Wednesday, 7 November 2018

Do I Need A Strength & Conditioning Certification As A Physiotherapist And If So Which One Should I Take?



                Over the last couple weeks I’ve gotten several messages in my Messenger inbox and I’ve also seen several social media posts discussing whether or not physiotherapists should get involved in strength training clients and discussing which certifications to get. The past decade has seen a huge increase in “hybrid” physiotherapists & strength coaches and while it’s great to see people that can take clients from in pain to high performance it begs the question – do all physiotherapists need S&C certifications and if so what route to take?
                The answer is, to quote my friend and mentor Stuart McGill, “it depends.” It depends on…

1) The demographic you want to work with

This is the biggest decision-maker. If you work in pediatrics – good luck getting them into strength training. If you work in ICU, or acute care in general, spending a lot of money on a strength & conditioning certification probably won’t offer the same return on investment as courses & education more tailored to that setting. Same goes for pelvic health physiotherapy.

When it comes to neuro rehab it’s a grayer area as it depends on how well functioning your clients are. If many of your clients have at least Grade 3/5 muscle strength than hell yes it’s worthwhile to know this stuff. If many of your clients tend to be more flaccid and lack that strength than learning more neuro-rehab specific techniques is likely a better use of your time & effort. As Stan Efferding said “you can be good at anything but you can’t be good at everything.”

If you work in orthopedics in a more general population setting I don’t believe a S&C certification is essential although it can be helpful if you have athletes and/or lifting junkies come through the door on occasion. That said I do believe a basic knowledge of exercise prescription is essential for all physios in any setting.

The biggest populations where having a personal training or strength coaching certification can be helpful are

- When working with chronic disease populations such as osteoarthritis, osteoporosis, cancer, diabetes, heart disease and/or lung disease due to the number of safety precautions and rules that you have to be aware of.

At UW KINNection 2018 where many Kinesiology students get their first experience making exercise programs for people with chronic diseases.

- The big one … if you work in a clinic with athletes and/or people who love weight training. This is self-explanatory as you need to, to do your job effectively, have the knowledge to transition those clients from pain & potentially very remedial levels of exercise to being able to do high performance movements such as lifting, sprinting, jumping, and potentially throwing based on their activities.

This may seem like common sense but, as strength coach Trevor Cottrell said, a lot of physios don’t know strength training and athletics & spend more time strengthening their clients’ glute med than they do physically preparing them to withstand the demands of athletic + strength training endeavours. It’s as big of an injustice to underload and underprepare someone and put them through “rehab purgatory” just prior to returning them to sport as it is to overload them.

Under Trevor Cottrell's coaching earlier this year at the Intro To Olympic Lifting course at The Vault Barbell Club

2) If you need it for a job

Some clinics, particularly sport rehab clinics or clinics in a gym, will require you or recommend you have a strength coaching or personal training certification.

So now to the second part of the article … which certification should I take?

Option #1: I work with elderly and/or diseased populations

In that case the best certifications are the CSEP (in Canada) or ACSM (in the US) Exercise Physiologist certifications. I do believe you should spend a fair amount of time working with those populations, under the direction of someone highly qualified, before working with that population on your own as there is great potential to help people but also great potential for harm if things are done incorrectly.

The GLAD (GoodLife with osteoArthritis in Denmark) courses done worldwide are fantastic for understanding lower body exercise prescription, not just for osteoarthritis, but in general.

BoneFit, done by Osteoporosis Canada in Canada, is quite useful as well.

Option #2: I work with athletes and/or weight training clients

CSCS is the most popular one that people go with. That said there are a couple holes that CSCS, in my opinion, leaves uncovered which are
-          Understanding how to coach, program and progress speed movements (I.e. sprinting & jumping): I recommend Joe DeFranco, Lee Taft, and Nick Winkelman’s work as resources for speed training as this is essential for returning team sport athletes to sport after certain injuries (i.e. ACL tear, hamstring strain)
-          Understanding how to coach and modify the powerlifts for clients: I did the Canadian Powerlifting Union Coaching Certification this year and found it insanely valuable. It was probably the best training related certification I’ve done specifically on the powerlifts.

At the CPU Coaching Certification earlier this year at The Vault Barbell Club

As with Option 2 – you still need to, in my opinion, spend time working with these populations under the supervision of a qualified coach before working with these populations on your own. That’s why, despite my certification, I don’t call myself a powerlifting coach.

Bonus: Who are good people to learn from?

People that I recommend other physios learn from in regards to strength training are

Physiotherapists: Scotty Butcher, Charlie Weingroff, Stefi Cohen, John Rusin, Dani LaMartina (Overcash), Christina Prevett (Nowak), Michael Mash, Zach Long … and myself.

Strength Coaches: Nick Winkelman, Brian Carroll, Chris Duffin, Travis Mash, Meghan Callaway, Mike Boyle, Eric Cressey, Mike Robertson.

I hope this article provided some useful advice and guidance and I hope you will share it with other physiotherapists & physiotherapy students who may have the same question. As always – thanks for reading.

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