Home Blog Corrective Exercise: Sequencing the Law of Repetition Motion Sequence

Corrective Exercise: Sequencing the Law of Repetition Motion Sequence

Written on July 6, 2011 at 6:32 am, by Eric Cressey

When it comes to corrective exercise programs, everyone simply wants to know “what” is and isn’t included – and rightfully so. Picking the right strength exercises and mobility drills – and contraindicating others – is absolutely crucial to making sure you get folks to where they want to be.

However, very rarely will you hear anyone specifically discuss the “when” in these scenarios, and as I’ll demonstrate in today’s piece, it’s likely just as crucial to get this aspect correct.

To begin to illustrate my point, I’m going to reuse a quote from an article I wrote a few weeks ago, Correcting Bad Posture: Are Deadlifts Enough?, on the Law of Repetitive Motion :

Consider the law of repetitive motion, where “I” is injury to the tissues, “N” is the number of repetitions, “F” is the force of each repetition as a percentage of maximal strength, “A” is the amplitude (range of motion) of each repetition, and “R” is rest.  To reduce injury to tissues (which negative postural adaptations can be considered), you have to work on each of the five factors in this equation.

You perform soft tissue work – whether it’s foam rolling or targeted manual therapy – on the excessively short or stiff tissues (I).  You reduce the number of repetitions (length of time in poor posture: R), and in certain cases, you may work to strengthen an injured tissue (reduce F).  You incorporate mobility drills (increase A) and avoid bad postures (increase R).

What I failed to mention a few weeks ago, though, was that the sequencing of these corrective modalities must be perfect in order to optimize the training/corrective effect and avoid exacerbating symptoms.  Case in point, we recently had a client come to us as a last resort with chronic shoulder issues, as he was hoping to avoid surgery.  Physical therapy had made no difference for him (aside from shrinking his wallet with co-pays), and following that poor outcome, he’d had a similar result with soft tissue treatments twice a week for six weeks.  In a single four-week program, we had him back to playing golf pain free.  What was the difference?

In the first physical therapy experience, he’d been given a bunch of traditional rotator cuff and scapular stabilization exercises.  There had been absolutely no focus on soft tissue work or targeted mobility drills to get the ball rolling.  In other words, all he did was improve stability within the range of motion he already had.  In the equation above, all he really worked on was reducing the “F” by getting a bit stronger.

In his soft tissue treatment experiences, he felt a bit better walking out of the office, but ran into a world of hurt when his provider encouraged him to “just do triceps pressdowns and lat pulldowns” for strength training.  In other words, this practitioner worked on reducing “I” and increasing “A,” but totally missed the boat with respect  to enhancing strength (reducing “F”) and increasing rest (“R”) because of the inappropriate follow-up strength exercise prescription.  Doh!

What did we do differently to get him to where he needed to be?  For starters, he saw Dr. Nate Tiplady, a manual therapist at CP, twice a week for combination Graston Technique and Active Release treatments (reducing “I”) at the start of his training sessions.  He followed that up with a specific manual stretching, positional breathing, and mobility exercise warm-up program (increase “A”) that was designed uniquely for him.  Then, he performed strength training to establish stability (decrease “F”) within the new ranges of motion (ROM) attained without reproducing his symptoms (decreasing “N” and increasing “R).

The sequencing was key, as we couldn’t have done some of the strength exercises we used if we hadn’t first gotten the soft tissue work and improved his ROM.  He may have had valuable inclusions in his previous rehabilitation efforts, but he never had them at the same time, in the correct sequence.

This thought process actually closely parallels a corrective exercise approach Charlie Weingroff put out there much more succinctly in his Rehab = Training, Training = Rehab DVD set:

Get Long. Get Strong. Train Hard.

Keep in mind that there are loads of different ways that you can “get long.”  You might use soft tissue work (Active Release, Graston Technique, Traditional Massage, etc.), positional breathing (Postural Respiration Institute), mobility drills (Assess and Correct), manual stretching, or any of a host of other approaches (Mulligan, DNS, Maitland, McKenzie, etc).  You use whatever you are comfortable using within your scope of practice.

When it’s time to “get strong,” you can do so via several schools of thought as well – but the important thing is that the strength exercises you choose don’t provoke any symptoms.

It’s interesting to note that this corrective exercise approach actually parallels what we do with our everyday strength and conditioning programs at Cressey Performance – and what I put forth in Show and Go: High Performance Training to Look, Feel, and Move Better.  We foam roll, do mobility warm-ups, and then get cracking on strength and stability within these “acutely” optimized ranges of motion to make them more permanent.

Related Posts

Corrective Exercise: Why Stiffness Can be a Good Thing
Strength Training Programs: Lifting Heavy Weights vs. Corrective Exercise – Finding a Balance

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12 Responses to “Corrective Exercise: Sequencing the Law of Repetition Motion Sequence”

  1. Jonathan Says:

    Good notes on order. Thanks Eric. I think it’s also important to note that you had another practitioner perform the soft tissue work. Too often I see trainers watch their colleagues do modified Graston techniques, ART, and soft tissue work and decide to emulate them. The best trainers understand these other disciplines and know when to use them in addition to having a strong referral network.

  2. Eric Cressey Says:

    Agree 100%, Jonathan!

  3. Dave Says:

    Another Gem Eric! Thanks for more terrific info. I’m looking forward to hearing you speak at the summit this month. Let’s try to chat for a bit that weekend!


  4. don smith Says:

    Sounds to me like the guy only needed some gentle active nerve glides EC. The rest of the soft tissue stuff is great for dishing out pain and getting the joints/nerves to shut down. It’s looking like movement patterns are stored in the brain and got nothing to do with jerking around the tendons bones etc. Great website and generally good posts though. Go Phillies and Pirates.

  5. donna Says:

    Love it! for years previous to my own upgrades in understanding and education i would always wait to workout until after, say, a physical therapy session – knowing that it would not only help me stabilize the presumably better alignment/muscle activation but also,why should/would i go into a workout knowing that my form was off because of issues which i myself could not control? Freud might’ve had a way of “diagnosing’ the issue, which seems endemic to our Western world – that we just keep pushing the envelope even if it means it might burst one day. ( BP oil spill, yellowstone river pipeline, real estate bubble…). Fix it before you use it, darn it! – or at least have some safeguards in place that will be able to right it immediately if the worst happens.
    Great advice, Eric, as always – love that you share yourself!!

  6. Col Says:

    Great blog Eric, Always top notch training/rehab advice and info.

  7. Lyndie Says:

    Great info and advice! I’m just starting out
    (a UNE grad) and I love reading your blog every afternoon after seeing my clients…I deal with a lot of post-rehabilitation cases and posts like this always offer valuable direction! Thanks!

  8. Andrew Says:

    Very interesting. As soon as I get paid I plan on getting some form of professional massage therapy. I was wondering which form of massage is effective, as in, am I wasting my money on a deep, shiatsu, swedish, etc. Also I have found some therapists who perform ART near me, should I opt for ART over other options. Currently I am in week 1 ofphase 2 of show and go and I have been foam rolling for over a year and using the theracane for a couple of months.

    Also, I haven’t heard much about the proper form for an incline barbell bench. I noticed that when I try to get my feet under my butt and arch my back, I have a lot more power, but I do feel a little pain in my lower so I stopped doing it that way. Any comments on this?


  9. Dustin Says:

    Great advice, as always.

    Suspiciously…today a fairly similar article by Michael Ranfone came out on T-Nation which also stresses the importance of sequence. Ranfone describes the “corrective complex” which sequentially includes “1) Soft tissue quality 2) Mobilize and lengthen soft tissue 3) Activate the antagonist.” Similar to your “Get Long. Get Strong.” except his get long is the tissue work followed by the mobility. And his get strong is antagonist training, which may follow your “strength exercises don’t provoke any symptoms.”

    p.s. Small typo here: “You reduce the number of repetitions (length of time in poor posture: R)”

  10. Pete Viteritti, D.C. Says:

    I wanted to correct Don Smiths assertion (post # 4)that movement patterns are simply stored in the brain and as he reports, “got nothing to do with jerking around the tendons, bones etc”. Clinicians who practice the new paradigm of Patient Centered Care match the most effective treatment modality with the particular pathology that is diminishing function. Fibrotic adhesions(arguably the most common pathology in the musculoskeletal system) are in fact effectively treated with ART and instrument assisted soft tissue mobilization. This is clearly demonstrated with pre and post treatment functional testing. In this case, applying corrective exercise without first reducing adhesions in the various soft tissues that demonstrated decreased forced production or limit active range of motion during functional testing is merely strenthening the bodies ability to compensate. Dr. Vladimir Janda in Rehabilitation of the Spine is clear to point this out when is says, “Respecting the approach of motor learning, any dysfunction in the periphery should be normalized first, because any pathologic propriceptive information from the periphery results in functional adaptive processes…”

  11. Sam Leahey Says:

    Dr.Pete, Eric, Don,

    Well said on everyone’s part. I believe that ultimatley the truth is “somewhere in the middle” and from my vantage point it seems like Gray Cook’s thought process of “Reset, Reinforce, then Reload” covers all our bases in sequence:



    All the best,

    P.S. Good seeing you again Dr.Pete at BSMPG!

  12. Scott Gillman, DC, DACBSP Says:

    Dr. Pete is correct. The physiology is revealing. Muscle spindle cells, receptors, do not attach to muscles. They attach to the fascia that surround muscles. Fibrosis, disruption, or adhesion literally constrain and impair spindle firing. This leads to altered neuromotor responses, including loss of fine motor control and reflex inhibition to muscles under load. Anyone can smoosh around soft tissues, but only skilled providers with sufficient training can more effectively alleviate these lesions. ‘Just because you own nunchucks doesn’t mean you’re Bruce Lee…

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