What is the role of coaches/ personal trainers in injury rehab?

The topic sort of asks the questions but hopefully I can clarify what I’m asking more directly.

After reading through and listening to pretty much everything BBM I am wondering what the role of coaches is. So say someone has an injury, sees an PCP and with no apparent abnormalities is referred to PT, undergoes PT and then is discharged. This would be under the assumption that the individual is “fixed” or on the other side of the coin, the individual stops going to the PT because they feel as though the PT doesn’t help and, that they believe they are going to be stuck with the injury/pain forever.

I know from the certifying organization standpoint the role of the coach is to develop programs and training methodologies to reduce/prevent injury, from BBM I know that’s not a 100% preventable concept but proper load/fatigue management isn’t a bad place to start.

I know a lot of the pain management is education so would it be a reasonable thing of a coach to attempt to educate the individual? Especially if they are receptive of what the coach or personal trainer is saying?

For me personally the first thing I would do is ensure the PCP clears them for exercise, and then I would probably have a conversation with the PT (hopefully have that type of relationship between coaches and PTs). If not me directly, then ask the individual what his PT has discussed with him/her. Find out why he/she stopped going to PT (if not discharged). If they are truly concerned pain/injury about it I would refer them back to see their PCP. Provide them with the tools/ knowledge to educate themselves about their injury and adjust training accordingly.

I ask because from the text books of a certification it talks about contraindications and shying away from training an injury while it heals. Doing nothing seems to me to be worse than doing what you can. Also, a lot of the discussions you
all have is from a clinician standpoint so it would be nice to see where you all place coaches in the hierarchy of injury/pain treatment.

I’ve not discharged one person as “fixed.” I’ve discharged them with the expectation they can now manage their predicament/condition/etc. And yes, many people do stop seeing their physical therapist not feeling as if it’s beneficial.

What certifying organization??? My understanding was a coach coaches a sport or skill to improve performance in said sport or skill. From a strength coach perspective, that may or may not prevent injury. The hope is with sensible training and program design, strength improves.

Yes, education is important, but titles matter. If you have MD after your name, folks take to heart what is said. If you have PT/DC after your name, they may listen. If it contradicts what the MD said, you’ll be ice skating up-hill so your explanation better be good. This can be good or bad. In many cases, it’ll take someone with a title the person respects for them to feel re-assured (or noceboed). Understanding when and who to “educate” is an art. And the act of educating is an art.

Sounds reasonable. If you don’t like the way something looks or sounds, refer them to someone trained to figure it out.

Best case scenario you have a multidisciplinary group of providers from surgical and non-surgical sports medicine, primary care, physical therapy, athletic training and strength coaches all well read and consistent with the BSP model of care. Each provider has a similar message in their patient interaction without nocebo, promoting of self efficacy, motivational interviewing and an understanding that loading is important to improve strength, resilience and return to function. All providers play an important role depending on when and where the patient enters the system. In some circumstances, all providers may play a role, in others only a select few. In some circumstances the coach may be the most important, others, the surgeon/etc.

Unfortunately, this model is rare to non-existent. In my zip code, there are very few coaches I’d recommend. That said, few people I see are looking for a “coach.” I’m the closest they’ve ever had to a strength coach.

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Yes, “fixed” is not the appropriate term that I should have used there but did so for lack of a better term. Your way sounds substantially better!

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What certifying organization??? My understanding was a coach coaches a sport or skill to improve performance in said sport or skill. From a strength coach perspective, that may or may not prevent injury. The hope is with sensible training and program design, strength improves.
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specifically I’ll go with NSCA since that’s who I went through. I used broad “certifying organization” since there are quite a few for S&C coaches and personal trainers.

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Yes, education is important, but titles matter. If you have MD after your name, folks take to heart what is said. If you have PT/DC after your name, they may listen. If it contradicts what the MD said, you’ll be ice skating up-hill so your explanation better be good. This can be good or bad. In many cases, it’ll take someone with a title the person respects for them to feel re-assured (or noceboed). Understanding when and who to “educate” is an art. And the act of educating is an art.
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I dont really know how to word this without sounding like a douche so I’ll start with saying, I Do Not Agree with what I’m trying to ask/say.

It seems as though more and more people are questioning the expertise of health care professionals and discrediting their knowledge in lieu of internet gurus. Have you found this to present its own unique challenge in your experience? I know even at the same level Coach v. Coach it can be challenging. An example would be where a previous coach of a client/athlete had one way of doing things and that impacted the perception of the client/athlete moving forward. I.E. the person is a firm believer in foam rolling etc… do you have this difficulty at the same level? Where you get a patient that has previously underwent physical therapy with a different PT,l further, what/how do you change those patients minds?

To be fair there are situations where I don’t discharge the patient, but their insurance denies further coverage of services. Those individuals are left with the choice to pay out of pocket. Few people ever do this. In these circumstances, if I feel additional physical therapy is beneficial (most commonly a post-op athlete) I’ll lay out objectives for them to aspire to prior to getting back on the field, court, etc. If they are a student athlete, I’ll be communicating with the athletic trainer. If they have the means to pay for a coach, I’ll make that recommendation.

Each organization is going to have its mission statements and/or marketing/advertisement to hook people. Things like “injury prevention” seem to be everywhere. Keep it simple, do what you are trained to do. Coach the athlete or lifter to get stronger. There is plenty of evidence to support strength training. Why do you need to expand into woo-woo, corrective exercise, foam rollings gobble-gook?

I see this daily. There is a lot misinformation out there. I don’t feel challenged by it. A routine question I ask is “what have you heard, read, understand about your situation/condition/etc.” I very simply explain what we do know, what we don’t know and in a non-conflicting fashion what is non-sense. I’m not trying to change their minds, simply inform them. They can choose what they want to believe.

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