Thursday, August 5, 2010

When Pain Intolerance Prevents Progression

Recently, I've begun teaching small group circuit classes at my new facility. Group training is tricky because you need to pay special attention to certain movements that you know may elicit pain or lead to injury. General population clients are typically prone to injuries by the sedentary lifestyle. It's usually the physical activity that "exposes" the abnormality. A great think about group training is that it contributes to a motivating atmosphere. Without a doubt, when there is a "community" of exercisers with a common goal of 'finishing the class', there is nothing but inspiration in the room. There are those that raise their personal expectations, and there are those that complain because they are being dragged out of their 'comfort zone'.

What I have found over the years working with a host of different personalities, different goals, and different excuses (although they are seem to be the same, but they do get creative); sedentary people will quit when they have reached their personal limit. When sedentary people exercise they do one of two things:

1.) do only as much that they are comfortable with and are able to justify that they "do exercise".
2.) give themselves a reason to validate their reason to "want to give up".

You see, as I conduct my class and walk around the room, I watch the faces of my clients as they perform the exercise stations that I designed earlier in the day. I look for winces, painful angles and arches. I look for anterior knee translation, raised heels, hip shifting, elevated shoulders, and protruding abdominals. I piece the expression to the dysfunction observed. I watch breathing patterns. I watch the breakdown of form. I methodically place rest periods in between certain stations to purposely elicit better form on certain movements that I know may be met with danger. This is a necessary habit to get into as some signs of painful activity may be more noticeable than others:



But what do you do when a client starts to complain of pain? Do you automatically stop? Or do you investigate? Do you modify or cease the activity altogether?

You see, many trainers will STOP the exercise without asking questions. Many trainers will become fearful that they are doing more harm than good. Many trainers will not try to decipher what their client's pain tolerance is. Let me re-iterate:

Is there a chance that by not stopping you are doing more harm than good? YES

Is there a chance that the client is actually hurting from an acute injury? YES
Is there a chance that the client is confusing PAIN with exercise-induced muscular discomfort? YES

Let's explore the third statement because I truly believe that injury can occur at any time during exercise if the instruction is inadequate, or if the form is poor, or if the client is matched with a movement that is inadequately loaded. However, if you've done your homework correctly and understood biomechanics and passed all your exams---there is a different facet to explore here. It is time to get into the client's psyche.

Many trainers walk a fine line of being overly abusive during group training; or under-challenging. They either dominate the leadership role and steam- roll through sessions without paying attention to detail and focus entirely on feeding the atmosphere's dynamics. Or they fear too much that the programming becomes inefficient. Most trainers that "under-challenge" clients meet 4 criteria:

1.) They are more 'friends" with clients than they are professional resource

2.) They lack confidence in exercise physiology and biomechanics

3.) They are inexperienced in "probing" or investigating outside of the normal dialogue between professional and client.

4.) They are not prepared for the unexpected.

Everyone feels "pain". I feel pain every day--mine is from weekly workouts that push me to the edge. Mine are from years of lifting weights and recently, adding homeowner activities to my daily grind: shoveling snow, gardening, mowing the lawn, cleaning gutters, etc, etc...

You must investigate your client's pain. Not simply stop the activity. The more you investigate,  the more it will prompt you to observe and research. Asking questions and investigating will enable you to create a "mental log" of certain descriptive phrases used for the pain. This will help you in the future when working with others that may experience the same discomfort.

You must learn to modify exercises. You can only modify exercises if you know why an exercise MAY hurt. Did you get that? Why does a standard push up cause painful shoulders or elbows and a modified does not? Answer: shortened lever. What does this mean? When a push up is performed on the knees, the length of the body is shortened and places less demand on the core musculature and shoulder girdle. This is going to take some experience. Learning how to modify movements by manipulating angles, body placement, loads, and progressive order. I talk about this a ton in Shatterproof Spine.
Stop being fearful. Listen, no one is asking you to "act like a doctor". But your fear may actually be preventing your client from getting some real results, real fast. Fear is usually a result of lack of preparation and ignorance. Be prepared for an injury. When a client begins to complain, listen to them but take control. If you went to your local hospital's ER for an emergency, would you want to be met with a doctor afraid to help you or do you want to be met by a doctor ready to take control? I chose the latter. Start with acquiring insurance with a minimal 2 million aggregate. Second,  try every exercise you use in your arsenal on yourself first. There has never been a day since 1999 that I have not tried an exercise scheme on myself before giving it to a client. Period. And thirdly, learn more about biomechanics, physiology, and first aid. If you are CPR certified, you are missing First Aid knowledge. If you lack in knowledge begin to research online, continuing education, or network with medical professionals.

Lastly, stop being your client's friend and get them where they need to go! Trust me, I am all for being friendly, relationship building, and singing happy birthday to my clients...but at the end of the day I have a job to do. My job is to bring them to the edge that they won't bring themselves to. Period. If you are simply bringing them to the level they are comfortable with--you are simply doing nothing for them that they already couldn't have done on their own. Now,  they simply have company doing it.

I hope the majority of you understand this blog post. The more you understand the mechanisms of injury and experience the different perceptions; the better you can serve your clients.

2 comments:

  1. Excellent article. Another one of those issues which seems obvious and simple to some trainers, but really isn't.

    I think the issue of knowing the biomechanics of things is pretty important, so you can have a go at figuring out whether we're talking about a genuine injury or just the stress of the body actually working for a change. And many trainers lack this knowledge.

    For example, looking at routines given by other trainers in my gyms, very very few account for postural issues.
    "Client has a sore lower back, oh well, must be weak, let's give her hyperextensions. And weak core, let's give her crunches."
    "Um, she has an increased lordosis."
    "What?"

    Sorry, just started two new jobs and I'm ragin'.

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  2. 'experience the different perceptions'. Individualize the program, learn to recognize your clients' unique responses to exercise. Thanks John, you're an enduring source of wisdom.

    Thank you

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