The Fragile Post-Rehab Client Who Can’t Lift

Chances are, you have someone at your gym who feels like their body is not cut out for the regular strength training routine. They’ve recently been discharged from PT, recovering from surgery, have a replacement of some sort, or have some chronic pain issue that no one has been able to figure out.

These clients might have been hurt by uneducated trainers in the past, which leaves them scared that they’ll be pushed beyond their limits. The last thing these clients want is more pain and discomfort.

Maybe a medical professional scared them of weight training by telling them that squatting and deadlifting would leave them hurt or injured.

These clients might have been fed ideas by other professionals going out of their scope or Dr. Google, and now believe they have fractures, tears, joints out of place, or other random dysfunctions that they most likely don’t have.

A lot of these people tend to stay away from gyms and lifting weights. They believe that low level activities like yoga and pilates are the only things their bodies are capable of doing.

Through physical therapy that didn’t fully rehab, unexperienced trainers, misinformation on the internet, and a no pain no gain fitness culture, these people are scared, and they have every right to feel that way.

As a coach, you can’t take that feeling away on day one, or you’ll never fully gain their trust. You’ll get little to no results. They might even stay with you, but they will always feel misunderstood by you.

Even though these people feel like they’re fragile as glass, and they think moving and lifting can be dangerous, they’re not broken. They won’t shatter if you have them get after in the gym.

HOWEVER…

You can’t treat them like your regular client that came to you specifically for aesthetic and strength goals.

You must meet this client at their story through appropriate progressions, building trust, and bringing awareness back to their own body. By working in this fashion, these clients can perform a strength training program just like any other client.

Unfortunately, that’s easier said than done.

How are you going to take someone that feels like delicate glass to feeling like a bulletproof window?

How do you convince these people to try new movements with confidence, when they think they’re one movement away from (re)injuring themselves?

How are you going to build enough trust so when the time comes, and they pick up the 62lbs KB off the ground, they truly believe their body is capable of doing it without hurting themselves?

How are you going to convince someone who believes they’re not capable of doing anything other than rehab exercises on the ground, to believing they can build a strong confident body by lifting weights?

Fortunately for you, it’s what I do on a daily basis, and I’m going to show you how I’ve been doing it for the last several years 🙂

90% of my clientele were/are those clients.

The ones that have been with me for a while walked in feeling broken, fragile and dysfunctional.

Now they feel fearless, safe, and are lifting weights.

Over the years I’ve improved enough to be able to progress people faster and efficiently. I’ve gotten better at earning their trust through educating and squashing misconceptions they once had. I’ve also developed a system that helps them feel safe while training, because the last thing you want with these people is for them to feel unsafe.

Here’s how I do it 🙂

 

  1. Build Safety

 

These clients are expecting exercise to hurt. They’re waiting for something to go wrong. They’re thinking your training will end up failing them, just like all the other things they’ve tried.

I assure these clients that we are going to take things slow, while secretly in my head thinking “little do they know they’ll be squatting and deadlifting in no time”. By slow, I mean using only 1-2 activities day one.

Yes. That slow.

Could I use my coaching skills and coach them through a decent KB squat or hinge? sure. But even if it was a perfectly done squat or hinge, they’re unfamiliar with those feelings. Unfamiliar = unsafe. Unsafe thoughts and feeling alone could cause them to have a flare up or experience pain, and then they believe I pushed them too hard.

If that happens, trust is gone.

With 1-2 lower level activities I’m able to 1) respect that they feel like they’re not capable of much 2) familiarize them with references and feelings that we will associate as “safe”, like hamstrings, glutes, quads, heels…etc, and 3) give me an idea of how their body responds.

On their second day I ask them how they handled their first day, and I’m prepared for them to say something like “My back acted up a little that night” or “My hip felt a little achy the next day.” Without making it a big deal, I ask  “Oh ok. How are you feeling today?” They usually respond with “I feel fine today” and I give them a big smile and say “that’s great! Your body handled it well, we’ll do the same thing today!”

We go through the same thing, but add 2-5 more low level activities in positions like supine, quadruped, and half kneeling.

On their third, day I’m prepared to hear a similar response, but I make sure to point out that they did 3-4 times the amount of work that they did on day one, which means their body is building up a nice tolerance and that they’re on the right track.

These activities are teaching their body what it means to work hard, be challenged, but most importantly, feel safe. Just because they barely get off the ground that doesn’t mean they’re not being crushed. If you coach them correctly, they’ll be extremely challenged by exercises like half kneeling, low bear, and wall squat.

Three to five training sessions of low level activities and the client starts to feel safe doing these exercises. From there, I convince them to try one round of squats, sled push, or something like ball slams. They end up feeling all those areas they spent familiarizing with over the last couple of sessions, which makes the more challenging move suddenly feel SAFE.

As soon as it feels safe, that’s when you can successful start loading them 🙂

 

  1. Get Buy-in with Your Assessment

This is funny because it’s usually the other way around. How are you going to get your regular client that wants to lift heavy to buy into breathing? You educate them and show them how it’s going to make them a better lifter.

With the fragile post rehab client, you use your assessment to get your buy in for the exercises your picking for them. For these clients, getting better assessment findings is a positive thing. My biggest test right now is the infrasternal angle (ISA). I also test hip and shoulder motion so the client can see improvements. Improved motion and assessment = GOOD in the client’s eyes.

After we do activities, I quickly assess something. Not just for my own findings, but for the client. If they see that their shoulder motion improve by 40 degrees after an exercise that felt like a super hard plank, there’s no way that exercise is dangerous, right?

Last week I had a new client ask if I could check her ISA because she could now exhale twice as long as she could when she first started. A wider ISA meant progress, and if she felt like she was progressing, it made sense when I came out with a new program where she’d be increasing her load on everything 🙂

If I yell out “Oh damn!! That angle is 90 degrees! That’s amazing! Great job!” Then what they’re doing must be a good thing.

Which takes me to my next step…

3) Get Excited.

These people already feel bad about themselves because they can’t do much. So I get jazzed up when they do things correctly. For someone who doesn’t show much emotion, I get extremely happy and proud of them. Then the clients actually start feeling good about themselves. If I can get them to believe that they’re doing a really good job, the more likely they’ll progress themselves at a faster rate. If they’re hesitant with what they’re doing, they’ll want to stick to the same weights.

4) Learn About Pain

As a coach, pain can’t scare you. Pain has been a voodoo word in the industry and I felt like it wasn’t my job to learn about it. I was always under the impression that if a client was experiencing any type of pain, I would have to refer out.

Unfortunately, referring out doesn’t mean pain will always be resolved. Bad things can be ruled out, but pain can still persist. My clientele forced me to learn the ins and outs about pain, and has helped me educate my clients on occasional post-training pain and flare-ups. Most of these clients associate pain with damage, and that’s not always the case.

A few places you can start learning about the Why and How people have pain is through Zac Cupples’ Pain Talk and his podcast that he is releasing next week!

 

5) Have Great Coaching Skills

There’s no way around this one. All the knowledge, people skills, patience, and empathy in the world won’t help if you can’t effectively coach exercise.

When it comes to coaching someone out of compensating, these clients will need it the most. I mentioned this in my last article, and I will keep mentioning it, you must follow people who know how to coach. People who are coaching on a daily basis, and are constantly getting better. Coaching people through movements is an art, and not many successful personal trainers do it well.

Follow these people on social media, bookmark their website, mimic what they’re doing, learn from their coaching, steal their cues, and become a good coach.

Michelle Boland, Pat Davidson, Justin Moore, Cody Plofke, Zac Cupples, Lance Goyke, Ty Terrell, Doug Kechijan, Mike Baker, Michael Mullin, Mike Robertson, Bill Hartman

These types of clients don’t get better with half-assed glute bridges and fire hydrants. They need the detailed individualized training that takes a high degree of coaching skills.

If you want to successfully work with these people, you can’t skip this step.

 

BONUS TIP

6) Find A Physical Therapist to Back You Up

Maybe you have great coaching skills, but despite your best educational efforts, your client still fears loaded movements. This is where comanaging a client with a like-minded physical therapist can be a dream come true.

But beware. If they don’t promote strength training, and they don’t have a coaching background, it can be a total nightmare.

I’ve made the mistake of communicating with a PT through a client, and that always ends in frustration. I’ve had PTs tell clients who were experiencing knee pain to not to do any lunges or squats, even though the only time they were experiencing pain was during random movements outside of the gym. I’ve had a PT tell my client that shoulder blade protraction is bad, that pecs are bad, and that she shouldn’t press, and because of that she has stuck to a 15lbs DB press for as long as I can remember.

If you can find a PT that promotes strength training, you can really help these people out. I’ve even scheduled movement consultations with people like Zac Cupples to help educate my client on loading their system. Even though it’s not a physical therapy appointment, it’s still a physical therapist saying “Hey. Lifting weights at Enhancing Life will be the best thing you can do. It’s not dangerous. If I were rehabbing you in-person, that’s how I’d progress you”

 

Summary: 

  • Build safety within their own body and gain their trust
  • Have a test and retest system that helps build buy-in with the exercise selection
  • Get excited for the things they can do
  • Learn about pain so you can educate your client when they have flare ups 
  • Work on your coaching skills
  • Have a PT that believes in strength training and who has a coaching background

Do you work with these people? How do you convince him to lift weights? Is there something I didn’t cover that you would like to learn more about?

 

Until next time 🙂

 

Lucy

 

 

 

 

Social Media Post of The Week

My first Social Media Post of the week must go to one of my favorite people in the industry.

The one and only, Pat Davidson!

He posted a status on Lateral Band Walks and the internet lost it.

It was a get your pop-corn and read the comments kind of post.

It makes you realize how emotionally attached people get when someone questions their thought process over an exercise they’re doing with their clients.

Pat basically said lateral band walks are a waste of time, and the justifications started pouring in within seconds.

Really smart people like Michael Mullin chimed in

Pat wasn’t saying you were a bad coach for doing them, he was just saying that they’re not doing what most people think they’re doing. Just like people try to juice cleanses to detox and flush their body but that’s not how it actually works.

Coaches that really thrive in this industry are constantly adapting to new information that they’re learning without getting emotional about it.

If I woke up one day and Pat Davidson, Bill Hartman, and Zac Cupples were telling coaches the best way to get people moving better would be be getting clients to push their bellies out as they breathe in, do a bunch of band pull aparts, and lateral band walks, I would throw my ego at the door, and start getting people to pinch their shoulders blades back and down and start getting people better.

Don’t get attached to anything that you’re doing. Someone will come around and show you how you’re not quite getting it. It happens to me DAILY. I’m constantly feeling like I’m messing up and I don’t actually know what I’m doing.

Always be ready to be wrong. That’s how you get better, and that’s how you get your clients the results no one else can.

You know what doesn’t get people better? Being close minded with a “we’ve always done it that way” mentality.

If you really want to know what true frontal plane work looks like, I would HIGHLY recommend buying Pat’s seminar –> Rethinking The Big Patterns. 

 

Until next time 🙂

Lucy

 

 

Training Modifications Using the Infrasternal Angle

When I started taking the courses from the Postural Restoration Institute, I started gaining a huge appreciation of the axial skeleton. At the time, I thought I knew a lot about breathing, but after their courses, my understanding of breathing mechanics went to the next level.

I learned that I couldn’t make assumptions about the rest of the body without taking in consideration the rib-cage and respiration.

Visual assessments like watching someone squat, lunge, walk, and move around all had a purpose, but it didn’t help me with individualizing a protocol that would increase my client’s movement variability. And since 80-90% of my clients are post-rehab or in chronic pain, chasing movement variability is a pretty high priority.

When I run my clients through 1-2 breathing activities/correctives/resets/whatever you want to call it, I want them to have a purpose, I want there to be a reason behind it, and I want them to produce a change. The last thing I want is for my client to waste their time doing something that doesn’t get them closer to the results they want.

With that said, I’m kind of obsessed at getting better at choosing the right activities for my clients that produce the biggest change to minimize the amount of time they spend on “breathing exercises”. The better I get at being precise with my exercise selection that faster I progress people to the training floor, and the less coaching I have to do.

Last year, on an exciting Saturday night cuddling with my cats and getting my continuing ed for the week, I watched one of Bill Hartman’s videos on Ifast University where he introduced me to the concept of measuring someone’s infrasternal angle (ISA).

With checking someone’s ISA, you could start making some assumptions of what stage of respiration someone was in, and what exercise selection would get the biggest bang for your buck. Not only what Bill was teaching seemed pretty promising, but as a coach, it was a great assessment that I could quickly do on the training floor. It takes three seconds, you don’t need a table, and you can individualize your client’s training to the next level. I don’t know about you, but my clients pay a lot of money for individualized training.

After watching that video, I was ready to upgrade my clients training, so I started checking people’s ISA.

and here’s a warning, you’re going to fuck it up many times. You’re going to have to practice.

You’re going to test someone’s ISA one day and it’ll be wide as fuck, the next day it’ll be narrow as fuck, and you’ll wonder “how the fuck did I fuck that up?!”.

All these things take practice. When I took my 5th PRI course a couple of years ago, I decided it was time to start implementing their assessment into my eval. I sent out an email to over 150 clients letting them know that Dave and I needed practice, and over the course of two months we went through 80 assessments. We failed many many many times. We over explained the assessment to clients and completely lost them. We didn’t successfully coach a client through the basics and got no results. We failed to make the breathing and assessment meaningful for the client and lost their buy-in.

Through all those fuck ups, we got better. Nowadays, successful movement assessments where I get the outcome the client wants far outweigh my failed ones with little to no results.

If you’re going to start testing someone’s ISA and individualize people’s warm-up and core activities in their training, just be ready to fail many times before you start getting consistent results. Practice on your favorite clients, your family, your staff, and friends before you make it part of your new client eval or clients that don’t like all the weird breathing stuff.

So what is the Infrasternal Angle, and how to do you measure it?

 

I’ll let Zac Cupples explain it to you 

In the following video Bill Hartman gives you an amazing visual on the differences between a narrow and wide ISA

If you want to learn more about it, check out the following debriefs. 

Here are a few quick modifications you can do depending on your findings:

 

Narrow ISA Warm Up: 

Wide ISA Warm-up:

 

What about an Asymmetrical ISA? 
What kind of modifications can you do with these people??

<<<GET YOUR WARM-UP>>>

 

If this was your first time hearing about the ISA, I know this can get confusing.  I’m still trying to wrap my head around it, every time I think I understand it, I learn more about it and realize how much I don’t get it. If it’s your first time hearing cues like exhale, reach, and tuck, get ready to struggle getting clients to do it correctly.  People SUCK at moving.

When it comes down to it, it’s not my knowledge or my understanding on the ISA and respiration that are producing the results. It’s my ability to coach my clients into super basic movements, my ability to progress in all three planes, and going beyond 90/90 and quadruped.

If you’re struggling with the coaching part, start by following people that are extremely good coaches, who are actually practicing on a daily basis, and not camped out online never coaching people in person.

The good news: I know a lot of people that are world class coaches 🙂

Follow these people on social media, bookmark their website, mimic what they’re doing, learn from their coaching, steal their cues, and start getting better results with your clients!

Michelle Boland, Pat Davidson, Justin Moore, Cody Plofke, Zac Cupples, Lance Goyke, Ty Terrell, Doug Kechijan, Mike Baker, Michael Mullin, Mike Robertson, Bill Hartman

more good news: I know of some courses you should think of taking

The Human Matrix with Zac Cupples. This event will teach you EVERYTHING you need to know to be able to assess and coach your client through all of this. You. need. to. go. to. this!

Rethinking The Big Patterns by  Pat Davidson. Let Pat take your knowledge base to the next level. Pat is my favorite person in the industry as of late…mostly because I thrive to be just as honest and blunts as he is.

IFAST University. That’s where I was first introduced to the ISA assessment. I’ve been following these guys since I started training. They’ve always had a huge influence in how I train.

All of the primary courses from the Postural Restoration Institute.

Here are a few quick videos if you want to learn how breathing can affect movement and why you really should think of getting into this whole “breathing” craze: 

 

Maybe you’re on in the industry and you are just interested in all this stuff….You have to check out Bill Hartman’s book ALL GAIN, NO PAIN: The over-40 Man’s Comeback Guide to Rebuild Your Body After Pain, Injury, or Physical Therapy.  (Even if you’re a female or someone under 40, it’s still an amazing book)

 

I hope all of this was helpful <3

Over the next few weeks I’ll be talking about how to coach ALLLL these movements

Until next time 🙂

Lucy