Exercise Correction

One of the foundations of physical therapy is exercise. We are trained to examine patients, find their impairments, and treat them with manual therapy, exercise, and education. Because of this, some view physical therapists as exercise specialists, which is a topic worthy of debate itself. There are several different schools of thought with exercise, primarily in regards to technique. Some focus on gross, functional movements, while others are very precise with corrections of movement impairment syndromes. Where it often gets difficult is with older, deconditioned patients. Some believe that these patients "just need to get moving." They are weak throughout, so any muscle stimulation is beneficial. It is easy to understand why many fall into this thought process, with less active individuals.

Personally, I believe it is essential to correct the form for everyone for several reasons. One, when patients move, they generally choose the path of least resistance, meaning the muscles that are strongest or have preferred activation will be the prime movers. Think of a patient doing squats, but you observe the knees flying past the toes. There could be several mobility, strength, and motor control issues leading to this movement pattern, which leads to increased risk of injury. Second, when compensation occurs, the muscle we think we are targeting ends up not being activated as much as we desire. An example would be a sidelying clamshell where a patient's pelvis rocks backward with each repetition. Finally, it is just plain harder, and thus more effective, for the patient. When we correct the form of an exercise, there is an increased likelihood of targeting the desired muscles to improve the functional deficits.

What you may have noticed is that all of the above examples are essentially the same. As physical therapists, we should include corrective techniques with all our patients as all will benefit from them. Even with gross strengthening exercises we can identify preferred muscle activation. With some practicing deadlifts or lifting techniques, we cannot allow excessive motion to come from the lumbar spine. The targeted areas are not reached as effectively and the patient's likelihood of injury increases. It is best that we be "picky" when correcting our patients' technique.

-Chris

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