Should We Train People in Pain?
I came across an interesting fitness blog post recently. It is a great point of thought, I make it a point, regardless of the program design for my client to ask how do they feel. Asking and listening to a client is very important and should determine how you proceed before training. How do you all address this subject with clients.
My scope of practice includes working with populations with diagnosed:
1. Cardiovascular Disease
2. Pulmonary Disease
3. Metabolic Disease
4. Immunological and Hematological Disorders
5. Orthopedic Diseases and Disabilities
6. Neuromuscular Disorders
7. Cognitive, Psychological and Sensory Disorders
My professional liability insurance covers me when working with these populations provided that I am adhering to the standard of care guidelines established for clinical exercise physiologists. If I don't I can be charged with negligence.
Having said that, there are assessment scales that one can utilize if they are working within their scope of practice to assess one's level of pain. The Borg CR 10 - Customized for Pain Measurement is one of those scales. I emphasize, though, that this scale is one of the scales an ACSM Registered Clinical Exercise Physiologist would use.
Thanks so much for your question.
And then there is an unexpected and new pain. That's when I stop, regroup, discuss and refer.
I do (to the best of my ability) try to determine during an initial consultation the client's appreciation and understanding of the difference between actual pain and muscle fatigue due to exercise.
For example, if a client says "this hurts" I typically have them stop performing the exercise. However, as I am sure we have all experienced, often times the client simply means "I really feel this in the muscle(s) that are working right now."
It is far beyond my scope of practice to diagnose injuries. Therefore I explain to my client's beforehand that they should only use the words "hurt" and "pain" when referring to injuries, and not simply muscle fatigue.
It is a dangerously fine line, though. When there is any doubt, I always err on the side of caution and suggest seeking the advice of a trained medical professional.
Pain is always a flag that should never be ignored.
Obviously, our clients may have aches and pains from time to time as a result of intense training or DOMS. As has been addressed here, there are different levels of pain. I don't see pain as something that can be described as soreness or slight discomfort. Physical recovery from exercise can often times be uncomfortable.
When "pain" shows up in areas that have been recently trained, the safest thing to do for your client is to assume that there has been some sort of injury that needs to be addressed. Depending on your scope of practice as a fitness professional, you may or may not be able to determine the best course of action. However, a fitness professional can never go wrong by referring a client. If a client refuses to see a qualified professional about the pain, another option might be to avoid training that would exacerbate the issue, if at all possible, until the pain subsides and the client feels OK to resume training.
Having said that, if the same kind of pain is reoccurring, a trip to the doctor is no longer a question, but a requirement.
I totally agree with Karin's statement that many people (including our clients, and even ourselves) do or will experience "pain" at some point in our lives. If the client has been medically cleared to workout despite the source of this pain, then it's part of my job to get them to improve their quality of life while living/dealing with the pain. This means that if they have chronic pain such as that related to arthritis, strengthening their muscles and joints to improve that condition, or if their source is an episodic or acute source (such as post-rehabilitation from surgery) to work through the slight discomfort/pain that is a necessary part of returning to full or close to full functioning.
"Yes," dealing with pain can be a slippery slope since each individual experiences pain and expresses it in different ways. This is why in my opinion it is vitally important to acknowledge your client's feeling, communicate effectively with them, and make sure that they obtain a medical evaluation to determine that their exercising is not exacerbating or causing the pain.
I hope that this helps.
There are many types of pain: If a client is sore from a workout, we will roll and stretch and work different muscle groups. If my client has a migraine we may turn the lights down and stretch.
With that being said, I'm not sure if this answers your inquiry?
-If you are looking to be the next negligence case then yes. Otherwise no.
Work within your standard of care as Joanne - which for most is going to far different than hers.
You have to remember that some people, because of what is ailing them, will always have pain. Say for example someone with Fibromyalgia; such a person will always be in pain. As Joanne said, use the pain scale (0-10). If the pain is 5 or over, don't train that person. As suggested by our fellow professionals, if it is within your scope of practice, you should try to help that person.
I think its important, as others have stated, to talk about the difference between fatigue and pain with clients. Its also important to perform a proper medical history prior to training so you can be aware of any previous injuries or medical conditions that may make them prone to pain or reinjury. Always err on the side of caution and client safety.
I never work with acute pain, but chronic pain, of course..
Chronic pain or long lasting pain can be a symptom of tight muscles (muscle knots), weak muscles (causing tendonitis) or misalignment or improper biomechanics (causing kinetic chain symptoms), it can be disease related, (such as arthritis, fibromyalgia), or a symptom or something more severe. The pain of arthritis can be measured on an arthritis pain scale to determine exercise acceptability, and we all know the best thing for arthritis is movement, same for fibromyagia.
Additionally, lower back pain is a common chronic pain that may be managed with the right stretches and strengthening exercises. In my health history screen I address and explore pain, discomfort and limitations.
Great question. The first thing we have to ask is what type of pain are they in.
Fitness professionals should train within their scope of practice.
Since their is no regulation on personal trainers it falls back on your education and your national certification. ACSM is the only medical national certified agency that while completing and showing competency as a health fitness instructor for example allows you to train certain clientele based again on the competency that one has completed.
All of the other 100+ certification agencies are not comprehensive nearly as is ACSM.
As a physical therapist, I am trained to assess and manage pain. Now with advanced knowedge and taken two classes in chronic pain, I won't train clients in chronic pain, because it will only exacerbate and foster the pain cycle.
However a person with mental pain(ie depression, anxiety, sadness) is pain. Will exercise hurt them? No, based on the science, research and recent studies, exercise will do just the opposite, increase a release of natural endorphins, blood flow, lower heart rate and blood pressure, change mood and decrease stress which we all know.
However a client with a given pathology, knowing the pathology, your distinct scope, education, training, and skillet should be the guide.
Therefore, if someone is in pain, is it really safe and logical to train them?
No it is not..