A new screening approach "Injury Assessment"

All injuries are located somewhere on a spectrum ranging from "pathological" at one end to "optimal" at the other -- where the injury to the body-part has been 100% resolved. Mid-way between the two extremes is the point physiotherapists refer to as "functional", and this is the point at which the trainer can resume charge of training an injured area.

A pathological injury is one in which some or all of the following may be present:

* significant pain
* swelling, inflammation or instability
* stability (tonic / local) muscles are inhibited due to the pain
* Movement is limited.

Sometimes the injury will be obvious, but not always. The purpose of the Injury assessment, of course, is to pick up the ones in 'hiding'. All pathological injuries are high-risk to train, so the only way a trainer can operate is to work around them as intelligently as possible. The care and rehabilitation of injuries in this state lies with a qualified professional therapist (physio, osteopath, sports physician etc).

A functional injury has:

* much better range of movement
* less severe and frequent pain
* minimal, if any, swelling * much improved muscular stability and movement control

At this point, the injured part may be trained with care, with strong emphasis on appropriately progressed loading and achievement of good biomechanics. The trainer is now primarily responsible, even though the client should still be receiving physiotherapy treatment to guide them through to an optimal state.

An optimal body part moves well: neuro-muscular co-ordination has been retrained, proprioception is good, range of physiological and accessory movement is good, and strength/flexibility/durability can be developed safely.

What injury assessment is NOT

It is not diagnosis

Most trainers are quite relieved that they are not expected to figure out what exactly has gone wrong with their client, or which type of structure exactly is injured. Rather, the task is simply to categorize the injury into a "risk profile". So let's be quite clear about it, fitness instructors and personal trainers should not be attempting to dabble in injury diagnostics: this is what physiotherapists spend four years learning about at university, and a good few more years getting to be halfway good at. A trainer who casually declares that their client's niggly shoulder is down to a "rotator cuff problem" risks looking ignorant when the physio diagnoses the injury as a nerve root irritation from the neck.

So the role of injury assessment is to provide a simple 'quick screen', for the purpose of deciding what impact an injured body part will have on the client achieving their stated fitness goals. It is an easy way to encourage the trainer to make a quick decision (for which, by the way, the client will rightly hold them accountable) concerning what to do about their client's injury.

The assessment can be carried out even if the client is already being treated for the injury. In this instance, it is important to contact the clinician before the next training session, to discuss diagnostics, do's and don'ts, and to agree on the best strategy to achieve a complete recovery.

It is not trying to predict future injury

To take a body part that is not in pain and predict whether it will in the future become painful is another 'black art' that requires many years of experience to become any good at. While some trainers (particularly those working with regular sportspeople as conditioning coaches) will be involved with specific injury minimization strategies, most will take a more broad-brush "whole body" approach to their clients' fitness needs. The initial injury assessment should focus therefore on existing problems, rather than future ones. Once the client is injury-free and the trainer is more familiar with their particular strengths and weaknesses, a more individualized "prehabilitation" strategy can be developed if that's what is needed.

It is not rocket science

The questions and tests that comprise an injury assessment are not difficult. Done properly, the process takes a few minutes, and leaves the trainer very clear about which path they will take with the injury. Every injury will either be "high risk" or "low risk".

Category I: Low Risk

Train through the injury

If the injury falls into this category the trainer can decide to train through the injury with secondary support from a physiotherapist (or other relevant clinician). The trainer assumes primary responsibility for the body part and the injury. The trainer's skills of movement analysis, stretching, safe training technique, correct exercise prescription and rehab drills are the right tools to guide a client's progress from functional injury towards an optimal state of injury resolution.

Category II: High Risk

 

Train around the injury

If the injury falls into this category the job of the trainer is to explain to their client that this injury could highjack their fitness goals unless they take it seriously. They must visit a good physiotherapist urgently, who will diagnose the injury, begin treatment and set a critical path from the pathological state towards a functional state. In this situation the physio has primary responsibility until the injury again becomes functional/low risk.

 

In the second part of this article, we will look in detail at the injury assessment protocol, describing the steps that must be taken to ensure that trainers can rate every injury accurately into the appropriate risk category.

Rehab Trainer

Ulrik Larsen developed the above concepts and PT-skills for use in Rehab Trainer, the professional development course that he founded in 2005.

Rehab Trainer equips Personal Trainer's, Sports Conditionists, and therapists to identify, understand and work with clients' injuries. The Rehab Trainer courses run in Brisbane, Sydney and Melbourne during the Autumn and the Spring. For full course details, exact dates and booking details, see www.rehabtrainer.com.au, and click on your relevant capita city.