Please click the link below to listen to our podcast titled "The Post Rehab Scope of Practice".
Dr Mike
Showing posts with label corrective exercise. Show all posts
Showing posts with label corrective exercise. Show all posts
Tuesday, September 16, 2008
Do you know the post rehab scope of practice?
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
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?
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
Dr Mike
Thursday, September 4, 2008
Quadriceps Review
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
Dr Mike
Thursday, August 28, 2008
Post Rehab Tip #14 - When do I use McKenzie or back extension exercises?
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
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
Tuesday, August 26, 2008
I referred my client to a physician but he never came back. How do I get my client back?
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
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
Wednesday, August 20, 2008
Post Rehab Tips #12 - Levels of Assistance
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
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
Tuesday, August 19, 2008
3 Keys to Managing the Post Rehab Rotator Cuff Client
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
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
Sunday, August 17, 2008
3 Keys to Managing Post Rehab MCL Sprain
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?
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?
Sunday, August 10, 2008
3 Keys to Managing the Post Rehab Shoulder Dislocation
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?
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
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
Dr Mike
Saturday, August 9, 2008
3 Keys to Managing the Post Rehab Ankle Sprain
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.
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
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
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
Post rehab conditioning is the story behind every Olympic star!!
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
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
Friday, August 8, 2008
3 Keys to Managing the Post Rehab Impingement Client
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
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
Medical exercise specialists - can you recognize PFS?
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
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
Wednesday, August 6, 2008
Medical Exercise Specialist and Post Rehab Conditioning Specialist - Think Critical Job Demands When Establishing Sets and Reps
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
Dr Mike
Tuesday, August 5, 2008
Post Rehab Tip #8 - The Use of the Thomas Test
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
Dr Mike
Monday, August 4, 2008
Post Rehab Challenge
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
Dr Mike
Selling Post Rehab Fitness Using the Assessment
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
Dr Mike
Sunday, August 3, 2008
My Post Rehab Story - Here's how the Medical Exercise Specialist certification started!
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.
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