Should fitness trainers diagnose their clients?

TB 26.8. 2020 0

Today, we have a vast amount of diagnosis courses available. Usually, it is even taught during fyzitherapy re-qualification courses and after FMS popularity boom we have even more methods and techniques. Despite all that I do NOT recommend diagnosis of clients in my courses. Today, I will go over the reasons why.

Why diagnosis is NOT recommended

The main reason is, that really understanding what is a problem and what is not, what we need to fix and which techniques to use is much more complicated than most trainers and fyzitherapists realize.Let’s begin with our posture.

Correct posture

Correct posture = military posture

Herrington study – 85% men and 75% women have on average 6-7° ante; 6% and 7% had posterior and only 9% men and 18% womenhad a neural pelvic position.

Based on this study only a very small minority of peope have a correct posture.

Nervous system

Taken from Dr. Andreo Spiny. It’s necessary to understand what you are doing and what you are looking and how the body reacts.

We cannot test only by sight and say that there is a poblem somewhere based on our (already disproved here before) faulty idea of a correct posture. That can easily be the case concerning pelvis and posture – study here.

Even if you can identify the problems correctly and want to use „appropriate“ measures to fix them, there is another problem.

All studies mentioned below have found no connection between hyperlordosis, asymetric lenght of legs, muscle strength, balance, movement range, stamina or lower back, neck and shoulder problems. Thus there is no reason to correct them.

Herrington (2011)
Bullock-Saxton (1993)
Christensen & Hartvigsen (2008)
Pope et al. (1985)
https://www.ncbi.nlm.nih.gov/pubmed/9742469 – not ven with pregnant women in last trimester, no connection between back pain and posture have been found
https://www.sciencedirect.com/science/article/pii/S0304395906006336

There is no problem even with athletes and there is no sign of hyperlordosis or shoulder protraction being conneced to worse results or higher injury risk.

Special rehabilitation exercises

Let’s say, that despite all of the reasons above, we really want to correct the problems we see. Do you have to use special rehabilitation execises, or is it not that necessary?

http://bjsm.bmj.com/content/44/5/376.short and other studies show, that a rapid improvement of condition is possible by rehabilitation exercise.

However, based on all other studies, there is no difference between rehabilitation and „classis“ exercises.

In other words, by beginning to move correctly and building muscle, majority of clients‘ problems get resolved naturally.

Emotional state of the client

Imagine, that you are diagnosing and testing someone who had an ugly fight the day before, or had a divorce request delivered or even divorced, or had a death in the family… what if s/he didn’t really sleep for the past 8 days? Or they returned from their vacation and had a 20h flight back? All that is important to keep in mind, expecially if you are talking about the upper/lower cross syndrome. Just because someone feels that a certain muscle if stiff it doesn’t have to be necessarily shortened.

Also, all of these points influence body posture.

Overall medical history and anamnesis of the client

You simply do not have overall medical history of the patient and so you also do not know, how long s/he has had that specific imbalance. Majority of people don’t even know that themselves.

These were the main points as to why a trainer should not do diagnosis. So why exactly?

Everything is solvable of course. You can have the right amount of correct questions, vast amount of testings etc. But most importantly you should see thousands of people and get experience, where you would underestand that also thanks to unmerous studies and basic recommendations you simpy know, that things like: „it’s all because of the trapeze muscle“ and „it’s best to not try to make it stronger“ is nonsense (even though this was a simple example that almost everyone should know nowadays).

There is of course the possibility to learn everyhing, know it by heart and understand everything. But that exactly is the thing I hav a problem with. For this purpose we have physiotherapists. We don’t expect them to know everything about building a detailed training plan, understand energy systems and so on. Their main occupation is diagnosing and working with people, correcting their problems and then giving them over to the trainers.

Main occupation of a trainer is to get people into their best shape, be it losing weight, gaining muscle, maximalisation of their athletic abilities, dealing with health issues or getting back to active training, or combination of all of those.

The amount of information necessary to study in order to do these things is so huge that we simppy have to choose what we will focus on. Just as physiotherapists should invest their time to study diagnostics, correction techniques etc. trainers invest their time to study training plans, exercises, nutrition, etc. Of course it is necessary to have some basic knowledge from other fields in order for communication to be possible between a physiotherapist and a fitness trainer.

There is another option – you choose work around health, fixing people’s problems and then diagnostics will be a vital part of your profession. Of course times when someone wth this specialisation will send cclients to see a phsiotherapist will differ from me.

So how should trainers approach diagnostics?

First we musn’t forget that the quality of physiotherapists is comparable to that of trainers or financial advisers. So it’s a must to first find a good physiotherapist you can trust, who constantly educates himself and does his work really well. As is apparent from this post I don’t do diagnostics for a living, but even I see people who come from physiotherapists with a diagnosis that is completely wrong.

What should we do?

Most importantly we should do, what uually lies nt mentioned and forgotten: get client’s goals straight. It may sound easy, but it’s very important. Many trainers forget, that we are here to help clients reach their goals. Yes, we have to be capable of explaining what is and isn’t realistic etc., bud if someone wants huge biceps and chest muscles and doesn’t care about legs, it’s not our job to persuade him otherwise. If we have a problem with him looking like a goof, you should say so, explain why his vision is not good in your opinion and if he still doesn’t budge, send him somewhere else. Don’t accept all clients and force our ideas and fitness visions on them and decide, what is best for them. Why am I saying this in a post about diagnostics? Because if someone comes and doesn’t say anything about health issues, or trying to better their health status, we should respect it.

Look at someone and say: „you have shoulder protraction so you need to do this, this and this“ and that „if your life isn’t crap now, it will be soon“ is what I hate most. You shouldn‘ forget that in some cases forcing someone through corrective rehabilition and correcting their mbalances might just start a cascade of other health issues. Why? That problem you corrected messed with something that has already adapted many years ago and wasn’t touched for e.g., 30 years and just had to start correcting it instead of only helping them lose weight.

If we have goal and the client says there are no health issues, we arrive at a main diagnostic point as a trainer.

Let the person move and test him while moving.

First, we want to see all major movement patterns you can think of. Have them do it with no weights and ideally with as little explanation as possible. If we show them the movement, do not explain it further and do not correct them. Why? It the client does a movement wrong, we can use it for correction. E.g., we see heels lift off the ground and knee valgus during a squat. We say: „I want your heels to stay on the ground and keep your knees apart.“ They repeat the exercise with heels on the ground but the knee valgus stays. Now we know, that the heels were only due to him/her no knowing that was the correct way to do it and we can focus on the knees. How about engaging core, etc.? These are basics, that ever trainer must know, teach movements he shows and show where are the problems that need to be adressed.

Next, we should add weights. Especially people who already exercise and athletes have a good looking form until you give them a big dumbell which shows all the weak spots in their form. Also, many people who are athletically inclined are able to pull off movements by engaging totally different muscle grus than expected. All tha will manifest under appropriate weight.

Last thing you nee to see is exhausted state. Even though, this in my opinion is only important with athletes you hep prepare for competitions or a certain season. You won’t really care about this with normal people.

Your testing kit doesn’t have any fixed shape. Everyone should make their own based on their clients and equipment used. Things I use most often:

Bulgarian squat
Pull-up
Plank
Side-plank
Push-up
Glute-bridge on a bench
Vyrious exercises based on what I have seen until now with various off-set weights
Vertical and horizontal jumps
Sprint

That’s it.

Based on these things we can sit down and start preparing an individual training plan or recommend a visit with a physiotherapist forfurther diagnosis.

Of course you can dare to go ruther in certain situations, it all depends on your experience and what kind of clients you have. There are many things where even if a clint tells me about certain pain, I make my own observation and prepare an appropriate correction for them. Easy example is back pain. There are so many people suffering from back pain I have spent a lot of time learning about different problems and ways of dealing with them, what to do, what not to and I have had hundreds of clients so I know when to send them to see a physiotherapist, etc. This of course is a matter of leaving your ego aside and know when to admit you don’t know something and send them to someone else.

Now, when I have trained thousands of different people and I make a living as a fitness trainer on 100 % for over 10 years, after all the education I have gotten I send people to see specialists more often than I did back when I started training. I though that after being in fitness centers since age 12 I could figure out what the problem is and after completing a couple educative courses learn hw to fix it.

Conclusion

It’s necessary to take interest in rehabilitation exercising. There will be more and more people who suffer from pains even if you only specialize in athletes. In my opinion, you should thoroughly study diagnostics (which should include internship period with a good diagnostition so you could ask question why he decided as he did and broaden your own set of tests) only if you want that to be your specialization or if you have such time possibilities for it to not impose on your trainer’s studies (methods and theory of building muscles, all about weight loss and nutrition, condition training, periodization, exercise and movement techniques, coaching methods, brain function and biomechanics, etc.)

Learn basic stuff, like „the empty can test“ to know, if you should send someone to see a speciaist because of their shoulders, have a plethora of exercises where you can observe person’s overall movement. That’s why I like FMS, which I think everyone should go through. Not because they need to use that system, but to understand, that many tests are just not suitable and that you should never make conclusions like: „this is the fault of piriforms so we will do these exercises…“

Don’t forget, why the client came to see you and try to help him/her with that.

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