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What do I do?

I just read a trainer on Facebook reach out for suggestions when someone with both shoulder and hip pain refuses to follow the advice of going to see a health care professional.
I am often asked in some fashion what is a trainer supposed to do when they feel they’ve followed this path involving referring out, division of labor, and scope of practice, yet the client is still not achieving results, sometimes just simple results like clearing that pain is not of a serious medical origin.

The situation is also common when a trainer refers a client to a health care provider for pain, or vice versa, but the end result is that when the client is back with the trainer, they are still in pain.

Here are some thoughts on what may be going on in this situation.

1) I think the most important reason to refer out in a fitness situation is really to be sure that the pain they are describing is not a threat of medical origin.  Many terrible diseases can be disguised as musculoskeletal pains.  I think this is also important as health care professional as well in situations when not changing even.
Are you ready to answer the question: How do you know it’s not cancer?
I have seen this twice in my career.  And if you want to add a third, you can add myself to that list.  Yeah, you never know.

When the person does get checked out by some kind of medical professional, I think this can give the fitness professional some kind of confidence that the client doesn’t have something that is disease or really insidious.  I would hope this would be communicated when the person comes back to you “still in pain.”
At the same time, I don’t think it should automatically yield confidence that training will not harm the individual by training through pain.
The person will be harmed.  And it will be your fault.
They just probably won’t die…………because you and the client just did the right thing and got it checked.

He knows when it's not cancer.

He knows when it’s not cancer.

2) There are some conditions that training through pain is more appropriate than not.  Some examples may be chronic tendonosis, central sensitization, and non-organic conditions.  I think these all can be trained as well without painful methods, but if there is communication and clarity after the referral process, it may just be above board.
Once again, don’t be a cowboy.  See bullet 1) above.

....especially not this cowboy.

….especially not this cowboy.

3) Send them back to the same referral source and try to further the discussion.
You need help.  That’s why you sent out in the first place. Asking for help is only going to wind up in the best interest of the client.  I think trainers should be holding PTs, Chiros, MDs to a standard, and vice versa.  If the physician or PT is so offended by you reaching out, then they are garbage in the first place.  This doesn’t solve your problem, but maybe then you move on to bullet 4).

4) Steal the client and send them to your guy.  This is obviously a last resort, and it must be weighed out.
It would go without saying that your client is on board with this.  But remember that you work for your client, and if you have a team guy as a referral source, the client will benefit in the end.

This is clearly a very difficult problem you have and also one that doesn’t have a clear answer.
What I think is always a consistent message is If It Hurts, Don’t Do It.

It's usually just that simple.

It’s usually just that simple.