One of the subjects that has been on mind for sometime now is Assessments. I’m referring to the Postural and Movement assessments currently being taught to FItness Professionals.
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First off, lets get one thing clear – I do not disagree with using some sort of assessment nor do I deny the importance of looking at movement. I personally use my own hybrid of Gray Cook’s FMS.
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That said, I do have concerns that this Assessment boom has brought with it confusion and misunderstanding. Heck, I get confused about the subject and I have lots of expirence and soeak with top PT’s on a daily basis!.
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I’m afraid our industry (the Fitness Industry) maybe getting overly caught up thinking we need to “fix” everyone’s problems because I regularly see fitness clients being treated like a re-hab patients and not nearly enough actual Strength & Conditioning is getting done.
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So, in the hopes to add some clarity to some of the confusion surrounding Movement Assessments, I put together this multi-part series called Assessing Our Assessments.
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To kick off part 1 – I wanted to provide you with some information on the scope of practice between a Fitness Professional and a Physical Therapist. And, discussing the definition of the two different professions. My good friend and colleague, Coach JC Santana has done a great job clarifying the two practices.
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Check out theses insightful words from JC Santana taken from his book “Essence of Program Design”. Which by the way is my favorite book on Program Design!
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“At the Institute of Human Performance, we rarely test or undergo formal assessment procedures. We believe that observing clients is what trainers do best. We also believe orthopedic assessments and tests are the specialty of physical therapists and orthopedic specialists, not personal trainers.”
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“Looking at some of the techniques and courses being offered to personal trainers, we wonder if the providers of the courses realize that the audience is made up of personal trainers. The content of the material we have seen at conferences and in educational materials targeting personal trainers is more appropriate for therapists and doctors. Here is our reasoning for not jumping onto the assessment bandwagon.”
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Before we even get into the efficacy of an assessment strategy, let’s first talk about the scope of practice of a personal trainer. As of this writing, I have only been able to find two organizations that have attempted to delineate the job description of a personal trainer: the ACSM and the NSCA. According to the ACSM, “The ACSM Health Fitness Instructor conducts exercise programs and provides health education for apparently healthy people.” Likewise, according to the NSCA, “The NSCA-Certified Personal Trainer trains active and sedentary, physically healthy individuals, as well as the elderly and obese.
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” Now, let’s compare this to the job description of a physical therapist. According to the Maine Physical Therapist Practice Act, ”physical therapy” means the evaluation, treatment and instruction of human beings to detect, assess, prevent, correct, alleviate and limit physical disability, bodily malfunction and pain from injury, disease and any other bodily condition; the administration, interpretation and evaluation of tests and measurements of bodily functions and structures for the purpose of treatment planning; the planning, administration, evaluation and modification of treatment and instruction; and the use of physical agents and procedures, activities and devices for preventive and therapeutic purposes; and the provision of consultative, educational and other advisory services for the purpose of reducing the incidence and severity of physical disability, bodily malfunction and pain. Now, where do you feel the assessments of muscular imbalances, compensations and other orthopedic problems belong? If you ask me, and based on the above job descriptions, they are the job of therapists and orthopedic specialists.”
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I am not suggesting you should not be educated in various areas of the allied health professions. I encourage education in any field of interest. However, practicing what you learn is another story. Heck, you can watch all the Discovery Channel you want; it still does not make you a surgeon.”
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I think it’s great you’re putting this campaign together Nick.
There defiantly seems to be an overwhelming majority of Strength&Conditioning Coaches that unfortunately fall into one the 2 traps below:
The asses-correct-and-never-get-anyone-strong-and-powerful coaches
The just-get-strong-and-sprint meathead coaches
In my mind, guys like Mike Boyle and Eric Cressey have done the best job of keeping ACTUAL strength and conditioning the priority and not letting athletes underachieve just because he has forward head posture. They have their priorities straight and NEVER do these two guys let assessments hold the team back from progressing towards performance enhancement.
I’m really looking forward to reading the following blog posts man. Keep up the good work and its about time someone brought this to the forefront of the profession. . .
I agree that we aren’t PT’s and our focus should be exercise programming. I think one major issue is when clients are released from PT and still need assistance to gain or get back to an active lifestyle. This is where I think education and movement/postural assessments are crucial. As long as fitness professionals stay within their scope, there is no reason why they can’t use assessments (and contact with medical professionals) to help them best help their clients.
As always, thanks for making us think, Nick!
Just started receiving your emails. I really like your approach, and learned quite a bit from the six part video series you sent out. Helped me enjoy the Superbowl much better (never had much interest, but those guys sure have well trained nervous systems (per video # 5, if I recall correctly.))
Whilst I agree wholeheartedly with the contention too many well intentioned but ill informed trainers are out of their depth with overzealous assessment and correction protocols, it’s also apparent a similar disconnect exists in the therapeutic world. It seems many patients are underwhelmed with some of the passive treatment modalities espoused by physiotherapists and their ilk (ultrasound, TENS, muscle stim etc) and are seeking a more active ‘hands on’ approach to treating their conditions.
A need has been created for a hybrid professional of sorts, one who bridges the gap between rehab and exercise. Someone who speaks the language of the rehabilitation expert yet understands how to apply active modalities to actually help their client improve and get stronger/more mobile. Unfortunately this skill set is beyond most (not all) typical personal trainers and their education set, however a therapists knowledge of rehabilitative techniques does not a strength and conditioning specialist make either. In this case a clear communication between the therapist and trainer should exist to facilitate the best possible outcome. However this communication is often more difficult to engage in than it should be as both camps often take on an “us vs them” stance, to the detriment of the client/patient.
Only when a mutual respect of the abilities of each practitioner and a wholehearted consideration in the best interests of the patient is apparent can we as allied health/fitness professionals truly perform our duties to the fullest. Clearly therapists and physicians have their role, and it is different from that of trainers. A good practitioner will recognize his/her limitations and refer as required to outside assistance.
All this said, I think it’s wonderful trainers continue to attempt to better themselves by studying, growing and expanding their horizons in the pursuit knowledge and expertise. Why pigeon-hole yourself with artificial limits?
M.
Hi Nick, I couldn’t agree with you more. My background is musculo-skeletal rehab/medicine. I am seeing exactly what you described in the gym every day – PT’s attempting to fix every muscle imbalance and joint problem they can come up with. Clients spend so much time rehabing they never train and subsequently lose interest or develop a fear of working out hard in case they injure themselves.
There is obviously a fine line between poor form and keeping someone moving without injuring them. I tend to approach this differently depending on the client.
One of the problems is of course that we can only identify what we know. A PT learns an assessment technique for hip function, so they always identify faulty hip function etc etc.
I encourage our PT’s to watch and assess movement and to develop good skills to cue correct movement. The ability to modify exercises according to what we see is also important. I personaly think this is an area PT’s should develop.
Cheers for the excellent post as always.
Sue
I’m going to agree and disagree here.
I agree I’m a personal trainer, not a physio therapist – that bum knee you’ve had since your car accident is best handled by a physiotherapist. As a personal trainer it’s only my job to see that as you’ve chosen to exercise and or play a sport around the injury that we do our best in the gym to 1) not make it worse 2) do exercises that can/will strengthen it and/or lessen pain.
I currently use a very basic assessment before I begin training clients. I’m 100% with you on a personal trainer’s best assest is being able to watch and “evaluate” their performance from what we see or don’t see. And that’s the approach I take. I utilized Paul Chek’s concepts in his book Movement That Matters where we as humans essentially need to capable to 6 movements patterns: squat, lunge, bend, push, pull and twist. I’ve met VERY few who are both good at squatting and bending (deadlifting), they generally slide into one movement pattern more than another.
So that’s it, I choose three simple, mostly non-loaded exercises for each movement pattern and I WATCH my client perform them. This gives me and them TONS of information about what they’ll be go at, where they need work and why their aesthetic muscular development is in the state it’s in today.
I find this all the more important in training figure athletes/competitors.
From there I take that info and build thier first 3-4 week program. It saves us a lot of guessing what they may or may not be good at in the beginning.
Plus it gives a great chance for the client to get acquainted with the trainer’s style. It may not work for them. This client may not work for me either.
That’s something I find very tough to figure out from the usual rush of a full, athletic training session.
Cheers,
Adrian
Excellent article!Do what you do best, and don’t pretend to be something you are not. Many websites offer links to knee or shoulder rehab “protocols” yet they are so inaccurate and dangerous. Try examining the screw that an orthopedic surgeon uses to fix a torn rotator cuff and you’ll see why they don’t want you lifting any more than a coffee cup-if that! Have you ever seen the atrophy after a ACL repair?
As a PT(Physical Therapist) ATC and M.Ed. in Exercise Physiology this issue has become more relevant in recent years than any other in my 20 plus years of working. If a personal trainer is working with a client with rehab problem, send them to a qualified PT before risking your liability. If the client has been discharged from PT and they are seeking “treatment” or conditioning to get through the injury, at least contact the PT they were working with or send them to another PT who might be either more qualified or offer another perspective to treat the patient before you work with them as a “patient.” Too often patients are discharged too early from PT or choose to bypass these services for financial or otherwise reasons, but caution needs to be taken because even in the best of hands as a personal trainer, it will only take one lawsuit from a client or letter from the state Physical Therapy Board that you work in to make you think of what your scope is before proceeding. Even if a client is requesting help from you for a “rehab” problem, you will not lose business and will be looked upon as better qualified if you refer the client or contact the physical therapist to work together. It is true that many PT’s have limited experience in developing training programs outside the rehabilitation clinic, and if you as a personal trainer show concern for the client and contact the treating physical therapist, not only will you stay within your scope but will get referals from the PT for future patients that need or want to transition to a personal trainer after discharge. There is nothing wrong with properly screening a client for movement restrictions prior to developing a training program, but be cautious of “treating” pain or limitations with hands on techniques that the state boards of Physical Therapy will see as an infringement on the scope of their members and will have an attorney knocking on your door quickly. We all should be able to stay within our scope of practice and find enough business without infringing on the work of others. Just think before you provide a service as only one lawsuit is all it could take to make one have to find another line of work.
Using postural assessments and FMS screens for what I call “Frame Alignment 101″ speaks loads over training clients into or during dysfunction. Contrary to some opinions, chronic pain is not “natural”! If you’ve got a front tire that keeps wearing out and the wheel is in obvious need of alignment, would you keep taking it to a mechanic who only replaces the tire or possibly the steering wheel? Yet, people do this with their knees everyday.
Personal trainers don’t need to be therapists, but they should at least know the basics of proper “Frame Alignment”.
Coach Tumminello,
I think it’s important for a trainer to adopt some elements of testing from Physical Therapists, not in an attempt to wrongly impersonate one, but to have an additional tools for knowing when to refer out.
For example, something like Craig’s test is a great quick way to avoid wrongly implementing stretches with an athlete and to have more of an inkling of if you need to direct the athlete to a physical therapist in your network of connections.
I think you actually hinted at a big piece of the puzzle when you say that you consult with therapists on a daily basis. You likely pick up very useful quick ideas to use, and yet you also have plenty of folks to refer to as needed. That coupled with an eye for proper movement go a long way in assessment.
Constantly reviewing athletes results is another way to get a handle on things. If a coach has athletes who progress at a snail’s pace, stagnate, or regress and/or get injured a lot, then he may have to take a hard look at what he is or isn’t doing in terms of assessment.
Above all, just keep learning with an open mind and refining.
Nice Article as usual…I agree with both sides, learn as much as possible, however stay within scope of practice. Having a good eye with an excellent understanding of human movement takes many years to develop, you have to watch lots of bodies everyday.
Over the years I have noticed the fitness industry tends to ruin good ideas by going to extremes because trainers are always competing for the next “new thing”. Too much gets lost in the translation, especially with inexperienced trainers taking advanced courses too literally. They end up either not doing enough or too much as stated in the article. I hear it from my snowbirds every year…the trainer at home is too technical and they don’t feel anything, or the trainer is trying to kill them.
Most clients just want to work out…give them positive, safe and challenging programs, that’s what they want… and stop trying to fix them.:)
Dear nick, i have read somewhere that everything we know now gets possibly outdated in just 1-2 years! so probably this is one of the main reasons trainers keep getting in to courses which sounds like the next best thing when we train just about everyone. the IT industry brings in clients some of whom are totally sedentary & rehab kind of exercises are the only answer to their situation atleast in the beginning. concepts like periodization & program design,kinetic chain assessment, functional training, PT management (the business side), boot camp (for kids, athletes, corporates), underground training, the west side, east side etc etc are the topics which will not lose their glamour any soon. I am sure trainers like yourself are going to be the torchbearers & path breakers & articles like the one you have just started will shed light on the path less illuminated!keep them coming.
Interesting JC quote..thanks Nick! Good comment Sam. I concur!
I’m really looking forward to the rest of this series. I learn as much as I can about assessment and the more I learn the more I struggle with striking a balance.
Great post as always brother!
My philosophy with assessment these days is based on stuff that I have learned from you as well as things that I have read from JC. In his bodyweight training manual he says that the best way to assess a client is to watch the way that they move in all of the most fundamental movement patterns.
So for me, the first time I work with a client I make the entire workout into an assessment. I have them squat, lunge, step up onto a box, do a pushup, do a row, do side and front planks and then also test their kinesthetic awareness by seeing if they are capable of maintaining a correct arched back position and so on.
The end result is that not only do they get a great first workout that conditions their entire body and preps them for all the progressions that lie ahead, but I also get to identify all of their weaknesses and see which movement patterns are contraindicated for them and which ones require more intensive coaching on my part.
And the beauty of it is that because the movement patterns are so fundamental, it’s really easy to adjust the intensity for each individual too. Through adding or removing weight, leverage and speed this first workout can be adjusted to just about any ability level.
Until I figured this out I was spending a lot of time going through complex movement assessments that were just taking up a lot of time and weren’t actually helping me all that much. With this method, I’m more time efficient and I have a much better idea of what issues we need to work on in future sessions!
Yudi,
That’s why #1, you are a great Coach and #2. why you are light years ahead of most folks with the same experience level.
It took me years to figure out what took you only months!
Stop in for another visit soon!
Coach N
Bret,
Thanks for your comments!
Coach n
Well said my friend!
Techniques and exercise will always change, but the basic principles of training will ALWAYS remain the same!
Best regards!
Coach N
Claudia,
Smarter words have never been spoken! I may have to use your above quote in a future Blog post because what you said is just to good for everyone not to see. Is that okay with you?
Also, email me and we’ll talk dates for another workshop!
Coach N
Jack,
Well said!
Yes, I agree that more tools in the tool box is never a bad thing.
Actually, most of the conferences I currently attend are designed for PTs, not trainers.
I will admit that I’ve stolen a few tricks form the rehab side.
Thanks for your comments and great to have you on the site!
Coach N
JIm,
I agree with you 100%
As a Strength Coach, I never allow folks to use bad form, poor posture or sub-optimal alignment.
Plus, I will do extra work on any “weak” areas.
Thanks for your comments!
Coach N
MIchael,
I really appreciate you taking the time to post your wonderful comments!
It really all does come down to using common sense and knowing your role!
Great stuff my friend! Glad to have you on the site and hope to see more comments from you.
Coach N
Tony,
How right you are!
I’ve had ACL reconstruction. So, I’ve seen it first hand.
Best regards!
Coach N
Adrain,
Great stuff, as usual!
I think we agree on everything actually. I assess almost the same way you do. Plus, I agree with your first paragraph 100%.
As I said on another forum – As Strength Coaches, we do three things: 1. Strengthen/Stabilize, 2. Improve Mobility/Flexibility and 3. Functionally train/retrain (improve movement patterns)
If those three things don’t make things better, its beyond our scope!
Thanks again for commenting!
Coach N
Yeah but I had the advantage of getting to learn first hand from you – the best in the business!
Definitely going to stop in to talk shop and catch up soon. Been way too long!
Hope you’re doing well brother, don’t get too snowed in!
Yudi
Alana,
Always great to hear from you!
I agree 100%. It really is all about staying with our scope.
The issue is trying to “correct” or “fix” something is not really in our scope.
As Fitness Professionals, we really can only do 3 things:
1. Build Strength/ Stability
2. Increase Mobility and Flexibility
3. Functionally Retrain – increase body awareness, teach optimal movement patterns, etc:
Most of time, doing these three things will indirectly “correct” most peoples issues. But, if it does not, those remaining issues are out of our scope.
Would you agree?
Coach N
Sam,
Thanks for your wonderful comments!
I agree with you, those guys have found a great middle ground.
Best regards!
Coach N
Many thoughtful, well considered, helpful comments. Here’s a question for all you trainers. Who, among you has found that Physical Therapists will not recommend hard training after their re-hab work because they don’t want to be indemnified by someone who gets injured during training. I have heard many MD’s do just this, time after time. Their answer is “no”; the attitude: “I did my job, what you do after is none of my business, therefore, I won’t recommend anything.”( i.e. stick my neck out).
I think trainers should be know what good posture and alignment are, and be sure that their clients maintain them while exercising. Otherwise the natural tendency to do what’s easiest may mean the training exacerbates any problems, and not just be neutral. Long term, this approach may even resolve the issue.
Also, while keeping within ones expertise, scope of practice and ethical boundaries, a professional should respect the intentions of the client. If they want long assessments and programs based on the findings, do them within the constraints mentioned. If they want hypertrophy, likewise.
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