Exercise Order and Sequencing for

Corrective Exercise Programs

By Justin Price
Date Released : 08 Apr 2013

Learning Objectives:
1. The reader will learn why it is important to structure corrective exercise
programs in a sequential manner to help increase client confidence and
adherence.
2. The reader will learn the recommended exercise order for designing
successful corrective exercise programs.
3. The reader will learn how and when to progress a clients corrective
exercise program.
Many elements must be taken into consideration when designing successful
corrective exercise programs. Knowing how to select and implement safe and
effective exercises is important, but you must also incorporate the particular
needs and capabilities of every client to promote adherence and minimize
potential for discomfort. You must also structure programs in a logical
sequence so clients can achieve the greatest benefits in the least amount of
time and know when to progress and regress programs to maximize success.

Consider Your Clients Needs

When clients first discuss their physical problems or movement issues with
you, remember that they may have been feeling a lot of fear and anxiety
regarding their pain, injury, and/or dysfunction probably for quite some
time. They may have lost confidence in their ability to perform certain tasks
and will generally lack the self-assurance needed to perform complex motor
tasks, especially those that require the use of the affected or painful area(s). To
help boost client confidence at the outset of a corrective exercise program,
choose easy-to-perform exercises that address the clients' imbalances and
increase their own belief in the ability to perform the exercises/movements
successfully. When a person attempts a new exercise and is able to perform it
correctly, it increases self-confidence. This increased confidence will motivate
them to repeat the action and also increase the likelihood they will be open to
trying additional exercises.
The guiding principle of corrective exercise programming is the same as that
of traditional fitness programs - gradual progression. Introducing concepts and

exercises at a manageable pace for clients increases confidence, adherence

and belief in their own abilities.

Corrective Exercise Order

Corrective exercise programs should address imbalances and deviations in a
logical format. Damaged and stressed tissue structures must be reconditioned
and rejuvenated before attempts at dynamic stretching or strengthening
movements can be made. When designing a corrective exercise program,
incorporate activities that accomplish the following goals in the order listed
below:
1. Regenerate and release the fascia, muscles and tendons,
2. Realign and increase blood flow and range of movement to structures,
and
3. Strengthen the muscles and challenge the nervous system.
In other words, begin with the introduction of self-myofascial release (selfmassage) techniques, progress to stretching, and then to strengthening
exercises (Price, 2010). The remainder of this article will explain each of these
techniques and activities.

Self-Massage
Self-massage regenerates and rejuvenates soft tissues that have become
adversely affected by chronic malalignments (Abelson, 2003). These types of
exercises are usually easier for clients to perform than more complex,
movement-based exercises. Moreover, self-massage not only promptly
reduces painful symptoms, but clients can also be successful when doing these
techniques which helps build their confidence.
Two popular kinds of self-massage are:
1. Self-Myofascial Release (SMR) Self-myofascial release is a massage
technique of applying continual pressure to an area of the fascia that
contains restrictions or lacks movement. The sustained pressure
stimulates circulation to the area, reduces pressure build-up from
sluggish blood flow, and restores suppleness to the myofascial tissue
(Barnes, 1999).
2. Trigger-Point Massage. Trigger point massage differs slightly from
SMR in that it is intended to target a very specific area of a muscle (or
the surrounding fascia). Trigger points are so-called because they
trigger a painful response to the surrounding area when stretched,
moved, or touched. Both techniques are very effective methods for

preparing the soft tissue structures of the body for movement at the
beginning of any corrective exercise program or exercise session.
Teach clients how to utilize foam rollers, tennis balls, golf balls, lacrosse balls,
baseballs, racquetball balls, or trigger point therapy sticks, such as a
Theracane, electronic massage devices, and their hands and fingers to
perform self-massage. Recommend techniques that clients can replicate at
home, the office, or anywhere they feel completely comfortable.
An example of a self-massage technique would be using a tennis ball to help
recondition the soft tissues of the buttock area (i.e., glutes and hip rotators)
(see Figure 1).

Figure 1: Self-massage with a tennis ball

When to progress/regress between self-massage and stretching
You will know it is time to progress from self-massage to the stretching
component of a program when the client no longer feels any tenderness when
applying pressure to the target area or if the appropriate tissues have released
enough to perform the desired progression (i.e., stretch) with correct
technique. If a client is uncomfortable, experiences any type of pain, or finds
the exercise too difficult, regress the self-massage technique being used. You
can regress self-massage techniques by using a softer tool for applying
pressure (e.g., a less dense roller or softer ball) or instructing clients to apply
heat to the affected area instead.

Stretching
As deconditioned soft tissue structures become more fluid and healthy, it is
time to increase the comfortable range of motion for the muscles, fascia,
tendons, ligaments and joints. Stretching involves elongating and lengthening
muscle fibers (and their accompanying soft tissues and fascia) in order to
restore blood flow and elasticity to those structures (Walker, 2007). Many
different types of stretching exercises can help facilitate flexibility/mobility
and retrain movement in those parts of the body that have become

dysfunctional as a result of chronic malalignment (Alter, 1996). Stretching

also involves retraining the nervous system by moving the body in directions
that mimic the way the body should move when it is working properly.
Three common stretching techniques are
1. Passive Stretching
2. Active Stretching
3. Dynamic Stretching
Each technique should be utilized in the order listed above and offers a unique
benefit to clients as they prepare for the next stage of their corrective exercise
program.
Passive Stretching
Passive stretching involves holding a static position for a predetermined
amount of time to achieve and increase range of movement around a joint or
number of joints. Other muscles in the body are not being stimulated to a great
extent to contract in a passive stretch and are, therefore, in a relatively passive
state. Passive stretches are a good choice to use at the beginning of a
stretching program. An example of a passive stretch would be a seated lower
back stretch (see Figure 2).

Figure 2. Passive stretch - Seated lower back stretch

Active stretching
Active stretching involves a concept known as reciprocal inhibition, which is
based around the notion that in order for one muscle group to relax, its
antagonist muscle or muscle group must contract (e.g., contracting the
quadriceps to enable the hamstrings to relax). Active stretching is a great way
to begin integrating different functions of muscles or muscle groups to work

together in a lengthening/contracting fashion. A passive stretch, such as a

standing calf stretch (see Figure 3), can be turned into an active stretching
exercise by activating the tibialis anterior (i.e., pulling the toes of the rear foot
up toward the shin).

Figure 3. Passive stretch for the right calf

Note: This becomes an active stretch for the right calf when the toes of right
foot are elevated towards the right shin.
Dynamic stretching
Dynamic stretching mimics functional movements. It involves the use of
concentric activation (i.e., contraction) of certain muscles to move bones
while other muscles eccentrically load (i.e., lengthen with tension like a
bungee cord) to allow joint motion to occur with minimal stress to the joint.
This type of stretching helps clients learn to perform a desired range of
movement in a controlled and coordinated manner. An example of a dynamic
stretch would be performing a step backward to the calf stretch pictured

above. These types of stretches assist clients in progressing from the

stretching to the strengthening components of their programs more
successfully.
When to progress/regress between stretching and strengthening
Progress from stretching to strengthening when the muscles and soft tissue
structures in the area(s) you are stretching are working correctly and/or it is
appropriate to add a strengthening exercise as a client gains control of greater
ranges of movement during a stretch. Regress a stretch if a client is in pain or
discomfort, or has difficulty performing the exercise or remaining in control
of the movement. You can regress stretching exercises by applying a selfmassage technique instead or utilizing a less dynamic/more controlled stretch.

Strengthening
Once progress has been made toward improving the overall condition of a
clients dysfunctional soft tissue structures, begin incorporating strengthening
exercises into the program.
There are many different kinds of strengthening exercises. Following are four
effective corrective exercise strengthening strategies:
1. Isometric
2. Concentric
3. Eccentric
4. Kinetic chain multi-planar/dimensional
Follow the order detailed above to ensure your clients' benefit from each type
of strengthening exercise as they progress through their corrective exercise
program.
Isometric
Isometric contraction occurs when a muscle becomes activated, but stays the
same length (i.e., it does not shorten or lengthen). This is the easiest type of
movement for the nervous system to coordinate. Once the nervous system has
generated an isometric muscle contraction, it is able to continually keep motor
units firing to the muscle(s) involved in that contraction to maintain a state of
activation. When a clients muscles cannot activate correctly, or have shut
down as a result of chronic malalignment issues, it is important to get those
muscles firing again before attempting to engage them in dynamic
movements. An example of an isometric exercise would be instructing your

client to stand with their feet abducted and contracting their gluteus maximus
to help outwardly rotate the leg (see Figure 4).

Figure4. Isometric strengthening exercise contracting the gluteus maximus

Concentric
Concentric muscle action involves shortening a muscle to bring the origin and
insertion points of that muscle closer together and results in the movement of
a joint (e.g., contracting your biceps will bring your forearm closer to your
shoulder and flex the elbow joint).
Eccentric
Eccentric muscle action involves the lengthening of a muscle to slow down
parts of the body as they move (e.g., the biceps lengthen to slow extension of
the elbow joint when lowering a heavy box from shoulder to waist height).
Clients unable to perform an eccentric contraction correctly may experience
more stress to a joint and/or pain if they attempt an eccentric movement.
Therefore, concentric exercises are usually better choices when initially
progressing corrective strengthening exercises from isometric to
concentric/eccentric.
Both concentric and eccentric strengthening exercises can be performed using
a single joint, or many joints (i.e., a multi-joint movement). Begin with single
joint movements like a Single Leg Lift exercise (see Figure 5) that involves
using the glutes to lift and lower the leg using just the hip joint (as long as the
lower back does not arch and engage the lumbar erectors).

Fig
ure 5. Concentric/Eccentric strengthening exercise - Single Leg Lift
Progress to multi-joint movements when you feel confident your client has
control over each joint involved in the sequence (e.g., adding an opposite arm
lift to the exercise above to incorporate spine extension).
Kinetic Chain and Multi-Planar/Dimensional Movements
Once a client can control a muscle or group of muscles both concentrically
and eccentrically, and the joints those muscles cross, teach them how to use
those muscle(s) as part of a kinetic chain (e.g., a series of motions or
movements created by muscles working in sequence) (Whiting, 2006). For
example, the gluteal complex, which includes the Gluteus Medius, Minimus,
and Maximus, controls hip, leg and foot function (due to attachments of these
muscles on the upper and lower leg). When working together as a kinetic
chain, these muscles help slow forces to the feet, ankles, knees, and hips by
transferring the weight of the body to these structures at the right speed and
rate (e.g., Side Lunge with Reach picture below).

Figure 6: Side Lunge with Reach

When groups of muscles are working efficiently as part of a kinetic chain,
progress to whole-body, multi-planar exercises that move the body in all
different directions such as forward and backward (i.e., the sagittal plane),
side-to-side (i.e., the frontal plane) and in rotation (i.e., the transverse plane).
Performance of these types of exercises correctly and efficiently is the
ultimate goal of corrective exercise programs. Clients that have progressed to
this highest level should be free from pain, highly functional, and able to
perform coordinated, dynamic movements.
When to progress/regress between strengthening exercises
Progress the type of strengthening exercises you are using when your client
has reached a suitable level of competency and can do the movement well.
Always regress a strengthening exercise if a client experiences any type of
pain, has difficulty performing the movement, or reports excessive soreness
the next day or later the same day after doing the exercises.

References
1. Abelson, Dr. Brain and Abelson, Kamali. Release Your Pain. Calgary:
Rowan Tree Books, 2003.
2. Alter, M.J. Science of Flexibility (2nd ed.). Champaign, Ill.: Human
Kinetics, 1996.
3. Barnes, J.F. Myofascial Release. In: Hammer, W.I. (Ed.) Functional
Soft Tissue Examination and Treatment by Manual Methods (2nd
ed). Gaithersburg, Md.: Aspen Publishers, 1999.
4. Price, J. The BioMechanics Method Corrective Exercise Educational
Program. The BioMechanics Press, 2010.
5. Walker, Brad. The Anatomy of Stretching. Chichester, England: Lotus
Publishing, 2007.
6. Whiting, W.C. & Rugg, S. Dynatomy: Dynamic
Anatomy. Champaign, Ill.: Human Kinetics, 2006.

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