The time has come for the fitness industry to rise to the occassion and better serve the 1.5 BILLON people world wide that are suffering from chronic pain.
See what the opportunity is and how Function First can share what has worked for us over the past 20 years working with the chronic pain population.
By Kevin Murray CPT, CES, PES
Director of Education
“Almost every significant breakthrough is first a break with old tradition, with old ways of thinking, and old paradigms”. Thomas Kuhn, physicist, historian, and philosopher of science whose controversial 1962 book The Structure of Scientific Revolutions originally introduced the term paradigm shift. Stephen Covey, author of The 7 Habits of Highly Effective People further elaborated on this concept. Paradigm shifts guide us to new ways of thinking, shedding light on new ideas and concepts previously unseen. They are “Aha!” moments, when you suddenly view everything from an entirely different perspective, ultimately shifting your paradigm.
The Function First Approach is constantly evolving. A new era of growth, contribution and change awaits the movement industry, and we embrace this opportunity as industry innovators and educators. The Function First Approach is a principle-based outlook on movement and function. Principles are nature’s laws that forever endure and cannot be broken. Principles are fundamental truths that have universal relevance. If your parents or grandparents ever wonder why they’ve lost an inch or two, they need to look no further than the physics principle of gravity. Although we cannot see it, gravity is always there. It’s a universal principle.
One of the fundamental principles that guide the Function First Approach is simply this: the body is an interdependent unit that always functions as a whole. And just as the body is interdependent, the Function First Approach operates much the same way. It’s not a methodology, but rather a principle-oriented, systematic approach, utilizing various perspectives to help guide the implementation of a corrective strategy. One such perspective contributing to our approach of viewing the body as a whole is that of Thomas Myers and his 2001 groundbreaking book Anatomy Trains®.
I’ve had the privilege of working side by side with Tom over the last several years, and in 2012 was appointed one of his Associate Teachers for Anatomy Trains®. While traditionally, manual and movement professions have been viewed as independent of one another, the movement industry over the last decade or so has grasped onto many of the principles and insights of manual-based philosophy and teachings. Surrounded by such brilliant minds and immersed into the “manual world,” so to speak, I quickly discovered that, while the process behind manual and movement applications are indeed drastically different, our objectives, outcomes and ultimate vision are almost always identical.
The anatomy-based knowledge of manual professionals is astonishing, and Tom’s is particularly so. In the same respect, Tom is often taken aback in his journey of movement comprehension. His own paradigms shift as he understands more about movement and function. Tom has taken a keen interest in our approach to Corrective Exercise, movement and function, which is why Anthony and I are thrilled to be collaborating with him in his hometown of Walpole, ME this July for three full days of advanced insights and movement strategies for creating lasting change. Combining the Function First and Anatomy Trains expertise into one event creates something far greater than we could ever accomplish separately. Together, we create an interdependent paradigm, completely revolutionizing how we approach working with clients, patients or athletes, while simultaneously bridging the gap between manual and movement industries.
We understand that one of the most effective strategies for expanding your knowledge and growing your skill set is to surround yourself with like-minded individuals at live events. There is no substitute for immersing yourself into new ways of thinking, to step into the unknown and leave with a new sense of what’s possible for you and others.
2014 is an exciting time for us at Function First. We are celebrating 20 years since we first opened our doors. As we reflect on this accomplishment, we also look to the future and to our pledge to continuously raise the bar to even greater heights. Our revolutionary unlimited personal training package, X-Factor small group training, reactive training with the Core-Tex™, collaboration with Thomas Myers & Anatomy Trains, and the soon-to-be-launched online curriculum based entirely around the Function First Approach to Corrective Exercise are just some of the projects that are keeping us busy.
Have you ever wanted to help someone in pain, but weren’t quite sure how? Function First is among the world leaders in Corrective Exercise intelligence. Since 1994, Anthony has been on the cutting edge of Corrective Exercise innovation and intellect, educating thousands of professionals at conferences, workshops, seminars and mentorships how to create Pain-Free living through corrective exercises. What if you could begin your personal journey of Corrective Exercise Mastery with Anthony and me anytime, anywhere, and at your own convenience? On May 1st, the Function First online curriculum will be accessible worldwide and available to anyone looking to geometrically grow his or her Corrective Exercise comprehension and application.
The Function First online curriculum and Corrective Exercise Mastery is the culmination of all that Anthony has learned and assimilated in over 20 years of working with the chronic pain population. It’s designed to share all the principles, strategies and tools that make the Function First Approach so effective and powerful by taking advantage of the most current research in pain neuroscience, biomechanics, motor control and all that encompasses the bio-psycho-social model to overcoming pain.
If you’re ready to become a master of helping people overcome pain through exercise, are committed to raising your standards of excellence, and are dedicated to acquiring the expertise to create lasting change in your clients, patients and athletes, then here is our invitation to you. Join us on this journey: an interdependent, centered approach with the ability to transform lives.
1. Corrective exercise is a journey, not a destination.
With all that we are up against as humans, to assume we are ever really “done” is unrealistic. Between long-established musculoskeletal history, genetics, environmental factors, new activities, psychosocial stressors, nutritional factors, etc., there is always room for improvement. Does that mean that we never attempt anything until we are almost perfect? Quite the contrary. One of our fundamental principles is that every corrective exercise program ascends in biomechanical and neurological complexity to prepare the client for the day’s ensuing life, fitness or work demands.
2. Corrective exercises are a means to an end, not an end in and of themselves.
If I am doing a good job with my clients, I am constantly clearing my schedule. My goal is to improve the quality and confidence of my clients’ movement so they can pursue the activities that they enjoy and the health benefits that their bodies need.
Corrective exercises evolve into strategic movement preparation before activity. More remedial exercises may provide a restorative day when needed. All the while, the client’s activity level is ramping up toward more traditional fitness goals.
3. We change the invisible before we change the visible.
Movement synergies will be observed and can be immediate before any noticeable structural changes in the body. Proprioceptive input and the resulting changes in motor output are not dependent upon significant structural/postural changes.
Interestingly, some of this will be also be attributed to movement-confidence factors as a result of the trainer/therapist relationship to the client/patient, the environment and hosts of other psychosocial factors.
4. All forms of myofascial release have a corrective function but are not corrective exercises.
We regularly employ forms of self myofascial release (SMR) with our clients as a valuable tool toward their independent care. I believe SMR can be a critical component of the overall corrective strategy but it is no more an “exercise” than myofascial release provided by a practitioner.
Therefore, SMR alone is an incomplete intervention and should always be complemented by corrective exercises that require motor control/motor learning components necessary for lasting change.
5. Corrective exercises are programmed and progressed following pre-determined objectives, just like any other exercise programming.
As Steven Covey says, “begin with the end in mind.” There are movement efficacies (without pain) that we want our clients to achieve. When they demonstrate these to us, we progress. Some demonstrate this in the first meeting, and some take several weeks. If progress is not occurring, we modify our strategy.
Repeating the same remedial corrective exercises or spinal stability exercises for months on end does not provide the needed stimulus for progress.
6. A corrective exercise has less to do with intensity or complexity than it does with purpose and competency.
In the Function First Approach model, supine diaphragmatic breathing and a multi-planer lunge with an arm reach can both be considered corrective exercises. Does the exercise have a specific objective toward what you hope to influence on this client? Does it provide the necessary levels of variability and demand to promote improved competency?
With corrective exercises, progressions are much more than added resistance, reps or durations.
7. If you believe that you can positively influence your client’s movement with the right exercises, then you must also believe that you can negatively influence their movement with the wrong exercises. 
The above statement is my modification of a statement I read by Shirley Sahrmann, PhD. Beyond the obvious of what creates pain, it is important to consider the effects of load and repetition on the motor systems response. We don’t lunge for the sake of lunging or squat for the sake of squatting. Is it the right exercise at this time for this client?
8. If variability is not built into your corrective exercise programming, the motor system is not given the stimulus to expand and further develop the body’s movement catalog.
Repeating the same remedial corrective exercises or spinal stability exercises for months on end does not provide the needed stimulus for progress. The goal is competency and not perfection because no two repetitions are ever exactly alike. Building in variability to your program expands the motor systems available catalog and resources for both predictable and unpredictable movement.
In the initial 6-8 weeks at Function First, we modify the client’s home program every two weeks to ensure variability in their program.
9. Continued use of terms such as “weak,” “tight,” or “inhibited” perpetuates an isolationist view of the body and distracts clients/athletes from the primary objective: improved movement.
The relevance of a “weak,” “tight,” or “inhibited” muscle is not lost on us. But it is only one variable in a very comprehensive interaction of all the systems in the body. Focusing on a muscle or muscles in this way suggests a linear relationship to your goal. Assuming an “if this than that” relationship with the human body is a path to limited success.
10. Corrective exercises applied to the individual with chronic pain are as much about movement novelty, graded exposure, reducing apprehension and instilling movement confidence as they are about addressing movement dysfunction.
As a non-licensed fitness professional, it is outside my professional boundaries to “treat” anyone or diagnose an injury. Yet 99 percent of my clients come to me due to chronic pain. Pain does not dictate what we do with the Function First Approach but it does limit our options. We respect the pain and all its biopsychosocial components.
We are of the opinion, based on the interpretation of the research, that the postural-structural-biomechanical model is still very relevant to the chronic pain sufferer. But that relevance is weighted differently in our programming on a client-by-client basis.
The first threshold we have to cross is the one that reduces psychological apprehension and guarded movement. And sometimes this has nothing to do with the client’s postural-structural-biomechanical challenges. That comes later.
The understanding of pain mechanisms-in particular chronic pain-has taken a quantum leap in the last few years. This is a rare case where the research is much further ahead than how patients/clients are treated day to day.
What we do at Function First is always evolving as we are exposed to more and more science. The good news is that much of what we have always done continues to work. The better news is that we have a clearer picture on why the Function First Approach works so well for so many.
This video is a TED talk from one of the preeminent researchers in pain science. I have shared this with many of you in the past and wanted to be sure everyone in the Function First family had an opportunity to watch. The best part of this video is that Dr. Mosely is an extremely engaging and entertaining speaker. As someone who often speaks on difficult topics, it is refreshing to see a man of his background provide such an enjoyable presentation.
As for methods there may be a million and then some, but principles are few. The man who grasps principles can successfully select his own methods. The man who tries methods, ignoring principles, is sure to have troubel. Ralph Waldo Emerson
I’ve opened many workshops with a slide containing Emerson’s above words. To me it speaks volumes in perspective when working with the human body.
If I knew then what I know now….
How many of us have said that? As health and fitness professionals we should be assuming a best practices, evidence based strategy in our work with clients, athletes and patients. And as new research provides valuable insights along with practical experience, we evolve.
Personally, I have had to completely let go of and modify many of my long standing beliefs about the work I do. From my college experience in the mid ‘80s until today, much has changed. I have worked with chronic pain clients for 20 years, and the last several years alone have brought a monumental shift in the understanding of chronic pain and the neuromatrix involved in its perception. For me, this has influenced how I design exercise programs and how I educate my clients. But it has not changed everything. In fact in many cases it has provided a clearer understanding to why what we do has worked so well for clients who have not been successful elsewhere.
We have referred to what we do as the Function First Approach from day one. I did not name it a method and I did not name it after myself. Why? Because from the beginning I realized that an approach is more of a philosophy geared toward specific objectives AND that a great deal of what I was doing was based on the knowledge I gained from others. A method, on the other hand, is self-limiting and quite honestly a bit presumptive.
Merriam-Webster provides one definition: Method- (1) : a way, technique, or process of or for doing something (2) : a body of skills or techniques
At Function First, our core values are to improve the quality of motion and the quality of life of every client we are given the privilege to work with. Frankly, we can’t do that if we try to force every client into a recipe that we whipped up before we ever met them.
I assume that anyone who has ever called what they do the ___________(fill in a name) Method is very confident and passionate about how and why they do what they do. I would also suggest they have painted themselves into a corner. I personally know several brilliant people who have created a “method” and my point is not to make them wrong. But the reality is that those who have created a method will likely grow and evolve long before any of that information makes its way down to and is applied by their followers.
Are all the answers in one spot?
Does Facebook drive you crazy reading posts by those ridiculous practitioners and what they are doing with their clients/patients? I bet you can’t even get half way through their blog post or video before you stop in disgust.
Thank God we can scroll down a little further and see a post by that brilliant professional who actually “gets it”. Now this one really knows what he/she is talking about, right?
Or perhaps they both do?
Your disdain for the first post could be what psychologist B.F. Skinner referred to as Cognitive Dissonance-ignoring or refuting other information regardless of how valid if it conflicts with or threatens our views. Your attraction to the second post might have you experiencing Confirmation Bias. This is when we surround ourselves with people that think and act like we do to keep ourselves comfortable in our decisions. We follow their work, use their ideas as our own and become offended and defensive toward those that have opposing views.
Can we grow personally and professionally if we impose these self-induced limitations upon ourselves? For me, the first step was and continues to be the ability to realize whether I am ignoring important facts as I hold on to long standing beliefs that may no longer be valid.
As an educator, it is my responsibility to deliver information accurately and to be clear on communicating that which is evidence based, that which has worked for me and that which has worked for others-which may or may not be evidence based. The good is news is that I have some pretty happy and grateful clients from around the world. The bad news is that they may not have improved for all the reasons I originally thought.
I’d love to hear what you think in the comments below.
Add some 3 dimensionality to your whole body vibration training. Combining the amazing benefits of the Power Plate with the reactive variability of the Core-Tex super sizes your benefits from both products.
We all know stretching and creating mobility does not sell as “sexy”. But there is no denying the role it plays in moving better, more comfortably and preparing for activity. The unique motion of the Core-Tex™ provides a completely different experience to improving mobility.
The motion of the Core-Tex™ encourages and guides the body into positions that address the tissue 3 dimensionally with ease. The mobility exercises with the Core-Tex™ are its “secret weapon” and one of the favorite applications of Core-Tex™ users.
Note: This post was originally published on PtontheNet.com
Anthony B. Carey M.A., CSCS, AHFS
Objectives:
1. Establish a working definition of corrective exercise
2. Set reasonable expectations for a corrective exercise program
3. Introduce a corrective exercise model
Corrective exercises have become a foundational part of the fitness landscape in recent years. As the understanding of human motion evolves, the fitness community has embraced the opportunity to help their clients move better. This article will present a framework for a model of developing comprehensive corrective exercise programming. This framework is based on both scientific principles and the author’s 20 years of experience with corrective exercise.
For the purpose of this article, it is beneficial to establish a working definition of corrective exercise: Corrective exercise is the use of movements and/or postures to produce desirable changes in movement strategies, thereby minimizing or eliminating compensation and producing efficient movement patterns. Corrective exercises should precede more integrated exercises because they can cue the client’s motor system to respond in a more desirable way and assist in removing or improving biomechanical constraints.
Fitness professionals should be reminded that any reference or attempts at treating and/or diagnosing injuries is outside of the professional boundaries and should be the domain of licensed medical professionals.
It is of this author’s opinion that the various forms of myofascial and trigger point release play a significant role in the overall corrective strategy; however, they are not classified as “exercises” and will not be included in this article.
From one perspective, human movement is based on “reward” or “punishment” feedback. The positive feedback, known as the “reward”, most often goes unnoticed because these are the efficient, presumably pain-free movements. The “punishment” is the negative feedback we get in the form of aches, pains, soreness, stiffness, etc. The body will always take the short term reward despite the potential for longer term punishment. For example, if your patella is not tracking properly and leading to low-grade irritation (punishment), you alter your gait to avoid the provocative motion (short term reward). But as a result, the rest of the kinematic chain is affected and potential damage manifests elsewhere (punishment). Slouching in a chair (short term reward) is another example. The reduced effort required for slouching takes precedent over the stress applied to the tissue during that moment in time and cumulatively.
The reward/punishment model along with all motor learning is part conscious and part unconscious. Lemon stated, “Motor learning is a consequence of the co-adaptation of the neural machinery and structural anatomy.” Therefore, we must fully realize that the brain drives the body but the body’s structural adaptations will feed right back into the brain. For example, excitation of the motor nerve from the spinal cord determines how frequently the muscle is excited, but how the muscle actually contracts and relaxes is determined by the physical properties of the muscle tissue (Brooks).
An effective corrective exercise program must, therefore, influence both the structural anatomy and the neurological system via the efferent and afferent pathways. The efferent pathway carries nerve impulses from the brain to the muscles – the brain driving the body. Whereas, the afferent pathway carries nerve impulses from the muscles to the brain – the body communicating back to the brain. This is a departure from a corrective exercise paradigm based purely on “tight” muscles that must be stretched and “weak” muscles that must be strengthened.
The model proposed here as three driving principles:
1. Logical sequencing of the individual corrective exercises facilitates
immediate neuromuscular adaptation,
2. Positive cascading events related to the quality of motion will occur when a strategy is developed to address a hierarchy of associated dysfunctions, and
3. Beneficial and immediate short term changes in biomechanics and motor control will occur within a given session completely independent of any hands-on intervention.
Sequencing of Individual Corrective Exercises
Progressing exercises is a common component of effective exercise program design. Exercise progressions are typically defined by an increase in variables such as intensity, duration, frequency, tempo, load or volume. In other words, exercise progressions are quantitative and a broader component to exercise program design.
Exercise sequencing, on the other hand, has more to do with the relationship between exercises in a given series of exercises within a program. Sequencing looks at the effects of each exercise in the program in relation to others within the same program and is more qualitative (Carey).
As with all programming, a corrective exercise program should have a major objective. To borrow from business and personal growth guru, Steven Covey, “we should begin with the end in mind.” Sequencing is a way in which to create mini objectives, or stepping stones, to moving the neuromusculoskeletal system toward the main objective.
Having a series of mini objectives or routines within the program allows you to audit your progress through the program. The audit is necessary to ensure that the mini objectives are met. If not met, the program is not on target to meet the main objective. One exercise should prepare the body for the next and never cancel the benefits of a previous exercise.
The final exercises within the corrective exercise sequence should also be congruent with the main objective and adequately transition the client to their next stage of activity. For some clients, that may mean the session continues into a more traditional fitness program. Or this may mean leaving the session, walking out the door and getting into the car. In either event, at completion of the corrective exercise program, the client should be integrated into a vertically loaded position versus descending the program back to the floor.
Positive Cascading Events Related to the Quality of Motion
The 80-20 Principle is a principle historically applied to economics, production, engineering, and management. It states simply that 80 percent of the effect is a result of 20 percent of the causes. The corrective exercise model described here applies the 80-20 principle to the resultant movement dysfunctions we see in our clients.
If we agree the human organism is a highly integrated structure, then it is clear that no biomechanical event occurs in isolation. As a result, a change in motion of any joint in the body can create a change in motion of joints above, below, and/or far removed from the joint in question. This cascade often leads to regional symptoms or areas of limitations that the client does not even associate with the origin of the cascade. For example, a client that sits at a desk with a landline phone may continually hold their phone on the right side, between their shoulder and ear, because the phone is located on that side of the desk. As a result, there is continuous tension on the right side spinal musculature. The cumulative effects are chronic hypertonicity of the muscles and associated lateral flexion of the spine to the right. The shoulder elevated to the ear, while on the phone, eventually depresses during normal standing as the cervical spine laterally flexes left to reorientate the eyes to the horizon. This individual is susceptible to a myriad of mechanical stress that will be present as localized symptoms at the neck and shoulder, as well as from the thoracic back to the feet. The catalyst of all this was the ergonomics of their phone use. As a result, many fitness professionals may end up working with clients who were treated in the painful area of the body and cleared for exercise only to have the problem or associated problems resurface.
Returning to the 80-20 Principle, identifying the hierarchy of dysfunctions (the “20”) will assist us in formulating the program design. Programming objectives should emphasize the most influential structures and move out from there. This is in contrast to a corrective exercise program design that might assess multiple movement/postural dysfunctions and then create a corrective exercise program with exercises for each individual dysfunction.
Beneficial and Immediate Short Term Changes
The movement dysfunctions and limitations seen in clients can be multi-factorial. They may be a result of previous injuries, current pain and/or apprehension, genetics, pattern overload from work or recreational activities, psychological state, or any combination of these factors. If we return to our reward/punishment model, despite what the client might say- their body is behaving this way because there is a reward. Some examples of the reward are:
1. Pain avoidance.
2. Lower metabolic demands. The metabolic cost is too high for local
muscle groups or overall on the body and therefore it
is easier to continue with current strategy.
3. Conscious effort. The movement can only be influenced cognitively
and therefore other intellectual demands supersede the conscious
processing needed to influence their movement patterns.
4. Deficient motor control. No other options are available because their
motor system cannot assimilate the necessary steps to do it differently.
If we are to create qualitative change in the way a person moves, we must understand what is driving their movement strategies. A movement or motor strategy can be thought of as a way a person has learned to execute a movement. Gait is a fundamental movement strategy used by anyone who can ambulate.
Assessments of movement strategies are generally inferred by observing kinematic variables. For example, if you assess a person’s squat, the observations you are making are based on joint motions and segmental positions because we cannot see what the nervous system is doing. Even if we could see the nervous system, 10 squats that look very similar kinematically could be very different neurologically. This is because the nervous system is capable of producing very similar results through different combinations of motor unit pools, timing and contribution. This is referred to as kinematic redundancy.
Muscle synergies represent a library of motor subtasks, which the nervous system can flexibly combine to produce complex and natural movements (Safavynia et. al). Think of them as building blocks of a movement strategy (Torres-Oviedo and Ting). As building blocks, muscle synergies are more easily influenced than a complete movement strategy. From this perspective, we can see how the appropriate sequencing of the corrective exercise program can affect positive change.
Inherent to creating immediate positive changes in the quality of the movement is appreciating the variability intrinsic to any repeated movement. Variability in execution can be viewed as an advantage and not as a nuisance during execution because the variability leads to adaptation that was not previously present within the muscle synergies (Schöllhorn et. al.). With the proper corrective exercise program design, new (and presumably improved) muscle synergies can be stimulated within a session using the body’s own intrinsic variability. As a result, the various muscle synergies interact to create changes in global movement that serves as a “reward” to the body.
The results can also be of tremendous value to the chronic pain client. This client very often associates familiar movements as pain producing. By facilitating muscle synergies that produce a movement outcome in a novel way, it helps that client disassociate those movements from a familiar pain producing movement.
This change is short term since a learning effect likely did not occur within an hour session. But since changes were produced independent of the trainer or therapist, the client/patient can reproduce the results daily on their own.
Progressions within a program are made not by adding repetitions or load to the same exercises, but instead creating variability within the sub routines of the program that continue to work toward the main objective(s). We do this through graded exposure. Graded exposure in this context is applied to the amount of variability and novelty the client can successfully handle without pain and compensation. By doing so, the neuromusculoskeletal system is continually challenged by the quality and not necessarily the quantity of the input.
Conclusion
When structured properly and with a clear understanding of potential for change, corrective exercises can create very powerful adaptations in the quality of movement in our clients, athletes and patients. The model proposed in this article is part of a very successful approach that has helped clients from around the world.
References
Brooks, VB The Neural Basis of Motor Control. New York: Oxford University Press 1986
Carey, A. (2005). The Pain-Free Program: A Proven Method to Relieve Back, Neck, Shoulder and Joint Pain. New York: John Wiley and Sons.
Gelsy Torres-Oviedo and Lena H. Ting, Muscle Synergies Characterizing Human Postural Responses; Journal of Neurophysiol 98: 2144–2156, 2007.
Lemon, R.N. (1993) Cortical control of the primate hand. The 1992 GL brown prize lecture. Exp. Physiol. 78, 263–301
Seyed A. Safavynia, Gelsy Torres-Oviedo, Lena H. Ting, Muscle Synergies: Implications for Clinical Evaluation and Rehabilitation of Movement; Top Spinal Cord InjuryRehabilitation. 2011; 17(1): 16–24
Wolfgang I. Schöllhorn, Hendrik Beckmann, Keith Davids, Exploiting system fluctuations. Differential training in physical prevention and rehabilitation programs for health and exercise. Medicina (Kaunas) 2010;46(6):365-73