If you've recovered from an injury or surgery, are in a post-rehabilitation stage, or are living with a chronic orthopedic issue (including pain), you may want to consider exercising with a personal trainer for orthopedic conditions. The role of the personal trainer who is an exercise and fitness professional, is to understand your injury or condition and the implications it has on your life and functioning. They should be knowledgeable and skilled with assessing your movements and designing exercise programs to improve the efficiency of your movements. This involves increasing your stability, mobility, and strength. The end result may include improved posture, gait, and functional movements (for your lower body, spine, and upper body). These considerations are especially important for aging adults and seniors, and those who have lived with long term chronic musculoskeletal conditions.
It's important to keep in mind that a personal trainer with specialization in orthopedic exercise has a scope of practice to follow. Generally speaking, they are limited to observing and assessing posture, joint range of motion, and movement. They are not in the business of diagnosing injuries or conditions. They don't assess injuries or provide orthopedic rehabilitation. They are however qualified to identity movement inefficiencies and patterns, including those movements that cause pain or dysfunction. They can also refer you to an appropriate medical or healthcare professional. Your trainer should be qualified to design exercise programming to address the issues observed during assessments. And, they will be serving you in the best way possible if they implement pain free exercise sessions.
When you find a personal trainer who you like and whose background matches your preferences (along with rates you can afford), then you may be ready to start a first session. As you get to know the trainer, there are some important things to pay attention to so you can ensure your orthopedic exercise sessions are successful:
First, the trainer should be supporting you with your biggest, highest priority goals. These could be for reducing pain, increasing stability and balance, improving mobility and flexibility, more strength, extra endurance, speed and quickness, or something else you may have in mind.
Second, they should be in the habit of reminding you that your body (like all of our bodies) is not perfectly symmetrical. We are shaped imperfectly, so there is no point in obsessing over symmetry.
Third, your lifestyle habits and routines should be considered because activities of daily living have a major impact on the body and its reaction to injury or pain. This is especially true when we consider repetitive stress or strain positions and movements (like sitting for 6-8 hours a day in a chair at an office desk) that alter the length-tension relationship of muscles in our body.
Fourth, you as the client are the expert in yourself, not the trainer. You know your body best and you know what your pain feels like. The trainer should be checking in with you regularly to understand how you are feeling and how you rate your level of pain.
Fifth, if the fluidity or efficiency of your movements are continuing to stay the same or they are even worsening over the course of training (such as during a 3-6 month period), then it may be time to discontinue services with your trainer.
Lastly, your trainer should be focused on taking a client centered approach with you. This means they are asking you open ended questions (about your goals, values, motivations), supporting you with breaking down barriers that stand in the way (such as limiting beliefs and ways of thinking, fears around painful movements, or issues with time commitment to goals), and collaborating with you on exercises (discussing selection, progression/regression, readiness, comfort or confidence level, pain scale).
Now, let's discuss some specific steps to success in working with your orthopedic exercise trainer. The following are a list of the general steps to look for that your trainer should be taking with you starting with your first session and throughout your time together:
Observing and assessing your movement: To be successful, your trainer should be looking at your joints and considering any patterns of deviation or dysfunction in your kinetic chain. Don't get too stuck on analyzing any one area, but focus on the most important and obvious issues.
Identifying exercise opportunities that will provide the greatest impact: To be successful, your trainer should work with you to stay focused on the most obvious dysfunctional movement patterns and the impact of that movement on the kinetic chain. The solution should start out as the simplest one that will provide you with the most impact during your sessions and in between them.
Prioritizing the exercise program design: To be successful, your trainer should be focused on prioritizing your primary and secondary goals (stability, mobility, strength, etc). They should understand what phases of a fitness training model to emphasize and how to create an appropriate volume of exercises (amount of reps, sets, speed, load, impact), along with the right progression or regression in exercises for you.
Selecting the exercise order: To be successful, your trainer should encourage you to start with some movement preparation and warm-up activities, which may include inhibitory stretching of overactive muscles or stimulation of underactive muscles. Preparation may include around 5-10 minutes of activity that will engage underactive muscles (those that are lengthened, inhibited, or weak) or inhibit overactive muscles (those that are shortened, tight, or strong). This activity will also stimulate blood flow to tissues, lubricate joints, raise core body temperature, increase heart rate and respiration, and facilitate neuromuscular connections. There should be a neuromuscular progression of your exercise training within a session. For example, your trainer should be supporting a progression of exercises that addresses the quality of movement and emphasizes joint control in all three biomechanical/movement planes. This type of progression has an effect on functional performance, biomechanics, and muscle activation patterns of the surrounding joint musculature. It enhances your ability to produce controlled movement through coordinated muscle activity. The order of exercises should be selected to address your unique needs and goals related to neuromuscular control, stability, mobility, and strength.
Collaborating on realistic exercises to practice in between sessions: To be successful, your trainer should collaborate with you on realistic exercises for you to practice in between sessions when you are at home, work, or in the community. This means your trainer must get to know you to make recommendations that provide an incremental impact toward your goals. The exercises should be realistic to practice anytime and anywhere, regardless of the setting. This is an inclusive approach that promotes your ability to be successful with exercising in a variety of environments, using the resources on hand so you don't have to be at a gym or purchase equipment at home. It is functional and based upon the movements your body's anatomy is designed for and that you want to perform during your regular everyday activities.
So, in conclusion, please remember these steps be successful in working with a personal trainer to address dysfunctional movement patterns and to improve orthopedic conditions. Following these steps can prevent, manage, or even reverse the effects of some injuries and the resulting chronic pain. Orthopedic exercise training is intended to support positive neuromuscular and proprioceptive (the sense though which we perceive the position and movement of our body) changes for balance, sensation, quickness, and reactivity. Its intended to increase overall strength and muscle mass. You will be more likely to experience improved stability and mobility, which is associated with improved joint range of motion and function.
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