Pain, Injury and Load Management - A Case for 'Correctives'

The term ‘corrective’ exercise has been bouncing around the S+C school yard for a little while now, but similar to ‘stability’ - ( what makes a joint stable blog), I don’t think enough people actually understand what the term ‘corrective’ means. I also think most people are blinded by what is actually occurring when ‘correctives’ are programmed with a positive outcome. Before we delve into correctives, we need to lay the foundation for the conversation, pain, injury and load management.

Pain science in general is a very deep rabbit hole, however, it is well understood now that pain is often multifactorial with many contributing factors for the onset of pain and just as many factors that influence the rehabilitation of the pain/ injury. Pain doesn't always equal damaged tissues or broken structures, and for our discussion today in talking about ‘correctives’ and how they provide positive outcomes for people who train regularly we need to first discuss load, technique and tissue tolerance in relation to pain.

New school of injury reduction and management says ‘load/ volume is king’. When an injury presents it generally means the load/ volume at time point ‘X’ exceeded the tolerance of the tissue (muscle, tendon, joint) at time point ‘X’. This load exceeding tolerance understanding is true for both chronic injuries and acute injuries. For the rehabilitation of these injuries we must build the tolerance of the tissues back up with gradual exposure to load and stress. I must note though, we are purely talking about nociceptive pain in this article (biomechanical pain), pain not influenced by psychosocial factors or sensory hypersensitivity or the ‘rabbit hole’ of pain. This nociceptive pain would be indicative of more training based pain/injuries, damage to the tissue itself.

A sharp increase in load exceeded the tissue tolerance causing an injury at time point 5.

A sharp increase in load exceeded the tissue tolerance causing an injury at time point 5.

An acute example of this would be a full contact ACL rupture in Soccer. In general play, the ligament can tolerate the loads of jumping, cutting and deceleration, however, when an 85kg opponent slides in and crashes the leg, the ACL’s tolerance is exceeded and it ruptures.

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Tissue tolerance was exceeded after a long period of progressively increasing load exposure.

Tissue tolerance was exceeded after a long period of progressively increasing load exposure.

A chronic example of this would be patellar tendinopathy causing pain after a long volume/ hypertrophy phase of strength training. If recovery is not prioritised and adequate rest not prescribed, tolerance may be exceeded over the course of the program and pain/ injury may be the result.

A few things to note regarding tissue tolerance:

  • Gradual, increasing exposure to loads over time is the only thing that can INCREASE tissue tolerance. For most, this is either through strength training or specific training (running loads, jumping loads, sprinting loads etc.)

  • Tissue tolerance can be OPTIMISED through adequate recovery (sleep, hydration, nutrients, rest etc.).

  • Tissue tolerance can be heavily REDUCED with poor recovery (sleep, hydration, nutrients, stress).

  • A specific tissue’s tolerance can vary greatly at different joint angles and biomechanical positions.

  • High acute loads can be tolerated far better when shared across multiple joints, structures and tissues within the body (optimal technique).

  • High chronic loads can be tolerated far better with adequate rest, deloads / low stress training periods.

In summary, as soon as tissue tolerance is exceeded an injury will occur. Gradual increases in load exposure over time will strengthen the tissues allowing for a greater tolerance and greater exposure down the line. Exposure to too much load, too quickly and you are back to square one, either in pain or injured. Many factors will influence the tissue tolerance at any one point in time.

So where do ‘correctives’ fit into this discussion?

Mobility, Stability and Flexibility based drills are lumped into the category of ‘correctives’. For the most part these drills are designed to improve movement efficiency/ capacity/ competency and in some cases reduce pain.

Lat Hang Breathing - a staple corrective for our Strength Culture powerlifters.

Lat Hang Breathing - a staple corrective for our Strength Culture powerlifters.

The term ‘corrective’ is shunned by a lot of S+C coaches because no human movement is inherently bad. It is not the positions we are in that cause injuries, it is the load that is placed on the tissues in those positions at any one point or over a period of time. For example, valgus knee positions have been shown to be a mechanism for ACL ruptures as seen in in our acute ACL soccer example. However, the valgus knee position can be loaded without injury too, as seen by Zhou Jun of the Chinese Olympic Weightlifting Team.

Zhou Jun showing her robust her tissue tolerance is.

Zhou Jun showing her robust her tissue tolerance is.

The valgus position of the knee did not cause the injury, it was the acute increase in load placed on the ACL in the valgus position that caused the injury. Yes, valgus knee positions will stress the ACL with more load than a neutral knee, but moving your knee into valgus with a load that can be tolerated will not obliterate your ACL. This is why corrective exercise is often overlooked, and quite frankly refuted by some in the S+C world - acute or chronic exposures to load is what cause injury, not the positions.

Corrective exercises have the potential to improve biomechanics and technique over time. This biomechanical advantage shares the total load across more structures within the body for any specific movement. For example, improving Hip Internal Rotation with a 90/90 Hip Lift w/ IR Bias does nothing to change the load placed on the body in a single squat session or squat program. However, the corrective drill, 90/90 Hip Lift w/ IR Bias, allows for improved bilateral deep hip flexion which shares the total load across more muscular structures of the posterior chain. This increased posterior chain recruitment reduces the total load on the intervertebral discs of the lumbar spine though improved hip flexion. The same can be said for any ‘corrective’ programmed with a positive outcome for a lifter or athlete, the biomechanical improvements to technique allow for the load to be shared across more muscular structures reducing the total load on any one structure.

As you progress in your training age and you get stronger and more efficient over time with technique improvement, your reliance on ‘correctives’ to help improve your biomechanics should reduce. Someone who has squatted consistently for a long period of time will require less ‘correctives’ than a brand new lifter at 35 looking to get stronger to play with their kids. Yes, load management can completely stop injuries from occurring, but if you plan on pushing the envelope in regards to your tolerated loads and hence, adaptation to these loads, you best have strategies in place to accelerate technique improvements.

Here is a great article that delves far deeper into pain:

About the Author
Jamie Smith, Owner and Director of Coaching at Melbourne Strength Culture
IG: @j.smith.culture
YouTube: Melbourne Strength Culture