The Value of Tactile Cues on Your Client

When training a client, you may want them to contract a particular muscle/area of their body during an exercise.  In the fitness and rehabilitation industry, we realize very quickly that every person we work with has a different level of body awareness.  Some clients demonstrate great control, while others make you wonder how they survived walking from their car into your clinic.  Tactile cues, or in this case, "tapping" a muscle is very beneficial in getting your client to do the exercise the way you want them to.  Just remember how quickly you corrected your own posture upon feeling someone tap your lower back, telling you to "straighten up."  If a client is having difficulty "firing" the exact muscle that you are asking him to, tap the area of concern to provide manual/tactile cues, along with providing verbal cues.  The more information your client receives into their CNS (central nervous system), the better they will perform a given task.  This works especially well with stubborn muscles following injury, such as the Vastus Medialis (VMO).  This is the "tear-drop" shaped muscle on the inner aspect of your knee.  Following any knee injury or surgery, inflammation is expected.  Very little swelling causes the VMO to 'shut down.'  With the VMO "off," the lateral thigh muscle (Vastus Lateralis) pulls the patella laterally during a quad contraction.  During a quad contraction, the patella should track superiorly.  This does not happen when the VMO is not firing properly and therefore you can expect more problematic knee issues in the future.  When having your client perform a basic quad set, if the VMO does not appear to contract, have them tap it with each contraction. 

You can also use this technique to assist with lower trapezius recruitment during shoulder/scapula exercises in order to maintain stability of the scapula.  If you are observing an incorrect exercise movement, tap the muscles that should be activated during that exercise and see how quickly your client corrects his/her form.  This should help your clients progress quickly through the intial stages of rehab or post rehab fitness.

The Kettlebell Swing: The Shotgun Exercise

KettleBell Swing:

Everyday benefits

By: Nicholas Parmigiano MSPT, BSHS, CKTP, ACE-CPT, FMS, Crossfit Kettlebell Instructor

         The Kettlebell Swing is a fundamental exercise of what is one of the most popular exercise techniques of today – Kettlebell Training.  Used for fitness by most, I have been successful gearing this ancient art of training into Physical Therapy and Rehabilitation treatments for my patients with great results.  I call it the ‘Shotgun Technique’ because you can get the most “bang for your buck” by incorporating it into your program.  I have listed below just a few of the many benefits of this excellent exercise.

Lumbar Muscle Endurance:

         Many therapists and trainers feel that their clients are suffering from lower back pain due to strength deficits in their core and lumbar paraspinals.  They focus their sessions on seated trunk extensions using gym equipment or Roman Chair hyperextensions without realizing that these exercises actually create more compression and shearing force on the spine, which inevitably leads to herniated discs!  Most of my patients complain of lower back pain upon performing the lifting and repeated trunk extension movements required by their occupation.  They also experience symptoms in static positions, such as leaning over the sink to shave or to wash dishes.  This is not due to a strength deficit, but rather a muscular endurance deficit.  With proper form, the kettlebell swing will rapidly improve lumbar muscle endurance.  

Body Mechanics 

         Learning the proper technique of the Kettlebell Swing usually includes the following instruction: “keep your weight on your heels - Hinge at your hips, not your lower back - Sit back as if you are lowering yourself into a chair - Drive with your hips.” Following these instructions will protect your spine from any injury, which can occur from even the simplest functional task such as transferring out of a chair from a sitting to standing position.

Psoas Flexibility

         The psoas muscle is a hip flexor.  Tightness of this muscle is related to lower back problems. The explosiveness of the Kettlebell Swing applies a repetitive dynamic stretch to the psoas muscle, maintaining its flexibility, thereby minimizing it as a cause for lower back pain.

Lower Extremity Strength and Endurance

         Anyone who has performed over 2 minutes of non-stop Kettlebell Swings will understand this.  Once you become coordinated with the technique, the movement pattern will improve and you will be able to swing a heavier weight for a longer period of time.  Your legs, as a result, will gain strength and muscular endurance.

Scapula Stability

         To begin ‘The Swing,’ grab the kettlebell handle with one or both hands and stand up tall, holding the kettlebell at groin level.  In this position, your shoulders will ‘want’ to roll forward.  It is your job to pull your shoulder blades back (scapula retraction).  You can then proceed to perform multiple repetitions of the Swing.  Upon each repetition, your shoulder blades will again ‘want’ to roll forward - again, maintain retraction.  Holding your shoulders back isometrically strengthens the middle trapezius and rhomboid muscles.  Strengthening these muscles will assist you in maintaining proper posture.

         The possible rehabilitative and functional benefits you can derive from Kettlebell Training is endless, limited only by your experience and imagination.  Confucius once said, “Every journey begins with the first step.”  He failed to mention that you first need to be on the right path.  Therefore, seek a Certified Kettlebell Instructor who will guide your early experiences and walk you through the exercises, demonstrating proper form.  Then, you’ll be on your journey to strength and recovery.

Popular Causes of Knee Pain

Knee pain is a very popular issue for Personal Trainers and Physical Therapists.  Although the pain is localized to your client/patient's knee, you must observe the peripheral joints as possible causes.  One of the first joints you need to assess is the ankle/foot.  Many times, your client may be flat-footed on one or both sides.  Pronation or "flat-footed" many times creates a "down and in" movement of that entire lower extremity.  "Down and In" refers to an internal rotation motion of that leg.  This internal rotation leads to a shortening/tightening of the Ilio-Tibial Band/Tensor Fascia Latae (ITB/TFL).  This then leads to more internal rotation and "down and in" and it becomes a viscious cycle. 

Tightness of the ITB/TFL may create an increase in lateral pull of the patella or knee cap.  Instead of the patella tracking superiorly upon knee extensor contraction (quadriceps), it tracks supero-laterally.  In time, this may cause knee pain.  Most of my "knee clients" are taught how to perform proper calf (gastrocnemius/soleus) stretches to help minimize the "down and in."  They are also educated on ITB/TFL stretches if I observe the patella tracking laterally.  Unfortunately, these stretches alone will not correct the "down and in" motion.  You must ensure proper carry over by immediately practicing the activity in which the "comparable sign" (your client's chief complaint) was observed.  During the practice, make sure that the "down and in" motion is minimized.  For example, many times this motion will be obvious during step downs.  Instead of the knee tracking over mid to lateral foot, the foot arch drops (pronates) and the knee track medially over or past the big toe.  This step-down (using the affected leg to lower the body) may create your client's symptoms of knee pain.  Teach the stretches, and have your client perform the step down during that same session, making sure the knee tracks properly over the foot.  Many times, if you correct the movement pattern, the involved muscles will begin to work properly and efficiently.  Oh yeah, and don't forget to check the VMO contraction which assists with medial pull of the patella during contraction.  The VMO is the tear drop shaped muscle on the inside aspect of your thigh just medial and superior to the knee cap.  This muscle helps minimize lateral patella migration.  So, stretch the calves and ITB/TFL and strengthen the VMO.  Then perform the required activity and make corrections.  Remember "Perfect practice makes perfect!"

On a side note, for those trainers with clients who want to train barefoot, keep the above information in mind.  Training barefoot may have its benefits.  However, if your client demonstrates any of the pronation and "down and in" movement patterns with shoes on, their form will very likely worsen without foot/ankle support (training barefoot).  If they are unable to correct this inefficient pattern when barefoot, you may want to scrap barefoot training for now.  This is especially true if they already require orthotics in their footwear to reduce pronation.  Make sure the benefits outweigh the risks of barefoot training.

Client Assessment: Part 5

 C.H.A.R.T.S.

The "T" section of the assessment stands for Tissue Characteristics.  This is where you assess the length, strength, play, and tone of the joints/muscles.  You perform manual muscle tests, palpate the muscle belly and insertion/origin areas in search on tenderness (comparable sign), nodules, etc.  You also conduct functional tests such as sit to stand transfers, bending/lifting and stair climbing.

The "S" section stands for Special Tests.  These are tests that will help assess the integrity and involvment of ligaments, joints and tendon in your client's chief complaints.  Some special tests can determine ACL laxity or tears, rotator cuff tendinitis, elbow tendinitis, etc.  This will help guide your program design.

The past few blog entries should provide you with basic guidelines for performing a thorough client assessment.    Feel free to email me at nicparm7777@aol.com with any questions or comments. 

Client Assessment Part 4

C.H.A.R.T.S.

"R" Stands for Range Of Motion (ROM)

During your client assessment, you will want to evaluate the range of motion, particularly of the area related to the chief complaint.  You are looking for the 3 R's (Range or quantity, Resistance or quality/willingness to move, and Reactivity to the movement).  Be  especially attentive to the "Comparable Sign." The comparable sign is the client's chief complaint or symptom.  If you have your client perform an action that causes pain, however it is not the same pain that he is usually complaining about, then it is not the comparable sign.  Reproducing the symptoms/comparable sign will help you figure out the source of the problem. 

First have your client perform the movement actively.  If he feels symptoms, then you take him through the movement passively.  Lastly, test that movement resistively to assess strength.  With each of these, you are always looking for the 3 R's.  If there is pain prior to applying resistant, your client is highly reactive. Pain with resistance means he is moderately reactive.  While pain after resistance means low reactivity. 

A normal result of active range of motion is as follows:

-smooth motion at all speeds

-full ROM

-Pain free

-Normal strength

Abnormal result of active range of motion is:

-client resists movement

-painful area in the movement

-pain at end range

-compensations are observed

-you hear joint noises/crackling

Limited active range of motion may be a sign of the following:

-weakness

-tightness

-nerve issues

-internal derangement (you can use special tests to figure this out)

-pain

-tight joint capsule

What does Passive Testing tell you (you take your client through the movement)?

-Normal and pain free means no lesion

-Normal and painful may mean a minor sprain

-Hypomobile and painfree may mean a muscle contracture or joint adhesion

-Hypomobile and painful means acute sprain with guarding

-Hypermobile and painfree means a complete rupture of the tendon

-Hypermobile and painful may mean a partial tear

What does Resistive Testing tell you?

-Strong and no pain: no lesion

-Strong and painful: minor lesion

-Weak and painless: nerve damage or complete rupture

-Weak and painful: partial rupture

When performing Resistive Testing, remember the following:

-Isolate one motion for the test

-Test one joint at a time

-Test the motion at its mid range

-Increase your applied resistance slowly (do not crank on it)

-Hold the resistance 5 seconds

The above information should help a great deal in figuring out the cause of your client's condition. 

Client Assessment Part 3

C.H.A.R.T.S.

"A" is for Asymmetries

After taking an extensive history and finding out what your client's chief complaint is, you will want to begin gathering objective measures as a baseline status.  The first observation should be your client's posture. 

From the back, look for the following:

1. Foot position: are the toes pointing in or out, or is the foot flat?

2. Check out muscle mass: Is one calf bulkier than the other?

3. Position on the knees: Are they pointed in towards eachother or is it bowlegged?

4. Check for scoliosis: Does the spine have an 'S' curve?

5.  What about shoulder position: Is one shoulder elevated?

From a lateral view:

1.  Is the knee flexed or hyperextended?

2.  Is there an arch in the lower back?

3.  Is there a rounded upper back, rounded shoulders or a forward head posture?

With this section, you rely heavily on your observation skills and vision to determine asymmetries.  Noting these asymmetries will help a great deal in customizing an exercise plan with goals for your client. Setting up a plumb line to assist in your facility may help. 

Next we will discuss Range of Motion ('R' in C.H.A.R.T.S.)

Client Assessment Part 2

C.H.A.R.T.S.

"H"  Stands for History

During the assessment, it is important to gather information regarding patient history in order to determine the "health state" (behaviors/activities) as well as the "injury/disease state."  Knowing where your client was, helps to determine their goals as well as the extent of their injury.  During the patient history, you will want to gather the following information:

1.  General demographics: age, gender

2.  Growth/development: hand/foot dominance

3.  Present problem/complaint

4.  Past medical/surgical history

5.  Present medications: pain meds, muscle relaxants, anti-inflammatories

6.  Family history

7.  Vocational/Recreational info: Is their occupation a contributory factor? Ergonomics?

Following this section of the assessment, you will plan an in depth physical examination.  This is where you ask yourself:

1.  What are possible hypotheses for the cause of your client's problem? 

2.  How aggressive can you be with their training?  

Next entry will be "A" for Assymetries.

Another Acronym To Help Organize a Detailed Assessment

C.H.A.R.T.S.

When first meeting a client/patient or upon re-assessing that client to assess progress, a good guidance system to help accurately collect information is to base the assessment on the acronym C.H.A.R.T.S.  In the next few blog entries, I will break down each section.  Today, I will discuss "C".

"C" stands for Chief Complaint.  This is the subjective section of the client/patient interview/assessment.  Here you are finding out why that person is seeking your assistance.  It is also during this interview that you will decide whether there are other possible causes of the client's issues, especially any life-threatening pathologies that may contraindicate your services.  If the client has a complaint of pain, you will use the O-P-Q-R-S-T question format (previous blog entry) to analyze that.  Again, it is during the interview process that you want to rule out any other serious pathology that the client may have.  Some things the client may tell you that would lead you to believe there is a more serious issue are the following:

1.  Unexplained weight loss - Was he/she trying to lose weight?

2. Malaise/decrease in energy level

3. Fever/chills

4. Weakness/numbness

5. Fainting (loss of consciousness) or syncope (no loss of consciousness)

6. Pain at night

7. Pain at rest that is not affected by position change

8. Bowel or bladder problems

Also check out the previous blog entry on "Red Flags"

Lastly, you will want to assess that client's response to working with you. 
1. Did he/she have an unusual response?
2. Was there any symptom magnification?
3. Did the symptoms improve but then return for no reason?
4. Was their pain unaffected by your session/treatment?
5. Was the pain worsened by the session/treatment (considering you were not being too aggressive)?

 

All of the above information should help guide you in obtaining an in-depth description of your client's or patient's problem and will later help you in developing goals and customizing a program.  Next entry will focus on "H" for History of the condition.

P.R.F.C.T. Techniques: Upper Extremity Bias

In this video, we will combine the last 3 exercises into a non-stop circuit.  I will show you the Long Device Lateral Thrust, Persian Mil Drumming, and Persian Mil Squat Overhead Tap.  For the sake of time, each will be performed for 15 seconds and repeated twice.  You may perform each technique for 15, 30, 45 or 60 seconds before moving on to the next technique.  This combo is great for grip, forearm strength, shoulder/scapular stability, core stability, coordination, etc...  Check out previous posts for further descriptions of each technique.  Great for clients in the later recovery stages of hand, wrist, elbow, or shoulder injuries.

http://www.youtube.com/watch?v=dBUrmq0k59w

How Hard Should I Push My Client???

If you are working with a client who has one or more pre-existing medical or orthopedic conditions, you may be nervous when progressing him or her.  How aggressive should you be? 

Here are a few things to keep in mind when advancing your client.

1)Is their diagnosis recent or long standing?

You must find out whether the condition is acute (days old), subacute (weeks old) or chronic (months old).  If it is acute, you should be cautious, and advance intensity slowly.  If chronic, you may be more aggressive.

2) What is your client's reactivity?

Ask yourself: "Does a little activity causes a great deal of pain?"  If so, you need to modify.

3)Is the problem an inflammatory or mechanical issue?

Acute inflammation may present as red, swollen, hot.  It is usually better with activity due to the "moving around" of inflammatory chemicals.  Chronic inflammation presents with no resting pain, but may be worse with activity.  Is the activity you are performing creating more inflammation, rather than "flushing out" the inflammatory agents? With Mechanical issues, pain increases with activity and is better with rest.  However, there is no redness, swelling, or warmth.  If you adjust the mechanics, does the pain diminish?

4) What is the seriousness or severity of the condition? 

Is it a serious pathology that may worsen upon increased activity (Multiple Sclerosis, torn tendon/ligament, etc...)

So these are a few things to keep in mind when initiating a progression in your client's program.   They will help with your client's health and comfort level, his/her confidence level in you, the longevity of your relationship with your client, the speed of your client's recovery, and his/her return to a healthy fitness lifestyle.

"Red Flags" for Special Population Clients

When initiating sessions with special populations, many of them will come to you with an extensive past medical history.  They may be on medication for heart problems, diabetes, high blood pressure, cancer, etc... Although you should give each of your clients your undivided attention, you must pay particular attention to what these more "medically compromised" clients report to you.  Here are some "Red Flags" you must be aware of in order to maintain the safety of your clients.  If a client complains of any of the following, do not tell them to "brush it off!"  Refer him/her back to their physician before continuing your sessions.

RED FLAGS:
1)Complains of intense, unremitting pain
2)Pain is unaffected by medication or change in position
3)Complains of intense night pain
4)Complains of intense pain with no history of prior injury
5)Complains of intense spasms

Detailed Pain Assessment

When a new client begins working with you, he or she may come to you experiencing pain in one or more areas.  During your initial assessment, an easy way to formulate a detailed pain assessment is as simple as remembering O-P-Q-R-S-T.  If you know your alphabet, you can do this assessment.

"O" stands for onset of symptoms - when did the symptoms start? Is it an acute, subacute or chronic condition? Was it a slow or sudden onset?
"P" stands for properties of symptoms - What makes your symptoms better or worse?
"Q" stands for quality of symptoms - Type of pain...dull ache, sharp stabbing, shooting, etc...
"R" stands for radiating - Is it local or diffuse?
"S" stands for score - How does the pain rate on a scale from 0-10 where 0 is nothing and 10 is "get me to the emergency room!"
"T" stands for timing of symptoms - Is it constant or intermittent?

Answering these questions during an initial assessment and on subsequent sessions will provide you with a guidance system on whether your client is improving or not.  It will also help you to advise your client on what activities may be beneficial and which are detrimental.

P.R.F.C.T. Techniques: Mil Squat Overhead Tap

Today's P.R.F.C.T. Technique can be incorporated into any fitness or post rehab fitness routine. 

http://www.youtube.com/watch?v=UIn1kaDIu08

The benefits are as follows:
1.  Grip Strength: Controlling the uneven weight distribution of the Mil Device taxes your grip and forearm strength especially upon changing the grip position from a lateral bias to medial bias 

2. Shoulder/Scapula Strength:  The lateral raise itself focuses on the lateral deltoid muscle.  Controlling the "awkward" Mil device challenges your scapular stabilizers as you perform the lateral raise

3.  Lower Extremities: The squat portion strengthens your legs in order to assist in any squatting motion.  The squat is a functional every day movement required by everyone, so you want to maintain strength and efficiency

4. Core: Elevating your arms while descending/ascending from a squat requires a strong foundation or core to maintain control and stability of your trunk

5.  Coordination:  Some people can not chew gum and walk at the same time.  Squatting, while moving your arms with bilaterally weighted objects will definitely help with your coordination

Who will benefit from this:
Any client who needs to strengthen his forearm/hand, knee, hip, ankle, shoulder and/or requires strengthening in the overhead reaching/lifting actions due to his occupation or recreation

P.R.F.C.T. Techniques: Mil Drumming - Upper Extremity Bias

Click below to watch today's

P.R.F.C.T. (PERFECT) Technique:  Persian Mil Drumming

http://youtu.be/MxO3u1aNejA

P.R.F.C.T. stands for Post Rehab Fitness Circuit Training.  Today's exercise has the following benefits...

Grip Strength:  You must use your grip and forearm strength to control the device as it accelerates/decelerates.  You should not "flick" the wrist as this may cause tendinitis.  Your wrist moves in slight radial and ulnar deviation throughout, while maintaining a firm grip

Scapula Stability:  You have the option of holding the device with your arms at shoulder/chest height, angled overhead or diagonally toward the ground.  In either of the modifications, you must minimize shoulder movement, thereby maintaining scapulae stability (No shoulder blade protraction/retraction).  Working this at different angles just strengthens these muscles throughout a larger range of motion

Posture: As scapular retractors/stabilizers play a large role in posture, this exercise helps build muscle endurance, in order to maintain proper posture for extended time frames (like the entire day).

Core Stability: As your upper extremities are applying a force to move the devices, you will be moving one device at a time.  This unilateral movement applies rotational forces on the trunk.  It is your job to stabilize your trunk and not allow these forces to rotate your torso.  This develops core stability.  Perform the exercise with outstretched elbows for more challenge.  Bend the elbows slightly to decrease the challenge

Modification:  Incorporate a squat or lunge while performing the drumming.  This will work total body coordination, burn more calories, and will increase the challenge on your stabilizers, as there is more movement applied to the entire body while you focus on maintaining proper technique/form

Type of Clients Who Benefit:  Anyone in the later stages of recovering from hand/wrist issues, Lateral Epicondylitis (Tennis Elbow), Medial Epicondylitis, Bicep or Shoulder/Rotator Cuff Tendinitis, Shoulder Impingement, those in the later stages of Rotator Cuff Repair, and those who are trying to improve their posture

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P.R.F.C.T. ("PERFECT") TECHNIQUES: UPPER EXTREMITY BIAS

KB FITNESS or Knowledge Based Fitness presents P.R.F.C.T. (PERFECT) Techniques, which stands for Post Rehab Fitness Circuit Training Techniques.  These explanatory videos offer information for trainers and their clients on the how-to and functional benefits of many exercises, in order to guide their progression and prevent and/or recover from injuries.

The following video is the Nabard Long Device Lateral Thrust. 
http://youtu.be/_5tghrO5bQA


There are many benefits of this exercise, as it is a full body technique.  However, it is especially good for the upper extremity, including strengthening the shoulder, forearm, wrist and hand (grip).  This exercise provides:

1) Scapula Stabilization:  You must maintain isometrically retracted scapula when performing this, or else you risk causing shoulder injuries.  Scapular retraction is a major posture component.  So this technique will benefit posture and those clients recovering from shoulder injuries. 

2) Grip strength: With the offset handle of the device, you are forced to grip it tightly in order to control it.  Read the prior blog post on grip strength, irradiation and the homunculus for more details.  This movement also works on hand coordination and speed, as you transition from gripping the device to releasing the device frequently.

3)Core/Trunk rotation: As you increase speed of trunk rotation, you demand more from your core to control the rotation.  You should not allow the device to create rotation of your trunk.  Your trunk is what propels the device.  Maintaining core recruitment throughout the entire motion will protect your spine.

4) Dynamic stretch of the psoas: The psoas muscle is a hip flexor and is commonly tight in people with lower back issues.  When performing this exercise, the leg you are pushing off (the trailing leg) finishes in full hip extension with a gluteal contraction.  This maintains flexibility of the psoas.  If someone has a tight, symptomatic psoas/lower back, they may stop short of full hip extension and even hyperextend their lower back in order to complete the movement.  Watch for these compensations and correct them.  The hip drive you perform with this "trailing" leg during trunk rotation is a common motion in many sports.  As you become accustomed to the movement, increase the amount of hip drive.  This is a great technique to include in a athletes training program.

5) Foot speed: You must be able to adjust your weight distribution from 1 leg to the other frequently, rapidly, and safely to perform this technique.  As the demand on the upper body changes, the weight distribution on the lower extremities must also adjust in order to maintain balance and efficiency. 

So, give it a try.  Keep the upper points in mind throughout, and always move with P.E.R.F.E.C.T. Technique. 

Please help me provide you with valuable information:
1.  For those reading this blog, what type of information would be of interest to you in a rehab/fitness blog or website? 
2. What would you like to learn as a fitness/rehab professional or as someone recovering from an injury?
Questions, comments or requests, please contact me at: nicparm7777@aol.com

Join this blog to continue receiving fitness and rehab educational information

Grip and the Homunculus

Does anyone know who or what the Homunculus is? 

It is a "pictorial representation of the anatomical divisions of the primary motor cortex and the primary somatosensory cortex, i.e., the portion of the human brain directly responsible for the movement and exchange of sense and motor information (namely touch: sensitivity, cold, heat, pain etc.) of the rest of the body.  There are two types of homunculus: sensory and motor. Each one shows a representation of how much of its respective cortex innervates certain body parts." (Wikipedia)
In short, it is a caricature of a "little man" whose body parts are drawn in size to represent the area of the sensory/motor cortex of the brain that innervates each respective body part.  There are larger portions of the brain processing information received from some body parts compared to other body parts.  One example of this is the hands, which have a very large representation on the brain's sensory/motor cortex.

With this in mind, will training grip engage a larger portion of your brain/Central Nervous System?  Will grip strengthening assist with neural plasticity in patients or clients who have suffered a stroke and want to regain function?  Will it enhance the development of motor/movement patterns for athletes?  As a Physical Therapist and Personal Trainer, I have incorporated grip strengthening into all of my client's sessions.  When working with someone who is in the initial recovery stages of a rotator cuff repair, usually the protocol begins with 6 weeks of passive range of motion, meaning, the client lays down while I move their shoulder.  He/she is not allowed to actively move the shoulder on his/her own.  But, he is allowed to move the elbow, wrist and hand.  That is to maintain mobility/strength in the peripheral joints.  But will incorporating grip strengthening also assist in shoulder rehab by stimulating a large portion of the motor cortex?  Does working grip make neighboring joints, such as the shoulder stronger?

Try this: Next time you are performing a 1 arm shoulder press, as you approach fatigue, make a tight grip on both the working and the non-working hand.  Does it make it easier to press the weight?  Better yet, as you approach fatigue, tighten the grip on both hands, as well as clench your glutes and tighten your thighs.  Even easier now, right?  This "irradiation" technique can also be used with less functional clients who have difficulty transferring from a seated position to standing.  Ask them to move from sit to stand.  If they have difficulty, have them try again, this time while making 2 very tight fists.  This has amazed many of my patients, as at first they barely are able to stand, and then magically the second time they practically shoot out of their seat.  My advice is to incorporate grip techniques into every training session.

Nabard Combat Training For Post Rehab Fitness

Nabard Combat Training is a great way to incorporate multi-joint movement patterns into a client's fitness routine.  Mastering these diagonal patterns may assist in maximizing both functional and athletic skill performance.  In addition, the exercise techniques help in developing proprioception of the joints (joint awareness) as well as stabilization and grip strength.  Check out these videos.....After watching, you will see this style of training is much more than just combat training.  It can be incorporated into any post rehab fitness program as well for people of all ages.
http://youtu.be/tCo30lBPIHU
http://youtu.be/-DD96ukM1bo
http://youtu.be/9mNxq5VJKxQ
http://youtu.be/PfYv5quhbWU

Develop Shoulder Proprioception Part 2: Prerequisite to Kettlebells

Progressing your client from basic exercises to more challenging techniques should be a somewhat cautious task, especially with training devices that they are less accustomed to.  For example, when performing a Kettlebell Windmill or Overhead Squat, if your client does not "pack" his shoulder and maintain its stability, he may lose control of the Bell, causing injury to himself or others training in the same area.  Watch this video and try for yourself.  It is a great low risk exercise that trains your shoulder stability in 360 degrees.  You can easily adjust the resistance, and if you lose the shoulder "packed" position, there is less risk of injury.  Get your client used to this stability activity before handing him/her a Kettlebell.
http://www.youtube.com/watch?v=7c-ivj0prK0

Develop Shoulder Proprioception - Part 1

Proprioception is defined as the "the sense of the relative position of neighboring parts of the body."  It tells us where the various body parts are located relative to eachother.  In Physical Therapy, Proprioceptive Training is extremely important to assist a patient's recovery from joint injuries (such as rotator cuff tears or surgerical repair) as well as preventing future injuries.  If you have little control of your joints or extremities (aka poor body awareness), it is only a matter of time before you get hurt. 


When training with irregularly shaped devices such as the Kettlebell or Persian Mil, body awareness is particularly important, as these devices are more difficult to control than conventional dumbbells or barbells.  Prior to training a beginner with Kettlebells or Clubs, I would advise the basic prerequisite exercises shown in this video.  They can be used as a warm up or part of your program to maximize joint stability.

http://www.youtube.com/watch?v=hp8iOAj1Pas

Normal progression of the "tracing" exercise is:
1)Supine (lay on back) and trace small size letters/shapes with your eyes open
2)Supine and trace large letters/shapes with your eyes open
3)Seated with arm overhead, trace small and then large size letters/shapes with eyes open
4)Repeat the above order with eyes closed
Have someone give you feedback on the your ability to maintain control with your eyes open versus eyes closed
5)Progress to using the kettlebell or Mil

Uses of The Shot-Put For Fitness and Rehab

In this video, learn numerous benefits of using the Shot-Put with your clients.  These benefits include:
-Plyometrics for the upper extremities
-Shoulder Concentric Internal rotation and Eccentric External rotation exercises
-Improve eye hand coordination, timing and body awareness
-Quickly load and unload your shoulders and core musculature
Check it out here:
http://www.youtube.com/watch?v=_H7Z49zvhCM
These exercises are great to progress clients with rotator cuff injuries

Treatments for Bulging or Herniated Discs

If you have been suffering from lower back pain with radiating symptoms into one of your legs, you possibly are suffering from a bulging or herniated disc.  If you see a physician and he does not feel you require further diagnostic testing at this time, but recommends you see a Physical Therapist, these are some exercises you can expect to perform.

http://www.youtube.com/watch?v=Ed4AlkK-W1I&tracker=False

When performing these exercises, REMEMBER!!! You are looking for the symptoms to "centralize."  Centralized symptoms means this: If you have lower back pain radiating into the hamstring region of your right leg, centralizing these symptoms means they move up toward your lower back and out of your leg.  You must picture your lower back as a 'window,' and your goal is to move the symptoms up your leg and out the 'window.'  If the symptoms move further down your leg (peripheralize), make sure you are performing the technique correctly and try again.  If the symptoms continue to peripheralize, STOP and alert your practitioner.  Good Luck!

Scapular Stabilization

In order to protect the shoulder joint complex when training, you will need to first explain to your client how important the lower trapezius muscles are.  These muscles play a valuable role in what is called "shoulder packing." Simply put, when you pack your shoulder, it feels like you have 'screwed' the upper part of your arm (humeral head) into the shoulder joint (glenoid), while maintaining scapula depression and upward rotation.  Upon overhead lifting, maintaining lower trap engagement will prevent the shoulder and scapula from elevating, which will avoid shoulder injuries/inflammation such as impingement and tendonitis in the long run. 

CLICK FOR EXERCISE VIDEO: http://www.youtube.com/watch?v=SJBlOKaRnfA

Wall Supermans:
     This is a good way to have your client feel the lower traps working.  Keep an eye on their elbows, as your client will attempt to pull down as if performing a lat pulldown.  The arms should remain locked in extension while only the scapulae move down and towards eachother without rotating toward the floor.

Overhead Wall Ball Bounce:
     Now, have your client engage and statically maintain lower trap contraction while using the hands/elbows to bounce the ball overhead.  This is more dynamic, reactive and assists with upper body endurance, particularly of the lower traps which are weak and fatigue quickly on more people than you think

Push Up Shoulder Tap
     This will incorporate core stability as well as scap stability.  Initiate each push up with scap retraction to protect the anterior shoulder joint capsule.  (squeeze your shoulder blades together prior to lowering your body)

Half Get UP
     One of the best for rotator cuff strength, shoulder range of motion (ROM)  and body awareness.  Keep your eyes on the Kettlebell so you do not lose control.

I hope these exercises help you and your client with any shoulder issues

Long Log Overhead Cast with a Forward Lunge

WOW!!! That's a mouthful!!  Watch this video clip and try it out for yourself.
How many benefits can you come up with for this exercise?
Some benefits are as follows:
- Just holding the device in the start position works your hand grip and forearm strength as well as your shoulder stabilizers.  Due to this being a uni-lateral hold, you are also working your core stabilizers in order to prevent your upper body from sidebending toward the log
- Directing the device overhead will help with shoulder mobility, scapular stability, and body awareness (If you have little body awareness, you are likely to drive the device through your forehead). Also, throughout the movement, if there is forearm, grip or rotator cuff weakness, you will have little control of the path of the log
-  The lunge works your leg strength, foot positioning and speed for both acceleration and deceleration activities
-  When alternating sides, you work hand speed and coordination as well as increasing the demand for core stability due to the frequent and quick loading/unloading on each side of your body
-  Upon forward lunging with overhead casting, you MUST maintain a stable spine with engaged core (Lumbar stabilization) in order to prevent unwanted trunk rotation or hyperextension.
-  It's multi-jointed, so your heart rate will sky rocket
So, here it is.  Give it a shot!
http://www.youtube.com/watch?v=PfYv5quhbWU

So, What Was Being Targeted With the Diagonal Snatch, Log Uppercuts and Spirals??

Diagonal Snatch:
-In this exercise, you are moving the kettlebell in a D2 Flexion Pattern in PNF (Proprioceptive Neuromuscular Facilitation).  Basically, you were working a diagonal proprioceptive pattern which will lead to more efficient functional movement patterns (Targeting the Nervous System)
-You are working Shoulder mobility, scapular stability, grip, forearm strength, rotator cuff stabilization, core stabilization, glute activation

Long Log Uppercuts:
-More diagonal patterns, this time with speed and power, which is more challenging to maintain core stability
-Grip and forearm strength
-Scap stability as you do not want to allow your shoulder blades to protract while you are "punching" upward

Short Log Spirals:
-Diagonals again, this time combined with dragon lunges
-Do not allow the logs to move off of your forearm, so you must squeeze the handles tight (Grip)
-If you push off the rear leg when moving into the upright position, you get a dynamic psoas stretch and assist your push off which is necessary in many sports.  Obliques will also be targeted as your trunk rotates and the core must remain stable throughout

Now, watch it again.....http://www.youtube.com/watch?v=9mNxq5VJKxQ

More on Core Stability and A Dyna-Core Circuit

Scroll Down for Video Clip:


Definitions:
Static: Fixed; no movement or change
Dynamic: Continuous and productive activity or change (for our purposes, regarding the dynamic plank, this relates to the extremities; and for the dynamic uppercut, this relates to the spinal segments)
Mobility: Motion
Stability: Ability to withstand sudden change or deterioration...With the exercises shown, engaging the core withstands deterioration of spinal "control", thus avoiding injury

Static Stability: Maintain a neutral lumbar spine with no extremity motion
Dynamic Stablity Level 1: Maintain a neutral lumbar spine with extremity motion; the core withstands force exerted by the extremities
Dynamic Stability Level 2: Maintain a "stable", engaged core and lumbar spine with movement of the extremities and the spine...the spinal segments are moving with "control" (Controlled Mobility)

Goal:
To teach your client to engage their core throughout small and large movement patterns in order to increase coordination, efficiency and strength as well as decrease their risk of injury. 

Learn to maintain control throughout the full available range of motion, not just at mid range where the muscle is strongest.

Why the diagonal movement patterns???
Because functional movement is rarely in straight plane, but rather in diagonal directions.  Spiral and diagonal motions target the nervous system in order to maximize body awareness, proprioception and kinesthesia.  The better and "cleaner" we become at these movements, the more efficient we will be on the playing field or throughout everyday life.  A football player may be able to bench press 500 pounds, but if he can not effectively and efficiently move in and out of a lunge position, how "strong" is he???

This Circuit incorporates diagonal patterns with squatting, lunging and reaching activities.  It will also get you to break a sweat....Full Spectrum Fitness!!!  Pay attention to the 3 exercises in the clip.  What is being targeted?
CLICK HERE FOR VIDEO:
http://www.youtube.com/watch?v=9mNxq5VJKxQ

Dyna-Core Training: Core Stabilization Progressions

     We have all heard that "A house is only as strong as its foundation."  Well, similarly, our bodies are only as strong as our core stability/strength.  Without core stability, we would not even be able to walk.  In Physical Therapy and Personal Training, we teach our clients how to engage their core during various activities.  Static Stabilization is trained with minimal to no body movement (Static Plank).  Exercises which incorporate extremity movement while continuing to maintain a neutral spine are an example of Dynamic Stabilization (Dynamic Plank).  Unfortunately in every day life, we are required to not only maintain an engaged core while moving our extremities, but are also performing tasks that require the spine to transition in and out of the neutral position.  If we do not learn how to maintain an engaged core throughout our spine's available range of motion (Controlled Mobility/Stability), injury is inevitable. 
     Dyna-Core Training focuses on "Controlled Mobility Training."  You are not just going through the 'exercise motions' in hopes to break a sweat and burn calories.  You are becoming more efficient in functional movement patterns.  This is "Purposeful Training." 
     Going through Physical Therapy School, we were taught that a good therapist has "many tools in his/her toolbox."  A certain technique may work great on one client but not at all on another client.  So we must learn as many techniques, treatments, exercises, modalities, etc as possible in order to maximize results, improve retention and reduce boredom.  One tool that I have found to assist in enhancing this "Controlled Mobility Training" takes advantage of the Nabard Fitness System Devices.  Please watch the video for more details.
http://www.youtube.com/watch?v=-DD96ukM1bo

Recruit Your Core: Stage 1 of Lumbar Stabilization

http://www.youtube.com/watch?v=gGT8ckhUrE8

This video will be the first in a series of videos explaining the progression of Core Stabilization Techniques/Exercises.  You must first train your client/patient on how to engage their core and maintain its recruitment throughout an exercise in order to preserve the stability of the lower back. 
     The normal progression begins with static stability exercises in which there is no motion, just control and maintenance of one 'set' body position. 
     Next will be dynamic stabilization in which the trunk remains static, but the upper extremities are moving.  Here, the trunk is exposed to a force (developed by the moving extremities), and it must resist motion.  
     Even more difficult, the next challenge is to "control" the lower back/trunk, maintaining a 'stable' spine while moving it throughout its available range of motion.  This controlled or "stable" mobility is necessary in all sports and when performed correctly, will prevent injury.  Watch this video to get a feel of engaging your core.

Does Your Client Have Shoulder Issues?

If your client complains of shoulder discomfort, tightness or displays a limited range of motion with such exercises as the Shoulder Press or Kettlebell Snatch, it may be beneficial to teach him/her to perform a gentle Lateral Distraction Joint Mobilization for the Gleno-humeral Joint (shoulder).

In this video clip, learn a quick an easy "self" joint mobilization technique that will provide the following benefits:
-Improve overal shoulder range of motion/flexibility by gently stretching the joint capsule
-Assists in Synovial Fluid lubricating the shoulder joint
-Pain relief

Following the technique, be sure reassess the shoulder range of motion.  Then attempt the exercise again to see if you have made progress.

*Helpful with Frozen Shoulder (adhesive capsulitis) and impingement syndrome

http://www.youtube.com/watch?v=8pNziq4Ckbg

Multi-Angle Deadlift

Simple exercise to set up, all you need is 4 cones and possibly a kettlebell (challenging with no weight also). 
Click below for the video
 
Tips to remember:
-HIP HINGE!!! Do not bend through the lower back segments
-Maintain body weight on the posterior aspect of your foot (heel)
-Keep your hip bones facing forward (minimal rotation)

Functional Values:
-Glute Recruitment for lower back stability
-Core engagement
-Single leg balance
-Ankle and knee stability
-Acceleration/Deceleration pattern for sports
-Kinesthesia for the lower body

http://www.youtube.com/watch?v=-ZO1ZUjyntU

Enjoy,

Nick