Proof That Your Client is Progressing

When dealing with a client (or patient) who has been experiencing chronic pain, particularly lower back pain, they often become discouraged at the somewhat slow progress when working towards their goals.  The first thing you want to do is the obvious...make sure they are doing what they are supposed to be doing when they are not working with you (They should be compliant with a home exercise program on a daily basis).  So that you can make educated observations on your client's progress, you should begin with a detailed initial assessment with Objective and Subjective information.  Each session, you should be writing notes not only on what exercises your client is performing, but range of motion and strength measurements, observations on quality of movement, and quantity of work performed before rest is required (Endurance or Activity Tolerance).  This is the information that you will need to show the client many times to carry them along, minimizing discouragement and depression.  So many times, I am working with a client recovering from lower back pain and I hear "my pain has not changed at all since we started."  I explain that this is common.  As they make progress in their rehab sessions, they are able to perform more work outside of the clinic.  More work outside of the clinic is just like performing more exercise or new exercise in the gym.  This causes an increase in soreness.  When I look through the chronological notes with the client/patient, my explanation usually sounds like this..."When we first started, you felt 5/10 (pain score 5 on a scale from 0-10) when getting out of bed in the morning and were unable to perform any additional activities throughout the day without the pain increasing to a 7 out of 10 on the pain scale.  Now, you are exercising daily, cleaning your house, you have returned to work and your pain level is 5 out of 10.  That's progress!!!"  Progress is not a 'black or white' situation.  It is usually slow and steady.  Explain this to your clients and open their eyes to what other details they need to be focused on in order to truly assess their own progress.  Take their minds off "pain, pain, pain," and show them the other aspects which they have made improvements in.  Your clients are looking to you for support and guidance.  They are trusting you with their health and wellness.  Give them as much information on their progress as you can.  Don't just spit out a bunch of weight and rep numbers to show them that they have improved. That information does not mean much in terms of overall functional abilities.  Keep detailed records.  Many times, clients are selective in what they remember, especially when they are  not progressing as quickly as they would like to.  Show them they are not wasting their time.

How Hard Should I Push My Client???

If you are working with a client who has one or more pre-existing medical or orthopedic conditions, you may be nervous when progressing him or her.  How aggressive should you be? 

Here are a few things to keep in mind when advancing your client.

1)Is their diagnosis recent or long standing?

You must find out whether the condition is acute (days old), subacute (weeks old) or chronic (months old).  If it is acute, you should be cautious, and advance intensity slowly.  If chronic, you may be more aggressive.

2) What is your client's reactivity?

Ask yourself: "Does a little activity causes a great deal of pain?"  If so, you need to modify.

3)Is the problem an inflammatory or mechanical issue?

Acute inflammation may present as red, swollen, hot.  It is usually better with activity due to the "moving around" of inflammatory chemicals.  Chronic inflammation presents with no resting pain, but may be worse with activity.  Is the activity you are performing creating more inflammation, rather than "flushing out" the inflammatory agents? With Mechanical issues, pain increases with activity and is better with rest.  However, there is no redness, swelling, or warmth.  If you adjust the mechanics, does the pain diminish?

4) What is the seriousness or severity of the condition? 

Is it a serious pathology that may worsen upon increased activity (Multiple Sclerosis, torn tendon/ligament, etc...)

So these are a few things to keep in mind when initiating a progression in your client's program.   They will help with your client's health and comfort level, his/her confidence level in you, the longevity of your relationship with your client, the speed of your client's recovery, and his/her return to a healthy fitness lifestyle.