Training clients with injuries
I recently wrote a blog for Fitpro on bespoke training for specific injuries.
Dave Whiteley was a keen gym-goer, with a love for weight training. His world changed when he was involved in a horrific motorcycle accident, which resulted in 9 major breaks and 14 other fractures. He was told he would most likely need to have his right leg amputated for the best chance of recovery, he opted to keep it, surgeons managed to save it but no-one knew whether he would walk again. He then spent 3 months in hospital and 6 months in a wheelchair.
Dave knew he needed some help with his rehab and wanted to regain his health and fitness. He was fighting a daily mental and physical battle struggling to come to terms with his physical limitations caused by the pain he endured with every step he took.
Dave was introduced to me via a word of mouth referral at the Gym I’m based at. That was 7 years ago. For Dave to even seek help from anyone, let alone a Fitness Professional was a big step. He’s old school – comes from the school of hard knocks, he was in the Parachute regiment years ago and now runs a successful pub. He’s driven and motivated but also hugely stubborn and there’s no middle ground with him, which he freely admits!
My first steps with him were to liaise with the NHS physio who had initially worked with Dave and have his X-rays looked over with a specialist Physio I work with at the gym. I also contacted his wife (with Dave’s permission) to get an idea of how Dave’s accident had impacted his home life.
My practical concerns were;
· Would I cause any more damage if I pushed too hard or chose the wrong muscle actions?
· How much of a difference could I actually make to his lower body that was now full of metal pins?
· How much could I help his psychological state when I have no formal qualifications in this area?
Programming for someone like Dave to had to include a periodised training plan that we discussed together so he knew what to expect, why we were doing it, how long for, what I hoped he would achieve from it and ultimately what we’d be able to progress onto on the next phase. Once the foundation work had been done with rehab, re-building his core, mobility and stability I was then able to build him more hypertrophy based programmes – like the Chest and Triceps session you see in the video clips.
Swiss ball rollout to engage and strengthen the core and improve hip stability and control
Seated chest press machine, the goal here is to maximize the resistance Dave can press through his chest without overloading his hips so he can purely focus on the muscles we’re trying to build – in this case his Pectorals.
Cable pec fly, Dave is kneeling so as to reduce strain and load through back and hips but to make him focus on core as well as the chest, anterior delt and triceps through the continuous tension the cables provide.
TRX triceps press, a perfect example of how to train triceps whilst promoting core engagement, strength and stability through the rest of the body
No matter what we’re working on in any phase of training I always get Dave to perform some core work at the start of each session. This is to activate his TVA and obliques to help him stabilise and get his kinetic chain working effectively on his heavier lifts and help to prevent him from loading incorrectly through his lower back or hips.
When programming for someone with metal framework, a replaced hip and a worn knee I’m mindful not to put excessive repetitive strain through major lower body joints. For example, if I get Dave to perform a standing movement that loads through hips, I’ll deliberately follow it with a seated or lying movement so as to minimise lower body load and strain but still keep intensity up on the upper body muscles.
My goals for Dave have always been to ensure he can come into the gym and have structured workouts that he can follow safe in the knowledge that he won’t hurt himself, exacerbate any old injuries but relish, enjoy, see visible results in his physique and keep his confidence sky high!
Tips for other PT’s with a similar client; instead of programming entirely for what YOU think is best for the client, you need to include training modalities and exercises that the CLIENT enjoys and believes are good for him in order to get the best long term and sustainable result.
Don’t be afraid of asking for help and seeking the advice of other professionals who are experts in their chosen fields – like Physios and trained NLP or CBT practitioners. I believe our job as Fitness Professionals requires now more than ever for us to be a jack of all trades, and understand the mental as much as the physical aspects to long term health, fitness and happiness for US and OUR clients.
2 years ago Dave became one of the first people in the UK to have all his metal work removed from his body. He had built so much strength and stability throughout his entire body the surgeons said he would thrive without it. This is testimony to him as much as it is to me and he continues to train with me on a weekly basis with intensity and ability that belies his age and injury history.