"Corrective" Exercise for the Shoulder

There was a recent article this month in Fitness Trainer Magazine that spoke to some of the issues with what a personal trainer can and cannot do with "corrective" exercises.  As most of you are well aware of, the corrective exercise "kick" is still going strong.  For physical therapists this is nothing new.  We use corrective exercise everyday in the clinic.  However, when most here the word corrective exercise, they don't always think physical therapist.  

The purpose of today's post is to point out differences between when a sports physical therapist may be more effective at prescribing corrective exercises AND when/why a physical therapist should seek out a strength coach or personal trainer for their athletes.  

So where is the line drawn between trainers and physical therapists as far as corrective exercises?  Well, I'm not sure there is a specific answer to that question. It's really a gray line.  But maybe I can offer a different opinion from a sports physical therapists perspective.  

First and foremost, I think there are a lot of strength coaches and/or personal trainers that possess a vast knowledge base that make them very efficient at providing corrective exercises.  If you read up or watch videos on guys like Eric Cressey or Mike Robertson, you know they are some darn smart trainers/coaches.  But these are the guys that work with PTs, ATs, and doctors.  They listen to them and swap ideas.  It's when you get a personal trainer that hasn't had those discussions with physical therapists that corrective exercises become inefficient.  Let me give you an example.  Let's say a baseball pitcher comes in to work with a trainer and has some shoulder pain and decreased shoulder IR rotation.  Hypothetically a trainer may think that increasing the pitchers IR may help decrease the shoulder issues and/or improve motion.  However, biomechanically that pitcher may have proper ratio of ER to IR for his pitching arm.  Now lets say that trainer was unfamiliar with the biomechanics of a pitcher.  They prescribe sleeper stretch to improve IR.  Not a bad choice but if that pitcher has impingement going on its a horrible choice.  Why?  Because if you flip sleeper stretch around 90 degrees then its the Hawkins Kennedy test, aka an Impingement test.  So a cross body horizontal adduction stretch might be better.  See where this is going?  The point is, sometimes corrective exercises can be a bad thing, which is why some trainers get in trouble.  The intentions are great, but a physical therapist for this case, preferably a sports physical therapist, may be a great referral so that the trainer can work WITH the therapist.  

Now how about when a physical therapist should refer out to a strength coach or trainer?  Well, just as there are some trainers that are not fit for prescribing corrective exercises, there are plenty of physical therapists that couldn't return an athlete to a weight room.  Let's use that same pitcher as the above example.  Say the trainer and PT worked out a plan and the pitcher's impingement was improving.  But now, that pitcher needed more driving power in his legs.  Some of that is going to require weight training, unless the PT's clinic has some quality equipment.  So using the biomechanical knowledge the sports PT knows about the stride and trailing legs MVIC's and moments (adduction, abduction, etc) throughout each phase of pitching, they can work with the trainer/strength coach to come up with a plan.  See how that cycle is working?  Granted, its not always the case and not always possible.  But at the end of the day these resources are available for each profession to use.  So why not try it?  

Hopefully this gives a little insight into ways trainers and sports PT's can work together to each prescribe proper, efficient exercises for the athlete.  Check out Nick Clayton's article on Corrective Exercises for the Shoulder in Fitness Trainer Magazine for a great read on smart corrective exercises prescribing for trainers here. 

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