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NASM Corrective Exercise 纠正练习【英文版173页】
NASM Corrective Exercise 纠正练习【英文版173页】
NASM Essentials of
Corrective Exercise Corrective Exercise
“I have been in the group exercise and training industry for over 14 years ... NASM has taught me the broadest spectrum
of tools and techniques that I use today. I work with sedentary adults, children, seniors, pre- and post-pregnancy, post-
rehabilitation, physically disabled, diseased populations, and professional athletes ... The NASM certification brings a level of
competency that cannot be matched.”
— Cindy Feltman, NASM CPT, Arizona
“I work as a Divisional Fitness Manager for Fitness First in the UK. We have chosen NASM above all other training providers
to educate our staff across the UK ... Our trainers feel inspired by the NASM OPT model and quickly see how it is going to
put them ahead of the competition in their respective club. To sum it up, NASM has changed the way I train and train other
people but most of all it is opening the eyes of the industry in the UK.”
— Alan Holl, NASM CPT, England
“I felt like I didn’t have the competitive edge to make a lasting impact in the personal training industry. I would struggle to
see what other trainers were doing and what I wasn’t doing. I finally realized that the one major thing that NASM offered,
that most other certifications didn’t offer was Corrective Exercise as well as Optimum Performance Training. Keep up the
great work NASM as you continue to lead the fitness industry and change the lives of many for years to come!”
— Ralph Arellanes, NASM CPT, New Mexico
“I had been a trainer and in the business for approximately 13 years and carried three other certifications ... They were
helpful, but I knew I needed something to augment and enhance my knowledge ... NASM provided this. Due to the educa-
tional opportunities and leadership provided by NASM, I have been greatly enhanced as a trainer, simply because it is effec-
tive and builds upon itself.”
— Dan Cordell, NASM CPT, PES, CES, Georgia
“I read a lot of magazines and articles trying to learn more of the proper form and technique of lifting and different move-
ment patterns. But I didn’t really “get it” until I took the NASM CPT course... Knowing that there were many certifications to
choose from, I did a lot of research on the Internet to find the one that was the most in-depth and respected... I just liked
the integrated approach NASM taught.”
EDITORS
— Jeremy Cheung, NASM CPT, California, Top 10 Trainers in the U.S., Women’s Health Magazine
Micheal A. Clark
Scott C. Lucett
Chapter 8
Corrective Exercise
Strategy for Foot and Ankle
Impairments
Corrective Exercise Strategy for
Foot and Ankle Impairments
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Corrective Exercise Strategy for
Foot and Ankle Impairments
Introduction
The human body is susceptible to movement dysfunctions and neuromusculoskeletal imbalances. The rea-
sons for this include repetitive movement, overuse, sedentary living, and improper movement techniques.
These dysfunctions, in turn, lead to many of the common injuries seen today.
The foot and ankle complex is a region of the body with great influence on the entire Human Movement
System. This region represents the platform from which our base of support is derived and is the main
contact point between the ground and the body. As such, it must withstand the highest amount of contact
force (ground reaction force) with each step taken, as it is closest to the impact site (heel strike).
If there is movement impairment centralized within the foot and ankle region, it can lead to various symp-
tomatic responses, as seen in Table 8-1. These include plantar fasciitis, Achilles tendonitis, and posterior
tibialis tendonitis (shin splints). As the body is an interconnected chain (kinetic chain), compensation or
dysfunction in one region such as the foot and ankle can and will lead to dysfunctions in other areas of
the body. (1, 2) More proximally, dysfunction for the foot and ankle can also lead to patellar tendonitis
(jumper’s knee), iliotibial band (IT-band) tendonitis (runner’s knee), low back pain, hamstring, quadriceps,
and groin strains, as well as many shoulder and upper-extremity injuries. (Table 8-1)
Table 8-1. Common Injuries Associated with Foot and Ankle Impairment
For example, if the foot externally rotates and/or everts during movement, it is generally the collective
motion of the foot/ankle and lower leg. Therefore, the displacement of the foot will likely result in altered
lower leg motion/alignment, which is indicative of overactivity of the lateral gastrocnemius, peroneals,
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Corrective Exercise Strategy for
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short head of the biceps femoris, and/or the tensor fascia lata (TFL), and underactivity of the medial
gastrocnemius, posterior tibialis, medial hamstrings, gracilis, sartorius, popliteus, and/or gluteus medius
and maximus.
Locally, the lateral gastrocnemius, when activated, can externally rotate the lower leg as well as cause
eversion of the calcaneus. The peroneals (longus and brevis), when activated, will evert the foot. The
peroneus longus can cause external rotation as well. Proximally, the short head of the biceps femoris
and the TFL can externally rotate the lower leg because of their attachments to the fibula and tibia,
respectively. When the medial gastrocnemius, posterior tibialis, medial hamstrings, gracilis, sartorius,
popliteus, and/or gluteus medius and maximus cannot be sufficiently activated to counter these actions,
compensation occurs.
This combination of over and underactive muscles can also cause the knee (tibiofemoral joint) to adduct
and internally rotate. The lateral gastrocnemius and biceps femoris each externally rotate the lower leg
relative to the femur and flex the knee. When the knee is flexed and the lower leg is externally rotated
relative to the femur, it produces a lateral displacement (abduction) of the lower leg causing the femur
to internally rotate and adduct. (3) This can be further perpetuated by the TFL, which specifically pro-
duces internal rotation of the femur and external rotation of the lower leg. (3) Collectively, this places
disproportional stress on the patellofemoral and tibiofemoral joints (i.e., patellar tendonitis and general
knee pain). (1, 4)
Overactivity of the TFL can lead to underactivity of the gluteus medius. The flexion and internal rotation
of the hip/femur caused by the TFL places the posterior fibers of the gluteus medius as well as the gluteus
maximus in a lengthened position, which alters the length-tension relationship and decreases recruit-
ment due to altered reciprocal inhibition. (2) In turn, this creates a destabilized lumbo-pelvic-hip complex
(LPHC), which can lead to low back pain, hamstring, quadriceps, and groin strains. (2, 4)
Any alterations in pelvic positioning and stability will directly affect the latissimus dorsi, which attaches
to the pelvis via the thoracolumbar fascia network. (4) The latissimus dorsi has direct influence on the
shoulder region through its attachment to the scapula and humerus and this can lead to many shoulder
and/or cervical injuries.
Each of the typical injuries listed can be problematic for any individual and the reduction in pain or sever-
ity is the focus of many exercise programs. However, these injuries are primarily symptoms representing
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Corrective Exercise Strategy for
Foot and Ankle Impairments
a problem in the Human Movement System. The National Academy of Sports Medicine (NASM) has
developed a systematic corrective exercise strategy to identify and address the problem rather than the
symptoms. This allows the Health and Fitness Professional to develop a safe and effective solution for any
client. The purpose of this text is to demonstrate the corrective exercise strategy specifically for foot
and ankle impairment.
The specific movement impairment that will be discussed in this text is external rotation and/or eversion
of the feet (also known as feet turn out and feet flatten), seen in Figure 8-1.
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Corrective Exercise Strategy for
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Table 8-2. Probable Overactive & Underactive Muscles Accompanying Foot and Ankle
To ensure clarity and maximal retention of the information, the following section will provide a simplistic
overview of functional anatomy for the pertinent muscles, bones, and joints.
Moving up to the lower leg, the tibia and fibula bones form the proximal and distal tibiofibular joints as
well as the talocrural joint (tibia, fibula, and talus), typically collectively called the “ankle” joint.
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Corrective Exercise Strategy for
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More proximally (Figure 8-3), the patella, femur, and the pelvis, in conjunction with the aforementioned
bones, comprise the tibiofemoral (tibia, femur), patellofemoral (patella, femur) iliofemoral (femur, pelvis)
joints that anchor proximal myofascial tissues. These structures are important in terms of corrective
exercise because they will also have a functional impact on the arthrokinematics of the foot and ankle.
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Muscles
With all Human Movement System impairments, there are over and underactive muscles which create
an imbalance and lead to injury. The pertinent muscles of the lower leg which are overactive with this
impairment are discussed in Table 8-3 and pictured in Figure 8-4.
Table 8-3. Overactive Muscles of the Lower Leg Accompanying Foot and Ankle Impairment
Isometric –
Muscle Concentric Eccentric
Stabilization
Lateral Plantarflex ankle, evert Foot, ankle, and knee Decelerates ankle
Gastrocnemius calcaneus, externally dorsiflexion, internal rotation
rotate lower leg, and of lower leg, and knee
flex knee extension
Soleus Plantarflex ankle, Foot and ankle Decelerates ankle
externally rotate dorsiflexion, internal rotation
(supinate) lower leg, of lower leg and eversion
and assists in knee of subtalar joint, and knee
extension flexion
Peroneus Evert ankle, plantarflex 1st Metatarsophalangeal Decelerates ankle inversion
Longus ankle joint (MTP) and dorsiflexion
Lateral Gastrocnemius Soleus Peroneus Longus
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Corrective Exercise Strategy for
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The pertinent muscles of the lower leg which are underactive with this impairment are discussed in Table
8-4 and pictured in Figure 8-5.
Table 8-4. Underactive Muscles of the Lower Leg Accompanying Foot and Ankle Impairment.
Isometric – Eccentric
Muscle Concentric
Stabilization
Medial Plantarflex ankle, invert Foot, ankle, and knee Decelerates ankle
Gastrocnemius calcaneus, internally rotate dorsiflexion, external
lower leg, and flex knee rotation of lower leg, and
knee extension
Posterior Plantarflex ankle, externally Foot and ankle Decelerates ankle eversion,
Tibialis rotate (supinate) lower leg, dorsiflexion, and internal
invert foot/ankle rotation of lower leg
Anterior Invert ankle, Foot and ankle Decelerates ankle
Tibialis dorsiflex ankle plantarflexion and eversion
Medial Gastrocnemius Posterior Tibialis Anterior Tibialis
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The overactive muscles of the LPHC affecting the foot and ankle are discussed in Table 8-5 and pictured
in Figure 8-6.
Table 8-4. Overactive Muscles of the LPHC Accompanying Foot and Ankle Impairment
Isometric –
Muscle Concentric Eccentric
Stabilization
Biceps Femoris Externally rotate lower Knee Decelerates internal rotation of
(short head) leg and flex knee lower leg and knee extension
TFL Flex, abduct, and LPHC and knee Decelerates femoral extension,
internally rotate femur adduction and external rotation
(hip), externally rotate of LPHC, and internal rotation
lower leg, and extend of lower leg
knee
Biceps Femoris (short head) TFL (and IT Band)
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The overactive muscles of the LPHC affecting the foot and ankle are discussed in Table 8-6 and pictured
in Figure 8-7.
Table 8-6. Underactive Muscles of the LPHC Accompanying Foot and Ankle Impairment
Isometric – Eccentric
Muscle Concentric
Stabilization
Medial Hamstrings Flex knee, extend hip, LPHC and knee Decelerates knee extension,
and internally rotate hip flexion, and external
lower leg rotation of lower leg
Gracilis Adduct, internally LPHC and knee Decelerates femoral
rotate, weak flexion abduction, external rotation
of femur, and of lower leg
internally rotate
lower leg
Sartorius Abduct, internally LPHC and knee Adduct, externally
rotate tibia, knee and rotate tibia, knee and hip
hip flexion, and hip extension, and hip internal
external rotation rotation
Popliteus Internally rotate Knee Decelerates external
lower leg (open rotation of lower leg (open
chain), externally chain) and internal rotation
rotate femur (closed of femur (closed chain)
chain), and weak
flexion of knee
Gluteus Medius Abduct, externally LPHC and knee Decelerates femoral (hip)
(posterior fibers) and rotate, and extend adduction, internal rotation,
Gluteus Maximus femur (hip) and flexion
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Medial Hamstrings Gracilis Sartorius
Popliteus Gluteus Medius Gluteus Maximus
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Table 8-7. Probable Assessment Observations for Foot and Ankle Impairment
Assessment Observation
Overhead Squat Feet turn out (externally rotate) and flatten (evert)
Single-Leg Squat Feet flatten (evert)
Goniometric Measurement Decreased dorsiflexion (less than 15 degrees) and/or
secondary decrease in the hip flexion 90/90 position
(hamstring, short head of biceps femoris) and/or hip
extension (TFL)
Manual Muscle Testing One or more of the following muscles tested “weak”:
Anterior tibialis, posterior tibialis, medial gastrocnemius,
and/or medial hamstring;
Proximally, the gluteus medius and/or maximus
Integration
Inhibitory Lengthening Activation Techniques
Techniques Techniques Techniques
Integrated Dynamic
Self-Myofascial Static Stretching Positional Movement
Release Isometrics
Neuromuscular
Stretching Isolated
Strengthening
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Table 8-8. Sample Corrective Exercise Program for Foot and Ankle Impairment
*NOTE: If client is not initially capable of performing the Integrated Dynamic Movement
exercise listed, they may need to be regressed to a more suitable exercise.
Lateral Gastrocnemius and Peroneals Bicep Femoris (short head)
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Gastrocnemius/Soleus Stretch Bicep Femoris (short head) Stretch
Posterior Tibialis Medial Hamstrings
Anterior Tibialis Medial Gastrocnemius
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Single-Leg Balance Single-Leg Balance
START FINISH
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References
2. Sahrmann SA. Diagnosis and Treatment of Movement Impairment Syndromes. St. Louis, MO:
Mosby; 2002.
3. Vasilyeva LF, Lewit K. Diagnosis of muscular dysfunction by inspection. In: Liebenson C (ed).
Rehabilitation of the Spine. Baltimore: Williams & Wilkins; 1996. p. 113–42.
4. Neumann DA. Kinesiology of the Musculoskeletal System: Foundations for Physical Rehabilitation.
St. Louis, MO: Mosby; 2002.
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