Continuum of health and wellness
Writing the Fitness Solutions column has been one of the highlights of my professional life. It has allowed me to connect with members of our community in significant ways and has given me a forum for helping people I likely would never meet or interact with.
The range of conditions that I’ve spoken to people about really has been staggering. In fact, the greatest challenge for me has been in determining the appropriateness of someone undertaking an exercise program, or determining that they would be better served with a referral to a more qualified professional with a specialized skill set. This challenge has inspired me to write this week’s column.
For someone dealing with injury, illness or a long-term condition, there are times when it is more appropriate to be in the care of a physician or physiotherapist than it is with a fitness trainer or Medical Exercise Specialist.
Simply put, part of my assessment is to determine if the time is right for them to exercise. While the great majority of people who contact me will benefit from a structured plan, there are some who just aren’t ready. In other words, there is a time and a place for everything.
The majority of the clients I see are on a continuum of sorts in terms of their physical and mental abilities, and their management of various conditions. At one end, they are in need of medical attention, while at the other they are vibrant and living active lifestyles, even engaging in athletic events. What I do for a living is take people through the steps to keep them moving in the right direction.
The beginning of the “continuum” for many is medical care. Two years ago, I went through extensive shoulder surgery. While today I am pain-free and back to lifting weights, coaching hockey and playing golf, my recovery began with medical attention. That meant pharmaceutical (primarily non-steroidal anti-inflammatory drugs) and then surgical intervention. Exercise wasn’t an option for me with two torn rotator cuffs. Joint injury is one of the primary reasons that someone isn’t ready for exercise.
Some other reasons include numbness or tingling as a result of nerve damage, unstable blood pressure, angina, vertigo and radiating pain.
It’s important to bear in mind that while many conditions require medical intervention, there are cases where exercise could very well be part of a treatment plan. This determination, however, must be made by a qualified physician whose role is to diagnose and prescribe. While exercise specialists are able to work with referrals, it is outside of their scope of practice to do any of the diagnosing. They may “suspect,” but never diagnose.
Once a condition has been treated (in my case, I had shoulder surgery), physiotherapy plays an important role in restoring function, strength and mobility, as well as in pain management. Physiotherapists have a large number of treatment modalities at their disposal with which to do this.
Some are passive, like electric muscle stimulation, traction and ultrasound, while others are more active and include exercise. The best physiotherapists I have worked with have always made it their goal to get patients as active as possible and out of physiotherapy as soon as possible. My shoulder repair kept me in “physio” for three months, but my therapist was planning for my discharge from day one and constantly assessed my progress.
The time for Medical Exercise, or fitness training, is after physiotherapy has been completed, bridging the gap between medical care and exercise. It is the next logical step once medical and rehabilitation services end, and is the key to long-term management of most medical conditions.
The lines between medical care, physiotherapy and fitness can be blurry and often overlap each other. The best professionals realize this, are respectful of scope, and confident in their abilities to help clients (or patients) move to the “right end” of the wellness continuum.