Programming For the Injured Client: Biological Considerations
Now that we know resistance training and aerobic activity must be consistently pursued in spite of setbacks, we must learn how to manage the injured client
Practical Application
Joe, or Jane, a 43 year old tech executive, “tweaked” their back high bar back squatting 165 lb for a 3x10. They inform you that they’d like to get back into back squatting as soon as possible, but are really apprehensive and nervous. There are no red flags and he has physician clearance.
The Program:
Come up with a once weekly 4 week program that includes high bar back squats in it. You have 1 hour a week, so choose the appropriate amount of exercises.
Upon assessment he has 7/10 pain 10 degrees above parallel during his squat. Two weeks later he can comfortably hit parallel at 3/10 pain. Program around this while still having Joe squat while not exceeding 4/10 on a 1-10 point pain scale.
This may mean that exercises change weekly as Joe can tolerate deeper squats.
Include: Each session and exercise RPE goal(1-10), Total Weekly Volume((Reps + sets)RPE), Sets, Reps, and 2 other lower body exercises that are SPECIFIC to his goals
How?
The Entry Point:
Variables to Manipulate:
Intensity
External Intensity - Absolute Weight
Internal Intensity - Effort or RPE
Volume - Sets and Reps
Frequency of Exposure
Exercise Selection
Tempo
Where to Start?
Decrease external intensity
“We would generally prefer to “under-shoot” when seeking out the entry point rather than continually “overshoot.”
External Intensity and volume generally have an inverse relationship. To get the training stimulus needed it may be wise to increase volume at the decreased intensity.
Add tempo to get the training stimulus needed at lower external intensities.
Remember, think like a scientist. The more variables you adjust the harder it will be to pinpoint a potential root cause.
Let us use Occam's Razor to help guide us, “Entities should not be multiplied without necessity."
There is Complexity in Simplicity
What if we can’t get into that Range of Motion?
“Now, some individuals may have persistent, intolerable symptoms across all loading ranges for a particular exercise, even down to very low loads. At this point we can adjust the stimulus via 1) range of motion alteration based on tolerability, or 2) changing the exercise altogether.”
For Joe’s program, the first two weeks need a range of motion alteration, try your best not to change the exercise.
Managing Expectations:
“Once this entry point is found, our goal is to begin stringing together a series of small victories in order to build positive physical and psychological momentum. In this way, the nature of progression becomes critically important, as overly aggressive jumps in loading dosage increase the risk of symptom exacerbations.
A key point here is that being “pain free” is not typically a realistic short-term goal; symptoms are always a part of the rehabilitation process, and there will be ups and downs along the way. An increase or recurrence in symptoms may be related to a number of factors, including the dosage of stimulus (external intensity, volume, etc.), but also due to outside biopsychosocial factors such as anxiety, sleep disruption/restriction, life stressors, concurrent medical illness. This is an opportunity to reiterate that “hurt does not equal harm,” that symptoms are an expected part of the process, and that we have strategies to mitigate symptoms — typically by modifying the dosage and type of loading.”
Come up with your own program that addresses our clients unique needs.
