<span style="font-weight: 400;">Personal training is becoming a far more complex skill with the evolution of our client’s bodies, the ever changing environment including more &amp; more technology and the limitations surrounding us as a result of a virus. </span>

&nbsp;

<span style="font-weight: 400;">Personal training originally evolved predominantly as a standard to support our client’s in improving their aesthetics, to reduce body fat and increase muscle mass or to ‘tone up’ if you were a </span><i><span style="font-weight: 400;">lady</span></i><span style="font-weight: 400;"> of course….(tongue in cheek).</span>

&nbsp;

<span style="font-weight: 400;">What has happened, as with many things, is the requirement of our role has grown out of the original scope and with it additional responsibility. </span>

&nbsp;

<span style="font-weight: 400;">More &amp; more of our clients come with a modern ailment due to lifestyle. They expect us to ‘fix it’ or give them a specific exercise to solve the problem.</span>

<span style="font-weight: 400;">Yet we feel inadequate when it comes to responding to this kind of request. </span>

&nbsp;

<span style="font-weight: 400;">We need more assessments skills, more knowledge around pain science &amp; a deeper level of understanding the body when things are quite right. </span>

&nbsp;

<span style="font-weight: 400;">However we need to be sure we remain within our insurance remit or we must gain these additional qualifications or additional skills so we can upgrade our insured to continue to support and serve the new ‘pandemic’ of poor movers that we are gaining as clients today.</span>

&nbsp;

<span style="font-weight: 400;">Poor movement from a sedentary lifestyle can often come with pain. This is when movement practitioners (personal trainers, pilates &amp; yoga teachers, S&amp;C coaches) MUST be careful about scope of practice.  </span>

<span style="font-weight: 400;">Yet there are possibly MORE people out there experiencing a type of ‘pain’ that we CAN HELP WITH.</span>

&nbsp;
<h2><b>The Problem?</b></h2>
&nbsp;

<span style="font-weight: 400;">The problem is recognising and practicing in a way that demonstrates the limitations of our training in pain science and shows we appreciate we DON'T KNOW WHAT WE DON'T KNOW.</span>

&nbsp;

<span style="font-weight: 400;">So how do we exercise/movement practitioners, work with clients in pain? </span>

&nbsp;

<span style="font-weight: 400;">We MUST gain an understanding of pain</span>

<span style="font-weight: 400;">We MUST gain a clear understanding of red flags</span>

<span style="font-weight: 400;">We should work in a multidisciplinary team</span>

<span style="font-weight: 400;">We must utilise a thorough consultation process with clear referral points for red flags</span>

<span style="font-weight: 400;">We must ALWAYS refer when unsure</span>

<span style="font-weight: 400;">We must NEVER think </span><i><span style="font-weight: 400;">“ah I am sure it will be nothing</span></i><span style="font-weight: 400;">”</span>

<span style="font-weight: 400;">We MUST always put the client’s health &amp; safety first</span>

<span style="font-weight: 400;">We MUST NEVER KNOWINGLY CAUSE HARM</span>

&nbsp;
<h2><b>How do we do this?</b></h2>
&nbsp;

<span style="font-weight: 400;">Here are some of the basics to start you off that come from the book </span><i><span style="font-weight: 400;">Explain Pain </span></i><span style="font-weight: 400;">by Lorimer Moseley and David Butler, who are world leading neuroscientists. Their world renowned research is demonstrating how our clients experience pain and what we can do to help.</span>

&nbsp;
<ul>
 	<li style="font-weight: 400;"><span style="font-weight: 400;">Pain is good </span></li>
 	<li style="font-weight: 400;"><span style="font-weight: 400;">Pain is a warning signal</span></li>
 	<li style="font-weight: 400;"><span style="font-weight: 400;">Pain is telling you to change something </span></li>
 	<li style="font-weight: 400;"><span style="font-weight: 400;">Pain is subjective </span></li>
 	<li style="font-weight: 400;"><span style="font-weight: 400;">Pain is an input not an output</span></li>
 	<li style="font-weight: 400;"><span style="font-weight: 400;">Pain isn’t necessarily indicative of its location</span></li>
 	<li style="font-weight: 400;"><span style="font-weight: 400;">Pain is not necessarily indicative of pathology</span></li>
 	<li style="font-weight: 400;"><span style="font-weight: 400;">The degree of pain felt is not indicative of the amount of tissue damage </span></li>
</ul>
<span style="font-weight: 400;">So we strongly recommend investing in this book to learn more about the science of pain. </span>

<span style="font-weight: 400;">Also how to communicate the above with clients who experience pain or even live with chronic pain, often this alone enables them to feel less pain. </span>

&nbsp;
<h2><b>What else can we do?</b></h2>
&nbsp;

<span style="font-weight: 400;">Skilled communication is a huge contributor to understanding and reducing pain. We can support our clients' experience by offering them language appreciation to enable them to communicate better what they are experiencing. Thus allowing us to better understand how to support or refer them to another practitioner better suited to their requirements.</span>

&nbsp;

<span style="font-weight: 400;">Then we can use considered language to help clients better understand how pain works therefore offering a form of CBT to contribute to reducing their experience of pain. </span>

<span style="font-weight: 400;"> </span>

<span style="font-weight: 400;">One common miscommunication I come across a lot is when a client describes ‘tension’ or ‘stiffness’ as pain. </span>

&nbsp;

<span style="font-weight: 400;">So my role includes helping clients to differentiate </span><i><span style="font-weight: 400;">pain</span></i><span style="font-weight: 400;"> from </span><i><span style="font-weight: 400;">tension</span></i><span style="font-weight: 400;"> or stiffness. This may sound to some like a crazy notion and yet could be a game changer in how we work with a client or even IF we work with them. </span>

&nbsp;
<h2><b>Definitions </b></h2>
&nbsp;

<span style="font-weight: 400;">Pain comes under the descriptive group term for SENSATION. </span>

&nbsp;

<span style="font-weight: 400;">Examples of </span><i><span style="font-weight: 400;">Sensations </span></i><span style="font-weight: 400;">are; </span>

<span style="font-weight: 400;">Pain </span>

<span style="font-weight: 400;">Tension </span>

<span style="font-weight: 400;">Stiffness </span>

<span style="font-weight: 400;">Ache</span>

<span style="font-weight: 400;">Niggle</span>

<span style="font-weight: 400;">Tingle </span>

<span style="font-weight: 400;">Stretch </span>

<span style="font-weight: 400;">Pulling </span>

<span style="font-weight: 400;">Pinching </span>

<span style="font-weight: 400;">Numbness </span>

<span style="font-weight: 400;">Throbbing </span>

<span style="font-weight: 400;">Itching </span>

<span style="font-weight: 400;">Cramp</span>

<span style="font-weight: 400;">Stabbing </span>

<span style="font-weight: 400;">Sharpness</span>

&nbsp;

<span style="font-weight: 400;">Depending upon how you ‘read the client’ and other details of their history will dictate whether you deem any of these descriptions to be red flags. For example we could ask them to score their ‘sensations’....</span>

&nbsp;
<h2><b>Scoring Pain (or Sensations)</b></h2>
&nbsp;

<span style="font-weight: 400;">Using the adapted Borg scale 0-10 to score the level of pain we can ask a client to give us a number out of 10 that is representative of how much pain, or sensation, they feel. We also need to give them examples of extremes like...</span>

&nbsp;

<span style="font-weight: 400;">0 being no pain at all</span>

<span style="font-weight: 400;">10 having their arms ripped from the sockets </span>

&nbsp;

<span style="font-weight: 400;">Once they’ve given a score remember PERCEPTION can often be distorted when someone has </span><i><span style="font-weight: 400;">chronic</span></i><span style="font-weight: 400;"> pain or even a fear of movement OR even a fear you will send them away and refuse to work with them! Which is another reason to gather a team around you.</span>

&nbsp;

<span style="font-weight: 400;">However you can also ask questions like…. </span>

&nbsp;

<span style="font-weight: 400;">Can you describe the </span><i><span style="font-weight: 400;">quality</span></i><span style="font-weight: 400;"> of your pain? Is it sharp or dull?</span>

<span style="font-weight: 400;">Do you feel better moving or when still? Morning or evening? </span>

<span style="font-weight: 400;">Are there specific movements or positions that increase it? Or decrease it?</span>

<span style="font-weight: 400;">Is it constant or erratic? </span>

<span style="font-weight: 400;">Does it radiate or remain in a fixed point? </span>

&nbsp;

<span style="font-weight: 400;">This kind of questioning has several benefits other than the actual details. Clients will feel heard and valued when you spend time asking about how they feel. This has been shown to improve the likelihood of pain reduction and adherence. </span>

<span style="font-weight: 400;">Each of these, along with having the ability to read your clients face &amp; body language (sometimes quite separate to what they actually say) allow us to evaluate risk to make the decision as to whether we work with them or not.</span>

&nbsp;
<h2><b>So can I still work with a client in pain? </b></h2>
&nbsp;

<span style="font-weight: 400;">Some sensations a client initially describes as ‘pain’, upon further questioning, you may find are in fact simply ‘tight or stiff’. So our communication and interview skills are paramount when considering taking on a client who tells you they experience any degree of pain.</span>

&nbsp;

<span style="font-weight: 400;">Pain itself should be deemed a red flag until further questioning takes place like the above or for referral. This is why having a team of diverse professionals around you is vital in being able to retain clients while remaining with your own remit.</span>

&nbsp;
<h2><b>Our role in reducing clients pain</b></h2>
&nbsp;

<span style="font-weight: 400;">It’s worth keeping in mind a ‘pain’ or sensation that is low in grade, insidious &amp; has not come from a specific trauma, or with any red flags, is quite likely simply a biomechanical issue or you could describe it as a physical adaption or compensation. </span>

&nbsp;

<span style="font-weight: 400;">What this means is that there is a high chance it can be improved by changing something in your clients movement profile. So ‘remedial exercise’ movement techniques, like the iMoveFreely Programme, are hugely beneficial and greatly improve the results of any application of ‘strength’ training.</span>

&nbsp;

<span style="font-weight: 400;">We can teaching clients how to avoid things that irritate </span>

<span style="font-weight: 400;">We can monitor &amp; assess their movement quality</span>

<span style="font-weight: 400;">We can add in a special technique like an MET that is safe &amp; low grade</span>

<span style="font-weight: 400;">Then we can re-assess &amp; evaluate</span>

<span style="font-weight: 400;">..Add something else like a pure mobility technique </span>

<span style="font-weight: 400;">..re-assess &amp; evaluate </span>

<span style="font-weight: 400;">...add something else like a nerve mobilisation </span>

<span style="font-weight: 400;">...re-assess &amp; evaluate </span>

<span style="font-weight: 400;">Do this segmentally for each part of your clients body...ie pelvic, spine etc</span>

<span style="font-weight: 400;">It’s not complicated, but does it take time? Yes of course!! </span>

<span style="font-weight: 400;">Just remember it takes months/years of compensation to get to the point your client starts to feel discomfort...reducing it may well take a while too!</span>

&nbsp;

<span style="font-weight: 400;">AND....</span>

&nbsp;

<span style="font-weight: 400;">....ignoring or simply resting doesn't address the warning signal so they shouldn't be surprised if old pains recur. Recurring ‘issues’ indicate the root cause hasn’t been addressed. </span>

&nbsp;

<span style="font-weight: 400;">A clinician's job is to diagnose and treat a clinical problem.</span>

<span style="font-weight: 400;">Our role (exercise/movement professionals) is to improve movement quality.</span>

<span style="font-weight: 400;">If pain dissipates through movement there's a good chance it was a movement issue.</span>

<span style="font-weight: 400;">If clinicians struggle to identify a root cause of pain through diagnostics there's a chance its a biomechanical issue.</span>

&nbsp;

<span style="font-weight: 400;">We have a vital role in pain reduction BUT remember </span>

&nbsp;
<h3><strong>WE DON'T KNOW WHAT WE DON'T KNOW!!</strong></h3>
&nbsp;

<span style="font-weight: 400;">Build a team around you</span>

<span style="font-weight: 400;">Assess &amp; question often</span>

<span style="font-weight: 400;">Transfer meaningful information between your team</span>

<span style="font-weight: 400;">Never knowingly do harm</span>

&nbsp;

<span style="font-weight: 400;">Keep them moving, moving well &amp; moving more in less pain!</span>

&nbsp;
<h1><a href="https://www.biomechanicseducation.com/product/low-back-health-pain-online-cpd-training/#tab-description" target="_blank" rel="noopener noreferrer">Learn more about pain science HERE</a></h1>