Archive for May, 2008

The 3 Pitfalls that Lead to Chronic Pain

Thursday, May 29th, 2008

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:


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.


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.

Working with Post Rehab Clients

Wednesday, May 28th, 2008

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!

The Core-Tex buzz continues…..

Saturday, May 24th, 2008

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:

Anthony Carey’s Top 10 List for Getting Medical Referrals

Saturday, May 10th, 2008

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.