One of the hardest things to do as a person who prescribes exercise is to take an internal perspective on exercise design. There is so much talk these days of sets, reps, and protocols, and not enough on exercise biomechanics and quality of movement as it relates to load. Exercises are merely attempts to organise a movement which then challenges certain muscles in the body. Externally visible parameters of the event such as foot and hand placement, path of limbs during movement and global range of motion are and should be tailored to the individual.
To simplify things, we categorise exercises with names like “squat”, “push up”, etc, to denote what is actually an orchestration of joint movements by muscles. Following this we also try to sub-classify movements to show variations in execution, like “sumo squat” for wide stance squats, “diamond push ups” for narrow hand-placement pushups etc. This is for ease of discussion and to help the layperson understand the exercise. This is all well and fine, but exercise professionals looking to refine the stimulus miss the point. There are no “universal standards”, there are only clinical choices. As such, while it is fine to discuss exercise performance in these terms with the layperson, professionals need to take an investigative approach.
Anatomical structure determines performance in the immediate situation. Performance over the long-term will influence structure. This is a feedback loop that over time creates a more stable structure if done correctly, a damaged structure if not. In the immediate exercise session, we are essentially aiming to directly stimulate muscle in a safe manner. Indirectly we stimulate bone, connective tissue, and organs. That is why for exercise to be both effective AND safe, it must be internally determined. As such, while competition style exercise such as Crossfit and boot camps can and obviously do yield tremendous results, they do so in an unsafe manner and eventually lead to irreparably damaged joints.
But what about sports and other recreational activities. Again, I take the stance that movement execution should be predicated on the individuals’ structural reality. Once you add in externally driven elements such as competition or position requirements, you sacrifice structural integrity. If you enjoy running for instance, you need to find a style and method that is most congruent with the joints in YOUR body and no one else’s.
Note: I am not saying competition is unhealthy on a spiritual and emotional level, I am merely stating the fact that excessively poor movement done in a fatiguing fashion while pushing the envelope can cause unfavourable structural damage.
We discussed structural integrity with exercise design, but what about emotional integrity? When I see clients I don’t just get the physical situation they are in, but their emotional state and accumulated lifestyle stress. Poor hydration, work related stress, and lack of sleep affect joint ROM and muscular recruitment. One needs to adjust accordingly. This is where art and experience meet science.
As mentioned, what I propose is an investigative approach, mapping out the client’s physical and emotional situation on a day by day basis, ie the stability of their entire neuromuscular force generating system. More specifically, utilizing things like passive and active ROM tests for joints before exercising their respective muscles, and focusing on testing them in the positions you mean to load them. Too often do I see clinicians tests hip ROM with the client lying supine and then make them squat to depth. Joint ROM is often positionally related as Centre of Mass and direction of gravity changes relational to your position in space. When you use external loads such as a barbell, the COM of the barbell/human union changes as the weights increase, which changes muscular activation patterns.
The end goal is the guide the client through this process. It is more time and energy-consuming but necessary if one wants to be a top-level coach. For motivated clients, the coach should guide them toward being able to autoregulate and respond to biofeedback. This takes time. Some learn it automatically, but we can hopefully expedite the process.
Listen to your body, apply load when appropriate and progress safely and while maintaining ready-state health.