Designing a Fitness Plan (Part 1)
By Jeffrey Tucker, DC, DACRB
It doesn't matter if you come to my practice for pain relief, weight loss, healthy aging or something else. The formula I talk about for each patient's fitness strategy is pretty much the same. I want to know what they are doing to 1) build muscle; 2) get rid of excess fat around their middle; 3) strengthen bones; 4) boost lung capacity for better endurance; 5) improve their heart's pumping ability; and 6) improve balance and speed. To achieve these goals, patients need to know I am the doctor who creates a plan. Patients seem to like to hear, "I have a plan." If a patient is already exercising (yoga, sports, jogging, gym, etc.), I just like to make sure they are doing something for each of the six categories above. Patients who aren't exercising need to be taught fundamentals and I invite them (and you) to be guided along. I think I have a pretty good technique sequence I like to follow. It typically goes something like this...
The Plan: Overview
I assess range-of-motion restrictions, joints and soft tissues (ortho and neuro tests included). I apply mobilization / manipulation and release myofascial restrictions. I teach awareness exercises (posture, breathing) early on. I teach self-myofascial release approaches, such as foam roll and stick work. I teach patients self-stretch techniques. I teach low-load (body-weight, bands, balls, etc.) exercise techniques; then I teach whole-body exercise approaches using kettlebells and free weights. Discussion of therapeutic lifestyle changes is ongoing.
During the first clinician-patient meeting, as a rehab specialist we have a responsibility to do all of the following:
I also think it is important to perform provocative tests and functional movements, and provide some sort of self-"recheck." I am trying to get away from using the word homework when I prescribe corrective exercises. Instead, I ask the patient to frequently (throughout the day) perform a movement we identified as helpful and then "recheck" to see if it is improving.
The Plan: Specifics
When I talk to my patient about the "pain relief plan," I really tie everything together to create a "fitness game plan." I might say, "Let's get you more fit so you can age well" or "Let's make you're more durable for your next athletic event." Every effective fitness game plan needs:
I am ecstatic if I can encourage my patient to do a little resistance training, a little cardio, improve their nutrition a little, and perform a little brain-train (including meditation, breathing, balance). For my general patient population (I tend toward a chronic pain practice), I think it is healthier (and easier) to immerse yourself in one, two or even three of the four fitness disciplines, rather than just one.
Here is a summary of a typical fitness plan I will offer a patient who presents with chronic low back pain, is overweight (and knows it), and is deconditioned:
Each new-patient encounter includes asking the patient not only about their history, but also their own thoughts, feelings and beliefs regarding the pain or problem. It's important to me to know the outcome the patient wants, and what's really significant and worth pursuing. That process helps clarify the successful course of treatment. Then it's up to them! I become the teacher and the patient has the ultimate responsibility for their fitness plan.
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