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Tuesday, June 6, 2023

What dictates "good form"?

Brent Brookbush

Brent Brookbush

DPT, PT, MS, CPT, HMS, IMT

Panel Discussion: What dictates "good form"?

What dictates "good form" - that is, what signs do we look for to ensure optimal execution, and what cues do we commonly use?

Moderated by Brent Brookbush DPT, PT, MS, PES, CES, CSCS, ACSM H/FS

This Panel Discussion was originally posted on my facebook page - https://www.facebook.com/brent.brookbush - on November 15th, 2013

Nick Chertock Where I see a lot of exercisers go wrong is adding additional unwanted spinal curve as a compensation for unwanted curve elsewhere and because it 'looks right' to some trainers' naked eye they are stamped with "good form" when in fact their form would be better if it looked worse.

As in a golf swing, compensations paired together can produce a workable result but unraveling them is necessary for change to take place. When unraveling them naturally there will be an observed decline in the appearance of form unless they are in the presence of a coach who can unravel substitute movements in pairs while providing a safe environment for the client to leave their comfort zone.

Ironically in many cases when someone works on their form alone they are actually going in the wrong direction but think they are improving. Like a deep sea diver getting turned around in the darkness and heading toward what appears to be the surface but is actually a cave that will trap them for an eternity. Not to put a downer on things since this is a Friday.

November 15 at 1:10pm

Brent Brookbush Hey Sarah Ehsan,

The intrinsic muscles of the foot are not easily cued, but you are right… they are very necessary for maintaining the medial longitudinal arch… something Janda used to call "short foot". This does not include curling the toes though (MTP extension with IP Flexion). I would say that if you cue someone to push through there MTP's (metatarsal phalangeal joints/the "ball of the foot") while maintaining the heel on the floor you are in good shape.

November 15 at 1:10pm

Brent Brookbush Hey Nick Chertock,

I think I know what your talking about… many form issues are actually compensatory patterns caused by mobility issues at one or several joints. Since you cannot cue someone to better mobility at a joint you simply cue them into another compensation pattern. If you try first to fix the dysfunction and then correct the form you end up in better shape.

November 15 at 1:13pm

Nick Chertock To give an example, when I stand with a lot of lumbar hyperextension it brings my head more into alignment and I've been told I have good posture but truly do not. If I lessened the lumbar hyperextension this would be a move toward improvement but by itself would make my posture APPEAR far worse since my head would drift way over my toes in the absence of any improvement to thoracic extension.

November 15 at 1:20pm

Larry Hamilton Optimal execution always varies with each person, and can only be achieved by knowing limitation and dysfunctions of the human body.

November 15 at 1:22pm

Brent Brookbush Hey Larry Hamilton, if optimal execution always varies… what do you use to judge good versus bad?

November 15 at 1:26pm

Larry Hamilton Good versus bad execution can be gauged if there's….no pain or pain through certain movements, restrictions through muscles patterns/joint mechanics…the idea is to prescribe exercises that will complement/ fix any dysfunctions during a program cycle.

November 15 at 1:42pm

Brent Brookbush Nice Larry Hamilton, the only statement I may refine is whether the movement has potential to cause pain… that is choose exercises that do not pose more risk than benefit. Thanks for the contribution.

November 15 at 1:59pm

Sean Kim I would say Neutral Cervical Spine=Neutral Lumbar Spine. Also I just want to throw a few words for the 'good form'. Joint Centration(neutral spine, joint by joint etc), Stability, Mobility and Motor Control.(timing) I think understanding of theses words are critical as a trainer. The most important thing is we should be sensitive enough to know how to feel right about what we say through our body's feedback before we instruct clients.

November 15 at 2:52pm

Brent Brookbush So you are saying we should practice what we preach so we may better communicate optimal form to our clients, Sean Kim?

November 15 at 2:58pm

Sean Kim That's correct. Brent Brookbush Most of time, when I see other trainers session I found that they have a lack of understanding of movement pattern which means neurological disconnection between brain and body. That lack of right signal causes a false movement pattern.

November 15 at 3:04pm

Brent Brookbush Hey Sean Kim,

That is a deep well. Remember that the body and mind from the perspective you are speaking work in almost cyclical fashion. There is never a separation, but rather the execution of a motor patterns based on altered sensory input activating altered structures, which leads to faulty movement, which leads to further alterations in sensation, and so on. From the perspective of human movement science, this is where corrective exercise has its largest impact. By altering length/tension relationships, activity (tone), inter- and intra-muscular coordination, fascial extensibility, and arthrokinematics we play a role in improving the sensory input into the brain leading to better recruitment strategies that fire a more functional muscular system.

Adding cognition (thinking about moving) will have an affect, but if we do not correct the dysfunction of the structures themselves we still have to overcome altered sensation.

"You have to fix the pieces, before you assemble the puzzle."

November 15 at 3:15pm

Sean Kim You are so right about that. Also we can fix the pieces by moving entire chain as long as if we do right about the words that I mentioned.(Joint Centration, Mobility, Stability and Motor Control)

November 15 at 3:25pm

Kyle Stull I love the old squat form debate, as it never seems to get resolved.. And, perhaps there is a reason for that. My opinion is that (as a human being) we should be able to squat, with feet straight, knees in line with the 2nd and 3rd toe, with the spine neutral (from sacrum through cervical regions). If an individual can do this without deviating, then I would consider them to have adequate range of motion and coordination. Then, if they wanted to vary their squat stance from time to time, depending on the load, I would let them. But, the load becomes very important. The heavier the load, the more strict I become because the risk of injury increases.

November 15 at 3:24pm

Alexander Kaufman I quite frankly want to know who the girl is

November 15 at 3:40pm

Brent Brookbush I took the picture off of google images… she run's a blog aimed at the consumer. She is a personal trainer and not an educator as far as I can tell. I will not reveal her information, as from the looks of her site, she is only trying to do good things.

I can't condone her form, but given the debates recently in social media the picture seemed appropriate.

November 15 at 3:45pm

Andreea Broască Feet flat on the floor, shoulder distance apart or slightly wider, toes slightly pointed outwards(to avoid outward rotation of the knee), knees extended but soft, hips neutral, core engaged(to maintain neutral lumbar spine), chest opened(to maintain the natural curvature of the spine, in this case, the thoracic spine), head neutral, look forwards, squat down, preferably lower than 90 degrees as the knee joint with the knee perpendicular to the mid toes avoiding a too much flexion at the hip joint. push through the heels on the way up without lifting the feet off the floor and maintaining neutral spine. return to full extension(to engage all the 4 muscles of the quads) of the knee without hyperextending the knee.

November 15 at 3:45pm

Bernd Reicheneder In my experience you can discerne the performance quality of a movement by the aim the client wants or you want him to go. Example squat: Kyle is describing postual alignement rules, but there is also the placement of the points of support (feet) on the surface of support: If you want someone to learn the squat than mobility-stability-pattern is needed; next step: why squatting? Resting? Then try to feel comfortable and train it to reach 20 minutes. Walking/Running/Jumping? Try to bring the pressure maximum to your big toe! Lifting adaptively? Train to distribute weight evenly on the whole foot! Lifting maximum on an flat surface? Bring the pressure to the heel!

Generally speaking: There are overall postural rules for good form/technique and there is the need for adaptability according to circumstances or technical need.

November 15 at 3:47pm

Brent Brookbush Two Questions Andreea Broască,

Why so wide and turned out with the feet… we don't walk that way?

Second, how do you not get all 4 quad muscles to fire?

November 15 at 3:47pm

Andreea Broască The exercise I`ve described is a squat. Not too wide though. If you have your feet slightly pointed outwards you can avoid the rotation of the knees outwardly firstly for balance reasons and also anatomical reasons, for women especially, as we have a larger Q angle between hip and knee joint and a less efficient transfer of force between these 2 joints. And for the second question: all the 4 vasti muscles have a tiny difference in action, for example, vastus medialis works in only the last 15 degrees of extension to keep the patella moving smoothly, therefore, if you don`t go all the way to your extension, you risk not engaging all the quads and this can happen by transferring the work to other adjacent muscles if the movement is not done properly.

November 15 at 4:01pm

Terrence Thomas what exercise are we speaking of? what's the goal of drill? Who is the person performing the drill?

November 15 at 4:59pm

Brent Brookbush Andreea Broască,

External rotation of the feet is actually relative internal rotation of the femur and may actually increase the stress placed on the knee by the Q angle that you speak… another consideration you may think of is that VMO activity increases at the last 15 degrees in relation to the other vasti muscles, but all 4 muscles are active during all ranges of knee extension.

Last, compensation and postural dysfunction is more likely the cause of changes in vastus muscle recruitment, for example in a preliminary study by Fowles et. al, they found that stretching the biceps femoris increased VMO activity. The biceps femoris is an external rotator of the tibia and responsible for turning the feet out. The posture that you describe may actually increase biceps femoris activity, reciprocally inhibiting VMO activity and exacerbate this dysfunction.

Just food for thought.

November 15 at 5:05pm

Derek Nahar-Moore Brent, long time. I'll chime in real quick. This might be the least popular of the post today, but I'll give my 2-cents. I personally have never seen an exercise more debated by brilliant people than the barbell dead-lift (that doesn't mean its the most debated exercise, it's just been my experience). This is a fairly subjective exercise, and postural adjustments should probably be made based on each individuals strengths and weaknesses (blah, blah, blah, we all know that ). Now the argument can be made, and correctly so, that all exercises are this way, so whats the point of bringing it up in this case? To me, the point is that this particular exercise poses a much greater risk than the vast majority of all others to a persons health and safety. The cult following of the dead-lift has always fascinated me, as there are almost countless effective exercises at our disposal to safely strengthen all the muscles involved. I simply don't do it, nor do my clients. Anyway, take care bud, I enjoy your efforts.

November 15 at 5:07pm

Brent Brookbush Thanks Derek Nahar-Moore,

You bring up one of my favorite points… with 100's of exercises to choose from, why choose exercise that poses high risk?

I would disagree that postural adjustments are completely individual, and believe that most form issues could be remedied with corrective exercise. I think the elephant in the room when it comes to form on the deadlift and squat in particular is this: Some individuals will study, learn and practice corrective exercise enough to improve neuromuscular efficiency and the quality of their movement, and others would rather look for a quick fix (albeit short-term fix) and hold onto it with the emotional fervor of a badger protecting her cubs.

In essence, you could release and stretch your calves (work on lower leg dysfunction), or you can work around your compensation by turning your feet-out.

November 15 at 5:16pm

Andreea Broască There is still much debate among the experts about the proper stance for a squat/ dead lift and the VMO`s engagement and involvement in the knee`s extension. I`ll leave this to professionals, I`m not one of them Thanks for taking the time in replying and sharing your knowledge! Always eager to read your post. good luck with all your work!

November 15 at 7:04pm

Karam Al-hamdani When we turn the feet out we are limiting our base of support, when your foot is straight you have a large base of support we loose about 30% of the length of our foot that will cause a loos of balance and stability.

Also when we keep our feet straight you limit end-range Valgus collapse.

November 15 at 7:22pm

Michelle Langsam All I know about feet turned out constantly with deadllifts and squats is that I was walking behind a very buffed up male who was training for a body building competition - his side job was security .. The bloke I was walking with said omg there is no way I would argue or fight with THAT male if a situation arose (we were talking about handling scenarios) I looked at the male and said if I had to I would … The person I spoke to was looking at his upper body I was looking at his feet - extreme external rotation of the feet in training left the same in walking . One push and he would be off balance ( of course a duck of a fist might be in order but to me this guy s posture looked like a piece of cake to unbalance .)

In this case it was a scenario training but I use it regularly in my assessment of a person and in takedowns .. and as a pT I train people in several foot positions . We are forward walking people that's where we need balance in my view .

November 15 at 8:14pm

Shawn Fears "What dictates "good form" - that is, what signs do we look for to ensure optimal execution, and what cues do we commonly use?"

You have posted on cues before so here are my main ones again. Common cues: Big chest, big butt, brace the core. These apply to most lifts.

As far as good form goes that is a very general question and is impossible to answer specifically without the context of an exercise. That being said, I generally look at alignment of kinetic checkpoint positions(feet, knees, hips, lumbar, t-spine, c-spines, scapula/ shoulder girdle, elbow).

November 15 at 8:14pm

Michelle Langsam Feet turned out locks the SI joint more safely in place , feet forward relies more on muscles stabilising SI joint . I think there is a place for both .

This photo seems somewhere between Romanian and squat deadlift . Leaning this far forward = increase reliance on hip flexors , lengthening of gluts . Tight hips so can't go lower .. I'm with earlier comment ( apologies can't find your name a t m) why does this person need to deadlift at this stage of her bodies limitations ?

November 15 at 8:21pm

Michelle Langsam Or perhaps the photo has caught her half way thru the setting up ?

November 15 at 8:22pm

Matt Fleekop I like cueing the athlete/client to engage their lats. I think this helps them remain tight and keep a neutral alignment..along with many of the other cues everyone has used

November 15 at 8:28pm

Brent Brookbush Hey Michelle Langsam,

Can you explain your comment about the SI joint a little more thoroughly. As I understand it the SI joint is locked out in the extremes of nutation (via ligamentous lockout) or counter-nutation via congruence of joint surfaces. As these are both related to innominate rotation and not the feet I would be interested to here your thoughts on how one is linked to the other.

Feet turn-out does increase biceps femoris and adductor magnus activity which could lead to increase tension on the SI joint, but this is not necessarily a good thing.

November 15 at 8:52pm

Brent Brookbush Interesting Matt Fleekop,

Is that a reference to the Posterior Oblique Subsystem?

November 15 at 8:53pm

Barbara Fralinger Matt Fleekop is a Rowan student - go hard on him Brent!

November 15 at 8:55pm

Michelle Langsam Hey Brent Brookbush I don't have your skill level of detail .. Which is why I love reading your posts . I have learned from several practitioners and sadly personal experience or hip to now pelvis instability issues . Only yesterday did it come up again . With my trigenics practitioner when he explained my muscle to joint instability .

Actually I like that you called me on this cause i haven't ever had the scientific proof from reading , rather from listening and learning .

I am open to you questioning me further please . So here is what I understand so far ,.. Due to a severe sports injury I now have a hip replacement . My practitioners and on going pain and seizing up is in the SI joint . Whilst safer to turn feet out and 'lock the ball deeper into the socket ' it seems to apparently lock up my SI joint . When training feet forward it forces me to increase activation of stabilising muscles which I find through balancing exercises and some holding of posture . I was instructed yesterday to not do deadllifts for at least a year !

So I have learned this fri listening to physiotherapists , Pilates and trigenics practitioners then applying it to my own body .

November 15 at 9:14pm

Matt Fleekop Brent Brookbush yes, but I don't say engage the POS because most people will be clueless. I will use various cues to get the POS engaged in the movement.

November 15 at 9:14pm

Michelle Langsam I will call this further for your thoughts - feet turnout causes the adductors to lengthen , adductor lengthening causes a weakened rear part of the pelvic floor .

November 15 at 9:17pm

Matt Fleekop Michelle Langsam i think another problem when people get into this wide stance and turn their feet out their knees will buckle in

November 15 at 9:18pm

Lawrence Wolfe My son Joshua Klein, should check this out

November 16 at 11:02am

Brent Brookbush Hey Michelle Langsam,

It is hard for me to even speculate what is going on with your hip, but I would hope that you are working toward being able to do things in neutral. Your issue could be related to piriformis tightness, but I would need to know the approach they took when replacing your hip (sometimes they actually release the piriformis all together). You likely have some issues that are very different the issues we would talk about in this forum. Once, you get cut into things change pretty dramatically. It's not that corrective exercise won't work, but there is some stuff that needs to be taken care of first.

November 16 at 11:30am

Brent Brookbush As far as your question about the adductors: Feet wide would be abduction of the hip and would lengthen the adductors, generally speaking this increases adductor magnus activity during extension. Feet turned out may include tibial external rotation, the only adductor that crosses the knee is the gracilis and this muscle would be lengthened. Does that help?

November 16 at 11:33am

Brent Brookbush Hey Matt Fleekop,

Nice comment on communication… you are thinking about the intricate relationships in the human body and finding ways to communicate what you want to your clients in a simple way… Love it!

November 16 at 11:35am

Tony Susnjara I know these are body weight squats and not fully loaded but the question I ask is - is there one right way to do it? I'm sure there are many wrong ways where the risk of injury is greatly increased but I also think that there is more than one right way too. I picked this video randomly from many options that came up when I searched squat matrix //www.youtube.com/watch?v=A8YbGv3mfhQ

Squat Matrix

Attainable Growth, LLC. This exercise is inspired by principles taught by Gary Gray. For more information, visitwww.Grayinstitute.com

November 16 at 2:13pm

Barbara Fralinger What dictates good form to me is the ability to perform the movement through the full range of motion without compensating. Lifting optimal weight with proper form produces the best results with minimal chance of injury.

November 16 at 2:18pm

Brent Brookbush Hey Tony Susnjara,

I actually agree completely with your sentiment, until you start loading a squat with "max strength" levels of resistance - which you touched upon in your argument. The question is really not whether there is one right way, but whether is an ideal… and is that ideal is working around compensation, or correcting compensation and maintaining neutral.

November 16 at 2:21pm

Tony Susnjara are you looking for a 'Platonic squat' - I'm from a different segment of the industry (mostly yoga but other things too) so I wouldn't go outside of what I know but from a more abstract persepctive, I would start to establish a range of criteria such as alignment, neuro-muscular activation etc. I Googled (Google Images) Olympic Lifting out of curiousity and there was a fair range of squat variations. Another way to think about it might be - what are the weakest links in the movement pattern in terms of risk of injury? - my guess would be lumbar spine and knees.

November 16 at 4:07pm

Michelle Langsam Thanks Brent Brookbush yes my hip is a little more complicated than the average replacement because the arthroscope prior cut the external obturator ligament and who would have thought .. It wasn't a spare part! More on this SI joint thought , if external rotation locks in the hip joint more securely than neutral perhaps it is the location of the hip joint to the SI joint that 'locks in' the SI stability ?

November 16 at 5:36pm

Michelle Langsam Also The last workshop I did that based in the Gray iinstitute was big on changing feet direction throughout a workout

November 16 at 5:38pm

Jared Anderson any suggestions for someone that is working on thoracic outlet syndrom and my left lower trap is really hard to keep depressed while doing a deadlift it will pop from time to time. Everytime I do deadlifts even with 90lbs only my bracial plexus and scm and levator get real real tight any progressions to the deadlift to keep my shoulder protected

November 16 at 8:02pm

Kim-Lien Kendall Why is she doing an over under grip with … What is that? 65 pounds?

November 16 at 8:14pm

Jason Erickson Rather than consider "good form" for this specific image, I'm thinking in terms of good form for (nearly) all exercises. This is because the details of good form and cuing vary depending on the exercise, the client's build, the intended outcome(s), the client's experience level, environmental factors, etc.

Here are some things I consider prior to focusing on form and cuing details for a specific exercise:

Client safety - Can the client be reasonably expected to perform this exercise without unnecessary risk of injury? If not: regress, adapt, or choose something altogether different.

Intended outcomes - How well does this exercise support the client's goals? Does it need to be adapted to better prepare the client for sport/lifestyle performance needs?

Client learning - How does the client best learn new movements? How can I best present this movement to maximize the client's skill development?

November 17 at 1:17am

Michelle Langsam Wow I learn so much from everyone .. Thank you !

November 17 at 1:34am

Salma Azeem really a good forum regarding health and fitness

November 17 at 2:57am

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