Earth Day and Post Rehab Fitness

Tomorrow is Earth Day and the morning news broadcasts are all over it. With price of gas so high and the noticeable environmental changes we see, I have started to take a greater interest in conservation and global warming. I now have a granddaughter and I am concerned about her development but I must also be concerned with the planet I will leave behind for her. With this blog I realize the significant number of PRP's out there. As I sit here listening to the segments on GMA I wonder what can PRP's do to help conserve, I would like your assistance in putting together a list of environmentally friendly and responsible products that are easily used by PRP's to deliver post rehab services. Now I must admit I am not well versed in the conservation movement. So please forgive my ignorance but please share any thoughts you have on environmental friendly post rehab products. Please limit your posts to rehab-related products. We all are innudated with information on daily-use products that are more environmentally friendly but I feel the real savings for the planet might be in the modifications of everyone's professional lives in additional to their personal lives. Thanks for your responses and think about the Earth. In the future we will post a list of your responses.

Managing swelling in the post rehab client - the key to successful outcomes!!

Today I went to physical therapy with my mother-in-law. It was her first outpatient physical therapy session since her total knee replacement on March 31st. I have worked with her when I arrived on Monday. I focused on getting her swelling under control, thus giving her more flexion/extension and muscle fiber recruitment. I can't emphasize the importance with all rehab and post rehab clients of minimizing swelling. As a post rehab professional you are limited in your approach to managing swelling but advising the client to use ice liberally is certainly within your scope of practice. Another option for management of swelling is aquatic training. The water temperature as well as hydrostatic pressure are major aquatic factors in decreasing swelling. Remember, if swelling is decreased ROM increases, pain decreases, muscle recruitment and strength increase and overall functional capacity improves. Swelling is a byproduct of inflammation that we must respect. NEVER WORK THROUGH SWELLING!!

Quadricep or Extensor Lag - What is it?

The extensor lag describes the lack of full knee extension with full contraction of the quadricep. Limited knee extension range of motion may also cause the lack of full extension but eliminating limited ROM as the problem, quad weakness is the major issue. The extensor lag is commonly seen after total knee replacement, ACL reconstruction or patella tendon rupture. The weakness in the quadricep extensor mechanism causes the extensor lag. Vigorous strengthening of the quadriceps is necessary to remedy an extensor lag.

In the case of a patellectomy, the client should be able to fully extend the knee with the proper stregthening regimen. Though the patella does provide a fulcrum that makes knee extension easier and more efficient, the lack of a patella doesn't mean the inability to achieve full extension.

Here is a photo of extensor lag following total knee replacement. Notice the slight lack of full knee extension or the "extensor lag". If you do not look closely you might miss it. Standing terminal knee exercise, quadriceps strengthening, leg press, short arc quads will all help restore full active knee extension.



Please share your experiences working the post rehab clients with "extensor lag".

Senior Fitness Assessment with Post Rehab Clients

I recently received a call from an experienced MES with a specialization in aquatic fitness. She was interested in the incorporation of functional movement patterns into her aquatic fitness classes for seniors. As we discussed which movements might work best for the general senior fitness population I asked if she included an individual functional assessment in the intake process for new aquatic participants. She reported her facility did not because there were no functional assessments she found that were short and easy to perform as well as the the assessments were free to aquatic exercise participants. She needed a quick assessment that could easily be performed poolside and would take no more than 10 minutes. I immediately recommended the Functional Status Index (FSI). The FSI is more subjective than objective but it does give you an overall view of the client's functional status in a brief easy to use format. The FSI should take no more than 10-15 minutes to perform. If the assessment you provide is free, as in the case of this MES, then the FSI is the best choice because of its ease of use. Remember, if we assess function at the start of the program, we must reassess function at no greater than 30 day intervals to determine if our program is truly achieving the increase in function capacity we want. You may download a copy of the functional status index by clicking the link below.

We review the step by step procedure for administering the FSI along with eight other functional assessment scales in our Current Topics in Post Rehab DVD. The other functional assessments reviewed on the Current Topics DVD include the 1) Harris Hip Scale (commonly used with total hop replacements); 2) Lysholm's Scale (knee pathologies); 3) the Ankle Foot Scale (ankle and foot pathologies); 4) the Tinetti Gait and Balance Scale (balance dysfunction), 5) the Shoulder Strength Scale (shoulder pathologies); 6 & 7) and the Oswestry Scales for the lumbar and cervical spines (spinal pathologies). The Current Topics in Post Rehab 2005 DVD is part of our MES and Essentials of Post Rehab Fitness DVD workshops. For info on the MES or Essentials DVD workshops, please click on the link below.

Download the Functional Status Index

Link to the MES and PRCS Programs

There many functional assessment tools available. We (AAHFRP) have identified the eight we feel are most useful and easy to use for fitness professionals. I recommend you incorporate a functional assessment tool into your post rehab assessment.

Neural Pathways and the Post Rehab Professional

I am the proud grandfather of beautiful 3 year old enthusiastic little girl. I am also an addicted but pathetically terrible golfer. Let's put it this way, I look pretty good in golf clothes but don't ask me about my swing. Well I have started teaching my granddaughter to play golf. I have watched her closely and as a result I purchased a set of "Barbie" golf sets. Well she loves them! But one problem, I realized she naturally swings the golf club left-handed. She colors with her crayons using her right-hand. So I was amazed when she performed hitting the golf ball using the club backwards. So she hit the ball smoothly with her "Barbie"driver....BACKWARDS!! She hit the ball consistantly 20 to 30 yards. It was amazing as well as humbling to watch. But I realized her neural pathways must be overlapping. Next time you work with a client think about the neural pathways and proprioceptors the client uses to perform the task. You may find selecting exercises for your client might be easier if you introduce exercises that enhance neural performance rather than strength. Everything we do as humans begins and ends with neural transmission and neural integration. Start thinking about the neural aspect of movement, you find you can really fine tune the movements in some of your clients.