The Right Exercise Programs Can Prevent Injuries Before They Happen

"Pre-Hab" Train to prevent injuries before they happen. It may not be possible to reduce the risk of accidents, but you can train to reduce injuries from other sources such as falling, poor posture, and muscle imbalances. Start with a self-assessment or assessment by a qualified trainer who can help you develop a corrective fitness program.

The case histories below present a few common problems that can be observed and addressed in a fitness program, and some suggestions for each. You may have to make some changes to adapt your program to these phases, but you can still have a program that is effective and fun.

"Post-Rehab" If you've already had an injury or surgery, you're at a risk of recurrence. Follow a program designed to carefully get your body back into a regular training routine, while preventing a recurrence. The National Strength and Conditioning Association recommends that athletes continue with exercises they did in physical therapy - for many people, this can last a lifetime. Try to identify and correct the underlying causes of the injury, often muscle imbalances and postural distortions.

If you need help, I can show you how to incorporate physical therapy exercises into your workout routing, keep the routine interesting, and progress the exercises from the more controlled and "clinical" physical therapy environment to the gym.

CORRECTIVE FITNESS PROGRAMS

Over the past few years, I've shared several corrective programs with blog readers, you can access some of these programs by clicking below. The programs are general and appropriate for most people, however, if you have been treated for an injury you should talk to your physical therapist or doctor and get clearance before proceeding. You can also feel free to contact me for an appointment to develop a more customized program or program for other issues, and for personal instruction.

Low Back Pain Program

Plantar Fascitis/Shin Splints

Rounded Shoulders/Forward Head

Deep Core Training

PUBLIC ENEMY #1 - THE CHAIR

The problem with most People's Cores? Sit all day and the inner abdominal muscles and glutes get stretched out and weak, hip flexors and low back get short and tight...leading to low back pain, poor balance and other potential problems. Then you try to get active and things can really fall apart.

The problem with most people's core training programs?
1) too much emphasis on external abdominal exercises (crunches) and hip flexion (knee and leg raises);
2) not enough work on inner abdominals and glutes and stabilization while performing movement;
3) too many seated or lying exercise and machines, especially after sitting all day at work;
4 )inadequate or poorly targeted stretching;
5) lack of progression beyond a few basic exercises and failure to integrate movements with core stabilization.

Poor exercise selection can actually cause or exacerbate low back pain. However, an effectively designed fitness program can help protect you from injury and may speed your recovery. Some of the principles of these programs come from yoga and pilates, but you can actually incorporate them into a more traditional strength and conditioning program and progress them to provide continued improvement.

Here is a four step program that you can start to take to improve and train your innermost core:

Step 1- Flexibility: You can't properly work a muscle when the opposing muscles or synergists are tight and overactive, because your joints are in poor alignment. You're also more susceptible to injury. Most readers will benefit from a program like the one presented in the Ultimate Flexibility post, click here for a downloadable copy.

Step 2-Static Core Activation & Strengthening: Wake up the muscles that have been asleep all day long! These exercises focus on activating and strengthening the core in a stationary position, good examples include the 'plank' and quadruped with raised arm and leg. Static strengthening is a good start, but you'll also want to include exercises that train your core to stabilize your body as you perform movements.

Step 3-Integrated Core Training: Activate your core as you perform strength exercises for chest, back, arms, legs, shoulders - any muscle at all. Examples include single leg versions of standing chest press, rows, biceps curls, triceps extensions, as well as lunges and exercises performed on balance boards and stability balls. It is more challenging to stabilize as your perform the exercises, and these exercises train your core to stabilize in different ways that static core training. Once you've mastered this phase with good form throughout, you are ready to add more complex, dynamic movements that require core stabilization throughout.

Step 4-Dynamic Core Training: Here, we stabilize as we move multiple muscle groups together or move in multiple planes of motion, requiring constant effort to stabilize. A few examples include walking lunges with rotation and a step to balance, or a single arm row with a reverse lunge and step to balance, or multi-planar step ups onto a bench with balance and a biceps curl. These may sound over complicated, but they can be graceful to watch and help you stay balanced and on your feet when - for example - you have a near miss on the football field, track or crossing the street.

Deep CORE Exercise Progression

Here is a list of sample core strengthening exercises at each step. I'll be demonstrating them on the gym floor during Cary's Core Clinic and can help find the right level for you, and I incorporate many of them into the workouts at my Total Body Conditioning Class at NYSC Cobble Hill, Thursdays at 630AM

Static Core Activation & Strengthening	Integrated Core Training	Dynamic Core Training
Standing on 1 leg Stand/Balance on Wobble Board Drawing in Maneuver Plank Quadruped with arm and leg raise Side Lying Leg Lift Stability Ball Squat	Stand on 1 leg and bicep curl, shouder press/raise, tricep pressdown, row, chest press Balance on Board or Stability Ball and Curl, Skull Crusher, shoulder press/raise, row, check press Quadruped with row or triceps kickback Stability Ball Squat with biceps curls, shoulder press/raise Single Leg bent over row or triceps kickback	Step up onto bench, balance and curl or shoulder press/raise Walking lunge with rotation and step to balance on 1 leg Row or chest press with lunges and a step to balance on 1 leg Lunge, step to balance and curl or shoulder press; lateral lunge step to balance and curl or shoulder press

UltimateFlexibility(almost/so far)

I have two questions for you

• Are you happy with your current level of flexibility?
• What are you doing about it?

Most people I meet are not happy with their flexibility. Even people who are really flexible seem to want more. Yet, its the last thing most people spend time on. I have even been guilty of this myself. This issue is meant to slightly change the way that you think about flexibility, and give you a step by step approach and some specific tools that can lead you to results - if you take the time and do the work that is needed. You'll probably have questions so feel free to ask.

THE PROBLEM WITH MOST PEOPLE'S FLEXIBILITY PROGRAMS The top 5: not doing the stretches that are right for YOU; doing the same few stretches over and over again; not stretching for long enough; using brute force instead of your brain to stretch the muscles; and, neglecting the strengthening component of a flexibility program. So many people try to improve, don't see much progress and every day, leave the gym and go back to the same desk or lifestyle and the problems start over.

ARE YOUR MUSCLES TIGHT? OR IMBALANCED?
Probably both. If a muscle is tight, think of it as being short --- therefore, the opposite muscle compensates by being long. Or does one muscle get too long, and the opposite compensate by shortening? Maybe both at the same time. Some of us are born this way, but often our lifestyles are important factors. If you sit all day, the muscles that you sit on (glutes and hamstrings) tend to get all stretched out and the hip flexors and quadriceps get all tight. If you work on a computer all day, the muscles in front of your chest and shoulders get tight as the muscles behind get stretched out. The same think can happen from driving and biking. I've written about this before...we call these opposing muscle agonists and antagonists. You'll improve your flexibility if you can identify the tight muscles and stretch them, and identify the weak muscles and strengthen them.

STRETCHING IS IN YOUR HEAD You know that stretching is done to make a muscle longer.. but exactly how do you do that? By pulling it to the maximum possible length? Or by getting your brain to do the work? Actually, its the brain and nervous system that controls the length of your muscles, you can do some damage by pulling to much or in the wrong way. There are numerous effective stretching techniques, all of them rely on stimulate sensors in the muscles to send a signal to the brain, and electrical impulse that says "relax me." Those impulses travel through the nerves and spinal cord, then the brain sends messages back to the muscle fibers telling them to relax. It takes at least 7-10 seconds for this process to initiate, so that guy who you see grabbing the front of his shoe and pulling his knee back for 3 seconds and then running off...he's not stretching. Nor is that person who pulls so hard that they overstretch the ligaments while the muscle doesn't increase in length.




STRENGTH TRAINING CAN IMPROVE FLEXIBILITY Sometimes a movement is difficult because a muscle is tight, but often it is because the opposing muscle is actually too weak and extended. I see this a lot with the inner thigh, biceps, and hips/glutes. In some cases, the opposing muscle is literally asleep, and when you try to perform a movement it barely wakes up and you get that stiff feeling like rigor mortis setting in. You can stretch the tight muscles as much as you want but only see limited improvement, so fight back by strengthening the muscle opposite the one that is tight. Which brings us to another issue...

YOU REALLY DON'T NEED TO STRETCH EVERY MUSCLE The are all kinds of group stretching classes, yoga, etc, which are really nice and have helped many people improve their flexibility. Keep in mind that these classes offer a generic one size fits all set of stretches which may not be ideal for your specific needs. You may actually be stretching muscles that are already all stretched out. This goes for the programs that I've included in the sidebar on the left, they're good programs but generic because I haven't assessed you yet. A physical therapist, massage therapist and some personal trainers can assess you and identify which muscles need stretching and which need strengthening. This is an ongoing process: I often do on the fly stretches during a training session when a client has difficulty performing certain movements.

HERE'S AN EXAMPLE OF A FLEXIBILITY PROGRAM THAT IS WELL TARGETED TO PEOPLE WHO SIT A LOT AND MAY EXPERIENCE FOOT PAIN (PLANTAR FASCITIS) OR KNEE PAIN, POSSIBLY ACL INJURY. It aims to correct postural disortions such as feet that turn out, knock knees, tight hips.

STRETCHING BEFORE EXERCISING...AND AFTER TOO
Depending on your posture, fitness level and goals, some stretching before working out can be beneficial. The goal of this stretching is to relax those tight muscles so that the joints are in proper alignment before working out...because if the joints are in proper alignment you can work the muscles better and reduce risk of injury. Some forms of stretching may cause a short term reduction in the amount of force a muscle can generate, so you should avoid them before your powerlifting competitions or choose other forms of stretching. Other forms of stretching?

THERE'S MORE THAN ONE WAY TO LENGTHEN A MUSCLE Most people are familiar with two types of stretching: static stretching, which involves stretching in a stationery position and holding the stretch for about 30 seconds; and, assisted stretching, which is basically the same except your trainer or someone else helps you do it. There are many other techniques that may work for you, depending on your fitness level, exercise program and goals. I've summarized a few in the sidebar. Periodization, changing your stretch routine at regular intervals, can also be helpful in many cases.

LIKE GIVING YOURSELF A DEEP TISSUE MASSAGE
Myofascial release is a technique for working out knots and adhesions that limit the extensibility of your muscle tissue. Pressure is applied to the knotted area, and after about 30 seconds, the brain sends a signal to the muscle to relax. If you have some persistent tight spots, you can do this yourself using a foam roller. They're available in the gyms, and if you'd like one for home you can order one online for about 20 bucks. The most common areas that benefit from the attention with the foam roller are the calves, IT Band and quads, but you can actually use them in almost any part of your body. I've got a program that illustrates how to use the foam roller for many different body parts. Click here to view/download the program and choose those stretches that target your own personal tight areas. Do the foam rolling before your regular stretching routine for maximum benefit. Feel free to let me know if you need some help in learning this technique.

STRETCHING TECHNIQUES AND PROGRAMS

STATIC STRETCHING The most popular form of stretching, where you hold a muscle in a stretched position and gradually allow time for it to extend. Hold for 20-30 seconds, shorter is not effective, longer is not much more effective. ACTIVE ISOLATED STRETCHING is a progression from static stretching, appropriate if you have no postural distortions. These stretches typically are performed in 1-2 sets of 5-10 repetitions, each repetition is held for 2-4 seconds. Some require assistance, be very careful with these, I dont recommend having someone who is not trained assist you with them. SAMPLE AI STRETCHES

DYNAMIC STRETCHING is for the fit, and is actually more like exercise than a stretch, and includes lunges, pushups with rotation, walking sideways with a resistance band. PNF (AKA Neuromuscular or Contract Relax) STRETCHING PNF means Proprioceptive Neuromuscular Facilitation, and it basically tricks the brain into lengthening a muscle. A trained professional will alternate between stretching your muscle and having you resist against the stretch. Again, many require assistance and I do not recommend having someone who is not trained assist you. SAMPLE PNF STRETCHES

MYOFASCIAL RELEASE is a technique for working out knots and adhesions that limit ability of your muscles to fully extend. Pressure is applied to the knotted area, and after about 30 seconds, the brain sends a signal to the muscle to relax. SAMPLE SMR STRETCHES

Posture and Movement Assessments

I have a confession to make. From the minute I first see you, I am watching your posture and the way that you move and looking for way to improve you. Are your feet turned out? Do your shoulders round? Or are they elevated? Is your head forward? Does your back arch? Do your knees move in our out? If you answer yes to one or more of these questions, you have muscular or structural imbalances that need to be addressed in your exercise program. In many cases, certain exercises should be avoided to minimize risk of injury, and other exercises should be included to help correct the imbalance. For example, someone with rounded shoulders should avoid overhead shoulder exercises and strengthen the muscles that pull the shoulders back.

Posture can be addressed statically, basically in a stationary position, and dynamically, while moving. In addition to casual observations of movement, several assessments allow us to do a more focused evaluation. Here are two of the most common:

Overhead Squat Assessment: This consists of a squat with arms held above the head. Here, I'm looking for whether the heels lift, feet turn out, knees move in/out, low back arches or rounds, or the body leans forward.

Single Leg Squat Assessment: In the single leg squat assessment, look for whether the feel flatten, knees move in or out, or the hip shifts. These observations indicate imbalances in the calves, thigh muscles, back, core and shoulders that should be addressed in training.

Core Training and Stablility

There are 29 core muscles that work together to keep the body stable as it generates force, absorbs force, changes direction and moves in multiple different planes of motion. An effective functional exercise program trains your core to do all of this. Rather than training in isolation, we integrate core training into many exercises for other body parts. Ultimately, a core that is stronger while performing movements can improve your overall performance and strength and reduce risk of injury.

If your core training program consists mainly of crunches, leg extensions and back extensions, you're working in only one plane and risk overtraining your rectus abdominus. That's the "6 pack muscle" and yes, you can overtrain it to the extent that it increases the risk of injury - and in a way that will surprise you: A tight rectus abdominus pulls the pectorals forward, tight pectorals pull on the shoulders causing them to rotate in, rotator cuff muscles cannot function effectively and are at risk of injury. Running? By pulling on the chest muscles and moving the shoulders and head forward, an overtrained rectus abdominus can reduce your oxygen intake. Exercises that strengthen the deep inner abdominals, and exercises that incorporate core stabilization with other movements, are an essential component.

Public enemy number 1 is the chair, followed closely by the bench. If you spend a large part of your day sitting, it's a good idea to not to sit or lie down through your entire workout every time you train. Chairs and benches do the work of stabilizing your core as you perform the exercises.

Flexibility

Muscles need to be in proper balance to work together optimally. Our posture and movement assessments will tell us which appear to be too active or short and which appear to be underactive or extended. We need to stretch the short muscles and strengthen or activate those that are long or extended. Stretching and strengthening go hand in hand to achieve flexibility; the genera rule is that when a muscle is tight the opposite muscle is extended.

Here's an easy way to think about this: those muscles that you sit on all day long, your glutes, are probably asleep; the opposite muscles, hip flexors, are flexed all day long and remain short. The hip flexors can get so tight that they inhibit the glute. So stretch the hip flexors, strengthen the glutes, try not to overdo it on exercises that flex your hips... and you are on your way.

Do the same type of assessment and programming for other area of your body.

Advanced Functional/Core Mini Workout

The following are some selected exercises that some of my advanced clients are doing...you might not be ready for them right now but with consistent effort can work towards them. Feel free to ask me to demonstrate them if you don't know what they are:

Tube Walking (Hip Abduction with Band)
Reverse fly with Chest on Stability Ball
Single Leg Deadlift into PNF Pattern (drawing sword)
Single Arm Cable Chest Press/Lunge/Step to balance on One Leg
Single Arm Cable Row/Reverse Lunge/Step to Balance on One Leg
Lateral Lunge/Balance on one Leg/Biceps Curl
Single Arm Cable Triceps Pushdown Kneeling on Bosu Ball
Single Leg Box Jumps (Plyometrics)

We're generally working in a range of 2 sets of 12-15 repetitions. At the beginner and intermediate level, you might start with a standing cable chest press, progress to one leg chest press, then lunging chest press and so on, until you are ready to do the more advanced version of the exercises. One of my most advanced clients had never exercised until about 2 years ago and can do all of these exercises.