Review of Mike Boyle’s book: Advances in Functional Training

May 19th, 2010

(Due to a server crash, this post is being reposted after originally being posted on April 17th, 2010)

I have certainly known of Mike Boyle for many years. His name often came up in discussions and articles on strength and conditioning as well as functional training. Mike is as well known for calling it like he sees it as he is for his contribution to strength and conditioning.

Up until a couple of years ago, Mike and I had never met. I wasn’t sure what kind of guy he was going to be when we did finally meet because I can’t say that I’ve always agreed with everything Mike’s ever written. But who wants an industry of clones?

In the summer of 2007 I had arranged a meeting with Chris Poirer of Perform Better to show him a pre production prototype of the Core-Tex™ at the Perform Better Summit in Long Beach, CA. I sent Mike an email because I knew he was going to be presenting there and asked him if he would be available to take some time to look at the Core-Tex and give me his opinion.

There’s no doubt in my mind that Mike gets approached all the time by people with products and ideas (because I certainly do). Even so, Mike got back to me right away and graciously agreed to spend some time with me between his presentations.

When I finally got to meet Mike, it was a pleasure to see that he just one of the guys. Like so many of the great educators in our industry, Mike had no ego and was genuinely interested in hearing more about the Core-Tex™. He didn’t have to do this since he didn’t know me but he extended me a professional courtesy. And to me, that was a class act.

When I got Mike’s book, Advances in Functional Training, I took it on a plane to England and read it cover to cover. This book is probably the most comprehensive book out there right now in respect to the amount of content it covers on the various components of functional training.
We all know that some people believe that functional training equates to circus acts-which of course it is not. This book covers the full continuum of what functional training really is and leaves out the circus acts.

I often speak in terms of training for function versus functional training because for me functional training denotes a mode or method of training and training for function denotes and objective. The content covered in Mike’s book falls right in line with training for function.
Mike has spent a lot of years in the industry. Yet he is humble enough to readily cite those that have influenced his approach to training and states his reasons for following the training principles he adheres too.

Since the functional training continuum covers everything from restoring normal movement patterns to maximizing sport performance, there is a tremendous amount of information to cover. A book could be written for each aspect of training for function along the continuum. As comprehensive as Advances in Functional Training is, it couldn’t possibly cover everything along the continuum in the depth that each topic requires.

But that is not bad thing. Because what Advances in Functional Training does is give the reader a full appreciation of the many aspects of function. And there is no shortage of content in this book (314 pages).

For example, my professional strengths are focused more around the assessment process and corrective exercise. Therefore, it’s not often that I get to work with clients as they move toward the more advanced end of the functional continuum. Mike’s book serves as a great resource to me for identifying some of the critical variables that need to be part of the training progressions.

The term “soup to nuts” keeps coming to mind when I read through this book. The book begins with where all training should begin-the assessment process. It then takes you through the continuum with appropriate progressions right up to athletic preparation. Mike not only does a great job at guiding us through the functional continuum, but he highlights critical areas where injury and common training pitfalls take place.

A minor criticism of this book is the lack of direct references from the research literature. Although Mike does give credit to other authors and practitioners, I don’t recall reading any direct citations of the literature. Doing so would have strengthened the delivery of many of the concepts in the book.

Advances in Functional Training really is a comprehensive look at a topic that regularly stirs debate from trainers and coaches with different training philosophies. Mike Boyle has made some tremendous contributions to our industry and with this book he provides ample evidence and rationale for a functional training approach.

Published by On Target Publications (January 11, 2010)

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Is Your Body a 1974 Pinto?

May 19th, 2010

(Due to a server crash, this is being reposted after originally being posted on February 17th, 2010)

If it feels so right, how can it be so wrong?

If the only vehicle that you’ve ever driven in your entire life was a 1974 Pinto, then your only frame of reference for a car is a 1974 Pinto. As far as you know, all cars feel every tiny bump in the road, rattle when moving over 55 miles per hour and take 3 people to turn the steering wheel. Then one day a kind friend of yours hands you the keys to a 2010 Mercedes SL 600. Wow! You have just experienced automotive engineering excellence.

What if your body is a 1974 Pinto? Then that is your only frame of reference of how a human body feels when it moves. You can’t step out of your beaten up body and into the body of a Mercedes SL 600. And because you are unaware how good you could feel or how efficient you could move, you accept life as a 1974 Pinto.

From an aesthetic stand point, we can look at someone else and say “I want to look like that” (or “I don’t want to look like that!”). By looking in the mirror, we can see how we compare visually. But movement and kinesthetic awareness (awareness of your body parts and their relationship to one another in space) is not something we can evaluate in the mirror.

Most of what we do with movement every day is done unconsciously and automatic. We might initiate the process consciously but once the action begins, most of it is on autopilot. For example, you might see that your shoe is untied and consciously make the decisions to bend down to tie it. But once the movement starts you’re not thinking about how much to bend from the ankle versus the hip. Those movements are based on your existing, unconscious movement catalog (even if they are those of a 1974 Pinto).
74 Pinto

When you are learning a new exercise or dance move, nearly all of the learning is initially through visual and auditory information. The movement is demonstrated (visual) and the cues are spoken (auditory). The kinesthetic part of learning or what we feel works off its existing 1974 Pinto point of reference and are not something we can evaluate in the mirror.

When people learn a new movement, they often miss out on some of the critical kinesthetic cues the body provides. This is because when you learn a new movement or move, the tendency is to be more concerned with the final outcome of the movement, versus what’s the best route to getting there. In other words, the focus is more on what needs to be accomplished (i.e. tying your shoe) rather than the quality of the movement. Therefore, you end up working from a foundation of movements that you are already doing wrong, even though it feels so “normal”.

So what can you do about this? First, it is important to understand that the best way to influence how our body moves is with subtle movements. This is how our nervous system detects change from the status quo. A good example of this is with corrective exercise. The precisions and control of corrective exercise movements allow the nervous system to recognize differences in formerly familiar movements. This is opposed to rapid, dynamic movements that essentially generate momentum with the bigger muscles in the body. Granted, you won’t get your heart rate up the same way, but that is not the purpose.

Corrective exercises will help “reboot” your software so that your body can ultimately learn to do things in a new and improved way. With this your body starts to receive kinesthetic cues that are more like a Mercedes and less like a Pinto.

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Corrective Exercise #15

May 19th, 2010

(Due to a server crash, this is being reposted after originally being posted on January 20th, 2010)

As you are reading this, my guess is that your thoracic spine and the lower cervical (if not all the cervical segments) are in flexion. So I’ve taken another of the exercises from the Pain-Free Program for Corrective Exercise #15.

As always, I hope to offer you a little more insight and detailed information on an exercise/posture like this that goes way beyond the obvious.
Click on the image to watch this short, informative video.

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Ouch! Delayed Onset Muscle Soreness

May 19th, 2010

(Due to server errors this is being reposted after originally being posted on December 18th, 2009)

It’s the time of the year when people make those resolutions. You know the same ones we here every year: “I’m going to start taking better care of myself by exercising and eating right”.

You should be welcomed with open arms and applauded for taking the initiative toward better health. Statistics show a tremendous drop in exercise adherence after the first several weeks following the initiation of a new exercise regime. There are many reasons for this that are physical or psychological or both.

Ours is a society that wants things NOW. Therefore, all too often the previously sedentary person attempts advanced moves and to pick up where they left off 3 years ago…all on day one. On the next day they start to think that that might not have been a good idea. And two days after that first workout, they know that that wasn’t a good idea. It is forty-eight hours after a workout when delayed onset muscle soreness (DOMS) is at its peak. This is one of the most important events in shaping the attitudes of a new or renewing exerciser. It is the attitudes and beliefs about exercise that will keep them coming back, or throwing in the proverbial towel.

If the new exerciser does not know that DOMS in moderation is a positive benefit from exercise, they may not come back. If they do not know that it comes from micro damage to the muscle fibers and that they can control how much micro damage occurs (by reducing weight lifted, reps, etc.), they will not come back. And if they do not know that mild to moderate cardiovascular exercise can actually reduce DOMS by flushing the waste from the muscles, they may not see a light at the end of the tunnel.

Here are a few suggestions that anyone can use to see that new exercisers become seasoned exercisers by sticking with the health benefits of a regular regime:

1. Understand that there is often a transitional period of slight or moderate muscle soreness that might occur from new uses of the muscles.

2. Know that muscle soreness is OK, but joint pain, swelling and any sharp or localized pain is a sign that something is wrong and a qualified professional should evaluate them.

3. Get help. A qualified fitness professional can provide you with many safe and effective alternatives to properly work the body. The new exerciser will not know what their limits are until it is too late. (Check what our personal training services offer here)

4. Find a partner or work out with a small group so you can communicate with someone who might be experiencing similar challenges and provide each other with support.

Keeping the new exerciser invested in their health is good for all of us. It is good for the individual’s longevity and quality of life and it is good for society as a whole because it is one less person burdening our health care systems.

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Corrective Exercise #14-Supine Hip Rotations

September 11th, 2009

I hope you enjoy the latest in my series of Corrective Exercises. Up until now, the exercises have been in written form with still photos to accompany them.

Corrective Exercise #14 has gone to video. We are currently working on a membership web site that will contain a tremendous amount of educational content similar to this. We want to get this content to as many professional as we can, so the membership fees will be very reasonable. Along with the membership, there will be monthly discounts on products and events.

Supine Hip Rotations look like a familiar ab exercise. Surprise! The ab work is down low on the application of this exercise.

The Hip Rotations is one of the many exercises presented in The Pain-Free Program: A Proven Method to Relieve Back, Neck, Shoulder and Joint Pain. As with so many of our corrective exercises, the Hip Rotations has a lot more going on than just the obvious.

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The 25 Things You Must Know About Lower Back Pain

August 28th, 2009

Earlier this month I presented at the IDEA World Fitness Conference. It is a conference I’ve had the privilege of presenting at for quite a few years. Fitness professionals from around the globe come to learn and connect.

One of my presentations this year that was filmed by IDEA to share with others was,”The 25 Things Your Client Must Know About Lower Back Pain”.

I thought I would share with you the list of items in the presentation. Of course during the presentation each topic was discussed and explained in detail. But I’m sure you’ll find some great tips from the list alone!
iliopsoas

1. A bad back is not always a weak back.

2. A weak back can be a precursor to a bad back.

3. Muscle endurance is initially more important then muscle strengthening for your back.

4. Acute episodes of back pain respond better to ice than heat.

5. Positive finding on an MRI often have less to do with your pain than you might think.

6. Stretching alone is an incomplete answer to solving your back problems.

7. Your body adapts to exercise, so doing the same “back” exercises for months or years has diminishing returns.

8. Chronic back pain can be months or years in the making.

9. Sleeping on your stomach is good for some people.

10. Lower back pain can be caused by your feet.

11. Lower back pain can be caused by your neck.

12. Never roll out of bed and immediately stretch in the morning.

13. Pulling your knees to your chest may be bad for your back.

14. Lumbar supports when sitting are helpful.

15. More serious medical problems sometimes mimic lower back pain.

16. Stretching your hamstrings when you have sciatica can make the symptoms worse.

17. Pregnancy and monthly cycles with increased hormone production can decrease the stability of the sacroiliac joint in women leading to LBP.

18. The best back exercises are those that are designed for you following an evaluation.

19. An old injury to another part of your body can contribute to your back pain.

20. Lying on your back with your hips and knees bent to 90 degrees and legs supported can passively mitigate back pain.

21. Repeated work or recreational postures or movements will lead to imbalances in your body and impact the back.

22. Back surgery can almost always be rescheduled.

23. If medication is your only intervention, you’ll be medicating for life.

24. Hinging from the hip can spare your back.

25. Good spinal ROM is not correlated with an absence

Is there anything you’d like to add to this list?

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Trigger point acupuncture: The inflammation alternative

July 23rd, 2009

Definition and Brief History

The alleviation of pain in the body that originates from a focus or foci of neural hyperactivity in one or another of the different structures which together form the musculoskeletal system, has its origin in England in the late 1930’s.

It was there, at University College Medical School, that researchers discovered that referred pain from a focus of irritation in muscle and or other connective tissues or fascia may be felt in broad, diffuse, and specific areas, such as muscles, joints and even teeth.

This was significant, as pain from these foci of irritation did not and do not follow the dermatomal or nerve root distribution of neurological pain common to actual nerve injury. In fact, it was demonstrated by Drs. Good, Kelly, and Travel, in England, Australia, and the U.S., that each individual muscle in the body, when affected by these “irritant foci”, has its own unique and specific pattern of pain referral that is predictable and mapable.

These foci of irritation came to be called, over time, “myofascial trigger points.” It was discovered that the common characteristic of the various trigger points, regardless of the tissue, was electrical hyperactivity. It was also discovered that it is possible to “de-activate” these acutely tender points through the insertion of a needle, and in the process relieve the pain and inflammation that is common to sports injuries, degenerative pain like arthritis, or painful conditions such as headache or TMJ.

This method of pain relief is now called “Trigger Point” acupuncture. As such, it dovetails, somewhat, with the Chinese system of acupuncture points specific to pain, called “Ah Shi.” However, the practice of trigger point acupuncture requires a thorough knowledge of western anatomy, as well as the precise location and referral pattern of the trigger points found in the various muscles, tendons, ligaments, joint capsules, periosteum, and even skin of the body.

Trigger points occur, most often, in the thick portion of muscle bellies, particularly in the region of the motor point, but are also found in their origin and insertion.

Cause of Myofascial Trigger Points

Trigger points can form in weak, overused muscles, such as occurs in repetitive stress injuries in keyboard use. But they can also occur in very strong, but overused muscles, such as occurs in runners who rest inadequately, or other athletes. I recently deactivated the forearm and wrist trigger points in a patient that routinely does 1000 pushups at a stretch.

Trigger points may also occur in trauma from direct injury, such as a blow or sprain, as in the patient with sudden onset shoulder pain after being pulled suddenly and unexpectedly by her 110 pound dog

Many of us are familiar with the “tension” lumps found in both the shoulders and low back, properly called “fibrositic nodules.” These nodules also contain trigger points.

Effect of Trigger Points

The problem of trigger points is not just that they are at the source of much myofascial pain; but that a muscle containing active trigger points undergoes shortening, and becomes weaker and less capable of the task at hand. This can then lead to a cascade of compensatory biomechanics, that further increase pain within the affected, and allied, muscles.

Role of Stress

I have observed clinically a link between the presence of active trigger points and the presence of diffuse inflammation in the body. We know, scientifically, that constant and poorly managed stress places us in the “fight or flight” response that elevates our stress hormones like cortisol.

My informal theory is that this mechanism imitates an overuse syndrome in that our muscles are held as if ready to run or fight. This is work, and places our muscles into anaerobic sources of respiration and concomitant lactic acid
burn. This creates various chemical cascades that may contribute to both inflammation and the formation of active trigger points.

Treatment of Trigger Points and Stress with Acupuncture

One of the great things about acupuncture of any kind is that is places you into the relaxation response, similar to what is achieved by meditation. Acupuncture reduces our body’s biochemical responses to stress, lowers blood pressure and reduces inflammation and pain.

In terms of hormones and neurotransmitters it does this by increasing the secretion of our body’s natural opiates, endorphins; and by increasing secretion of natural cortisone-like anti-inflammation drugs in the adrenal glands.

Myofascial trigger point acupuncture goes one step further. In addition to being profoundly relaxing, as above, when you relieve trigger points, especially the ones in the muscle belly associated with motor points, the muscle responds by actually lengthening; this has a decompressing effect on joints, tendons, and tendon sheaths.

It is not unusual after a myofascial acupuncture treatment for the affected joints to “release” as after a chiropractic adjustment, gently, naturally, and safely. This is generally followed by an immediate relief in pain.

It is also typical that after acupuncture treatment to feel extremely refreshed, as if after a deep sleep. One will often sleep profoundly well the night of a treatment, which has enormous restorative value.

Acupuncture and the Function First Exercise Alternative for Pain

Acupuncture, like deep tissue manual therapies, works hand in hand with the Function First system. My favorite kind of patient is the one who wants to help herself. Acupuncture is passive. You lay there on the table and the therapist uses his skill to create an environment of reduced inflammation and pain, so that you can take matters into your own hands through exercise. As such, acupuncture can be a necessary “evil” that enables you to take it to the next level with your own efforts.

Function First with Anthony Carey was of enormous benefit to me in the rehabilitation of my own neck, shoulder, and back chronic pain. While I definitely treat myself with acupuncture on a regular basis to enable myself to keep as active as I do, I continue to this day to do my Function First exercises on a daily basis.

Eyton J. Shalom, M.S., L.Ac., is the owner of BodyMind Wellness Center at 3577 Louisiana St. in North Park, San Diego. He is expert in the practice of Myofascial Trigger Point Acupuncture for Sports Injuries and Chronic Pain, as well as the use of Chinese Herbal Medicine and Ayurveda in the treatment of Dermatological, Gastrointestinal, and Immune Disorders.

He can be reached at www.bodymindwellnesscenter.com, or 619/296-7591

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Exercise Variety is the Spice of Life

April 28th, 2009

If you think about all the movements your body does everyday, you should be quite impressed with what it accomplishes. The twisting, turning, bending, lunging, reaching stepping, carrying, etc., are all minor miracles in and of themselves. All those movements are occurring with multiple body parts working together in 3-dimensional space. Your body thrives with that kind of variety.

All too often in the exercise world, we wait until our mind becomes bored with an exercise. When in reality, if the mind is bored now the body was bored a long time ago. That is because classic fitness progressions typically revolve around either:

• increasing the resistance (i.e. weight)
• increasing the sets and/or reps
• increasing the duration or intensity

These are legitimate methods of further challenging a group of muscles to work harder than they are currently working with a given movement. Another variable for progressions that is usually forgotten about is the way we can challenge our motor system or the “software” of our body. One of the best ways to accomplish this is to introduce a variety of movements to the body that the body is not familiar with. When we do this, we can continually challenge the three main components of movement:

1. The mechanical (muscle force, direction of force)
2. The physiological (energy systems, fat burning, nutrients, etc.)
3. The neurological (the motor system and feedback systems)

An example of this is the lunge. The traditional lunge is done by stepping out with one foot in front of the body=sagittal plane. This is a great functional exercise. Yet the lunge has endless possibilities when we start to incorporate other dimensions in space.For example, stepping out to the side or in the frontal plane challenges our three components of movement distinctly differently than the sagittal plane lunge. In fact, having the toes point either forward or in the direction of the lunge would also create a different response in the body. The same is true for a rotational lunge in the transverse plane. Even changing the orientation of our upper body changes the exercise. For example, if you lunge with your torso vertical, the percentage of work done by your quadriceps is greater than if you lunge with your upper body leaning forward. The forward upper body position decreases quadriceps activity but significantly increases the work done by the gluteus maximus (buttocks).
Frontal Plane Lunge

When changing our movements frequently, the motor system has to adapt and learn to figure out the synergy to complete it. Initially, the body works harder as it uses more effort while figuring things out. Working harder means using more energy and therefore burning more calories.

If the body uses more effort in the beginning, than just the opposite is true if we do an exercise for too long. The body gets too efficient and is no longer challenged. This is improved efficiency is of tremendous value when training for sport or work related responsibilities. But if your goal is to improve your physical fitness, then spice up your workouts with ongoing variety.

Doing the same exercises for weeks or worse months on end is like driving around the fitness center parking lot for 20:00 minutes trying to get the spot closest to the door so you can go in and walk on the treadmill for 30:00. What’s the point?

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What’s your balance got to do with your pain?

April 6th, 2009

Are you as amazed as I am by some of the feats that performers of Cirque du Soleil can pull off? Is this a God given talent or thousands of hours of practice? I am sure it is both.

Balance is one of those physical traits that are subject to the, “if you don’t use it, you lose it” principle. It is also a trait that can be dramatically improved upon when progressively challenged.

Balance plays a critical role in athletic and life performance. Great athletes have exceptional balance that allows them to quickly change direction, effectively recover from movement errors and position their bodies in ways that maximizes performance and minimizes the risk of injury.

Balance also plays a key role in our everyday safety. This is clearly evident in the unfortunate frequency of falls and injuries to the senior population. What is even more unfortunate is that many of these falls can be prevented.

But balance is not just about avoiding falling over. It’s also about helping us find the most stable or safe position when our environment around us changes. How quickly and effectively we react to those changes can be the difference between a shot of adrenaline and a herniated disc in the back.

Balance equates to control. Lack of balance=lack of control. And like a car unable to stop properly or control its steering accurately, the body with poor balance is an accident waiting to happen.

Regardless of our age, we all have the same basic mechanisms that give us balance or help us restore balance. These can be thought of as information gatherers that tell our muscles what to do. These information gatherers include:

* Vision
* Inner ear
* Stretch receptors in the muscles
* Movement receptors in the joints
* Touch and pressure receptors on the skin (particularly the soles of the feet)

The difference between great balance and not-so-great balance is dependent on two main factors:

1. How fast our nervous system receives and processes the signals from our information gatherers
2. How quickly and efficiently our muscles act on that information to make the appropriate adjustments

The wonderful news is that both of these factors can be improved upon. Doing so will improve performance for some and reduce the risks of injury or falls for others.

Balance training goes way beyond standing on one leg statically or standing on one leg while performing other movements. Single leg standing probably falls in the area between beginning and intermediate balance work. Standing still on one leg is closer to the beginning scale and moving your upper body while on one leg would be more toward intermediate.

Beginning balance training might include just standing still with the eyes closed to remove the outer visual references from helping. Another beginning balance work might be to tilt the head back. Doing sore moves the contribution of the inner ear for balance. Combining these or doing these on one leg would certainly increase the level of difficulty.

Intermediate balance training might include active one-legged exercises such as lunges or directional changes on one leg. Intermediate balance work might also include maintaining static stability while supported on an unstable piece of equipment such as a wobble board or physio-ball.

More advanced balance training might include explosive work on one leg such as hopping. Adding dynamic movement to the unstable apparatus will increase the level of difficulty significantly. For example, doing squats while standing on a BOSU ball or lunges on a balance beam.

The Core-Tex(TM), a new piece of equipment that I have developed works on reaction. This type of equipment challenges you by taking you out of balance within a limited area and requiring your nervous system to immediately react to that dynamically.

Balance exercises should enhance musculoskeletal stability and improve performance for sport or life. Therefore, never progress yourself until you have demonstrated a proficiency at a less challenging level. Frustration, compensation (and even humiliation!) will result if you don’t progress properly.

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Exercise sequencing vs. exercise progressions: What’s the difference?

March 23rd, 2009

Progressing exercises is a common component to effective exercise program design. Exercise sequencing should also be a common component to effective program design but that’s not always the case.

There is a definite difference between exercise sequencing and exercise progressions. Exercise progressions are typically defined by an increase in the intensity, duration, frequency or amount of exercise. In other words a progression is quantitative. Therefore progressions are 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 to the other exercises within the same program and is more qualitative. Therefore sequencing is a deeper level to program design.

Consider the analogy of a phone number. You have 7 digits that are all an important part of the phone number. Each number represents a critical part of what it takes to successfully complete a call to the desired recipient. But if you change the sequence of just one of those numbers, the call does not go through.

The impact of improper sequencing may not be as immediately apparent with exercise as it is with a call not going through. For the healthy population or the asymptomatic population the effects are immediate but aren’t easily observed by the less experienced professional. Yet those immediate effects do become cumulative. Over time improper sequencing will lead to deterioration in the quality of movement and potentially injury.

Corrective exercise program design is particularly sensitive to optimal sequencing. One exercise should prepare the body for the next and never cancel the benefits of a previous exercise. Many of those who have studied with me state that this is one of the most challenging aspects of designing effective corrective exercise programs.

A successful corrective exercise routine is based on meeting an immediate objective. In other words, when I write a corrective exercise program I expect for there to be an immediate change in the structure and function of my client at the end of the session-not three or four weeks down the road. I will know if I met my objective because I will “audit” my program by seeing if my client can do now what they couldn’t do before the program.

If the objective pertains to the quality of movement of the client, optimal sequencing must have intermediate objectives under the main objective. This helps you lay out a clearer path to your final objective. They are stepping stones to the primary objective all within a given exercise program.

Using an oversimplified example, you have a client who is a baseball pitcher with chronic rotator cuff problems. Through you assessment procedures you identify that the shoulder girdle is being stressed due to his lack of thoracic rotation. The lack of thoracic rotation is due to his kyphotic thoracic posture. And his kyphotic thoracic posture is combined with a posterior pelvic tilt.

Where does your sequence begin? Shoulder girdle? Thoracic spine? Or hips/pelvis? If you say pelvis (I would) an intermediate objective would be to improve lumbar extension. This should immediately positively influence thoracic extension. And than your next objective would certainly be to further improve thoracic extension/rotation. Following successfully improving the preceding objectives you would want to integrate the shoulder girdle with the thoracic spine and hips.

I encourage you to review your current exercise sequences for your clients. Ask yourself if they are following a logical order that produces positive change immediately. And are you successfully linking together smaller objectives that allow you to meet your primary objective.

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