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Hey Folks,
I do like hearing what parts of the course resonated with other people who attended.
Here are a few of my take home points from the Reiman course:
I’m guilty as well of chronically underloading patients. It was easy to address this in the clinic yesterday by giving a patient a certain exercise and weight and asking them to do as many as they could. And then adjusting the weight or reps accordingly.
I like the way he explained several times that his fellow asks patients – “how confident are you that you can get these exercises done? Be honest. What can we do to increase that percentage/likelihood of you completing this home program?, etc”
The ease of use and effectiveness of using patient’s subjective RPE to gauge and progress load.What other clinical pearls did everyone else take away?
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Here is a great Podcast from Seth O’Neil on the Achilles/isometrics study that Mike referred to a few times, and (group of Podcasts from this group); he discusses the study, some questions we have discussed already regarding carryover of research conclusions to various regions, etc.
Thanks Justin for starting the post about take home/clinical points from the past weekend.
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There were a couple points from the course that I can do a better job of incorporating into my clinical practice. Occasionally, I will ask a patient during an eval if they feel that it is reasonable for them to be able to complete their HEP. I need to do a better job of doing this more consistently as it could improve compliance with HEP and also help build a therapeutic alliance with the patient. Additionally, I enjoyed our discussion and activities about acute:chronic workload ratios. I think this could be particularly helpful with our patients who we are helping return to run in order to ensure that they are not doing too much too soon and further injuring themselves. I may tinker around on Excel a bit and see if I can make a patient-friendly spreadsheet for them to track their mileage so they can progress appropriately.
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Hey Justin, I took home a couple of key points that I have already started to incorporate. I have a younger athlete with ACLR who I utilized a few things with last night. I really liked Mike’s emphasis on “active rest” periods. This athlete plays rugby and he rarely ever stops moving during a match, let alone sit all the way down. So I began to incorporate active rest periods with him. I also made sure to monitor RPE with him. One of the exercises I thought was the hardest for him, he only reported a 4/10 with, so I felt confident in progressing some increasingly difficult quad strengthening exercises. At the end of the session, he reported an overall workout of 8/10. I think this goes back to Mike’s point that we are chronically under-loading these patients. I never would have known this if I hadn’t have asked him about RPE! Im definitely going to try to incorporate this more.
Another point I thought was interesting was the amortization phase concept. I have a volleyball athlete who plays on the back row and she needs to be able to explode from a prolonged loaded “ready” position. We started her working on some explosive movements laterally from a loaded position to make sure she is preparing for her sport-specific needs.
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I think one of the main issues I have as a clinician is ther ex. I think this course helped push me in being more creative in designing ther ex for a patient and the specific activities they need to return to. Like wise, it helped break down how each players position on a team can also impact exercise prescription and type of activity (power vs endurance vs strength). I think the biggest point I got from this weekend was that as a profession we are guilty of under loading patients and sending them back to sports they may not be ready for. This is going to impact my practice in making sure we are doing sport specific tasks to further make sure they are returning with their tissues fully prepared. This ties in with another point I started using in my evaluations. Screening the likeliness of a patient to perform their HEP and how often they can perform them is a new step in my evaluations after this course. I feel like making HEP a joint decision will help with pt buy in as well and help them decide what they would get the most out of.
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I think one of the main issues I have as a clinician is ther ex. I think this course helped push me in being more creative in designing ther ex for a patient and the specific activities they need to return to. Like wise, it helped break down how each players position on a team can also impact exercise prescription and type of activity (power vs endurance vs strength). I think the biggest point I got from this weekend was that as a profession we are guilty of under loading patients and sending them back to sports they may not be ready for. This is going to impact my practice in making sure we are doing sport specific tasks to further make sure they are returning with their tissues fully prepared. This ties in with another point I started using in my evaluations. Screening the likeliness of a patient to perform their HEP and how often they can perform them is a new step in my evaluations after this course. I feel like making HEP a joint decision will help with pt buy in as well and help them decide what they would get the most out of.
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I definitely can better monitor RPE to progress and prescribe exercise, both with my athletes but also my older patients. The acute:chronic workload ratio and spreadsheet was a big takeaway for me as well. Especially coming into the fall, when we get a lot of chronically under-loaded athletes over the summer starting school sports. I agree with Jen with using all of the tools we learned to get better buy in from day one. Making exercise prescription even more personalized and discussing it with the patient – i.e. your goals are “x,y,z” and then deciding together what they can realistically manage to do at home and what will be the focus in session (1 day of endurance, 1 day strength, etc). Further monitoring RPE not only makes sure we are not underloading but helps with patient buy in as well.
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