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Doctor Examining Male Patient With Knee Pain

Restoring Movement and Mobility: The fitness professional’s role in total joint replacement care

According to the American Joint Replacement Registry, there are 860,000 total knee and hip replacements done in the United States per year. This number is projected to double in the next ten years. There are more knees than hips done per year and more females have these joint replacements than males.

According to Mike Carberry of Advanced Medical Integration, “Regenerative medicine is one of the most talked about subject healthcare has ever known; and for good reason. It could hold the solution to the puzzle of America’s failed healthcare system.”

This is wonderful news for the personal training industry. Insurance is paying for less and less, costing more while the number of consumers seeking optimal health is increasing. A perfect storm in the making!

A personal training certificate, however, is not enough to appropriately deal with the typical client with total joint needs. Specialization in anatomy, joint physiology, biomechanics and therapeutic exercise are necessary in order to adequately and appropriately manage total joint conditions. These skills and techniques in conjunction with medical communication skills will give physicians confidence to send these patients to the appropriately skilled personal trainer. Spending time with a physical therapist and surgeon specializing in these areas will go a long way in establishing confidence, trust and credibility in handling the client with total joint conditions.

Most individuals with true joint pain have some level of osteoarthritis. Approximately 27 million Americans suffer from degenerative joint disease (also known as degenerative arthritis or osteoarthritis). Degenerative joint disease is the most common chronic condition of the joints and occurs most often in knees, hips, lower back and neck, small joints of the fingers, and the bases of the thumb and big toe.

Osteoarthritis is the most common form of arthritis that causes a breakdown of joint cartilage, and it affects mostly middle-aged and older adults.

Although there is no cure for osteoarthritis, the good news is that it can be helped, and quality of life maintained by implementing and maintaining some simple changes in daily life. Regardless of the intervention, from routine steroid injections to platelet rich plasma/stem cell treatments to total joint replacement, here are a few areas where the personal trainer can intervene with great success.

Exercise

Exercise is key component of arthritis care, exercise strengthens the muscles, lessens joint pain and stiffness and improves overall health. Types of recommended exercises may include strengthening, aerobic activity (aquatic activity is wonderful), range of motion or stretching activities and balance exercises.

Joint protection

Protect the joints to ease pain and avoid further damage. Make sure to balance rest with activity as well as know when to stop. A good rule of thumb is to adjust down the frequency, intensity and duration by 50% of what a “normal” client can do or what the client thinks they can do. Remember these clients are typically deconditioned relative to strength and cardiovascular fitness. They will not handle the all-too-popular high-intensity interval training (HIIT). This population will succumb to overload and may be injured.

Pain control

Pain control routinely treated with prescription or over-the-counter medications can be replaced or augmented by relaxation techniques (yoga, Tai Chi, meditation and massage) along with application of heat, cold and/or vibration.

Post-procedure care

If the client has had regenerative therapy or a total joint replacement, they will need a specific post-procedure plan to allow for healing/protection, early intervention and return to activity function. Hopefully, they had pre-intervention care inclusive of appropriate exercise, nutritional counseling and insight on what to expect with the procedure and post-procedure care. Appropriate nutrition for optimal health and healing along with hydration techniques and insights are a must during these sessions.

Phase 1: Post-procedure care

Typical post-procedure care is in three to four phases. Phase one is protect/rest, restore and control pain. During this phase the focus is on mediating pain, restoring range of motion, controlling swelling and protecting the joint. This is typically fourteen to twenty-one days in duration. Stitches or staples are usually removed at this time and scar management can commence around the twenty-first day.

Phase 2: Post-procedure care

Phase two is the restore and regenerate phase. The

wound is healing (healed), the joint and soft tissue healing continues, and remodeling of tissue has begun. This phase is typically three to six weeks in duration. Techniques to restore range of motion and other soft tissue techniques to facilitate healing according to tissue physiology and the client’s general health are initiated (conditions such as diabetes, obesity, cardiovascular disease and others will alter the healing and remediation phases). Techniques for ambulation, gait and balance are initiated along with appropriate cardiovascular conditioning.

Phase 3: Post-procedure care

Phase three typically commences when the client has gained full range of motion, has good balance and gait mechanics and is able to tolerate closed-chain activities for both upper and lower extremity movement patterns. This phase is the final phase and progresses to full functional activity and return to sport or recreational activities of choice (these activities may be placed into a fourth phase). During this phase it is incumbent upon the personal trainer to load appropriately and have working knowledge of the mechanics of the sport or recreational activity. There are some tremendous resources available for this purpose.

Complications

Complications to be aware of when working with these patients include but are not limited to infection, blood loss, dislocation, blood clots and fatigue. The personal trainer should also be in contact with the client’s physician and physical therapist if one has been engaged. These are medical conditions requiring communication and conservative care.

Most physicians like to know who is working with their patients and appreciate the communication for optimal outcomes. The insightful and knowledgeable personal trainer with the right training can be an invaluable member of the total joint care team. The future is bright!

This information is provided as an overview and in no way should be interpreted as a protocol for treatment or otherwise. Our goal is to inform the reader on opportunities in the profession and stimulate further investigation.

This article was featured in MedFit Professional Magazine fall 2019 issue.

Subscribe to MedFit Professional Magazine to read more great content like this!


Dr. Stephen A. Black is a sports medicine specialist, author and clinician. His doctoral degree is in sports medicine and he holds degrees in physical therapy, athletic training and certification through the National Strength and Conditioning Association. Dr. Black has over forty years’ experience in patient care and practice management. He lectures frequently on topics in sports medicine, works with professional, Olympic and youth athletes and holds several academic appointments. Visit his website, rockymountainhpc.com

Prescription for good health diet and exercise flat lay overhead with copyspace.

A New Era Begins

The rallying cry is, “Let’s change healthcare!” From all corners of the medical universe, there is agreement that change is necessary. The biggest questions are, “What is the change?” and, “Who will make it happen?”

DNA-puzzle

The Evolution of Truly Personalized Medicine: Epigenetics, Food, and Fitness

Most would not argue that there is ongoing transition in how our healthcare is being delivered. This article will examine some of these transitions as a result of breakthroughs in technology, as well as how genetic information, exercise, and diet will play an increasingly greater role.

When medical science was first getting its start, a more holistic philosophy was taken on how to treat illness and maintain health. Hippocrates is often deemed the father of modern medicine, and even today the allopathic physicians (M.D.s) take the Hippocratic Oath – to do no harm to their patients. Hippocrates knew, even in 400 B.C., that the best healer of the body is the body itself. For the most part, the best treatment is to create a strong body and get out of the way. Five guiding principles used in his philosophy for treatment include:

  1. Walking is man’s best medicine.
  2. Know what person the disease has, rather than what disease the person has.
  3. Let food be thy medicine.
  4. Everything in moderation.
  5. To do nothing is also a good remedy.

The second and fifth principles emphasize the power of knowing the individual and getting out of the way! The first and third principles show the power of exercise and food for healthy living. Even the genius, Thomas Edison, realized that a health maintenance organization (HMO) approach was the best method of healthcare both practically and financially. His quote, “The doctor of the future will give no medicine but will interest his patient in the care of the human frame, in diet and in the cause and prevention of disease,” is evidence that a holistic, preventative approach is what he advocated. He is also quoted, “…you can’t improve on nature.”

One size does not fit all

Personalized medicine is now on the forefront and it utilizes the genetic and epigenetic data of a person to guide medicines and treatment plans. Cancer drugs have probably harnessed this advantage to the greatest extent, thus far. Former President Jimmy Carter received Keytruda (pembrolizumab) for his brain cancer and it boosted his immune system and beat the cancer. While most of America (71%), still doesn’t even know about personalized medicine, those who were familiar with it did not know it would yield better results with fewer side effects. The different directions of personalized medicine are still being realized, but the field of pharmacogenetics is the first to really jump on the bandwagon of highly effective, precision-based treatment.

The reasons some drugs work for some people and not for others, or why side effects occur in some individuals and not others, is due to individual variability in metabolism. Why are some people lactose tolerant, or some can drink alcohol with no problem, and others have severe issues? It is usually because of enzyme differences, which are under the control of our genes. Interestingly, our enzyme genes can often be turned on or off by “inducible sequences” known as promoters or suppressors of operons, respectively. These “switches” can be repressed or induced depending on our environmental stimuli. Thus, we actually have some control over our gene expression, and this field is known as epigenetics.

Knowing what gene variants someone possess or not will guide the personalized medicine physician on which drug to use or not. By knowing allergic reactions in advance or which medicines may have side effects will help physicians to not make a bad situation worse. Unfortunately, the cost of personalized medicine drugs is much higher than alternative treatments. There is still a lot of exploration to be done on all the various applications of this technology, but the bottom line is that understanding individual variations and enabling the body to do what it is designed to do is a very good thing! Companies like Toolbox Genomics is one of many companies that use your genetic information to then tell you what foods and supplements to eat or avoid, and which exercises may help you the most, and ones that you may not respond to so well. The reason physicians do an intake on family history, or run various tests is to collect information that will guide their treatment. A genetic test on certain gene variants is simply taking this a step further.

How does exercise and diet apply to our epigenetics?

Did you know that exercise is highly beneficial to not only help with fighting cancer once it is already present, but also to never getting it? Physical exercise or movement in general will shift the epigenetics so that genes that suppress tumors are increased, and genes that cause cancer (oncogenes) are decreased. It does this by changing the amount of certain reactions called methylations. Things go wrong when there is too much or too few methylation reactions. Exercise has been shown to reduce or even reverse the epigenetic mutations that often result in tumorigenesis or tumor production. Exercise has also been shown to reduce genetic factors associated with aging like telomere length.

The fields of proteomics and metabolomics as well as pharmacogenomics, are all emerging because of the knowledge on how our genetics affects proteins, metabolism, and reactions to drugs, respectively. The field of nutrigenomics is rapidly expanding, and several companies are capitalizing on studying the relationship of how our genes affect how we process and utilize foods, as well as how food can affect our genes. Vitamins A and D, certain fatty acids, especially medium and short chain, some sterols (derived from cholesterol) and zinc have been shown to directly influence gene transcription. In direct effects include how diet affects gut bacteria, which in turn influences gene expression. Soon when nutritional recommendations are given, it will likely be “for this individual.”

The future of medicine will be taking our genetic information to a whole new level. Soon “smart” watches, clothes, hats, and other common devices will collect information that can benefit our health in many ways as the way healthcare is delivered continually evolves.

This article was featured in MedFit Professional Magazine summer 2019 issue.

Subscribe to MedFit Professional Magazine to read more great content like this!


Dr. Mark P. Kelly has been involved with the health and fitness field for more than 30 years. He has been a research scientist for universities and many infomercial projects. He has spoken nationally and internationally on a wide variety of topics and currently speaks on the use of exercise for clinical purposes and exercise’s impact on the brain. Mark is a teacher in colleges and universities in Orange County, CA., where Principle-Centered Health- Corporate Wellness & Safety operates.