• • • Injury history of the patient: this should include the success and failure of previous treatments. Movement competency: knowing how well your patient can squat, hip hinge, etc., is important so we can determine where along the exercise continuum to start with their programming. Type and level of participation: the type of sport as well as the level of competition will impact the intensity of exercise prescription. Maiers M et al, 2014; Petersen et al, 2015; Southerst et al, 2015; Walston and Yake, 2016). A study by the National Chiropractic Board of Examiners found that 98 per cent of surveyed chiropractors reported using “corrective and/or therapeutic exercise” as part of their treatment plan. This is where the use of individualized exercise programs directed at either injury rehabilita-tion or injury prevention can be beneficial. Although pragmatically, it’s important to stress that prehabilita-tion exercises are best directed at preventing chronic injuries, as traumatic injuries can occur without warn-ing when a load or force too great for the tissues to withstand is applied, causing tissue failure and ulti-mately injury. In order to customize a prehabilitation exercise program for a patient, there are three main points that must be addressed: www.canadianchiropractor.ca The injury history of your patient is an important starting point for designing and implementing a prehabilitation exercise program. Patients with a history of ACL injury, chronic lower back pain, repetitive strain injuries or tendinopathies must all be treated differently and have exercise selections customized. Along with their injury history, the success and failure of previous treatments is impor-tant to include. For example, Jill Cook’s research on tendinopathies has demonstrated favourable re-sponses to appropriate loading, including eccentric exercise, and more recently heavy, slow resistance training. Knowing if your patient has performed the appropriate rehabilitation for their prior injuries will help inform their training. Research by Lauersen (2014) has shown that strength training programs can reduce sport related injuries by nearly two-thirds and overuse injuries by nearly half. However, many factors can contribute to overuse injuries. Giffin and Stanish (1993) found that muscle imbalances, excessive training load, and poor technique could all contribute to the develop-ment of chronic overuse injuries. Fortunately these factors are all modifiable once they are identified. The use of a movement assessment tool can be beneficial for identifying muscle imbalances and movement deficiencies to recognize major areas of limitation. There are several movement assessment tools utilized by manual therapists, with the Functional Movement Screen (FMS) and Selective Functional Movement Assessment (SFMA) among the most commonly used. The FMS was long touted as a screening tool to identify those deemed to be more vulnerable and susceptible to injury (Butler et al, 2013; Cook et al, 2014; Kiesel et al, 2007). Busch et al (2017) have linked the poor scores in the shoulder screens of the FMS and SFMA with increased like-lihood of overuse injuries during a baseball season. A recent systematic review by Bonazza et al (2017) in the AJSM found that the FMS had excellent in-ter-rater and intra-rater reliability. They also found that those with a composite score of <14 had a higher likelihood of sustaining an injury, compared to those with higher scores. Similarly, a critical appraisal of the SFMA from the November 2018 issue of Journal of Sports Rehabilitation found that although some of the studies surrounding the FMS/SFMA were low-quality, the SFMA could correctly identify dys-functions and limitations, which assisted the clini-cians in the creation of an individualized exercise February 2019 Canadian Chiropractor 15
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