Program design can be extremely challenging. A training professional can feel overwhelmed just trying to figure out where to begin. It would be easy if a universal training program could be prescribed to an individual based on the person’s sport or functional goals. The advantage of a “cookbook” program or protocol is that it can offer training suggestions purported to be beneficial by other trainers, coaches, or rehabilitation professionals. Unfortunately, cookbook programs do not account for individual differences in athletes or clients.
The following are clinical cases that represent examples of clients or athletes seen every day in athletic training rooms, rehabilitation clinics, and fitness centers. As you read each scenario, attempt to identify potential functional weaknesses or limitations for each client. Then generate some training ideas to help correct those dysfunctions.
- Clinical scenario 1: A 35-year-old female wants to resume a running program. In the past, she ran to maintain physical fitness. She has also participated in weekend 5K and 10K fun runs in the past and wishes to be able to do that again. She had a cesarean section 4 months ago and has not run in over a year and a half. This client will present with abdominal weakness related to the cesarean and more than likely will also present with muscular weakness or imbalance in the remaining core muscles. Failure to address muscular dysfunction and weakness may contribute to the onset of a lower back or lower extremity running-related injury. The addition of a core training program may help to reduce the risk of sustaining an injury.
- Clinical scenario 2: A high school discus thrower is frequently straining muscles in his low back. He usually experiences an episode of low back pain when he practices longer than 2 hours in a day. He is currently performing a training program (which his coach adopted from a track and field Web site) that includes squats and lunges. He is able to demonstrate adequate power and strength based on the amount of weight he is able to lift, but something is obviously missing. Evaluating the endurance capacity of his core muscles is crucial. Fatigue of these muscles will affect how forces are generated and transferred through his kinetic chain as he throws.
- Clinical scenario 3: A 23-year-old female has suffered pain in the front of both knees for 3 years. Her previous three attempts at physical therapy have failed to reduce her pain or improve her functional ability. She is employed as a medical transcriptionist and is generally sedentary. She continues to do the exercises previously prescribed by her physical therapist: straight leg raises and short arc quads to strengthen the hip flexors and quadriceps, and hamstring stretches. Is a rehab or postrehab program complete if it emphasizes only the quadriceps and hamstrings? There is research suggesting that the hip musculature plays a crucial role in lower extremity biomechanics. Weakness in the hip may dramatically affect the stresses experienced at the knee.
In the scenarios described in the previous section, the exercise programs likely failed because they were missing one essential component: core training.
Core training, a popular buzzword in the fitness and rehabilitation worlds, is still poorly understood. In the training programs prescribed by some trainers or therapists, the choice of exercises for training the core (or the lack of core exercises) is often shocking. Core stability training should serve as a foundation for all training and rehabilitation programs. Core training should not promote or cause dysfunction in clients! Fitness professionals who follow the advice of a training guru may invite trouble for their clients. These trainers may apply the flavor-of-the-month exercise or implement a generic training program for all of their clients irrespective of individual needs and goals.
The strategies outlined in this book will help you design and implement evidence-supported core training programs that reduce the risk of injury and maximize the client’s performance (sport or functional performance). To develop optimal training programs, you must be able to assess your clients’ functional needs, identify their weaknesses, and prescribe the appropriate exercises. This text guides you through the process of assessment, testing, and prescription of core exercises.