Injuries and RehabTell us where it hurts! Do a quick search before asking about your shoulder injury to make sure your question hasn't already been answered (about 50 times), and read the sticky post first.
If looking for help in your Rehab problems Julie Keen certainly has a grasp on this area and without pretension or prejudice. Great interview and you are sure to learn something.
How cool is it to be a fitness professional and have a last name like Keen? You are destined for greatness by this very fact alone. But just as Peter Parker is told "with great power comes great responsibility” same goes with a great name and Julie Keen has more than lived up to it.
Leigh Peele-Julie, can you tell us a little about yourself, give our readers a little background into what you do, love, and what field you are in?
Julie Keen-Well, when I was a teenager I had a few pretty severe athletic injuries that piqued my interest in sports medicine. I went off to the University of Connecticut majoring in athletic training. Near the end of my four years, I realized that what I really wanted to do was physical therapy. So I graduated, moved to Boston for two wild years while I finished my prerequisites, and came home to attend UConn again for PT.
For the past 12 years I have worked in many therapy settings (hospital, rehab, home care, and outpatient) but most of my time has been spent in outpatient orthopedics where the majority of my caseload has been persons with lower back pain. I was fortunate at one time to work for an organization who paid for a lot of continuing education, so I was able to take many cutting-edge manual courses: Geoffrey Maitland's mobilization, Brian Mulligan's mobilization with movement, David Butler's neurodynamics, Philip Greenman's muscle energy, balance training, Shirley Sahrmann's lumbar stabilization, Jenny McConnell's taping techniques for the knee and shoulder, etc.
I have always had an interest in exercise and weight lifting (since I found the weight room as a high school athlete), but after working for a few years in PT, I realized that many PTs don't have a great knowledge base in exercise, beyond what to do in the acute and sub-acute stages. Probably because most PTs don't get to see their client's beyond the sub-acute stage! So I made it my mission to learn as much as I could about exercise and fitness. This led me in the past year to get my NSCA-CPT certification.
A few years ago I married a wonderful man and we started a family. I am fortunate enough to be able to stay home with my girls. I do some training in the evenings and weekends, and work one weekend per month as a per diem physical therapist. I also write articles, and have some online clients.
As for what I love? My family. My kids, husband, and parents are my life! My passions? Food. Eating food. Cooking food. Talking about food. Reading about food. Seriously!! I like to stay active ... I waterski, bike, showshoe, xc-ski, hike ... pretty much anything outdoors. And if we are somewhere and there is a pick-up game of anything going on, I'm in there tussling with the boys! Football, basketball, softball, volleyball, I love it all!
Leigh Peele-Let me guess Julie, you like food?
Those courses you took sound fantastic. Of those or any of recent that you have been too what is the most exciting and surprising thing you have learned? You know the kind of knowledge that you want to slap yourself in the head for missing out on before and makes you want to shout at the fitness world to let more know.
Julie Keen-I would have to say that Gary Gray's Chain Reaction course was the best I've been to. It was one of those completely paradigm-shifting experiences! As I said before, many therapists are focused on isolated exercises to fix one part of a dysfunctional chain. So my education, and my early experience with weight training in the heydays of the muscle magazines and isolation exercises/body part splits left me squarely inside the proverbial box.
Gary taught me to think outside that box and to figure out how to get the muscles working again from a functional standpoint. (For example, in functional life, the quad rarely extends the knee, especially in isolation, it more typically decelerates knee flexion.) So, I'm big on functional movements. I rarely prescribe isolated movements now unless there is a real isolated weakness that prevents improvement solely with the functional movement.
That said, I think many trainers who purport to be "functional" miss one of Gary's big basic tenents. Have a reason, a purpose, for everything you are doing with a client. So having some overweight housewife (whose main goal is to lose fat) stand on one foot on a Bosu ball and do bicep curls ... my question is WHY? What purpose is that going to serve in a fat loss program? I could maybe see it in an ankle rehab program, but not in a fat loss program. It just doesn't follow common sense.
Leigh Peele-Ha but Julie, It is cutting edge balance super inner core work that really hits those "upper abs"!
I couldn't agree more with you on any of those statement you listed.
You mentioned that you do training in person and in online conditions. Do you focus more on rehab/chain work? What is your average client like?
Julie Keen-I would say that most of my online clients have pretty significant rehab needs. Most are folks who have had either major surgery at some point, or a major injury at some point. I also have many who have avoided major injury or surgery, but are a biomechanical mess. They have come to me because I am a physical therapist in addition to being a trainer, so they want that rehab aspect. Most of those clients have goals of improved health and mobility leading to improved fitness. I also have a small number of online fat loss clients.
My in-person clients are all fat loss, but they also have significant rehab needs. Many have had joint replacement or back surgery. The majority are significantly obese. Even in those fat loss clients, my programs are heavy on warm-up drills, emphasizing mobility and activation.
It's funny because I did not set out to be a fat-loss trainer, but the obese clients have a whole host of physical ailments that go along with their obesity and can really limit their ability to effectively exercise. My goal for them is to be able to exercise successfully and painfree so that they feel good doing it and stick with it. I teach them that if they focus on health first, the changes in the mirror will follow. In turn, they chose me as their trainer, because I am also a physical therapist and that makes it feel more safe for them. I think they also like the fact that I do not work out of a gym, but rather come to their house. It is much less intimidating for someone new to exercise, especially if he/she is obese.
Leigh Peele-I know the gym atmosphere can be really intimidating, especially for those who are starting out. What are some of the common problems you see with obese clients? Can you point out some mobility issues that obese clients might have to deal with more than non-obese clients?
Julie Keen-Well, I don't really like to make generalized statements based upon someone's body weight, but my obese in-person clients have many mobility restrictions because they have all had some sort of orthopedic surgery. The obese people I have treated in the physical therapy clinic don't necessarily have more mobility restrictions than the average person, but that might be since I'm comparing among physical therapy clients.
Common mobility restrictions that I have noticed in general include:
(Please note that these are gross generalizations, obviously every one is an individual!)
*Protracted scapulae with upper extremity internal rotation (in relaxed standing the palms will face backwards)
*Forward head
*Poor lumbar stability and motor control
*Weak glutes with a tendency to compensate using lower back muscles
*Limited hip mobility
*Short hip flexors (may or may not be weak)
*Long and weak hamstrings
*Poor body awareness - I think that obese people in general have had such shame around their bodies that they are used to tuning them out. Consequently, they have a lower awareness of where they are in space.
One of the real issues I see with out of shape obese clients is that they are very weak even with body weight exercises. So to have someone up and down on/off the floor in a workout can be a workout in and of itself! But that can be true with an out of shape thin client too I suppose.
Another is that sometimes an obese person will get soft tissue approximation during some stretching exercises before a stretch is felt. For example, in heel sitting, many people will feel quad stretch. But if someone is obese, and tries to heel sit, their calves and hamstrings might come into contact before the muscle is put on stretch.
But I really don't like to make generalizations; I evaluate each person as an individual with no preconceived ideas about what he/she might have as a restriction or limitation!
Leigh Peele-That is a great rule to follow Julie. While I know we have been discussing some more physical aspects I was curious what roles nutrition plays in your programs with clients be it recommendations or more specific guidelines?
Julie Keen-Well, in general I believe that people should eat balanced. Balanced protein, carbs, veggies, and fats. I think that each food group plays a vital role in homeostasis, from hormone balance to digestive health to immune function and more. Completely eliminating any one food group can lead to significant imbalances.
That said, each person's body is different, and each person will need differing levels of each macronutrient depending upon his/her individual constitution. So with my clients we start with a baseline diet, and adjust as progress dictates. Progress being fat loss or cravings or energy levels or whatever.
I emphasize health above appearance with all my clients, so if someone has a lot of dietary changes to make, we make them over time with small, manageable steps, again adjusting as the client progresses. In general, I have people eat 5-6 meals per day, with a portion of protein, a portion of real carbs (unprocessed) and a lot of fibrous veggies, topped with some healthy fats at each "meal".
Most of my client's don't obsessively track calories, but rather portions, or sometimes grams of certain macros. When someone has more than 50 pounds to lose, I just don't think it's necessary when they aren't even doing the basics. Once someone gets the basics down, then we move more toward tightening things up, especially if we need to jumpstart progress.
Nutrition is huge ... it is the fuel that feeds your body. If you want to have a healthy body, you can't be feeding it crap!! I spend a lot of time on nutrition with my clients. Each one keeps a log and we review it at least once a week, when we problem solve regarding energy levels and cravings, substitutions for less healthy options, eating out etc. Cooking is a major hobby of mine, so we talk about cooking and recipes and shopping for healthy options.
Leigh Peele-Julie this is fantastic stuff, real common sense approach and I could pick at you all day but I will leave this to be my last intrusion.
I am starting a new section that I am adding on to the end of my interviews titled "The Pro and the Case Client". I give you the case and you give me what you would do in a training aspect to help them with their problem.
Case Client #001-Posture Gadget Addict
Client #001 has a problem with upper postural distortions that lead to a forward head posture and the dreaded hunchback. Frantic to fix this problem #001 has gone out and gathered pillows, braces, the posture pal and some sort of restraint made fit for medieval times. Overwhelmed by their new toys and plagued with an internet full of advice #001 has come to you for help. He asks you " Is there a gadget safe to use to help his particular posture problem and what should he really be doing to fix it?"
Julie Keen-Well, as is typical, it depends! In general I am not big on gadgets unless he has an abundance of money!
Assuming that #001 has a desk job, then I would advocate four things. First, either an ergonomic chair, or at a minimum a lumbar cushion. When someone sits all day, and gravity exerts the constant pull toward the ground, most people end up losing that ideal posture. Even those with the best of intentions end up looking like a teenager in front of the TV after time. A good lumbar support (either built into a good ergonomic chair, or a lumbar cushion) can help foster good posture throughout the day. Second, a sticky note on his computer monitor reminding him to correct his posture every 10 minutes, and third a timer to get him up out of his chair doing easy postural exercises every 20-30 minutes (things like stick-ups, standing backward bends, and upper cervical nodding).
Fourth is for when he is not at work ... the ever-loved foam roller. He needs to work on mobilizing his thoracic spine to reduce kyphosis and improve extension and rotation. His workouts should include a healthy warm-up with lots of thoracic mobilization, pectoral stretching, and postural activation exercises.
I would avoid exercises that promote trunk flexion like crunches. I would also avoid things like Good Mornings and even Romanian Deadlifts until proper posture comes more easily. Proper posture must be emphasized in all training activities or he will just be promoting the poor posture.
I would also recommend that he limit recreation activities that promote poor posture like video games (unless it is the Wii), TV-watching, and sometimes even long-distance road biking.
Kyphosis (that dreaded hunchback) is correctable with concerted effort and the lack of underlying structural defect (like Scheuermann's Disease) ... it just takes time to improve mobility of the joints, strengthen the structures that are weakened, and stretch those that are tight. Sometimes extended time. You can't correct a 40-year old guy's issue, which he has likely had for at least 25 years, in 2 weeks. It is a continual effort.
Sometimes persons with postural deficiencies also need hands-on physical therapy. If the joints are really stiff, they might need manual mobilization by a qualified therapist. Also some people just have poor body awareness (commonly referred to as "motor morons" - not very politically correct, but pretty accurate!) and need verbal, visual, and tactile cueing with frequent monitoring to correct long-standing habitual postures.
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Don't know how I missed this before. GREAT interview, Leigh. I always learn something when I listen to Julie.
You weren't the only one called out, Jeff. Hello, my name is Bill and I'm a motor moron...
__________________ The trick is in what one emphasizes. We either make ourselves miserable, or we make ourselves happy. The amount of work is the same. -- Carlos Castaneda
Interview with Julie Keen
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