"Shit," I said to myself quietly after being told for the umpteenth by the same client that [insert body part of choice for that day] was bothering them and wanted to know what could be causing it. I get this question a lot. I get it from clients. I get it from family members. And I get it from friends.
You see there seems to be some confusion, at least in my opinion, among both the general population and personal trainers what exactly a trainer's scope of practice includes and excludes. It seems that most of the general population thinks personal trainers can diagnosis and treat musculoskeletal injuries, particularly when there is pain present. I don't blame these people. It isn't there fault.
I blame the trainers. Well not all of the trainers just the confused ones I mentioned above.
These confused trainers seem to believe their scope of practice has no boundaries. They believe that since they have read a little something about shoulder impingement syndrome and can pronounce fancy terms like patellofemoral pain syndrome or femoral acetabular impingement they have the prerequiste knowledge and experience to evaluate client's pain, attribute it to a particular cause (also known as diagnosing) and prescribe exercises that will treat this client's pain and make them whole again.
And you know what I think of that?
I think it is utterly fucking ridiculous.
I think it is dangerous, reckless, and arrogant.
Personal Training in the U.S. is an unregulated industry.
Which I personally like and agree with because it creates a market that is purely predicated on competition. The best trainers who know their shit and get clients results will survive and those who don't will die off and leave the field.
However this does create this issue of having people with little to no formal education (not even mentioning the fact that if they did is any of it relevant to human anatomy, physics, or human physiology), a weekend certification, and a few training clients under their belt trying to use advanced orthopedic assessments and therapeutic exercise on clients in pain.
Now I don't want to fall into the trap of the Fundamental Attribution Error, so I will not pin this entire problem on over zealous trainers. I have to assume that trainers began overreaching their scope of practice after client after client showed up to sessions in pain and wanted answers for this pain from their trainers. And as we all know the law of supply and demand dictates that when there is a demand someone will rise to fill it regardless of whether or not that someone has the knowledge or ability to do so.
Thus I assume that many trainers who are attempting to diagnose and treat did so out of an effort to help their client, but in my opinion it has ended up in an EPIC FAIL.
However this has created a huge and I mean HUGE problem both for clients and trainers.
Clients feel trainers should be able to "fix" them and trainers feel that it is their responsibility to fix their clients and if they cannot they are some how incompetent or inferior.
This problem has been even furthered exacerbated by the production of continuing education products marketed to fitness professionals with the idea of trying to help fitness professionals further advance their understanding of anatomy and physiology particularly in relation to injuries. While these products were produced with good intentions I think many trainers believe that because they have taken a course about low back disorders or read a book about muscle imbalances they some how are qualified to diagnosis clients with dysfunctions and prescribed treatments for them. However this is far from reality.
In fact a good comparison for this practice would be like a fifth grader trying to pick up and read a calculus book, unless of course that fifth grader is Steven Hawkings or Albert Einstein.
You see becoming a personal trainer takes little time or experience. All you need is the ability to read and remember information and a bit of cash to pay for an exam fee.
I know this and acknowledge willing.
But it doesn't mean that what we do isn't beneficial and we can't help people feel better, move better, and look better.
It doesn't mean that we can't continue to expand our knowledge in order to become better coaches, writers of exercise programs, and more in tuned with clinical musculosketetal dysfunctions, but it does mean that we need to understand what our intended role is in the larger picture.
On the other hand physical therapist go through 7 years of formal education and spend hundred of hours supervised by other experienced physical therapist before ever being allowed to treat a patient solo. Chiropractors receive similar training and education with an emphasis on alignment of structures. Orthopedic surgeon can spend up to 12 years receiving a formal education in combination with numerous hours of practice honing their craft and ability to diagnosis and treat patients.
You see all these professions require much more intensive study, more hands on training experience, and not to mention licensees which are not required of personal trainers. These professionals are the ones who are trained to deal with pain and injury. They have the knowledge to assess it, diagnosis it, and treat it. Although each professional tackles things from a different angle and all have their individual areas of specialty these are the professionals that should be handling our client's pain.
I am not opposed to assessing clients. I use the FMS in my practice so that I have a systemized way of evaluating the readiness of a client for particular exercises allowing me to put clients in a position to succeed and feel confident. I don't use the screen to try and figure out what is wrong them (although it is fine for me to have my own thoughts). I use the screen as a "prove to me" test in other words I want to see what you can do well and what you can't do well.
However if pain presents during the assessment they are immediately referred out to get the pain evaluated. If they can bring me back a diagnosis from a physician or therapist with recommendations I can then help implement the rehab plan and/or use the tools I have in my toolbox to help improve this diagnosis because now I know without a doubt what I am dealing them.
Not every client will follow your recommendation to get their pain evaluated and that is why you have a liability waiver and insurance. However as trainers we should continually encourage them to go get it handled.
I am also not saying that we shouldn't try to improve each client's ability to move and create programs that give clients the appropriate time to work on gaining mobility or stability in the correct areas. In fact I have found that just be cleaning up people's movement patterns, helping them lose some weight, and getting them moving again clears up a lot of nagging injuries.
But I understand my scope of practice and I don't reach beyond it.
I specialize in helping pain free individuals reach greater health through exercise and nutrition. I work to help optimize the health of "healthy" people.
I don't specialize in assessing, diagnosing, and treating individuals who are injured or in pain.
I don't specialize in managing or treating chronic diseases.
I believe the remedy to this problem is to create a network of professionals who work in a concerted effort to help an individual deal with pain, get health, and reach their goals. This way each professional can do what he or she does best and allow all the other stuff to be handled by someone who is more capable in these areas.
None of this is written to discourage trainers from broadening their knowledge or venturing into more clinical educational material however this knowledge is not gained in order to broaden our scope of practice it is gained so that we can better communicate with the clinical professionals and understand their approach to pain and injury.
In addition having this knowledge will make physical therapist, orthopedic surgeons, and chiropractors more comfortable with treating our clients and referring us new ones. They see us as competent and knowledgeable because we can speak their language, talk with the client about their treatment, and offer progress reports about how things are going on our end with the client.
I know this was a bit of a rant, but it is a bone I have been needing to pick for some time. And as I don't believe in just talking about problems I did offer a solution. This solution being that instead of trying to be all things to our clients we should work to develop a network of professionals who have their own areas of expertise, but share a common philosophy about caring for the human body.
Happy moving and heavy lifting!
Pratical, Purposeful, Effective Training