Written by: Kevin Cann
I have been seeing a few interesting posts on the internet in the last week or so. These posts were discussing corrective exercise and the importance of getting stronger as well as the importance of the person’s psyche in getting better.
These articles really struck a chord with me, as they are directly in line with my beliefs. First, I want to discuss a person’s psyche when taking part in a strength and conditioning program after some type of injury. The post that I had read was from Dr. John Rusin, a physical therapist. It stated that as clinicians, no one should tell a client they will never be able to do certain exercises ever again.
For example, you should never squat and deadlift again due to your back injury. Telling a client this is going to immediately make them fear this exercise. It can also lead them to altering movement patterns. Fear of injury changes the way we move, and whether that doctor likes it or not, that person is required to squat and deadlift all of the time to go through life.
Anytime that person gets up or goes down to a chair, or needs to pick up something to move, he or she is squatting and deadlifting. You can’t avoid these movements in life, so why would you avoid them in the gym? Now you put fear in a client and every time they sit down or stand up, or have to pick up something from the floor, they are going to move with a fear of injury. This can actually lead them to getting injured.
Wouldn’t we want to strengthen these movements? There will be times when a person cannot squat or deadlift, but in these cases our job is to put them in a position to work towards doing those things. In most cases as a strength coach, if a person comes in with an injury or has been cleared from a PT, they will be able to bodyweight squat and kettlebell deadlift at the minimum. Maybe the bodyweight squat is performed to a high box and the kettlebell deadlift is raised up from the floor to start.
You may be saying “Well I would assess that client to see what he or she can and cannot do.” This is not a terrible answer, but may not be the best answer either. Let us look at an example. The Functional Movement Screen (FMS) by Gray Cook is a widely used assessment. This is a great tool to have in the tool box, but not the end all be all of training clients.
One of the tests is called the active straight leg raise (ASLR). Basically, you have the client lie on their back and lift one leg as far as they can without bending either knee. Depending on their available range of motion it is scored a 1, 2, or 3. Anything less than a 2 is failing and an asymmetry between left and right side cannot be ignored. A 0 is when pain is present and a referral is suggested.
Many people will tell you that a score of a 1 or asymmetries between left and right rules out deadlifting from the floor until it is corrected. You know what fixes these scores? A well coached and executed deadlift.
A well executed deadlift requires us to breathe properly, brace our abs, hinge at the hips and extend through the t-spine to strengthen our posterior chain. Not only is it teaching us how to move properly, but it is strengthening the muscles that actually protect our spine. The stronger these muscles are, the safer our back is.
Just laying on our backs and working on breathing drills, hip lifts, and light stretching is not enough (although these exercises do have their place). The overload principle applies to corrective exercise as well. You need to do enough to actually strengthen the tissues that surround the joint. We need enough intensity to strengthen our motor control as well. The stronger we get in each movement, the easier it is to walk around, get up and down, pick things up, and so on.
The breathing drills, hip bridges, and light stretching can be exercises to prep us for the bigger movements. These exercises make the perfect warm-up if they are weaknesses that have been discovered in an assessment. Keep in mind the overload principle when coming up with a warm-up as well. The exercises need to advance and become more challenging as the earlier ones become too easy.
In the FMS and other assessments they suggest that you refer out if there is pain found in any of the tests. This is more for liability reasons, and it is not necessarily wrong. However, is it in the best interests of the clients? Sometimes a referral is absolutely necessary, but other times it is not.
For example, if someone’s hip hurts during an overhead squat test, you are told to score it a 0 and refer out. The problem with this is that their hip might just be pinching because their squat looks like garbage. Is a poorly executed squat that leads to hip pain a referral to a doctor? I do not think so. Take them and teach them to execute the squat well and see how they respond. In most cases the pain will go away. This is a case where good coaching is corrective exercise. If you cannot get them to move around pain free within a couple of minutes then I would suggest referring them out.
Never tell a client that they cannot do an exercise because they failed an assessment or have a previous injury. This can create fear within the client and actually alter how they perform daily tasks. It is our job as coaches to teach them to move properly and to strengthen those movements. There is nothing better to do this than big barbell lifts such as squats and deadlifts. There will be cases where some people will not be able to execute a proper squat and/or deadlift. In these cases start them where there is not pain and progress appropriately.