One of the many intersections between Physical Therapy and Strength & Conditioning is at corrective exercises. Integrating concepts here makes each profession better and the athletes they work with more successful. Working on mobility and stability to improve movement patterns is the foundation of rehabilitation and athletic performance. To bring out the best of both worlds, we must understand the purpose of corrective exercise and how to use them effectively.
A corrective exercise is an exercise designed to improve poor mobility or poor motor control. Corrective exercises are designed to enhance how well you move and perform, not to reduce pain or prevent injury. They must be layered with strength training, which is where resilience to injury is built. Don’t think of corrective exercises as taking someone that is below their baseline capacity and getting them back to baseline. Think of it as enhancing someone's baseline and raising their capacity. An example of a corrective exercise is an ankle dorsiflexion mobilization to improve squat mechanics.
In comparison, a rehabilitation exercise is an exercise designed to address pain and injury. An example of rehabilitation exercises would be isometrics for tendinopathies, or repeated movements for discogenic pathologies.
While rehabilitation exercises are commonly utilized by rehabilitation professionals – Physical Therapists, Chiropractors, and Athletic Trainers, corrective exercises are utilized by Strength and Conditioning coaches, Personal Trainers, and rehabilitation professionals.
Remember, if you are going to use corrective exercises, you must screen and assess (see previous article “Is Stretching a Waste of Time?”) because without an assessment, you’re just taking a guess.
Corrective exercises are not a quick fix, and they don’t work for everyone. But some people do respond very favorably and often rapidly to corrective exercises.
Those that respond favorably are those looking for performance enhancement. An example would be doing a preseason screen and assessment on a sports team to assign individualized corrective exercises to enhance their performance in the weight room. An example in a rehabilitation setting would be a baseball player looking to improve his mobility to help him feel more confident in the catcher's position.
For those who are not going to respond to corrective exercises at all, something is not allowing the correctives to work. Perhaps it is pain, pathology, or structural abnormalities. These people essentially need more than corrective exercises. They might need pain relieving modalities, or a referral to a physician, or imaging if you're suspecting something sinister. An example would be an injury such as a fracture in which activity needs to be limited to allow it to heal, and cross training should be done to maintain fitness. Once the injury is healed, they can ease back into full activity.
Everyone else in the middle may respond to corrective exercises, but it might take a while. An example would be screening someone and finding poor shoulder mobility. On examination you also find that they have hypomobile arthrokinematic mobility, so you combine manual therapy with corrective exercises.
If you screen and assess someone and find movement patterns that could be enhanced via corrective exercises, they shouldn’t only do corrective exercise, they still need to be doing the movement patterns. Corrective exercises are essentially accessory exercises of a training program or a rehabilitation program; similar to what supplements are to a nutrition program – useful but not the entire program in itself.
Successful outcomes depend on identifying specific impairments, addressing them with individual corrective drills, and then reinforcing the movement with an intentional, loaded movement pattern.
In a performance setting, the training program should be built where the compound lifts and sport specific training make up the bulk of what you’re doing, and the corrective exercises are simply accessory pieces. They can be done as a warm up, or they can be implemented between compound lifts.
If your ankle is restricted, you can do a thousand ankle mobility drills but that doesn’t mean your ankle mobility during squats will improve if you continue to squat with a vertical shin and don’t focus on reinforcing the movement you are trying to improve. What ankle mobility drills will do is warm up the ankles to prime the body for the movement it is about to perform.
In rehabilitation setting, depending on the phase of rehabilitation and the individual you are treating, corrective exercises might be the bulk of the session initially, but they typically shift to a warm up tool or an accessory movement.
If you have a patient in the acute phase of injury, you screen and assess and find some impairments, your mobility and stability drills will probably make up the majority of the first few weeks of rehabilitation while the injury heals. You, as the rehabilitation professional, can give them corrective exercise to enhance their performance while they are patiently waiting for the injured tissue to heal, and help them focus on what they can do while their injury is healing. Complete rest is rarely the answer.
If you have a patient who is further along in the rehabilitation process in the return to sport phase, your session will start to look more like a training session. Corrective mobility and stability drills are done as a warm up, the compound lifts and sport specific movements are the main component.
Remember, corrective exercises are designed to improve poor mobility or poor motor control, and they must be followed up with reinforcing the movement pattern you are trying to enhance.
Here are some examples:
· You implement a mobility drill to improve shoulder flexion mobility; you then load the newfound range of motion with a pressing variation, such as landmine press or overhead press.
· You implement a stability drill to improve motor control of a hinge pattern to prime the body to perform RDLs or deadlifts through whatever variation they can perform at that time.
· Here is a specific example of how corrective exercises can be incorporated into a warm up based on the RAMP principle from the National Strength and Conditioning Association:
RAISE: elevate body temperature (bike, row, jog)
ACTIVATE: stability drills (shoulder screwdrivers)
MOBILIZE: mobility drills (quadruped rock back)
POTENTIATE: sport specific activities (building squat weight, increasing running speed)
· Here is a specific example of how corrective exercises can be implemented into a training session:
MONDAY: cleans + ankle mobility; front squat + squat stability
WEDNESDAY: push press + shoulder flexion stability; RDL + posterior chain stability
FRIDAY: snatch + shoulder ER/IR mobility; back squat + hip mobility
Sources
Haff, Greg, and N. Travis Triplett. Essentials of Strength Training and Conditioning. Human Kinetics, 2021.
Henoch, Quinn. Weightlifting Movement Assessment & Optimization: Mobility & Stability for the Snatch and Clean & Jerk. Catalyst Athletics, Inc., 2017.
Lauersen, Jeppe Bo, et al. “Strength Training as Superior, Dose-Dependent and Safe Prevention of Acute and Overuse Sports Injuries: A Systematic Review, Qualitative Analysis and Meta-Analysis.” British Journal of Sports Medicine, vol. 52, no. 24, 2018, pp. 1557–1563, https://doi.org/10.1136/bjsports-2018-099078.
Reinold, Mike. “Do We Really Need Corrective Exercises?” Mike Reinold, 21 June 2019, mikereinold.com/do-we-really-need-corrective-exercises/.
Somerset, Dean, and T Nation Dean Somerset. “Stop Doing Corrective Exercises!” T NATION, 5 Apr. 2021, www.t-nation.com/training/stop-doing-corrective-exercises/.