A structural assessment is one of the most important tools health and fitness professionals can use to gather information to better understand clients’ structural and movement dysfunctions (Price & Bratcher, 2010). The BioMechanics Method structural assessment process is designed to enable you to gather pertinent information about the musculoskeletal condition of your client’s feet and ankles in a structured, logical format. The process involves utilizing noninvasive evaluations that will not only provide you with information about a client’s structural integrity in the area you are assessing, but will also yield clues as to how that client moves in general and their possible compensation patterns. For example, if a client has flat feet (i.e., they overpronate) when standing in a static position then it is likely their feet would flatten too much when they are performing dynamic activities such as walking or running (Kendall et al., 2005).
While the assessment of a client’s feet and ankles can produce invaluable information that will assist you with the selection of appropriate corrective exercise recommendations, it can be a brand new experience for most clients. Therefore, before you actually begin the face-to-face consultation and assessment of your client’s feet and ankles, there are a number of matters you need to consider to ensure the process runs smoothly. The following guidelines regarding initial contact with clients will ensure that your assessment consultation is conducted in a proficient manner and minimizes stress for you and your client.
Making Initial Contact with Clients
- Always try to make contact with clients before their appointment to answer any questions they may have regarding the assessment of their feet and ankles. This will help reduce any anxiety they may be feeling in regard to the appointment itself or the assessment process. Contacting clients in advance will also provide you with the opportunity to let them know that you will be asking them to remove their shoes and socks for the assessment. Most people like to know this ahead of time so they can prepare their feet, ankles and legs from a cosmetic or hygienic standpoint. As such, it is not advised to surprise a current client with a foot and ankle assessment during a regular personal training session without warning them in advance.
- On rare occasions, a client may indicate to you that they are not comfortable being in bare feet for the assessment or you may hear in their voice that they are anxious about taking off both their shoes and socks. If this is the case, never insist that a client remove an article of clothing and try to find an alternative that will suit both your needs (e.g., perform the assessments while the client remains in their socks).
- In order to prepare clients adequately, it is also important to let them know what to expect during the assessment. For example, you may say something like “During the assessment I will answer any questions that you may have about your feet and ankles and perform a thorough musculoskeletal assessment to help identify the causes of your pain and dysfunction.”
- If a client has never been to your facility, gym or place of business before, provide them with accurate directions to the building or meeting area, information about parking and any other relevant issues which may be unique to your premises. Follow up after your conversation with an email detailing this information so the client can reference it on the day of their appointment.
Scheduling an initial consultation can be a stressful experience for a client. As such, do not overwhelm prospective clients with too much information when you first speak to them on the telephone or in your follow-up email. Keep your instructions concise, clear and simple. You can always elaborate on additional matters when you meet the client in person.
Structuring Your Assessments
Regardless of the area of a client’s body you are assessing, the structural assessment process consists of three distinct, but interrelated parts:
- A verbal assessment
- A visual assessment
- A hands-on assessment.
Each part of the process contributes important information to the overall assessment results. Make certain to address each in turn and do not skip any part (Price & Bratcher, 2010).
The verbal assessment is used to gain insight from clients into their interpretation of the function of, and pain in, their feet and ankles. It also helps you build rapport with clients so that they feel comfortable as you progress to the visual and hands-on portion of the assessment. You will use a Client Assessment Diagram (CAD) (which will be discussed in more detail later in this section) to ask specific questions about the client’s feet and ankles. Mark an ‘X’ on the CAD to indicate specific areas of pain or dysfunction reported. You may need to ask follow-up questions to help clarify exactly where they feel pain and/or how or when that specific pain started. Conduct the verbal assessment in its entirety at first so clients can answer all your questions while they are seated and comfortable. Bear in mind that clients will be nervous during the verbal assessment hoping that they do not forget any relevant information that may affect the success of their program. Therefore, it is important to finish the verbal assessment by reassuring clients that if they remember anything else as you are conducting the visual and hands-on assessment portion, they can simply tell you and you will make a note of it.
Visual and Hands-On Assessment
Visual and hands-on assessments are used to further assess the client’s feet and ankles. These two components of the assessment process are distinct; yet they should be carried out at the same time to make the process more practical and less time consuming. Although you may be interested in endlessly prodding and poking a client to truly understand the problems they are experiencing in their feet and ankles, the client will feel nervous and anxious standing in front of you in bare feet. Therefore, try to make the process as smooth, quick and effortless as possible, while still ensuring that both you and your client understand what you are doing during each stage of the assessment.
As the name implies, hands-on assessments will require physical contact between you and the client. You should always ask permission prior to touching a client’s feet and ankles. You should also tell clients to inform you if they feel uncomfortable, do not wish to be touched, or do not wish to continue with any of the assessments. As you perform the visual and hands-on assessment for the feet and ankles, it is imperative that you explain your actions to the client so they understand what you are doing. If a client expresses pain or discomfort at any time during an assessment, stop the assessment immediately and continue to the next assessment, if appropriate.
As you become more experienced in performing these assessments, it will become easier for you to explain things in simple terms so that clients can readily understand the process. Your clients can then start to see their particular deviations and/or imbalances for themselves and understand how these deviations are causing pain in their feet and ankles. Explaining the process to your clients can also help with adherence to the corrective exercise program you design for them. For example, imagine you are working with a client who has come to see you to address pain in his ankle. If you recommend that he start doing exercises for his feet, he may not see the value or point in doing those exercises. However, if you explain to him how his malaligned feet are causing the pain in his ankles, then he will be more likely to perform the exercises you give him to correct deviations in his feet.
You should also use the assessment process to determine for yourself how one part of the foot/ankle complex may be affecting the part you are currently evaluating. For example, when assessing a client for a deviation at the ankle, look to the feet for additional possible causes of that deviation. At the end of this section, there will be a discussion of how the feet and ankles are interconnected with the rest of the body and how imbalances in the feet/ankles can cause pain and dysfunction elsewhere in the kinetic chain. Even though you are only assessing a client’s feet and ankles, it is important to understand and remember that each individual structure is merely a link in the entire interconnected chain of the human body.
Client Assessment Diagram (CAD)
As you conduct your assessments for the feet and ankles, you will need to record all the information you gather during the assessment process. The easiest way to do this is to use the Client Assessment Diagram (CAD) developed by The BioMechanics Method specifically for this purpose.
A Client Assessment Diagram provides you with a list of basic information that should be ascertained during the initial assessment process and includes areas to record the verbal, visual and hands-on results for each area being assessed. There is also an anatomical figure to mark those areas of pain and dysfunction that are reported to you during the verbal portion of the assessment. Make quick reference marks with an ‘X’ during the verbal assessment so that your attention can remain focused on other verbal and non-verbal clues your client may reveal as you conduct the assessment.
A blank Client Assessment Diagram for the foot and ankle can be found in Appendix A at the end of this course.
Scope of Practice
In the remainder of this course you will learn the verbal, visual and hands-on assessments for the feet and ankles. You will also be introduced to corrective exercises and program design information that will prove remarkably effective in helping to alleviate your client’s foot and ankle pain and dysfunction. As you become proficient in applying these techniques, your clients will begin to see you in a different light; not only as someone they trust to help them reach their health fitness goals, but also as someone who can assist them in overcoming their musculoskeletal pain issues. As your reputation in the health and fitness industry elevates, the number of clients referred to you for pain relief issues will increase. It is also likely that more and more people will seek out your help to diagnose their painful conditions. While this positive attention is exciting for you and your business, you should always remember that, as a fitness professional, it is never appropriate to diagnose or treat a medical condition. The identification and diagnosis of such conditions should be left up to a licensed medical professional (Price, 2015).
Staying firmly within your scope of practice as a fitness professional should not be viewed as a limitation. In actuality, it is an opportunity to network with like-minded professionals to provide a more comprehensive service for your clients. Allied health practitioners and licensed medical professionals are always looking for trusted personal trainers that they can refer patients/clients to—particularly those clients who are experiencing musculoskeletal limitations/pains that prevent them from engaging regularly in exercise programs. You can become the “go to” trainer for allied health practitioners by applying your assessment skills, knowledge of muscles and movement and talents in correct exercise program design in a manner that is appropriate to your role as a fitness professional of helping safeguard clients from injury as they transition/participate in more dynamic fun athletic/gym-based activities (American Council on Exercise, 2010). Focusing on these talents and respecting the boundaries of your role in helping clients with their pain-relief issues is the ultimate way to cement your reputation as a valuable corrective exercise specialist in the health and fitness industry.