A case study in movement screening and nutrition habits
In conjunction with movement screening, for personal training clients, questionnaires are administered to get data on where one should begin with nutrition and behavioral habits. Client 1# did a consultation at the end of October 2014.
Client 1# came to Rugged Fitness looking to get healthier overall, but kept running into some old injuries. This limited her to only training a few times a week and dealing with pain on a regular basis. In my expert opinion dealing with painful movement will ultimately leak its way into other aspects of life. Eating healthy, pursuing hobbies/activities and overall mood are much more likely to suffer when pain is present in movement. Thus she found herself taking one step forward and sometimes two steps back.
During her consultation we screened her and found four patterns that had pain. Pain was noted in both anterior hips, left ankle and right wrist. We decided that personal training was the best option to allow her the attention and personalized plan she needed. Her goal was to be back doing group training exclusively by June 2015. She went home filled out her questionnaires and I planned out what we were going to do over the next month based off her screen and other movement assessments.
Session 1
We took girth measurements, weight and checked her painful screens. After establishing a baseline we started working on two things: breathing and removing the painful patterns from her training program. The key to her first session was removing the painful stimulus, which we narrowed down to a lack of ankle mobility and motor control, along with loaded wrist extension. This removed a wide range of exercises from our tool box.
Breathing allowed us to re-establish stability and her connection to her own body. With pain we tend to lose feedback from our sensory system because we avoid using the affected site. The brain will up regulate pain receptors making areas hyper sensitive to stimuli. In doing so we develop compensation patterns to allow for survival. Without recovery and reintegration these patterns will become detrimental rather than helpful over time. Breathing is also a great way to dampen down the central nervous systems response to pain. Pain will put the body into a flight or fight mode even if the threat is no longer there.
We were able to load her hinging and pulling patterns. We decided to go with an elevated Kettlebell deadlift (35lbs) and TRX rows. She was able to get a good amount of work done with these two exercises along with working on soft tissue quality in-between. We went over some soft tissue strategies to work on at home and re checked her screens at the end of the session. We saw some positive change which helped gain confidence in our approach.
trx row 
elevated KB deadlift 
Session 2
We started with re checking our screens and seeing what movement capacity was still with her. She had reverted back but was able to regain her progress after the warm up. After the training session, we went over her nutritional habit of drinking more water. Going through her food record from the questionnaire packet we were able to see that water intake was her biggest limiting factor. We came up with the habit of getting 64oz of water a day.
Session 6
Still checking her girth measurements, weight and screens at the beginning of each week, we have found things that work. When she drinks at least 64oz of water, her foot cramps happen far less frequently. These used to keep her up at night. After trying to do the soft tissue work on her own for a week we decided that a massage was a better avenue. After going to one session she saw a dramatic improvement in pain reduction. We were able to increase her deadlift from a 35lb KB to a 53lb KB and started introducing squatting motions (previously painful).
Session 12
Still checking her girth measurements, weight and screens at the beginning of each week, she has lost 4 inches and 4lbs in a month. Without focusing on weight loss we were able to see progress in this area by adding in more water/protein. We also focused on improving strength and mobility in her training sessions while keeping her out of pain.
Session 14
She has been pain free for 3 weeks. One week after the holidays she is down another 1lb/2inches and deadlifted a 70lb KB. We have also reintroduced previously painful patterns into her training. Single leg training and push ups are now staples in her training programs.
Session 18
Most recent measurements taken show a clean movements screen going from a 9 to a 15. Her weight loss was 9lbs and 9inches. She deadlifted a 70lb KB for 7 reps and is working on band assisted push ups.
Final Thoughts
This training system had very slight variations throughout the process. She trained twice a week privately and 1-2x with the group. The first few weeks, she only trained with the group if she had no pain. After about a month she was able to train with group classes as much as she felt she could. Although she still has some difficulty with single leg patterns there is no longer pain.
Using a training system that allows the practitioner to rule out limiting factors at the beginning is invaluable. If we had not done the movement screen or the questionnaires, this process would have taken much longer and we may never have reached a point of functionality. It is extremely crucial that the trainer and client work together to build a plan and execute it with confidence in each other. Having tools that you can gather information from and then go back to as an audit of your work is important. This is why starting small with habits and progress able exercise allows for success.
In just about 2 months we were able to get her out of pain and back to group classes while losing weight and getting stronger (6 months ahead of her timeline). Without the information gathered in the beginning I find it very hard to achieve the initial success shown above. Using a sound system of screens and assessments, one should be able to determine where to start and how to adjust in a timely manner.
TS Training Systems 