Looking for some client advice (injuries)

[Teethatyourfeet]

Hey.

So I start next week with my first client (woo!), and she has had a few injuries in the past.

8 years ago she fell off of a truck and crushed her tailbone. It's only been in the last 3-4 months that she has been feeling "better" and more confident with walking, crouching, that sort of thing. She participates in yoga, but she can't handle certain exercises (can't run because of the jarring it causes, can't bike because staying in that seated position for too long causes extreme discomfort). She has also gone from being able to do 3 squats to 15 with no pain. After 15, she can't stand the pain.

She has no rotator cuff in her left shoulder. It was crushed when she was 16 while playing football (awful injury, also pretty awesome story).

And she suffers from adhesive capsulitis (frozen shoulder) in her right shoulder, as diagnosed by her physiotherapist (same guy that helps with her tailbone/spine issue). She recently has a cortisone shot.


What I'm wondering is if anyone here has dealt with clients who have had any or all of the above injuries, and what sort of actions did you take while creating their program?

Thanks a lot for any knowledge and tips. I'd really like to help this woman out. She's in great shape, surprisingly.

[RevolutionFF]

Well done on starting your first client - it is an exciting time.

It's a tough situation for you there - I have not dealt with any of those problems - she sounds like quite an extreme case.

My advice:

1) Network with other fitness pros so that you can get answers to questions you do not know.
2) Research the problems

The main problem here being she is your first client. You do not want to be turning down business, but sometimes things are just beyond your scope. Start with a good movement screen - look for movement issues/pain. Take things slow, and be very talkative to her about why you are taking things slow. Extract as much info from her as you can - during the session and about her past experience/problems.

Good Luck

[WoofieNugget]

Jesus tapdancing Christ.

Why the hell was this client assigned to you, a new trainer? You have no business touching this person in any capacity when it comes to exercise because you have no experience dealing with any of her injuries (you don't even know what they are) and have no experience at all.

Do this client a favor and tell her that she was assigned to a new trainer who has no idea how to deal with her and that she should walk into the gym managers office, demand her money back and find another gym that won't potentially injure her further with their stupidity.

Sorry for the rant OP and it has nothing to do with your aptitude as a trainer, either now or in the future. It is a rant about the idiots who run gyms that think it is okay for someone with potentially serious physical issues to get told what to do by someone that is brand new and has no idea what to do.

[Teethatyourfeet]

Jesus tapdancing Christ.

Why the hell was this client assigned to you, a new trainer? You have no business touching this person in any capacity when it comes to exercise because you have no experience dealing with any of her injuries (you don't even know what they are) and have no experience at all.

Do this client a favor and tell her that she was assigned to a new trainer who has no idea how to deal with her and that she should walk into the gym managers office, demand her money back and find another gym that won't potentially injure her further with their stupidity.

Sorry for the rant OP and it has nothing to do with your aptitude as a trainer, either now or in the future. It is a rant about the idiots who run gyms that think it is okay for someone with potentially serious physical issues to get told what to do by someone that is brand new and has no idea what to do.

I feel confident with my knowledge. I'm not afraid to work with this client and get her sorted out...

Again, if anyone has any useful advice, I'd appreciate it. Thanks.

[SFT]

My advice is to speak to her physio and find out what her orthopedic contraindications are. They will know better than anyone here. The issue isn't you being afraid, it is whether or not you possess the knowledge, or know someone who does, to make sure that you train your clients safely. Unfortunately, most gyms don't have a good head trainer that all the other trainers work under. If you did, they would not be assigning these clients to you initially, or they would be providing guidance and oversight throughout the training.

I do have to agree with Woofie's reaction. There are at least 1-2 posts a week of new(er) trainers being assigned clients with a pretty significant history of injuries or other health issues. Unfortunately most trainers are idiots and the "experienced" ones probably prefer working with lonely housewives.

[Teethatyourfeet]

Thanks SFT.

The issue is I work at GoodLife... It's a great company in many ways, but some aspects make it very difficult to be successful. This is how it works:

The front end staff, who know very little - if anything - about PT, are able to book one-on-one appointments for the trainers. They are also allowed to sell 3 or 6 pack sessions with a trainer, and sell entire PT packages if the member really wants it. This was a case where the member wanted the training, and they sold it to her without asking.

Being a generous person, the front end staff member saw that I had yet to get a client, so she assigned the member to me. She didn't ask any of the right questions because she wasn't trained on how.

It's frustrating, to saw the least. I'm meeting with the client again this Saturday to go over some more things, and if I feel she'd better off with someone else, I'll definitely let her know. I'd love to to help her, though.

Thanks for tips and advice.

[zhand]

Its good that you have front desk staff that is looking to help you out by sending walk up client your way to help you out, however all those injuries will make training this client very difficult for a new trainer and even an experienced trainer. I understand you are very excited to start training being that this is your first client but remember, someone like this can be easily hurt if prescribe a innappropriate exercise. I totally agree with the replies in this post and the one thing i promise you do not want is the reputation of being a new trainer and hurting a client. (not saying that you will hurt the lady)

If you do decide to take on the client, dont hesitate to ask for advice from your fitness managers and co-workers for some exercises and training methods you feel would work best for the lady.

Good Luck!

[Ronin4help]

No rotator cuff??? Am I the only one who caught that? Who has surgery to remove those muscles and tendons and why?

[SFT]

From the post, it was my understanding that the rotator cuff was an injury? I'm guessing that it was bad enough that it couldn't be repair, or she waited too long? I could be wrong, but people generally screw up these diagnoses. For example, she might have torn a muscle or two and not all four rotator cuff muscles.

[Teethatyourfeet]

I met with her this morning to do a full assessment (she didn't have time earlier).

Her rotator cuff injury is located at the subscapular fossa, so she has some mobility. It's definitely not nearly as bad as she had made it sound.
Her frozen shoulder is feeling "better" and she has some mobility there as well. I've been researching it, and it looks like I'll be doing plenty of stretching (external and internal).

[OhSoFocus]

I think youll be fine. My advice would be to do your research on her conditions, sPeak with the handling doc, educate yourself and take it easy. I think both an experience and unexperienced trainer would have to do this, unless ofcourse ur a PT who specialize training this type client/condition rehab aka physical therapist. Determine clients goal, determine which movements the client should not do, then proceed.

[SJHunter]

Hey.

So I start next week with my first client (woo!), and she has had a few injuries in the past.

8 years ago she fell off of a truck and crushed her tailbone. It's only been in the last 3-4 months that she has been feeling "better" and more confident with walking, crouching, that sort of thing. She participates in yoga, but she can't handle certain exercises (can't run because of the jarring it causes, can't bike because staying in that seated position for too long causes extreme discomfort). She has also gone from being able to do 3 squats to 15 with no pain. After 15, she can't stand the pain.

She has no rotator cuff in her left shoulder. It was crushed when she was 16 while playing football (awful injury, also pretty awesome story).

And she suffers from adhesive capsulitis (frozen shoulder) in her right shoulder, as diagnosed by her physiotherapist (same guy that helps with her tailbone/spine issue). She recently has a cortisone shot.


What I'm wondering is if anyone here has dealt with clients who have had any or all of the above injuries, and what sort of actions did you take while creating their program?

Thanks a lot for any knowledge and tips. I'd really like to help this woman out. She's in great shape, surprisingly.

Crap like this pisses me off. This woman should be in physical therapy until she's mildly mobile, not passed to a brand new personal trainer because the gym wants to hit their sales goal. Ridiculous.

Anyway, I can tell you straight off the bat your client is only telling you half truths. Yea, maybe she was injured, and maybe she has contraindications, but I guarantee you she's exaggerating on her capabilities. You don't execute 15 squats and then suddenly they begin to irritate your tailbone. If it was irritating, they would have hurt the first 15 as well. If she can do 15 squats, then she can squat now. It's safe to say.

"Crushed her rotator-cuff"?? I honestly have no idea what this means. Your rotator-cuff can't be "crushed". The way you describe this client, she sounds like she should be in a wheel-chair with double arm casts on.

In my professional opinion, you shouldn't be training them. They are outside of your scope of expertise and require a clinical doctor like a physical therapist to re-mobilize them. If you are absolutely not willing to give up the client, then you should start finding credible corrective exercise sources to learn what you should be doing with her contraindications. Find out what exercises she CAN do, and make her do them a lot. You don't heal unless you try to use the muscle/joints/tendons in a healthy manner. They re-adapt back to normal over time if you force them to gradually. It's uncomfortable, but that's physical therapy in a nut shell.

I don't mean to sound negative; it's not your fault your gym passed you a client that they should have said "No" to. I would have taken one look at her Par-Q and said absolutely not. I have been passed clients with a laundry list of contraindications in the past so I feel for you. It's a crappy situation to be in.

Best of luck with this one!

[Teethatyourfeet]

Crap like this pisses me off. This woman should be in physical therapy until she's mildly mobile, not passed to a brand new personal trainer because the gym wants to hit their sales goal. Ridiculous.

Anyway, I can tell you straight off the bat your client is only telling you half truths. Yea, maybe she was injured, and maybe she has contraindications, but I guarantee you she's exaggerating on her capabilities. You don't execute 15 squats and then suddenly they begin to irritate your tailbone. If it was irritating, they would have hurt the first 15 as well. If she can do 15 squats, then she can squat now. It's safe to say.

"Crushed her rotator-cuff"?? I honestly have no idea what this means. Your rotator-cuff can't be "crushed". The way you describe this client, she sounds like she should be in a wheel-chair with double arm casts on.

In my professional opinion, you shouldn't be training them. They are outside of your scope of expertise and require a clinical doctor like a physical therapist to re-mobilize them. If you are absolutely not willing to give up the client, then you should start finding credible corrective exercise sources to learn what you should be doing with her contraindications. Find out what exercises she CAN do, and make her do them a lot. You don't heal unless you try to use the muscle/joints/tendons in a healthy manner. They re-adapt back to normal over time if you force them to gradually. It's uncomfortable, but that's physical therapy in a nut shell.

I don't mean to sound negative; it's not your fault your gym passed you a client that they should have said "No" to. I would have taken one look at her Par-Q and said absolutely not. I have been passed clients with a laundry list of contraindications in the past so I feel for you. It's a crappy situation to be in.

Best of luck with this one!

She does physio twice a week and was told to get a trainer with how far along she is injury-wise. She also sees a chiropractor twice a week.

I appreciate everything you said. I pretty well explained exactly that (what I can and can't do) to both her and my fitness manager. The client is OK with it, even gave me the contact info for her physiotherapist and chiropractor, and we're moving from there. She definitely has exaggerated about how injured she is... she is far more mobile than she let on in sessions 1 and 2.

She went ahead and purchased a years worth of training today. She seems to be comfortable with what I can and can't do, and I've been reading up on frozen shoulder and how to work with clients who have tailbone injuries. Her rotator cuff problem is more or less she can't perform the full ROM, but can do most it... so she'll be fine.

Thanks for input everyone, I really appreciate it. Now to start planning.

[Endevorforever]

Yeah if her doctor or Physical Therapist has cleared her for exercise, then ROM with light weight and arm strengthening should fix the frozen shoulder. arm rotation exercises with light weight should strengthen the rotator cuff. Don't worry just be careful listen to the client and keep seeking information like you did here and you will be fine.

[KyleAaron]

I feel confident with my knowledge.

Then why are you asking a bunch of anonymous strangers on an internet forum how to deal with her?

Let's say you were going for an arthroscopy, and you found out your doctor was asking a bunch of other doctors on an internet forum how to do the operation, would you feel confident in that doctor's abilities?"

I'm not afraid to work with this client and get her sorted out...

Perhaps you should be.

Mate, it's no shame to not know stuff. It takes time, usually one injury at a time is enough for us to deal with.

[WoofieNugget]

She does physio twice a week and was told to get a trainer with how far along she is injury-wise. She also sees a chiropractor twice a week.

I appreciate everything you said. I pretty well explained exactly that (what I can and can't do) to both her and my fitness manager. The client is OK with it, even gave me the contact info for her physiotherapist and chiropractor, and we're moving from there. She definitely has exaggerated about how injured she is... she is far more mobile than she let on in sessions 1 and 2.

She went ahead and purchased a years worth of training today.

I'm glad you were transparent about what your capabilities are. Again though, what I'm astounded by is that any person would commit thousands of dollars of their own money knowing that they are dealing with someone who has no experience dealing with their issues and is just learning even what they are and how to apply things. I'm quite sure OP that you will do your best judging from what you are saying but it makes me shake my head that people in chain gyms are really that stupid.

Unless of course your fitness manager and you both sat down and went over the typical "one year periodization plan: adaptation/build/burn/strength" GoodLife BS, which is a total crock of crap in order to sell her a package.

[Teethatyourfeet]

Then why are you asking a bunch of anonymous strangers on an internet forum how to deal with her?

Let's say you were going for an arthroscopy, and you found out your doctor was asking a bunch of other doctors on an internet forum how to do the operation, would you feel confident in that doctor's abilities?"

There are a lot of people on here with a lot of different backgrounds. There's nothing wrong with asking for opinions and then fact-checking them. It doesn't mean I'm going to listen to people I don't know anything about, but someone could easily have piped up with something useful. That's the nice part about the internet... there is a ton of information out there.

I'm glad you were transparent about what your capabilities are. Again though, what I'm astounded by is that any person would commit thousands of dollars of their own money knowing that they are dealing with someone who has no experience dealing with their issues and is just learning even what they are and how to apply things. I'm quite sure OP that you will do your best judging from what you are saying but it makes me shake my head that people in chain gyms are really that stupid.

Unless of course your fitness manager and you both sat down and went over the typical "one year periodization plan: adaptation/build/burn/strength" GoodLife BS, which is a total crock of crap in order to sell her a package.

I actually explained that it would take her a lot longer than 1 year. I can't fix someone. I'm not a physiotherapist or a miracle worker. She knows all that. She wants to get in shape, exercise, and have some guidance. If I can help increase her ROM and maybe alleviate some pain, then that's great. If not, she knows exactly what she's getting.

[KyleAaron]

Frightening.