1. Based on NASM’s Corrective Exercise Specialist Certification
Corrective Exercise Training: An Introduction
Based on NASM’s
Corrective Exercise Specialist Certification
© 2018 NPTI Colorado | page 1 | Revision 5 (6/24/18) DM

2. Lecture Objectives Students should be able to:
Understand the state of today’s typical client
Learn the scientific rationale of corrective exercise
Describe the Corrective Exercise Continuum

3. Modern Client Concerns
Improvements in technology
Increased automation
Physical education is being cut from public schools
People are less engaged in physical activity

4. Improvements in Technology
Encourage bad posture
Lumbar, Cervical Lordosis/ Thoracic Kyphosis
Improvements in Technology

5. Improvements in Technology
Encourage sedentary lifestyles
Bodies are adapting to an environment that doesn’t require much movement
Lose the our ability to move optimally and
Tissues remodel themselves to match the demands of our environment

6. Automation Increased technology = increased automation
Since society is moving into an era where many things are now automated, we must simulate activities for our clientele
These should include activities that provide optimal ROM and Functional Strengthening

7. Physical Education
Many economies in many states cannot any longer justify physical education in schools
Sedentary behaviors will transition into a sedentary adult lifestyle
Their bodies and behaviors will all be geared towards a sit down and inactive environment

8. Less Physical Activity Today
Technology, automation and lack of proper instruction during critical years means many people are ill-equipped for the rigors of an active life and basic exercise
Injury may occur when they attempt to become more active
This may further reinforce their behaviors towards an inactive lifestyle

9. An Integrated Approach
To correct these problems we must have programs that are going to increase the function of the client
Multifaceted programs that optimally improve:
Flexibility and ROM
Integrated Strength for specific activity
Functional neuromuscular control
Function can be measure by what the client is attempting to do

10. Rationale for Corrective Exercise
Musculoskeletal pain is more common now than it was 40 years ago
Decreased activity may lead to muscular dysfunction and, ultimately, injury.

11. Rationale for Corrective Exercise
Today’s client is not ready to begin physical activity at the same level that a typical client could 20 years ago
Why?

12. The Future Training programs must consider each person
their environment
tasks that will be performed
Important to address any potential muscle imbalances

13. Corrective Exercise Training
Corrective Exercise Training: a term used to describe the systematic process of:
Identifying a neuromusculoskeletal dysfunction
Developing a plan of action, and
Implementing an integrated corrective strategy

14. Corrective Exercise Training
The process of Corrective Exercise Training requires knowledge and application of an integrated assessment process, corrective program design, and exercise technique

15. Corrective Exercise Training
Collectively, the 3-step process includes:
Identify the problem (integrated assessment)
Solve the problem (corrective program design)
Implement the solution (exercise technique)

16. Corrective Exercise Training
SUMMATION OF ALL INFORMATION
EXTERNAL ENVIRONMENT
MOVEMENT
CENTRAL NERVOUS SYSTEM
INTERNAL ENVIRONMENT
HUMAN MOVEMENT EFFICIENCY

17. Corrective Exercise Training
Joint Actions
Planes of Motion
Muscle Actions
Length Tension Relationships
Force-Couple Relationships

18. Corrective Exercise Training
Arthrokinematics
Joint Support System / Local Stabilization System
Global Muscular Systems (Movement Systems)
Deep Longitudinal System
Posterior Oblique System
Anterior Oblique System
Lateral Subsystem
(These are covered in depth in the Advanced Corrective Exercise elective)

19. Corrective Exercise Training
Proprioception
Muscle Synergies
Sensorimotor Integration

20. Human Movement Impairment
Optimal Neuromuscular Control
Optimal Length- Tension Relationships
Optimal Force-Couple Relationships
Optimal Arthrokinematics
Optimal Sensorimotor Integration
Optimal Neuromuscular Efficiency
Optimal Tissue Recovery

21. Health Appraisal Medical History Static Assessments
Dynamic Assessments
Range of Motion Assessments
Strength Assessments
NOTE: These are covered in more depth in the Advanced Corrective Exercise elective

22. Corrective Exercise Training
Based on your findings from the previous steps, solving the identified neuromusculoskeletal problems will require a systematic plan
This plan is known as the Corrective Exercise Continuum
The Corrective Exercise Continuum will specifically outline the necessary steps needed to properly structure a corrective exercise program

23. Corrective Exercise Training
Inhibit
Activate
Integrate
Inhibitory Techniques
Self-Myofascial Release
Activation Techniques
Isolated Strengthening
Positional Isometrics
Integration Techniques
Integrated Dynamic Movement
Lengthen
Lengthening Techniques
Static Stretching
Neuromuscular Stretching

24. Corrective Exercise Training: Inhibit
Inhibitory techniques are used to release tension or decrease activity of overactive neuromyofascial tissues in the body
This can be accomplished through the use of self-myofascial release techniques (e.g. foam roller)

25. Corrective Exercise Training: Inhibit
To alleviate the side effects of active or latent trigger points
Tender areas of muscle tissue
Develop as a result of micro-trauma/stress to the soft-tissue system

26. Corrective Exercise Training: Inhibit
Less rigid materials (soft) affect superficial layers of the fascia.
More rigid tools (hard) access deeper layers of the fascia.
Hard Tools
Soft Tools

27. Key Application Points for Self-Myofascial Release
Proper postural alignment
Drawing-in maneuver
Use extremities to alter the amount of weight on the treatment area

28. Key Application Points for Self-Myofascial Release
Instruct the client to relax and not tighten up while working on an area.
Areas that have myofascial restrictions will be more painful to mobilize.
As soft tissue restrictions break down with subsequent sessions, treatment will become less painful.

29. Contraindications

30. Acute Variables

31. Corrective Exercise Training: Lengthen
Corrective Exercise techniques used to increase the extensibility, length, and range of motion (ROM) of neuromyofascial tissues in the body
This can be accomplished by static stretching or neuromuscular stretching

32. Corrective Exercise Training: Lengthen
Corrective Exercise techniques used to increase the extensibility, length, and range of motion (ROM) of neuromyofascial tissues in the body
This can be accomplished by static stretching or neuromuscular stretching

33. Corrective Exercise Training: Lengthen
Static stretching
Flexibility technique used to increase the extensibility of muscle and connective tissue and thus range of motion at a joint.
Static stretching adaptations
Mechanical
Mechanically lengthen shortened neuromyofascial tissues
Neural
Produce an inhibitory response via the nervous system
Only necessary for use on neuromyofascial structures identified as being in a shortened state.

34. Corrective Exercise Training: Lengthen
Neuromuscular (PNF/Contract-Relax) Stretching
Received greater attention over the past 20 years as a method for lengthening neuromyofascial tissues
NMS combines the benefits of both static and active stretching while keeping the risk of tissue injury low.
Current research has demonstrated that NMS is equally (or more) effective at increasing ROM when compared to static stretching.
Some studies have shown NMS to be more effective and impact muscular power less than static stretching.

35. Traditional Theory Behind Stretching
Regular stretching is a recommended component of exercise programs.
Decrease risk of injury
Improve performance
Traditional Theory Behind Stretching
© Photos.com

36. Traditional Theory Behind Stretching
The proposed mechanism for the use of stretching as it relates to injury prevention
Traditional Theory Behind Stretching

37. Traditional Theory Behind Stretching
The proposed mechanism for the use of stretching as it relates to performance
Traditional Theory Behind Stretching

38. New Theory Behind Stretching
New scientific rationale for stretching
Recent research has indicated that pre-stretching negatively impacts
Force production
Athletic performance
May not influence injury risk
© Photos.com

39. New Theory Behind Stretching
The proposed mechanism of pre-exercise stretching and force production
New Theory Behind Stretching

40. Scientific Rationale for Stretching
Should stretching be performed to improve performance and decrease the risk of injury?
Review what the evidence has shown on stretching’s effect on
Improving range of motion
Performance enhancement
Injury prevention
© Image Source/Alamy Images

41. Improving Range of Motion
Stretching exercises are primarily used to increase the available range of motion at a particular joint, specifically if the range of motion at that joint is limited by tight neuromyofascial tissues.
Some literature reviews have found that stretching, both acutely and chronically, increase the range of motion at the target joint.

42. Improving Athletic Performance
Research that has investigated changes in athletic performance due to stretching protocols is less clear.
Reviews of the best available research suggest that acutely, stretching may have a detrimental effect on muscular strength and power.
Chronic long term stretching protocols have produced varied effects on athletic performance.
Many studies have demonstrated increases in vertical jump, muscular strength, power, and balance ability after a regular stretching program.
© Photos.com

43. Improving Athletic Performance
Integrated assessment process
Shortened/lengthened
Strengthening exercises
Integrated dynamic movements

44. Prevention of Injury
Many coaches and athletes perform stretching as part of a routine warm-up prior to activity, prompted by the belief that stretching can prevent certain injuries.
Current evidence suggests that acute pre-exercise stretching does not have a significant impact on injury risk.
Several researchers have shown that regular, long term stretching can lead to
Decreased incidence of injury
Decreased cost of time lost from injury
Fewer severe muscle/tendon injuries
Injury rates decreased by 18-43%.
There do not appear to be any negative consequences relative to injury risk when implementing a regular or acute pre-exercise stretching program.
© grant pritchard/Alamy Images

45. Summary of the Evidence
There is moderate evidence to indicate that regular (chronic) stretching improves
Range of motion
Strength
Performance
Decreases injury risk
There is moderate evidence to indicate that acute, pre-exercise stretching performed in isolation decreases
Does not affect injury risk

46. NASM Position on Static Stretching
Strongly advocates stretching as part of an exercise program for increasing ROM in mechanically shortened neuromyofascial tissue.
Promotes the use of static stretching prior to activity or an athletic event in conjunction with dynamic warm-up exercises.
Especially true for clients who exhibit human movement system impairment or muscle imbalance.
Static stretching
Dynamic warm-up exercises

47. Application Guidelines for Lengthening Techniques

48. Static Stretching Acute Variables
Static stretching should only be applied to muscles that have been determined to be overactive/tight during the assessment process.

49. Neuromuscular Stretching Application
Move joint to the first point of tissue resistance.
Isometric contraction of 20–25% (3–15 seconds)
Relax (1–2 seconds)
Passively move the limb to the new barrier (20–30 seconds)
Repeat

50. Neuromuscular Stretching Acute Variables
Stretching should only be applied to muscles that have been determined to be overactive and/or tight.

51. Precautions and Contraindications: NMS

52. Summary
Lengthening techniques are used to increase the extensibility, length, and range of motion of neuromyofascial tissues in the body.
Proper application of stretching depends upon the needs of the client and the goals of the fitness program.
Neuromuscular stretching should be used to correct faulty movement patterns, specifically to lengthen shortened neuromyofascial tissues.
Stretching should not be used without conducting a movement assessment first.

53. Corrective Exercise Training: Activate
Corrective Exercise techniques used to re-educate or increase activate of underactive tissues
This can be accomplished by the use of isolated strengthening exercises and positional isometric techniques

54. Scientific Rationale for Positional Isometrics
Incorporates isometric contractions performed at the end ROM of a joint
It is a static technique (no active motion).
Most appropriate for a person with adequate core strength and neuromuscular control as it will involve higher intensity contractions or force
To increase the intramuscular coordination of specific muscles necessary to heighten activation levels prior to integrating them back into their functional synergies
Must be a qualified health and fitness professional

55. Scientific Rationale for Positional Isometrics
Positional isometrics are used to heighten the activation of underactive muscles of a joint.
Isometric muscle contractions
Generate higher levels of tension than concentric muscle contractions
May provide a better initial stimulus necessary for increased activation of specific muscles
Emphasis can be placed on a particular muscle through proper positioning and force application.

56. NASM Use of Positional Isometrics
The set up for positional isometrics requires the health and fitness professional to first place the desired muscle in a shortened position.
The client is asked to hold this position while the health and fitness professional applies force in the opposite direction in an attempt to lengthen the desired muscle.

57. Application of Positional Isometrics
Positional isometrics are performed immediately following inhibitory and lengthening techniques and prior to integrated strengthening.
Inhibition techniques decrease the overactivity of tissues.
Lengthening techniques increase the extensibility of the tissues.
The targeted underactive muscle is able to activate as a result of improved intramuscular coordination.
Lengthening techniques
Inhibitory technique
Positional isometrics
Integration exercises

58. Scientific Rationale for Isolated Strengthening
Isolated strengthening improves intramuscular coordination of a specific muscle or muscles.
Enhanced motor unit activation
Synchronization
Firing rate
Isolated strengthening exercises

59. Rationale for Isolated Strengthening
Increase the force production capabilities through concentric-eccentric muscle actions throughout the full range of motion
Avoid over-compensation of synergistic muscles (synergistic dominance)

60. Application
Isolated strengthening is performed immediately following inhibitory and lengthening techniques and prior to integrated strengthening.
Inhibition techniques decrease the over-activity of tissues.
Lengthening techniques increase the extensibility of the tissues.
The targeted underactive muscle is able to activate through a full range of motion as a result of improved intramuscular coordination.
Inhibitory technique
Lengthening techniques
Isolated strengthening
Integration exercises

61. Precautions and Contraindications

62. Acute Variables

63. Corrective Exercise Training: Integrate
Corrective Exercise techniques used to re-train the collective synergistic function of of all muscles through functionally progressive movements
This can be accomplished by the use of integrated dynamic movements

64. Integration Techniques
Integrated dynamic movement enhances the functional capacity of the human movement system by increasing multi-planar neuromuscular control.

65. Rationale for Integrated Dynamic Movement
Integrated dynamic movements
Promote high levels of intermuscular coordination in a progressive manner to stimulate functional activities
Re-establish postural control
Decrease risk of injury
Involve low load and controlled movement in ideal posture
Courtesy of J01 Mark D. Faram/U.S. Navy

66. Progression Sequence
The incorporation of upper body movement, plane of motion, and challenge to stability can also be added.
Ball wall squat with overhead press
Step-up with overhead press
Lunge with overhead press
Single-leg squat
Multiplanar hops with stabilization

67. Precautions and Contraindications

68. Acute Variables

69. Summary
Phases one and two of the Corrective Exercise Continuum address the overactive myofascial tissue that can restrict optimum joint range of motion and ultimately decrease movement ability.
The third phase, activation, refers to the stimulation (or re-education) of underactive myofascial tissue.
The final phase, integration, is used to re-educate the entire human movement system back into a functional synergistic movement pattern.

70. Any questions?