Panel Discussion: What changes would you like to see in your profession over the next 10 years?
This panel includes personal trainers, physical therapists, athletic trainers, chiropractors, massage therapists, podiatrists and professional educators - PLEASE STATE YOUR PROFESSION IN YOUR POST
Moderated by Brent Brookbush DPT, PT, MS, PES, CES, CSCS, ACSM H/FS
This discussion was originally posted on my facebook page - https://www.facebook.com/brent.brookbush - on 3/27/2014
Gary Miller I would like to see our fitness professionals/ personal trainers LICENSED. Like chiropractors, massage therapist etc… I think it will add credit to what we do and shake out the ones who do not take what we do seriously.
March 27 at 9:22am
Kathy Benson Zetterberg As a personal trainer I would like to see our profession regulated and licensed similar to physical therapists, message therapists and athletic trainers. Certifications alone are not enough!
March 27 at 10:37am
Ryan Crandall Licensure may sound great and it might help a little bit but as a licensed professional who works in physical therapy I still see a lot of stuff that could be a lot better.
March 27 at 10:40am
Kathy Benson Zetterberg Agreed Ryan Crandall.. But at the very least it will help reign in the improprieties in the health and fitness industry.
March 27 at 11:31am
Barbara Fralinger I would like to see less entitlement and more student accountability at the college level. I could go on for pages but I won't jam up this discussion. Let's just say college needs to return to being a place of "higher" education instead of 13th grade, where coddling is expected by both the students and administration.
March 27 at 1:07pm
Maurice D. Williams Trainers taught how to be their own bosses & how to be a professional personal trainer. Licensure would be nice, if the gurus could come down off their high horses…
March 27 at 1:25pm
Gary Miller Yes Maurice D. Williams… business and leadership development for the trainers….everything from what a P&L is to marketing of the business your in. I was never taught these skills in college and had to learn them crash course. Which made it hard to run a business and be a leader.
March 27 at 1:42pm
Sue Hitzmann Licensing for Neuromuscular Therapy! Seeing 13 years ago I was told that's where these certifications were leading… and got nowhere… it would be a great asset. I don't think you should have to go to massage therapy school simply to get a "license to touch" and not learn anything of use in practice. I agree with Barbara too, all study should be set at a level of continuing for excellence!! And I also agree with Maurice, trainers, therapists… all great at practice… not so great with marketing or business. More education on how to is needed for many great practitioners to thrive. I've spent a decade on my business helping others grow their business by giving them guidance, tips, and assets that they'd not otherwise have access to!
March 27 at 3:13pm
Brent Brookbush Hey Maurice D. Williams,
As I have been forced to enter the "Guru Race" in my heart felt intent to improve the delivery of education in Human Movement Science, I would love to hear more on why you think "Gurus" are on a "High Horse" and how this is impeding the progress toward licensure.
March 27 at 3:59pm
Brent Brookbush Hey Sue Hitzmann,
I agree that not everything taught in many licensure programs is not evidence-based, or even particularly effective, but I wonder what you think the minimum amount of knowledge should be for someone who puts there hands on someone else.
March 27 at 4:00pm
Brent Brookbush Gary Miller, Maurice D. Williams and Kathy Benson Zetterberg…
Let's not forget that licensure has issues to… for example, who gets to dictate what knowledge is imperative to practice, or what the minimum standard should be? What is the cost in time and money to get licensed as it worth the effort give the salary that can be expected? If we require licensure will personal training specifically still be a profitable business model, or will the cost result in less jobs available?
March 27 at 4:02pm
Brent Brookbush What I would like to see personally,
Enough with the in fighting. I want an integrated model where those professionals with scope are free to address issues. Everyone is fighting each other for their cut of the pie and forgetting that the real goal is better practice, access, and quality of life for professionals and clients/patients alike.
I would like to see the "haters" who feel that it is their right to criticize called out and asked to offer a better solution. We can debate on which practices are more effective providing that their is a resolution that offers practical application, but I despise those who discredit an effective practice because they think they are better… and yet offer nothing in the way of practical education.
March 27 at 4:06pm
Steve Middleton For healthcare providers, I would like to see a national scope of practice designated by the national associations. There is too much politically influence in scopes of practice at the state levels.
I have seen PTAs be able to do grade I-II mobilizations to any joint in one state where in another they can perform grades I-IV to any peripheral joint (but cannot mobilize the spine).
In some states, massage therapists can apply kinesiology taping but in other states it is outside their scope of practice.
In some states, massage therapists are not allowed to treat anyone under the age of 18 (think masseuses).
In some states, PTs can do manipulation, dry needling, etc, but in other states they are only allowed to performed Therapeutic Exercise with patients.
A lot of times, it seems like personal trainers have a broader range of options than licensed clinicians because they are unregulated.
March 27 at 4:58pm
Brent Brookbush Thanks Steve Middleton,
As a personal trainer, educator and soon to be physical therapist… I can tell you that personal trainers undoubtedly have a restricted scope, dictated by similar legislation. One of the big reasons I returned to school for my DPT was scope of practice, but I here you. Some of the laws seem rather arbitrary.
March 27 at 5:24pm
Tony Susnjara it sounds like you (in the USA) need national standards for each segment of the industry and the state by state standards create a lot of inconsistency so perhaps the professional bodies that accredit health professionals need to lobby for a national code or set of standards.
March 27 at 5:59pm
Maurice D. Williams Brent Brookbush: the guru statement was a pun. However, i don't think organizations such as NASM, NSCA, ACE, etc. Are willing to lose a major part of their for profit business (revenue from certs & recerts) to come together on a national licensure.
March 27 at 6:36pm
Andy Hall I am not in favor of anything that would include regulation by any federal agency
March 27 at 7:00pm
Melinda Reiner Steve, podiatry has the same issues regarding scope. I did training in New York and California. In New York, I was severely limited in what I could do regarding just the foot, and in California, I could do surgery from the tibial tuberosity (below knee) down. In Oregon, where I was in practice, folks can have two different levels of scope (foot only, or foot/ankle) and that is totally ridiculous. As in any profession, the abilities of each individual professional varies greatly, and that's where we need to focus our attention. Brent calls it the 20-80 rule (20% competent and the rest total bottom). I call it the 10-80-10 rule…10% are absolutely incompetent, 80% are mediocre, and there are different levels of competancy in the top 10%. As a new CPT and former practicing sports medicine/trauma physician, I can tell you that it's scary what I see out there, but I am unsure what can be done to bring a huge part of a profession up to a basic competancy level. Would love to hear other's thoughts! (Great topic, Brent!)
March 27 at 7:05pm
Melinda Reiner As far as licensure, all health-related professions are controlled by politics and money, and that is a huge barrier. Not in favor of licensure by each state--I see a huge downfall in that (and could write a book on it) from being a former practicing physician. Andy is correct in leaving out federal or state organizations.
March 27 at 7:10pm
Brent Brookbush Hey Maurice D. Williams,
You may find it interesting that only NASM is "for profit" while NSCA, ACSM and ACE are set-up as not-for-profit organizations. With that being said (and I know I am biased), it is interesting to see NASM pull far ahead as the leader in personal training education. Both in the content they offer and in terms of educational support and quality control.
There have been efforts to create a governing body, but as Melinda Reiner mentioned this is so political I cannot say that I am in favor of liscensure at this point. Some feel we should not do corrective exercise, some orginizations still teach the olymplic lifts as basic exercise for the general populations, and some organizations give such general recommendations on how to design a program and select exercise they might as well pull from popular magazines to write programs.
Although money is involved, it is not money alone that impedes the process.
March 27 at 8:53pm
Melinda Reiner Great explanation. Couldn't agree more regarding NASM model and how to approach training. I have done so much with corrective exercise to allow folks to be more functional, I cannot imagine being limited in not being able to do so. Seems counterproductive. Aren't we in the business of treating others as human beings?
March 27 at 8:57pm
Ryan Crandall ^i personally like the PTA global model more than any of the fitness certifications. They all have something to offer.
March 27 at 9:46pm
Brent Brookbush Do you have any other certs Ryan Crandall… how is PTA Global different?
March 27 at 9:49pm
Ryan Crandall I have NaSM now and active. Too much trouble to keep up with numerous certs.
I like PTA globals focus on psychology
March 27 at 10:04pm
Ryan Crandall I do mostly rehab now though.
March 27 at 10:05pm
Brent Brookbush Is it fair to say the human movement science should be our foundation and that psychology is an important addition to exercise selection, or are you saying that we should focus on psychology and the movement part of exercise is secondary?
March 27 at 10:07pm
Melinda Reiner Human beings are complex; can't focus on one area. Each person is unique. That is why I don't believe in "models."
March 27 at 10:09pm
Brent Brookbush I agree Melinda Reiner, but as a movement professional I would be of the opinion that focusing on psychology is putting the cart in front of the horse. People do not come to me for psychological aid, and although I am very aware of behavior modification, basic psychology, and have some knowledge on the psychology of pain, this is the icing on the cake of what I do.. in essence, I think we need to know, but I think we need to stay in our scope. You cannot be a master of all things.
March 27 at 10:13pm
Barbara Fralinger Unless one is Yoda….
March 27 at 10:15pm
Ryan Crandall Integration of all. It's so complex. We can't compartmentalizations human function.
March 27 at 10:19pm
Ryan Crandall PTs are notorious for compartmentalizing…I'm trying to change that in our clinic.
March 27 at 10:20pm
Sue Hitzmann Brent, I think that you always have to be learning, whether it's from other practitioners, college, advanced certifications and training, but the most important thing about education is how you then utilize it. You have to PRACTICE and practice more. You must document your findings, be willing to be challenged on your beliefs so you KEEP LEARNING! Then you must apply and practice more. It's a continuous learning curve. For me, every time I think I know something, I'm recognizing that in knowing I need to learn more, do more, be more, listen to others… learning is a lifetime process. If you have good resources and people around you, whether you have a pedigree or many letters behind your name, you can always be better and perhaps help more people than you did yesterday. Again, it's a process of trust, learning, science, belief, and practice.
March 27 at 10:21pm
Brent Brookbush Hey Ryan Crandall,
What I am thinking has more to do with education. If you start with a base in psychology but do not understand basic exercise science and functional anatomy you are kind of dead in the water. If you were capable of creating an exercise program, and did little more than approach every client/patient with empathy you will find success. I agree in integration, but PTA global is marketing themselves as an introductory certification and not a continuing education program.
March 27 at 11:24pm
Brent Brookbush Sue Hitzmann, I agree and you know I am on a constant mission to learn, but we can't lose sight of the intent of our practice.
March 27 at 11:28pm
Jason Erickson I feel it's important that those who achieve some prominence in their chosen field continue to be held to the same standards of evidence as anyone else. Too many people create "methods"/"modalities"/"protocols", start selling them successfully, and then avoid engaging in public debate(s) with those who have doubts about the explanations provided in the marketing/teaching of that material.
Whether someone sells books, videos, classes, webinars, does television appearances, speaks at conferences, … NONE of that constitutes evidence that their claims are valid.
Personally, I'd love to see my colleagues all become science literate enough to be able to identify the difference between good marketing and good evidence. That alone would decimate most of the existing "gurus" and raise others whose work deserves more attention to greater prominence.
March 27 at 11:32pm
Brent Brookbush Love your comments Jason Erickson,
but… what about debates like this? Is this not a powerful educational opportunity for everyone, myself included?
March 27 at 11:47pm
Jason Erickson Yes, and this is the sort of conversation that many professions need to have more of.
Personal training engages in a lot of discussions but a ton of brand names exist and those behind them are lauded but rarely forced to actually back up their claims. Massage therapy has very little tradition of actively challenging explanations, and right now efforts to bring critical thinking skills and research literacy into massage therapy is a very painful learning experience for many. Many "gurus" avoid openly discussing their work with anyone who isn't a "follower".
Though this is a great learning conversation, we aren't actually digging into any particular methodology… so any "gurus" who may participate are unlikely to feel threatened by it, yet.
I'm teaching some CE classes and whatnot, but I am very uncomfortable with the idea of being considered a "guru" of any kind. The notion of creating yet another method/modality brand name is repellant to me. Instead, I am focusing on teaching the science and concepts necessary to inform critical/clinical thinking. My knowledge of some aspects is limited and I make certain that those I teach know it. Some have far more expertise in those areas, and I welcome their input so that others in my classes may benefit by it. I learn as much from my students as they do from me. Sometimes it feels more like an organized, hosted conversation than like a class.
If someone's goal is to become known as a guru of some sort, they will forever be closed to learning good information that exposes their errors and oversights. Instead, they will be more inclined to cherry-pick information and restrict their interactions with those who have different opinions on that information. I've seen it over and over, on many different discussion forums, and have received PMs from "gurus" in which they state that they won't join a conversation about their work because they just don't want to face the heat of critical inquiry. (They always phrase it differently, as if their avoidance was someone else's fault, but it amounts to the same thing.)
I could post a list of names of people who have lost my respect for these very reasons, but I won't. There's no point. They can choose to avoid scrutiny that would endanger their marketing; that's a good business decision. I just don't respect that motivation, and I am much less inclined to trust ANY of their claims, particularly when it leads to a sales pitch (usually presented as an educational option).
On the other hand, I have great respect for those folks who put themselves out there, debate with anyone, who hold themselves responsible for basing what they do/teach on the best available evidence, and who continuously update what they do/teach as the evidence indicates.
March 28 at 12:53am
Brent Brookbush Great comments Jason Erickson,
Maybe one of the changes we would all like to see is less "guru worship." Personally, I don't like the word guru either, but I know I am in that race. After speaking to several consultants last year we rebranded the company to the "Brookbush Institute" - not because I wanted the company to be a lasting image of "me" or for some other narcissistic desire, but because no on was following my company. In essence, my name had "marketing power", my company did not. I believe this to be a reflection on how we look for information. People want mentors and distrust large corporations. Thoughts?
March 28 at 7:51am
Barbara Fralinger Well, maybe just a smidgen of narcissistic desire….
March 28 at 8:56am
Joy Weiser Education requirements before being allowed to train or teach fitness classes. Its really easy to become licensed or certified and most don't have a clue as to what the science is or why they should or should not do something. I'm a fitness professional…group fitness and NASM cpt
March 28 at 10:46am
Ken O'Neill A personal history of training establishes an experiential prime nothing else can replace - and cross training in at least the contractile and metabolic dimensions of basic mechanisms of hypertrophy by means including bodybuilding, Olympic lifting and power lifting to cover rudimentary bases.
I'm from a time in which personal trainers and certifications did not exist, and despite that America did far better in international and Olympic competition - most of that before PEDs came on the scene.
Bottom line koan is YOU facing a barbell or other resistance, effectively moving it without getting hurt. Long term - ie, life long training - thriving mandates eschewing IATROGENIC TRAINING. If you haven't achieved personal mastery of minimal dimensions of hypertrophy training, then you're just plain incompetent to train anyone else since you'll be immersing them in your deficits and ignorance.
Sorry to be ruthlessly hard ass - those are the simple truths and disinterested in sugar coating them for the tastes of weaklings.
March 28 at 11:08am
Steve Middleton I tend to learn as much in my CE courses as my attendees!
Everybody has a different movement compensation and everybody has a different approach to fixing it…
March 28 at 11:18am
Ken O'Neill Steve Middleton: you guys today have an immense luxury, a veritable tower of babel of information overload amplified by commercialilzation the moves at the speed of greed. Fifty years ago we didn't have that, pseudo-science and opinion, often odd, ruled. The overnight success of Arthur Jones' is largely accountable for in terms of the otherwise fathomless depth of ignorance prevailing a scant 40 years ago. Otherwise we had to hunt and dig in pre-internet research, hardcopies in university libraries, and scattered among various disciplines, putting it all together in our own bodies. Gyms like Vince's in the Valley, Bill Pearl's in Pasadena, etc were Meccas not just for their iconic owners/coaching figures, not just leading edge equipment, but as high points of an emerging culture of late 20th century physical culture.
Today the opposite holds. Claims and counter claims without a multidisciplinary orientation forcing a meta-model paradigm where the bullshit ends and something approaching a meta scientific paradigm emerges.
March 28 at 11:24am
Steve Middleton I hold a much higher respect for the PhDs of old because they really had to work exponentially harder to get the information we now have at our fingertips.
There are many "gurus" out there who do not seem to be science based. I wonder how they get approved by state boards but have learned you only have to provide 5 referenced articles to be approved. 5 references for 6-24 hours of courses? Seriously?
March 28 at 11:31am
Brent Brookbush There seems to be a general distaste for the current educational offerings… what's the solution?
I would like to offer a counterpoint to the profit is bad argument… creating a quality program requires money. At the very least to support the individual (s) providing the education. Many may be surprised to find out that despite revenue growth I have not taken a dime from my company in 2 years. Development, marketing, support staff…. are on going expenses. And when my company does reach past development and becomes a viable business model what do you think I should recieve as compensation? Do I not deserve a salary, maybe backed salary?
March 28 at 4:25pm
Steve Middleton I believe you pay for what you get. However, I also think you should get what you pay for:
I was contracted with a company a couple years back to teach a manual therapy and kinesiology taping. I emphasized the number of labs and hands-on activities which they used as marketing points.
When I showed up to teach, I had 45, 40 and 65 on the 3 days. There was no way I could adequately supervise that many people!
When quality takes a backset to profits, the person has crossed the line.
March 28 at 4:52pm
Andy Hall I do think at the very least a 4 year degree and shadowing should be required before trainers are allowed to sit for a national accredited certification and health clubs should be required to not label employees as trainers unless they have met certain credentials governed by the industry not state or federal governments
March 28 at 4:56pm
Tony Susnjara I think it depends on what segments of the industry we are referring to. As for trainers, if I could suggest an education format I would say that the education offered right now would be a reasonable starting point and getting them out to work as quickly as is safe and reasonable is a good thing provided that there is continuing education equivalent to a university qualification. Reason being that 4 years in school is one thing and hours of practical experience is another. If you could give the them a basic foundation, get them working and then keep on expanding their knowledge base, I think they will get there much faster than if they are simply burried in books for a number of years.
March 28 at 5:02pm
Sue Hitzmann Brent, there are so many great comments yet different topics, you should start a new thread for each idea here. You also have some super smart, super out of the box thinkers here too, though I'm not surprised by that.
March 28 at 6:45pm
Brent Brookbush I agree Sue,
Alghough have hosted some similar panel discussion before… you could head to the forum in the link posted in the original feed… If there is one you won't to see again though I will definitely take note
March 28 at 10:22pm
Ryan Crandall …then one would have to agree on what trainers should know.
Is it about maximum strength? Mobility? Endurance? How to define "corrective exercise" and based on what school? How much should they know about nutrition/refer out? What kind of anatomy…straight from the book(the hamstring flexes the knee) or integrative/chain reaction(the HS can flex the knee but more likely controls the pelvis and knee in 3 planes)…so many questions….
March 28 at 10:41pm
Scott Mitchell Less dogmatic thinking and more humility.
March 29 at 12:35pm