Back with another post-rehab post for you.

After the feedback from the post-rehab article that Dean Somerset wrote,  I asked Dean if he has some great tips when it comes to post-rehab and hip imbalances.

This is what he had to say on the topic.

Take it away, Dean.

Hip Imbalances

We always hear about how important good hip strength and mobility is in relation to knee, low back, and even shoulder health and performance.

It’s pretty much the greatest thing since sliced bread, however if you’ve had a chance to read “Wheat Belly,” you’ll probably think any relation to bread should be avoided at all costs.

Be that as it may, hip imbalances can cause issues with squats, lunges, pushups, step-ups, running, walking, posture, and pretty much everything you can do in a gym or in a recreational setting, so figuring out how to get the most bang for your buck when it comes to the hips is pretty important, and should go far beyond the basic tests such as the Thomas test for hip flexor length, passive internal and external rotation for range of motion, and a 2-foot squat pattern analysis to see how everything plays nice together.

Considerations for Hip Testing

There’s a lot of “stuff” that crosses the hip, so picking tests to use to determine specific muscle length-tension relationships is kind of tricky.

A wide-open test on someone with a normal body composition and healthy tissues & joints is going to look completely different on someone carrying an extra 50 pounds and showing early signs of arthritis, likewise with movement tests comparing someone who is fairly fit and strong to someone who is pretty weak and de-conditioned. The same tests won’t work on different people all that well.

A Test for the Hip

Let’s look at the hip flexor test known as the Thomas test.

Here’s a quick little video showing an example of one done correctly.

Things to Think About When Performing the Thomas Test

Having the leg extend over the bench while the other one is pulled to the chest can be a good indicator of how tight the iliopsoas is by how low the leg hangs and how high to the chest your can pull the opposite leg.

However, let’s assume for a second that someone has a really tight posterior hip complex, and when they pull their knee to their chest they go through a posterior pelvic tilt.

Would that affect their Thomas test?

Absolutely!

Maybe they’re also restricted through their SI joint, they have a tight IT band, excessive kyphosis, tight rectus abdominus, flux capacitors out of whack, whatever. As a result, a test for a tight hip flexor can get muddied in a whack of other issues.

Meanwhile, buddy squats like the Tin Man.

When you do an assessment, a better thought process than trying to find isolated muscles that need to be worked on is to find specific sites of the body that need to be worked on.

If you want a diagnosis, send the person to a physio or a doctor, and then follow their instructions.

If you want to fix someone, watch how they move, find out areas that are deficient, and train the deficiencies.

For instance, I had a consult yesterday with a guy looking to get in shape for skiing.

An Example of Hip Assessment and Post Rehab

He’s had some injuries (inguinal hernia, bad wipeout on his motor bike, a few concussions), but wasn’t feeling in pain or having any kinds of problems. When I got him moving, he had some significant weakness during single leg squats to a knee angle of 90 degrees on his left compared to right.

During a single leg back extension, his left side created movement by hinging at the low back versus the hip, whereas his right one was through the hip.

In a single leg stance hip rotation, he wobbled and fell while standing on his left leg, but was rock solid on his right. As a result, I started training the hell out of his glutes with a lot of single leg exercises, really specific technical feedback to get him fired up properly, and made him walk like John Wayne by the end of the session.

From a training perspective, I could care less about whether his glute medius is restricted or not, but I want to make sure his movement patterns are absolutely perfect.

This is what Post-Rehab training is all about: finding the deficiencies and making them better.

In Post-Rehab Essentials, I go through assessments like the ones mentioned, as well as what they mean and how to use multiple tests to come to an informed conclusion about what needs to be worked on, as well as specific programs for common injuries seen in gym settings and private studios.

This makes you more of an efficient problem solver with respect to injuries than a diagnostician, and it puts the emphasis back on training versus simply regurgitating the pink dumbbell tubing exercises everyone else uses.

As an added bonus, it makes you look crazy smart when you can show immediate improvements in someone’s performance within a 20 minute period by finding what they’re weak in, training it, and then re-testing it like a boss.

Dean Somerset

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Thanks again, Dean.  Great information.  Thank you for sharing.

To check out Dean’s Post Rehab-Essentials course, click here.

I am still working through it but I have pick up a lot of great info, thanks Dean.

Rick Kaselj, MS

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I got a great Q and A for you today.  It is on the very important topic of Post-Rehab.

As you know, I am an injury guy.

A huge trend that I am seeing is more and more people going into the gym, recreation centre, studios, home training and bootcamps with previous injuries.

If you don’t believe me that injuries are a big deal, have a look at this:

Siewe J, Rudat J, Röllinghoff M, Schlegel UJ, Eysel P, Michael JW. (2011). Injuries and overuse syndromes in powerlifting. Int J Sports Med. 2011 Sep;32(9):703-11. Epub 2011 May 17.

 

• 43.3% of powerlifters complain of problems during their routine workouts
• Injury rates were calculated at 0.3 injuries per lifter per year – or 1000 hours of training equalled 1 injury
• Most common areas injured were the shoulder, lower back and knee (No surprise)
• READ THIS ==> Use of weight belts increased the injury rate of the lumbar spine (WoW!)
• Upper body injuries increase with age and gender (female)

Okay, I am not a powerlifter. You may not be a powerlifter either.

These people lift heavy stuff and train hard which can lead to injuries, but in order for them to lift for a long period of time they have to have good technique.

Let’s look at regular people and the issues they have.

Kolber MJ, Beekhuizen KS, Cheng MS, Hellman MA. (2010). Shoulder injuries attributed to resistance training: a brief review. J Strength Cond Res. 2010 Jun;24(6):1696-704.

 

• 45 million Americans who engage in strength training regularly (that is a lot of people.)
• For those that do resistance training, the shoulder complex is the most common area of injuries (interesting)
• Reviewing the research, the researchers found that intrinsic risk factors such as joint and muscle imbalances and extrinsic risk factors like improper exercise technique lead to the majority of injuries in the shoulder (good old muscle imbalances.)

Interesting, interesting, interesting.

To sum it up, there is a good chance we will train someone with an injury and we need to know what to do about it.

In order to get a little more info on post rehab, I reached out to my friend, Dean Somerset to chat a little more about post rehab and what health & fitness professionals need to know about it.

Rick – Let people know a little about you.

Dean – I’m a kinesiologist in Edmonton, Alberta, and I’ve built a practice around the gap that exists between rehabilitation in the classic sense and gym-based workouts.

Most patients will be discharged from physiotherapy or chiropractic and still have needs to build strength, mobility and flexibility through a lot of their movements, and will need someone to walk them through the process.

Over the past decade I’ve formed relationships with over 100 allied health professionals in my city who refer me their patients to continue their rehab, and who I refer clients out to if I feel there is something deeper than just a tight muscle or a weak muscle. I run a large component of my companies (World Health) continuing education program, including the Post-Rehabilitation workshop.

This is the first exposure a lot of trainers have with any concepts involving injury, what to do with them and what not to do with them to get them stronger and not risk re-injury.

Post-Rehab and the Trainer

By teaching other trainers how to increase the results they can get with a broader base of clients, as well as how to prevent and help recover from various injuries, their perceived value goes up in the eyes of their clients and their potential clients, and also lends a degree of reputation to our organization by having a standardized course all trainers have to take to work with any medical referrals we receive.

Dean’s Story of Post-Rehab

My main interest in Post-rehab came from my own injuries after playing competitive athletics for the majority of my early years. I wasn’t very good. I managed to get injured a lot, so I spent a lot of hours in physio clinics, chiropractic clinics, and doctors offices. A lot of the time my questions of “what should I do now?” fell on deaf ears. I wanted to know if there was anything I should do more of or less of on my own to help the process out, but found getting any specific guidance was difficult. Because of that, I had to do a lot of research, trial and error, and find out on my own what worked of different injuries and problems, then I refined that by working with over 1000 different post-rehab clients over the course of my career.

Here is a clip from Dean’s presentation from MIRU:

Rick – What is “Post-Rehab”?

 

Dean – Post-Rehab is the gap that exists from the time a patient is discharged from their treatments until the time they could be considered to have a complete recovery from their injuries.

Many clinicians will discharge when the person is:

• able to return to work
• when their insurance runs out
• when their insurance company deems they are ready

They are not necessarily discharged when the person is physically capable of preventing their injury from coming back. As a result there are a lot of people with recurrent injuries that weren’t addressed properly in the first incidence, and have to go through further rehab.

A Post-Rehab Example

To give you an idea, I recently started working with a client discharged from physio following a motor vehicle accident in 2010 that resulted in a broken ankle and a rotator cuff tear.

He was still walking with a noticeable limp, acute tenderness through the foot, and reduced range of motion in his shoulder. He wanted to get back to playing recreational hockey and be able to rough house with his kids without feeling like the tin man, but the way he was presenting if he would have strapped on the skates he wouldn’t have made it to the second period without some serious problems, and the first flying body slam would have sent him to the ER.

He needed a lot more strength, balance and range of motion through his ankle before we could put him on the ice, so we trained to get him ready for it.

After 2 months of training, he now skates three days a week, no problem and hasn’t had any issues in his shoulders since prior to starting.

Post-Rehab is also about helping those with long-standing injuries who don’t necessarily fit nicely into the mix of the “average” population. Considering the fact that nearly half of people over 60 show evidence of rotator cuff tears on MRIs, you could say that if you train anyone over the age of 50, you would need to be proficient in managing shoulder injuries.

Likewise with spinal issues, knee problems, and other musculoskeletal conditions. As I said earlier, I had a lot of my own injuries, and training for the first little while was a crap shoot of wondering if this set of deadlifts will make my spine buckle or if there was another way to get strong without the risk, and sifting through the confusion of where physio should end and where training should begin. This series helps reduce the confusion and get trainers off on the right foot to help people when they can, and understand when they need some additional assistance.

Here is a clip from Dean’s Post Rehab Essentials course:

Rick – Why is it important for a fitness professional to know about post-rehab?

 

Dean – Post-Rehab training services are going to be the next wave for fitness professionals to capitalize on as the population continues to age.

Trainers who know how to work with post-rehab clients will be able to work with a broader array of clients, and through a larger portion of the wellness continuum.

To put it another way, if your clients get injured and you can’t work with them, you’re out of business. This will help keep you in business and keep your clients in the game.

 

This has nothing to do with post-rehab or injuries but it is a very funny video:

Rick – From talking and teaching fitness professionals, what common mistakes or misconceptions do they have about post-rehab?

Dean – Aside from thinking they’re fragile little birds who can only do tubing exercises and walk on the treadmill, some of the biggies would be the biomechanical components that go into an injury development pattern.

If a client says their shoulders are sore, performing sets of side raises and military press will probably make it worse sooner than Kim Kardashian can file for divorce.

Along the same vein, trying to give an exercise to everyone because it’s good for a shoulder or a hip, even if the person doesn’t need to develop that specific area in that specific way.

We go through assessments in the videos and learn how to tailor a workout around what those assessments show, be it tightness in the ankle, weak balance in one hip versus the other, limited internal rotation in the shoulder, or a flexion bias through the spine.

Exercise is like medicine: the right medicine for the right reason produces the best benefits, whereas the wrong medicine can produce either no benefits or massive repercussions.

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Thanks so much, Dean.

Dean has come a long way since I met him at a conference in Edmonton a few years back.

It is great that he is sharing more of what he does with fitness professionals around the world.

Dean has recorded his course that he teaches for trainers in his company on Post-Rehab.  It is awesome.  I am still going through it but I am picking up some great tips.

If you are a fitness professional and would like to better know what to do with a client that has an injury, I would highly recommend Dean’s Post-Rehab Essentials course.

==>  CLICK HERE to get More Information on Dean’s Post Rehab Essentials Course  <==

That is it.  Thanks for reading the post on post-rehab.

Rick Kaselj, MS

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With this blog thing, I get a lot of email.

It is great.

I hear from fitness professionals from around the world.

I just got this one on referral sources for post injury personal training clients.

Thought I would pop you a message.

I would love to pick your brain on the topic of referrals from chiropractors and physical therapists to myself and my employees.

We are working together to put together a more clearly defined avenue for clients to transition from acute care at the chiropractor or physical therapist to a more aggressive strength and conditioning program.

Right now the medical network I am with is looking to have the hand-off be a little smoother.

Right now they are just handing cards/pamphlets out and are finding it frustrating that they end up seeing the client again because they didn’t do anything to correct the initial reason for the visit.

Do you have anything standardized in place, or is it just a time thing and people know who you are now and its automatic?

I look forward to chatting with you more on this topic.

Thanks for your time Rick.

RJ

This is more of a business kind of question but let me help you out.

Have You Trained the Doctors, Physical Therapists and Chiropractor?

Read the rest of this entry »

A common injury with the shoulder is shoulder impingement.  Rotator cuff exercises are important on helping your client recover from shoulder impingement.

What is Shoulder Impingement?

When the non-injured arm is at your side, there is about 6 to 14 mm of space in the subacromial space (the space between acromion and humerus).  As one moves their arm out to the side (abduction), the space in the subacromial space decreases.  With some people the humerus and acromion end up pinching the structures in the subacromial space.  The structures that could be pinching are the bursa, supraspinatus tendon or long head of the biceps tendon.  This pinching is called shoulder impingement.  Shoulder impingement is a big problem and commonly seen in my clients.  If shoulder impingement is not addressed it could lead to a partial or full tear of the rotator cuff.

3 Ways the Rotator Cuff Could be Causing Your Clients Shoulder Impingement

Read the rest of this entry »

 

Today I got an interview that will help you build your post rehab exercise business with social media.

There has been all kinds of hype when it comes to social media.  I can tell you, I have been using it to help my exercise rehabilitation business.  I started about 2 to 3 years ago with a blog.  Over the last 6 months, I have finaly figured it out and how it can help me get more clients.  I will be covering how I use social media in the 17 Ways to Get More Exercise Rehabilitation Clients Using Social Media webinar.

I interview Jimmy Smith who is a personal trainer in Stamford, Connecticut.  He has used social media to help his personal training business.  Jimmy is going to share a number of tips on how you can use social media to help with your exercise rehabilitation business.

What is Covered in the Social Media for the Post Rehab Exercise Business Interview with Jimmy Smith:

 

- What should fitness professionals do when starting out with social media
- The three ways social media has helped his training business
- How should fitness professionals use social media
- Resources that fitness professionals should use to help them with social media
- What three social media site fitness professionals should be using
- How often to do social media
- What are the best social media services
- Social Media and Privacy

 

==> CLICK HERE to learn improving your post rehab exercise business

Thank you so much Jimmy for the great interview.  To get more information on Jimmy Smith make sure you visit http://jimmysmithtraining.com/

Rick Kaselj on Social Media – Make sure you follow me on social media:

 

- I have been using a blog to let fitness professionals know about exercises and injuries – http://www.ExercisesForInjuries.com

- If you are looking for exercises and injuries articles and resources you can follow me on Twitter and get them – http://twitter.com/Rick_Kaselj

- If you want to see what I am doing, you can visit me on Facebook – http://www.facebook.com/Rick.Kaselj

- To see various exercises that help all kinds of injuries, you can watch my YouTube Channel – http://www.youtube.com/ExercisesForInjuries

- For more of my professional side, you can follow me on LinkedIn – http://www.linkedin.com/pub/rick-kaselj/a/712/97a

Leave Your Comments Below:

 

Make sure you leave a comment below on what you think of the interview and if you have any tips for fitness professionals on social media.

- Rick Kaselj, MS

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