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Senior woman with help of physiotherapist

The Space Between Fitness and Medicine: Where “the Good You Do For Others” Brings the Reward you Deserve | Part 2

In our first part of this three-part discussion, in addressing the topic of financial reward, I asked you to ponder the value of restoration.  What, I prompted you to consider, is the value of helping someone who has moved along the dis-ease continuum, gradually leaving health in the proverbial rear-view-mirror back toward divine health?

It isn’t an easy question to answer.  We can tackle it by considering all of the dollars those who incur inflammatory issues, chronic challenges, and cellular degradation will have to invest in maintaining function and comfort.  We might also attempt to place a monetary value upon lost quality of life.  We might even consider the simple question, “what would someone pay to rediscover health” considering their fear and apprehension of the alternative, and from that extrapolate the value.

If you are willing to believe that personal trainers with advanced education and the development of a complementary skill set can have immeasurable impact upon “the unwell population,” one perspective becomes clear.

The trainer versed in restoring health commands a far greater value than the personal training mainstream.

That’s important.

STEPPING UP A LEVEL

As in any field, a specialist with enhanced value will serve his or her marketplace best by finding a direct line of contact with those in need of their specialty.

In the sentence above, “need” is the key word.

While it’s oft been said that personal trainers are a luxury or a privilege, with an appropriate adjustment in perspective, those who have slipped into the largest segment of our adult population, the unwell market, might consider any therapeutic resource, if wellness is a goal, a “need.”

Now that I’ve mentioned it a few times, I’ll provide a general description of the market I’m referring to as “unwell.” Then I’ll help you see the opportunity to step up, to meet this population in an arena where they “need” you.  I’, to command a value in line with a well-justified fee, and . . . here’s the biggie . . . to provide them the service they will truly benefit from.

WHO ARE THE UNWELL?

Let’s be really clear here.  I’m not suggesting the opportunity lies in training “sick people.”  I’m suggesting the largest, most opportune market share is made up of many American adults between the ages of 35 and 65.  They aren’t “sick” in a clinical sense.  They work.  They drive their kids to school.   They shop in the malls and grocery stores.  They eat in the neighborhood restaurants.  They pump gas in the same gas stations you do and they frequent Starbuck’s, Chipotle, and the local pizza place.

They don’t have need for hospitalization or chronic care . . . but they’ve slipped, moved along what I’m calling the dis-ease continuum.  They’ve begun a process of maladaptation, a movement away from healthful homeostasis, and while many haven’t yet been diagnosed (many have), their bodies have become imbalanced.  Whether it’s a hormonal imbalance, thyroid irregularity, blood sugar elevation, hypertensive condition, hypercholesterolemia, or chronic inflammation of one or several bodily systems, they have moved into a place where innate homeostasis is no longer their “norm.”

Not sick, at least not clinically, but not well.  What’s alarming is, I’m describing near 65% of the adult population over the age of 45.  Yes, the market is vast.

If the unwell were being cured of their ailments or remedied by the conventions of medicine, I wouldn’t see the “need” as being this opportune.  All I need to share is a single statement to help you see why there’s a desperate need for a new type of health practitioner, one who masters the exercise and eating intervention.  Here’s that statement.

In a society where chronic disease is most treated with pharmaceutical intervention, there isn’t a single medication that will cure any chronic disease.

Read that again.  While there exists a wild array of meds to manage conditions and change biomarkers, there isn’t one that will cure the plight of the unwell.

Conversely, there is an extensive body of evidence to demonstrate the power we have over shifts in blood sugar, blood pressure, and hormonal disruption when we strategically employ a variety of exercise modalities and guidance in the realm of supportive nutrition.

If the demand is great, the “need” remains unfulfilled, and the greatest potential lies in the skill set we, as fitness professionals, have access to . . . our value escalates above virtually any conventional yet impotent “cures.”

THE LEVEL 2 TRAINER AS A CORRECTIVE HEALTH SPECIALIST

If we consider a “Level 1” trainer someone who is qualified, credentialed, and able to provide safe and effective exercise prescription to a healthy population, let’s consider a “Level 2” someone who can effectively target this Unwell niche and deliver improvements in biomarkers, condition, and quality of life.

The Level 2 trainer can identify his or her “ideal client avatar.”  Moving forward I’ll refer to the Ideal Client Avatar as an “ICA.”

In establishing a presence and a track record with the Unwell, the enhanced personal trainer (enhanced with a higher level of education than the standard and an ability to implement positive change in the unwell) can justifiably command fees in line with other health practitioners, medical practitioners, and specialists.

In setting a fee structure, there should be a professional standard, a relationship-based fee that is consistent, one that exceeds “an industry standard.”  Remember, if you deliver above the standard, you deserve reward above the usual.

HOW DO YOU STEP UP AND CREATE AN AUDIENCE?

Marketing, for the Level 2 trainer targeting this niche is not as haphazard as “pass out cards, talk it up in the gym, and talk to everyone about what you do.”

In order to establish your position, you’ll want to have four.  Four strong successes.  Four living examples of the value you deliver, and finding those four requires a bit of front-end work.  Once you have your four you have a sound foundation upon which to build.  The question, therefore, that merits consideration is . . . how do you “break in.”  Where do your “four” come from.

I’ll make it step by step.

Note that everything that follows is based upon the assumption that you have received extraordinary training, that you’ve established a level of education complementary to your base credential, and that you’re positioned to initiate and maintain a practice with a revised focus on empowering clients to reverse the imbalances inherent in chronic disease.  This is a prerequisite of paramount importance and although I won’t invest any more time in addressing it here, don’t allow my failure to repeat and reiterate this point as an indication its any less than vital.

STEP ONE: Define your Ideal Client Avatar.  If you have a personal connection to a given condition or population (i.e. a relative with diabetes, a personal history with thyroid issues, etc.) and you have a passion for helping others who you feel are kindred spirits, that’s where you should best direct your marketing.  You can’t “market well” until you define your ICA.  This is a “must” in turning your ambition into financial security (and it’s the step most who seek to elevate their careers miss or ignore).  Your ICA may not be based on your personal experience, but rather on where you see the greatest opportunity or where you have the greatest inroads.  Devote time to getting clear on your ICA.  It’s the true key to successfully “Stepping up to Level 2.”

STEP TWO: Determine your fee structure, your promise, and your offer.  You don’t want to approach each prospective client with an open negotiation, nor do you want to exhibit uncertainty.  As any business owner, design your foundation.  What, precisely, are you promising each client?  How are you compensated for that?  What, precisely, is the person considering retaining you, supposed to do now, as a point of commitment.

STEP THREE: Choose a location, an affiliation, a network, and a social media platform where you can “meet” your ICA and spread the word.  This is far simpler than it sounds.  In outlining your ICA, simply as the question, “where do I find him (her)?”  This is marketing at its core.  Don’t think “medical.”  Think real life.  Where can you do a talk, a workshop, a presentation, knowing your ICA sits in the audience.  I realize this is the intimidating step . . . but it’s also the one that brings  you to human connection, and ultimately to commitment and money exchange.  Perhaps in the future I’ll share an entire article devoted to “finding your ICA in the real world.”   For now, accept that you have the answer to the question, you have the ability, and all it takes is a bit of courage and determination.

STEP FOUR: Create your Four.  Do your thing.  Work your magic.  Use your skill set.   Bring about change.  Documentable change.  Once you have your first four successes, you begin to build what I call an Arsenal of Evidence, and from that point on, the marketing challenge is replaced by magnetic appeal.

STEP FIVE: Build your business confidently, massively, professionally, and without limit.

This 3-part piece is intended, not to be a complete primer for business building, but to give you a sense of both the opportunity and your ability.

In creating a distinction between the progressive trainer willing to study, learn, and elevate, I’ve used the term “Level 2,” not to suggest any elite status, but to demonstrate a clear escalation in earning potential.  Before I conclude this second part of the piece, I’ll outline a few elements of what I’m calling The Level 2 Trainer.

FIVE DISTINCTIVE ELEMENTS OF THE LEVEL 2 TRAINER

  1. You are a specialist among a given population
  2. You command fees above the norm
  3. You have a consistent promise and offer
  4. You have a track record and consistently grow a marketing / referral base
  5. You understand and recognize the value in the potential you have as a guide to empower others to move away from chronic disease and back toward divine health

Is there a level above the Level 2 trainer?  Yes.  And the sky’s the limit.  Literally.  More to come in Part 3!

This is 3 part series. Read part 1 here, and part 3 here

 


Phil Kaplan has been a fitness leader and Personal Trainer for over 30 years having traveled the world sharing strategies for human betterment.  He has pioneered exercise and eating interventions documented as having consistent and massive impact in battling chronic disease.  His dual passion combines helping those who desire betterment and helping health professionals discover their potential.  Email him at phil@philkaplan.com

senior man having a massage in a spa center

What is an Allied Healthcare Professional?

Whether it’s exercise, nutrition, or massage therapy you are seeking, finding the right person to do the job can be incredibly challenging. The area known as allied healthcare professionals can be a challenging one to navigate.

The professions that require a state or national licensures, such as physicians, nurses, or physical therapists, help to provide checks and balances on who should and should not be providing a service to any individual. However, there are many professions within our healthcare community that are poorly understood and many times misrepresented by individuals with minimal certifications or credentials.

Allied healthcare professionals are thought to make up roughly 60% of the healthcare workforce by providing a range of diagnstic, technical, therapeutic and direct patient care and support services that are critical to the other health professionals they work with and the patients they serve. All categories of allied healthcare require either registration by law to practice or post secondary degree or higher education. Click here for more information about allied healthcare professions.

Is it time to re-assess who you trust with your healthcare needs?

It is essential to know the credentials and education of anyone you are trusting for information or advice whether it be an accountant, lawyer, dentist or teacher. Healthcare is no different, but there are many misunderstood healthcare professions.

Distinct from nursing, dentistry or medicine, allied healthcare professionals make up approximately 60% of the health workforce. Examples include athletic trainer, exercise physiologist, paramedic, and massage therapist. Many times, these professionals are those you are referred to by your physicians to help manage your healthcare needs daily, weekly, and monthly. National and state licensures ensure that certain healthcare professionals uphold the standards and scope of pratice that is pertinent to their level of education.

senior man having a massage in a spa centerMultiple allied professions remain to establish this key aspect of standardized care which simply means that certain professions are more susceptible to individuals claiming a level of expertise or knowledge that can be misleading or confusing to the general population. For example, as a Clinical Exercise Physiologist, I clearly understand the difference between my skillset and that of a personal trainer; however, to the general public, both professions provide guidance with exercise. Due to lack of established licensure exams, it is unclear to many people that some Exercise Physiologists (like myself) have a Master’s Degree, while others may have earned a weekend certification. It is incredibly important for you to understand the roll of any healthcare professional from which you seek treatment and advice as well as their experience and background in relation to your particular healthcare needs. Accessing information about these resources from a knowledgeable professional can help to ensure proper connection to an individual that is appropriately educated to effectively meet your needs.


Jaclyn Chadbourne, MA, CES has worked within the allied health profession as a Clinical Exercise Physiologist for 15 years.  She is currently the Director of Research and Development at Universal Medical Technology, and serves as Adjunct Faculty at University of New England DPT Program

personal trainer showing stopwatch time to senior client

The Space Between Fitness and Medicine: Where “the Good You Do For Others” Brings the Reward you Deserve | Part 1

This is part one in a three-part series.

In every field you find the big earners and those who are “paying the bills.”  In every field you find excellence and mediocrity. In every field you find those who fully engage and those who invest just enough to play in the arena.

Here’s one of the many challenges that keeps the personal training field in its own aura of uniqueness. The delivery of extreme value isn’t always met with what we might consider just reward. In other words, an investment of attention, energy, discipline, and devout practice ensures nothing more than a fair attempt at turning human interaction into revenue.

I think its time to change that.

VALUE SHOULD BEGET REWARD

Great surgeons command great remuneration, as do great quarterbacks, great attorneys, and great architects. We can judge them by the effectiveness of their work, by their “wins,” or by their track records.

Do great work. Make great money.

A peripheral glimpse of our field might lead to the perception that the big earners rely more on personality, social skill, and media exposure than expertise, but that’s only a glimpse. Whether it’s an accurate or flawed conclusion, I promise you this. It can be changed.

In this 3-part series, I want to change the way you think. I want to give you control over your future, your position, and… your income, not by sharing marketing tricks bur rather by giving you a willingness to accept an important truth.

You are an entrepreneur.

I know. Some of you gagged, some fought back the vomit reflex, and others considered it might best to stop reading. Entrepreneurs have to have some business expertise, they have to deal with finance, and they have to… ready for this… sell!!!

EEEAAAAUGH!!!!!

I’m not finished turning the screw. I’ll make it, for the moment, even harder to swallow. As an entrepreneur you are FULLY IN CONTROL of the value you deliver, the number of lives you touch, the number of lives you change for the better, and the number of dollars that make up the balance in your bank account. Nobody will do it for you. It’s all on you.

Here’s another truth.   Most personal trainers pursue their professional commitments out of two complementary driving forces. They love helping people and they have a passion for fitness. That’s good. It’s both, their greatest strength and their source of vulnerability . . . because “making money” falls somewhere lower on the list than “finding reward in gratitude.”

IF THANK YOU’S WERE DOLLARS, YOU’D BE A MILLIONAIRE

As a trainer you LOVE when a client says thank you. You melt when a client says, “you changed my life,” and you puff up like a blowfish when you read the text that says, “OMG, lost 20, feel great!  Thank you.”

This innate deep-rooted altruism allows you to work for less money than you deserve and to justify the financial deficiency with “I’m helping people.”

Let me share another insight. You are wired more like a doctor than you are like the proud and hungry entrepreneur. Doctors are driven by the same altruistic inner calling, at least when they decide to sit for the MCAT’s and pursue intensive study, knowing it’ll be followed by an internship and residency before they even earn their first dollar.

So why do doctors earn what you perceive to be “the big money” while trainers settle for per-session fees?  One reason. They’re given permission.

The medical paradigm is polarizingly different than the one you operate under. The medical student doesn’t “set” his future pricing, the paradigm does.

The fees for an MRI, a bypass procedure, lab tests, and cosmetic enhancements are established. The medical student simply steps into the universe where value already exists.

You, whether you emerged your educational prep with a degree or a certification, stepped into a universe where the paradigm is based upon “training sessions,” not upon true delivery of value.

I might not share these perspectives with an audience of trainers at a general fitness conference. I’m sharing them with you because you’ve demonstrated interest in or become connected with the Medical Fitness Network. This demonstrates that you have an interest beyond “training sessions.”  At some level, you have interest in helping people rediscover health. There’s value in that. Extreme value.

Let’s do a quick comparison.

Where is there more perceived value?  In a training session promising to make someone sweat, contract, stretch, and increase respiration, or in the undoing of a chronic condition?

WHAT IS THE VALUE OF RESTORATION? 

We dare not suggest we can cure any disease, but there’s a massive and-ever growing body of evidence demonstrating that shifts in eating and movement can create shifts in biochemistry and physiology moving people away from physical compromise and back toward health.

I’m suggesting that if you become a practitioner delivering human betterment to those who live in compromise, you’re standing on the cusp of establishing a new paradigm. You’re potentially moving into a position where you can claimpower over the impact you have upon your clients and concurrently upon the fees you command and the reward you deserve.

I want you to see yourself as somehow different than “the rest of the field.”  Without ego playing a role, consider that you have the ability to elevate, to accept a position of greater responsibility, and with it, greater reward.

In the next two parts of this three-part article, I’ll share what I call “The Three Levels of Profitability” and show you how you immediately leave the income ceiling behind when you stop up to Level 2, but for now I simply want you consider movement. I want you to realize, if you opt to pursue a “specialty,” to offer a solution to a market that is bound by pain, discontent, or limitation, you have a far greater value than a practicing workout expert.

No longer will you be “in the fitness field.”  You won’t leave it entirely, and you’ll still carry your fitness passion and wield it as a weapon, but you’ll move into a space that’s the open sea, a space where earnings will escalate for those who master the skill set allowing them to find a new level of comfort in entrepreneurship. We’ll consider it the space between Fitness and Medicine. It’s the space where a massive segment of our population will rediscover their own power to live in health, regardless of their past or present level of compromise. It’s the space where guidance is lacking, the space where ancient wisdom will marry scientific discoveries, the space where you can prosper and thrive.

If you hunger to be in this space, stay connected. This is simply the eye opener. I’m about to share insights that will completely shift your recognition of your own potential. Stay tuned.

This is 3 part series. Read part 2 here, and part 3 here


Phil Kaplan has been a fitness leader and Personal Trainer for over 30 years having traveled the world sharing strategies for human betterment. He has pioneered exercise and eating interventions documented as having consistent and massive impact in battling chronic disease. His dual passion combines helping those who desire betterment and helping health professionals discover their potential. Visit Phil’s website, philkaplan.com; you can email him at phil@philkaplan.com

senior-yoga-water

Evolution of Medical Fitness

Once upon a time, exercising used to have a uniform and a regiment specific for men and women. Men would suit up in short shorts, beach themed tank tops, white headbands, wrist-bands, calf high knee socks, and white New Balance shoes. Women would shimmy into their sleek leotards, heads decorated with colorful braided headbands, legs adorned with scrunchie leg warmers, and feet comforted by puffy, linen white high-tops.

talbot-article-exerciserx

The Exercise Prescription

With the recent push for getting everybody moving, for some, Health Screening, Exercise Testing, Exercise Prescription as well as Fitness Programming are all areas where professional guidance may be necessary. The knowledge and experience of multiple Healthcare and Fitness Professionals combined provides a holistic approach for a lifetime of optimal health and well-being.

Doctor Examining Male Patient With Knee Pain

The knee complex: understanding the science behind both movement and dysfunction

Introduction

The foot is where movement begins, requiring mobility to perform simple functional movements. The knee however, requires stability with daily movements, but more importantly, dynamic sport movements such as soccer or football. In this article, we will review the anatomy of the knee, common injuries of the knee, functional assessments and training strategies to work with clients with previous injuries.

Basic anatomy of the knee
Let’s look at the anatomy of the knee.. The joint is vulnerable when it comes to injury, because of the mechanical demands placed upon it and the reliance for soft tissue to support the knee. There are two primary joints within the knee, the tibiofemoral joint and the patellofemoral joint.

Figure 2. Structures within the knee joint

Figure 2. Structures within the knee joint

Knee Joints

a. Tibiofemoral joint: Is a hinge joint that permits some rotation between the distal end of the femur and proximal end of tibia. The joint capsule surrounds the femoral condyles and tibial plateaus and provides stability to the knee by the medial collateral ligament(MCL) and the lateral collateral ligament (LCL).

b. Patellofemoral joint: Is formed by the patella(knee bone) that glides in the trochlear groove of the femur. The height of the lateral femoral condyle helps prevent lateral subluxation, while soft tissue surrounds the joint to increase stability. This is seen in figure 3.

Figure 3. Patellofemoral joint

Figure 3. Patellofemoral joint

Primary structures within the knee joint: ligaments and mensici
Several ligaments described below provide stability at the knee joint.

a. Collateral ligaments: The two primary supporting ligaments are the medial collateral ligament (MCL), which is along the inside of the knee. The MCL is a thinner and weaker ligament biomechanically, making it more susceptible to injury more often injured per the research. While the lateral collateral ligament(LCL) is along the outside or lateral aspect of the knee providing lateral knee stability.

b. Anterior cruciate ligament(ACL): is the most commonly injured knee ligament and is taut during knee extension. It originates more proximally on the femoral side than the posterolateral (PL) bundle. It inserts anteromedially(front and to inner side) on the tibia. The ACL limits and controls forward translation of tibia on the femur and limits tibial rotation.

c. Menisci: the menisci are fibro cartilaginous discs located on the articular surface of the tibia along the medial and lateral tibial plateaus. The outer portion of the meniscus(lateral meniscus)is oval shaped (O) and thick. Attaching at the anterior and posterior horns via coronary ligaments.

Vascularity: The middle third and inner third of both menisci are relative avascular. The medial meniscus is more C-shaped, and thinner in structure. Both menisci receive nutrition through synovial diffusion and from blood supply to the horns of the menisci.

Function of the menisci: The menisci provide shock absorption, joint lubrication and stabilization.

Common injuries and causes

There are several common injuries that affect the knee. The most common are patella femoral syndrome(PFS), osteoarthritis(O.A.) and anterior cruciate ligament(ACL) injuries.

In this next section, we will review each condition providing a deeper understanding of each.

a. Patellofemoral syndrome
Pathophysiology/sign and symptoms: PFS is a condition where the patella does not translate biomechanically in the trochlear groove between the femoral condyles. Here the patella is positioned in either a tilt, glide or rotation accompanied by diffuse, achiness in the front of the knee.

Contributing Factors(Evidence Based Research): Several studies have shown that decreased flexibility of quadriceps and hip flexors(Lankhorst et al. 2012 & Meira et al. 2011) contribute to PFS. Decreased hip abductor strength has been shown a significant factor seen in multiple studies as contributing to PFS (Khayambashi, H., et al. 2012, Meira et al, (2011), Bolgla et al. (2008),Cichanowski et al. (2007), and Robinson et al. (2007).

Other factors include prolonged wearing of high heels, muscle imbalances(quadriceps>hamstrings).

b. Osteoarthritis(OA) of the knee

Figure 4. Osteoarthritis of knee

Figure 4. Osteoarthritis of knee

Pathophysiology/sign and symptoms: A degenerative process of varied etiology, which includes mechanical changes within the joint as seen in figure 4.

Risk Factors: Excessive weight born on hip joint, muscle imbalance, repetitive stressors.

Sign and symptoms: Pain in the a.m. described as “achy” that decreases as the day progresses, pain with weight bearing or walking, difficulty squatting, and lateral thigh discomfort.

c. Anterior cruciate ligament injuries
In the last several years, there has been more news about the incidence of ACL injuries. The incidence rate is greatest between the ages of 16 and 18 years. Female athletes are 3-9x more likely to sustain an ACL injury then male athletes. This results in at least 200,000 ACL reconstructions are performed each year in the United States, with estimated direct costs of $3 billion (in U.S. dollars) annually (Frobell, R., et al 2010).

Figure 5. Mechanism of injury for ACL tear

Figure 5. Mechanism of injury for ACL tear

Pathophysiology/Mechanism of Injury: The knee is struck while in hyperextension, forcing tibia anterior(forward)on the femur, as seen in figure 5. The ACL can also be injured with same mechanism of injury with combined with medial rotation of the lower extremity(LE). This creates instability and a direct disconnect the nervous system to the musculoskeletal system because of the “lack of control” within the knee joint.

Common assessments
One great test to assess a client’s movement pattern, is the squat. The squat is a classic fundamental primal movement that someone typically performs almost on a daily basis. With this test, you can observe how the client’s ankle, knee, hip and back moves compared to normal movement patterns. This is seen in the figure below.

Figure 6. Squat in frontal and side view

Figure 6. Squat in frontal and side view

Figure 7. In place lunge

Figure 7. In place lunge

Another simple assessment is an in place lunge, which examines one’s control through the entire kinematic chain. The lunge is another fundamental primal movement. The lunge is a dynamic movement that is typically performed during daily activities (stooping down to pick something up) or as part of an athletic movement.

This test examines ankle control, knee control and pelvic movement in the sagittal plane. Lastly, a diagonal traveling forward lunge looks at the ability of the client to control ankle, knee, hip, and pelvic movement in both the sagittal and frontal planes. This is not only a functional movement, but very effective for sport specific clients.

Training strategies and programming for knee injuries

Figure 8. Traveling forward lunge

Figure 8. Traveling forward lunge

With any injury, the most important thing to remember is the type of injury, healing time and prior level of function of the client.

a. Patellofemoral syndrome
Recommendations for training:
Continued stretching of tight hip flexors, ITB, and hamstrings is fundamental. Client should be taught initially static core strengthening exercises, and then progressed to dynamic core strengthening as appropriate. Client would also benefit from education on shoes with respect to type that are most effective for them, and to cross train utilizing, such as hiking, yoga, pilates, and swimming. Lastly, to alter running surfaces(if client runs) and educating the client about changing their shoes every 500 miles or 6 months for maximum stability and control.

b. Osteoarthritis of knee (O.A.)
Recommendations for training: Aqua therapy has been shown in the research to significantly reduce pain, improved physical function, strength, and quality of life (Hinman, Rana S., et al 2007), stretching ITB, hip flexors, quadriceps and hamstrings, strengthening weaker hip abductors(glute medias/minimus). Strengthening specifically hip abductors in various studies when compared to general strengthening resulted in s significant reduction in knee pain, objective change in functional outcome tests, physical function and daily activities (Bennell,K.L., et al. 2010 & Hernández-Molina, G et al. 2008). Core strengthening shoulder also is an integral part of the training program.

Figure 9. Dynamic stabilization Training

Figure 9. Dynamic stabilization Training

c. ACL injury(Anterior cruciate ligament injury)
Recommendations for training:
should focus on hamstring strengthening. Strengthening the hamstrings biomechancally transfers the load from the front of the knee to the back, thereby decreasing the stress to the ACL. Neuromuscular training as seen in figure 9, is very effective. It challenges the connection between the nervous and musculoskeletal system requiring the client to stabilize the entire kinematic chain. Research has shown neuromuscular training reduces ACL injuries (HUBSCHER, M. 2010 & Griffin LY, et al., 2006). Core strengthening should be multidirectional in nature as seen in figure 10.

Figure 10. Multidirectional Training

Figure 10. Multidirectional
Training

In the picture on the left, left trunk rotation involves the internal/external obliques, atissimus withdorsi, and right glute medius and minimus muscles to stabilize, as the left glute medius and minimus to stabilize. With the yellow cord applied from the back, this engages the abs primarily to stabilize (from the front) accompanied by the obliques to stabilize, which the low back extensor muscles contract to prevent being pulled backwards. It is important to include dynamic training focusing on hamstrings, glute medius, maximus. Closed chain strengthening (CKC) exercises, such as diagonal forward and diagonal reverse lunges are not only functional, but replicate many common sports as soccer, football and basketball accordingly.

Contrainidications/Precautions: Avoid leg extension exercises completely this causes an anterior translation(shearing) of the tibia on the femur/stressing the graft. Therefore, the exercise is contraindicated. *Biomechanically, shearing stress on the ACL is greatest from 30 degrees of knee flexion to full extension.

Recommendations for training: American Academy of Orthopedic Surgeons (AAOS) Guidelines Post Therapy:
• Continuation of closed kinetic chain exercises(ie. reverse lunges, diagonal lunges,
forward lunge with medicine ball trunk rotation)
• 3 ½ months light jogging begins
• 4 months running begins
• 4 months introduction of plyometrics
• Surgical reconstruction typically sidelines athlete for 6-9 months and once cleared by physician can return to sport activities.

Summary

The knee is a dynamic joint that is comprised of a multitude of ligaments, tendons,
connective tissue, muscles that synergistically initiate and correct movement, and
stabilize when an unstable environment. Understanding the anatomy, biomechanics
and weak links of the knee, common injuries and evidenced based training strategies, should provide you with the insight to better understand and work with clients with these kind of injuries more confidently.


Written by Chris Gellert, PT, MMusc & Sportsphysio, MPT, CSCS, AMS.

pinnacle-logoChris is the CEO of Pinnacle Training & Consulting Systems (PTCS). A continuing education company, that provides educational material in the forms of home study courses, live seminars, DVDs, webinars, articles and min books teaching in-depth, the foundation science, functional assessments and practical application behind Human Movement, that is evidenced based. Chris is both a dynamic physical therapist with 14 years experience, and a personal trainer with 17 years experience, with advanced training, has created over 10 courses, is an experienced international fitness presenter, writes for various websites and international publications, consults and teaches seminars on human movement. For more information, please visit www.pinnacle-tcs.com.

REFERENCES
Bennell, K.L., et al., 2010, ‘Hip strengthening reduces symptoms but not knee load in people with medial knee osteoarthritis and varus malalignment: a randomized controlled trial,’ Journal of Osteoarthritis and Cartilage, vol. 18, issue 5, pp. 621-628.

Bolgla, L, et al., 2008, ‘Hip Strength and hip and knee kinematics during stair descent in females with and without patellofemoral pain syndrome,’ JOSPT, vol. 38, pp. 12-18.

Cicanowski, H et al., 2007, ‘Hip strength in collegiate female athletes with patellofemoral pain,’ Medicine Science Sports Exercise, vol. 39, pp. 1227-1232.

Frobell, R., et al 2010, ‘A Randomized Trial of Treatment for Acute Anterior Cruciate Ligament Tears,’ New England Journal of Medicine, vol. 363, issue 4, pp. 331-341.

Griffin LY, et al., 2006, ‘Understanding and preventing noncontact anterior cruciate ligament injuries: a review of the Hunt Valley II Meeting, January 2005, American Journal Sports Medicine, vol. 234, pp. 1512-1532.

Hernández-Molina, G., et al., 2008, ‘Effect of therapeutic exercise for hip osteoarthritis pain: Results of a meta-analysis,’ Journal of Arthritis Care & Research, vol. 59, issue 9, pp. 1221–1228.

Hinman, Rana S., et al 2007, ‘ Aquatic Physical Therapy for Hip and Knee Osteoarthritis: Results of a Single-Blind Randomized Controlled Trial,’ Journal of Physical Therapy, vol. 87, no. 1, pp. 32-43.

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7 Simple Steps to Becoming ‘The Biggest Winner’

You may have read Jaclyn’s recent post outlining her thoughts on the television show  The Biggest Loser. Here, she follows up and outlines simple steps you can take to become the ‘biggest winner’ the healthy way, not relying on short term rapid weight loss to reach your goals.


Research demonstrates that rapid weight loss programs are not recommended nor do they support any correlation to long-term success. Follow some of these simple steps to maximize your chances for success in achieving your “healthy lifestyle goals.”

STEP 1: Assess your Readiness for Change

Embarking on something that you are not ready to do could be harmful because an unsuccessful program could impair your self-esteem and dampen future efforts to achieve your healthy lifestyle goals. Before setting any short or long-term goals, it is recommended to take some time to reflect on your reasons for wanting to set these goals and initiate this journey.

senior-yoga-waterSTEP 2: Realize you are an individual

Just as with success, we define what “healthy” means to us. This is an individual aspiration and although our loved one’s can help to motivate us to want to make changes, we ultimately need to aspire to our own picture of “healthy” in order for us to stick with new lifestyle changes. Define what healthy means to you!

STEP 3: Eat real food

Evaluate where you can make minor changes in your dietary intake. Increase fruits, vegetables and water and decrease your intake of sugar and processed food. Eat close to the earth and prepare as much food as possible on your own. But be realistic – don’t expect perfection! You can start by making small nutritional changes that have a big impact on your health! And remember….FIBER is your FRIEND!

Copy of Mixed_Cut_Fruit_iStock_000003017352SmallSTEP 4: Don’t “DIET”

Always remember that a calorie is not just a calorie. Contrary to what we were taught in school many years ago, it is not just as simple as calories in, calories out. Many different factors make up the quality of the calories you take in (or expend). To determine what the best foods are for YOU, it is best to contact a Registered Dietitian or qualified healthcare professional.

STEP 5: Exercise

Choose an activity you enjoy and get some professional advice on the right activities for you and how to do them safely. It should challenge your muscles so you get stronger, but exercise should not hurt. No Pain No Gain does NOT pertain to YOU if exercise is done properly.

STEP 6: Focus on progress

Rid yourself of the All IN or All OUT mentality. Rather than telling yourself “I need to lose X pounds” set small goals toward better health and be proud of your accomplishments in the process. Many times if we set a goal and don’t achieve it, we can give up all together thinking that if we don’t make it to the summit of the mountain, than what’s the point. You still made progress – reward yourself for that and get up tomorrow and do it again. If you fall into old habits, don’t beat yourself up – tomorrow is another day.

STEP 7: Simple Strategies

Switch from drinking soda to seltzer water. Keep raw nuts, carrots and high fiber foods readily available for snacking. Take a therapeutic walk every day. When you’re stronger and ready for something new, challenge yourself a little more with things like roller skating, indoor rock climbing, or setting a goal for a summer hike. If you fall into old habits, don’t beat yourself up – tomorrow is another day.

Everyone has different health goals, and the way we approach them is not a one-size-fits-all process. It’s about more than just numbers on a scale. It’s also about your energy, how you feel, and so many other factors. Health is a journey, and we are all on it together, but in different places. When we understand that, and support ourselves and each other, we all win. And THAT is the message I want my son, and all of America, to hear.

Jaclyn Chadbourne, MA is a Clinical Exercise Physiologist and Co-Owner of the Medically Oriented Gym (M.O.G.) in South Portland, Maine. With a passion for sustainable healthy living and desire to advocate for patient-centered care, Jaclyn works to help the M.O.G. support community resources for all special populations and to implement and oversee clinical protocols. Read more from the MOG on their website, themoggroup.com/blog