Is a nociceptive exam part of your clients evaluation? Why or why not?

If a client is in pain, then he/she should not be training with me. If the client has gone the doctor and PT route, has been cleared for exercise with me and still experiences pain in an anticipated and controlled manner (with the expectation of the pain to subside over the course of training) I usually use a scale from 1 to 10 for the client to have a point of reference. That way, I can immediately refer back to the doctor or PT if things are heading in the wong direction.

I use this method throughout if that need arises.

While we as personal trainers do often help our clients manage their pain we are not pain specialist, therefore we do not measure for pain in our health screens or fitness evaluations. However, we certainly ask the client if they are experiencing discomfort in any or various parts of their body and determine, based on their response, whether to get a physician's release and a professional prescription. If the client has been to a professional, then I might use a pain monitor, like the arthritis pain scale of 0 to 10. Prior to a workout I ask where they are on the scale.
Danielle

I am not sure what you are referring to Louie. However, in a clinical setting, subjective assessments of pain/discomfort are measured. Scales are generally used (angina scale, claudication scale, dyspnea scale) to assess the degree of pain or discomfort during the assessment.

In response to you question as to why these clinical exercise tests are undertaken? It puts the clinical exercise physiologist in a position to design a safe program that will the patient/client beneath the onset of their threshold of pain.

Knowing that you are a graduate of Dr. Mike and having responded to several of your questions, I would really like to know more about your approach to a nociceptive exam.

Thank you Louie for your questions, and please know taking Dr. Mike's course is definitely on my bucket list.

Joanne, first congratulations on being on this month issue of the IDEA Fitness Journal, very cool! As an Exercise Physiologist this is my gripe with our industry, i use a nociceptive exam (checking fro trigger points, for those of you in Rio Linda) on my first evaluation as well as at the start of every session. I do this for two reasons, first, it is part of my philosophy and second because, my certifications are in Physical Therapy, not Fitness. For me this is the difference between a PROCESS VS PROTOCOL, being a Pioneer vs a Settler, thinking Outside the box vs Inside, being told by someone else what you can do vs knowing what you are capable of doing. I think you get my drift? On a previous answer you ask me what is my code of ethics? They are "Do no HARM" and part of my Motto is "Helping those who need it most" Thank you for the reply.

Thanks for the clarification Louie. 8)) And I do get your drift and actually agree with it somewhat. I don't like being told what I can and what I cannot do and having limitations on what I know I am capable of doing. That's one of the reasons I worked so hard on achieving the RCEP credential. I wanted the freedom to work with populations that were out of my scope of practice as indicated through the credentials that I possessed prior to earning the RCEP credential.

I share your thoughts as far as your code of ethics is concerned "Do No Harm" and Helping Those Who Need It Most" and for this reason as mentioned above, I worked hard to be in a position to help those who need it most by earning the RCEP credential.

Regarding "nociceptive exam", I have to be honest and say this is the first time I am ever seeing that term. I am very familiar with myofascial TrPs and currently use the foam rolling approach with my clients after I have performed all their subjective and objective assessments which include a static and dynamic postural assessment. One of the other things that I utilize is Body Map, it is a digitized method of assessing static posture. It also allows me to measure joint angles using a digitized goniometer.

One of the resources I have that I frequently tap into to better understand TrPs is Travell & Simons' Myofascial Pain and Dysfunction - the Trigger Point Manual. I have both volumes. It is a wealth of information. Interestingly, one of my clients, who by the way is an MD, her boyfriend was a former patient of Dr. Travell.

In closing, thanks for your response and the props regarding the IDEA Fitness Journal.

Be well.