The Corrective Exercise Trap

PainSci » bibliography » Tumminello et al 2017
updated Dec 18, 2020

Tags: exercise, structuralism, sports, fibromyalgia, self-treatment, treatment, biomechanical vulnerability, risks, etiology, pro, contested illness, pain problems, controversial, medically unexplained symptoms, signs & symptoms, diagnosis, pain

Seventeen pages on PainSci cite Tumminello 2017: 1. Does Posture Matter? 2. Quite a Stretch 3. The Complete Guide to Plantar Fasciitis 4. Shin Splints Treatment, The Complete Guide 5. The Complete Guide to Muscle Strains 6. The Art of Rest 7. Strength Training for Pain & Injury Rehab 8. Your Back Is Not Out of Alignment 9. Pseudo-Quackery in Physical Therapy 10. Guide to Repetitive Strain Injuries 11. The Functional Movement Screen (FMS) Reviewed 12. Deep Cervical Flexor Training for Neck Pain 13. What Works for Chronic Pain? 14. Body repair motions 15. Getting stronger is corrective 16. Reality versus best practices in musculoskeletal medicine 17. Can you prevent strains by upgrading your “muscle balance”? (Member Post)

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!

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