Post Rehab Blog

The Post Rehab Blog Has Moved!!

2008-11-28T18:41:00.000-08:00

You can find the Post Rehab Blog now at www.postrehabblog.com. Please visit us there for information to help you build a profitable post rehab practice and effectively manage a wide range of medical exercise clients. Happy Holidays!!

www.postrehabblog.com

Do you know the post rehab scope of practice?

2008-09-16T14:36:00.000-07:00

As post rehab fitness grows and gains acceptance by medical professionals it is important to make sure you understand the services and activities that fall within the scope of practice for the post rehab professional. The practice of all medical disciplines is closely regulated by a board of examiners usually appointed by the state or provincial legislature or governor. The board specifically outlines the educational requirements, licensing procedures, accepted treatment and procedures practitioners may use in their manage of patients. At this point, no state or provincial legislature has established a scope of practice for the post rehab professional. We have established a scope of practice for our Medical Exercise Specialists, Post Rehab Conditioning Specialists and Medical Exercise Program Directors. We teach this in every post rehab workshop we offer. Continue below to look review the post rehab scope of practice. Our next post will review the red flags indicating a client needs evaluation and/or treatment by a licensed medical professional.

Please click the link below to listen to our podcast titled "The Post Rehab Scope of Practice".

Dr Mike

The knee meniscus - Where is it and what does it do?

2008-09-16T01:28:00.000-07:00

The menisci of the knee are the most important structures in the knee. The cruciates are important to knee stability but the menisci are most important because at this point, the menisci cannot be repaired or regenerated. There are two menisci, the medial and lateral, found in each knee. The larger of the two menisci is the medial. The most often damaged of the two is also the medial meniscus. For more more detailed anatomical review of the knee menisci, please click the link below to our video outlining the knee meniscus.

Dr Mike

ACL Graft - Hamstring or Patella Tendon?

2008-09-13T19:40:00.000-07:00

Tiger Woods recently underwent an ACL reconstruction using a hamstring graft. But many professionals athletes have the ACL reconstructed using the patella tendon graft. Why use the hamstring tendon opposed to the patella tendon?

We know the patella tendon draft is 110% (research estimates) stronger than the original ACL but some surgeons still prefer the hamstring graft. This is because the hamstring is vascularized immediately and the hamstring does not cause as many issues with the development of scar tissue. The patella tendon is the stronger of the two grafts but the patella tendon is stronger but it must re-vascularize after the surgery. Re-vsacularization is vitally important to the stability and resiliency of the new ligament. The patella tendon graft does have a slightly higher incidence of scarring but the durability of the graft makes it very attractive for use with athletes.

The selection of the graft may be affected by the age of the client, the degree of knee instability and the preference of the surgeon. The outcome studies on the use of the two grafts doesn't show a significant advantage for either. Physician preference and comfort are usually the deciding factor in graft selection.

For you the PRP, the most important knowledge our need regarding the graft selection is the intensity level of progression the graft can tolerate. Usually the patella tendon graft and tolerate greater forces at the 4-6 month mark than the hamstring graft. But overall, the functional outcomes for both grafts are the same. With both grafts caution with the last 30 degrees of open-chain knee extension is important.

Dr Mike

The ACL - Where is it and what does it do?

2008-09-09T21:23:00.000-07:00

The recent ACL rupture in Tom Brady's knee and the reconstructive surgery that Tiger Woods recently underwent has highlighted the ligaments of the knee. There are 4 primary ligaments of the knee. These include the anterior cruciate ligament (ACL), the posterior cruciate ligament (PCL), medial collateral ligament (MCL) and lateral collateral ligament (LCL). The cruciates are major stabilizers in the knee. The ACL is important in maintaining stability in the knee during dynamic activities such as cutting, turning, pivoting and changing direction. The ACL prevents the anterior translation of the tibia beneath the femur. The tear of the ACL allows the uncontrolled movement of the femur on top of the tibia. That uncontrolled movement may cause menisical damage. Meniscal damage may lead to arthritic changes in the knee. Click the link below to watch the review of the major ligament structures in the knee.

Dr Mike

Quadriceps Review

2008-09-04T22:53:00.000-07:00

The quadriceps in the most important muscle group in the lower extremity. The four heads of the quadriceps are innervated by the femoral nerve. The quadriceps acts to extend the knee. Click the link below to watch the review of quadriceps function and anatomy.

Dr Mike

Post Rehab Programming to Increase Revenue

2008-09-01T06:29:00.000-07:00

The summer is over and schools are opening. Thoughts now shift to education and getting back into the groove of work, study and exercise. This fall is a great time to offer group based post rehab programming such as the Dynamic Back School or Women's Fitness 101. These two programs are easily introduced in a club or private studio setting and they will allow you to capture a new group of clients. The group based approach to the client with medical issues will allow you to tap into the medical market at a lower price point but with an opportunity for significant revenue. We recommend a $180-225 fee per participant in the back school or Women's Fitness 101. These programs are delivered in six sessions over a 30-day period. The thirty day approach is very attractive to medical professional who are usually very reluctant to refer patients to long-term fitness programs. In my next blog post I will explain the Dynamic Back School.

Dr Mike

Do you know the symptoms of mild knee arthritis and how those symptoms translate to x-ray studies?

2008-08-30T06:21:00.000-07:00

As many of you know I am an avid golfer and a former army paratrooper. Between the acl rupture and meniscal damage sustained during my army career and the wear and tear on the right knee from my quest to over take Tiger's number 1 ranking, (I dont think Tiger has much to worry about), I have a low level effusion (swelling) of the knee. I have no pain but occasionally a feeling of stiffness after playing more than 18 holes. My knee's tolerance level seems to be about 18 holes of golf before effusion begins. Steep inclines, hitting out of sand traps and just the 18 holes of compression on the knee seem to be the major issues. I have no feeling of giving way or instability.

Here's your post rehab challenge. Develop an exercise program for a 46 year old male he can perform at home. You have a Bowflex, a stationary bike, dumbbells from 10-50 pounds and a Swiss ball. The program goal is at the end of 18 holes there is minimal effusion with no residual stiffness the next morning. Take a look at the x-rays below for a look at arthritic changes that causes a mild effusion in the knee. The knee on the right shows narrowing along the lateral joint line and if you look closely you will see mild osteophytes (bone spurs) right at the joint line. This x-ray shows the early stages of osteoarthritis of the knee.

Dr Mike

Post Rehab Tip #14 - When do I use McKenzie or back extension exercises?

2008-08-28T02:21:00.000-07:00

McKenzie or back extension exercises are best used with clients diagnosed with lumbar disc herniation. The goal of McKenzie exercise is to centralize radiating pain into the low back and then eliminate the pain. In recent years I have noted the shotgun use of McKenzie exercise on all lumbar post rehab clients. The McKenzie exercise concept should be used with discogenic clients in a very structured process. There are 3 exercises associated with the McKenzie concept. They are:

1) Prone Lying

2) Prone Prop

3) Prone Press-Up

These exercises, properly used with strategies to minimize spinal flexion and prolonged sitting, will make a significant difference in managing the post rehab lumbar disc herniation client after their discharge from physical therapy or chiropractic care. Click the link below to watch my demonstration of the McKenzie exercise sequence.

Dr Mike

Post Rehab Referrals - How do I contact physical therapists, physicians and chiropractors?

2008-08-27T02:55:00.000-07:00

The lifeblood of any post rehab or medical exercise practice is developing referral relationships with local medical professionals. Approaching physical therapists, chiropractors and/or physicians requires an organized process as well as understanding the needs of these referral sources. You must develop a post rehab/medical exercise marketing package and presentation to maximize your chances of establishing a referral relationship. Once you make your presentation but referrals aren't coming in you must ask yourself four questions. The organized approach, the contents of the post rehab marketing package and the four questions are included in my recent interview with David Gilks, MEPD. Please click the link below to listen and learn how to contact medical professionals.

Dr Mike

I referred my client to a physician but he never came back. How do I get my client back?

2008-08-26T18:37:00.001-07:00

In an earlier blog post I discussed a problem many post rehab professionals encounter, the loss of a client when you refer the client to a medical professional for an evaluation. Here are three strategies you can use to prevent the loss of your client.

1) Send a letter of introduction to the medical professional. This letter should be given to the medical professional by the client and not given to the front desk staff or nurse. This letter will introduce your client and outline the exercise program you developed for the client as well as listing the client's complaints. In the letter request the evaluator to contact you with recommendations for modification of the client's exercise program.

2) Contact the medical professional's office the next day to find out if exercise modifications are warranted and/or if the client needs medical treatment. Also, thank the medical professional for assessing the client.

3) Contact the client and ask the outcome of the evaluation visit and the recommendations given to the client.

One of these three actions will allow you to obtain the information you need to modify the client's exercise program and avoid the loss of your client. Sometimes medical professionals may dismiss you because they simply don't understand you want to be involved in the management of the client's condition. This is where clearly outlining your role/scope as well as the benefits exercise offers to the client (without exercising the affected area) can win the day and develop a referral relationship with the medical professional. I can't say this will happen in 100% of the cases but it will help establish you as the post rehab professional in your community.

Dr Mike

Post Rehab Practice Builder...Developing an Affiliate Program

2008-08-25T01:33:00.000-07:00

Have you heard of affiliate program many Internet marketers use to promote their products and skyrocket their revenue. Well David Gilks, MEPD owner of Core Essentials of Naniamo, BC developed his own affiliate program to market businesses owned by clients that use his studio and post rehab training services marketing his business to potential new clients. David's affiliate program titled the "Inner Circle - Platinum Card Advantage" is a unique marketing concept and this is the first time I have heard of it used to market post rehab services. Click the link below to listen to my interview with David. If you want to develop an affiliate program in your practice join our "Post Rehab Profits & Protocols" program by going to www.profitsandprotocols.com.

Dr Mike

When I make a referral to a medical professional my client never comes back, what do I do?

2008-08-24T22:14:00.000-07:00

I am a strong advocate for referring clients in your post rehab practice to a medical professional for evaluation if you encounter a situation beyond your scope of practice. But more post rehab professionals are noting the complete loss of the client referred. The medical professional may advise the client simply to discontinue exercise or institute a program of treatment for the client without communicating the findings of the assessment and/or recommenndations for treatment. I can see how this can be very frustrating for the post rehab professional. In your attempt to act professionally by making a referral to lose the client annd receive no communication. I would certainly feel used.

I would follow up with the client directly and find out what recommendations were made. If you have made a referral and sent along a letter of introduction with your client, you certainly deserve to know the outcome of the visit. In this situation, I will admit this is not professional conduct on the part of the medical professional. Medical professionals regularly receive referrals and common practice is to send a follow-up report to the referral source with recommendations and a thank you. I can only guess the medical professional may not feel a referral from a fitness professional warrants a follow-up report. In one of my next blog posts I will note a strategy that will help you eliminate this situation and make it easier to communicate with medical professionals.

If you have encountered this issue, please share your experience with other post rehab professionals by commenting here on the Post Rehab Blog. Thanks.

Dr Mike

When do I begin exercise after a cortisone injection?

2008-08-24T15:14:00.000-07:00

The post rehab professional is often faced with managing the post rehab client after a cortisone injection. I just got back from teaching our first post rehab skills workshop. During one of the workshop breaks the participants asked when is it safe to begin exercise after cortisone injection. First, understand cortisone injections are an attempt to break the "pain/inflammatory" cycle associated with an injury. Once the pain cycle is broken, exercise is used to strengthen and stabilize the area. Wait at least 24 hours before beginning any exercise after cortisone injection. The injection itself may cause pain. If the client has pain beyond the 24 hour period, wait until the pain from the injection has completely subsided before beginning exercise. Contact the client's physician or physical therapist before you begin exercise. Start with gentle exercise and a gradual increase in intensity based on the client's tolerance. Gentle ROM and stretching exercise followed by light resistance activities for the first one or two sessions after the injection is my recommendation then you can gradually progress back to the levels the client was able to tolerate before the injection. Remember, the cortisone is used to break the pain cycle to allow strength and stability training. The cortisone may completely eliminate the client's pain but the underlying pathology is still present. Progressive strength and stability training is a major factor in the resolution of the condition. If later during the course of the post rehab program the client's symptoms re-appear, contact the client's physician immediately for program guidelines or possible referral for further evaluation.

Dr Mike

Dr Mike

Post Rehab Tip #13 - What documents do I need for insurance reimbursement?

2008-08-24T00:16:00.000-07:00

When seeking insurance reimbursement for post rehab services contact the client’s insurance claims adjuster. You will need the following documents when you make the contact:

a. Signed post rehab referral for the client's physician
b. Post Rehab Program Goals (functionally-based)
c. Post Rehab Program Design (include duration, frequency & number of sessions)
d. Post Rehab Assessment

Securing insurance reimbursement for post rehab services requires more than having these documents on hand. How to negotiate the insurance reimbursement maze is reviewed in detail in our "Insurance Reimbursement for Post Rehab Professionals" workshop. Dealing with insurance carriers is becoming part of the daily life for post rehab professionals. This and other streams of post rehab income are reviewed in our podcast titled "Multiple Streams of Post Rehab Income". Follow this link to listen in our how to develop multiple streams of income in your post rehab practice - Multiple Streams.

Dr Mike

3 Keys to Managing Post Rehab Bicipital Tendinitis

2008-08-22T02:09:00.000-07:00

Tendinitis, regardless of the region affected, occurs often with athletes. Managing the bicipital tendinitis client is challenging but if following the "3 Keys" you will see a positive functional outcome. The 3 keys are:

1. Eliminate bicep activities until receiving approval from physician or therapist.

2. Strengthen the rotator cuff and scapular musculature.

3. Avoid overhead activities or any activities that increase pain.

Follow these 3 keys and you will develop safe and effective programs for the post rehab biceps tendinitis. Please click the link below to listen to my discussion of 3 keys.

Dr Mike

3 Keys to Managing the Post Rehab LCL Sprain

2008-08-21T02:36:00.000-07:00

We spoke about managing the MCL post rehab client and now we will discuss managing the LCL post rehab client. Some of the keys are same for the MCL but there is one important distinction. The 3 keys are:

1) Limit knee flexion to less than 90 degrees.

2) Strengthen the quadriceps and hamstrings.

3) Avoid activities that increase swelling and/or pain.

These 3 keys are very similar for the post rehab management of the MCL client. Listen to my discussion of these 3 keys by clicking the link below.

Dr Mike

3 Keys to Managing the Post Rehab Achilles Tendon Rupture Client

2008-08-20T14:08:00.001-07:00

Though we often see Achilles tendon ruptures in the middle-aged population, it is seen in athletes. Once the tendon has healed from the surgical repair or via conservative treatment, this client will need a post rehab program after discharge from physical therapy. The 3 keys to managing the Achilles rupture in a post rehab setting include:

1) Improve and maintain ROM

2) Increase strength and power in the gastroc and soleus

3) Improve stability for return to functional activities

Follow these 3 keys to establish a safe and effective post rehab program for the Achilles tendon rupture. Click the link below to listen to my description of these 3 keys.

Dr Mike

Post Rehabilitation - The Future is Bright and Profitable

2008-08-20T04:57:00.000-07:00

AAHFRP offered the first post rehab course, the Medical Exercise Specialist workshop, in Washington, DC in 1994. The acceptance and usage of post rehab services by fitness participants, health clubs, medical professionals and insurance carriers has exceeded our wildest dreams. Our hope was to expose fitness professionals to the basic concepts in exercise management of common medical conditions. Now post rehab fitness has become a standard part of the rehab management model and we see more physical therapy clinics and hospital-based fitness facilities adding post rehab and medical exercise programs throughout North America.

The future of post rehab fitness and medical exercise services are bright. The aging of the baby boomers and the overwhelming numbers of hypertensives, diabetics and other chronic diseases will heighten the need for post rehab fitness and medical exercise services. Within the next decade we will see university exercise physiology and kinesiology programs offering concentrations in medical exercise and post rehab fitness. We will also see physical therapy clinics, sports medicine centers and hospital-based fitness centers establishing the "medical exercise specialist" or "post rehab conditioning specialist" as job titles within the organization with various levels of specialization and training. Insurance carriers will embrace medical exercise as a standard component of treatment for conditions such as diabetes, hypertension and other cardiovascular disorders. The same will be true of post rehab fitness for conditions such as osteoarthritis and disc herniations along with some surgical procedures including acl reconstructions, laminectomies and total joint replacements. Post rehab services will be utilized after physical therapy and chiropractic services once the client is medically stable and has received the maximum benefit from the treatment provided by the licensed medical professionals. Though insurance reimbursement will become common place for post rehab services, group programs will increase as insurance reimbursement decreases per session. Medical exercise specialists and post rehab conditioning specialists will become staff members in physical therapy clinics and sports med centers but licensure is quite a way off. States will begin registering fitness professionals. To obtain insurance reimbursement, post rehab professionals must hold the MES or PRCS certification as well as a personal training certification.

The next decade will one of tremendous growth for the post rehab arena. Opportunities will abound and income will grow but so will administrative tasks such as writing progress reports, documenting sessions and authoring progress summaries. This means a cottage industry will develop around post rehab fitness. Software programs, administrative workshops, liability insurance plans, practice management workshops and even lawsuits will become part of the post rehab phenomenon. Just think of it, higher incomes, greater respect from medical professionals, higher liability premiums and the need to practice defensively. Welcome to the medical community.

Post Rehab Tips #12 - Levels of Assistance

2008-08-20T00:13:00.000-07:00

Sometimes you will receive a referral to work with a client that requires assistance with balance, transfers and ambulation. You must be aware of the three levels of assistance. The levels of assistance are:

a. Maximal Assistance
b. Moderate Assistance
c. Minimal Assistance

Click on the link below to listen to the definition of each level and how impact on the post rehab program.

Dr Mike

3 Keys to Managing the Post Rehab Rotator Cuff Client

2008-08-19T03:57:00.000-07:00

Rotator cuff injuries are common in sports requiring overhead activities. The tear of the rotator cuff can be both painful and functionally limiting. The exercise management of rotator cuff tears is based in 3 keys that include:

1) Strengthen the rotator cuff muscles.

2) Avoid overhead activities and increase the subacromial space.

3) Strengthen the periscapular musculature.

These 3 keys form the foundation of a safe and effective post rehab program for the rotator cuff tear client. These keys will optimize the possibilities of a positive functional outcome. Click the link below to listen to the discussion of these 3 keys.

Dr Mike

Post Rehabilitation Red Flags.........when should you refer or proceed with caution?

2008-08-19T01:55:00.000-07:00

When should you refer your client to a medical professionals? Do you know the signs your client needs an evaluation by a licensed medical professional? If you are not 100% sure, then using our post rehab red flags might be helpful. These red flags are reviewed in each of our post rehab workshops and these are a vitally important concept all post rehab and corrective exercise professionals must embrace and understand. The red flags are listed above. When you see these red flags, as a post rehab professional, you must refer the client to a medical professional or modify the client's exercise program. It's up to you, the post rehab professional, to determine is a referral or program modification is necessary. For more information on the post rehab red flags go to www.postrehabfoundations.com.

Dr Mike

Member Spotlight - Focus Integrated Fitness

2008-08-19T00:06:00.000-07:00

Our members in the spotlight for this segment are the owners of Focus Integrated Fitness of New York City, Gabe Valencia, MES and Joe Masiello, MES. Gabe and Joe bring a very unique approach to the development of fitness programming and the education of personal trainers. This is a great interview. Every post rehab professional and anyone interested in developing their own fitness facility should listen. Please click the link below to listen to this fantastic interview.

Dr Mike

Corrective Exercise.....when to correct or when to refer?

2008-08-18T08:10:00.000-07:00

As post rehab courses and guidelines proliferate, knowing when to appropriately use corrective exercise techniques and post rehab training programs seems to get lost in the discussion. Simply the presentation of a client with a postural fault, muscular imbalance or pain is sometimes not enough of a reason to begin corrective exercise. A thorough medical history and assessment on the client must be completed first. Also, discussion with the client's physician or physical therapist is required to ensure you have the full picture before proceeding with exercise. Its interesting that few corrective exercise or post rehab courses really focus on the pathology and assessment of these postural faults, pain and/or imbalances but they do readily encourage exercise. Remember, posture and pain may be the result of a long-term condition or fault and what we see is not what is really going on with the client. The introduction of corrective exercise can exacerbate a dormant condition. Sometimes pulling the string of a postural fault may cause the breakdown of other faults and result in the client having more pain. Now it is important to get to the underlying problem but if you can't anticipate the possible complications, then you shouldn't begin corrective exercise without a thorough history, assessment and discussion with the client's physician. Remember, what is you see is not what you get in posture or with pain. Though a thorough assessment, medical history, x-rays, CAT Scans and MRI's are not 100% accurate, these allow us to eliminate possible conditions. Then we can start to correct faults with a better understanding of possible causes. I am not saying corrective exercise is not great for clear cut postural faults which are easily corrected. But in the back of your mind you should always think, what other complications might be causing the pain or fault and have I given enough consideration to these complications. What you see with human posture and pain is seldom what you get. If you see red flags, talk to the client's physician or therapist. We will discuss the post rehab red flags in our next blog post.

Dr Mike

3 Keys to Managing the Post Rehab Low Back Pain Exercise Program

2008-08-18T00:12:00.000-07:00

Back pain affects 80% of the American population at some point in their lives. For many, this back pain becomes a constant part of their lives. The exercise management of chronic low back pain (LBP) is an important skill the post rehab professional must master. LBP is seen in both the athletic and non-athletic populations. There are 3 key components of the exercise program for the chronic LBP client in a post rehab setting. The 3 key components are:

1) Cardiovascular training with appropriate levels of support.

2) Spinal stabilization including techniques in lifting, pushing, pulling and carrying as well as flexibility training.

3) Lower extremity strengthening.

These 3 components must be included in each LBP client's exercise program design. Include these 3 essential components and you will see positive outcomes with your LBP clients. Click the link below to listen to my discussion of these 3 key components.

Dr Mike

Post Rehab Tip #11 - The step-by-step medical history interview

2008-08-17T23:07:00.000-07:00

A thorough medical history must be completed on each post rehab client. Verbally ask the client each question on the med history form. Direct interaction with the client allows for a much more accurate medical history appraisal and avoids the possibility of a medical condition slipping through the cracks. The medical condition missed in the medical history may result in the client exacerbating an old condition or causing a new injury. The most important aspect of the medical history is to listen. Your client will tell you every medical concern they have but you must listen closely for the subtle meanings within the medical history interview. The importance and approach to taking a medical history is reviewed in our Medical Exercise Specialist and Essentials of Post Rehab Fitness workshops.

Dr Mike

3 Keys to Managing Post Rehab MCL Sprain

2008-08-17T02:54:00.000-07:00

Another common injury we see with athletes is the MCL sprain in the knee. The MCL is a stabilizer of the knee and often damaged. Though MCL ruptures are seldom surgically repaired, the occurrence of 1st and 2nd degree sprains is common. The 3 keys to managing this client in a post rehab setting are as follows:

1) Avoid full knee extension until authorized by physician or physical therapist.

2) Strengthen the quad and accentuate vastus medialis recruitment.

3) Avoid activities that increase swelling.

These 3 keys are the foundation of the post rehab program for the MCL client. Also remember, PFS is always lurking with the effused knee. Effuse is common with MCL involvement. Please click the link below to listen to the discussion of these 3 keys.

Dr Mike

Post Rehab Challenge
Your client is a 24 year-old cyclist. She sustained a 2nd degree of the left MCL. She has completed physical therapy and now she has full ROM but an atrohied quadriceps. She has some swelling and point tenderness at the MCL after cycling. How would you adjust the seat for this client and what motion would you limit until the swelling and point tenderness are gone? What complications are associated with knee swelling or effusion?

When does post rehabilitation begin......acute, subacute or chronic stage?

2008-08-16T03:37:00.000-07:00

At what stage during the rehab process does post rehab begin? Does it start in the acute stage? Is post rehab only allowed during the chronic stage? Where should post rehab begin? Well there are no established standards on post rehab but we know the acute client is not ready for post rehab. For some clients in the subacute stage post rehab exercise is appropriate but we can say that 80-90% of all post rehab clients are in the chronic stage. The chronic client and/or the client in the late stages of sub-acute phase are the ideal post rehab client. The client is ready for post rehab when he or she is medically stable, is able to participate in 30-60 minutes of exercise with rest breaks, has completed physical therapy or chiropractic care, and has a referral from a physician. The chart belows outlines the stages of recovery and identifies key characteristics of each stage as well as the appropriate professional to deliver services. The chart will make the understanding of the stages of rehab clear to all post rehab professionals.

Dr Mike

3 Keys to Managing Post Rehab AC Joint Separations

2008-08-16T02:50:00.000-07:00

AC joint sprains are common in contact sports. Sports such as judo have an abundance of AC joint sprains. AC joint sprains and separations are use synonymously. The danger to the AC joint is both cartilaginous and ligamentous. The damage to these structures causes inflammation, pain, instability and weakness in the shoulder. The AC joint separation, on presentation, looks similar to impingement syndrome. The 3 keys to managing AC joint separation are as follows:

1) Limit overhead and full adduction activities

2) Strengthen the rotator cuff

3) Identify AC joint separation

These keys will help you develop a safe and effective post rehab program for the post rehab AC joint separation clinic.

Dr Mike

Post Rehab Challenge
What are the signs and symptoms that identify the AC joint separation? How is the AC joint separation differentiated from shoulder impingement?

Have you really seen a sports medicine clinic?

2008-08-15T15:16:00.000-07:00

Today I came across a great article in "Fast Company" magazine. One of the lead articles is titled "The Most Valuable Player in Sports". The article discusses James Andrews, MD of Birmingham, AL. Dr Andrews is one of the best known orthopedic and sports medicine surgeons in North America. I was lucky ennough several years ago to visit Dr Andrew's clinic in Birmingham and spend 2 days there learning their philosophy to orthopedics and sports medicine. This is one of the most comprehensive sports medicine clinics around. The incorporation of cutting edge orthopedics, advanced physical therapy and rehabilitation techniques and dynamic sports conditioning is the basis for the best sports med facilities. I was also lucky to do a week long fellowship at Cincinnati Sports Medicine in Cincinnati, OH. If you really want to see the ideal model of a sports medicine clinic visit one of these facilities or attend the annual Cincinnati Sports Medicine Symposium held in Hilton Head, SC in May. If you cant attend, purchase the symposium DVD's to learn advanced sports medicine concepts. You will be glad you did.

Dr Mike

3 Keys to Managing the Post Rehab Meniscal Tear Client

2008-08-15T02:03:00.000-07:00

Meniscal tears are common in runners and other athletes. If you can manage the post rehab meniscal tear client, you will have great success as a post rehab professional. Arthroscopic surgery sometimes diminishes the importance of the rehab process afterward. This sometimes leads the client to neglect rehabilitation and start running before the meniscus has fulled healed and the quadriceps has regained its strength. The 3 keys to managing PFS are noted below:

1) Control swelling

2) Strengthen the quadriceps and recruit the vastus medialis

3) Avoid high impact activities

Dr Mike

Post Rehab Challenge
Your client is the same 46 year-old female noted in the previous 'post rehab challenge". Please explain the importance of the meniscus and why the menisci are the most important structures ih the knee and not the cruciates.

3 Keys to Managing the Post Rehab Patello-Femoral Syndrome Client

2008-08-14T01:54:00.000-07:00

Patello-Femoral Syndrome (PFS) is another common condition seen in athletes. PFS is associated with weakness of the quadriceps and chronic effusion (swelling). PFS can curtail a post rehab training program. There are 3 keys to managing the post rehab PFS client. The 3 keys are listed below.

1) Recruit the vastus medialis.

2) Stretch the IT band.

3) Strengthen the quadriceps.

4) Control swelling - this is the bonus key.

Click the link below to listen to my discussion of these 3 keys.

Dr Mike

Post Rehab Challenge
Your client is a 46 year-old runner training for a 10K run. She reports low grade anterior knee pain after prolonged sitting. She also has mild swelling after running greater than 2K. Please develop the exercise program for this client and explain how the swelling might assist in the development of PFS.

3 Keys to Managing the Post Rehab Spondylolethesis Client

2008-08-13T16:01:00.000-07:00

Spondylolethesis is another condiion commonly seen in athletes. Managing the spondylolethesis is challenging. Spondylolethesis are graded using a 1-4 or 1-3 scale. Severe spondylos (grade 3-4) are sometimes treated surgically. Those spondylos that are non-surgically managed (1-3) should be referred for post rehab conditioning after discharge from physical therapy. There are 3 keys to managing the post rehab spondylolethesis client. The 3 keys are:

1) Determine the grade of the spondylolethesis. This information will come from the physician, physical therapist or chiropractor.

2) Avoid lumbar extension 10 degrees beyond neutral.

3) Strengthen the abdominals and position the client is slight lumbar flexion for normal activities. Slight flexion protects the spinal cord from damage.

Follow these 3 keys to develop a safe and effective post rehab program for the spondylolethesis client. Click the link below to listen to my discussion of these 3 keys.

Dr Mike

Post Rehab Tip #10 - Overall Leg Strength in Post Rehab Fitness

2008-08-13T05:00:00.000-07:00

"Overall Leg Strength" is a concept to be considered when working with clients referred with lower extremity disorders such as total knee or hip replacement and ACL rupture. Overall leg strengthening simply means strengthening the muscles of the lower extremity to lift 2-3 x bodyweight. This is important for climbing stairs, stepping off curbs and getting out of a chair. The lower extremity must be able to control and support the client's bodyweight. Closed chain exercises such as the lateral step up, leg press (both bilateral and unilateral) and wall squats improve overall leg strength. Overall leg strength is vitally important to the clients functional capacity and level of independence.

Dr Mike

3 Keys to Managing the Post Rehab ACL Reconstruction

2008-08-12T00:01:00.000-07:00

As surgical technology improves so does the rehabilitation of the ACL reconstructed knee. The number of ACL reconstructions has increased as our understanding of the ACL has improved and our ability to diagnosis the symptoms and signs. ACL reconstructions are common in athletes. Let's list the 3 keys to managing these clients.

1) Control swelling!!

2) Activate the vastus medialis as quickly as possible.

3) Improve overall leg strength while protecting the new ACL graft.

These 3 keys are important during all stages of rehabilitation for the ACL reconstruction. Remember these 3 keys as you manage the post rehab ACL client and you will see must better functional outcomes.

Dr Mike

Post Rehab Challenge
Your client is a 27 year old fencer with a right ACL reconstruction which performed 22 weeks ago. He completed physical therapy and has moderate quadriceps atrophy but full pain-free ROM with both flexion and extension. His ACL was reconstructed using a hamstring graft. He is able to walk with no pain or gait deviation. He has de-rotation brace but he runs with a slight limp when in the stance phase on the right side. He has clearance from his physician and physical therapist to begin the post rehab program. Please explain what activities are restricted or contraindicated for the ACL reconstruction client and why.

3 Keys to Managing the Post Rehab Hamstring

2008-08-11T00:01:00.000-07:00

Hamstring pulls are another common injury seen in athletes. Chronic hamstring pulls can limit athletic performance and drag on until properly managed. There are 3 keys to managing the post rehab hamstring client. These 3 keys include:

1) Allow time for proper healing;

2) After the tissue damage has healed, make the tissue pliable with stretching:

3) Use proper strengthening and stretching techniques to prepare the athlete for return to sports.

These are 3 very simple concepts but they are often overlooked in the management of the post rehab hamstring client. Remembering these 3 concepts will allow you to develop better and more effective exercise programs for your clients. Please click the link below to here my discussion of these 3 concepts.

Post Rehab Challenge
Where in the running cycle does the hamstring pull occur? Heel strike, footflat or push off?

Dr Mike

3 Keys to Managing the Post Rehab Shoulder Dislocation

2008-08-10T15:53:00.000-07:00

One of the few conditions that requires immobilization for a significant period after injury is the shoulder dislocation. Dislocations are common injuries suffered by athletes. Once physical therapy care is over, the shoulder dislocation client should be referred to a post rehab program to continued strengthening. Let's outline the 3 keys to managing the post rehab shoulder dislocation client.

1) Improve joint stability

2) Strengthen the pectoralis

3) Avoid extreme shoulder horizontal abduction, external rotation and extension

These 3 keys are a foundation for the post rehab shoulder dislocation program. Developing the post rehab program based on this foundation will produce positive functional results.

Dr Mike

Post Rehab Challenge
Your client is a 48 year old female who fell on an outstretched hand resulting in a shoulder dislocation. She completed a 7 week program of physical therapy. She presents at your facility with a post rehab referral signed by her physician. She has 160 degrees of shoulder flexion and abduction. Both movements are pain free. She does have weakness when reaching overhead but no pain. Her rotator cuff muscles are weak. Which muscle(s) are important to strengthen to improve her joint stability? Which ligament structures are damaged with shoulder dislocation?

Post Rehab Tip #9 - Understanding Bone Spurs or Osteophytes

2008-08-10T05:56:00.000-07:00

Bone spurs are known as osteophytes. Osteophytes occur as a result of osteoarthritic changes. Rheumatoid arthritis (RA) does not cause osteophytes. RA usually polishes the end of long bones. When the physician looks at an x-ray, an indicator of osteoarthritis is the presence of bone spurs along the margins of the joint. Osteophytes are a normal occurrence with osteoarthritis.

Dr Mike

3 Keys to Managing the Post Rehab Ankle Sprain

2008-08-09T23:12:00.000-07:00

Chronic ankle sprains are a constant presence in training rooms in all sports. The ankle sprain is the most nagging injury an athlete can sustain. Without proper management, the residual effects can limit the athlete for months. There are 3 keys concepts in managing the post rehab ankle sprain. The 3 keys are:

1) Control swelling at all times. Use ice, NSAID's (prescribed by a MD or DO) and elevation to control the swelling.

2) Strengthen the peroneals using both open and closed chained methods. The peroneals are the primary muscles to strengthen but other muscles in the leg should be strengthened also.

3) Even a series of first degree sprains will cause instability. Refer the client for assessment by a medical professional if instability persists.

Every ankle sprain, regardless of severity, should be seen by a physician, chiropractor or physical therapist. Once the client is past the acute and subacute phases, post rehab exercise may begin. In many situations, the client attempts to manage his ankle sprain on his own and this results in a prolonging of the chronic stage and instability. Exercise management of the ankle sprain is important to the restoration of function. If you remember these 3 keys, you will see significant improvement in your client's function. Please click the link below to listen to my explanation of these 3 keys.

Dr Mike

Post Rehab Challenge
Your client is a 28 year old soccer player with a recent history of a second degree sprain of the left ankle. After 2 weeks of treatment by the team trainer and release by the team physician; the client is now practicing again. He has no pain and very minimal swelling. He is icing his ankle twice per day and wearing a brace during practice. What is the most common type of ankle sprain and which ligament is usually involved? Please outline both open and closed chain exercises you would design for this client to improve his functional capacity.

Post Rehab Insurance Reimbursement

2008-08-09T17:04:00.000-07:00

For many fitness professionals entering the post rehab and medical exercise market, their first question is, "can I receive insurance reimbursement for providing post rehab services"? Well, the answer is yes, but there is a "post rehab ideal client scenario" that makes the possibility of reimbursement much greater. The "ideal post rehab scenario" and/or "post rehab insurance reimbursement criteria" is outlined below.

The key for post rehab professionals is understanding the insurance reimbursement maze and being able to identify the client scenario that offers the best chance for reimbursement. There is an "ideal post rehab scenario" that is usually reimbursed to some degree by the insurance carrier. We have titled this the "Post Rehab Insurance Reimbursement Criteria". It is as follows:

1) The client must have insurance coverage through a workman's compensation, motor vehicle accident claim or have a third party insurance carrier such as Blue Cross/Shield, ATENA or Connecticut General (these are just examples) .

2) The client must have sustained a traumatic injury and/or underwent surgery. Example of this would be a client with a ruptured anterior cruciate ligament in the knee or a disc herniation in the lumbar spine either of which has surgery to correct the injury. These clients need long-term supervised exercise after the completion of physical therapy or chiropractic care is done.

3) The client must have residual functional deficits that are present after the client has completed physical therapy and/or chiropractic care. At some point the client no longer needs PT or chiropractic but there are still functional deficits that impair the client's function. These include functional limits in ROM/flexibility, strength, power, endurance, balance, proprioception, joint stability, muscle recruitment and coordination. The post rehab exercise program addresses these deficits after discharge from physical therapy.

4) The client has a signed referral from his or her physician or physical therapist requesting a supervised functional conditioning program.

5) The client has received the maximum benefit from physical therapy and chiropractic care. The client has been through a course of physical therapy and/or chiropractic and reached the maximum level of function with these services and now is discharged. The client must be seen by a licensed medical professional prior to referral for post rehab services. This ensures the proper care and treatment are delivered in the acute and subacute stages following the injury.

The process of insurance reimbursement for post rehab services is more complicated then simply holding a post rehab certification such as the "Medical Exercise Specialist". I must admit we never thought we would see MES' or PRCS' receiving insurance reimbursement. Your best chances for reimbursement are far greater when working with clients that meet criteria. As you can see, the post rehab reimbursement criteria encompasses a wide range of clients. Medicare and Medicaid will not reimburse for post rehab services.

Click the link below and listen to my explanation of the post rehab criteria. We also have an audio-based workshop titled "Insurance Reimbursement for the Post Rehab Professional" that discusses the process and procedures for securing insurance reimbursement. The course takes you step by step through the insurance reimbursement process. For more information visit www.postrehabinsurancereimbursement.com.

Dr Mike

Member Spotlight - Bill Rothschild, BS, MES

2008-08-09T07:02:00.000-07:00

Dr Mike interviews Bill Rothschild, BS, MES. Bill is the director of the Monterey Sports Center where his has developed a comprehensive "medical exercise/post rehab" program. Click the link below to listen.

Dr Mike

Post rehab conditioning is the story behind every Olympic star!!

2008-08-09T00:49:00.000-07:00

Weren't the opening ceremonies of the Olympics fantastic!! The Beijing Olympic Committee did a magnificent job pulling off the opening ceremonies. My favorite part of the opening ceremony is the procession of the athletes into the stadium. I really enjoy seeing the athletes of lesser status meeting the more prolific athletes on the infield as the torch ceremony proceeds. As I watched tonight, I counted no less than 27 potential gold medalists with histories of recent major injuries, but they are now making a run for gold. I realized each of these athletes at some point followed up physical therapy or chiropractic care with a well developed post rehab conditioning program.

Many of you reading this blog have worked with high level athletes and you know the importance of using exercise to manage athletic injuries. So over the 17 days of the Beijing Olympic Games I will write each day about a common injury I have encountered as a physical therapist in my 23 years of managing athletic injuries. I will discuss the three keys to managing each condition and give you a flowchart from our PREPS - Post Rehab Exercise Protocols to help you better manage each condition from a post rehab perspective. Each day I will record the "3 keys to managing....." for you to listen to or download. After each session I will also give you a "post rehab challenge" for you to analyze and solve to enhance your post rehab critical thinking process. Answer all the challenges correctly and I will send you our Post Rehab Tips CD free of charge. This CD contains video clips, post rehab regional exercise guidelines and 101 post rehab tips you can use immediately with your clients. Join me tomorrow for our first condition and learn the 3 keys to managing the post rehab shoulder impingement client. CYA tomorrow.

Dr Mike

3 Keys to Managing the Post Rehab Impingement Client

2008-08-08T21:45:00.000-07:00

Impingement syndrome is common in athletes. Usually seen in athletes involved in overhead activities. There are three key concepts to remember when managing the post rehab impingement syndrome client.

1) Increase the size of the subacromial space using the pendulum exercise.

2) Strengthen the rotator cuff muscles using resistance techniques.

3) Strengthen the periscapular muscles (rhomboids, traps and serratus anterior) to assist with stabilization of the scapula against the thoracic cage.

These are the 3 keys to managing impingement syndrome with exercise. The actual step by step exercise protocol is far more detailed with specific exercise techniques and progression guidelines. To get more information or to purchase the PREPS - post rehab exercise protocol for impingement syndrome go to www.postrehabprotocols.com.

If you follow these 3 key concepts you will produce positive functional outcomes with your impingement clients. To listen to my recording of the 3 keys to exercise management of the post rehab impingement client click the link below.

Post Rehab Challenge
Your client is a 21 year old swimmer. She specializes in the 100 meter butterfly. She was treated 3 months ago for right shoulder impingement. She was discharged after 7 visits with no pain with overhead activities or night pain and full shoulder strength and ROM. She is now competing in Beijing. How would you manage her exercise program during the 7 days before her event to ensure maintenance of her strength gains as well as avoiding any exacerbation of her shoulder. Please outline your program and post it in the comments section of our blog as well as emailing the program to DrMike@postrehab.com. Remember, if you correctly answer all 16 post rehab challenges during the Olympic Games, you will receive a free Post Rehab Tips CD.

Dr Mike

How do I write a post rehab progress report?

2008-08-08T10:13:00.000-07:00

When writing your post rehab progress report make sure you include these 5 essential components:

1. Who is the client?
2. Why was the client referred?
3. What services are you performing?
4. How is the client progressing? (strength, ROM/flexibility, endurance, balance and functional activities)
5. What are your recommendations for the client's exercise program?

If you include these five components and don't make the mistake of adding useless information, this will make your reports easy to read for medical professionals and enhance your professionalism in their eyes. If more detailed information, samples of post rehab progress reports and to listen to the our podcasts on writing post rehab progress reports and post rehab assessment reports go to www.postrehabreports.com or www.postrehabforms.com.

Dr Mike

Medical exercise specialists - can you recognize PFS?

2008-08-08T03:15:00.000-07:00

4 early signs your client has patello-femoral syndrome

Patello-Femoral Syndrome (PFS) can easily ruin a post rehab program and you may never pick up on the early signs. PFS is a very common development in clients with knee pathologies, especially in those clients having recently undergone a recent knee surgery and/or with chronic effusion (swelling) of the knee. Low grade anterior knee usually appears in these clients. It may show up after sitting and watching a full length movie in the theater or sitting during a coast to coast flight. The pain gradually increases to the point of limiting range of motion and function. Activities involving knee flexion or extension cause severe pain and make further rehabilitation almost impossible. Early signs of PFS include: 1) vague anterior knee pain; 2) the feeling of the knee giving way on stairs; 3) low grade swelling in the knee and 4) an underdeveloped vastus medialis. These are the four early signs of PFS. If you see any one of these signs, avoid continued resisted knee extension or flexion and encourage the client to ice the knee and perform standing terminal knee extension exercise to recruit/activate the vastus medialis. If the pain is severe and limits function, refer the client back to their physical therapist, chiropractor or physician.

Remember, PFS is always lurking for the client with chronic knee pain and effusion. The best way to manage PFS is prevention. With all clients suffering from knee disorders insert standing terminal knee extension (STKE) into the post rehab program as soon as the client is able to tolerate the exercise. Start with sets of 15 reps and gradual work up to 25-50 reps. STKE prepares the quadriceps for walking, absorbing the compression forces associated weight-bearing and the medialis for controlling the tracking of the knee. Calculate the number of steps you client takes with a standard daily activity such as walking to the rest room. Use this number as the basis for the STKE sets and reps. All the reps shouldn't be completed at once but through a series of sets over the course of the post rehab session. Click the link below to see a demonstration of the standing terminal knee extension exercise.

Dr Mike

Medical Exercise Specialist and Post Rehab Conditioning Specialist - Think Critical Job Demands When Establishing Sets and Reps

2008-08-06T21:41:00.000-07:00

Think function and critical job demands when establishing sets and reps with post rehab and medical exercise program design. If the client's critical job demands require walking the equivalent of a football field two to three times during his or her shift, two to three sets of 10-15 reps won't prepare the client for return to work and certainly doesn't give the client a chance for a successful outcome. 30-45 reps doesn't give the client the necessary intensity to meet the critical job demands. Sets and reps take require a total of 150 to 200 reps might be closer to the demands placed on the client at work. Now we do not start the exercise program with 150 reps but we work toward that goal. Remember to recognize the need for sets and reps that mimic critical job demands. The concept of critical job demands applies to post rehab clients as well as industrial workers and athletes. So, are you preparing your client for a postive functional outcome when he or she returns to work?

Dr Mike

Get Booked Solid!!

2008-08-05T06:24:00.000-07:00

Hi folks. I just finished reading two great books recently by Michael Post. Michael is a great small business and service professional marketing specialist. Michael has two great books, "Booked Solid" and "Beyond Book Solid". These two books are written for service professionals such as personal trainers. They do a great job giving your marketing concepts and ideas to help book yourself solid. If you are a Facebookie, as I am, add Michael Port as a friend on Facebook and find information on his weekly free teleseminar. While you are on Facebook you can add me as a friend also, Michael Jones....look forward to seeing you there.

Dr Mike

Post Rehab Tip #8 - The Use of the Thomas Test

2008-08-05T03:15:00.000-07:00

The post rehab and/or corrective exercise assessment of the lower extremity commonly includes the the Thomas test. The Thomas test is often illustrated and demonstated incorrectly with the pelvis positioned far back on the surface supporting the client. The test should be performed with the ischial tubs placed on the edge of the surface supporting the client but the tubs are fully supported. The error in placement of the pelvis will cause inaccurate test findings. Please watch my demonstration of the Thomas test by clicking the link below.

Dr Mike

Medical Professionals Transition to Post Rehab

2008-08-04T22:55:00.000-07:00

More medical professionals have contacted our office in the last few months with thoughts of transitioning from the clinical environment to the post rehab arena. Nurses, chiropractors, physical therapists and physical therapy assistants are finding the gains working with clients in a fitness setting are just as rewarding as those made with clients in a rehab setting. Though they may not have a large repertoire of exercise techniques to select from, their grasp of the medical based client helps these newcomers more than hold their own in the fitness setting. We would like to hear from medical professionals making the transition to post rehab fitness. Share your thoughts, concerns and success stories about your transition to fitness. Thanks!!

Dr Mike

Post Rehab Challenge

2008-08-04T22:45:00.000-07:00

Here is an interesting case study you might like to figure out. You receive a post rehab referral from a local rheumatologist. The client is a 48 year old female with a history of rheumatoid arthritis and two recent motor vehicle accidents (the last accident was 5 months ago) with subsequent cervical injury. She completed a course of chiropractic care to manage the cervical pain. She no longer has cervical pain and she full cervical ROM but she complains of right shoulder pain. The shoulder pain occurs with overhead activity and movements across the midline of the body. She also has pain at rest along the lateral aspect of the right shoulder in the area of the deltoid. Her x-rays after the second accident show no fracture. The shoulder pain seems to occur with cervical right side-bending and right rotation. X-ray and MRI of the right shoulder show are unremarkable. What cervical nerve root innervates the lateral aspect of the shoulder? How does right cervical sidebending/rotation effect the client's shoulder pain? Please email your responses to this case study to DrMike@postrehab.com.

Dr Mike

Selling Post Rehab Fitness Using the Assessment

2008-08-04T05:00:00.000-07:00

For medical exercise specialist and corrective exercise specialists selling personal training and post rehab sessions is becoming more challenging in this economic environment. I interviewed a former student, good friend and very successful post rehab professional, David Gilks, MES, MEPD of Nanaimo, BC. David shared his strategies for selling personal training and post rehab sessions using the post rehab assessment. Click the link below to listen in our this interview. I guarantee it will change your concept on the use of the post rehab assessment as a sales tool.

Dr Mike

My Post Rehab Story - Here's how the Medical Exercise Specialist certification started!

2008-08-03T12:00:00.000-07:00

Hi, I am Dr Mike and in 1994 we offered the first post rehab certification for fitness professionals, the Medical Exercise Specialist workshop and certification. I am asked frequently how it started. So I would like to share this story. Please click the video link below to learn how the MES and our other post rehab certifications began more than 14 years ago. For more information on our certifications visit us at www.postrehab.com.

Post Rehab Tip 7 - The Components of Function

2008-08-03T08:51:00.000-07:00

Medical Exercise Specialists and Post Rehab Conditioning Specialist are bombarded with information on "functional training" programs. It's important to understand the components of function and how exercise will impact on the overall functional capacity of the post rehab client. Functional improvement is the most important aspect of rehabilitation. The components to function include:

If any or all of the components of function improve with exercise, then the client's overall functional capacity will improve. Remember, its all about "function" with the post rehab client. Click the link below to listen to this post rehab tip.

Dr Mike

The post rehab fitnesss/medical exercise approach....do you have a system?

2008-08-01T11:20:00.000-07:00

Managing the post rehab client requires a systematic approach to assessment and exercise program design. The first step is understanding the related clinical anatomy and pathology of the client's condition. The next step is understanding what NOT to do with regard to exercise for the client. Once you understand what not to do now you must determine the key areas that must be assessed to determine the client's exercise capacity and function. After you have completed the client assessment now you may proceed with establishing an exercise program. Each post rehab client must be approached using this step-by-step systematic approach.

Understand the related clinical anatomy and pathology.
Based on the client's condition what exercises and/or activities are contraindicated.
Determine the key assessment techniques, based on the client's condition, you must utilize to assess the client.
Develop a safe and effective post rehab exercise program based on your assessment findings.

If you can establish a systematic approach to developing the post rehab program, you will increase your clients success levels as well as establish yourself as the post rehab expert in your community. We use this same approach in our PREPS - Post Rehab Exercise Protocols. Visit www.PREPS-Protocols.com for more information and to download a sample protocol.

Dr Mike

Post Rehab Product Spotlight - TubeTrak

2008-08-01T09:00:00.000-07:00

The TubeTrak is a great new post rehab product developed by Fran Scheel, MS, MES. The TubeTrak is a great tool you may use to provide rubber tubing resistance for several regions of the body. I tried the TubeTrak with a few clients and it's easy to use and provides a simple means of giving resistance in functional movement patterns for a wide range of joints and conditions. If you have a small studio and you need a way of providing resistance with rubber tubing, TubeTrak might be your answer. Go to www.tubetrakstation.com for more info.

Assessing function in seniors.....which method do you use?

2008-07-30T01:16:00.000-07:00

I recently received a call from an experienced MES with 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 general senior fitness population I asked if she included an individual functional assessment during 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. 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 young lady, 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 more than 30 day intervals to determine if your 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.

Functional Status Index

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 series. The other functional assessments reviewed on the Current Topics DVD include the Harris Hip Scale (commonly used with total hop replacements), Lysholm's Scale (knee pathologies), the Ankle Foot Scale (ankle and foot pathologies), the Tinetti Gait and Balance Scale (balance dysfunction), the Shoulder Strength Scale (shoulder pathologies), 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.

There many functional assessment tools available but we here at AAHFRP have identified the nine 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.

Dr Mike

Should I use soap?

2008-07-27T10:43:00.000-07:00

SOAP notes are used in clinical settings to document the treatment, progress and recommendations for future management of the patient. Utilization of the SOAP format is usually thought of in a clinical setting. I don't recommend the soap format for the post rehab professional. I do recommend the use of narrative and/or form-based progress reporting format. We developed a session log to document the activities and the outcome of a post rehab session . Our post rehab progress report form allows PRP's to report client progress on a one-page sheet while noting changes in strength, rom/flexibilty, endurance, balance and function. Look for our upcoming podcast on writing post rehab assessment and progress reports.

Dr Mike

Congratulations to our New Medical Exercise Specialists and Post Rehab Conditioning Specialists

2008-07-25T12:07:00.000-07:00

We would like to congratulate our new Medical Exercise Specialists (MES) and Post Rehab Conditioning Specialists (PRCS). These individuals recently passed either the MES or PRCS exam. Again, congratulations and best wishes building your post rehab practices.

Lisha Perini, MES - San Luis Obispo, CA
J.R. Smith, MES - Somerset, KY
John Johnson, PTA, PRCS - Petaluma, CA
Alana Yates, MES - Tulsa, OK
Marsha B. Pogue, MES - Tulsa, OK
Michon Wynn, MES - Tulsa, OK
Neil Hodgson, MES - Tulsa, OK
Eric G. Nieusma, MES - Fort Lauderdale, FL
Michael Marasigan, MES - New York, NY
Angel Perez, MES - Westwood, NJ
Albert R. Ferrara, MES - New Providence, NJ
Jill Foster, MES - Burke, VA
Steve S. Page, MES - Corona Del Mar, CA
Julia Derek, MES - New York, NY
Steve Beattie, MES - Toronto, ON
Jeanne M. Douthit, MES - Tulsa, OK
Vinisha V. Shah, MES - Toronto, ON
Adele Tevlin, MES - Toronto, ON
Stewart Knorr, PRCS - Riverside, CA
Ronald Holley, PRCS - Washington, DC
Kristin Fisher, MES - Washington, DC
Leslie Lawrence, MES - Edmonton, AB
Lesley Bates, PRCS - Comox, BC
Sally Whibley, PRCS - Errington, BC
Jeffrey F. Collingwood, MES - Salisbury, CT
Joan Collingwood, RN, MES - Salisbury, CT
Karen Church, MES - Salisbury, CT
Juliana DeFriese, PRCS - Concord, CA
Sheryl Oeftering, PRCS - Keyport, NNY
Michael Fitch, MES - Miami Beach, FL
Hayley Ridgway, PRCS - Cheshire, England
Jim Keizer, MES Miami Beach, FL
Elizabeth Blanton, RN, MES - Valdese, NC
L. Reine Vilim, MES - New York, NY
Paul McKinney, MES - Victoria, BC
Jacquelyn M. Campbell, PRCS - Fort Washington, MD
Nicholas Luciano, MES - Bel Air, MD
Jon Rainey, PRCS - Victoria, BC
Kaly William Robinson, PRCS - Victoria, BC
Thomas Acheson, PRCS - Victoria, BC
Aisha Ellis, MES - Toronto, ON
Derrick Whelan, MES - Toronto, ON
Michelle Hosty, MES - Toronto, ON
Levi Sampson, PRCS - Victoria, BC
Kari Putnam, PRCS - Austin, TX
Austin Barbisch, PRCS - Austin, TX
Kimberly Lawrence, PRCS - Dublin, CA
McAllister Dodds, PRCS - Lafayette, CA
Lori Anne Thompson, MES - Belleville, ON
Courtney Gregory, PRCS - Arnold, MD

How does a Medical Exercise Specialist Build Credibility?

2008-07-23T11:56:00.000-07:00

Credibility seems the one thing post rehab professionals are consistantly searching for but in all the wrong places. I think our Medical Exercise Specialist workshop and certification is the best on the planet. The MES workshop is thorough and gives you all the tools and knowledge you need to succeed. But just having the MES won't give you instant credibility. Credibility is built from the ground up by working with a large number of medically-based clients with wide range of conditions over a long period. During that period you demonstrate the ability to manage and progress these clients effectively and you communicate this information to medical professionals and insurance carriers in a clear and concise manner. Again, this is over a long period.

I built credibility as a physical therapist not because I had a PT degree or a license. It was built over a long period treating a wide range of patients and working closely with their physicians and other medical professionals. If you think credibility comes in a certification, weekend workshop, an exercise technique or website, you are sorely mistaken. If you can look back at a large number of your clients and unequivocally say you have managed them well and 80% reached their goals.....YOU HAVE CREDIBILITY!!! The MES certification will give you more knowledge and skills to reach more medical professionals and clients. The MES certification can not make your credible if you have no foundation.

Please let us hear your comments on building credibility by recording your thoughts at 214-615-6505 x9985. We appreciate hearing from you. Click the link below to listen to my comments on building credibility.

Dr Mike

Do you have the "8 Habits of Highly Effective Post Rehab Professionals"?

2008-07-21T12:51:00.001-07:00

As I travel North America teaching our Medical Exercise Specialist and Advanced Essentials of Post Rehab Fitness workshops, I have noticed the highly successful Post Rehab Professionals (PRP’s) demonstrate eight habits that guarantee their success. We will discuss each of these 8 habits and explain the impact each has on a post rehab practice. Successful PRP’s are able to develop safe and effective post rehab programs for a wide range of medical conditions, establish long-term referral relationships with medical professionals, and receive insurance reimbursement for post rehab services. If you embrace these habits, I guarantee you too will grow a profitable and successful post rehab practice. The 8 Habits of highly successful post rehab professionals include:

Define
Present
Report
Follow-Up
Assess
Progress
Motivate
Educate

PRPs define their scope of practice and role in a clear and concise statement in their brochures, marketing materials and presentations. Defining your scope of practice and clearly outlining your menu of services allows you to position yourself as the expert in the rehab spectrum, rather than relying on someone else who lacks a true understanding of your background and education. This could result in an inaccurate definition that will negatively impact the destiny of your practice. Providing a definition of post rehab fitness will further reinforce your scope of practice and prevent any misunderstanding or misconceptions regarding your role as a PRP.

To read more about the 8 Habits, please click the image below to download the podcast and full version of this posting.

Post Rehab Tip #6 - Utilization of Heart Rate Monitors

2008-07-21T12:04:00.000-07:00

Use heart rate monitors with ALL clients. Even clients with musculoskeletal disorders should use heart rate monitors. Many clients do not exercise at the appropriate intensity levels. Working in the target zones ensures the improvement of cardiovascular efficiency and the avoidance of extremely high exercise intensity. Though heart rate monitors may not work for clients on certain medications, primarily beta-blockers, the majority of clients will benefit from their utilization. Listen to this post rehab tip by clicking on the link below.

Dr Mike

Member Spotlight - Debbie Pickersgill, MS

2008-07-14T16:38:00.000-07:00

Our post rehab member in the spotlight is Debbie Pickersgill, MS of Queensland, Australia. Debbie is the manager of a unique program at the University of Queensland titled "AgeFit". Debbie attended our Medical Exercise Specialist workshop and certification in Fort Lauderdale in March 2008. AgeFit is a unique supervised exercise program designed to meet the needs of seniors with medical disorders. The program serves more than 100 senior participants with neurological, cardiovascular and musculoskeletal disorders. Please take a few moments to learn about AgeFit and to meet Debbie. Click the title "Member Spotlight" to access our website to listen to the interview.

Post Rehab Tip #5 - Wolfe's Law

2008-07-07T11:47:00.000-07:00

Wolfe’s Law is the very basis of post rehab and strength training. Wolfe postulated that if we stress connective tissue it will become stronger. Strengthen training actually makes bone, muscle, tendons, ligaments, muscle and even cartilage stronger. Even connective tissue has limits. This limit is known as the "physiologic threshold". The physiologic limit or threshold is the amount of force the tissue may absorb before damage occurs. Tissue damage occurs when the force exceeds the limit. Sprains, strains and ruptures are examples of exceeding the physiologic limit or threshold. Wolfe's Law is fundamental in understanding the injury process and post rehab program progression guidelines. Click the link below to listen to this post rehab tip.

Dr Mike

Post Rehab Tip #4 - Post Rehab Red Flags

2008-06-16T11:42:00.000-07:00

When we implemented our Medical Exercise Specialist workshop and certification program, we realized it was important the post rehab professional be able to identify the inappropriate client. We established the "Post Rehab Red Flags" to give post rehab professionals hard fast signs they could easily see to identify that inappropriate client. The post rehab red flags are noted below:

a. Numbness/tingling
b. Radiating pain
c. Swelling
d. Nite pain
e. Loss of range of motion
f. Loss of function
g. Chest pain/shortness of breath
h. Open Wounds
i. Abnormal vital signs

Clients demonstrating any red flags should be referred to a medical professional. The client's exercise program may require modification based on your discussion with the medical professional. Recognizing these red flags will help you avoid exacerbating existing conditions or possibly injurying an apparently healthy client. Follow the link below to listen to this post rehab tip.

Dr Mike

Post Rehab Tip #3 - Post Rehab Scope of Practice

2008-06-04T11:38:00.000-07:00

The scope of practice for the post rehab professional includes the following functions:

a. Fitness Assessment
b. Strength Training
c. Cardiovascular Training
d. Flexibility Training
e. Functional Conditioning
f. Aquatic Exercise
g. Spinal Stabilization Training
h. Diabetic/Hypertensive Training
i. Weight Reduction Programming

There should be no attempt to offer your services in lieu of physical therapy, chiropractic or any services provided by a licensed medical practitioner. The terms “therapy” and “therapeutic” should not be used. These terms convey that licensed therapists are providing the services. Remember, clients are easily confused and may misunderstand the terms "therapy" and "therapeutic". Clarify and avoiding such confusion by clearly defining your role and scope of practice in all of your brochures and marketing materials will enhance your image and standing the medical professionals in your community. Follow the link below to listen to this tip.

Dr Mike

Post Rehab Tip #2 - Pain Levels

2008-05-20T11:35:00.000-07:00

Avoid exercise when the client reports pain levels above 5 on a 1-10 scale. Pain levels above 5 indicate possible tissue damage. Follow the link below to listen to this post rehab tip.

How many streams of income do you have coming into your post rehab practice?

2008-05-13T08:00:00.000-07:00

There are 15 primary post rehab income streams for post rehab professionals trying to build a profitable practice. Join us May 14, 2008 for a FREE 90-minute teleseminar titled "Multiple Streams of Post Rehab Income". As our economy slows the importance of the post rehab professional of developing additional streams of income beyond one-on-one training is clear. In this teleseminar Dr Mike will discuss the primary streams of income a post rehab professional may establish to increase the profits in his or her practice. We will discuss these streams:

Medical Referrals
Insurance Billing
Dynamic Back School
Women’s Fitness 101
Balance Assessment/Senior Fitness Classes
Hypertension/Diabetes Training
Ergonomics and Job Site Analysis
Pilates Training
Massage Therapy
Sports Conditioning
Volunteer in Sportsmed/Chiropractic Clinic
Body Fat Assessments
Presentations to Local Support and Civic Groups
Phone and/or Online Fitness Coaching
Development of DVD’s, Fitness Products or Publishing

Click here for more information on this FREE teleseminar.

Multiple Streams of Post Rehab Income

2008-05-12T23:02:00.000-07:00

Can you use your post rehab assessment to sell personal training sessions? Listen as I (Dr Mike) interview David Gilks, MES, MEPD owner of Core Essetials Personal Training and Rehab Studio discuss how he uses his fitness assessment to sell personal training sessions? David will be one of our co-hosts for the "Post Rehab Profits & Protocols" program which starts on May 14th. Our introductory call will identify "Multiple Streams of Post Rehab Income" post rehab professionals may establish to make their practices more profitable. Click on the link below to listen as Dr Mike interviews David on how he uses a comprehensive assessment to sell personal training. David reports a 100% closure rate on sales of personal training packages using this strategy.

Click here to listen to "Using Fitness Assessments to Sell Personal Training"

First Hand Information Gives Clarity

2008-05-12T22:40:00.000-07:00

I had an interesting conversation with a kinesiologist working in a physical therapy clinic about the role of the rhomboids and lower trap in shoulder and mid-thoracic dysfunction. During the conversation she quoted the work of Dr. Shirley Sahrmann, PhD, PT of Washington University in St Louis, MO. Dr Sahrmann's work on identification and treatment of postural and muscular imbalances is standard learning for physical therapists. During the conversation I noted this young lady either misunderstood or left out key components regarding Dr. Sahrmann's guidelines for the management of the mid-thoracic region. When I asked questions to clarify her understanding (not to embarrass or ridicule her, but to make sure she was following the appropriate exercise guidelines for her client) she noted she never attended a seminar or read Dr. Sahrmann's book “Diagnosis and Treatment of Movement Impairment Syndromes”. She obtained her information from a colleague that attended a Sahrmann seminar.

For fitness professionals’ credibility is a key in establishing relationships with medical professionals. Attending workshops taught by medical professionals and reading textbooks for medical professionals will significantly improve your understanding of medical conditions and your ability to develop safe and effective post rehab program for clients. This will go a long way toward your credibility. The point I am trying to make is educate yourself and understand all aspects of a rehab philosophy if you plan on incorporating it into an exercise program. The subtle nuisances are lost when you use second-hand information rather than authentic information from the author. Important points are lost when the concept travels by word of mouth. I recommend reading articles and/or texts from these authors as well as attending workshops that focus on the concepts they developed.

• Vladmir Janda, MD (start with Janda's compendium which you may purchase at www.optp.com)
• Shirley Sahrmann, PT, PhD (we mentioned Sahrmann's book earlier)
• Robin McKenzie, RPT (McKenzie's technique for managing discogenic back pain produced lumbar extension as a means of treating radiating pain.)
• Greg Johnson, RPT (founder Institute for Physical Art - the institute offers a great course titled “Functional Orthopedics”. I don't think non-therapists are eligible to take the course but it is a fantastic workshop.)
• Frank Noyes, MD & Bob Mangine, RPT (Cincinnati Sports Medicine Center - their spring sports med symposium at Hilton Head, SC is the best and most comprehensive out there.)
• Philip Greenman, DO (Dean of the Michigan State University College of Osteopathic Medicine - his textbook “Principles of Manual Medicine” is a must read for massage therapists, physical therapists and chiropractors.)
• James Andrews, MD & Kevin Wilk, RPT (Alabama Institute of Sports Medicine – Andrews and Wilk have developed rehabilitation guidelines for a wide range of orthopedic surgical procedures.)
• Stuart McGill, PhD (Waterloo University - his research in spinal function is fantastic. Dr McGill's book is titled "Low Back Disorders".)
• James Cyriax, MD (the father of orthopedic medicine. His book the “Textbook of Orthopedic Medicine” is a classic text for physical therapists and chiropractors)

Post Rehab Tip #1

2008-05-11T22:47:00.000-07:00

When developing the post rehab program for the spondylolethesis client avoid excessive lumbar extension (beyond neutral) and strengthening of back extensors with movement beyond spinal neutral or past zero degrees. Emphasize strengthening of the abdominals and maintaining slight trunk flexion. Any extensor strengthening must be done while positioned in slight trunk flexion and should not allow the client movement past neutral spine into excessive extension. Follow the link below to listen to Dr Mike's discussion of this post rehab tip. Visit us again in 3-4 days for another post rehab tip.

Click here to listen to Post Rehab Tip #1

How to Utilize Post Rehab Professionals?

2008-05-06T21:12:00.001-07:00

How should the medical community utilize the post rehab professional and post rehab programs?

First and foremost, the post rehab professional (PRP) is not trained to nor has the ability to replace the physical therapist, chiropractor or any other medical professional. The PRP should limit his or her practice to the development of functional conditioning programs for clients after their discharge from physical therapy and/or chiropractic care. The post rehab program should be developed based on feedback from the client's physician and physical therapist. This maximizes the possibility of a positive functional outcome.

With the aging of North America, or the "silver tsunami", the number of babyboomers being discharged from rehab in the next 10 years will become staggering. Research studies estimate more than 800,000 total knee and hip replacements were performed in 2004. That number is expected to increase 22% by 2010 for total hip replacements and 63% by 2010 for total knee replacements. Babyboomers between ages 50 and 75 will need the bulk of these total joint replacements. Each patient will need a regimen of physical therapy but the bigger issue is the maintenance of the functional gains made in rehab and the use of exercise to manage the residual functional deficits that remain after rehab. These deficits include lack of strength and endurance; balance dysfunction, joint instability, minimal muscle fiber recruitment, limited proprioception and power and restricted flexibility. Each of these deficits is treated by the physical therapist or chiropractor using various treatment modalities but at some point, due to insurance restrictions or the patient's plateau of progress, the patient must be discharged. This is the point where the licensed rehabilitation professional should refer the client to a certified post rehab professional or program (the term aftercare fitness is also used).

Physical therapists, occupational therapists and chiropractors over the next decade will be overwhelmed by a steady stream of boomers seeking treatment for a wide range of musculoskeletal, cardiovascular, neurological and metabolic disorders. The smart therapist or chiropractor will establish a network of trained and certified medical exercise specialists and post rehab conditioning specialists to refer his or her patients to at the time of their discharge. The MES' and PRCS' should be well trained in post rehab program design as well as being adept at identifying post rehab "red flags" that indicate the need to refer the client back to the physical therapist, physician or chiropractor. As you can see, the post rehab professional can augment the physical therapist's treatment plan and ensure the highest possible functional outcome for the client.

There are a few important basics that make the "post rehab model" work. They are 1) the client when discharged and referred to the PRP must be "medically stable". Medically stable means no radiating pain or significant swelling; no night pain or significant functional loss; normal vital signs, no open wounds and the client must have fair+ strength in the effected region. It is the medical professionals responsibility to ensure the client is medically stable before referring the client to a post rehab program. If the client demonstrates these "red flags" the possibility of a positive outcome is significantly decreased. The "red flag" client needs further medical treatment and is not a good candidate for referral to post rehab. The medical professional should not refer this client until the client is medically stable. 2) The post rehab professional must understand his or her role is to develop the post rehab exercise program and progress the client through the exercise sessions. The PRP must assess the client's progress at 30-day intervals and report that progress to the referring medical professional. Not reporting the client's progress to the referral source impairs the overall medical management of the client's condition. This is also unprofessional and should warrant the elimination of any future referrals to the PRP. 3) The client must be compliant with the program and attend as well as participate in the post rehab exercise sessions. 4) the PRP must have skills and knowledge to design of post rehab programs for a wide range of medical conditions. The PRP should hold a certification to design programs for post rehab clients. 5) All the members of the rehab spectrum; physician, physical therapist, occupational therapist, nurse, chiropractor and post rehab professional; must understand the post rehab program is not part of the treatment process but it is a means of improving on or maintaining the functional gains made during rehabilitation program provided by the licensed medical professional. The treatment is performed by the medical professionals, once the client is stable, the PRP steps in and provides safe and effective functional conditioning programs. If the PRP fully understands and accepts his or her role, the utilization of PRP's will become an essential part of the rehab spectrum as well as positively affecting the functional outcome of rehab programs. I predict, over the next decade, the PRP will become a more integral part and accepted member of the rehab network.

What do you have in your post rehab library?

2008-05-01T17:41:00.000-07:00

Do you have the essential post rehab resources and references in your library? There are a few essentials texts every post rehab professional must have in his or her library. There are so many fitness and rehab textbooks available but I will narrow the list to six essential textbooks and a couple of periodicals. Take a look at the list of PR library essentials and/or click on the link below to listen to my descriptions of these resources and the reasons I consider them the Post Rehab Library Essentials.

1. Gray's Anatomy - this is the gold standard in anatomy. This text is used to train physical therapy, chiropractic, nursing, medical and other allied health professional students around the world. I know many of you have other anatomy books but as I stated earlier, Gray's is the gold standard. Having a copy of Gray's in your library is a good purchase.

2. Merck Manual - the Merck Manual lists and reviews every medical condition known to mankind. Each condition is reviewed in detail with discussion covering etiology, signs and symptoms as well as treatment guidelines. This is a must when dealing with complicated post rehab clients.

3. Examination of the Spine and Extremities - this is another classic that every post rehab professional should have. This text is used in the orthopedic training of physical therapy, occupational therapy, chiropractic and medical students. This is an easy to use text with great illustrations and diagrams. If you don't understand all the tests the physician or therapist performs on your client, get a copy of Hoppenfeld so you can understand. This text is a must for massage therapists, Pilates instructors, aquatic therapists as well as fitness professionals.

4. Physician's Desk Reference (PDR) - Though sometimes difficult to understand, the PDR lists all the medications known to man and their indications for usage. The biochemical action of the medication is outlined in the PDR but more importantly; the PDR lists side effects of these medications. The effect of these medications on exercise is your chief concern as a post rehab professional. This text should be updated no less than every two years.

5. PostRehabWorks - this is an interactive post rehab reference/resource with the 60 most common medical conditions encountered in a fitness setting reviewed. We provide post rehab exercise protocols, exercise flowcharts, post rehab assessment guidelines and more than 220 video clips of exercises, muscle and range of motion testing procedures as well as post rehab administrative forms. This is the most comprehensive post rehab resource available. If you are digging through physical therapy or chiropracitc textbooks trying to figure out what to do with your post rehab client, try PostRehabWorks. It takes the guesswork out of post rehab program design.

6. Post Rehab Exercise Protocols (PREPS) - PREPS is a simple use manual containing 62 post rehab exercise protocols for the most common medical conditions found in a fitness setting. These protocols are based on clinical observation with 1989 patients in a physical therapy/sportsmedicine clinical setting over a three-year period. These protocols are used by Medical Exercise Specialists, Post Rehab Conditioning Specialists, physical therapy and chiropractic clinics and fitness facilities around the world. These protocols provide step-by-step post rehab guidelines.

7. Journals/Periodicals - I highly recommend the "Journal of Orthopedic and Sports Physical Therapy" (JOSPT) for post rehab professionals and sports conditioning specialists. This journal is geared toward physical therapist but you will find some of the articles useful in post rehab program design. The other journal I would recommend for those "hard core" fitness professionals with an interest in human performance research, the European Journal of Applied Physiology (EJAP). I have found research topics in this journal I could not find everywhere else. Such topics as advanced muscle physiology and muscle function are regularly reviewed inn EJAP.

Click on the link below to download the MP3 file and listen to my discussion of each of these resources and my reasoning as to why they are on our "Post Rehab Library Essentials" list. Go to www.postrehablibrary.com for information on where to buy these resources.

Post Rehab Library Essentials MP3

Earth Day and Post Rehab Fitness

2008-04-21T07:29:00.000-07:00

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!!

2008-04-21T01:34:00.000-07:00

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?

2008-04-20T09:18:00.000-07:00

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

2008-04-11T00:11:00.000-07:00

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

2008-04-05T01:01:00.000-07:00

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.

Can Using the Real Age Calculator Help You Attract Clients?

2008-03-30T07:05:00.000-07:00

I am a great fan of the work done by Michael Rozien, MD and Mehmet Oz, MD in developing the "Real Age" concept. You may have seen these gentleman on Oprah. I feel every post rehab professional should incorporate the real age concept into the exercise/wellness program for your clients. The "Real Age" calculation of physical age versus chronological age is as great concept that can be easily incorporated into your facility's and your practice's marketing plan. Everyone wants to look and feel young. Real age makes the sale of fitness services very easy. Check out the Real Age calculator at www.RealAge.com. Ask you clients to take this test during their first session and then layout of plan for them to get "younger". I think you might be surprised how much "youth" and not fitness is the real key to selling fitness.

Presidential Candidates Might Make "Wellness" a National Concept

2008-03-18T01:14:00.000-07:00

For the first time in US history we candidates vying for the two major party nominations that have made health care prevention a part of their health care platform. With all eyes on the presidential race the use of "prevention" will hopefully galvanize more American companies and citizens to move away from the traditional health care paradigm and begin to embrace exercise and wellness as their insurance policy for their senior years. Can you imagine the day when apples replace snickers in vending machines? Please respond and share the latest wellness initiatives you have noticed in your community, facility or practice.

Attracting Post Rehab Clients Using Presentations

2008-03-13T00:48:00.000-07:00

Successful post rehab professionals (PRP's) report the most effective means of attracting clients and referrals is by far due to speaking to community groups. Making a presentation to the local business leaders group or introducing your services to a local physical therapy or chiropractic office is one of best marketing efforts you can employ. Local community groups are always looking for speakers for their meetings. A brief but engaging fitness presentation is a perfect opportunity to cultivate new referrals. A presentation setting out the "7 Reasons Most People Don't Stick to Their Fitness Program" might turn some heads at the monthly breakfast meeting of the local Rotary club. Include a couple simple desk exercises or give everyone a piece of theraband and demonstrate a couple of exercises they can perform in their hotel room will certainly keep the attendees attention. They all won't sign up for a 20 session package tomorrow but enough of these presentations will establish you as the "fitness and post rehab expert" on your community. Presentations to local medical support groups such as the "Parkinson's support group" will further your standing as the post rehab expert. Please share your experiences attracting clients with presentations by responding to this posting.

Tissue Tolerance Levels in Post Rehab Fitness

2008-02-24T00:55:00.000-08:00

When we deal with post rehab clients with pain, we sometimes forget about the physiology of pain. Our perception of pain is cause by a stimulus that triggers the sensation of pain. In most situations, the pain stimulus must be present for some period of time to trigger the pain response. In assessing the client's pain we must determine the "tissue tolerance level" or the level of stimulus that must be present to trigger the pain response. The classic example is the client who complains of pain in the lower extremity after standing for a period of time. If this pain stimulus is consistent during the time period, then this is the tissue tolerance level for client. We may find increasing the strength of the surrounding muscle and the stability of the joint structures may, with time, increase the amount of time the stimulus must be present before the client reports pain. This is a shift in the tissue tolerance level. Now the client is able to function for a longer period before reporting pain. Continued exercise may further enhance the tissue tolerance levels.

The Components of Function

2008-02-16T00:37:00.000-08:00

The need for post rehab professionals is everywhere. The aging of north America and tremendous advances in public health, not individual health, are pushing our health care systems to the limit. Public health enhancements have eliminated chlorea, dysentery, and other epidemics that have resulted in major loss of life. With the increased life-span we now can see the results of our longevity. Arthritis, total joint replacements, stroke, and complications from diabetes now are making exercise a mandatory part of life for babyboomers. They have to exercise to continue to boom. A few years ago I introduced the "exercise is the key to long-term management of most medical conditions" phrase. This is the statement that every PRP should have etched in their mind. This justifies the existence of post rehab fitness. Drugs, physical therapy treatment, chiorpractic manipulations only do so much. We know exercise is the key.

Exercise for our seniors and those recovering from cardiovascular, musculoskeletal, neurological and/or metabolic disorders is essential in their day to day schedules. Its only a short time before the medical community starts to look to our MES', PRCS' and MEPD's as a component in the long-term management solution of those limited mobility and function.

Do we really understand that exercise simply enhances and maintains function. There are several components of function. Exercise enhances each aspect of function. Post rehab clients are referred to improve the residual functional deficits left after their physical therapy, chiropractic care or medical treatment. The components of function include:
Exercise can enhance each component of function. Develop exercise programs for your clients with functional enhancement in mind. Based on improvement in any one or a combination of these components of function.

6 Essential Skills Every Post Rehab Professional Must Master

2008-01-27T14:02:00.000-08:00

I am often asked by post rehab professionals (PRP) what should they know to get started in post rehab fitness. In most cases they are referring to marketing techniques and materials. Yes, marketing is important but of greater importance is the need to possess the essential skills to work with a wide range of post rehab clients. There are 6 essential skills each post rehab professional must possess. Every post rehab professional must be competent with each of the skills to develop safe and effective programs for their post rehab clients. The six essential post rehab skills are listed below.

1. Take a thorough medical history. A thorough history is vitally important. Go thru each question on the medical history form. Obtaining an accurate medical history and understanding the key facts obtained from the interview will assist with the development of the post rehab program.

2. Take blood pressure using a sphygmomanometer (manual cuff). Take the client’s BP using a manual cuff the first three sessions. The use of the manual cuff allows you to accurately measure the blood pressure. You may use an electronic BP cuff after the first three sessions. Every PRP must be able to assess blood pressure manual. This is an ABSOLUTE must for every PRP.

3. Assess the strength and ROM for each joint and the surrounding muscles. It’s not necessary to have skills with a goniometry but minimally the PRP must have the ability to visually judge joint limitations by asking the client to move the uninjured and injured joint thru a ROM and compare the two is essential. In addition, you must be able to assess strength levels in the major muscles surrounding the join.

4. Assess function using a functional scale. Post rehab is really about improving the “residual functional deficits” remaining after the client’s discharge from physical therapy and/or chiropractic care. Assessing function is more important than assessing joint ROM and strength. Measuring the improvement in function and not just gains in strength or ROM is the key in post rehab. The PRP must select the appropriate functional scale to best measure their client’s functional improvement.

5. Determine the appropriate post rehab protocol to follow when developing the exercise program. Selecting the appropriate protocol whether the client has one or multiple conditions is important. Understanding the post rehab hierarchy and the ability to combine protocols is essential with the complicated post rehab client.

6. Communicate effectively with medical professionals. The PRP must be able to effectively communicate with medical professionals via phone, through written reports and assessment summaries. To truly become part of the rehab spectrum the PRP must convey the improvement or regression of the client to the referral source. Communicating with insurance carriers is also becoming a necessary skill for post rehab professionals.

We have established the first “Post Rehab Skills Checklist”. This checklist will allow PRP’s to measure their skill level and determine the areas in which more training is needed. Please go to www.postrehabskills.com to download your copy of the Post Rehab Skills Checklist.

Listen to our latest podcast posting by following the link below.

6 Essentials Skills Podcast

Best in Fitness,

Dr Mike

5 Mistakes Post Rehab Professionals Make When Building a Post Rehab Practice

2008-01-02T13:40:00.001-08:00

Its time for a new look and new goals. What better goal then to build a profitable post rehab practice. If your post rehab practice isn't profitable, this blog entry will help you identify the common mistakes post rehab professionals make when attempting to develop a profitable post rehab practice. There is a huge need for post rehab services. Every post rehab professional should be able to develop a profitable practice. Look for these mistakes you I guarantee you will have better success in 2008.

1) Allowing the health club to be the sole provider of post rehab referrals. If you work in a health club setting the worst thing you can do is allow the health club to be your sole source of post rehab referrals. You must establish your own referral sources and communicate directly with these sources. Medical professionals want to know everyone working with their patients.

2) Not developing your own marketing materials. You must have three basic marketing materials – a business card, letterhead and a brochure. Clients want to review information later when they are making the decision whether to utilize your services. With nothing to review, it’s pretty easy to see why the client might pick another trainer or facility. Without a business card, letterhead or brochure, DO NOT attempt to contact a medical professional. Would you do seek treatment from a physician or therapist without a business card? Yes, thas right….you would think something is terribly wrong. Need I say more on this topic? Your local Kinkos has graphic artists and printing services to help you develop your marketing materials.

3) Not sending an introductory letter to the client's physician. Send a brief introductory letter to every new client’s physician. Your client will provide the physician’s name in the paperwork they complete when they join the fitness facility. Send a brief note stating the client has started an exercise program. Mention the goals of the program and give a quick description of the program. This letter will lay the foundation for future communications and eventually referrals.

4) Not sending progress reports to the referral source. If you receive a referral from a medical professional have the courtesy to send a brief (one-page) progress report to the referral source when the client’s returns for a follow-up visit. Not sending the progress report is a sign of lack of professionalism. I guarantee you will lose the referral source simply because you did not send a one-page progress report.

5) Thinking or feeling I am only a personal trainer. If you have ever felt like this, you are terribly wrong! Exercise is the key to long-term management of most medical conditions. I made that quote during a lecture at one of our Medical Exercise Specialist workshops and it is so TRUE. As a post rehab professional, you may play a major role in the outcome of your client’s rehabilitation. You are not just a trainer – you make a huge contribution. Never feel this way when contacting the client’s physician, physical therapist or chiropractor.

Many of the post rehab professionals I have met around the world have made these mistakes. Any of these five mistakes can kill your post rehab practice. These mistakes are easily corrected but you must recognize them first. Listen to my podcast at www.PostRehabToday.com on the remedies to the five common post rehab practice-building mistakes.

Attend our teleseminar - "Establishing a Profitable Post Rehab Program" on January 4th, 2008 at 5pm Eastern. Learn the 5 keys to making your post rehab practice more profitable. Click on the link below for more information on this teleseminar. Best wishes for a profitable 2008!!

"5 Keys to Establishing a Profitable Post Rehab Practice"