Assessment versus Diagnosis: The Post-Rehab Specialists Role

I just spent a great week in Calgary teaching a 4 day intensive Post-Rehabilitation for Personal Trainers course. While the participants were great and picked up on the thought process I was using, there was a common theme when covering the assessments for different parts of the body that kept coming up. When we were doing tests for, say, rotator cuff strength or range of motion, some of the trainers were incline to thinking they could tell whether it was a dysfunction or potential injury to that area. While a positive test may indicate possible damage to an area, our job as trainers is to screen for potential injury and refer out to health care professionals (ex doctor, physiotherapist, chiropractor) to get a diagnosis and treatment plan if needed. What we don’t want to try to do is think because we know how to do one or two tests for an area that we can tell if it is a rotator cuff tear, impingement, AC separation, neural entrapment, or thoracic outlet syndrome, or any combination of these.

Trainers can look at a body and see if it is functioning normally or abnormally. We can then look at it to see if it is a case of muscle weakness, stiffness, or other problem brought on by conditioning, posture, or neural recruitment. If the body is functioning dysfunctionally, and is causing pain or problems with function beyond simple strength or flexibility (re: damaged), it is our professional responsibility to get those people in front of someone who can accurately diagnose their condition, and then make recommendations on what we as trainers can do to help them.

Now, I have a lot of clients who come in with injuries, so my job is to see whether that injury is presenting with a functional limitation, and if so, by how much. If I have someone come in with a ruptured achilles tendon from playing basketball, and they have had surgery, physio, and are ready to start training, I have to look to see if they are ready to begin training or if they need more time with the physio. The testing I would do would be for strength, range of motion and function, and would not involve any provocation, stress testing, or other techniques used by clinicians to diagnose or treat conditions like this. I went to school to be a trainer, not a physiotherapist, so my realm of expertise should only include what I know and what is in my scope of practice. I have told many clients after assessing them that something was wrong with a part of their body, and that they should go to a doctor, physio or chiro to get it checked out before I would start training them. I usually have an idea of what the problem is, and I am usually right. But on those occasions I am wrong, I don’t want to train that person to make them worse, and would rather have that second opinion.

So to conclude, trainers can assess to train, clinicians can diagnose to treat. Hopefully this clears things up and makes our world a lot less confusing, especially when we realize we can ask for help from those who have more experience and knowledge in the specific areas we need assistance in.

About deansomerset

Certified Strength & Conditioning Specialist, Post-Rehab Specialist, personal trainer and probably the coolest guy my mom knows, I try to impart a little knowledge with a sense of humor to keep people reading. I've always thought if it's something that can grab your attention, you're gonna remember it tomorrow!!
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