Having answered questions on the PTontheNet Forum for almost five years, I can see how often a personal trainer is faced with the challenge of creating a training program for a client that has some kind of musculoskeletal pain or even chronic disease.
It is natural for us as trainers to educate ourselves and gather the tools needed to serve our clients to the highest levels possible. Thus, I feel it is safe to say it is the fact we experience (an abundance of) clients in musculoskeletal pain that has increased our interest in assessments and therapeutic methods that teach us how to deal with pain.
However, the administration of these assessments has become a controversial area. “Personal trainers want to become therapists.” “Personal trainers should not perform assessments.” Those are just some of the comments that flourish in our world.
If we look strictly at the realm of personal training, the assessments that one could perform could have a huge impact - in a positive way. If we include the “grey area” between personal training and therapy, the possible assessments are almost endless. Therefore, it is not the purpose of this article to discuss specific assessments. Rather, this article is intended to serve as a guideline for how to THINK about assessments. After reading this article, you should have a clear perspective on assessments, in general, as well as an understanding of your own role in these assessments.
It is often helpful to begin an exploration of a certain topic, in this case testing - also referred to as assessments - by looking at what the words really mean. Here is the definition according to the dictionary (Collins Dictionary, 2000):
Assess = to evaluate, to estimate the value of
Test (vb) = to ascertain the capability of a person by subjection to certain examinations
Test (n) = a method, practice designed to test a person
As a personal trainer there is probably nothing in the above definitions that surprise you. Yet, now we have a common base from which to proceed.
There are several purposes of assessments and it is very important that you have a clear understanding of WHY you are assessing.
The primary purpose of assessments is to identify “weak links,” limiting factors for the client’s ability to achieve their stated goals. It is this purpose that is behind the saying that “the training program can never be better than the assessment” (C.H.E.K Practitioner Programs).
Let us assume that there are 10 factors (covering spiritual, mental, emotional, nutritional and physical factors) that affect the outcome of the training program. If you only assess 5 of those ten factors and the client’s true weak link (limiting factor) was one of the areas that you did not assess, then chances are that the program will not deliver optimal results. For this reason, it is important to attempt to collect VALID and RELIABLE information about ALL the factors that affect the outcome of the training program.
Note: Validity refers to the degree to which a test measures what it is supposed to measure. Validity is the most important aspect of testing. Reliability is a measure of the degree of repeatability of a test result (Harman, 2008).
A secondary purpose of assessments, strongly tied in to the first above-mentioned purpose, is to establish a baseline - a starting point. By subsequently measuring changes in relation to the baseline, client motivation increases (hopefully because of progress!) and you get feedback about the effect of the training program.
Key Areas to Assess
There is no doubt that we are multi-dimensional beings. In fact, one of the greatest frustrations about personal training can be that what the client is doing OUTSIDE the gym affects their progress more than what they do INSIDE the gym.
Because we are multi-dimensional beings, the list of possible areas to assess is rather long (Jensen, 2010):
- Internal biochemistry
- Internal organs
- Injury/pain (muscle, nerve or joint problem)
- Length-tension relationships
- Muscle activation patterns
- Technical and tactical ability (if you are an athlete)
How can one person possibly be able to perform all of those tests? That is a great question. The list covers 5-6 (if not more) fields of expertise. There are professionals who spend their ENTIRE career mastering JUST ONE of those areas.
The obvious solution (and probably the best) is to work in a team or referral circle with different professionals so the team, as a whole, can cover all the areas. Think about it this way: You need the result of the assessment, the information that it yields, but you don’t need to do the assessment yourself.
The other solution is to engage in more than one major education, which a few very committed trainers do, or attend limited-time continuing education courses that cover various areas of the list.
I have personally taken limited-time continuing education with the purpose of broadening my skills beyond my main area of expertise, exercise physiology. The courses were great and I felt that I learned a lot. However, a nagging question crept into my mind after a while: How good can I really be at ... [name area (nutrition/therapy)] compared to someone who has spent YEARS learning this and now spends ALL his/her time practicing this?
If you have taken a limited-time continuing education course and have the legal rights to perform an assessment, then you can, of course, perform that assessment. However, you should also ask yourself: Even if I have the rights to perform this assessment, how well can I execute (and interpret) this assessment compared to the professional standards that I set for myself?
So beyond legal rights, it comes down to these questions: Which areas of assessment do I wish to master to the level that I desire? Which areas of assessment CAN I master to the level that I desire? Only you can answer those questions.
Formal vs. Informal Assessments
The former section discussed mainly formal assessments, assessments performed by following a well-established testing protocol.
Remember, however, that it is all about getting the information we need to create the best possible training programs. There are three additional and significant ways to gather useful information:
1. Observations during training (trainer’s training diary)
2. Client training diaries
3. Observations outside training
Observations during training – the trainer’s training diary - can have both quantitative (a measurement with numbers) and qualitative (a measurement without numbers) elements. The trainer can take notes about the client’s technique, focus and performance in general. These notes can be taken DURING the session and do not need to take additional time. NOTE: A personal trainer should always carry the written program during the training session, as well as paper for taking notes.
Example: 5 Step Scale for Rating Technique (RTE) (Jensen, Exercise Instruction Manual).
RTE 1 = the athlete/client repeatedly performs the movement with substantial to small deviations from the optimal technique that inhibits performance and poses a significant risk of acute or chronic injury.
RTE 2 = the athlete/client repeatedly performs the movement with small deviations from optimal technique that may inhibit performance, but poses no or low risk of injury.
RTE 3 = the initiation, execution and ending of the movement is in alignment with optimal technique. There is not a lack of excessive movement in any joint, in any plane of motion.
RTE 4 = the athlete/client performs the movement with RTE 3. Further, the athlete performs the movement with optimal breathing patterns and optimal application of high tension OR relaxation techniques (depending on the specific nature of the movement). (High tension techniques are described below.)
RTE 5 = the athlete/client performs the movement with RTE 4. Further, the athlete/client makes optimal use of his/her spiritual and mental emotional faculties. This includes, but is not limited to:
A. Complete awareness of the entire body at any point in the movement.
B. Deeply enjoying the movement in the presence of high effort and possibly severe fatigue.
It is advantageous to include the client in the process and ask them to evaluate their own performance (Harre, 2012). The client is included in the process via a requirement to fill out a client training diary.
The client training diary should include the exercises performed, sets, repetitions, time, heart rate, etc. Additionally, it can be of great benefit to ask the client, “What did you improve today?”, “What is your goal for the next training session?”
The client training diary can also include a column where the client lists any “body talk” (“I felt stronger,” “slightly sore Achilles tendon,” etc).
Additionally, a subjective rating of stress, fatigue, sleep quality and muscle soreness on a 1-7 scale (low – high) can help predict overtraining (Hooper, MacKinnon, Howard, Gordon, & Bachmann, 1995).
Observations outside of training relate to conversations with the client. For example, in the locker room, other places than the gym, etc. You can assess the client’s sitting, standing and walking postures, breathing patterns as well as how their bag is carried. Obviously, you get a chance to assess their mood as well and they may share other aspects of their life with you.
The formal assessments can be demanding on time and resources, therefore, it is highly recommended to get everything that you can out of the informal assessments.
Time: The most important aspect here is to have the right expectations. While the one hour fitness assessment is certainly better than no assessment at all, one hour is simply not enough to yield all the necessary information. A complete assessment will take several hours, which often needs to be distributed over several days.
We are promoting a pragmatic view of assessments here. Perform the assessments that give you the information that you need in order to create the training program. Don’t do an assessment just to do the assessment. Thus, assessing a new client will typically be more time consuming than testing a client that you have worked with for months or even years.
Tests should be performed at one or more of the following time points:
- In the beginning of a new macro cycle,
- When progress can be expected (before and right after training periods when the program is geared towards improving that particular parameter), and
- At the end of a macro cycle.
Equipment: Two main categories of formal tests include laboratory tests and field tests.
Laboratory tests often use specialized equipment requiring investments of thousands of dollars. Field tests are often simpler and performed with limited equipment, for example, a measuring tape. Advances in technology, noticeably via apps, are making more and more tools available for field tests. Keep yourself updated on the ideal tests for the type of clients you work with to have an awareness of both the “high tech” and the “low tech” tests.
Conclusion and To-Do
Testing has one main goal: To gather the information you need in order to create the best possible training program for your client.
Formal tests are the foundation, but there is a “gold mine” of information to be excavated from the informal types of tests as well.
Continue to educate yourself on various tests from reliable sources. Decide which tests you want to master, then connect with a team of professionals who can perform the tests that you can’t.
(2000). Collins Dictionary 2nd Edition. Harper Collins Publishers.
CHEK Exercise Coach & C.H.E.K Practitioner Programs.C.H.E.K Institute. Retrieved from http://www.chekinstitute.com/Advanced_Training_Programs/EC_CP.php
Harman, E. (2008, June 8). Principles of Test Selection and Administration. Essentials of Strength Training and Conditioning 3rd Edition, 239-240, Chapter 11. Human Kinetics.
Jensen, K. (2010, September 13). 9 Steps to Create a Training Program. The Flexible Periodization Method, 334-335, Chapter 4. F. Lepine Publishing.
Jensen, K. The Art of Exercise Instruction Manual. Yes To Strength Level 1. Retrieved from http://yestostrength.com/shopyts/index.php?page=detail&get_id=120&category=24.
Harre, D. (2012). Principles of Athletic Training. Introduction to the Theory and Methods of Training, 138, Chapter 4. Ultimate Athlete Concepts.
Hooper, SL., MacKinnon, LT., Howard, A., Gordon, RD., Bachmann, AW (1995, January). Markers for Monitoring Overtraining and Recovery. Medicine and Science in Sports and Exercise, 27(1), 106-112.