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The Challenging Corrective Exercise

Written by Kento Kamiyama PT, DPT

Two weekends ago, I got to experience my first out of state teaching experience in Pensacola, FL.  As nervous as I was regarding traveling and teaching out of state, I received some great southern hospitality from 25 great therapists!

The more I teach, the more I fall in love with it.
The more I teach, the more I fall in love with it.

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Similar to the first course that was taught, it was about Movement Assessment and Corrective of the Spine with a sprinkle of breathing and pain science.  I wrote a blog on the top 5 things I learned from this course here.  Today I want to discuss about challenging corrective exercises.

Many of the corrective exercises that I prescribe tends to be neurologically challenging for the individual.  Most attendees reported that the correctives given at the course were not easy to perform especially when given to the right individual.

I do want to emphasize that good corrective drill choices always comes from good assessment FIRST.  One of the biggest reasons most of the correctives worked for most attendees is because the drills were specifically attacking their individual energy leaks or weak links.   Before each corrective exercise, I explained “this corrective exercise is beneficial if you saw _____ during ______ assessment”.

Hence, even an exercise that looks easy like a T/S Rotation exercise can be difficult if given to the right individual.  Here are some criteria’s that I have when I choose an exercise:

1. A good assessment is performed and the exercise attacks the energy leaks from the data collected from assessment.

2.  Its challenging enough neurologically that the client make mistakes and LEARNs from the mistakes (this is when neural plasticity happens).

3.  After a test – retest, positive outcomes are meet afterwards.

4.  No pain during exercise.  Or for chronic pain individuals the pain does not increase during and after exercise.

This concept is nothing new and  Perry Nickelston has taught this often calling it “The neural edge concept”.   You can find his movement lecture here.  For the individual to progress, the exercise shouldn’t be too easy nor too hard.  If its too easy, they won’t learn anything.  When its too hard, they tend to give up and also tend to use a high threshold strategy (i.e.- breath holding, jaw clenching, toe curling).

Soft Rolling, its harder than you think. This pic is an oldie but a goodie
Soft Rolling, its harder than you think. This pic is an oldie but a goodie

Know that neurologically challenging exercises in this sense does not mean its about lifting more weights, adding therabands, or doing 1000x reps.  The exercise itself is difficult because its neurologically challenging. Its always about quality, not quantity.

We tend to love easy.  However, maybe its because we are trying to do ‘easy’ things we continue to hit our walls such as pain or not able to progress.  Often, I realize the client needs extra support or encouragement to perform these exercises because its challenging.  However, once they learn by increasing engagement/awareness they have a lot more confidence on how to improve and take care of their body.

Lastly, once they learned how to perform the correctives well, I want to make sure it carries over to their every day movement patterns such as lifting, pressing, pushing, walking, etc so they can maintain good movement patterns and progress to prevent future flare ups.  As Ben Franklin once said “An ounce of prevention is worth a pound of cure”.

 

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