Transcript Slide 1 - pinnacleapps.com

Chapter 21 Clients with
Orthopedic, Injury and
Rehabilitation Concerns
NSCA’s Essentials
Introduction
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The personal training profession has been
gaining more acceptance and with that it
allows for more flexibility and opportunity in
training individuals with injury orthopedic
dysfunctions
A personal trainer’s unique knowledge and
experience provides a unique perspective to
helping these types of clients
Introduction
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This chapter, while informative, is not to
provide the reader with rehabilitation
protocols or replace medical professional’s
advice
It is designed to explain the physiological
events that accompany orthopedic-related
injury and disease processes
Ultimately it is information to be used in
conjunction with healthcare/medical providers
to facilitate communication
Injury Classification
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Several ways to classify injuries such as type of injury
(sudden or gradual) and tissue damaged.
Macrotrauma: sudden, specific episode of overload
injury to a given tissue
Microtrauma: overuse injury (over a long period of
time), repeated stress on body…many overuse
injuries are due to too little recovery time, poor
technique, training surfaces, but not necessarily
repeated physical activity.
Tissue Healing Following
Injury
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General Phases of Tissue Healing
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Inflammation Phase
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During injury blood flow increases along with
capillary permeability causing edema
This also causes a decrease in joint mobility
and tissue function
Increased pain associated as well with
increased nerve fiber stimulation
Tissue Healing Following
Injury
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Inflammation
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Typically last two to three days following
acute injury, but can last longer (5-7 days)
Goal during this phase is to prepare for
new tissue formation during subsequent
phase of healing
RICE (rest, ice compression and elevation)
are primary treatment
No exercise during inflammation phase
Tissue Healing Following
Injury
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Repair Phase
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Three to five days following acute injury
and may last 7 days up to two months
Allows for replacement of tissues that are
not viable following injury or surgery
Damaged tissue is regenerated (scar
tissue) and new capillaries and vessels
form in the area and collagen fibers are
randomly laid down for a framework.
Tissue Healing Following
Injury
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Repair Phase
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Goals is to prevent excessive muscle atrophy and joint
degeneration of injured area
Also avoid disruption of newly formed collagen fibers
Introduce low level stresses on the body
Specific exercises should be used during repair phase only
after consultation with client’s physician or physical therapist
 Isometric exercise allows strength gains to occur, but the
intensity is low enough to not disrupt the collagen fibers.
Tissue Healing Following
Injury
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Remodeling Phase
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Can last two to four months or ≥ 1 year
Weakened tissue formed during repair phase is
not becoming strengthened
Collagen fiber production has significantly
decreased
Mainly work on increasing function and structure
of area…optimizing tissue function
Eventually add more stress on the injured area
Orthopedic Concerns and the
Personal Trainer
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Personal trainers should have an awareness of different types of
orthopedic injuries and types of exercise strategies for them
Indication: activity that will benefit the client
Contra-indication: an activity or practice that is inadvisable or
prohibited because of given injury
Precaution: an activity that may be performed under supervision
of qualified personal trainers and according to client limitations
and symptom reproduction.
It is not your job to determine movement or exercise
restrictions…rather it is to identify and abide by appropriate
contraindications and precautions
Must communicate with the client’s physical therapist or
physician
Orthopedic Concerns and the
Personal Trainer
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It is not feasible for a personal trainer
to know all the injuries, but being
familiar with general information is
important
See table 21.1 (pg. 537) for common
injuries to muscles, tendons, bones and
joints
Low Back
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Low back pain means a lot of things
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Disc dysfunction, muscle strain, lumbar
spine stenosis, etc.)
Different types are treated differently
Aim of this section is to provide
appropriate movements and understand
inappropriate movements
Low Back
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Movement and Exercise Guidelines
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Hypomobility (tight muscle: stretch it) and hypermobility
(weak muscle: strengthen it) are not uncommon.
 Balance work is recommended
Responds well to stabilization exercise, posture corrections,
and flexibility exercises.
A proper flexibility and mobility assessment should be
conducted.
If the client has a considerable history of low back pain or a
low back injury or experience an increase of symptoms, or if
the personal trainer is unclear about the condition or status,
a consult with the medical providers is warranted.
Low Back
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Lumbar Disc Injury
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When a lumbar disc herniates part of the nucleus
pulposus makes its way through the outer annulus
fibrosis, resulting in inflammation
This irritation then irritates the spinal nerve roots
Client may feel:
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Pain in back
Lower extremity pain, abnormal sensation and weakness
Excessive flexion may be a big contributor to this
Seek treatment from a physician if this happens!
Low Back
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Movement and Exercise Guidelines (table 21.3, pg.
543)
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No lumbar flexion exercises
Use extension exercises
Resistance training contraindication are full sit ups
Resistance training precautions include squatting, rowing
movements and deadlift
Aerobic exercise contraindications include bicycle riding
(possible increased flexion with forward lean)
Contraindicated flexibility include hamstring stretches
(lumbar flexion)
Precautions for stretching include gluteal, hip adductor and
upper back stretches
Muscle Strain
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Tears to muscle fibers
An overuse muscle strain may require
client to improve proper posture and
movement patterns
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Retraining muscles to function in their
intended manner will enable them to work
more efficiently, thereby decreasing the
abnormal stress the affected muscles
experience.
Movement Exercise Guidelines
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Restrictions highly dependent on the
muscle that is strained
Once therapist or physician have
pinpointed muscle that has been
strained then one should avoid all
exercises that rely on that area
Spondylolysis and
Spondylolisthesis
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Spondylolysis: defect or fracture in the lumbar
vertebrae (pars interarticularis region)
Spondylolithesis: possible progression of
spondylolysis, a forward slippage of one vertebral
body on another
Commonly occur following lumbar extension injuries
or in persons participating in activities that require
lumber extension (divers, football linemen, etc.)
Clients with this usually describe low back pain and
lower extremity pain, muscle weakness, etc.
Spondylolysis and
Spondylolisthesis
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Movement and Exercise Guidelines
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Focus on strengthening muscle surrounding the
spine
Avoid exercises that involve lumbar extension
Many abdominal exercises are fine (crunches, and
exercises for the obliques and transverse
abdominis are good)
Walking and other forms of standing
cardiovascular exercise are not considered
contraindicated
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if client does have back pain after 8-10 minutes with
standing cardio, then keep it at that duration and
increase when tolerance is built up