Weight of Injury
People like Kris will do best by restricting range of motion and reducing the overall volume of exercise (reps + sets + load + frequency = volume) to her injured body part. Remember, if pain exists, there will be a neurological re-education in strength followed by decondi-tioning and, eventually, atrophy of the surrounding muscles. To properly prevent the recurrence of the initial injury, you must continue strengthening even after the pain is gone.
Educate for return to independence. Before returning independently to their exercise program, patients should have comprehensive plans, including realistic fitness goals. All too often, however, people are not realistic.
Brian, for example, would continually compare his current weight lifting routine with his college routine. He had yet to face the fact that he was older, less flexible and less athletic than he was 20 years ago. He essentially risked his current health for the reward of being young again. He needs to consistently address his flexibility and lower the amount of weight he lifts. To stay healthy, he also needs to train his entire body (not just his chest and arms) and include lower back, legs and abdomen.
Kris, although presenting with a different set of problems, has a similar mind-set. Determined to get in shape, she had every intention of achieving that goal. In fact, she was willing to risk injury for the reward of being fit, even though she hadn't been athletic most of her life. To prevent injury, she'll need to reduce the volume of exercise. She also needs guidance and training about exercise techniques.
The most important defense against re-injury-or a first-time injury for that matter-is teaching your patients to recognize the difference between an ache and a pain. If pain occurs, they must listen to their bodies by modifying or changing an exercise routine. There's a big difference between the normal muscular fatigue at the end of a set and the tendon strain or joint pain that leads to injury and disability.
Design programs that will help people like Brian and Kris make progress, while simultaneously eliminating deficits, raising their overall health and fitness and guiding them toward realistic short-term goals. 
- Article written by Stephen Clark, PT, DPT, MHS, OCS, MBA. This
article was published in the January 2001 issue of Advance for Directors In
Rehabilitation.
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