I was a first year physical therapy student (SPT). Until that point, I'd earned two degrees in exercise science, held several "lofty" certifications and owned my own personal training business. I worked full time as a trainer in a small private space and handled my school load without too many problems. I also found that my Master's degree actually took a lot of pressure from my course load. I was more easily able to grasp some of the movement and biophysics concepts and none of the anatomy was 100% new to me. That said, the depth which we would eventually get into the anatomy and biomechanics study was far beyond my training to that point. I was excited. I was now working toward my ultimate goal of obtaining the highest level of useful knowledge to maximize my ability to help people.
Fast Forward to today:
The realization that the public has little knowledge of the depth and breadth of a physical therapists' training compared to that of a personal trainer, athletic trainer, massage therapist, chiropractor or any number of alternative medicine practices...
Now I'm a cynic. I am highly critical of the poor exercise technique and progression education offered to physical therapists. I'm also embarrassed at the lack of quality and standards in personal training with regard to formal training, work ethic, customer service and accountability. How did my views of these once esteemed fields fall so far?
Working out the other day I couldn't help but to have an almost visceral reaction to another jabroney trainer who was "working" with a client while he alternated between staring at his phone and having a completely non-verbal conversation with another member across the gym; Oh, and the entire time was sitting down. I'm sure many of you have witnessed something like this.
I'd seen this scenario many times before but on this occasion I literally could not help myself and loudly asked 'WHY IS HE SITTING!?'. Needless to say, the trainer, the client and even I stopped in our tracks for a brief moment. I didn't expect to have this outburst and to ease tension I continued on my way. Upon looking back in that direction, the trainer was standing.
If I were only a physical therapist it wouldn't be my place to criticize this trainer. There was no OBVIOUS reason he needed to be sitting to work with his client but not all reasons to be seated are obvious. Yes, he did stand right up after I called him on it, but that might have been coincidence too. But here's the thing: my work as a trainer shaped the way I feel people should be treated when they purchase a premium service like training. This brings me back to my original thesis: Personal training is more valuable than physical therapy. This client paid a premium cost for the highest level service that this gym could offer. I have a difference of opinion as to how this service should look and feel, but that's important to me and maybe not so to this gym.
"Cost is what you pay. Value is what you GET"
The question you need to realize is 'would a person off the street pay YOU, a physical therapist, the amount they would pay their personal trainer?' Even if the above low-quality scenario isn't the norm, how do you think a random person would answer this question?
After years of asking it, I will tell you: The vast majority of clients (in the Northern Virginia area) would pay a trainer $75-$125 per hour of their time. Ask that same person about what they would pay for physical therapy and the answer is invariably, "Well, I have health insurance, so I would have to pay my $20 copay".
And that's it. This is the value difference between personal training and physical therapy. We, physical therapists, are completely to blame. We are the supposed ‘movement professionals’ but my colleagues often find themselves stumped by simple exercise and ‘return to full activity’ questions.
Why is 'Training' so important? We're just training, right?
Physical therapists spend at LEAST 7 years in formal training; earning first a Bachelor's Degree in a health related field, and then to graduate school to earn Doctorate Degrees in Physical Therapy (DPT). Once you're done with that, you study for three to six months FULL TIME to pass the NPTE (National Physical Therapy Exam for licensure). A proud achievement and each grad is excited about being able to help lots of people with their pain.
To become a personal trainer, you "must" be 18 years of age, there is NO REQUIREMENT for formal education, legitimate licensure or stringent continuing education. The number of organizations that will 'certify' someone to teach exercise and nutrition grows each day and there are no standards for these companies.
That said, the good and great personal trainers will almost always have at least a Bachelor's degree in something. The best fitness pros concentrate from an earlier time in their development in seeking relevant education. The trainers you KNOW are a crap shoot of differing experience, training and skill sets. I say that to mean for every "Jillian Michaels", there are a dozen skillful and dedicated exercise pros. However, DO NOT LET THE MEDIA FOOL YOU. A trainers' exposure has NOTHING to do with their skills or education. In fact, if you know a trainer who has appeared in TV, commercials and in every fitness magazine you can think of, you're probably looking at someone who is more of a fitness model than a fitness professional. Not a value statement, just a fact.
Another story from my past:
I was told early on that, "We train people to be physical therapists. Not personal trainers who also do physical therapy". Aside from being told outright that I should not work through my physical therapy education, this was one of the more unsettling blows to my future plans. Was I in school to do all of my work from a treatment table? Is "making sure those knee arthrokinematics are perfect" really the thing that's going to get my patients back to health? I'm glad I questioned this thought process then because it's proved to be faulty.
There is a HUGE gap between personal training in the "pain-free" public and physical medicine, the pain sciences, orthopedics and sports medicine. Since early in my career my goal has been to focus my energy on FILLING THIS GAP. Far too many personal trainers are attempting to do this. While I respect the talent of some trainers world wide, this gap MUST BE FILLED FROM THE TOP DOWN.
I don't care how many times a technician has observed cardiac bypass surgery, no one would EVER be comfortable with that person stepping outside of their scope because they thought the surgeon might have missed something.
Everyone's an expert, except the ones who aren't. The term fitness-guru is completely overdone and anyone referring to themselves as one is deserving of immediate suspicion. The reality about fbook, twitter, the blogosphere and all manner of TV and radio is such that, for the most part, only the highest trained 5-10% are the ones worth listening to. This is good as it means that there will always be good information to guide your way.
The problem is that EVERYONE is speaking. Sifting through the myth, fad, cult and propaganda that is cleverly designed to drive revenue is difficult. If you've followed this blog, you have some strategies to be your own best advocate. Research credentials. Look for legitimate sources. Make sure that statements are grounded in solid science and logical and critical thinking. That said, I'd honestly take ANY orthopedic physical therapist's exercise advice/opinion over ANY trainer even if they've never gotten their hands dirty teaching someone how to clean and jerk. Even the most novice ortho or sports physical therapist would out-duel the most seasoned fitness pro in the realm of anatomy, physiology, health and biomechanics.
A problem that therapists have is communicating this to the public in a way that truly exhibits the knowledge base. Trainers have been over inflating their knowledge base for so long (I was guilty of this once too) that it's much more natural and convincing. The reality is that most people are looking for functional power, balance, flexibility and endurance. They aren't looking to perfect their clean and jerk. For those that are, referring to a seasoned olympic movement coach is a wise move.
This post reminds me of a recent comment I made on a fbook thread that related to a blog pointing out some very serious shortcomings of my own physical therapy colleagues. The blog was a sharp indictment of the knowledge and practice of solid movement fundamentals and advice by physical therapists and orthopedic physicians. The post was by a well-known strength coach and was overall a very well done piece but I fear that information like this left unchecked is poisonous to the truth about the level of physical therapy practice that is AVAILABLE if you look hard enough.
During the conversation, a therapist I respect argued a point that wasn’t well received but I feel that this was more a case of internet syntax error than a real difference of opinion. Unfortunate too because I believe that these two highly educated therapists actually share similar views. That said, I did miss an opportunity to point out a fundamental principle that I base all of my own work, writing, speaking and teaching. That is that physical therapy MUST begin to take the formal training in movement patterning, exercise progression and real world biomechanics more seriously.
So what's the solution?
The American Physical Therapy Association (APTA) has goals for the year 2020. As is stated in their materials, the APTA is pushing for physical therapists to be:
"...recognized by consumers and other health care professionals as the practitioners of choice to whom consumers have direct access for the diagnosis of, interventions for, and prevention of impairments, activity limitations, participation restrictions, and environmental barriers related to movement,As a former physical therapy student, current physical therapist and current strength and conditioning pro, I can tell you for a fact that we are WAY BEHIND the trainers of the world when it comes to the above highlighted portion of this statement. My discipline is partially at fault: 'Physical therapy' might think that we are “above” training/trainers. This is simply not the case. In fact, the public has dictated the exact opposite. Good trainers demand high hourly rates and do a fabulous job transforming people’s lives. The level of customer service seen at a “physical therapy mill” (our term for the churn and burn factory-like settings that most PT is done in) stand almost NO CHANCE at creating perceived value for clients. Trainers who pick fights with physical therapists are making their point based on the amount of time that is afforded a client who is paying for a full hour of service. In some cases, training sessions can be shorter than an hour but the difference is that the time is devoted 100% to the client. This is a value point that my discipline MUST recognize and move toward correcting.
Until part or all of this issue is addressed we will not be considered by the public as the high-value-service provider for health; but we MUST be. Because pain is everywhere and the potential for pain is even more pervasive, physical therapists must take on a larger role in this field of influence. If our training programs don't address it, we need to seek these skills ourselves.
The short story is that while there are quite a few good/great, very vocal, personal trainers and strength coaches, their knowledge base falls far short of that of an even novice level physical therapist.
The world of physical therapy, sports medicine and REAL healing and performance will be inherited by the professionals who take their assessment and treatment of MOVEMENT to the level of the PHYSICAL THERAPIST / PERSONAL TRAINER. I like to believe that I am one of these pros, I work with several others and am partnering with as many of the rest as I can. My goal of being a true advocate for patient healing and our powerful field of practice is paramount. The "NEW BREED HYBRID THERAPIST" skillfully combines the best parts of physical medicine with high level, high energy training to produce the highest VALUE movement product available. If your goal is ALL-THE-WAY-WELL find someone who can provide this combination of care.
This group is small but growing. I'm fortunate to work with lots of students at our practice. Some have just graduated high school and are contemplating a career in PT. Others are in their undergrad studies and getting feel for what physical therapy will be like. The last and most abundant group are those who have already begun their physical therapy education. More and more of these young professionals already have backgrounds in exercise, yoga, pilates, sports... you name it. It's VERY exciting for our field, the mission of the APTA and for us as the collective movement specialists.
The winning formula: Physical Therapy + Personal Training = WIN
Dr. Carlos J Berio, PT, DPT, MS, CSCS, CMTPT is a licensed Doctor of Physical Therapy, Certified Strength and Conditioning Specialist and a Certified Myofascial Trigger Point Therapist. In addition he holds a Master's Degree in Clinical Exercise Physiology. He has treated high school, collegiate, recreational, and professional athletes of various sports including baseball, softball, football, hockey, tennis, swimming, golf and the martial arts. His experience as a collegiate and semi-professional athlete as well as a professional baseball coach make him a sought after resource among elite level athletes on the field and in the training room. The concept of 'all the way well' in his work as a physical therapist and fitness professional is what continues to drive Dr. Berio to be the best movement specialist there is. Dr. Berio is the founder of SPARK Physiotherapy in Alexandria, Virginia. A clinic and approach designed from the ground up to set the new standard for integrity and patient satisfaction in the PT industry. Carlos remains active in several sports and enjoys agility training, power lifting and adventure races. He is an advocate for his patients, clients and his fellow PT colleagues. He can be reached at email@example.com.