31st March. Duration: 6 hours (4 clients)
My first client was a female 52-year-old, suffering from hospital diagnosed degenerative rheumatoid arthritis, predominantly impacting her hands and elbow joints at this stage. The clients GP advised she needed to be more mobile, hence she had really come for advice and some guidance. I informed her our aim was to:
- Keep her joints supple.
- reduce pain.
- strengthen her muscles and bones.
Treating an older client was relatively new to me, and as she was not and had never been sporty, I thought it prudent to suggest we try some exercises that she enjoyed, and to set realistic goals, which we could change or adapt as her condition dictated (Levinson et al., 2010). I emphasized the importance of doing these exercises or activities regularly. Having read around this issue (Baillet et al., 2020; Hu et al., 2021; Peçanha et al., 2021), I now realise those afflicted suffer pain almost daily, with intermittent flare ups.
I started the session with passive/active ROM tests followed by STR on the clients’ arms to increase blood flow and stretch muscles, which the client really enjoyed, and during this spoke about things the client enjoyed doing, one of which was swimming/hydrotherapy etc. I STR provided some relief from elbow pain. I advised low-impact exercises were recommended placing less stress on the joints, such as using resistance bands and swimming or cycling, and provided some practical examples of resistance bands stretches and a URL link to specific exercises for arthritis suffers, which included lifestyle ideas: VERSUS ARTHRITIS . The client was extremely satisfied with the session and advice provided, however, I believe I need to develop my knowledge of arthritis related diseases further, to offer the clients more exercise options applicable to their affliction (Chen et al., 2021).
My next two clients (aged 20-25) were in the latter stages of recovery from lower back injuries caused through conducting dead lifts during weight training. I assessed both clients using passive/active ROM and briefly discussed how the injuries occurred and their training programmes and it appeared they had neglected to strengthen their core. I could have used the Quebec back pain disability scale (Fritz & Irrgang, 2001), but both clients were in latter stages of recovery and moving well, so did not feel it would achieve much as they would likely score incredibly low (Fig. 3).
Both clients were clearly into bodybuilding, hence I did not wish to appear presumptuous, so tentatively discussed the benefits of a progressive training programme (Lloyd et al.,2014), (Fig. 1), and importance of maintaining correct form in daily activities and whilst training to prevent injury and assist their longer-term goals (Faigenbaum et al., 2016; Leysen et al., 2021; Silva et al., 2021; Sørensen et al., 2021; Wilkie et al., 2021). I performed STR on their lower and upper backs and informed them if any pain was evident during this and following exercises to inform me immediately. I wished to exercise their core muscles to increase stability, improve flexibility and strengthen general area, and was aware they may not have conducted these exercises previously, hence tried to add an element of fun into doing them and advised they could be done at home in privacy.
I provided explanation, demonstration and got them to imitate doing (Gafurova & Ruzimbaev, 2021): Bridges, knee to chest stretches, lower back rotational stretches, draw in manoeuvres, pelvic tilts, lying lateral leg lifts, cat stretches, supermans’, seated lower back stretches, partial curls, and resistance band exercises (side-lying: Clam shells; hip abduction; Supine: straight leg raises; hip bridges; cat/cow; Quadruped: Glute Kickbacks; Bird Dog; Plank: Band Pull-Throughs). To add some weightlifting style exercises, I used a resistance band to do Romanian deadlifts (Fig.2), which I though both clients liked. I ended the session informing both clients that if they experienced lower back pain that was severe or does not go away with gentle stretches and exercise, they should make an appointment with their doctor. I felt the session went well, but I could have adapted some of the exercises a bit more to match their ‘male’ persona. The use of resistance bands was new to them, and I feel this was successful.
My final client today was a footballer experiencing a slight pain in his upper thigh after taking a penalty kick that day, which he said although not bad, was causing him to take some weight off it when walking. I conducted an assessment asking if they had any previous injury or medical conditions, which he did not. I conducted observation and palpated the area and noted there was no sign of swelling or heat from the painful area pointed out. Passive/active ROM was conducted (knee bends, resisted muscle tests/hip flexors), which when resistance was applied, he experienced a slight twinge of pain. From the history and assessment, I thought it may be a mild (Grade 1) Rectus femoris tear (Von Fange, 2019; Davis & Rizzone, 2021) but was uncertain as I knew there were four quadricep muscles in the area, however, his history suggested it was more likely to be the Rectus femoris, but I sought a second opinion from the supervisor, who agreed on the diagnosis, advising if it was another quad injury, the initial treatment will be the same, hence I informed the client we would conduct PRICE initially for 72-hours and then reassess the injury.
Fig.1: Youth resistance training guidelines with progression based on each athlete’s resistance training skill competency (RTSC) to perform the desired movements.
Fig. 2: Romanian Deadlift with resistance band
Fig.3: Quebec back pain disability scale
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