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1st Oct

2009

Personal Trainer or Physical Therapist?

Personal trainers, who most often work at health clubs but may also be self-employed, can provide well needed motivation and guidance for many people who exercise, thereby assisting in improving their health.

Not infrequently, however, do people develop painful musculoskeletal conditions, or they start on exercise programs with preexisting, but perhaps pain free, tissue wear and tear or they are in general very deconditioned and weak.

The question then arises, should they sign up for exercise sessions with a personal trainer, or should they first see their physical therapist?

DIFFERENCE IN TRAINING

Personal trainers’ education varies, and there are hundreds of certification programs to chose from. Most trainers have completed only short term correspondence or on-line training in order to be certified. On rare occasions, the personal trainer has had more extensive formal training in exercise science, such as an exercise physiologist.

Most commonly, personal trainers do not have extensive training in anatomy, biomechanics, musculoskeletal pathology, and how to use exercise science to properly and safely rehabilitate such pathology or abnormal mechanics, nor do they have the training to diagnose such dysfunctions in the first place.

The majority of physical therapists today receive doctorate degrees from physical therapy school, which typically is a three year program, and follows a four year college degree in a related field such as kinesiology or exercise science.

Some physical therapists, such as ourselves, continue through certification, residency and fellowship programs in a field of specialty (in our case orthopedic manual therapy), with such programs being between one and four years in length. Orthopedic Manual Therapy programs typically put emphasis on diagnosis and treatment of movement disorders, with extensive study in biomechanics, musculoskeletal pathology and the application of exercise science to restore normal movement and musculoskeletal health.

QUESTION OF JUDGEMENT

The intent here is not to minimize the role that personal trainers play in helping people exercise and get healthy. On the contrary, I applaud their efforts in doing so. The real issue may be one of good judgment, on the part of the trainer, and even the person exercising.

An effective personal trainer knows enough to decide when to stop or change an exercise which could put the client at risk, or make a condition worse, and when to refer a client to a physical therapist. In my experience, this is usually an experienced trainer, who has had the chance to over the years work with physical therapists and physicians, and a person who simply has good judgment.

Unfortunately, we also see many patients, who have been pushed inappropriately hard by their trainers, or who have performed exercises that could be outright detrimental to their conditions.

My best advice to people is : Know your body, always gradually get into an exercise program, and don’t continue if the exercise hurts (learn the difference between “bad pain”, and good temporary muscle discomfort) or if the exercise “feels wrong” or strained. If you continue to have discomfort or difficulties, or you are unsure of whether or not you should sign up for exercise sessions with a trainer, contact your physical therapist or physician.

REHABILITATION AND POST-REHAB TRAINING

When a person has developed a painful musculoskeletal condition, a significant movement disorder, or has undergone surgery for such conditions, the appropriate avenue to take is physical therapy rehabilitation. If this person instead goes to a personal trainer, the trainer should in most cases, although they are typically not obligated to do so, refer that person back to his physician or physical therapist.

However, when the condition has been sufficiently rehabilitated, the physical therapist may give the patient the go ahead to work with a qualified personal trainer for post-rehabilitation conditioning training. I usually ask my patients to tell the trainer to call me, if he or she has any questions. I have found that good trainers often do that, since they may be unsure of what positions or movements could aggravate the client’s condition.

Best wishes,

Gunnar

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