Why “corrective exercise” is incorrect

If you’ve ever spoken with a rehab professional or a personal trainer before you have likely heard the term “corrective exercise”.  Although there is no formally accepted definition of the term, the concept typically refers to exercises that are intended to correct muscular imbalances in the body or address dysfunctional movement patterns.  The implication behind both of those “problems” being that they somehow directly cause injuries.  

We’re just going to get right to the point - corrective exercise is a bogus concept that was invented by the fitness and rehab industry to increase bottom line earnings.  

Here’s a screenshot taken directly from the National Academy of Sports Medicine (NASM) website (https://www.nasm.org/injury-prevention/why-corrective-exercise).  Nowhere on this page is there an attempt to define corrective exercise, but there are plenty of reasons for someone to pay NASM to become certified in them.   

We realize that this can be a sensitive subject for many people but allow us to explain.  Please note that our issue is not with trainers who have purchased the certification. Our issues are with the industries-at-large that push a concept that can be potentially limiting to those we are all collectively trying to help. 

Muscular Imbalances

Let’s face it - we’re all a little off balance.  Most of the time we think of having a “stronger” side in either the arms or legs because we tend to be more coordinated on that side.  For example, a baseball pitcher may feel stronger on their throwing arm because, well, that’s the side they know how to throw from. Sure, if we were to objectively measure their muscle mass via Bio-electrical Impedance Analysis or DEXA scanning they may have more muscle mass there because of more time spent utilizing the muscles of said arm and shoulder.  However, muscle mass is not the same as muscle strength and it is certainly not the same as coordination, work capacity, and a bunch of other characteristics within the neuromuscular and musculoskeletal systems.   

Ok, so what if I’m talking about my muscular strength imbalances?

The instances that first come to mind where muscular strength imbalances are related to injury are quad strength asymmetry after ACL reconstruction and hamstring to quad strength ratio in sprinters.  

For the ACL injury group, the key factors to note here are that this risk pertains to reinjury of a previously reconstructed ACL.  The quadriceps muscle group has a tendency to atrophy immediately following an ACL reconstruction and the ratio that poses the greatest risk of reinjury is if the quad on the reconstructed side is greater than 10% different in force production than the non-surgical side.  

Two things come to mind when considering this statistic.  

1. 10% is fairly significant.  Just because your jeans fit tighter over one quad than the other doesn’t mean you have a 10% difference in strength (again, mass does not directly equate 1:1 to strength).  

2. This is referring specifically to post-operative ACL patients.  This is NOT referring to just anybody who has a strength difference in their quads.  If this were the case you would see people experiencing hemiparesis (one-sided weakness of their bodies) after a stroke tearing their ACL’s just walking around.

As far as sprinters go, the argument has been made that it isn’t so much the difference between hamstring and quad strength that poses an injury risk so much as it is an inadequate baseline strength of hamstrings at lengthened positions and during eccentric contractions that poses the truest risk of sprint-related injuries.  

Dysfunctional Movement Patterns

This is another buzzword (or buzzwords?) that gets tossed around a lot, popularized by the Functional Movement Screen (FMS) by Gray Cook.  The implication here is that a “dysfunctional movement pattern” as determined by an arbitrary battery of tests with an arbitrary scoring system can predict an athlete’s likelihood of injury.  Unfortunately, the research tends to point to this not being the case at all and even suggests that athlete’s with a greater variety of movement capabilities tend to withstand against injury better than those who demonstrate less variability.  

But even taking this discussion one step further, what is a dysfunctional movement pattern?  Who determines what that is? Sure, certain technique changes to particular movements can be more efficient for some people in performing a particular task, but that doesn’t mean someone is more likely to get injured having a less-than-efficient movement technique.  Here are some instances where a variety of movement patterns exist to achieve the same functional task.

1. Runners in a marathon 

2. Basketball players shooting free throws

3. Weightlifters at the olympics

Why does all this matter?

Aren’t we just talking semantics here?  

Yes, yes we are.  And semantics matter when discussing a person’s injuries, risk for injury, and more importantly their potential for healing.  

Our collective stance is this: Anybody, whether they be a trainer, a coach, a therapist, or joe-schmoe is free to do any exercise they wish.  However, when selecting exercises and creating an exercise program the important questions to ask yourself are:

1. Is this exercise targeting what needs to be targeted? 

2. Is the dosage (sets, reps, and load) appropriate to create the adaptations I need?

These questions are as pertinent to rehab as they are to training.  After all, what’s the difference between rehab and training anyway? We’ll discuss this in our next post.