// Bridging the gap between trainer and physio

by Tim Keeley

In the health and fitness industries, and more specifically in the field of exercise rehabilitation, a large gap still exists between the disciplines of the physiotherapist and the personal trainer. This is predominantly due to a lack of education and communication on both sides, which ultimately impacts upon the client’s rehabilitation and recovery from pain and injury, progression and performance in training and sport, and prevention of injury while training.

Too many physiotherapists don’t know enough about exercise programming and technique, and too many trainers don’t know enough about functional anatomy, injury prevention and specific exercise rehabilitation! There is a clear need to bridge the gap between the two professions by educating personal trainers in areas specific and relevant to their clients.

FUNCTIONAL ANATOMY

Many personal trainers’ knowledge of functional anatomy leaves something to be desired. To enable correct verbal hands-on cueing, sequencing, training technique and instruction to the client, the personal trainer must know exactly what each important muscle does and how to evoke correct muscle activation so the client performs the right action and learns correct execution for the long term. Clients who are in pain, weakness, dysfunction or experiencing imbalances will find it more difficult to activate certain muscles due to a number of feedback loops in the muscle and nervous system. To help overcome this, specifi c exercise must be taught with correct verbal and kinesthetic education. A sound knowledge of functional anatomy is needed in order to do this. A fantastic resource for enhancing your understanding of functional anatomy is the Strength Training Anatomy series by Frederic Delavier (available from Human Kinetics at www.fitnessnetworkcentre.com) and Essentials of Interactive Functional Anatomy which can also be purchased online.

PAST AND PRESENT PAIN AND INJURIES

As the personal trainer may train a client that a) is in pain; b) is recovering from injury; or c) has had an injury or pain problem in the past, the trainer must know about specific injuries in order to help the client. The more knowledge the trainer possesses about how the injury occurs, and the short and long term consequences of such injuries, the better the training program design and client outcomes they will achieve. Many clients will have old injuries that have aff ected their muscle programming, strength and training ability. They may also have muscle imbalances and/or compensatory patterns that lead to secondary problems, and eventually re-injury or new injuries. This may be due to a number of factors, including pain inhibition, coordination issues and poor muscle awareness, global muscle dominance and muscle atrophy, poor muscle stabiliser control and postural problems. The trainer must understand these issues in order to get the program design and exercise progression right, each step of the way. It is also needed for the trainer to educate the client in postural and lifestyle changes. If this does not happen, the training circle breaks down and injury, weakness and de-conditioning sets in, frustrating the client and contributing to a lack of trust in both the trainer and exercise in general.

CORRECTIVE EXERCISE PROGRAMMING

The shoulder and the knee are frequently injured by clients during sports or training, and are the areas of the body the client frequently struggles to improve in terms of strength and long-term recovery gains. As two of the hardest joint complexes in the body to relieve of pain, they are the personal trainer’s worst nightmare. In both areas the function of the joint and the corresponding stabiliser muscle groups are generally poorly understood or neglected. They are also joints that are historically trained incorrectly or not at all.

The exercises most suited to rehabilitation of these joints are based on closed-chain kinetic exercise principles. When the body moves, it does so relative to the hand or foot that is in a fixed or semi-fixed position, working multiple muscle groups simultaneously rather than concentrating on just one, as many open-chain exercises do. Programs that involve closed-chain exercises are preferable because they simulate normal physiological and biomechanical functions, create little shear stress across injured or healing joints, and reproduce proprioceptive stimuli. These advantages have led to closed-chain kinetic exercises being integral parts of accelerated rehabilitation programs worldwide.

An additional advantage of closed-chain kinetic exercises is the ability to give progressions and advancement to existing non-rehabilitation programs. The more activated and stronger the client’s important muscle stabiliser groups, the better and more powerful the global muscle groups will be in training performance and sporting activities. By incorporating these exercises into programs for all clients, not just rehabilitation ones, personal trainers will enable more clients to reach their training goals more often and more effectively.