Bridging the gap between PT and Personal Training

[clo]

Interesting topic here. As we all know patients get released from PT because they are either done with rehab or insurance has limited the number of visits.

I've encountered many patients over the years that fit both bills. When someone is cleared from rehab they are given a set of exercises they should do on their own. do they do them? No, in fact they forget them.

Same with patients whose insurance has run out.

So why is there not more of a "working relationship" between DPT's and CPT's? Good trainers with degrees in the field, certifications and time under their belt are not that hard to find.

Better yet, why is there not some element of personal training taught in school? I'm talking just the basics here. I've been left scratching my head in the past when a patient tells me how their therapist instructed them how to do a core exercise, or a lifting movement.

I say the DPT or PTA with experience as a trainer would be most successful for they would be able to take that persons hand and rehab their injury to the point that they are cleared AND THEN train them to get to a MORE functional state depending on where they were to begin with.

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[DPT ATC]

the problem with your idea is that someone is still going to have to pay out of pocket for those services. i doubt that you are going to provide these personal training services for free. if they are going to pay out of pocket for a personal trainer, why not PT?

the interesting topic that you do bring up is that patients are being discharged based on limits of insurance. this is where we need to rethink what has always been the way of doing things in the past. if a patient has a limit of 12 visits, don't see them 3x/week for 4 weeks and kill their benefits. the other thing we need to do a better job of is documenting FUNCTIONAL need. there are many practicing PTs out there that do not do this, which only hurts the profession and patient care.

 

[atstudent]

There is a program, I think it's called Silver Sneakers or something like that, where certain insurances will pay for the person's fitness memberships depending on a few things of course.

Also, the clinic that I work for gives their patients 2 months membership in the fitness center at the end of their PT. They work with the Exercise Specialists and Physical Therapists to construct a program for the patients.

 

[MinnDasota]

Many practices have a post-rehab program in which they continue to come to the PT setting (with a good gym) with a specific plan laid out by the treating PTs. It's not considered PT and usually it's paid out of pocket. Many times, these practices have trainers or certified strength and conditioning specialists to help carry out these programs.

I work in a setting that's within a large sports complex and training facility and I consistently work with the personal trainers (either through screens for their clients, education, and/or post-rehab regiments) and have found it very beneficial as a bridge back to their workout routines.

In outpatient ortho and sports PT private practices, many are going towards this route knowing that people will pay for good training vs copays.

Many PTs have received their CSCS or some other fitness/training certs to help bridge this gap.

 

[clo]

i guess this depends on the area. I've not seen many programs like this. There should be more! The flip side of paying out of pocket is the patients willingness to do so.

My understanding is DPT's have the same problems we do with clients not showing up for sessions or doing "homework" on their own.

I've seen one of these rehab/training places on line local to me but for the love of god I can't find the site now.

and yes DPT ATC I would NOT offer my services for free. the client would need to pay out of pocket OR insurance would need to pay. And no offense, while DPT's certainly go through extensive training in A&P, most don't have the floor time in the gym and I feel that personal training should be left to the GOOD trainers. we are a dime a dozen unfortunately.

There needs to be more rigorous testing for trainers to weed out the ones that just want to do it on the side for the $$$ vs. those who do it to make a difference.

there's another disconnect! getting more insurance companies to pay some amount for personal training. However I feel that there would need to be some level of control over who gets to take advantage of this.

 

[pwrtrainer]

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[clo]

I agree with you. MOST trainers do not know limitations some patients have. There is a HUGE turnover in training and it's due mainly to their misunderstanding of what it takes to make it in this business.

Rare will you find a gym whose training department focuses on the member vs. the $$$ they can bring in from that person. Members are treated like $$ signs not "members". So they hire trainers based on looks not on qualifications AND/OR will train them with their own certification.

Over the years I've found the most qualified trainers are not those in gym settings (although you will find them there), but the ones working for themselves. They not only have alot of experience but you'll find that alot of them are athletes. As one myself I feel that these type of trainers understand more what it's like to have an injury and what it takes to rehab, work around and get back to 100%.

 

[truthseeker]

There is an issue that I didn't see raised in the previous posts. It is a legal issue that has to do with the expected level of care. If a patient in PT turns into a client for a personal trainer, and the client knows that his personal trainer is a PT they can expect the PT to recognize health related things even in the role of a personal trainer.

Clear as mud.

If I have been treating someone for lets say low back pain. They get mostly better but then wish to be discharged to a home exercise program. If my patient is discharged to a personal trainer, and that personal trainer is me, I am not going to do a physical therapy evaluation again in the new setting. I am going to supervise and progress the exercise program that I started when they were my patient and I was their PT. THEN I did a health screening, and review of systems, periodic re-evaluations. NOW, I just help them work out. What if they lose 10-15#, great right? that's a by-product of exercising. Wait, what if they are more lethargic or having night sweats too? Maybe some of their back pain before was bony mets from prostate cancer?

If you are providing personal training services and your client knows that you are a PT, they are arguably able to hold you to the PT standard of care, not the personal trainer standard of care. If you are performing PT, you are performing PT. It is not a technique, it is a skill set and body of knowledge that makes you a PT. If they are paying out of pocket it doesn't matter what its called. If you are a physical therapist, it is physical therapy you are providing.

 

[clo]

very good point truth seeker. honestly I wouldn't train a client who was mine to treat as a patient.

as a PT if you have released a patient from your care to a trainer than you'd be clear from any wrong doing, if god for bid something happen, no?

not sure, but it sounds like you may be thinking I want to do both. my answer to that would be no.

 

[truthseeker]

very good point truth seeker. honestly I wouldn't train a client who was mine to treat as a patient.

as a PT if you have released a patient from your care to a trainer than you'd be clear from any wrong doing, if god for bid something happen, no?

not sure, but it sounds like you may be thinking I want to do both. my answer to that would be no.

That would put you in even greater legal peril I think. If it was your patient in the first place, you have at least done one indepth evaluation and ROS. If they are coming from someone else and Know you are a PT, then I think you will be held to the standard of a PT. Really, if you are PT, you are performing PT. Remember physical therapy is not a technique, it is a skill set which is unique and legally protected in many states. If you are doing things outside of work, you should have liablility insurance, you should just call it physical therapist supervised exercise that happens to be out of pocket for the client. let them have whatever expectations they might have but you should charge more for your knowledge base that the trainer at Bally's because you know more!!

If they don't want that type of service, they can go to Bally's and see the 22 year old underachiever, or they can see the 35 year old superstar personal trainer. I'll bet that their rates are different.

 

[MJHUSKERS]

I still have yet to meet a physical therapist who really knows anything in the field of fitness and training....especially training athletes. Just because you have a higher degree doesn't make you an expert in a different field. I would never go to my home doctor for say nutritional advice because they don't know anything about it. Likewise, I would never go to a trainer for surgery. Hence I would never go to a physical therapist to prepare for Olympics let alone to just simply get into shape.

 

[clo]

 

[pwrtrainer]

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[truthseeker]

I still have yet to meet a physical therapist who really knows anything in the field of fitness and training....especially training athletes. Just because you have a higher degree doesn't make you an expert in a different field. I would never go to my home doctor for say nutritional advice because they don't know anything about it. Likewise, I would never go to a trainer for surgery. Hence I would never go to a physical therapist to prepare for Olympics let alone to just simply get into shape.

Husker,

That isn't the point, in my understanding, of the OP. That said, there are very few personal trainers who are qualified to train an Olympic caliber athlete. I would say that the numbers of PTs and personal trainers who are capable are probably similar. Its not about a "higher" degree, its about safety of the 56 year old man who wants to resume running after a heart attack who had a knee replacement last year. Or some similar scenario where there are comorbidities that personal trainers just haven't been properly exposed to.

If that person goes to a physical therapist, they should reasonably expect that person to be able to recognize some health related issues that would preclude certain types of exercise. Not so much in the personal training profession.

Certainly there are those personal trainers that have that knowledge but you know as well as I do that some in your profession aren't that bright, they just know how to lift weights and work out. They don't really get anaerobic threshold, or the usefulness of plyometrics or the concept of rest and active rest etc . . . Some, and I am sure you are one, get that stuff, actually got an A in exercise physiology and biomechanics classes, think about stuff, and don't just put people through the "circuit"

There is a broad range of skill levels in both professions, I just think that the difficulty in getting into and through PT school eliminates some of the dregs. The superstar personal trainers are spectacular, (Vern Gambetta comes to mind) but I know people in my exercise phys class in college that probably got a D, partied too much to be hired as a teacher/coach and could only find work at the local SNAP fitness or Bally's. Tell me that's not true?

 

[clo]

So this implies that a patient needs no additional training when they are done PT? I disagree.

I met a lady today whose needs to lose a bunch of weight AND also has just started PT because of two herniated disc in her neck which will ultimately require surgery. Her PT recommended she start restricted exercise to reduce the weight by using the bike and an elliptical.

At some point as therapy progresses her PT will hopefully allow her to start doing some form of lifting whether it be with bands or machines.

So as a PT what would you do for this patient? blindly send them into a gym and hope for the best? hope they don't get Joe muscle head who has no idea what a herniated disc is?

check that, he probably has one already from all the heavy lifting he does

In three years I will introduce myself.😀 However, in all my time as a trainer I have only met about three other trainers whom I would refer my patients to if I were a PT. And one is currently a classmate. I feel that the sad reality is that most people who can afford personal training probably have great insurance, so the need for a trainer to take up any slack, so to speak, is minimal since the PT probably succeeded in "fixing" them. Tough call to send a patient to one. I probably won't.

 

[PTtoBe]

We should remember that PT and personal training are focused on two different things: PT is about restoring functionality, personal training is about already healthy people getting more fit. Someone suffering a physical set back will receive whatever aid and assisted exercises from a PT that's needed to recover full functionality as it is possible.

After that, sure a PT may prefer they maintain a healthy lifestyle (I think most PTs by their nature are proponents of fitness and nutrition), whether it be on their own, in active sports, going for walks, hiring a personal trainer, or whatever, but the PTs responsibility at that point is completed. PTs can't refer a patient to a trainer since the trainer isn't involved in the medical process.

At any rate, while the patient is still trying to recover from their condition a personal trainer doesn't really enter the equation. I don't see PT or training as related professions that complement each other.

 

[truthseeker]

We should remember that PT and personal training are focused on two different things: PT is about restoring functionality, personal training is about already healthy people getting more fit. Someone suffering a physical set back will receive whatever aid and assisted exercises from a PT that's needed to recover full functionality as it is possible.

After that, sure a PT may prefer they maintain a healthy lifestyle (I think most PTs by their nature are proponents of fitness and nutrition), whether it be on their own, in active sports, going for walks, hiring a personal trainer, or whatever, but the PTs responsibility at that point is completed. PTs can't refer a patient to a trainer since the trainer isn't involved in the medical process.

At any rate, while the patient is still trying to recover from their condition a personal trainer doesn't really enter the equation. I don't see PT or training as related professions that complement each other.

I thought the whole point of this post was if a PT should be providing personal training services, and I think that we shouldn't because of the implied responsibility we would have because of our PT degree and license. The client would reasonably be able to expect our body of knowledge to be factored into their service. If you want to do that, fine, but you are providing continued physical therapy. A persona trainer cannot provide physical therapy because their training is not the same as ours. (note I said different, not better or worse.)

 

[clo]

Please re read my original post. Heck read the thread title "bridging the gap between both professions".

first of all PTtoBe you are either generalizing or your perception of personal training is WAY off if you think our job is to get already healthy people more fit. I'd say 1% of the population of people I've EVER worked with are already healthy, fit people. 99% are overweight, desk jockies with health issues.

Never did i imply that PT's should at all get into training. In fact I've met only 1 PT in my 10 years of training who was even capable of actually training someone.

My post yesterday is the perfect example of why I created this thread. this lady CLEARLY will need proper guidance when given the go ahead from her PT to start some form of weight training.

So based on this do you aimless send your patient into a gym environment and hope that she will get the proper care she needs? what would be your hesitation? is it a liability issue?

We should remember that PT and personal training are focused on two different things: PT is about restoring functionality, personal training is about already healthy people getting more fit.

 

[clo]

A persona trainer cannot provide physical therapy because their training is not the same as ours. (note I said different, not better or worse.)

oh I caught that and I agree!! 😀

 

[truthseeker]

Please re read my original post. Heck read the thread title "bridging the gap between both professions".

first of all PTtoBe you are either generalizing or your perception of personal training is WAY off if you think our job is to get already healthy people more fit. I'd say 1% of the population of people I've EVER worked with are already healthy, fit people. 99% are overweight, desk jockies with health issues.

Never did i imply that PT's should at all get into training. In fact I've met only 1 PT in my 10 years of training who was even capable of actually training someone.

My post yesterday is the perfect example of why I created this thread. this lady CLEARLY will need proper guidance when given the go ahead from her PT to start some form of weight training.

So based on this do you aimless send your patient into a gym environment and hope that she will get the proper care she needs? what would be your hesitation? is it a liability issue?

I would develop a relationship with a personal trainer that I trust, has a brain and good communication skills. I would look for the trainer who actually knows anatomy and physiology and the difference between good pain and bad pain.

Whenever possible I try to develop those relationships. There are idiot doctors, idiot PTs, idiot politicians (but I am redundant here) and idiot personal trainers. There are also brilliant people in all of those fields. The trick is to find the good ones, refer to them and avoid the bad ones like the plague.

 

[PTtoBe]

Please re read my original post. Heck read the thread title "bridging the gap between both professions".
...
So based on this do you aimless send your patient into a gym environment and hope that she will get the proper care she needs? what would be your hesitation? is it a liability issue?

Yes, by "bridging the gap" I understood that to mean a closer working relationship between PTs and personal trainers than currently exists. I may have been unclear, but I don't think there's a need for a closer relationship, because the professions focus on disparate goals of the individual. I respect the good CPTs out there and am glad they're helping people, and I don't see enough of a relation between what they do and what PTs do to warrant fostering closer ties between the two.

By "working with healthy people" I meant you are working with people who's condition doesn't require surgery or who were suffering from an injury or some other muskuloskeletal disorder (poor choice of words on my part).

If I'm discharging an obese patient who was receiving therapy (be it for a total knee replacement, cardiac surgery, or whatever) and am recommending that they get more active, I'd prefer to give them options to increase the likelihood they'll be successful, rather than steer them directly to a specific personal trainer. I may recommend an individual see a personal trainer if they have nobody to be accountable to in their daily life, or if they needed to perform limited exercises in a gym but seemed unfamiliar with the recommended exercises. Most of the limited exercises I've seen recommended for patients upon discharge involved dumbbells, T-bands, walking or some variation of a stationary bike, and honestly I just don't think there's a need for a personal trainer if the person's motivated (or has a motivated family member motivating them). Granted, my exposure has been primarily to patients of a specific population (geriatric).

There was a thread very similar to this one at RehabEdge several months ago, where a CPT argued for a closer working relationship with PTs. I searched around there and couldn't find it, but as I recall at least some of the PTs were vocally against the idea of a closer working relationship between PTs and trainers.

That's interesting that there are facilities where DPTs and CPTs work side-by-side. That shows there's another side to this coin.

 

[MJHUSKERS]

I'm not a personal trainer or never plan to become one, but rather strength and conditioning/human performance is my background. I have interned with a lot of great strength coaches at various colleges and they all have incorporated corrective training modalities to fix asymmetries that specific athletes have. The strength coaches have learned from the PT's and ATC's quite a bit over the years, just read Mike Boyle or Eric Cressey books. However, I can't say the same for PT's.

Also, going off on a rant here, last time I checked, strength and conditioning was about more than just being the "weights coach." We do a ton of dynamic flexibility/mobility, soft tissue work, recovery modalities, proprioception, and prehabilitation! We also know that resistance training is the basis for modern physical therapy - which I'm pretty sure is aimed at restoring inappropriate movement patterns which can cause structural/functional defects/abnormalities from reaching threshold and becoming symptomatic. Should there be a bridge between PT and various trainers....YES. This is why I see more and more PT's attending NSCA seminars listening to various PT's and strength coaches talk.

 

[MinnDasota]

I'm not a personal trainer or never plan to become one, but rather strength and conditioning/human performance is my background. I have interned with a lot of great strength coaches at various colleges and they all have incorporated corrective training modalities to fix asymmetries that specific athletes have. The strength coaches have learned from the PT's and ATC's quite a bit over the years, just read Mike Boyle or Eric Cressey books. However, I can't say the same for PT's.

Also, going off on a rant here, last time I checked, strength and conditioning was about more than just being the “weights coach.” We do a ton of dynamic flexibility/mobility, soft tissue work, recovery modalities, proprioception, and prehabilitation! We also know that resistance training is the basis for modern physical therapy - which I’m pretty sure is aimed at restoring inappropriate movement patterns which can cause structural/functional defects/abnormalities from reaching threshold and becoming symptomatic. Should there be a bridge between PT and various trainers....YES. This is why I see more and more PT's attending NSCA seminars listening to various PT's and strength coaches talk.

I am slightly confused with your post. You mentioned "PT" a few times. Did you mean PT (physical therapist) or PT (personal trainer)?

Either way, we both have talked about in the past. This seems to be the direction that a lot of outpt ortho/sports PT practices are heading. Not so much in other aspects of PT. At my practice, this model of human performance works well. However, I work in an area where fitness and training is commonplace. Obviously, this is not true everywhere.

That said, I don't think it should be required that PT students should have some sort of personal training cert as not every PT wants to go that route. However, it may be beneficial for PTs who work with the gym rats and athletes on a regular basis to get the CSCS (or be trained in faulty movement patterns taught by those you mentioned or Gray Cook--FMS/SFMA). We have to make clear that doing either doesn't equate to personal training. It does, however, help bridge that gap.

We can beat this topic to death, but I think the what's most important is the communication between the PT and the trainer once the patient leaves rehab. If the patient is not going to work with a trainer, then it is the PTs job to educate the the patient the importance of proper exercise to prevent future injuries.

 

[clo]

I agree we can beat this to death, but in the end I think you both are right. trainers who are really interested in working more with PT's should look towards the CSCS certs and go to seminars that focus more on the rehab side of training.

I myself am looking at taking NASM's Corrective Exercise Specialist as a start.

On the PTA side I am setting up an appointment next week with a local school to discuss their PTA program. I'm trying to wrap my head around this whole going back to school thing; especially since I work and have a family to support.

should be interesting!!

 

[PTtoBe]

I dug up the discussion on this at RehabEdge. I'm not reading it all again, but I think elements of it relate to this thread.

 

[clo]

thanks! I'll check it out when I get home.

on an unrelated note I just got done talking to a co worker I train who was rear ended a couple days ago. the lady who hit her was doing 10 when she hit her but enough to cause some mid back pain.

she went to urgent care and the doctor told her to do some light stretching she should be ok.

the next day it got worse so she went to her GP who told her gave her some muscle relaxers😡.

after some minor persuasion I convinced her to go seek the advice of a PT since the pain was slowly creeping up her back to her neck.

doctors frustrate me.

 

[PTtoBe]

Yeah, that's a familiar tune unfortunately. A friend/PT recently left the physician-owned company he worked for because he was tired of having his judgement overridden by his physician/boss, who would too often order the wrong types of treatment (often very outdated) for the wrong types of muskuloskeletal morbidities, with the result that patients weren't healing as well as they could. He ended up working at a PT-owned clinic.

I respect doctors in the realm of pharmaceutical prescription for the proper disease; I just wish they'd respect (and many do, I should say) PTs in the realm of muskuloskeletal disorders.

 

[clo]

I partly blame patients too though. I mean everyone knows there are GP's, OB's, Dentists, Orthodontists, etc........

so why would you take the advice of a GP when it comes to back pain? I mean they are "General" pracitioners! doesn't that give it away? Women dont' go to their GP's when they know they need to see ther OB's!

 

[lee9786]

I was surprised to hear one PT state they would rather use ATC over a PTA. I guess in some settings ATCs do take an active part in rehabilitation.

 

[clo]

WOW, PTtoBe I can see why you didn't want to read it all again.😛 I've got short attention span and stopped after page one. I'll most likely read it in chunks but from the sounds of it the trainer dug himself in a ditch with some of his comments.

I don't think nor hope I did that here.

I considered reviving the post, but it's a few months old and I don't want to get people worked up again!!

I dug up the discussion on this at RehabEdge. I'm not reading it all again, but I think elements of it relate to this thread.

 

[PTtoBe]

I think the CPT made some fairly broad-brushed remarks about PTs on his blog, and that's what sparked it. As I recall I think they generally reached some common ground eventually, and it was probably a good thread to learn a little more about each others' challenges.

I found the diversity in opinion among the PTs interesting. The PT/strength and conditioning specialist seemed more apt to see where the CPT was coming from given his background.

 

[MJHUSKERS]

Like you guys have mentioned, there's good and bad in any profession. My thoughts were that each profession can learn from eachother.

If you want to work as a PT in a hospital, the way it was intended, then obiously there's nothing you need to know more than what PT school teaches you. You're helping people get back to just daily function and discharge. However, if your goal is to work in athletics and returning an injuried athlete/client to not only daily functionality and BEYOND, then I think a background as a CSCS (strength coach) would be beneficial. If qualified in both areas, you could stay with the athlete from injury all the way to high performance.

Am I wrong? This is why I decided to study human performance at a graduate level before I applying to PT schools.