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.

ONCE AND FOR ALL, SHOULD I USE HEAT OR ICE??

Many patients and clients have asked me whether they should use heat or ice on an injured or sore body part.  There seems to be many opinions about this.  What has worked for me in the past and what I tell my patients/clients is this:
1.  If it is an acute injury, meaning it is days/weeks old such as surgery, ice is the only option.
2.  If it is subacute or chronic, meaning it is months old, heat may be used.
Reasoning: After initial injury, inflammatory agents rush to the injured site.  To minimize swelling/edema, ice is applied.  Ice may be applied from session to session.  However, after a few weeks or even months swelling may continue to be present.  At this point, heat, specifically moist heat may be applied.  The heat will increase blood flow to the recovering site notonly bringing healing agents to the area, but actually "flushing" the remaining inflammatory agents and swelling out of the region.
Exceptions: 
1.  Some overuse injuries such as shoulder impingement, tendinitis, etc... may be a chronic condition, meaning it began months ago.  However, continued use of the body part may cause consistent pain due to aggravation and further inflammation.  Meaning, you never leave the Acute stage and should continue to use ice, particularly after a workout when it is most aggravated.
2.  Being that I live in Florida, I have only had a handful of patients who do not mind ice.  Those who do not like ice actually tense up their entire body when it is applied.  With these clients, you are better off not even using either modality if they are in the acute stage.  The tension caused by applying the ice can actually cause more pain for the patient.

Here is a economical way of making your own ice pack:
Fill a freezer ziplock with 3 cups water and 1 cup rubbing alcohol.  Make sure most of the air is out of the ziplock before freezing it.  Seal it and freeze it overnight.  It will freeze into a gel-like substance and so conforms to whatever body part you apply it to.

Hope this helps.  Good Luck