Program Design for Injury Management Presented by Maureen

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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

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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.

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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.

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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!

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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.

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ADD FURTHER INSULT TO INJURY WITH

• Poor Posture
• Poor or incorrect movement mechanics/patterns
• Poor conditioning/fitness level
• Poor instruction/supervision
• Poor nutrition
• Genetics

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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.

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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.

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Expand Your Repertoire

• ?

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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?

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Upper Cross Syndrome
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Lower Cross Syndrome
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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

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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.

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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.

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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.

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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.

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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.

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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!

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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.

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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.

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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.

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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.

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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.

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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).

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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)

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Lumbar Spine Proprioception

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

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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.

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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 .

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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.

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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.

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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.

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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?

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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

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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