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joint-replacement

Proprioception Training: An integral aspect of joint replacement fitness

/6 December 2023/ All MFN blog/

Proprioception refers to the conscious and unconscious perception of postural balance, muscles sense, and joint position and stability. Basically, it is your sense of where you are in time and space for movement. We have found over the years that the best way to explain proprioception to clients comes from Dr. Eric Cobb at Z-Health Performance Solutions:

“Proprioception is the body’s 3D map of itself in time and space. AKA our movement and awareness map”.

The detail and definition of this “proprioceptive map” comes from several specialized mechanoreceptors (i.e. nerve endings) in the muscles, tendons, joint capsules, fascia, and skin. As fitness trainers as we are usually taught about muscle spindles and Golgi tendon organs when we learn about flexibility training, but there is a lot more to proprioceptive input. You are affecting the proprioceptive input to the brain when you use a neoprene knee sleeve (pressure), kinesiology tape (skin stretch), heat or ice packs (temperature), TENS units (electric), etc. 

Why understanding and training proprioception is important for joint replacement clients

Several conditions can alter proprioception, thus “clouding” the map and degrading movement sense and capability, including pain, trauma, effusion, and fatigue. A joint replacement client also likely had poor motor control of the joint in the first place that resulted in compensatory movement patterns and overuse injury over time. Complicating the matter further, although it may have been necessary, the surgery itself is an “insult” to the musculoskeletal and nervous systems.

To move a joint well, you must be able to feel the joint and surrounding tissue well. An extreme example of what can happen without the sense of touch or joint position is the story of Ian Waterman. A rare neurological illness resulted in his losing all touch and joint position sensation, effectively paralyzing him from the neck down even though the motor control area of his brain and the descending pathways to send movement information to his musculature were fine!

Varied stimulus drives improved mapping

We can improve proprioception in several ways:

  • Reduce causes of proprioceptive “inhibition” (i.e., pain, fatigue, and effusion) – Therefore we need to only move in pain-free ranges of motion, and build muscular endurance.
  • Augment sensory information – We can do this by providing novel sensory stimulus to the affected area such as vibration, kinesiology taping, skin stimulation, pressure, or temperature. 
  • Weight Bearing Exercise Therapy – Loading, appropriately and progressively, compound movements.
  • Motor Skills Training – Exercises to target accurate movement such as multi-directional movements based on visual stimulus.

The important take away is that building a “library” of prior movement patterns is especially important for the post-medical joint replacement client. We want to get their new joint moving in multiple directions, at multiple speeds, under multiple loads.

The concept of proprioception and how to harness it is not only for joint replacement, but also for general fitness, performance, and pain clients! Begin learning a neuro-centric approach to medical fitness and how to work with joint replacement clients with our Joint Replacement Fitness Specialist online course, available through the MedFit Classroom!

Pat Marques is a Z-Health Master Trainer and NSCA-CPT specializing in training the nervous system to improve performance and get out of pain.  After retiring from the Active Duty Army, Pat pursued his education and certifications in exercise science, initially working with wounded, ill, and injured soldiers. During this time that Pat discovered the power of using a neurological approach to training to get out of pain and improve fitness and performance. He currently provides exercise therapy, movement reeducation, and strength and conditioning for all levels of clients at NeuroAthlete, from chronic pain sufferers to Olympic-level and professional athletes.

References:

  1. Lephart, SM and Fu, FH. (2000). Proprioception and Neuromuscular Control in Joint Stability. Champaign, IL: Human Kinetics.
  2. Roijezon, U., Clark, N., and Treleaven, J. (2015). Proprioception in musculoskeletal rehabilitation. Part 1: Basic science and principles of assessment and clinical interventions. Massage Therapy (20).
  3. Cole, J. and Waterman, I. (1995). Pride and the Daily Marathon. MIT Press.
  4. Roijezon, U., Clark, N., and Treleaven, J. (2015). Proprioception in musculoskeletal rehabilitation. Part 1: Basic science and principles of assessment and clinical interventions. Massage Therapy (20).
female-trainer-senior-client-exercise-ball

Become a Movement Detective!

/17 November 2023/ All MFN blog/

Often clients have nagging pains and aches that do not seem to go away. Pain inhibits seniors from doing more. And they WANT to do more.  You need to find out what is causing pain. You might need a team of referral partners. You might figure it out yourself. You start by becoming a Movement Detective !

Analyzing your clients’ daily patterns and repetitive activities as well as how they spend their “down” time will give you many CLUES into what might be causing the aches and pains of daily living. A careful detective asks the best probing questions in a conversational manner. There once was a 70’s TV detective named Columbo. He was always asking questions to get to the bottom of the crime. You need to get to the bottom of the crimes of poor movement and poor sedentary postures.  

Once you discover a few clues, then you can incorporate alternative patterns and postures that may be less irritating to the joints and safer for the client. Just because they are still climbing stairs and ladders does not mean they are doing it well. Sewing all day in a hunched over position is doing nothing to improve that chronic neck and shoulder pain. Plopping into car seat and grabbing the seat belt with too much force and rotation is not helping with their back pain. See where this is going?

A. WHAT to look for 

Ask your client to answer these questions. Give them a day or two to think about it. Write them down on an index card for them to carry around and be prompted to pay attention to their personal patterns.

Things you do the most often…

  1. Where do you sit? 
  2. Where do you stand and what do you do there?
  3. Where do you move around? What areas of the home?
  4. What tools do you use? Home. Garden. Hobbies.
  5. What do you pick up and put down? Pets. People. Stuff.
  6. What shoes do you wear? Home. Outdoors. Exercise.
  7. What kind of car do you drive?  SUV. Sedan.  Low/High.
  8. In what position do you like to sleep? Side. Back. Tummy.

B. HOW to set up the crime scene for examination. Clues are in the moves.

  1. Have your client demonstrate how they maneuver through their day inside and outside the house.  
  2. Have them demonstrate a few ADLS like picking up and putting things down.  
  3. How they work at a counter and desk.  
  4. How do they talk on the phone and work on their devices. 
  5. How and what do the like to keep clean? 
  6. Have them sit in their favorite chair and get cozy.

C. WHO to refer to if you spot a problem that you are not qualified to address.

Having a strong network of allied health professionals for your client to consider is a level of service most trainers are unable to provide.

Sometimes we notice things that are troublesome like seeing the client wince in pain when doing daily movement. This is when you ask about it and see if they would consider going to the doctor or physical therapist to determine if there is pathology to the pain or other discomforts such GI issues, headaches, etc. (Take detailed notes here. This will help the allied health professional if your client goes to them for diagnosis and treatment).

Important things to remember:

  • Refer not Defer!  
  • When in doubt… Refer Out!
  • Stay in Your Scope of Practice!

D. WHEN and WHERE to begin teaching the client new ways to do these everyday things.
BETTER and PAIN FREE.

Fit Pros: Guide Older Clients as a Geriatric Fitness and Lifestyle Specialist

Millions of people over age 65 looking for guidance from fitness professionals who are knowledgeable in exercise, nutrition and lifestyle principles that can help them improve functional mobility, while also preventing and managing chronic conditions to live their highest quality of life. The Geriatric Fitness and Lifestyle Specialist online certificate course will give you insights, strategies and tools to be a successful professional in this rapidly growing market. Learn how to be a valued part of clients’ continuum of care, working with the medical team to improve functional outcomes and positively impact people’s lives.

Holly H. Benson, BS, is a veteran in the Recreation and Fitness industries with over 35 years of administrative and technical experience. She holds two bachelor’s degrees, Corporate & Community Fitness and Recreation Administration, and numerous fitness certifications. She has developed thriving fitness programs for special populations and has passionately focused her career on the much older adult.  She currently owns and operates Moving Strong Medical Exercise, LLC in Lakewood, Colorado and provides in-home and virtual fitness training to older adults and persons with chronic medical and orthopedic conditions.

Caregiver-and-Senior-Woman

Caregivers: The Often Overlooked Gold Mine in the Senior Market

/6 November 2023/ All MFN blog/

Caregivers… what does that mean? Obviously, it means someone who takes care of others. In this case, seniors 65 and older. Now you might say that 65 is a very young age to need caregiving, but not if you have a chronic condition like Parkinson’s, COPD, Multiple Sclerosis, even Type II Diabetes. What happens when these seniors suddenly can’t navigate through their life like they used to and even simple things like getting to the doctor and grocery shopping become extremely difficult to manage? They find they need a break after doing these simple tasks. At this point, they either have their adult children take on these tasks or hire someone to do them. These people — the Caregivers — are a huge untapped market for medical fitness professionals to provide our valuable services.  

Do you have connections to this market? They tend to be overlooked as they are not the end-user of our services.  Yet, they hold the key to introducing us to pre-qualified clients. There is a huge trust already established between these caregivers and their relatives or employers. The client values and relies on their recommendations, therefore, it is very advantageous to cultivate a presence in their world.  

As with all targeted marketing, where do they hang out and what are their needs? Did you know there are entire associations geared specifically toward caregivers with a subcategory of the adult children, or “parents taking care of parents”? If you didn’t, you need to. It is where the goldmine begins, and the subcategory of caregivers we are going to focus on.  I have been a caregiver with both of my parents and with numerous clients I’ve worked with. When you tap into this market, you find yourself becoming a caregiver as well. If you are great at establishing trust, you too become a trusted resource for referrals. This is a compelling reason to develop a network of preferred medical practitioners that hold similar values and approach towards care. 

From the biopsychosocial aspect of where these caregivers are, they are stressed out from providing care for both their parents and their own children as well. Their parents will fall under the category of Condition Impacted Dependent© to Extensively Dependent and Frail©, meaning they need assistance or improvement with their IADLs (Instrumental Activities of Daily Living). The caregiver demographic will be working a full-time job and juggling their own children, they have very full plates. They literally will not have the energy or time to research and find a qualified professional who can provide in-home medical exercise services designed to make their lives easier. They will welcome any respite in managing their parents’ condition; improving function is added frosting on the cake. 

When it comes to getting noticed, start with your message.

  • Preventing further decline – how valuable do you think that is to stressed-out caregivers? 
  • Increasing their parents’ ability to function more independently can prevent further decline, allowing them to take on more of their own IADLs and in the process keep their cognition. 
  • The capacity to bounce back after setbacks is instrumental to all the people involved. 
  • The biggest take-home is that it will reduce the caregiver’s anxiety of having to care for their parent.
  • Have your materials ready to educate people on what medical exercise is and specifically what the benefits are to the caregiver and the client’s lives.

Marketing Plan

  • Research groups that support caregivers, specifically adult children of seniors (see resources)
  • Offer presentations on how-to’s.  Build fall resilience, improve strength for grocery shopping, resources on balance training, presentation on 10 best exercises seniors can do for function. Make sure you have these ready to go, it will save a lot of stress later. 
  • Have a PDF ready of your services and costs. The caregiver might be tech-savvy, but they will need to have something easily accessible to show to their parents
  • Hone your empathic listening. When a potential caregiver calls you up, listen. A lot of times this technique will put you above the competition. Seniors love to chat, it is how they make connections and establish trust. I know that if a trainer is constantly interrupting me or seems to have divided attention when talking to me, they are certainly not going to be listening to my rambling parent/client. 
  • Network within your community. Join a local chamber of commerce, look up villages and volunteer your time. 

This is just the tip of the iceberg, we haven’t even covered other categories of caregivers, CNAs, housekeepers, assisting hands companies, etc. That and more is covered in-depth in the Geriatric Fitness and Lifestyle Specialist online course, available through MedFit Classroom.  

Sharon Bourke has been involved in the health and fitness industry for more than 28+ years presenting, teaching and coaching in fitness clubs and private studios throughout the Washington metropolitan area. She holds certifications in Medical Exercise Specialist, Personal Training Pre-Postnatal fitness, Fitness for Arthritis, and Multiple Sclerosis. Sharon founded the Life Energy Foundation,to utilize her extensive experience and network to create exercise and behavior modification programs and resources to help people avoid becoming immobilized from their chronic conditions. 

trainer-client-strength-training-exercise

Exercise For Sobriety

/1 November 2023/ All MFN blog/

The crucial element that I always recommend to people when they say they have been experiencing anxiety, depression, addiction/s of some sort, or even sleeplessness, is exercise. Almost every time, I get a response like, “Does that help you?” Then I get to explain to them why I am so incredibly passionate about fitness. I discuss the fact that I never used to enjoy working out, and, as a matter of fact, still don’t enjoy it, but rather enjoy the feeling it gives me afterwards. This then opens the gateway for me to plead my case as to my passion and explain the many benefits that fitness provides. Exercise has helped people in many ways, but especially in terms of boosting mood and keeping mental illnesses at bay, both of which have a direct impact on addiction. 

Types of Sobriety

The reason I live, eat, drink, and breathe all things fitness is because of how beneficial it has been on my own personal wellness journey. Rather than get into my whole life story, I will instead discuss how crucial fitness is to achieve sobriety. When people hear the term “sobriety” they tend to think of only substance abuse — mainly alcohol, opioids, or hard drugs. Not only can sobriety refer to the latter, it can also include medications that an individual was prescribed that their body happened to develop an addiction to, or could even refer to an undesirable behavior or reaction. For example, I had a client who would unconsciously binge eat after an unpleasant encounter with her then-husband, now ex-husband. Eventually, we realized that she was using food, and unhealthy foods at that, to make her feel better after arguments. In essence, she was supplementing her body with sugary foods that would help her body produce the dopamine her body was craving in order to produce the emotional high that would make her feel better. Here’s a different example: a different client would unconsciously lash out at her mother after having been insulted by her critical father. Once we realized why this was happening, I had her incorporate fitness into her daily schedule, right before she went home from school to her parents. Going to the gym every time she got angry with her father resulted in much less conflict between her and her mother, and, in conjunction with therapy, opened up a new line of communication between the two of them.

Improved Physiology and Psychology

Another common comment I encounter is after discussing the fact that I generally hit the gym for an hour and a half each day. Almost every single time, I get the exact same response, “I wish I had your energy!” For me, it’s not energy, it’s anxiety. I have discovered that I cannot eliminate it any other way than, as I say, “working out until I pass out,” or at least, until I’m thoroughly exhausted. I have found many other individuals who share my same sentiment, most of whom have also endured several instances of trauma, with the later group showing the most benefit and overall improvement from fitness. There have been numerous studies about the positive impacts that physical activity has on an individual’s mood and overall state-of-being. Exercise has been proven to reduce anxiety by promoting positive adaptations of several physiological processes within the body, such as improving dysregulations of the HPA axis of the brain, restoring abnormalities in monoamine function, producing endogenous opioids in the brain, and increasing BDNF (brain-derived neurotropic factors). There have been studies that suggest that fitness may increase neurogenesis, as well. Exercise has also proven to reduce the psychological effects of anxiety as well, such as reducing anxiety sensitivity, improving one’s sense of self-efficacy, and providing “time out” from one’s daily activities and stressors.

Work Out to Work It Out

In short, work out to “work it out.” All of the above are reasons why I always suggest to anyone struggling with their mental health that they start some sort of exercise regimen. Whether a person is addicted to a substance or even an undesirable or destructive behavior, fitness will improve the problem and provide results.

Tambryn Crimson-Dahn is a certified personal trainer, fitness coach, nutritionist, and addiction recovery specialist with 4 years of experience. After having worked in the gym industry, she founded and now operates her own company, Crimson Wholistic Fitness. She specializes in overall mental health and wellness, addiction, and relationships and how they can affect mental health.

References

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5 Pilates Exercises to Improve Respiratory Function

/26 October 2023/ All MFN blog/

Pilates is a total body exercise method that is highly effective for strengthening and lengthening the entire body. While Pilates is mostly known to improve core strength (the “Powerhouse”), posture, and range of motion, this exercise method can be used to improve respiratory function in those suffering from respiratory diseases. Respiratory diseases include asthma, COPD, chronic bronchitis, emphysema, lung cancer, cystic fibrosis, pneumonia, and now COVID-19.  These diseases affect the way one breathes and lowers oxygen saturation that the body needs to function properly. One of the main principles in Pilates is breathing, thus the need to take a closer look at the effects of Pilates on respiratory function.

Benefits of Pilates Related to Respiratory Disease

  • Improves postural cavity to breathe properly.
  • Expands breathing capacity with diaphragmatic breathing.
  • Increases pulmonary ventilation which is needed for better respiratory function.
  • Improves lung volume.
  • Develops intercostal muscles (respiratory muscles) to better “squeeze” out impure air.
  • Improves exhaling all impure air out of the body while inhaling pure air.
  • Improves thoracoabdominal mobility.
  • Improves circulation to deliver oxygenated blood more efficiently.
  • Increased SpO2 (blood oxygen saturation).
    • >95% indicates healthy respiratory function.
    • <95% indicates taxed respiratory function.

The Pilates Breathing Method

Joseph Pilates, the creator of Contrology, stated in his book Return to Life Through Contrology: “Lazy breathing converts the lungs, literally and figuratively speaking, into a cemetery for the deposition of diseased, dying and dead germs as well as supplying an ideal haven for the multiplication of other harmful germs.”1

  • Lateral Breathing: The main goal for Pilates breathing is to breathe deeply expanding the ribcage without raising the abdominal muscles training them to jet out. Therefore, deep lateral breathing through the ribcage is the hub of the breathing technique. Proper breathing is inhaling through the nose and exhaling forcefully through the mouth. When one inhales, the ribcage expands out to the sides using the intercostal muscles, and then when exhaling the ribcage knits together like one is being sinched in a corset. According to Joseph Pilates, one should exhale forcefully getting all impure air out of the lungs like wringing out every drop of water out of a wet cloth.
  • Set Breathing Pattern: When performing the Pilates exercises, one should inhale to prep for the movement and exhale as one performs the movement.
  • Rhythmic Breathing Pattern: In some exercises, one breathes in rhythm to the exercise. This breathing consciously activates respiratory muscles to enable the lungs to expand and transport oxygen.

5 Effective Pilates Exercises to Improve Respiratory Function

The Hundred (Rhythmic Breathing)

  • Begin a tabletop position with the shoulder blades and head lifted off the mat looking forward.
  • Pump the arms up and down 100 times vigorously so the abdominals respond to and control the movement.
  • Inhale through the nose 5 times to the rhythm of the arms pumping, then exhale 5 times to the rhythm of the arms pumping.
  • Keep the lower back imprinted to the mat at all times.

Single Leg Stretch (Rhythmic Breathing)

  • In a supine position, lift the shoulder blades and head off the mat looking forward.
  • Bend the right knee towards the chest as the left leg extends straight out hovering over the mat.
  • Inhale through the nose as you switch the legs 2 times, then exhale as you switch the legs 2 times.
  • Inhale, inhale, exhale, exhale as you switch, switch, switch, switch.
  • Keep the lower back imprinted to the mat at all times.
  • Perform 8 sets.

Dying Bug (Set Breathing Pattern)

  • In a supine position, position the legs in table-top and arms extend straight up towards the ceiling.
  • Press the right hand firmly on the right thigh and press the right thigh to the right hand in opposition.
  • Inhale through the nose as you extend the left arm back overhead and the left leg extends straight out hovering over the mat.
  • Exhale through the mouth and draw the arm in and the leg back to tabletop. Repeat on same side and switch.
  • Keep the lower back imprinted to the mat at all times.
  • Perform 8 reps on each side.

Toe Taps (Set Breathing Pattern)

  • In a supine position, lift the legs into tabletop keeping the upper body and head down on the mat.
  • Anker the arms next to the body pulling the shoulders back and down on the mat.
  • Inhale through the nose as you lower both feet and legs together towards the mat. Keep the knees at 90º and the feet away from the glutes.
  • Exhale as you pull the legs back up to tabletop.
  • Keep the lower back imprinted to the mat at all times.
  • Perform 10 reps.

Thread the Needle (Set Breathing Pattern)

  • Start in a side kneeling position with the hips lifted off the mat and one forearm down on the mat with the other arm straight up to the ceiling.
  • Inhale through the nose as you lean the body back an inch to expand the ribcage.
  • Exhale through the mouth as you rotate forward and thread the arm under the armpit towards the back. Crunch the obliques and transverse abs.
  • Inhale through the nose as you un-rotate and return to the start position with the arm lifted towards the ceiling.
  • Perform 8 reps on each side.

Pilates, respiratory function and research

The literature is scarce and sometimes conflicting about the benefits of Pilates breathing related to the respiratory system. However, there are some existing studies that look at the increase in lung volumes, respiratory motion, SpO2, and the reduction in respiratory rate using Pilates breathing exercises. More research needs to be conducted. Refer to suggested reading at bottom of article.

Education for Fit Pros

Fitness Professionals & Personal Trainers: Become a Respiratory Disease Fitness Specialist!

Some of your clients may suffer from a respiratory disease and you may be an important source of relief. The Respiratory Disease Fitness Specialist online course will equip you with the knowledge to safely and effectively work with these clients to help improve their quality of life.

CarolAnn, M.S. Exercise Science and Health Promotion, is a 30+ year veteran in the fitness industry educating other health/fitness professionals to increase their expertise and brand influence.  She is on the MedFit Education Advisory Board and the head health/fitness educator for FiTOUR.  She is currently the Head Instructor at Club Pilates in Athens, GA.

Suggested Reading

  1. Cancelliero-Gaiad, K. M., Ike, D., Pantoni, C. B., Borghi-Silva, A., & Costa, D. (2014). Respiratory pattern of diaphragmatic breathing and pilates breathing in COPD subjects. Brazilian journal of physical therapy, 18(4), 291– https://doi.org/10.1590/bjpt-rbf.2014.0042
  2. de Jesus, L.T., Baltieri, L., de Oliveira, L.G., Angeli, L.R., Antonio, S.P., Pazzianotto-Fort, E.M. (2015) Effects of the Pilates method on lung function, thoracoabdominal mobility and respiratory muscle strength: non-randomized placebo-controlled clinical trial. Pesqui. vol.22 no.3. http://www.scielo.br/scielo.php?pid=S1809-29502015000300213&script=sci_arttext&tlng=en
  3. Hagag, A.A., Salem, E.Y. (2019) Pilates Exercises Improve Postural Stability, Ventilatory Functions and Functional Capacity in Patients with Chronic Obstructive Pulmonary Disease. IOSR Journal of Nursing and Health Science (IOSR-JNHS), vol. 8, Issue 4 Ser. VI., PP 86-91 http://iosrjournals.org/iosr-jnhs/papers/vol8-issue4/Series-6/M0804068691.pdf
  4. Baglan Yentur S, Saraç DC, Sarİ F, et al. (2020). Fri0613-hpr the effects of pilates training on respiratory muscle strenght in patients with ankylosing spondylitis. Annals of the Rheumatic Diseases;79:912. http://dx.doi.org/10.1136/annrheumdis-2020-eular.2129

References

  1. Pilates, J., William, J. M., Gallagher, S., Kryzanowska, R. (2000). The Complete Writings of Joseph H. Pilates: Return to Life Through Contrology and Your Health. BainBridge Books, Philadelphia, PA. (Originally written 1945)
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The Feet: The Body’s Foundation

/9 October 2023/ All MFN blog/

The feet are one of the most overused and taken for granted parts of the body. Since the feet are the foundation for the rest of the body, it would only be logical to begin developing strong, aligned, and full functioning feet from the start when developing a personalized fitness program. The feet should be a priority for developing sound fitness education in order to prevent injuries. Most fitness and sport injuries usually involve the feet. Even when the injury is to the knee, hip or back it can usually be traced back to a misaligned foot pattern.

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Fitness: Readiness Assessment & Setting Priorities

/6 October 2023/ All MFN blog/

My biggest concern as a personal trainer was always the safety of my clients – both physically and medically. Over the years a common theme emerged with each new client relationship that I developed and that was how unprepared people were to really engage in a significant training program and what skills and knowledge they would be required to develop for success. Physicians were often unprepared to advise their patients on what to do, how to proceed, or what limitations and issues needed to be acknowledged by their patients before engaging a trainer to help them “get to the next level”.