We all know stretching and creating mobility does not sell as “sexy”. But there is no denying the role it plays in moving better, more comfortably and preparing for activity. The unique motion of the Core-Tex™ provides a completely different experience to improving mobility.

The motion of the Core-Tex™ encourages and guides the body into positions that address the tissue 3 dimensionally with ease. The mobility exercises with the Core-Tex™ are its “secret weapon” and one of the favorite applications of Core-Tex™ users.

Note: This post was originally published on PtontheNet.com

Anthony B. Carey M.A., CSCS, AHFS

Objectives:

1. Establish a working definition of corrective exercise
2. Set reasonable expectations for a corrective exercise program
3. Introduce a corrective exercise model

Corrective exercises have become a foundational part of the fitness landscape in recent years. As the understanding of human motion evolves, the fitness community has embraced the opportunity to help their clients move better. This article will present a framework for a model of developing comprehensive corrective exercise programming. This framework is based on both scientific principles and the author’s 20 years of experience with corrective exercise.

For the purpose of this article, it is beneficial to establish a working definition of corrective exercise: Corrective exercise is the use of movements and/or postures to produce desirable changes in movement strategies, thereby minimizing or eliminating compensation and producing efficient movement patterns. Corrective exercises should precede more integrated exercises because they can cue the client’s motor system to respond in a more desirable way and assist in removing or improving biomechanical constraints.

Fitness professionals should be reminded that any reference or attempts at treating and/or diagnosing injuries is outside of the professional boundaries and should be the domain of licensed medical professionals.

It is of this author’s opinion that the various forms of myofascial and trigger point release play a significant role in the overall corrective strategy; however, they are not classified as “exercises” and will not be included in this article.

From one perspective, human movement is based on “reward” or “punishment” feedback. The positive feedback, known as the “reward”, most often goes unnoticed because these are the efficient, presumably pain-free movements. The “punishment” is the negative feedback we get in the form of aches, pains, soreness, stiffness, etc. The body will always take the short term reward despite the potential for longer term punishment. For example, if your patella is not tracking properly and leading to low-grade irritation (punishment), you alter your gait to avoid the provocative motion (short term reward). But as a result, the rest of the kinematic chain is affected and potential damage manifests elsewhere (punishment). Slouching in a chair (short term reward) is another example. The reduced effort required for slouching takes precedent over the stress applied to the tissue during that moment in time and cumulatively.

The reward/punishment model along with all motor learning is part conscious and part unconscious. Lemon stated, “Motor learning is a consequence of the co-adaptation of the neural machinery and structural anatomy.” Therefore, we must fully realize that the brain drives the body but the body’s structural adaptations will feed right back into the brain. For example, excitation of the motor nerve from the spinal cord determines how frequently the muscle is excited, but how the muscle actually contracts and relaxes is determined by the physical properties of the muscle tissue (Brooks).

An effective corrective exercise program must, therefore, influence both the structural anatomy and the neurological system via the efferent and afferent pathways. The efferent pathway carries nerve impulses from the brain to the muscles – the brain driving the body. Whereas, the afferent pathway carries nerve impulses from the muscles to the brain – the body communicating back to the brain. This is a departure from a corrective exercise paradigm based purely on “tight” muscles that must be stretched and “weak” muscles that must be strengthened.

The model proposed here as three driving principles:

1. Logical sequencing of the individual corrective exercises facilitates
immediate neuromuscular adaptation,
2. Positive cascading events related to the quality of motion will occur when a strategy is developed to address a hierarchy of associated dysfunctions, and
3. Beneficial and immediate short term changes in biomechanics and motor control will occur within a given session completely independent of any hands-on intervention.

Sequencing of Individual Corrective Exercises

Progressing exercises is a common component of effective exercise program design. Exercise progressions are typically defined by an increase in variables such as intensity, duration, frequency, tempo, load or volume. In other words, exercise progressions are quantitative and a broader component to exercise program design.
Exercise sequencing, on the other hand, has more to do with the relationship between exercises in a given series of exercises within a program. Sequencing looks at the effects of each exercise in the program in relation to others within the same program and is more qualitative (Carey).

As with all programming, a corrective exercise program should have a major objective. To borrow from business and personal growth guru, Steven Covey, “we should begin with the end in mind.” Sequencing is a way in which to create mini objectives, or stepping stones, to moving the neuromusculoskeletal system toward the main objective.

Having a series of mini objectives or routines within the program allows you to audit your progress through the program. The audit is necessary to ensure that the mini objectives are met. If not met, the program is not on target to meet the main objective. One exercise should prepare the body for the next and never cancel the benefits of a previous exercise.
The final exercises within the corrective exercise sequence should also be congruent with the main objective and adequately transition the client to their next stage of activity. For some clients, that may mean the session continues into a more traditional fitness program. Or this may mean leaving the session, walking out the door and getting into the car. In either event, at completion of the corrective exercise program, the client should be integrated into a vertically loaded position versus descending the program back to the floor.

Positive Cascading Events Related to the Quality of Motion

The 80-20 Principle is a principle historically applied to economics, production, engineering, and management. It states simply that 80 percent of the effect is a result of 20 percent of the causes. The corrective exercise model described here applies the 80-20 principle to the resultant movement dysfunctions we see in our clients.

If we agree the human organism is a highly integrated structure, then it is clear that no biomechanical event occurs in isolation. As a result, a change in motion of any joint in the body can create a change in motion of joints above, below, and/or far removed from the joint in question. This cascade often leads to regional symptoms or areas of limitations that the client does not even associate with the origin of the cascade. For example, a client that sits at a desk with a landline phone may continually hold their phone on the right side, between their shoulder and ear, because the phone is located on that side of the desk. As a result, there is continuous tension on the right side spinal musculature. The cumulative effects are chronic hypertonicity of the muscles and associated lateral flexion of the spine to the right. The shoulder elevated to the ear, while on the phone, eventually depresses during normal standing as the cervical spine laterally flexes left to reorientate the eyes to the horizon. This individual is susceptible to a myriad of mechanical stress that will be present as localized symptoms at the neck and shoulder, as well as from the thoracic back to the feet. The catalyst of all this was the ergonomics of their phone use. As a result, many fitness professionals may end up working with clients who were treated in the painful area of the body and cleared for exercise only to have the problem or associated problems resurface.

Returning to the 80-20 Principle, identifying the hierarchy of dysfunctions (the “20”) will assist us in formulating the program design. Programming objectives should emphasize the most influential structures and move out from there. This is in contrast to a corrective exercise program design that might assess multiple movement/postural dysfunctions and then create a corrective exercise program with exercises for each individual dysfunction.

Beneficial and Immediate Short Term Changes

The movement dysfunctions and limitations seen in clients can be multi-factorial. They may be a result of previous injuries, current pain and/or apprehension, genetics, pattern overload from work or recreational activities, psychological state, or any combination of these factors. If we return to our reward/punishment model, despite what the client might say- their body is behaving this way because there is a reward. Some examples of the reward are:

1. Pain avoidance.

2. Lower metabolic demands. The metabolic cost is too high for local
muscle groups or overall on the body and therefore it
is easier to continue with current strategy.

3. Conscious effort. The movement can only be influenced cognitively
and therefore other intellectual demands supersede the conscious
processing needed to influence their movement patterns.

4. Deficient motor control. No other options are available because their
motor system cannot assimilate the necessary steps to do it differently.

If we are to create qualitative change in the way a person moves, we must understand what is driving their movement strategies. A movement or motor strategy can be thought of as a way a person has learned to execute a movement. Gait is a fundamental movement strategy used by anyone who can ambulate.

Assessments of movement strategies are generally inferred by observing kinematic variables. For example, if you assess a person’s squat, the observations you are making are based on joint motions and segmental positions because we cannot see what the nervous system is doing. Even if we could see the nervous system, 10 squats that look very similar kinematically could be very different neurologically. This is because the nervous system is capable of producing very similar results through different combinations of motor unit pools, timing and contribution. This is referred to as kinematic redundancy.

Muscle synergies represent a library of motor subtasks, which the nervous system can flexibly combine to produce complex and natural movements (Safavynia et. al). Think of them as building blocks of a movement strategy (Torres-Oviedo and Ting). As building blocks, muscle synergies are more easily influenced than a complete movement strategy. From this perspective, we can see how the appropriate sequencing of the corrective exercise program can affect positive change.

Inherent to creating immediate positive changes in the quality of the movement is appreciating the variability intrinsic to any repeated movement. Variability in execution can be viewed as an advantage and not as a nuisance during execution because the variability leads to adaptation that was not previously present within the muscle synergies (Schöllhorn et. al.). With the proper corrective exercise program design, new (and presumably improved) muscle synergies can be stimulated within a session using the body’s own intrinsic variability. As a result, the various muscle synergies interact to create changes in global movement that serves as a “reward” to the body.

The results can also be of tremendous value to the chronic pain client. This client very often associates familiar movements as pain producing. By facilitating muscle synergies that produce a movement outcome in a novel way, it helps that client disassociate those movements from a familiar pain producing movement.

This change is short term since a learning effect likely did not occur within an hour session. But since changes were produced independent of the trainer or therapist, the client/patient can reproduce the results daily on their own.
Progressions within a program are made not by adding repetitions or load to the same exercises, but instead creating variability within the sub routines of the program that continue to work toward the main objective(s). We do this through graded exposure. Graded exposure in this context is applied to the amount of variability and novelty the client can successfully handle without pain and compensation. By doing so, the neuromusculoskeletal system is continually challenged by the quality and not necessarily the quantity of the input.

Conclusion

When structured properly and with a clear understanding of potential for change, corrective exercises can create very powerful adaptations in the quality of movement in our clients, athletes and patients. The model proposed in this article is part of a very successful approach that has helped clients from around the world.

References

Brooks, VB The Neural Basis of Motor Control. New York: Oxford University Press 1986

Carey, A. (2005). The Pain-Free Program: A Proven Method to Relieve Back, Neck, Shoulder and Joint Pain. New York: John Wiley and Sons.

Gelsy Torres-Oviedo and Lena H. Ting, Muscle Synergies Characterizing Human Postural Responses; Journal of Neurophysiol 98: 2144–2156, 2007.

Lemon, R.N. (1993) Cortical control of the primate hand. The 1992 GL brown prize lecture. Exp. Physiol. 78, 263–301

Seyed A. Safavynia, Gelsy Torres-Oviedo, Lena H. Ting, Muscle Synergies: Implications for Clinical Evaluation and Rehabilitation of Movement; Top Spinal Cord InjuryRehabilitation. 2011; 17(1): 16–24

Wolfgang I. Schöllhorn, Hendrik Beckmann, Keith Davids, Exploiting system fluctuations. Differential training in physical prevention and rehabilitation programs for health and exercise. Medicina (Kaunas) 2010;46(6):365-73

This movement for the thoracic spine with the Core-Tex is sure to create improved mobility through the upper back and shoulder girdle. Varying the hand position gives you multiple options on how to influence the body.

There are distinct advantages to incorporating strategic movement as part of your overall myofascial release strategy. But it is more than just big movements. Watch the video and see how rhythm, timing and amplitude make all the difference in the world.

This powerful exercise from The Pain-Free Program: A Proven Method to Relieve Back, Neck, Shoulder and Joint Pain is a much different way of doing the familiar bridging exercise.

This article originally appeared on Ptonthenet.com

Do you own a pair of minimalist shoes? If you do, you’re in good company.

I present and teach all over the world, and I’ve seen minimalist shoe use among my fellow health and fitness professionals increase substantially, especially during the last 3 years. Enter any training facility or health club around the world and you are sure to see personal trainers wearing Vibrams or something similar. In fact, many fitness professionals have done away with other forms of footwear altogether and have embraced minimalist shoes as their full-time footwear.

Minimalist shoes – also sometimes referred to as barefoot shoes – include shoes ranging from traditional-looking shoes with very thin soles and structural support around the rearfoot to tighter fitting “gloves” (like Vibrams) for the feet that allow for separation of each toe. The term “barefoot shoes” is, of course, an oxymoron…a shoe of any kind insulates the skin of the bottom of the foot from coming in direct contact with the support surface, in contrast to going truly barefoot. Still, while much of the relevant research has examined barefoot versus shod running, many have extrapolated the barefoot results to minimalist shoes and used the positive outcomes as a basis to make a shift in their preferred training and day-to-day footwear.

Rather than focusing on the pros and cons of minimalist shoes, this article will instead examine how to maximize the benefits and minimize the risks of going minimalist. Let’s begin by taking a look at the science behind the movement

The Science Behind Barefoot/Minimalist Running & Walking

Many would argue that physical therapist Michael Warburton’s 2001 review of barefoot running in Sports Science was a major catalyst for the minimalist movement’s growth over the last decade. In 2009, journalist Christopher McDougall helped bring the concept of barefoot running to the masses with his bestselling book Born to Run: A Hidden Tribe, Superathletes, and the Greatest Race the World Has Never Seen.

A number of studies have compared the science behind barefoot and shod running (Eskofiera et al., 2011; Altman & Davis, 2011; Hamilla et al., 2011), and of particular interest are the kinetic and kinematic data related to running economy and injury. Daniel Lieberman, professor of human evolutionary biology at Harvard University, has done several studies comparing barefoot and shod running and is often quoted by proponents of barefoot running. One recent study – “Foot Strike and Injury Rates in Endurance Runners: a retrospective study,” published online ahead of print by Medicine and Science in Sports and Exercise (2012) – found that rear foot strikers (typically runners in shoes) had twice as many lower extremity repetitive stress injuries as forefoot strikers (common in minimalist and barefoot runners). The competitive, college-aged cross country runners in the study all wore running shoes. (It should also be noted that this study was partially funded by Vibram USA.)

But does this research on barefoot/minimalist running apply to people who do not necessarily run, yet spend the majority of their time in minimalist shoes?

In terms of walking, lunging, and squatting, etc. the answer is no.

To understand why, we need to first remember that the foot has two basic functional roles for human locomotion:

1) to provide a rigid platform to propel the body forward, and
2) to adapt to the surface it is on as bodyweight is accepted and through mid-stance.

If the surface is consistently hard and flat, the foot will adapt to that surface by consistently flattening out. When running barefoot or minimalist, the forefoot strike creates an immediate need for active myofascial stabilization of the foot and ankle that prevents foot flattening. This does not occur with a heelstrike when barefoot or shod.

But is flattening or pronating the foot a risk factor for injury? Not necessarily. In and of itself, pronation of the foot is supposed to occur. From a functional perspective, what it is important is: 1) how soon after the heel strike pronation occurs, 2) how fast maximal pronation occurs, and 3) how much total pronation occurs. Excessive pronation, however, can be a problem. Overpronation has been shown to correlate with increased tibial stress fractures (Hetsroni et al., 2008) and to affect pelvic alignment (Khamis & Yizhar, 2007). Further, asymmetrical amounts of pronation have been associated with a functional leg length discrepancy (Rothbart, 2006).

Studies show reduced stance times and shortened stride lengths when walking barefoot versus shod. The first peak of ground reaction forces, however, occurs at the same time and with the same shape for both barefoot and shod walking (Sacco, 2010). This means that when walking barefoot (versus running) one does not assume a mid- or forefoot strike. The muscular activity and fascial loading that is so advantageous even on flat, hard surfaces during barefoot/minimalist running is simply not present with barefoot/minimalist walking. As a result, total time and exposure to flat, hard surfaces should be a consideration when you or your clients are wearing a minimalist shoe. A training session on flat, hard surfaces may be beneficial if there is variety in movements and loads the body experiences during that session. Nevertheless, the benefits of wearing minimalist shoes as “everyday” shoes may be debatable for many clients/athletes.

Limitations of Minimalist Shoes

The ligaments and joint capsules of the 33 joints in the foot are rich in proprioceptors, as is the ankle retinaculum. The retinaculum of the ankle has shown to be thickening of the fascia of the foot and leg and are dynamic, non-static structures that are also very rich in proprioceptors (Stecco, 2010). Therefore the plantar fascia of the foot and the ankle are intimately connected. Movement of these joints of the foot and ankle provide valuable information to the central nervous system (CNS) regarding maintenance of our upright posture, weight distribution and locomotion.

When minimalist shoes are worn in highly predictable environments like health club floors, sidewalks, airports, and shopping malls, there is very little variation in the proprioceptive stimulation to the foot. In contrast, environments that have changing surfaces and surfaces of varying density that cause the joints of the foot to move with more variety will likely provide greater proprioceptive input to be processed by CNS. The variety in joint position creates much more diversity of muscular recruitment and fascial loading throughout the myofascial system. The evolutionary development of the human foot without shoes cannot be argued. We have to keep in mind that this development occurred over rocks, roots, branches on grounds with varying inclines in all directions.

A second aspect to acknowledge with the minimalist shoe is the absence of any significant cutaneous stimulation if the shoes are exclusively worn on man-made surfaces. The bottoms of the feet are one of the areas of the body with the highest concentration of cutaneous receptors. These receptors are optimally stimulated when pressures and contact surfaces to the sole of the foot are variable. The fitness floor does not provide this kind of stimulation. For the cutaneuous receptors to be appropriately stimulated in a minimalist shoe, localized and varying pressures would be applied to the foot as with walking on a dirt trail.

The plantar fascia and palmar fascia are tightly connected to the overlying skin. This skin/fascial relationship prevents the degree of sliding between skin and superficial fascia commonly seen in other areas of the body (Benjamin, 2009). This may be another connection in the role touch and pressure play in these two key areas as part of our evolutionary development.

Philip Beach points out in Muscles and Meridians: The Manipulation of Shape (2010) that the soles of the feet are innervated by sensory nerve roots from L4/L5 and S1, and that these spinal segments are the most vulnerable in upright posture. This means we must provide the ample stimulation to the soles of the feet to keep the lower back safe. Beach goes on to call shoes “sensory deprivation chambers that cut down the raw information we need to stand and walk in our precarious upright manner.”

There are other direct links from the sole of the foot to the health of our lower back. The small intrinsic and extrinsic muscles of the foot are innervated from L4 to S3. These same nerves also innervate muscles of the lumbar spine and pelvic floor.

Bringing Minimalist & Barefoot Training to the Fitness Floor

When wearing minimalist shoes themselves or recommending them to clients, trainers should be clear on their benefits and limitations. A body that has always worn supported shoes may not be able to tolerate changes to repetitive loading to the tissues of the foot and/ or lower leg for long periods of time on man-made surfaces. In a traditional training environment, it may be best to introduce the foot to minimalist shoes by reserving them for exercises that always have at least one foot in contact with the floor and involve multi-directional movements that create variability in joint positions throughout the foot and ankle.

It stands to reason that if a minimalist shoe is worn consistently on flat, man-made surfaces, you can use your professional creativity to maximize the potential benefits of stimulating the foot during training sessions through motion and tactile stimulation. This can be done while wearing minimalist shoes, but tactile stimulation is further enhanced when using no foot covering at all.

At the Function First studio, we built a simple but elegant rock garden containing three sections: one with small rocks, one with medium rocks, one with large rocks. Either prior to or at the conclusion of a training session, depending on individual needs, our clients will spend time in their bare feet on the rocks. Some clients walk on the rocks prior to a session to obtain the benefits of mobilizing the plantar fascia and muscles of the foot. Others walk on the rocks at the end of a corrective exercise session to “flood” their feet with cutaneous and proprioceptive input that can be processed and assimilated with the movement strategies facilitated during their corrective exercise program. In either case, there is no way to separate out tissue and joint mobilization from cutaneous stimulation; all happen simultaneously.

A rock garden can be any shape or size as long as the foot fits into it. Ours is made out of plywood and two by fours. The most important aspect of a rock garden is that the rocks are confined and not given the opportunity to slide around very much, if at all.

If the goal is to increase the tactile stimulation to the soles of the feet, we will also use balance pods. The balance pod is dome shaped, about 6 inches in diameter and has raised plastic protrusions. These protrusions provide very specific points of tactile stimulation to any area of the foot in contact with the pod. Clients can stand with each foot on a pod. Because of the dome shape and conforming surface of the pods, the joints of the foot can be taken through movements that are not consistent with flat ground.

Our studio has traditional mat flooring that our clients will exercise on barefoot or in socks. Since the foot is only stimulated through motion on this surface and not through variable pressures or unpredictable foot placement, the rock garden and pods fill that need. Clients are encouraged to spend time barefoot or minimalist outdoors on natural surfaces to stimulate the foot regularly. The same advice applies to anyone with continuous exposure to man-made surfaces.

Liability issues, as well as concerns regarding hygiene and safety, may keep us from going completely barefoot when we want to. As an alternative to going barefoot, minimalist shoes provide an opportunity to appropriately challenge foot function in our bodies’ best interests.

Reviewing the research on barefoot walking versus shod (shoes), we see that the foot strike does not shift to the mid-foot and forefoot the way it does with running. As a result, when seeking the benefits of minimalist or barefoot training, we must be cautious when we extrapolate the impact on walking and everyday use based on running-specific research. The modern adult foot has probably not been exposed to the variable terrain and minimal foot coverings that our ancestors experienced. Removing a client from the support of shoes after decades of wearing them should follow a progressive exposure to surfaces other than those that are flat and man-made. When an environment conducive to foot variability is not present, the fitness professional can minimize the risks and maximize the benefits of the foot by providing an appropriate stimulus such as the rock garden described above.


References

Altman, A. & Davis, I. (2011, May). Comparing Barefoot Running to an Altered Strike Pattern in Shoes. Medicine & Science in Sports & Exercise, 43(5): 59.

Beach, P. (2010). Muscles and Meridians: The Manipulation of Shape. Philadelphia, PA: Churchill Livingstone.

Benjamin, M. J. (2009). The fascia of the limbs and back – a review. Anatomy: 1-18.

Eskofiera, B., Krausb, M., Worobetsa, J., Stefanyshyna, D., Nigga, B. (2011, Feb.) Pattern classification of kinematic and kinetic running data to distinguish gender, shod/barefoot and injury groups with feature ranking. Computer Methods in Biomechanics and Biomedical Engineering.

Hamilla, J., Russella, E., Grubera, A., & Millera, R. (2011). Impact characteristics in shod and barefoot running. Footwear Science, 3(1).

Hetsroni, I., Finestone, A., Milgrom, C., Ben-Sira, D., Nyska, M., Mann, G., Almosnino, S. & Ayalon, M. (2008, January). The Role of Foot Pronation in the Development of Femoral and Tibial Stress Fractures: A Prospective Biomechanical Study. Clinical Journal of Sport Medicine, 18(1): 18-23.

Khamis, S. & Yizhar, Z. (2007). Gait & Posture, 25: 127–134.

Lieberman, D.E., Daoud, A.I., Geissler, G.J., Wang, F., Saretsky, J., Daoud, Y.A. & (2011, Published ahead of print). Foot Strike and Injury Rates in Endurance Runners: A Retrospective Study. Medicine & Science in Sports & Medicine. Retrieved from http://journals.lww.com/acsm-msse/Abstract/publishahead/Foot_Strike_and_Injury_Rates_in_Endurance_Runners_.98750.aspx.

Rothbart, B. (2006, November/December). Journal of the American Podiatric Medical Association, 96(6).

Sacco, I., Akash, P. & Hennig, E.M. (2010, Feb. 3). A comparison of lower limb EMG and ground reaction forces between barefoot and shod gait in participants with diabetic neuropathic and healthy controls. BMC Musculoskeletal Disorders, 11: 24.

Stecco, C., Macchi, V., Porzionato, A., Morra, A., Parenti, A., Stecco, A., Delmas, V. & De Caro, R. (2010). The Ankle Retinacula: Morphological Evidence of the Proprioceptive Role of the Fascial System. Cells, Tissues, Organs, 192(3).

Vincent, K.R., Vincent, H.K., Seay, A.N., Lamb, K.M., Greenberg, S., Conrad, B.P. (2011, May). Effect of Running and Walking in Barefoot and Shod Conditions on Gait Parameters in Trained Runners. Medicine & Science in Sports & Exercise 43(5): 60.

Warburton, M. (2001, Dec.). Barefoot Running. Sport Science.