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To book a call, visit: breathe.education/call
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Before we move on with the rest of the book, let’s check in with where
you’re at right now in your client work.
Below, rate yourself on a scale from 1-5 on how accurate the
statements are.
1 means “strongly disagree.”
5 means “strongly agree.”
Once you’ve rated yourself for each statement, total up your scores
and then use the answer key to determine your next steps.
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~ Mahatma Gandhi
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1. Ask open-ended questions
2. Actively listen
3. Agree on shared goals
Let's look at each of these skills in turn.
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To become good at active listening, practice with your friends and
family.
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~ Noam Chomsky
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Most serious
Least serious
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1.
2.
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o
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~ Jocko Willink
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What is a strategy you can use to achieve this?
Healthy Behavior
Current level (0-10)
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Desired level (0-10)
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Education is a core recommendation of all high-quality clinical
guidelines(3). However, with education for people in pain, a little goes
a long way.
Some is good, but more is not better(162).
Keep your education simple, short and focused on what is important to
the client(163):
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Why it hurts
Prognosis
Treatment options
Self-management strategies
Here’s a summary of the answers to these four items that you can
share with your clients about their condition.
Don’t show them the whole table! Just share and explain the
information relevant to their diagnosis.
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Use short, plain-language words that a nine-year-old could understand.
Avoid using alarming diagnostic labels.
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Diagnosis
Classificati
on
Why it
hurts
Prognosis
Treatment
options
Spine
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Tendinopathy
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Achilles
tendinopa
thy
Patellar
tendinopa
thy
The tendon has
become
aggravated by
an unusual
loading event
Plus, the pain
system has
become
sensitized as
per NSLBP
Most people
return to full
function within
12 months but
around 23%
experience
continued
symptoms for
up to 10
years(166)
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Hip
replaceme
nt
Knee
replaceme
nt
Postsurgical
rehabilitation
Artificial joint
implant
Improvement
to 80% of
function
compared to
healthy
population(167)
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Heavy graded
resistance
training
Eccentric
overload
training
Address
psychosocial
factors
Educate on
load
management
Stretch calves
if restricted
ROM
Load
management
Graded
strength &
flexibility
exercise of all
leg
muscles(168)
Walking
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Address
psychosocial
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o
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Anatomy
Anatomy is the study of what bits go where. To understand anatomy is
to make an accurate mental picture of the parts inside the body.
Knowing the names of the parts is not important and is not the same
thing as understanding them.
Knowing the names of the parts does not enable you to problem solve
or understand why things work or sometimes don’t work in the body.
Making an accurate picture in your mind DOES enable you to
problem-solve, and to understand WHY things work, or don’t work.
If you’ve “learned” anatomy by memorizing lists of muscles, actions
and other trivia, learning to make a picture in your mind will be a total
game changer for you.
Let’s learn the anatomy of the rhomboid muscle.
Look closely at the picture:
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The second level of the pyramid tells us to guide our exercise choice
based on client preference and expectation, and we’ve addressed that
throughout this book also.
The final, topmost layer of the pyramid tells us to modify a client’s
exercise program based on guidelines particular to their medical
condition or injury, if such guidelines exist.
It is well beyond the scope of this book to give you specific
recommendations on exercise modifications for every possible injury
and medical condition, and that information is freely available already.
The reality is that, for most injuries and medical conditions, there are
no additional special considerations beyond what we’ve already
covered. However, in some cases, there are particular things you need
to be aware of, which will guide you to modify your exercise choice.
You can find these recommendations in ACSM’s Guidelines for
Exercise Testing & Prescription. Search for the current edition as this
is updated every 2-3 years.
ACSM’s Guidelines include specific recommendations on
modifications for the following conditions:
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Pregnancy and postnatal
Cancer
Arthritis
Diabetes
Multiple Sclerosis
Parkinson’s disease
Cardiovascular disease
Stroke
Children
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Older adults
Fibromyalgia
Obesity
Osteoporosis
Spinal cord injury
At the time of writing, the guidelines retail for around $40 USD and
you can easily find them online.
Specific recommendations for postsurgical clients
Postsurgical clients will have a piece of paper from their surgeon
laying out the recommended time to protect the body part in a sling or
brace.
As a rule of thumb, your job starts when the sling or brace comes off.
Ask your client to see the surgeon’s recommendations for particulars.
Body region
Spine
Upper extremity
Lower extremity
Condition
Special
considerations
Low back pain
Spondylolisthesis
Spondylolysis
Facet joint arthritis
Stenosis
Sciatica
Graded exercise(4, 197-199)
Cervical radicular pain
Neck pain
Cervical disc bulge
Graded exercise plus
manual therapy(102)
Scoliosis
Graded exercise(200)
Shoulder impingement
Subacromial bursitis
Rotator cuff tendinopathy
Rotator cuff tear
FAI (femoroacetabular
impingement)
Hip replacement
Hip labral tear
Gluteal tendinopathy
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Educate on load
management
Reassure of
favourable outcome
General graded
strengthening &
stretching
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ACL (anterior cruciate
ligament) surgical repair
Avoid positions that
aggravate
symptoms(202)
Graded exercise per KNGF
guidelines(130)
Patellofemoral pain
●
Graded exercise to
strengthen hip
muscles, then knee
muscles
●
Educate on load
management
●
Retrain running to
forefoot strike /
increase cadence /
reduce valgus(203)
●
Heavy strengthening
>80% 1RM
Eccentric overload
training (>100%
concentric 1RM)
Stretch calves if
limited ROM(204, 205)
Patellar tendinopathy
Achilles tendinopathy
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~ Ruth Bader Ginsburg
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