Preventive and postrehab exercise strategies for the backs and shoulders of part-time athletes who give it all they've got.
One of our favorite philosophies is to train not just to add years to our clients’ lives, but to add life to their years.
Traditionally people have aged prematurely from physiological and attitudinal perspectives. Today, however, with an arsenal of knowledge on health, wellness, nutrition and fitness, many people are redefining what is possible in these realms. Our expectations for activity levels are much higher. Pro athletes peak later in their careers and many play on the world stage into their 40s. Recreationalists train to compete throughout their 40s and 50s against themselves and others.
Still others continue to age prematurely because of sedentary lifestyles. Some weekend warriors attack specific events only to withdraw to a nominal fitness existence between events. For lifetime athletes, weekend warriors and the inactive resuming workouts and sport participation, injury prevention and rehablitation will always be important. Whether your clients are prone to injury or well conditioned enough to prevent it has as much to do with training style as it does the exercise variables available to keep each phase safe and effective.
Over the past three decades science and sweat have combined to help establish fitness protocols and guidelines that enable all people to enjoy the benefits of exercise and recreational activities well into their golden years. An ideal fitness program now focuses on retraining the body to move in different directions and speeds, and balances strength and flexibility, essentially creating a “younger,” more agile client.
Children run, jump, hop, skip and constantly move at different speeds and in different directions. Their bodies are agile, flexible, balanced and strong. They can physically accomplish most actions with few repercussions. But as adults we slow down, begin moving in only one direction (often simply up and down out of the desk chair and onto the couch) or we don’t move at all. Our adult bodies are more mature yet less functional as a result of static day-to-day routines that have chipped away at our physical childlike resiliency.
We all enjoy the intellectual wisdom we gain with age. Can it be too much to hope that perhaps our physical selves could follow suit? You and your clients might be surprised to discover that with proper training and some insight on the factors influencing incidence of injury, the body’s mind-muscle connections can likewise become smarter with age, building a more responsive, youth-like neuromuscular system.
Herein lies the challenge: A distinct difference exists between the demand placed on Office Joe versus Joe Athlete. While there may be times when the office is absolutely out of control, the stress it causes and the reactions needed to deal with it are very different from those encountered in a chaotic sports environment where read-and-react, combative play is the name of the game. Entering this environment unprepared can be rather unforgiving and the injuries substantial. Lack of recent, regular exercise, inappropriate exercise program design, resumption of sport activity and elite sport demands all play a role in the incidence of sport injuries.
Consider this scenario: A buddy invites your client, Office Joe, to partner up for tennis, squash, skiing, hiking, biking, running or surfing. Or perhaps the friend desperately needs a sub for his softball, soccer, hockey, basketball or lacrosse team. Knowing that Joe was once an outstanding player, he calls upon him to fill in. Pumped up about the opportunity to rekindle his “athlete of the year” performances from junior and senior high, Joe accepts the challenge. You now officially have a weekend warrior on your hands! How do you help Office Joe transition to Joe Athlete safely?
Sport places extreme demands on the body. Even highly tuned athletes become injured. The more a client challenges himself athletically, the closer he comes to reaching his body’s threshold. During multi-directional sports with unpredictable read-react-respond sequences, knees and adductors can lose the battle, most often from high speed and unexpected eccentric contractions.
Lower back pain is the most costly musculoskeletal disorder in industrial societies. Up to 80 percent of the population will suffer from low back pain over the course of a lifetime (Whiting & Zernicke 1998). The onset of such discomfort can be acute or chronic because of overuse and inappropriate movement strategies. Often low back problems result from inappropriate firing sequences within the core muscle group. Deceleration and absorption of external forces can overload the readiness level of lumbar back strength, placing undue stress on the spinal segments, leading to possible disk and vertebral problems. (For an indepth look at the lumbar spinal extensors, see the Fine Anatomy column in the September 2002 issue of IDEA Personal Trainer, pp. 52-55.)
The shoulder joint has great mobility, allowing the healthy individual 360 degrees of movement. However there is a balancing act between mobility and stability. Mobility compromises stability. Therefore, impact forces caused by collision or unexpected falls during contact sports can cause acute shoulder injury, as can falls to the body’s most versatile yet, least stable, joint. (For an indepth look at the shoulder, see the Fine Anatomy column on page 36 of this issue.)
The muscles of the core form the base of support from which movement forces are generated. Teaching clients proper activation sets the base for all future training and movement. The core works to connect the lower and upper extremities and allows the body to function as one comprehensive unit. While the core and lower back may initiate all movement through preparatory, muscle stabilizing contractions, its bony, ligamentous and fascial connections also influence movement of every body segment (Vleeming & Lee 2001). Whether postrerehabbing a bulging disc or sciatica, it is rare that consideration is given to how a previous injury (e.g. shoulder dislocation) and the resultant muscle imbalances, muscle firing patterns or postural misalignment (e.g. forward head posture) may cause core instability and force production inefficiencies during movement-based training.
Most movement-based training should begin with specific attention to proper firing sequences. Educating the core muscles will contribute to greater success (Mills et al. 2003); proper movement coordination; and reduced torsion to the pelvis (Lee 2001), vertebral column and shoulder. While a full understanding of linked system training is beyond the scope of this article, it is important to have a basic understanding of these mechanisms; it will better prepare you to design a more functional, athletic-based program for your clients. (For a complete explanation of linked system training, see “Extreme Measures,” IDEA Personal Trainer May 2003, pp. 26-38.)
Force closure is the muscle’s ability to contract and provide adequate joint stabilization through its connections to joints and surrounding bones (Lee 2001). Several ligaments, muscles and myofascial connections contribute to closure of the pelvis, spinal column and glenohumeral (shoulder) joint. The collective action of these tissues has been referred to as a self-locking mechanism (Vleeming 1990). When muscles are firing in proper sequence, forces between joints are controlled, allowing resistances to be transferred from the pelvis through the spine and into the upper body with maximum efficiency and without risk of serious muscle damage.
Creating a stable base involves an interaction between two muscle groups—the inner and outer units—within the lumbopelvic region. (Vleeming and Lee, 2001). The inner unit includes multifidus, the pelvic floor, transverse abdominus and diaphragm, all of which function to stabilize the lumbopelvic joint. The outer unit includes the mobilizers and links into both the lower body and upper shoulder girdle. The prime movers are divided into three subsystems of muscles: the posterior oblique, anterior oblique and lateral. These are the primary subsystems for rotational sports movements and they all connect the lower and upper body through the core in a contralateral, cross body pattern (see Table 1).
These muscles must work as force couples balancing the muscular activity coming from both sides of the joint. Think of these force couples in terms of agonist and antagonist. For example, when a muscle is signaled to shorten on one side of a joint, an opposing muscle helps prevent excessive lengthening. This means that when the posterior oblique system is contracted by a pulling movement, it is resisted by the lengthening of the anterior oblique system (see One-Arm Row Progression in “Suggested Exercises” for an example). This balanced operating system is recruited to provide corrugated sequential movement, making balanced flexibility and strength especially important.
All joints are designed to produce efficient movement. However, repetitive focus on just one side of a joint can cause the muscles on that side to become long and weakened, while those on the other side become short and strengthened. If the exercise program is unbalanced, the resulting joint misalignment increases risk of injury. Good program design will balance exercise volume and intensity on both sides of the joint and help prevent injury during recreational and sports activity.
The principles of specificity demand that the type of movement required for any sport or activity is best trained by performing these movements. Traditional weight training exercises that are slow and controlled will not help develop speed and power. In fact traditional machine-based muscle isolation training and body building-type exercises can predispose elite athletes and recreationalists to injury during full-body, multiplanar reaction-based sports. Exercise must train all links within the kinetic chain and challenge movement toward explosive force production (power initiation; braking forces or deceleration; and directional changes or coupling).
Strength training must include components of strength, mobility, stability, deceleration, movement initiation, explosive power, transitional balance and reactivity.
Successful exercise resumption, progression, sport preparation, prehabilitation and injury postrehabilitation are all highly reliant on exercise mechanics, tempos, movement patterns and lift phase emphasis. Whether he is a new exerciser or ex-athlete-turned-workaholic, train your client in much the same way you would train your postrehab client.
You can train your client to reinvent a childlike state of cognitive learning (Schmitt & Lee, 1999) by guiding him with slow and progressive movement patterns that reprogram his injury-prone body. Following the progressions on page 25 is one way to ensure that your healthy and recovering clients safely and effectively rekindle their youth athleticism.
Treating your weekend warrior client as if he is injured doesn’t mean that training is easy. On the contrary, especially during postrehab of back and shoulder injuries, cardiovascular challenge and maintenance are keys to a successful reintegration to sport. Increasing the amount of muscle and specific function required to perform each exercise will help contribute to a safe return to the playing field.
Higher expectations for what is possible physically and the desire to be active and soak up life are definitely positive mindsets. However aging Boomers who have adopted more sedentary lifestyles are at particular risk when they try to relive the glory days in one weekend.
Is your client truly prepared to deal with the stresses that retraining his neuromuscular pathways will demand? Probably not. The good news is, as his trainer you can do something about this. Your weekend warrior will want the latest sport specific, quick fix preparation techniques. Your knowledge of sport and a progressive step-by-step fitness program will take him from acclimation to sport readiness, transferring to a richer life and injury-free activity.