation of Personal Trainers, 2012. www.nfpt.com
Price, J. 2018. The Biomechanics Method for Corrective Exercise. Champaign, Illinois: Human Kinetics.
Schroeder, Jan., and Donlin, Ayla. 2013. IDEA Fitness Programs and Equipment Trends Report. IDEA Health & Fitness Association.

Wearing High Heels All Day? These 5 Moves Will Help Alleviate Lower Back Pain

Ke Wynn Lee/3 March 2021/ All MFN blog/

Women love their high heels. They’re designed to symbolize feminine beauty by accentuating the butt and legs, and make us taller. But, there’s a trade-off — they hurt your feet, hips, lower back, and even your shoulders and neck!

The human body is designed to walk flat. High heels raise our heels and put our feet into a plantar flexion position where the weight is concentrated at the ball of your forefeet forcing your center of gravity to shift forward. To prevent you from falling, you have to lean back and this indirectly creates excessive curvature on your lower back (lordosis) resulting in stress being placed on the lumbar area. Over time your lower back muscles become overactive in order to maintain your balance when you wear heels. While your posture in heels looks great, it’s actually abnormal.

Photo: Erik Dalton

Apart from lower back pain, other side effects of wearing high heels include tight and stiff calves and soleus muscles, which run from below the knee to the heel. You may also increase your risk of spraining your ankle and having sore hips due to muscle imbalance.

5 Tips To Alleviate Lower Back Pain

1. Tennis balls to release tight and overactive lower back muscles

Lie on your back with both knees bent, lift your hips and place the 1 or 2 tennis balls under your lower back or the area that’s sore – avoid placing the ball directly on your spine. Gently lower your body onto the ball and place sufficient pressure until you feel a tolerable level of pain.

Maintain this pressure for at least 1 minute, or until the pain lessens. Increase the pressure and repeat the process for another 2-3 minutes. Repeat on the other side of your lower back.

2. Hip Raises to strengthen your butt

When your lower back muscles become overactive, your butt muscles weaken. This is referred to as lower cross syndrome. To strengthen your butt, lie down on your back with both knees bent, and raise your hips by pushing off from your heels. Contract your butt muscles by squeezing your cheeks together at the top. Hold for 2-3 seconds and return to the start position.

Maintain a neutral and braced spine throughout and perform 2-3 sets of 10-15 reps.

3. Strengthen abdominal muscles with the Dead Bug

Excessive curvature of your lower back causes abdominal muscles to lengthen and weaken. Unfortunately, exercises like sit-ups and crunches can harm your spine and don’t strengthen your abs effectively. Doing the Dead Bug targets your abs and improves endurance and function, while keeping your spine safe.

To begin, lie flat on your back with your arms held out in front of you pointing to the ceiling. Bring your legs up and keep your knees bent at a 90-degree angle. Slowly lower your right arm and left leg at the same time, and keep going until your arm and leg are hovering just above the floor. Engage your abs and keep your back as flat as possible. Hold the position for 2-3 seconds and slowly return to the starting position. Repeat on the opposite side.

Stop if you feel pain at your lower back as this could mean your abs aren’t properly engaged and you’re using your lower back instead of your abdominals. Opt for an easier variation or skip this exercise and consult a qualified trainer.

4. Stretch the calves and soleus muscles

Place your hands on a wall and stand with one foot behind. Keep your back leg straight and push your heel towards the ground to stretch the calves. After 30 seconds, bend your back knee slightly and try to keep your heel on the ground to target the soleus. Repeat with the other leg.

5. Stretch your hip flexor

Stretching the hip flexor for people with lower back pain is important. To do this effectively, get into a lunge position, contract your butt and tilt your hips upwards by tucking in your tailbone – you should feel the muscles above your quads stretch. Cushion your knees with a towel or exercise mat. Hold this stretch for at least 30-60 seconds, then repeat on the other side.

Lower back pain is unfortunately inevitable if you wear high heels over a period of time. Try wearing a lower heel to minimize muscle compensation or only wear heels if it’s absolutely necessary. If your lower back is acting up, wear cushioned flat sole shoes to alleviate the pain, and don’t forget to practice the exercises above!

Reprinted with permission by Ke Wynn Lee. Pictures courtesy of Ke Wynn Lee.

Ke Wynn Lee, author and an international award-winning corrective exercise specialist, currently owns and operates a private Medical Fitness Center in Malaysia. Apart from coaching, he also conducts workshops and actively contributes articles related to corrective exercise, fitness & health to online media and local magazines.

References