As my work in post rehab training continues, I am asked many times about when strength and conditioning coaches or trainers should “refer out” a client who is experiencing difficulty in the training program. What would constitute a referral to a physician, Physical Therapist, or other medical professional or perhaps even another trainer? Is pain your primary reason? Are poor mechanical issues the culprit? The best interest of the client should always be kept in mind and if done well and with a systematic approach, you can provide the top notch care that your clients deserve.
Rather than taking a situational approach to a referral, it has been my experience to set up a system of health care providers and include the trainer as part of that system. This network of providers are the Physician, Physical Therapist, Chiropractor, Massage Therapist, Trainer, Nutritionist, and also an alternative medical provider such as an acupuncturist or herbalist (I’m on the west coast, give me a break). Each of these practitioners can provide a piece of the puzzle that can provide the total care of the client. Each can cross refer and the client can enter the network from any of these entry points. No one provider, no matter how good they are, can provide the complete care that the client needs. There are many who think that they can provide the total care, but each has their area of specialty and training. Let’s take a look at how each of the providers can help the client and how the care can be intertwined with the Physician and Physical Therapist being the closest in working with the trainer.
Physician: The Physician is the provider that will take care of all medical needs and in many cases is the catalyst that insurance companies need if there tests, procedures, or Physical Therapy that will need to be paid for or reimbursed to the client. The Physician is also the one who clients will go to when there is a general health issue that needs to be addressed. The Physician, in many cases can make the direct referral to any of the practitioners. In the case of the trainer, the physician can provide the annual physical for the client, then based on the results, can say that some better diet and proper exercise may be the best thing to do at first prior to getting on any drug therapies for cholesterol, blood pressure, blood sugar, or obesity issues. This is where the referral to the trainer comes in. The trainer is someone who the client can trust easier because the referral came from the physician and it keeps the client from seeing the big box trainer at the chain store fitness center. If there is an injury that must be addressed, there may be a referral to the PT, with the recommendation that the client begin an exercise program after dealing with the initial injury or problem. The PT is aware of the referral to them AND the trainer and this will enable them to continue the process. We use a fitness prescription pad that the physician can write out for the client that will state whether they need conditioning, flexibility work, strength, or movement training. The physician can check off what the client needs. We have found a very high compliance rate when the physician uses this “prescription” for fitness.
Physical Therapist: The PT is the provider that will deal with any of the musculoskeletal issues that the client is having. There may be some specific mobilization work, soft tissue work, or mechanical issues that maybe needed prior to the client working on a training program. The PT may also be one that the trainer refers to when they need answers to specific anatomical, mechanical, mobility, or stability issues. It is a great idea to have a PT that you can consult with, ask questions, and refer to when needed. PT’s a great source of information. It is very important that the trainer and PT work together in the client care. We have a system with our PT’s that was developed by Mark Looper, PT and Ken Cole, PT of Olympic Physical Therapy. The system uses color coded stages of work with a client/patient. When a client is injured we place them in a stage:
RED = Pain management and ROM work
YELLOW = Begin pain free movement of the area. May work on other areas outside the clinic.
GREEN = Aggressive movements still in the clinic. Regular, limited workouts with the trainer.
BLUE = Discharge from PT, full performance enhancement with the trainer.
During the phases of rehabilitation, there is communication throughout the network with the MD, PT, and trainer. This keeps everyone on the same page and gives the client/patient a good understanding and feeling of trust that they are getting complete care.
To establish these relationships, it is best to start with the PT. Find some PT’s in your area, ask around and find out who the better ones are. Make contact with the PT and get in to talk with them about the total care of the client and that you would like to establish a relationship so that you can have someone to refer to. A big mistake that many trainers make is just going in to look for clients and a referral source. Be sure that you are giving the impression (and also believe it) that you are looking to add a service for YOUR clients by having a PT to refer to. Ask to see if you can volunteer in the clinic or observe. As you establish this relationship and send them a few clients, your clients will speak for you and if you have good communication, the PT’s will send you post rehab clients. If you are a part time trainer and are wishing to move to full time in the future, see if you can get a part time job as an aide in a clinic. Think long term for your career and don’t shy away from the experience because it pays little. The payoff will come to you in knowledge.
The PT is also you’re in to the Physician. Most MD’s will not want to speak to a trainer directly unless they have an established relationship. Many of my clients are MD’s so that helps me quite a bit. PT’s regularly market to MD’s for their business and as the clients see the MD, they will refer to the PT. If you have the relationship established with the PT, it can carry over to the MD as well.
With the health care issues that are facing our country, good, established systems of care are in the best interest of any person. If the medical field recognizes the importance of regular exercise with a qualified trainer, there will be a greater chance that trainers will be considered a solid part of the preventative medicine cycle. We are seeing a larger blend of the Strength and Conditioning fields with the Physical Therapy field. Guys like Grey Cook and Gary Gray and certainly led the way in this direction. Recognizing the various roles that each part of a network can play are a big part of reaching the best goals for your clients. Maintaining your position as a professional will also beneficial in your marketing efforts and your reputation both in the training and medical fields.