Teaching Your Fullest, Within the Scope of Practice
As movement professionals we spend a lot of our own time, money, and energy pursuing many facets of our own health. We may see osteopaths, massage therapists, an array of wholistic medical practitioners, and physical therapists. We read extensively about nutrition and supplements, and may commit to certain dietary practices in our quest for better health, wellbeing, and physical performance.
Our clients see this and may have questions for us about these various modalities, diets, and supplements. Clients often ask me “what do you eat?”, “Do you take supplements?”, or “what is this chronic pain in my hip?” And having been drawn to this profession out of a passion for helping and teaching people it’s tempting to share with them all the great information I’ve found over the years.
But I’m very aware of the boundaries of my “Scope of Practice”. Whatever entity through which you obtained your certification probably has a code of conduct, or some guidelines that reference your scope of practice. There may also be state or local laws that determine what can and cannot do within your practice.
Over the years I’ve overheard fellow trainers slipping into offering advice on supplements or diet, giving clients specific medical advice, and have seen some doing what borders on chiropractic adjustments that were clearly outside the bounds of our training as fitness professionals.
We’re immersed in this world of health and anatomy, and we know a LOT. But sometimes not as much as we may think. We may be missing important pieces of information crucial to properly understanding a medical situation. And even if we are right and do know what we’re talking about, we are obligated by the license contracts we’ve signed, possibly by law, and definitely by ethics to refrain in our interactions with clients from straying outside our scope.
What are the big no-no’s in regard to scope of practice? And how do we navigate these restrictions to best serve our clients?
Do not give the client a diagnosis, or anything that may be interpreted as a diagnosis. In your experience it may be very clear to you when a client complains of a sharp pain around the ribs that’s worse with deep breaths and accompanied by shoulder pain that there is likely a rib out of alignment. But we can’t present that to the client as being a fact that we have determined.
We can however state that sometimes when this happens there’s a possibility that a rib may be out and we then need to advise the client to see their physical therapist, osteopath, or doctor to see if this might be the case, or if it might be something else. We can guide clients to the information, but we cannot make the statement “Your rib is out”, as that slips into the realm of diagnosis.
There have been several instances when a client has come to me and based on their reports of pain and on my observations of their movement patterning I have a strong sense that they’re going to need a hip replacement. But I cannot tell them that. What can I do? I’ve handled it by saying “I’m really concerned about what’s going on with your hip. I think there might be something more than I can see going on in there and I think it would be a good idea to get that checked out by a doctor who’s good with hip issues.” If they don’t know whom to see I’ll point them in the direction of doctors I’ve heard good things about.
This way I’m helping connect the client with the appropriate professionals and information, without stepping outside of my scope.
We can’t offer medical or dietary advice. If a client reports pain or symptoms that are outside of what we can safely address through movement and breath we need to refer that person to someone with the proper medical training.
It is within our scope to offer information that is considered common knowledge. Such as if a client complains of swelling from an injured ankle we can suggest that they elevate the ankle. We start to stray outside our scope when we start recommending taking anti-inflammatory medications. If a client asks “should I take ibuprofen?”, I might tell them that I’ve heard that does work for some people, but that I can’t really give them advice on what specific medications might be right for them and to give their doctor's office a call to ask.
There have been several occasions in which I’ve seen clients with what appears to be some pretty bad inflammatory issues in the body. They complain about joint pain, may have red, blotchy skin, or other symptoms that are generally red flags for inflammation. In my personal opinion, from my reading and experience, I might feel they should be eating an anti-inflammatory diet. But it is not my position to tell them that specifically, or to tell them what foods they should eat or avoid.
What I can do is say some thing like “I’m not suggesting that this is right for you, as I am not a dietitian and not trained to give dietary advice, but I’ve heard some people with these issues have done well on an anti-inflammatory diet. If you’re curious about this I can give you the name of a wholistic nutritionist who can help you figure out if this might be an good option for you”
Remember, you can always give common knowledge advice, such as “eat more veggies and less processed foods and sugar”, but cannot suggest a specific diet.
So what can we do if we feel our clients have gotten “bad” medical advice?
Being in the movement field it may seem clear to us that long term investment in the body, through good movement, healthy eating, and manual work such as massage, physical therapy, or chiropractic, etc, generally provides better long term outcomes than quick fixes, such as surgery as a first option. So what do you do if a client’s doctor has recommended a surgery to fix a problem you’ve seen over and over again to be easily addressed through movement? Or my pet issue, cortisone shots?
We cannot tell the client to ignore medical advice, or that we know better, or offer our own medical advice. What we can do is gently suggest the client seek a second opinion, and possibly direct them to links to credible medical sites, such as the mayo clinic site. We can not push our opinions, so if they don't seem receptive to the suggestion we must back off and let it be.
In regard to cortisone shots, about which I have strong feelings and opinions, when this comes up with my clients I generally say “I’m not a medical professional, so I am certainly not giving you medical advice here, but there are some conflicting opinions out there about these shots, so it may be worth looking into a bit more before you decide. My orthopedic doctor advised me strongly against the shots because he says they degrade the joint, so are not appropriate for a younger, active person, with lots more years to go on the joint. That is what he said to me, but your situation may be different. If you’re thinking you want to investigate more before making a decision I can give you the names of a few local doctors who might be able to give you a second opinion. But again, I am not medically trained and have not seen all that your doctor is looking at to give you this recommendation.”
We have to be super careful with this, to be very clear we are not giving medical advice and that there’s no way the client could infer that we are telling them to disregard medical advice given to them by a medical professional. I would consider the advice to seek a second opinion within the realm of common knowledge, so I feel that keeps us within our scope.
So what about supplements, essential oils, and muscle recovery rubs?
There are countless products that are meant to support our health, recovery, and general wellbeing. We may swear by some of these, and might possibly sell some of them, too. How do we navigate discussing these products with clients?
I would say that any recommendation of supplements definitely falls outside our scope of practice. We should suggest, if a client asks, that they speak with their wholistic or osteopathic doctor to address these questions.
There is one supplement, called Zyflamend, that was highly recommended to me by the occupational therapist I saw after a TFCC tear in my wrist, resulting from a bicycle accident, followed by a bit too much handstand practice. She told me it was clinically tested with great results, and shown to be safe. I used it and continue to use it for flare ups of inflammation in any joints. Occasionally I have a client who asks if there’s anything they should take, or that I take for similar issues. I’m careful not to recommend the supplement. I might state that, while I cannot make recommendations about supplements, they could ask their doctor about it and see if it might be an appropriate option. I clearly state not to take it on my advice, as I am not qualified and don’t know their medical details to know if it’s safe and appropriate for them. If I write down the name of it for them I'm always sure to write “ask your doctor about..” before the name of the supplement. So even if they find the paper lying around months later it is clear that I am not recommending the supplement, only suggesting that they could bring it up as a possible option with their doctor. And I only do this when specifically asked about supplement or anti-inflammatory options, so it’s clear I’m not promoting a product or medical approach.
Essential oils and muscle recovery rubs, such as arnica ointments, are in another category in terms of scope. These have good anecdotal support, but not a lot of specific scientific research backing them. Most importantly for us though, is that they have little in the way of side effects, other than possible allergic reactions. Most directions for use state to test a small patch of skin for allergic reaction before using in greater amounts. So we’re looking at a pretty safe product, if used properly, with lots of great stories of helping people with all sorts of health issues. So is it safe and within our scope of practice to recommend these products to our clients?
I personally feel that as long as we do not recommend the products in place of medical treatment there is a place within our scope to suggest trying some of these as options. Also, if you sell these products great care must be taken not to step over the boundary of a suggestion and a beautifully arranged display of pretty bottles, into an overly strong sales pitch that pressures a client into making purchases. As trainers our clients put a great deal of trust and faith in us, so we must be careful not to exploit that trust for up-selling our retail products. Yes, we need to bring in revenue, and that’s fine, but a soft sell approach is more ethical (and probably much more appealing) in our line of work.
What about hands on assists for clients? It’s very difficult, if not impossible, to teach movement effectively without giving hands on assistance and cueing. This is especially true of the GYROTONIC® system, in which most movements have carefully coordinated hands on support from the trainer, which are learned in the teacher training course as part of our basic cueing.
Both the Pilates and GYROTONIC® systems incorporate some form of assisted stretching or tractioning. But while we may assist in guiding a bone through the proper pathway of its joint, or giving a little pull at the ankles to create decompression through the legs and up through the spine, we need to be sure that the hands on we’re executing is clearly for the propose of guiding movement, and not stepping into the bounds of massage or osteopathic manipulation. Even if for those trainers who are qualified in these other modalities a clear distinction should be made between movement training, massage, and manipulation.
If you are unclear as to where that boundary lies, ask yourself what is the purpose of the assist? If it’s to guide, support, or traction movement or alignment, then you’re probably within your scope. If it’s to adjust the boney alignment or release soft tissues in manner in which the client is passive, then you might be stepping out of the scope of practice. This can of course get into grey areas, so it’s important to maintain an active awareness and to keep evaluating your cueing to be sure you’re keeping clarity of your scope.
As trainers we should be able to share our passion and knowledge about heath and wellness, and there’s plenty of room to do that within our scope of practice. If you’re a bit unclear still about what’s okay and what’s not, take a few minutes to review any code of conduct or scope of practice guidelines provided by the entity through which you certified.
Do you have any grey areas you’re coming across in your teaching and want some guidance of how to stay within scope? Let me know!