This is a guest post.
“I think I slept wrong”
“Is ‘X’ supposed to hurt?”
“My back’s tight today. Can we stretch first?”
Everyday I hear one of these 3 lines. Before you chastise me for not taking care of my clients consider how often your clientele complains of pain. Little aches become big aches to both your client and your wallet if they’re not taken care of. Bad advice can ruin a relationship and hurt your client.
On Tuesday Mike Robertson answered the question “Should we train clients in pain?”. Today I’m going to give you my quick and dirty system for assessing client pain at the beginning of the session.
Step 1a: Pain vs. Soreness
The first step is to explain the differences between pain and soreness. Pain = bad. Soreness = good (to a point). Here’s what I say during the initial meeting with my client:
“Let me know at all times how you’re feeling. Send me a text the day after a workout and call me if there’s anything happening with your body that you don’t understand. I need to know exactly what’s going on with you at all times in order to help you as best I can. What I particularly want you to do is help you differentiate pain and soreness.
Pain is always bad. It could happen for a variety of reasons. If you feel sharpness, tingling, or referred pain anywhere let me know immediately. Soreness, on the other hand, is usually good. It’s called DOMS (Delayed Onset Muscle Soreness) and lasts for 24-72 hrs. Let me know if it ever lasts longer than that. In addition DOMS makes the area tender to touch. This is one of the most reliable indicators of soreness vs. pain (especially in the low back or spinal erectors).”
Step 1b: Create an atmosphere for sharing
This sounds like I’m about to break into song and dance with Elmo and Fozzy Bear. Fact is without an open and honest relationship I can’t take care of my clients. The more I know about them the better and I make sure they know that. I need to know if they stuck to their diet or binged on beers for their cousins bachelor party the previous weekend, I need to know if they’ve done their homework, and most of all I need to know if their body has been feeling good.
At the beginning of every session I ask my client how they’re feeling. It’s always an open-ended question. Then I shut my mouth. I wait 2s when they’re finished talking to make sure they got all the info out. If they respond with a simple “I’m fine” I follow up with asking if they had any pain and soreness. Again — I shut my mouth.
The reason for this is two-fold:
1. I need to know exactly what’s going on with my client. If they’re in pain I need to know. In addition I need to know how they’re managing they’re recovery. If it’s taking them 4 days to recover from soreness that’s a pretty strong sign to start managing nutrition and rest better
2. I want them to increase awareness of their own bodies. It doesn’t take long for them to start paying more attention to how they’re feeling and recovering. It’s amazing the amount of times I hear “I was sore for 3 days but I think it’s because I wasn’t sleeping well and I forgot to take my fish oil”. – Mission accomplished!
(While we’re on the topic of sharing. Add me to Facebook. I share lots of “Facebook only” posts there)
Step 2: Gather info — Quick!
Once my client says that they “slept wrong” (can anybody explain what that actually means to me…) I delve further into the problem. I change my question asking method from open-ended to directed and specific. The reason for this is that I know exactly what information I need to gather. This information will determine whether I can train the client or need to refer them out. Here are the questions I ask:
1. Is the pain sharp? dull? direct? tender to touch? numb?
2. Is there any tingling or referred pain?
3. Does the pain stop you from doing anything? (At this point I demonstrate the full range of movement for whatever joint or muscle is hurting and ask them to copy me)
These questions take me about 30s to go through. The barrage of questions happens quicker than Michael Corleone’s massacre against the Solozzo family in the end of Godfather 1
Pain is emotional and how it’s felt is largely due to individual interpretation. In order to really understand what my client is feeling I don’t want to give them time to think through the issue. The more they think the more they may convince themselves the pain is real. I want to know their subconscious response. (note: for a great understanding of the physiology mechanisms of pain check out this post)
Step 3: Gather more info
Now that you have an understanding of what the pain feels like you can get some background info. Ask questions like:
1. How / when did the pain start?
2. When did you feel it for the first time and what were you doing?
3. Is there anything specifically that brings on the pain?
4. Is there anything that makes the pain go away?
Step 4: Do an assessment
If there’s 1 thing you take away from this post make it this:
Your pain assessment is not to diagnose the problem. The assessment is to decide whether or not your client can work out that day. You should know enough about injuries to be able to recognize when to train through it and when/where to refer out.
I go by feel but err on the side of caution. If I’m not 100% sure the client is fine I don’t train them. Spending years on the floor training 1000s of hours has given me a good feel. Less experienced trainers need to be extra careful. If they don’t know what’s going on with a client or see something that “doesn’t seem right” then they must refer out.
My assessment usually includes watching the client attempt a full range of motion through the affected area and doing some passive stretching on the table. The stretching is not meant to help. I want to see whether the body is protective. If muscles are seizing up around a painful shoulder it’s a pretty strong sign somethings awry.
If the client can work through the full range with minimal or no pain and doesn’t seem to be protective over the joint they’re likely ok to train. Do some self-myofascial release and complete your dynamic warmup.
Note: Steps 1-4 should be completed within 5-10 minutes. This will happen often. Be comfortable with your system of gathering information and know exactly what info you want to gather. Run through it with precision and move on.
Step 5: Workout but keep the injury in mind
Do technique warm ups for 2-4 reps with each exercise that uses the affected area. Make sure the exercise looks normal. If it looks as awkward as Madonna’s dancing during half-time at the Superbowl then you have issues. (yessss…. Topical joke success!)
Ask all throughout the workout how the area feels. Make sure the lines of communication are open at all times
Step 6: Prepare better next time
Get some benefit out of the workout. Use it as an opportunity to ask your client to text or call you ahead of time with any concerns. The more you know the better. I prefer to know 3 hours before a workout if my client has a sore low back from sitting on a George Castanza wallet as opposed to finding out seconds before they’re supposed to train. This way I can tweak my workout and be prepared with prehab and a paper shredder for all of the useless receipts in their wallet.
You’re the expert and you’ve spent years in the gym perfecting your craft. If something doesn’t seem right it probably isn’t. Trust your instincts and err on the side of caution.