To increase your success rate with fitness & health clients and improve your reputation, study and treat each person as an individual. Test as many factors as you can before you come up with a treatment plan. Diagnose as much as you can within the limits of your state’s scope of practice. Then, customize your treatment program so it is specific to each person’s needs.
Constantly learn more so you can get more specific with each person. Never accept poor results on a single client. It is up to you to figure out what every person needs, even if you have to call in psychologists, motivational speakers, bio-chemists, doctors, social workers….whatever is needed to help them reach their goals. Learn how to help your clients identify their goals carefully and specifically. Inspire them to reach for more than they thought they could possibly do.
This is the kind of commitment that it takes to be a champion in the competitive world of professional athletics and high performance achievers. To be successful treating your fitness & health clients, it takes even more commitment to be a teacher of champions.
Before recommending any type of stretch or therapy for restricted movement or for a warmup, it is essential to know what is causing the tightness. Otherwise, any recommendation for stretching the muscle might:
Result in poor or no results
Cause more problems by altering a muscle that is the correct length and optimally functioning.
Not correct the issue that actually needs to be fixed
Cause permanent damage to the tissue that is actually involved, when you miss a limited window of opportunity to correct the issue.
Here are some of the questions I would want to know answers to before recommending a course of action:
1) Is the muscle just too tight or too short? Do you want to lengthen the muscle, relax the muscle or stretch the connective tissue within the muscle?
2) Is the joint at either end of the muscle properly positioned? These would help you start determining if there is an imbalance of muscle tone &/or strength.
3) Are the nerves to the muscle working properly? Certain nerve problems will cause muscle tightness. If you stretch the muscle instead of addressing the nerve issue, you might end up with an overlong muscle after the nerve is repaired. You also miss the opportunity to find out what is wrong with the nerve and possibly speed up nerve repair as well as potentially missing a window of opportunity to fix the problem before permanent damage sets in.
4) What is the relative strength of the antagonist (opposite) muscle? i.e. Is a weak quadriceps allowing excessive hamstring contraction or tightness? If you stretch the hamstrings instead of strengthening the quads, you end up with 2 muscles that are excessively weak or long instead of fixing the problem.
5) Are there adhesions in the muscle and if so, are they generalized throughout the muscle or are they focalized to one specific site? Widely dispersed adhesions would need generalized or more broadly applied treatments. Focalized adhesions such as you might get through certain traumatic injuries or muscle strains, would need more pin point therapeutic applications.
6) What are your active and passive ranges of motion for a) your hip joint?, b) your hamstrings?, c) your knee joint? Is the problem really with a tight hamstring, or is it more of an issue with a frozen hip or knee joint?
7) Any vascular abnormalities to your hamstrings? If you circulation is impaired to the hamstrings, this can cause abnormalities in both tightness and length. For example, if you have bulging or varicose veins over your thigh, this could be a sign that a vein is being compromised closer to the heart. If you’re not draining blood properly from the muscle, you can be accumulating lactic acid and other chemicals that can alter your hamstring sensations and function. Alternatively, bulging veins in the thigh could indicate that the deep veins returning blood to the heart that run through the muscle are being compressed by an overly tight hamstring forcing blood to re-route through the veins closer to the surface.
8) Which of the four hamstrings are involved? Whatever causes are involved and whatever treatments are eventually needed will differ depending on which of the hamstrings are involved. For example, if some form of stretching ends up being indicated, each of the four parts of the hamstrings has different points of attachment to the bones. This will result in different vectors of stretch will be needed. Applying a broad based hamstring stretch when only one part is involved, will not only get you slower or no results, it could also cause new problems in the unaffected muscles by making them overly long.
9) Are the any contributing chemistry issues? For example, a common issue causing excessive tightness of muscles is having certain abnormal mineral or electrolyte levels. Abnormal calcium or magnesium levels can cause outright muscle cramps. Smaller chemical abnormalities can just increase muscle tension. Chemistry caused muscle tightness tends to occur across the entire body however, so a second or third issue would also need to be present with the hamstrings to localize the tightness to that muscle specifically.
Examining some of these factors to determine if they are involved or not is critical to achieve the results you want. It is time we move beyond the concept that all stretches are good. Hypermobility, joint imbalances, arthritis, disability and decreased performance are likely by doing the incorrect type of stretch or stretching when perhaps an exercise or trigger point work is more appropriate. It is very important to rule in or out as many factors as you can in order to improve results and decrease the chances of making your situation worse.
A regular topic in fitness therapy forums relates to client ‘excuses’ for why they miss treatment sessions or fail to follow through on diet or exercise recommendations. Reasons for these excuses are frequently attributed to the client’s motivation, unrealistic expectations, social factors in their home environment or other psychological factors.
I’d like to add another factor for consideration that the therapist has a lot of control over. A thorough assessment of the cause(s) behind the client’s current fitness status will encourage client confidence that the therapist is recommending the correct course of action. This can enhance client motivation and decrease ‘excuses’.
For example, someone might have a fitness goal of climbing a set of stairs without difficulty. Some therapists might immediately start an incremental exercise program of climbing a few steps and gradually increasing the quantity as the client improves. This is frequently done on the assumption that the stair climbing difficulty is because of a weakness in the stair climbing muscles or cardiovascular system. Before recommending an exercise program, it is necessary to determine the cause(s) of why they have difficulty climbing stairs.
The difficulty could indeed be because of a cardiovascular or climbing muscle weakness due to a sedentary lifestyle. If this is the sole cause of the difficulty, an incremental training program might be perfect. What if however, a contributing factor to stair climbing difficulty is excessive adhesions in the knee? Perhaps the adhesions are the result of a chronic knee pain issue. Perhaps the client has an essential nutrient issue causing anemia or ATP production deficiencies? This could give fatigue symptoms that can mimic cardiovascular weakness. Perhaps multiple factors are involved simultaneously.
While some of the causes of stair climbing difficulty may be outside your scope of practice, many causes will fall within it. Let’s say that the knee pain issue is the result of an imbalance of muscles in the legs. The client’s knee flexors and extensors may be too strong compared to their adductors or abductors. Alternatively, the client may have a foot pronation issue causing their knee to deviate medially. Either of these examples can cause chronic pain and adhesions in the knee which will make stair climbing more difficult. These types of factors can be assessed by therapists in most states with careful observation and muscle strength testing before beginning an exercise program.
In this type of situation, initiating a stair climbing exercise program before correcting the muscular imbalance could actually make the situation worse. A more appropriate treatment plan would start with correcting the foot pronation and knee muscular imbalance, then proceeding on to a cardiovascular exercise program.
Getting slow progress or increased pain can be devastating to a client’s motivation and get them searching for any ‘excuse’ to miss appointments. Doing an assessment that is thorough into possible causes before initiating a treatment plan can help boost your client’s confidence that you are recommending the right program for them. Finding and correcting all the causes for a client’s health issue should also result in faster progress in client’s reaching their health goals. Thorough assessment before treatment is another factor in building an excuse-proof business.