Corrective Exercise Specialist Notes

Corrective Exercise Specialist Notes: Introduction

From the mid-1980s to the present, increased technology and automation in the U.S. have negatively impacted public health.
Automation, computers, mobile devices, and other technologies are more prevalent, leading to less physical activity.
Approximately 25% of Americans engage in no leisure-time activity.
Sedentary behavior increases all-cause mortality (U.S. Department of Health and Human Services, 2018).
Lack of regular physical activity reduces the kinetic chain's ability to adapt and recover, increasing injury rates (U.S. Department of Health and Human Services, 2008).

Rationale for Corrective Exercise

Musculoskeletal pain is more common now than 50 years ago (Harkness et al., 2005).
Poor movement quality can adversely affect injury rate, biomechanical stress (e.g., ground reaction forces), and physiological stress (e.g., increased cortisol) (Frank et al., 2019; Powers, 2010).
Appropriate movement preparation techniques, integrating flexibility, core, balance, targeted strength, and dynamic warm-up exercises, may improve force absorption and reduce injury incidence (Al Attar & Alshehri, 2019; Pollard et al., 2017).
Decreased activity and poor movement quality may lead to muscular dysfunction and injury.
Corrective exercise and optimization of movement quality are beneficial across populations and environments.

Corrective Exercise Philosophy

The primary objective is to optimize movement quality to enhance performance, results, injury resistance, movement efficiency, and recovery.
Optimization involves minimizing less-than-ideal motor recruitment strategies that cause postural distortion and movement impairment.
The role is to reduce the likelihood of musculoskeletal injury in healthy clients or athletes.
Corrective exercise can be applied post-injury after treatment and clearance from a healthcare provider.

Corrective Exercise Continuum

Corrective exercise is a systematic process of identifying neuromusculoskeletal dysfunction, developing a plan, and implementing a corrective strategy.
Involves integrated assessment, corrective exercise program design, and exercise technique.
Three-step process:
1. Identify the problem.
2. Solve the problem.
3. Implement the solution.
Solving neuromusculoskeletal problems requires a systematic plan known as the Corrective Exercise Continuum.
Four primary phases:
- Inhibit: Reduce tension or decrease activity of overactive neuromyofascial tissues using inhibitory techniques (e.g., self-myofascial techniques like foam rolling).
- Lengthen: Increase extensibility and range of motion (ROM) of neuromyofascial tissues using lengthening techniques (e.g., static stretching, dynamic stretching, and neuromuscular stretching).
- Activate: Re-educate or increase activation of underactive tissues using activation techniques (e.g., isolated strengthening exercises).
- Integrate: Retrain the collective synergistic function of all muscles through functionally progressive exercise using integrated dynamic movements.
Before the Corrective Exercise Continuum, an integrated assessment process (postural, movement, and mobility assessments) determines which tissues need inhibition/lengthening and activation/strengthening.
The Corrective Exercise Continuum is a sequence of targeted flexibility and strengthening exercises tailored to an individual’s posture and movement quality.

Regional Interdependence Model

Regional Interdependence (RI) is a concept describing how a patient’s primary musculoskeletal complaint region is affected by remote sites or factors.
Example: Knee pain may be affected by dysfunction at the hip and/or ankle.
Symptoms can be influenced by multiple physiological and psychological systems beyond the musculoskeletal.
The RI model expands treatment strategies beyond local biomedical intervention.
Though Corrective Exercise Specialists aren't clinicians, the RI model provides a paradigm to assess and improve movement dysfunction; impairments in one region influence movement quality and functional capacity in others.
Health and fitness professionals should take both global and local perspectives when assessing clients’ movement and designing exercise strategies.

Professional Scope of the Corrective Exercise Specialist

Optimized movement quality significantly affects the achievement of fitness goals.
A Corrective Exercise Specialist plays an integral part in the health and fitness industry; understanding the professional scope of practice is critical.

Health Care and Fitness

The healthcare system comprises overlapping and complementary disciplines.
Example: Physical therapists work with orthopedic surgeons.
Scope of practice defines limitations and boundaries of medical interventions a person can and cannot perform; applies to clinical, licensed professionals and those who are not licensed.
Licensed healthcare providers have licensing requirements established by governing bodies.
Scope of practice includes acceptable caseloads, practice guidelines, and referral recommendations.
The fitness industry has debated a distinct scope of practice for all fitness professionals.
Scope of practice defines service delivery, minimum responsibilities, who can receive services, and sometimes the setting.
It describes actions, procedures, and processes permitted in meeting the terms of a professional’s license or credential.
Procedures outside a fitness professional’s scope should be avoided; clients should be referred to appropriate healthcare professionals.
Corrective Exercise Specialists do not require state licensure, but standards are essential to ensure public safety.
Corrective Exercise Specialists and other fitness professionals share an identical scope of practice, except where the professional is a licensed healthcare provider.

The Continuum of Client Care and Performance

Emphasis on preventive care has become a priority due to escalating healthcare costs.
Certified Personal Trainers, Corrective Exercise Specialists, and other fitness professionals are being welcomed into the healthcare system.
It's vitally important for Corrective Exercise Specialists to understand their role and refer to other disciplines when necessary.
The Care and Performance Continuum incorporates:
- Hospitals (emergency clinics and trauma centers).
- Ambulatory care centers (personal physicians and specialists).
- Therapists (physical therapists, cardiac rehabilitation professionals, massage therapists, and athletic trainers).
- Ancillary facilities (dentists and optometrists).
- Behavioral health specialties (psychiatrists and psychologists).
- Alternative medicine practitioners (licensed, e.g., chiropractors and acupuncture physicians).
- Long-term care (home health and hospice).
- Health and fitness specialties (Certified Personal Trainers, Corrective Exercise Specialists, nutrition coaches, and group exercise instructors).
- Athletic performance specialties (strength and conditioning coaches and performance specialists).

Professional Responsibilities

Corrective Exercise Specialists perform individualized assessments and design safe, effective, and individualized exercise programs based on evidence.
They work with clients who have no medical or special needs or collaborate with licensed healthcare professionals for clients undergoing treatment or post-rehabilitation.
The objective is to optimize the movement quality of participants to enable them to perform at their desired fitness or performance level.

Goals

Corrective Exercise Specialists focus on optimizing an individual’s movement quality to maximize performance and resistance to injury.
When working with allied health professionals, they take clients from post-rehabilitative treatment to optimal performance.
Optimized movement quality may increase a client’s resistance to muscle and tendon injury through improved neuromuscular efficiency and control, kinetic chain management of force, and mobility.
Programs targeting specific movement compensations (e.g., knee valgus) related to particular injuries (e.g., anterior cruciate ligament tear) have been successful at reducing occurrence rates (Al Attar & Alshehri, 2019; Padua & Marshall, 2006).

Populations

Appropriate populations include post-rehabilitative treatment clients, fitness clients with no medical or special needs, and recreational and competitive athletes.
A medical release is required for a history of relevant injury.
If a client is under the care of a licensed healthcare provider, the Corrective Exercise Specialist is obligated to regularly consult with and obtain clearance from that professional.

Professional Settings

Common settings include fitness facilities, private studios, independent service providers, and healthcare offices providing exercise services.

Techniques and Skills

Corrective Exercise Specialists are skilled in assessment and program design.
They implement a more detailed and individualized level of assessment than Certified Personal Trainers.
They interpret results to design and implement individualized and effective programs to improve client movement performance.
Specialists are proficient in interfacing with other members of the Care and Performance Continuum.
Fitness professionals must hold current cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) certifications.

Diagnosis and Treatment

Diagnosis involves reviewing an individual’s health history, current medical conditions, and symptoms to determine a specific condition or disease.
Treatment involves providing specific plans, including therapeutic exercise programs, dietary counseling, nutritional supplementation, home remedies, therapeutic aids, medical interventions, or prescription drugs.
Corrective Exercise Specialists must refer clients to the appropriate licensed provider when they report symptoms or conditions outside their skill set.

Pain

Pain can be acute or chronic and can originate from multiple systems (e.g., musculoskeletal or neuropathic).
Pain is a complex multifactorial and personal experience influenced by biological, psychological, and social variables (i.e., the biopsychosocial model of pain).
Each person’s thoughts, experiences, behaviors, and expectations influence their response to exercise or treatment.
The origin of pain requires proper diagnosis from a licensed healthcare provider.
It is irresponsible and potentially dangerous for Corrective Exercise Specialists to assume that pain is rooted in musculoskeletal dysfunction.
It is inappropriate to diagnose or treat areas of pain or disease; clients must be referred to other healthcare professionals, especially if the pain is acute and localized.
CRITICAL: Corrective Exercise Specialists should not assume client pain originates in musculoskeletal dysfunction and should refer clients to the appropriate licensed healthcare provider when necessary.

The Future

A sophisticated skill set is required to meet the needs of today’s clients and athletes.
The health and fitness industry recognizes the trend toward nonfunctional living.
Health and fitness professionals are witnessing a decrease in the physical functionality of their clients and athletes and addressing it.
Clients have been physically molded by furniture, gravity, and inactivity; athletes are injured by overuse patterns (Patel et al., 2017).
Today’s client is not ready to begin physical activity at the same level as in the past.
Training programs must address functional capacity as part of a safe program designed for each individual.
Training programs must consider each person, their environment and goals, and the tasks performed.
It will also be important to address any potential muscle imbalances and movement deficiencies to improve function and decrease the risk of injury.
Introduce an integrated approach to program design.
NASM presents the rationale for the Corrective Exercise Continuum and its integration into current exercise programs.

Summary

Today, more people work in offices, have longer hours, use more technology, and move less daily.
This leads to inactivity, impaired function, and increased musculoskeletal pain and injury rates.
Health and fitness professionals must consider muscle imbalances when designing programs.
An integrated approach should be used to create safe programs that consider the functional capacity for each individual.
Address factors such as appropriate forms of flexibility, increased strength and neuromuscular control, working in different environments, and training in different planes of motion.
These are the basis for the use of corrective exercise and NASM’s Corrective Exercise Continuum model.
All phases in the model are designed to follow biomechanical, physiological, and functional principles of the human movement system (HMS).
The Corrective Exercise Continuum is a systematic process that helps address muscle imbalances, improve resistance to injury, optimize movement quality, and maximize results.