Post Rehabilitation Training Series Article 2

Introduction

The human body is a magnificent machine comprised of many parts like a car that synergistically works together. It is inevitable that with ageing, injuries, re-injury, and surgery, all of these circumstances will result in compensation, pain, dysfunction and functional decline over time. At the forefront of movement are the nervous and musculoskeletal systems. These two systems initiate and control movement. Despite ageing, or whether an injury or surgery occurs, musculoskeletal injuries require healing, physical therapy and most of all, a retraining of the nervous system. This directly affects the musculoskeletal system.

In this second article, we will review how to get started with post a post rehab client, review functional assessments and discuss the continuum of care.

Getting started

Where does one begin? Before meeting the potential post rehab client, it is important to do an inventory checklist of your strengths and weaknesses. A checklist of what you know versus what you don’t know. Meaning if there are specific subject areas within movement science, that you are not sure or lacking information, then study the science. Understand the science. If for example it is difficulty understanding what muscles flex the shoulder, or when the knee is flexed, biomechanically what happens with respect to the tibia on femur, one first option is to review videos online. Then go to the science books. Review and use practice quizzes to test your knowledge, which reinforce learning.

Knowledge

Working with any post rehabilitation client, requires that the fitness professional have a solid understanding of anatomy, functional anatomy, biomechanics, periodization training principles, exercise prescription and understanding common movement dysfunctions. If you are lacking the understanding of any of the foundational material areas mentioned above, then you owe it to yourself and future clients to do one thing. Study!

Communication

The next step is communicating with a physical therapist or establishing a relationship with other mid-level providers or medical providers in your area. The fitness industry is not regulated, nor does mandate what personal trainers are required to know. This not only weakens the fitness professional if they are not held to a ‘standard’ such as a physical therapist, dentist, lawyer or similar. One thing is for certain, there needs to be of an open dialogue. It needs to happen now. I urge you to reach out, contact some physical therapists in your area, through email or even a personal letter. Explaining your background, education, credentials, will go a long way. Moreover, asking a physical therapist to send a test ‘client’ is a way of showing that physical therapist you has the passion, knowledge and skillset to safely help their patient transition form physical therapy to the gym. Likewise, physical therapists also seek professional relationships with qualified fitness professionals not only to refer to but also to receive referrals from. After all, they are also trying to maintain and grow business revenue.

Follow-up

As both a practicing physical therapist and personal trainer, nothing impresses me more, is a follow-up. A follow-up could be in the form of a phone call, email, hand written note, typed letter or something similar. Getting to know physical therapists in your area can not only turn to be a great referral source, but also can help fulfill areas of interest you may have.

Functional assessments

There are many ways to assess someone, and the fitness professional should use and perform movement assessments that are not only objective, but also measurable. This relates to screening, assessing and assigning corrective exercises to your client.

If you’re not assessing movement you’re guessing. Prior to looking at a client’s dynamic movement, a static posture evaluation should be performed. In other words, you can’t teach a client a dynamic exercise, until they master a static exercise. Why should a dynamic movement assessment be performed first? There are several effective assessments, which include; in place squat, in place lunge, diagonal reverse lunge and diagonal forward lunge.

Post Rehabilitation Training Series Article 2

Squat

The squat is a classic fundamental primal movement that someone typically performs almost on a daily basis. Whether it is to perform to pick something up or move an item. Biomechanically, as the body descends, the hip flexors concentrically contract with slight lumbar flexion, while the knees undergo flexion, glute maximus and hamstrings eccentrically contract. At the ankle, dorsiflexion occurs where the anterior tibialis (concentrically contracts) while the gastrocnemius eccentrically contracts. Returning to upright position, the opposite happens.

Post Rehabilitation Training Series Article 2

Post Rehabilitation Training Series Article 2

In place lunge

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. Look at figure two below. Biomechanically, Let’s look at a left leg forward in place lunge. Let’s examine an in place lunge where the left leg is forward and the right leg is behind. During the eccentric or lowering phase, consists of concentric (L) hip flexion, knee flexion, and ankle dorsiflexion. While the right hip is eccentrically contracting, the right hamstring, right glute maximus and right gastrocnemius are concentrically contracted.

Post Rehabilitation Training Series Article 2

Post Rehabilitation Training Series Article 2

Diagonal forward lunge

Functional anatomy of diagonal forward lunge: The hip flexors and quadriceps are the primary muscles recruited in the anterior sagittal plane, while glute maximus and hamstrings are recruited in the posterior sagittal plane. Glute medius and glute minimus are dynamic stabilizers at the hip in the frontal plane.

Biomechanical analysis of right diagonal forward lunge: During the descending portion, the right hip flexors and quadriceps concentrically contract, while the left hip flexors eccentrically contract and left hamstrings and glute maximus concentrically contract. The right knee undergoes flexion while the right glute maximus and right hamstrings eccentrically contract. During ascending, the opposite happens. Common dysfunctions are the same with the previous two assessments.

Continuum of care

In order to work with any potential client who has experienced a prior injury, surgery or other dysfunction, the fitness professional should ensure they understand the following:

  • Functional anatomy
  • Biomechanics
  • Understanding the kinetic chain
  • Joint movements and actions
  • Exercise prescription
  • Periodization training/program design
  • Post rehabilitation principles

If you are weak or don’t understand these areas, study and learn the essentials. Second, if a client seems very complicated or you are confused, contact the client’s physical therapist through a phone call or email. Start and improve the dialogue to build on the Rehab Triangle.

Author

By Chris Gellert, PT, MMusc & Sportsphysio, MPT, CSCS, C-IASTM

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