t’s common for patients to come to our office with complaints related to ‘working out’ or ‘over-training’ and not enough rest and recovery in between workout sessions. I see clients involved with athletic pursuits like cross fit, yoga, martial arts, running 5 K’s, swimming, biking, and/or other sports. We have such extremes in the population, those who sit way too much and wind up getting dehydrated and inhibited glutes from excessive and prolonged sitting (they never get physical activity), and those who are exercise ‘junkies.’ I think it’s important as part of the patient history for doctors to question clients about there past and current exercise routines and programs. My hope is that you are able to provide knowledge and have the ability to write exercise programs for home, or at-the-gym sessions for patients in a way that allows for recovery and (high) performance.
I like using the following ‘exercise template’ when educating patients on what a long-term exercise program includes:
- Perform self-myofascial release using foam rolls, sticks, and “knot-outs” as the beginning of an exercise session. These are tools to break up hypertonicity and tension in muscles.
- Perform stretching (static and dynamic) on the overactive muscles. I teach my clients techniques using the ‘Stretch straps’, yoga straps, and bands.
- Perform movements or isometric exercises that re-awaken and/or strengthen the core and underactive muscles. These are usually bodyweight or thera-band exercises targeted at isolated weak stabilizers muscles.
- Perform whole body integrated exercises that will add lean muscle and decrease fat.
- Next, if the client has more time and wants to perform cardio work, this is where I place it.
After talking with patients and hearing what they do or don’t do physically, my suggestions begin first with ‘remove the negatives’. I discuss proper posture, breathing, hydration, diet, supplements, attitude, and sleep. I want to make sure patients are doing the right thing and not the wrong (negative) thing in each of these categories. In addition some patients need to “add in” cardio, strength, or flexibility training depending on there goals. The ‘fatty-bomba-lattes’ who do absolutely no physical activity need to start a walking program; the long distance runner, swimmer or cyclist might need a flexibility program; the Country Western dancer’s and the ‘dance-with-the stars’ people might need some strength training; the yoga dominant person might need some free weight training; the weight lifter might need some cardio and flexibility added on. Depending on the patient’s goals (fat loss, finish a marathon, flexibility, etc), I often find the program they designed isn’t “enough” on its own.
Physique-related goals are popular these days. Women want to lose pant sizes and men want to look good without a shirt on. No matter the goal, I still like the functional approach - start with teaching patients how to use the foam roll to inhibit overactive muscles, then teach a little stretching to those same overactive muscles, then do a little bodyweight or band exercises to the underactive muscles, then teach the “conventional” weight lifting approaches, then do some cardio. For fat loss, it isn’t really necessary for someone to have to add steady state cardio. An improved nutritional plan and consistent 20-30 minute workout with bodyweight exercises, bands, balls, free-weights or kettlebells produces incredible results.
Mobility and stability: Our typical patient who has a ‘ginger’ or ‘sensitive’ low back, usually needs some mobility and some stability work. The starting point to enhanced stability training begins with improvements in mobility. The stability work gives clients joint protection, helps get them stronger, and this reinforces the new mobility and the new mobility makes improved stabilization possible. This sort of dual reinforcement (mobility and stability training) is powerful—it can motivate people to permanently adopt a healthier workout lifestyle.
Whether your patient is into yoga, power training, competitive sports, martial arts, or other athletic pursuits, I am seeing more and more clients that seem to short change their rest and recovery. I also see clients who are repetitively lifting weights using bench press and biceps curls and this contributes to a forward head and forward shoulders posture. At the end of the article I’ll give you an example workout of how I have made a corrective exercise/conditioning program work within one of my patient’s lifestyle who has been working heavy on the chest. This patient and I have created the long-term goals of improving posture. The routine is specifically designed with enough rest days to allow for the inclusion of other sports and activities. The program I wrote for the patient is especially upper body focused, but emphasizes the back side. Just keep in mind that if your patient’s “extracurricular activities” are particularly upper body inclusive you may wish to choose a lower body routine to work with. If they are cardio dominant, make sure they have a flexibility program.
Personally, I like shorter duration workouts aimed towards skill building, optimal movement patterns, and the control of maximum tension where needed in each rep.
An important thing to remember with both cardio and weight lifting training is that less is often more. I teach my clients to keep strict form and coordinated full body tension with each exercise—while not training to failure. In my opinion, practicing flexibility, strength training (I prefer about 6 reps and 2-3 sets), balance training, and cardio workouts can be done with high intensity and short rest periods between sets. Think of a marathon vs. a sprint—to run a marathon, the athlete will need to pace themselves. In a sprint, the athlete will basically go “all out” for a short period of time. Personally, I like shorter duration workouts aimed towards skill building, optimal movement patterns, and the control of maximum tension where needed in each rep.
I like to write exercise programs for patients that I ‘change up’ about every 6-10 weeks. It usually takes patients several weeks to adapt to this type of progressive exercise training. The weeks following the example below would have variations in the band, the ball, kettlebells and free-weights. This is a fairly typical example of my program training for a patient that needs back work to improve posture:
Monday: 5-8 minutes of foam roll, stick, or “knot out” especially to the hip flexors, lats, pecs and thoracic spine; 5 minutes of stretching to the hip flexors, lats, pecs and thoracic spine; 10-15 minutes of alternating Turkish-get-ups on the right and left side and doing 20 kettlebell swings.
Tuesday: 5-8 minutes of foam roll, stick, or “knot out”; 5 minutes of stretching; 5-10 minutes of 30 – 60 second isometric plank holds, side bridges, birddog, glute bridges; 5-10 minutes of kettlebell swings. The swing technique for this workout is 15-20 reps range followed by 20-30 seconds of rest.
Wednesday: 5-8 minutes of foam roll, stick, or “knot out”; 5 minutes of stretching; 5-10 minutes of isometric planks (prone, supine, side) and “stir the pot” position holds with forearms on the ball (ensuring scapula stability); 5-10 minutes of Y-T-W-L maneuvers. I have them finish with hands held overhead with band resistance doing squats – usually 2 sets of 8-10 reps is enough. Optional: cardio work.
Sunday: Rest/Recovery/Mobility. Be with loved ones.
Thursday: Rest/Mobility/Yoga practice. I usually suggest some resisted neck retraction work using the bands on this day.
Friday: 5-8 minutes of foam roll, stick, or “knot out”; 5 minutes of stretching; 5-10 minutes of 30 – 60 second isometric plank holds, side bridges, birddog, glute bridges; 5-10 minutes of kettlebell swings. The swing technique for this workout is 15-20 reps range followed by 20-30 seconds of rest.
Saturday: 5-8 minutes of foam roll or “knot out”; 5 minutes of stretching; 5-10 minutes of Y-T-W-L maneuvers. A 5-10 minute kettlebell challenge circuit workout or band work – usually includes 1 arm rows, 2 arm rows, supine pulls.
Sunday: Rest/Recovery/Mobility. Be with loved ones.Dr. Jeffrey Tucker is the 2012 ACA Rehab Council Doctor of the Year. He is a certified instructor for the Functional Movement Screen (FMS) workshops, on the education committee for the Hygenic Corporation, and is a post-graduate instructor for the Diplomate program offered by the American Chiropractic Rehabilitation Board. Visit his website at www.DrJeffreyTucker.com