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Breathing Disorders

Most people do not think much about breathing until it becomes difficult (i.e., when you’re exercising, when you come down with a cold, etc). When you have a breathing disorder, you’ll suddenly find yourself thinking about your lungs in ways you never did before, and you'll no longer take breathing for granted. Knowing what goes on inside the body helps. The more you understand about how the lungs work, the better you’ll be at figuring out how breathing disorders affect you and your clients.

Symptoms

Breathing disorders such as chronic bronchitis, emphysema and asthma are conditions associated with chronic obstructive pulmonary disease (COPD) and are the most common diagnosed diseases related to respiratory dysfunction. Chronic bronchitis is an inflammatory condition caused by persistent production of sputum due to a thickened bronchial wall, which in turn creates a reduction of airflow. Emphysema is a disease of the lungs that affects the small airways. An enlargement of air spaces accompanied by the progressive destruction of alveolarcapillary units leads to elevated pulmonary vascular resistance, which in most cases can contribute to heart failure. Asthma is usually brought on by a spasmodic contraction of smooth muscle around the bronchi that produces swelling of the mucosal cells lining the bronchi and an excessive secretion of mucous. Constriction of airway paths associated with asthma results in attacks that may be caused by allergic reactions, exercise, air quality factors and stress.

Pulmonary diseases affect the respiratory system’s ability to transport oxygen during exercise to the tissue level via the cardiovascular system. The systematic breakdown that occurs as a result of inadequate oxygen supply creates a greater than normal demand on the function of the cardiorespiratory system, in some cases markedly reducing exercise tolerance.

The major signs or symptoms of COPD include the following:

* Dizziness or fainting (syncope)
* Unusual fatigue or shortness of breath with usual activities
* Shortness of breath at rest or with mild exertion
* Rapid heart rate (palpitations or tachycardia)
* Pain and/or discomfort in the chest, neck, jaw, arms or other areas that may be due to lack of blood flow

It is important for personal trainers to understand these signs and symptoms. If an individual exhibits these signs or symptoms, it is the role and responsibility of the personal trainer to take appropriate action, and if you are ever unsure of what the appropriate action is, refer your client elsewhere.

COPD steals your energy, which has a ripple effect through the rest of your body during everyday activity and exercise. For clients with healthy lungs, normal breathing doesn’t take a lot of energy. In fact, clients with healthy lungs only use energy to breathe when they inhale to inflate the lungs (exhaling is a passive activity because healthy lungs are elastic and can push the air out on their own). With COPD, the lungs can lose that elastic quality, so you have to use extra energy to force air out of the lungs. In other words, your client has to use twice the energy just to breathe. The gas exchange is less efficient, so your client’s body doesn’t have as much oxygen to fuel itself, and your client becomes tried more quickly. Some clients will even use more calories to breathe, which may sound good but is not as it leaves fewer calories for energy and exercise. Unfortunately, the energy drain can also make it harder for clients with COPD to get the nutrition they need. The digestion process itself takes a great deal of energy, so COPD clients often do not feel like eating (medication can also affect appetite), which can be very unhealthy.

Exercise Program

As we all know, exercise has many benefits. It makes your heart and circulatory system stronger, helps control blood pressure and improves the heart’s ability to pump blood, which in turn means more oxygen and energy. The lack of oxygen and sufficient calorie intake (as stated before) may lead to a loss of muscle mass and strength. This is why exercise is such a critical component of a comphensive treatment plan for any severity of COPD. Aerobic exercise like walking or riding a stationary bike helps to bring more oxygen into the body and tone the muscles. This kind of conditioning has been shown to reduce symptoms like shortness of breath and improve overall quality of life, no matter the severity of your client’s COPD. A regular exercise regimen improves sleep quality, which increases energy and promotes better posture, balance and flexibility. The list of positives for regular exercise in COPD sufferers goes on and covers everything from emotional to physical strength and everything in between.

Before starting any COPD exercise program, an evaluation of physical activity and exercise patterns should be completed. This evaluation needs to include identifying the specific activity and the frequency, volume and level of intensity of that activity. Also, you'll need to document any potentially harmful signs or symptoms associated with the activity, particularly shortness of breath or chest pains. Any musculoskeletal concerns related to joint discomfort or chronic pain should also be identified.

Every effective exercise program needs to take into consideration proper regression and progression. With clients who have COPD, every exercise should be a regression (the level of regression will be dependent on the individual's fitness level). The following aerobic exercises are listed in order from LEAST to MOST likely to induce an attack such as exercise-induced asthma or exercise-induced bronchitis.

* Pool Swimming
o Low Intensity - The moisture will help keep the air passage from drying, which can cause an attack.
* Walking
o Low Intensity - It is very easy to keep the heart rate consistent when walking.
* Cycling
o Low to Moderate Intensity - The intensity can be easily controlled while cycling.
* Treadmill Running
o High Intensity - The body needs more oxygen for this activity, so you most progress to this point.
* Outdoor Running
o High Intensity - A lot of oxygen is needed to run outdoors, plus the outside temperature could cause an attack. This is the last aerobic progression.

Any progression beyond this could be to increase the intensity further by introducing weight training. The key is to pay close attention to your client's breathing. The weight training program to follow looks like this:

* Light Weight/Moderate Reps
o Low Intensity - Helps to build a foundation.
* Basic Movements (i.e., push, pull, bend, twist, lunge, squat)
o Help to improve posture, which will make it easier to breath.
* Body Weight Movement
o Low to Moderate Intensity - You can control the intensity by adding speed and reps.
* Isometric Exercise/Continual Resistance
o Low to High Intensity - Push muscles to endurance failure, which is great for calorie burn and strength building.
* Circuit Training
o High Intensity - Perform both aerobic and anaerobic workout. This is the last progression point.

The key is keeping the workout intensity controlled until your client has progressed to a higher intensity. Like any client, progress should be gradual, but with clients who have COPD, this will take longer. A tip is to keep heart rate consistent (i.e., try not to let it dip or spike). Most attacks occur due to dry, cold air or when a high volume of oxygen is needed in a short period of time, so keep that in mind when training outside or during high intensity workouts.

Clients who have COPD use more energy to do less. Even relatively passive activities like reaching for something on a shelf or bending to pick something up from the floor takes more energy. So much of the body’s resources are diverted to the task of breathing, eventually there’s next to nothing left over for other activities. The right combination of nutrition and exercise can and will fend off attacks and improve your client's overall quality of life.

References:

1. Berge, William E. & Gordon, Debra L: “Allergy & Asthma Relief” 2004. Reader’s Digest Association Inc.
2. Earle, Roger W. & Baechle, Thomas R.: “NSCA’s Essentials of Personal Training” 2004. Human Kinetics
3. Felner, Kevin & Schneider, Meg: “COPD for Dummies” 2008. Wiley Publishing Inc.
4. Nagourney, Eric. “Athletes’ Asthma Tied to Sweat Levels” Sep 23, 2008. The New York Times.
5. Michael Greenhouse

Forwarded By, Natalie Pyles

Fitness & Weight-loss Expert, Nutrition Specialist, Author, Speaker

Call Me For Your FREE Consultation Today! 1-800-681-9894 or e-mail fitnesselementsassociates@yahoo.com
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"How To Train Teens Through Exercise & Eating"

With the increasing concern of rising obesity levels, more and more attention is being turned to encourage young people to become physically active. Here, we look at the differences in physiological response to exercise between young people and adults.

Many adolescents already take part in physical activity or sport regularly, and are already reaping the benefits of being physically fit at a young age. Such benefits include:

• An increase in bone density
• Increased likelihood of participation to continue into adulthood
• Having a lower incidence of injuries
• Weight management
• Improvement in asthma symptoms and cholesterol levels
• Being physically fit enables an athlete to maximize their potential in sport

With greater numbers participating in more than one sport and taking part in competitions frequently, of concern to many fitness professionals, parents and youngsters alike is the amount of training young people of this age are undertaking. We all know their bodies are undergoing rapid change, and consequently we need to be particularly cautious about ever increasing intensities in sports competitions. A number of different factors need to be taken into account before any training program is designed for these athletes and below are a few helpful pointers to guide fitness professionals in the right direction.

Exercise and Growth

Boys and girls have different growth spurts whereby girls undergo their adolescent growth spurt and peak velocity height about two years earlier than boys. However, boys experience longer growth spurts that are more intense than girls2 and they tend to overtake the growth period of females during this life stage. Training therefore needs to take into consideration these differences and fitness professionals need to ensure that individual recognition takes place where no child is undertaking a program too strenuous or intense for their physical development.

Energy and Fluid Needs

Although there is mounting evidence among adults that daily energy requirements are related to total amount of training, there is a limited amount of information in this area for children participating in specific sports. Of the available research, when energy cost is calculated per kg body mass, walking or running at any given speed is significantly greater in children than in adolescents and adults, and this relative cost is higher the younger the child. For example, a seven-year-old child who is walking or running at the same speed as a young adult would need as much as 25 to 30 percent more energy per kg body mass.3 As a result of their greater energy needs while performing physical activities, children also produce more metabolic heat per unit body mass than adults. Consequently, fluid intake must reflect such production and as core body temperature during dehydration increases faster in children than in adults,4 it is vital for coaches and trainers to try to prevent dehydration in child athletes. An ideal approach is to introduce fluid breaks every 15 to 20 minutes during prolonged activities.

Cardiovascular Responses

Sub-maximal cardiovascular responses are different between children and adults, with children tending to work at a higher
heart rate at sub-maximal levels of exercise. Children have smaller hearts and less total muscle volume than adults and therefore any such cardiovascular training should account for such differences. Oxygen extraction by the tissues (a-VO2 diff) also tends to be slightly larger in children than in adults, so it is important to remember that if exercising on hot days, children's core body temperature will increase more rapidly. Ensuring children are fully hydrated will help reduce the negative effects of such increases.

Aerobic Power

After the age of 14, girls' aerobic power can be as much as 15 percent less than boys. However, the effect of endurance training programs on VO2 max on both genders has proved inconclusive.2 This may be due to other growth factors playing a more significant role, such as greater musculature or larger levers, which dominate the effectiveness of aerobic activities.

Anaerobic Power

As expressed per kg of bodyweight, anaerobic capacity is much lower in children than adults and increases progressively with age in both boys and girls. It is important therefore to be aware of the intensity of exercise regimes, as it is not the duration but the intensity of exercise that could lead to more harm. Appropriate activities would include long-distance runs instead of vigorous short sprints, as these may also aid in meeting appropriate body composition requirements.

Strength

After the adolescent growth spurt, muscle development is influenced by hormones and, since testosterone production is greater among males, they will become stronger and faster than females. For such boys, however, it is important to not put too much strain on the body. Two times per week has been proven to ensure significant changes, compared to more frequent sessions where no further improvement was found.3 Activities should be based on individual bodyweight and restrictive weight exercises on machines should be avoided.4 Below are a few recommendations of how to incorporate strength training into young athletes’ regimes. The exercises should be progressive: starting at one and, as the adolescent develops, moving them up through to five.

1. Obstacle courses: rope pulling, climbing
2. Vertical strength: standing push-ups, hanging exercises
3. Bodyweight exercises and medicine ball-based activities/throws
4. Horizontal strength: push-ups, pull-ups
5. Single leg squats, step-ups, dumbbells and barbell exercises

Skill Development

All sports, no matter what discipline, require a high level of skill in order to excel. However, specialized training too early on in adolescence can actually have more of a negative than positive effect. Movement skills such as balance, agility and coordination which would usually be developed as part of a broader based program become neglected and as a result can leave the young athlete with little competency outside the speciality.

Peak Velocity Height (PVH)

Sports scientists believe that it can take up to 12 years of training for a young talented athlete to reach elite status. The use of athletic models to develop these athletes has been successful in recent years. However, due to differences in physical, cognitive and emotional development, research states that age is not a good indicator on which to base athletic development models for athletes between the ages of 10 to 16. Instead, the onset of peak velocity height (PVH) is recommended, which is the point where a child reaches their maximum growth rate. This is affected by genetic and environmental factors (climate, cultural and social) and can be an advantageous reference point for training program design. PVH for girls is usually around age 12 and for boys, age 14. By taking basic measurements (standing height and sitting height), PHV can be observed and specific training programs can be designed to match the child's development.

Recommended Activities

Much debate has surrounded the question of whether young sportspersons should specialize in particular sports at an early age. Current evidence suggests that adolescents should participate in activities that develop overall capacities rather than specialized programs. Furthermore, research has found that when development of strength, power and flexibility is undertaken gradually, higher levels are achieved and the maintenance of such factors remain for longer periods of time. Since growth rates of male and female adolescents vary considerably, it is important that a comparison between athletes is avoided. Certain individuals will improve rapidly on some exercises, while others who have not gone through a particular growth phase will often lag behind. On a personal level, young athletes may also feel confined to the realms of one sport if they specialize too early, which may have a negative effect on participation levels. By experiencing a range of activities and training programs, the young person is more likely to develop a range of athletic abilities, which will increase their options to specialize later on.

References:

1. Borms J (1986), The Child and exercise: an overview, Journal of Sports Sciences, 4, 3-20.
2. Drabik J (1996), Children and Sports Training: How Your Future Champions Should Exercise to Be Healthy, Fit, and Happy , Island Pond, VT: Stadion Publishing Company, Inc.
3. Overend T, Paterson D, Cunningham D and Taylor A (1985), Interval and continuous training: A comparison of training effects. A paper given at the Annual Meeting of the Canadian Association of Sports Sciences, Laval University, Quebec.
4. Rushall B, Marsden J and Young C (1993), A suggested program of foundational conditioning exercises for age-group swimmers: a manual for coaches, NSWIMMING Coaching Science Bulletin, 2(1), 1-23.
5. Stahle S, Roberts S, Davis B and Rybicki L (1995), Effect of a 2 versus 3 times per week weight training program in boys aged 7 to 16, Medicine and Science in Sports and Exercise, 27(5), Supplement abstract 648.
6. www.evolution-sports.com
7. Tara Finnerty

Forwarded By, Natalie Pyles

Fitness & Nutritional Expert, Author, Speaker

Call Me For Your FREE Consultation Today! 1-800-681-9894 or 480-212-1947 e-mail fitnesselementsassociates@yahoo.com

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"Health & Fitness Before the Core" - Part 1

As the words "core" and "function" have taken center stage in the arenas of health, fitness and strength and conditioning. Many professionals are making the terms mutually exclusive. In other words, they are using both words to mean the same thing. Is core training and functional training one in the same? The answer is "no."

Core training and stabilization is agreed upon by most authors and researches to refer to the lumbo-pelvic complex and spinal stabilization. Functional training refers to training the body to optimally perform "real world" movements involving acceleration, deceleration and stabilization, using biomechanically efficient and coordinated movements.

The critical differentiation to make here is that a complete functional training progression must include core training and stabilization. However, core training and stabilization do not always equate to complete "functional training." In fact, many exercises that have been labeled as "core strengthening" exercises can contribute to perpetuating an individual's existing dysfunction.

By dysfunction, I am referring to existing muscular imbalances and altered sensory perception that create faulty movement patterns. It is often not the exercise that is at fault but rather the execution of the exercise by the individual. This can occur when an individual is placed in a position or positions that require static or dynamic stabilization utilizing the core musculature. During this stabilization, the strategy that their motor system uses may be biomechanically inappropriate. The individual in this case will resort to their unique position of strength. For example, the person in Figure 1 is keeping a neutral spine and eccentrically loading their abdominals to avoid excessive lumbar extension. Figure 2 depicts the same individual demonstrating a stabilization strategy for someone with weak lower abdominals and tight hip flexors. Notice how the individual in Figure 2 flexes through their middle thoracic back. They have sought to stabilize themselves using the superficial upper rectus abdominus, pecs and abducting their scapulae. The flexion in their thoracic spine is their strategy to indirectly minimize excessive lordosis in the lumbar spine in this position.



Figure 1


Figure 2
A movement strategy occurs high up the decision making process of planning a movement. According to Massion, strategy implies the existence of a choice in attaining the movement goal. Therefore there is some cognitive input by the individual and the response is not purely reflexive - happening below the cortical level.

A strategy is created when a movement synergy or synergies is repeated enough times that it is learned. A movement synergy is a coordinated pattern of muscle activity that produces force, reduces force or stabilizes against force.

The individual in Figure 2 will eventually become more stable on the ball using this kyphotic positioning. His balance will improve using this strategy but this balance will come at the expense of the biomechanics of his shoulder girdle. As he further trains his core in this manner without correction of the substitution patterns, he will develop what Kibler calls a sub-clinical adaptation complex. The adaptation is the use of a compensatory mechanism utilizing thoracic flexion for indirect lumbar stability. It is categorized as sub-clinical because there is no pathology present – yet. However, it is only a matter of time before this individual exhausts his body's ability to compensate and pathology will be present.

Why would someone use an inappropriate strategy when you, as a professional have clearly explained and demonstrated the desired outcome? Hanna refers to this as "Sensory Motor Amnesia." He describes this as a condition in which a person's ability to voluntarily contract or relax a muscle(s) is directly dependent on the degree to which a muscle can be sensed or felt. Therefore, our peripheral output (the way we move) is directly dependent on the quality of our proprioceptive input. Computer programmers have a saying for bad software: Garbage in equals garbage out. If the code (proprioceptive input) you place in your software isn't accurate, your program (your movement) will crash.

Another contributing factor to this thoracic flexion example is that tight muscles have a low irritability threshold. They will become active or overactive during instances when they are not the prime movers. Janda did a study in which subjects with lower back pain were given abdominal curl up exercises. EMG recordings of the lower back erectors showed that these lower back muscles actually fired prior to the abdominals at the initiation of the curl up. Does this imply that the subjects' lower back musculature contributed to lumbar flexion? Absolutely not. Instead it demonstrated the low irritability threshold of this muscle group. The individual who is represented by the example in Figure 2 would likely be tight through the muscles of the chest and anterior shoulder. With the upper extremities placed in a weight bearing position, these muscles immediately became the dominant stabilizers.

You may repeatedly tell your client to engage the abdominals and allow the thoracic spine to passively drop into extension and they can't. They might be able to do one or the other but not both. And they certainly can not do this on an unstable apparatus.

Prior to putting your client in the position of Figure 1, use a modification of the exercise (i.e., Prone Plank on Knees, Elbows on SB). This exercise reduces the overall demand on the body by shortening the body as a lever. In addition, the gravitational vector pulling the pelvis into an anterior tilt is lessened. With the elbows flexed on the ball the individual’s use of the biceps for stabilization is minimized. This improves their ability to extend the thoracic spine and reduce the tendency toward scapular abduction.

What happened in Figure 2 can in fact happen with any exercise or any movement. But because of the way the industry has gravitated toward core training, it is very important for health and fitness professionals to understand that that the application of an exercise categorized as addressing the “core” does not give one cart blanche to use it with anyone anywhere at anytime.

I am continually asked by professionals at my seminars about this stabilization exercise or that stabilization exercise. It is usually a "sexy" new exercise that they saw at a workshop or in a magazine. And my first question is: "For who?" And my second question is: "For what?"

Responding with a question is my attempt to have the individual realize the uniqueness of each and every one of his or her clients. And the only way to differentiate uniqueness is to assess. A simple postural screening can provide a wealth of information to begin the assessment process. This combined with extensive health history is an excellent starting point. Of course, what you do with the information gathered is what really counts.

In Part 2, I will expand on the need for using corrective exercises for all of your clients, regardless of their current level of musculoskeletal health.

References: Anthony Carey

Forwarded By, Natalie Pyles

Call Me For Your FREE Consultation Today! 1-800-681-9894 or e-mail fitnesselementsassociates@yahoo.com

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Health & Fitness Expert, Nutrition Expert, Wellness Coach, Author, Speaker

"Corrective Exercise Is Functional - Part 3"

This article is a continuation from Part 2....

Kinematic Redundancy

Kinematic redundancy is the ability of the kinetic chain to complete a movement task using numerous combinations of joint motions and levels of contribution from various muscles. This is evident even in a motion as repetitive as walking. If we were to evaluate sophisticated gait analysis data (ground reaction forces, EMG, joint angles and displacement), we would see that no two sequential strides are exactly alike. There are patterns and ranges within the data, but they will not be exactly alike. Interestingly, those ranges could involve desirable kinematics or undesirable kinematics. Just because a motion falls with a given kinematic range does not mean that it’s the range we want.

With kinematic redundancy, the more variables (i.e., joints) involved, the greater variability in the muscle activation pattern and greater variability of motion at the involved joints. A standing one arm cable row with lunge, for example, could produce different responses on each repetition at both ankles, knees, hips, lumbar spine, thoracic spine, scapulo thoracic joint, gleno-humeral joint, elbow joint, radio-ulnar joint, wrist and even the interphalangeal joints.

This presents a challenge for the fitness professional who assumes the client is engaging the appropriate muscle groups at the optimal time in the movement sequence with the optimal force contribution. In the one arm cable row, the goal would be to extend the ankle, knee and hip of the front leg prior to extending the lumbar spine. This allows the gluteus maximus to fire and contribute to force closure, along with the contralateral latissimus dorsi of the S.I. joint. The preferred firing sequence of the involved muscles produces the desired movement sequence.

If the lumbar spine extends prior to the hip, the desired stability from the gluteus maximus is late. Lumbar extension prior to hip extension increases lumbar stresses and places the lumbo-sacral region at greater risk of injury. If the fitness professional is not accurately assessing these motions during the exercise, the “functionality” of the exercise is questionable.

Another biomechanical consideration is that of limited motion in a link of the involved chain. Limitations in motion of one joint in the involved chain will transfer the responsibility to another joint, and motion will occur first in a more flexible joint. The body will produce motion at the more mobile segments in the chain first. For example, in our cable row, if the client is kyphotic, during the eccentric phase of the exercise, the thoracic spine will flex prior to the hips and lumbar spine. This decreases the mechanical line of pull of the thoracic extensors with tendinous attachments on the lumbar spine and thereby reduces their contribution to lumbar stability. It then increases stress on the passive soft tissue structures of the lumbar spine as the flexion moment is more concentrated in the lumbar spine because there is no flexion left to give in the thoracic spine.

A corrective exercise program that addresses these dysfunctions by improving thoracic extension and proprioceptive awareness of spine/hip motion can enhance the overall quality of the more integrated movement.

Myofascial Slings

The gluteus maximus is linked with the contralateral latissimus dorsi via the thoraco-dorsal fascia making up the Posterior Oblique System. The Posterior Oblique System is one of multiple myofascial slings present in the human body. Recent advancements in the understanding of force transmission through muscle, fascia bone, tendons and ligaments have shed new light on how the body maximizes mechanical efficiency through these slings. Thomas Myer’s book “Anatomy Trains” is an excellent resource on this topic.

A myofascial sling is formed when any of the previous mentioned structures (i.e., muscle, fascia, etc.) lie in series and parallel to one another. They are anatomically connected and functionally related. Myofascial slings can cross multiple joints and can be “active” during certain movements and “inactive” during other movements based on the relationships of the body parts during the given movement. They allow the body to store kinetic energy from ground reaction forces in motions like walking or the above cable row example when the trunk and arm are rotated in one direction and the contralateral hip and pelvis are rotated in the opposite direction. When they contract, they act as one continuous muscle. This provides the body with an enormous advantage for stability and force production. The Posterior Oblique System literally connects the hip and opposite shoulder. Other myofascial slings throughout the body will be active in the sagittal plane, frontal plane and transverse plane motions.

The structures that give myofascial slings a mechanical advantage may also contribute to disruption of normal movement patterns. Any dysfunction in one part of the sling will have an effect on the rest of the sling. For example, we often see clients with shoulder girdle issues that are directly related to hip issues on the opposite side of the body.

In our cable row, if the dysfunction in the posterior hip was not addressed prior to performing this exercise, the resulting muscle activation patterns would be much different at the shoulder girdle than expected. This would stress the lumbar spine as previously mentioned but would also increase stress on the entire upper extremity of the rowing arm due to poor ground reaction force transfer from the lack of contralateral hip stabilization.

Corrective Exercise Application

I use corrective exercises prior to introducing the cable row to promote the desired movement sequence and minimize an environment for compensation. The number one purpose behind using corrective exercises is to improve the quality of overall movement, not to isolate joint movement or a muscle or produce artificial movement. Cognitive processing is used to reinforce movement patterns by accessing another part of the brain during the execution of the exercise.

Corrective exercises create the road map for the body to follow on its route to producing improved movement patterns. The fundamental goals of the corrective exercise program to enhance movement are:

* Activate latent muscles
* Release hypertonic muscles
* Create proprioceptive awareness of enhanced segmental motion
* Improve postural alignment and the body’s center of gravity
* Improve osteokinematics and the path of the instantaneous center of rotation of the joints
* Functionally integrate the responses across multiple segments in the kinetic chain
* Create a baseline for improved movement strategies

This methodology of corrective exercise follows the well established motor learning approach of "segmentation." Segmentation consists of taking a complex movement and practicing it in small parts. The small parts are progressively linked together, producing the more complex skill. Segmentation is similar to Keel’s Gearshift Analogy. When learning to drive a stick shift, initially each of the individual actions are independent motor tasks. With practice, similar tasks are linked together, decreasing the overall number of tasks. Eventually, the process is automatized and becomes one independent motor task, allowing the driver to add other tasks involved with driving (i.e., turn signals, climate control, etc.)

When working with clients and athletes that have active symptoms or chronic injuries, corrective exercises allow the fitness professional to progress the client safely. Corrective exercises avoid end range loading of joints and exceeding tissue tolerance thresholds. Exercises are progressed as the client successfully meets the objectives within the exercise program. If a client is apprehensive, unable to perform an exercise or the exercise produces pain, the exercise can be changed with less chance of injury.

In a more comprehensive and loaded exercise from the FR, there is a much smaller “buffer” zone. If an unsafe exercise is mistakenly given, the risk of injury is much higher. If a client has been asked to do a transverse plane lunge with an ankle level reach and their lumbar facets didn’t cooperate, the damage would be done if the client could not control the acceleration of his body. You can’t “un-ring” the bell. If an unsafe corrective exercise is mistakenly given, the movements are slow enough and the ROM is controlled enough to allow the client to stop the exercise before any damage is done.

All exercise is about manipulating the environment to produce a desirable change in the client or athlete. Sometimes that requires going backwards to ultimately move forward. We cannot mistake being effective for being efficient. Corrective exercises are functional because they are part of the safest and most influential continuum for many clients and athletes.

We should be cautious in adopting a single thought process that is applied to all our clients and athletes all of the time. And we should be equally cautious not to discount the value of other thought processes being used by others. Because one will soon discover that the process that they have become dogmatic about, will not work for all of the people all of the time. The true craftsman always chooses the best tool for the job... not his favorite tool.

Corrective exercises should not be left out of the conversation on “function” just because at first glance they don’t look like an activity of daily living or an athletic movement. If the result of a corrective exercise sequence is transferable to improvements in activities of daily living or athletic movements, then there is a functional result. And a functional result is the ultimate goal.

References:

1. Babyar SR: Excessive scapular motion in individuals recovering from painful and stiff shoulders: causes and treatment strategies, Physical Therapy 76:226, 1996
2. Brooks, VB The Neural Basis of Motor Control. New York: Oxford University Press 1986
3. Edgerton, VR., Wolf, SL., Levendowski, DJ., Roy, RR. (1996). Theoretical basis for patterning EMG amplitudes to assess muscle dysfunction. Medical Science in Sports and Exercise 28: 744-51.
4. Hungerford B, Gilleard W, Hodges P 2003 Evidence of altered lumbopelvic muscle recruitment in the presence of sacroiliac joint pain. Spine 28(14):1593
5. Jeansonne, J, (2004). Motor skill learning looks beyond outcomes. Biomechanics Magazine Online. Retrieved June 2004.
6. Keele, S.W. Summers, JJ (1976). The structure of motor programs. In G.E. Stelmach (Ed.), Motor control: Issues and Trends (pp. 109-142). New York: Academic Process.
7. Lee, Diane (2001). An Integrated Model of Joint Function and Its Clinical Application. 4th Interdisciplinary World Congress on Low Back and Pelvic Pain. Montreal, Canada, 137-151.
8. Laskowski ER, Newcomer-Aney K, Smith J, (2000). Proprioception. Physical Medicine and Rehabilitation Clinics of North America. May;11(2):323-40, vi.
9. Magill, RA, (2001). Motor learning: Concepts and applications. New York. McGraw-Hill, 2001
10. McGill, Stuart (2002). Low Back Disorders: Evidence-Based Prevention and Rehabilitation. Champaign, IL. Human Kinetics.
11. Myers, T. (2001). Anatomy Trains: Myofascial Meridians for Manual and Movement Therapists. New York, NY: Churchill Livingston.
12. O’Sullivan PB, Twomey LT, Allison GT. (1997). Evaluation of specific stabilizing exercise in the treatment of chronic low back pain with radiologic diagnosis of spondylolysis or spondylolisthesis. Spine;22:2959-67
13. Anthony Carey

Forwarded By, Natalie Pyles

Fitness & Nutritional Expert, Author, Speaker

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"Corrective Exercise Is Functional - Part 2"

This article is a continuation from Part 1....

Although working with clients in pain for the purpose of “treating” or “fixing” their pain is outside the scope of practice of the fitness professional, this does not mean that our clients do not have active symptoms. Many clients feel they have exhausted treatment options or have plateaued with their care. Managed care and capitation that has limited visits for physical therapy has created a new demographic seeking personal training. Add the aging baby boomer generation and the health history profile of many personal training clients is increasingly more complex. These individuals still want to be healthy, physically active, functional and productive. The appropriate training progressions can help them do that.

There is a critical point here I would like to emphasize. In my observations, many fitness professionals have adopted the "Far Right (FR)" philosophy, not recognizing the full complement of tools that a physical therapist or chiropractor - who also uses the FR philosophy - utilizes as part of their intervention. Aside from having a more in-depth education on joint mechanics, tissue tolerance, etc., physical therapists and chiropractors also apply joint mobilization, joint distraction, manual resistance and even orthotics to enhance what they will do with fully integrated, multiplanar exercises.

Following comprehensive assessments on their patients, these medical professionals will use these various other “tools” to prepare the patient’s body for fully integrated, multiplanar exercises. These tools are used to address dysfunctions at the local level to improve the global response. The fitness professional who applies exercise strategies from the FR philosophy without addressing the local segmental dysfunctions first provides the body an environment to perpetuate compensatory movement patterns.

The appropriate application of corrective exercise can produce benefits similar to many manual interventions. In fact, from a motor learning perspective, the benefits of corrective exercise can be even superior to manual intervention because the client can reproduce the benefits independently of the health professional. This allows for more frequent and proactive changes by the client that can not occur with manual interventions performed two or three times a week. This is assuming the fitness professional has the prerequisite knowledge of functional anatomy and application of specific corrective exercise.

A fitness professional who does not assess musculoskeletal function or who does not have a thorough understanding of the results of an assessment may incorrectly believe that getting an exercise done is the same as getting an exercise done right. Or that if an exercise does not produce immediate pain, it is not doing any harm. The reality is that cumulative mechanical stress from inappropriately applied functional exercises is the same as cumulative mechanical stress from any other activity.

Proprioceptive Flow Following Injury

The ligaments and joint capsules contain mechanoreceptors that provide feedback on joint position and acceleration. Certain mechanoreceptors also contain pain receptors. When a ligament or the joint capsule is injured, the amount and quality of proprioceptive information is reduced. During the healing process, scar tissue forms. The properties of scar tissue are not the same as the original ligament tissue. Therefore, proprioceptive information remains reduced, unless the injury was followed by a comprehensive rehabilitative process that challenged the local proprioceptive system.

Unless you are working with high level athletes, how many of your clients have gone through comprehensive proprioceptive training following an injury? Many people won’t even go to a doctor for a diagnosis following a sprain, never mind therapy.

Muscle spindles will adapt to injury as well. Edgerton et al. studied the muscle activation of spinal muscles during a variety of motor tasks in whiplash patients. Their research showed an under activity of agonists and over activity of synergist. They concluded that the nervous system can detect a reduced capacity to generate force from a specific muscle or muscle groups and compensate by recruiting more motor neurons. This compensation is achieved by recruiting more motor units from an uninjured area of the muscle or from other muscles capable of performing a similar task (synergist).

Babyar looked at a population that had experienced shoulder pain. As part of the patient’s compensation strategy, they elevated their scapula when the arm was raised. Patients were reevaluated after the shoulder pain was gone. Babyar observed that the scapular elevation continued even in the absence of pain.

Janda also describes muscles that have a low irritability threshold. These are posturally shortened and hypertonic muscles. These muscles will create a bias of the motor neuron pool and are prematurely active (or overactive) and exert inappropriate influence on selected movements.

Interestingly, joint range of motion (ROM) may return to pre-injury levels after the ligament or joint capsule heals. But ROM does not correlate directly with proprioceptive flow from the mechanoreceptors. Therefore, even if a previously injured joint has normal ROM, it may not be “feeding” the necessary proprioceptive information to the CNS during activity. Our internal feedback systems are based on the quality of the proprioceptive information we receive. Therefore, poor proprioceptive flow from the periphery will negatively affect the quality of the motor response based on that poor proprioceptive information.

For example, the client or athlete with a history of ankle sprains that were never rehabilitated properly will have poor proprioceptive flow from the damaged ligaments. The body will not sense the “stuck” talus that is inhibiting adequate dorsi flexion during midstance in gait. The body unconsciously figures out the best way to maintain equal stride lengths is by prematurely lifting the heel on the affected side during the stance phase. This creates biomechanical changes at the hip and lumbar spine.

Also associated with joint injuries are two muscular responses resulting from disruption of the joint integrity. Both are unconscious and neurologically based. One response is reflex spasming. This is a response to pain in which the muscles splint via co contraction around the joint to protect it by reducing movement and minimizing additional damage. Motion required at the protected joint must be transferred to joints proximal and distal to the protected joint.

An alternate response by the CNS is reflex inhibition. This is the complete opposite of spasms. As the result of the arthrogenic reflex, the muscles surrounding the joint become inhibited. This often follows distention of the joint due to effusion (swelling). Inhibition prevents the body from using that joint, thereby avoiding any potential additional harm. Biomechanical compensation is therefore necessary to compensate for the weak link.

An often overlooked example of this is the role a blocked sacroiliac (SI) joint has on the function of the ipsilateral gluteus maximus, internal oblique and multifidus. If the appropriate movement of the sacrum on the innominate does not occur, the activity of these three vital lumbo-pelvic stabilizers is delayed due to inhibition by the CNS. Force production is secondary to appropriate timing of muscle activation for joint stabilization. The role of the SI joint is critical in load transfer of forces from the ground to the upper body. Poor load transfer through the SI joint requires compensatory reactions at the knee, hip and lumbar spine, compromising optimal lumbo-pelvic stabilization.

Therefore, it is questionable if, for example, an anterior lunge with the trunk flexed forward can improve gluteus maximus function if the SI joint is blocked on the same side. According to Hungerford’s study, there is more likely to be an earlier onset and increase in activity of the biceps femoris, also a hip extensor. Clearing the SI joint with the appropriate corrective exercises prior to lunging will facilitate appropriate timing of gluteus maximus function in the lunge.

Stay tuned for the third and final part of this series... coming soon!

References:

1. Babyar SR: Excessive scapular motion in individuals recovering from painful and stiff shoulders: causes and treatment strategies, Physical Therapy 76:226, 1996
2. Brooks, VB The Neural Basis of Motor Control. New York: Oxford University Press 1986
3. Edgerton, VR., Wolf, SL., Levendowski, DJ., Roy, RR. (1996). Theoretical basis for patterning EMG amplitudes to assess muscle dysfunction. Medical Science in Sports and Exercise 28: 744-51.
4. Hungerford B, Gilleard W, Hodges P 2003 Evidence of altered lumbopelvic muscle recruitment in the presence of sacroiliac joint pain. Spine 28(14):1593
5. Jeansonne, J, (2004). Motor skill learning looks beyond outcomes. Biomechanics Magazine Online. Retrieved June 2004.
Keele, S.W. Summers, JJ (1976). The structure of motor programs. In G.E. Stelmach (Ed.), Motor control: Issues and Trends (pp. 109-142). New York: Academic Process.
6. Lee, Diane (2001). An Integrated Model of Joint Function and Its Clinical Application. 4th Interdisciplinary World Congress on Low Back and Pelvic Pain. Montreal, Canada, 137-151.
7. Laskowski ER, Newcomer-Aney K, Smith J, (2000). Proprioception. Physical Medicine and Rehabilitation Clinics of North America. May;11(2):323-40, vi.
8. Magill, RA, (2001). Motor learning: Concepts and applications. New York. McGraw-Hill, 2001
9. McGill, Stuart (2002). Low Back Disorders: Evidence-Based Prevention and Rehabilitation. Champaign, IL. Human Kinetics.
10. Myers, T. (2001). Anatomy Trains: Myofascial Meridians for Manual and Movement Therapists. New York, NY: Churchill Livingston.
11. O’Sullivan PB, Twomey LT, Allison GT. (1997). Evaluation of specific stabilizing exercise in the treatment of chronic low back pain with radiologic diagnosis of spondylolysis or spondylolisthesis. Spine;22:2959-67

12. Anthony Carey

Forwarded By, Natalie Pyles

Fitnes & Nutritional Expert, Author, Speaker

Call me For Your FREE Cosultation & FREE Report Today! 1-800-681-9894 or visit WWW.MyFitnessElements.com

"Corrective Exercise Is Functional" - Part 1

"The only thing that interferes with my learning is my education." - Albert Einstein


As the evolution of the fitness industry continues, perhaps one of the greatest benefits to emerge is the “discussions” it has generated. With all of the gains in research that have expanded our understanding of human anatomy and physiology, there are still vast differences in the interpretation and application of the available information. And this is understandable, since that is the nature of research meeting practical application.

Perhaps no other topic has created more “discussion” than that of function and functional training. And with the overwhelming varieties in human bodies and what they are used for, is it any wonder?

Corrective exercises are of growing interest in the fitness industry, and they are part of this discussion on function. This three part article will attempt to provide a clear understanding of what corrective exercises are and demonstrate the vital role they play in the functional continuum.

The approach and application of corrective exercises I use and teach are often quite different than the perception many professionals have on the topic. This article will further differentiate the functional contribution this approach and application has to optimal health and performance.

I am a proponent of and use all forms of what most consider functional training. This includes but is not limited to multiplanar movements using multiple segments as well as unstable surfaces. But perhaps instead of calling it functional training, we should call it training for function since function is ultimately defined by the individual. This may seem like pure semantics, but it is not. Functional training implies a specific mode of training. Training for function implies an objective.

Corrective Exercise vs. Post Rehab Exercise

It may be useful to first draw a distinction between corrective exercise and post rehabilitative exercise. Corrective exercises are not dictated by symptoms or a current pathology. They are based purely on positively influencing the neuromusculoskeletal system. Exercises will always involve areas of the body far removed from the site of pain or past injury. In a symptomatic client such as those I work with, the symptoms do not dictate what we do. They only place certain limitations on what we do because we do not want to exacerbate the symptom(s).

Post rehabilitation exercises are dictated by a specific objective related to prior treatments by a licensed medical provider following an injury or medical intervention (e.g., surgery). Technically, a fitness professional should not be doing post rehab without directives from the treating professional. Post rehab is most commonly a continuation of the medical providers’ treatment plan.

Post rehabilitative exercises are often body part or quadrant specific. For example, post rehabilitative exercises for a knee procedure would include attention to the quadriceps and hamstrings. And then ideally, it would include the joints above and below the effected knee (ankle and hip).

As the outcomes of the post rehab plan are met, it would be prudent to move on to a more global corrective exercise strategy, realizing that any disruption to the motor system will have consequences far removed from the site of the procedure or pathology.

Whose Function?

Two questions that always drive my training paradigm are: “For whom?” and “For what?” When we ask these two questions, differing philosophies on function inevitably move closer to common ground. Once we’ve answered these two questions, in order for our training approach to be functional, it must be transferable to the unique characteristics and needs of that client/athlete.

To further expand and perhaps cloud the discussion on function, I’ll use one of my clients with chronic lower back pain as an example. This woman can not sit for more than 15 minutes and can no longer work. For her session, I dance around her in a dimly lit room waving incense and singing The Smiths’ song “Girlfriend in a Coma.” She finishes our session with no back pain and proceeds to drive for two hours to Los Angeles still pain free. Was that a functional training session? If you asked my client, she wouldn’t care. She had a functional outcome.

And that may be a critical point: function is determined by output and not necessarily input. In the hypothetical example, the client’s back pain would not be gone long unless it was completely psychosomatic. Therefore, an appropriate functional exercise program would follow.

But what is functional for this client and at this point in her progression? Here is where the divergence occurs in philosophies. One end of the spectrum might involve floor work that is purely cognitive driven motor re-education. We’ll call this the Far Left (FL) of the spectrum. The other end of the spectrum would include completely vertically loaded multi planar exercise including squats and lunges. We’ll call this the Far Right (FR) of the spectrum. Which is “right” or more effective?

I believe they both are. I believe that they are not mutually exclusive and are both in fact part of the total functional continuum. The goal ultimately is to minimize cognitive input and move to the far right of the continuum as quickly as the client is capable. “Capable” means the client has demonstrated a level of competency (quality of movement, stability, endurance, etc.) that justifies moving her to the next stage in the continuum.

There are many practitioners who would agree with me on this, and this approach is supported by many researchers (including McGill, O’Sullivan and Lee) in the area of spinal rehabilitation. But what many practitioners don’t realize is that the continuum I am speaking of does not necessarily span weeks or months. It spans minutes.

Why Corrective Exercise?

When used with specific functional objectives in mind, corrective exercises can be progressed to multiplanar and/or proprioceptively challenging exercises within a given one hour session. This is what I do every day. I use corrective exercises to create an environment where the client can be most successful, performing exercises that are vertically loaded, multiplanar and/or on labile surfaces.

The body is cued to move differently through the stimulus of the corrective exercises. The corrective exercises are ascended, progressively linking together more complex movements. Even as the program is progressed to movements of the FR, we continue to apply exercises that challenge the client’s individual functional needs versus generic multi planar exercises. By following this programming strategy, we facilitate changes to the individual’s biomechanical constraints and motor control strategies.

Corrective exercises are applicable to every client and athlete. They are not limited to clients currently experiencing pain. We can be reasonably confident that most, if not all, of your clients have been in pain at some point in their lives. Show me a client or athlete older than 15 years of age who has never had an injury that created pain avoidance, and I’ll show you someone with a very short memory.

Pain is the single greatest stimulus to enter our body. Through resulting changes in the central nervous system (CNS), the influence of pain is reflected in biomechanical characteristics. Even if pain is no longer present, its effects are. To quote Doctor Janet Travell, the former White House physician and pioneer in trigger point work: “Tissues heal, but muscles learn. They readily develop habits of guarding that long outlast the pain.”

Pathological or disrupted proprioceptive information from the periphery (skin, muscles, joints, tendons, connective tissue) results in functional, adaptive processes through the whole motor system. The symptoms might be felt locally, but the response is experienced globally.

Far Right (FR) on the Functional Continuum

The FR approach has its basis in stimulating the proprioceptive system through “natural” movements that most often require eccentrically controlling gravitational forces. This elicits an appropriate concentric contraction to overcome gravitational forces such as in walking or to produce acceleration and power for a movement such as throwing. The mass and momentum of various body segments are manipulated through verbal instruction from the trainer or therapist to dynamically produce desirable biomechanical reactions of other muscles and joints. For example, changing the orientation of the trunk in a lunge relative to the gravity vector will alter the muscular and joint responses throughout the body.

For these reasons, the FR approach elicits a more integrated and higher level of musculoskeletal function than a floor based, cognitive approach that is to the far left (FL) of the continuum. Assuming the client’s existing biomechanical constraints have responded to the designed stimulus (exercises), the CNS is able to assimilate a more comprehensive catalog of improved movement strategies.

The FR approach assumes, however, that the proprioceptive system will respond in a predictable manner and thereby produce the desired biomechanical response. In the case of the client currently experiencing pain or with pain events in her health history, the proprioceptive system may be “rewired.” And even in cases where the dysfunction is pre-pathological, adaptations/compensations are already underway that will eventually lead to exceeding tissue tolerance and manifesting as regional symptoms.

It can also be argued that exercises from the FR actually use more cognitive processing than the appropriate application of corrective exercises. The complexities of many of the multiplanar, multi joint exercises are completely foreign to many people’s motor systems and are therefore novel movements. This unfamiliar exercise requires a higher level of cognitive processing to both understand and execute than a corrective exercise would. The more complex the unfamiliar movement is, the more likely it will initially produce inefficient co-contractions at many joints, potentially blocking degrees of freedom at those joints. This results in stiff and awkward movement patterns.

Even if the desired proprioceptive response is produced in the CNS, the body must still deal with any possible biomechanical constraints (myofascial adhesions, trigger points, scar tissue, osseous obstructions, etc.). Excitation of the motor nerve from the spinal cord determines how frequently the muscle is excited, but how it actually contracts and relaxes is determined by the properties of the muscle tissue.

Stay tuned for Part 2 of this fascinating series... coming soon!

References:

1. Babyar SR: Excessive scapular motion in individuals recovering from painful and stiff shoulders: causes and treatment strategies, Physical Therapy 76:226, 1996
2. Brooks, VB The Neural Basis of Motor Control. New York: Oxford University Press 1986
3. Edgerton, VR., Wolf, SL., Levendowski, DJ., Roy, RR. (1996). Theoretical basis for patterning EMG amplitudes to assess muscle dysfunction. Medical Science in Sports and Exercise 28: 744-51.
4. Hungerford B, Gilleard W, Hodges P 2003 Evidence of altered lumbopelvic muscle recruitment in the presence of sacroiliac joint pain. Spine 28(14):1593
5. Jeansonne, J, (2004). Motor skill learning looks beyond outcomes. Biomechanics Magazine Online. Retrieved June 2004.
6. Keele, S.W. Summers, JJ (1976). The structure of motor programs. In G.E. Stelmach (Ed.), Motor control: Issues and Trends (pp. 109-142). New York: Academic Process.
7. Lee, Diane (2001). An Integrated Model of Joint Function and Its Clinical Application. 4th Interdisciplinary World Congress on Low Back and Pelvic Pain. Montreal, Canada, 137-151.
8. Laskowski ER, Newcomer-Aney K, Smith J, (2000). Proprioception. Physical Medicine and Rehabilitation Clinics of North America. May;11(2):323-40, vi.
9. Magill, RA, (2001). Motor learning: Concepts and applications. New York. McGraw-Hill, 2001
10. McGill, Stuart (2002). Low Back Disorders: Evidence-Based Prevention and Rehabilitation. Champaign, IL. Human Kinetics.
11. Myers, T. (2001). Anatomy Trains: Myofascial Meridians for Manual and Movement Therapists. New York, NY: Churchill Livingston.
12. O’Sullivan PB, Twomey LT, Allison GT. (1997). Evaluation of specific stabilizing exercise in the treatment of chronic low back pain with radiologic diagnosis of spondylolysis or spondylolisthesis. Spine;22:2959-67


Forwarded By Anthony Carey

By,

Natalie Pyles

Fitness & Nutritional Expert, Author, Speaker

Call me For Your FREE Cosultation & FREE Report Today! 1-800-681-9894 or visit WWW.MyFitnessElements.com