HealthPhilosophy

Dear therapist, you’re not a strength coach.

(or a personal trainer)

When I write these types of blogs, they’re mostly in reflection because of mistakes I made earlier in my career. I feel no need to be embarrassed by most of these mistakes, although I do regret some of them. Most were faults of passion with few direct casualties. But, at this point, I am willing to call them mistakes.

And here’s a mistake I made rather overtly: I called myself a chiropractor and strength coach.

It’s not a protected term and, quite frankly, I had the resume to show I could use the term and skill set at will. I started training other human beings at the age of 16 in the local YMCA and never fully stopped. But, as I matured (well…got older at least), a few stark realizations have set in for me. I know there will be many reading this who are still afloat in the same boat I was 5 years ago. For our mutual dissonance, I apologize. But I think it goes without saying that YOU, if you’re reading this as a therapist, are not in fact a strength coach.

A strength coach is not a qualification, nor is it an add-on to your current day job. It’s a vocation, a job, a profession. Let’s give strength coaches the respect they deserve.

A resume does not a profession make.

Let’s be perfectly clear about my own past: I had a Kinesiology Degree, CSCS after my name, 15 years of training others under my belt, and pretty well all the other industry qualification many strength coaches would have. I regularly attended NSCA Conferences, Perform Better Summits, and the likes. I took the continuing ed courses every other strength coach took, I worshipped all the same people they did, and read dozens —  if not hundreds —  of books on the topic (not pop-sci books, actual S&C books).

But here’s the thing…90+% of the clients who walked through my door from the time I graduated from chiro school wanted one of two things from me:

  1. How do I get rid of this pain/injury? -OR-
  2. How do I move better, so I can avoid injuries?

Even though my intervention almost always involved exercise and movement based therapies (as well as education and manual therapy to complete the three pillars I use in most NMSK cases), clients were not coming to me for exercise or athletic development; they were coming to me to remove the barriers to exercise/movement. These are categorically different.

I get a sparkle in my eye talking about the fire chief whom I had deadlifting an all time PR only 8 weeks after back surgery, or the runner who did their first ever marathon without pain, or the 60 year old lady who bottoms-up KB carried more weight than me during her shoulder rehab…BUT this speaks only to the intervention used on the person, not the profession.

I, compared to the vast majority of therapists and clinicians out there, am qualified to get people stronger, make them use load, and build more robust humans through training. But at the end of the day, a strength coach is much more than showing people exercises for the purposes of pain (and often ego).

It disrespects those who do the actual job.

I don’t know about the average chiro/physio out there, but I am not horribly confident that I could prepare an MMA athlete for a fight. Could I make them hurt less and move better through exercise/load? Hells yes. Could I develop the exact energy system and nervous system output needed from that athlete? Strong maybe. Could I take an “athletic person” and turn them into a mixed-modal, middle distance, or multi-demand professional athlete? Frankly…no. I cannot. VERY few therapists actually can (I can think of three off the top of my head).

True strength coaches don’t “exercise” people like they’d exercise a dog. They train the human system for very specific and measurable outcomes to be expressed in a very specific context. Training for fitness, training to reduce pain, and training athletes are simply not the same thing. They overlap greatly, but the end game is often quite different. Getting rid of pain and improving specific performance parameters are also fundamentally different.

Getting rid of pain? We have LOTS of options. Producing a mutant athlete (or keeping them safe from injuries while babysitting them) is much more narrow. You can educate and motivate your way into less pain. You can “exercise” into less pain. You can “therapize” into less pain. You can put weight in your clients’ hands and use it to improve pain. Unless you’re on of the select few who truly does both (Charlie Weingroff comes to mind), you are very unlikely capable of the nuance required to train an NHL athlete, an NBA star, or even the local 14-16 year olds competitive basketball team. The strength coach prototype and profession generally takes clients from lower to higher levels of specificity in athletic performance. Therapists…well…not so much…

Unless you’re capable of doing a thorough athletic assessment and implementing a regime of training/lifestyle to measurably improve energy system and nervous system output…you’re not a strength coach. Stop disrespecting those who are because you got someone to deadlift without pain.

A personal trainer is not a strength coach.

Let’s be honest…if you’re a therapist who’s putting weights in peoples’ hands (which you should, by the way), you’re closer to a personal trainer than a strength coach. This is a good thing.

I think personal trainers are THE MOST under-utilized resource we have as a Western society.

Have you seen me use any other absolutes in any of my other blogs? It doesn’t happen often, because I save it for when I mean it. I think personal trainers (yes, even the “weekend certification” ones) should be covered by all secondary insurance companies, medicare/medicaid, the VA, and be just as much a family expense as groceries. Therapists: if every single one of your clients managed to exercise 3-5 times per week with a competent personal trainer…can you imagine the effects on their overall health, pain, mood, relationships, motivation, and every other aspect of our jobs? Or imagine if every family had an assigned trainer like their family doctor? I have more love for personal training than almost any other profession out there because it simply has one of the biggest positive impacts (on a per-client basis) of all professions, including medicine. We just don’t measure the outcomes because we only measure whats broken in health most of the time. I digress. That was a preamble.

A few months ago, I took on a second job for a brief period. It was for a friend of mine who was going to get married in a romantic location on the other side of the planet and needed someone to cover his clients for a month during the festivities and honeymoon. This friend was a mobile personal trainer with a large load of long-time clients. Some of you may cringe at this, but I showed up to client 1 with no set plan. I had no training regime to follow, no exercise list, and minimal guidelines. For most clients, I got a list of their injuries/issues, what they generally wanted out of their training, and their address/phone number. Because f my background, it took me all of 90 seconds to star the warmup and figure it out as I go. I proceeded to train 50 ish client sessions in the coming weeks with very little issue and quite a bit of smiles and praise. I’d venture to say a few of those people are better off because I didn’t show up with a pre-made plan.

You should care because of this: a personal trainer can do this for a month, a strength coach should not. A month of an athlete’s off-season, fight camp, or competition prep done in this fashion could be the difference between a gold medal and not even making the finals. It could mean gassing in the 3rd round versus win by split decision.

The point I am trying to make here is that personal trainers usually have a goal in mind and specific parameters. This is how it should be. But… a strength coach has deadlines, stakeholders and highly specific outcomes. Personal trainers usually have categories of outcomes (lose weight, run a marathon, or hurt less…all of which are noble and insanely valuable to general public). Strength coaches *typically* have specific outcomes (make weight on Friday night at xxx.xx lbs, run a sub 3:00:00 marathon, improve measured speed, improved measured reaction time, hit X numbers at the meet, etc). Yes, they overlap. Don’t get your knickers in a knot.

As therapists, our goal often seems specific: get out of pain or prevent it from returning. But, if there’s anything we should have learned about pain in the last few years, it’s that pain is only specific when it is. General exercise and sloptimal loading are often (I’d estimate at 75% of the time) good enough to change pain when combined with movement alterations, education, and progressive loading strategies. And there are plethora ways to achieve this outcome in the case of sore shoulders, sore low backs, etc. There is a time and a place for highly specific assessments and interventions, where our tools become few and we must select the right one, but the average low back pain client does not fall into that category.

If our goals are broad (get rid of pain) and the tools we have to achieve this goal are practically endless, then we are not operating in the realm of the professional strength coach. We are operating in a realm much more associated with the personal trainer (who’s job is often way more fun anyway). Clearly this is not meant to detract from any one profession, I just think we need a little more honesty and awareness of what everyone is about. There will ALWAYS be overlap across many professions. And yet, I don’t see any chiros of physios say they’re also a personal trainer. Odd.

You’re not helping your own profession, just giving credence to another.

I hear almost daily “you’re not really a chiropractor though” to which I can respond in two ways:

  1. Verification of their perceptions. I did this a lot early in my career. Claiming I was a mashup of different things, depending on the client sitting in front of me and my perception of their perceptions of said mashup ingredients. It usually went “Yeah, not really. I’m more of a blah blah blah blah please-love-me-and-don’t-judge-me-for-being-a-chiropractor blah blah blah”. And heck…people came back!
  2. Doing your profession a solid. This is my preferred choice now. I have the opportunity to say something to the tune of, “I am indeed a chiropractor. There’s lots of chiropractors like me nowadays, you just happened to find me because I am so good looking and sing so sweetly”. I then proceed to explain how things are changing quite a bit and the research is showing exercise to be one of our best interventions, so more people are getting into it. “Sure, I am lucky, because I used to be a personal trainer and have a head start with almost 2 decades of training under my belt, but there’s lots of people nowadays who operate like I do. I jus happened to be the first one here in Kelowna to have a barbell in my office. Now STFU put some more weight on that bar and let’s go! 5 reps, reset after each rep then….blah blah blah”

Admittedly, if you feel threatened, feel like there’s lots of competition in your market, or need to differentiate yourself somehow, it’s really tempting to throw a million “little” qualifications after your name (seriously? FRCms is something to print on business cards now? I love it as much as the next guy…but 2 days of getting cramped on the floor doesn’t go on my business cards). Or, as in the case of my intended audience here, you could call yourself a strength coach as an extra qualification or something to make you sound better if not different. But when we do this, unless we really ARE a paid strength coach, we’re minimizing the public perception of what it means to be a regulated profession. Let your clients and their outcomes do the talking for you. If you used nothing but deadlifts and sound advice to help their back pain, believe me, their friends are going to hear about it. Stop taking the fact that you use exercise as your intervention and making it sound like it belongs in another profession. EXERCISE BELONGS IN OUR PROFESSION. By calling yourself a strength coach, people will perpetually expect manipulation from their chiro and stim form their physio. We can do better.

Say it with me “I am a [chiropractor, physio]. Come with me if you want lift (without pain)”.

It prevents collaboration.

I don’t always agree with what the strength coach down the road is doing. They won’t always agree with what I am doing either. Shocker. But, can you imagine the outrage if you caught that trainer/coach doing a cervical spine manipulation? How would you feel if their strength coach said, “Yeah I am pretty much a physiotherapist”? I’d venture to say that there may not be a whole lot of client-sharing going on.

We live in an industry where we offer INSANE value to people, and yet everyone acts scared, like there’s not enough business to go around. Even though only about 20-30% of the population sees a chiro/physio every calendar year. Let me tell you how I feel about it without any literary finesse:

Referring out (when indicated) is the biggest sign of maturity in any professional. 

This means referring to ANYONE that is more qualified than you to deal with the problem. If they only have a weekend certification, this should be no deterrent from referral of your client once you have built the trusting relationship required to do so. Do you think that the person in front of you needs tailored programming to their performance needs, regular hour-long sessions with trained eyes on them, or needs to lose 50 lbs to feel better? Here’s a crazy idea…send them to a professional. Not loosely suggest that they should get a trainer/coach. Explicitly send to a specific person at a specific location for a specific reason.

Now, think of this from the perspective of the strength coach: I hear of this chiropractor/physiotherapist across town who everyone is talking about because he claims to be a chiropractor and strength coach. Wow, he must be special indeed. I find out that he has the same “resume” as me before going to chiro/physio school. Impressive. This guy could be a great resource for me. But wait. Hold on. Does he train people? If I send a client his way, is he going to turn around and claim they don’t need me? Man, it looks like I could lose clients quite readily. Are they going to view what he does as overlapping with me? What if he doesn’t like how I train people? Is he going to try to one-up me?

Back to first person as Dr Ben. I have seen this one happen repeatedly. There is no right answer to this. I caught this happening early in my career, not because I was stealing clients from coaches, but because clients would get sent to me from X trainer and they’d find out from me that their coach was doing something that led to their problem. Oops. It’s because of my training as a therapist (and involvement in it daily) that allowed me catch this little nuance. BUT, I am also a strength coach, so now the client think that their strength coach is incompetent and asks if I can train them. Lower case “oops”. Can I train them? Sure. Should I train them? Not in a town where theres a dozen or so competent strength coaches. ESPECIALLY not if I ever want to have a collaborative presence in my community. This exact scenario was the tipping point for me in deciding to let all my S&C/Fitness certifications laps.

SFG1+, CFL-1+, FRCms, CES, DNS etc etc do NOT make you a strength coach.

I feel like this is low hanging fruit, but I’ve got to say it anyway. Following someone else’s downloaded system doesn’t make you a strength coach any more than it makes you a clinician. I see value in ALL of these, but let’s not pretend that these things mean anything besides a very specific philosophy/system. One of the reasons I started teaching Kettlebell Science Courses was specifically because I saw so many clinicians fall into one of two camps: “I don’t know anything about exercise/loading besides theraband exercises” or “I am a strength coach because I have a certificate to prove it from my weekend certification”. The reality is that you can be a great therapist, understand everything that a strength coach understands, have all the same after-market qualifications as a strength coach, and still not be a strength coach. Why? Because it’s unlikely that most people walking through your doors are there looking for a strength coach; they’re there looking for a therapist. So give them exactly that. Load em up as much as you want. Use all the tools in your tool belt. But just know that somewhere out there exists a professional strength coach who will one-up you on every single aspect of your “strength-coach-ness” and your duty is to find that person and work with them when the scenario calls for it. All the three-letter acronyms in the world following your name PAIL (see what I did there?) in comparison to the consummate professional. The professional knows what he is not. I, for one, am not a strength coach. There was a time when it felt sexy to say it. Now it feels as childish as saying “I’m not three years old…I’m three and a half“. Be the professional three year old and let the two and four year olds own their own bracket.

Sooooooo…now what? (for therapists)

This advice would have been very valuable early in my career:

  1. Take ONE course per year from the strength & conditioning community. But only so you know what’s going on in their world and can have meaningful conversations about co-managed athletes. Focus the rest of your time on becoming expert level at the things you’re uniquely qualified to do as a therapist. Why would you want to pretend to be something that requires less qualification than what you’ve got? You don’t see a surgeon pretend to be a hypnotherapist and you don’t see a lawyer pretending to be a bylaw officer. Put on your big boy hat and go become the best version of your highest qualification.
  2. Shadow a true strength coach. It is not below you to go watch a true strength coach at work and ask lots questions (just don’t get in their way). If you want to see the real skill set that sets them apart form almost anyone else, watch them train a group of 10-12 year old boys, like a hockey or soccer team. You quickly realize the hard AND soft skills of a strength coach are far different than a therapist or even a personal trainer. Herding cats has a new meaning after training a group of twenty or more 12 year old boys. Do the same thing with a personal trainer at a large gym chain and you’ll see that personal trainers have the funnest job of any of us, but we’re all extremely different
  3. Don’t be afraid to train people if necessary, but only if you know how. I have clients that I still train. But it is not long term to get to a highly specific goal. It’s because they’re half metal from a car crash and need heavy guidance in their re-introduction to the real world. They’re officers with PTSD who can’t trust anyone but me. They are post-concussion-number-3-on-the-year and want to be tracked very tightly during return to play. If they’re fit, pain-free, and motivated, send them to a strength coach or trainer depending on their goals. If you have clients who are like the ones I just described and you do not have the skill set to put big weights or high demand on them, you owe it to your community to develop a relationship with a coach who does. I dare say you may have to take it upon yourself to teach them what they need to know and support them along that journey. Which leads me to…
  4. Teach. If you are one of the few therapists out there who trained people before becoming a therapist, you owe it to your profession to show others the ropes. You should show the trainers/coaches in the area how to do a little of what you do when appropriate. You should show other therapists in your circle the best ways to load people and the contextual variables that will matter. Again, this is why I started teaching coaches and therapists that fall into this space. All parties need to know more about what all other parties are doing. Once we take ego and business interests out of the room, this is where the beginnings of true collaboration and high-brow care take place. A therapist who can deadlift 2x BW and a coach who can improve someone’s tendinopathy are a match made in heaven…if only they could learn to work together and not claim to take part of the other’s pie. Therapists NEED to get better at loading people, they just need to know that there are other professionals who should also be involved to fill the gaps in their skill set.
  5. Understand if you are pilot or co-pilot. Generally speaking, those with more education feel as though they should be “in charge” or have the final say on a matter, especially when the matter falls into their scope of practice. However, if you want to grow as a person, improve your business outlook, and sleep better at night, it is FAR more important for you to ask yourself the simple question with every client: Am I the pilot, or am I the co-pilot? The question is NOT “who has seniority?” or “who has the best training to be a pilot here?” For example, when working with surgeons, I often hear the bemoaned truism of “Surgeons do surgery, not rehab. Let them do their job and let me do mine.” You might feel as through the surgeon is trying to be the pilot when you feel as though he should be the co-pilot. Well, the same applies to you and the strength coach. Sometimes the therapist is the pilot. Sometimes the strength coach is the pilot. The goal should always be to get the client safely to their destination. Everyone must know their roles, which is always contextually determined, and lend support to the others who are serving the same clients. It is about the clients’ goals, after all. Personally, I choose co-pilot the vast majority of the time, as this allows egos to settle, businesses to run, and clients to trust the process.

What to write about next? I think it’s obvious. I shall call it “Dear trainer, you’re not a therapist”.

Let the internet disagreements…BEGIN!

7 thoughts on “Dear therapist, you’re not a strength coach.

  1. Very well written and spot on. This is a trap I need to be conscious not to fall in to. How do you navigate the a patient with a trainer/coach who is are clearly drifting out of their lane?

    1. First, it is all contextual and based on trust. If there is a trainer or coach who is overtly (as oppose to subjectively) stepping out of their role and it is a danger to their client or athlete, it is your duty to step in. Your duty is always to the client first. Full Stop. This can be done very respectfully through conversations even though they’re uncomfortable. BUT, you also have to keep in mind that the body and psyche don’t usually care about your qualifications. They care about safety (trust) and biology primarily. It’s entirely plausible that you as a clinician can give harmful inputs (both physical and other) and the coach give helpful input. So we need to make sure we’re stepping in only for the safety of the client, not for our own ego or to show a coach that they need to stay in their lane. It’s not about scope of practice; it’s about how best to serve the client in front of you. If someone is overstepping and it’s causing objective risk (either short term or long term), then step in right away. If they’re overstepping and it’s mostly just irritating, then your job should primarily be to demonstrate what you do/know to them and gain their trust so that they have better resources (and you have a platform to step in on if they go too far). But always always always start with trust. You can’t go wrong.

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