Tips for Personal Trainers From a Sports Physical Therapist

Dan did a talk recently at a local fitness facility at the request of the personal training director on sharing some common mistakes that personal trainers make with their clients or injuries we see as a result of some training practices.  We also talked about some specific diagnoses that personal trainers may be working with that their clients are either dealing with or have a history of.  Here’s a synopsis of what we talked about.

1.  Careful with lunges and step ups.  When talking about the hip and knee, we commonly see personal trainers allow their clients to let the knee collapse inward.  Using an analogy of a train track, the patella is the train and the leg is the track.  Obviously, with a knee “buckled” inward, that is a bad track.  The “track” muscles are the gluteals and hip external rotator muscles.  If people have knee collapse with these two exercises, you need to address the hip muscles first.  Try doing modified lunges with less depth and keeping that step height lower to start.
2. Doing overhead activity with poor thoracic spine mobility.  Try this experiment: slouch in your chair and raise your arm.  Now sit up tall and raise your arm.  When you sit tall, you get higher and it’s not as uncomfortable right?  Well, in our sitting world now – texting, driving, sitting at a computer, video games – we’ve gotten rounded and stiff. As a result, when people raise their arms, the rotator cuff gets “jammed” into the roof of the shoulder.  Think jumping up and hitting your head on the ceiling repeatedly.  Not comfortable right?  Well, it’s the same deal.  Work on thoracic mobility with a foam roll, or just refer to a physical therapist or athletic trainer for some suggestions.  For your older clients, overhead activities are not a great idea.  With each passing decade of age, the risk of an attritional rotator cuff tear increases.
3. Seated knee extensions.  Now, some people are appropriate to do seated knee extensions.  For example, people that are non-weight bearing due to an injury, bodybuilders, or people needing quad development after knee surgery are good candidates for it.  However, the risk/reward is low with this exercise.  The compressive forces on the patellofemoral joint are through the roof with this exercise.  So, in your clients with the “rice krispies” in the knee when they move it, you may be making them worse.  The point is that there are many other better choices at the gym for quad work.
4. Lateral raises/front raises in the elderly or people with a history of neck issues.  The problem here is long axis traction on the nerves that come out of the neck to the arm.  Front/lateral raises can just irritate a nerve root and cause pain or numbness/tingling in the arm.  An alternative would be to strap a cuff weight above the elbow and do those exercises.
5. Squatting through “pinching” in the groin or deep squats past 90°. If people have pinching in the groin, particularly in the older population, they likely have hip arthritis and continuing to do this may make them worse.  Regarding squatting, the deeper you go, the more compressive forces on patellofemoral joint and the more risk you have of tearing a meniscus.
6. “Just because you have it, doesn’t mean you have to use it.”  There are many tools to use to challenge patients in the gym.  However, having an elderly lady do squats on the BOSU is not very safe and frankly, not too practical.  Agreed, she needs balance, but she needs balance on stable surfaces first.  And if you think that using the BOSU makes muscles work harder, the research on this is scant at best.  Similarly, squatting on an exercise ball is just a terrible idea.  Safety first!
7. Avoid the seated abdominal crunch and the seated back extension machines.  Both of these machines increase disc compressive forces and can ultimately cause lumbar disc herniations.  Again, better options exist.
8. Starting a sedentary client with too many exercises with eccentric loading.  Walking lunges are a great activity, but in someone with little to no exercise history, they’ll be sore for days.  Then compliance goes down.  Keep your sets to 1-2 per exercise and limit how much eccentrics you do early on.
9. Teach diaphragmatic breathing FIRST in clients when doing core training.  This is the foundation of all core training.  Can you breathe correctly with appropriate use of the diaphragm while you exercise.
10. Know your limitations.  Because personal training is not a regulated profession, there are trainers out there who do things that many feel are outside their bounds or scope of practice.  The bottom line is that if you try to “treat” something and the person isn’t responding or having a lot of pain, refer them to someone that can help them – their doctor or a physical therapist for example.  Using your resources will make your clients happy and you’ll earn their trust (and the trust of other medical providers who will refer to you!).  Plus, if you do something and the client suffers an injury, you can be held accountable.

We hope the fitness community will use the sports medicine experts at SSOR for their clients.  Our staff is composed of Kansas City’s only fellowship-trained physical therapist in sports medicine, a Certified Strength and Conditioning Specialist, a USA Weightlifting Coach, and a Certified Golf Fitness Instructor through the Titleist Performance Institute.  Give us a call if your clients need some help or if you want to discuss how to maximize your training sessions  – (913) 904-1128.