Panel Discussion: Should a CPT be allowed to use goniometry and manual muscle testing?
Should a personal trainer be allowed to use goniometric assessment and muscle testing? It could be a powerful tool in creating corrective exercise programs and enhancing performance, but does it cross a line in relation to our scope of practice?
Moderated by Brent Brookbush DPT, PT, MS, PES, CES, CSCS, ACSM H/FS
This Panel Discussion was originally posted on my facebook page - https://www.facebook.com/brent.brookbush - on July 21st, 2012
Kaisa Tuominen Of course they should be able to use these techniques if trained in them. :)
July 21 at 11:44am
Brent Brookbush The argument against it is… Does a personal trainer know what to do with the results they get? For example, if you have a client who only has 175 degrees of passive shoulder flexion, how does that affect your programming for that individual?
July 21 at 11:48am
Kaisa Tuominen You'd have to have training in what to do with your assessment results or work together in a team of professionals who tell you what to do with the results. Otherwise it's pointless, oi?
July 21 at 12:01pm
Brent Brookbush Agreed… I actually think that certain tests should be offered to our more advanced peers, and I am considering another level of the B2C Fitness Functional Anatomy workshops (www.b2cfitness.com/cec.html ) that would include these assessments. Granted I will only teach the assessments that a trainer can do something about and are "easier to perform" with minimal equipment. Certain goniometric and muscle strength tests can lead down a slippery slope where only manual techniques would improve results and that is a well defined line… outside of manual stretching, manual techniques are not with in the scope of a non-licensed professional.
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July 21 at 12:10pm
Kaisa Tuominen Then how do you feel about MAT?
July 21 at 12:13pm
Jemimah Simms Goni, no. MMT maybe. My argument with goni is because most trainers don't know how to differentiate between contractile and non-contractile issues like a pt does. MMT, how would it make a better trainer if the national certs ready have their formulas in place for determining strength and endurance?
July 21 at 12:14pm
Rick Richey How detrimental is having only 175 degrees of passive shoulder flexion? If the ROM is grossly limited do you need a goniometer? Probably not, because it is easily observed. If it is barely limited, do you need a goniometer? Maybe not, because nominal deviations will not be a focus of most training programs. I do not have issue with trainers using this tool. I just don't know how useful or applicable of a tool it is for personal trainers in their common setting.
July 21 at 12:18pm
Brent Brookbush Oooh, that's a tricky question. Somehow every time I get baited into giving my opinion on a competitor I get chewed out. I will give it another shot, but please understand I am biased (B2C Fitness is my company, and I am faculty for NASM) and this is only my opinion… First, I question any educational platform or model that dismisses an entire modality. MAT does not recommend stretching and that is a disservice to both the practitioners and clients of practitioners. Second, they ride a very fine line… they use manual activation techniques that in some states could be viewed as a breach in scope. I think if they were larger… say the size of an NASM, ACSM, or NSCA they might take some heat and have to modify their programming. With all that being said it is great stuff if you want to learn activation techniques as an amendment to your current training.
July 21 at 12:21pm
Brent Brookbush Interesting thoughts Jemimah Simms, I would be more apt to dismiss MMT, and keep goniometry. In my view MMT requires a better understanding of neuromuscular control (something that is not expected of personal trainers) and requires a feel that should be learned under the supervision of an experienced practitioner. Your point about goniometer is an important point though. Some times release and stretching is not the answer, and there are more complicated (non-contractile) issues involved. I think at the end of the day, release and stretching is going to fix what it can and the trainer could refer out if it did not improve re-assessment results. I am not sure that holds true for MMT. I weak muscle may be easily fixed by a trainer, but knowing whether to release and stretch, activate and integrate, or whether a mobilization is necessary may just leave a personal trainer confused
July 21 at 12:26pm
Jemimah Simms True. But with MMT you can bastardization that much like a lot of anatomy and other stuff out there for trainers. The thought from my perspective, you teach trainers what 'normal' is and teach them how to potentially position clients if they show weakness, not just power through and make them lift heavier. (I'm being very very general)
July 21 at 12:29pm via mobile
Brent Brookbush Rick Richey!!! Wuddup brother (team R2B2 in the house), thanks for joining the party. My thoughts on 175 degrees - it's 160 degrees waiting to happen - and then you do have a problem. You make some great points. Most practitioners would not be accurate enough to delineate between small deviations (less than 5 degrees) and large deviations can be easily seen with out a goniometer. Then again, it was learning goniometry that taught you the norms to begin with.
I don't think every trainer should be using these tools, but I do think it should be available to our most ambitious professionals… for example, someone who is taken on all of the B2C Fitness courses, or someone who is NASM CPT, PES, CES.
July 21 at 12:30pm
Joshua Stone Atc It shouldn't matter if you utilize a tool to identify ROM. If you utilize a goni or inclinometer to measure ankle Dorsiflexion which you find to be 7 degrees. As a personal trainer your job and conclusion is limited dorsiflexion. You are not to decide if this is talar / fibular positional fault. You cannot tell the client you have a tight posterior capsule at the ankle. Your only thought is - this client has limited ankle mobility. Then utilize the tools to address this deficit, so long it is within scope. If you are attempting to utilize data and make a diagnosis / prognosis - you are beyond scope. However, if simply using the device to track client progress there is no harm at all.
Manual muscle testing is much different as you are now applying a manual external load.
July 21 at 12:30pm
Brent Brookbush Really well said Joshua Stone Atc… Can I assume you would have similar views as myself on MAT?
What is our scope when it comes to manual resistance… does anybody know the laws for their state, or the wording in their insurance policy?
July 21 at 12:34pm
Joshua Stone Atc Yes, with regards to MAT, tread lightly and I would only use if clinacally approved to do so.
July 21 at 12:35pm
Brent Brookbush Are you saying "tread lightly" because it is not legal, not insured, or you think it is an area that could become another definitive border in our scope if abused (like manual release techniques that are illegal in the state of NY by non-licensed individuals)?
July 21 at 12:39pm
Joshua Stone Atc I think many believe they are "trained" and "qualified" to perform MAT, but this does not mean you are free and clear to do so. Failure to adhere to state guidelines is something you do not want on your track record.
July 21 at 12:54pm
Perry Nickelston Numbers tell you what is. They do not tell you why it is? Using gonio is fine by me, that's the easy part. The magic happens when you design a program based on why the body changes joint motion and the relationship between muscle balance which alters centration.
July 21 at 1:01pm
Brent Brookbush Agreed Perry Nickelston, that's really the tough part. With the tools available to trainers (self administered release, streteching, and a few self-administered mobs), is goniometric assessment beneficial to the trainer?
July 21 at 1:09pm
Perry Nickelston Not in my opinion no. Movement means more to me
July 21 at 2:02pm
Sean Mullowney All trainers should know how to use them in assessments. It becomes too subjective if not measured. If the numbers don't change then something is wrong with program design if the that is the goal.
July 21 at 5:32pm
Sean Mullowney Many clients are very left brained so showing them their left hamstring has moved 22 degrees toward optimal ROM also helps with compliance.
July 21 at 5:37pm
Rich Fahmy-nasm Very nice comments from everyone so far. If a trainer is skilled enough to administer and interpret the results of such tests then incorporate them into the rationale for their program design, I see no problem with it at all. Trainers use different assessments to design programs and different clients respond to different measurements. Use of these measurements doesn't cross the line, it's what we do with the results that make the difference. If we are using them to focus our program design, track progress and assist us in deciding when to refer out, that's great. Results don't always point to structural cause, they measure deficits. If we use the measurements to diagnose and attempt to treat underlying structural causes, that's where I consider it stepping outside a trainer's scope because it's just still "objective guessing" if that makes sense. What I find though is that the more I know and am able to do, the less I want to work with someone. I refer out pretty quickly nowadays. I find in the long run for the client, it's better to bring in a therapist early on and work with them to complement treatment. The outcome is usually quite positive all around.
July 21 at 9:18pm
Brent Brookbush Nice stuff Rich Fahmy-nasm
I think you sum up to important point -
1. Goniometric Assessment and MMT are not problems unto themselves; it's what you do with the results.
2. This argument is not about whether everyone should use these tests; the argument is whether everyone should be prohibited from using them.
July 22 at 11:38am
Yusuf Boyd I dont feel I need to comment because Joshua Stone Atc and Rich Fahmy-nasm may great comments that I would only be repeating…
July 22