Treatment vs Training: Deciding when to use physical therapy vs personal training

Writen by Dr. Paul Ochoa



“PT” is an acronym used for two major players in musculoskeletal health; PHYSICAL THERAPISTS and PERSONAL TRAINERS. When we talk about what each of these professionals do there are a few question that come up from the viewpoint of the client or patient and from the perspective of the professional.


I’ll address the professionals since we are the ones guiding our patients and clients.  The easiest way to decipher whether someone needs therapy or training is to ask yourself a simple question…


I S   T H I S   P E R S O N   I N J U R E D ?


If we define ‘injury’ as a state of functional loss, then we can compare an individual’s potential to what they can do when they first come in. This can present in 2,348,623,794 different ways, so let’s just take a few examples:


“ I T   H U R T S  T O  S T A N D”


For example, what if someone came to a personal trainer and said they bent over yesterday and now they can’t stand up straight without intense pain? This one is an easy choice and hopefully we can all agree that a referral to a physical therapist or at least their primary care doctor for further assessment is appropriate.


“I   C A N ‘ T   S Q U A T  ( A N Y M O R E ) ”


Here’s where it can start to get tricky. This person walks into my clinic and says they’ve been strength training on their own for a few months and would now like to learn how to properly squat. My first instinct here is to refer them to a trainer for instruction on form and appropriate progression. However, if they tell me that they already have a foundation of squatting and have recently had to reduce their front squat weight from 180lbs to 90lbs because their back and knee hurt, THEN I would most likely do a thorough assessment to tease out whether this is due to an injured tissue or if it is a technique issue. If we discover that it is purely technique, then I’d happily refer them to one of the many trainers I know for proper instruction. If I find there to be some biomechanical or neurological impairments, I would take this person on as a patient with the goal of returning them to their front squat weight of 180lbs pain free.


“I   H A V E   A N   O L D   S H O U L D E R   I N J U R Y”


I’ve seen examples like this a hundred times. Someone with an old injury who never FULLY rehabilitated it wants to get back into shape. Their range of motion is clearly limited on one side but there is little to no pain with exercise. From the perspective of the personal trainer, this person may require some stretching and some mobility exercises to get that range back. I totally agree with that as long as the stretching and exercises do not cause the person pain AND (this is important) the personal trainer does not push the shoulder into a stretch.  

So why can’t a trainer help someone stretch? They can. Verbally. Technically.


… and down the rabbit hole we go…


Unfortunately, unless you are licensed to ‘manipulate soft tissue’ (like massage therapists, physical therapists, chiropractors, and physicians) it is actually a huge no-no to manually stretch someone. So do I go around to every personal trainer I see that is stretching someone and yell, “STOP!!”? …No, of course not.  But it is definitely something to think about.  Let’s go back to the example of the person with the old shoulder injury.  Let’s say they have a great first session and the trainer decides that it would probably benefit the person to finish the session with a nice gentle stretch. I would totally agree IF that person was recently medically cleared for the injury that they were coming in to address, by a physical therapist, their surgeon (if they had one) or a physiatrist. In a recent study published in the Orthopedics Journal, primary care physicians without a SPECIFIC orthopedic residency were shown to have “inadequate training” to properly diagnose and treat musculoskeletal injuries. That means that if this client was “cleared” for weight training by their primary care physician, they may still be at risk for an injury. With old shoulder injuries that cause limitations in motion there is always the risk of unintentionally aggravating that shoulder and possible causing larger issues.


S O   H O W   D O    Y O U   K N O W   W H O   I S   S A F E   T O    T R A I N ?


The ACSM states that personal trainers should only work with “apparently healthy individuals to enhance fitness.” This is a great guideline to work with and it helps to ensure the safety of not only our patients and clients, but also the livelihood of the personal trainer.  


W H A T   A B O U T   A   P H Y S I C A L   T H E R A P I S T  T H A T   T R A I N S ?


Good question. Yes, there are many therapists that continue the transition from patient to client in their practice. I can’t say I’m a big fan of this. I understand the importance of bridging the gap between injury rehab and strength and conditioning, but in a city with so many excellent practitioners, why not refer out and expand your referral sources!? This is also beneficial  from a business perspective.  


Our goal is to help the people who walk through our door. Let’s leave our egos at home – I think you’ll find there is benefit in growing your circle by knowing when to use your expertise  and when to use someone else’s.  


A   J A C K   O F   A L L   T R A D E S   I S   M A S T E R   O F   N O N E   A N D   A        M A N   (O R    W O M A N)   W I T H   T O O   M U C H   S U G A R   N E V E R         M E E T S   T H E I R   N E I G H B O R S