“If the technique makes a difference and makes the person better, then that’s what I’m after”, said the tutor at the one day course I attended recently. The course, a CrossFit Movement and Mobility course aimed to have participants be able to identify, prioritize, and begin to program for common movement dysfunctions like low back pain, knee pain, and shoulder pain by the end of the course. I was keen to attend a CrossFit course as this increasingly popular form of exercise is available and suitable to all willing participants. As with all sports, CrossFit has been known to cause a few injuries. Read on to follow my experience of this one day intensive course…..
Sunday morning I arrived at the CrossFit gym and was politely welcomed by the course tutor (a Physical Therapist from America with several years experience in CrossFit training and teaching) and met a few of the other attendees. I was surprised to see that the majority were CrossFit instructors or Personal Trainers that had completed CrossFit certification courses. I was expecting more physiotherapists on the course, those that did attend included myself and my two colleagues.
What was my reasoning for attending? Well to understand more about the exercise routines, the associated movement patterns and the their associated injuries. I had not completed a CrossFit certification course but I felt I had a reasonably competent understanding of movement patterns and motor control therefore I felt it deemed appropriate to attend such a course. How naive, innocent and oblivious I am to the practices of some non-medically trained individuals. I became increasingly concerned throughout the duration of the day. Why? Well according to the eligibility requirements to enroll for a CrossFit certification programme participants must be 17 years of age or over and do not require any formal medical training (reference). Why is this such an issue you ask? Hopefully this will all become clear as you continue reading.
First I feel it is pertinent to provide a brief overview of my understanding of CrossFit. This relatively new training approach has taken the world by storm, a training regime that consolidates functional movements into short duration high intensity workouts to maximise fitness outcomes with staggering results. The nature of CrossFit referred to as the ‘jack of all trades master of none approach’ is said to define that exact strategy to achieve optimal fitness (reference). Take a look at any exercise/rehab book and functional exercise is regarded as fundamental to achieving optimal movement and fitness. Isolated joint movements to train muscles are less popular as they don’t specifically have a clear effect on body movement, rather they increase the muscle mass/strength/endurance of the target muscle. This is not integrated into movement unless it is applied appropriately. Therefore functional training is seen as the mainstay to promoting optimal movement. CrossFit as I understand embraces these principles.
Now to me that seems pretty comprehensive and I am a Physiotherapist that trained for four years, continues to develop my clinical practice through professional training, reading, critiquing, reflection, participating in peer review, auditing, clinical review, presenting, teaching and collaborating with colleagues. This is part of Physiotherapy legislation, in place to protect the public and the profession, without this I do not fulfill the statutory requirements laid out by any Physiotherapy board and I am deemed unfit to practice. As I understand Personal Trainers can attain their certification through various forms that range from 1 day courses to one year full-time diplomas. A CrossFit Lvl 1 certification is taught in a weekend and there is no obligation to join an exercise body.
Why am I banging on about all this? Well let’s get into the real reason for this post. The course I attended was effectively giving new powers to Personal Trainers to perform diagnostic assessment and treatment to their clients. As highlighted at the beginning of this post it was a course to help identify common movement dysfunction in back pain, knee pain and shoulder pain. Now if I’m not mistaken I’m pretty sure that is my job??
The course was broken up into a morning theory session and an afternoon practical session. The theory session consisted of learning to differentiate whether motor control or mobility as predictors of outcome could change movement dysfunction in the presence of pain. There was no differentiation between acute and persistent pain. Pain was an indicator that something was wrong in the tissues thus referring to pain as a pure nociceptive input. At no time was there any discussion of screening for pathology, co-morbidities, red flags or contraindications to treatment application.
The practical session consisted of learning techniques to mobilise, release, elongate tissue with various tools. This was the point I began to start sweating and began to lose my cool. I had already indicated to my colleagues that what was being discussed was effectively trigger point release, manual therapy or mobilisation with movement, nerve sliders and also motor control training. What I experienced next was shocking and verging on grounds for gross misconduct. All manner of torturous techniques were used to mobilise spines and perform ‘myofascial release’. Kettle bells to release hip flexor muscles, to mobilise ankle joints and tennis balls and weights to mobilise spines. Standing on clients to perform massage rather than using hands on techniques for fear of breaching professional boundaries with Physiotherapists and other healthcare practitioners.
So why am I concerned? I believe that if Personal Trainers are to start moving into the field of mobilisation, release techniques and motor control training there needs to be legislation to protect the public and other professions. This is a serious issue which I was deeply concerned about, even more so when I questioned the tutor regarding the content of the 1 day course. I witnessed a distressing nonchalant behavior towards clinical reasoning and professional development. A criticism towards evidence based healthcare explaining that it had restricted our field of practice and that using trial and error and being mindful in our application was more appropriate.
I warn every clinician and personal trainer reading this that type of attitude can cause serious repercussions!!
Evidence based healthcare is a conscientious act by a skilled professional. Using current best evidence to justify making decisions, skilled professionals apply health practices to promote the rehabilitation or recovery of an individual (reference). It provides a justification for our reasoning process and it is ubiquitous providing a resourceful library for current medical practices.
To that effect my experience of personal trainers is one of determination, enthusiasm and willingness to learn. I respect this completely but I have also been witness to egotistical behaviour, chastising of clinicians and an attitude of my way is the right way. Therefore providing powers to trainers as described above with no formal training in pathophysiology, clinical examination and application, no understanding of red flags and contraindications to treatment, no understanding of pain mechanisms and tissue healing and no formal professional development strategies such as peer review, note taking and auditing, clinical reasoning and critical thinking is imprudent and extremely unsettling not only for my profession but also for the welfare of the public.
I can only ask those members of the public that are reading this to be mindful of any treatment application that is not in line with evidence based medicine, is being performed by an untrained professional, to question it and if you are unsure to speak to your healthcare professional before you agree to performing any specious activity.
Thanks again for reading, please do not hesitate to place a comment here or on twitter.
Well written article Paul. I think the points you have raised are very fair. I saw this as in issue a couple of years ago as a Physio and so spent over 2 years here in Aus with a friend who is an Osteopath creating a course designed for coaches that would educate them in basic anatomy, physiology, injuries that can be sustained and the initial signs and symptoms of these. The aim with this course, was to get the coaches to be active in the initial stages but mainly to give them the knowledge of when something should be referred on to a health professional. My background is a Physio for 6 years, Crossfit coach for 3 years and have treated over 250 crossfit athletes via our business Evolutio that specialises in treatment and advice for these athletes based out of Melbourne. http://www.evolutio.com.au. If you’d like to have a look through our course let me know. Cheers, Alex
Thanks for the feedback. THis is something I am working on at the moment a long with the 101 other projects I am working on! Currently I am in the process of putting a package together that includes A&P but also gets them to critically think and use a reasoning process that will help to determine if using a kettle bell on your iliacus is really indicated!!! My experience with trainers is that they are keen to help and do tend to adopt a monkey see monkey do approach because they have no understanding of clinical reasoning.
Taking a look at your course content would be very helpful. Please don’t hesitate to email me at firstname.lastname@example.org