PERSONAL TRAINING QUARTERLY

PTQ VOLUME
VOLUME21
ISSUE
ISSUE 11
ABOUT THIS PUBLICATION PERSONAL TRAINING QUARTERLY

PTQ
Personal Training Quarterly (PTQ)
publishes basic educational
information for Associate and
Professional Members of the
NSCA specifically focusing on
personal trainers and training
enthusiasts. As a quarterly
publication, this journal’s mission
is to publish peer-reviewed
VOLUME 2
articles that provide basic,
practical information that is
ISSUE 1
research-based and applicable to
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Copyright 2014 by the National EDITORIAL OFFICE EDITORIAL REVIEW PANEL

Strength and Conditioning EDITOR: Scott Cheatham, DPT, PT, OCS, ATC, CSCS
Association. All Rights Reserved. Bret Contreras, MA, CSCS
Mike Rickett, MS, CSCS
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ISSN 2376-0850
PTQ 2.1 | [Link]
TABLE OF CONTENTS

04
INSTABILITY TRAINING—HELP OR HYPE?
RONALD SNARR JR., MED, CSCS, JASON CASEY, MA,
CSCS, ASHLEIGH HALLMARK, AND
RYAN ECKERT, NSCA-CPT

10
COMMITMENT TO THE PROFESSION—TIME TO STEP
UP OR STEP OUT
ROBERT LINKUL, MS, CSCS,*D, NSCA-CPT,*D

12
OVERTRAINING AND RECOVERY
JONATHAN MIKE, PHD(C), CSCS,*D, NSCA-CPT,*D, USAW

16
EFFECTIVE FUNCTIONAL EXERCISE
PROGRAMMING FOR THE OLDER FITNESS
CLIENT AFTER A TOTAL KNEE REPLACEMENT
KEITH CHITTENDEN, MS, CSCS,*D, TSAC-F,*D

22
A SWOT ANALYSIS OF THE SCOPE OF PRACTICE
FOR PERSONAL TRAINERS
DAN MIKESKA, MS

28
BEST BUSINESS PRACTICES—INTERVIEWS FROM
EXPERTS IN PERSONAL TRAINING
CARMINE GRIECO, PHD, CSCS

30
ATTENUATING DELAYED ONSET MUSCLE
SORENESS IN UNTRAINED INDIVIDUALS
MICHAEL RANDONE, MS, CSCS

34
PERSONAL TRAINING FOR THE RECREATIONAL
DOWNHILL SKIER
CHAT WILLIAMS, MS, CSCS,*D, CSPS, NSCA-CPT,*D,
FNSCA

PTQ
PTQ2.11.1| [Link]
| [Link]
FEATURE ARTICLE

INSTABILITY TRAINING—HELP OR HYPE?

RONALD SNARR JR., MED, CSCS, JASON CASEY, MA, CSCS, ASHLEIGH HALLMARK,
AND RYAN ECKERT, NSCA-CPT

A
ctivities of daily living and sport performance present a MOST POPULAR INSTABILITY DEVICES
multitude of situations in which an individual must exert EXERCISE BALLS
force while in unstable and potentially compromised Exercise balls, also known as stability balls or Swiss balls, are
positions. Thus, it has been suggested that due to the concept large, inflatable vinyl balls that typically come in a variety of sizes
of training specificity, one should mimic an unstable condition to (e.g., 45, 55, and 65 cm) (Figure 1). These commercial devices are
elicit adaptations that would allow the individual to excel when capable of movement in all directions and can provide a base for
placed in such a situation (3). As a result, instability training has a plethora of common exercises (e.g., bench press, crunches, etc.).
been a popular and common method of resistance training used Purported benefits include improved balance, core strength, and
in strength and conditioning and general fitness facilities for a coordination while improving joint alignment.
number of years. Instability can be achieved through various
devices such as medicine balls, exercise balls, balance trainers, BALANCE TRAINERS
balance boards, and foam pads. More recently, gymnastics rings Balance trainers, also known as BOSU® Balls, are double-sided,
and other forms of suspension training have only added to the inflatable instability devices that offer users either a flat or
abundant list of methodologies that utilize instability training. rounded base to perform exercises upon (Figure 2). Depending on
which side is against the ground, the balance trainer may provide
Most anecdotal claims for instability training include improved various levels of instability. For instance, if the dome side is down,
core strength and endurance, increases in functionality of daily then it is capable of multidirectional movement because of the
activities, improved stability and balance, promotion of lean rounded surface. However, if the flat base is against the ground it
muscle tissue growth, as well as reductions in body fat. While it provides an unstable surface top on which to perform movements.
has been shown that these instability training devices may be
useful, a debate remains within the current literature with regards SUSPENSION TRAINERS
to their efficacy on overall performance and physical development Suspension trainers are a newer fitness trend that involves the use
(3,7,15,16,20,23). With a growing body of evidence elucidating both of hanging straps and handles. Typically secured overhead, this
the benefits and downsides of instability training, this article will device mimics the Olympic rings and is offered with a single or
briefly examine the most popular devices and ultimately conclude dual attachment point, depending on the manufacturer (Figure
as to how instability training may be incorporated into traditional 3). The lengths of the straps may also be shortened or lengthened
resistance training programs. to accommodate the performance of a variety of exercises. Unlike

4 PTQ 2.1 | [Link]

other instability products, suspension trainers allow the individual in one repetition maximum (1RM) values between a stable and
to perform pulling movements that cannot be done with the other unstable surface (9). Researchers also showed no differences in
devices (e.g., inverted rows, pull-ups, etc.). muscle activity of the primary movers or ranges of motion during
the movement (9).
BALANCE BOARDS
Balance boards, also referred to as wobble boards, have typically Although multiple studies exist supporting the use of these
been used in rehabilitation and outpatient settings. These boards devices, not all studies have shown increased muscle activity;
are usually made of a flat hardwood or plastic platform with a in fact, some have even provided evidence to suggest reduced
small, rounded surface underneath to promote instability (Figure activation. For example, Schoffstahl et al. examined a traditional
4). Depending on the manufacturer, the board height may be crunch in comparison to isometric pikes upon an exercise ball,
adjustable as well. This adjustment in height is claimed to provide suspension device, and ab wheel while measuring activity of
an increased challenge to the individual during exercise, due to the the abdominal wall (19). The researchers found no significant
increased distance between the platform and the ground. differences between any of the exercises performed (19). A
separate study was performed to determine if switching an
LITERATURE REVIEW exercise ball for an exercise bench would increase abdominal wall
Much of the current literature focuses on abdominal wall and activity during traditional exercises, such as the shoulder press,
primary agonist activity during traditional exercises performed on biceps curl, triceps overhead extension, chest press, etc. Results
instability devices. For instance, multiple studies have examined indicated no differences in the core musculature regardless of the
bodyweight push-ups performed on various types of surfaces base of support during weight training (11).
including balance trainers, exercise balls, and suspension devices
(2,5,8,14,15,20,23). Most of the studies have reported increases in Most of the literature on instability training focuses on either
activation within the abdominal wall (e.g., rectus abdominis [RA], abdominal movements (e.g., crunches) or pushing movements
external oblique [EO], erector spinae [ES], etc.), prime movers (e.g., push-ups). To the authors’ knowledge, only two studies
(e.g., pectoralis major, triceps brachii, and anterior deltoid), as well to date have examined pulling movements (e.g., traditional
as secondary and supporting musculature (e.g., latissimus dorsi, and inverted row) with varying levels of stability. These studies
serratus anterior, and trapezius). had subjects perform the traditional and inverted row with a
suspension device while the electromyography (EMG) of the
While most of the literature focuses on whole body movements traps, lats, biceps, and posterior deltoids were examined. Results
(e.g., push-ups, squats, etc.), abdominal movements (e.g., indicated that no differences existed between the two types of
crunches, planks, etc.) are typically the most commonly rows except that the biceps showed greater activity during the
performed exercises when incorporating instability devices traditional method than during the inverted row (16,21).
into an exercise routine. However, some findings in the literature
are conflicting. For example, a recent study by Saeterbakken et While increased muscle activation is one of the primary motives
al., showed no differences in RA activity when subjects performed for using instability devices, other key factors to consider are
sit-ups with and without a balance trainer (18). In addition, power, strength, and force production. Studies have shown
researchers found significantly reduced activity in the obliques decreases in force production from as little as 6% to as much
when sit-ups were performed sitting on the balance trainer (18). as 60% in exercises such as the bench press and squat when
However, Duncan found that curl-ups, jack-knives, and roll-outs performed on unstable surfaces (1,10). Zemkova et al. further
performed on the exercise ball activated the RA to a significantly reinforced this by demonstrating the loss of peak and mean
greater extent when compared to performing the exercises in a power when comparing stable bench press to the exercise ball
stable manner (7). bench press (24). Participants also suffered from a greater fatigue
index when the bench press was performed on the instability
Another popular abdominal wall exercise, the plank, has also device, which would affect power production negatively (24).
been shown to increase activation of the core musculature under
conditions of instability. Exercise balls and suspension devices HOW TO USE INSTABILITY DEVICES PROPERLY
elicited a significant increase in activity in the RA, EO, and lower As previously indicated, there is conflicting research in regards
back musculature during unstable planks compared to stable floor to the effectiveness of instability training. While most research
planks (4,12,22). shows significantly increased abdominal wall activity, primary
musculature may suffer or have no measurable differences
One of the most common strength training exercises performed when performing traditional resistance exercises upon these
on instability devices in commercial gyms and personal training devices. Therefore, it is recommended that the practitioner
studios is the bench press. A deeper look into the research on this consider the goals and specificity of the training program for
movement reveals inconsistent results. A study by Norwood et the individualized client.
al. revealed that with decreased stability, stabilizer muscles (e.g.,
latissimus dorsi, internal obliques, and erector spinae) increased For instance, if the primary goal of the individual is strength,
in activation (primary musculature was not examined during this power, or hypertrophy, then performing multi-joint, compound
study) (17). The exercise ball bench press has also been shown to movements (e.g., squats, bench presses, shoulder presses, and
elicit increased activation of the deltoids and RA when compared deadlifts) on a stable surface should form the foundation of the
to the traditional method (13). However, not all studies have program. Performing these compound movements on instability
shown differences in activation or weight lifted between surfaces. devices may decrease force production and thereby limit the
Goodman et al. demonstrated that there were no differences maximal load that can be utilized during a particular exercise

PTQ 2.1 | [Link] 5

INSTABILITY TRAINING—HELP OR HYPE?

(1,10). On the other hand, if the goal is increased core activation 9. Goodman, CA, Pearce, AJ, Nicholes, CJ, Gatt, BM, and
or local muscular endurance, then instability training may be Fairweather, IH. No difference in 1RM strength and muscle
occasionally supplemented into workouts to introduce unstable activation during the barbell chest press on a stable and unstable
environments and thus increase abdominal wall endurance surface. The Journal of Strength and Conditioning Research 22(1):
and stability. In addition, performing compound exercises with 88-94, 2008.
reduced loads and increased volume on instability devices may 10. Koshida, S, Urabe, Y, Miyashita, K, Iwai, K, and Kagimori, A.
still be of benefit to individuals wishing to improve or maintain Muscular outputs during dynamic bench press under stable versus
the general health benefits of exercise, as well as individuals in a unstable conditions. The Journal of Strength and Conditioning
deload training phase who need to decrease forces and velocities Research 22(5): 1584-1588, 2008.
to allow for recuperation. The latter approach would be most
recommended with upper body movements (6). Table 1 provides 11. Lehman, GJ, Gordon, T, Langley, J, Pemrose, P, and Tregaskis,
an example of several movements that can be performed under S. Replacing a Swiss ball for an exercise bench causes variable
varying levels of instability. changes in trunk muscle activity during upper limb strength
exercises. Dynamic Medicine 4: 6, 2005.
There are clearly some negative consequences to utilizing 12. Lehman, GJ, Hoda, W, and Oliver, S. Trunk muscle activity
instability training. However, there is significant evidence during bridging exercises on and off a Swiss ball. Chiropractic and
indicating that when utilized properly, with appropriate specificity Osteopathy 13: 14, 2005.
in regards to the goals of the individual, instability training can be
a valuable supplemental tool. As with any form of exercise, the 13. Marshall, PWM, and Murphy, BA. Increased deltoid and
use of instability training should be introduced progressively to abdominal muscle activity during Swiss ball bench press. The
beginners to allow for proper adaptations prior to moving to more Journal of Strength and Conditioning Research 20(4): 745-750,
advanced movements. 2006.
14. Marshall, R, and Murphy, B. Changes in muscle activity and
REFERENCES perceived exertion during exercises performed on a Swiss ball.
1. Anderson, KG, and Behm, DG. Maintenance of EMG activity Applied Physiology, Nutrition, and Metabolism 31(4): 376-383,
and loss of force output with instability. The Journal of Strength 2006.
and Conditioning Research 18(3): 637-640, 2004.
15. McGill, SM, Cannon, J, and Anderson, JT. Analysis of pushing
2. Beach, TAC, Howarth, SJ, and Callaghan, JP. Muscular exercises: Muscle activity and spine load while contrasting
contribution to low-back loading and stiffness during standard and techniques on stable surfaces with a labile suspension strap
suspended push-ups. Human Movement Science 27(3): 457-472, training system. The Journal of Strength and Conditioning Research
2008. 28(1): 105-116, 2014.
3. Behm, DG. Neuromuscular implications and applications 16. Mok, NW, Yeung, EW, Cho, JC, Hui, SC, Liu, KC, and
of resistance training. The Journal of Strength and Conditioning Pang, CH. Core muscle activity during suspension exercises.
Research 9(4): 264-274, 1995. Journal of Science and Medicine in Sport 2014. doi:10.1016/j.
4. Byrne, JM, Bishop, NS, Caines, AM, Crane, KA, Feaver, AM, jsams.2014.01.002.
and Pearcey, GEP. Effect of using a suspension training system 17. Norwood, JT, Anderson, GS, Gaetz, MB, and Twist, PW.
on muscle activation during the performance of a front plank Electromyographic activity of the trunk stabilizers during
exercise. The Journal of Strength and Conditioning Research 28(11): stable and unstable bench press. The Journal of Strength and
3049-3055, 2014. Conditioning Research 21(2): 343-347, 2007.
5. Chulvi-Medrano, I, Martinez-Ballester, E, and Masia-Tortosa, 18. Saeterbakken, AH, Andersen, V, Jansson, J, Kvellestad, AC,
L. Comparison of the effects of an eight-week push-up program and Fimland, MS. Effects of BOSU ball(s) during sit-ups with
using stable versus unstable surfaces. International Journal of body weight and added resistance on core muscle activation. The
Sports Physical Therapy 7(6): 586-594, 2012. Journal of Strength and Conditioning Research 28(12): 3515-3522,
6. Cressey, EM, West, CA, Tiberio, DP, Kraemer, WJ, and Maresh, 2014.
CM. The effects of ten weeks of lower-body unstable surface 19. Schoffstahl, JE, Titcomb, DA, and Kilbourne, BF.
training on markers of athletic performance. The Journal of Electromyographic response of the abdominal musculature
Strength and Conditioning Research 21(2): 561-567, 2007. to varying abdominal exercises. The Journal of Strength and
7. Duncan, M. Muscle activity of the upper and lower rectus Conditioning Research 24(12): 3422-3426, 2010.
abdominis during exercises performed on and off a Swiss ball. 20. Snarr, RL, and Esco, MR. Electromyographic comparison of
Journal of Bodywork and Movement Therapies 13(4): 364-367, traditional and suspension push-ups. Journal of Human Kinetics
2009. 39(1): 75-83, 2013.
8. Freeman, S, Karpowicz, A, Gray, J, and McGill, S. Quantifying 21. Snarr, RL, and Esco, MR. Comparison of electromyographic
muscle patterns and spine load during various forms of the push- activity when performing an inverted row with and without a
up. Medicine and Science in Sports Exercise 38(3): 570-577, 2006. suspension device. Journal of Exercise Physiology-online 16(6):
51-58, 2013.
6 PTQ 2.1 | [Link]
 [Link]
[Link]

22. Snarr, RL, and Esco, MR. Electromyographical comparison of Jason Casey is the Coordinator of Fitness Services at the University
plank variations performed with and without instability devices. of Alabama and pursuing a PhD in Exercise Science. In addition,
The Journal of Strength and Conditioning Research 28(11): 3298- Casey holds a Master’s degree in Exercise Science from the
3305, 2014. University of Alabama, is a Certified Strength and Conditioning
Specialist® (CSCS®) through the National Strength and Conditioning
23. Snarr, RL, Esco, MR, Witte, EV, Jenkins, CT, and Brannan,
Association (NSCA) and Health Fitness Specialist through the
RM. Electromyographic activity of rectus abdominis during a
American College of Sports Medicine (ACSM-HFS). Casey has
suspension push-up compared to traditional exercises. Journal of
over 10 years of experience as a strength and conditioning coach
Exercise Physiology 16(3): 1-8, 2013.
and personal trainer. In addition to the general population,
24. Zemkova, E, Jelen, M, Kovacikova, Z, Olle, G, Vilman, T, and he primarily works with collegiate, powerlifting, and extreme
Hamar, D. Power outputs in the concentric phase of resistance conditioning athletes.
exercises performed in the interval mode on stable and unstable
surfaces. The Journal of Strength and Conditioning Research Ashleigh Hallmark is a first year master’s student studying
26(12): 3230-3236, 2012. exercise science at the University of Alabama. She holds a
Bachelor’s degree in Human Movement and Performance from
Florida Southern College and has three years of experience
ABOUT THE AUTHOR working in the fitness industry.
Ronald Snarr is a PhD student studying Exercise Physiology/
Human Performance at the University of Alabama. He currently Ryan Eckert is a senior studying exercise, wellness, and nutrition
holds a Master of Education degree in Exercise Science from at Arizona State University and is a National Strength and
Auburn University at Montgomery. Snarr is also a Certified Strength Conditioning Association Certified Personal Trainer® (NSCA-
and Conditioning Specialist® (CSCS®) through the National Strength CPT®). He is currently a personal trainer for Core Concepts
and Conditioning Association (NSCA), Health Fitness Specialist Personal Training. Eckert has three years of experience in
through the American College of Sports Medicine (ACSM-HFS), personal training, working with the general population as
and a Certified Personal Trainer through the American Council on well as recreational athletes.
Exercise (ACE-CPT). Snarr has 10 years of experience in strength
and conditioning, personal training, as well as worked with athletes
at the Olympic, professional, and collegiate levels.

FIGURE 1. EXERCISE BALL FIGURE 3. SUSPENSION TRAINER

FIGURE 2. BALANCE TRAINER FIGURE 4. BALANCE BOARD

PTQ 2.1 | [Link] 7

INSTABILITY TRAINING—HELP OR HYPE?

TABLE 1. SAMPLE INSTABILITY TRAINING MOVEMENTS AND PROGRESSIONS

INTERMEDIATE
EXERCISE BASIC MOVEMENT ADVANCED PROGRESSION SETS X REPS
PROGRESSION

Hold medicine ball Hold medicine ball with

Exercise Ball Crunches Bodyweight 3 x 20
at chest level arms extended overhead

Feet on the exercise ball Feet on the ground with

On knees with the forearms
Exercise Ball Planks with arms extended and arms extended and 3 x 30 s
on the ball
hands on the ground hands on the ball
Dome portion on the
Balance With flat side Dome portion
ground and one leg 3 x 10
Trainer Push-Ups on the ground on the ground
off the ground
With feet in the
Hands in device and Forearms in device and feet
Suspended Planks device and forearms 3 x 30 s
feet on the ground on the ground
on the ground

On toes with
Suspended Push-Ups On knees Feet elevated 3 x 10
legs extended

Suspended With 90° knee bend and Legs extended and

Feet elevated 3 x 10
Inverted Rows feet on the ground heels on the ground

With knees bent and feet Legs extended and L-sit

Suspended Pull-Ups 3x6
on the ground heels on the ground (knees and hips at 90°)

8 PTQ 2.1 | [Link]

 [Link]

LET’S
CHANGE
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TOGETHER
BRANDON JOHNSON, NSCACPT
[Link]/TRAINERB

FREE TOOLS TO HELP YOUR CLIENTS SUCCEED:

EXERCISE DATABASE  RECIPES  NUTRITION INFO
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PTQ 2.1 | [Link] 9
COMMITMENT TO THE PROFESSION—TIME TO STEP
UP OR STEP OUT
ROBERT LINKUL, MS, CSCS,*D, NSCA-CPT,*D

T
he personal training industry can be a tough business to studio to studio, and personal trainer to personal trainer; however,
succeed in. Most trainers enter this industry on a part-time all professionals could benefit from focusing on the following four
basis with the intention to make some extra money on goals to seek a higher standard.
the side. Eventually every trainer hits a point in which they must
self-reflect on their career and decide what their next professional 1. Respect Your Circle
move will be. Will they leave the industry entirely, maintain part-
All professionals have a circle of people in their lives. This
time schedules, or take the next step towards becoming full-time
circle includes family, friends, associates, professional
personal trainers?
peers, current clients, and possible future clients. Respect
Is it time to step up, or is it time to leave? This is the question is reciprocal; so the more respect a trainer dishes out,
that each personal trainer must ask themselves when considering the more likely they are to receive some back. Being well
their future. Maintaining a part-time schedule is great for getting respected in a profession, and in life in general, is a huge
a start, building a clientele, and gaining experience. However, benefit to a successful business and career (1).
a true professional should not dabble for very long, they should
2. Follow Through On Commitments
commit. Dabbling may lead to inconsistent income and a
lackluster reputation (3). Clients typically seek out a personal trainer for one
reason—they need help. What they need help with can vary.
Usually, a part-time trainer has a part-time mindset and that is
For instance, they may need help losing weight, getting
not the type of professional that clients want to work with. Clients
stronger, or learning how to be motivated. No matter what
usually want a committed professional; they want a personal
the goal is, they need the help from a personal trainer and
trainer who takes great pride in their work and who makes every
the personal trainer can better position themselves to help
effort to learn more and increase the quality of the product they
them achieve their goal by fully committing to their cause.
provide. Clients would rather fully commit to a professional who
fully commits to them. This is how a professional reputation is Clients are often intimidated by the idea of working with
developed and the power of the referral is realized (6). a personal trainer and can easily have one bad experience
ruin the idea of seeking professional help altogether.
It is estimated that the average personal trainer will leave the
Personal trainers should fully commit to their client and
fitness industry in under eight years, making their time spent as
make their time spent together professional, efficient,
more of a job than an actual career (4). The ones who surpass this
and enjoyable.
barrier tend to be highly successful as they have a better chance to
become fitness professionals who implement and practice sound 3. Dedication To Education
business strategies. The intention to leave the industry better than
when they entered it is an admirable mindset for any professional The personal training industry is growing and evolving
to have (4). quickly. Research studies regarding health and fitness topics
are being performed at an all-time high. These studies are
When the less committed personal trainers leave the fitness producing some amazing findings and training practices
industry, it helps to make the industry stronger. Slowly, the that should be studied by dedicated professionals seeking
personal training profession weeds out the personal trainers who the most current and up-to-date strategies for their clients
are less dedicated, which elevates the committed professionals (4). Additionally, personal trainers should attend seminars,
to a higher level. In an industry that has no governing body, the clinics, conferences, and other networking events to further
responsibility of holding a high standard falls on the personal their education in the field.
trainers themselves. These standards can differ from gym to gym,
10 PTQ 2.1 | [Link]
 4. Conduct Yourself As A Professional REFERENCES
1. Chittenden, K. Developing leadership in fitness professionals.
The simple things that all professionals should do are
NSCA Coach 1(1): 6-7, 2014.
sometimes the most easily overlooked. Personal trainers
should always maintain a current certification and 2. Kompf, J, Tumminello, N, and Nadolsky, S. The scope of
professional liability insurance. They should also utilize practice for personal trainers. Personal Training Quarterly 1(4): 4-9,
appropriate paperwork and make sure they always work 2014.
within their professional scope of practice (5). They should 3. LaGary, C. The personal trainer: A perspective. Strength and
not work with clients they are not qualified or comfortable Conditioning Journal 23(1): 14, 2001.
working with and should work to create a network of
4. Linkul, R. NSCA Career Series 2013 – Implementing systems:
professionals in which they can refer (2).
Managing your business and your personal training team.
These practices, while simple, are what separate the “part-time” Retrieved 2015 from [Link]
trainers from the committed and career-driven professionals. development/developing-a-career-as-a-certified-personal-trainer/.
These committed professionals accept the challenges that face 5. Lowe, JU. Your business backbone: Understanding legal and
them, continue to educate themselves, and overcome obstacles insurance regulations. PFP Magazine July-August, 18-19, 2014.
that come their way. They push themselves to uphold a higher
6. McCall, P. 7 strategies for helping clients train smarter—Not
standard and to improve the quality of the product which they
harder. American Council on Exercise. 2015. Retrieved 2015 from
provide (5). By striving to achieve a higher standard, true career-
[Link]
driven personal trainers embed a positive footprint on the fitness
clients-train-smarter-not.
industry and do their part in leaving the profession better than
when they entered it.
ABOUT THE AUTHOR
Robert Linkul is the National Strength and Conditioning
Associations (NSCA) 2012 Personal Trainer of the Year and is a
volunteer with the NSCA as their Southwest Regional Coordinator
and Committee Chairman for the Personal Trainers Special Interest
Group (SIG). Linkul has written for a number of fitness publications
including Personal Fitness Professional, Healthy Living Magazine,
OnFitness Magazine, and the NSCA’s Performance Training Journal
(PTJ). Linkul is an international continued education presenter
within the fitness industry and a Career Development Instructor for
the National Institute of Personal Training (NPTI).

BUILDING THE PERSONAL TRAINER’S TOOLBOX

MAY 15 – 16, 2015 | COLORADO SPRINGS, CO | CEUs 1.6 | BOC 16 | [Link]/PTTOOLBOX2015

PTQ 2.1 | [Link] 11

FEATURE ARTICLE

OVERTRAINING AND RECOVERY

JONATHAN MIKE, PHD(C), CSCS,*D, NSCA-CPT,*D, USAW

O
vertraining remains one the most controversial topics aspect of training is the recovery process. Another useful way that
within the field of strength and conditioning, as it accounts strength and conditioning professionals might refer to and think of
for increased fatigue and can result in performance overtraining is “under recovery,” (12). Therefore, attention must be
impairment. One of the many topics that persists among strength given to the process of recovery.
and conditioning professionals is the topic of overtraining. A
common question that is asked is how does overtraining differ OVERTRAINING SYNDROME VERSUS
from overreaching? Additionally, some may even question the OVERREACHING
very existence of overtraining. Although the prevalence of What is the definition of overtraining syndrome (OTS)? There
overtraining varies considerably among a variety of sports, is currently no single agreed-upon definition of overtraining
the overall occurrence of actual overtraining seen in normal syndrome; however, a number of alternatives have been
day-to-day resistance trained individuals is very low (11,17,22). used. Halson and Jeukendrup have provided a definition of
The purpose of this article is to address the implications of overtraining as:
overtraining and overreaching, the recovery process, signs
“An accumulation of training and/or non-training stress
and symptoms of overtraining, how resistance training and
resulting in long-term decrement of performance capacity with
supplementation can affect these outcomes, and future directions
or without related physiological and psychological signs and
within the topic of overtraining.
symptoms of overtraining in which restoration of performance
Understanding the importance of recognizing overtraining is capacity may take several weeks or months,” (6).
essential because there are numerous physiological conditions
How does overtraining differ from overreaching? According to
that can lead to overtraining. For example, research has reported
Meeusen et al., overreaching is defined as:
that individuals participating in endurance training for many hours
at a time have been shown to have an overactive pituitary gland, “An accumulation of training and non-training stressors that
which may result in increased levels of cortisol and a disruption result in a short-term decrement in performance capacity with
in muscle growth (15). Overtraining is a multifactorial, complex or without related physiological or psychological signs and
phenomenon. Overtraining is typically discussed in terms of only symptoms of maladaptation in which restoration of performance
training; however, a very important and sometimes neglected may take ranging from days to several weeks to recover,” (14).

12 PTQ 2.1 | [Link]

These definitions of overtraining and overreaching are nearly SIGNS AND SYMPTOMS OF OVERTRAINING
identical. One of the only differences is the amount of time to The onset of overtraining develops due to a specific training
restore performance, not the type or duration of the training schedule or more particularly, a sequence of training bouts that is
stress. Another difference is that overreaching may take several abruptly increased, exists for an extended period of time, and/or
days to several weeks to recover, whereas overtraining likely takes exhibits high volume or high-intensity exercises with inadequate
several weeks to several months (6,14). recovery and regeneration time. The responses to overtraining
are usually characteristic of fatigue, stress, and exhaustion. The
RECOVERY AND TRAINING extent to which specific training loads induce overtraining is
Recovery is a fundamentally important process to the overall
uncertain. Additional training loads and insufficient recovery
training program and is vital for maximal performance benefits.
can be the primary factors for the occurrence of overtraining.
If the rate of recovery is enhanced, greater training volumes and
Notwithstanding, it would be incorrect to assume that training
intensities are achievable without consequential overtraining (2).
load and inadequate recovery account for every circumstance of
Although many strength and conditioning professionals often use
overtraining, as it is important to consider other factors that may
different approaches for this process, recovery may not always
be involved, such as nutrition, sleep, illness, overall health, and
be addressed fully, particularly in the area of fatigue. Strategies
emotional or physical stress.
for optimal recovery exhibit individual variability that depends on
the type of fatigue (e.g., central or peripheral), training history, A decrease in performance is often the hallmark of an overtrained
and ability to cope with other potential stressors (e.g., emotional athlete. However, the level of performance impairment that has
or psychological). to occur in order to classify one as overtrained is currently
unknown. Other common characteristics of overtraining include
Recovery can be defined as the ability to meet or exceed
a change in the role of exercise-induced immunosuppression as
performance in a particular activity (2). Typically, training
well as an increased incidence of illness, particularly in the upper
sessions produce a level of fatigue or depletion that is followed
respiratory tract (e.g., upper respiratory tract infection [URTI],
by supercompensation. If the recovery intervals between training
swollen lymph glands, flu-like symptoms, bruising, and decreased
bouts are maximized, the next training session will accompany
recovery) (6,13).
supercompensation and performance may be enhanced (23).
There are also other important functions that coincide with Even highly trained individuals may be vulnerable to illness
recovery, particularly after exercise, including restoration of or injury as a result of a sudden increase in training volume or
physiological functions and replenishment of energy sources (9). intensity. This timeframe of immunosuppression is known as the
However, an individual should achieve a balance where adaptation “open window,” as an individual is more susceptible to infections
and recovery takes the athlete to supercompensation and may or injury directly after and throughout various stressors (15). The
lead to a more physically conditioned state. open window is described as a period of 3 – 24 hr after prolonged
endurance training when host defense is reduced and more
The onset of recovery develops during and after exercise. This
susceptible to URTIs (15). Therefore, any accelerated increase in
is exhibited by the removal of metabolic end products such
training volume or training intensity can compromise the exercise-
as lactate. Throughout exercise, recovery is crucial in order to
induced immune system response.
restore blood flow, not only for the delivery of oxygen which
stimulates adenosine triphosphate (ATP) resynthesis, but also for Early reports have listed more than 90 different signs and
the recovery of muscle membrane potential, and to reestablish symptoms that have been reported from overtrained athletes
intramuscular pH (20). Furthermore, a greater increase in excess (4). Below are just some of the more common physiological and
post-exercise oxygen consumption (EPOC) occurs. psychological factors from recent reports (5):

Initial recovery, referred to as “immediate recovery,” occurs 1. Muscle weakness and soreness
throughout exercise. Bishop et al. provides an example of a race
walker with one leg in immediate recovery between each stride 2. Decreased exercise performance
(2). During this immediate recovery period, the lower extremities
regenerate ATP. If each leg recovers more rapidly, the walker will 3. Decreased appetite
more quickly be able to accomplish the stride with efficiency. The
4. Reduction in quality and/or quantity of sleep
second type of recovery is termed “short-term recovery.” This
method of recovery generally takes place between exercise sets 5. Gastrointestinal abnormalities
or between interval training bouts (18). The final form of recovery
is referred to as “training recovery,” which is characterized 6. Increased risk of infection
by the recovery between various training sessions or athletic
competitions (2). If individuals engage in continuous training (e.g., 7. Increased resting heart rate
multiple training sessions in the same day or multiple events in
8. Increased time required for recovery
a single competition) without an adequate recovery period, then
performance impairments are more likely to occur (2,18). As a 9. Decreased desire to train
result, the individual is unlikely to be prepared for the subsequent
training bouts. Overtraining is most often related to the form of
training recovery.

PTQ 2.1 | [Link] 13

OVERTRAINING AND RECOVERY

RESISTANCE TRAINING AND OTS CONCLUSION

The fundamental nature of resistance training programs should Many questions currently remain about identifying the aspects
be designed to incorporate a specific and selective combination of overtraining. However, it is clear that additional research is
of variables including choice of exercise, sequence effect, training warranted to explain the complicated nature of overtraining.
intensity or load, training volume, and rest intervals. As mentioned During all training programs, the recovery period should be
previously, the two principle factors that induce overtraining are tailored to the needs of the individual in order to determine the
training volume and intensity (1,3). It is common for beginning period of time needed to elicit optimal recovery.
and intermediate trainees to accumulate large amounts of training
volume and increase the magnitude of training intensity early in The following questions provide some awareness and direction for
their programs, which also may lead to them extending the period future research into overtraining:
before adequate recovery can be achieved. Research suggests that
• Is there a general and/or specific timeframe by which
excessive training volumes usually produce a reduction between
changes in performance occur to assist in detecting signs of
the testosterone-to-cortisol ratio, which may lead to performance
overtraining?
declines (1). This ratio is believed to show the balance of action
between anabolic and catabolic activity. However, recent research • Is there a threshold for a specific training volume or
suggests that cortisol is not entirely a negative aspect, but intensity required to induce overtraining?
may actually depict a quality training session, and that acute
cortisol is more related to anabolism after weight training (21). • What detrimental performance measures occur through
It should be noted that it becomes a challenge to formulate any training, which would better identify overtraining (i.e.,
conclusions regarding alterations in hormonal levels due to various in-season, off-season)?
performance assessments and modifications in training intensity
and length. • To what degree do protein and amino acid supplementation
play a role in reducing the overtraining response?
SUPPLEMENTATION
Protein and amino acid supplementation are believed to protect • Are there similarities and differences that exist between
against many harmful effects of overtraining. Research has and within a variety of sports?
reported that adding protein to a moderate carbohydrate meal
• Are there gender differences when it comes to
stimulates glycogen synthesis and increases exercise performance
overtraining?
after an initial exercise session, compared to a moderate
carbohydrate-only meal (7,8). In addition, evidence shows Although it may be difficult to answer these important questions
that supplementing with amino acids attenuated performance regarding overtraining and overreaching currently, acknowledging
reductions in the bench press and squat during periods of and seeking solutions to these questions can serve as a model and
overtraining (16). In addition, creatine supplementation has been guide in helping to reduce or even prevent overtraining.
shown to be effective for maintaining muscular performance
during the initial phase of overreaching using high-volume REFERENCES
resistance training (19). 1. Adlercreutz, H, Härkönen, M, Kuoppasalmi, K, Näveri, H,
Huhtaniemi, I, Tikkanen, H, et al. Effect of training on plasma
IDENTIFYING AND MEASURING OVERTRAINING anabolic and catabolic steroid hormones and their response during
It is imperative that strength and conditioning professionals have physical exercise. International Journal of Sports Medicine 7(suppl
the ability to identify and anticipate the onset of overtraining 1): 27-28, 1986.
so they can reduce its negative effects or potentially avoid it
altogether. One instrument that can assist in identifying the onset 2. Bishop, PA, Jones, E, and Woods, AK. Recovery from training:
of overtraining is the Profile of Mood States, which serves as an A brief review. The Journal of Strength and Conditioning Research
easy assessment for early markers of overtraining. In addition, 22(3): 1015-1024, 2008.
the concept of total quality recovery focuses attention of the
relationship between training and recovery, and can be very 3. Fry, AC. Overtraining with resistance exercise. American
useful to consider (17). Keeping this aspect in mind is essential College of Sports Medicine: Current Comments. 2001. Retrieved
in designing effective training programs and promoting strategic 2014 from [Link]
recovery. Lastly, the Recovery-Stress Questionnaire for Athletes [Link].
can be used, which acknowledges the recovery stress conditions
4. Fry, RW, Morton, AR, and Keast, D. Overtraining in athletes: An
based off several different general and specific recovery scales
update. Sports Medicine 12(1): 32-65, 1991.
(10). Professionals should investigate these tools and learn how to
utilize them properly before implementing them with any potential 5. Gleeson, M. Biochemical and immunological markers of
clients or athletes. overtraining. Journal of Sports Science and Medicine 1(2):
31-41, 2002.

14 PTQ 2.1 | [Link]

 [Link]

6. Halson, SL, and Jeukendrup, AE. Does overtraining exist? 19. Volek, JS, Ratamess, NA, Rubin, MR, Gómez, AL, French, DN,
An analysis of overreaching and overtraining research. Sports McGuigan, MM, et al. The effects of creatine supplementation on
Medicine 34(14): 967-981, 2004. muscular performance and body composition responses to short-
term resistance training overreaching. European Journal of Applied
7. Ivy, JL, Goforth, HW Jr., Damon, BM, McCauley, TR, Parsons, Physiology 91(5-6): 628-637, 2004.
EC, and Price, TB. Early postexercise muscle glycogen recovery
is enhanced with a carbohydrate protein supplement. Journal of 20. Weiss, LW. The obtuse nature of muscular strength: The
Applied Physiology 93(4): 1337-1344, 2002. contribution of rest to its development and expression. Journal of
Applied Sports Science Research 5(4): 219-227, 1991.
8. Ivy, JL, Res, PT, Sprague, RC, and Widzer, MO. Effect of a
carbohydrate-protein supplement on endurance performance 21. West, DW, and Phillips, SM. Associations of exercise-induced
during exercise of varying intensity. International Journal of Sport hormone profiles and gains in strength and hypertrophy in a
Nutrition and Exercise Metabolism 13(3): 382-395, 2003. large cohort after weight training. European Journal of Applied
Physiology 112(7): 2693-2702, 2012.
9. Jeffreys, I. A multidimensional approach to enhancing recovery.
Strength and Conditioning Journal 27(5): 78-85, 2005. 22. Winsley, R, and Matos, N. Overtraining and elite young
athletes. Medicine and Sport Science 56: 97-105, 2011.
10. Kellmann, M, and Kallus, KW. The Recovery-Stress
Questionnaire for Athletes: User Manual. Champaign, IL: Human 23. Zatsiorsky, V, and Kraemer, W. Science and Practice of
Kinetics; 2001. Strength Training. (2nd ed). Champaign, IL: Human Kinetics; 2006.

11. Kellmann, M. Preventing overtraining in athletes in high-

intensity sports and stress/recovery monitoring. Scandinavian
ABOUT THE AUTHOR
Journal of Medicine and Science in Sports 20(suppl 2): 95-102,
Jonathan Mike is in the final stages of completing his PhD
2010.
in Exercise Physiology from the University of New Mexico in
12. Kellmann, M. Underrecovery and overtraining: Different Albuquerque, NM. He received his Bachelor’s and Master’s degrees
concepts—Similar impact? In: Kellman, M (Ed.), Enhancing in Exercise Science from Western Kentucky University in Bowling
Recovery: Preventing Underperformance in Athletes. Champaign, Green, KY while also serving as a Strength and Conditioning
IL: Human Kinetics; 3-24, 2002. Assistant. He also worked at the University of Louisville as a
Strength and Conditioning Assistant and has been a frequent
13. Lakier, SL. Overtraining, excessive exercise, and altered contributor and guest host of several websites and radio shows. He
immunity: is this a T helper-1 versus T helper-2 lymphocyte is a member of the National Strength and Conditioning Association
response? Sports Medicine 33(5): 347-364, 2003. (NSCA) Exam Development Committee for the NSCA-Certified
Personal Trainer® (NSCA-CPT®), Job Analysis Committee, and a
14. Meeusen, R, Duclos, M, Foster, C, Fry, A, Gleeson, M, Nieman, member of the Personal Trainers Special Interest Group (SIG).
D, et al. Prevention, diagnosis and treatment of the overtraining Mike has authored or coauthored various works related to sports
syndrome: joint consensus statement of the European College nutrition and strength and conditioning. Further, he has been
of Sport Science and the American College of Sports Medicine. published in the Strength and Conditioning Journal and has
Medicine and Science in Sports and Exercise 45(1): 186-205, 2013. both authored and coauthored multiple book chapters in areas
of sports nutrition and strength training and conditioning. His
15. Nieman, DC. Effects of athletic endurance training on infection
research interests include strength and power development,
rates and immunity. In: Kreider, RB, Fry, AC, O’Toole, ML (Eds.),
functional movement, exercise and energy metabolism, and areas
Overtraining in Sport. Champaign, IL: Human Kinetics; 1998.
of sports nutrition. In addition, he writes for numerous fitness and
16. Ratamess, NA, Kraemer, WJ, Volek, JS, Rubin, MR, Gómez, AL, bodybuilding consumer magazines and outlets.
French, DN, et al. The effects of amino acid supplementation on
muscular performance during resistance training overreaching.
The Journal of Strength and Conditioning Research 17(2): 250-258,
2003.

17. Richardson, SO, Andersen, M, and Morris T. Overtraining

Athletes: Personal Journeys in Sport. Champaign, IL: Human
Kinetics; 2008.

18. Seiler, S, and Hetlelid, KJ. The impact of rest duration on work
intensity and RPE during interval training. Medicine and Science in
Sports and Exercise 37(9): 1601-1607, 2005.

PTQ 2.1 | [Link] 15

FEATURE ARTICLE

EFFECTIVE FUNCTIONAL EXERCISE PROGRAMMING

FOR THE OLDER FITNESS CLIENT AFTER A TOTAL
KNEE REPLACEMENT
KEITH CHITTENDEN, MS, CSCS,*D, TSAC-F,*D

A
s people get older, many biological changes take place compression of the knee. This pain may be a result of obesity, the
in the structure of their bones and joints. One change constant wearing down of articular cartilage (development of OA),
that can cause significant pain and loss of functional degeneration or injury to the meniscus, or rheumatoid arthritis,
ability is degenerative joint disease, also known as osteoarthritis. to name a few. The material used for a TKA is comprised of metal
Osteoarthritis (OA) is defined as the degenerative changes of parts made of titanium or cobalt-chromium based alloys (2). The
the hyaline articular cartilage on the ends of bones that make plastic parts are made of polyethylene and are a lightweight yet
up a joint (1,2,3). OA can cause the formation of divots and/ strong material (2). These materials are chosen because they are
or osteophytes (bone spurs) on the end of the bone within the accepted by the body, duplicate the knee structure, are strong and
knee joint (i.e., distal end of the femur and tibial plateau) (1,3). flexible enough to take weight-bearing loads, will not typically
Walking and standing can cause compression of the joint and break when stressed, and can last for many years (2).
can put pressure on the osteophytes formation. As a result, the
individual may experience pain and may potentially decrease The two types of fixations for TKAs are cemented and cementless.
his or her mobility in an effort to avoid the pain from the hyaline Cemented fixation uses fast curing bone cement called
articular cartilage breakdown. Many older adults who experience polymethylmethacrylate (2). Cementless fixation relies on new
this pain during standing and walking will elect to undergo a bone growing into the implant (2). The most common type of
total knee replacement surgical intervention known as total prosthesis is the fixed-bearing (cemented), where the upper
knee arthroplasty (TKA). Personal trainers should be aware of portion of the polyethylene component of the tibia is attached
the effects that are commonly experienced by people who have to the underlying metal component that makes up the tibial
undergone this surgery as well as the interventions and exercises plateau (2). The femoral component can smoothly roll on the
that can help these clients regain functionality. surface without any friction (2). For clients who are younger and
more active, there is the mobile-bearing prosthesis, which allows
TOTAL KNEE ARTHROPLASTY for a greater range of motion (ROM). The one drawback to a
TKAs have become a surgical intervention used to treat the mobile-bearing prosthesis is that the patient must have good joint
development of osteoarthritis. In 2006, there were 516,000 TKAs support in the ligaments (i.e., collateral ligaments). If the joint
performed in the United States (1). By 2030, the projected amount does not have good support from the ligaments, the occurrence of
of TKA procedures will be around 3.48 million (1). Most candidates dislocation is higher (2).
for TKAs are between 50 – 85 years old (2). TKA is a surgical
intervention performed to alleviate pain from bone on bone

16 PTQ 2.1 | [Link]

For people with chronic OA, TKAs may relieve most of the pain PERSONAL TRAINING FOR THE TKA CLIENT
they commonly experience, and result in improved quality of Some clients who have had a TKA procedure may prefer to
life. Research suggests that patients who are one month post- continue their exercises while being supervised by a competent
TKA show a significant deficiency in strength and functional and certified health and fitness professional. This could be a great
ability in the knee extensors, flexors, hip extensors, and hip opportunity for personal trainers to make a significant impact in
abductors (2,3). Quadriceps torque was reported as 60% below their client’s overall functional capacity after their rehabilitation is
their original preoperative strength four weeks post-TKA (3). complete. The personal trainer should be aware that a client who
Even though traditional rehabilitation was initiated the day after has undergone a TKA might still suffer from decreased functional
the surgery, there is a significant torque deficit of voluntary capacity due to decreased glute, hip, and quadriceps strength.
quadriceps activation due to quadriceps atrophy and impaired According to research, a decrease in hip abductor strength
motor unit recruitment (3). Patients that have gone through a TKA post-TKA can result in a decrease in stair-climbing ability and
within the previous year have a 24.7% higher risk of falls (2). The trunk stabilization, and can lead to an increase in compressive
reason for the risk of falls is likely because patients demonstrate forces through the contralateral (non-affected) knee (5). Another
increased postural sway, decreased knee proprioception (typically impairment that is noted for clients after a TKA is difficulty in
due to the loss of the meniscus, a major proprioceptive sensor in balance and loss of proprioception (4). Research has shown a
the knee), and decreased static postural control (2). combination of functional and balance training six months after
surgery can increase gait speed and stair-climbing ability, and
INTERVENTIONS also decrease the risk of falls, weight-bearing asymmetry (i.e.,
One of the interventions used to increase functional
relying on the uninvolved knee instead of using both knees
strength is neuromuscular electrical stimulation (NMES) (3).
for functional walking), and gait compensations due to lower
NMES electronically elicits muscle contraction leading to muscular
extremity weakness (4).
hypertrophy (3). One study showed that NMES implemented 24
– 48 hr post-TKA surgery demonstrated improvements in walking Personal trainers should not be intimidated by working with a
and extensor lag and decreased the length of hospital stays client who has undergone TKA. Adding gluteal strengthening
(3). Licensed healthcare professionals (e.g., physical therapists, and balance training to the exercise programs for these types of
chiropractors, physicians, etc.) are usually the professionals that clients may help to increase their activities of daily living (ADL)
would implement NMES on a patient. and recreational abilities. The client should be able to see and
feel their progress as physical activities become easier and less
Other early interventions include strength training (focusing
physically straining for them. By tracking this progress, it can help
on the sagittal and frontal planes) with low weight which is
motivate the client to continue working with the personal trainer,
targeted at the quadriceps, gluteal muscles, and hip abductors
thereby increasing the likelihood of retaining this client for a long
at a lower maximal intensity (i.e., 40% 1RM) (2). Home exercise
time. The personal trainer should conduct a thorough movement
programs are typically issued to patients who used similar
assessment to examine how the operated knee is moving relevant
exercises and stretching as they did during the supervised therapy
to the other joints in the lower kinetic chain. It is important that
in a physical therapy clinic (2). Many early rehabilitation strategies
the personal trainer recognize any dysfunctions at other joints in
focus primarily on knee ROM and underemphasize resistance
the lower kinetic chain, such as the lumbo-pelvic-hip complex or
training for the knee and the hip (2). As a result, these patients
the foot and ankle joints. During the movement assessment, the
may demonstrate weakness and impairments in activities, such
personal trainer should focus on identifying the possible causes
as decreased gait speed and balance for up to a year after
of movement dysfunctions, such as overactive and underactive
their TKA (6).
muscles, reduced flexibility, and decreased core conditioning, and
Patients may go through multiple phases of rehabilitation in adjust programming accordingly.
physical therapy, which can last up to eight months, but will
CONCLUSION
ultimately vary between individual cases. Because of limitations
TKAs are a common surgery for the treatment of OA in the
of insurance benefits, many patients are discharged from
knee. Strengthening of the lower extremities is crucial to return
physical therapy before total lower kinetic chain strengthening
the client to his or her prior level of function. Quadriceps
can be finished. As a result, it becomes the job of the patient to
training is important to increase functional mobility. However, a
strengthen certain areas such as the gluteal muscles (i.e., gluteus
considerable focus in the client’s programming should be placed
maximus, gluteus medius, and gluteus minimus) on their own.
on strengthening the gluteal musculature. The combination of
When the patient is discharged from physical therapy, they are
quadriceps, hip abductor, and hip extensor strengthening in the
encouraged to continue an exercise program at home or at a
lower kinetic chain can help to produce a smooth, synchronized,
health club.
and prolonged endurance capacity during functional tasks (4,5,6).

PTQ 2.1 | [Link] 17

EFFECTIVE FUNCTIONAL EXERCISE PROGRAMMING FOR THE
OLDER FITNESS CLIENT AFTER A TOTAL KNEE REPLACEMENT

RESISTANCE BAND WALKS – FRONTAL PLANE (SHACKLE

WALKS) (FIGURE 1)

FIGURE 3. RESISTANCE BAND WALKS – SAGITTAL

PLANE (MONSTER WALKS)
FIGURE 1. RESISTANCE BAND WALKS – FRONTAL Similar to shackle walks, monster walks activate the gluteus
PLANE (SHACKLE WALKS) medius, gluteus maximus, and rectus femoris muscles. The
knees should be bent slightly as the client gets into a semi-squat
Resistance band walks are a great way to activate the gluteus
position. The feet should be straight and the upper back should
medius muscle group (hip abductors). To perform the shackle
be as erect as possible without any arching at the lumbar spine.
walk, place a resistance band around the lower leg halfway
The client should take larger than normal steps straight ahead for
between the knees and the ankles (start with light resistance
8 – 10 steps and then repeat going backward. Again, the personal
and increase as necessary). Have the client assume a semi-squat
trainer should monitor the client for proper form. If compensations
position and walk sideways keeping the feet facing forward. Have
such as arching of the lower back, narrow strides, or excessive
the client lead with the knee followed by the ankle without turning
trunk rotation are observed, reduce the resistance of the band.
the foot toward that side. The client should walk 8 – 10 ft to one
side while maintaining the semi-squat position, then walk back EXERCISE BALL WALL SQUATS (FIGURES 4 – 5)
to the opposite side. Form is very important in this exercise; the Lower extremity strengthening is important to work as a whole
personal trainer should monitor the client during the movement for improved functional integration of ADL tasks (e.g., stair
to make sure the knees do not collapse inward, the trunk does climbing, rising from a chair, getting out of a car, etc.). Exercise
not sway toward the opposite side, and the foot does not turn ball wall squats are a good way to work the entire kinetic chain.
outward. If any of these compensations are detected, then the The emphasis should be placed on the downward phase (the
resistance may be too great. eccentric phase) of the squat. The client should be instructed to
descend slowly toward the floor until the thighs are parallel with
RESISTANCE BAND WALKS – SAGITTAL PLANE (MONSTER
the floor, or as close to parallel as the client is capable. The client
WALKS) (FIGURES 2 – 3)
should be cued to keep their back flat against the ball and to
tuck their glutes at the end of the downward phase. There should
be a 2-s delay (isometric contraction) before the upward phase
(concentric) is initiated. The feet should be positioned shoulder-
width apart, knees pointed straight ahead, head in a neutral
position, shoulders down, and navel drawn in to activate the
core muscles.

FIGURE 2. RESISTANCE BAND WALKS – SAGITTAL

PLANE (MONSTER WALKS)

FIGURE 4. EXERCISE BALL WALL SQUAT

18 PTQ 2.1 | [Link]

 [Link]
[Link]

FIGURE 5. EXERCISE BALL WALL SQUAT FIGURE 7. SINGLE-LEG BALANCE

WITH TOUCHDOWN
SINGLE-LEG BALANCE WITH TOUCHDOWN (FIGURES 6 – 7)
AEROBIC ENDURANCE EXERCISE
The client should first start the exercise with the non-involved
Aerobic exercise is important to incorporate into a client’s
leg. This can provide a framework on how the exercise should feel
program after they have undergone a TKA procedure. Most health
when they are performing it on the repaired leg. The client should
clubs and gyms will have a variety of cardio machines to choose
start the movement by drawing in the navel (activation of the
from (i.e., treadmill, elliptical, stationary bike, rowing machines,
core muscles) and isometrically contracting the gluteal muscles.
recumbent bike, etc.). One bout of 30 – 60 min of cardio activity
They should then shift the weight on the stance leg and bring the
at an intensity of 50 – 75% heart rate reserve (HRR) should be
opposite foot off the ground. The client should bend the knee and
incorporated into the client’s program 2 – 3 times per week.
assume a semi-squat position. The client should balance on the
Another option is to have the client walk 25 – 50 min, 2 – 3 times
stance leg for 15 – 30 s, then return the foot to the ground, switch
per week on flat terrain. The personal trainer can incorporate
sides, and repeat. Once the client masters that technique, the
interval training in conjunction with the client’s strength and
personal trainer can progress them to adding in the touchdown.
conditioning program during the workout session. Depending
The touchdown starts with the single-leg balance. When the core
on the client’s level of fitness, a cardio-based interval can
is activated and steady balance is accomplished (> 30 s of steady
be anywhere from 2 – 10 min in duration. The number of cardio
single-leg balance), the client should flex at the hip while keeping
intervals within the client’s strength program should
their spine erect and reach down to touch their knee with the
range between 1 – 6 intervals, depending on the client’s
opposite hand of the stance leg, or reach beyond the knee if the
conditioning level.
client is capable as seen in Figure 7. If the stance leg is the left,
then the touchdown hand is the right. Single-leg balance should
be done for 3 sets of 5 holds (30 s). Single-leg balance with
touchdowns should be done for 3 sets of 10.

FIGURE 6. SINGLE-LEG BALANCE

WITH TOUCHDOWN

PTQ 2.1 | [Link] 19

EFFECTIVE FUNCTIONAL EXERCISE PROGRAMMING FOR THE
OLDER FITNESS CLIENT AFTER A TOTAL KNEE REPLACEMENT

REFERENCES
1. American Academy of Orthopedic Surgeons. Knee ABOUT THE AUTHOR
replacement implants. AAOS. 2010. Retrieved December 20, 2014 Keith Chittenden is a Certified Strength and Conditioning
from [Link] Specialist® with Distinction (CSCS,*D®) and Tactical Strength and
2. Bade, M, Kohrt, W, and Stevens-Lapsley, J. Outcomes before Conditioning Facilitator® with Distinction (TSAC-F,*D®) through
and after total knee arthroplasty compared to healthy adults. the National Strength and Conditioning Association (NSCA).
Journal of Orthopedic and Sports Physical Therapy 40(9): 559-567, He holds a Master’s degree in Exercise Science from California
2010. University of Pennsylvania and is a doctoral candidate at the
University of Hartford. He was a columnist for the NSCA’s TSAC
3. Mintken, P, Carpenter, K, Eckhoff, D, Kohrt, W, and Stevens,
Report and continues to be a regular contributor to NSCA Associate
J. Early neuromuscular electrical stimulation to optimize
publications. Chittenden has over 13 years working with athletes,
quadriceps muscle function following total knee arthroplasty: A
police officers, and military personal in areas such as fitness,
case report. Journal of Orthopedic and Sports Physical Therapy
performance enhancement, and post-rehabilitation.
37(7): 364-371, 2007.
4. Piva, SR, Gil, AB, Almedia, GJM, DiGioia, AM, Levison, TJ, and
Fitzgerald, KG. A balance exercise program appears to improve
function for patients with total knee arthroplasty: A randomized
clinical trial. Physical Therapy 90(6): 880-894, 2010.
5. Piva, SR, Teixeira, EP, Gil, AB, Almedia, GJM, DiGioia, AM,
Levison, TJ, and Fitzgerald, KG. Contributions of hip abductor
strength to physical function in patients with total knee
arthroplasty. Physical Therapy 91(2): 225-233, 2011.
6. Walsh, M, Woodhouse, LJ, Thomas, SG, and Finch, E. A
comparison of individuals 1 year after total knee arthroplasty with
control subjects. Physical Therapy 78(3): 248-258, 1998.

TABLE 1. SAMPLE STRENGTH AND CONDITIONING PROGRAM FOR A TKA CLIENT

EXERCISE SETS REPS REST

Resistance band/shackle 5 (each rep consists of walking

3 30 – 60 s
walking (frontal plane) 8 – 10 steps left and right)

5 (each rep consists of

Resistance band/monster
3 walking forward and 30 – 60 s
walking (sagittal plane)
backward 8 – 10 steps)

Exercise ball wall squats 3 10 30 s

Single-leg balance 3 (each leg) 5 (each rep is 30 s) 30 – 60 s

30 – 60 min; if interval training,

Aerobic endurance activity 15 – 25 s between
1 perform 2 – 10 min
(treadmill, elliptical, bike, etc.) aerobic activity
per bout of interval

20 PTQ 2.1 | [Link]

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combat
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PROTEIN FREE
™

- LOW SUGAR & NET CARBS

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REAL ATHLETES.
PTQ 2.1 | [Link] REAL SCIENCE. ™ 21
FEATURE ARTICLE

A SWOT ANALYSIS OF THE SCOPE OF PRACTICE FOR

PERSONAL TRAINERS
DAN MIKESKA, MS

R
isk management is the “process of making and carrying To continue the example, Mr. Smith is 46 years old, works at
out decisions that will minimize the adverse effects of a sedentary job, and has not exercised regularly since college
accidental losses upon an organization” (14). Accidental football. He is overweight, has residual knee pain from football,
loss can be in the form of income or property, and often results and eats most of his meals on the fly. Mr. Smith knows he needs
from negligence. In a gym or health club, poorly maintained to start exercising and eating better. He joins a gym and is
property, malfunctioning equipment, or a breach of duty by immediately sold on the benefits of hiring a personal trainer.
personnel can result in a negligence lawsuit. One such breach The membership sales representative recommends one of the
of duty in a gym or health club that is commonly found is when best trainers at the gym. However, that recommendation is usually
a personal trainer works outside their scope of practice, which based on sales instead of professional credentials or experience.
can be defined by their level of experience and education Depending on this trainer’s experience and credentials, if
(17). Therefore, having a clear understanding of the strengths, nutritional advice is given, if treatment for injury or disease
weaknesses, opportunities, and threats (SWOT) from offering is recommended, or if behavioral counseling or therapy is
personal training services needs to be considered in order to offered, then the trainer may be working outside their scope
optimize the quality of care and to mitigate potential litigation. of practice. This would make the trainer and facility a target
for a negligence lawsuit (1).
BACKGROUND
As an example, Acme Fitness has a 50,000 square foot fitness By offering personal training services, it is implied that a Certified
facility boasting close to 5,000 members. The facility has free Personal Trainer (CPT) has the knowledge, skills, and ability to
weights, selectorized machines, and plate-loaded machines, as provide a safe workout. It is assumed that a CPT accepts the
well as a large selection of cardiovascular equipment that includes responsibility associated with exposing a client to the stress of
treadmills, elliptical machines, stair climbers, and stepmills. The exercise without causing injury (1). Therefore, the client expects
gym is staffed by a number of full-time sales representatives that the CPT will have an understanding of exercise science and
whose primary responsibility is to sell memberships and services. exercise progression. To qualify for a basic personal training
There is also a fitness director who oversees a number of staff certification, a candidate is usually required to be 18 years of
trainers. The fitness director’s salary is based, in part, on revenue age or older, have a high school diploma or equivalent, and be
generated by the personal training department. CPR certified. With a basic personal training certification, a CPT
may implement an exercise program for an apparently healthy
individual or one who has a physician’s approval to exercise (3).

22 PTQ 2.1 | [Link]

Close to 70% of the population in the United States are THREATS
overweight, and it is estimated that the prevalence of chronic Any accident or injury comes with the possibility of legal action
joint symptoms (CJS) in adults is close to 33% (7,9). There are against the trainer and the facility (1). For example, in 1997,
many individuals inflicted by being obese or overweight, suffering a personal trainer recommended a supplement containing
from CJS, and having co-morbidities such as diabetes, heart ephedra to one of his clients who was also taking medication
disease, and musculoskeletal dysfunction. Because of the shear for hypertension; the client had a stroke and died (23). The
amount of people who have these medical conditions, CPTs who trainer, facility, manufacturer of the supplement, and store that
hold a low-level certification are ineligible to work with a large sold the supplement were all named in the lawsuit that ensued.
portion of the population. In another case, a lawsuit in 2003 claimed that a 42-year-old
woman was pushed beyond her physical limitations resulting
The scope of practice refers to the specific boundaries, based on in rhabdomyolysis (30). The trainer was accused of failing to
knowledge and skills, in which a professional can work (17). In a apply current professional practices. Instead of personalizing
2009 American College of Sports Medicine (ACSM) survey, it was the program to fit the needs of each individual, he used a similar
concluded that, although many CPTs work with apparently healthy exercise program for all of his clients. More recently, in 2009 a
individuals, a large percentage of CPTs work with individuals New Orleans women accused her trainer of failing to provide
who have heart disease, diabetes, are obese, or are in need of adequate instruction and supervision that resulted in a surgery
behavioral counseling—all of which are outside the scope of to repair an injured rotator cuff and biceps musculature (19).
practice for a CPT (21). Table 1 identifies the differences of the Regardless of the outcome of a lawsuit, injury to a client and the
scope of practice between a CPT and other health professionals associated negative publicity may cause irreparable damage to
in which the boundaries may be blurred. the reputation of the trainer and facility/organization.

SWOT ANALYSIS OPPORTUNITIES

The goal of a SWOT analysis is to explore the strengths According to an article in Forbes, a company is only as good
and weaknesses of an organization or a situation, and to as its employees (12). When care and outcomes are inconsistent,
find corresponding opportunities and threats. Once factors the results can be compromised safety. Therefore, uniform
are identified, a strategy can be developed to build on the practices may increase care and value to the customer and reduce
strengths, exploit the opportunities, and mitigate the costs (24). Consistent employee training and opportunities
weaknesses and threats (13). Table 2 exemplifies the criteria for continuing education should be priorities for strength and
based on the opening scenario. conditioning professionals (29). Standardized training assists
employees in understanding roles and boundaries that allow an
STRENGTHS
organization to realize a high standard of excellence (15).
As more fitness facilities open, many of which are budget gyms
with dues of only about $10 per month, owners and operators The ACSM recommends a self-reported medical and health
realize that non-membership revenue must increase. Although risk appraisal for anyone contemplating engaging in physical
the majority of revenue in a fitness facility is generated from activity (4). Self-guided methods include a pre-activity readiness
membership dues, a recent study shows that about 9.5% is questionnaire (PAR-Q) and a health history. The PAR-Q asks
generated by personal training (26). Furthermore, having trainers general questions such as “has your doctor ever said that you
on staff provides an additional selling tool that integrates the have a heart condition?” or “do you have bone or joint problems?”
membership sales process with personal training by providing new A positive answer indicates the individual should consult with a
members with a complimentary initial consultation (6). In addition physician prior to increasing physical activity. A health history
to the increased revenue, trainers can help with membership is more in-depth than a PAR-Q and inquires about a number of
retention by providing many benefits to their clients, such as health issues including diabetes, cardiovascular risks, and prior
accountability, motivation, expertise, and personalized fitness medical events. As with the PAR-Q, a positive answer indicates the
plans to help identify and achieve goals (31). individual should seek physician approval prior to beginning or
increasing physical activity, or the individual should exercise in the
WEAKNESSES
presence of a qualified medical professional.
As the demand for personal training has increased, so have the
number of available certifications. However, not all certifications Although CPTs are not qualified to diagnose or treat pain, a
are equally rigorous or credible. According to Archer, there are CPT may be qualified to assess muscular imbalances (8). An
over 200 certifications available, many with differing areas of overhead squat assessment (OHS) can reliably detect movement
emphasis and required qualifications (5). Consequently, consumers dysfunctions for upper and lower extremities, as well as assess
and some hiring managers do not know the differences between dynamic flexibility, core strength, and balance (10,16). Another
the certifications and may hire or recommend a trainer who is not method that is more involved than the OHS is the Functional
qualified to meet the needs of a particular client. Additionally, Movement Screen (FMS), which can detect dysfunctions in certain
personal trainers are often treated as transient employees and, on fundamental movements (11). CPTs should receive appropriate
average, a trainer stays with any given organization for only about training prior to administering the OHS or the FMS. They should
18 months, which makes fostering loyalty a challenge (22). The also always refer a client to a qualified health professional when an
lack of specific qualifications, coupled with the temporary nature assessed dysfunction, such as joint or muscular damage, is beyond
of the position, may leave some trainers not only unprepared their scope of practice.
to deal with certain situations, but there may also be a level of
apathy that could potentially lead to harm for the clients.

PTQ 2.1 | [Link] 23

A SWOT ANALYSIS OF THE SCOPE OF PRACTICE FOR
PERSONAL TRAINERS

Table 1 compares the scope of practice, educational requirements, 8. Brookbush, B. NASM corrective exercise workshop. Lecture
and job descriptions of various fitness, health, and wellness conducted at Gold’s Gym, Manassas, VA. 2012.
professionals. Professional networking provides opportunities to 9. Centers for Disease Control and Prevention. Fast stats:
interact with like-minded professionals, increase an organization’s Obesity and overweight. 2014. Retrieved September 7, 2014 from
brand awareness, and share knowledge (18,27). Abbott suggests [Link]
that trainers will best serve the needs of their clients by forming
multi-disciplinary networks (1). The World Health Organization 10. Clark, MA, and Lucett, SC. NASM Essentials of Sports
believes that collaboration with healthcare practitioners from Performance. (1st ed.). Baltimore, MD: Lippincott, Williams, and
multiple professions will result in improved client/patient Wilkins; 85-88, 2010.
outcomes (32). It is also suggested that referral networking 11. Cook, G, Burton, L, and Hoogenboom, B. Pre-participation
indicates a level of professionalism, and suggests to clients that screening: The use of fundamental movements as an assessment
their success is the ultimate goal (1). of function – part 1. North American Journal of Sports Physical
Therapy 1(2): 62-72, 2006.
CONCLUSION
A SWOT analysis reveals that personal trainers who stay within 12. Criscoe, J. Your company’s only as good as your best
their scope of practice and refer clients out when warranted employees. Forbes. 2012. Retrieved September 6, 2014 from http://
may reduce the potential for client injury, provide a stream of [Link]/sites/jeremycriscoe/2012/08/03/your-companys-
revenue for a fitness facility, and offer a valuable service that will only-as-good-as-your-best-employees/.
increase client loyalty and membership retention. Continuing 13. Dyson, RG. Strategic development and SWOT analysis at the
education opportunities increase the trainer’s base of knowledge University of Warwick. European Journal of Operational Research
and allow for a better understanding of a trainer’s role within the 152(3): 631-640, 2004.
healthcare continuum. Standardizing assessment practices will
14. Eickhoff-Shemek, JM. The legal aspects: Health/fitness
ensure that clients receive the same high level of care by detailing
manager as risk management manager. ACSM’s Health and Fitness
information required to design an individualized program or, if
Journal 7(3): 26-28, 2003.
necessary, refer the client to an appropriate health professional.
Furthermore, knowing the advantages and limits of each 15. Epley, B, and Taylor, J. Developing a policies and procedures
occupation in the network of health professionals will ensure that manual. In: Essentials of Strength Training and Conditioning (3rd
each client receives suitable care when a referral is appropriate. ed.). Champaign, IL: Human Kinetics; 570-587, 2008.
An understanding of the strengths, weaknesses, opportunities, and 16. Hirth, CJ. Clinical movement analysis to identify muscle
threats of the scope of practice of a CPT can provide direction to imbalances and guide exercise. Athletic Therapy Today 12(4): 10-14,
improve the quality of care, as well as protect against litigation. 2003.

REFERENCES 17. Janot, JM. Do you know your scope of practice? IDEA Fitness
1. Abbott, AA. The legal aspects: Scope of practice. ACSM’s Journal 1(1): 2004.
Health and Fitness Journal, 16(1): 31-34, 2012. 18. Llopis, G. 7 reasons that working can a professional
2. Academy of Nutrition and Dietetics. Registered development boot camp. Forbes. Retrieved September 10, 2014
Dietician: Educational and professional requirements. 2014. from [Link]
Retrieved September 10, 2014, from [Link] reasons- networking-can-be-a-professional-development-boot-
BecomeanRDorDTR/[Link]?id=8143. camp/. 2012.

3. American College of Sports Medicine. ACSM certified personal 19. Massey, M. Lawsuit claims personal trainer responsible for
trainer. 2013. Retrieved September 5, 2014 from [Link] client’s injuries. The Louisiana Record. 2010. Retrieved August
[Link]/acsm-certified-personal-trainer. 31, 2014 from [Link]
claims-personal-trainer-responsible-for-clients-injuries.
4. American College of Sports Medicine. ACSM’s Guidelines
for Exercise Testing and Prescription (9th ed.). Baltimore, MD: 20. National Board for Certified Counselors. Requirements for the
Lippincott, Williams, and Wilkins; 19-34, 2014. NCC certification. 2012. Retrieved September 2, 2014 from http://
[Link]/Professional/NCCReqs.
5. Archer, S. Navigating personal trainer certifications. IDEA
Fitness Journal 1(2): 2004. 21. Paternostro-Bayles, M. The role of a job task analysis in the
development of professional certifications. ACSM’s Health and
6. Bell, L. Increasing personal training profits. Club
Fitness Journal 14(4): 41-42, 2010.
Solutions. 2009. Retrieved September 10, 2014 from http://
[Link]/2009/07/increasing-personal- 22. Popowych, P. Finding and hiring qualified personal
training-profit/. trainers: Discover the best ways to hire trainers who meet your
organization’s needs. IDEA Fitness Manager 16(3): 2004.
7. Bolen, J, Helmick, CG, Sacks, JJ, and Langmaid, G. Prevalence
of self-reported arthritis or chronic joint symptoms among adults –
United States, 2001. Morbidity and Mortality Weekly Report 51(42):
948-950, 2002.

24 PTQ 2.1 | [Link]

 [Link]
[Link]

23. Pristin, T. Health club and trainer are sued in a death. The New
York Times. 1999. Retrieved September 10, 2014 from [Link]
ABOUT THE AUTHOR
[Link]/1999/06/29/nyregion/health-club-and-trainer-are-
Dan Mikeska is the owner of Fairfax Fitness and Self-Defense in
[Link].
Chantilly, VA. In addition to a Master of Science degree in Human
24. Rozich, JD, Howard, RJ, Justeson, JM, Macken, PD, Lindsay, Movement from A.T. Still University, he has over 30 years of martial
MF, and Resar, RK. Standardization as a mechanism to improve arts and personal training experience. He is currently pursuing
safety in health care [Abstract]. Joint Commission Journal on a doctorate in Health Science also through A.T. Still University.
Quality and Patient Safety 30(1): 5-14, 2004. Mikeska can be reached at Dan@[Link].
25. Society for Human Resource Management. Job descriptions:
Behavioral health specialist. 2014. Retrieved September 7,
2014 from [Link]
jobdescriptions/pages/cms_010205.aspx.
26. Spiegel, B. Personal trainers bring added revenue to your
club. 2012. Retrieved August 31, 2014 from [Link]
home/2012/5/9/personal-trainers-bring-added-revenue-to-your-
[Link].
27. Stacey, D, Hopkins, M, Adamo, K, B, Shorr, R, and
Prud’homme, D. Knowledge translation to fitness trainers: A
systematic review. Implementation Science 5(28): 1-9, 2010.
28. The American Physical Therapy Association. Today’s physical
therapist: A comprehensive review of a 21st-Century health care
profession. 2011. Retrieved September 4, 2014 from [Link]
[Link]/uploadedFiles/APTAorg/Practice_and_Patient_Care/PR_
and_Marketing/Market_to_Professionals/TodaysPhysicalTherapist.
pdf.
29. Thompson, W. Now trending: Worldwide survey of fitness
trends for 2014. ACSM’s Health and Fitness Journal 17(6): 10-20,
2013.
30. Webb, M. Workouts and programs. A personal trainer’s
legal armor guide. ACE Fit Share. 2014. Retrieved September 1,
2014 from [Link]
article/2727/ACEFit-workout-advice-and-exercise-tips/.
31. Winkowitsch, K. 6 reasons hiring a personal trainer is worth
the cost: Hiring a personal fitness trainer could help you to propel
your fitness levels forward by leaps and bounds. It really pays
off. Here’s why. MSN Money Smart Spending. 2014. Retrieved
September 4, 2014 from [Link]
tips/post--6-reasons-hiring-a-personal-trainer-is-worth-the-cost.
32. The World Health Organization. Framework for action on
interprofessional education and collaborative practice. 2010.
Retrieved September 7, 2014 from [Link]
resources/framework_action/en/.

PTQ 2.1 | [Link] 25

A SWOT ANALYSIS OF THE SCOPE OF PRACTICE FOR
PERSONAL TRAINERS

TABLE 1. SCOPE OF PRACTICE FOR HEALTHCARE PROFESSIONALS (2,3,17,20,25,28)

CERTIFIED PERSONAL REGISTERED BEHAVIORAL
PHYSICAL THERAPIST
TRAINER (CPT) DIETITIAN (RD) COUNSELOR
Master’s or doctorate
Master’s or
degree (doctorate Bachelor’s degree
doctorate degree
High school diploma or required by 2016)
12 months
Education equivalent (depending Supervised clinical
6 months supervised practice
on organization)
clinical residency Board exams
Board exams
(in most states)
Board exams
Recognize and treat
Administer medical mental disorders and
Developing and nutrition therapy as part psychosocial problems
Diagnose and manage
implementing of the healthcare team
movement dysfunction Treat and manage clients
appropriate
exercise programs Manage food with chronic emotional
Restore, maintain,
service operations and/or health problems
and promote optimal
Assisting clients in
Basic Job Description physical function Teach and advise on Manage clients who use
setting and achieving
and wellness healthy eating habits medical visits to obtain
realistic fitness goals
and about the needed social support
Prevent the onset
Teaching correct connection between
and progression Transfer clients into
exercise methods food, fitness, and health
of impairments appropriate mental
and progressions
Conduct research health specialty care
when indicated
Diagnose No Yes Yes Yes
Treat Illness or Injury No Yes Yes Yes
Prescribe Medication No Yes Yes Yes
Rehabilitate/Counsel No Yes Yes Yes
 [Link]
[Link]

TABLE 2. SWOT ANALYSIS OF EMPLOYING PERSONAL TRAINERS

STRENGTHS WEAKNESSES
Training can produce revenue Trainers may be unprepared

Available training services are an added sales tool Based on minimum qualifications, there is a limited
target market
Appropriate training can help members achieve goals
Members may be harmed
OPPORTUNITIES THREATS
Standardized training and continuing education Potential harm to members
opportunities to increase all trainer’s knowledge, skills,
and ability Potential litigation

Standardized assessment procedures Potential publicity that could be damaging

Increased brand awareness by networking with health

professionals

BRIDGING
the gap

NATIONAL ‘15
38TH ANNUAL NATIONAL CONFERENCE & EXHIBITION
July 8 – 11, 2015 | Orlando, FL | Swan & Dolphin Hotel

27
BEST BUSINESS PRACTICES—INTERVIEWS FROM
EXPERTS IN PERSONAL TRAINING
CARMINE GRIECO, PHD, CSCS

T
he profession of personal training has exploded into Robert Linkul (RL), MS, CSCS,*D, NSCA-CPT,*D, the NSCA
a flourishing industry over the past two decades. I am Personal Trainer of the Year for 2012, NSCA Southwest Regional
constantly astounded by how much change has taken place Coordinator, and owner of Be Stronger Personal Training
within the field of fitness and, more specifically, in the profession
of personal training. As personal trainers have taken on a variety Chat Williams (CW), MS, CSCS,*D, CSPS, NSCA-CPT,*D, FNSCA,
of important societal roles over the last 20 years (e.g., fighting the NSCA Personal Trainer of the Year for 2013, and owner of
lifestyle-related disease, etc.), new and creative initiatives have Youth Performance
expanded the reach and impact of personal training. Once
WHAT IS THE BEST WAY YOU HAVE FOUND TO
considered a luxury only affordable to the rich and famous, now
REACH POTENTIAL CLIENTS?
personal training has gone mainstream in a big way.
JCS: “Belly-to-belly business. Nothing beats a handshake and
Nevertheless, personal training is still an emerging profession passionate communication. Period; end of story. I’m old-fashioned
that is experiencing “growing pains” as we collectively strive in this regard.”
to professionalize our trade. Compounding this issue is the fact
RL: “Our number one way to reach potential clients is through
that, unlike most other professions, the field of personal training
referrals. Ninety to 95% of our business is generated through
does not have a single governing body to establish universal
word-of-mouth referrals and the rest is through social media.”
standards of education and conduct. Consequently, standards
vary widely from one certifying agency to another and even CW: “I’m going to be a little different from most people because
within individual training facilities. As a result, personal training I’ve never really marketed myself as a personal trainer and I rarely,
suffers from a very high attrition rate. There is no statistical data if ever, do traditional marketing (radio, newspapers ads, etc.).
to support this due to a dearth of published studies regarding the People saw me training and saw that I actually cared about my
profession of training. However, over the past 20 years I have had clientele, so I would say word-of-mouth is definitely how I’ve
the opportunity to speak with hundreds of personal trainers and attracted my adult clients. For our youth program, however, it’s
the consensus is that this is, in fact, an accurate representation of more important to build long-term relationships with coaches
attrition among personal trainers. (middle and high school).”
Therefore, this column will begin an exploration of “best practices” WHAT ARE THE MOST IMPORTANT BUSINESS-
in the profession of personal training. This first column will RELATED LESSONS YOU HAVE LEARNED DURING
address what is likely the most important issue facing the new YOUR TIME IN THE FITNESS INDUSTRY?
(or struggling) personal trainer—business practices. Without JCS: “Stay small (with your business facilities) for as long as you
the requisite business savvy, even the most passionate personal can and run a lean business. Also, it’s very important to get in
trainer may have a very difficult time successfully establishing and people’s faces and allow them to feel your passion.”
maintaining a clientele base.
RL: “This is personal training. Any trainer can give someone a
To explore this critical issue, I have interviewed three of the top workout, but it’s that personal connection that you make with a
personal trainers in the industry: client (when the client believes in me as much as I believe in them)
that makes all the difference. When you achieve that, they become
Juan Carlos Santana (JCS), MEd, CSCS,*D, USAW, USATF, FNSCA,
a walking marketing campaign for you.”
former Vice President of the NSCA, owner of the Institute of
Human Performance, and a frequent presenter at national and
international strength and conditioning conferences

28 PTQ 2.1 | [Link]

WHICH BUSINESS PRACTICES DO YOU CONSIDER AND, FINALLY, THE MOST IMPORTANT QUESTION:
ESSENTIAL TO THE SUCCESS OF YOUR BUSINESS? WHAT BUSINESS ADVICE DO YOU HAVE FOR NEW
JCS: “I’m old-fashioned in this regard also, so the answer is simple: OR STRUGGLING PERSONAL TRAINERS?
professionalism and customer service. When I say ‘professionalism’ JCS: “Personal training is not about exercise. All you need for
I don’t mean crazy stuff, just show up on time, conduct yourself in excellent functional fitness and health is what all animals really
a respectable manner, and do what you say you are going to do. need—clean food and water, clean air and sun, and movement;
When it comes to customer service, I don’t mean the customer is simple. The rest of the stuff is all man-made (from the need
always right (some people need to be shown the door), but that to look a certain way to winning a championship). Personal
is part of professionalism, you don’t compromise on principles training is about people and providing what is missing in their
for anybody.” life. It’s about the human experience. It’s about becoming aware
of, developing, and expressing the indomitable human will. It’s
RL: “My dad taught me that marketing campaigns don’t start about the exploration of, and connection between, the physical
or end, they are constant. So for me, marketing is a non-stop and spiritual consciousness that is in every breath we take. Great
pursuit. To do that, I take 1% of my income (no matter how much coaches, like the great Vince Lombardi, understood this—that’s
I make weekly) and I apply that to marketing. Keep in mind that why they were able to move the great mountains of the human
marketing always has a cost, but that doesn’t necessarily have to will. Great personal trainers understand this too, they just use
mean money. Marketing through social media, for example, may exercise techniques to move those mountains. That’s why great
not cost money, but it does take your time.” trainers don’t market much, are always busy, have huge followings,
and their clients are among their best friends.”
CW: “Without a doubt, showing your clients that you have a
vested interest in them, that you truly care about their progress. CW: “I think small group training is the way to go. I think the one-
Like with the kids that I train: I go to their competitions (on my on-one training is good in certain instances, such as very technical
time and on my dime). Frequently, that means that I have to times like when working with someone that has had a stroke or
travel, and sometimes it’s even on my one day off a week. I go to when rehabbing an injury. But with small group training, you make
swimming events, soccer, everything. This is one of the things that training affordable for most people, and it’s going to bring in
really demonstrates that you care. That caring about your client is more money per hour for the trainer. Also, personal trainers can
huge. So they will keep coming back to you because you care.” get burned out doing 5 – 8 sessions per day (and sometimes even
more), day in and day out. If you can work only 4 – 5 hr per day
WHAT BUSINESS PRACTICES HAVE BEEN MOST
and (with small group training) theoretically you could make the
RESPONSIBLE FOR THE GROWTH OF YOUR
same (or more) money, then I think that will extend the lifespan
BUSINESS?
of the average trainer.” Note: For more detailed information about
JCS: “What I call ‘belly-to-belly’ sales. You have to get in front of
small group training check out Chat Williams’ article titled “Small
someone, square up, and look at them in the eye. Give them a firm
Group Training Utilizing Circuits” in the December, 2014 issue of
handshake (or give them a hug), and engage them with passion.
Personal Training Quarterly.
And follow up when you say you will.”
CONCLUSION
RL: “The most important thing is accessibility; I am accessible to
After interviewing these seasoned and successful trainers, one
my clients 24 hours a day. Our business is very much a ‘right now’
thing is abundantly clear—business success in personal training is
business and if I don’t get back to them (my clients or potential
largely based upon “personal” factors. While technical knowledge,
clients) immediately, I might have missed an opportunity. This
the latest technology, and business training may help you build
absolutely feeds the success of my business, however, this is
and/or maintain a successful business, the most important aspects
tricky because it comes with great benefits, but it has downfalls
also happen to be the simplest—communication and care for your
as well (constantly being ‘on call’). The negative part of that is
clients. I am reminded of an old saying that seems to perfectly
that it can be tough when I’m just trying to spend some time with
describe the successful trainer/client relationship: “they don’t care
my wife and baby, or when I’m on vacation. But my clients really
how much you know, until they know how much you care.”
appreciate it and that makes all the difference.”

CW: “That’s a combination of consistency and programming. For

example, at the health club where I am the Director of Personal ABOUT THE AUTHOR
Training, I’ve been here going on 16 years, there’s another four or A personal trainer with over 15 years of experience, Carmine Grieco
five trainers that have been here up to 18 years. When you have recently made the transition from personal trainer to college
a lot of turnover in the staff, I think that reflects poorly on your professor. Now an Assistant Professor of Exercise Science at
business. Also, our staff has to be NSCA certified. While we don’t Glenville State College, Grieco received his Doctorate degree in
all train exactly the same way, we are all preaching the same thing, Human Movement Sciences from Old Dominion University in 2012.
and there is consistency across the board. Staffing is probably the He is the National Strength and Conditioning Association (NSCA)
biggest thing that’s been good for our business. Along with that, West Virginia State Director and is passionate about the profession
I’d also say programming is important. For example, in addition to of fitness. Grieco is now focusing his time and energy on training
working at the health club, I also own Youth Performance, a 5,400 the next generation of fitness professionals.
square foot facility in which we train young athletes. At Youth
Performance I write out the workouts each Sunday, so there is
always consistency across the training programs.”

PTQ 2.1 | [Link] 29

FEATURE ARTICLE

ATTENUATING DELAYED ONSET MUSCLE SORENESS

IN UNTRAINED INDIVIDUALS
MICHAEL RANDONE, MS, CSCS

P
ersonal trainers and other strength and conditioning CAFFEINE
professionals have most likely encountered a situation Performance benefits demonstrated with caffeine ingestion
where a client experiences muscle soreness following may lead one to believe that muscle damage after exercise may
exercise. A personal trainer may possess a large percentage of be more profound with caffeine supplementation. It has been
clientele consisting of unhealthy and inactive individuals who shown that despite caffeine ingestion increasing maximal heart
would like to become healthier through exercise. With untrained rate, oxygen uptake, and time to exhaustion, cellular oxidative
individuals, muscle soreness can be experienced frequently and damage remained unaltered (11). This implies that taking caffeine
more severely with the initiation of an exercise program. This as an ergogenic aid should not exacerbate soreness. Additionally,
type of soreness is referred to as delayed onset muscle soreness caffeine ingestion may have beneficial effects such as improved
(DOMS), which consists of physical pain or discomfort that can performance while not compromising workouts performed
occur as soon as 24 hours after exercise, usually lasts 2 – 3 days, on consecutive days. Most studies have utilized 5 mg/kg of
and can take as long as 8 – 10 days to fully subside (4). bodyweight, which is approximately the equivalent of two cups
of coffee (6,10).
Approximately 22 percent of the population participates in regular
sustained physical activity (3). This low percentage suggests The timing, however, may be the major determinant of caffeine’s
that a large portion of the population will experience this type of effectiveness on successfully attenuating soreness. When the
soreness upon becoming active; therefore, it is necessary for the relative dosage is consumed over long periods, it may not have
strength and conditioning professional to be able to successfully the same level of impact (10). Most successful interventions have
minimize or avoid DOMS. In fact, client retention could be greatly participants consuming their entire dosage prior to exercise (6,9).
impacted by an exercise professional’s ability to reduce client Caffeine has also been shown to reduce DOMS after both upper
soreness following exercise. Understanding various methods body and lower body resistance exercise effectively (6,9). This
can give these professionals an edge in dealing with hesitant research also shows that in addition to lower ratings of exertion
participants. A number of factors must be considered when during exercise, caffeine can also reduce recovery time (5).
deciding on a treatment for DOMS: the methods that are currently Therefore, caffeine could be a viable option for the strength and
available, the accessibility of those methods, and the feasibility of conditioning professional to prescribe to individuals prior
their use. The purpose of this article is to compare and contrast to exercise.
popular methods used to reduce soreness that are feasible for
most clients.

30 PTQ 2.1 | [Link]

CRYOTHERAPY is imperative. Having the ability and knowledge to implement
Cold water immersion, or whole body cryotherapy, has commonly a specific protocol to reduce a client’s soreness may greatly
been used by collegiate athletes to help aid recovery for reduce the number of clients deciding to cease exercise due to
consecutive exercise sessions. Only recently has this modality DOMS. Soreness can also negatively affect a client’s workout
become more commonly used by recreational exercisers as performance and session frequency, either of which could
well. There seems to be some contradicting evidence on the ultimately lead to goals not being attained. This knowledge and
effectiveness of cryotherapy. The duration is a major contributing ability can affect a personal trainer’s business by increasing
factor to cryotherapy’s effectiveness or ineffectiveness. Short client retention and satisfaction.
immersions of 1 – 3 min may not have a profound effect, whereas
research that utilizes immersions for 3 min, with a 10-min post-
CONCLUSION
Attenuating DOMS can have a substantial impact on a personal
recovery resting period, has shown benefits (14,17). Longer bouts
trainer’s business and overall client satisfaction. For successful
of 10 min may be more beneficial in attenuating muscle soreness
reduction in soreness, an understanding of the methodology
(1,13,20). Although the evidence appears to support sustained
of a preferred method is essential. Caffeine ingestion may be
immersion, intermittent immersion between 6 – 18 min, with 1-min
effective with the consumption of 5 mg/kg of bodyweight
intervals has been shown to be beneficial, with no dose response
before and/or after exercise. Despite the contradiction in the
relationship (21). Although the research suggests a benefit to
research for cryotherapy, it appears that immersion of 10 or more
cryotherapy, an individual’s tolerance to cold and possible risks
minutes or 6 – 18 min of intermittent submersion are the most
for individuals with peripheral vascular issues should be discussed
successful protocols for reducing DOMS. In regards to BCAA
prior to implementation.
supplementation, there appears to be benefits for ingesting
BRANCHED-CHAIN AMINO ACIDS BCAAs before and after exercise. Whether used prior to resistance
Branched-chain amino acids (BCAA) have been widely taken by exercise or during active rest between sets, aerobic exercise
exercise enthusiasts and prescribed by nutrition experts. Although also appears to be a viable method to decrease DOMS. Personal
the research has not been definitive, most studies demonstrate trainers should have a conversation with each client to determine
positive outcomes. Claims of increasing muscle protein synthesis which method, if any, would work best for them.
and helping to prevent muscle breakdown have been associated
with BCAA supplementation (16). Studies have shown that taking
a dosage before and after exercise may have a greater impact
on attenuating soreness (15,18). However, if supplementation
immediately after exercise is the only option, there may be a slight
reduction of soreness (22). In another study, similar results were
shown when taking a leucine and carbohydrate supplemental
beverage after anaerobic exercise (19). BCAAs can be easily
implemented into an individual’s diet, which may make them a
viable option to help attenuate DOMS.

AEROBIC EXERCISE
Out of the aforementioned methods, aerobic exercise may be the
easiest method to implement for the strength and conditioning
professional. Aerobic exercise is a vital part of most workout
regimens. Moreover, aerobic exercise done prior to, rather than
after, resistance exercise appears to be more beneficial (2,8,12).
Performing cardio prior to exercise could be effective when
performed as one continuous exercise that lasts for 10 – 20 min
(8,12). Another option is to incorporate an “active rest” between
resistance exercise sets. This is done by completing each set of
resistance exercise immediately followed by a short duration of
cardiovascular exercise. One study using this method was able to
eliminate DOMS by the fourth week of training completely (7).

PRACTICAL APPLICATION
Experiencing DOMS may come as a surprise to most inactive
individuals, and it may even cause them to question their
motivation. This effect on motivation may even lead to an
individual preferring to remain inactive, and thus, negatively
affecting a personal trainer’s business. For personal trainers,
having the ability to reduce a client’s muscle soreness effectively

PTQ 2.1 | [Link] 31

ATTENUATING DELAYED ONSET MUSCLE SORENESS
IN UNTRAINED INDIVIDUALS

REFERENCES 15. Ra, S, Miyazaki, T, Ishikura, K, Nagayama, H, Kommine, S,

1. Bailey, D, Erith, S, Griffin, P, Dowson, A, Brewer, D, Gant, N, et Nakata, Y, et al. Combined effect of branched-chain amino acids
al. Influence of cold water immersion on indices of muscle damage and taurine supplementation on delayed onset musccle soreness
following prolonged intermittent shuttle running. Journal of Sports and muscle damage in high-intensity eccentric exercise. Journal of
Science 25(11): 1163-1170, 2007. the International Society of Sports Nutrition 10: 51, 2013.

2. Bhatia, AP. Effect of warm-up and cool-down on delayed- 16. Romotsky, S, and Bonci, L. The importance of protein for
onset muscle soreness in university students. Indian Journal of athletes. NSCA Coach 2(1): 26-31, 2015.
Physiotherapy and Occupational Therapy 5(3): 113, 2011. 17. Sellwood, KL, Brukner, P, Willliams, D, Nicol, A, and Hinman,
3. Center for Disease Control. Physical activity and health. 2009. R. Ice-water immersion and delayed-onset muscle soreness: A
Retrieved July 12, 2014 from [Link] randomised controlled trial. British Journal of Sports Medicine
pdf/[Link]. 41(6): 392-397, 2007.

4. Dierking, JK, and Bemben, MG. Delayed onset muscle 18. Shimomura, Y, Inaguma, A, Watanabe, S, Yamamoto, Y,
soreness. Strength and Conditioning Journal 20(4): 44-48, 1998. Muramatsu, Y, Bajotto, G, et al. Branched-chain amino acid
supplementation before squat exercise and delayed-onset muscle
5. Gliottoni, RC, and Motl, RW. Effect of caffeine on leg-muscle
soreness. International Journal of Sports Nutrition and Exercise
pain during intense cycling exercise: Possible role of anxiety
Metabolism 20(3): 236-244, 2010.
sensitivity. International Journal of Sport Nutrition and Exercise
Metabolism 18(2): 103-115, 2008. 19. Stock, MS, Young, JC, Golding, LA, Kruskall, LJ, Tandy, RD,
Conway-Klaassen, JM, et al. The effects of adding leucine to
6. Hurley, CF, Hatfield, DL, and Riebe, DA. The effect of caffeine
pre and post exercise carbohydrate beverages on acute muscle
ingestion on delayed onset muscle soreness. The Journal of
recovery for resistance training. The Journal of Strength and
Strength and Conditioning Research 27(11): 3101-3109, 2013.
Conditioning Research 24(8): 2211-2219, 2010.
7. Jackson, DW, Wood, DT, Andrews, RG, Elkind, LM, and
20. Vaile, JM, Gill, ND, and Blazevich, AJ. The effect of contrast
Davis, BW. Elimination of delayed-onset muscle soreness by
water therapy on symptoms of delayed onset muscle soreness.
pre-resistance cardioacceleration before each set. The Journal of
The Journal of Strength and Conditioning Research 21(3): 697-702,
Strength and Conditioning Research 22(1): 212-225, 2008.
2007.
8. Law, R, and Herbert, R. Warm-up reduces delayed onset
21. Versey, N, Halson, S, and Dawson, B. Effect of contrast water
muscle soreness but cool-down does not: A randomised trial.
therapy duration on recovery of cycling performance. European
Australian Journal of Physiotherapy 53(2): 91-95, 2007.
Journal of Applied Physiology 111(1): 37-46, 2011.
9. Maridakis, V, O’Conner, PJ, Dudley, GA, and McCullly, KK.
22. Watanabe, S, Inaguma, A, Bajotto, G, Sato, J, Kobayashi, H,
Caffeine attenuates delayed-onset muscle pain and force loss
Mawatari, K, et al. Effects of branched-chain amino acid (BCAA)
following eccentric exercise. The Journal of Pain 8(3): 223-243,
supplementation before and after exercise on delayed-onset
2007.
muscle soreness (DOMS) and fatigue. The FASEB Journal 21: 539.7,
10. Nobahar, M. Effect of caffeine consumption and aerobic 2007.
exercise on delayed onset muscle soreness. Advances in
Environmental Biology 7(11): 3440-3443, 2013.
ABOUT THE AUTHOR
11. Olcina, GJ, Munoz, D, Rafael, T, Caballero, JM, Maynar, JI,
Michael Randone owns a personal training company in Omaha,
Cordova, A, et al. Effect of caffeine on oxidative stress during
NE called Randone Wellness, LLC. He has nearly a decade of
maximum incremental exercise. Journal of Sports Science
personal training experience through multiple organizations.
Medicine 5(4): 621-628, 2006.
Randone has earned several accreditations such as the Certified
12. Olsen, O, Sjøhaug, M, Van Beekvelt, M, and Mork, PJ. The Strength and Conditioning Specialist® (CSCS®) certification through
effect of warm-up and cool-down exercise on delayed onset the National Strength and Conditioning Association (NSCA). He
muscle soreness in the quadriceps muscle: A randomized earned a Master’s degree in Exercise Science from the University
controlled trial. Journal of Human Kinetics 35: 59-68, 2012. of Nebraska-Omaha. While attending graduate school, Randone
13. Paddon-Jones, D, and Quigley, B. Effect of cryotherapy earned a grant to conduct research on lactate mechanics in
on muscle soreness and strength following eccentric exercise. addition to an academic scholarship.
International Journal of Sports Medicine 18(8): 588-590, 1997.
14. Pournot, H, Bieuzen, F, Louis, J, Fillard, JR, Barbiche, E, and
Hausswirth, C. Time-course of changes in inflammatory response
after whole-body cryotherapy multi exposures following severe
exercise. PLoS One 6(7): e22748, 2011.

32 PTQ 2.1 | [Link]

 [Link]
[Link]

TABLE 1. REFERENCE TABLE

METHOD PARTICIPANT TIMING DOSAGE RESULT RESOURCE

F/LC 24 and 48 hr post 5 mg/kg ↓ Maridakis (2007)

Caffeine
M/LC 1 hr prior 5 mg/kg ↓ Hurley (2013)

R 15-min emersion 8 – 10ºC ↓ Vaile (2007)

Cryotherapy
T 3-min emersion -10/-60/-110ºC ↓ Pournot (2011)

2 weeks pre; 3 3.2g BCAA

M days post; 3x day ↓ Ra (2013)
BCAA 2g Taurine
F After anaerobic ↔ Watanabe (2007)
exercise 5.5 g BCAA

M+F 20 min 60 – 70% HRmax Pre Olsen (2012)

Aerobic
M+F 10 min 4.5 – 5 kph; 3º Pre Law (2007)

M=male participants; F=female participants; R=recreationally trained; T=trained individuals; LC=low caffeine consumers; ↓=Demonstrated
a significant decrease in DOMS; ↔=Demonstrated no significant reduction in DOMS

PTQ 2.1 | [Link] 33

PERSONAL TRAINING FOR THE RECREATIONAL
DOWNHILL SKIER
CHAT WILLIAMS, MS, CSCS,*D, CSPS, NSCA-CPT,*D, FNSCA

E
ach winter, individuals start hitting the slopes with body injuries (2). These injuries include rotator cuff contusions,
friends and family to enjoy the physical demands, fitness anterior glenohumeral dislocations, acromioclavicular separations,
challenges, and stress relief of skiing. Incorporating a and clavicle fractures. Accidental falls contribute to many of these
strength and conditioning program can improve total body injuries, usually with a direct fall onto an outstretched arm (2).
strength, reduce injuries, and improve several motor skills for
recreational downhill skiers. Understanding the movements Knee injuries can occur during knee extension, or full dynamic
involved in skiing and the potential injuries is important when flexion with the addition of one or a combination of anterior draw
considering the type of strength and conditioning program and of the tibia, and internal/external rotation (2). A study at the
which exercises to include. Jackson Hole Ski Resort reported that from 1982 to 1993, about
30% of all reported injuries were knee sprains (4). Non-contact
MOVEMENT PATTERNS injuries can take place with different techniques used in skiing,
There are four major movements involved in downhill skiing: the which include a slip-catch, snow plow, and back-weighted landing.
initiation phase, turning phase, completion phase, and transition The most common of these techniques is called a “slip-catch,”
phase (2). During the initiation phase, the outside leg will support which is when the skier makes a turn and the outside leg leaves
the body. In the turning phase, the shoulders will become level the ground while the extended leg makes a turn across the body.
with the snow and the outside leg will remain straight while the Another technique commonly seen is the “snow plow,” which
inside leg will bend, bringing the hips closer to the snow. Next is occurs when knee and hip flexion are very deep and then turn
the completion phase, where the hips rise up to decrease the angle quickly under the body, causing rapid internal rotation. During
of the skis. And finally, the transition phase is where the feet move the back-weighted landing, the back of the ski hits the ground
under the hips and prepare for the next turn (2). causing anterior draw of the tibia and an internal or external twist
of the body (2).
In the neutral position, the major muscles used are the quadriceps
of the upper leg and the anterior tibialis, gastrocnemius, and STRENGTH AND CONDITIONING
peroneals of the lower leg; additionally, the rectus abdominis and Downhill skiing requires total body strength, power, and motor skill
gluteals are critical in maintaining an erect position (1). The upper development. This can be achieved by using dynamic and static
body requires deltoids and the flexor muscles of the lower arms exercises (3). A downhill skiing program should simulate skiing
to maintain position of the ski poles (1). The quadriceps maintain actions by including exercises that are slow and controlled, and
balance throughout the entirety of the four movement patterns. movements that are rapid and explosive (3). Squats, leg presses,
The turn phase requires the hips to extend. During the completion bench presses, deadlifts, and dumbbell rows are all examples
movement, the tibialis anterior muscles help pull the body of foundational strength exercises that can be included into a
forward with dorsiflexion. The rectus abdominis has the highest training program. Box jumps, lateral box jumps, squat jumps, and
electromyography (EMG) activity during the turning phase, and hurdle jumps are just a few of the exercises that can be included
the hamstrings and glutes are activated in the eccentric portion of to improve power. Balance exercises can be added to challenge
the transition and turning phases (2). neurological adaptations by incorporating unstable surfaces and
performing movements unilaterally (2).
SKIING INJURIES
While skiing, contact and non-contact injuries can take place with The following are some examples of power, strength, and balance
a small percentage coming from running into another skier or exercises that can be incorporated to help improve performance
an obstruction. Injuries with downhill skiing commonly occur at in downhill skiing. Additionally, Tables 1 and 2 provide an example
the knee and shoulder joints (2). For example, shoulder injuries strength and power program that can be used as a guideline (5,6).
account for up to 4 – 11% of all injuries and 22 – 41% of all upper

34 PTQ 2.1 | [Link]

SQUAT JUMP (FIGURES 1 – 2)
The client should start with feet shoulder-width apart preparing
to squat. They should lower the body to a half squat (loading
the hips) and jump explosively while performing triple extension
with the ankles, knee, and hips. The client should land in the same
position with “soft” knees and ankles while under control. It is
helpful to maintain posture by keeping the core tight.

FIGURE 3. BOX JUMP – START

FIGURE 1. SQUAT JUMP – START

FIGURE 4. BOX JUMP – FINISH

FIGURE 2. SQUAT JUMP – EXECUTION

BOX JUMP VARIATIONS (FIGURES 3 – 9)

The client should start with feet shoulder-width apart preparing
to squat. Lower the body to a half squat (loading the hips) and
jump explosively while performing triple extension with the ankles,
knees, and hips. The client should land on top of the box with the
feet facing forward and the knees slightly bent. The landing should FIGURE 5. LOW-LEVEL BOX JUMP 2 TO 1 – START
be soft with minimal noise made by the feet. It is also important
for the knees to remain aligned over the feet through the
movement (do not let the knees collapse inwards). Progressions
can be incorporated by adding unilateral landings and hops onto
the box. Starting with jumping from two feet and landing with
one on the box, then hopping and landing with one foot. Landing
techniques stated above should be applied to both of these
movements as well. Lateral box jumps can be added by having the
client stand next to the box with the shoulders perpendicular to
the box. The jump will be performed in the same manner but from
the side.

FIGURE 6. LOW-LEVEL BOX JUMP 2 TO 1 – FINISH

PTQ 2.1 | [Link] 35

PERSONAL TRAINING FOR THE RECREATIONAL DOWNHILL SKIER

SKATERS (FIGURES 10 – 11)

The client should start by standing with feet together and push off
laterally to one side. Immediately after landing, the client should
explosively push off with the outside foot and land on the other
foot. This should be repeated by going back and forth from one
foot to the other.

FIGURE 7. LOW-LEVEL BOX JUMP 1 TO 1 – START

FIGURE 10. SKATERS – START

FIGURE 8. LATERAL BOX JUMP – START

FIGURE 11. SKATERS – FINISH

DIAGONAL SKATERS (FIGURES 12 – 14)

The client should start by standing on one foot (Figure 12)
and push off laterally to one side aiming for the dot diagonally
placed on the floor. Immediately after landing (Figure 13), the
client should explosively push off with the outside foot and
return to other foot while progressing to the next dot in the
FIGURE 9. LATERAL BOX JUMP – FINISH sequence (Figure 14).

36 PTQ 2.1 | [Link]

 [Link]

SUPINE MEDICINE BALL CHEST PASS (FIGURES 15 – 16)

The client should lie on their back as a partner holds a medicine
ball while standing on a box above them (Figure 15). The partner
should drop the ball to the client around chest level (Figure 16).
The client should catch the ball and explosively return it upwards
with a chest pass.

FIGURE 12. DIAGONAL SKATERS – START

FIGURE 15. SUPINE MEDICINE BALL CHEST PASS – START

FIGURE 13. DIAGONAL SKATERS – LANDING

FIGURE 16. SUPINE MEDICINE BALL CHEST PASS – CATCH

FIGURE 14. DIAGONAL SKATERS – RETURN

PTQ 2.1 | [Link] 37

PERSONAL TRAINING FOR THE RECREATIONAL DOWNHILL SKIER

HURDLE SQUARE (FIGURES 17 – 18) LATERAL HURDLE JUMP (FIGURE 19)

The client should start in the middle of the hurdle square and The client should start by standing beside a hurdle and then
complete jumps to the outside of each hurdle, then return back to laterally jump over it. After landing, immediately load and unload
the center each time. This should be done as quickly as possible the lower body by laterally jumping back over the hurdle. This
and include decelerating, reloading, and explosive movements can be measured by total repetitions or for time (quickness and
while under control. The client should jump laterally left, right, power). For example, three sets of 20 reps, or the total amount of
forward, and backward. There is no specific pattern and can be reps performed in 10 – 30 s.
performed in a clockwise or counter-clockwise sequence.

FIGURE 19. LATERAL HURDLE JUMP

FIGURE 17. HURDLE SQUARE – JUMP
SQUAT ON BALANCE TRAINER (FIGURES 20 – 22)
The client should start with feet shoulder-width apart while
standing on a balance trainer. While under control, lower the body
to a position that mimics sitting in a chair (Figure 20). Keep the
core tight and maintain a neutral spine. Knee flexion should be
approximately 90 degrees, meaning the thighs should be parallel
to the floor, or as close to parallel as possible without sacrificing
form. Drive through the feet and return. A more challenging
variation includes adding a diagonal chop. To do this, a medicine
ball can be taken from the shoulder to the opposite knee (creating
a chopping motion) when ascending and descending during
the squat.

FIGURE 18. HURDLE SQUARE – LANDING

FIGURE 20. SQUAT ON BALANCE TRAINER

38 PTQ 2.1 | [Link]

 [Link]

FIGURE 21. SQUAT ON BALANCE TRAINER WITH

FIGURE 24. SINGLE-LEG DEADLIFT – FINISH
DIAGONAL CHOP – START
SINGLE-LEG SQUAT (FIGURE 25)
The client should start by standing and balancing on one leg (a
suspension trainer can be used for balance). Once balanced, lower
the body until the thigh is parallel to the floor (Figure 25). Then,
the client should drive through the heel of the foot and extend at
the knee to return to the starting position. The depth of the squat
depends on strength and can be increased once there is more
strength and stability in the leg.

FIGURE 22. SQUAT ON BALANCE TRAINER WITH

DIAGONAL CHOP – FINISH
SINGLE-LEG DEADLIFT (FIGURES 23 – 24)
The client should start by standing on one leg with the knee
bent about 5 – 10 degrees (Figure 23). Then, the client should
lean forward flexing at the hip. In a controlled manner, the
dumbbells or medicine ball should be lowered to the ground while
maintaining a tight core and a neutral spine (Figure 24). The depth
FIGURE 25. SINGLE-LEG SQUAT
of the deadlift will be determined by the strength and flexibility of
the hamstrings and glutes. The client should engage the glutes to
return back to the starting position.

FIGURE 23. SINGLE-LEG DEADLIFT – START

PTQ 2.1 | [Link] 39

PERSONAL TRAINING FOR THE RECREATIONAL DOWNHILL SKIER

LUNGE ON BALANCE TRAINER (SAGITTAL, FRONTAL, AND FRONTAL/TOE TOUCH

TRANSVERSE) (FIGURES 26 – 28) The client should start with feet shoulder-width apart and step
The client should start with feet shoulder-width apart and step to the side onto the balance trainer (laterally) or in the frontal
forward onto the balance trainer while flexing at the knee and plane. The toes should be kept straight ahead with the lead leg.
hip. After taking the step, lunge forward; the thigh of the lead leg The client should maintain an upright position and tight core
should be parallel to the floor and the knee should be at about throughout the movement. While lunging, reach across the
90 degrees. The rear leg should be approximately 2 – 4 in. above body with both dumbbells towards the toes to create more of a
the ground. During the lunge phase of the movement, the client challenge for the hips and glutes.
should perform shoulder flexion to raise the medicine ball directly
over the head. When returning to the starting point, perform TRANSVERSE/TOE TOUCH
shoulder extension to bring the medicine ball back down to about The client should start with feet shoulder-width apart and initiate
thigh level. the movement by opening up the hips to create rotation in the
core region. The lead leg should finish approximately at 135
degrees on the balance trainer while the toes of the trail leg might
turn in slightly. This will depend on knee mobility, flexibility of
the hips and the core, and the overall strength of the lower body.
While opening up the hips, the client should reach towards the
lead foot with dumbbells to create more of a challenge for the
hips and glutes. The ability to decelerate the movement (lead leg)
in the transverse plane and return to the starting position will also
create challenges.

REFERENCES
1. Atkins, J, and Hagerman, G. Sports performance: Alpine
skiing. National Strength and Conditioning Association Journal
5(6): 6-8, 1983.
FIGURE 26. LUNGE ON BALANCE TRAINER – SAGITTAL PLANE
2. Hydren, J, Volek, J, Maresh, C, Comstock, B, and Kraemer, W.
Review of strength and conditioning for alpine skiing. Strength and
Conditioning Journal 35(1): 10-28, 2013.
3. Plisk, S. Skiing: Physiological training for competitive alpine
skiing. National Strength and Conditioning Association Journal
10(1): 30-33, 1988.
4. Warme, WJ, Feagin, JA Jr, King, P, Lambert, KL, and
Cunninghman, RR. Ski injury statistics, 1982 to 1993, Jackson Hole
Ski Resort. American Journal of Sports Medicine 23(5): 597-600,
1995.
5. Williams, C. Complex set variations: Strength and power.
Personal Training Quarterly 1(3): 20-25, 2014.
6. Williams, C. Speed and agility training outdoors. Personal
FIGURE 27. LUNGE ON BALANCE TRAINER – FRONTAL PLANE
Training Quarterly 1(2): 28-33, 2014.

ABOUT THE AUTHOR

Chat Williams is the Supervisor for the Norman Regional Health
Club. He has served as a member of the National Strength and
Conditioning Association (NSCA) Board of Directors, NSCA State
Director Committee Chair, Midwest Regional Coordinator, and
State Director of Oklahoma (including being named the 2004 State
Director of the Year). He also served on the NSCA Personal Trainers
Special Interest Group (SIG) Executive Council. He is the author
of multiple training DVDs. Williams also runs his own company,
Oklahoma Strength and Conditioning Productions, which offers
personal training services, sports performance for youth, metabolic
FIGURE 28. LUNGE ON BALANCE TRAINER – TRANSVERSE PLANE testing, and educational conferences and seminars for strength and
conditioning professionals.

40 PTQ 2.1 | [Link]

 [Link]

TABLE 1. STRENGTH AND POWER PROGRAM EXAMPLE

TYPE EXERCISE SETS X REPS

LBPWR Box jumps 3x5

LBS 45-degree leg presses 3x8

UBS Bench presses 3x8

PWR Supine chest passes 3x5

LBS Single-leg squats 3 x 6 (each)

PWR/QUI Hurdle lateral jumps 3 x 20

LBS Lunges on balance trainer 3 x 6 (each plane)

UBS Pull-ups 3 x 8 – 10

Core Stability ball ab exercises 3 x 15

TABLE 2. STRENGTH AND POWER PROGRAM EXAMPLE – MORE VOLUME

TYPE EXERCISE SETS X REPS

LBPWR Lateral box jumps 4x5

LBS Squats 4x8

UBS Dumbbell presses 4x8

UBS Dumbbell rows 4x8

LBS Squats on balance trainer 4x8

LBS Single-leg deadlifts 3 x 8 (each)

PWR Diagonal skaters 4x8

UBS Push-ups 3 x 10

PWR/QUI Hurdle square 4x2

Key:

LBS – Lower body strength LBPWR – Lower body power

UBS – Upper body strength PWR – Power

QUI – Quickness

PTQ 2.1 | [Link] 41

STRENGTH AND CONDITIONING FOR CHILDREN AND YOUTH FOR SPECIFIC
SPORT SEASONS

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