Leveraging the corrective exercise continuum for lasting pain reliEf
If you have ever had a session with me, you know I can be big about post-treatment movement and exercise. At best, I only see you in my office a couple of times per month, so what you do outside of your time with me can make a huge impact in terms of pain management and range of motion.
And I like it that way
I would rather you only see me 1-2 times per month and make progress on your own than see me multiple times per week and become reliant on me. Perhaps this makes me an awful salesman, but I beleive it is the most ethical way to operate, and I'm convinced that I get so many referrals because my clients agree.
I don't want you to "need" me. I want you to be empowered. My goal is to always have peope coming in for monthly maintenance massage. If you need to see a practittioner 2-3 or more times per week, frankly they aren't doing their job.
I've started to realize that many people would have better outcomes, AND be able to help themselves more effectively, if they understood some of the theory behind what I do. So I've decided to write this 5-part article series to outline how I leverage the National Academy of Sports Medicine's (NASM) Corrective Exercise Continuum to do just that.
This first article will outline and summarize the phases of NASM's continuum, with the other 4 articles taking a deeper dive into each.
My hope is that you can read this series and have enough info to begin to guide yourself to better pain management and ROM if you aren't able to get in to see me as often as you'd like...or if your just sick of looking at me.
Also, it will allow me to devote more of my time to video games and sleeping. It's a win-win.
Let's talk about the continuum
Corrective exercise deserves special attention.
Yes, from a psych perspective, I hate the term "corrective exercise", as it can be inherently nocebiotic (this is a whole other article that I'll be writing soon). Also, technically, we're not "correcting" anything outside of a surgical intervention. I don't want to turn this into a semantic/linguistic discussion, though, so onward...
When I talk to many clients in my office, their main way of dealing with their pain or ROM issues is stretching. Specifically, static stretching. While I believe that all forms of movement and stretching have their place in an effective program, I feel that static stretching is often used as a catch-all at the expense of strengthening other regions of the body that may be contributing to the problem.
Creating lasting change, at least from a structural perspective, requires treating everything that is a contributing factor. And outside of structural issues, this gets even messier in the context of pain management and the biopsychosocial model. That's a bit beyoind the scope of this article, but let me tell you: your attitudes and beleifs about your pain are just as important as the structural aspects of your body...
Back to the continuum...
So, yeah, we like to stretch a lot and miss the mark sometimes. This is where the NASM continuum comes into play. While not foolproof (it does, in fact, get a bit myopic), applying this continuum and the principles will take you much farther than simply stretching something that currently hurts.
It involves 4 phases.
These phases are: Inhibit, lengthen, Activate, Integrate.
Let's talk about them.
The first stage of corrective exercises is the Inhibit stage, and this stage aims to reduce or modify the activity of the nervous system. For some reason or another, there are muscles that are overactive, and usually we identify these through various movement assessments in my office, or through palpation. Before we can do anything to manage the problem, these areas need to be inhibited. In an nutshell, we need to calm the nervous syste, down before we do anything.
I do this with my hands, or with various other soft-tissue tools I have in my office, but the most common one that you can do this is - you guessed it - foam rolling (AKA: self myofascial release). This can also be done with a percussion massage gun, etc.
Basically, if the nervous system is spooled up, we can't get the muscle to relax and lengthen, so this is the FIRST step in the process, and one that is often misapplied or simply skipped.
AFTER the target area has been inhibited, we can go ahead and stretch it. Stretching exercises can help improve flexibility and range of motion...no secret here. High flexibility may improve your performance in physical activities or reduce the risk of injuries by assisting joints to move through a full range of motion and enabling muscles to work more effectively. Stretching exercises also increase blood flow to the muscles.
We'll get more into this in the dedicated article, but after inhibition is a good time to stretch the affected area: static stretch, assisted, active isolated, etc. You have many options here.
The first two phases of the continuum are the most commonly misused. These last two are generally ignored altogether. To be fair, this is because these last phases require at least a basic understanding of anatomy, physiology, and movement.
The third stage - Activate - involves underactive muscles. Here, we are essentially stimulating the musce tissue, usually of the antagonist mucsle (this will all make sense in the article specifically dedicated to activation, so stay tuned).
How do we do this?
Usually with a set or two of corrective exercises done immediately after phases one and two. For this, NASM recommends the use of isolated reinforcement - so we'd be doing a single-joint movement that will be highly controlled and carried out slowly and carefully. As for equipment, we can use dumbells, bands, bodyweight movements, or even isometrics.
If you've ever been to a Physical therapist, a lot of these movements a reminiscent of what they will assign you for rehabilitation of a specific area. In fact, this is so similar that I have to be very careful about wandering out of scope as a Massage Therapist. I also can't fathom why so many personal trainers do this, as it is DEFINITELY out of scope for them.
Integration exercises help with muscle coordination because they use multi-joint movements and multi-muscular synergy.. In addition, integrated techniques are used to re-measure functional movement patterns by re-establishing neuromuscular control and promoting coordinated movement.
In English: we take what we did in phases 1-3 and integrate that into a full body movement pattern to "groove" it, so to speak.
Integrate exercises begin with slow, focused, multi-joint activities.. Over time, these exercises evolve and advance the movements involved in Integrate exercises by changing resistance, speed, movement levels, the base of support, introducing upper body movements and even increasing impact in some cases.
How about an example?
Ok, in the event that the above made no sense, here's an example from and actual client.
"M" comes in to see me with a chief complaint of neck and upper trapezius pain. His ROM is clearly limited in neck rotation bilaterally. Palpation reveals hypertonicity of the neck and upper trap.
We do some neck and upper back work (Inhibition), as well as some assisted stretching techniques to the are (strectch).
I've identified the rhombiods and mid/low traps as part of the issue, so I go through a range of active resitance exercise on the table with "M" (activation). Once the session is complete, we do a series of integrated exercises (integration).
"M" leaves with the following suggestions daily*:
Use a lacross ball or roller to release the upper traps for 45 seconds (Inhibit)
Stretch traps and levator for 30-60 seconds (stretch)
perform 1 set of 15 reps of shoulder "Y" (activate)
Perform a squat to overhead "Y" with resitance band (Integrate)
* this is off of the top of my head, we may modify things, or the integration phase my simply involve whatever movements they are doing in the gym as part of their current training plan.
wrapping it up
Hopefully, you have a better indication of what goes into the creation of post-treatent suggestions after reading this. Or, a least you realize why you aren't getting lasting releif if all you have been doing is stretching and foam rolling things with no rhyme or reason behind it.
Creating a movment routine that will get you out of pain and get you the performance results you are looking for require a bit of thought.
And now you know.
In the next article, we will discuss the inhibition phase in depth, including some of the most common and effective foam rolling strategies and protocols (Spoiler: most people are foam rolling incorrectly and it isn't helping them).
If you got something out of this, or have any questions, I'd love to hear from you! Shoot me a comment or email....or better yet: book a session with me and we can talk all about this while working on your goals!