My client has gout in his elbow. Is there anything I should be aware of in his training? He has tight anterior delts and chest muscles.
The first thing we should do is clear up for the readers what gout actually entails. I am sure you have done your homework on this one because you mentioned that you have discussed diet with him already. Simply stated, gout is a buildup of uric acid that is stored in the joints. It affects about 2.1 million people in the U.S. Men aged 40 to 50 years are the most likely to have gout. Uric acid is a by-product of purine and is supposed to be broken down in our blood and excreted through our urine. In some cases, the uric acid has a hard time being broken down and will be stored in the joints. The most common joints affected are the big toe, knee, ankle, foot, hand, wrist and of course elbow. One simple way to decrease the symptoms of gout is to stop eating foods rich in purine. Some foods that contain a lot of purine are alcoholic beverages especially beer, anchovies, sardines and organ meats like liver, kidneys and legumes. This is only an abbreviated list. There are many other foods that contain purine.
The tight anterior muscles are what we term rounded shoulder pattern, or upper cross syndrome. As a trainer, we should never use the term syndrome because it implies a clinical diagnosis. Trainers NEVER diagnose. We assess the structure and try to make the best choices of exercises for that individual. In this gentleman’s case, it sounds as though he has a classical rounded shoulder pattern. Vladimir Janda, to my knowledge, is the first one to receive credit for grouping muscles that tend to become facilitated, or tight, and muscles that tend to become inhibited, or lengthened. He then classified certain patterns that would develop because of certain muscles being tight. The classic rounded shoulder pattern is typified by tight anterior shoulder capsule, tight pec minor and tight lats. It is harder to understand that the lats are tight because they are located in the back. The reason they contribute to this pattern is they attach on the anterior superior humerus. When the lat becomes facilitated, it will internally rotate the humerus, creating a rounded shoulder pattern. There are many other muscles that contribute, but for the sake of this article, let’s limit it to these three. The trainer needs to try to focus on releasing or stretching these muscles. Another technique that can be used is self myofascial release. This is simply where you have the individual roll each of those muscles on a foam roller. By rolling over the facilitated muscle, you will break up the adhesions that have been formed inside of the muscle tissue. These adhesions will not allow you to stretch the muscle as effectively through conventional stretching. Please be careful when you roll these muscles because they tend to be quite sore.
After you have appropriately de-facilitated or lengthened the facilitated muscles, it is now time to work on strengthening the posterior shoulder capsule. The posterior shoulder capsule includes the rhomboids, rear delts and the mid and lower trapezius. If you try to skip the stretching or de-facilitation and go straight to the strengthening, it can lead to a shoulder impingement. Some exercises that strengthen the posterior shoulder are wide grip seated rows, wide grip scapula adduction and the PNF diagonal patterns. When doing any type of pulling exercises, try to take an underhand wide grip that is at least six inches wider than the width of shoulders. This will keep the humerus from internally rotating and overusing the lats. Try to stay away from heavy bench presses and narrow grip pulls of any kind. If you can, substitute two arm exercises for single arm exercises. This will let the scapula move independently and will allow for more natural movement. Shirley Sahrmann has a book titled Diagnosis and Treatment of Movement Impairment Syndromes that could be quite useful in helping work with clients with these issues. The book was written for therapists and doctors who can diagnose, not for personal trainers. Personal trainers can get some really good information from her text, but we still can never diagnose.