The Student​ Physical Therapist
  • Home
  • About Us
  • TSPT Academy
  • Resources
    • Newsletter
    • Orthopedic Blog
    • Featured Articles
    • Research Articles
    • Residency Corner
  • Special Tests
    • Cervical Spine >
      • Alar Ligament Test
      • Bakody's Sign
      • Cervical Distraction Test
      • Cervical Rotation Lateral Flexion Test
      • Craniocervical Flexion Test (CCFT)
      • Deep Neck Flexor Endurance Test
      • Posterior-Anterior Segmental Mobility
      • Segmental Mobility
      • Sharp-Purser Test
      • Spurling's Maneuver
      • Transverse Ligament Test
      • ULNT - Median
      • ULNT - Radial
      • ULNT - Ulnar
      • Vertebral Artery Test
    • Thoracic Spine >
      • Adam's Forward Bend Test
      • Passive Neck Flexion Test
      • Thoracic Compression Test
      • Thoracic Distraction Test
      • Thoracic Foraminal Closure Test
    • Lumbar Spine/Sacroiliac Joint >
      • Active Sit-Up Test
      • Alternate Gillet Test
      • Crossed Straight Leg Raise Test
      • Extensor Endurance Test
      • FABER Test
      • Fortin's Sign
      • Gaenslen Test
      • Gillet Test
      • Gower's Sign
      • Lumbar Quadrant Test
      • POSH Test
      • Posteroanterior Mobility
      • Prone Knee Bend Test
      • Prone Instability Test
      • Resisted Abduction Test
      • Sacral Clearing Test
      • Seated Forward Flexion Test
      • SIJ Compression/Distraction Test
      • Slump Test
      • Sphinx Test
      • Spine Rotators & Multifidus Test
      • Squish Test
      • Standing Forward Flexion Test
      • Straight Leg Raise Test
      • Supine to Long Sit Test
    • Shoulder >
      • Active Compression Test
      • Anterior Apprehension
      • Biceps Load Test II
      • Drop Arm Sign
      • External Rotation Lag Sign
      • Hawkins-Kennedy Impingement Sign
      • Horizontal Adduction Test
      • Internal Rotation Lag Sign
      • Jobe Test
      • Ludington's Test
      • Neer Test
      • Painful Arc Sign
      • Pronated Load Test
      • Resisted Supination External Rotation Test
      • Speed's Test
      • Posterior Apprehension
      • Sulcus Sign
      • Thoracic Outlet Tests >
        • Adson's Test
        • Costoclavicular Brace
        • Hyperabduction Test
        • Roos (EAST)
      • Yergason's Test
    • Elbow >
      • Biceps Squeeze Test
      • Chair Sign
      • Cozen's Test
      • Elbow Extension Test
      • Medial Epicondylalgia Test
      • Mill's Test
      • Moving Valgus Stress Test
      • Push-up Sign
      • Ulnar Nerve Compression Test
      • Valgus Stress Test
      • Varus Stress Test
    • Wrist/Hand >
      • Allen's Test
      • Carpal Compression Test
      • Finkelstein Test
      • Phalen's Test
      • Reverse Phalen's Test
    • Hip >
      • Craig's Test
      • Dial Test
      • FABER Test
      • FAIR Test
      • Fitzgerald's Test
      • Hip Quadrant Test
      • Hop Test
      • Labral Anterior Impingement Test
      • Labral Posterior Impingement Test
      • Long-Axis Femoral Distraction Test
      • Noble Compression Test
      • Percussion Test
      • Sign of the Buttock
      • Trendelenburg Test
    • Knee >
      • Anterior Drawer Test
      • Dial Test (Tibial Rotation Test)
      • Joint Line Tenderness
      • Lachman Test
      • McMurray Test
      • Noble Compression Test
      • Pivot-Shift Test
      • Posterior Drawer Test
      • Posterior Sag Sign
      • Quad Active Test
      • Thessaly Test
      • Valgus Stress Test
      • Varus Stress Test
    • Foot/Ankle >
      • Anterior Drawer
      • Calf Squeeze Test
      • External Rotation Test
      • Fracture Screening Tests
      • Impingement Sign
      • Navicular Drop Test
      • Squeeze Test
      • Talar Tilt
      • Tarsal Tunnel Syndrome Test
      • Test for Interdigital Neuroma
      • Windlass Test
Picture

Form with Exercise

10/13/2014

9 Comments

 
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.
Picture
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.

-Chris
9 Comments
Harrison link
10/14/2014 01:00:08 am

Hi Chris,
Thanks for your post - I enjoy checking in time to time to see what you guys are up to.
I am a little perplexed by this particular post and I wonder if you might help me understand where I'm going wrong. What other than scapular retraction to you consider to be a component of stabilization in pressing? Or, are you saying that you shouldn't be stabilizing in these presses? What is the advantage of protracting at the end of the pushup or shrugging at the end of the shoulder press?
In the interest of full disclosure and good discussion, I am inclined to think that shrugging - at least in the bench, though I am more open to it in the pushup, mostly because of the difference in weight, though even it should be progressed - is highly undesirable. I have two reasons for thinking so: (1) these are the positions which athletes who get shoulder injuries are most often in and (2) the forces at the shoulder in these movements seems to be on the passive structures of the shoulder and not the musculature. It is for the same reason that I urge athletes to externally rotate in over head or pressing positions (a long time advantage that especially male gymnastics have known about, and which can be seen in any iron cross or especially maltese cross or planche).
It does seem to me that serratus anterior - which seems to be the primary driver in the additional "shrug" at the top of a pushup or bench press - is worth paying attention to, but it seems to me that most people's serratus anterior would be too weak for this movement to be profitable.
This has left me with several questions, and I'd love to hear your thoughts. Thanks.
-Harrison

Reply
Chris link
10/14/2014 05:40:28 am

Hi Harrison,

Thank you for your questions. I definitely understand where you are coming from with the questions. With the bench press, performing scapular retraction is a form of stabilization that is commonly used. I completely agree that we are able to maximize the force of other muscles by doing so, allowing greater force for the exercise. However, my question is, are we not encouraging abnormal movement patterns in doing so? Take your arm into flexion and notice the scapular upward rotation/protraction. With a bench press, this does not occur if you are stabilizing the shoulder with scapular retraction. With the shoulder press, again we are wanting that additional shrug to emphasize sufficient upward rotation. You say that most people's serratus anterior is too weak to do this. Should we accept that? When I evaluate my patients and find a muscle grade of 3/5 or worse, you better believe I am focusing on training that muscle, especially if it is near the involved region. This may require lowering the load to a level that the technique will be correct. I can bench and press far more without emphasizing these aspects, but I can tell that I am compensating. It's not that the exercises are performed incorrectly per NSCA guidelines or whatever. They may be allowed for competition and great for maximizing strength of a particular muscle, but are they appropriate for normal shoulder mechanics? Weight-lifters tease those who use machines because they allow mechanical stabilization compared to free weights. But our body knows how to find compensations as well. I was looking at these exercises and exercise in general as more of a movement retraining approach and discussion on the exact technique. I hope this clears it up, but let me know if you have any other questions.

-Chris

Reply
Buffalo SPT
10/14/2014 03:35:42 am

Harrison I also agree with your points.
Many competitive powerlifters are taught to retract and depress the scapulae to provide a stable base for the concentric portion of the lift. I like the analogy of firinging a cannonball from a canoe vs on land. A stable BOS would seem advantageous. Pressing with protracted scapulae at best seems less than optimal and at worst may increase risk for subacromial impingement as the "anterior opening of the subacromial space narrowed as the shoulder moves from a retracted to a protracted position." (http://www.ncbi.nlm.nih.gov/pubmed/8222458)

Great points about emphasizing end range with MDT. I had a clinical instructor who always said "end range is where the magic happens".

Reply
Chris link
10/14/2014 05:43:34 am

I would not say pressing is done in a protracted position. The exercise is completed normally and a protraction or "punch" is performed at the extended position, just like serratus punches. If the scapula is retracted, could that lead to too much GH horizontal adduction and impingement? I don't know, but I don't get hung up on pathoanatomical studies too often. Just a different way of looking at some exercises!

-Chris

Reply
Chris Byers link
11/20/2020 03:56:24 pm

Love this! Thank you for sharing!

Reply
Simple workouts link
4/21/2021 03:28:29 am

This is a great post! Thanks so much for sharing!

Reply
magic pen trick link
7/31/2023 03:43:55 am

The form with exercise is a crucial aspect of any fitness routine, emphasizing the importance of proper technique and body alignment during physical activity. Whether engaging in strength training, cardio exercises, or yoga, maintaining good form is essential to prevent injuries and maximize the effectiveness of the workout. By focusing on the phrase "Form with Exercise," individuals can enhance their overall performance, build strength, and achieve their fitness goals more efficiently.

Reply
ทางเข้าUFABET link
8/5/2023 02:46:12 am

In the realm of fitness and well-being, the amalgamation of form with exercise encapsulates the essence of achieving optimal physical prowess and mental equilibrium. The precision and alignment of one's movements, combined with the choice of exercises tailored to individual needs, foster a harmonious union between strength and flexibility. This holistic approach underscores the significance of proper posture, controlled motions, and targeted muscle engagement, akin to the meticulous execution of a masterful art form. Just as the phrase "ทางเข้าUFABET" serves as a gateway to a realm of opportunities, the fusion of form and exercise opens the door to a world of enhanced vitality and enduring wellness.

Reply
storm door installation link
10/26/2024 03:29:56 am

Boomerang Bonanza Casino offers an exciting online gaming experience for players in Germany, providing opportunities to win real money through a wide range of games and promotions. With its vibrant design and user-friendly interface, players can easily navigate through various options, from classic slots to immersive live dealer games. The casino also prioritizes safety and security, ensuring that players can enjoy their gaming experience without concerns. Whether you’re a seasoned player or new to the world of online casinos, Boomerang Bonanza has something for everyone. And while you’re strategizing your next move at the tables, don't forget that just as careful planning is essential in gaming, so is it crucial for home projects like storm door installation, which can enhance your property’s value and security.

Reply



Leave a Reply.

    Picture


    Archives

    July 2019
    June 2019
    May 2019
    March 2019
    February 2019
    January 2019
    December 2018
    November 2018
    October 2018
    September 2018
    August 2018
    July 2018
    June 2018
    May 2018
    April 2018
    March 2018
    February 2018
    January 2018
    December 2017
    November 2017
    October 2017
    September 2017
    August 2017
    July 2017
    June 2017
    May 2017
    April 2017
    March 2017
    February 2017
    January 2017
    December 2016
    November 2016
    October 2016
    September 2016
    August 2016
    July 2016
    June 2016
    May 2016
    April 2016
    March 2016
    February 2016
    January 2016
    December 2015
    November 2015
    October 2015
    September 2015
    August 2015
    July 2015
    June 2015
    May 2015
    April 2015
    March 2015
    February 2015
    January 2015
    December 2014
    November 2014
    October 2014
    September 2014
    August 2014
    July 2014
    June 2014
    May 2014
    April 2014
    March 2014
    February 2014
    January 2014
    December 2013
    November 2013
    October 2013
    September 2013
    August 2013
    July 2013
    June 2013
    May 2013
    April 2013
    March 2013
    February 2013
    January 2013
    December 2012
    November 2012
    October 2012
    September 2012
    August 2012

    Categories

    All
    Chest
    Core Muscle
    Elbow
    Foot
    Foot And Ankle
    Hip
    Knee
    Manual Therapy
    Modalities
    Motivation
    Neck
    Neural Tension
    Other
    Research
    Research Article
    Shoulder
    Sij
    Spine
    Sports
    Therapeutic Exercise


    RSS Feed

Home

Contact Us

Copyright © The Student Physical Therapist LLC 2023
Photos from dsearls, moo.review, liverpoolhls, matturick, lwpkommunikacio, Lake Clark NPS, Tobyotter, Charly Meunier, Vincent Albanese, CNBP, Zepfanman.com, aotaro, sportEX journals, jillccarlson, Yann07, US Department of Education, osseous, TheeErin, ajy591, Mark P / PIX41, Thomas Fisher Rare Book Library, UofT, teresatrimm, donnierayjones, NNelumba, Tobyotter, Frédéric de Villamil, Jordanhill School D&T Dept, danabooo, cadillacjr2002, ingridkreuz, RDECOM, U.S. Naval Forces Central Command/U.S. Fifth Fleet, Wonderlane, hectorir, Jeffrey, Chris Hunkeler, quillons, COD Newsroom, Alan Cleaver, CCFoodTravel.com, liverpoolhls, Dr.Farouk, Jeffrey, Sten Dueland, Håkan Dahlström, PPGWings, Parker Michael Knight, MLazarevski, dno1967b, Fimb, Jim Larrison, infomatique, U.S. Naval Forces Central Command/U.S. Fifth Fleet, Idhren, iwona_kellie, AnEternalGoldenBraid, quinn.anya, jlk.1, Villainette, mlsaero, roelandpype, Defence Images, CiscoANZ, istolethetv, Our Dream Photography (Personal), BraNewbs, Meg Stewart, phalinn, akeg, hectorir, philcampbell, MilitaryHealth, akeg, Army Medicine, Shar Ka, Subconsci Productions, Eric Kilby, Anonymous9000, quinn.anya, COD Newsroom, UMN Department of Plant Pathology, familymwr, all of olive., Keith Allison, JD Hancock, Synergy by Jasmine, roger_mommaerts, John-Morgan, a.drian, Instant Vantage, Beshef, markhillary, Vegar S Hansen Photography, DEC International, kaolin fire, smith_cl9, cinnamon_girl, jillccarlson, Extra Ketchup, brain_blogger, heyjoewhereyougoinwiththatguninyourhand, tv42, COMSALUD, Nicholas_T, Ano Lobb. @healthyrx, kaibara87, mlinksva, smbuckley23, sappsnap, Menage a Moi, brain_blogger, MaloMalverde, One Way Stock, ethet., ~ggvic~, MAClarke21, Keith Allison, pictures of money, mendolus shank, HotlantaVoyeur, Mr. T in DC, abbamouse, HystericalMark, Travis Hornung, jenny downing, shock264, Peter Mooney, Futurilla, sfslim, Emily Carlin, PFX Photo, ITU Pictures, TP studio, akunamatata, Magdalena Roeseler, osseous, smith_cl9, warrenski, Sh4rp_i, mrbichel, Renaud Camus, sicamp, GreenFlames09, infomatique, mark i geo, Volker Davids, TerryJohnston, Daniela Vladimirova, CJS*64, VarsityLife, Quentin Verwaerde, Annie Mole, US Army Africa, RLHyde, openBIT e. V., Vox Efx, fabola, Gerry Dincher, mlsaero, Infomastern, N4n0, Wonderlane, TheeErin, Nanagyei, gogogadgetscott, Pulmonary Pathology, PELeCON, Elvert Barnes, @RunRockPrincess, woodleywonderworks, Asbestos Bill, Joelk75, otisarchives4, jillccarlson, sportEX journals, The Wandering Angel, perpetualplum, V31S70, colecamp, jpalinsad360, JulyYu, Andres Rueda, Whenleavesfall, melloveschallah, Pink Sherbet Photography, canonim, BrianHenry ////|//, Leonard John Matthews, mikecogh, Zepfanman.com, Kevin M. Gill, Claire L. Evans, afunkydamsel, The Official CTBTO Photostream, cyOFdevelin fame, dok1, Pam loves pie, hoshi7, opensourceway, hatcher10027, Andy G, sandiegopersonalinjuryattorney, rubyswoon, OIST (Okinawa Institute of Science and Technology), Jiv.Talking, ljgoyke, www.ilkkajukarainen.fi, giulia.forsythe, Carine06, RRaiderstyle, Keith Allison, Andrew Campbell Photography, shinya, ljgoyke, marcoverch, Peder Sterll, sportEX journals
  • Home
  • About Us
  • TSPT Academy
  • Resources
    • Newsletter
    • Orthopedic Blog
    • Featured Articles
    • Research Articles
    • Residency Corner
  • Special Tests
    • Cervical Spine >
      • Alar Ligament Test
      • Bakody's Sign
      • Cervical Distraction Test
      • Cervical Rotation Lateral Flexion Test
      • Craniocervical Flexion Test (CCFT)
      • Deep Neck Flexor Endurance Test
      • Posterior-Anterior Segmental Mobility
      • Segmental Mobility
      • Sharp-Purser Test
      • Spurling's Maneuver
      • Transverse Ligament Test
      • ULNT - Median
      • ULNT - Radial
      • ULNT - Ulnar
      • Vertebral Artery Test
    • Thoracic Spine >
      • Adam's Forward Bend Test
      • Passive Neck Flexion Test
      • Thoracic Compression Test
      • Thoracic Distraction Test
      • Thoracic Foraminal Closure Test
    • Lumbar Spine/Sacroiliac Joint >
      • Active Sit-Up Test
      • Alternate Gillet Test
      • Crossed Straight Leg Raise Test
      • Extensor Endurance Test
      • FABER Test
      • Fortin's Sign
      • Gaenslen Test
      • Gillet Test
      • Gower's Sign
      • Lumbar Quadrant Test
      • POSH Test
      • Posteroanterior Mobility
      • Prone Knee Bend Test
      • Prone Instability Test
      • Resisted Abduction Test
      • Sacral Clearing Test
      • Seated Forward Flexion Test
      • SIJ Compression/Distraction Test
      • Slump Test
      • Sphinx Test
      • Spine Rotators & Multifidus Test
      • Squish Test
      • Standing Forward Flexion Test
      • Straight Leg Raise Test
      • Supine to Long Sit Test
    • Shoulder >
      • Active Compression Test
      • Anterior Apprehension
      • Biceps Load Test II
      • Drop Arm Sign
      • External Rotation Lag Sign
      • Hawkins-Kennedy Impingement Sign
      • Horizontal Adduction Test
      • Internal Rotation Lag Sign
      • Jobe Test
      • Ludington's Test
      • Neer Test
      • Painful Arc Sign
      • Pronated Load Test
      • Resisted Supination External Rotation Test
      • Speed's Test
      • Posterior Apprehension
      • Sulcus Sign
      • Thoracic Outlet Tests >
        • Adson's Test
        • Costoclavicular Brace
        • Hyperabduction Test
        • Roos (EAST)
      • Yergason's Test
    • Elbow >
      • Biceps Squeeze Test
      • Chair Sign
      • Cozen's Test
      • Elbow Extension Test
      • Medial Epicondylalgia Test
      • Mill's Test
      • Moving Valgus Stress Test
      • Push-up Sign
      • Ulnar Nerve Compression Test
      • Valgus Stress Test
      • Varus Stress Test
    • Wrist/Hand >
      • Allen's Test
      • Carpal Compression Test
      • Finkelstein Test
      • Phalen's Test
      • Reverse Phalen's Test
    • Hip >
      • Craig's Test
      • Dial Test
      • FABER Test
      • FAIR Test
      • Fitzgerald's Test
      • Hip Quadrant Test
      • Hop Test
      • Labral Anterior Impingement Test
      • Labral Posterior Impingement Test
      • Long-Axis Femoral Distraction Test
      • Noble Compression Test
      • Percussion Test
      • Sign of the Buttock
      • Trendelenburg Test
    • Knee >
      • Anterior Drawer Test
      • Dial Test (Tibial Rotation Test)
      • Joint Line Tenderness
      • Lachman Test
      • McMurray Test
      • Noble Compression Test
      • Pivot-Shift Test
      • Posterior Drawer Test
      • Posterior Sag Sign
      • Quad Active Test
      • Thessaly Test
      • Valgus Stress Test
      • Varus Stress Test
    • Foot/Ankle >
      • Anterior Drawer
      • Calf Squeeze Test
      • External Rotation Test
      • Fracture Screening Tests
      • Impingement Sign
      • Navicular Drop Test
      • Squeeze Test
      • Talar Tilt
      • Tarsal Tunnel Syndrome Test
      • Test for Interdigital Neuroma
      • Windlass Test