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Title: Program Design for Injury Management Presented by Maureen


1
Program Design for Injury Management
  • Presented by
  • Maureen Hagan, BScPT (Physiotherapy)
  • BA PE (Physical Education)
  • 1998 IDEA Program Director of the Year
  • VP Operations- The GoodLife Fitness Clubs- Canada

2
OBJECTIVES
  • Gain knowledge of common exercise- related
    injuries within the scope of practice as a
    fitness professional.
  • Heighten awareness of injury management and
    injury prevention with practical programming
    ideas for your clients.
  • Expand your training repertoire to include
    Functional Rehabilitation. Introduce
    Functional Fitness Formula.
  • Avoid risk associated with training post
    rehabilitated clients.
  • Provide fitness professionals with practical
    training tips and recommendations.
  • Discuss a dozen corrective patterns of movement.

3
Define Scope of Practice
  • Diagnose
  • Prescribe
  • Physical Therapy versus Physical Activity
  • Gather information from clients past history,
    medical history, clients activity prescription
    issued by a health professional.
  • Management exercise design, dosage and delivery
    based on sound principles of training and
    assessment.
  • Network with clients health professional as
    appropriate.
  • Review and understand professional code of
    ethics and scope of practice and be responsible.

4
To Heighten Awareness of MOI
  • Repetitive motion that may be forceful and,or
    stressful
  • ? Poor posture
  • ? Poor movement mechanics/patterns
  • ? Overuse
  • ? Leads to repetitive strain injury
  • ? Inactivity
  • ? Sedentary living
  • ? Regular participation in exercise and sport
  • The aging process
  • These type of injuries result from an
    accumulation of faults and in the most
    innocent way!

5
OUR BOOTS ARE MADE FOR WALKING..
  • INJURY CAN OCCUR IN
  • 1. Muscle/Tendon- damage and scar tissue or
    imbalance of muscle.
  • 2. Joint- abnormal motion of a joint or joint has
    become unstable due to ligament stress/injury.
  • 3. Nerve- tension or compression? decrease in
    power to nerve.
  • 4. Biochemical- if over-trained or deficient in
    specific nutrients ? global decrease in strength
    which may compound the problem. Understand the
    PITTS.

6
ADD FURTHER INSULT TO INJURY WITH
  • Poor Posture
  • Poor or incorrect movement mechanics/patterns
  • Poor conditioning/fitness level
  • Poor instruction/supervision
  • Poor nutrition
  • Genetics

7
Signs Symptoms
  • None to mild to moderate discomfort/ache at
    rest
  • Swelling and discomfort in the specific area or
    joint
  • Muscle fatigue
  • Muscle spasm
  • Numbness and,or tingling
  • Compensation and/or change in mechanics
  • ?early signs symptoms progress to
  • Chronic pain
  • Re-occurring swelling
  • Muscle weakness and atrophy
  • Immobility
  • Possible joint instability and/or disability
  • More severe dysfunction
  • Red Flag PRICE
  • 90 of all repetitive strain injuries begin in
    the most innocent way.

8
FUNCTIONAL REHABILITATION
  • Defined as
  • Practical exercise guidelines that facilitate
    and/or progress the rehabilitation process.
  • Also referred to as post-rehabilitation or
    functional rehabilitation.
  • Know your limitations of practice!
  • Your role is a facilitator or coach in the
    rehabilitative process, to work as a member of
    the health professional team in the best interest
    of your client to program or assist in providing
    appropriate exercises that complement therapy and
    progress client post rehab.

9
Expand Your Repertoire
  • ?

10
Top 10 Repetitive Motion Injuries in
Exercise/Fitness
  • Lower Compartment Syndrome
  • Ankle Sprain
  • Plantar Fasciitis
  • Achilles Tendonitis
  • Stress Fractures
  • Patellar Femoral Pain/Syndrome
  • Carpal Tunnel Syndrome
  • Epicondylitis
  • Rotator Cuff Tendonitis, Impingement, Frozen
    Shoulder
  • Hip Flexor Syndrome
  • What about TMJ Dysfunction? What about LBP?

11
Upper Cross Syndrome
12
Lower Cross Syndrome
13
Functional Fitness Formulabased on Dr Stuart
McGills Research and Program Ultimate Back
Fitness and Performance
  • Develop speed, power
  • and agility ?
  • Increase endurance
  • Build strength ?
  • Build whole body
  • and joint stability ?
  • Develop corrective patterns ?
  • build basic pattern through to
  • complex patterns

14
Ensure that you do the following to avoid common
mistakes liability...
  • Ask for the clients medical professionals
    guidance about your mutual client. Seek a signed
    consent from your client to do this first and
    have clients complete all necessary medical
    clearance/PAR Qs forms/consents.
  • Assess history and quality of exercise program
    adherence prior to your supervision.
  • Assess lifestyle habits outside the gym and
    physical activity habits to understand common
    faults that may influence performance.
  • Incorporate a postural assessment and analysis
    into your repertoire.
  • Assess quality of functional (integrated/whole
    body movement) versus isolated strength,
    flexibility, muscular endurance, muscle balance
    AND CORRECT.

15
Ensure that you do the following to avoid Common
Mistakes...
  • 6. Never diagnose or prescribe treatment (limited
    to R.I.C.E) and always recommend ongoing medical
    supervision.
  • 7. S.O.A.P all client visits and keep client
    file up to date and accurate. Report all
    exercise related incidents.
  • 8. Focus on exercises and progression that
    maintain and progress a clients fitness and
    overall health using principles of training that
    make sense for the client. Train smart!
  • 9. Trial and Error one thing at a time and
    re-evaluate outcome within 4 to 6 sessions.
  • 10. Do not ignore innocent signs/symptoms. Listen
    to your clients comments before training, between
    exercise and observe body language and follow up
    between sessions as appropriate.

16
Tips and Recommendations...
  • Seek to grow and understand MOI Overuse can be a
    result of
  • A single event of innocent onset
  • Faulty biomechanics repeated
  • Overload
  • Improper Progression
  • Educate clients to be responsible in their own
    health.
  • Motivate participants to listen to their body and
    recognize signs of fatigue, muscle soreness and
    even structural and biomechanical changes.

17
Tips and Recommendations
  • Offer exercise options in the warm-up and cool
    down so participants can prepare and recover
    effectively.
  • Encourage cross training and periodization cycles
    based on training goals and timelines.
  • Teach according to sound principles of training
    including functional to address ADLs as well as
    performance goals.
  • Create programs built on a foundation of
    stability progress intensity once base is solid
    1-3 sets of 8-15 repetitions however quality of
    motion is primarily goal. Train smart using a
    variety of training principles.

18
Tips and Recommendations
  • Incorporate posture and alignment checks
    throughout training.
  • Assess and correct movement mechanics early and
    provide positive reinforcement.
  • Be observant to a fault and offer options to
    every client recognizing their unique
    differences.
  • Communicate with empathy. Provide exceptional
    customer service. Be observant. Listen and
    continually learn.

19
Tips and Recommendations...
  • Utilize a multi-disciplinary approach to working
    with your client. Establish your own Allied
    health professional advisory.
  • Network in your community and establish a
    credible referral system without judgment.
  • Network in your community and build your own
    credibility so to enhance confidence with the
    health community.
  • Gain additional courses and certifications and
    association memberships active and keep your
    resume/business portfolio up to date.
  • Never diagnose and prescribe Rx- Prevention and
    management of health is your only role.
  • Prepare yourself with knowledge of how to utilize
    the appropriate medical clearance request forms,
    PAR Qs etc.
  • Protect yourself with the appropriate liability
    insurancemanage your risk!

20
THINK outside your box...
  • 1. Many injuries are avoidable.
  • 2. Learn more about how the body relates as it
    ages and help your clients find more prudent or
    user-friendly ways to train as they age.
  • 3. Post-Rehabilitation and Functional
    Rehabilitation will continue to grow in
    popularity as the baby boomers age so prepare
    yourself and your business.
  • 4. Refer to your health professional team to help
    you grow your credibility and expand your
    business opportunity.

21
Have a Healthy Neutral Spine
  • Upright standing should produce minimal
    contraction in the low back extensors however
    poking chin and slouched shoulders will cause
    chronic contraction.
  • Learn to find the relaxed posture to shut the
    lumbar extensors off by retracting the chin and
    shoulders centering the body over the supporting
    lumbar spine.
  • To correct positioning of the shoulders, make a
    fist and rotate the thumbs out to lift the chest
    and position the thorax. Relax the arms and
    recheck the low back extensors are relaxed.

22
Abdominal Bracing Over Hollowing
  • Hollowing technique of intentionally sucking in
    the abdominal wall towards the spine shown to
    compromise stability and create spine
    dysfunction.
  • In contrast the abdominal brace has been proven
    to enhance stability. The brace produces a true
    muscular girdle around the spine- both the
    abdominals and extensors are active
  • Begin in a flexed forward position and feel the
    extensors contract then extend to an upright
    position until you feel the extensors shut off.
    Without moving, contract the abdominals and feel
    the extensors contractthis is a brace.

23
Take a Bow with the Hip Hinge
  • Eliminate other joints in the body by kneeling,
    then drop their hips back to their heels to
    isolate the hips and provide a 45 degree path of
    motion for the pelvis to travel posterior.
  • Perform from a standing position a supported hip
    hinge (short stop position) with hand resting on
    the hips, sending the hips back.

24
Get Into Glute Action- Basic Squats
  • Squat up out of a chair without momentum.
  • The lumbar spine is neutral and braced. The hips
    move back and down. The knees move very little
    however bending to allow the hips to translate
    back to emphasize gluteals for hip extension,
    unloading of both the knees and the back.

25
Glorious Gluteal Patternswith Squats
  • Healthy glute patterns are needed to protect the
    back. Retraining the gluteals cannot be performed
    with a traditional squat movement that involves a
    barbell on the back. There is little hip
    abduction (glute medius recruitment) and gluteus
    maximus recruitment is delayed. Traditional
    squats target quadriceps.
  • One legged squats activates the gluteus medius
    immediately with sooner integration of gluteus
    maximus during the squat descent motion.
  • To learn how to activate gluteus medius side
    lying (bent knee) Hip Opener and, or lateral
    leg raise with isometric external rotation.
    Palpate with fingers (thumb on ASIS).

26
Single Leg Squats and Step Ups
  • Make them as functional as possible by
    integrating arm reaches to the floor, or overhead
    or by adding weights.
  • Complex motions involving squats include
  • Cross over lunges, step ups, one legged bent over
    rows (lean n lifts)

27
Lumbar Spine Proprioception
  • Emphasis on spine stabilization with a neutral
    spine using proprioception and position awareness
    exercises
  • 4 point kneeling
  • Sitting balance

28
The Dead Bug
  • Introduces dynamic limb motion into an abdominal
    curl up.
  • Involves a pre-bracing of the abdominal wall with
    a neutral spine and the opposite arm and leg
    flexed at the shoulder and hip to mimic the
    motion of a bug on its back.
  • Beginners can stabilize their lumbar spine by
    placing their hands underneath-to ensure no
    lumbar motion occurs.

29
Hip Hip HoorayBridging for Maximizing Your
Bottom Line
  • With lumbar spine remaining in neutral squeeze
    the buttocks, not by extending the pelvis. Lift
    off the floor. Minimize hamstring dominance by
    pulling the toes up (to firing the quadriceps).
    Progress to one leg hip bridging .

30
Spine Sparing Side Bridge
  • Ideal for stabilization
  • Utilizes all layers of the abdominal musculature
    to optimize performance while spine loads are
    minimized as one side of the torso musculature
    has much lower activation.
  • Important stabilizers are trained including the
    quadratus lumborum.
  • Bent knees (with hips slightly flexed) progressed
    to straight legs (with top leg in front) offers
    various degrees of muscle recruitment and
    challenge.

31
Its not SupermanIts a Bird-Dog
  • Minimize spinal load and compression and helps to
    ensure stable patterns of muscle activity.
  • The objective is to be able to hold the limbs
    parallel to the ground for 8-10 seconds.
  • Progression to prone plank.

32
Be a Star Exercise
  • Star exercises facilitate basic arm and opposite
    arms lifts, squat and lunge patterns into all
    directions or quadrants ideal for pre-training
    patterns of movement functional in nature.

33
In Closing...
  • As we embark on the quest to promote Physical
    Activity to everyone, the Fitness Professional is
    responsible for recognizing and understanding
    this rehabilitation process.
  • How do/will you fit in?

34
Your Speaker
  • IDEA Fitness Instructor of the Year 2006
  • IDEA International Program Director of the
    Year1998
  • Vice President- Operations, GoodLife Fitness
    Clubs, Canada
  • Director of Education-Can-Fit-Pro (Canadian
    Fitness Professionals)
  • Licensed Physiotherapist
  • adidas sponsored athlete
  • Author of FIT-iology-the study of fitness in
    action,
  • Volumes I II
  • Professional Speaker with Canadian Association of
    Professional Speakers
  • Website www.mohagan.com
  • Email mo_at_goodlifefitness.com
  • Or defyaging_at_golden.net

35
References available upon request.
  • For more information on workshops contact
    Maureen at
  • Website
  • www.mohagan.com
  • Emails
  • defyaging_at_golden.net
  • mo_at_goodlifefitness.com
  • or
  • MITMO Enterprises Inc
  • 64 Fullarton Street
  • London, ON N6A 1K1
  • GREAT Resource for Functional Training ideas.
  • FIT-iology- the study of Fitness in Action
    Volumes I , II III by Maureen Hagan, BScPT, BA
    PE
  • Ultimate Back Fitness and Performance by Dr
    Stuart McGill
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