Monday, May 3, 2010

Shoulder help

Oh My Aching Shoulders
Gender: Female
Age: 40
Goals: Fat loss/Strength gain/ to play on her company softball team
Medical Issues: Micro trauma to the left rotator cuff
Jane Doe is 40 years old and would like to play on her company softball team; however she has few issues that need to be taken care of first. The first issue that needs to be addressed is getting the weight loss issues handle. The above client hasn’t given a specific amount of weight that she would like to lose so let’s presume that she would like to lose about 25lbs and that needs to be done in 10 weeks, now considering that the above clients nutrition knowledge is like that of the average American (which is very low just for the record) the simple approach of consistent eating i.e. 3 meals a day for the first month would be ideal. Once that is accomplished then we would introduce the idea of more meals in smaller portions sizes. Because as the research has shown frequent smaller meals lead to a greater reduction in body fat and a greater accrual of lean mass. This step is key in not only achieving success with the weight loss but also for teaching the client how to eat sensibly and in moderation for a lifetime not just while they are training.
The next phase that would need to be followed is movement screening and conditioning assessment. Considering that we already know that the shoulder is injured then the ROM on the left shoulder is already going to be lessened depending in the type of movements involved and there will in most cases be some discomfort when doing certain movements. The idea is to come up with a program that allows the individual to train while minimizing pain, the use of pressing movements should diminish but not disappear altogether and the use of pulling movements should increase i.e. , some sort of rowing movement a good example would be the seated row. The conditioning assessment can take many different forms the simplest one is the 1 mile test see how long it take the individual to complete a mile on the treadmill and then try and get them to reduce the time it takes during the 10 weeks this is a linear progression.
Since the above client is also interested in increasing her strength, the program would revolve around increasing strength. The exercise selection would be built around that goal using basic compound movements which burn the most calories and produce the greatest strength gains in the shortest period of time. Prehab/rehab/ exercises for the shoulder are inserted at the beginning when training the upper body and mobility work is used on lower body (note client is training 2x per week). As it pertains to safety there is and always will be inherent risk when one decides to start working out or training, that is why it is very important to have a physical check-up before beginning a workout regimen. When dealing with a novice or even an advanced trainee the safety of an exercise should take priority, however since we are dealing with a novice then any exercise done is going to be high-skill oriented even something as basic as a push-up can be high skill to a novice trainee especially for a 40 year old woman with micro-trauma to the left rotator cuff (note the push-up would be a contraindicated exercise under these circumstances at least in the beginning).
The appropriateness/safety of an exercise solely depends on the skill level of the client as we have covered already the client has micro trauma to the left rotator cuff, so as the surrounding tissues get stronger with the rowing movements, compound and accessory movements, which could be everything from face-pulls to I’s-Y’s-T’s and As, the client can the transition into more of the pressing style movements with modifications. Which would then mean that the client could indeed perform push-ups an exercise that was once a contraindicated exercise is now no longer unsafe, inappropriate, or contraindicated.

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