A big issue I have noticed in the fitness industry, in general, is personal trainers going outside their scope of practice. These days functional training has taken over the personal training industry as the best evidence based practice. However, I believe this has lead to many trainers crossing the line of their qualifications. Many health clubs and personal training studios have their trainers perform things such as postural assessments and functional movement screens to diagnose potential problems to normal everyday activities. How many trainers are actually trained to do this? For example, I have seen X-rays of people that look like they have exaggerated postures when looking at their skin but the X-ray shows nothing abnormal. In this context, if we attempted to correct the situation, we could actually be doing more harm. The question I feel needs to be answered is: are we really qualified to diagnose anything?
I see a lot of “functional” trainers walk a fine line between physical therapist and personal trainer by diagnosing problems (muscle imbalances, joint pain, etc.) and attempting corrective exercises to fix the problem. Is this really within the scope of practice of a personal trainer? Let’s take a closer look at some definitions of scope of practice by the American Council on Exercise (ACE), American College of Sports Medicine (ACSM) and National Strength and Conditioning Association (NSCA). These are three very well recognized and established personal training certifications within the fitness industry. The NSCA developed a practitioner definition for their premier certification, the Certified Strength and Conditioning Specialist (CSCS), which states that the CSCS is a professional who “practically applies foundational knowledge to assess, motivate, educate and train athletes for the primary goal of improving sport performance.” It further states that it is the job of a CSCS to consult and refer athletes to medical, dietetic, athletic training and sport coaching professionals when appropriate. ACE says nothing in their definition of a personal trainer’s scope of practice about diagnosing abnormalities. It does mention that trainers can develop and implement programs for individuals who are apparently healthy (what does “apparently healthy” really mean? Is it a judgment call?) or have medical clearance. Similar to the CSCS practitioner definition, it specifically says a trainer’s job is to “recognize what is within the scope of practice and always refer clients to other healthcare professionals when appropriate”. The ACSM states that “The ACSM Certified Personal Trainer is a fitness professional involved in developing and implementing an individualized approach to exercise leadership in healthy populations and/or those individuals with medical clearance to exercise”. There is nothing in their scope of practice statement that says a trainer should be able to diagnose and/or treat any ailments. These statements are echoed by Eickhoff-Shemek & Deja (2002) in their article “Four steps to minimize legal liability in exercise programs”. Sean Riley, a licensed attorney and exercise physiologist, warns us that a trainer legally can only design and implement training programs (Riley, 2005). He further states that acting outside of this scope is to unlawfully practice medicine (Riley, 2005). Trainers can be found guilty of a crime if they “practice or attempt to practice, or…advertises or holds himself or herself out as practicing, any system or mode treating the sick or afflicted…or who diagnoses, treats or operates for or prescribes for any ailment blemish, disorder, injury or other physical or mental condition…without being authorized to perform such act…” (Herbert & Herbert, 2002). This was specifically written for California but many states have similar statutes. As with the aforementioned scope of practice statements by the NSCA, ACE and ACSM, Riley points out that it is “…up to you to refuse clients whose needs exceed your abilities and knowledge”. This opens up a whole new can of worms as most trainers are paid on commission thus making it difficult to turn clients away.
To me, it IS appropriate for us, as exercise professionals to notice limitations in our clients. This could range anywhere from limitations in ROM, strength, coordination and even mental capacity. From here, unless you are a qualified professional, it is our job to work around these issues while keeping our clients active and healthy and not make the problem worse. Bottom line: personal trainers must keep themselves in check and know when their job ends and another professional’s begins.
Eickhoff-Shemek, J. & Deja, K. (2002). Four steps to minimize legal liability in exercise programs. ACMS’s Health and Fitness Journal, 4(4), 13-18.
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