Accommodative versus Corrective Movement

Categories: Blog May 23, 2022


And now, a guest article by OS Instructor, Dr. Kurt Brooks...

 

Are we accommodating the dysfunction, or correcting it?
The OS coaches I get to work with on a daily basis are hands-down some of the best in the business with modifying exercises and activities for our clients in the gym.  I’ve seen them modify activities for clients with back pain, rotator cuff injuries, arthritis, strokes, Parkinson’s, spinal cord injuries, and more.  But recently, we were discussing a client with significant ankle mobility restrictions and one of our coaches suggested adding a block/board under the client’s heels to allow them to squat with better form.  
 
 
Adding a block/board under a client’s heels is a popular choice for improving squat mechanics in someone who is lacking ankle mobility (loss of ankle dorsiflexion due to joint or soft tissue restrictions). Loss of ankle dorsiflexion can lead to mid-foot pronation, rear-foot eversion, tibial internal rotation, valgus collapse of the knees, inhibition of the glutes, and excessive forward trunk lean with squatting and lunging.  So, modifications such as shortening the squat, using a Smith machine, adding a board under the heels, or widening the stance (Sumo squat position) and others, can help get around the stiff ankles and avoid injuring other parts of the body.
 
 
Those are all great ideas! None of us got into the medical or fitness industries to see our patients/ clients get hurt.  So, we modify!  And we’re good at it!  But when do we (or do we at all?) switch from modifying an exercise to correcting the underlying problem?  Are we stuck playing with range, rate, load, or other modifications?... Or are we adding joint and soft tissue mobility activities and isolated strengthening exercises? Are we pressing reset to determine if the limitation is neuromuscular in nature (excessive sympathetic tone or neuromuscular inhibition) or truly a mobility restriction or muscular weakness?
 
 
For our client with stiff ankles, we absolutely modified his squats with the addition of a board under his heels.  We didn’t want to see him hurt something else.  We absolutely gave him banded activities to improve glute recruitment.  But we also added a “monster band” to his Lego rocks to add a posterior glide to his talus (the top of his ankle) while he rocked forward, as his ankle (talocrural joint) lacks significant posterior gliding and thus limits his ability to dorsiflex his ankle.  As I am also a physical therapist, I spent quite a bit of time with manual interventions to improve his ankle, rear-foot, and tib-fib joint mobility before moving to resets and banded mobility and strengthening exercises.
 
 
In a world of compound exercises and global movement trends, we can’t forget that there is a time and place for isolated muscle strengthening and isolated joint mobility activities.  If we are only modifying activities for our clients and not addressing the underlying cause of the dysfunctional or painful movement, we may be missing what our client truly needs.  If you are stuck in a rut of modifications and accommodations with a client, have a coworker take a look at your client or refer them out to another medical/fitness professional who can tease out the underlying cause of the client’s pain or movement dysfunction. Then with the addition of specific mobility, strengthening, and neuro-motor control activities and/or manual interventions (if your profession allows them), the need for modifications goes away.
 
 
When you’ve worked through modifying activities with a client and that client can now do something they were unable to when they first met you, you are no longer just a movement expert… You are a healer!

 

Kurt is a physical therapist with almost 30 years of experience. Working with orthopaedic and sports medicine injuries, he continues to build on his love of learning - from completing a manual therapy fellowship, earning an advanced doctorate in Physical Therapy, to teaching at the Duke University School of Medicine/ Department of Physical Therapy. His love of movement has evolved from participating in all major sports during his childhood and playing college-level volleyball, to attaining his 2nd-degree black belt in Tae Kwon Do and challenging himself with Spartan races in time for his 50th birthday. Kurt continues his love of anatomy and biomechanics, lifelong learning, caring for others, and movement by incorporating Original Strength concepts into his clinical practice and daily life.

Kurt's average client is 10 - 100 years old. Most have a fear of movement for one reason or another. Sprains and strains... aches and pains... to pre and post-op care. Sports conditioning and general fitness.


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