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Unformatted text preview: First Edition A Comprehensive Guide to Corrective Movement Training Course Textbook for CORRECTIVE EXERCISE SPECIALIST 1015 Mark Avenue • Carpinteria, CA 93013 1.800.892.4772 • 1.805.745.8111 (international) ISSAonline.com Corrective Exercise International Sports Sciences Association 800.892.4772 • ISSAonline.com Corrective Exercise A Comprehensive Guide to Corrective Movement Training Chad Waterbury, DPT First Edition Course Textbook for CORRECTIVE EXERCISE SPECIALIST CORRECTIVE EXERCISE A Comprehensive Guide to Corrective Movement Training Chad Waterbury, DPT Corrective Exercise: A Comprehensive Guide to Corrective Movement Training (Edition 1) Official course text for: International Sports Sciences Association’s Corrective Exercise Specialist Course 10 9 8 7 6 Copyright © 2019 International Sports Sciences Association. Published by the International Sports Sciences Association, Carpinteria, CA 93013. All rights reserved. No part of this work may be reproduced or transmitted in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including xerography, photocopying, and recording, or in any information storage and retrieval system without the written permission of the publisher. Direct copyright, permissions, reproduction, and publishing inquiries to: International Sports Sciences Association, 1015 Mark Avenue, Carpinteria, CA 93013 1.800.892.4772 • 1.805.745.8111 (local) • 1.805.745.8119 (fax) DISCLAIMER OF WARRANTY This text is informational only. The data and information contained herein are based upon information from various published and unpublished sources that represents training, health, and nutrition literature and practice summarized by the author and publisher. The publisher of this text makes no warranties, expressed or implied, regarding the currency, completeness, or scientific accuracy of this information, nor does it warrant the fitness of the information for any particular purpose. The information is not intended for use in connection with the sale of any product. Any claims or presentations regarding any specific products or brand names are strictly the responsibility of the product owners or manufacturers. This summary of information from unpublished sources, books, research journals, and articles is not intended to replace the advice or attention of health care professionals. It is not intended to direct their behavior or replace their independent professional judgment. If you have a problem or concern with your health, or before you embark on any health, fitness, or sports training programs, seek clearance and guidance from a qualified health care professional. About the Author | iii ABOUT THE AUTHOR Chad Waterbury is a graduate of the nation’s #1 ranked Doctor of Physical Therapy (DPT) program at the University of Southern California (USC). Chad is a physical therapist, neurophysiologist, and author whose unique training methods are used by a wide range of athletes, bodybuilders, figure models, and fitness enthusiasts of all ages and from all walks of life. Chad was the director of strength and conditioning at the Rickson Gracie International Jiu Jitsu Center in West Los Angeles and now works with professional athletes, celebrities and non-athletes one-on-one. Chad is the author of Huge in a Hurry and Muscle Revolution and contributes to many publications such as Men’s Health, Men’s Fitness, Fight! and T Nation. Chad has a master’s degree in physiology from the University of Arizona, where his focus on the neurophysiology of human movement and performance led him to make radical changes in the way he trains competitive athletes as well as nonathletic clients. His workouts are now shorter and faster, producing superior results in strength, power, and muscular development, while at the same time inducing less fatigue and allowing for shorter recovery periods between workouts. International Sports Sciences Association CONTENTS Introduction: What is Corrective Exercise? p.1 SECTION ONE: CORRECTIVE EXERCISE SCIENCE, p.9 1 Skeletal System, p.11 2 Muscle and Fascia, p.25 3 The Nervous System, p.43 4 Joint Actions, p.61 5 Movement, p.81 SECTION TWO: CORRECTIVE EXERCISE PRACTICE, p.93 6 Preparing for the Client, p.95 7 Create a Just Right Challenge, p.113 8 Perform a Single-Joint Movement Analysis, p.121 9 Perform an Upper Body Multi-Joint Movement Analysis, p.135 10 Perform a Lower Body Multi-Joint Movement Analysis, p.155 11 Restore Structural Alignment and Stability, p.173 12 Restore Mobility through Stability, p.185 13 Soft Tissue Assessments and Correctives, p.209 REFERENCES, p.239 GLOSSARY, p.248 Corrective Exercise TOPICS COVERED IN THIS UNIT Plato Was Right Benefits of Corrective Exercise Improve Performance Restore Performance Reduce Injury Risk Target Audience of this Course Health-Care Professionals Certified Personal Trainers Corrective Exercise Defined Final Thoughts INTRODUCTION WHAT IS CORRECTIVE EXERCISE? 2 | Introduction What You’ll Learn In this unit, you’ll learn how important both posture and exercise are for optimal health. You will also learn what has caused the surge in movement and postural dysfunctions over the last decade. Then we’ll cover the three ways that corrective exercise can improve your client’s life or sport. Finally, we will wrap up by outlining the perils of doing too little or too much exercise. By the end of this section, you should have a clear understanding of the necessity and benefits of corrective exercise. PLATO WAS RIGHT Personal trainer: A person who instructs and prescribes exercise. Physical therapist: A licensed health-care professional who helps patients reduce pain, improve mobility, and enhance movement patterns. Rotator cuff: A group of tendons and four muscles that attach the upper arm to the shoulder blade. Risk factor: Any physical, psychological, or environmental factor that can increase a person’s likelihood of developing an injury or disease. Posture: The position of a person’s body while standing, sitting, or moving. Forward head posture: An anterior positioning of the cervical spine. I started working as a personal trainer in 1997, 18 years before I entered the doctor of physical therapy (DPT) program at the University of Southern California. At the time, there was a relatively clear separation between the roles of a personal trainer and those of a physical therapist. A personal trainer helped people lose fat, gain strength, and build muscle (not always in that order), whereas the primary job of a physical therapist was to help patients overcome some type of physical dysfunction. It might be an acute injury, like a torn rotator cuff, or a chronic problem, like low back pain. But whatever it was, it was not something that anyone expected a personal trainer to understand, much less treat. However, the line between the two professions has since blurred, thanks to a dichotomous shift in activity levels that I believe began in the mid-2000s. We start with the fact that many people are now more sedentary throughout the day, which is one of the biggest risk factors for poor health. Inactivity is exacerbated by the fact that most people are doing things that encourage poor posture. Indeed, these days it is common for people to spend hours throughout the day with a rounded spine, anteriorly rotated shoulders, and a forward head posture, whether they’re sitting at a desk or texting on a smartphone. The average head weighs about 12 pounds. The soft tissues of the neck are typically well suited to stabilizing and balancing that load when it’s positioned directly above the shoulders in what we consider “ideal” posture. However, for each inch the head moves forward, the supporting muscles must control Corrective Exercise Figure I.1. Typical posture with a smartphone. This posture results in excessive stress to the neck, spine, and shoulder joints. What Is Corrective Exercise? | 3 an additional 10 pounds of weight. When your head is angled down 45 degrees—a common position while texting or working on a laptop—the load on the neck may be as much as 42 pounds. Not only does this strain the neck muscles, but it also can decrease your lung’s vital capacity by 30%. Chronic forward head posture can increase curvature of the thoracic spine (i.e., thoracic kyphosis), which can increase mortality rate by 144% in older populations. Thoracic kyphosis can also increase the compressive loads on the intervertebral discs throughout the lower half of the spine. Simultaneously, a significant increase in the number of people who engage in high-intensity exercise has occurred. This can include individual workouts focused on powerlifting; preparing for an extreme challenge such as a marathon, triathlon, or adventure race; or participating in group classes supervised by someone with minimal training and coaching experience. Many of the individuals in any of these circumstances are unprepared for these extreme challenges—because of a lack of fitness, poor movement quality, or inadequate instruction in specific exercises like the powerlifts and Olympic lifts. People are generally more sedentary than ever, yet when they do move, they often perform workouts beyond their strength, mobility, and motor-control capacity. The convergence of these opposite ends of the fitness spectrum creates a large population of people with movement and postural dysfunctions that we rarely saw prior to the 21st century. When one of them first experiences a problem, whether it’s knee pain or a nagging discomfort in the shoulder, he or she will rarely make an appointment with a physical therapist or physiatrist. Instead, this person will go to a regularly scheduled workout and tell the trainer about the new problem. In my experience, it plays out something like this: “My shoulder hurts when I lift my arm overhead. What can we do to help it?” Vital capacity: The maximum amount of air that can be exhaled after a maximum inhalation. Thoracic kyphosis: An abnormal forward curvature of the thoracic spine. Mortality rate: The number of deaths within a specific population of people. Intervertebral disc: The shock-absorbing, gel-filled structure between each vertebra. High-intensity exercise: A form of exercise that requires a large percentage of a person’s physical power. Powerlifting: A strength sport that requires a person to lift the largest load possible for one repetition in the squat, deadlift, and bench press. Movement: A physical motion occurring at one or more joints that is influenced by mobility, stability, posture, and motor control. In other circumstances, the trainer will observe a client’s physical dysfunction before the client even realizes something is wrong. Olympic lifts: The snatch and the clean and jerk. That’s why I believe it’s essential for trainers to learn how to identify problems and to develop the knowledge and skills to provide solutions. I say this knowing that some physical therapists, chiropractors, and medical doctors disagree with this sentiment. After all, they have spent $100,000 or more to earn the degree and license that allows them to lawfully treat painful joints and bulging discs. Strength: The maximal force that a muscle or muscle group can generate. However, after two decades of training clients from all walks of life, I can say this with utmost certainty: Many physical problems do not require the intervention of a licensed clinician. The gym is often the best place to correct movement, eliminate pain, and restore performance, with no clinic or insurance copayment required. Of course, some physical dysfunctions should only be treated by a qualified clinician, and I’ll tell you how to identify the symptoms in Section Two of this course. Knowing what you can’t do as a trainer—especially what you should never attempt—is just as important as is being able to recognize, assess, and correct the more common movement flaws and structural imbalances. My point is that a certified personal trainer can bridge the gap between simple, straightforward fitness training and more complex physical therapy offered by a health-care professional. Certified personal trainers can thus be the first line of defense against rising health-care costs. As noted, movement and postural dysfunctions are more common than ever, and this trend has created a large and growing demand for Corrective Exercise Specialists. That is, an increased need for trainers and therapists who know how to recognize these problems and to correct them using the latest evidence-based interventions has arisen. Mobility: The ability to move freely through a normal range of motion using minimal effort. Motor control: The process of activating and coordinating muscles during movement. Physiatrist: A physician who specializes in restoring normal function to the bones, muscle, and nervous system. Chiropractor: A licensed clinician trained to restore interactions between the spine and nervous system. Medical doctor: A physician who specializes in treating disease and injury with medicine. Plato was right: necessity is the mother of invention. International Sports Sciences Association 4 | Introduction Movement dysfunction: The faulty execution of an exercise or multiple-joint movement due to a lack of mobility, stability, posture, and/or motor control. Muscle imbalance: When one muscle is stronger and/or stiffer than is the muscle that opposes its actions. BENEFITS OF CORRECTIVE EXERCISE Given the widespread increase in movement dysfunctions, muscle imbalances, and joint aches that afflict both active and sedentary populations, corrective exercise is a necessary tool that seeks to help your clients achieve better results in their training and to move without restrictions throughout the day. You can deliver three primary benefits to clients once you become a Corrective Exercise Specialist. IMPROVE PERFORMANCE The reason I entered a DPT program was to enhance my ability to identify and treat movement disorders. Before I enrolled in the program, many of my clients were professional athletes who wanted to take their strength, speed, or endurance to a higher level. When I assessed these athletes, I frequently discovered muscle weakness, joint stiffness, or poor motor control—all dysfunctions that prevented my clients from achieving their performance goals. It was frustrating to realize I sometimes did not have the knowledge or skills to make the necessary corrections. The more I learned, and the more experience I accumulated, the better I became at helping my athletes. You’ll be able to do the same with your own athletes and clients with the information in this course. RESTORE PERFORMANCE Sometimes the goal is to help a client regain strength or to return to a previous level of occupational performance. Suppose for example that your client is a 40-year-old male construction worker who hangs drywall for hours each day. He’s not concerned with how much weight he can add to his bench press. He just wants to be able to do his job without shoulder pain. Or imagine a dentist who spends hours a day bent over examining the teeth of his or her patients. The only goal is to get through the day without experiencing low backaches. Sometimes your client will be an athlete whose goal is to perform without discomfort or movement restrictions. If that athlete is already at the top of his or her game, your job might be to help this person return to a previous level of performance, assuming the athlete’s dysfunction does not require a medical intervention. REDUCE INJURY RISK Anterior cruciate ligament (ACL): A ligament that attaches on the femur and tibia that resists excessive motion at the knee joint. Corrective Exercise In explosive, chaotic sports such as basketball, football, soccer, and mixed martial arts (MMA), it’s impossible for any athlete to always move with perfect body mechanics. And even if possible, he or she still wouldn’t be able to control when or where contact with an opponent will be made. A wide receiver who takes a powerful medial hit to his knee just as he plants his foot is likely to suffer a torn anterior cruciate ligament (ACL) no matter how beautiful his stride may have been in the moment before the tackle. The same applies to the ordinary world that we all must navigate. Sidewalks can be icy. Stairs can get slippery. Someone can accidentally bump into you at your most vulnerable moment. The list of unpredictable events is endless. What Is Corrective Exercise? | 5 No trainer can make his or her client injury-proof. No amount of training or corrective exercise can offset the chaotic, unpredictable events of life and sports. But when the client’s muscles and joints have sufficient strength and mobility, and when the nervous system can precisely control muscle activation, the client has a more durable body, which is the best defense against injury. That’s what you can control and what you should strive to achieve in your training sessions. Durable body: A body that is able to withstand wear or damage. TARGET AUDIENCE OF THIS COURSE This course is designed to teach you, the fitness professional, how to identify and correct common muscular, neural, and soft-tissue problems related to movement. The course’s goal is to improve the coaching and training guidance given by everyone from chiropractors to certified personal trainers. How you use this information will depend on your professional status. Thus if you’re a licensed clinician, and qualified to put your hands on a client, you can use corrective exercise as an adjunct to the manual therapies you provide to manipulate joints and treat soft tissue injuries. However, many of you taking this course are not licensed and qualified clinicians. For you, this course teaches you to provide “hands-off” corrective exercise by visually assessing movements and positions. If the motion or posture is faulty or compromised, you’ll learn to employ corrective actions, either through movement retraining or soft tissue mobilization without hands-on corrections. This strategy is the foundation of a Corrective Exercise Specialist’s practice. Research has mounted over the past 20 years that demonstrates the value of a handsoff approach using exercise and mobility training. This is especially true for the everyday back, knee, shoulder, and neck pain your clients experience and hope that you can address. This course is designed to help certified personal trainers and health-care professionals identify and correct those problems. Soft tissue mobilization: The act of removing restrictions from muscles and connective tissues. HEALTH-CARE PROFESSIONALS A health-care professional is someone who is trained and qualified to use a hands-on approach with patients recovering from acute injuries or experiencing chronic pain. This category includes chiropractors, physical therapists, and athletic trainers, all who have a license that allows them to put their hands on a patient. CERTIFIED PERSONAL TRAINERS Athletic trainer: A healthcare professional trained to help prevent and treat physical injuries. A certified personal trainer is someone who is only qualified to teach exercises, whether it’s resistance training, stretching, or something in between. Because certified personal trainers are not health-care professionals, they should minimize any handson therapy and limit their coaching to verbal cues and minimal tactile feedback. Importantly, a certified personal trainer is not qualified to work with clients who have pain. All clients with pain should be referred to a health-care professional before you employ any of the guidelines and techniques outlined in this course. International Sports Sciences Association 6 | Introduction CORRECTIVE EXERCISE DEFINED The goal of corrective exercise is to improve movement to enrich a person’s life or sport. It seeks to identify the complex factors associated with poor movement patterns and correct them with the simplest methods possible...
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