PT on the Net Research

Degenerative Facet Joints


Question

I have a client with degenerative facet joints. My client is reluctant to give me her physicians name and phone number and she says she knows her limitations. She has purchased 5 sessions with me, what should I do?

Answer:

Thank you for your question! We are very happy to hear you asked to contact her physician, it is unfortunate you were not able to communicate with the person who probably knows best. Without an assessment it is difficult to give you exact advise, however, we can provide you with very helpful guidelines:.

  1. Develop proper muscle balance. Utilize an integrated training approach.
  2. Correct all kinetic chain imbalances. An example with facet problems could be an over active hip flexor complex especially the iliopsoas.
  3. Develop proper structural integrity before activity specific training. Do not get too "fancy" or too progressive to soon! STABILITY PRECEDES MOBILITY!
  4. Establish multi-planar postural control. We must have the ability to function in all planes of motion, therefore, the training program must condition the person to handle every day stress to avoid injury and increase performance.
  5. Develop optimal levels of stabilization strength, core strength, and neuromuscular efficiency PRIOR to extremity strength, prime mover strength or explosive power. Applied this means to reduce traditional machine use when the person is in need for intrinsic stability. As the saying goes; "You can't shoot a cannon out of a canoe".
  6. Establish optimal levels of activity specific functional strength, neuromuscular efficiency, reactive neuromuscular control and power. Activity specific is the key word...what is your clients everyday environment like? Do they need more eccentric strength, isometric or concentric strength? What is the dominant plane of motion they need to be trained in? What speeds do they need to be trained at? What are the loading needs (how many normal clients need to bench press?)?

Remember, each client is a special person with special goals, needs and wants and on top of that they exhibit individual abilities. Always watch your clients form and never progress a person too quickly!

References:

  1. NASM Integrated Training for the New Millennium for an extensive list of definitions and practical programming examples.