Title: Program Design for Injury Management Presented by Maureen
1Program 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
2OBJECTIVES
- 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.
3Define 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.
4To 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!
5OUR 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.
6ADD FURTHER INSULT TO INJURY WITH
- Poor Posture
- Poor or incorrect movement mechanics/patterns
- Poor conditioning/fitness level
- Poor instruction/supervision
- Poor nutrition
- Genetics
7Signs 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.
8FUNCTIONAL 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.
9Expand Your Repertoire
10Top 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?
11Upper Cross Syndrome
12Lower Cross Syndrome
13Functional 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
14Ensure 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.
15Ensure 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.
16Tips 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.
17Tips 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.
18Tips 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.
19Tips 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!
20THINK 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.
21Have 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.
22Abdominal 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.
23Take 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.
24Get 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.
25Glorious 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).
26Single 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)
27Lumbar Spine Proprioception
- Emphasis on spine stabilization with a neutral
spine using proprioception and position awareness
exercises - 4 point kneeling
- Sitting balance
28The 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.
29Hip 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 .
30Spine 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.
31Its 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.
32Be 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.
33In 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?
34Your 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
35References 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