Due after 48 hours/// CASE STUDY
barsharena
CaseStudies.pptxCase Studies
Eric C. Olson, DC, MS
Half Marathon Runner – Recreational Adult
Sally Brown, a 35-year-old female runner, was referred to your personal training studio by one of your clients. She has been struggling with IT band syndrome for 3 months and was diagnosed by her orthopedic specialist, Dr. Miller. She hopes to get back to enjoying running without pain. Dr. Miller prescribed prescription strength ibuprofen and specific stretches and exercises. She also recommended that she reduce her running mileage and incorporate cross-training. She scheduled a 1-month follow-up in which she will re-evaluate and determine whether physical therapy or additional medical treatment is needed.
She has a goal to complete the Dallas half-marathon this December. She is currently running 6 miles/week (2 miles, 3 days/week) and is struggling to build her mileage due to her left lateral knee pain that starts after about 1 mile of running. She was running 20 miles/week before her knee pain started. She describes the pain as sharp and stabbing when it starts but it gradually goes away when she stops.
She does not train with a heart rate monitor and runs based on “feel”, which is a moderate to hard effort level on every session. She has never been through any baseline data tests. Her typical pace is 9:30 min./mile. She does not do any resistance training or foam rolling but stretches occasionally before her runs.
Clinical Correlation - IT Band Syndrome
Common knee injury caused by inflammation of the distal aspect of the iliotibial band OR a pathological bursa between the IT band and femoral condyle
Characterized by a sharp, burning pain approx. 2 cm proximal to the lateral femoral condyle
22.2% of all lower extremity injuries in runners
https://www.hindawi.com/journals/jsm/2013/367169/
Management of IT Band Syndrome
Conservative – shown to be 44% effective at 8 weeks and 91.7% effective at 6 months for successful return to sport
Massage
Manual therapy – Graston, ART, joint mobilization
Active care – foam rolling, stretching, rehab
Modification of running habits – reduce volume & intensity
Prescription pain relieving ointment (voltaren gel)
Anti-inflammatory medication (ibuprofen, aleve, naproxen)
Corticosteroid injection
Surgical – should only be considered for chronic cases unresponsive to conservative treatment
Release of IT band from its insertion point with debridement
https://www.youtube.com/watch?v=PYzsBayFh4s
https://www.youtube.com/watch?v=49_DTnHAO_c
Half Marathon Runner – Exercise Prescription
What is the ideal training frequency and volume to start with?
2 sessions/week
10-min bouts of jogging with brisk walking for warm-up and cool-down
What is the ideal intensity to start with?
Slow pace – jogging (12 – 15 min./mile)
60-70% HR reserve (low-end of the “vigorous” range)
Use the “talk test” to determine whether HR reserve range is appropriate!
What is the ideal training surface?
Well-groomed, short grass on level ground OR gravel trails
What are other forms of cardio you could incorporate?
Stationary biking
Rowing
Elliptical
| Cardio | |||||||||
| Dates: 04/12 – 04/18 | Walk | Run/Jog | Bike | Row | Swim | Circuit | Time | HR | Details |
| Monday | 20 min. | 10 min. | 30 min. | < 70% HR reserve jogging, 40 – 59% HR reserve walking | If HR increases above 70% HR reserve or if knee pain develops, stop jogging and walk briskly | ||||
| Tuesday | |||||||||
| Wednesday | 20 min. | 20 min. | 60 – 70% HR reserve | ||||||
| Thursday | 20 min. | 10 min. | 30 min. | < 70% HR reserve jogging, 40 – 59% HR reserve walking | If HR increases above 70% HR reserve or if knee pain develops, stop jogging and walk briskly | ||||
| Friday | |||||||||
| Saturday | 30 min. | 30 min. | 40 – 59% HR reserve | ||||||
| Sunday | |||||||||
| Totals | 70 min. | 20 min. | 20 min. | 110 min. | |||||
| Dates: 04/19 – 04/25 | Walk | Run/Jog | Bike | Row | Swim | Circuit | Time | HR | Details |
| Monday | 20 min. | 10 min. | 30 min. | < 70% HR reserve jogging, 40 – 59% HR reserve walking | If HR increases above 70% HR reserve or if knee pain develops, stop jogging and walk briskly | ||||
| Tuesday | |||||||||
| Wednesday | 22 min. | 22 min. | 60 – 70% HR reserve | ||||||
| Thursday | 20 min. | 11 min. | 31 min. | < 70% HR reserve jogging, 40 – 59% HR reserve walking | If HR increases above 70% HR reserve or if knee pain develops, stop jogging and walk briskly | ||||
| Friday | |||||||||
| Saturday | 33 min. | 33 min. | 40 – 59% HR reserve | ||||||
| Sunday | |||||||||
| Totals | 73 min. | 21 min. | 22 min. | 116 min. | |||||
| Dates: 04/26 – 04/31 | Walk | Run/Jog | Bike | Row | Swim | Circuit | Time | HR | Details |
| Monday | 20 min. | 10 min. | 30 min. | < 70% HR reserve jogging, 40 – 59% HR reserve walking | If HR increases above 70% HR reserve or if knee pain develops, stop jogging and walk briskly | ||||
| Tuesday | |||||||||
| Wednesday | 24.2 min. | 24.2 min. | 60 – 70% HR reserve | ||||||
| Thursday | 20 min. | 12.1 min. | 32.1 min. | < 70% HR reserve jogging, 40 – 59% HR reserve walking | If HR increases above 70% HR reserve or if knee pain develops, stop jogging and walk briskly | ||||
| Friday | |||||||||
| Saturday | 36.3 min. | 36.3 min. | 40 – 59% HR reserve | ||||||
| Sunday | |||||||||
| Totals | 76.3 min. | 22.1 min. | 24.2 min. | 122.6 min. | |||||
| Dates: 05/01 – 05.07 | Walk | Run/Jog | Bike | Row | Swim | Circuit | Time | HR | Details |
| Monday | 20 min. | 10 min. | 30 min. | < 70% HR reserve jogging, 40 – 59% HR reserve walking | If HR increases above 70% HR reserve or if knee pain develops, stop jogging and walk briskly | ||||
| Tuesday | |||||||||
| Wednesday | 26.6 min. | 26.6 min. | 60 – 70% HR reserve | ||||||
| Thursday | 20 min. | 13.2 min. | 33.2 min. | < 70% HR reserve jogging, 40 – 59% HR reserve walking | If HR increases above 70% HR reserve or if knee pain develops, stop jogging and walk briskly | ||||
| Friday | |||||||||
| Saturday | 39.9 min. | 39.9 min. | 40 – 59% HR reserve | ||||||
| Sunday | |||||||||
| Totals | 79.9 min. | 23.2 min. | 26.6 min. | 129.7 min. |
Rehab and Stretching – MD Prescription
Foam Rolling:
What muscle groups would recommend?
Stretches:
Psoas
Hamstrings
Quads
What would you add?
Exercises:
Straight leg raises
Side lying hip abduction
Wall sits – 3 x 30 sec.
Planks – front, right, left (30 sec. each)
What would you add?
Professional Rower – Lab 3
24-year-old elite rower hoping to qualify for the Olympic games. You have recently been hired as a strength and conditioning consultant for the US Rowing team and the coach is asking that you put together a resistance training program for this athlete to build strength and power. He has an exceptional aerobic capacity but needs to work on his final 500m sprint during the 2000m individual scull event. He does not have any pain or injuries. His current training program consists of full body exercises involving barbells, machines, and calisthenics.
| Mon. (Heavy) | Tues. (Light) | Wed. | Thurs. (Light) | Fri. (Heavy) | Sat. | Sun. |
| 4x5 bench press | 4x5 trap bar deadlift | OFF | 4x5 bench press | 4x5 trap bar deadlift | OFF | OFF |
| 4x5 barbell row | 4x5 incline leg press | 4x5 barbell row | 4x5 incline leg press | |||
| 4x5 shoulder press | 2x10 weighted glute bridges | 4x5 shoulder press | 2x10 weighted glute bridges | |||
| 4x5 weighted pull-ups | 2x10 standing calf raises | 4x5 weighted pull-ups | 2x10 standing calf raises | |||
| 2x10 high pulley lateral raises | 2x10 hip abduction machine | 2x10 high pulley lateral raises | 2x10 hip abduction machine | |||
| 2x10 shoulder cable flys | 2x10 hip adduction machine | 2x10 shoulder cable flys | 2x10 hip adduction machine | |||
| 2x10 shoulder IR w/ pulley | 2x10 leg extensions | 2x10 shoulder IR w/ pulley | 2x10 leg extensions | |||
| 2x10 shoulder ER w/ pulley | 2x10 leg curls | 2x10 shoulder ER w/ pulley | 2x10 leg curls | |||
| 2x10 arm extensions | 2x15 hip ER w/ 2-lb. ankle weights | 2x10 arm extensions | 2x15 hip ER w/ 2-lb. ankle weights | |||
| 2x10 arm curls | 2x15 hip IR w/ 2-lb. ankle weights | 2x10 arm curls | 2x15 hip IR w/ 2-lb. ankle weights | |||
| 2x25 incline bench sit-ups | 2x15 single leg glute bridges | 2x25 incline bench sit-ups | 2x15 single leg glute bridges | |||
| 2x25 Roman chair back extensions | 2x2-min. single leg balance on bosu | 2x25 Roman chair back extensions | 2x2-min. single leg balance on bosu | |||
| 2x50 Russian twists w/ 10 lb. medicine ball | 2x50 Russian twists w/ 10 lb. medicine ball | |||||
| 2x15 Roman chair side bends | 2x15 Roman chair side bends | |||||
| 10-min. plank circuit | 10-min. plank circuit |
Polarized Training
“Easy” does not necessarily equate to the ACSM “light” intensity range of 20 – 39% HR reserve! Easy refers to rating of perceived exertion (RPE).
According to the 3-zone training model, this is a minimum of 50% VO2max, which would be in the ACSM “moderate” range of 40 – 59% HR reserve
The upper end of the green zone is approximately 75% HR max, which equates to a slightly lower HR reserve (there is some individual variance), but approximately 65% HR reserve.
Do not confuse the ACSM “vigorous” intensity range as “hard” training!
This is a broad range (60-89% HR reserve) with significant variation in RPE
The low-end of this range (60 – 70% HR reserve) is typically not hard to sustain for trained, healthy adults!
Need to account for individual variation in the fitness level in your clients
Polarized Training Model
Zone 1
Beta Oxidation
LT1 = 1st lactate turn point; known as the “aerobic threshold”
Low cardiovascular and metabolic stress
< 2 mm blood lactate
Type 1 muscle fibers
Zone 2
Primarily slow glycolysis and beta oxidation; lower contribution of fast glycolysis
LT2 = 2nd lactate turn point (i.e., lactate threshold, maximal lactate steady state, or anaerobic threshold)
2 – 4 mm blood lactate
Type 1 and Type 2a muscle fibers
Zone 3
Fast and slow glycolysis
High cardiovascular and metabolic stress
> 4 mm blood lactate
Type 1, Type 2a, and Type 2x muscle fibers
Relative Intensity
For the average healthy adult, exercise intensity must be at least 50% of HRR OR 70% max HR!
Application of the Fick Equation
Volume of O2 (ml/kg/min.) = cardiac output (L/min) x arteriovenous oxygen difference (ml O2/100 ml blood)
VO2 = Q x a-vO2 diff
Central adaptations are acquired primarily through high-intensity aerobic training
Peripheral adaptations can be acquired through continous aerobic training under LT1!
Important to enhance both the pumping capacity of the heart and oxygen extraction capacity of the skeletal muscles for greatest gains in aerobic fitness!
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