The Corrective Exercise Conundrum
On a daily basis I receive questions about the best corrective exercise for _______. You can put almost anything you want in that blank and I've probably been asked about it - you'd be pretty shocked to see my messaging feed.
I struggle with these questions for a few reasons - the biggest one being, what is a corrective exercise. When we look at the root words we end up with:
Corrective - "designed to correct or counteract something harmful or undesirable." -source google
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Exercise - "activity requiring physical effort, carried out to sustain or improve health and fitness." - source google
When we combine these we end up with -
Physical activity that is designed to correct or counteract something harmful or undesirable.
This brings in the issue of - what are we correcting, what is harmful/undesirable.
What are we correcting? What is harmful?
If you're like most people, you have social media influencing you and telling you about a host of things that are wrong with you you didn't know about. Whether it be anterior pelvic tilt (blog on this soon), ankle pronation, or the dreaded forward head posture (AKA Text neck).
Image link - http://mzo5g3ubj8u20bigm1x3cth1-wpengine.netdna-ssl.com/wp-content/uploads/2014/12/Text-neck-high-res.jpg
The problem is that these things are likely more normal or context dependent than inherent problems. Let's take "text neck" as an example.
Can people experience pain in the neck while looking down at their phone? Sure
Is this a new phenomenon that has emerged with texting? Nope
Image link - https://english.eagetutor.com/images/newspaper.png
Have you heard about newspaper neck? What about book neck? Probably not because these are not so sensational. Unfortunately some individuals noticed that individuals were having some kind of discomfort and linked it to texting without examining before running with it.
The same premise and sequence can be applied to most of the corrective exercise industry. In order to correct something, we need to know that what we are correcting is a problem - which we usually don't.
These things are much more context dependent than we generally appreciate. In the case above, being able to bend my head forward to look down - such as at my phone, a book, or papers - is really beneficial and "correcting" it would really not make much sense. In contrast, if I find myself not being able to tolerate the load I put on my neck due to the volume I'm looking down, this might a case for intervention. However, the narrative around it is different, which is very important.
Instead of telling someone they have a condition which needs correction, we provide them with a simple explanation of their tissue is currently a bit sensitive and not quite able to handle the stress at the moment, this may benefit from either modifying the stress, increasing the capacity of their tissue, or a bit of both. We may still end up providing the same kind of exercises (debatable) but now the person isn't thinking they have some scary condition wrong with them and internalizing it to their pain.
Prescribing exercise with the focus of it being corrective to some make believe dysfunction is a step into over-medicalization and a possible dark path for that person to decreased activity participation. Instead, let's shift away from that way of framing it and move to optimizing the person's current capacity and future potential.
Image - http://www.austinfitmagazine.com/Managing-Low-Back-Pain2(1).jpg
Please, tell me what you're correcting? What stimulus is the challenging the person to adapt to?
If all you take away from this blog is we need to shift away from saying corrective exercise and start to encourage exercise with less bullshit narrative, job accomplished.
When it comes to health care, our job is to encourage people to live a more fruitful life - not to steal it from them. Empower and promote, be critical, logical, and skeptical.
Move often, get stronger, have fun,