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

How do I write a post rehab progress report?

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?

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

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!!

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

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

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