// 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.
Tim Keeley, BPhty CredMDT
Tim is a leading senior physiotherapist, rehabilitation expert and clinical educator with over 11 years practising experience in the fi tness industry and with sporting teams in New Zealand, the UK and Australia. He is the director of Get Active Healthcare which has physiotherapy clinics inside health clubs at Carlingford, Castle Hill and Dee Why in NSW. For more information e-mail t.keeley@getactivephysio.com.au
NETWORK • AUTUMN 2009 • PP60-61