Top 11 Mistakes Human Movement Professionals Make
Panel Discussion: What are the Top 11 Mistakes: Human Movement Professionals Make? - This includes CPT, DPT, DC, ATC & LMT's - How can we keep new professionals entering these fields from making the same mistakes?
This panel discussion was inspired by Rick Daigle's Lecture - TOP 11 MISTAKES PHYSICAL THERAPISTS MAKE -http://www.movementlectures.com/MEG0913-03.html - Thanks Rick!!!
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 September 14th, 2013
Brent Brookbush Because this is a fairly open ended question I am going to get this conversation started with one of my "Pet Peeves"
Mistake #1: The thought that a single exercise, technique or cue can correct a movement impairment/postural dysfunction.
What you should know: The body is a complex set of integrated systems; all of which may be affected by movement impairment and will be affected given enough time. There is no single technique or type of techniques that address all systems (muscular, arthrokinematic, fascial, nervous system, etc).
You see this all the time in gyms, clinics, and studios… for example, addressing a problem with release techniques alone, or those who manipulate only, or telling someone that keeping their "knees from passing over their toes" is going to fix their dysfunction during a squat.
Worse, we all seem to be looking for that one technique that is going to fix everything… like somehow, someone is going to create that one thing that sets everything right. I see people throw out great techniques all the time, only to replace them with techniques that have nothing to do with the first technique. For example, throwing out release techniques for active isolated stretching. These two techniques cause different adaptations and work better when used together. Use an integrated approach, not an isolated one.
September 14 at 11:00am
Joshua Morton Completely agree with you here, go figure The body is a host of dysfunction inside and out. What has become the most obvious place many go wrong is as you stated. Doing some sort of release technique without proper follow up. So now you've "released" the rhomboids. What are you going to do next? Leave them relaxed, or worse, inhibited? Most would do exactly that and move on to the next release in their protocols. What about stabilization after whatever release you use? What about some manual work to help with scar tissue reformation? Everything seems to be about releasing this and releasing that. If you release a splinted or weak muscle it is merely going to re-splint. In the end it may re-splint with a vengeance! Only "releasing" tissue also makes the same tissue prone to injury/re-injury. Sometimes a muscle simply does not need a "release". It needs to be re-stabilized. It will never relax and regain function until it is strong and reeducated again. Ive been incorporating more and more stability work into the CE classes I teach over the years as I realize exactly how important it is.
September 14 at 11:55am
Brent Brookbush Great stuff Joshua Morton… you know I am big on activation, core support, and integration of under-active musculature. What's another mistake you see Human Movement Professionals make… maybe something you were guilty of when you first started your career… maybe something that you fixed that helped you go from struggling starter to financially stable professional.
September 14 at 12:02pm
Brent Brookbush I am going to add another mistake to the list that is near and dear to my heart:
Mistake #2: Educational Complacency
What you should know: You are dealing with the most complicated machine on the planet. To think that a single certification, course, book or even a single degree is enough is to leave yourself stranded on a very small island with a limited population that you can help.
You have to keep learning… to make this more personal… this complacency can only lead to boredom, dissatisfaction, poor financial compensation, and eventually unhappiness. Your dedication to education and the application of ideas new to you is what will keep you engaged, keep your business growing, and keep you satisfied with your career.
September 14 at 12:15pm
Joshua Morton One of my biggest pet peeves is working on function when there is not a foundation in place to support it. Why would anyone do a lunge to strengthen med/min etc? Begin with the basics, the foundation, then progress to function and super man sort of stuff like cross fit or your favorite, burpees I was guilty of complete ignorance and thinking I knew what I was doing. In some ways this came from my teachers as they told me I will be able to fix people with sciatica by digging my elbow into their butt. It took time and finding true teachers and dare I say, masters of their work, to get me to understand it is a much bigger system than that. While pushing into someones butt with your elbow will accomplish some things, it will never really lengthen or re-stabilze the tissues that is struggling. It may break the cycle of splinting and realign some collegian (maybe and if your good and patient), but other than that it begins to have diminishing returns on a complete rehab protocol. I took me years to learn this. Ive been in practice near 20 years and I think it is fair to say I was in more or less complete ignorance for the first near decade. I had some good tricks up my sleeve and was helping people get out of pain but I didnt really get it. The last few years in particular have been very formative. Everything I have learned since the beginning is truly sinking in and finding its place in the work I do. And it is finding its place with intelligence. Intelligence gained from a ton of experience in the clinic, research, dialogue and interaction with high level professionals. Damn, Ive still got a lot to learn. I do know now, when I attend a seminar I actually understand how and when to use things. Very little gets thrown out. If something works, it works. It is a questions of when and on who that something is needed. Like you pointed out above, Ive met practitioners who get great results with blank technique. Then they learn something new and totally throw out blank technique rather than incorporating the new with the old. Crazy world we live in. If it works, it works. It does even matter why, not really though it is nice to know. Hell, it doesnt really matter if it is placebo. If your placebo gets 70% of people out of pain more power to you and your persuasiveness! Im not so fond of placebo though. Im too analytical for it.
September 14 at 12:19pm
Joshua Morton boy that was a lot to say!
September 14 at 12:19pm
Joshua Morton Next pet peeve- group exercise. Need I say more?
September 14 at 1:03pm
David Becker Not being a professional. More often than not I see the "fake it till you make it approach" with new trainers. At one point I was the same way. For example, having the CES credentials does not make you a specialist. Proper presentation and application would make you a specialist. By presentation I mean communicating complex ideas simply. I used to fumble terms while poorly explaining the "why". This was a horrible way to introduce my newly acquired "specialty". So, know what you know and not what you think you know. As a professional I feel you should practice within your scope and outsource when necessary.
Eager to learn and you have a lot of info out there. Thanks
September 14 at 1:13pm via mobile
Brent Brookbush Hey David Becker,
If we are going to talk about being professional we could actually go simpler. Showing up on time to every appointment would be the first step. I cannot tell you how many professionals I see that are routinely late, reschedule last minute, or flat out no show there clients/patients. Totally agree with your point, but let's try not to have client's and patients despise us the way they despise their primary care physician for wasting their time. (oooooooh, physician jab ;-)~ )
September 14 at 1:17pm · Like · 3
Jason Erickson Mistake #3: Not really listening to clients/patients. Too many medical/health/fitness professionals spend more time jumping to conclusions than they do listening. On many occasions, I've figured out something that was missed by many others because I spent more time listening and asking questions before we did anything else. That simple act builds rapport, develops trust, and provides a wealth of information to guide my thinking. Too many people wash out of their professions (or are never very successful) because they rush to action, often doing inappropriate/ineffective things with clients/patients based on insufficient understanding of the person, their background, and their needs/wants.
September 14 at 4:25pm
Brent Brookbush Great Jason Erickson… The importance of listening, which could be extended to a good evaluation and subjective assessment is the first step in optimal service.
September 14 at 5:47pm
Orlando Carmona Not conducting proper assessments; Not continuously educating themselves; Not understanding/knowing acute variables and the "Why". Anyone can put a routine together. understanding the "Why" makes a trainer a professional.
September 14 at 6:59pm
Barbara Fralinger Mistake #4: Not educating clients on the importance of nutrition to go along with the workouts. A lot of trainers will focus on exercise but don't have enough knowledge on nutrition in order to build a complete program for their clients. Even worse, they will recommend nutrition programs when they are not qualified to do so!
September 14 at 10:12pm
Kenny Roger Wong Once ur clients have trust in u, u can basically get them to do anything u want. It is frustrating with the way people think and believe, but hard to change. Thanks for trying to make a difference.
September 14 at 11:34pm
Joshua Morton M=Mistake #4- most of us dont really know enough about nutrition but think we do. Unless we have really studied it is best to refer out. Even if we have studied, unless we do a proper evaluation and perhaps even some testing we are stabbing the dark. Most of us are not in any situation to truly evaluate a client/patient in regards to nutrition. We need blood and other tests to truly understand a clients nutritional needs.
September 14 at 11:36pm
Jason Erickson Too true, Joshua. I know enough to get my clients started on some basic good habits, but for detailed guidance I refer to others who know WAAAAAYYY more than I do about nutrition and supplementation. Better for my clients = better for me.
September 15 at 1:19am
Brent Brookbush Great comments about nutrition Jason Erickson, Joshua Morton, and Barbara Fralinger… I wrote all I am going to write about nutrition in my book "Fitness or Fiction: The Truth About Diet and Exercise" - I think there is 150+ citations in that chapter, and it really just covers the most basic stuff.
Nutrition should be evidence-based, just as our practices are… While the fundamental science of what we do is "Functional Anatomy", the fundamental science of nutrition is biochemistry. Let me go on record as saying - I have no real interest in delving into the research regarding nutrition and chemistry is certainly not my favorite topic. But… I have taken two semesters of nutrition (one in my Bachelors and one in my Masters), and I have spent a fair amount of time in research courses looking at various supplements. This is many times the amount of education that you get from a weekend certification or reading a single book. The next time I have to listen to some one try to bash me over the head with the paleodiet, some ridiculous cleanse, or talk to me about the importance of vitamin D I am going to scream… Yes, this topic is not within our expertise, but learn the fundamentals before you come at me with garbage.
Mistake #5: You have a single certification, read a single book, have looked at 2 research studies, or it worked for you, so you must be an expert.
What you should know: "Calm down… you just got here, and you have barely scratched the surface of available information."
This is a huge problem in the fitness industry… everyone invited to this panel has read dozens if not 100s of texts, 1000's or research studies, and likely has a decade or more of experience. If you are new to the industry, stay humble, open minded, and never stop learning. They say "it takes 10 years or 10,000 hours to master a craft" - but what is missing from that statement is those hours and years have to spent with a concerted effort to get better and learn more.
September 15 at 10:25am
Joshua Morton Amen to mistake #5! Even at 10 years/10k hrs many are not there and never will be. They are either dabblers or are working simply to work, pay rent. That will likely never make a master. You forgot one key ingredient, passion! Without that a master will never appear.
September 15 at 11:38am
Rick Daigle Awesome discussion and thank you Brent Brookbush for using my blog/lecture as inspiration. I feel very strongly that every profession has their good, their bad and their own really really ugly. From my standpoint as a clinician, it frustrates the crap out of me when I see careless, thoughtless and a lack of effort happening. There are too many clinicians in my opinion that are just content with being "ok" and not great… My other big frustration is when a clinician is either unwilling to listen to another professional or looks down on them because they are of a different profession. We should all be In line on at least 2 things: 1- Getting our patients./clients better and 2. Learning from each other.
September 15 at 1:21pm
Joshua Morton If we are in this for any reason other than helping the people who trust us with their health we should step right on out. That means we must always be open minded and ready to try new things. Of course we are not enlightened (most of us) so the ego is ever present but there can be a healthy ego or an unhealthy one. Ultimately it is up to us. A little sappy I know but I believe it.
September 15 at 2:08pm
Brent Brookbush Could not agree more Rick Daigle, and I too get really frustrated. I could go on a multi-page rant about my problems with education from post-secondary education to workshop instructors, but you and I are the lucky ones. We are in a position to make change. We both have considerable platforms to advance practice in our industries. The real questions are why are concerned with why individuals are so complacent? Are they not getting the information they want? Is it not in the format that they want to see it? Are we making it difficult to consume, comprehend, retain, and/or apply? Are we not considering the challenges their particular work environment imposes on them?
We need to be the innovators of better delivery and dissemination of information, and we need to use others frustration and complacency as motivation to provide better.
Humility is a necessity for us as educators, and I try to take in as much information as I can, but this speaks to a different issue all together. Why do we feel it necessary to condemn rather than integrate? As you can imagine I have had a tough time in school… I am a nationally recognized educator, published author, and considered by many to be an expert in human movement science… but I still have to do my clinical affiliations and respect the practice pattern of my clinical instructors. I try to be quick and remind them that my experience is limited to a particular patient population using a particular model and a specific set of techniques… there is always more to learn, and I try to consider that regardless of the quality of the professional who I am being instructed by, they have more experience with their patient population within there specific work environment. I could tell you all sorts of stories about trying to apply my model in an inpatient rehab center within a nursing home… what a crazy learning experience.
I think humility for me comes from being confident that I am really good at what I do, but comfortable with knowing that I am not good at everything… You want to see me pull my hair out… sit me down with a stroke patient, want to see me with my mouth shut, eyes wide and notepad in hand… sit me down with someone like yourself who has mastered acute post-surgical rehab… Surgery does some very curious things to the human movement system… but, 6 weeks post rehab with lingering pain and a need to regain prior levels of performance I'm a "technician".
Rick, thanks for the inspiration, and I hope you will consider me for one of your podcasts soon. I would love to mix it up and I think I have some students who would love to hear me, rather than just read my work… you know all those auditory learners who get left out in a format such as this… there I go back to the delivery of information "thing" again…
B2
September 15 at 2:48pm
Steve Middleton #5 - Understanding your client's abilities
I see this all the time at the gym where I work out. These hot shot personal trainers try to use all the latest gadgets and single limb activities with new clients who end up falling all over the place. It is a matter of simple progression: if you cannot do a full body weight squat with good technique, you should not being doing weighted squats and/or single-leg squats. If you cannot do a proper pull-up, the TRX systems are an accident waiting to happen. I consider these to be indirect sufferings because, while they don't cause specific injuries, they do no allow the client the progress either.
Gray Cook uses the term "neural edge". This must be respected in order to gain strength/balance/endurance/etc. This applies to the above listed as it does no one any good to be able to do a 1/4 single leg squat and then fall the rest of the way to the bench under them. The other extreme is do so much on the 1st or 2nd session that it take a week or more for the client to recover. Again, the neural edge is surpassed and the client has suffered directly for it.
September 15 at 2:59pm
Steve Middleton Understanding the role of an exercise is another one. An anecdote I have told often in my classes goes:
When I first started teaching, I was looking everywhere for people/examples to take pictures of for the presentations. I had watched a guy a personal trainer had doing push presses. Nothing wrong with the exercise or technique per se but the personal trainer had him push off with his left leg and step forward with his right on EVERY rep. Watching how the guy stood between his sets, his right hip was flexed and his pelvis was rotated to his left…because that was what he was training his body to do. I approached the guy about taking a picture and he politely declined
About 7 months later, the guy shows up at our clinic with complaints of low back pain. I explained (again) everything above and talked to him about getting a new personal trainer who was a bit more attentive.
September 15 at 3:03pm
Brent Brookbush Nice Steve Middleton… Appropriate, progressive and specific programming. It is amazing to watch new trends adopted while throwing progression out the window… Why stop with TRX?… we could say the same thing about kettle bells, battle ropes, the bosu ball, CrossFit, the Rip Trainer, the ViPr, burpies, olympic lifts, etc….
September 15 at 3:03pm
Brent Brookbush Let me ask you a question Steve Middleton,
If you had that trainer in your class, what would be the lesson you would teach so that the whole class did not make the same mistake?
September 15 at 3:08pm
Steve Middleton Good question, Brent. I deal a lot with repetitive motions causing local and systemic responses. Most personal trainers understand the role of balancing on bench press vs rows and squats vs deadlifts so I would probably start by using those examples. Another cool thing is to tell him how he sits based on how his pelvis postures. Fascial bands form and create pelvic rotations based on prolonged sitting postures. It is a fun party trick as well…
September 15 at 3:23pm
Eric Grossman Not listening to a client's goals. Some trainers program for their own goals
September 15 at 4:03pm
Brent Brookbush Hey Eric Grossman, sounds like you and Jason Erickson have similar thoughts… although I like the addition of trainers trying to fit people into their goals rather than the other way around.
September 15 at 4:10pm
Eric Grossman Right on Brent and Jason. I was guilty of not reading this entire thread. I also like to stay close to the basics, so that my clients learn the how and why of what we're doing. They need to be able to duplicate the things we do, when we're not together, or God forbid they ever stop training with me.
September 15 at 4:58pm
Jason Erickson Steve Middleton brought up repetitive motion adaptations. This stuff was being recorded and treated by guys like Per Henrik Ling in 1813 (and earlier!). Ling was (among other things) a fencing master and a therapist who happened to notice predictable patterns of injuries among fencing students who did highly repetitive practice of specific techniques. Two hundred years later and we're still seeing the same stupid mistakes day in and day out. *sigh* That's not the kind of job security I want, but there it is.
September 15 at 11:23pm
Brent Brookbush Thanks for the history lesson… love that stuff Jason Erickson
September 15 at 11:25pm