Programs & Assessments Osteoporosis: A Case Study by Lenny Parracino | Date Released : 16 Feb 2000 0 comments Print Close The intent of this case study is to bridge the gap between academic and everyday worlds by putting scientific fact and theory into application. Personal trainers can use the following "real life" client profile to add to and/or enhance their current program design process. The case study can be used in conjunction with other specialized textbooks to gain an understanding of how training programs are planned, designed, manipulated and progressed. Exploring case studies can form the links between scientific fact, theory and actuality. For example, if you are already working with a client with similarities to the client in this case study, you should try to see how the content of the article relates to your experience. This will encourage thought and help to develop skills you will use for the rest of your career. This article will cover the following: A brief introduction of the client’s goals, needs, wants and levels of ability Clarification of client’s main condition: Osteoporosis Associated risks General guidelines for program design Sample stretch program and exercises Sample strength program and exercises Client Introduction Diane is 47 years old and has just been diagnosed with severe osteoporosis. When Diane first came into the gym, her primary objectives were to improve strength (doctor’s recommendation), lose fat, improve general fitness and in her words, "Tone up to look good in a bathing suit." Diane came to me frustrated with her previous trainer and the lack of results from her exercise program. She was concerned that her program was not individualized for her condition. She had been working with a trainer for four months with no improvement. When reviewing her exercise program, it mainly consisted of lower body exercises performed on guided machines (i.e., leg extension, leg curl, butt blaster) and two 30-minute treadmill sessions per week (intensity unknown). Diane is a secretary and sits most of the day. On a scale of 1 to 10, she has expressed that her career and home stress level is a 7. She is a very fragile and thin looking woman. She has had two C-sections in the past 14 years. Currently, she is going through menopause and is taking estrogen to regulate her hormones. She has committed to three 60-minute training sessions per week. When I assessed Diane’s natural posture, my observations were she had a slight forward head, slight protracted shoulder girdle and slight anterior tilt with noticeable abdomen distention. Length/tension assessments showed predominate tightness of the levator, upper traps and hip flexors (rectus femoris). Diane also complained her neck was "tight," especially after a day on the computer. Diane’s core (lumbo-pelvis-hip complex) assessments showed marked weakness in strength and coordination. Movement quality was poor when assessing body weight squat technique and walking. Before viewing the sample program, it is essential to know what osteoporosis is, the associated risks and general guidelines. This information is not only necessary for the program design process but also can be reproduced and used as an information handout for your client’s awareness. This "caring approach" goes along way! Clarification of the Main Condition What is osteoporosis? Simplistically speaking, osteoporosis is a condition of decreased bone density causing ones bones to be more susceptible to fracture. A fall, blow or lifting action that would normally not bruise or strain an average person may cause fracture in a person with severe osteoporosis. According to the National Osteoporosis Foundation, more than 24 million Americans currently suffer from this condition. Eight times as many women suffer compared to men. Most of these women are of the mature population whose bone mass have dropped significantly following menopause. Associated Risks Females are more likely to get this condition than males because of their lower bone mass Post – menopausal women Women who experienced early menopause Women who have had their ovaries removed Women with exercise induced amenorrhea (cessation of menstruation) Underweight females compared to overweight females Frequent radical dieting Cigarette smoking Calcium deficiency Immobilization or prolonged bed rest Now that we’ve briefly described what osteoporosis is and the risks associated, lets explore a general guideline trainer’s should use when dealing with a client with osteoporosis. General Guidelines FYI: The optimal type and amount of physical activity with this condition has not been established, but a moderate weight-bearing program such as walking and light resistance is recommended. Employ a low to moderate whole body approach Weight bearing exercises Avoid isolated machine training Improve balance/posture/coordination Progress based on client’s ability Recommend client to a nutritionist. There are many dietary supplements that have shown to help with osteoporosis. Sample Program We have provided you with a sample of Diane’s phase one program. Diane’s program is specific to her goals, needs, wants, levels of control and, most importantly, her medical condition. The following exercises and program can be used as an educational guideline when dealing with a client with osteoporosis. We have provided a space for INDIVIDUAL MODIFICATION. By using general guidelines along with your current assessment knowledge, you will be on the path to individualized programming. Individualized programming truly separates the average trainer (one who memorizes protocol) from the professional (a program designer)! NOTE: Because all clients are different, one should not assume that the sample programs and exercises in this article fit all clients. As a trainer, it is your job to extract useable information from this article and formulate your own hypothesis, depending on your client's needs. Diane's Stretching Program STRETCH REPS DURATION Levator/upper trap 3 each side 15 seconds Standing hip flexor 3 each side 15 seconds INDIVIDUAL MODIFICATIONS Seated Levator/Upper Trap Stretch (see Figure 1) Figure 1 Sit comfortably, keeping your spine lengthened – "sit tall." Grasp the right side of the chair. Use your right hand to depress shoulder girdle and lean your head toward your left shoulder. Use the left hand to gently move into the stretch. Switch sides and repeat. Note: You may need to play with different head positions to find the place of stretch. Standing HF Stretch (see Figure 2) Figure 2 Stand upright. Place one hand against wall for balance. Bend one leg backward, and grab the ankle with your hand. Draw the belly button inward and roll the pelvis backward. Avoid arching the low back, twisting your body and jerking the foot backward. Diane's Strengthening Program Objectives Exercise Tips Increase bone density Increase muscle mass and strength Improve balance and everyday function Warm-up prior to exercise Perform individual stretches prior to workout Always move through a pain-free range! MEDICINE BALL - FRONT SQUAT Preparation Place/hold medicine ball on top of the chest Feet should be comfortably apart in a "stand tall" position Movement Draw your belly button inward toward the spine Descend in a controlled manner maintaining proper posture Ascend to start position and repeat required reps ORDER EXERCISE STATION MOVEMENT BODY POSITION REPS SPEED REST SETS GUIDELINES 1 medicine ball front squat standing 12 2-1-2 1–2m 1-3 * Resistance movements should be directed to the large groups that are important in everyday activities 2 cable cross bi-lateral push standing 10 3-0-3 1.5m 1-3 * Each repetition is performed slowly through a pain free range of motion. 3 cable cross over uni-lateral pull standing 10 3-0-3 1.5m 1-3 Performing the movement more quickly will not enhance gains and may increase the risk of injury 4 exercise mat 4-point abdomen draw kneeling on hands & knees 10-12 10 sec. holds 1m 1-3 *Start with 1 set of each 3 times a week. Progress to 3 sets as the body grows accustomed INDIVIDUAL MODIFICATIONS 1 2 3 4 FREE MOTION CABLE CROSS – BI-LATERAL PUSH Preparation Adjust cable arms to the level of your shoulders. Grasp handles Assume a "stand tall" position with a split stance Movement From the start position, draw your belly button inward toward your spine Maintaining the "stand tall" position and push the handles forward, DO NOT OVER EMPHASIZE PUSHING MOTION WITH ARMS! Return to start position and repeat required reps FREE MOTION CABLE CROSS – UNI-LATERAL PULL Preparation Adjust cable arms low. Grasp handle Assume a "stand tall" position with split stance Movement From the start position, draw your belly button inward toward your spine Maintaining the "stand tall" position, pull the handle toward your body Return to start position and repeat required reps EXERCISE MAT –FOUR POINT ABDOMEN DRAW Preparation Assume a 4-point stance Maintain neutral spinal alignment Movement Maintaining spinal alignment draw your belly button inward toward your spine Hold position for recommended time and repeat required reps Diane’s Cardiovascular Program Activity type Heart Rate Zone Duration Frequency Walking 76 – 95 BPM 15-20min 3 times/wk Diane’s goals and wants (lose fat/look good in a bathing suit), needs (core strength/flexibility) and functional abilities (inability to coordinate everyday movements) led to this functionally balanced program design. Diane’s program not only follows the medical exercise guideline for osteoporosis, but also addresses: Stretching Diane’s tight muscles Strengthening Diane’s weak muscles Strengthens postural stabilizers as well as prime movers Trains patterns of movements that carry over to everyday life Isolates inner unit (4-point abdomen draw) Fits into Diane’s 60 minute, three day a week availability Weight bearing cardiovascular fitness High caloric expenditure program, allowing for a potential energy deficit that’s required for fat loss ("look good in bathing suit") As one can explore, Diane’s phase one program offers multiple benefits! Designing programs with a balanced mind set can improve your client’s posture, balance, flexibility, stability and coordination, leading to efficiency in movement, both in and out of the gym. These factors make a person feel good, both physically and psychologically, allowing them to walk away with a positive outlook on each fitness experience. Isn’t that what personal training is all about? Back to top About the author: Lenny Parracino Lenny Parracino is a former author, hands on instructor and clinician for The National Academy of Sports Medicine. Currently, he serves as a faculty member of the Gray Institute of Applied Functional Science. He has spent over 20 years serving the health industry as an international lecturer, soft tissue therapist and movement therapist. Lenny has performed over 300 lectures/workshops, has written educational materials and consulted/lectured in the fitness, manual therapy and educational industry and for various medical organizations around the world. Lenny has earned his degree in Health Science, is a Fellow of Applied Functional Science, holds a California certification/license to practice soft tissue therapy. As a full time clinician, he integrates an eclectic approach of movement conditioning with Dr. Vince Guagliano and Dr. Carina Escudero at AIM Sports Medicine in Hermosa Beach, California. 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