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Most Personal Trainers Shouldn’t do Assessments (How to Collaborate)

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The push towards assessment and corrective exercise is rampant in the training industry. And you know what?

  • Most trainers performing assessing are improperly diagnosing issues.
  • Most trainers prescribing corrective exercises don’t know enough about what they are correcting to know what exercise to prescribe.

It is irresponsible for you to tell your client that complains of pain that they have X issue, Y impingement, or Z-itis. It’s not your job to know about these things; there are professionals who do years of advanced education that specialize in diagnosing and treating movement malfunctions and injuries.

Even then, many physical therapists will tell you that they don’t assess correctly 100% of the time. Seeing as how they have at least four more years of specific schooling than most trainers, you are not in the position to diagnose your client because you took a weekend course. (Even if you took the level 2 later on that year.)

This article is a dual effort between my friend Mike Reinold and I. Mike is a top physical therapist having published 50+ journal articles, books, and a prominent website. He has worked with the Boston Red Sox and is currently in private practice in Boston, MA.

Increasingly, trainers are infringing on the roles of the physical therapists. After speaking about the issue, Mike and I decided to write this article to draw the lines so that trainers know how they can provide the best service for their clients. Also, we both feel strongly that there is a great opportunity to collaborate with one another.

We have broken up this piece into two sections. In my section, I speak about the trainers role as I see it. In Mike’s, he discusses what physical therapists do and how trainers can best work alongside them to get their clients the best results and encourage cross-referrals.

Enjoy.

-Jon

The Trainers Role – Jonathan Goodman

The Assessment

I don’t believe that trainers should be doing assessments for the sole reason that they are rarely done well. I think it’s irresponsible and sometimes even edging on malpractice when I hear about the assessments that occur in most gyms across North America.

A weekend or even week long course is not enough for us to tell our client that they are dysfunctional—and it’s definitely not enough for us to tell our client that they have an imbalance that needs corrective exercise. In full disclosure I used to diagnose clients without really knowing what was going on. I had an educated guess, but didn’t really know. As I evolved as a trainer, I become more comfortable in saying, “I don’t know, but I know who does”.

Evolved trainers are comfortable saying, “I don’t know, but I know who does” – Click to Tweet

I believe that a trainer’s role when it comes to assessment is similar to a general physician. It’s our responsibility to educate ourselves enough to be able to identify a problem and know what expert to refer out to.

personal trainer assessment

You may argue that an assessment creates a baseline for measurement and improvement. To this I ask you, what are you measuring? And does it really matter?

Nobody comes into a gym saying that they want to improve their straight leg raise or inline lunge. They might say that they want to improve their posture, but more often than not they don’t really know why. They probably believe that an improved posture will reduce pain, which may or may not be true. Point is, posture improvement isn’t the goal, pain reduction is—so you should be measuring and tracking pain, not posture.

Personal training comes with a lot of important responsibilities. We’re in charge of our clients well-being, and a lot of the time their health is completely in our hands. If we say that getting an extra two points on an assessment will make them feel better, they will believe it and make it their goal. But don’t be confused; their goal is to feel better, not to score a 17. You’ve just arbitrarily convinced them that, once they achieve a better score, they will feel better.

My assessment was to have the client fill out a medical history questionnaire and get clearance if necessary. If there were no red flags, I watched them move without weights—squat, deadlift, push, pull, and anything specific they may do for work—and see whether anything jumps out at me as abnormal. After each “test” I’ll ask them if there’s any pain.

How personal trainer assessmentWe Need to be Focusing on Performance

99% of the times, clients want to look better naked and to not be in pain. This is your job and this is your responsibility. If a client can do all of the major movements without pain and with adequate form (keep in mind that regressions may be necessary) then your job is to get them to perform, lose weight, or gain muscle.

If you feel that a client has a movement dysfunction or is in pain, refer them to a professional who specializes in dealing with that. As Mike will talk about in a minute, referring to a physical therapist doesn’t mean that you stop training the client for that period of time. With good communication, the clients will be best served working with both of you at the same time working within your professional capacities.

The Physical Therapists Role – Mike Reinold

As a physical therapist, I’ll be one of the first people to admit that I truly feel that I have become a better therapist by learning from and collaborating with many great personal trainers and strength coaches.  I say that because I fear that there are some physical therapists that do not feel this way.  Maybe it is ego, or stubbornness, or maybe even a perceived turf war, but I’m not sure why every therapist doesn’t feel the way I do.

In fact, I’m sitting at my desk and looking at all the books, journals, and DVDs that I have in my bookcase.  For every physical therapy based resource, I have another that is fitness based.

We are all technically in the same field.  Sure, I perform physical therapy and you perform personal training.  That is our respective “products” that we provide.  However, we both provide the same “commodity” to the general public – we help people attain optimal health and function.

In the broad spectrum of care, I see it as helping people “feel better, move better, and perform better.”  While I think both physical therapists and personal trainers can help people achieve all three of those goals, there is no doubt in my mind that collaborating will surely provide the best service to our clients.

And isn’t that what it is all really about?  Helping our clients?

As a physical therapist, I combine my knowledge of anatomy, biomechanics, and injury pathomechanics to properly evaluate and treat injuries and dysfunction.  I say “injuries and dysfunction” because I think a common misconception is that you need to either have a blow-out injury or surgery to see a physical therapist.  This is not true at all.  In fact, physical therapists excel at evaluating, identifying, and correcting dysfunction that can prevent injuries as much as rehabilitate injuries.

personal trainers assessments

Anybody else notice the improper grip?

Think about the sports medicine model in professional sports today.  Gone are the days of retrospective care of injuries.  Medical departments in the sports world now consist of a team of multidisciplined physicians, athletic trainers, physical therapists, strength coaches, massage therapists, and other health care professionals.  Developing this model is one of the accomplishments I am most proud of in my past experiences working in professional sports.

If the professional sports teams have this model, why don’t we?

The majority of people that a personal trainer may encounter could be excellent candidates for physical therapy.  But when would I recommend a personal trainer referring a client to a physical therapist?  In effort to simply, let’s say there are two candidates:

1. Anyone in pain.  This doesn’t just apply to that new client you just started working with that stated they wanted to exercise again because they have knee or low back pain.  That is the obvious physical therapy candidate.  This also applies to someone that doesn’t have an injury but may experience pain during certain movements or exercises.  As a personal trainer, you have two options – work around the pain or refer to a physical therapist for help.  Take a step back and think about what is in your client’s best interest.

2. Anyone that moves poorly.  I know this is a pretty broad statement.  I am all for the current trends in personal training to assess movement and develop an individualized program for someone.  This may be appropriate for many clients, however the client that doesn’t respond to corrective exercise strategies and improve their movement patterns is a perfect candidate for physical therapy.  Otherwise, you risk putting strength on top of dysfunction, which often times leads to muscle imbalances, compensatory movement patterns, and eventual injury.  Have you ever had that client that just seems to always tweak their back when they start to make strength gains?

Many times, corrective exercises are ineffective because the dysfunction requires a combination of manual therapy and corrective exercise.  Many of the common assessment tools that are in place in the personal training world make a great attempt at trying to provide a template to add corrective exercises to a program. This is great, and surely better than nothing, however, we all know that not many people fit into a template.

Referring a client to physical therapy doesn’t always mean that you have to stop training your client, either.  This is just another example of why collaborating is always best.  Rather than stopping the client’s workouts, personal trainers and physical therapists can work in tandem to best address the client’s needs.  I often work side by side with personal trainers collaborating on clients.  I handle the dysfunction, they work around it for awhile, then as the client improves, they are ready to roll full steam ahead.

It really is all about collaboration and putting our strengths together.  Each time I personally collaborate, I learn something, and that makes me better at what I do.  Why do you think Jon and I are collaborating on this article?

To quote Charles Darwin, “Those who learned to collaborate and improvise most effectively have prevailed.”  As we all continue our own evolution, both as individuals and as a profession as a whole, those that avoid collaboration will not prosper as much as those that do.

Communication

One of the keys to making all of this work is great two-way communication.  As a physical therapist, you referring me a patient is no different than a physician.  My level of communication to you should be the same as it would be to a doctor.  I love to keep personal trainers in the loop with my findings and game plan because I know it will enhance your approach with that client as well.

The reverse is also true.  In all honesty, if you have been training a client for a long duration, you probably know more about the client than they do themselves.  That is valuable information for me.  I want to be armed with every bit of info that I can before I see your client so I can address their goals as best as possible.

For the physical therapists that may be reading this — pay attention! Find a few personal trainers in your area and get to know them, learn from them, and start to work together. It will be a rewarding experience, I promise.

If you are a personal trainer and do not feel that the physical therapist you send clients to is involving your or respecting your experience, move on. Find a better therapist, they are out there and your clients will thank you.

Here is a partial list of things I would love to know when a personal trainer is referring me a patient:

  • What is the client’s chief complaint?  Is it pain?  Dysfunction?
  • What do you think is the reason for the chief complaint?
  • How long have they had this dysfunction?  How did it begin?  Was it insidious or was there a mechanism of injury?
  • How long has the client been training with you?  What are their goals with you (weight loss, strength, performance, etc)?
  • How advanced have their fitness level and programs been?
  • What other functional limitations have you noticed, even if they seem unrelated to the chief complaint (they may be related!)?

If you have taken any objective measurements or performed any screens, like the FMS, I would love to know this information as well. Systemized screens are great ways for multidisciplined professionals to communicate in a standardized format.

When the Lines Are Clear, We All Benefit – Jonathan Goodman and Mike Reinold

Play to your strengths, and know when to play to others. Physical therapists like Mike are trained in improving movement and reducing pain. Trainers, even those with a degree in exercise science, don’t have the requisite schooling and experience to correct movement patterns. Our job is to take pain free clients and provide a service; usually this service is fat loss or muscle gain.

When we identify the boundaries and work together:

  1. You benefit because you get a relationship with the physical therapist for referrals.
  2. The physical therapist benefits because they get more work.
  3. And most of all, the client benefits because they get the best service for them.

[From Jon]

I want to take a minute and thank Mike for contributing his time on this piece. His bio is below:

personal trainer assessmentsMichael M. Reinold, PT, DPT, SCS, ATC, CSCS is considered a leader in the field of sports medicine, rehabilitation, and performance enhancement.  As a physical therapist, athletic trainer, and certified strength and conditioning specialist, Mike uses his background in sport biomechanics, movement quality, and muscles imbalances to specialize in all aspects of human performance.  He has worked extensively with a variety of professional athletes with emphasis on the care of throwing injuries in baseball players. You can find him at http://www.mikereinold.com/

Now it’s your turn. Join the conversation in the comments below. Tell us what you think about assessing. The one rule is to be cool. Debate is cool. Respecting others is cool. Making your thoughts known is cool. So please be cool.

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Written by Jonathan

Jonathan Goodman CSCS is the author of Ignite the Fire: The Secrets to Building a Successful Personal Trainer Career and Race to the Top: How to Take Over the Social Media Feed. He'd love it if you added him on Facebook and/or joined him on Twitter. He also explores the psychology of social media over at Viralnomics

  • Kyle

    I want everyone to be able to do some sort of squat, some sort of push, some sort of pull, and some sort of hip hinge.

    If a movement causes pain, first check technique. If technique is bad, fix it. If technique is good and there is still pain, do something else. If every version of the movement causes pain, refer.

    It’s not very complicated. I have however had clients who had pain which was always bad enough to prevent their doing a movement, but never bad enough to make them see a medical professional. They may just have been lazy, I’m not sure. I stopped training them, they are generally quite surprised by this.

  • mo

    Hi John are you refering to the fms when you speak of assessment? Because part of the mantra if you would os to refer people out of pain is present. the whole point of the fms is to make sure someone is ready to train safely

  • http://www.facebook.com/profile.php?id=100002001930052 Luis Garcia

    Sounds like an attack on FMS. Weekend course. Take level 2 later on. Just saying. BTW, whenever you watch someone perform an exercise and ‘prescribe’ exercises to fix the faults, is that not an assessment? I understand where you’re coming from. Stay within your expertise. However, an assessment is what sends your client to a Dr. or PT in the first place.

  • http://www.facebook.com/profile.php?id=100002001930052 Luis Garcia

    and before anyone says how do I know they are talking about FMS, read: “straight leg raise or inline lunge.”

  • Cory Sims

    Great for generating discussion, as is any article with a provocative title. If that’s what it takes to make people think, that’s fine, but as the article suggests each trainer/therapist is the ultimate authority on their OWN skill set.

    Simply put, if its within your skill set, use your knowledge. You’re not automatically an idiot because you didn’t go to PT school. How many of us would trust our primary care doctor with the most up-to-date nutrition research? I’m willing to bet not many. I’m a firm believer that you should “know your strike zone.”

    In certain places it can be tough to establish relationships (we’re in a town dominated by the university and its hard to make contacts) but we have sports med people we refer out to all the time. For whatever its shortcomings, the FMS/SFMA model does allow people to speak the same language and share expertise.

    I know some great therapists and some so-so therapist. The letters behind your name, CPT, CSCS, ATC, DPT don’t mean diddly about how you do your job (they indicate that you certainly SHOULD). Think about it, why does anyone even listen to Mike Reinold? Certainly not because he’s spitting our everything he learned in PT school. In most cases, its despite the things he learned or he’s learned how to do them better. Certs and school provide everyone with a general knowledge and we continue growing and learning from there.

    If certain assessments are a part of that growth, be responsible and help your clients get better. I don’t pretend to be a PT or a Chiro or a Sports MD. I know my role, but I also know that to be taken seriously I DO need to know about certain things so I can be a part of the conversation. The last thing this industry needs is smart, ambitious people willingly “dumbing themselves down” because someone else didn’t feel they were qualified to approach a situation critically. The MORE you “know”, the MORE you know when something is definitely NOT in your wheelhouse and you know what do (to whom to refer your client) about it.

    • http://www.facebook.com/profile.php?id=100002001930052 Luis Garcia

      Agreed. it’s the way the information is disseminated. Mike Reinold says you shouldn’t assess the way a PT does based on a weekend (to which I agree) but he and Eric Cressey had seminars that taught trainers to assess people as a PT would (such as the hawkins impingment test). From reading this article, I’d have to assume Cressey and Robertson’s Assess and Correct should not be used by trainers because they’re not qualified to do so.

      • Kyle

        No, no, you don’t get it. All the weekend certs I’ve done and sold are good, it’s just all those OTHER weekend certs that are useless. :)

  • Cory Sims

    Also, if we’re being technical, the FMS is NOT an assessment, its a movement screen. That’s the distinction between the FMS (screen) and the SFMA (Assessment, performed by qualified individuals). That system very clearly tells you what is and what is not within your scope of practice.

    I don’t believe that a weekend cert makes you any more of an expert than 4 years in school does. The best teacher of all is experience and I’ll take the experience of an educated person over that of a “schooled” person any day of the week.

    I appreciate all of the great information you share and the opportunity to speak freely on the site but I do have to call it like I see it. I hope this is viewed as healthy criticism on a topic and not an indictment on the authors and their works.

    Thanks.

  • http://www.facebook.com/profile.php?id=506036404 Elsbeth Vaino

    I hate to say it but I think you missed the mark here. Trainers absolutely should assess their clients so that they can better see how to help that client. If a client is in pain, of course they should be referred to a health care practitioner. But there are loads of people out there who are not in pain but move terribly. I can watch their horrible squat and send them to a physio who will just send them right back telling them that the solution is exercise. Or I can learn how to look at a squat, learn what movement ability is required for it to be good, look at a few other movements to help me really understand, and then I can make a smart decision about whether that person should squat, and whether I should add any other exercises to help them improve that squat.

    I think a lot of people get hung up on some of the new fangled terms and systems, like the FMS and corrective exercise, but these are just modern versions of what has been done forever. Today it’s FMS; yesterday it was sit and reach and situp test. I am of the opinion that the FMS is a much better option, but really both are just tests to help a trainer decide how best to help their client. Today we call them corrective exercises; yesterday we called them stretches, isolation exercises, and accessory lifts.

    And as it turns out, in some cases a good trainer is more knowledgeable about exercise than a good manual therapist. This is not a knock on the manual therapist, but a reality: they have to spend most of their continuing ed time on therapy techniques; whereas we get to spend all of our con ed time on exercise. They also tend to have 5 minutes at the end of a session to show someone exercises and then hope their patient will do them at all, let alone properly. We get to spend as much time as we need to show our clients how to do exercise, encourage them to do them, and spend the time correcting them if they forget some of the key aspects of the exercise the next session. The fact that I do assessments and provide corrective exercise is why I get so many referrals from physios, chiros, athletic therapists, doctors, osteopaths, and massage therapists.

    That said, I 100% agree that we must respect the scope of practice line, and I suspect there are some trainers that don’t. That is unfortunate. If a movement causes someone pain, it is not for me to try to fix the pain: I send them to a manual therapist or doctor for that. Ideally we all work together at that point. For the record, that is exactly what the FMS teaches trainers to do. I always try to get direct contact with any health care practitioner working with my client so that the client doesn’t have to interpret. This is great for all of us: the therapist knows I will stay within their guidelines, I know what the therapist really said and what their intention was (we often discuss and that often leads to great ideas from both of us), and the client feels like suddenly they have a team working on their behalf.

  • Kris, PT

    In my experience, personal trainers and PT’s have a historically difficult time trusting each other, rightly so unfortunately. I have witnessed many trainers refer to themselves as PT’s and mislead the general public on their role. I had a patient with CP (yep, cerebral palsy) with multiple symptoms exercising in the gym with a “PT” who was a personal trainer. I eventually told the gym manager, and the gentlemen mysteriously quit soon after. In the three gyms I have recently worked out in, personal trainers advertise on billboards or somewhere else that they do rehabilitation for sports injuries, ahhhh! I’m pretty confident they don’t know how to evaluate and treat a cartilage lesion of the knee or a partially torn hamstring muscle with sciatic nerve involvement, etc. I mentioned some case examples and understand this may not be the norm. The point is, the personal trainers need to be sure and understand their role and be proud of what they do.

    On the flip side, I see PTs (me included) attempt to discharge a patient at times with a somewhat understated and simplistic home exercise program, when they should have referred that patient to someone who could take them well past their rehabilitation goals, of “resolve pain with daily activities.” They may need to lose weight, gain strength in key areas, improve balance/proprioception, progress flexibility, etc. to prevent future problems. That could take a year or two for some patients/clients, not 6 weeks. Instead, the PT stops the process by inducing fear in the patient to stick to the plan laid out by them, as it is the most safe. The patient is dangerously close to being therapeutic, but not quite. The patient doesn’t have the motivation or skill to see the long term goals through.

    I am motivated to further build on some personal trainer relationships I have, thanks for the nudge fellas. But of course, it isn’t always easy to find a trainer who is in it for the long-term career. To be good at anything, your life in some way must be committed to it. A smart personal trainer who has committed their professional life and put in the hard hours and years, I’ll work with any day and look forward to collaborating and learning from them as well.

    • Jo Butler

      Fantastic comments. I find that getting PT to ‘help me’ as a Personal Trainer is not very forthcoming. Any suggestions to get them on board. In my experience (yes, just my experience) most patients, or clients as we call them, will not continue with a home program set by a PT. However, if referred to a Personal Trainer, who is given specifics, the accountability is there and they are much more likely to continue with the program. Of course, I’m referring to Personal Trainers who will listen, take all advice on board and follow through with it as well as have the client’s long term interest at heart.

  • Jo Butler

    does anyone have a form that they can complete that the client takes to the Physical Therapist who then gives the PT feedback on ‘dos and don’ts’ etc. Its all very well to say that we don’t know what we are doing, but ultimately a lot of clients are most times going to train anyway (whether with us or with anyone who will ignore PTherapist advice not to do so) If Physical Therapists would give advice on specific stretches or other techniques we should be doing and things we should be avoiding, the client would benefit.







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