Choosing the best exercises for a client can be challenging, even for skilled exercise and rehabilitation professionals.
With so many exercises to consider, not to mention the influx of new technologies and the unique physical condition of your client, making the right choices becomes much harder.
In the last of our three-part series about the seven steps of the CHEK system, I’ll show how CHEK practitioners help their clients integrate their tailor-made set of exercises safely, then how to apply them correctly based their lifestyles.
(Catch up on this series on exercise selection by checking out part 1 and part 2 that explains how to develop an exercise plan, then approach that plan quickly.)
For the purpose of this series, I’ve been using a fictitious case history — a 35-year-old surgical nurse named Sally who has three young children — to show how these principles work in the real world.
During your first session, Sally tells you her goals are to reduce body fat and alleviate the chronic back pain that has persisted since the birth of her third child.
Principle 5: Isolate, Then Integrate
Based on Sally’s history, it is likely she will need both specific coordination and strengthening exercises, such as integrating the inner unit with Primal Pattern® Movements as well as more general exercises.
Here is where Principle 5 comes in. Orthopedic testing to identify a given muscle weakness directly, or indirectly related to our client’s condition, allows us to effectively apply the Isolate, Then Integrate principle.
In Sally’s case, core assessments (as described in my Scientific Core Conditioning correspondence course) will isolate any inner unit weaknesses.
Let’s assume we find Sally needs improved sacroiliac joint stability. We may decide to use exercises, such as the Belt Squat. In deciding where to place this exercise in the overall program, however, we must consider Sally’s ability to perform the exercise.
If she can do an exercise with greater complexity or greater load that also demands performance of the local and regional stabilizers of the pelvic/sacroiliac joint complex, the Belt Squat will come after such exercises.
If Sally’s back or pelvic girdle cannot take any load greater than offered by the Belt Squat, and you decide this is the most important exercise for her at this time, the Belt Squat would rise to the top of the exercise order. As she heals and improves, you will progress as able from isolation-type exercises to more integrative exercises.
Principle 6: Use Correct Application of Open vs. Closed Chain Loading
In her job as a nurse, Sally has to pick up and move patients. By applying force in an open chain with her upper body, she is overcoming the resistance and moving it. Her lower body applies force to the floor which doesn’t move, therefore, the chain is closed for the lower extremity.
In our selection of exercises, we have already used the Bent Over Row in Principle 3 (an open chain for the upper body and closed chain for the lower body). However, it would be easy to go astray here by trying to make the exercise more “functional” or “fun.”
If Sally performed the Bent Over Row on any type of wobble or rocker board, she would now open the chain for the lower extremity during force development. Such a modification would make balance the primary biomotor ability to be trained, an ability that was not one of Sally’s weaknesses.
This would also limit the capacity for loading her body and inhibit the development of strength and endurance.
Principle 7: Use Correct Reflex Pathways
While the topic of reflexes can become very complex, generally, I break exercises into two classes:
- Those that activate Righting Reflexes, or any exercise performed on a stable surface.
- Those that activate the Tilting class of Equilibrium Reflexes, or any exercise performed on a moving surface underneath you.
In Sally’s case, the choice of a Bent Over Row fits this principle because you are primarily concerned with her ability to lean over an operating table or bed. In this work scenario, the floor is fixed so the environment of the exercise application is righting reflex-dominant.
Should you have Sally performing a Supine Lateral Ball Roll, you are still working with this principle because of the nature by which the force is applied during the exercise.
In the Supine Lateral Ball Roll, Sally applies force while holding a bracing position on top of the ball. While her balance and other biomotor abilities are challenged to some extent, force is applied through the fixed floor with her feet (a righting reflex), and through one arm and shoulder complex into the more mobile ball (relatively open chain).
If force were applied when the ball was moving, or if the application of force induced a significant challenge to her balance, the equilibrium class of reflexes would limit her performance.
Serve the Needs of Your Client First
While there are a myriad of exercise options to consider in an example like this, your focus should be to prioritize your choices based first and foremost on the needs of your client and, second, on the wants of your client. To do otherwise would risk their safety.
In Sally’s case, her desire for body fat reduction is high, but we need to address the more pressing concern of back pain and its accompanying weaknesses and imbalances.
As she progresses, we can increase the number of exercises performed and her total volume per week. This will help Sally achieve her fat-burning goals.
By using the seven principles I’ve discussed to select the right exercises for Sally, as her personal trainer, you will help her to get optimal results and achieve all of her goals!
