I got a couple of good questions from one commenter recently. They deal with some topics I probably haven’t talked about enough on this site. Problems I spend a lot of time thinking about and working on though. I decided to make my answers their own post.
I imagine most of your clients are older people who are looking to mostly just lose weight and get out of pain. However how would you approach training a younger 20-30 year old client with interests in weight lifting and body building? Is there any exercises that you would contraindicate at all costs? The reason I ask is because it seems to me that these sports(activities?) fly in the face of the movement first approach that you generally advocate on your site and so I’d be interested in hearing your thoughts.
One of the biggest missing aspects of bodybuilding programs is the volume of horizontal pushing and pulling (horizontal and vertical) in relation to the volume of overhead work. That is, there is a ratio of approximately a shit ton to none. (This is a problem with most programs.)
Beyond that, it all depends on how a person is.
I’ll go off on a tangent here and use an example. Shoulder problems are probably the most common ailment of this group. When someone is in the pain state, which is what a lot of my writings are about, then yes, it can be very hard to “bodybuild” and get rid of pain at the same time. In a 20-30 year old, because they are almost guaranteed to be in decent health -they aren’t prediabetic- I don’t care about improving the gun show in the beginning. I care about getting them out of pain. I care about them not having surgery, how their shoulder is when they’re 50, you get the idea.
So, for a person suffering from shoulder problems, a problem usually stemming from a bodybuilding program:
-Bench pressing is a no.
-Any and all pulling is a no.
-Any and all horizontal pushing is a no. (Push ups included.)
-Bicep curls are a no.
-Squatting with a conventional barbell on the back is out. (Safety Squat Bar is ok, but few have access to this.)
-Front squatting with a barbell is out.
-Deadlifts are out.
-If the person’s shoulders are really jacked up, how they hold weights will need to be modified. (I write about this some here.)
(You’ll notice overhead work is not axed. In fact, it’s going to be something heavily focused on. I write about this here.)
In a bodybuilding sense, we aren’t left with much. The reason these things are out is because 1) They either cause pain or 2) They aren’t helping the person get out of pain. Where, if anything, they are making matters worse. Many with shoulder issues can do chin ups without pain, however, if a person has pain lifting their arms overhead, then they shouldn’t be doing an exercise which makes it harder to lift their arms over their head!
I get plenty of people where I take these things out and they aren’t the happiest, but it’s the fastest way to getting their shoulder(s) feeling better. As the person starts to improve (typically 1-3 months), then certain elements can be slowly added back in. I have progressions I use to go about this. Which exercises I start with, volume, etc. For most, this transition happens after a month. In the grand scheme of things, a month is not much to ask of someone.
I have plenty of people who bench press, do chin ups, DB presses, OH presses, squat heavy, I mean you name it, I have people do it. In a healthy person, it’s rare I don’t do these things. But, those people 1) Don’t have a shoulder history 2) Don’t have current shoulder problems 3) Have been out of pain for a while and had these things gently put back in to where they can get away with doing them again. That said, the volume of what they do (mentioned in the beginning) needs to be carefully considered. You don’t just go back to doing a ton of bench pressing and pulling and expect your shoulder pain to stay at bay.
Hopefully that makes sense. I used the shoulder as an example, but the same principles apply to other areas.
In terms of your classic movements, the most common stuff out there, the only thing I’ve gotten to the point where I don’t bother with it anymore is deadlifting. I’ll write about this one day, but suffice to say I’d give someone a lot of money if they could persuade me to have an everyday client deadlift. And this includes 20-30 year olds.
“Brian – thanks for the response. I definitely agree with your approach but the biggest problem I’ve found is that it’s hard to get people that age to back off their normal training routine for a few weeks or months. So pretty much even though we might focus on eliminating their pain during their routine, odds are pretty good that they’ll go and bench, row, squat, etc. later on that week or even that same day.
That’s why lately my thinking has started to shift to something like “Ok, how can I keep the load heavy enough so that the client is sore enough NOT to do more stuff after their session.” as oppposed to “Ok, don’t do this, this, that, oh and that too.” There’s usually a thin line you can walk with the first approach but at least it’s better than them going home and running wild on their own.”
Re: Getting people to stop certain things, that’s definitely true. It’s often quite hard. I wouldn’t say “Odds are they’ll go back to X” though. That hasn’t been true in my experience. Regardless of age. There’s a lot you can do to tilt the odds in your favor.
Again, this is going to be heavily person dependent. To start with, there is a middle ground for some:
-Floor press instead of bench press
-Safety bar squat instead of back squat
-Plank instead of crunches
-Pulldowns done in this fashion (we’re pulling but still working on good upward movement):
You can still get a solid training effect with these changes.
For others, I don’t compromise. At least not initially. That is, they shouldn’t have a bar on their back, they can’t plank with good form, they can’t floor press without anterior shoulder pain.
I get some people who have had a messed up, say shoulder, for years. Even those in their 20s and 30s. It’s rare I see someone who goes, “I’ve only had an issue for three months.” They are often more than happy to comply as long as they understand how and why it will make them better, and they understand this is not forever. This is one reason I go to exhaustive lengths to detail why something will work for somebody.
When I send people their programs I have a strategy tab where I notate pictures and write paragraphs so they understand the approach we’re taking. I often refer people to something I’ve written here so they can spend however long they want understanding the approach we take. This is actually a big reason I started this site. To send clients more persuasive arguments than I could make in person.
For in person assessments, they often last 90-120 minutes -I’ve spent five hours with people (see here (this guy was in his early 30s at the time))- often with the majority of that time spent talking. I routinely take videos and pictures of people throughout the assessment, where at the end I’ll use that media to delineate why and what is going on. I always, always make sure the person gets what I’m saying before they leave me.
I write down what they’re to do every single day of the week. One way to get people to not do other things is make it so they don’t have the time to do other things, because they’re too busy doing what they should be. I routinely give people programs where I know they are going to come back to me and go, “Is there anyway we can lessen this? I’m having trouble fitting this in with my schedule.” When I don’t hear anything from a person about this, I get nervous. Those are often the people who want to train three hours a day, everyday. (I’m looking at you, runners.)
Based on what my clients tell me, and my own experience with aspects like the physical therapy / personal training worlds, doing much of the above is highly unusual. But you HAVE to get people to buy into what you’re doing.
This is just like coaching athletes. If your athletes don’t understand what you’re doing, if you and Stalin have a lot in common, they lose faith in you. You don’t need to get people to understand the intricacies and nuances of everything, but there is a line you have to reach. This is a skill; one I’m constantly working on.
Another thing that’s great is to have a jacked up person talk to or see a formerly jacked up person. I regularly will go, “You see John over there? He had shoulder problems like you. It took him a while, but you can see him doing push ups, squatting, bench pressing, etc. now. We can do that stuff eventually, but you have to be patient.” I’ll often bring John over to talk to the person as well. (A perk of small group training.)
If they have scapular winging, I’ll show them a before and after video of someone who also had that issue.
And what else that person can do.
(Which also lets the person know I am in noway against training hard.)
If a person had knee surgery, I always make sure to tell them about my own experience. The fact they see me walking around, bending over, that I can run 10ks, all without a problem, gives them confidence in me.
I also have no problem putting fear into people. “If you continue this path you are headed down a very well traveled road. Once all the ibuprofen you’re taking starts wearing off there are the cortisone shots. Once those wear off the heavy pain killers get put on the table. Pills that are addictive as hell and kill millions of people every year. Then there is a surgery or three. Finally ending with a joint replacement.”
If they’re young, “At your age, there is a possibility of having multiple replacements due to the first one wearing out.” That they can either choose the be smart for a month or two avenue or the hellish one I just laid out. “It’s going to be hard to play catch with your kid with a shoulder that can’t move.”
Between how you communicate, how you program, how you structure sessions, there is a lot to be done to get people to come on and stay on board.
You can lead a camel to water but…
The other side of this is no matter what, some people are going to do stupid shit. I had a person I spent two hours with, made every argument I could possibly make, and it didn’t work. It not only didn’t work, I didn’t even make a dent in their armor.
This person was training in Jiu-Jitsu and I mentioned for their shoulder to get better they needed to stop letting it get held in a 1) Arm bar and 2) Pulled behind their torso. Basically, I told this person for at least a month they shouldn’t let their elbow nearly break and their shoulder nearly dislocate on a weekly basis. After that, I’m not sure another word I said mattered.
I equate this to the person who has a heart attack, has quadruple bypass surgery, the person is basically on the verge of death, and they go right to McDonald’s after leaving the hospital. The person with lung cancer, using an oxygen mask, intermittently huffing a cigarette. (The addiction world fits well here too.)
But, and this may be where we disagree, I can’t in good conscious say to that Jiu-Jitsu person they can still do that activity. I realize that’s more of an extreme example, but if you know something is not good for someone, and you recommend it anyways, you’re getting into an ethical dilemma. One in which I think the answer is almost always obvious…don’t make the recommendation.
I get what you’re saying, where you try to ameliorate. I do this with other things. The first gym I started at forced the trainers to fit people into 30 minute sessions. One of the obvious issues here is if someone is late, even only 10 minutes, 30% of the session is gone.
One of the first things I did was tell people, “Come at X time” -which was 15 minutes early- “so you can do these few warm up exercises.” This way, if the person was 10 minutes late, it didn’t matter as much. We still got our 30 minutes and I wasn’t left dicking around waiting for someone.
After talking with management a bit, and now that I’m self employed, I started giving people time windows. “Just show up between this time and this time.” I moved exclusively to smaller groups where it’s rare I have more than four people. So, even if a person is an hour late, it’s no big deal. (Not unless everyone happens to show up at the same time, which happens occasionally.) I have clients who I swear to god no matter what they will show up late. Some of whom will be an hour late, weekly, for years. It truly does not matter what time you give them. They will take that time and still be late. It’s like it’s part of their DNA that when they hear “Show up at X time” they biologically have to respond “Blow me.”
I got tired of dealing with it, so I gave into it. I have some clients who I literally tell “Show up anytime between 6am and noon. Just know I have to leave the gym at 12:30.” Problem solved. They show up at 12:15, I still leave at 12:30. Not only that, they now have zero ability to complain about what time they come in. I’m giving them six hours worth of time to pick from. They get to be the cable company, and it doesn’t matter because I’m home all day anyways.
But dealing with pain / a person’s health is different. The fact of the matter is you can’t mitigate every activity. A lung cancer patient should not smoke, period. If a person is sun burned, they have to stay out of the sun for a while, then we can talk about how to better handle the sun.
Where, whatever that activity may be, I say, “Look, if you want to do X, Y or Z, you need to know that will make this take longer, you are likely to stop it at some point when the pain gets bad enough anyways, or it may make this not work at all. It’s your shoulder, not mine, so it’s your decision, but blah blah blah…”
If the person is young enough, you can often get away with doing things they shouldn’t be doing. Even then though, if they want to hurt themselves, that’s their prerogative. Again, there is a line here. For me, it’s one of those I can’t exactly articulate it, but I know it when I see it. Sometimes you don’t know it at first, but you figure it out eventually. “We tried keeping in X and Y but you’re still not improving. Time to take it completely out.”
If a client insists on going off on their own, there are times I will drop the client. (This is also a skill.) For some, I will not be part of their affliction. There are plenty of people who genuinely want to be helped where you don’t need to spend your time talking to a wall. The ironic thing here is this can be a turning point. Some clients I’ve tried to ax end up being great clients. For those who don’t, I still end up happier because I have less stress in my life.
Figure out what that person’s line is -what they can get away with; along with your own -what you’ll put up with.