Building a Better Corrective Exercise Certification:
by Dr. Brent Brookbush DPT, PT, MS, CPT, HMS, IMT
Defining Corrective Exercise:
Before we consider what a better "corrective exercise" certification would look like, it is important to define the term. Note, you do not have to agree with this definition, but this is how the term "corrective exercise" is used in this article.
- Corrective Exercise: Self-administered exercises that are recommended with the intent to address an assessed movement impairment and improve the quality of motion. Corrective exercise may also be referred to as therapeutic exercise and/or rehabilitation exercise (or specific exercise when compared to general strengthening). Corrective exercise is commonly included in corrective exercise programs, movement preparation warm-ups, home exercise programs (self-management programs), and supervised physical rehabilitation programs. Specific techniques may address muscle imbalance (altered length, overactive, underactive, hypertonicity, hypotonicity), joint stiffness, mobility, osteokinematic or arthrokinematic alignment, altered movement patterns, posture, and/or functional movement.
- To further refine our definition, corrective exercise is NOT lunges, pull-ups, bench press, squats or other compound exercises performed with the intent to improve strength, fitness, or sports performance. Further, massage therapy, manual trigger point release, instrument-assisted soft tissue mobilization, joint mobilzations, joint manipulations, and other manual techniques that a client or patient cannot perform on themselves are NOT corrective exercises. Our definition of corrective exercise is purposefully written to exclude specific techniques to enhance general strength, fitness, sports performance, and all manual techniques. That does not imply these exercises and techniques are of lesser quality, they simply belong to different categories of beneficial techniques.
Corrective Exercise is the Most Important Modality?
Corrective exercise may be the most important and versatile modality in fitness, performance, physical rehabilitation, and sports medicine. Before we get trolled by 100s of professionals defending their favorite exercise or therapeutic intervention, hear us out. We are huge fans of fitness programs, strength training, and power training, for EVERYONE from the elderly to the athlete, and for reasons ranging from regaining function for everyday life to optimizing performance for professional sport. We even think all movement professionals (personal trainers, fitness instructors, physical therapists, athletic trainers, massage therapists, chiropractors, occupational therapists, etc.) should do far more to embrace fitness and strength training. This is why we built our evidence-based and peer-reviewed Certified Personal Trainer (CPT) Certification , include it in membership , and recommend it to all movement professionals. We also love supervised clinical modalities intended for the treatment of pain and injury (including chronic pain and sport injury), and the rich history and expansive repertoire of techniques that can be categorized as manual therapy. We have continued to promote the body of research that overwhelmingly demonstrates larger effect sizes, faster recovery rates, and more reliable long-term outcomes when manual therapy, corrective exercise, and some clinical modalities are combined (integrated). Again, this is why we developed the Integrated Manual Therapist (IMT) Certification . But, corrective exercise has some unique advantages.
So why are we suggesting corrective exercise programming may deserve the top spot? Corrective exercise also boasts a huge repertoire of techniques and has demonstrated a variety of potential benefits in research and practice. The library of available corrective exercise techniques has grown exponentially in the last 20 years, including release techniques for over-active muscles , self-administered joint mobilization techniques , mobility techniques for muscles and joints that have lost extensibility (a.k.a "tight" muscles), muscle activation techniques for addressing "weak muscles" (although "weak" in this case should be replaced with the term "underactive"), and neuromuscular reeducation techniques to address altered recruitment patterns (a.k.a. faulty movement patterns, movement impairment, postural dysfunction , and muscle imbalance). Research and outcomes have demonstrated corrective exercises are beneficial for improving performance when used as a warm-up exercise program to optimize alignment, and may significantly reduce the risk of injury by improving posture prior to painful conditions (i.e. addressing cervical posture resulting from desk work that could increase the risk of chronic neck pain). Further, corrective exercise may enhance the rate of recovery between frequent bouts of high-intensity exercise when used as a daily home exercise program, and corrective exercise (a.k.a. therapeutic exercise) has been used clinically to improve outcomes for painful conditions for nearly a century. But, that is still not the most important advantage of these techniques.
The most important characteristic of corrective exercises, and the reason they deserve the top spot, is that they are self-administered (the client or patient can do the exercise program alone). This implies clients and patients can use it as part of their self-management programs, home exercise programs, daily recovery programs (strength training and performance), and long-term continued care programs. Further, because corrective exercises are both self-administered and low-intensity, they are also very low-risk activities. This should motivate clinicians, clients, and patients to do the experimentation necessary to find the optimal program for their goals. Generally, the worst thing that happens following an inaccurate corrective exercise recommendation is nothing... as in, literally no result at all. Compare that to joint mobilizations that may exacerbate symptoms if not optimally selected based on a movement assessment, or using the wrong verbal cue during a max strength lift resulting in a painful (although likely minor) strain. Finally, because corrective exercises are self-administered, low-risk exercises, intended to optimize movement, they can be recommended by all movement professionals regardless of scope. In fact, we may argue that corrective exercise could be used as the bridge that begins the integration of our various movement professions.
For these reasons, when we took on the development of our corrective exercise curriculum and corrective exercise certification, we wanted to do something really special. We didn't just want to launch something that is comparable to other certifications. We wanted to build something that was 10X better. Something that would help put this tool in the hands of more of our colleagues. We attempted to disrupt the way certifications were offered, advanced credentials were offered, and optimize the way education was delivered. We wanted to be the first to develop a comprehensive, evidence-based, systematic, integrated, patient-centered, and outcome-driven approach to corrective exercise. The Brookbush Institute's Human Movement Specialist (HMS) Certification was our first attempt at a certification, has been updated many times since its launch, and now you know why. I think you will find that the Human Movement Specialist (HMS) is so much more than "just another corrective exercise certification".
Summary of Innovations:
- FREE Corrective Exercise Certifications: What if all credentials that an organization offered were available to that individual, with the same fee or charge?
- Stop Getting Double and Triple Billed: What if all the credits you earned counted toward certification, continuing education credits, and re-certification (at the same time, automatically)?
- It Needs to be Convenient and Accessible on the Go: Education should be easily accessible via desktop (laptop) or mobile device (phone), easy to start and stop, and consumable in smaller chunks.
- Adults Should Have Choices: Rather than a fixed set of courses, what if you could choose from a library of courses to complete a certain number of credits per category? You could customize your learning plan.
- End Summative Final Exams: As an industry, we have to end cram-and-forget-inducing summative final exams and replace them with iterative testing and benchmarks based on progress through coursework.
- It Has to be Evidence-based: It seems social media has accelerated a trend toward promoting gurus with controversial positions (confirmation bias, cherry-picking, fundamental attribution errors). Evidence-based practice is a check on the potential for bias and error and may be the only way to RELIABLY achieve the HIGHEST levels of content accuracy.
- It Has to be Practical: The gross majority of a corrective exercise certification should be focused on assessments and corrective exercises. Most importantly, the techniques have to work, based on immediate improvements of reliable objective measures.
- An Integrated Approach: If a joint mob didn't work, the answer is probably not more joint mobs. If foam rolling didn't work, the answer may not be more foam rolling. Optimizing outcomes is likely dependent on our ability to address changes in each component of the human movement system, as assessment indicates which techniques are likely most beneficial for the structures involved in the assessed impairment.
- Systematic and Outcome Driven: Another major issue with corrective exercise certifications is the presentation of exercises without context, perspective, relationship to other effective interventions, or clear demonstration of the effect any one technique will have on an objective, reliable outcome measure (e.g. the Overhead Squat Assessment or Goniometry ). Unless there is a system for assessment and intervention, it is not possible to refine interventions by comparing outcomes.
- Best Possible Techniques: If we could figuratively put every possible assessment, technique, modality, and exercise, on a table, from all of the various movement professions we should choose which techniques we will use based on outcome (not titles or degrees).
For Additional Resources on Certification and Accreditation:
- The Best Personal Training Certification?
- How Much Does a Personal Training Certification Cost (Including Hidden Fees)?
- Building a Better Corrective Exercise Certification
- The "Real Cost" of Manual Therapy Certification
- Certification Cannot Change the Scope of Practice of a Movement Professional
- What is a Fully Accredited Personal Trainer Certification?
- What is NCCA accreditation?
- We Think About Continuing Education Credit Approval (So you don't have to)
- State-by-State Course Approval and Credit Requirements for PTs and PTAs
- Approval and Accreditation of Courses and Certifications Could Be MUCH Better!
What If Corrective Exercise Certifications Were FREE?
Corrective exercise certifications, and other advanced credentials, are notoriously priced at a premium, but what if there was a different business model? What if all credentials that an organization offered (within an individual's scope of practice) were available to that individual, with the same fee or charge? This solves several issues discussed below, but sticking to price for the moment, this implies that if you have already been working on another certification (for example the Brookbush Institute Certified Personal Trainer (CPT) or Integrated Manual Therapist (IMT) certifications), you could start, try, finish, or switch to the Human Movement Specialist (HMS) certification (our corrective exercise focused certification), and there would be no additional cost. The Brookbush Institute does exactly this. $399.00 - $2000.00/certification is CRAZY, so we included all of our certifications and courses with a "Netflix-like membership." No additional fees, no extra charges, no additional commitments. If you are dedicated to your education, you can acquire as much education as you would like. Now, if only we could get every professional to binge-watch education like they were watching the "Tiger King" during the Covid-19 pandemic.
The Brookbush Institute has also done away with a dizzying array of post-purchase costs and hidden fees other certifying organizations should be ashamed of. For more on the "true cost" of certifications check out:
- How Much Does a Personal Training Certification Cost (Including Hidden Fees)?
- The "Real Cost" of Manual Therapy Certifications
Stop Getting Double, Triple, and Quadruple Billed
A few additional amazing price benefits to a membership model (and credit system) exist. Say goodbye to paying separately for continuing education credits (CECs/CEUs/CPDs), certifications, advanced credentials, and re-certification. All of our courses that provide credits toward certification have also been approved for continuing education credits with dozens of organizations. So, while you are completing certifications with the Brookbush Institute , you are also preparing for re-certification or license renewal. For more on this, check out:
Say goodbye to penalties for changing your mind. You can do the Certified Personal Trainer (CPT), Integrated Manual Therapist (IMT) (if within your scope), and/or the Human Movement Specialist (HMS) certifications, and there is no penalty for doing 1, 2, or 3 certifications (and more as we add credentials), and there is no penalty for switching in the middle, starting, stopping, or doing multiple certifications at the same time. We have removed the penalty that other companies charge for being curious, passionate, and want to learn more.
No additional charges for re-certification either. And, with the Brookbush Institute , when you complete one certification and start on the next, the credits achieved during your second certification will automatically be applied to re-certification of the first certification, and if you start a 3rd, your credits will automatically be applied to the first 2 certifications. You don't have to do anything... it's automatic! Every additional course you finish extends your re-certification date, and there are no additional fees.
It Needs to be Convenient and Accessible on the Go
It often feels like education is where customer service and convenience went to die. Move over Amazon.com, move over Netflix.com... you want it easy, affordable, enjoyable, and in the palm of your hand, look to education for none-of-that. The world has changed and education needs to catch up. Education should be easily accessible via desktop (laptop) or mobile device (phone), easy to start and stop, and consumable in smaller chunks. The Brookbush Institute completely re-imagined education content delivery, to make it possible to fit education into the schedule of working individuals. With the Brookbush Institute you can knock out a course in a single study session (or maybe a couple of sessions), pass a short final exam (7-15 questions), get your credits, and that content is complete. You do not need to return to it, because we have also done away with the ridiculous single-shot, pass-or-fail, summative final exam. With us, if you earn credit, you keep the credit, and you are closer to completing your certification. There is no back-breaking final exam waiting for you at the end, and no time limits on certification completion. When we picture someone taking our courses, we imagine the working professional who just had a cancellation, is in-between appointments, is on a commute, or is on a lunch break... they whip out their phone or laptop, knock out another credit or two, or at least "favorite" and "bookmark" another course, and are an hour closer to completion.
Adults Should Have Choices:
Another opportunity provided by a membership model (all courses and credits included) is allowing learners choice and control over their learning path. Now, this is only possible because the Brookbush Institute also did away with the giant (most often outdated) textbook and summative exam format, and replaced it with short courses (1 - 4 credit/hours long), with short exams, certification built on a credit system, and made it available online (website and mobile app). Our curriculum is not built from a fixed set of courses, instead, you have to complete a certain number of credits per category, and since all of our courses are included in the same membership this does not affect the price. This means as we continue to publish more and more courses, you will have more and more choices in each category. You will get to customize your learning plan! We even went a step further to feed your curious side, adding 10 elective credits to every certification, which can be fulfilled by taking any course within your scope.
End Summative Final Exams
As an industry, we have to end cram-and-forget-inducing summative final exams and replace them with iterative testing and benchmarks based on progress through coursework. We must find a way to assess ability while motivating students to learn more. The BI HMS certification is achieved using a library of 1-4 credit courses (1 credit = 1 hour), each with a short exam (7-20 questions), practice exams to aid in determining readiness, and credits are awarded for each individual exam. You never lose credits, you can attain credits at your own pace, and when you achieve enough credits you are certified... no summative final exam. And, all of these exams are included in membership, with no additional costs. The crazy part about this approach is that our certified professionals have higher pass rates, having answered a larger number of far more challenging questions, and most go on to complete more courses and exams after they are certified... because they enjoyed the process. It is amazing how much more willing we all are to face a challenge when that challenge is just 7, 10, or 15 questions... and not a grueling 2-hour, 100+ questions that do a better job of testing our stamina.
It Has to be Evidence-based:
Too many corrective exercise certification base their content on the thoughts of a "genius founder", make half-hearted attempts at citing their pre-conceived notions (cherry-picking and confirmation bias), is woefully out-of-date, and/or are far from comprehensive. It seems social media has accelerated a trend toward promoting gurus with controversial positions, who can wave around a couple of cherry-picked secondary sources (systematic reviews), pulling the industry away from true evidence-based and optimal practice.
As educators, our goal should be to develop content with the highest possible levels of ACCURACY and the best chance of efficacy. We need to prevent our colleagues from experiencing that sickening feeling that comes from finding out they spent hours, days, or months, studying incorrect information. Or, attempting to practice assessments and interventions, over and over, that have little chance of being successful. We could easily start pointing to corrective exercise certifications with misprinted origins and insertions of muscles, inaccurate assessment strategies (lack validity, specificity, sensitivity, or reliability), weak associations between assessment findings and intervention recommendations, and corrective exercises that have almost no effect on any objectively measurable outcome, and nearly all other corrective exercise certifications completely ignore re-assessment. Think about that last point. They completely ignore the thing that demonstrates whether something is effective. Re-assessment using reliable objective measures at the end of a session demonstrates whether a technique was effective during the session. Re-assessment at the beginning of the next session demonstrates whether the strategy resulted in any carry-over from session to session, and what modification may need to be made. The fact that without reassessment we have no proof of efficacy, and this is so commonly ignored by corrective exercise certifications, implies we may need to do something dramatic... Boycott any corrective exercise certification that does not include and promote reassessment.
The bigger issue, if evidence-based practice was the standard, the issues above would start to disappear. Evidence-based practice is a check on the quality of work, and it is the only way to RELIABLY achieve the HIGHEST levels of content accuracy. Over the last 10 years, the Brookbush Institute has created potentially the most rigorous and transparent processes for evidence-based content development in the industry, intending to develop all courses from a comprehensive systematic review of all relevant original research. We want to be the resource you know you can trust... not because of "faith in a genius founder", but because of peerless scientific rigor and processes. We believe our colleagues deserve the most accurate and effective information available. We know certification is not the goal, helping our colleagues achieve success with their clients is the goal... and that is hard to do with inaccurate information and less effective interventions.
It Has to be Practical:
I don't need theory, I need techniques. The gross majority of a corrective exercise certification should be focused on assessments and corrective exercises. Further, they should include sample routines to aid in demonstrating where techniques fit within an integrated program. Having a strong scientific foundation, or being aware of corrective exercise is important, but only if the practitioner knows what to do with it. A great corrective exercise certification should be built with the goal of "making the practitioner better with their first client on Monday morning."
You want cool exercises, we got cool exercises. Although evidence-based practice, assessment, re-assessment, and a systematic approach are paramount, we know that you are probably going to "geek out" on great techniques, just like we do. Corrective exercise certifications need to do more than demonstrate a half-dozen cues "to fix your squat". They need to cover dozens, or 100s, of corrective exercises, that can be easily matched to a variety of assessment findings. Further, those techniques should be easily progressed, regressed, gamified, included in home exercise programs, and inspire professionals to develop their own techniques! What if a corrective exercise certification could not only help you build a huge repertoire of exercises, but also made you a problem-solving, exercise-creating, routine assembling machine? Note, the Brookbush Institute features 100s of assessment and corrective exercise videos, full of thorough explanations, progressions and regressions, and ideas for further experimentation.
It has to work. We mentioned this above, but a corrective exercise certification has to work. Our Human Movement Specialist (HMS) certification teaches "assess, address, and re-asses"; setting a high standard of immediate improvement based on reliable objective measures. The goal is optimal outcomes and maximally effective intervention plans. Too many corrective exercise and intervention courses claim that "you should see results in 2 - 3 weeks", or they base efficacy on how the client "feels". But, if a technique did not result in an objectively measurable change during the first session, then there is no guarantee that the intervention worked at all, and short-term changes in client perception are not a reliable indicator of long-term outcomes (feelings are easily swayed by physical contact, activity, a "nice practitioner", etc.). The HMS is outcome-driven and refined by reliable objective measures. "Feels better" and "it will work later", are very different than our intent to maximize efficacy and optimize outcomes based on reliable objective measures.
An Integrated Approach:
If a joint mob didn't work, the answer is probably not more joint mobs. If foam rolling didn't work, the answer may not be more foam rolling. It's strange how our profession becomes fixated on a modality or technique, rather than a systematic approach that is built from assessment , considers the intent of each intervention type, and refines based on outcomes. Joints, muscles, fascia, and the nervous system areintegrated systems, but they do not respond the same way to all techniques. Optimizing outcomes is likely dependent on our ability to address changes in each component of the human movement system, as assessment indicates which techniques are likely most beneficial for the structures involved in the assessed impairment. After all, what carry-over can we expect if joints are addressed, but trigger points , instability , or fascial restriction are left behind? Further, dozens of randomized controlled trials (RCTs) have demonstrated the superior efficacy of an integrated approach, i.e. a minimum of joint mobs/manips, soft tissue therapy (foam rolling), and specific exercise. The results of these comparative studies are nearly unanimous. The Brookbush Institute is less focused on a single modality and instead focused on "integrated interventions" to address compensation patterns (not isolated impairments). Techniques are tools and should not be confused with systems. (The Brookbush Institute's template for corrective exercise includes: Release, Mobilize, Lengthen, Activate, Integrate, and Support)
Systematic and Outcome-Driven:
Another major issue with corrective exercise certifications is the presentation of exercises without context, perspective, relationship to other effective interventions, or clear demonstration of the effect any one technique will have on an objective,reliable outcome measure (e.g. the Overhead Squat Assessment or Goniometry ). If you enjoy taking courses, certifications, and workshops, it does not take long to develop a large exercise repertoire; a "big bag of tricks". But, like a bag of anything, there is no order, direction, best fit, or means of testing the effectiveness of the whole bag. To be truly outcome-driven, an approach must teach a system of objective reliable assessments , and the intervention plan has to be systematic, resulting in a consistent approach. Unless there is a system for assessment and intervention, it is not possible to refine interventions by comparing outcomes.
The Brookbush Institute courses are built from a comprehensive systematic review of all relevant research, resulting in the modeling of compensation patterns, informing the selection of reliable objective measures, and a systematic approach to developing integrated interventions. The goal is to build a system that can be a foundation for further refinement and learning. Even if you choose to replace a corrective exercise technique from our courses, with a technique learned from a different course, you will know where to put it in your intervention plan, what to test it against, and how to make an outcome-informed decision. Switching modalities should not force you to switch systems, leaving you with the feeling that you just walked into the clinic for the first time. I am not sure we could do an unbiased comparison of corrective exercise certifications and the quality of their systems, but the Brookbush Institute has worked hard to build a congruent set of courses with sample routines that aid in demonstrating how evidence, modeling, assessment , and intervention can lead to easy to follow templates.
Best Technique Selection
At the end of the day, the only thing that matters is the client/patient's outcomes. Their complaints or goals do not care about what your title is, the license you acquired, the degrees you hold, the letters after your name, or even what "modality" you specialize in. All that matters to clients and patients are outcomes. Our license only dictates our scope. If we could figuratively put every possible assessment, technique, modality, and exercise, on a table, from all of the various movement professions (personal trainers, fitness instructors, physical therapists, physiotherapists, chiropractors, osteopaths, athletic trainers, occupational therapists, massage therapists, etc.) we should choose which techniques we will use based on one thing. The best possible outcome. Now, we should measure our outcomes based on objectively measurable qualities like reliability, efficacy, time to goal, rate of recurrence, best possible performance, long-term outcome measures, and cost (including financial, time, and emotional), but at the end of the day... our goal is still best possible outcomes.
The Brookbush Institute has a dream of an integrated profession, in which all movement professions would be included in a single evidence-based group of professionals, and scope and access to populations would be rewarded for completing progressive steps in a dynamic education plan leading to various specializations. This starts with putting an end to the in-fighting between movement professions and attempting to build a system of the most effective combination of techniques, regardless of the profession that is currently associated with them. Corrective exercise, in particular, is a great place to start because it is a group of self-administered (patient-performed) techniques, that fall within the scope of practice of all movement professionals. There is no legislation in the USA or Canada, that prevents a movement professional from teaching someone an exercise. The Brookbush Institute is trying to promote the integration of movement professions by building a congruent set of courses (all included in membership) with the goal of an evidence-based, systematic, integrated, patient-centered, and outcome-driven approach. We do not build courses for specific professions; however, we have ensured that all courses and certifications are approved for continuing education for most movement professionals. We want you to stretch, try new techniques, take courses that are a little different than your average colleague might take, and not be penalized for doing so. We all want the same thing... the best possible outcomes for the clients and patients we care for.
© 2022 Brent Brookbush (B2C Fitness, LLC d.b.a. Brookbush Institute)
Comments, critiques, and questions are welcome!