Category — Q&A

In response to Monday’s blog post, Stress!!, the following question was asked

Getting into some of our conversation from yesterday, is there any way we can quantify this stuff without extreme ends? Have you used anything like the Profile of Mood States?

Regards,

Carson Boddicker

Carson, great question.  Quantifying whether or not the athlete is under high amounts of stress and ready for intense/high quality work that day can be done several ways.

First, on my general intake form there is a question regarding the clients own subjective stress levels.  This is something that I further enquire about when talking with the individual, as I want to try and determine where they are at before I start adding more stress.  I’ll ask them about their sleep, their overall daily mood, and times when they feel the most stress.

Having a stress profile as you suggested can be helpful.  Having the individual jot down and/or rate how well they slept the night before, how they feel today, are they sore, how hard would they rate the last workout, etc, can provide you with valuable information to plan training on a specific day.  Additionally, resting heart rate and blood pressure can be taken and compared to previous tests to determine if they are at or around their general norm.

If you don’t want to have the athletes fill out paper work every time, you can also just talk to them and observe them during the warm up.  Being a good observer is an important aspect of being a good coach.  Notice how the athlete(s) look when walking into the gym.  Are they looking sluggish?  Do they look down?  What is their overall posture like (this can tell a lot about a persons general mood)?  From there, during the warm up, you may notice the athlete(s) moving in a slower or uncharacteristic manner.  When I see things like this, I immediately start asking more questions.  If I feel that the athlete is not prepared for intense/high quality training that day, based on what I see and the feedback I am getting, then we go ahead and do a back off day or we just do some soft tissue work and mobility exercises.  I have also sent people home on certain occasions when I felt that taking a full day of rest would be the best thing for them.  Additionally, knowing when stressful periods of the year are coming up can help you plan training.  For example, you work with several collegiate athletes.  Midterms and finals time would be a good time to turn down the training stress as the athletes are usually staying up late to study or write papers, and under high amounts of stress from taking tests all week.

Finally, performance measures can be used if you have a base to measure them against.  A vertical jump or a broad jump (following a good warm up of course) can help to determine if the athlete is ready for strength or power work on a given day.  I believe in Fleck and Kraemer’s Optimizing Strength Training, they recommend taking the average of three jumps.  That number should be roughly 90% or greater than their normal vertical or broad jump if you are going to train power or strength that day.  If it is below 90%, then the athlete is not prepared for high quality work that day and should take a back off day to allow for more recovery to ensure they are ready for the next intense workout.

Those are a few “low-tech” ways of evaluating the athlete, others may have additional ideas, so hopefully they leave the in the comments section.  Of course you can also try and go more “high-tech” with things like the Omega Wave (which I confess I don’t know much about at this time) or even a Polar watch/heart rate monitor that can take your heart rate variability (HRV).

Patrick
patrick@optimumsportsperformance.com

A question that I commonly get asked is, “How do I go about choosing a soft tissue therapist to refer my clients to?”

My last two blog articles were on the topic of going about obtaining a massage licensure.  For some people, this may not be an option as they want to focus on being a great trainer or strength coach rather than “serving to many masters”.  This is something I can certainly appreciate, as picking one thing and really trying to own it will always help you more professionally than trying to do everything.  That being said, if you are not planning on doing the soft tissue work yourself, the next best thing is to partner up with a good therapist!

Having a soft tissue therapist in your network can be an incredibly valuable tool, as they can be instrumental in helping your clients enhance mobility, so that you can then go in and fine tune the movements you are trying to develop.  Additionally, the better you educate the therapist on what you do, your goals and philosophy on training, the more they will be inclined to refer their clients to you for training, as they will realize that you can’t have one (soft tissue work) without the other (training).  You really need both to be effective, in my opinion. 

With so much information out there about different techniques (Active Release, Myofascial Release, Rolfing, Neuromuscular Therapy, “Sports Massage”, etc), knowing who to select can be a daunting task.  So, here is a little cheat-cheat of what to look for in a therapist to ensure that you can find a professional that will prove to be a good referral for your clientele.

• Education -  University education is not everything and many therapist that you will encounter may have nothing more than a diploma from a massage college and a professional licensure (always ensure that they have a professional licensure to protect yourself and your clients!).  By education, I mean, what do they read?  What do they study?  Talk shop with the therapist and get a feel for what they know with regard to anatomy and physiology.  I have found a few massage therapists that are more educated on the body than those who hold degrees in chiropractic or physical therapy because their commitment to continuing education has allowed them to surpass those in other fields who have gotten lazy since obtaining their degrees.
• Do they workout? - While they may not be as educated as you on exercise programming (remember that whole bit about owning your craft?) you do want to know if they exercise and train themselves.  Many masssage therapists that I have run into do very little resistance training and stick with things like yoga or pilates, if they do anything at all.  I am not trying to bash on yoga or pilates, but those that are devout followers of these types of exercise typically don’t believe in strength training (of course there are always exceptions to the rule) and usually will not be open to understanding what it is you try and do for your clients in the weightroom.  Talk to the therapist and get a feel for how much they understand training.  You may additionally want to invite them down for an assessment so that they can get a feel for what you do and how your skills will be a good blend with their skills.
• Get a session - Try out a few therapists and see what their treatment is like.  One thing I always like to find out is what happens during the first session, is there an evaluation that takes place?  What is their intake paper work like?  Do they ask you a lot of questions about any pain you have been feeling, any injuries you have sustained or any surgeries you have gone through?  Do they put you through an assessment to determine a treatment plan?  If so, what does that assessment consist of?  You would be amazed at how many therapists just get you on the table and start working!  That would be like having someone show up for a first training session and you just start working them out.  That doesn’t happen (or at least it shouldn’t)!  You need to ask questions, perform some assessments, and get a general feel for what the individual is capable of so that appropriate training progressions are chosen.  During the session, ask a lot of questions.  What are you doing now?  Why are you doing it?  What is the goal of what you are trying to do?  How does this affect my problem?  Asking questions willl help you get a grasp of whether or not the therapist will be someone you can, or should, refer too.  If I am refering my clients out, I want to be able to communicate to the therapist what I am feeling, what I think is going on, and what my training goals are.  They should be able to be an active participant in the conversation and not just go by what I am saying.  I want them to tell me what they found in their evaluation, what they their course of action is going to be, and any recommendations they have for me regarding exercise progressions based on what they feel or how the client responds to treatment.  Basically, I need the conversation to be a two way street, where we can talk shop and discuss the client to ensure that the best possible outcome is achieved.  Another good option is to ask if you can attend one of your clients sessions so that you can see how they work and what takes place during treatment.
• What is in their tool box and do they know when to use the hammer or the wrench? - I know that things like ART are all the rage right now, but honestly, it doesn’t really matter what letters are after their name.  A good knowledgeable therapist will always be a good knowledgeable therapists, and treatment techniques should be dicated based on what the client needs at the time and not what was learned in this past weekends continuing education course.  Therapists should have a tool box of options and know when to use those tools – when ART would be a better choice over some other technique, and vice versa.  This part comes down to how well the therapists has developed their thought process and application of that which they have learned.  I have seen people get really amazing results with incredibly gentle/superficial techniques and I have seen people get amazing results with really agressive techniques.  Techniques are just that, techniques.  They don’t tell you when to do something, they just tell you how to do it.  The later will get you inconsistent results at best (since not everyone will fit into the mold of any one technique), while the former will allow you to choose wisely based on what you feel, what the client reports, and information gained during the assessment process, ultimately leading to better treatment outcomes.
• Crystals, hot stones, and fancy creams and lotions…………RUN!!!! -  There is nothing wrong with spa services and treatments.  However, this is not something that I would consider to be essential for your training/athletic clientele.  While this stuff may feel good and help you to relax, when you need more clinical based treatments in order to enhance movement, decrease pain, or improve function this is not the way to go.  Aside from the fact that these sessions can be extremely expensive, the overall goal of them is to pamper the client, not deliver a therapy session that is specific to the functional needs of the individual.  So, if you find yourself walking into an establishment that turns out to offer more spa oriented treatments, be polite, say hello, slip them your business card and perhaps pick up a gift certificate for your significant other.

Hopefully these ideas will help you in making a worthwhile selection for yourself and your clients.  If anyone has any other ideas that have helped them select a soft tissue therapist feel free to leave them in the comments section!

Patrick
patrick@optimumsportsperformance.com

Yesterday’s blog about getting a massage license brought on some great comments, concerns, and questions from colleagues in the field.  Rather than answering them in the comments section, I decided to start a new entry pertaining to their thoughts as I think they are important and others may benefit from reading them as they may have some of the same questions.

Patrick
patrick@optimumsportsperformance.com

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Hi Patrick, 

Very interesting blogpost about massage therapy, answered a lot of questions I’ve had.

Regarding “getting the license”, is it really just a case of going to any suitable MT school, making the grade, and then after that is when you can start adding to your skills with things such as Graston techniques, Gua Sha etc.?

Or do you have to pick a direction you want to go with first e.g. NMT, SI etc.?

Thanks
Cedric

Cedric,

Yesterday I posted some notes about fascia, and received a great question from Carson Boddicker.  Rather than answer it in the ‘comments’ section, where it may go unnoticed, I decided to answer it with a blog entry of its own.

Excellent stuff, Patrick. Does your knowledge of fascia influence your training at all to this point?

Regards,
Carson Boddicker

Carson,

Thank you for the question.  I think the idea of fascia and exercise is something that has a number of fitness professionals confused, as many of them are questioning whether this stuff should be filed in the “Hmm, I can really use this” box, or the “This is very interesting, but I don’t think it has application to what I am doing” box.

While it is not the only thing I consider, fascia obviously plays a large role in how I think about soft tissue therapy.  With regard to exercise, as you well know, performing an exercise, stretch, or mobility drill for one muscle or joint does not only affect that joint/muscle(s), but has ramifications elsewhere up (or down) the chain via fascial (and other) connections.  I think where some industry professionals are getting confused about applying this stuff is that they feel they need to totally change their programming or start renaming exercises to represent the fascial lines/trains of the body.  Rather than renaming exercises or just dismissing it as something that “doesn’t fit in a training program”, I currently tend to think of this stuff as something to just consider with regard to the exercises/movements you prescribe in a given workout.

I Talked a little bit about this idea in an article I wrote for Mike Robertson’s website on the Deep Front Line.  Basically, what you can start thinking about is how different things are affected when you perform an exercise.  In the example of the Deep Front Line, we could consider how that entire line is affected when we work on breathing or when we perform a Psoas stretch.  Now, instead of just thinking of those as separate exercises unto themselves, they start to take on greater meaning as we can draw their connection to everything else besides just the muscle we are working.

Additionally, this may help strengthen our assessment process, as when we see poor movement patterns, rather than just thinking about one muscle being tight or weak, can start to consider certain areas of a specific line to work on (either strengthen or inhibit) in order to improve the overall pattern.  This is how the concept would be applied in a soft tissue therapy setting but we could certainly bring it to the gym floor as well.

It is helpful to remember that all of the lines have a connection with and thus an influence over each other.  This is not only apparent in the fact that many muscles are a part of more than one line – the SCM for example is part of the Superficial Front Line and the Lateral Line – but also in the fact that various lines are antagonists and/or synergists of each other.  Whole body movements would certainly have an affect on all of the lines that are functioning to produce the movement, not just the primary muscles involved, as each muscle has an affect on its respective line.

When we look at some of the movements that we do in half kneeling for example – chops, lifts, or half kneeling mobility exercises with arm drivers – we are influencing many lines all working together.  This is also so with some of the Gary Gray exercises (transformational zones and matrixes) that incorporate whole body movements in various planes of motion.  Movements like this may help to stimulate mechanoreceptors within in fascia (Paciniform Corpuscles for example, which are sources of feedback for movement) and create awareness/proprioception to the entire line.

Finally, another way that fascial lines may be considered in the training process is in some of our mobility drills as we attempt to “explore” new or lost ranges of motion.  As mobility is enhanced at one joint, it will have an affect over the fascial lines that correspond to that joint, and taking that into consideration, this could be something we could use to our advantage in order to bring the person from a basic mobility drill, into a full body movement which incorporates many fascial lines, allowing their body to develop proprioception/awareness to the new mobility that has been gained and how everything else has been affected.

I am sure others have their own ideas as well.  There are so many ways to think about it and I am just scratching the surface.  However, I think the more we can hash out ideas and develop our thought processes, the better we can see the application some of this stuff has to our training programs.

Hope that answers your question.

Patrick
patrick@optimumsportsperformance.com

The Radial Group is a company that specializes in marketing and business strategies for the health and fitness industry.  In their blog this month, they are running a poll on whether or not the personal training industry should be regulated.  Click HERE to see the poll and/or cast your vote.

I think this is an extremely important question and quite honestly, I feel that the personal training industry should be regulated in some way.

I think it is silly that students can spend thousands of dollars earning degrees in exercise science, exercise physiology or kinesiology and when it comes time to apply for a training job at a gym, those degrees are pretty much worthless as the gym is more interested in whether or not you have a specific certification (the certification that the gym chooses to endorse is probably centered around some sort of affiliate kickback).  They gym is more interested in whether you took a weekend course and can answer questions like:

Which of the following is a macronutrient?

a) Water

b) Chocolate

c) Protein

d) All of the above

And yes, that is a real question from one of the top certifying bodies in the country.  Seriously, WHAT A JOKE!

I feel that with some regulation, we can start to weed out the people who not only are clueless as to what they are doing, but don’t care to learn or advance their knowledge in anyway.  I base my opinion on the nonsense that I see going on in the gym when I go workout.

- Trainers with fat loss clients working on biceps and triceps for an hour.

- Trainers not being able to teach a squat, lunge, deadlift or push up properly.

- Trainers relying on machines rather than teaching exercises where the client has to actually move their body through space against gravity.

- Trainers not understanding assessment and how to determine what is appropriate (or not appropriate) for a given client.

- Trainers who do the exact same workout with all of their clients.

- Trainers who don’t understand anatomy and physiology and cannot properly communicate with doctors, physical therapists or chiropractors about the best way to properly integrate a specific client back into an exercise program following an injury.

- Trainers who don’t understand simple concepts of program design and how to properly set up a training plan for the client.

The list goes on and on…You know who you are!

Now, this is not to say that getting an education from a school or university automatically makes you superior or knowledgeable.  I have met several people who have degrees from universities who don’t understand any of the things that I discussed above.  On the flip side of that, some of the smartest people I know have no degree in the exercise field; however, they were motivated enough to read textbooks, attend workshops and learn as much as they possibly could about exercise, physiology and science.

This is true in every field, even those that are heavily regulated like the medical field, physical therapy, and chiropractic.  There are good and bad in each of those fields, even though they all have gone through the same amount of schooling (relatively) and have passed the same types of board exams.  One thing that sets those fields apart from the exercise field is that the students actually have to do residencies, clinicals, precticums or internships to help them gain real-world experience.  The majority of those in exercise-based programs around the country simply take the necessary courses, they may work in the rec center at the college training people (which is hardly an internship or learning experience), and then they graduate with their degree.  Shouldn’t these students be spending time working with industry professionals, learning the “in’s and out’s” of how to work with a client and properly develop an exercise program?

I think that some sort of regulation would be great for the fitness industry as it would not only raise the bar as far as the people coming into the field, but it would give the field a lot more credibility and make it a lot less of a “joke”.  One large certifying body would ensure that we are all on the same page with regard to education (as opposed to the hundreds of certifications which all have their own idea of how things should be done), it would establish personal trainers as credible experts on exercise and it would ensure that we all maintain a certain level of education and stay on top of current trends and science with specific continuing education demands.

What do you guys think?

Patrick

patrick@optimumsportsperformance.com