If you have ever worked with a fitness professional or maybe contemplating hiring a fitness professional to help you there are certain questions and testing that should be carried out prior to any workout being designed or implemented.    This is a perfect opportunity to let you know what I, as a fitness professional, is looking for when I meet with a new client for the first time.  All my clients will go through the same assessment process.  Certain exercises may be omitted or altered if there is a physical limitation or problem that arises during our initial conversation.  So, let me take you through a typical first meeting that is done at our fitness studio.

Your first meeting with me is for your initial assessment.  During this time, I am asking a lot of questions regarding medical and exercise history.  We then will head into the gym for a series of exercises and tests.  I am going to go through the assessment process and in a future newsletter I will explain how I take the information garnered in the assessment and apply it to program design for your workout.

I usually start my assessment at ground level and work my way up.   I prefer to use a systematic approach to ensure that we cover all the bases and at times it will remind a client of an old injury or event that occurred in the past.  I will start by inquiring about any issues involving the feet or ankles.  This could range from anything like bunions to Achilles tendon injuries or ankle sprains or fractures.  Any of these would have implications in designing a program and exercise selection.  We do know that ankle sprains affect glute activation through possible nerve interruption.  The exact mechanism is not known yet, but it is evident that the glute muscle
on the side of the injury is quite often affected and for this reason, we will want to ensure that we add glute activation work in that person's program.

Moving up the ladder, I will address the knees.  Issues such as anterior knee pain, old injuries (meniscal tears, ligament injuries) or lateral knee pain are all very relevant and will influence the program and exercises used.  A lot of knee issues  can be the result of hip or ankle mobility problems, so I will take this into account when discussing location, severity and occurrence of knee pain.

Next I will address the hips and low back.  Sciatic pain, hip bursitis, low back pain are all areas that need to be addressed, discussed and evaluated during this initial assessment.  Working with an older population quite often will mean spinal stenosis, disc injuries, arthritic changes, degenerative changes – all of which are vital to know prior to both the rest of the assessment in the gym and the eventual design of the program.  Some clients will
arrive with x-ray reports, a physio report or a physician's note all of which must be discussed.

Following the lower body, I will move on and question the shoulders, neck, elbows and wrists.  Shoulder issues abound and a large percentage of clients will  have varying shoulder issues.  These range from impingement syndrome, rotator cuff injuries, capsule weakness or injury, decreased ROM due to calcium deposits.  The neck can be a constant source of pain and irritation for some people and the causes can be varied ranging from arthritic/degenerative changes in the cervical vertebrae to stress and constantly tight muscles.    Elbows are another area that a lot of people will have issues with.  With our very active lifestyles, elbow tendonitis is common.

Wrists and hands can be problematic in a lot of occupations with repetitive use activities resulting in carpal tunnel syndrome.  I will also quiz on family or personal history of heart disease, hypertension or diabetes.    I am also interested in your present activities both work and leisure related.    Repetitive use activities such as computer work, grocery store checkout, or even a golf pro will lend themselves to injuries or altered movement patterns due to the repetitive nature of their job.  Exercise history is also important as that will usually give me a good indicator of how your muscles will respond to the teaching of new movement patterns and also your tolerance of activity.

I will also go over medication history and request a list of present medications.  We do need to know of certain medications, primarily diabetic or cardiac medications that may have a bearing on your exercise tolerance and program safety.   Rounding out the interview part of the assessment is height, weight, measurements if requested or needed and resting heart rate and blood pressure.

We will also discuss in detail your goals, hopes and expectations of an exercise program.  Helping you to establish realistic and healthy goals can be an integral part of this first assessment.

The assessment process is an integral part of the overall plan for a new client.  After all if you don’t know where you are, don’t know where you want to go to – how will know how to get there.  I use the assessment process as a road map for our fitness journey.  We have a starting point, we have established our destination or goal,  and from that we will determine our planned route.

The assessment is part of the blueprint for fitness success.  Without it, no plan is possible.

Till next time,

Narina

“Monitoring, Mentoring, Motivation”

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In our last newsletter, we discussed mobility vs flexibility and how our bodies are a collection of joints, some requiring mobility and others requiring stability.  We covered the need for mobility through the ankle and the hip.  In this newsletter we are going to talk about knee stability, thoracic mobility, and shoulder health.

The knee demands stability.  The knee as a joint has very little rotational ability.  It's movement is basically that of a hinge.  Basic movements that require this hinging movements of the knee are squats and dead lifts.  Most issues involving pain in the knee are usually the result of a dysfunction either above or below.    Solve the ankle mobility problem and a lot of knee issues will clear up.   Start looking at mobility of the hip and the knee will benefit.

The thoracic spine or mid back area is not as well studied yet as some of the other areas such as hips, lumbar spine and knees.  It is however, proving to be a critical component in maintaining a healthy lumbar and cervical spine.   For the golfers out there, this is especially important.  In the golf swing you need you need to be able to separate the upper body from lower body.  During the backswing your pelvis needs to be stable allowing the shoulders to turn.  If you are unable to separate the upper and lower body, you will be limited as to how much shoulder turn you can perform.  This is where thoracic mobility is important – to allow movement through the back while keeping the pelvis stable.

Last but not least is the shoulder or gleno-humeral joint.   Also closely connected to the health of the shoulder is the area of the shoulder blade (the sacpulo-thoracic joint).  You cannot discuss shoulder health without talking about the stability of the shoulder blades which directly reflects the health of the rotator cuff.  The scapula, rotator cuff and shoulder is an area that whole exercise physiology textbooks are written about.  In order to have a shoulder that allows mobility, you need to have a stable base first.    Without a stable base provided by the scapular muscles, the shoulder joint can become quite immobile, causing decreased range of motion and pain. 

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The scapular stabilizers (lower trapezius, rhomboids, serratus, levator scapula) are responsible to hold and lock the shoulders in the right position for the shoulder to function properly.    Some of the exercises that we use to strengthen these various muscles are as follows.  All rowing movements will help to strengthen the trapezius and rhomboids.  We will instruct clients to pinch the shoulder blade prior to initiating any rowing movements.  When you pinch your shoulder blades together, the rhomboid muscles in the middle of your upper back activate.  These muscles originate along the spine (C7 and T1) and then attach themselves to the inner border of your shoulder blades.  The pinching action will pull the shoulder blades together and this in turn with other muscles throughout the upper back and shoulder (rotator cuff) will cause the shoulder to sit in an anatomically correct position allowing proper function of the shoulder.

Other exercises that benefit the shoulder joint are the lat pull down and prone trap raise.  We also have variations along those exercises that we use (stiff arm pull downs, high pulley rows).   Often with these exercises we will instruct clients to “pull their shoulders to their hips”.  This prevents the shrugging so often seen with these exercises and once again helps to maintain the shoulder in a healthy position.  The muscles primarily responsible for this are the middle and lower trapezius.  The trapezius muscle is a large muscle that originates at the skull , the spine of C7 and all the thoracic vertebrae .  It then inserts along the rear of the shoulder, the scapular spine and part of the clavicle.  The  trapezius muscle's main responsibility is to keep the scapula down (no shrugging) and to maintain stability to allow shoulder mobility.

So, this is starting to turn in Anatomy 101 and I may have gotten a bit off track.  The scapular and shoulder, as I mentioned are worthy of a book on their own.  I am sure either you personally or someone you knows has had, does have or will have shoulder problems.  It is probably the most common problem we see in  and out of the gym.  And because of so much of what we need to do the keep healthy and strong, involves the shoulder, we much be diligent about the work necessary to keep the this joint healthy.

Till next time,

Narina Prokosch, RN CPT

“Monitoring, Mentoring, Motivation”

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Often during our warm up routines that we have our clients perform at the gym, clients will mention feeling a stretch in certain muscles during some of the drills.   This will then lead to an explanation of what it is we are hoping to accomplish during the warm up and what you should be feeling.   We go through several drills prior to a more dynamic warm up that will lead into the strength portion of your workout.  The drills are specifically designed to increase mobility through a joint.    You need a certain amount of mobility or the ability to move your joints through a normal range of motion.  But what is mobility and what is flexibility?

In a nutshell mobility is the ability of the joint to move through a range of motion and flexibility is the ability of the muscle to stretch to allow movement.  In this article we are going to deal with mobility.  Physical Therapist Gray Cook's (1) analysis of the body and its function is by means of a series of joints.  Each joint has a specific function and is prone to specific dysfunctions.  He devised a table that describes the body on a joint-by-joint basis from the bottom up:

Ankle Mobility
Knee Stability
Hip Mobility
Lumbar Spine stability
Thoracic Spine mobility (upper back)
Gleno-humeral stability (shoulder)

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As you can see from this chart the joints alternate between mobility and stability.  Injuries and problems occur when the joints lose the ability to perform their specific function be it mobility or stability.    For our clients we will go through ankle range of motion testing.  To do this we have clients kneel on the floor in a lunge position.  We then ask them to push forward with their knee over their toe, keeping the heel down.  We then used a stick from knee to ground to measure distance the knee moved past the toes.  We know that a good range of motion for the ankle is 4″ or more past your toe.  If your ankle lacks the mobility it needs, when  we ask you to perform exercises such as squats or lunges, you either will not be able to perform these exercises correctly , or you will get knee pain when you do perform them.  For this reason, we have included 3 specific ankle mobility drills (ankle rolls, knee to wall, toes on foam roller) in our warm up routine.  We also know in our own unscientific test that performing these ankle drills does work.  We had one client go from 1/2″ ankle mobility to 3″ ankle mobility in both ankles in a 3 month period.

The hips must be mobile in all planes of movement (front to back, side to side and rotational).  If the hip loses its ability to be mobile, you get low back pain.  Most lower back pain is not caused  by a weak back, it is most often caused by a tight and immobile hip.  To work on increasing hip mobility, we will go through a series of hip drills (leg swings front to back and side to side; wide squats).  With some clients we will also use a form of lunge on a block.  This exercise is called a dynamic warm up in that we are using body weight and a little momentum to increase the range of movement in the lunge.  We also use everyone's favorite exercise – the Bulgarian squat – to increase the hip's range of motion.

The lumbar spine or “low back” needs to be stable.  Great strides have been made in recent years in understanding the function of low back.  Shirley Sahrmann (2) and Porterfield and De Rosa (3)say that increasing range of motion through the lumbar spine isn't recommended and can be dangerous.  For our clients we do not do rotational exercises where the pelvis is staying locked and you are twisting side to side.   Our warm up at the very beginning of our program is rotating, but we also need  to ensure your whole hip and foot are rotating to the direction you are moving the ball.   So, the rotation is happening through the hip, not the lower back.  Also for you golfers, the cable chop exercise is also done rotating the hip and foot to the  direction you are moving.  In other words you are “leading with the hips” not the lower back or the shoulders.  

This should help explain the difference between mobility and flexibility and the need to have both.  But, ways to improve each of them are different.

Till next time,

Narina Prokosch, RN CPT

“Monitoring, Mentoring, Motivation”

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As trainers, we are  are constantly monitoring client form and how they perform each exercise.   We do have client safety in mind always, and ensure that you do exercises correctly to prevent injury.  But, we also want to make sure that the body is moving through movement patterns in correct form.  That is, recruiting the correct muscle fibers in the right number and in the right sequence to perform any given exercise.  I realize that this can be a bit difficult to picture, but our bodies are wired to perform movements in a certain way.  There are a multitude of reasons why it doesn't move correctly at times, and that is worthy of another article on its own.

I would like to focus briefly on a theory that I have subscribed to.  Paul Chek (1) (world-renowned rehabilitation and exercise specialist) hypothesized in his book "Movement That Matters" that human beings moved in what he calls Primal Patterns.  In fact, he developed a system of assessment for rehabilitation of his orthopedic patients called the Primal Pattern System.  He believes that "selective pressures of evolution must have resulted in human  anatomy that was specifically designed to meet the demands made by nature".  He also proposed that if one could not perform the basics of these patterns, then chances of survival would dwindle.

Paul Chek proposed that there are six main primal patterns – 1) twist pattern  2) pull pattern  3) lunge pattern  4) bend pattern  5) squat pattern  6)  push pattern.  In fact much of the functional training craze that has hit the gyms the last 5-7 years has stemmed from these basic movement patterns.

 
But the control of the muscles comes from the brain.  Schmidt (2) proposed that the brain stores "generalized motor patterns" and that each motor program can be used for groups of movements that have the same relative timing.  So, how does this science relate to your workouts?    It means that we basically all have the inborn ability to perform many of the tasks asked of us in the gym.   It is sometimes just a matter of putting it in the right context that the brain will understand.

For example, if I asked you to perform a squat and if you have never heard the word, you may not be able to perform the exercise correctly.  But, if I asked you to sit down in a chair, you would automatically put your hips back and sit down.  The same applies to the lunge movement.  If I asked you to perform a lunge, you may have trouble doing so correctly.  But, if I put a small block on the floor and asked you to step over you would do so without  hesitation.  This tells us that the brain stores patterns in different ways.    Depending on what we have done in the our past and what activities we currently do, that knowledge will help to determine the best way
to teach or learn a particular movement pattern .

Along that same vein, the brain stores movements in what are called n-grams.  It takes several thousand repetitions of a movement for the brain to store that pattern as an n-gram.  You can see why we strive so hard to get correct movement established early and why we always say 1 repetition done with correct form is far superior to several done with incorrect or faulty form.

Till next time,

Narina Prokosch, RN CPT

“Monitoring, Mentoring, Motivation”

(1) Chek, P.  Advanced Program Design, correspondence course.  A
C.H.E.K. Institute publication and production, 1998
(2) Schmidt, R.J.  Motor Learning and Performance.  Champain, KL:
Human Kinetics, 199.
C.H.E.K. Institute – Corrective High Performance Exercise Kinesiology

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