The following is an excerpt from JC Santana’s "Essence of Program Design" book.
In the current climate of the fitness industry, much is being made of assessments and tests to get baseline measurements. Although we understand the usefulness in these tests and assessment procedures, we strongly believe they have been overemphasized. At times, we have made the training process more about the assessments, and not enough training is getting done. At the Institute of Human Performance, we rarely test or undergo formal assessment procedures. We believe that observing clients is what trainers do best. We also believe orthopedic assessments and tests are the specialty of physical therapists and orthopedic specialists, not personal trainers. Looking at some of the techniques and courses being offered to personal trainers, we wonder if the providers of the courses realize that the audience is made up of personal trainers. The content of the material we have seen at conferences and in educational materials targeting personal trainers is more appropriate for therapists and doctors. Here is our reasoning for not jumping onto the assessment bandwagon.
Before we even get into the efficacy of an assessment strategy, let’s first talk about the scope of practice of a personal trainer. As of this writing, I have only been able to find two organizations that have attempted to delineate the job description of a personal trainer: the ACSM and the NSCA. According to the ACSM, “The ACSM Health Fitness Instructor conducts exercise programs and provides health education for apparently healthy people.” Likewise, according to the NSCA, “The NSCA-Certified Personal Trainer trains active and sedentary, physically healthy individuals, as well as the elderly and obese.” Now, let’s compare this to the job description of a physical therapist. According to the Maine Physical Therapist Practice Act, "physical therapy" means the evaluation, treatment and instruction of human beings to detect, assess, prevent, correct, alleviate and limit physical disability, bodily malfunction and pain from injury, disease and any other bodily condition; the administration, interpretation and evaluation of tests and measurements of bodily functions and structures for the purpose of treatment planning; the planning, administration, evaluation and modification of treatment and instruction; and the use of physical agents and procedures, activities and devices for preventive and therapeutic purposes; and the provision of consultative, educational and other advisory services for the purpose of reducing the incidence and severity of physical disability, bodily malfunction and pain. Now, where do you feel the assessments of muscular imbalances, compensations and other orthopedic problems belong? If you ask me, and based on the above job descriptions, they are the job of therapists and orthopedic specialists.
I am not suggesting you should not be educated in various areas of the allied health professions. I encourage education in any field of interest. However, practicing what you learn is another story. Heck, you can watch all the Discovery Channel you want; it still does not make you a surgeon. Personal trainers should not be FORCED to learn this advanced information, much less made to feel inferior if they don’t know it. I have seen some personal trainers pushed short of tears in assessment courses because they either questioned the methods or did not know some of this advanced assessment information. That, my friends, is WRONG. Not to mention, many personal trainers who learn this information now feel like they can diagnose various imbalances, compensations and the like. This is not only misguided, it is dangerous and possibly a legal liability.
Let’s now tackle the aspect of efficacy. Ask any physical therapist about the accuracy of a diagnosis. Also, ask them about the art of the diagnostic process. Finally, ask them about the success rate they see in the clinic. The honest ones will tell you they would love a 60% success rate, which means six out of 10 patients would fully resolve their problems. Here are allied health professionals, with more academic preparation on how the body works than anyone else in the field, and they are getting a 60% success rate. If they received those grades in school, they would have never graduated. The point being, if physical therapists are challenged by assessments, what do you think a personal trainer is going to do with a book and a weekend course? The answer is, nothing but get into trouble and waste training time. One question that continues to come up is, “So what can a personal trainer do to evaluate a client and decide on a good direction to take, keeping safety in mind?” The answer is, “THINK SIMPLE!” If you want to make 90% of the people who come into your facility better, here is an approach for that level of success.
Most of the problems we see on the fitness side of things are associated with one thing: PEOPLE SIT TOO MUCH! Sitting too much will cause several things to happen (see if this syndrome sounds familiar): (1) Most people sit too much; (2) Sitting too much makes most people sedentary, resulting in a low functional capacity; (3) Due to this sedentary lifestyle and low functional capacity, most people are carrying more weight than their bodies feel comfortable carrying; (4) The sitting position also puts certain muscles into shortened and lengthened states, further adding to orthopedic problems.
If we can agree on these four observations, we will be at the root of most of the evil we see in fitness and sports. If this is the case, the findings of the assessments can be predicted with almost 100% certainty. In the fitness field:
- Most clients will be overweight and will be looking for some weight loss.
- Most clients will be sedentary and will be looking to get into shape.
- Most clients will be sitting the majority of the day and, therefore, will have weak hip flexors, weak hamstrings, weak butts, weak para-spinals and a weak, protracted shoulder complex.
If the conditions above are almost 100% predictable, so are the test results and the cure. So why do you need to test strength, VO2 and the overhead squat or do postural compression tests? We train people to combat the sitting position. Since this position is the problem most of the time, we are successful most of the time. The majority of the people that walk into a commercial gym looking for personal training will exhibit the following conditions:
- Obesity/overweight - Solution: Start an exercise and nutritional program
- Chronic disease - Solution: Start an exercise and nutritional program
- Low functional capacity - Solution: Start an exercise and nutritional program
- No movement skills - Solution: Start a well-balanced exercise program
- Knees come in upon squatting - Solution: Strengthen the butt
- Knees come out upon squatting - Solution: Strengthen the butt
- Pelvis tilts back upon squatting - Solution: Strengthen the butt and hamstrings
- Weak core muscles - Solution: Strengthen the core muscles
- Slouched posture with rounded shoulders - Solution: Strengthen the pulling/shoulder muscles
In basic terms, people need to move, strengthen and lose weight. If we can make these three things happen with our clients, we will have over 90% success rate in dealing with fitness and health issues. What would that do for our industry and for our country’s healthcare situation? If our industry could help every client drop 10-15 pounds of body fat, what would happen to the pharmaceutical and medical industries? They would have to start looking for work in another industry, maybe personal training. Below I have summarized what the sitting position does to the human body and what you can do to address it.
The K.I.S.S. Principle of Assessment Training
The sitting position causes:
- Weakness and low functional capacity - Solution: Restore tri-planar ROM, strength and condition.
- Low functional capacity, leading to too much weight, orthopedic problems and chronic diseases - Solution: Drop weight by strength and conditioning
- Short and weak hip flexors - Solution: Restore tri-planar ROM, strength and conditioning in the core and hip flexors.
- Collapse of the spine into flexion due to fatigue, causing long and weak upper, mid and low back muscles - Solution: Restore tri-planar ROM, strength and conditioning in back muscles.
If we can agree on the simple scenario we have painted above, then why can’t we start people on an exercise and nutrition program aimed at dropping weight, enhancing movement skills, undoing the sitting position and increasing functional capacity? With the modalities available today, it would be easy to create a movement-based exercise program that would be energy-intensive, provide great training for the core of the body and enhance movement mechanics. It would be very easy to provide such training in a pain free and controlled manner. Throw in some sound nutritional and lifestyle education, and the program is complete: weight reduction and function, problem solved! With that general approach, how can you go wrong? If we can execute what we have just outlined above, we would be effective 90% of the time with 90% of our clientele.
On the nutrition front, the approach is also simple, perhaps too simple to be sexy. The simplicity of this approach makes it hard to sell to those looking for the quick fix. Our recommendations are: (1) If it has a label, don’t eat it, and (2) Eat small and balanced portions frequently (e.g., five to six meals per day, 300-500 calories per meal, each meal consisting of a little protein, a little carbohydrate and a little healthy fat). We don’t expect people to follow these recommendations to the letter, but we make sure they understand that the closer they get to perfect, the closer to perfect the results. For clients interested in accelerated gains and ergogenic advice, we refer them to our Directors of Research and Nutrition, Dr. Joe Antonio and Dr. Allyn Brizel. Between these two wizards, we can handle any medical or ergogenic challenge that comes to IHP.
This general approach to fitness and wellness has worked 90% of the time for us. The rest of the challenges are related to creating a training environment that is safe and fun. However, this is not rocket science and is just a matter of staying creative and keeping our eyes open. As long as the training is pain free and proper progression is followed, clients will progress safely and accomplish their goals.
Although some trainers give themselves fancy titles, at the end of the day, we are just modern physical education teachers for a population that has lost physical education. If the same training and nutrition approach will work for all of the problems that come into our training facility, then why shouldn’t we use that training approach for everyone? Furthermore, if the same exercise and nutrition approach can be used regardless of what tests or assessments say, then what real information do we get from the tests or assessments? If that is the case, why should we test or assess the obvious. If the answer is, “So you can quantify your results,” the answer is, “Hogwash.” Client knows when they fit into their old clothes, they know when they don’t get tired, they know when the pain is gone, and they know when they feel like a million dollars. And they know the results before they are re-tested. Clients are impressed with their own version of results, not 10% increases in VO2, 4% reduction in body fat or a 21 on a sit-and-reach test. Heck, by the time you run all of these tests, I’ll be sitting on the beach with my client, sipping margaritas and celebrating their success.
Our position and preference is simple: we start training and use continuous charting as a measure of progress and success. However, we are not the client, and in our world, the paying client rules. Therefore, we ask the client a simple question that will lead us to the tests and assessments we will use. The question we ask our clients is, “How would you know when we are successful and your goals have been reached?” If they say, "I will weigh X pounds," then we take a weight. If the client says, "I will look like X," then we will encourage a picture (some hate that idea, so we axe it if they do). Some clients will say they will feel successful when their back pain is gone, so we will rate the pain using a pain scale (i.e., from 1-10). If the client wants to lose inches around the waist, then we take circumference measurements. Many times, a client will just say, “I’ll know when I reach my goal, no need for measurements or pictures - let’s get to work!” Basically, the tests or assessments we use are dictated by the clients' goals and preferences. To date, no one has asked for equal shoulder flexion on both sides, an increase in VO2, three inches on their sit-and-reach or a 10-mm reduction in their abdominal fold. Although much has been made of testing, we still think clients respond better to their own reference of results.