Optimal Exercise Form Is Not Always Right

Aized and I had an interview with a physiotherapist last week. She found out physiotherapists in our clinic worked 4 days a week and she was keen to join our team. The interview had a practical component where she had to ask questions, assess and treat my "mid and low back pain" (for my twice broken back). 

After some questions and assessments, she decided that my weight lifting form was causing my discomfort. She then proceeded to "correct my form" for my weight training.

I understand the need to be very strict with textbook form for lifting and making sure technique is efficient to complete the task at hand whether it is during a rehab exercise or just moving a barbell in a strength movement from A to B.

Just so we can be on the same page, I am writing about what most personal trainers, strength coaches and physiotherapists consider textbook form. Feet shoulder width apart, back straight during a squat/ deadlift for instance.

That being said, there are definitely situations where less than "ideal" or "optimal" form is indicated and this is what I will be writing about.

Patients who have anatomical or even mobility limitations cannot do an exercise with textbook form or through full range correctly. Consider the following pictures above and below. Our bones and joints are shaped and angled differently and this will mean that there will be a large variability in individual ranges of motion and variations in exercise form and technique. You may have to squat wider with toes out while others may squat in a narrower stance with toes facing inwards.

Different femoral head angles

The squat technique is usually advised when lifting heavy objects over the stoop technique since this technique is thought to result in lowering intervertebral disc (IVD) compression and shear forces compared to the stoop technique.

Squat (a) versus stoop (b) lifting

However, when we compare squat versus stoop lifting, the squat lifting is not favored over stoop lifting (this is in contrast to current recommendations). 

The following study actually showed that lifting with a flexed spine produced LOWER spinal compression forces than lifting with a neutral spine (Van Arx et al, 2021).

Then there are patients who have widespread chronic pain but no tissue pathology. There is often lots of fear and avoidance of activity in these patients that if you focus too much on form it will be counter productive.These patients may be in a deconditioned state and I will be happy just to get them moving compared to someone who wants to deadlift a 100 kg.

Similarly with patients who are not active and had never play sport their whole lives. They often struggle with what we think are really simple movements and exercises. So long as there is no pain and they are not aggravating anything in low level exercises (example a half squat), I am fine with form that is not ideal for the time being and may work at improving it later.

Older patients often have other multiple health conditions and they may be other things to work on instead of spending too much time trying to teach a single exercise.

Physiotherapists who treat patients with neurological conditions like Parkinson's disease and stroke, will tell you that these patients definitely cannot do exercises with textbook form.

This post is not meant to ridicule anyone who insists on teaching textbook form while teaching exercises. Nor am I suggesting you let your patients have freedom to do whatever they want when exercising. I am simply suggesting that there are situations where insisting on textbook form is not ideal nor practical.

Reference

Von Arx M, Liechti M, Connolly L et al (2021). From Stoop To Squat: A Compressive Analysis Of Lumbar Loading Among Different Lifting Styles. Front Bioend Biotech 4: 9: 769117. DOI: 10.3389/fbioe.2021.769117

Please read this for more on squat versus stoop lifting.

Different shaped pelvis