It’s always an honor to be invited to speak on a podcast, and even more so when that podcast is for IDEA Health and Fitness Association. The interviewer, Sandy Todd Webster (Editor in Chief at IDEA) and I have known each other for years and Sandy was a client of mine at one time. Sandy truly knows the fitness industry inside and out and had some great questions that led to a fun exchange.
This is a short clip of our conversation where she asks me for any word of advice I would offer to fitness pros working with or wanting to work with clients dealing with chronic pain.
Following the PFMS A-D Levels of Designation, the Half Kneeling “Hula” is a Level “C” exercise. Besides the points of contact and relationship to gravity, this corrective exercise requires some kinesthetic awareness and movement coordination and is an excellent progression to the standard, static kneeling hip flexor.
Adding variability not only provides superior outcomes, but it also often exposes restrictions we didn’t know were more prevalent.
The pain itself is almost always the primary focus. But their are multiple inputs that can lead to a downward cascade in the quality of life of those challenged with chronic pain. And equally, the sum of many inputs can also lead to a positive cascade and opportunity for improvement.
This clip taken from a live webinar I did with the American Council on Exercise, sheds some light on how the right exercises, for the right person, at the right time can be a catalyst for positive change.
If we can appreciate and impact through exercise, more of the dynamic systems involved in the pain experience , we provide our clients with a path to positive change.
Looking beyond the primary movement in a corrective exercise offers tremendous opportunities and insight into ways that we can influence our clients’ global movement needs. Here, I use an example of a familiar corrective exercise for the shoulder girdle and apply our Levels A-D strategy to demonstrate the different considerations when selecting a working posture/position.
It is common to focus on a joint or body segment only, when choosing corrective exercises for your client. Disregarding the implications (positive and negative) of the posture or position from where the exercise is initiated, means that we are not recognizing the integrated, functional biomechanics involved.
We have one of our Level D correctives from the PFMS library that is part of our educational website. Level D exercises are what I refer to as “top of the foodchain” in the corrective exercise world.
These highly integrated exercises carry extensive value beyond the biomechanical integrations. For some clientele, the Level D is the immediate segue to their more traditional fitness workout. For others, the Level D is an element of a workout itself.
• Momentum from desired pelvic list promotes lateral spinal flexion, which is enhanced throughout the vertebral column when torso and righting reflexes resist maintaining a level orientation to the horizon.
• Arm overhead act as an extension of the rib cage, creating a longer lever and greater mass to ensure that all vertebrae contribute to the lateral spinal flexion.
• Maintaining a pure frontal plane motion with thoracic extension counters any rotational tendencies of the torso.
• Slight rotation of the intervertebral joints are coupled with lateral flexion of the spine.
• Lateral trunk musculature on the lengthening side are eccentrically loaded & decelerate mass of the trunk in the side bend, then transition concentrically to return trunk to the vertical.
Neurological | Physiological Outcomes:
• Promotes connective tissue elasticity associated with dynamically loading / stabilizing sagittal, frontal and transverse plane motions of the thorax.
• Increase connective tissue compliance and resiliency through the promotion of tissue extensibility, amplifying the viscoelastic and force closure demand to uphold lumbar spine integrity and stability.
• Extensibility of the lateral hip musculature to allow for and additional hip adduction, flexion and internal rotation.
• Elicit a heightened somatosensory response due to the simultaneous bottom-up (lateral lunge) and top-down (lateral flexion / thoracic rotation) influence.
Psycho | Social Outcomes:
• Establish a multidimensional environment involving the neural-networks associated with managing heightened emotional states (anxiety, hyperviligence, etc) during the execution of a complex, autonomic motor task.
Modifications:
• Begin pre-positioned w/ both hips abducted, greatly reducing ground reaction forces.
• Remove ipsi-lateral glenohumeral abduction.
Contraindications:
• Subacromial impingement syndrome.
• Inability to control multi-segmental deceleration of descending body weight.
What drives your decision making when designing your client’s/patients exercise program? No doubt some of the decision is based on your client’s goals, as it should be. That is why they are seeing you.
But there are often many routes to a goal. And when we throw conquering pain into the equation, the route that is chosen becomes much more significant.
With the Function First Approach and its Pain-Free Movement Specialist curriculum, the sequencing of the exercises is critical. Much like a phone number, the same elements in a different order will often yield a different result.
With the client who has experienced or is experiencing chronic pain, the biomechanical, neurological and physiological characteristics of the exercise are critical. But those characteristics can be negated and potentially pain provoking if we have not acknowledged, validated and considered the psychological state (readiness, expectations, apprehensions, preconceived ideas, etc.) as it applies to the exercises we will provide.
And this is where the PFMS excels. Marrying the critical movement and mechanical needs to the psycho-social needs of the client at that time. Delivered with empathetic and confident coaching and you can see why Function First has served clients from around the globe who could not have their needs met elsewhere.
As such, I want to give you a peak into one of the many ways our Function First Academy can be a resource and support you in your mission to serve those challenged by chronic pain.
In the video below, I will walk you through a few of the aspects of the site that will change the way you program.
Any exercise that requires you to match a force with a counter force to maintain stability, will be self regulating. In other words, you can only push or pull to a level that can be stabilized by your own internal force generation.
The opposite of this would be ground reaction forces (GRF). The limitations on force production would be strength issue because you can push through the ground. This is the case with most exercises when the force is moved vertically against gravity. But when the force applied is horizontally or perpendicular to the field of gravity, we don’t get the same benefits from the GRF that we get with a vertical load.
Instead, we must turn to our own internal stability from which to create an anchor point for force generation.
As such, this corrective exercise is an excellent core exercise predominantly for the sagittal plane that does just that. It’s also happens to have some great foot benefits too.
In this video we are bringing you a very influential exercise that does a surprisingly effective job at lower back stabilization as it challenges the mobility of the shoulders and efficiency of the the thoracic spine in extension.
As you are probably acutely aware, when working with corrective exercises and the client in pain, it is more than just the exercise, it is a thorough understanding of:
“For Whom?”
“For What?
And “When”
Insight into the biomechanics, psychological mindset of the client and social setting/implications of the movement all come into play and are critical to the client’s success.
This version of the glute bridge is a great corrective exercise for teaching the body the sequencing and synchronization from the ankle to the lumbar spine that is associated with triple flexion and squatting.
It will certainly challenge dorsi flexion in a pseudo closed chain environment as the knee moves over the toes. There is feedback from the wall and load placed into the wall, but no vertical forces acting on the joint.
The body gets comfortable with relative lumbar flexion in an unload position because it has to go through that motion to get the buttocks of the floor. The beauty is both the novelty and very limited load placed on the spine. So even those with lower back pain will find this a helpful exercise as it reduces the threat.
Additionally, it helps create some separation and distraction of the tissue at the thoraco-lumbar junction. The upper part of the body is fixed on the floor as the lower part moves away, creating the distraction.
This simple exercise can be quite challenging for those with a history of lower back pain, as well as the deconditioned client. The ability to disassociate the hip motion from the movement of the lower back and pelvis can be very helpful in removing stress from the lower back.
This “Level B” exercise from the PFMS is both a corrective and assessment opportunity. You will be able to see, and the client will be able to feel any control and/or range of motion differences between the two sides.
The Half Frog is also an exercise, that as a Level B allows for more intrinsic focus of attention for motor learning purposes. The client is able to concentrate on what muscles are engaging and the sensory feedback of those contractions.
