Personal Trainer (rehabiliation)

PT(r)

By Bill Branson (Photographer) [Public domain or Public domain], via Wikimedia Commons

Greg Plaugher, DC and Joone Lee DC

Copyright 2016
All Rights Reserved

Background/Prerequisites: MD, DC, DO, L.Ac, TCM, personal trainers, physical

therapists, massage therapists, body workers
The PT(r) works with the doctor (chiropractic, medical) and performs rehabilitation therapy
such as balance exercises/fall prevention, neurological rehabilitation (e.g. vertigo, frailty),
similar to a physical therapist, but is also well-versed in resistance training, strengthening,
lifestyle modification/coaching, sports nutrition, and weight loss. The PT(c) can perform
pre- stretching before an adjustment and also do brief (e.g. 8 minutes) massage/tuina, soft
tissue therapies, trigger point therapy and myofascial release. This course is introductory (90
hours). It provides basic educational, testing and certification services for individuals who
work as personal trainers and health or lifestyle coaches for clients and the general public, in
sport studios/and gym settings, and also individuals working as rehabilitation (e.g. physical
therapists) and weight-loss therapists in clinical settings integrated with doctors of
chiropractic, medicine and osteopathy, and allied health professionals (e.g. acupuncturists,
traditional Chinese medicine doctors).
Book: Textbook of clinical chiropractic a specific biomechanical approach. Plaugher G,
editor

Module 1 Ethics, Risk Management and Informed Consent

Ethics
Basic ethics consistent with a clinical setting. The doctor-patient relationship, the trainerclient relationship, the doctor-patient-trainer relationship.
Power/control, power differentials, boundaries, boundary violations, non-therapeutic touch,
informed consent, assault, risk management.
In the clinical setting, when the trainer assaults the patient or engages in sexual
misconduct, gratification, or begins a relationship with the patient, the supervising doctor
and the trainer carry responsibility. In clinical settings, the doctor knows or should have
known what occurs in the clinic. From an accountability perspective, when a doctor
prescribes a massage, they (the doctor) are massaging the patient through the
therapist's/trainer's hands.
The trainer-client relationship in non-clinical settings also demands the highest level of
ethics. We don't have sexual relations with our patients or clients at the hospital, at their
home, at the gym, or in the park. It's important to behave with actions and talk that are of a
nonsexual nature. Joke commentary of a sexual nature is a red flag. Melton et. al summarize
the following on personal trainers.
"Although research has identified a number of qualities and competencies necessary to be an
effective exercise leader, the fitness industry itself is largely unregulated and lacks a unified
governing body. As such, a plethora of personal trainer certifications exists with varying
degrees of validity that fail to ensure qualified trainers and, therefore, protect the consumer.
It is argued that the potential consequences of this lack of regulation are poor societal
exercise adherence, potential injury to the client, and poor public perception of personal
trainers. Additionally, it is not known whether personal trainers are meeting the needs of
their clients or what criteria are used in the hiring of personal trainers. Thus, the purpose of
this investigation was to examine the current state of personal training in a midsized
Southeast city by using focus group methodology. Local personal trainers were recruited for
the focus groups (n = 11), and the results from which were transcribed, coded, and analyzed
for themes using inductive reasoning by the authors. Qualities and characteristics that
identified by participants clustered around 4 main themes. Client selection rationale
consisted of qualities that influenced a client's decision to hire a particular trainer (e.g.,
physique, gender, race). Client loyalty referred to the particular qualities involved in
maintaining clients (e.g., motivation skills, empathy, social skills). Credentials referred to
formal training (e.g., college education, certifications). Negative characteristics referred to
qualities considered unethical or unprofessional (e.g., sexual comments, misuse of power) as
well as the consequences of those behaviors (e.g., loss of clients, potential for litigation).
These results are discussed regarding the implications concerning college programs,
certification organizations, increasing public awareness of expectations of qualified trainers,
and a move towards state licensure."

Informed Consent
Chiropractic informed consent in California. It's important to obtain informed consent from
a patient prior to any examination/assessment and again at the end of a "report of findings."
The chiropractic office visit often follows a common format known as S.O.A.P. At the
conclusion of examinations, the doctor renders a diagnosis based on a combination of
subjective and objective findings (S-subjective, O-objective). This conclusion is called the
assessment or A of the SOAP. The p refers to a plan. The plan or prescription for the
trainer/therapist to follow is included in the SOAP note. During the report of findings, the
elements of the SOAP note are reviewed, In addition medical, surgical, and natural history
options are presented to the patient, questions are answered, and the patient decides if they
want to go forward with treatment. Informed consent should be memorialized in the patient
record. An example of a first visit form, consistent with California regulations follows:
Name__________________________________I give consent to be examined for myself
(or minor child:_____________________) and to ask questions. Today's Date_________
Address_________________________________________________________________
Phone _____________Sex___Birthdate___/___/___Soc.Sec.No.(if available)_________
************************************************************************
Height_____________ Weight_____________BMI____Goal Weight________________
HR:
RESP:
TEMP.:
(Subjective and Objective findings)
REPORT OF FINDINGS and INFORMED CONSENT
DIAGNOSES:
(Assessments, Plan)
POTENTIAL RISKS & BENEFITS OF PROPOSED CARE, and ALTERNATIVESINCLUDING NO CARE HAVE BEEN EXPLAINED. I HAVE BEEN GIVEN THE
OPPORTUNITY TO ASK QUESTIONS AND I GIVE CONSENT TO DR.
XXXXXXXXXX XXXXXXX, D.C.
Patient Signature______________________________________________Date_____
Doctor Signatue_______________________________________________Date_______
Doctor's address and Contact information

In California, chiropractic trainers are unlicensed, and are supervised by a doctor of

chiropractic.
(312. Illegal Practice) of the California Code reads as follows, "Unlicensed individuals are
not permitted to diagnose, analyze, or perform a chiropractic adjustment. An unlicensed
individual is defined as any person, including a student or graduate of a chiropractic
institution, who does not hold a valid California chiropractic license. An exemption is hereby
created for student doctors participating in board approved preceptorship programs. The
permitted activities of unlicensed individuals are as follows:
(a) Unlicensed individuals may take the history of a patient. However, this activity is
separate from the consultation which at all times must be conducted by the licensed doctor.
(b) Unlicensed individuals may conduct standard neurological, orthopedic, physical and
chiropractic examinations, except they may not perform such examinations which require
diagnostic or analytic interpretations nor may they render a conclusion either verbally or in
writing regarding the patient's physical condition. As an example, unlicensed individuals may
not perform evaluations of heart or lung soundings. Such individuals shall be at all times
under the immediate and direct supervision of a licensed Doctor of Chiropractic.
Immediate and direct supervision means the licensed Doctor of Chiropractic shall be at all
times on the premises where the examinations are being conducted. The licensed Doctor of
Chiropractic shall be responsible for the verification of the recorded findings and will be
solely responsible for rendering a conclusion based on the findings.
(c) Unlicensed individuals may administer physical therapy treatments as an adjunct to
chiropractic adjustment, provided the physical therapy treatment is conducted under the
adequate supervision of a licensed Doctor of Chiropractic.
Adequate supervision shall include all of the following:
(1) The doctor shall be present in the same chiropractic facility with the unlicensed
individual at least fifty percent of any work week or portion thereof the said individual is on
duty unless this requirement has been waived by the board. The doctor shall be readily
available to the said individual at all other times for advice, assistance and instruction.
(2) The doctor shall initially examine and prepare a written treatment program for a
patient prior to the providing of physical therapy treatment by the unlicensed individual.
(3) The doctor shall provide periodic reevaluation of the treatment program and of the
individual's performance in relation to the patient. Periodic reevaluation shall mean at least
once every thirty days the patient is under active care.
(4) The doctor shall perform and record an evaluation of the patient and his or her
response to treatment at the termination thereof.
(d) Unlicensed individuals may mark X-ray films administered by a Doctor of
Chiropractic. Marking X-rays is defined as drawing and measuring between reference
points and making angular and linear measurements. Unlicensed individuals are not
permitted to make any diagnostic conclusions or chiropractic analytical listings, and the
licensed doctor is responsible for any pathological entities covered or obstructed by the
markings.

(e) Unlicensed individuals may not administer X-rays unless they hold a valid X-ray
technician certificate from the Department of Health Services, or participate under the direct
supervision of a licensed Doctor of Chiropractic in a training program approved by that
department and set forth in Section 25668.1 of the California Health and Safety Code. This
prohibition, set forth in Section 30403 of Title 17 of the California Administrative Code
includes the following activities:
(1) Positioning of patient;
(2) Setting up of X-ray machines;
(3) Pushing a button;
(4) Developing of films. The Department of Health Services has determined that
unlicensed individuals may develop X-ray film if that is their sole radiologic responsibility.
Unlicensed individuals who exceed the permitted scope of practice set forth in this
regulation shall be in violation of Section 15 of the Chiropractic Act and shall be prohibited
from applying for a California chiropractic license for such time as may be determined by the
board. Student doctors participating in board approved preceptorship programs are not to
be considered unlicensed individuals when working in said program.

Nevit Dilmen [CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0) or GFDL

(http://www.gnu.org/copyleft/fdl.html)], via Wikimedia Commons