Don't Forget Injury History

Keeping your clients safe and fit with customized workout programs.

How can you create an optimal exercise program for a client if you don't have appropriate baseline measurements beyond blood pressure, heart rate, body composition or one repetition maximum strength? Basic orthopedic screening techniques can really put your exercise programs on track, especially if the person has a history of a previous injury.

The research study, "Injuries in Recreational Adult Fitness Activities" (American Journal of Sports Medicine, Vol. 21, No. 3, 461-467, 1993) found that almost three out of four participants reported one or more "previous significant injuries." The knee was the most frequently injured site followed by lower back, ankle, foot and shoulder. A significant previous injury almost doubled the risk of sustaining a subsequent injury. Wouldn't you like to help those previously injured members avoid a reoccurrence that could possibly limit the consistency and longevity of their exercise lifestyle?

Identifying common muscle imbalances can be one way to individualize an exercise program to avoid an injury reoccurrence. There are two primary postural syndromes: upper crossed syndrome, which is typically seen in individuals with rounded shoulders and forward heads, and lower crossed syndrome, which is characterized by increased anterior pelvic tilt and an increased lumbar lordosis.

These muscular imbalances are due to postural adaptations and a sedentary lifestyle. Individual muscle length or flexibility testing is required to identify specific tight muscles. An excellent re-source for posture and flexibility assessment is Muscles: Testing and Function by Kendall (Lippin-cott, Williams & Wilkins).

A tight or short muscle is more easily recruited and can inhibit its antagonist. This tight muscle actually acts to perpetuate the muscle imbalance. For example, a tight hip flexor can inhibit the gluteus maximus. The exercise approach should initially focus on stretching the tight hip flexor (agonist) rather than strengthening the gluteus (antagonist). Improving the length of the hip flexor will allow more facilitation or activation of the gluteus. A facilitated muscle can be strengthened more effectively.

Weakness or tightness of key muscles in the shoulder or pelvic girdles can contribute to many common injuries such as neck pain, shoulder impingement, low-back pain, and various hip and knee problems.

As health care continues to change, the fitness professional will play a more prominent role in the orthopedic well-being of clients and members. In addition to exercise, members should be educated in basic body mechanics in an attempt to have them avoid postures that contribute to muscle imbalances. Basic observational skills combined with specific muscle flexibility testing can make a significant difference in designing individualized fitness programs.

Functionally Tight Areas

- Pectoralis major/minor

- Levatore scapulae

- Upper trapezius

- Latissimus dorsi

- Sternocleidomastoid

- Scalenes

- Psoas

- Rectus femoris

- Hip adductors

- Upper rectus abdominus

Functionally Weakened Areas

- Rhomboids

- Middle/lower trapezius

- Teres minor/infraspinatus

- Posterior deltoid

- External obliques

- Transverse abdominis

- Internal obliques

- Multifidus

- Gluteus maximus

- Biceps femoris

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