- Learn the hidden perceptions and patterns that can cause post-rehab clients to resent their injuries and even their bodies.
- Identify the four areas where the trainer can either unknowingly undermine or assist the client's healing process and wellbeing.
- Understand how fitness professionals can help clients make peace and progress by supporting a productive mindset.
Injuries and illness happen to our clients, our colleagues, and ourselves. On any given week, fitness professionals are bound to be working with someone through an injury or an illness. In fact, Dr. Mike Jones of AAHRP estimates that 50% of current personal training clientele is already comprised of post-rehab (M. Jones, personal communication, 2011).
Much information is available in regards to the programming protocols and scope of practice relating to post-rehab, but what information is available to trainers on the recovery or chronic illness mindset? Where do trainers learn how to address the client standing in front of them, who is more than just a body in need of repair?
This article is intended to supplement the tools utilized in post-rehabilitation training. The content may be applied toward any client recovering from or struggling with illness or injury.
The journey through injury or illness can feel like a lonely road. It may begin with a “moment of impact,” such as when a client suffers a serious fall or hears, "It's cancer and it has spread to your lungs." Or it may begin more subtly and develop over time, slowly encroaching on the client's life, such as acute tendonitis, osteoarthritis or diabetes.
When it hits home and becomes real to the client, many emotions can arise, often simultaneously at times (Bergelson, 2008):
- Regret, Guilt, Shame, Embarrassment
Understand that clients don't and can't leave these feelings at the door when they come in to train with you. Their emotions become part of the fabric of the session and trainers who are aware of this can take the client's current state into consideration.
Clients may experience guilt or regret for doing the action that led to their injury, or feel anger toward their bodies for not being more resilient or faster to heal. They may also become afraid that they will miss out on something, or resentful that they will be held back and lose momentum on important goals they had planned. Setbacks can be devastating. Doubts and questions are raised around themes of self-worth, identity and vulnerability. These issues are core to personal mindset and will affect the nature of the training sessions. These issues can derail even the most skillfully crafted training programs if ignored.
Clients may grapple with disruption of their own patterns and perceptions on a variety of issues, including:
- Internal & External Relationships (with the self and with others)
- Giving-receiving love
- Balance of power
Look for signs of how clients refer to themselves, their injuries or conditions, and their lives as a result of their injuries or conditions. Notice if they are displaying apathy, resentment, or disassociation from their body. Be on alert for expressions of “feeling like they are not themselves” and observe if they seem lost without being able to do the things they normally did.
Imagine a court stenographer who takes pride in being the fastest, most accurate of her peers. Then suddenly she is unable to work indefinitely due to acute carpal tunnel and tendonitis. A significant source of positive reinforcement, validation of her self-worth and possibly even what had become a source of identity is now absent from her life. Consider how over time this may impact her perception of what she can accomplish in her training when she reaches a temporary plateau or simply has difficulty performing an exercise. As she continues to be out of work, money may become tight and she may grapple with the red tape of insurance companies or government aid. She may become discouraged by the amount of time the recovery is taking or frustrated by rules, regulations and authority. By understanding what she is going through, her trainer can more adeptly help her to maintain her mindset and wellbeing throughout her training program.
Ways to Hurt or Help
No two people, or two recoveries, are identical. Likewise, clients sharing the same chronic condition will each deal with it differently. That said, there are four areas where trainers can either unknowingly undermine or assist clients’ healing process and wellbeing.
- Our language
- Our behavior
- Our treatment
- Our accomplice status
When a client looks to the trainer for an outside view, the picture reflected back by the trainer can open new perspectives, confirm existing ones and possibly reinforce perceived limitations.
In the rehab world of +/-, scoring by number value and pass/fail, patients/clients have to reconcile the assessing and judging of their performance. Trainers can phrase and explain markers (or scoring) to clients as a tool that simply gauges a specific aspect in a specific moment, rather than a reflection on the client. While they may already understand this intellectually, hearing it from the trainer can reinforce the delineation between metrics and self and thereby help preserve a positive mindset. Identifying with scores is a slippery slope and conscientious phrasing can prevent the client’s confidence and motivation from sliding down it.
How trainers act around clients, about their own body, their personal illness/injuries, and how trainers behave toward others in varying states of ability sends a strong message to clients. Clients will pick up on how we think and feel and since trainers are positioned as authorities and experts, this will likely influence how the clients see themselves.
The way in which trainers treat their own bodies communicates the value placed on health, wellbeing, tolerance, and acceptance. This affects the sense of collaboration, patience, trust, self-awareness and inter-cooperation each individual can potentially develop as a partnership between the mind and the body (or the mind, body, spirit for those who view it as such). Showing neglect for oneself or becoming fixated on certain outcomes may send signals to clients to regard themselves, their bodies and their recoveries with the same neglect.
Our Accomplice Status
If a trainer were to witness a person verbally or physically abusing another client, that trainer would step in, yes? Think of situations where it would be intolerable to sit by and allow mistreatment. Why is it any different when clients speak disrespectfully, cruelly, or violently about their own bodies? When trainers hear complaining about a “dumb” body part or self-ridicule, it is time to intervene, support and re-frame the client’s self perception. To say nothing is to implicitly approve of the behavior. Remind clients how to be kind and respectful to their own bodies.
Show them how to appreciate their body again with a refreshed perspective:
Trainer (while client is performing lower body exercise): How does that feel?
Client: OK I guess. My “bad” leg is driving me nuts. When I got here this morning, I was just trying to step out of the car and…(swats leg lightly) my dumb leg just kinda buckled. Even now after all this rehab and time it’s so pathetic.
Trainer: OK I understand those moments can be disappointing, but hang on a second. Why are you calling it a bad leg? Do you see how hard it’s working? Do you see how much of an effort your leg is making to do just what you’re asking it to do?--- And it’s overcoming incredible obstacles to do what it’s doing right now. That’s a pretty amazing leg. (Half jokingly) That leg deserves some re-spect!
In the middle of difficulty, lies opportunity.
- Albert Einstein
How to Support a Productive Mindset during Crisis
Clients in the midst of a debilitating illness or injury often find themselves in “crisis mode.” Priorities shift and life becomes about getting the basic needs met and getting through the day. Prolonged time spent in crisis mode without a way to handle the changes can wear the will of any person. Without the proper support from friends and family, or the care from appropriate professionals, a healthy self-image can suffer and at some point clients will display a debilitating mindset.
The ability to reframe a situation to maintain a productive and peaceful mindset is a skill; a mental practice that becomes habit through repetition. The trainer’s role is to support, model and guide that practice throughout sessions so that clients may have the greatest chance to reach their best outcomes.
Recovery is a Team Sport
First, recognize the support system and seek support where needed. The entire picture of the support network can be summed up as having both the macro and the micro systems:
- Micro System
- Macro System
- Complimentary Modality Approach, Interventions, Support network
Trainers, like physical therapists and other practitioners, are on the Macro Team. In addition to knowing about the body and post-rehab program protocol, trainers are ideally positioned to guide communication, influence perception and cultivate kinesthetic awareness; all of which aid a client with injury and chronic disease. When trainers model the team ethic, they encourage clients to do the same - with both the micro and macro teams.
What to Discover about Your Client
Next, your own knowledge of the client will steer you toward areas where you may need to focus on casting a positive light and provide support. Consider the following:
- Personality of your client
- Is the information you provide your client empowering or overwhelming for them?
- Is your client able to forgive?
- How does your client respond to obstacles and emotional challenges?
- Makes excuses to give up, stops training, or becomes passive
- Blames himself/herself
- Blames others
- Competes with obstacles to prove they are stronger than the obstacle or to prove they are not hurt, beaten, or conquered
- How do they “put” things? You can use the same phrases to help relate to them.
Common Reframing Opportunities
Be conscious of the words, phrases, and cues you use when communicating during training sessions. Refer to the chart below for examples of how to reframe common communications in a positive and empowering way:
|Start with your bad knee
||Start with your left/right knee
|Stand with your hurt foot in back
||Stand with your recovering foot in back
|We can’t progress to jumping until you are farther along in your rehab
||You are gaining back the strength you need for solid jumping
|Your hamstrings are too weak
||We’re going to keep building up your hamstring strength to…
|You’ve worn out your rotator cuff—that doesn’t come back
||It is vital to focus on preserving the integrity of your shoulder joint.
|You can’t …
||You’re closer to…
Reading Strong Signals
There may be times when it is clear that the client could benefit from assistance in coping with the stresses of his or her condition. It is important too, that any referrals to mental health care providers or support organizations be suggested by the trainer without a hint of judgment. Clients do not have to wait until they are in an emotional crisis to seek and benefit from professional support. Trainers can present this option as a preventative measure when pressures on the client are running high.
Other Avenues of Action
- Re-direct injurious speak. Guide your client to re-frame the idea.
- Acknowledge and appreciate team (esp. body)
- Communicate and reinforce the team ethic
- Facilitate mind-body communication and respect
- Raise awareness of each team member’s contribution, as close to moment of occurrence as possible
- Set the stage for success and safe risk-taking
- Inspire confidence in self strong enough to override momentary disappointments
- Acknowledge and celebrate victories
- Reframe disappointments to foster pro-activity
- See the aspect of joy wherever possible
Beyond exercise physiology, beyond protocols and techniques, trainers are uniquely positioned to set clients up for a sense of accomplishment. Through the conscientious care of trainers, clients are able to practice the necessary patience, cultivate and maintain a constructive mindset, which increases their ability to persevere in the presence of an injury or chronic illness. It may not be in the textbooks yet, but the results of trainers supporting the post-rehab mindset in the field indicate that day is coming.
- Interview with Dr. Michael Jones, 2011
- Bergelson, I. (2008, April 19). Injury-InJourney. Address at the Club Industry Conference, New York, NY.
- Interview with Magdalena Agabs, MA, LCSW, 2008
- Millman, D. (Ed.). (2000). Way of the peaceful warrior. Novato, CA: New World Library.