Trainer? Therapist? What Do We Call Ourselves & What’s Our Role? Part II


Post Therapy

What comes after physical therapy? By various standards and regulations, personal trainers can’t claim to offer injury rehabilitation. That’s for physical therapists. Physical therapists are licensed by states where as the term “personal trainer” is very loosely regulated. But what happens when someone is finished with physical therapy?

Simply finishing physical therapy may not mean someone is ready to return to sport or vigorous exercise.  As I discussed in this post, the damaged structure may be repaired, but the nervous system may still be on guard. Thus pain and tightness may persist in someone who has been technically cleared to exercise.  He or she still needs the proper guidance in their return to physical activity.  Are personal trainers prepared to handle this challenge?

“Personal trainer” has a negative connotation in some circles.  According to some, trainers are undereducated, sloppy, and use unsafe methods to get clients in shape.  From what I’ve seen, this opinion is often spot on.  Many trainers are totally unequipped to work with anyone with movement dysfunction and/or pain.  Most trainers are still caught up in machine weight training, bicep curls and simply making their clients work harder and not smarter.

What’s Needed

Seems like we need some other grade of exercise professional.  We should have higher standards than the typical personal trainer.  We should be in conversation with  physical therapists, surgeons, chiropractors–even mental health professionals.  The education requirements must be higher than what we see with the typical trainer certification.  For good or ill, some sort of state licensure may be necessary if for no other reason to convey to our clients that we’ve reached a certain status.

The bottom line is a sizable portion of our population and potential clientele need help overcoming pain and poor movement.  Many of these folks have gone through physical therapy, chiropractic treatment, acupuncture–all sorts of treatment and they may still be looking for pain relief.  (The frustrating thing is, in my experience a good number of these therapists are also unprepared to address the cause of pain and dysfunction.  Again, this is just my experience but in my quest to address my own pain, most of them never recognized that the site of my pain was not where my problems were rooted.)  These people aren’t ready for the typical commercial “kick your butt” sort of workout.  There is a clear opportunity here if we’re willing to step into the role of…. what?  I’m calling myself a Movement Re-education Specialist.

Chronic Pain & Z-Health


I find chronic pain to be a tremendously fascinating topic.  It’s all around us and it’s mysterious.  Even though it’s 2010 and we’re the beneficiaries of thousands of years of medical advances, we still have trouble fixing various lingering aches and pains.

Reconceptualizing Pain According to Modern Pain Science comes from the wise Australians at Body in Mind.  Much of the world’s population is wracked with chronic pain.  It seems anyone near the age of 30 has at least a little bit of mysterious lingering pain.  Many a neck, shoulder, knee and/or low back has been treated over and over again yet the pain stays.  Why?  Further, chronic pain is typically very different from acute pain.  There’s no blood, perhaps no swelling, and the pain often comes on gradually and for no apparent reason.  Chronic pain is very different from the pain of a sprained ankle or dislocated shoulder.  So what are we dealing with? The article makes four key points:

  1. Pain does not provide a measure of the state of the tissues.  (i.e. Pain doesn’t necessarily = injury.)
  2. Pain is modulated by many factors from across somatic, psychological and social domains.
  3. The relationship between pain and the state of the tissues becomes less predictable as pain persists.
  4. Pain can be conceptualized as a conscious correlate of the implicit perception that tissue is in danger.  (The PERCEPTION of a threat may generate more pain than the actual threat itself.)

Many Z-Health methods are based on these factors.  We recognize that pain may be rooted in any number of sources including emotions and stress.  We also recognize that the nervous system is in charge of pain, and that the site of the pain is often not the site of the problem.  We may be wasting our time if we spend time at or around the painful area.

For example, Z-Health practitioners may make use of opposing joint motion to address pain.  If someone has left knee pain then we might go to the right elbow and ask the client to perform elbow circles.  To take it a step further, we may ask the client in what position does he or she experience pain?  Does the left knee hurt when the hip is extended (leg behind the torso) or flexed (leg in front of the torso)?  If the left knee hurts in hip flexion then we may put the client’s right arm into extension (arm behind the torso) and then call for elbow circles. Many times I’ve seen a client’s pain reduce in moments as a result of these types of drills.

I’ve seen big-toe pain reduced through opposite thumb mobility.  I’ve seen shoulder pain reduced through opposite hip mobility.  Low-back pain may be eliminated through neck mobility drills.  (This stuff is wild!)

Further, if either our visual or vestibular reflexes are faulty then the result may be joint pain.  The nervous system is sending a message: Change something.  Our eyes and inner-ear structures are the seats of very powerful forces.  If these two mechanisms aren’t working together then the nervous system will perceive a threat.  The nervous system can use pain to alert us to that threat.  Addressing the visual and vestibular systems is vital if we’re combating chronic pain.

None of this obviates the need for other diagnostics.  MRIs and X-Rays may indeed show structural problems contributing to pain.  Various drugs may cause pain in some regions of the body.  Some cholesterol meds may cause low-back and leg pain for instance.  The main point here though is that pain is often a very complex issue, the causes of which may not be obvious.  You can have power over your pain if you recognize how it works.

Please go to the link above and read the article to learn more about how chronic pain works.  For further reading on Z-Health, Todd Hargrove’s Better Movement is an excellent source.

Pain: A Complex Matter


When will this end?!

Anyone who’s experienced chronic pain knows it can be a very mysterious issue.  Chronic pain presents very different characteristics and patterns when compared to acute pain such as a skinned knee or a sprained joint.  It may start for no clear reason and progress with no clear pattern.  A long-ago healed injury may continue to hurt even though the tissue is no longer damaged.  Oddly enough even amputees and paraplegics may experience pain emanating from missing or non-working limbs.  Chronic pain seems as if it’s driven by a very mysterious force.

The issue of hope–or hopelessness–can be a truly crushing burden in the quest to resolve long-term pain.  Typical methods in addressing chronic pain may include drugs (ibuprofin, steroid shots, muscle relaxers), heat, ice, physical therapy, chiropractic adjustments, massage (Active Release Therapy, myofascial release, Rolfing, and others) and acupuncture, and then if none of the above works then we often resort to what certainly must be the final sure cure: surgery.  These methods often provide temporary relief at best.

This past weekend I attended the first half of the Z-Health R-Phase certification.  Pain and resolving pain was the overarching theme.  I learned a tremendous amount about the issue.  As many people have observed, pain doesn’t always equal an injury.  Pain sometimes feels better with movement: someone with a slightly sore shoulder may feel better as he or she moves the arm around.  In contrast, pain often does indicate an injury.  If I break my leg and I continue to walk, then the pain will increase with every step.

A key issue we discussed is that the site of pain is rarely the site of the problem.  Pain is often a symptom of dysfunction elsewhere in the body (Or sometimes even outside the body.  More on that in a moment.)  For instance, absent a blow or violent twist of the knee, knee pain is rarely a knee problem.  Knee pain is often rooted in hip or foot dysfunction.  Similarly, shoulder pain is often rooted in poor spine or hand movement.  As the renowned neurologist Karel Lewitt said, “He who treats the site of pain is lost.”

Emotions are often overlooked when we deal with pain.  Again we often think of pain as strictly a bodily thing.  Still a lot of us have noticed that our pain increases during times of stress.  This is an indication that we must consider our mind and our emotions when we’re trying to resolve long-term pain.  It may be that our “physical” pain is rooted in the conditions that surround us.  In fact what happens in many cases is that the pain itself causes us such distress that it becomes a self-perpetuating situation in which our fear of pain drives only more pain.  It’s an enormously complex matter when we start to look inside our head in order to address pain; but if we’re not considering the inside of our skull then we’re probably missing the mark by a long shot.

One of the books Z-Health creator Eric Cobb suggested we read is David Butler’s Explain Pain. Butler is an Australian neurologist who specializes in pain research and treatment.  His blog on pain is called Explain Pain.  If you’re currently in pain or if you’re in the business of treating pain I highly suggest you look into it.  Pain treatment professionals should also look into the Neuro Orthopedic Institute.  The NOI site describes their mission as such:

“The nervous system is our prime focus, integrating neuroscience, neurodynamics and manual therapy into patient management.  NOI’s core philosophy is to provide progressive, current material, always challenging existing management protocols, to promote professional reinvestment, and to ensure that course participants benefit from the most recent research in a fun way.”