Manual Therapy & The Personal Trainer’s Scope of Practice

  • manual thearpy

Here’s What You Need To Know…

1. Trainers and coaches, if you do NOT hold a license to manipulate soft tissues, manual therapy is off limits to you, even if you think you are doing your clients a favor by going out of your scope of practice.

2. There is a new emergence of hybrid strength coaches who hold licenses in massage, physical therapy, chiropractic and other specialties that provide a unique programming and care that incorporates manual therapy for their clients which goes above and beyond what a personal trainer can legally do.

3. Having the ability to manipulate soft tissues legally with your clients while also having a vast expertise in training and exercise is one hell of a combination, and provides greater value to yourself and your clients.

4. Knowing your current role as a professional in the fitness and medical model, while also recognizing your other allied healthcare and fitness professionals is the most tried and true way to build a strong network. No, every coach doesn’t have to become a licensed in manual therapy, but it’s imperative that every coach knows his boundaries and scope of practice.


If you’re a coach or personal trainer, you’ve heard this time and time again…pain is out of your scope of practice, so…refer out! That is the status quo when it comes to trainers dealing with pain and lets be clear, it’s the correct move.

Your client has pain, refer them to someone else who specializes in pain and dysfunction, and has the ability to diagnose and manually treat. While it is important to have a network of health professionals such as physical therapists and chiropractors to refer to, why not expand your horizons as well as your practice as a coach? What am I talking about?

Enter the new hybrid coach, who is not only licensed and certified in strength and conditioning, but also manual therapy. Manual therapy skills are used to optimize movement and health, and then coupled with training and coaching to enhance fitness and performance. Let’s analyze a growing niche of professionals of coaches and trainers that also hold a license or certification as massage therapists, or dare I say a “physical” therapists.

The Power of Movement Specialists

Alone, both the training and massage professions perform a great service for the populations in which they serve.  The role of strength coaches and trainers is primarily to get people moving, get them stronger, as well as healthier. This role is largely limited to the education and training they’ve received. In many cases, their clientele’s goals are to lose weight, gain muscle, prepare for a sport, or move without pain. Thus, that should largely be the focus. They may even play a role in preventative exercises, provided they have a rationale behind the exercises they are programming.

However, the trainer needs to know their limitations. According to the National Strength and Conditioning Association (NSCA), a trainer’s scope of practice is limited to “developing and implementing appropriate exercise programs, assisting clients in setting and achieving realistic fitness goals, and teaching correct exercise methods and progression.” (1)

They are not a manual therapist, so they need to remain hands off when it comes to the client, from both an ethical and legal standpoint. Trainers have no training in manual manipulation, which is largely consists of various techniques combined with force into the body to create change in soft tissue. This is mainly referring to massage, but can even include using a foam roller on a client (yea, I’ve seen that), assisted self-myofascial release and various forms of stretching. The title and privilege of a “manual therapist” comes with the in depth studying of the body, not the least of which includes palpation and assessment.

If you have pursued personal training throughout your educational career, then your career is limited to personal training and the scope of practice associated with it. There is nothing wrong with that career path. There is though something wrong with crossing the boundaries of that scope as well as a legality component to such acts. Personal trainers need to be aware that there are those who have sought out multiple avenues in the health industry, allowing them the ability to physically manipulate their clientele.

Unfortunately, many trainers, wanting to add value their sessions or repertoire, take it upon themselves to treat, and that lack of education ends up hurting the clients in the end. It’s understandable that you would want to do everything you can to help your clients feel good, or not be in pain. Unfortunately, you’re crossing a boundary that doesn’t need to be crossed. There are other experts out there, utilize them, set up a network of professionals.

Hybrid coaches cringe when they catch trainers doing some sort of soft tissue manipulation, whether its stretching clients, or digging into muscles with thumbs or elbows. Please do not mimic techniques you see others performing, there is more to a therapeutic session than simply poking and prodding tissue.

The only thing your adding is to your sessions is risk and unwanted consequences should something go wrong. Reading a book or watching a YouTube video does not give a trainer the wherewithal to program stretches, myofascial release techniques or to physically manipulate tissue.

Think of it this way, if you had to go up against a judge or jury, could you defend your actions and programming then back it up with the proper educational background and credentials to practice manual therapy? If not, hands off!

The Synergy of Manual Therapy and Coaching

manual thearpy

While trainers can only guess as to what a client may need to do as far as corrective exercise (SMR, Activation, Mobility) is concerned, a massage therapist can test specifically to find the source of the problem, eliminate and treat it.

Professionals licensed in manual therapy have extensive training in many aspects of manual manipulation. What that schooling allows is the legal ability to manipulate tissues for the betterment of your client, whether they are general population or athlete.

As a sports/medical massage therapist, you are taught how to treat to maintain healthy tissue and rehab injuries. Those treatment protocols require planning, much like you would program a clients training program. A treatment strategy is designed based on a number of things, like movement assessments, where a client is feeling pain, muscle testing, and previous injury history. Your role is to get to the root of the issue, to figure out why there is pain.

Massage Therapists, according to the New York State Office of Professions, clearly defines that LMT’s will give the “highest quality of care to those who seek their professional services, and will provide only those services which they are qualified to perform.” The key phrase being “qualified to perform,” and where one isn’t qualified, LMT’s will and should refer out to other professionals. This is usually in cases where contraindications are present. Massage Therapists only provide treatment where there is an expectation that the client or patient will benefit. (2)

As an LMT, your hands become sensitive to the different quality and stages that tissue goes through for performance, recovery, and injury. That sensitivity is essential when it comes to treating clients and comes with experience. Additionally, when it comes to working on certain areas, like psoas, you learn to feel the difference between muscle and organs.

Those courses teach you the difference between the feel of what is soft tissue and what could be something else. Additionally, knowing what the end feel of a muscle is, knowing if you’re targeting actual muscle belly as opposed to tendon, ligament, joint capsule. Learning the difference between a structural or bony restriction vs soft tissue restriction is inherently key to the success of a manual therapist.

Although LMT’s cannot diagnose, do not dismiss them as a valuable source for treatment. They can be just as integral to your athlete or clients training as a chiropractor or physical therapist would be. A Licensed Massage Therapist is there to help optimize your client’s musculature to aid them in moving better, feeling better and performing better in the much the same manner as the above professionals.

The Hybrid Approach to Health and Performance

manual thearpy

When you put those skills and knowledge together in one person, they become a coaching superhero, with the ability to write out strength programs that coincide with treatment strategies. You get the best of both worlds when you’re a hybrid coach.

A key asset when it comes to performance is the ability to understand what muscles are working and what may not be. As well as learning to apply the correct modalities to optimize your client’s movements. A hybrid coach can effectively and efficiently do both, making them a valuable component to an athlete or clients progress.

A dual practitioners brain rarely shuts off or shifts to solely one practice over the other, they wear both hats all day, every day. When you’re training, the LMT brain is firing, analyzing movement patterns, figuring out what may need work. Same goes when you have a client on the table for treatment, you’re thinking of exercises that may help to strengthen or activate muscles that may need attention.

What’s great to see is that there is a growing trend of taking a hybrid approach to strength training, rehab, and performance training. While the common profession when you think of blending strength training and therapy would be a physical therapist, a dual LMT and trainer can be a vital asset to any training program and athlete. In fact, there is a growing niche of practitioners that have made their careers from being a dual threat. Having that dual background as an LMT and a strength coach/trainer makes YOU a vital part of a client or athletes program. Imagine having the ability to treat clients, while making them stronger.

These practitioners should not be overlooked or discounted, as they definitely serve a role in the process. The process starts with an assessment and runs through treatment and exercise programming.

Assessment

The value of an assessment is well known. This is one area that a dual practitioner will shine. Having a background in movement assessments and muscle testing will give you a step up in the game. During your assessment, you’ll be able to see compensation patterns in movement and that will lead you to develop treatment strategies.

Treatment Strategy

One of the things you learn as an LMT during the education process is how to come up with a treatment plan. This process is reflected in learning to take proper subjective, objective, assessment, plan (SOAP) notes, and being tested on it throughout the clinical process. You need to be proficient and be able to defend why you are using certain strokes, certain techniques, and what muscles you’re treating. Your strategy will go a long way towards speeding recovery time, increasing range of motion, improving function and reducing hypertonicity, not to mention decreasing pain.

Corrective Programming

Programming SMR, mobility, and activation exercises aren’t necessarily meant to “fix” a person, but more to put them in an optimal position. As a dual threat, you are well within your scope to program exercises that will add benefit to the manual therapy you are giving.

Based on the above assessment, you will know what needs soft tissue work, what may need stretching, what may need activation. In many cases, when you’re treating systemically, it’s a combination of all three, depending on the case and client.

Most of the controversy that surrounds “treating” clients with corrective exercise stems from the fact that trainers are not physical therapists and that is true, trainers and coaches do not have the same educational depths as a DPT. However, where the education of a typical personal trainer lags, the education of the hybrid coach shines. Corrective exercises are often ineffective because the issue at hand requires a combination of manual therapy and corrective exercise. The hybrid coach has the requisite training where that does not become an issue.

Strength Programming

From assessment to treatment strategies, you start to get an idea of what muscles, or groups of muscles need to be strengthened for your client or athlete. In addition to doing corrective exercises as part of an optimizing process, strength training can take remedy several muscular imbalances. The number one goal when training clients is to keep the focus on what their goal is. What they want, is your primary task, yet that does not mean you can’t sprinkle in the things they absolutely need for long term healthy success.

Other Allied Hybrid Healthcare Professionals

manual thearpy  In addition to massage therapists versed in manual therapy being excellent hybrid coaches, there is a growing population of physical therapists and chiropractors that are adding strength and conditioning certifications to their arsenal. This can help them bridge their own gap between rehab and performance.

The education process for these professions typically prepares graduates to handle generalized injuries with no depth into what happens or should happen once function returns and pain subsides. But there are those that take continuing education into their own hand and broaden their scope of knowledge.

Physical therapists and chiropractors that add strength coach to their title are also a valuable resource for performance, and put themselves above their peers that haven’t taken that leap.

Bringing More To The Table Than Just Exercise

This is not a testament to say you need to go back to school to become a licensed massage therapist, or another healthcare professional if you’re solely a trainer or coach, because you don’t. However, this does lay out guidelines as to what you, the trainer, are allowed to do.

Additionally, this is a testament to how valuable the dual threat of strength coach/trainer and massage therapist can be to clients and athletes. Synergizing coaching and strength training with manual therapy gives you the tools to include mobilization, soft tissue techniques, stretches, corrective and strength exercises all with the health and wellbeing of your client in mind. A “physical” therapist.


About The Author

chris cooper

Chris Cooper, NSCA-CPT, LMT is a personal trainer with 10 years of experience in the fitness profession. He is co-owner of Active Movement & Performance, a training facility on Long Island. In addition to being a trainer, he is also a New York State Licensed Massage Therapist, which has allowed him to blend the two worlds to not only get his clients stronger and in better shape, but to also fix dysfunctions to make them better movers overall. His firm belief in education is manifest as an educator for Fitness Education Institute, presenting at their yearly convention.  He is an expert contributor to Watchfit.com and his work has been featured on Movement Resilience, Men’s Health, TonyGentilcore.com & Stack.com.

Website — AMP Training

Facebook — AMP Training

Instagram — @amptraining

Twitter — @chriscoopercpt


References

1. DAN MIKESKA, M. (n.d.). A SWOT ANALYSIS OF THE SCOPE OF PRACTICE FOR. Retrieved from NSCA.org: https://www.nsca.com/uploadedFiles/NSCA/Resources/PDF/Education/Articles/Assoc_Publications_PDFs/swot-analysis-of-the-scope-of-practice-for-PT.pdf Manual Thearpy

2. Manual Thearpy Practice Guidelines. (n.d.). Retrieved from NYS Office of the Professions: http://www.op.nysed.gov/prof/mt/mtguide.htm

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38 Comments

  1. Arthur Henandez May 26, 2016 at 2:41 pm - Reply

    Great article! Getting licensed in massage was one of the best things I have ever done for myself and my personal training clients.

  2. Nick May 26, 2016 at 2:51 pm - Reply

    There is a local “health engineer” with a degree in physics performing manual techniques (including joint mobs) and marketing “rehab.” As far I see it, as a physical therapist practicing manual therapy in TX, I have a more challenging barrier to entry with a higher liability with more education and training. Why on earth would a personal trainer get more education (as far as their bottom line goes) when they can call themselves whatever they want without carrying additional liability (read with intense cynicism)? Being a libertarian, I think practitioners should have the right to do what they want, the consumer should have the right to choose who she wants to pay for services, but I get aggravated when the playing field is not even.

  3. Christopher Cooper May 26, 2016 at 3:16 pm - Reply

    Nick, as a PT you certainly have a higher barrier to entry which is awesome. It weeds out the crap. The guy you see should be 1) written up on assault charges 2) be told to stop 3) maybe reported to state board of professions if that’s a thing in TX.

    The issue with letting practitioners do what they want is that the consumer is pretty dumb. They likely have no idea what goes into the education aspect of really anything.

  4. H May 26, 2016 at 10:34 pm - Reply

    This is bullshit. You are taking an uneducated LMT with minimal training, paired with an uneducated personal training cert and trying to talk like you are a physical therapist. LMTs have no background in biomechanics and need to be careful before they hurt someone. Don’t try to do more than your scope. Out of line.

    • Christopher Cooper May 27, 2016 at 8:41 am - Reply

      Sorry, but uneducated LMT? That my friend is bullshit. In new york state the educational requirements are as followed:
      Complete coursework in anatomy, physiology, neurology, myology, kinesiology, pathology, hygiene, first aid, CPR, infection control procedures, the chemical ingredients of products that are used and their effects, as well as the theory, technique and practice of both oriental and western massage/bodywork therapy. Within the 1000 hours of education, you will have had to complete a minimum of 150 hours of practice on a person.
      Then a license exam, plus continuing education to maintain that license.

      • Kingland July 14, 2016 at 2:52 am - Reply

        None of those courses give you the ability to establish a rehab diagnosis for a medical condition. That is the job of a physical therapist and its expansive educational background that includes differential diagnosis. In addition, a massage therapist does not have coursework that help decide therapeutic exercise for rehab, nor does it have the same level of biomedical knowledge or training as that of doctor of physical therapy.

        How are you allow to treat someone if you can’t give a diagnosis. Why should you treat someone if you can’t give a diagnosis or even know what is wrong with the patient, is that even ethical? I’m not saying LMTs can’t use exercise or manual therapy. They shouldn’t be doing it without a proper diagnosis which even the article admits. If an LMT/personal trainer gives an exercise that was intended on treating a musculoskeletal injury or condition without a proper diagnosis and he ends up hurt then they should be sued and rightly so.

        I think the article is right, but not fully correct. I am tired of these LMT/personal trainers who pretend to be Physical Therapists who the equal of parasites for consumers. This is a tremendous compromise to the safety of consumers and patients.

        “The length of professional DPT programs is typically 3 years. Primary content areas in the curriculum may include, but are not limited to, biology/anatomy, cellular histology, physiology, exercise physiology, biomechanics, kinesiology, neuroscience, pharmacology, pathology, behavioral sciences, communication, ethics/values, management sciences, finance, sociology, clinical reasoning, evidence-based practice, cardiovascular and pulmonary, endocrine and metabolic, and musculoskeletal. Eighty percent (80%) of the DPT curriculum comprises classroom (didactic) and lab study and the remaining 20 percent (20%) is dedicated to clinical education. PT students spend on average 27.5 weeks in their final clinical experience.”

        This is taken directly from the APTA website.

        1000 hours of education and a min of a 150 hours of practice on a person does not even BEGIN to scratch the surface of the level of education of a physical therapist…

        27.5 weeks of full time 1 on 1 patient contact that includes diagnosis and treatment that is over 5500 hours of direct hands on patient contact and that is ONLY their clinical experience. In addition that is only 20% of a physical therapist education. The other 80% (22,000 hours) are for the advanced course work ON THE BASICs such as anatomy, physiology pathology. Totaling a 3 year full time course load to reach the entry level doctorate education. This is in addition to a bachelors, which i’m not even sure massage school even requires (I couldn’t find that anywhere).

        That totals to 27500 hours of combined course work and direct hands on experience. Not to mention this is only the minimum required for some programs… OTHER PROGRAMS REQUIRE MUCH MORE.

        TL:DR. A physical therapist has over 23 TIMES the level of education of a massage therapist. So yes LMTs are quite uneducated. I’m a doctor of physical therapy and we have LMTs in our program who are learning to become physical therapists one day so I know both sides.

        That doesn’t mean I haven’t met some great massage therapist or personal trainers, though, and many of them even understand a specific subject more than than I do. However when it comes down to treating patients with actual musculoskelatal issues or injuries, most rarely have the ability to take the complexity of the issue at hand and tackle them. They are not the medical movement experts.

    • Chris Cooper May 27, 2016 at 9:02 am - Reply

      Even the national board certification requires 750 hours of education and
      250 hours of professional, hands-on experience

  5. Kris May 27, 2016 at 9:09 am - Reply

    A trainer can do a lot of good with screening, proper assessments like NKT / NeuroKinetic Therapy and having the clients self release, activate, and assign homework.

    Having an LMT doesn’t make you a better trainer necessarily and not having it doesn’t limit a trainer from help pain and dysfunction.

    Not that I disagree with the future of training but I do disagree that the two together make a better trainer or coach.

    Just my two cents.

    • Chris Cooper May 27, 2016 at 9:19 am - Reply

      Being an LMT does allow you treat and put hands on clients/patients.

      Just being a trainer limits your ability to put hands on

    • Chris Cooper May 27, 2016 at 9:22 am - Reply

      Pain is outside the scope for trainers. Pain requires treatment and a medical professional of which an LMT is.

  6. Ken Kasper May 27, 2016 at 12:05 pm - Reply

    @Chris Cooper my degree is a four year degree in exercise physiology and I have been practicing as a personal trainer since 1989. For you to say that stretching is a form of manual manipulation or that we need to ignore or immediately become hands off and seek someone out like yourself comes across as self serving and arrogant.

    Last I checked my ACSM cert allows me to stretch a client in Illionis. It seems to me to be the same argument that I hear from other trainers when they disparage the WITS cert or argue that NASM is inferior to someone else. Or the really aggravating situation when there is a “trainer” who is nothing more than a gym rat turned trainer by one of the big box gyms.

    While I agree there is a need for guidelines and rules to create a safe system for the consumer I find your recommendations a little ridiculous, especially since the term certification is thrown around like crazy and given such heavy weight with regard to a trainers ability.

    Licensing would be a better avenue for the personal training profession and it will happen eventually but that isn’t perfect either. The fact is that the vast majority of trainers are not sued for these types of malpractices or that many others as evidenced by the relatively low insurance premiums we all enjoy.

    While I agree with you on principle, I disagree with your guidelines to some extent. Mainly because it sounds a lot like a person who has invested much time and money into his profession but may not be getting the amount of business he had expected when the organizations who sold you your certs. told you, you would. You are basically saying as soon as a client feels pain that the trainer needs to call you in to take over for them until there is no pain, because they are unqualified. what a GREAT WAY for YOU to BUILD your business!

    • Chris Cooper May 27, 2016 at 12:15 pm - Reply

      Ken, I see what you’re saying, but what is the goal when you’re stretching? Likely to create some sort of change in the tissue, right? That’s manual manipulation of soft tissue. And this is coming straight from the state board for massage therapy in NY. I’m not pulling it out of nowhere.

      I am a licensed professional in NY state, with over 1000 hours of education to get said license. So there are no certs or anything that sold me anything or promised me anything as far as business.

      Lastly it’s called a client centric approach. Caring about a clients wellbeing over your own pocket can do amazing things for your relationship with said client. Telling a client, oh you have pain, I know an awesome LMT or PT that can help with that, and we’ll work together to come up with a strategy to get you better.

      That makes you as the trainer look good and professional instead of reaching and going outside your scope

      • Ken Kasper May 28, 2016 at 12:05 pm - Reply

        What I am trying to accomplish by stretching is allowed in Illinois and should be allowed in New York.

        A personal trainers purview is fitness which consists of flexibilty, strength/endursnce, body comp and cv how can you argue that serving should not be allowed in a session.

        By this rule is partner stretching disallowed?

        While I appreciate type 1000 hours of training, I’m gonna ask you to appreciate my 40,000 to 60,000 hours of experience as a pt.

        Look I refer out for things I can’t handle but stretching or hand s off?

        You argue that it is in the best interest of the client to stop everything in the presence of pain and refer out, but I will argue that certain pains can be relieved with simple stretches immediatelywhich to me is better for the client than waiting 24 to 48 hours to get an”expert” in to do what I’ve always done. You know that inflammation increases healing time and waiting to ice or stretch or treat the issue will prolong recovery so why is it in the clients best interest to do what you are proposing here?

    • Chris Cooper May 27, 2016 at 12:17 pm - Reply

      Where and how exactly did you learn
      how to stretch
      What an end range feels like
      Tissue quality
      Joint angles
      Assessing whether a muscle NEEDS to be stretched
      Why you’re stretching
      Difference in feel of muscle vs joint capsule vs ligament.

      • De Motu August 14, 2016 at 11:40 pm - Reply

        You see this type separation with different kinds of disciplines all the time. It’s such a waste of time and energy. Most professional associations are on a constant mission to “protect” their professional market value, in other words, $$. The mission is to brand and secure a fruitful future for all those who hold that particular license.

        Do you have any idea how much money is spent to prevent other similar professions from having access to consumers? When in reality, we only make it harder for the consumers to find the care they need. In Texas, we would need to

        Every professional school (MD vs. DO or DC vs. DPT vs. OT vs. EP vs. ATC vs. LMT vs. Accupontruast and on) teaches their students to differentiate themselves from the other branches of care. I currently have friends in most mentioned professional schools, and it seems to be a constant theme. A dean of a renowned PT school in Texas denounced Chiropractors. Another friend starting her first year in Chiropractic school in Texas was told not to compare herself with DPTs (during her welcoming orientation, addressed to the entire class) because Chiropractors are primary care physicians, and to hold themselves in much higher regards.

        We do this with race, color, religion, political beliefs, professions and everything in between. And it’s always about MONEY. On a legislative level, Physical Therapists are pushing for Direct Access (rightfully so). Although most states have passed this bill, the remaining states are still fighting. Well, guess which professional associations are the resisting forces acting against the bill. Yup, you’ve guessed it…the chiropractic association and the medical association. To make things even more attractive; guess who gives push back against Occupational Therapy from becoming a doctoral program or a wider scope of practice? Yup, PT. Guess who stands against Exercise Physiologist from becoming a licensed practice? You got it, PT and OT. Guess who hates how DC and PT have incorporated dry needling in their practice? Guess who can prescribe Physical Therapy in Texas? Wait for it, wait for it…a DC.

        Like a never ending story, it keeps going and going and going.

        PT school: Significantly expands on neurology (which in my opinion, is one of the most important aspects of human movement), manual therapy, and most recently (less than 10 years in most states, less than 6 years in Texas) differential diagnosis.

        But do most schools teach exercise prescription as the main focus of the program? I believe majority veteran PTs might agree, most exercise based education, particularly the more innovative skills, were obtained after school – through rotations, continued education, certifications, and experience. Most schools don’t have the time to teach you the art of exercise prescription. Conversely, individuals that hold advance degrees in exercise physiology have dedicated the majority of their academic life to understanding the effects of exercise on the human body and the system in which moves the body.

        If schools have a hard time providing a strong educational foundation on exercise, can certifications?

        How many PT graduates do you know that come out of school knowing everything and can effectively puzzle together a plan of care that is innovative and truly effective? Would I be wrong to say a lot of trial and error goes into work? Since we have many specializations in the PT field, would it safe to suggest sports therapy or ortho can quickly become repetitive – which leads to the common use of protocols when designing a poc?

        How many times have you or someone you know received a massage that was considered mediocre? A training session that was found to be poorly designed or irrational? Finished six to twelve rounds of physical therapy sessions with no satisfying results, not enough time spent with the PT, and “gave me basic stretching and exercises that everyone else got”? How about a chiropractic adjustment that exacerbated the injury? Does that mean everyone in these professions is incompetent?

        @Chris Cooper, to answer your question:
        I am a 32-year-old with a BS in Kinesiology with an emphasis in Clinical Exercise Physiology, and MS in Rehabilitation and Human Health Movement Systems. I hold certifications in CEP, CES, and NASE-CSS. I own a multidisciplinary and specialty practice, with a dynamic staff that includes a PT, and a hopefully a Chiropractor in the near future. So I’m all about uniting to improve the quality of care.

        Academically, I’ve been trained to discover the functional and anatomical consensus of excessively toned and overly lengthened musculatures, or reversely. Be able to observe, identify, and correct movement impairments. Benefits, and (through research and independent learning) the delivery of PNF, schematic compressions, and neuromuscular stretching which means knowing “what an end range feels like, tissue quality, proper assessments, and measurements.” I’m very research-based, so I apply a great deal of problem-based and independent learning to find the best solutions for my clients suffering from movement impairments or move with acute aches and pains. And truth be told, I still feel like I don’t know anything because there is so much more to learn.

        In my professional opinion, corrective and effective application of stretches and exercises are imperative to the overall outcome. In a traditional setting, a practitioner who prescribes a stretch without properly introducing the patient to the correct biomechanical positioning may be ineffective in practice. Sometimes, the patient may not understand what to feel, how to feel, and why it’s a proper stretch. In hindsight, a patient might greatly benefit from a trained professional (not holding a particular license) by manually demonstrating those hard to articulate areas, manually showing them what to feel and how to replicate the feelings independently.

        The outstanding practitioners always stand out and their services will be sought out by consumers regardless what the opposing businesses say about them.

        We have 7 billion people living on this planet, more than enough for all of us to serve. But the reality of our world is such that if it was so easy to understand, we wouldn’t be having this discussion. We wouldn’t live in a country so divided, and the extent of my words would be acceptable or at least understood. But that’s another topic of debate.

  7. Heather Osswald May 27, 2016 at 12:35 pm - Reply

    This articles displays the value duel practitioners have in the strength and rehabilitation field.

    It is also placing values on conducting yourself as a professional and understanding the boundaries of your scope. Not assuming simply because you are certified that you are fully prepared for the task. Do not get defensive, think of your clientele and what will be the optimal course for their health and goals.

    If your doctor refers you to another doctor who is a specialist in a particular field which you need, would you think any less of them for not being able to care for you or be thankful they care about your health to make sure you get the best care.

    Check the egos at the door and think of those whose health is your responsibility. Otherwise the fitness industry is in for a sad future.

  8. Lisa May 27, 2016 at 3:32 pm - Reply

    Curious as to why No mention of certified athletic trainers? I obtained a bachelors in the science of athletic training ( sports rehab) had a national licensure exam and skills competencies in anatomy, physiology, sports psych, nutrition , manual therapies, exercise conditioning, massage, supportive taping, brace making, rehab assessment and first aid care as well as hours of clinical time prior to being able to sit for the exam. I am now a DPT and a certified health coach so I understand overlaps and limitations. Am just curious as to why those ATC not noted in an area they are probably the best qualified to
    Call the hybrid. In fact they are a licensed profession in a chunk of states as well.

    • Chris Cooper May 27, 2016 at 8:44 pm - Reply

      Lisa you are 100% correct. That is an oversight on my part. ATC’s definitely fit in this area as well.

  9. […] Manual Therapy & the Personal Trainer’s Scope of Practice — John Russin […]

  10. matt hertel May 29, 2016 at 3:20 pm - Reply

    Chris, I like what you’re saying about the value of hybrid coaching, but you’re a bit off here. You’re arguing from a NY legal perspective and your own personal feelings, both of which are valid—for you. But you are aware that the laws governing manual therapy are determined on the state level, and not the federal, right? In VA, for example, as long as you are not claiming to be operating as a Certified Massage Therapist or a Licensed Massage Therapist, you can perform other equally valuable forms of bodywork—such as Rolfing or Thai bodywork. Depending on the county, you may only need a massage technician permit, which does not require certification. Also, the personal trainer certification doesn’t necessarily train you to address movement dysfunctions and impairments with corrective exercise in any meaningful way, and neither do most, if any, massage therapy schools. It’s a separate specialty, requiring much more time and attention than can be gained as just part of basic PT or CMT training. There are other, more specific, certifications and credentialing programs for movement health in the corrective exercise context, such as NASM’s CES or the FMS program.

    You’re using circular reasoning here: starting with your conclusion and then arguing it from a narrow, personal perspective, confusing is from ought. Good articles start with open-ended questions, not foregone conclusions. That’s not good journalism, or useful to anyone but yourself or those sanctioned in your article.

    Let’s not be so dogmatic, exclusionary, and absolutist in our thinking.

    • Chris Cooper May 30, 2016 at 7:40 pm - Reply

      I guess it does vary state to state. FMS has made strides to take hands on work out of their courses because of the variance in scope of practice.
      Was unaware of Virginias.

      There is however a National exam that does state certain guidelines

      What kind of open ended questions would you suggest?

    • Chris Cooper May 30, 2016 at 7:56 pm - Reply

      This is quoted from Virginia.
      Massage therapy” means the treatment of soft tissues for therapeutic purposes by the application of massage and bodywork techniques based on the manipulation or application of pressure to the muscular structure or soft tissues of the human body.

      Does that mean that you could equally claim to not be a surgeon but perform equally valuable kinda of surgery? That seems rather ridiculous. As long as I don’t claim to be ___, I can do what I want.

    • Ken Kasper May 30, 2016 at 9:18 pm - Reply

      Beautifully articulated and explained and I wish I had better adopted your tone, well done. Matt Hertel.

    • Chris Cooper May 31, 2016 at 8:45 am - Reply

      Rolfing you need to be knowledgable in manual therapy, meaning you had to have gone so some sort of school to learn.

  11. mike June 1, 2016 at 11:30 am - Reply

    good article … pain and simple.. If one does not have a license to do any soft tissue work they should not.. on the flip side if a LMT does not have the background as a Personal Trainer they should not be giving correctives at all… I have seen Personal Trainers doing soft tissue work and I know they do not ave the license to do that..

  12. matt hertel June 1, 2016 at 1:02 pm - Reply

    Chris, the difference, I think, is between top down and bottom up decision making. I’m arguing for the consumer to have the right to decide between providers (bottom up), and you seem to be advocating for government to decide who can even be a provider (top down). There’s value in both those positions and that’s why (I guess) Virginia allows for more leeway. No one said that anybody can just “do what I want.” That’s taking the argument to logical extremes—reductio ad absurdum—and nobody buys that. Consumers aren’t stupid and the law is much more strict regarding who can perform medical procedures. But we’re talking about bodywork.

    Yes, a Certified Massage Therapist / Licensed Massage Therapist performs “massage therapy.” The piece you quoted from the VA website refers to that which CMT’s and LMT’s perform, as stipulated in VA Title 18 VAC 90-50-10. But that regulation is only describing CMT/LMT’s and giving them title protection. This was required because the title ‘massage therapist’ was being used too widely, particularly for illegal services.

    To become certified as a Rolfer takes an average of about two years, including the required ten series, preliminary training, and the three phases. The entry requirements are high and it’s a very professional certification program and profession. The intent of Rolfing is different than massage therapy, and the techniques differ. It works toward structural integration for efficiency of movement through balanced structural alignment, using a variety of techniques, some of them manual. Yet, by your standards, Rolfers would not be allowed to practice because they are not CMT/LMT’s, as defined by law. Fortunately, VA recognizes that this would be overstepping their authority and so consumers can decide for themselves if they would like to work with a Rolfer.

    Likewise, if you’re ever received authentic Thai bodywork (a system in development for thousands of years) from a highly trained, highly proficient practitioner, you would have to agree that it, too, is a legitimate “manual therapy” or whatever you want to call it. Thai bodywork is all about freeing movement, optimizing performance, preventing injuries, and so on. In Thailand, manual laborers and Thai boxers receive it regularly. Isn’t practitioner facilitated movement sort of the theme of your article? Yet, again, you seem to be saying that by your standards, consumers would have to see a CMT, and not a Thai bodywork practitioner. Does that seem right?

    These are just two examples of many bodywork systems that don’t fit the CMT/LMT mold by legal definition. Further, in order for practitioners in any other bodywork systems to become certified in “massage therapy” and practice as a CMT/LMT, they would have to start from the beginning in a system they are not particularly interested in practicing. Similarly, many CrossFit people are upset at the moment at the idea of making personal training a licensed profession. This would mean that all the CrossFit trainers would have to be certified in systems different than their own, by organizations they don’t want to be affiliated or trained by, and then pass a certifying test on methods they don’t agree with. Same argument. Should people not be allowed to CrossFit? Again, a ridiculous logical extreme, but not in Washington D.C., the first state to license personal trainers.

    Maybe, open-ended topic questions could be: How can manual techniques and correctives be incorporated into personal training / strength coaching… why is there value in doing so… and what are the legalities involved?

    How, what, why, instead of should, should, should…

    Although, with everyone who has contributed to this conversation, maybe we’ve come at least part way towards answering these questions.

    • Chris June 2, 2016 at 8:10 am - Reply

      Appreciate your input Matt.
      You’re giving consumers too much credit in my opinion. Most would let trainers do what they want because they are in a position of trust and power.

      Those two forms of bodywork have extensive training. That’s way different than your average run of the mill trainer performing any sort of manual therapy on a client. Do you think most trainers are trained in Thai or Rolfing? Odds are slim.
      What I’m saying is trainers need to know where the limits are on manual manipulation.

      As for personal trainer licenses, i think egos on the certifying bodies needs to be put aside and come up with a uniform criteria. Nothing about methodology or systems. More based on A&P, kiniseology, biomechanics, contraindications, health guidelines. But that’s a whole other topic.

      I do like your questions and I think we’re working towards them. Like I said, having a network is great, and I along with many I know are lucky to work in the same building with PT’s or LMT’s.

  13. Tim June 4, 2016 at 2:49 am - Reply

    This article makes me excited as a PT currently in training to become a physical therapist.

  14. Christian June 16, 2016 at 1:39 pm - Reply

    This article does nothing but add confusion. This is why personal trainers need to be added to the health network like other practices. Most trainers have a hard time obtaining clients so when you say refer out, most people will say they cannot afford that theyre barely affording the training. We don’t have the power as a doctor to say “hey i suspect this is your problem, I have a person credentialed that will help you correct this, you medical insurance will cover this”. And the whole deal about stretching is a joke so what you’re saying is everything I learned about Static, Dynamic and PNF was for nothing because No stretching allowed and I’m really interested in seeing the success rate in that when its been found that stretching in a warm up is necessary to help prevent injury and move more effectively. Also I heard an ATC make a good point at a NSCA clinic, personal trainers interact with people’s bodies more than any other practice out there. When Physical therapy is done you wont see that person until something else happens, Gen Prac. don’t even see people but a few times a year, personal trainers see clients 2,3 maybe 5 times a day. Am I saying that means personal trainers are qualified to do what was mentioned in the article, no. I am working on becoming a “hybrid trainer” currently but I also would love to see some regulation in personal training because while you all struggle with trainers going out of practice I struggle with people who can’t name more than 5 muscles becoming trainers, or people who have no basic PT certification at all taking clients. Who polices that? There needs to be more regulation and levels and clearer practicing scope so. Personal trainer being level 1 and to become that you need to actually no about the body not just be experienced at working out and be able to pass a mediocre written exam

  15. Tom Jennings June 17, 2016 at 10:32 am - Reply

    So this feels a lot like when PT’s started TELLING ATC’s what they can and cannot do. There is a spectrum of manual therapy and at the beginning range is ROM ex’, stretching and foam rolling. The other end of the spectrum is joint mobilization & soft tissue mobilization. Yes, trainers should not be performing end of the spectrum manual therapy but to insists they can’t do stretching or foam rolling is absurd. As clinicians it’s time we engage with or fellow clinicians and quit talking down to them and marking your territory.

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  18. CMP September 1, 2016 at 4:43 pm - Reply

    With all do respect Chris, I think that you are overselling your cards here. I am a LMT and a Certified Exercise Physiologist through ACSM, I have my BS in Exercise Science and and my PES and CES through NASM….but non of that qualifies me to perform physical therapy services, and no matter what fancy buzz words you use to describe what you are advocating for in this article, you are describing the very essence of physical therapy. Sure, I see the benefit of combining exercise prescription with manual techniques and other modalities so guess what… I decided to go to PT school! You know how you say you cringe when you see unlicensed personal trainers putting their hands on clients? Well that’s the same way PTs cringe when they see people pretending to be a physical therapist by calling themselves something fancy like “hybrid coach” or “dual practitioner”. As an LMT, I have the utmost respect for the profession of massage, we receive much more education than many people think and are highly qualified to help clients with soft tissue ailments, but to think that by adding a simple personal training certificate you can work in the same space a a licensed DPT is ridiculous…the education isn’t even comparable. This frustrates me because this is exactly what confuses patients/clients and prevents them from being seen by the most qualified professional.

    On a side note you are incorrectly using the term “manual therapist”. You are a massage therapist, which can only legally perform soft-tissue manipulation. Now, soft tissue manipulation is a form of manual therapy, but manual therapy also includes the manipulation of bony tissue and the separation of joint spaces through joint mobilizations and thrust manipulations. No states allow LMTs to preform thrust manipulation and thus you should not refer to yourself as a “manual therapist”…please stick to “massage therapist” or “soft tissue specialist”.

    • Bryce September 1, 2016 at 7:38 pm - Reply

      Well said, CMP.

      This would be like getting a Doctor of Physical Therapy Degree, AND a Doctor of Pharmacy, and then trying to exist in the same space as Physicians (and especially Physiatrists).

      • Bryce September 1, 2016 at 7:46 pm - Reply

        This hypothetical “hybrid Doctor” would have loads of the highest quality training in the neuromusculoskeletal system AND in pharamkokinetics/pharmacology. The problem, of course, is that the DPT/PharmD would not have the integrative training that a physician has in order to make decisions about which pharmaceuticals should be used to influence pathology in the neuromusculoskeletal system.

        In the same way, the hybrid LMT/personal trainer does not have the training to choose which tissue interventions plus exercises should be used to correct movement disorders. That’s what a physical therapist is for.

        • CMP September 1, 2016 at 8:39 pm - Reply

          Great analogy Bryce!

  19. Ram December 17, 2016 at 11:14 am - Reply

    This is a great article and a great discussion. DPT’s are rehab specialists, you are highly educated, good! Chiropractors are joint mobilization specialists, way to go, no one can do what you do quite so well. Same goes for the Athletic trainer and the exercise physiologist. Trainers/Coaches specialize in performance enhancement. When was the last time you heard of a trainer or coach complaining of a clinician practicing performance enhancement? Does any clinician here understand the pitfalls of performance enhancement? If you did, you would understand Chris Coopers argument. It is not a perfect argument but who here is perfect? I pray there is a clinician who can answer this because the egos in this article are out of touch!

  20. Ram December 17, 2016 at 2:17 pm - Reply

    Furthermore, who here knows what it’s like to squat 750 or run a mile in 4 minutes flat! Who spent the last 7 years working on a 450 pound bench? Can a clinician here run the 40 yard dash in under 5 seconds? Do all have an average arm size of 20 inches? Surely all your years of study has prepared you. When was the last time you won a boxing title, or scaled a rock wall in under 7 seconds? As a clinician it must be child’s play. But being a DPT is the same thing as knowing what it takes to have a 50 inch vertical.

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