PT’s and Injured Clients
Ask any personal trainer what they hate most about training clients and they will probably say “injuries”. It is understandable why this should be: an injury represents a stumbling block that can de-rail a client from achieving their sporting or fitness goals.
Most of the time the trainer can only share the client’s frustration as they walk through the ‘minefield’ of “Does this exercise hurt? Does that stretch hurt?” lacking as they do the competence and confidence to know how best to help manage the injury.
There are massive implications of poor injury management for the PT industry. Here is a brief summary of why this widespread problem matters:
* short term: the incidence of failure of personal trainer small businesses (in Australia the figure up to 40% within 18 months of start-up) is, I believe, partly attributable to the prevalence of injuries among clients. This helps to create a lack of public confidence in the profession
* Medium term: litigation and its attendant publicity, if a client sues a trainer for incompetence (real or perceived), it can strike a critical blow both to that trainer’s business and more widely to the profession in a particular locality or city.
* long term: the cumulative effect of inadequate professionalism, high profile cases and media reports will, I believe, undermine the viability of the personal training industry.
The law of thirds
When clients who are carrying an injury sign up for personal training, in my experience one of three things tends to happen:
* One-third of injuries will simply resolve. Given training and time, the client’s improved fitness and conditioning will contribute to the resolution of the injury. Everyone is happy and the trainer can pursue the client’s fitness goals without worry.
* One-third of injuries will plateau. These injuries will either fail fully to resolve (improved fitness may help reduce symptoms but will not cure the underlying problem), or, if already chronic, they will simply persist, unchanged in nature or intensity by the training. Some otherwise healthy and fit clients (and none are more guilty of this than personal trainers themselves) will carry around niggling injuries for years, content in the knowledge that it isn’t getting any worse and that the limitations imposed by the injury do not trouble them too much. Many clients, while not happy about their ongoing injury, will choose to put up with it, having briefed their trainer about their pain and limitations.
* One-third of injuries will get worse. It may happen gradually or suddenly, but in general the worsening of the injury may be down to the trainer’s lack of awareness, overloading the injured body part in such a way that it progresses to the next level of pain and dysfunction. Or it may be that the lifestyle of the client so aggravates the injury that training now becomes a contributory factor.
These injuries are the dangerous ones that haunt personal trainers, threaten their businesses, and can reduce the membership numbers of the gyms they work in.
Current practice by PT’s when faced by an injury
Back to the physio?
So is it simply a matter of every personal trainer having a good physiotherapist (network) or two in their contacts book to sort out the injuries as they come along? In my experience with trainers, when it comes to referring injured clients to physiotherapists, they tend to take an “all or nothing” approach:
“Refer All Injuries…” APPROACH:
Some personal trainers, too nervous even to entertain the notion of training a client with an injury, refer all clients immediately for treatment and don’t want to see them for a month or three, until they are fully recovered. The obvious downside of taking this approach is a loss of training income and the risk that the client, once declared fit again, will never return – either because they have lost momentum or, worse, because they have lost confidence in a trainer who is linked in their mind with the onset of injury but not its resolution.
“Train through the Pain!” APPROACH
Other trainers take the opposite approach, going into denial about their clients’ pain, and urging them to train on in the hope that the pain will spontaneously disappear or (less irrationally but not necessarily correctly) will be sorted out with muscle strengthening around an affected joint. These trainers are at risk of alienating their clients emotionally because the client will feel they are not being listened to and cared for. That alienation may well result in litigation at some point and even if it doesn’t get that far, these unhappy clients are at high risk of dropping out or going elsewhere.
Current Standard Practice
Most fitness instructors and personal trainers have two procedures in place to screen for injury that may be adversely affected by exercise: a standard health questionnaire which attempts to reveal injuries past, current; and some kind of postural screening, conducted by trainers with greatly varying levels of competence and given greatly varying levels of significance.
In reality clients often gloss over problems in answering their screening forms, perhaps citing only their worst or most recent injuries or operations, maybe forgetting an injury altogether or selectively mentioning only those things they believe to be “relevant”. Some clients, overly keen to get started, will undoubtedly omit some injury details, fearing that if they admit them it will stall their precious momentum.
After all, how could a 10-year-old niggling shoulder twinge be of any relevance?
As for a postural assessment, a standing assessment will in theory pick up some relevant details, but let’s be honest, are they useful for assessing whether or not the body-part in question will get worse with training? After all, who doesn’t have bad posture when they first turn up for exercise? And anyway, when is bad posture too bad? The postural assessment process is just too subjective for the last majority of trainers, and is not reliably reproducible as a way of determining progress down the
line.
I believe standing postural assessments are only of value for trainers who have had a good few years’ experience – and even then they are a poor predictor of injury severity. While poor static posture can be a reasonable predictor of poor movement quality and control, it’s just impossible to tell without doing a further assessment of patho-mechanics (poor movement biomechanics), how in reality the associated injury will fare under load.
In short, it is simply not good enough to take the “All or nothing” approach to referring a client’s injuries. And neither dose current screening methods adequately address the primary goal of injury assessment as stated above: to weed out injuries that will be exacerbated by training.
For this, we need a different assessment strategy. That is what we will look at more next time!
Want to know more about the Rehab Trainer course currently run in Australia for personal trainers? Visit www.rehabtrainer.com.au, email Ulrik Larsen with your expressions of interest, and read what it’s all about.
