After attending my first fellowship lecture, I did some reflection on exercise technique in my own workouts. We had talked about common substitution patterns such as scapular retraction for stabilization with both shoulder press and bench press exercises. I realized in my gym workouts, I was guilty of these same compensations. Since then, I have learned to be more critical of my exercises, whether it be protracting at the end of both my push-ups and bench press or add a shrug at the end of my shoulder press. I quickly noticed the exercises were much harder, requiring lower loads; however, I no longer was relying on compensatory stabilization methods. It's easy to understand why the most dedicated of body builders likely has abnormal scapular positioning and mechanics. This exactness of exercise applies to other parts of the body as well.
No matter what exercise theory you subscribe to, the need for exact form cannot be over-emphasized. There are particular methods with each theory that need to be directly followed for each exercise type. For example, Sahrmann theory is built around relative hypermobility. A hypomobile region may lead to hypermobility at another region, and that hypermobility is the source of both degeneration and pain. Sahrmann treats this by focusing on re-training movement patterns to take the excessive movement out of the painful region. In lumbar movement impairment syndromes, a careful eye is needed to point out and critique the most miniscule movements in the affected region. This can be portrayed with a supine BKFO. If a patient is complaining of pain and you notice even a slight pelvic rotation with the exercise but the pain dissipates with stabilization, the reasoning is that even that small motion is the source of pain. We must learn to be both watchful and critical of these compensatory patterns. With McKenzie theory, repeated motions require end-range to succeed. I can't tell you how many times in the past I would assess repeated motions but not emphasize the end-range. I would either see no change or worsening of symptoms and quickly move to a different approach. Since gaining a better understanding from repeated motions, I have learned to critique the form with repeated motions and enforce end-range. This has lead to significantly greater success with a reduction in pain and improvement in motion.
We cannot be lazy with our therapeutic exercises. People compensate for a reason, which often contributes to the dysfunction that injured them in the first place. If we do not focus on correcting these mistakes, we may indeed be reinforcing the dysfunction. It can become difficulty with certain populations to keep a keen eye watching for these compensations, but it remains imperative that we do if we intend to deliver quality care.
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