Therapeutic Exercise – Is Good Form Enough?

As Physical Therapists we prescribe exercise on a daily basis. Some experts say focus on the correct movement pattern and you will automatically use the correct muscles. While I agree good form is essential I’m not sure it is the whole story.

This point came up when interviewing Nancy Bloom (PT, DPT, MSOT) about Movement Impairment Syndromes of the Hip. Nancy is an Assistant Professor at Washington University in St Louis and has worked alongside Shirley Sahrmann for many years.

When asked , “Are there any common mistakes you see physical therapists make when treating hips?”, this is what Nancy said:

Nancy Bloom: One of the things I feel very strongly about when prescribing exercise is that you
can’t just give a person an exercise and expect it to be done perfectly.

For example, side-lying hip abduction is supposed to be an abductor strengthening exercise, a posterior gluteus medius exercise. Well, if you take someone maybe who’s had surgery or who’s pretty weak, you put them in side-lying, and you ask them to perform hip abduction and they tell you, “I feel that in my inner thigh.” You’re like, “That’s kind of crazy isn’t it? Why would you feel it there? That’s your adductors not your abductors.”

But when people are recruiting in an effort to perform a motion they’re going to recruit a variety of things. So, the motor performance to me has been something that I have found that I really spend more time on, not giving an exercise that’s too hard which causes them to recruit compensating muscles. In these cases I downgrade the exercise so that they can perform it and feel it in the correct spot.

Another good example is sitting hip lateral rotation. It’s frequently not really followed well in many patients, but particularly patients who have had total hip replacements. The deep lateral rotators are cut and there’s a lot of emphasis on “can you walk without a limp?” Nobody’s really watching for are they medial rotating when they walk. And then when you give them an exercise, sitting hip lateral rotation, they often feel it in their hip flexors or they’re lifting their leg up off the table as they laterally rotate because they are using their Sartorius in a compensating manner.

So, there’s so many ways to cheat, and it’s just so important to downgrade the exercise and make sure that the muscle you’re after is performing the exercise. The motor performance related to an exercise to me is something that people don’t often pay attention to.

Nancy also discusses some of the more common Movement Impairment Syndromes of the Hip including Femoral Anterior Glide and Hip Adduction Medial Rotation.

To read more excerpts from the interview or to sign up to listen to the entire interview please visit http://www.physicaltherapycontinuingeducation.org/movement-system-impairment-syndromes-of-the-hip-with-nancy-bloom/

Physical Therapy Continuing Education.Org is a free resource, bring the experts to you. Check out the entire interview series including: Stuart McGill, Brian Mulligan, Tim Flynn, Gwendolen Jull, Stanley Paris, plus many more.