It’s a common conundrum many athletes face. You’ll have various aches during a workout that you can’t really replicate for your manual therapist, who ends up trying to play detective in a befuddling guessing game. Or maybe your bodyworker has their finger on the pulse, but you find yourself wracking your brain about what they told you to do the next time you’re in the gym.

Several years into their 14 years of practice, licensed massage therapists Jason Pederson and Kacey Grissom were well aware of the deficiencies in their sports massage practice.

“Manual and movement techniques are helpful in many ways, and yet it can too often be a passive experience for the client. After time, I found myself frustrated that too many clients would leave sessions feeling great, yet would re-engage with their old physical patterns during their favorite movement activities when away from session. Down the road the same pain would re-emerge,” Grissom said. “Bodywork is a wonderful adjunct to active pursuit of long-term change and reaching wellness goals. This in conjunction with thorough assessment, and assessment-based client education, movement re-education and corrective exercise technique, I can more effectively help clients actively engage with their body on a new level—and reach long term, lasting physical goals.”

Pederson noticed similar shortcomings. “I started off just doing manual therapy, and it wasn’t working 100% of the time,” Pederson recalled. “It got us to a point, but there were still people that would get off the table that weren’t better. Fortunately for me, many of those people were open enough to say, “Well, let’s figure this out.” They’d say, ‘It feels good after the treatment but when I go and do a squat, there’s the pain again.’ Eventually, I said, “Well, let’s see you do a squat and figure out what’s causing the pain.”

Although Pederson and Grissom blended corrective exercise and movement re-education with bodywork long ago, they wanted to take it one step further. So they did. Studio B is Pederson and Grissom’s hybrid facility, which includes a treatment room for bodywork and a small gym for individualized assessments, movement re-education, training and/or corrective exercises. “We do full assessments on our clients, and six-week programs where we do corrective exercises and specific training for alignment, postural and performance issues. We use the activity room for corrective exercises. Oftentimes, we’re looking at correcting imbalances and so we’ll look at the program they’re already doing and maybe modify their technique,” Pederson explained, noting that the majority of the athletes he sees incorporate squatting and Olympic lifts into their program. “We’ll see where the person’s falling apart and give them pointers. We have very basic equipment; free weights, kettlebells, medicine balls, bumper plates and plyo boxes. We also had a metal rack built to support a lot of weight. It’s 19 feet long by 12 feet wide, and at 9 feet tall, we can do any kind of hanging, swinging or inversion work. Just imagine an adult sized jungle gym that is also a squat rack; that is the activity room. ”

Grissom noted that adding the corrective exercise element to her practice left her clients with better long-term support, as they began to understand their own movement patterns and take greater responsibility with the information they had. “Corrective exercise is no different than regular exercise,” she pointed out. “It’s just noting which muscles are important to strengthen, which to inhibit and which to stretch for the particular individual, and then following suit to bring the body back into postural balance. Creating a balanced program for each client is important for their overall health and wellness.”

Although each client is different, Grissom said she commonly sees a lot of anteriorly translated head carriage, increased thoracic kyphosis, pelvic rotations (both anterior and posterior), and weak, under-coordinated cores. All of these postural anomalies contribute to an alarmingly high number of orthopedic and sport-related conditions, including thoracic outlet syndrome, lumbar spine disturbances, hamstring tears, medial and lateral knee conditions and tracking disorders, and a long list of foot conditions which create pain and contribute to further postural disturbances. Many of these issues stem from improper movement patterns, which can be addressed in the activity room as well as on the table.

Pederson has noticed that about 70% of his clients have some kind of incorrect breathing pattern, core weakness “They may have structural or positional imbalances that put their diaphragm ‘out of place’; one side may be flared out or it isn’t functioning correctly. Technically it isn’t able or in position to function correctly. They may have a rib angle that is extreme, or some kind of core instability; functionally they are misaligned. Proper muscular tone in the diaphragm is key to core stability,” Pederson explained. Treatment is tailored to the individual, depending on the neuropattern they’re trying to address. Some clients may need to work on breathing patterns, for example, and others may need to work under load.

Pederson points out that many movement dysfunctions or imbalances are due to one muscle group being tight and overactive and one not working at all. He helps clients release the active group but also activate the inactive group of muscles.

He feels Turkish getups are particularly useful. “They are a direct process of the developmental kinesiology we used as infants. Rolling and using these primary roll mechanisms, being able to isolate and specifically move through closed chain and open chain processes. Just watching someone do a few of them, I can pick up on what’s stable and what’s unstable. I get a lot of feedback and use that information,” he said.

Although both Pederson and Grissom incorporate various exercises into their practice, Studio B isn’t exactly personal training. “I’m still primarily a manual therapist,” Pederson says. “But what I was finding is that manual therapy really does need a certain period where the neuromuscular system is activated, so there needs to be exercise with manual therapy for high-end athletes—really, for everyone.” A session at Studio B starts with an assessment process, and could be followed with manual therapy, activation, more manual therapy, weights or an activity where all of it is happening at the same time. “Some people don’t need manual therapy at all, but they are the minority,” Pederson said.

Grissom believes assessment is one of the most useful tools in decoding the movement pattern puzzle of the clients she sees, and Studio B gives her the space and tools to assess her clients fully—both in movement, and static postures. She believes it is paramount in assessment to keep things simple—which muscles are short and tight, as opposed to tight and long, or long and weak. Such simple practices create ease in the development of treatment plans—something she has found important for educating therapists and clients, better supporting client goals and facilitating lasting relief from simple postural disorders, orthopedic and sports-related conditions.

Pederson and Grissom work with a roster of professional, collegiate and amateur athletes in sports including baseball, football, basketball, soccer, cycling and golf, so another benefit of Studio B is that Pederson can help clients finish their workouts even if they are injured. “Professional athletes have a very regimented schedule; to miss a workout due to injury is a big deal, this becomes even more important if the competition isn’t missing their workouts. There are only so many days before a season starts,” he explains. Pederson would watch his clients finish workouts and if they exacerbated an imbalance he could treat them right then and there, allowing them to finish their workouts.

Studio B isn’t the first hybrid gym/manual therapy combination. With athletes wanting to work through injuries but unlock the puzzle pieces rather than just searching for a quick fix, it’s no wonder that there’s growing interest in putting the functional back into functional training.

“The key component in injury prevention is motor control,” said Pederson. “Really what we’re looking for is this motor control, then stability and then strength. That creates improvements in the specific motions you use in your everyday life.”