The Fragile Post-Rehab Client Who Can’t Lift

Chances are, you have someone at your gym who feels like their body is not cut out for the regular strength training routine. They’ve recently been discharged from PT, recovering from surgery, have a replacement of some sort, or have some chronic pain issue that no one has been able to figure out.

These clients might have been hurt by uneducated trainers in the past, which leaves them scared that they’ll be pushed beyond their limits. The last thing these clients want is more pain and discomfort.

Maybe a medical professional scared them of weight training by telling them that squatting and deadlifting would leave them hurt or injured.

These clients might have been fed ideas by other professionals going out of their scope or Dr. Google, and now believe they have fractures, tears, joints out of place, or other random dysfunctions that they most likely don’t have.

A lot of these people tend to stay away from gyms and lifting weights. They believe that low level activities like yoga and pilates are the only things their bodies are capable of doing.

Through physical therapy that didn’t fully rehab, unexperienced trainers, misinformation on the internet, and a no pain no gain fitness culture, these people are scared, and they have every right to feel that way.

As a coach, you can’t take that feeling away on day one, or you’ll never fully gain their trust. You’ll get little to no results. They might even stay with you, but they will always feel misunderstood by you.

Even though these people feel like they’re fragile as glass, and they think moving and lifting can be dangerous, they’re not broken. They won’t shatter if you have them get after in the gym.

HOWEVER…

You can’t treat them like your regular client that came to you specifically for aesthetic and strength goals.

You must meet this client at their story through appropriate progressions, building trust, and bringing awareness back to their own body. By working in this fashion, these clients can perform a strength training program just like any other client.

Unfortunately, that’s easier said than done.

How are you going to take someone that feels like delicate glass to feeling like a bulletproof window?

How do you convince these people to try new movements with confidence, when they think they’re one movement away from (re)injuring themselves?

How are you going to build enough trust so when the time comes, and they pick up the 62lbs KB off the ground, they truly believe their body is capable of doing it without hurting themselves?

How are you going to convince someone who believes they’re not capable of doing anything other than rehab exercises on the ground, to believing they can build a strong confident body by lifting weights?

Fortunately for you, it’s what I do on a daily basis, and I’m going to show you how I’ve been doing it for the last several years 🙂

90% of my clientele were/are those clients.

The ones that have been with me for a while walked in feeling broken, fragile and dysfunctional.

Now they feel fearless, safe, and are lifting weights.

Over the years I’ve improved enough to be able to progress people faster and efficiently. I’ve gotten better at earning their trust through educating and squashing misconceptions they once had. I’ve also developed a system that helps them feel safe while training, because the last thing you want with these people is for them to feel unsafe.

Here’s how I do it 🙂

 

1. Build Safety

 

These clients are expecting exercise to hurt. They’re waiting for something to go wrong. They’re thinking your training will end up failing them, just like all the other things they’ve tried.

I assure these clients that we are going to take things slow, while secretly in my head thinking “little do they know they’ll be squatting and deadlifting in no time”. By slow, I mean using only 1-2 activities day one.

Yes. That slow.

Could I use my coaching skills and coach them through a decent KB squat or hinge? sure. But even if it was a perfectly done squat or hinge, they’re unfamiliar with those feelings. Unfamiliar = unsafe. Unsafe thoughts and feeling alone could cause them to have a flare up or experience pain, and then they believe I pushed them too hard.

If that happens, trust is gone.

With 1-2 lower level activities I’m able to 1) respect that they feel like they’re not capable of much 2) familiarize them with references and feelings that we will associate as “safe”, like hamstrings, glutes, quads, heels…etc, and 3) give me an idea of how their body responds.

On their second day I ask them how they handled their first day, and I’m prepared for them to say something like “My back acted up a little that night” or “My hip felt a little achy the next day.” Without making it a big deal, I ask  “Oh ok. How are you feeling today?” They usually respond with “I feel fine today” and I give them a big smile and say “that’s great! Your body handled it well, we’ll do the same thing today!”

We go through the same thing, but add 2-5 more low level activities in positions like supine, quadruped, and half kneeling.

On their third, day I’m prepared to hear a similar response, but I make sure to point out that they did 3-4 times the amount of work that they did on day one, which means their body is building up a nice tolerance and that they’re on the right track.

These activities are teaching their body what it means to work hard, be challenged, but most importantly, feel safe. Just because they barely get off the ground that doesn’t mean they’re not being crushed. If you coach them correctly, they’ll be extremely challenged by exercises like half kneeling, low bear, and wall squat.

Three to five training sessions of low level activities and the client starts to feel safe doing these exercises. From there, I convince them to try one round of squats, sled push, or something like ball slams. They end up feeling all those areas they spent familiarizing with over the last couple of sessions, which makes the more challenging move suddenly feel SAFE.

As soon as it feels safe, that’s when you can successful start loading them 🙂

 

2. Get Buy-in with Your Assessment

This is funny because it’s usually the other way around. How are you going to get your regular client that wants to lift heavy to buy into breathing? You educate them and show them how it’s going to make them a better lifter.

With the fragile post rehab client, you use your assessment to get your buy in for the exercises your picking for them. For these clients, getting better assessment findings is a positive thing. My biggest test right now is the infrasternal angle (ISA). I also test hip and shoulder motion so the client can see improvements. Improved motion and assessment = GOOD in the client’s eyes.

After we do activities, I quickly assess something. Not just for my own findings, but for the client. If they see that their shoulder motion improve by 40 degrees after an exercise that felt like a super hard plank, there’s no way that exercise is dangerous, right?

Last week I had a new client ask if I could check her ISA because she could now exhale twice as long as she could when she first started. A wider ISA meant progress, and if she felt like she was progressing, it made sense when I came out with a new program where she’d be increasing her load on everything 🙂

If I yell out “Oh damn!! That angle is 90 degrees! That’s amazing! Great job!” Then what they’re doing must be a good thing.

Which takes me to my next step…

3) Get Excited.

These people already feel bad about themselves because they can’t do much. So I get jazzed up when they do things correctly. For someone who doesn’t show much emotion, I get extremely happy and proud of them. Then the clients actually start feeling good about themselves. If I can get them to believe that they’re doing a really good job, the more likely they’ll progress themselves at a faster rate. If they’re hesitant with what they’re doing, they’ll want to stick to the same weights.

4) Learn About Pain

As a coach, pain can’t scare you. Pain has been a voodoo word in the industry and I felt like it wasn’t my job to learn about it. I was always under the impression that if a client was experiencing any type of pain, I would have to refer out.

Unfortunately, referring out doesn’t mean pain will always be resolved. Bad things can be ruled out, but pain can still persist. My clientele forced me to learn the ins and outs about pain, and has helped me educate my clients on occasional post-training pain and flare-ups. Most of these clients associate pain with damage, and that’s not always the case.

A few places you can start learning about the Why and How people have pain is through Zac Cupples’ Pain Talk and his podcast that he is releasing next week!

 

5) Have Great Coaching Skills

There’s no way around this one. All the knowledge, people skills, patience, and empathy in the world won’t help if you can’t effectively coach exercise.

When it comes to coaching someone out of compensating, these clients will need it the most. I mentioned this in my last article, and I will keep mentioning it, you must follow people who know how to coach. People who are coaching on a daily basis, and are constantly getting better. Coaching people through movements is an art, and not many successful personal trainers do it well.

Follow these people on social media, bookmark their website, mimic what they’re doing, learn from their coaching, steal their cues, and become a good coach.

Michelle Boland, Pat Davidson, Justin Moore, Cody Plofke, Zac Cupples, Lance Goyke, Ty Terrell, Doug Kechijan, Mike Baker, Michael Mullin, Mike Robertson, Bill Hartman

These types of clients don’t get better with half-assed glute bridges and fire hydrants. They need the detailed individualized training that takes a high degree of coaching skills.

If you want to successfully work with these people, you can’t skip this step.

 

BONUS TIP

6) Find A Physical Therapist to Back You Up

Maybe you have great coaching skills, but despite your best educational efforts, your client still fears loaded movements. This is where comanaging a client with a like-minded physical therapist can be a dream come true.

But beware. If they don’t promote strength training, and they don’t have a coaching background, it can be a total nightmare.

I’ve made the mistake of communicating with a PT through a client, and that always ends in frustration. I’ve had PTs tell clients who were experiencing knee pain to not to do any lunges or squats, even though the only time they were experiencing pain was during random movements outside of the gym. I’ve had a PT tell my client that shoulder blade protraction is bad, that pecs are bad, and that she shouldn’t press, and because of that she has stuck to a 15lbs DB press for as long as I can remember.

If you can find a PT that promotes strength training, you can really help these people out. I’ve even scheduled movement consultations with people like Zac Cupples to help educate my client on loading their system. Even though it’s not a physical therapy appointment, it’s still a physical therapist saying “Hey. Lifting weights at Enhancing Life will be the best thing you can do. It’s not dangerous. If I were rehabbing you in-person, that’s how I’d progress you”

 

Summary: 

• Build safety within their own body and gain their trust
• Have a test and retest system that helps build buy-in with the exercise selection
• Get excited for the things they can do
• Learn about pain so you can educate your client when they have flare ups 
• Work on your coaching skills
• Have a PT that believes in strength training and who has a coaching background

Do you work with these people? How do you convince him to lift weights? Is there something I didn’t cover that you would like to learn more about?

 

Until next time 🙂

 

Lucy

 

 

 

 

• Category: Uncategorized