1. Orthopedic Conditions and Corrective Exercises

2. Back and Spinal Cord The biggest musculo-skeletal issue you will face as a trainer Most of your clients will currently have, or have had, back pain Why: –People are overweight and out of shape –People sit on their butts all day –No Core Strength –Limited Flexibility –Poor Posture –Bad Biomechanics

3. Low Back Pain (LBP) One of the leading causes of pain and disability Low back pain is a generalized term involving several different diagnoses, including but not limited to: –Disc dysfunction –Muscle strain –Lumbar spinal stenosis –Spondylolisthesis –Spondylolysis –Sciatica

4. Back Rehabilitation Surgical Treatments –Laminectomy –Fusion Non-Surgical Treatments –Rehab exercises –Injections

5. Vertebral Characteristics Vertebrae: –Vertebral Body –Vertebral Arch –Processes –Intervertebral Disks 20-30% of column length Two parts: –Nucleus Pulposus: central portion, 80% water, consistency of toothpaste –Annulus Fibrosis: tough outer layer that surrounds the nucleus pulposus

6. Movement Effects During Flexion: –Anterior portion of annulus fibrosis is compressed –Annulus fibrosis bulges anteriorly –Posterior portion is stretched i.e., rubber ball between wood blocks Under Compression: –Nucleus pulposus distributes pressure in all directions to annulus fibrosis –Pressure is transmitted to the vertebral bodies –Under high compressive forces DISK WILL RUPTURE!

7. Bad Biomechanics Disc Pressure Increases: –33% while sitting –33% while standing when slightly bent forward –45% while sitting when slightly bent forward –52% while standing when bent far forward –63% while sitting when bent well forward

8. Herniated Disk Herniated discs are also called protruding, bulging, ruptured, prolapsed, slipped, or degenerated discs Part of the nucleus pulposus makes its way through the outer annulus fibrosus, resulting in inflammation; this inflammation irritates the spinal nerve roots The client may feel pain in the back; or changes may occur in the lower extremities, including pain, abnormal sensation, and weakness When a client has a herniated disc, he or she should seek medical treatment

9. Herniated Disk http://www.youtube.com/watch?v=zEOlXm UeK7ohttp://www.youtube.com/watch?v=zEOlXm UeK7o

11. Preventing Disk Herniations Most disc herniations occur in 30 to 50 year- old people. Physical activity is a key to preventing injuries Consistent and rational exercise, maintaining good body weight, good posture, core stability and strength, and good nutrition all support good back health Accident prevention – is your body prepared for the activity you are about to do?

12. Herniated Disk Movement and Exercise Guidelines Clients are encouraged to avoid lumbar flexion to prevent the posterior protrusion of the disc material Resistance training contraindications may include full sit-up’s, while precautions may include the squat, all rowing movements, and the deadlift. Aerobic exercise precautions may include bicycle riding due to possible increased flexion with forward lean Contraindicated flexibility exercises include hamstring stretches emphasizing lumbar flexion (i.e. toe touch)

13. Diagnosis Movement Contraindication Exercise Contraindication Exercise Indication Disk InjuryLumbar Flexion Lumbar Rotation Sit-up Knee to chest stretch Spinal Twist Toe Touch Passive lumbar extension stretches Isometric abdominal and extensor strengthening progressing to lumbar stabilization program

15. Back Strain Strains to the muscles of the lumbosacral spine are common, and may have a variety of causes including direct trauma and overuse Retraining muscles to function in their designed manner will enable the muscle to work more efficiently Movement and exercise restriction is highly dependent on the muscle that has been strained For example: If erector spinae muscles have been strained, lumbar extension exercises and exercises requiring static maintenance (bent-over DB row and elliptical or stair-climber) should be avoided during the early phases of tissue healing

16. Diagnosis Movement Contraindication Exercise Contraindication Exercise Indication Muscle Strain Passive Lumbar Flexion (during inflammatory phase) Active lumbar extension (during inflammatory phase) Knee to chest stretch None during inflammatory phase, progressing to gentle flexion stretching, followed by extension strengthening

17. Vertebral Injuries Spondylolysis –A stress fracture caused by excessive or repeated strain involving the pars interarticularis –The pars interarticularis connects the vertebral body in front with the vertebral joints behind.

18. Vertebral Injuries Spondylolisthesis: –When one disc slips over another –Usually caused by a Spondylolysis

19. Vertebral Injuries Movement and Exercise Guidelines Clients should focus on strengthening the muscles surrounding the spine and should avoid exercises involving lumbar extension Most abdominal crunches are appropriate Exercises for transverse abdominis and obliques are recommended

20. Diagnosis Movement Contraindication Exercise Contraindication Exercise Indication Spondylolysis and Spondylolisthesis Lumbar extension Squat Shoulder press Push press Abdominal crunch Drawing In Knee to chest stretch Piriformis stretch

22. Spinal Stenosis Stenosis means narrowing Spinal stenosis is a narrowing of the spinal canal, which places pressure on the spinal cord People with spinal stenosis may feel pain, weakness, or numbness in the legs, calves or buttocks Individuals should seek Physical Therapy to help stabilize the spine, build endurance and increase flexibility.

23. Sciatica

24. Shoulder The shoulder has the greatest range of motion of all joints in the body –Higher injury risk Relationship between the Scapula and Humerus is key

25. Shoulder Conditions and Injuries Impingement Syndrome Biceps Tendonitis Rotator Cuff Tear Shoulder Subluxation/Dislocation Thoracic Outlet Syndrome –Neurological Issue

26. Shoulder Impingement Syndrome Also known as rotator cuff tendonitis or bursitis It is the pinching of the supraspinatus, the long head of the biceps tendon or subacromial bursa under the acromial arch What not to do: –Anything overhead –Most “pressing” exercises –Anything heavy –Be wary of “pulling” exercises What to do: –Focus on the specific scapular and rotator cuff muscles to re-establish shoulder stability –Gradually move back into general exercise program once pain subsides

28. Diagnosis Movement Contraindication Exercise Contraindication Exercise Indication Shoulder Impingement Syndrome Overhead with internally rotated shoulder Shoulder press Lateral DB raise with internally rotated shoulder Upright row Incline bench press Side-lying external shoulder rotation Prone shoulder extension Prone horizontal shoulder abduction Lateral DB raise with externally rotated shoulder and supinated forearm

29. Shoulder Rehabilitation Exercises

30. Anterior Cruciate Ligament Exercises following ACL reconstruction are an extremely important part of a person’s rehabilitation The function of the ACL is to control knee motion and provide proprioceptive feedback The ACL limits anterior tibial translation and rotation relative to the femur

31. Diagnosis Movement Contraindication Exercise Contraindication Exercise Indication ACL Reconstruction Open knee movements less than 45 degrees of knee flexion Leg extension performed from greater than 90 degrees of knee flexion to greater than 45 degrees of knee extension Leg curl Step-up Horizontal leg press with feet positioned slightly higher on platform Partial lunge ½ squat

33. Heel slide: Sit on a firm surface with your legs straight in front of you. Slowly slide the heel of your affected leg toward your buttock by pulling your knee to your chest as you slide. Return to the starting position. Do 3 sets of 10. Quadriceps isometrics (Quad Set): Sit on the floor with your affected leg straight and your other leg bent Press the back of your knee into the floor by tightening the muscles on the top of your thigh. Hold this position 10 seconds. Relax. Do 3 sets of 10. Rehabilitation Exercises

34. Hip Total hip arthroplasty is commonly termed a hip replacement Total hip arthroplasty movement restrictions include the following for 10-12 weeks after surgery: –No hip flexion greater than 90 degrees –No hip adduction past neutral –No twisting or pivoting the hip internally or externally –Do NOT cross legs at the knees or ankles when sitting, standing, or lying down Personal trainers should avoid high impact activities with their clients (running, plyometrics…)

35. Diagnosis Movement Contraindication Exercise Contraindication Exercise Indication Total Hip Arthroplasty Hip flexion greater than 90 degrees Hip adduction past neutral Hip internal rotation Resisted hip flexion Full sit-up Hip adduction machine Swimming Walking Elliptical trainer ½ squat Horizontal leg press

36. Hip Replacement Exercises

37. Ankle Inversion Ankle Sprain (80%) –Foot rolls in Rehab –Focus on strength and proprioception –Exercises Four-way band Proprioception

38. Ankle Sprain Exercises

39. Hand-Carpal Tunnel Syndrome Irritation of the median nerve at the carpal tunnel that causes tingling and numbness of the thumb, index and the middle fingers –The carpal tunnel - a narrow, rigid passageway of ligament and bones at the base of the hand that houses the median nerve and tendons.

40. Causes A congenital predisposition –Carpal tunnel is smaller in some people than in others. Trauma to the wrist that cause swelling –Sprain or fracture Repeated Motion –Typing, assembly line worker Vibrating hand tools Fluid retention during pregnancy

41. Carpel Tunnel Rehabilitation What not to do: –Heavy resistance training –Excessive wrist flexion/extension What to do: –Focus on flexibility Exercises –Supination, pronation, circumduction, radial/ulnar deviation –Finger extension and flexion –Opposition