Interview with Dr. Trent Nessler

Interview with Dr. Trent Nessler: How to Advance Yourself as a Personal Trainer and Educator

Trainers act as the motivator, educator, source of inspiration, coach and psychologist all rolled into one. In order to be effective, you have to not only have access to the latest info, and live the lifestyle, but you have to know who you’re working with and how best to reach them. How do you advise trainers to develop these essential skills? We spoke with Dr. Trent Nessler, former personal trainer and MPT, DPT, whose specialties include return to play from ACL injuries. Read on for Dr. Nessler’s insights into the makeup of the ideal trainer and how to advance yourself as a personal trainer.

How can trainers do a better job of getting clients back into the swing of a fitness routine – whether they’re coming back from injury or just deconditioned?

First thing is to find out what are the motivators to the client. All too often, we trainers make the mistake of thinking that our motivators are the same as our client’s. The client has stepped into your facility and has enough motivation to take that first vital step. Encourage that and praise them simply on the fact they have taken the hardest step. Psychologically, they have made some form of commitment and we can build on that. Next it is important to find what motivated them to come in: Did a doctor point out their risk of heart attack? Was it a recent fall they had in the home? What is it that caused them to take that first step?

What are their goals? Some are going to be motivated to have a beach body but a lot are not. Finding out why they are there and creating your message and education all around their goals will aid in driving motivation.

“People are much more likely to do something when they know why.”

The best motivator is education. People are much more likely to do something when they know why. Why am I doing cardio and why am I doing strengthening? However you decide to educate them, make sure to message it around their motivators. Example: maybe you have a client who has become deconditioned because of a recent fall in the home and her primary care physician has sent her to do some physical activity. Let her know the physiological responses to cardiovascular exercise and how this leads to improved endurance and decreased risk of falls. Educate her on how strengthening the core and lower kinetic chain improves balance, proprioception, bone strength and ability to ascend/descend stairs. Be sure she understands how this not only reduces the risk for falls, but also reduces the risk for fracture if a fall does occur. Including this as a part of every session aids in motivating but also in a longer-term understanding of why they are doing what they are doing.

How should trainers address clients with previous injuries?

In today’s healthcare arena, personal trainers are positioned well to be a part of the healthcare continuum. As such, more and more clients will be coming to personal trainers following injuries. With limited health care coverage, more clients are being discharged from physical therapy before they are truly ready to continue on their own. We personal trainers can educate ourselves on pathophysiology, biomechanics, soft tissue healing and rehabilitation progressions to make sure we’re ready for this new type of clientele. Not that a personal trainer will replace a physical therapist, but in the right environment, a personal trainer educated in pathology can be an invaluable asset to the healthcare continuum.

Optimal care for the clients depends on transparency and communication among healthcare providers. Often this is lost once the client is referred or ends up with a personal trainer. The best course of care for the client returning from an injury includes the personal trainer communicating with the physical therapist. Before you talk to a therapist, do your homework. Due to HIPAA compliance issues, the client will need to go to the physical therapy office and fill out a HIPAA form listing you as someone they can speak with. Find out the client’s diagnosis. Construct a list of questions so that the call is quick and concise and you come out getting all the answers you needed. Calling the therapist and asking to schedule 15 minutes to communicate about the client will often result in better results than just randomly calling them during a day when they may be seeing 15 to 20 patients.

Once you start training the client, it is important to understand his injury and the positions that can cause irritation to the tissues. Also know that all shoulder injuries are not the same. For example, the patient who is returning from a rotator cuff repair will not tolerate behind-the-head lat pulls or front raises to 90 degrees with palms down. Yet a patient returning from SLAP (superior labral anterior to posterior) tear won’t tolerate full end range of motion on rows or heavy bicep curls.

“Pain is the number one indicator of how they are doing.”

In the initial phases of working with these clients, pain is the number one indicator of how they are doing. Specifically, the intensity, frequency and duration of pain are key indicators of their progress.

  • Find out how bad it hurts when it feels its best and its worst. Specifically, ask how bad it hurts with 0 being no pain and 10 being taken to the hospital.
  • How often does it hurt? Does it hurt all the time or intermittently?  If intermittently, how many times a day?
  • When it is painful, how long does the pain last? Ten minutes or 3 hours?

The more intense the pain is, the more frequent it is and the longer it lasts are all indications that something is making it worse. As personal trainers, we need to make sure that what we are doing is not aggravating it. Understanding the injury and the biomechanics will help us easily identify aggravating positions and exercises.

How do you help trainers understand the importance of a client’s psychological readiness before really pushing them? What do trainers need to be aware of and look for when progressing their client after an injury?

There has been a lot of research looking at the psychological status that is critical for optimal return to sport. We can take this knowledge and apply that same understanding to our clients. In the American Journal of Sports Medicine (June 3, 2013), Ardern et al. showed there are three major psychological factors that feed into an athlete’s ability to return to sport. This includes fear of re-injury, sport locus of control and recovery expectations. Briefly, if athletes don’t have faith in the injured limb, if their fear of re-injury is high, if they don’t feel like they are in control of their destiny (sport locus of control) or their recovery expectations are low, then they are less likely to return to a high level. If you hear things like “I am just not sure I can do that” (fear) or “I have torn my ACL and I will never be quite the same” (sport locus of control) or “My therapist said I would only regain about 70%” (recovery expectations), you know psychological factors are playing a role.

“As a personal trainer, you have just as much of an impact on the athlete’s ability to return to sport as some of the psychological factors feeding into their not returning.”

This is especially prevalent in the patient who is returning to high-level activity after an ACL reconstruction. In this example, there are things we can do in the clinic to mitigate a client’s fear with return to sport or activity. Since ACL reconstruction was the most frequent reason listed for not returning to sport, there are a lot of ways to reduce fear.

  • Early onset of single leg activities. Get a client to do single leg activities early (within protocol) and often. Building the confidence in the limb as soon as possible so that they can put weight on the leg will not result in re-injury. Sounds basic right? Unfortunately, it’s not.
  • Intensity of training. Implementing a higher level of intensity earlier in the protocol (as long as within protocol) will help boost confidence that they are training for return to sport. When they feel like they are getting a workout similar to what they did in sport, they will be more confident in a positive outcome.
  • Sport-specific single leg lateral and diagonal movements. Again it sounds basic, but it’s amazing how many times these moves are not standard practice. As long as within protocol, the sooner that athletes start lateral and diagonal single leg movements, the more confident they will be in their stability and ability on the injured limb.
  • Sport-specific training. Implementing sport-specific drills into the rehab process is critical to building confidence. Their confidence will be low, for example, if their first sport-specific training is just one or two weeks prior to return to sport.
  • Rehab vs. coach. There is a tremendous amount of psychology that goes into coaching great players into becoming exceptional players. If this same psychology is applied clinically, then the athlete’s confidence is boosted and rehab will be more successful.

As a personal trainer, you have just as much of an impact on the athlete’s ability to return to sport as some of the psychological factors feeding into their not returning. So it is not just above the shoulders of the athlete but the personal trainer as well!

What are the best qualities trainers can have to help their clients reach their goals?

All too often people think it is the biggest guys or most fit gals that make the best personal trainers. But the reality is there are some very similar personal traits that set the exceptional trainers apart from the rest.

  • Drive/passion. A deep drive and passion for what you do will be contagious to all those around you. It will also drive you to know more by constantly seeking to learn and digging into the latest research. Your knowledge will be expressed in your passion as you educate your clients and help them achieve their goals. This drive and passion will not allow you to settle for second best. It will drive you to be better than the rest and to constantly push your profession. These are the folks who set the bar for others.
  • Empathy – not sympathy. Being able to empathize with your clients is critical to your their psychology and overall results. Your empathy pushes you because you want to do better for your clients. An empathetic person knows when and how to push a client without being demeaning or demotivating.

For example, how others perceive you is important. It does not mean you have to be the biggest guy in the gym or the fittest trainer, but it does mean you need to set the example. Don’t just preach the healthy lifestyle but live it. This means people will pay attention when you talk about overcoming obstacles.

 “Don’t just preach the healthy lifestyle but live it.”
  • Stay on top of the latest research and science in fitness, wellness, exercise physiology and biomechanics – whether in formal classes or through self-education. Scientific knowledge is rapidly advancing and if you don’t advance with it, you will not only be left behind but also do a disservice to your clients.
  • Detail- and goal-oriented. These individuals know what they are going to do with clients before they come in. They are advancing the program and constantly reevaluating its success to help clients meet their goals. They aren’t late to their clients’ appointments, don’t text or check email during appointments, don’t let the client perform the exercises with improper form while they talk about their weekend to the client. Detail-oriented and goal-oriented are expressed in a lot of ways but always result in clients who have better outcomes.

What is more important in a personal training session – the client’s physical or mental state?

Physical state does play an important role, especially for a client dealing with pathology or disease state. Serious disease like diabetes, heart disease, etc. can all have a dramatic impact on training sessions. In high-risk cases, these should be done only by a properly trained individual and under close supervision. So in those cases, physical state is more important.

“It is also important to watch the client, keeping in mind that depression and lack of motivation can be an indicator of overtraining.”

However, in most instances, our clients are relatively healthy but deconditioned. In these cases, mental state is critical. We all know that if you are ultra-fit and don’t have your head in the game that your workout that day is half of what it would normally be. Knowing the impact that it has on you, it has an even bigger impact on your client. As trainers, it is up to us to motivate our clients. This may mean breaking from the plan to change things up a little in order to make it a little more engaging to the client. It is also important to watch the client, keeping in mind that depression and lack of motivation can be an indicator of overtraining. Although they may not be overtraining in your session, external factors – like an outdoors job in Arizona in the summer – can quickly result in overtraining signs and symptoms.