Respect for medical professionals

[KyleAaron]

Working in the fitness industry has made me lose a lot of the respect I once had for medical professionals.

When promoting effective training, a trainer's obstacles are not only fitness world nonsense, but the medical world, too. Just considering what's happened today:

One of my fellow trainers had shin splints for two months. Her physio said she had muscle imbalances and needed to work her soleus muscle, she did this but her shins kept hurting over the next month. I looked at her running style, surprise surprise, strong heel strike. Take off the shoes, run across the grass, ooh look, now she's running on the balls of her feet. Okay now do that with shoes on, same running style. One week later, no more shin splints. Must have been her soleus, right?

One of my clients, her doctor told her she's overweight and must lose some weight. She's 173cm tall and weighs 65.5kg.

I think medical professionals are excellent at dealing with acute issues, like broken legs or whatever, and terrible at dealing with chronic issues, like recurring non-specific back pain. And they're also really bad at promoting overall good health.

Thoughts?

[doingwork30]

I've lost about all trust in general practitioners.

Had two herniated disks, was told it was muscular. Advised to take a week off.

Costal cartilage problem, was told it was a strain of my serratus anterior. Not even same part of body, but whatever.

Told md I squatted around 225, she told me it was unsafe for children. I was 16.

Told me it wasn't strep, gave me Meds for allergies. It was strep.

Creatine is not natural. I mustve forgot the body produces its own.

Physical therapists too. Brb do the same exercises for the same amount of reps with the same amount of weight for a month and people just happen to need to come back.

Fuark. End rant. I'm going to be an MD and I really hope to be part of the upswing of the profession

[keys_10]

I think there are some who can spoil the reputation of the majority. Just like there are trainers who can give the rest of us a bad name.

One of the problems (especially with GPs) is everyone expects them to know everything when realistically they can't be expected to know everything and diagnose correctly all the time.

I don't know how much training they receive regarding exercise & fitness but i'd guess it would be a very small amount in comparison to other subjects so they wouldn't be able to give great advice regarding exercise.

[SFT]

There are bad doctors, bad physical therapists, and plenty of bad personal trainers. The only difference is that I feel as if the MD and DPT titles and prestige bring with it more trust and create egos.

In any case, you have to understand their side of things as well. General practitioners often have quite a case load and they have to get through people efficiently in hopes of making a decent living after years of student loans in medical school. From my understanding, at least here in the States, things aren't great for GP these days. Also, doctors don't care about optimal performance for athletes, etc. like you might. They couldn't care less how much you squat.

Physios/Physical therapists are generally trained to work with the patients they will often see. Most of these are either going to be in an inpatient setting: strokes, amputees, severely deconditioned individuals, joint replacements, etc. In an outpatient setting, they will commonly see these individuals, on top of common orthopaedic problems: lower back, shoulder, knee pain, etc. A therapist that doesn't have a strong athletic background might not be the best one to work with someone with shin splints.

Regardless of all this, we aren't any better than MDs or physios as a whole. We help people in completely different ways. I think that having access to different healthcare professionals is great because we can challenge each other and work together to problem solve. Rather than thinking they're stupid for what they did, we might consider speaking with them briefly about a client's success and what you did. We might hope to gain more respect for the profession that way and hopefully educate other professionals.

Those are my thoughts anyways. Think about all the poor doctors and physios who have had the pleasure to hear some of the "great" advice given by some of the personal trainers out there.

[KyleAaron]

Yes, they are overworked and don't know about exercise, etc. Guess what, I work hard, too, and there are lots of things I don't know about. Difference is, I recognise the limits of my knowledge.

If someone presents with recurring pain on particular movements, or otherwise hindered movement, I refer them to a medical professional. If I think the advice they get sounds stupid, I say, "That's not what I expected. Let's follow that advice, but I suggest you seek a second opinion, perhaps from another kind of medical professional."

Results count. With every client, I encourage them to try out advice given them, whether by me or some medical professional. After they've tried it for a bit, they should ask, "How's that working for you?" If there is now less or no pain, less or unhindered movement, then the advice must be good. If they hurt more or the same, and the movement is more or just as hindered, then the advice is no good. This applies whether the advice is "squat!" or "don't squat!" or "do this light isolation exercise and stretch" or whatever. Try it and see, results count. And recognise the limits of your knowledge.

[LuWellness]

I completely agree with you. But there's always going to be good/bad medical professionals. When the Physiotherapist prescribed Soelus strengthening exercises, it's not necessary wrong. Every condition has to be looked at differently, and it's great that you fixed the problem. Not all trainers would be able to properly assess a client's gait, and notice an excessive heel strike. When it comes to Musculoskeletal conditions, I believe that Personal Trainers do have a great understanding, but when it's other issues then it's a little bit out of our domain.

[Quistfitness]

You make a great point. I feel that doctors have an inability to say "I don’t know". They must always have an answer; even if it is unfounded in truth. Every person is still a human under any title they may present. Every person will have an opinion; it’s up to us to determine whether we want to accept that as unwavering truth, or to show skepticism. The only difference between a CPT and a DR. is one is expected and welcomed to have limitations, the other is not.

[WoofieNugget]

Don't even get me started. The amount of incompetent physios and physicians I deal with (mostly because I deal with injured people) makes me want to throw things. I actually had a physio email me about her client a couple of weeks ago - she has been treating her for a YEAR due to a broken foot. The funniest part in the email is that she was horrified that I had her client attempt a limited range deadlift with 30 pounds of load. She "strongly advised" me that her client should not be deadlifting, lunging or squatting. It made me facepalm. I didn't even bother responding and when her client deadlifts 100 pounds for the first time I'll send her a picture.

MD's unfortunately just aren't trained in anything resembling physiology or biomechanics, and the smart ones will admit it. I have doctors as clients and get referrals from some as well. You have to realize that now it is a doctor's job to simply triage and manage symptoms. Gone are the days of doctors doing anything resembling actually healing disease beyond telling people to rest and prescribing drugs to manage conditions. They are overwhelmed with people who don't help themselves and then expect the doctor to magically reverse a condition they have been working on for a decade.

As trainers, we can help by being the first carriers of preventative medicine and providing life long solutions that will actually help people not need drugs and surgery if we do our jobs properly.

[PlantStrong]

Working in the fitness industry has made me lose a lot of the respect I once had for medical professionals.

When promoting effective training, a trainer's obstacles are not only fitness world nonsense, but the medical world, too. Just considering what's happened today:

One of my fellow trainers had shin splints for two months. Her physio said she had muscle imbalances and needed to work her soleus muscle, she did this but her shins kept hurting over the next month. I looked at her running style, surprise surprise, strong heel strike. Take off the shoes, run across the grass, ooh look, now she's running on the balls of her feet. Okay now do that with shoes on, same running style. One week later, no more shin splints. Must have been her soleus, right?

One of my clients, her doctor told her she's overweight and must lose some weight. She's 173cm tall and weighs 65.5kg.

I think medical professionals are excellent at dealing with acute issues, like broken legs or whatever, and terrible at dealing with chronic issues, like recurring non-specific back pain. And they're also really bad at promoting overall good health.

Thoughts?

I wholeheartedly agree with this post especially the last few sentences. Excellent at fixing acute issues such as broken limbs, gunshot wounds, or an emergency bypass surgery. However, when it comes to prevention doctors are mostly clueless. It's all about disease management these days. And the pharmaceutical companies are laughing all the way to the bank. Most of the doctors I know and see are also out of shape and overweight. It's sad really.

[KyleAaron]

I think there needs to be a change in the way we think about "health", "disability" and so on.

For example, most people would consider a below-knee amputation to be a disability. There's a guy in my gym who has that, and he deadlifts 80kg and does weighted wide-grip chinups with a 20kg plate hanging from him. At any time in the gym, I can point to a guy his age and size who cannot deadlift 60kg without rounding their backs, and cannot do a single unweighted chinup of any kind. Which one is disabled? The officially-disabled one is actually more able than the officially-able one. And there are many other examples like that, of people with injuries and conditions of various kinds, who because they work to minimise the effects of the thing, end up considerably fitter overall than most "healthy" people. So we need to think about "when is it a disability, and when is it just being weak?"

As for health, health is more than the absence of sickness. And no single number such as bodyweight can be the sole indicator of health. I told my "overweight" client that I'd rather see her 80kg, able to deadlift 100kg, do a chinup, get 50kg overhead, and run 5km without stopping, and happy, than see her 60kg, not able to deadlift or do chinups or get even the empty bar overhead, nor run far. Fit, strong, with joint mobility but fat is healthier than unfit, weak, stiff but lean.

I think the questions when is it a disability, and when is it just weakness? and what is health? need to be discussed more. Most medical professionals don't consider these questions.

[jdwhitney]

I think there needs to be a change in the way we think about "health", "disability" and so on.

For example, most people would consider a below-knee amputation to be a disability. There's a guy in my gym who has that, and he deadlifts 80kg and does weighted wide-grip chinups with a 20kg plate hanging from him. At any time in the gym, I can point to a guy his age and size who cannot deadlift 60kg without rounding their backs, and cannot do a single unweighted chinup of any kind. Which one is disabled? The officially-disabled one is actually more able than the officially-able one. And there are many other examples like that, of people with injuries and conditions of various kinds, who because they work to minimise the effects of the thing, end up considerably fitter overall than most "healthy" people. So we need to think about "when is it a disability, and when is it just being weak?"

As for health, health is more than the absence of sickness. And no single number such as bodyweight can be the sole indicator of health. I told my "overweight" client that I'd rather see her 80kg, able to deadlift 100kg, do a chinup, get 50kg overhead, and run 5km without stopping, and happy, than see her 60kg, not able to deadlift or do chinups or get even the empty bar overhead, nor run far. Fit, strong, with joint mobility but fat is healthier than unfit, weak, stiff but lean.

I think the questions when is it a disability, and when is it just weakness? and what is health? need to be discussed more. Most medical professionals don't consider these questions.

Like SFT said previously you can find examples of bad practitioners in any field, and to judge an entire field by a few poor examples is a disservice. I've seen personal trainers that have pushed clients so hard they've actually fainted, but I certainly don't discount the value of personal trainers because of that.

As to why most people would consider an amputation to be a disability its because the vast majority of amputations aren't due to traumatic injury in relatively otherwise healthy individuals, as likely is the case in the example you mentioned. Over 80% of amputations are due to vascular disease, often exacerbated by diabetes among other things. These individuals aren't likely going to be doing chin-ups, deadlifts, or probably any other type of physically demanding exercise.

[Mr.ILL]

Pisses me off when I get my clients eating less carbs especially starches and more healthy fats then their doctor tell them to eat less fat less protein and more carbs like whole wheats and legumes.

[CoQ10]

MD's unfortunately just aren't trained in anything resembling physiology or biomechanics, and the smart ones will admit it.

Are you serious? Physicians must complete four years of undergraduate studies - usually in biology or a related field - followed by four years of medical school and a 3-5 year residency. The notion that doctors "aren't trained in anything resembling physiology" is absolutely asinine.

-C10

[KyleAaron]

Given that he paired it with "biomechanics", I assume Woofie meant exercise-specific physiology, like how muscles and bones adapt to exercise, how they respond to traumatic forces, etc.

I'm fairly sure he wasn't saying they know nothing about digestion or mitochondria or whatever, but rather that they have no clue as to whether squats are bad for your knees, or what a healthy bodyweight is for an non-sedentary adult.

[CoQ10]

I assume Woofie meant exercise-specific physiology, like how muscles and bones adapt to exercise, how they respond to traumatic forces, etc.

I would agree that many GPs are woefully unprepared to deal with fitness-related issues. However, the majority certainly understand the importance of aerobic and resistance training and will refer to a specialist as necessary.

Having said that - I do remember visiting an orthopedist (back specialist, actually) who didn't know what a deadlift was. That was pretty shocking.

-C10

[WoofieNugget]

Are you serious? Physicians must complete four years of undergraduate studies - usually in biology or a related field - followed by four years of medical school and a 3-5 year residency. The notion that doctors "aren't trained in anything resembling physiology" is absolutely asinine.

-C10

Yes - you are right. I should have put "exercise" before physiology.

Like I said I have had doctors as clients. One I trained for about a year was the head of oncology at one of the larger hospitals in my city. After a few sessions when I kept saying "you know how this works", etc. about things like anaerobic threshold and muscle physiology he said "listen - I forgot all of that stuff fifteen years ago. My job is to know enough about the body to make sure that someone's chemo treatment won't kill them but will kill their tumor. Yours is to know that stuff. I can't tell you the difference between a bicep and a bicuspid valve".

[SFT]

At the end of the day, the reality is that until people get to know you well, they aren't going to trust any of us lowly personal trainers. Sure, our knowledge might surpass that of physios or doctors in certain subject areas. However, we are talking about medical professionals versus personal trainers. We are not considered medical professionals. I think the biggest problem seems to be that the majority of people in our profession have jack in the form of education. Exercise science programs are often a stepping stone for MDs, physical therapists, physician assistants, etc. There are a few that stick around and go on to receive graduate degrees. However, these are few and far in between (and doesn't mean your necessarily well-educated anyways).

In order for our field to gain more respect, there needs to be more educated individuals sticking around and not jumping ship to the other fields listed above. We need to have education in pharmacology, advanced biomechanics, and pathophysiology just to name a few subjects. In my opinion, most graduate programs seem to be a repeat of the undergraduate coursework, plus a research project.

I'd be surprised if the average personal trainer could list a few exercise considerations for those with diabetes, or even hypertension. Let's not even talk about basic clinical skills. This wouldn't be a problem if trainers weren't working with these individuals.

So, I guess in drawing some conclusion, I would say that we need to show other medical professionals that we are educated and ready to fit into the puzzle of healthcare. Instead of saying, this doctor is a moron, or this physiotherapist doesn't know ****, we should try to interact with them in a professional manner. If they blow you off, then forget that particular person. However, there are people out there that will appreciate what you are doing with their patients. If you continually get results and medical professionals take note, we can potentially gain enough respect that our opinion might matter to an MD or physical therapist.

[Nothing_Clever]

Yes - you are right. I should have put "exercise" before physiology.

Like I said I have had doctors as clients. One I trained for about a year was the head of oncology at one of the larger hospitals in my city. After a few sessions when I kept saying "you know how this works", etc. about things like anaerobic threshold and muscle physiology he said "listen - I forgot all of that stuff fifteen years ago. My job is to know enough about the body to make sure that someone's chemo treatment won't kill them but will kill their tumor. Yours is to know that stuff. I can't tell you the difference between a bicep and a bicuspid valve".

Isn't that just an effect of specialization. Why do so many people constantly expect doctors to know so much? I was shocked at the amount of animosity directed at doctors in massage school. These men and women spend years being taught about the body from a pathological perspective. Most of their patients only go to them for acute injuries or traumas. Why do we expect them to be the champions of preventative care when their education and work load stress acute pathological conditions. I am going back to school for nutrition,exercise science, and social work because my doctor was woefully unprepared to teach me about diet and exercise's affect on diabetes. He couldn't address the eating disorder that led to my diabetes. He couldn't address the social anxiety that led to my lack of physical activity. I don't hold a grudge against my doctor. He wasn't being paid to teach and guide me through my recovery. I did a lot of that on my own. He was being paid to make sure I didn't go into a diabetic coma or destroy my kidneys. Instead of lamenting that doctors don't know anything I think we should accept that they can't. We should be fighting for higher standards for personal trainers. We should be fighting to change the way health insurance addresses health. I should have been refereed to a dietician, personal trainer, and psychological therapist for my diabetic treatment. I doubt my insurance provider would have paid for that. That's the real problem.

[KyleAaron]

Why do so many people constantly expect doctors to know so much?

I would expect a doctor to have a good idea of what a healthy bodyweight is for a young woman, and how bodyweight can be balanced with strength and fitness to give an overall picture of the risks of heart disease, etc. This is pretty basic knowledge.

A physiotherapist who treats shin splints should know about heel strike during running. It's a leading cause of shin splints. This is pretty basic knowledge.

I'm not setting the bar terribly high. Each professional should actually get a knowledge of the subject before giving people advice about it. Radical idea, I know, especially in the health and fitness fields.

Why do we expect them to be the champions of preventative care when their education and work load stress acute pathological conditions

My PT education didn't teach me how to coach a pushup. Would that be an excuse for me not being able to do it? It's up to each professional to make up for the stupid gaps in their education. Most professional organisations require continuing education, we can do pretty much whatever we like for that.

[AAOBob]

I have some knowledge of this and the problem is rather simple. There is just too much to know about the human body for any one person to really "get" it. Even if you do get it, there is too much to keep up with everything, so what you were taught 10 year ago is no longer considered valid.

One of lifes truisms is this.

There are those that know, and know that they know (the rockstars of a profession)
Those that know what they don't know (the good practitioners)
Those that don't know what they know (the bad ones)

Ego, arrogance, and a lower IQ is what seems to create the last group. There is no change in how one thinks about medicine that is going to change that, its just called being human. Though I do wish rank in class was posted along with a license number

[littlebones6]

Like everything, there's good and bad. I've learned to go to sport medicine clinics if I want the most accurate diagnosis OR a referral to some other specialist who has a knowledge of that specific problems.

It's hard to blame GP's considering the breadth of knowledge they're supposed to hold and the large amount of patients. Prevents them from really being experts in anything, hence why good ones will not hesistate to refer to a specialist when the case calls for it. That said, some do go the extra mile to educate themselves on subjects they're interested in, like a doctor who is interested in sports may subscribe to Medicine and Science in Sports and Exercise.

There's also differences between PT's who work with sports injuries, and let's say, oncology patients. Just like how some personal trainers will specialize in bodybuilding training and others in powerlifting or Olympic weightlifting, etc. Kyle Aaron makes a good point though, most PT's should be versed in assessment of both running and walking gait.

[KyleAaron]

Seriously, it's okay not to know sht, so long as you know you don't know - just refer 'em to someone who does.

Last week a woman asked me for a programme, she wanted to do an ocean swim. I can barely swim, a colleague does aquatic education classes. My choice: (a) bullsht my way through, or (2) refer to my colleague.

Simple, really.

[MuscledHorse]

As a doctored medical professional (Dr. of Pharmacy) let me say that 99% of the physicians and pharmacists out there have less than zero percent knowledge about fitness or nutrition. Patients being treated for chronic diseases are frustrated by the conflicting information they receive about what they should be doing in nutrition and fitness. I always send people off to read Jeff O'Connell's "Sugar Nation" and Harvard MedSchool Dean Jerome Groopman's "How Doctors Think." Both are excellent primers on the problem. I, along with my own physician (a D.O., of course), are rare in that we do know both sides of the patient equation, owing in part to the fact we are both bodybuilders so we have to "walk the talk" and I am also NSAM CPT. My frustration with fellow medical professionals inability to either admit ignorance of the subject matter or competently advise patients on that important first line treatment for hypertension, diabetes, and obesity--lifestyle modifications--before reaching for the drugs drove me to start my own Wellness company to bridge that gap.

[ericmackcarter]

Thoughts?

An important issue here is perspective. Specifically, it is my perspective you made a poor attempt to fix her issue, and by luck, succeeded. Gait analysis is subjective* at best. What objective muscle testing did you do? In other words, you asked "what deviations are present in her gait?" instead of "what aberrant conditions are present that would cause such deviation?". For some reason, your client's brain is telling her body to perform that movement exactly as she is. Until you understand that reason and correct it, she may either revert back to old habits or develop new issues. I'm not speaking in absolutes here, perhaps your client had no muscular issues and simply needed to be taught how best to run for her body. Without objective muscle testing, you won't know.

I'll give you a counter anecdote. When I was training for my professional tryouts, I hired a sports scientist to analyze my gait. I wanted everything to be perfect. I ran a 40-yard in 4.3 in our trials. Not bad. Except I had occasional heel strike and my feet flared out to the side way too much. We worked on my technique and built up from 10-y to 40-y. I couldn't run that 40-y in in under 5-s. I just had to re-learn and adapt to the correct technique, right? Well, that never happened because I pulled my hamstring during one of our trials with the new technique. I had to tryout with a damaged hamstring.

For some reason, my body is more efficient with occasional heel strike and excessive feet flaring. I've never had any pain from it. Is there some aberrant condition present causing this to be true? Quite possibly, but actually, it is my compensations that are keeping me healthy and able (relative to the topic). If the gait analysis was partnered with some objective muscle testing system, and specific issues were recognized and corrected, perhaps I would be able to run 4.1 with "correct" form. But in my present** condition, it is correct for my body to run like a goof ball.

In your example the physio, it seems, did not understand muscle imbalance. It is a term that is both widely used and misunderstood. I agree with your OP, however. I believe the problem has been alluded to throughout the thread: professionals trying to broaden their scope of practice. The world needs more specialists. The world needs more PROUD specialists. Do one thing and do it very good. Physical therapists know way more than I do about how to treat a shoulder following rotator cuff surgery. So if that client comes to me, I'll send them to the physical therapist. Following their rehab, if that shoulder has poor bio-mechanics or weakness, I'll be happy to assist.

As a personal trainer, for example, it is tempting to pretend to be a nutritionist. KyleAaron, you often say it best by asking "would you go to your dietitian to learn how to squat?". And that's coming from someone who believes that well trained personal trainers do have scope of practice to dispense nutritional advice in very specific conditions (performance) or very general conditions (eat more vegetables).

*Please do not assume I'm implying "subjective" is equal to "not useful".
** As my ability to squat heavier weight increased, my heel strike decreased or was eliminated. My assumption is that they are related but have no empirical evidence for my argument. I still flare my feet "excessively".

[Nothing_Clever]

Eric I hope to become educated enough in the fields I am persuading field to reply as eloquently as you did.

[CoQ10]

As a doctored medical professional (Dr. of Pharmacy) let me say that 99% of the physicians and pharmacists out there have less than zero percent knowledge about fitness or nutrition. Patients being treated for chronic diseases are frustrated by the conflicting information they receive about what they should be doing in nutrition and fitness. I always send people off to read Jeff O'Connell's "Sugar Nation" and Harvard MedSchool Dean Jerome Groopman's "How Doctors Think." Both are excellent primers on the problem. I, along with my own physician (a D.O., of course), are rare in that we do know both sides of the patient equation, owing in part to the fact we are both bodybuilders so we have to "walk the talk" and I am also NSAM CPT. My frustration with fellow medical professionals inability to either admit ignorance of the subject matter or competently advise patients on that important first line treatment for hypertension, diabetes, and obesity--lifestyle modifications--before reaching for the drugs drove me to start my own Wellness company to bridge that gap.

I find it ironic that you claim that "99% of physicians...have less than zero percent knowledge about fitness or nutrition" and then proceed to recommend "Sugar Nation." "Nation" is chock full of misinformation and I would suggest you reconsider advising people to read it.

I do like Groopman's books though.

-C10

[SFT]

The last thing I want to do here is start a five page thread about this, but your post has me confused. Is it possible that Kyle's success was "luck" and wouldn't work in many other cases? I'm no expert on long distance running biomechanics so I will leave that up to someone smarter than I to decide. However, I'm confused as to what information an objective muscle test would give us if she just has a faulty motor pattern? Or what if we have findings that deviate from the norm in objective muscle testing, but they are independent of faulty mechanics? I think muscle testing is valuable in some cases, but is it indicated in EVERY scenario? Should we be the ones doing it or the PT?

Also, I'm confused by the statement "Gait analysis is subjective at best", which sounds negative. Then, you mention in a footnote that you're not implying that subjective testing is useless?

If there's a problem and other professionals are failing, I think it is reasonable to try a few ideas if you are not harming the individual. I wanted to post a few other points, but I'm going to eat some steak.

An important issue here is perspective. Specifically, it is my perspective you made a poor attempt to fix her issue, and by luck, succeeded. Gait analysis is subjective* at best. What objective muscle testing did you do? In other words, you asked "what deviations are present in her gait?" instead of "what aberrant conditions are present that would cause such deviation?". For some reason, your client's brain is telling her body to perform that movement exactly as she is. Until you understand that reason and correct it, she may either revert back to old habits or develop new issues. I'm not speaking in absolutes here, perhaps your client had no muscular issues and simply needed to be taught how best to run for her body. Without objective muscle testing, you won't know.

I'll give you a counter anecdote. When I was training for my professional tryouts, I hired a sports scientist to analyze my gait. I wanted everything to be perfect. I ran a 40-yard in 4.3 in our trials. Not bad. Except I had occasional heel strike and my feet flared out to the side way too much. We worked on my technique and built up from 10-y to 40-y. I couldn't run that 40-y in in under 5-s. I just had to re-learn and adapt to the correct technique, right? Well, that never happened because I pulled my hamstring during one of our trials with the new technique. I had to tryout with a damaged hamstring.

For some reason, my body is more efficient with occasional heel strike and excessive feet flaring. I've never had any pain from it. Is there some aberrant condition present causing this to be true? Quite possibly, but actually, it is my compensations that are keeping me healthy and able (relative to the topic). If the gait analysis was partnered with some objective muscle testing system, and specific issues were recognized and corrected, perhaps I would be able to run 4.1 with "correct" form. But in my present** condition, it is correct for my body to run like a goof ball.

In your example the physio, it seems, did not understand muscle imbalance. It is a term that is both widely used and misunderstood. I agree with your OP, however. I believe the problem has been alluded to throughout the thread: professionals trying to broaden their scope of practice. The world needs more specialists. The world needs more PROUD specialists. Do one thing and do it very good. Physical therapists know way more than I do about how to treat a shoulder following rotator cuff surgery. So if that client comes to me, I'll send them to the physical therapist. Following their rehab, if that shoulder has poor bio-mechanics or weakness, I'll be happy to assist.

As a personal trainer, for example, it is tempting to pretend to be a nutritionist. KyleAaron, you often say it best by asking "would you go to your dietitian to learn how to squat?". And that's coming from someone who believes that well trained personal trainers do have scope of practice to dispense nutritional advice in very specific conditions (performance) or very general conditions (eat more vegetables).

*Please do not assume I'm implying "subjective" is equal to "not useful".
** As my ability to squat heavier weight increased, my heel strike decreased or was eliminated. My assumption is that they are related but have no empirical evidence for my argument. I still flare my feet "excessively".

[KyleAaron]

I don't think it was luck, because I saw dozens of guys in the Army go through recruit course and get shin splints, when a PTI went through the drills to reduce heel strike, at least 3 in 4 no longer had shin splints. The 1 in 4 who didn't lose 'em were usually city boys, so unused to marching around with heavy boots - the ADF marching style also has a strong heel strike during maximum dorsiflexion.

I always ask if there's any history of injury, etc. Obviously previous ankle breaks and the like will mean something else might be going on, and then I refer them to a medical professional. Absent contraindicating injuries, around 4 in 5 of shin splint cases I see in the gym, the person also has a strong heel strike. Again, about 3 in 4 taught an improved running gait will find the pain goes away.

I'm not claiming they end up running faster, so I don't see the relevance of your 40yd sprint example. I'm merely claiming that I can improve their gait enough to reduce the incidence of injury. Of course there are other gait issues, but this is a very basic and common one.

It's like coaching some random gym-goer to squat, when they say "squats hurt my knees" and do one of those awful quarter-squat with knees collapsing in. We may not be able to coach them to a double-bodyweight squat, but we can get them to go bar with pad off, down from neck to shoulderblades, weight through heels, knees out, chest up, below parallel. We do that and their knees stop hurting, miracle.

There's a difference between coaching movement for reducing injury, and coaching movement to improve performance. Obviously performance is zero while the person is injured, so reducing or removing the injury will by definition improve the performance - from nothing to something. But improvements from "good" to "excellent" or whatever require a different skillset. I don't need to be a top running coach to help stop most people's shin splints, any more than I need to be a top powerlifting coach to get someone to a 60kg squat.

Our job is to teach correct movement. A medical professional ought to have some grasp of what correct movement looks like, and if they don't, they ought to realise it and refer the person to someone who does.

[SFT]

I guess I'll continue with a few more thoughts now that I have some food in me. What about the case for someone who has excessive lumbar lordosis/anterior pelvic tilt? How do we fix this? Do I need to get them on a table and do some fancy assessments of muscle strength, ROM, etc? From there, do I need to work on a muscle by muscle approach to fix the problem? Is my only option to use exercises to fix the problem?

Alternatively, could I teach the person to understand anterior/posterior pelvic tilt? This might be something that they could implement throughout the day. In my personal experience, being aware of posture throughout the day made a considerable difference over using corrective exercise alone.

I'm not an expert in rehabilitation and neither are the majority of us on this site. However, I don't understand why we wouldn't consider that there is more than one way to skin a cat. Perhaps uncovering a muscular imbalance and using corrective exercise might have fixed her problem. However, changing motor patterns and/or habits such as posture might work as well. At the end of the day, if the risk:reward makes sense, why not try it? Why not use a combination of corrective exercise and changes in movement and/or posture? We can use both objective and subjective assessments.

In my book, if you get results without harming clients, I don't care what some textbook or "expert" says is the right way to do things.

[Nothing_Clever]

Kyle I agree that medical professionals should be taught how to refer. As a new massage therapist I refer all patients with medical problems out of my scope of practice or if I don't know enough about the injury or disease to the proper professional. What would be your guidelines, enforceable by law, for when and how another medical professional should refer a patient to a personal trainer? Specifically what guide lines would you suggest to legally protect the referring professional. Imagine a PT that focuses on out patient rehabilitation referring a client to a personal trainer since the problem could be his or her running gait. The Physical Therapist then refers the patient to a trainer he knows and respects but the patient chooses a different trainer. Since we are not regulated this could be a someone with a weekend certification. The Physical therapist will be blamed and sued if the patient is hurt because he told her go to a personal trainer. How would you address the education, compensation, and legal road blocks to better referring practices?