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[edit] Group Members

Joe, Victor, Alyssa, Andra and Caitlyn

[edit] First Meeting with the Client

Thursday September 29, 2011

Alias Name: Bia - spirit (daimona) of force, power, might, bodily strength and compulsion. She and her sister Nike (Victory) and brothers Kratos (Strength) and Zelos (Rivalry) were the winged enforcers of Zeus who stood in attendance about his throne.

Female

Age= 46

Weight= 132 lbs

Height = 5 feet 7.5 inches


Client Question and Answer

1. What do you hope to achieve with our help?

-Loves to exercise/stretch

-Motor vehicle accident February 14th 1996; sustained whiplash to neck and back, causing neck and back pain

-Knee issues – left knee torn ACL and PCL, which was never reconstructed with fear of further damage being done

-Osteoarthritis in both knees, which was diagnosed by her doctor (Due to knee injuries, advised by health care professionals not to do squats or run)

-Torn rotator cuff in the right shoulder 5 years ago

-Wants to look like “Jillian Michaels”; she wants to be toned (muscular tone)

-Goal mainly is to improve and maintain flexibility and strength in the back and neck, as well as complete a 100km bike ride (already completed a 50km ride)

-Cardiovascular fitness will be done on her own, while she wants our program to develop her strength using light weights

-She will continue her regular workout program, along with participating in our program


2. Do you have exercise knowledge or is this your first time exercising?

-recently done a 50km cycle

-Squash player for many years

-Enjoys to participate in strength and ball classes at the Zone, along with spinning classes

-Works out 5-6 days a week

-Hikes, kayaks, walks, and used to be a swimming instructor, taught Aqua-Fit


3. Have you exercised before? What was the purpose?

-Yes she has exercised before

-To stay active

-To get more fit

-Help to regain and maintain function in neck, back, knees


4. What types of exercise are you familiar with? And of these what is your favourite?

-Cycling (spin classes)*

-Kayaking

-Ball/exercise class

-Squash used to be her favourite, but due to shoulder injury no longer participates


5. Do you own a bike, have a dog, or access to the pool?

-Owns a bike, loves to cycle (has completed a 50km cycle this past summer)

-Has a dog, enjoys to walk the dog

-Has Zone membership


6. What are your hobbies?

-Kayaking, hiking

-Yoga

-Weight training

-Working out, going to the gym

-Walking the dog

-Gardening


7. What is your job like? Is it physically demanding?

-Sitting at a desk for multiple hours a day

-Needs to stand up and stretch every hour (at most)


8. How many days a week would you like to exercise with us and/or on your own?

-2-3 days a week with us

-Exercises 5-6 times a week on own

-Enjoys to exercise on her own, only wants to work with us 2-3 time but continue workouts on her own


9. How long do you have for an exercise session (i.e. what is convenient for you)?

-2-3 days a week

-45 minutes each session BUT in the mornings


10. Do you have time factors that affect your ability to exercise?

-Works at Brock

-Only wants to exercise before work in the mornings, not during lunch or after


11. What is your family status? Do you have any kids?

-Married

-Has 2 boys (ages 16 and 13)

-Enjoys staying active with the family, however over the years and as her kids grow, they are less active together


12. Do you have or feel more comfortable with an exercise partner?

-Enjoy group classes

-Does not need to exercise with a partner; comfortable alone

-More motivation achieved when she works alone


13. Where do you prefer and feel most comfortable exercising?

-The zone

-Walks dog outside at home

-Gym environment

-Comfortable in the pool, however not enough time to do pool exercises


  • A PAR-Q was also given to the client and returned with no issues, and she is able to partake in the exercise program

Members present: Joe, Victor, Alyssa, Andra

[edit] Assessment

October 11, 2011

Functional Movement Screen

It is a ranking and grading system that documents movement patterns that are important to normal functioning. By doing a screening, limitations and asymmetries are documented and then can be used to target problems and track progress. The movement is scored on a 0-3 scale: 0 - any pain associated with the movement 1 - unable to perform the full movement 2 - the movement is achieved with some compensation 3 - demonstrating full ability to perform the movement [1]

Shoulder mobility test

Is a part of the functional movement screen.

Raise one arm, bend elbow, and reach down across back, with palm facing upper back. Position opposite arm down behind back and reach up across back with back of hand against back.

With fingers extended, try to cross fingers, upper hand over lower hand. Repeat with arms in opposite position.

Measure distance from fingertip to fingertip. If fingers overlap, score as a plus. If fingers fail to meet, score as a minus.

Score of 3 - fists are within one hand length; 2 - fists are within one and a half hand lengths; 1 - fists are not within one and a half hand lengths [2]

  • The client scored a value of 3 for the shoulder mobility tests, meaning the mobility of the shoulder is not a big issue

Muscle Screen and Manual Muscle Testing To test each group of muscles, allowing for an alert in strength or difference in strength from side to side become identifiable. Allow for a problem to be detected and targeted.


Image:Muscle screen.jpg

  • Slight pain felt in the left shoulder flexors, and scapular upward rotators when trying to push the arms into extension
  • Pain was felt in the left shoulder when assessing the elbow extensors
  • No pain was felt in the right shoulder, which was subject to injury in previous years, and no weakness was noticeable in comparing the left and right shoulders

Goniometry

To test flexibility and movement of muscle groups

Only shoulder ranges of motion will be tested

Image:wiki-gonio.jpg

- A decrease in range of motion in hyper-extension and a slight decrease in medial rotation


Posture Assessment Looking for deviations in the neck and shoulder girdle, may contribute to back and neck pain

Image:posture.jpg

  • Scoliosis detected in spine of the client
  • Lumbar lordosis

Rockport Walking Test

To test cardiovascular fitness. Client walked around a track measured to one mile in distance. The heart rate was taking after the walk, Using the calculation, taking into account weight and age, her VO2 max was estimated. [3]

Time to walk one mile: 14 minutes and 23 seconds.

Heart Rate: 130

Weight:132 lbs

Height: 5 feet 7 1/2 inches

Age: 46

male=1, female=0

132.853 - (0.0769 × Weight) - (0.3877 × Age) + (6.315 × Gender) - (3.2649 × Time) - (0.1565 × Heart rate)

VO2 max = 37.56 mls/kg/min

Her VO2 max is superior when comparing to normative values.VO2 max [4]

Functional Impairments - decreased joint mobility, decreased shoulder strength and endurance

Functional Limitations - grocery shopping, lifting heavy objects, job (sitting for a long period of time), housework (pain when lifting arm above her head)


Members present: Alyssa, Joe, Victor

[edit] Exercise Program

Exercise Days: Tuesdays and Thursdays

Time: Noon

Where: In the Zone

Weights: 5 lbs free weights

[edit] Tuesday: Focus on Shoulders, neck and arms and abdominals

The sets and reps listed below are the GOAL sets and reps; each week we will be progressing towards these numbers


  • Warm-up


5 minute cycle -moderate speed


  • Stretch


Inch-worm

- standing with your feet hip-distance apart, slowly bend at the waist, keeping your legs as straight as possible, until your hands touch the floor about 8 to 12 inches from your feet. Walk your hands out to push-up position, then walk your feet in toward your hands. Work up to 2 sets of 8 reps Inch-worm


Ball-on-wall

- with your arm outstretched in front of you gently grasp onto a ball and make circles with the ball against the wall. Perform for 30 seconds in a clockwise direction. Then perform the same exercise in a counter clockwise position for 30 seconds. Ball on Wall


Wall Climbs

- place one of your hands on the wall at about eye level. Walk your fingers up the wall, climbing as high as you can. Feel your shoulder joint and arm muscles working together. Hold your hands at the highest point you can manage for about 15 seconds. Relax your arms and let them slide down to your starting position. Repeat the front wall climb 3 to 5 times with each hand. Wall Climbs Note: This can be done facing the wall or with your side to the wall Wall Climbs


Neck stretches

- sitting or standing, tilt head to one side while other shoulder is depressed to feel a stretch, hold for 15 seconds switch sides and repeat


Triceps Stretch

- bringing shoulder in flexion, reaching hand as far down the back as possible, other hand may help to force a deeper stretch, hold the stretch for 15 seconds, switch arms and repeat Tricep Stretch


  • Exercises

Full range of motion with band: shoulder press on stability ball

- while sitting on a stability ball, and feet flat on the floor hold dumbbells in each hand. Sit up tall with back straight and eyes focuses forward. Raise weights to ear level with your palms facing forward. Press weights up and in so they barely touch above your head then slowly lower to starting position. 3 sets, 12 repetitions. Shoulder Press


Anterior Shoulder Raises

- stand with feet shoulder-width apart, arms at your side holding a dumbbell in each hand. Keeping arms straight, lift the weights in front of you to shoulder level, hold for a second, then return arms to starting position. 3 sets, 12 reps. Anterior Shoulder Raise


Lateral Shoulder Raises

- stand with feet shoulder-width apart, arms at your side holding a dumbbell in each hand. Keeping arms straight, lift the weights out to the side until they are parallel to the ground, hold for a second and then lower arms back to the starting position. 3 sets, 12 repetitions. Lateral Shoulder Raise


Bicep Curls on Stability Ball

-Sit feet shoulder-width apart on the stability ball and arms at your side. Holding a dumbbell in each hand, keeping elbows close to the body, curl both arms at the elbows making hands closer to the shoulder. Slowly lower arms back to starting position. 3 sets, 12 repetitions. Bicep Curls


Lateral Leg Resistance

- using a resistance band tied around the working leg, and the trainer holding the opposite end (or tied to a stable object i.e. railing or post) stand facing parallel to the band, feet shoulder width apart. Keeping both legs straight, lift the working leg off the ground and move the leg out towards the resistance band and then medially, crossing the body as far as you can. 2 sets, 12 reps Lateral Leg Resistance


Anterior Leg Resistance

- using a resistance band tied around the working leg, and the trainer holding the opposite end (or tied to a stable object i.e. railing or post) stand facing perpendicular to the band, feet shoulder width apart. Keeping both legs straight, lift the working leg off the ground and move the leg out towards the resistance band and then posterior, behind the body as far as you can. 2 sets, 12 reps Anterior Leg Resistance


Posterior Leg Resistance

- using a resistance band tied around the working leg, and the trainer holding the opposite end (or tied to a stable object i.e. railing or post) stand with your back to the band, feet shoulder width apart. Keeping both legs straight, lift the working leg off the ground and move the leg out towards the resistance band and then anteriorly, in front of the body as far as you can. 2 sets, 12 reps Posterior Leg Resistance


Abdominal Crunches on Body Ball

- sit on a body ball with feet placed flat on the floor hips width apart. Keep your hands behind your head, with elbows out, or arms folded across your chest. Slowly pull abs inward as you lean back on the ball so your entire back is resting on the ball. Curl forward until shoulder blades are off the ball, and hold this position for a second, then lower back down onto the ball slowly. Repeat 15 times. Abdominal Crunch


  • Stretch

Pretzel Stretch

- while sitting on the floor, have one leg straight and flex he other leg and cross it over the straight leg. Rotate upper body to the opposite side of straight leg. Use arms to push off the bent leg to increase the rotation and maximize the stretch. Hold 15 seconds on each side, and repeat 5 times. Pretzel Stretch


Downward Dog to Upward Dog

- start with upward dog by laying on stomach, pushing chest up to the ceiling with arms infront of body, from there raise bottom up into the air with feet shoulder width apart into an upside down V with your body.Downward Dog Continuing on the way down, push your hips down, arching your back with your weight on your hands. Rest the hips, legs and feet on the floor. Downward Dog to Upward Dog Sequence


Neck stretch

-sitting or standing, tilt head to one side while other shoulder is depressed to feel a stretch, hold for 15 seconds switch sides and repeat


Hands clasped above head, push palms outwards

- hold for 15 seconds, relax and repeat


Hands clasped behind back, push palms outwards

- hold for 15 seconds, relax and repeat

[edit] Thursdays: Focus on Back Muscles including some leg strengthening exercises

  • Warm-up

5 minute workout on the elliptical trainer


  • Stretch

Inch-worm

- standing with your feet hip-distance apart, slowly bend at the waist, keeping your legs as straight as possible, until your hands touch the floor about 8 to 12 inches from your feet. Walk your hands out to push-up position, then walk your feet in toward your hands. Work up to 2 sets of 8 reps Inch-worm


Ball-on-wall

- with your arm outstretched in front of you gently grasp onto a ball and make circles with the ball against the wall. Perform for 30 seconds in a clockwise direction. Then perform the same exercise in a counter clockwise position for 30 seconds. Ball on Wall


Wall Climbs

- place one of your hands on the wall at about eye level. Walk your fingers up the wall, climbing as high as you can. Feel your shoulder joint and arm muscles working together. Hold your hands at the highest point you can manage for about 15 seconds. Relax your arms and let them slide down to your starting position. Repeat the front wall climb 3 to 5 times with each hand. Wall Climbs Note: This can be done facing the wall or with your side to the wall Wall Climbs


Neck stretches

-sitting or standing, tilt head to one side while other shoulder is depressed to feel a stretch, hold for 15 seconds switch sides and repeat Neck Stretches

Overhand Triceps Stretch

- put one arm overhead. Position forearm as close as possible to upper arm. Grasp elbow overhead with other hand. Pull elbow back and toward head. Hold stretch for 12 seconds. Repeat with opposite arm. Tricep Stretch


  • Exercise

Wide Grip Lat Pull-Downs

- sit on the seat and adjust the thigh pads so that the quads above the knees sit comfortably under the support. Grasp the cable bar with a narrow underhand grip (supinated grip) and pull down the bar to chin level. Keep back and core muscles tight and straight up in good posture while pulling down the cable bar. Repeat 10 times for 3 sets. Pull Down


Hip adductors/Hip abductors

- sit on the seat and feet in the foot holders and place the lateral sides of the knees on each pad. Open up legs (abduction) through the whole range of motion. Keep upper body straight, with the back remaining on the seat with no leaning. Hip Abductors

- sit on the seat and feel in the foot holders and place the medial sides of the knees on the pad. Legs should be in an open position. Close the legs until back in the neutral position. Keep upper body straight with back remaining on seat with no leaning. Hip Adductors


Lat Pull-Downs

- sit on the seat and adjust the thigh pads so that the quads above the knees sit comfortably under the support. Grasp the cable bar with a wide overhand grip (pronated wide grip) and pull down the bar to eye level. Keep back and core muscles tight and straight up in good posture while pulling down the cable bar. Repeat 10 times for 3 sets. Lat Pulldowns

Triceps Pull-Downs

-Stand with feet shoulder-width apart with elbows touching side of side. Grasp the rope with both hands, and with elbows staying close to body extend elbows, making sure back remains straight. Do the pull-down slowly and return back to starting position. Repeat the exercise 10 times, doing 3 sets. Tricep Pull-Down


Back Extensions

- stand in the middle of the back extension station. Facing the large pad lean forward until your uppers thighs are on the pad with your hip bones just above it and place your feet on the feet stand. Beginners start with arms crossed at the chest, and more advanced can begin with hands behind the head. Slowly lower your body at the waist until it is almost perpendicular to the floor, then slowly lift your body back to the starting position. Do not swing your body during the exercise, but maintain speed of movement. Repeat 15 times. Back Extensions


Dumbbell Rows

- stand straight with dumbbell in each hand, with feet shoulder-width apart. Bend forward at the waist until torso is almost parallel with the ground. Keeping knees slightly bent, pull both dumbbells up until they touch the sides of your chest. Hold for a second then slowly lower weights back to starting position. Repeat. 3 sets, 12 reps. Dumbbell Rows


Superman

- lie on your stomach with your forehead on the floor and arms straight out in front of you. Simultaneously lift both arms and legs a couple of inches off the floor. Hold for a second, and then lower limbs back down to the floor. Repeat 15 times. Superman


Inner leg squeeze

- sitting in a chair, putting a ball or towel between the flexed knees, squeeze for 5 seconds and then relax for 5 seconds, repeat 10 times Inner Legs


Calf Raises

- using a stair or standing on the ground, start with feet together legs and knees extended. Raise heels off the floor and then bring them back down to the floor. Repeat 15 times. Calf Raises Calf Raises on a Stair


  • Stretch

Cat stretch

- on hands and knees, force back upwards, forming a rounded spine, hold for 20 seconds then force head and bottom up making back concave, hold for 20 seconds. (repeat 3 times) Cat Stretch


Downward Dog

- start with upward dog by laying on stomach, pushing chest up to the ceiling with arms in front of body, from there raise bottom up into the air with feet shoulder width apart into an upside down V with your body.


Pretzel Stretch

- while sitting on the floor, have one leg straight and flex he other leg and cross it over the straight leg. Rotate upper body to the opposite side of straight leg. Use arms to push off the bent leg to increase the rotation and maximize the stretch. Hold 15 seconds on each side, and repeat 5 times. Pretzel Stretch

[edit] Training Sessions

[edit] Session One

Wednesday October 19, 2011 (Tuesday's Workout) - members present: Joe, Andra and Caitlyn

As this was our very first training session with our client after the assessments, we provided our client with an exercise log and pictures of each exercise we have planned to do with her.

  • The first training session:

Image:Session1.jpeg


  • After beginning the workout, the client soon revealed that her left shoulder was hurting from an injury from the weekend
  • Many of the exercises we originally planned had to be modified or changed completely to make sure that the left shoulder could heal and not increase the agitation


[edit] Session Two

Friday October 21, 2011 (Thursday's Workout) - Members present: Joe, Alyssa, Victor

  • Day Two of Training

Image:Session2.jpeg


  • The previous injury of the client's shoulder was still aggravated and inhibited her from performing many of the planned exercises
  • Original plan of doing Lat Pull-downs was eliminated due to the aggravated left shoulder, and client's pain
  • The client also expressed interest in adding more leg exercises to her workout


[edit] Session Three

Tuesday October 25, 2011 (Tuesday's Workout) - Members present: Caitlyn and Andra

  • Day Three of Training

Image:Session3.jpeg


  • The previous shoulder injury was still sore; modified workout by performing less shoulder and arm exercises
  • Instead of Anterior Shoulder raises and Shoulder Press on Stability Ball, Lateral, Anterior, and Posterior Leg resistance exercises were added


[edit] Session Four

Thursday October 27, 2011 - Members Present: Alyssa and Victor

  • Day Four of Training

Image:week4.jpg

  • Our client discussed pain felt in her knee after the last session and did not want to continue with any leg exercises this session
  • Her shoulder was feeling better, and she was willing to try the Lat Pull-Downs

[edit] Session Five

Tuesday November 1st, 2011 - Members Present: Andra and Caitlyn

  • Day Five of Training

Image:Session 4.jpeg

Image:Picture 3.jpeg


  • The client indicated that her shoulder was still sore from the previous week and weekend
  • Shoulder was too sore to complete bicep curls with previous weight (5lbs); reduced weight to 3lbs
  • Also, new leg exercises implemented last week went well expect for the lateral leg raise; caused too much stress on client's knee so these are now eliminated from the program


[edit] Session Six

Friday November 4th, 2011 - Members Present: Alyssa and Joe

  • Day Six of Training

Image:Joes2.jpg


  • Our client discussed how her shoulder felt much better than the previous week and she was ready to do lat pull-downs.
  • When performing the dumbbell rows, the client felt pinching in her left shoulder on the second set. To be safe, our client only performed 2 sets of the exercise.
  • The client expressed that she wanted to do some chest exercises. Due to there being extra time because of not performing the hip adductors/abductors exercises, we had the client perform both dumbbell chest press and dumbbell flys.


[edit] Session Seven

Tuesday November 8th, 2011 - Members Present: Caitlyn and Joe

  • Day Seven of Training

Image:Session7.jpg


  • The client informed us that her shoulder was feeling much better compared to the previous week.
  • The client had increased the weight used on the bicep curls, and shoulder press.
  • The client had also increased the amount of reps performed on both the anterior and posterior leg lifts. She also performed one more set of the shoulder press.
  • She also indicated that she still felt a "pinching" feeling in the right shoulder when performing the anterior shoulder raises with weights. Instead, the client performed the exercise without weights.
  • The client had mentioned that she had noticed more tone in her core after 4 weeks of training.
  • The client has shown progression with the abdominal exercises. To increase the difficulty of the crunches, We had the client perform 2 sets of 15 of crunches with a twist (touching one elbow to the opposite knee).


[edit] Session Eight

Thursday November 10th, 2011 - Members Present: Joe and Victor

  • Day Eight of Training

Image:Joes thing.jpg

  • The client informed us that her shoulder was feeling great but her knees were very sore from the training session on Tuesday.
  • The client showed progression in many of the exercises due to performing either increased reps, sets or weights.
  • The client see more motivated from the training program compared to previous sessions. This is possibly due to her seeing improvement in her fitness because of it.
  • As an example of her motivation, our client had made it clear to us that she wants to use weights when performing back extensions.

[edit] Session Nine

Tuesday November 15th, 2011 - Members Present: Caitlyn and Andra

  • Day Nine of Training

image:week5.jpeg


  • Client noted that definition in arms was noticed
  • Shoulders still a little bit sore
  • Spent longer time warming up at the beginning
  • Did own stretches using medicine ball before workout
  • Stretched again on her own after workout and our stretches



[edit] Session Ten

Tuesday November 22, 2011 - Members Present: Caitlyn and Andra

  • Day Ten of Training

image:week6.jpeg


  • Client noted that she felt stronger than previous sessions
  • Shoulder felt very good and had little to no complaints about pain
  • Was able to increase weight on lateral shoulder raises
  • Also able to increase sets and reps in bicep curls and shoulder press
  • Does not want to work out on her own after working with us!


[edit] Complete Log (Week 1-6)

Image:completelog.jpg


  • Week 5 Thursday session was cancelled by the client, and week 6 Thursday consisted of the final assessment, so there is no data for the bottom half of the exercises on the log due to those reasons (those exercises performed on Thursdays)

[edit] Post-Assessment

Thursday November 24, 2011 The Zone Members present: Victor and Alyssa


Functional Movement Screen - Shoulder Mobility Test

A score of 3 on the shoulder mobility test

-No difference was shown in this test comparing pre-assessment to post-assessment results. In both instances a score of 3 was obtained.

Muscle Movement Screen

Image:muscle.jpg

-Felt slight pain in the shoulder flexors and scapular upward rotators along with slight pain in the shoulder abductors and horizontal abductors

-Although there was pain described, the pain had decreased in intensity and more muscle endurance was noticed as positions were able to be held longer


Goniometry

Image:gonio-post.jpg

-Most ranges of motion maintained the same however hyper-extension of both the left and right shoulder were higher in post-assessment

-There was also a slight increase in the range of motion for both the medial rotators of the left and right shoulder


Posture Assessment

-Posture remained the same as slight scoliosis was still observable along with lumbar lordosis


Rockport Walking Test

Time= 15 minutes 11 seconds

Heartbeat= 116

male=1, female=0

132.853 - (0.0769 × Weight) - (0.3877 × Age) + (6.315 × Gender) - (3.2649 × Time) - (0.1565 × Heart rate)

VO2 max = 37.14 mls/kg/min

Her VO2 max is superior when comparing to normative values


-The VO2 max stayed in the superior range, and when comparing to pre-assessment the value did not change too much

-The value may be skewed due to human error, as the client began talking to a friend on the track and decreased her pace to match that of the friend


When comparing the client's post-assessment results to that of pre-assessment, the client has benefited in many ways. Has decreased pain in shoulder muscles, increased endurance in the shoulder muscles, as well has developed strength and a feeling of being toned throughout the body.

The client has requested the program for future use, and is very happy with the results shown in such a short amount of time. She was sad the program was over.


THE END !!

[edit] Notes and References

  1. http://www.functionalmovement.com, "Functional Movement Systems", October 2 2011.
  2. http://www.wdpowerliftingclub.com/functionalscreen.html, "Functional Screening Test", October 21, 2011.
  3. http://www.brianmac.co.uk/rockport.htm, "Rockport Fitness Walking Test", October 21, 2011.
  4. http://www.brianmac.co.uk/vo2max.htm#vo2example.com, "VO2 Max", October 12, 2011.
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