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The Corrective Exercise Trap

updated

Tags: exercise, sports, biomechanics, fibromyalgia, self-treatment, treatment, etiology, pro, chronic pain, pain problems

Eight articles on PainSci cite Tumminello 2017: (1) Quite a Stretch(2) Complete Guide to Plantar Fasciitis(3) The Complete Guide to Shin Splints(4) Strength Training for Pain & Injury Rehab(5) Your Back Is Not Out of Alignment(6) Repetitive Strain Injuries Tutorial(7) The Functional Movement Screen (FMS)(8) 5 Main Reasons Athletes Stretch… All Flawed

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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