All of us know loads of exercises, we have been using them for our own training, performance training and for rehab for many years. At first a lot of the exercises come to most of us from watching others – either people in the gym or colleagues. I remember learning exercises by body part as part of my sport science degree, and then from prominent industry experts when I was working in gyms. The process was always the same: watch the exercise, learn the teaching cues and then correct others’ technique.
However, it occurs to me now that this might be a bit backwards!It’s probably a process we’ve all been through, but we are learning random exercises with no structure (or at least I was). Now when I am prescribing exercise I really want to build the exercise based on that individual patient, not simply give out pre-determined exercises.
I often see patients who have been given exercises by someone else, or found them on the internet, and although there is nothing wrong with the exercise in itself it is totally inappropriate for that individual. For example, given standard exercises for whiplash – which are fine for some and make others much worse – there’s no thought process. Now I believe that the exercise has to be for the individual, and not the other way round.
So how do we build exercise?
The starting point has to be an understanding of function. You need to know what is happening in the individual’s desired function eg gait, kick a ball, jump etc. I most commonly work with gait as a basis as that is what my patients need. Then we need to know the goal of the exercise eg range, strength, power, stability etc. Then it’s time to put it all together, build the exercise around the desired function and then tweak the parameter to suit the goal.
Here’s an example:
Limited right hip internal rotation in gait, causing the foot to spin out when it is a back foot (we’ll assume I’ve cleared all other joints/planes).
Well, we know the function is gait, so we need to know what is contributing to this function, we’ll stick to the hip so it doesn’t get too complicated. If we are looking at a back foot motions we know the hip will be going through extension, abduction, and internal rotation. We know the goal is range as internal rotation is limited. So let’s build!
We want the exercise to challenge end range, so I would keep the right foot (limited side) on the floor to allow the foot to be relatively fixed. I would start the exercise with right foot forward and drive the left foot either anterior or right anterior lateral. This creates a fair amount of extension and internal rotation, but limited abduction if any. I would then add bi-lateral arms, right rotation at shoulder height, timed to hit end range immediately after the hip reaches end range. You can then tweak the arms to add more hip extension or more abduction as you think necessary.
This is a totally different process, but you end up with the perfect exercise for that individual and you have far more control over the exercise. Because you built it with your thought process, you can tweak it infinitely to meet the needs of your client.