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.
Thanks for your question Gillon.
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.
I think that there is pain, and then there is PAIN. I have clients, all medically cleared, to whom pain is a factor of life, and exercise is a potential way to improve the situation. Arthritic conditions are an example; I have also trained a person prior to knee replacement surgery. In cases like this, I have no problem training people who have pain because it is in a controlled situation. With constant feedback from the client, it is often possible to bring the pain level down on the scale that Joanne mentions.
And then there is an unexpected and new pain. That’s when I stop, regroup, discuss and refer.
It really depends on they type/severity of pain. For liability reasons, however, it is best to err on the side of caution.
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.
As suggested in the previous answers, “pain” covers a wide spectrum. If a client complains of pain my first recommendation is to refer your client to his/her physician to rule out a chronic or an acute problem that needs to be dealt with medically. As Karin points out, some conditions such as arthritis which lead to chronic pain may respond well to an appropriate exercise regimen.
Pain is always a flag that should never be ignored.
The power of referral is probably one of the greatest powers that a personal trainer has. Referring a client with legitimate pain concerns to a qualified healthcare professional should only help to build a stronger client/trainer relationship. If a client is in pain, the prudent way to proceed, in my opinion, is to refer that client to someone who may be able to address the situation. At a minimum, a trainer who has a client claiming that he or she is experiencing “pain” should always attempt to get an understanding of the pain that is being felt so that you, the trainer, can write an appropriate referral letter to a qualified professional.
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.