Excuse Proof Factor – Find the Cause!


no excusesA 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.

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