Individualized Exercise Prescription

Individualized Exercise Prescription

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• Alex comes into the fitness center where you are working. He is a 16 year old high school football and basketball player. Currently, he is preparing for his upcoming football season. His coach is concerned about him having injuries because his flexibility is rather poor.

1. Please provide a thorough description of your first session with your client by answering a, b, and c.
 Client Intake Forms: What processes did you go through prior to conducting any flexibility assessments for your client? (6 pts)
 Before conducting any flexibility assessments with my client, I met with Alex and discussed the purpose for the meeting and his goals. I then obtained his liability release forms, patient history forms, and clarified that medical clearance was not needed. Alex is six foot and weighs 170 lbs. During this meeting, I was informed that Alex is a younger high school student who participates in both football and basketball sports teams. Football practice is 1 hour every morning before school starts and basketball is three days a week for 2 hours. Football games are almost every Friday and basketball games are every other Saturday.

 Give background information pertinent to your client that may affect this program—what did you learn about them in the intake process? (4 pts)
 During our meeting, I have learned that Alex undergoes a lot of physical activity with football and basketball but not enough time to properly stretch and cool down his muscles. Alex is also worried that if he does not learn to adequately stretch his muscles and improve his flexibility, the chance for injuries is higher. Based on drills that he performs for practices, I will be able to provide both dynamic and static stretches for warm-up and cool down that will gradually help increase flexibility.

 Tell what assessments you chose to conduct and HOW they were conducted. What were your client’s results (You make these up) & corresponding SMART goals? (8 pts)
 With Alex, I felt that the three assessments needed to measure his flexibility would be the sit and reach test, the calf flexibility test, and shoulder flexibility test. Because there is no targeted area for improvement, I felt that these three would be a good starting point to assess his flexibility improvements.
 For the sit and reach test, I had Alex remove his shoes and sit on the ground with his soles of his feet place flat against the box. Then I had him straighten his legs and pressed against the ground.

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While his palms face downward, either overlapping each other or next to each other, I had him reach as far forward as he could. According to ACSM guidelines, Alex was in the low percentile with a measurement of 24 cm. In four weeks with my program, Alex will increase his flexibility in this test by at least 20% which is 4 cm.
 For the calf flexibility test, I had Alex face the wall and find a comfortable distance where he could keep both heels flat on the ground and still allow his knees to touch the wall. I measured the distance between the wall and his big toe and recorded that number. Alex was unable to keep his heels down more than 18 inches from the wall. In four weeks with my program, Alex will increase the flexibility in his calves by being able to perform this test 3 more inches away from the wall and still be able to keep the heel flat on the ground and knee touching the wall.
 For the shoulder flexibility assessment, Alex will flex one arm completely overhead and flex at the elbow so that his palm is facing his upper back. Then with the opposite arm, slightly hyperextend and flex the elbow. The palm of this hand should be facing away from the back. Then slide hands as close together as possible. Measurements were based on the minimum distance between his hands. In this test, Alex received a poor score, meaning his fingers were more than two inches apart. In four weeks with my program, Alex will increase his flexibility to be able to achieve less than two inches in difference.

2. Based on your client’s overall assessment and your conversation with him/her, what type of flexibility program are you going to prescribe?—Be sure to justify each answer!

 What type of exercises will you give your client to fulfill his/her needs? Be specific but concise in your description. Please provide at least 5 different exercises that work for different parts of the body. (7.5 pts)
 The first exercise I would like Alex to perform is the gastrocnemius and Achilles tendon stretch. Alex will stand upright and slightly more than arm’s length away from the wall. I will then have him flex one knee forward while keeping the opposite leg straight. While keeping the rear foot sole flat on the ground, flex elbows and shift weight forward towards the wall. When ready, Alex will slowly extend the elbows to come off the wall, extend the previously flexed knee, and slowly return to anatomical position.
 The second exercise I will have Alex perform is a hamstrings stretch. I will have him sit upright on the floor with both legs extended. Then flex one knee and slide the heel until it touches the inner side of the thigh of the extended leg. Then lower the outer side of the thigh and calf of the flexed leg onto the floor. While keeping the extended leg straight, Alex will inhale then exhale and bend at the hip and lower the torso onto the extended thigh.
 The third exercise will be a quadriceps stretch. Alex will stand upright and flex one shoulder to place hand against a surface for balance. Flex one knee and bring heel to buttocks. Then slightly flex the supporting leg. The he will extend the shoulder of the same side to grasp the raised foot and grab with that hand. He will need to use strength from that arm to pull the knee into flexion. After holding the stretch, he can release the grasp of the ankle and slowly extend the knee until the foot reaches the floor and return to the anatomical position.
 The fourth exercise will be a lower back exercise. I will have him lie supinated on the floor with his body extended. Then he will flex his knees and slide his feet towards the buttocks. Then slightly flex shoulders in order to grasp behind the thighs in the crease of the knees. As he inhales, he will use his strength from the arms to pull the knees towards the chest and shoulders. Hips should be elevated off the floor. After holding the stretch, he can exhale and re-extend his legs slowly one at a time and return to starting position.

 The fifth stretch will be a shoulder abductors stretch. I will have Alex sit or stand upright with one arm flexed behind his back. While grasping the elbow, or wrist if unable to reach elbow, from behind with the opposite hand. As he inhales, he will pull his elbow across the midline of his back, and exhale as he holds the stretch. This will stretch the posterior part of the shoulder.

 Describe other aspects of works out: warm-up, location of workout (gym, home, etc) Why did you choose these? (7.5 pts)
 For warm-up, I would like Alex to use dynamic stretching exercises based on an article from STACK sports. Dynamic stretching will help with range of motion as well as targets muscles needed for his practices. Some stretches I will prescribe to him are:
o Walking knee hugs – good for hip and glute stretching.
o Backward skips – good for engaging the glutes
o Inchworm – good for the core, abs, back, shoulder, and hips.
o High knees – good for engaging calves, hips, quadriceps, and glutes.
 For the cool down, he will use the static stretches provided in the previous question.
 Location of the workout can be done in any location. As of right now, Alex will be doing these exercises on the field/courts and in the gym.

 Describe the frequency of your client’s flexibility program. How many times per week is your client doing the program and which exercises will he/she do at each workout? How often will he/she meet with you and how often will they be on their own? Why did you make these choices? (7.5 pts)
 Alex will be doing this flexibility program in correspondence to each sport. With football, he will be doing it every day before and after practice. With basketball, he will be doing it for each practice three days a week before and after.
 During football season, Alex will meet up with me twice a week for weekly measurements of progress in flexibility and any concerns or opinions about the program. Since the program requires him to stretch every day with football practice, and if he follows it, twice a week will be good enough to keep him on track and consistently stay on top of any progression or regression.
 With basketball season, Alex will increase his session with me up to three times a week. Because there are less practices than football, I want to make sure Alex is still keeping a consistent training schedule with his flexibility program to continue his progress.
 For the most part, Alex will be on his own or working with the coaches to keep up the program.

 Describe the duration. How long do you want your client to do each exercise? How many reps? Whether you chose to go with or against the current ACSM recommendations, why did you choose this? When will you reassess? (7.5 pts)
 For each stretch, I would like Alex to hold each stretch for at least 30 seconds and repeat each stretch twice for the first week. For the second week, I would like him to repeat each stretch three times for the same time duration. Gradually, based on progression, Alex’s time and repetitions will increase each week.
 I feel that 30 seconds per repetition is a good time frame to begin with in order to lengthen the muscle fibers for each muscle group without straining his muscles.

 Give any other details you feel necessary in your program prescription, such as use of props to ease into stretches, partner stretching, etc. Why did you choose these? If you don’t have any included, why not? (6 pts)
 For the first four weeks, Alex will be doing the prescribed stretches. After the four weeks, I will modify his program to include partners with a deeper hamstring stretch and PNF stretching for his shoulders. Every two weeks, we will focus on targeting different sets of muscles to include in the program as well. On top of his dynamic and static stretching, I will prescribe rolling his muscles out. This can help reduce fascia build up in the muscles and also help with soreness.

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