(This is an edit from my original blog posted on 6/1/23)
What lane am I in as a physical therapist? What lane is a personal trainer in? I am biased from my experience as a personal trainer turned physical therapist and I will say, an orthopedic physical therapists should be in all the lanes. I'm updating this as a podcast I listened to, Finally Fearless with Dr. Mel made some good points.
For a bit, the phrase ‘stay in your own lane’ was popular. I’ve been wondering what it even means. I think of my profession of physical therapy and what that means. Under my state practice act, I am allowed to perform therapeutic exercises therapeutic activities neuromuscular verification manual therapy soft tissue mobilization and patient education. Wellness is one of those areas that sounds like Physical Therapists are encroaching on.
Because of social media of what it is and how far reaching it is sometimes I see people pedaling wellness or exercise and they say things that are so watered down that it teeters on being incorrect and all I want to say is: STAY IN YOUR LANE. But it's not because I'm trying to get gate-keep exercise. Physical therapist prescribing exercise can be very different than a personal trainer, a personal trainer typically works on how people look (not all of them and not always) and building muscle. I know that's an oversimplification but for sake of argument we're going to go with that. Personal training isn't something you can just walk into from the street and just start doing. If you go into a gym with a decent reputation, their personal training staff will have a nationally recognized personal training certification.
That's where physical therapist and personal trainers differ. When I was a personal trainer, I had my NSCA personal training certification for almost 10 years, and I let it lapse to pursue something else, mostly focusing on my physical therapy career. Now as a physical therapist I am allowed to prescribe exercise which sometimes looks similar to what personal trainers do, but there is a deeper understanding of how the joints move, how the soft tissues respond to movement and how the brain takes in information. Is there overlap between personal trainers and physical therapists? Yes, there should be. Neither profession owns a squat, a row or a heel raise. But when I hear a personal trainer tell me they know more than a physical therapist, I have questions. Some personal trainers have 4-year degrees in exercise science and even master’s degrees or, they’re even ATCs (athletic trainers). To drive the point home, a physical therapist has a 4-year bachelor degree and a 3.5-year doctorate; yes… we are doctors of physical therapy.
I’m rambling a little bit but bear with me. Physical therapists typically work with 4 primary codes if you will. Therapeutic exercise, therapeutic activities, neuromuscular reeducation, and manual therapy. Out of order: therapeutic activities are the activities that you need to be a human-moving from sitting to standing, standing to sitting, laying to sit, sitting to laying and walking. Is sit to stand a fancy way of saying squatting? Yup. (It’s a technical loophole we use when a physician says no squats See this blog) When a personal trainer has someone squat, sometimes they’re preoccupied with the alignment of the knees over the toes or with making sure they’re preventing dynamic knee valgus (knees caving in). Is it a bad thing? Not always. A physical therapist understands there is correct for a person’s body, not for everyone. I’ve learned in the past 8 years of practice, not everyone’s form needs to be corrected. Neuromuscular reeducation: The brain really runs everything; knowing what to look for in someone with MS or Parkinson’s when they’re fatigued, working with someone with neuropathy secondary to diabetes or someone with cerebral palsy is a learned skill that you need the foundation of from a physical therapy program. Yes, there are some trainers who have been working a long time and have spoken to physical therapists or work with physicians, but it will never replace sitting in a lecture and synthesizing the information. In real time, when you’re in clinic, coming up with a plan of care that takes into consideration these conditions takes time and effort.
Therapeutic exercises: this is where there is the most overlap. A squat is a squat. A pushup is a push up. A straight leg raise is a straight leg raise. The question is: why? Back in my training days, I would use bridges, straight leg raises and long-arc quads as a warm-up. Looking back, I have no idea why I did that, but I also somehow in the recesses of my brain, I knew it would help knee pain but had no idea why. As a physical therapist, I know that those exercises help strengthen the muscles of the quads help decrease the amount of force that goes through the joint surfaces, additionally how important it is to strengthen the muscles of the hip. I could go on for days about the gait cycle and how the body moves when walking but no one wants to read that long of a blog. When a person does a push up, most personal trainers should be able to tell their client the pec major and triceps are working together. A physical therapist should be able to say it is horizontal ADDuction of the humerus while in flexion, what the range of motion is, and when the pecs and triceps fire. When it comes to post-surgical treatment, it’s a different animal. Personal trainers can read as much literature as they want, they do NOT know how to rehabilitate post-surgical people. As a physical therapy student, we study the big surgeries and how to treat most the post operative cases, but we don’t even get the full picture in lecture. We learn how to treat post-surgical cases, it is in clinic with our clinical instructors who are fully licensed clinicians. Even as a novice clinician, it takes work and mentoring to rehabilitate a knee replacement, let alone a shoulder replacement. Fun fact: some surgeons will only refer to a select group of physical therapists to rehabilitate a shoulder replacement and some doctors will refer a physical therapist by name.
Manual therapy… I have only been practicing for 8 years and I feel like this is the final frontier for me. In school, you juuuuust barely learn how to touch people. As you start to practice, you start noticing how people respond to your hands. If you want to be a decent therapist, you start looking at the cues your patients give you. Do they cringe? Do they physically tense up? I thought I knew what I was going until I read up on a condition and I took a manual therapy course. This course changed the way I treat my patients. After 16 hours over the course of a weekend, I learned how to feel exactly when my patient starts to feel a stretch, when they feel discomfort and when their body can’t physically tolerate the motion anymore. I can promise a personal trainer can’t feel those nuances and I stand behind that because there are a LOT of physical therapists that do not know how to feel the change in tissue tensions. Knowing what I don’t know with manual therapy keeps me excited about what I do, because I know learning more will help my patients.
As I said above, I was listening to a podcast a podcast by someone I admire; Dr. Melissa Cioffi (@drmel_pt) and she had put out a podcast on this topic about 12 hours after I originally posted this blog. She made some really good points when comparing physical therapists and certified personal trainers, and when you should see one over the other. (Listen to the podcast here) She did a really good job at comparing both professions as she also had experience as a personal trainer before becoming a physical therapist. Dr. Mel also has a post on her Instagram the other day and her bottom line was: Vet. Your. People. Which brings me to wellness. Wellness is the wild, wild west. It is. It’s an unregulated term and literally anyone can provide wellness which brings me back to staying in your appropriate lane. It’s admirable to want to genuinely help people with their goals whatever they may be. But…check if that person is in their lane. I know schooling and certifications aren’t for everyone but they help. Check the provider's background, ask questions. I am always willing to answer questions that anyone might have: (Email me). As a PT who provides wellness, I make sure people know the difference between wellness and physical therapy because it’s the right thing to do. I could write this as 10 page term paper, but I won't. Long story short, physical therapists are in all the lanes, but not all personal trainers are in the right lanes.