This is a guest contribution by Mike Robertson.
Let me begin by telling you a few clients who I absolutely won't work with, under any circumstances:
- Anyone in neck pain. This is always a referral out.
- Anyone with radicular/shooting back pain. Again, refer out.
- Anyone who has just incurred what I deem to be a serious acute injury to a joint, ligament, muscle, etc.
And along those same lines, there are certain things I will never do to someone, based on my current skill-set:
- Joint mobilizations, and
- Hands-on soft-tissue work.
Now that we've got that out of the way, let's dig a bit deeper.
It's my opinion that almost every single client we train has had pain at one point in time in his or her lives.
It could be an old sports-related knee injury.
Maybe it's a lower back tweak they suffered when putting up the Christmas tree last year.
Hell, it could be a strained shoulder that they endured while playing toss with their kids!
What I'm getting at here is this: It's rare that we get a full-deck when it comes to our clients. Almost everyone has had some pain in his or her life, and most will have some pain the second they walk in your day to start "getting into shape."
So what is the dividing line?
How do we distinguish who we will train, and who we should refer out?
This is perhaps the most important thing I will say here, so be sure to read this carefully:
- If you are in doubt, refer out.
- If you aren't 100% comfortable training this person, refer out.
- And if you think you're super-duper smart, you probably are - but refer again #1. When in doubt, refer out.
As trainers and coaches, our #1 goal should be to do no harm. And if you're training someone that is beyond your skill-level, you can't promise him or her that that will be the case.
However, if someone has knee pain from time-to-time that's the result of an ACL injury they had 10-15 years ago, I don't feel a referral is necessary. Some people may disagree with me here, but chances are they aren't going to go back and go through physical therapy again.
What they really need is some intelligent training - they need a quality program that adheres to the joint-by-joint principles, coupled with some coaching that will ensure they are doing things correctly and not placing excessive stress on the knee.
The same thing goes for lower back pain. Now again, if someone shows up on my doorstep with shooting pain down to their heel, they're getting referred out - no questions asked. I'll often ask this on the phone before they ever come in, just to save everyone time.
Here's a scenario: Someone comes to you with horrible low back pain. You refer out, and physical therapy cleans it up. Now they're back to see you for fat loss, sports performance training, or even post-rehab, if you want to call it that.
Can you design a program that keeps them pain-free?
Do you understand enough about the back to create a "back-friendly" training program?
Do you understand the positions that are most likely to be provocative? Or put them back into pain?
Can you administer the exercises in a fashion that keeps them healthy going forward?
I feel like it's our job as trainers and coaches to have an understanding of what things cause pain or dysfunction, and how to avoid those in their training programs.
You may never treat their pain head-on, but at the very least, you should be able to keep them out of pain going forward.
Should we train people in pain?
My answer would be "it depends." How's that for a cop-out?
And who you work with may be different at different points in your career. We all need to know our own personal limits, but I know I'm willing to take on more serious issues now than I would have in the past.
I've seen more things and have a better idea of who I can help and who I can't. Experience will do that for you. But remember, there is never any reason to be ashamed of referring out. I would much rather refer someone out and look somewhat intelligent, than to try and fix someone up that is beyond my skill-level and look like an idiot!
Before we wrap this up, though, I want to mention something that I feel is even more important. We get so caught up in the idea of pain - but why aren't we talking more about prevention?
Addressing the little issues before they become BIG issues?
One of the things we pride ourselves on at IFAST is not only getting people out of pain, but making sure our healthy clients never get into pain in the first place!
Again, it comes down to the basics - understanding the anatomy, taking them through an initial assessment, developing a program based on their needs and goals, and of course, high-quality coaching.
The more you know and understand, the greater the success you'll have. And this is why I feel like my Bulletproof Knees and Back Seminar DVD's will be so valuable to you. Beyond being able to help more people, you'll be able to keep the clients you already have moving and feeling better than ever before.
It's not necessarily a "goal" for them, but it's always a goal for me.
The longer I can keep someone moving well and feeling great the longer they're going to enjoy training with me at the gym.
