As I’ve dug further down the rabbit hole of the coursework offered by the Postural Restoration Institute, I’ve gained a better appreciation for the totality of their message.
I think of “corrective exercise” through their lens less about correcting posture and more about:
Providing a sensory-rich environment for the individual to feel positions that he/she may not have much experience in achieving or controlling
Down-regulating excessive muscle tone, largely driven by primitive reflexes
Providing a “clearer pathway” for optimal respiration
It’s not the “stand up tall and breathe with your diaphragm” approach that I think most people associate with the word posture. In fact, I don’t think posture serves as anything more than a metaphor for how the individual is responding to the cumulative stressors and sensory inputs in their lives at any given moment.
While I don’t think I’m saying anything inconsistent with what PRI teaches, I don’t think these concepts necessarily come across readily in the introductory courses and believe that people that form opinions on what PRI is or isn’t after taking an intro course or two haven’t even begun to see past the tip of the iceberg.
I see you down there
With this in mind, I recently came across an article on PRI’s site from Bill Hartman that I really enjoyed. The article discusses some of the deeper implications of PRI’s information and what we’re really looking at by using their tests. Great read for anyone interested in their courses. Check out the article at the link below.
As an aside, I’ll be heading to Lincoln for Advanced Integration this December. If you’re thinking about going, shoot me a note to let me know. It was one of the best courses I’ve ever taken when I took it a few years ago, so I have high expectations for this year!
PRI Cervical-Cranio-Mandibular Restoration Course Review
A few weeks ago, we were very fortunate to have an opportunity to host Ron Hruska teaching the Cervical-Cranio-Mandibular Restoration course at our training facility Endeavor Sports Performance in Pitman, NJ.
Prior to this most recent course I had taken Myokinematic Restoration (twice), Postural Respiration (twice), Pelvis Restoration, Impingements & Instabilities (I&I), Advanced Integration, Postural-Visual Integration, and sat for the PRT, since first diving into PRI in 2010. I tend to take courses for one or more of three major reasons:
Attain information or develop a skill set that I can implement immediately
Satisfy an immediate intellectual curiosity
Recognizing that the information may not make any sense to me now, but it’s another important piece of the puzzle and taking it now may facilitate a light bulb moment years in the future
The CCMR course really satisfied all three criteria, and frankly, I left feeling like I should have taken the course a year or two earlier. Working in a training setting that deals with a lot of hockey players, I took my first course as a means of finding better information to prevent common hip injuries. I continued taking courses because I left each course with a sense of there being more to the picture. Simply, I could tell there was much more to the picture than the musculoskeletal system, and while I heard things like “it’s all neuro” in I&I, I didn’t feel like I appreciated the full concept of how integrated the patterns taught in the introductory courses are with every other bodily system until the CCMR course.
A few take homes from the course:
1) There are cranium and jaw correlates to the pelvis. In CCMR, you’ll hear Ron say things like “you have iliac bones in your head, and you have temporal bones in your pelvis.” Often times these analogies are meant to make you think (can you follow him down the rabbit hole?), but they’re also great teaching tools. If you feel comfortable with the myokin material, you’ll be able to track the CCMR course material, even if you don’t feel as comfortable with the anatomy of the neck and head.
2) The patterns taught in the introductory courses are body wide. If you think of everything in terms of gait patterns, it’s easier to appreciate how a change in foot position may change shoulder range of motion, as each phase of the gait cycle is associated with changes in musculoskeletal positions throughout the entire body. This explains why a cue like “find your left heel or right arch” may improve right HG (shoulder) IR. Relevant to the CCMR course, it’s important to recognize that these patterns don’t just stop at the thorax; they continue up through the neck, cranium, and jaw. As with the above example, this helps explain why changing a bite may influence loading through the foot. Ron discussed several examples of how a sub-optimal bite can influence body wide patterns and how simply interrupting the sensory input from this bite can shift the entire system. There are clear correlates here to foot orthotics. The goal is to find the primary driver for any given individual’s pattern and address that. The CCMR course provides a few new assessments, manual techniques and exercises to help find and address top-down drivers, but it also provides a new perspective on how to view the entire system.
3) PRI, as a whole, is heavily based around controlling autonomics and sensory input. There are several reasons why someone may get “stuck” in a pattern. In my mind, the more obvious ones are pattern overuse (e.g. sitting at a desk shifted into your right hip for 8 hours a day for a decade), and injury (e.g. a left ankle sprain may cause someone to shift their weight to the right). Maybe less obvious is the idea that any trigger that shifts someone into a chronic pattern of excessive sympathetic tone could also result in them being stuck in a pattern. This could be a sub-optimally functioning visual or auditory system, insufficient sleep time or poor sleep quality, excessive work/relationship stress, etc. While I haven’t heard Ron say this directly, I think you could justify taking steps to improve someone’s sleep as a “PRI program”. Maybe more holistically, failing to address prominent lifestyle triggers may be hampering the individual’s progress within a rehabilitative or preventative program.
Of all the PRI courses, this one gave me the best perspective of PRI’s evolution and the totality of integration in which they’re viewing the human system. If you’re on the fence about taking the course, I would strongly encourage you to register. CCMR is more than a head/neck/jaw course; it’s an integration course, and in my opinion, one of the best ones they offer!
Optimizing Movement Interview on Strength Coach Podcast
As I write this I have a player waiting for me to work on him, so I’m going to keep it short and sweet. Last week I did an interview for the “Hit the Gym with the Strength Coach” segment of the Strength Coach Podcast. The Strength Coach Podcast has been one of my go-to audio resources for several years, as it features many of the most innovative professionals in strength and conditioning and sports rehabilitation.
In the interview, we covered a lot of topics from my new DVD-set Optimizing Movement, including:
Foundations of optimal movement
Ways to determine if a joint is neutral or centrated
How being naturally asymmetrical influences assessment findings
How we incorporate breathing work into our programs and how I introduced it to a new team I train
Several “big rocks” from DNS and PRI, and how it influences the way we view and coach our exercises
This is a great episode as Coach Boyle, Mark Verstegen and Charlie Weingroff are also on to share their insight. Check it out at the link below!
Optimal Movement: The Truth About Corrective Exercise
Part 1 of the “Optimal Movement Series” discussed several reasons why it’s so important to have an assessment process in place and identified a few ways in which structural changes will influence movement. If you missed that, you can check it out here: Structural Adaptations: Not Just a Hockey Problem
Today we’ll continue the discussion by delving into the topic of corrective exercise, what it means and when it’s appropriate to use.
The Truth About Corrective Exercise
I first started hearing the term “corrective exercise” about 7 years ago. Typically, it’s used within the context of basic mobility exercises or lower level stability exercises thought to help restore balance in mobility and stability across joints and improve “awareness” to ultimately improve movement quality. The general rationale here was to take exercises used in the rehabilitation of certain injuries, and integrate them into training programs in a pre-emptive effort to help minimize the risk of these injuries ever occurring. This made sense to me then, and still makes sense to me now, to an extent.
One thing that has become more clear to me as I’ve had opportunities to attend FMS, PRI, and DNS courses, among others, is that in order for something to be truly “corrective”, there needs to be some sort of test or “audit”. In other words, if you’re telling someone to do an exercise to “correct” something, how do you know if it’s working? Thinking in this way has really changed the way I think about the entire training process (as I’ll discuss more in a future piece).
As an example, if you’re familiar with the FMS Active Straight Leg Raise test, you know that the test is scored as a 3, 2, or 1 depending on how high the individual can raise his/her leg while maintaining the specified alignment or a “0” if the individual has pain. These zones are separated by measuring the distance between the ASIS of the hip and the mid-patella, and then marking half of that distance (roughly the mid thigh). Anything above the midpoint is a “3”, anything between the midpoint and the mid-patella is a “2”, and anything below the mid-patella is a “1”. If it’s painful, it’s a “0”. As a general rule, the desired goal here is to get “2’s” on both sides.
Active Straight Leg Raise
If, for example, someone had a “1’s” on both sides, and you integrated a Supported Single-Leg Lowering exercise into their program as a means of helping them achieve 2’s on both sides, this could appropriately be called a “corrective exercise”. You have a test, and you’re programming a specific exercise to improve a quality that you can then assess the effectiveness of by retesting.
Band-Supported Single-Leg Lowering
As another example, I’ve seen a good number of people that have a limited Adduction Drop Test (see video below) on the left, that also have less Active Straight Leg Raise motion on the left compared to the right. This is likely because of the position of their pelvis, which is oriented to the right and forwardly tipped on the left, placing the left hamstring complex under tension.
A picture taken from PRI illustrating the pelvic position most humans gravitate towards
In this situation, a Left Adductor Pullback may be sufficient to reorient the pelvis to a more neutral position, which would then clear the Adduction Drop Test AND the discrepancy in Active Straight Leg Raise.
These examples highlight two situations where exercises are being used to correct a pattern. Importantly, the goal here is to now integrate the newly acquired function (be it mobility, stability or both in nature) into more “functional” or capacity-based exercise. For example, once we’ve established a reasonable amount of symmetry within an Active Straight Leg Raise pattern, we have a green light to progress to double- and single-leg loaded hip hinge variations (e.g. trap bar deadlifts, 1-leg stiff-legged deadlifts, etc.), and if appropriate for the individual’s training goals, more explosive movements within this pattern, such as broad jumps, kettlebell swings, hang cleans, etc. These are just a few examples; obviously there are other factors that need to be accounted for in exercise selection, but the idea is to progress beyond corrective work.
This idea of Assess -> Correct -> Reasses has a different end-goal, in most cases, than integrating exercises like glute bridges, miniband walks, front planks, etc. into programs. The latter can be considered more “activation” in nature, or really simply fall into the broader bucket of what I think of as core training. If you call any miniband walk a corrective exercise, the follow up question should be “corrective for what?” There may be an answer for that, depending on the athlete. Athletes that are well trained and have established a quality squat, deadlift, and single-leg patterns may do mini-band walks with the intent of activating the lateral hip musculature almost within the same context as a warm-up. In contrast, an athlete whose knees touch while squatting may benefit from the neuromuscular cuing that the band provides to engage the glutes and lateral hip musculature to maintain better alignment during the movement. One is warm-up; one is corrective.
The reality is that in most cases the goal is to do as little true “corrective” work as possible, and quickly progress to training that will enhance physical capacities (e.g. speed, power, strength, conditioning, etc.). In many instances, depending on the dysfunction, I think it should be a quick journey to individual-specific full training clearance. The waters get a little muddier when programming is attempting to counteract positions the athlete/client spends time in outside of the training facility.
It’s for this reason that I don’t think it’s a bad idea to continue incorporating exercises designed to be corrective on an ongoing basis. For example, having a guy that sits hunched over in front of a computer all day do a couple sets of glute bridges and thoracic spine rotations is unlikely to hurt, and very likely to help. If they continue to pass your reassessment, the exercises can be viewed as reinforcement, warm-up, activation, neuromuscular cuing, etc. If they aren’t passing the reassessment, then you have to consider (among other things):
Does the corrective exercise actually work for THAT individual?
Do you need to discuss alternative strategies for the positions/postures that individual spends the majority of their time in away from you?
Do you accept that you may never “win” the corrective battle for a given individual, but continue to program specific corrective work in an attempt to “minimize the bad, and maximize the good”?
In the last year, I’ve heard a few people “in the industry” with whom I have a lot of respect dismiss the term “corrective exercise”, and I completely get it. Corrective exercise is being thrown around a lot, often to simply refer to low-level activation exercises, which may not be correcting anything. There are two major problems with this:
If there is too large of a disconnect between corrective exercise and the individual’s functional activities, the correctives won’t stick.
Some people in training professions get so caught up in trying to correct everything that they forget their job is to improve physical capacities.
As an example of both, sometimes range of motion is restricted as a protective mechanism if the individual doesn’t possess the stability/control or strength to own that range. In these (and many other) circumstances, strength training with traditional exercises may be the most corrective thing the person can do.
The important take homes here are that corrective exercise needs to be programmed to correct something, and there should be a way to assess whether it’s working or not. Corrective work doesn’t always need to be in the form of low level activation exercises, and not every low level activation exercise needs to be programmed with a corrective intent. As with every exercise in your program, you should ask yourself, “Why am I programming this exercise, and is it producing the intended results?”
In a couple days, I’ll be back with the third part of this series, “Individualizing Corrective Exercise and Movement in a Group Setting”. In the meantime, don’t forget to check out the Optimizing Movement DVD set, which you can get for a $20 discount until next Saturday (December 7th), as part of a special “Extended Black Friday Sale”. Click the link below for more information!
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Philadelphia Union Fitness Coach Kevin Miller on Optimizing Movement
My new DVD set Optimizing Movement was released several months ago and I continue to get outstanding feedback from a wide range of professionals throughout the training and rehabilitation spectrum.
Today I wanted to share a review that Kevin Miller, Fitness Coach for the Philadelphia Union Major League Soccer Team, recently sent me. This is a neat review because it shows how this information not only impacts his athletes, but also his own health/performance. It also highlights the fact that there are underlying patterns that affect all movement, regardless of sport, and that these need to be addressed in order to get the most out of more sport-specific work. Enjoy!
“I recently purchased a copy of Optimizing Movement by Kevin Neeld. As a coach I am always looking for ways to reduce injuries as well as improve the performance of the athletes and clients that I work with. As an athlete myself I want to make sure that I am staying up with the latest research to improve my performance as well.
When I heard that Kevin was coming out with a product I had no doubt that what he was planning to offer would be a quality product. With new products coming out every day it’s hard to decide what products will actually offer value. I have followed Kevin over the past few years so I was confident that this product would offer tremendous value.
One of the main reasons I purchased the DVD was I wanted to see how Kevin and his staff set up their training system and specially their assessment and corrective exercise philosophy. Having taken a PRI course, I wanted to know what is the best way to implement these strategies into a group training environment. The DVD is broken down into three parts, which I’ve described below with a few of my own thoughts.
Part 1 Key Topics
Goals of training
Movement is a big piece of reducing injuries
Athletic Performance Pyramid
Foundations of Optimal Movement
Explains joint neutrality and basic overview of PRI
Importance of the diaphragm in performance
Provides excellent pictures of athletes that present with problems
Overview of FAI
Provides his assessment for FAI
Discusses regional interdependence
Joint by Joint
Part 2 Key Topics
Talks about his assessments
Does a really good job of explaining some of the PRI tests
This section was really good because he has videos for all of his assessments and does a really good job of explaining each test
Part 3 Key Topics
Talks about how to manage movement and how he sets up his corrective exercise strategy
Provides the four places he puts corrective exercise
Provides video for LAIC problems and solutions for people that present with this pattern
Overall this product is excellent. Having taken a Myokinematic Restoration course from PRI this product has really helped my understand how to implement what I was able to learn in the two day course and integrate it into a team setting. The information that I was able to learn in this DVD will help me tremendously with the professional soccer players as well as the weekend warriors that I work with on a daily basis.
From a personal standpoint I am a classic LAIC pattern in the PRI world. So for me I took a lot of the information that I was able to learn in this product and I have started to implement these strategies into my own training and I can honestly say that I feel better. Over the years I have suffered several nagging injuries on my left side and I really had no solution as to why this was happening. Foam rolling and stretching was not cutting it. With the addition of some simple changes and a better understanding of why I may have had these injuries I expect to reduce the number of injuries in the future while improving my performance in the weight room as well as on the track.
In summary, I would definitely recommend this product. I have spent much more on products that were not worth the shipping costs. This product is high quality and Kevin provides valuable information to the coaches in the sports performance field.”
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