Function First was incorporated in 1994.  I like to tell people that because the word “function” was not being used as every third word in a sentence in 1994 the way it is today.  As important as this topic is to human performance and rehabilitation, we should be treating it with a little more respect.

One positive note is that we are moving away from the notion that squatting on a physio-ball is the pinnacle of function.  So as an industry, we are heading back toward solid ground (pun intended).

Let’s start with semantics.  Very important semantics.  “Functional training” implies a mode of exercise, like resistance training or cardiovascular training.  Training for function implies an objective.  This is extremely important since function is ultimately determined by the individual, not the mode of exercise.

Those that believe that any exercise in and of itself can always be “functional” just by the nature of the movement are living the big lie.  They are relying on generalized movement patterns and/or props that have been used to train for function for specific individuals, but are not by default “functional”.

You could ask 50 trainers in a room to name just one functional exercise.  And inevitably you would get responses of lunges, squats, step ups, balance boards, etc.   And these all could be functional exercises, but are not by default functional exercises.  These trainers unknowing have bought into the big lie or are choosing to perpetuate it.

Before any answer to the question was given, every one of those 50 trainers should have responded with their own series of questions regarding a functional exercise:

Who?
What?
Where?

Who is this exercise for?  Is this a functional exercise for my 48 year old obese client with osteoarthritis of the knees?  Or is this functional exercise for my 13 year old female with idiopathic scoliosis?  Or is this functional exercise for my 28 year old NFL linebacker?  The answer should be different for each one.

What is the functional goal?  Is it to avoid surgery?  Is it to better prepare them for surgery?  Is it to improve their competitive performance?  Is it to avoid boredom in their workout?  Is it so they can mow their own lawn?

Where are they in their progression with you?  Is their body demonstrating the necessary movement prerequisites for this exercise?  Are they compensating to get it done versus getting it done right?  Are they exhibiting any apprehension toward the movement?

The next consideration must then be can a “functional” exercise ever be dysfunctional?  Absolutely.  A lunge for example, can produce compensation, reinforce existing dysfunction and produce undesirable mechanical stress as much as any machine based exercise.

We must first understand our client.  Then we must understand functional anatomy.  And then we can understand what function for that client really is.

It is the time of year many people ramp up their activity levels. The warm weather is upon us and longer days have will have people outside taking on all kinds of physical challenges they have no business doing. 

As their body exits from its winter hibernation, I sometimes think they left the mind sleeping.  What makes a person think that riding for 20:00 a day, three times a week on a stationary bike prepares them for getting yanked out of the water by a speed boat while holding onto a tow rope?  Or that playing 18 holes twice a month gets them ready for 72 holes over 3 days while on vacation?

If you’re currently suffering from an injury that is keeping you from exercising or requiring you to modify what you do for exercise, chances are that you didn’t get to this point overnight.  Overuse injuries and injuries that end with “itis” (meaning inflammation) are often chronic issues that have become acute.  These injuries are usually tied to a number of small incidents that have occurred over a period of weeks, months and even years.

Most people don’t stop and think about their bodies when they sustain a mild to moderate injury.  Minor injuries especially, are rarely given the time and consideration that they deserve.  It’s often the minor injuries that turn into major problems down the road.

After working with people with musculoskeletal pain for more than 17 years, I’ve identified three steps that lead to long-term musculoskeletal issues:

Denial

Most people deny the seriousness of their injury, especially when it’s something like a sore elbow from a couple of sets of tennis.  If it’s not broken or gushing blood, then it’s nothing to worry about, right?  Wrong.  Thinking that your sore elbow is no big deal or that it will clear up on its own is a mistake.  Denying that there is anything seriously wrong enables you to miss a very important window at the onset- the very beginning is when you can do so much to avoid compounding the injury.

Pain avoidance. 

We all know that the body doesn’t like pain, so when we experience pain we begin to change our habits and mannerisms in order to avoid it.  People who have chronic lower back pain are prime examples of this.  When they stand for a certain period of time, or garden, or walk, it hurts their back.  What do they do?  They start to avoid activities that are going to hurt them.  Eventually, any movement or activity that is similar to those that initially caused the discomfort will cause pain as well.  It’s a snowball effect that gradually gets worse.

If the stairs hurt your knee, you stop doing step aerobics.  The next sacrifice is to cut out squats and lunges.  At a time like this is where many folks reach their threshold.  It is here where they will seek therapy, surgery or medications for relief.

Shortsightedness. 

When people finally do take action against their pain, it is often only enough to mitigate the current symptom.  Just enough therapy to calm things down.  Or a surgery to repair the damaged part or pills to mask the pain for now….. Unfortunately, this does nothing for all the factors from the previous incidents leading to the major pain.   

Don’t blame your aches and pains on the easy cop out, “I’m getting older”.  I tell my clients, “it’s not that you’re getting older, it’s that you’ve been doing things WRONG longer”. And pain is the price that is paid.

The cumulative mechanical stress that the body has experienced demands cumulative action to first slow, then stop and finally reverse the damage.  Equally important is to recognize that it is never too late to change and it is never too late to recognize what is happening today and keep it from haunting you tomorrow. 

A corrective exercise program designed around your specific needs can literally teach your body to move and function differently.  Bad old habits can be replaced with good new habits.  This gives the body a chance to restore itself instead of breaking down more over time.

The body has a tremendous capacity for healing when given the right environment and provided the right tools.  The right exercise, proper nutrition and a healthy mind can work miracles.

As a health and fitness professional, you work closely with people on a daily basis.

Knowing and understanding your clients is key to establishing long-term relationships with them, as well as enabling you to get more referrals down the road.

People coming out of rehabilitation make up a large part of many health and fitness professional’s client base, and fully understanding their needs and tendencies can only benefit you and your practice.

Post-rehab clients fall into two main groups

Those who exercised before their medical treatment and those who did not.  Both offer a unique set of challenges that, as a health and fitness professional, you’d do well to expect and understand.

The post-rehab client that did exercise before their procedure can be a firecracker to handle.

This type of client realizes the value of exercise (and, just as important, the value you bring to their exercise) and will probably want to jump right in where they left off before their procedure.

Their mindset is …”Well, my physical therapy is done so I must be healed!”

The reality is that their insurance will only cover so many sessions, and it’s rarely enough to ensure adequate recovery.

Because of their past history with exercise they’re very likely to find post-rehab boring and tedious.

Your job is to make sure they don’t go too far too fast.

Many of these clients will religiously follow instructions until they are 80-90 percent healed, but then feel they are good enough to quit following instructions and they jump back on the horse.

It’s usually this last 10 percent that leads to chronic problems down the road.

Clients who have never exercised present an entirely different set of challenges for you.

Chances are high that you’ll be working around a host of physical problems. They might be referred to you because their doctor sees them as a high risk of heart attack due to a poor lifestyle.

But, that isn’t their only problem. If they’re overweight, they probably have problems with their knees, or their hips.

They might be seeing multiple doctors for all of their different conditions, which may lead to conflicting instructions for their exercise regime.

For example, an overweight cardio patient may need 30 minutes of walking per day to reduce her risk, but the doctor she is seeing for her degenerative hips may only recommend 15 minutes per day.

This can be challenging for you, but it can lead to some great opportunities if you know how to take advantage of them.

By acting as a “go between” between all of your client’s doctors, they’re in perfect position to see what a great job you’re doing with their patient.

This could lead to many more referrals down the road for you. Spending some time dropping off brochures and business cards would make it even easier for these doctors to pass your name along to their patients in the future!

This past week I was invited by one of the top orthopedic groups in San Diego to give a demonstration of the Core-Tex for their physical therapists. As mentioned in a previous post, the fitness industry is chomping at the bit for the Core-Tex to be available. And it will be soon.

But this was the first demo for physical therapists only. What was supposed to be a 15:00 introduction and demonstration for 6 therapists, turned into an hour and half with about 20 more therapists, assistants and several patients getting in on the act.

The Core-Tex is one of those pieces of equipment that you just can’t ignore. If you see it, first you see the fun. But then through exploration and a little instruction, the incredible therapeutic value becomes apparent.

This group liked it so much they are interested in doing a study using a population with a specific lower extremity injury and comparing the benefits of the Core-Tex to an existing protocol. Obviously, it is very rewarding when others see the value.

We believe the Core-Tex has as much value to the rehabilitation field as it does to the fitness and sports performance fields. If you have any questions on the Core-Tex or would like to be on the Core-Tex interest list, email: education@functionfirst.com

In my book, Relationships and Referrals: A Personal Trainer’s Guide to Doing Business with the Medical Community I write extensively about working with the medical community. I thought I would share my top 10 list of things to keep in mind when seeking to work with the medical community. Each of the top 10 are covered extensively in my book.

10. Be persistent

We’d love to believe that we are the most important person on the mind of your targeted referrals. The reality is that the “sales” cycle for getting medical referrals is often months. Sometimes many, many months. Plant the seeds consistently and when that first referral arrives, you’ll need to shine.

9. Nurture the best and forget the rest.

You will quickly realize that some doctors are advocates of exercise and understand your value. Others just don’t “get it” for a number of reasons. Nurture those that can help you help more people. Even get to know their practice and types of patients so you can have confidence providing reciprocal referrals.

8. Understand your certification doesn’t mean sh*t to a doctor.

Few if any medical doctors will know what the letters after your name mean. That doesn’t mean they are not of value (some of them anyway). Just don’t expect that to open doors for you. Use your education to help validate your work.

7. Don’t market to medical providers the way you would market to clients

Understand that medical professionals refer to whom they know and trust because you will be an extension of their care. They will not refer because of a brochure, web site, business card or ad. These collateral marketing materials are only supplementary to the person or business.

6. Provide them with documentation whether they ask for it or not.

Gather your client’s medical provider’s contact information. Get permission from your client to share your exercise plan with their doctor and send the doctor your assessment and plan. Send an accompanying cover letter and that exercise plan should end up in your client’s file with their provider. Your paperwork will be part your client’s discussion with their doctor at their next visit.

5. Let your reputation precede you.

Use your clients to open doors for you. If you are doing a great job with them, have them make introductions for you to their doctors. Your client should be your biggest advocate with their medical provider which can ultimately lead to more referrals once a relationship is established with that provider.

4. Don’t overstep your professional boundaries.

Most of us are in this business to help people and this may cloud our judgment when a client presents a physical complaint or limitation. Our relationships with our clients are often stronger than the client’s relationship with their doctor. Don’t attempt to diagnosis or “fix” your client because they trust you. Refer them to the appropriate medical provider.

3. Speak the language

Never communicate with a medical professional (oral or written) using terminology that you would use with your clients. An understanding of the terminology is a reflection of your level of expertise as well as being the form of communication they are accustomed to. Medical providers have professional standards they must uphold with their documentation. Providing correspondence to them in this manner also implies that you will comprehend any documentation received from them.

2. Find your niche

Working with medical referrals means working with special populations. Special populations have special needs and special risks. Know a lot about a little versus knowing a little about a lot. Do not attempt to be all things to all people.

1. Know your subject matter.

It’s not a good idea to promote to medical professionals that you do “post rehab” when you don’t know what occurs during rehab. This means from the therapeutic procedures, structures involved and contraindications. Please remember, POST REHAB IS NOT A FORM OF TRAINING. IT IS AN OBJECTIVE.

I am constantly reminded of the incredible differences between people’s commitment to their own health and well being. Those reminders are often people that walk through our front door at Function First.

Today I worked with woman who lives in Chicago, is staying in Palm Desert and drove 3 hours for her one hour appointment with me. And she is 72 years old! What an inspiration. She knows what she wants. She knows what her body needs. And nothing is going to detour her from her goals of exceptional health.

Several weeks ago I worked with a woman who was in from the United Kingdom. She has been all over Europe for help and heard about us through her personal trainer in London. And after her appointment she was thrilled beyond words. The travel meant nothing.

When do you reach your threshold? Is that when you will finally be willing to do something proactive? Is it going to take a full-blown crisis before you take the extra steps you know you need to take to prevent that heart attack or herniated disk in your back? I hope not.

After doing this work for more than 17 years, I am still astonished at the person I meet who will spend $40,000 on a car but won’t spend a dime on their health outside of what their insurance will pay for. That same person will take better care of their car then they will their own body.

The health crisis in the US is a societal issue. People placing blame and responsibility outside of themselves (how dare you not tell me how many grams of fat were in those french fries!). Your health insurance is crisis care. Not health care. How many people do you know that go to a medical provider because they feel great and just want to take their health to the next level?

Make yourself a promise and commit to moving beyond the “status quo” of your current health. Your body will thank you and your life will be much richer.

You can only tread water for so long until you begin to sink……

I just recently attended the IHRSA convention here in San Diego.  IHRSA is the largest fitness equipment trade show/convention in North America.  This show was the first time that I publicly demonstrated the invention that my good friend Olden Carr and I developed.

The Core-Tex was an amazing hit.  I couldn’t believe the response we got. Olden and I had been working on this project for many years never really giving it the effort it deserved.  We recently picked up the pace and had a pre-production prototype ready for this show.  And was it worth it!

We should have units available for retail in mid May.  Watch for the Core-Tex to be rated as one of the most innovative products for 2008.

If you want to see a couple of video clips of me using it, you can find them here on the Function First web site.

I had the privilege of being interviewed by Rick Kaselj of Healing Through Movement in Vancouver, B.C. Rick will sponsoring my final public presentation of the Foundations for Function: Movement By Design course.

Rick did a great job of having me describe the course as well as our processes with clients at Function First.

You can listen to the interview here:

It is the ultimate cover your a** statement placed on any piece of exercise equipment, exercise video, exercise book, exercise facility, etc. It comes in many variations, but the message is the same: You could die or get seriously hurt if you engage in this exercise related activity.

How’s that for encouraging our obese, lower back pain crippled society to exercise? I can’t think of a better way to scare off those who need exercise the most.

We’ve all seen a variation of this warning a million times. And anyone with a mild interest in exercise has probably become oblivious to it because they’ve seen it so many times.

This warning obviously is important to a very small percentage of the population. And even those in that small percentage should not be discouraged from starting a gentle exercise program (such as walking) before seeing their doctor.

But here is the biggest surprise of all: Your doctor is not going to tell you how to exercise because your doctor does not know anything about exercise prescription. As brilliant as he or she might be, the extent of their exercise knowledge is likely limited to their own personal experience (and for some, it’s not even that).

Even if the doctor is physically fit, there is little correlation between what he does to stay in shape and what his patient needs to do. Instead, what the physician should be doing is referring patients with risk factors to a degreed and certified exercise professional that has experience working with that type of client.

Too many physicians are not even recommending exercise in the first place. This begs the question, “Why not?!” Under what rock must a physician be living to not know about the countless studies that support the benefits of exercise on lifestyle related diseases and disabilities?

A survey, “Fitness American Style II” commissioned by IHRSA (International Health, Racquet and Sportsclub Association) found that 70% of Americans say they had an annual physical last year. But only 28% said their doctor suggested exercising regularly to improve their overall health, and only 41% said their doctor asked if they exercised regularly.

The American College of Sports Medicine has initiated a program in partnership with the American Medical Association that is “Calling on physicians to assess and review every patient’s physical activity program at every visit”.

It’s great to see this happening. But once the physician assesses the patient’s physical activity and finds out they are not doing enough-then what? This is where I believe the medical field over estimates the influence they have over their patients. Because most doctors believe that if they just tell their patients to exercise the patient will immediately follow that advice.

The reality is that these patients have never exercised or have not exercised for an extended period of time for their own reasons (whatever they may be). We refer to these as “barriers to exercise”. With all due respect to the doctors, they do not wield the same influence that their house-call making predecessors did. Patients now literally have to be scared to death before they see the consequences of their lifestyles.

One of the best ways to overcome barriers to exercise is for the doctor to provide the patient with clear directions for the next step. Since the doctor is not an exercise expert, those directions should involve a direct referral to a qualified exercise specialist.

Here is where the “check with your doctor part” becomes most valuable. The doctor’s referral should include what the patient should NOT do, also referred to as “contraindications”. This saves the doctor time and the potential embarrassment of not knowing what to tell the patient to do.

For example, the patient 6 months out from a hip replacement will have specific ranges of motion to avoid. This is great information for the doctor to include and for the exercise professional to be aware of.

Another example is the hypertensive patient on beta blockers who should not exceed 60% of their maximum heart rate. The exercise specialist can safely work within these parameters

That is step 1. The doctor documents this in the patients file and can follow up with them on their next visit.

Step 2 is when contact has been made with the qualified fitness specialist. Now that professional is in a position to use their expertise. Their expertise is not just about designing a safe exercise program. It also involves many of the skills necessary to help this person overcome many of the past barriers to exercise. Then it is the exercise specialist responsibility to communicate their assessment, objectives and plan to the physician.

During your next doctor’s visit, let them know your current exercise status. If they don’t ask, tell them anyway. Ask them for contraindications. And then ask them for a referral to an exercise specialist. If they look like a deer in the headlights with this question, tell them you know this group called Function First…..

Exercise specialist can find lots of great tools for working with doctors in my book, Relationships and Referrals: A Personal Trainer’s Guide to Doing Business with the Medical Community.

I’ve just submitted a HUGE article to PTontheNet.com titled “Corrective Exercise is Functional”. It was so big they have decided to divide it into 3 articles.

I’m really excited about this article and the justification I make for the need and role of corrective exercise in the total continuum of training….even for uninjured athletes.

The first part of the series should be online February 1st.

The article is certainly going to ruffle a few feathers. And this is a good thing.

We should all be open to challenging the thoughts and convictions of one another for the purpose of expanding our own knowledge.

If you’re not a member of PTonthenet.com, remember you can get a discount by going to the Function First sign up page:

http://www.ptonthenet.com/bam.aspx?P=79525

Stay tuned…..