- Treatment
B. Malingering and Somatization
- Signs and Symptoms
- Treatment
XII. CASE STUDY (Please Help Mr. Smith!!!)
38 y/o engineer completed 12 weeks physical therapy for R rotator cuff impingement/tendonitis (MD cleared him to
workout!!!)
5/5 strength w/full R.O.M., no swelling or difficulty w/ADLs
Typical Workout 3x/week
- Low Bar Rear Squats (10, 8, 6, 3, 3)
- Behind the Neck Press (3 x 6)
- Wide Bench Press (10, 6, 3, 3, 2)
- Rear Lat Pull-down (3 x 10)
- Parallel bar Dips (4 x 10 weighted)
- Chest Flys (3 x 12)
- Overhead Dumbbell Tricep Press (4 x 10)
- Incline Dumbbell Bicep Curls(4 x 10)
- Supine Triceps Extensions (4 x 8)
- Biceps Preacher Curls (4 x 10) What is Wrong Here?
- Start with exercises to build a stable base (scapula).
- Add exercises to strengthen the rotator cuff muscles.
- Add compound exercises. Emphasize synchronized motion between the scapular stabilizer and rotator cuff muscles.
(general exercises)—remember not normal for probably 9 months !!!^ - Add exercises which challenge balance, stability and proprioception (i.e., position sense).
- Modify exercise techniques of commonly performed workout activities. Avoid pain!!!!
- Contact MD immediately if new or worsening symptoms occur!!!
XIII. Four Take Away Messages
A. Personal trainers must operate within their scope of practice when working with clients who have chronic,
painful conditions. New or worsening pain warrants immediate client referral to their physician(s)
B. Physicians provide a compliment of diagnostic, surgical and treatment services which can improve physical activity
tolerance in patients experiencing chronic pain. Personal trainers can benefit from understanding the potential benefits
and risks posed by them.
C. Exercisers often use pain as a guide for return to activity and of tissue health and healing but pain levels often decrease well
before tissue healing is complete. Exercises must neither under stimulate nor overstress healing tissues.
D. Knowledgeable Personal trainers can help their clients improve their health and fitness levels while they are healing without
increasing their risk(s) of injury or re-injury.
XIV. Conclusions
Tell your clients not to ignore pain
Address pain early and consult a physician
Do not attempt to "push through" or work through chronic pain
Everyone’s pain is different
If not getting better, look harder
Personal trainers should work cooperatively with their client's physician to develop safe, effective strength and
conditioning programs