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The past few posts I have been writing about physical therapists and personal trainers quite loosely and have ruffled some feathers, it would seem.

I have received about 500 hits in the past 24 hours on just this post alone:

It got some people rather outraged – enough to write some pretty strong criticism of my non-physical therapist perspective.  But I welcome this.  I appreciate any comments people make.. just leave my mother out of it next time, ok?  😉

Here’s how I see the roles of physical therapist and the personal trainer

Right now there is a problem (and you can’t blame it on me – phew!)

I (as a personal trainer) have people asking for help with problems a physical therapist should be dealing with and physical therapists I refer out to who are dealing with clients that should be seeing a personal trainer instead (a qualified one, not some dumbbell jockey with a weekend cert).

It’s a problem because personal trainers and physical therapists are getting annoyed with each other…  Like ‘egg your house at halloween’ kind of annoyed (yep, that bad).  So rather than put myself under the microscope again, let me ask for help from YOU.

We need to connect the two worlds so they can know and trust when to pass off people and to who.

But I want you to help me (and any others) to build a bridge between the therapists and the trainers (and others perhaps).

I need your opinion on:

What personal trainers / physical therapists need to do to improve their communication with each other.

The two groups don’t really talk with each other, but rather tend to talk at each other.   If there is to be a smooth transition back and forth (which means more business and better outcomes for us all) then we must have communication.  Let’s talk in a way that helps us connect and improve rather than criticizes and encourages hostility between the two.

Let me open the batting and say this:

Any physical therapist in the Denver area is more than welcome to one of my personal training sessions for free & I will take you through a workout while we discuss theory, technique and all matters physical & personal,then have a nice cup of tea afterwards.

Who else wants to tell us what personal trainers and physical therapists need to know about ourselves (and each other!)
Bring it!  We need to know these things!

  • Selena Horner May 11, 2009 Reply


    For me to better understand personal trainers, I’d like to know how the majority of personal trainers define “optimum health.” I’d also like to know how “optimum health” is measured, the components of “optimum health” that are considered within the measurement, what activities or what actions are directed toward deficit areas of “optimum health” along with how those activities/actions are chosen, and an idea of the amount of time it takes to reach “optimum health,” and since I’m a nerd… of course, I’m very interested in the research that supports validity and reliability of the tool used to measure “optimum health.”

    Thanks for offering assistance in better understanding personal trainers and their role in “optimum health.”

    • fitprosarah May 11, 2009 Reply

      “Optimum health” was a term I heard often when working for a chiropractor. I can’t stand that term. I never use it…BUT, if I had to define it, I would say that “optimum health” is something none of us has…it’s something none of us can obtain…it’s something out of our reach, much like the “tail” used to lure Jack Russells during races (if you’ve ever watched Jack Russell racing, you know what i’m talking about). I own a Jack, lol 🙂 When you consider the fact that I live in Baton Rouge, Louisiana, and our city is surrounded by huge plants (BASF, Dow, etc) that pump out tons and tons of smoke on a daily basis…the idea of obtaining “optimum health” seems impossible. We encounter stuff day in and day out that counteracts “optimum health”…ie: second-hand smoke, pollution (mentioned above), an 8-hour desk job that wreaks havoc on one’s posture, and a sedentary lifestyle in general. Now, it’s obvious you can MOVE more…EAT better…and change up your workstation. You can also stay the hell away from smokers and maybe invest in a bubble so that you never encounter pollution…heck, maybe that bubble will even keep the UV rays away. lol

      There is no tool that measures “optimum health,” obviously.

      MY JOB as a Fitness Professional, is NOT to diagnose clients…I am not an MD. MY JOB is not to rehab a client post-injury…I am not a PT. MY JOB is, however, to educate my clients on SAFE & EFFECTIVE ways of improving their lives via MOVEMENT and proper nutrition. MY JOB involves more know-how than most realize…until they train with me…then they realize the difference. I am not your run-of-the-mill Personal Trainer. I don’t simply throw together exercises and call it a program. I don’t disregard a client’s health history and previous exercise experience. I don’t smack my gum, hold my clipboard, and stare at people in the gym while my client struggles on the bench press. THOSE “don’ts” define way too many trainers out there, and i’ll be the first to tell you. I’m proud of the fact that I take my job VERY seriously, and I work 24/7 most of the time…if i’m not training clients, i’m reading, learning, watching videos pertaining to my profession, networking with other top-level trainers, and working on programs for my clients. Oh yeah, and I make time to train myself. That’s important too! 🙂

      Jamie, I tweeted about your last post on this topic, so expect more chiming-in from top-notch pros.

  • Bill Jones May 11, 2009 Reply


    Well you’re getting pick on for the use of the words “optimum health”…hell I don’t know what it is but I do know what it isn’t…me a few months ago!!

    Nice blog…


  • John Izzo May 11, 2009 Reply

    I think you bring up a good point. I think all trainers should be rehearsed in functional anatomy and how/which muscles work at which joints. The cumulative injury cycle (which most general population clients suffer) is easily understandable if a trainer knows what they are talking about. Most physical therapists just follow a script of modalities (if X doesn’t work, go to Y, etc, etc). I think that a trainer should scratch his head and do some research on something. The info is out there–read up on McGill, Sahrahm, Cook–why limit yourselves in personal growth? When I meet a PT (and I have a few clients that are), I feel good that they respect me because I can HANG with them in a conversation, or that I DO get what they re talking about. That is important. Doctors don’t “dummy down” information when they talk to one another, so why should trainers do it when we talk to each other?

    • Kyle May 14, 2009 Reply


      I am sorry but NO physical therapist JUST follows a script of modalities. If you think this, then you have grossly misunderstood what PT is and does. Even if a patient is referred with a specific diagnosis (ACL tear, rotator cuff tear, tendonitis, frozen shoulder, etc) The physical therapist still conducts an examination and evaluation to determine that person individual impairments, problems, etc. And then formulates a PERSONALIZED treatment/intervention that includes specific exercises, manual therapy, stretching, etc, etc, etc.

      • jamieatlas May 14, 2009 Reply

        Kyle – I wrote this post to try and build a bridge on how trainers and therapists can work with each other, not to talk about what a physical therapist does. Although impressive, I know some trainers feel their clients didn’t get the level of care you are talking about. I would rather talk about about how the trainer can work with the therapist to maximize the results of their client – since that is who we all are trying to help here.

        Here’s an idea:

        If a world existed where a personal trainer wanted to ‘doubleteam’ with a client by referring them to a physical therapist to help this person improve then EVEN THOUGH the personal trainer knew less, the two could benefit by working together – if just because the PT doesn’t get to see the same people the trainer sees and could open up their market because of it.

        Are you guys getting where I am coming from? My real message is that both groups work with people that want to get better at something. Can a bridge or an understanding be found?

        One group has much more knowledge, but can both groups learn ways that they can work together in a way that builds rapport and teamwork? I know we can – we just need to focus on the fact that despite what might have been said, there are synergies.

        If you are a trainer or a therapist who has worked with the other and found it useful PLEASE talk about how you did this and what your ‘secrets to success’ were.

        Thanks guys!


      • Kyle May 21, 2009 Reply


        I understand what this post is about, but when someone posts things that are either untrue or misguided, it is fair to address these. My post was meant to address the falacies presented by the previous poster…see my post below.


  • Selena Horner May 11, 2009 Reply

    Thanks for your reply, Sarah.

    Jamie is the one who suggested the role of personal trainers in optimum health in his first blog post:

    “My truth is this:
    The therapists role has traditionally been to get the person pain free and functional. The trainers role has been to get the client to the point of optimal health.”

    Sarah, I view “optimum health” as you are describing…. basically lip service to potential customers. The perception that it sounds good so it must be good is used to lure customers customers…. but when some actual thought is put into “optimum health” and what it means that creates a sticky situation.

    Since “optimum health” is Jamie’s truth, maybe he needs to take the time to explain?

  • Christie May 11, 2009 Reply

    As mentioned previously, optimum health is certainly not easy to define. However, there becomes a point where someone has reached the point at which “skilled” PT services are no longer required. What this means generally is that the person had been able to resume most or nearly all of their functional activities; and they certainly may still need to work out and exercise…sometimes with guidance. Has this person met “optimal health”…probably not in most cases…but we can step them down to a less structured and formalized force of care. This is usually when the patient is stable in their condition and/or they have been educated well enough to understand appropriate limitations. This is where I have no problem handing a patient off to a personal trainer…in fact, I recommend it if they need further assistance in continuing to exercise. I see no reason to bill a patient’s insurance company for anything else at this point. I’ve also worked with patients who were still getting formal physical therapy, but they were things they could be supplementing their PT with by working with in conjunction with their personal trainer.

    I’ve been fortunate enough to have a couple sharp trainers in the area actually call me (with the patient’s permission, of course) so we could discuss what is and isn’t appropriate for a particular patient or where they are still lacking in their recovery.

    It’s unfortunate that our health care system does not recognize the need to cover advanced health conditioning…seeing it as a luxury rather than a necessity. Personally, I’d like to see well persons and persons done with the “skilled” portion of PT be elligible for at least 6 sessions with a qualified trainer to further encourage their health.

  • jamieatlas May 11, 2009 Reply

    Hi guys – I am just lovin’ this series of posts – I think we could totally go on the road with just the Selena, Sarah, John and Christie. With such a great collection of minds I could come along but I think it would probably just be for comic relief 🙂

    Let me address where I am coming from in regards to ‘optimal health’ – I use the term because we all exist on a continuum of ‘health’ (what is health? I think it is a permutation of a large range of factors: musculoskeletal, functional, emotional & mental to name a few.)

    I use the term because I don’t have a better word to use. However, the concept is that we exist on a continuum. When we are lower on the continuum we experience joint pain, poor health, injury and general malaise. However, at a higher point on the continuum we experience greater capacity to withstand stress, improved levels of awareness, vitality and general capacity.

    If I am being vague it is because I don’t want to confuse ‘optimal health’ with athletic performance. I have trained olympic level and professional athletes and have found some of them to be more unhealthy in some ways than many of my general population clients. Athletic performance is not necessarily the best indication of health. Think Flo-Jo.

    I certainly agree with Sarah that ‘optimal health’ is something that is not really attainable and I understand that I am not offering a measure for that as Selena has requested – the variety of what that can mean for each individual and each stage of life is so varied to label it would be to ignore the complexity of the magical thing that is a human being.

    But what is most important is the quest to attain that optimal health – to be constantly working towards improving our health no matter where on the continuum we be, be it getting rehabbed or preparing for a special event.

    That is what I mean by optimal health. To be improving in some way on a multidimensional spectrum no matter where I currently exist on that spectrum in an attempt to finely tune our bodies to be able to ‘live our best’. No matter what that might mean.

    Wouldn’t it be great if PTs could recommend 6 sessions with a qualified trainer – but how would we determine them as ‘qualified’? That is the real challenge I want to get to the bottom of.

    Since being a personal trainer can mean so many things, perhaps if we let PT’s say what they would need to know about someone that would make them ‘qualified’ that would help us out (whether they were a trainer or not).


  • Sean May 11, 2009 Reply

    I wonder.. does the problem lie within the ranks of the two professions and there communication?
    Or does the mis-communication come from the public’s warped perception and definition of these two very different professions?

  • Tyler Keeter May 11, 2009 Reply

    I have referred many folks to personal trainers following their Outpatient PT, but the patient had to take an interest in the suggestion before I did. At that point, I would call the local 24-hour fitness (where I used to work out) and speak with a trainer to let them know the situation… and then actually meet the trainer next time I was in the gym. Sometimes if I was already at the gym I would sit in on part of a personal training session with my former patient… seemed to be a good situation for everyone.

    I would encourage all Personal Trainers to simply go out to busy outpatient practices and offer lunch inservices or the like to show us what you do and how you might benefit our patients. Get to know one or two busy practices and you might have a steady flow of business. You see, we are very busy and it is up to the personal trainer to put yourself at the tip of our brain…

    Tyler Keeter PT, DPT, MHA
    Boulder, CO

  • Kyle May 21, 2009 Reply

    What do personal trainers/physical therapists need to do to improve their communication with each other?

    Personal Trainers:
    • Recognize their limitations
    • Recognize that physical therapy is the first, and most qualified, line of care in the movement, musculoskeletal, exercise arena
    • Be comfortable, and embrace, referring more potential clients for physical therapy evaluations BEFORE taking them on as clients
    • NOT try to treat pain/injury/etc no matter how minute and simple it may seem
    • Do a better job understanding what physical therapy entails and the training of PTs

    Physical Therapists:
    • Bridge the gap between physical therapy care and patient pursuit of community based fitness including personal training
    • Integrate patients into community based exercise programs (including personal training)
    • Send patients who want to pursue personal training when they are ready with specific recommendations/guidelines for the trainer
    • Reach out to/communicate with/network with trainers
    • Understanding which trainers in the area are “quality”

    If personal trainers start routinely referring patients for a physical therapy evaluation before taking them on as clients, I think they would more than reap the benefits. Establishing this type of relationship with an outpatient clinic would be invaluable. This clinic would then be sending discharged patients the way of the personal trainer. It is essentially free advertising for the personal trainer and PT. Both parties would benefit. But, personal trainers must be willing to accept physical therapy as the first course of action.


    Personal Trainer:
    “I routinely send potential clients of mine to a physical therapist for an evaluation first. This is to ensure that you are appropriate for personal training. If the physical therapist finds anything of significance he will treat you for that, and then send you to me for personal training. This is done for your, and my, safety. I just want to ensure that there is nothing that can be treated first by a PT, so you are fully ready for personal training. Further, the PT may make some specific recommendations for your exercise plan.

    Have you had physical therapy before? If so, do you have a preferred physical therapist? If not, I would suggest X, Y, and Z.”

    Physical Therapist:
    “I know you are interested in keeping up a regimented exercise program when you are done here. I know a personal trainer (or community based exercise program/class) that I routinely send patients to once they are done with physical therapy care. We can essentially start decreasing the number of PT visits as you start personal training. I will personally call the trainer and fill him in on where you at and what you have been doing making specific recommendations for your program. Then I will have you back for a follow up 4-6 weeks after you are done with PT care to check in your progress and current program. Also, the personal trainer knows me personally, so if he has any questions/concerns he can contact me directly.”

    “I (as a personal trainer) have people asking for help with problems a physical therapist should be dealing with and physical therapists I refer out to who are dealing with clients that should be seeing a personal trainer instead”

    No offense, but I think the majority of the problem is that there are way, way, way more people seeing a personal trainer who should be seeing a physical therapist. With insurance reimbursement what it is, it is very rare for someone to end up in physical therapy who does NOT need it. There only very rare circumstances when someone ends up in PT when they should NOT be in PT, but should rather be with a personal trainer. A PT can almost always provide better services than a personal trainer as a first line of service…

    CONSUMERS: Contact a PHYSICAL THERAPIST FIRST for your musculoskeletal and movement needs!!! Including, but not limited too:
    -Low Back Pain
    -Neck Pain
    -Knee Pain
    -Decreased Strength
    -Movement/Exercise Recommendations
    -Etc, etc, etc,


    • jamieatlas May 21, 2009 Reply

      Thanks Kyle – I have to agree that Trainers don’t refer out to pt’s when they should. Kyle, you being a PT in the denver area I am glad you are stepping up to the plate. If anyone knows of a great PT that personal trainers should know about who likes educating and working with personal trainers, please comment here – would love to have your details here. It can only help build relationships and improve the level of care experienced by the end user – which is what we are all here for, right?!

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