The Corrective Exercise Trap
Ten articles on PainSci cite Tumminello 2017: 1. Does Posture Matter? 2. Quite a Stretch 3. Complete Guide to Plantar Fasciitis 4. Shin Splints Treatment, The Complete Guide 5. The Complete Guide to Muscle Strains 6. Strength Training for Pain & Injury Rehab 7. Your Back Is Not Out of Alignment 8. Repetitive Strain Injuries Tutorial 9. The Functional Movement Screen (FMS) 10. What Works for Pain?
PainSci notes on Tumminello 2017:
Tumminello, Silvernail, and Cormack decisively but gently and diplomatically tip over this most sacred cow of personal training and therapy: corrective exercise, which is based on the idea that there is something in-correct about patients — fragile, weak, or uneven — which can be both identified and fixed by specific, expertly prescribed exercises, mainly strengthening and stretching exercises, the staples of stereotypical physical therapy. The trap is the belief that this “technical” approach is inherently superior to good exercise in general.
The danger here is that many fitness professionals might end up making their training process more about a formalized evaluation procedure and less about good personal training. …In order to spot a physical flaw that needs to be corrected, one must begin by having a reliable measure of whether or not it is actually problematic in the first place.
Spoiler alert: there is no such reliable measure! Corrective exercise is built on wishful thinking. Screening for movement dysfunctions has been failing one fair scientific test after another. The importance of posture has been wildly exaggerated. The importance of anatomical variation has been virtually ignored.
These authors all have excellent credentials and top notch clinical reasoning skills. These are smart guys tackling several thorny sub-topics like postural dysfunction, movement dysfunction, core stability, and — most important of all, I think — the “nocebo concerns” with corrective exercise: “when clients are told such things about themselves from an authority figure (as they might be during some corrective exercise evaluations), that this potentially makes one’s clients less resilient and more prone to injury and pain.”
Translation sans diplomacy: stop #%&^ telling patients they are fragile and weak!
related content
- “Reasoning exercise dosage for people with persistent pain,” Paul Lagerman, In Touch, 2018.
- “At the borders of medical reasoning: aetiological and ontological challenges of medically unexplained symptoms,” Thor Eirik Eriksen, Roger Kerry, Stephen Mumford, Svein Anders Noer Lie, and Rani Lill Anjum, Philos Ethics Humanit Med, 2013.
- “Thomas L. DeLorme and the science of progressive resistance exercise,” Janice S Todd, Jason P Shurley, and Terry C Todd, Journal of Strength & Conditioning Research, 2012.
- The End of Physiotherapy (book), by David Nicholls.
This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights:
- Exercise and education versus saline injections for knee osteoarthritis: a randomised controlled equivalence trial. Bandak 2022 Ann Rheum Dis.
- Association of Lumbar MRI Findings with Current and Future Back Pain in a Population-based Cohort Study. Kasch 2022 Spine (Phila Pa 1976).
- A double-blinded randomised controlled study of the value of sequential intravenous and oral magnesium therapy in patients with chronic low back pain with a neuropathic component. Yousef 2013 Anaesthesia.
- Is Neck Posture Subgroup in Late Adolescence a Risk Factor for Persistent Neck Pain in Young Adults? A Prospective Study. Richards 2021 Phys Ther.
- Sudden amnesia resulting in pain relief: the relationship between memory and pain. Choi 2007 Pain.