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
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
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.
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.
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.
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.
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
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, 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
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