As I was walking out of the first day of the Optimizing Athleticism Seminar, Dr. Culleton asked me, “That was phenomenal, what do you think the audience took from that?” I had been contemplating the same thought as the day progressed. The audience was primarily strength coaches and physical therapists and Dr. Rakowski who headlined the first day was not playing coy with big words and systems biology. I responded to Dr. Culleton,”Probably not that much right now, but they now know what they don’t know, and this group of people will run with that somewhere special.”
This conversation has floated in and out of my mind over the past week and it becomes a question of scope of practice and ultimately responsibility to the client to do the right thing. Davis and I have posted on this topic many times. We both believe that a Strength Coach’s knowledge base must be vast, but not necessarily overly specific until they find their passion/niche. They have to be able move seamlessly and talk intelligently with many other professions. I will give two examples of how I feel the strength coach or personal trainer is either the gateway to health or the hammer of dysfunction.
Many of us have seen and/or signed the waiver forms that say: You must see a health care professional before starting this or that exercise program.
And how many clients actually do that?
But this is because the average Joe primary care physician isn’t going to tell anyone anything unless they have some set of obvious symptoms that fit into the bundle of this or that disease that can then be medicated “appropriately”. At which point you might be thinking why the hell did I go or send someone I care about there!
“Disastrously, primary care is a dying field, yet at the same time primary care diseases are increasing at dramatic rates.”
Mark Hyman MD
The average primary care physician can tell you nothing about function or underlying causes of dysfunction, let alone address how these dysfunctions could or are leading to decrements in performance. They can only tell you if you have a disease state. This is not very helpful to the strength coach, personal trainer, or client. However, a strength coach that has been introduced to functional medicine will know that there are those professionals out there that can tell them something of value and help further individualize and care for their clients throughout the life course.
Does the strength coach or personal trainer need to be an expert in Functional Medicine? Absolutely not, that cannot be expected, but they do need to understand the recommendations and the potential pitfalls of their approaches in the weight room and work with a health care professional to form a plan that will include more data points and quality input over time. Some strength coaches or nutritionists may catch the bug and want to go back to school for a decade or so to thrive in such a profession and that is also powerful but we cannot try to fix problems beyond our current abilities, because in that scenario everyone loses.
If you weren’t at the seminar you may be asking – Dude! What is Functional Medicine?
“Functional medicine is a dynamic approach to assessing, preventing, and treating complex chronic disease. Functional medicine helps clinicians identify and ameliorate dysfunctions in the physiology and biochemistry of the human body as a primary method of improving patient health. Functional medicine clinicians focus on restoring balance to the dysfunctional systems by strengthening the fundamental physiological processes that underlie them, and by adjusting the environmental inputs that nurture or impair them. This approach leads to therapies that focus on restoring health and function, rather than simply controlling signs and symptoms.”
Jeffrey Bland PhD
The second example moves to the realm of physical therapy. Many strength coaches, including myself have taken a plethora of physical therapy or massage therapy based certifications or apprenticeships. I am confident with my hands and can fix a lot of problems that come up in the gym, but I am not naïve enough to think that I can fix all the problems. For example, a strength coach doesn’t need to know everything a DPT does, but they should know what they don’t know and refer out when they can’t fix a problem or need a second opinion. And then if a strength coach is lit with a passion for physical therapy they should follow that path and enroll in physical therapy or massage therapy school and/or shadow the best of the best.
This may strike some as unfair, why does the strength coach have to be a generalist and be able to communicate effectively with so many other “specialties” to be able to provide a true health building performance experience for their client. Yet, the same can be said for the functional medicine practitioners and physical therapists. They need to lift and have an understanding of foundational strength and conditioning concepts, programming, and exercise selection so that they can in turn communicate effectively with the strength coach or personal trainer.
The ultimate goal is for this network of professionals to be able to have a thoughtful conversation, understand and formulate a plan for the client, and then test that this plan is working and redirect if needed.
That one sentence…will likely take you years to find the right people and learn enough to make this happen. Take that as a challenge, I hope it doesn’t stop you.
Canada Basketball deserves some props here as they have built an interdisciplinary model and have hired a staff of stellar physical therapists, strength coaches, and functional medicine practitioners to drive performance as far as possible while monitoring and building health from underneath. All of us are building and tuning up this machine while it’s being driven and there will likely be many models and systems that come out of this work, but Canada Basketball seems to be integrating and applying faster than most. Here is a great Podcast with Dr. Marc Bubbs, Canada Basketball’s Functional Medicine Doc.
On the private side, many may have noticed that Davis and I bridge the gap between S&C and Nutrition/Functional Medicine (and we are not alone). Davis is in my mind one of the best S&C minds in the country and will stop at nothing to understand how the body adapts to different exercise and lifestyle stimuluses and then how best to apply this knowledge. I still maintain a personal training client load and likely always will, but have slowly transitioned more towards the functional medicine side of the spectrum with the help from many unbelievable mentors and colleagues. Yet, given all this, if there is a physical therapy problem or pathology that we can’t figure out we have physical therapists, osteopaths, MDs, and DCs, that we can refer out to without hesitation.
No one has all the answers, but ignorance is dangerous. Hunt down what you don’t know. Then establish what and how much you need to know so that you can further understand and help your clients. Strip the shackles of what other people think you should do because of some title and create a community to get the job done.