Panel Discussion: What is Our Scope?
As personal trainers, what should be permissible within our scope of practice? It’s illegal to perform manual release techniques without a license in NY… Is this too restrictive, or not restrictive enough. What about joint mobilizations, muscle testing, manual resistance, and capsule stretching?
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 August 1st, 2010
Gabriel Martinez, August 1, 2010 at 2:48pm: Ahh I don't mess with that sort of stuff 2 much… I find it can be dangerous if you don't know what you’re doing. I also find it quite boooooooring. I do some quickie massage techniques and some mfr but that's about it. Save the other stuff for the pro's
Brent Brookbush, August 1, 2010 at 3:11pm: Although I think manual techniques are an exciting solution to corrective exercise, I can understand your lack of interest. The interesting thing about your post, is you mention doing "quickie massage techniques" which are not in your scope or interests… I think you might have more to say about this question if these laws become more restrictive :-)
Mikal Payne, August 1, 2010 at 5:32pm: Brent, you seem to getting into areas that are not part of our scope of practice but to be affective in what we do I think knowledge is our best defense if you cannot perform something, legally, you can relay information. Also humans being humans come into play here. Not all things are impossible to understand but in that understanding doesn't make you able to administer it correctly, but having said that which cert. you hold may help you make the best decision as to what you can and can't do and your personal choice.
Chrissy Nettekoven, August 1, 2010 at 5:44pm: Interesting question. I've worked on both ends of the spectrum, personal trainer and in the PT world. While advanced hands-on techniques such as mobs, capsule stretching, etc. would be helpful in some situations, I believe that that the current restrictions are useful. However, I think that MMT is a simple enough technique with a low degree of risk to the client/patient. And this technique would be useful to trainers to utilize because it would allow a person to see where someone is weak. However, the level of knowledge and care that is needed to perform joint mobilizations, especially on difficult joints like the hips, is far beyond what could be covered in a weekend personal training certification course. The advanced anatomy knowledge that is involved, plus the higher risk of injury, are just too great of risks for the majority of trainers. I have heard of even physical therapists injuring a patient when they were trying to loosen up a tight knee replacement, and having soft tissue tear. It's a fine line when manually working on a patient/clinic, and even advanced professionals have run into issues…even with all of their knowledge. I think basic stretching, such as hamstring, piriformis, quads, etc. could possibly be argued to be in the scope of practice, especially for someone who has a comprehensive understanding of anatomy, and enough knowledge to not hurt a client. But the question remains, where do you draw the line in allowing certain practices? The more that is allowed, the more I feel people will push the envelope with hands-on techniques and could possibly hurt someone.
Mikal Payne, August 1, 2010 at 5:48pm: Oh well said Christy
Brent Brookbush Hey Kats,
I agree that many of these practices are not within our normal scope, but as the industry grows it is important to consider what we should be allowed to do. I see trainers massage, perform trigger point release, and sometimes even low level joint mobs on a fairly regular basis. Some of the problem being the necessity for these techniques in the presence of certain dysfunctions. I do not expect trainers to treat injury (such as knee replacements), but could see manual static release as part of our corrective exercise, or regenerative arsenal.
I think the thought of restricting trainers from manually stretching clients is a little ridiculous. Even in the presence of questionable practice, to go as far as not being allowed to touch a client seems excessive.
Keep in mind, there are just as many bad PT's as there are bad personal trainers.
Mikal Payne, August 2, 2010 at 7:07am: Good morning all,
I guess m biggest hang-up and out of our scope is when you lay hands on people There are message therapist, or chiropractors, and on. We as personal trainers should show, demonstrate, correct form, not manipulate. Stretching, resistance training, relaxation, and on. That is our scope if you want to expand your practice maybe another Cert. or a degree is needed.
Brent Brookbush, August 2, 2010 at 11:10am: Hey Mikal,
My current understanding is personal trainers are not qualified to perform manual techniques outside of stretching, but there is some grey area. Do you think a trainer should be allowed to manually apply resistance to a movement? What stretches are we allowed to do (For example should I be able to perform a manual SCM stretch)? Is goniometric assessment and manual muscle testing within my scope? This is a really important conversation to clarify - we will have a state-sanctioned scope eventually, but we need to make the decisions, rather than have them dictated to us.
Mikal Payne, August 3, 2010 at 5:00pm: Nope, I would think there would be more of a chance of doing harm then good. But having said that Man eating my words almost Are we talking a rehab. setting or gym orientation showing someone the proper form to use weights?
Shawn Fears, August 5, 2010 at 10:58am: Manual SCM stretch??? Sternocleidomastoid? lol wouldn't go near a manual stretch there…didn't a trainer severely injure somebody doing that stretch last year..I think it was on today show last winter when they did a piece on personal training certifications being a joke and they used some idiot that tore muscle and nerves by manually performing a SCM stretch.
Brent Brookbush, August 5, 2010 at 1:31pm: Wow Shawn that is a horrific story… and exactly what we need to hear as personal trainers. Although I feel very comfortable performing various stretches for cervical musculature, I have also had many hours with manual therapists and have a fairly deep knowledge of the anatomy of the neck (I have spent too many hours trying to find the root of my neck discomfort :-)~)… I would agree that a sternocleidomastoid stretch is potentially dangerous and should not be applied by the gross majority of personal trainers.
But let’s move on to another manual technique… Manual resistance… How many of you have added resistance to a core exercise by applying gentle pressure with your hands to their arms or shoulders? Is this safe?
Shawn Fears, August 5, 2010 at 2:22pm: What separates manual resistance from adding any resistance? Its all externally loading, so while I don't do it manually I do load externally with thera-bands, balls, and weight vests. Isn't that what we as personal trainers do, is teach/train how to control internal load and move external loads? Oh wait I think I am about to answer my own question here lol…constant external resistance. I feel more comfortable knowing exactly what is being added than guessing how much pressure I am adding. Also I do agonist contract/relax stretching so I guess that might fall under manual therapy…another gray area im sure.
I too have neck issues which is why I don't touch that area and focus on the lower traps for resetting the posture. I have also had a L shoulder surgery, a herniated disk(leading to 3 epidurals and 6 months o not being able to walk), and 2 R knee surgeries. This is why I became a personal trainer.
Mikal Payne, August 5, 2010 at 2:25pm: Shawn, Ouch never heard that but good point. Brent- too true