Post-Rehab Fitness. By Lynda Huey LyndaHuey.com MeetTheDoctorsPodcast.com

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1 By Lynda Huey LyndaHuey.com MeetTheDoctorsPodcast.com INTRODUCTION A. All Fitness Levels in Many Classes Students of all fitness levels come to many of our classes o All ages, weekend warriors, Olympic athletes, pregnant women. Add rehab patients and the range of abilities gets wider. o Low back pain, sore shoulders, sprained ankles, arthritic hips. o Prehab and post rehab fitness after surgeries. Can create specific classes for Hips, Knees, Back, Ankle, Shoulder, Neck. o Having only one or two body parts in a class simplifies the program. o Market new classes to your students and to nearby doctors and surgeons. B. Protect the Injury Site Know what the weak link is for each student; some have several Sore knees, low back pain, sore shoulders, sprained ankles, arthritic hips. Prehab and post rehab fitness after surgeries. C. Basic Concepts Put a flotation belt on anyone with weight-bearing pain or injury, in both shallow and deep water. Focus on low-impact or no-impact movements. The Red Line theory. Don t cross the Red Line! Learn who is fragile and have them back off at first sign of pain. Learn who comes back feeling good and push them more each time. D. You re the One Students Turn to Keep Learning! Read the latest fitness news and research studies in Akwa magazine, other publications, or online. Listen to Meet the Doctors podcast on itunes, Spotify, Google, etc. Look up every word you don t completely understand. Learn the basics about the most common injuries and surgeries. Find a mentor: MD, DC, PT, ATC or other.

2 2 E. Many Students Seeking Prevention of Surgery Come to Your Classes Start with the expectation of PREVENTING surgery If pain diminishes and ROM returns, heading toward prevention 2-3 months later, little improvement, probably heading toward prehab get stronger to face rigors of surgery Should rehab with physical therapist after surgery, but be prepared in case they return to your class. Research, learn. CAUTIONS FOR SPECIFIC BODY PARTS A. Ankles Learn to tape ankles or find someone who can. o White tape to immobilize first few weeks. o Switch to Elasticon tape for ROM. Cautious with Body Swing, Curl and Stretch. Go slow at first on kicking exercises. B. Knees General principles: o Learn which movements cause pain for which students. o Avoid twisting movements. o Cautiously try Curl and Stretch, then Body Swing. o If there s patellofemoral pain or a tracking problem, use shallow-water running, not deep-water running. Most Common Knee Conditions: o Meniscus tears stabbing pain along the joint line, remove impact. o Osteoarthritis (OA) loss of articular cartilage; risk factors are obesity and family history; usual reason for total knee replacement. o Ligament injuries MCL heals without surgery, the LCL, ACL, and PCL usually need surgical repair for a stable knee. o Patella tracking problems. o Baker cyst 15% have this cyst at back of knee. If swollen, indicator of damage elsewhere in the knee; don t remove, it will grow back. Osteoarthritis, Loss of Cartilage Four Stages o Stage 1 scratches on surface of cartilage o Stage 2 deeper cracks and fissures that run vertically from surface through full thickness of cartilage down to the bone o Stage 3 exposed areas bald spots or pot holes o Stage 4 bone on bone

3 Finnish Study, December, 2013 o 160 people signed up with knee pain and a suspected torn meniscus, not knowing if they would get real or sham surgery. o 146 were candidates for partial meniscectomy; 76 got fake surgery. o Doctors asked for instruments, moved the knee as in real surgery, used a shaver without a blade. o Conclusion of study: Common knee surgery may help no more than a fake operation. British Medical Journal, May, o We make a strong recommendation against the use of arthroscopy in nearly all patients with degenerative knee disease, based on systematic reviews; further research is unlikely to alter this recommendation. o Knee arthroscopy is the most common orthopedic procedure in countries with available data. o Healthcare administrators may use the number of arthroscopies performed in patients with degenerative knee disease as an indicator of quality care. This should change soon. C. Hamstrings No stretching during acute phase. Keep knee bent not to tug on hamstring. Easy to reinjure hamstring when working too hard. Ease into every movement slowly can be surprised which exercises cause pain or not. D. Hips General Principles o Stay in pain-free ROM. o Work on gluteal strengthening. o Start Power Walk slowly to avoid hip flexor strain. o Consider diagnosis, age, sports. Most Common Hip Conditions o Osteoarthritis (OA) main cause of hip pain and dysfunction. o Labral tears damage to fibrocartilage around rim of acetabulum. Can become frayed, torn, or ossified. Crucial to keep labrum: Seals in joint fluid, keeps negative pressure inside joint, nourishes cartilage. Helps create stability in the joint. Without labrum, hip joint starts to deteriorate. 3

4 Femoroacetabular Impingement (FAI) o Bony abnormality impinges on labrum and damages it. o Torn Labrum can be repaired arthroscopically. o Protect the labral repair: no deep squats, lunges, extreme ROM. After Hip Surgery o Hip replacement surgery Be aware of any movement precautions; most common are no hip flexion > 90 o, no crossing the midline of the body, no internal rotation. Limit extreme ranges of motion for comfort and no disruption of scar tissue formation. o Arthroscopic surgery/labral repair Protect labral reconstruction, less flexion and abduction. Focus on gluteal strength, to prevent hip flexor tendinitis. E. Back Generally avoid hyperextension. Find out if flexion or extension feels good for each student and choose their exercises based on that. Avoid twisting movements: Bent-Knee Twists, Straight-Leg Twists. DO: Superman, Rock & Roll, Buoy Pull Downs Build strong abs and other core muscles. F. Shoulder Use water s buoyancy to increase ROM. Use hand buoys in DWIs until normal movement restored. Find pain-free ROM by turning hands. Flexion and abduction stretches, hand on deck, squat to resistance. Use noodles or hand buoys, pushing down for resistance/strength. G. Pain as a Friend Treat pain as a friend teaching exact movement warnings. Review activities with your students determine if they are nurturing or abusive, delete the abusive ones. o Abusive running, ballet, martial arts, soccer, extreme ROM. o Nurturing pool, bicycling, elliptical. 4

5 5 H. Teaching Tips Learn students names right away. Helps you give warnings. Start each exercise with warnings for specific students. o Get the exercise going. o Make sure those with warnings are safe. o Increase the exercise for more advanced students: faster, harder. Don t let students exercise with bad form slow them down, correct the movement, back to speed. Visit LyndaHuey.com/AEA for a copy of this PowerPoint. MeetTheDoctorsPodcast.com will teach you the latest in medicine in many fields. **References: First two studies show improvements in bone mineral density in postmenopausal women in both shallow-water and deep-water exercise programs. Aboarrage J, Teiseira C, et al. A High-Intensity Jump-Based Aquatic Exercise Program Improves Bone Mineral Density and Functional Fitness in Postmenopausal Woman, Rejuvenation Research, June, Moreira L, Fronza F et al. The Benefits of a High-Intensity Aquatic Exercise Program (HydroOS) for Bone Metabolism and Bone Mass of Postmenopausal Women, Journal of Bone Mineral Metabolism, 2014, 32: Lerebours F, ElAttrache N, Mandelbaum B. Diseases of Subchondral Bone 2, Sports Medicine Arthroscopy Review, Volume 24, Number 2, June, Heal Your Hips 2 nd Edition Klapper R, Huey L, Turner Publications, Postsurgical Protocol for Femoroacetabular Impingement, Jason Snibbe, MD, unpublished paper. Lesson 12 of Lynda Huey s Aquatic Rehab Online Course on modifying exercises during group classes. See until May 21 st. Heal Your Knees Klapper R, Huey, L, M. Evans Publishing, 2007.