Re: personal trainer advertising (yet another example)

[Guest guest]

Here's another example of an ATC treating someone that should be treated

by a PT. I write not to whine or complain but to mention that this may

be our fault: We are not marketing ourselves well enough, we are not

making ourselves accessible enough, and we are not in the public

consciousness as the " go to " people for muskuloskeletal conditions - let

alone neurological conditions!

Walking after 29 years

<http://www.billingsgazette.net/articles/2008/11/25/news/local/18-walkin\

g.txt> Local man's decision, work leads to steps up, out of wheelchair

By ZACH BENOIT

Of The Gazette Staff

Even the longest journey begins with a single step, but for Chayne

Popelka, a 29-year journey ended with one.

About two weeks ago, Popelka, 37, took his first steps in nearly three

decades.

" I didn't ever think I was going to make it this far, " Popelka said. " I

just couldn't see sitting in a wheelchair for the rest of my life. "

Diagnosed with a degenerative condition called ataxia, he has had very

limited movement and control of his body from the neck down since he was

a boy and has spent most of his life in a wheelchair. Since the

beginning of October, Popelka has been working out with a trainer at Oz

Fitness in West Park Plaza three times a week with the goal of regaining

the strength and mobility he lost as a child. In the short time he has

been training at Oz, he has made what he considers remarkable progress.

" My doctor said he had never met someone my age that has the ataxia

problems I have that wasn't paralyzed, " Popelka said. " I guess I was

always too dumb or too stubborn to let that happen. "

Baby stepsAtaxia affects the cerebellum, the part of the brain that acts

as the management center for movement and coordination throughout the

body. In ataxia, messages sent from the brain have trouble reaching the

rest of the body.

Doctors believe that Popelka's ataxia developed after he suffered from

stroke-like symptoms at age 8. His mother, Schuman, said he

was infected as a young boy with viral meningoencephalitis - an

inflammation of the brain and membranes surrounding the brain and spinal

cord - which caused his brain to swell and brought on the ataxia.

" It seemed like he had something like the flu, " she said. " He just kept

getting sicker and finally went into a coma. "

Three days later, Popelka awoke from the coma and began losing mobility

and full control over his movements, and he has required the use of a

wheelchair ever since.

" He had very little function, very little movement, when he came in, "

said Jonnie Jonckowski, Popelka's trainer. " Before he even got the

chance to educate his body, he lost it. "

At a workout last Friday, Popelka was able to walk about 70 feet in one

session, the longest he had gone to date. With an Oz staff member on

either side for balance and Jonckowski a few yards in front of him,

Popelka slowly raised his right leg, bent his knee, pointed his leg out

in front of him and stepped forward in a short, deliberate step. He

repeated the steps until he had traveled about 35 feet, returned, in his

wheelchair, to the starting point and did it again.

'I felt it in my body'The path to those first steps began with a simple

thought that popped into Popelka's head one day.

" I woke up one day and decided something needs to be done, " he said. " It

was time. I felt it in my body. "

He underwent nerve treatment in Fort Worth, Texas, earlier this year,

then sat down with his mother and worked out a plan to begin training.

Popelka - who grew up on a ranch near Big Timber - said the most

important factor was his own motivation. In the past, he gave up easily

and it was easy for those working with him to do the same, he said.

His family has known Jonckowski, a world champion bull rider, for about

20 years and knew she was a trainer at Oz. That, he said, combined with

his respect for her accomplishments and tough attitude, was enough to

get him to approach her about training.

" The only one we could think of was Jonnie, " he said. " If I didn't snap

to, she would kick my butt. I needed someone who could and would

challenge me every day. "

After being paired up with Jonckowski, he started a training regime that

focused on stretching, muscle control and posture.

The exercises focused on re-establishing communication between his brain

and his body, like reaching out and touching a ball. When Popelka first

began, he had little control over his left arm and hand, and it took up

to 20 seconds to complete that simple movement.

Now, it only takes a second or two, and his motion is getting smoother

and easier with every session. Even when not at the gym, Popelka

practiced stretching and working his left arm and hand, which had been

curved down and across his body for nearly 30 years.

" That was no real fun chore, " he said. " It hurt, and it was pretty

intense, but I knew I couldn't stop because it'd just go right back. "

After 10 sessions, Jonckowski decided Popelka was ready to try a few

steps. Earlier this month, with his mother and others looking on, he

slowly stood up and took the first steps.

Now, seeing him in a training room at Oz with his shoulders high and

straight and his back flat against a chair, stretching and doing

resistance exercises, it's nearly impossible to tell that just six weeks

ago, Popelka couldn't sit up straight - his body was curved into a sort

of forward-leaning crooked S - or do the exercises he does routinely.

" It's a night and day difference, " Jonckowski said.

Three miraclesSchuman said her son's life has been marked by three

miracles.

First, doctors told her they could not detect a fetal heartbeat when she

went into labor with him and that he would most likely be stillborn. A

few tense moments after he was born, however, he took his first breaths.

Then, at age 8 when he went into the coma, doctors weren't sure if he

would ever wake up. Three days later, he opened his eyes.

And just two weeks ago, at age 37, Popelka took his first steps in 29

years.

" I never thought I'd see this in my lifetime, " Schuman said. " Every

parent wants their kids to be independent and happy, and he wasn't. You

always worry, 'What happens when I'm not there?' I don't have to worry

about that any more. "

Popelka, who works full time as a sales associate at Shipton's Big R

West, said he's not worried anymore, either.

Since his training began, Popelka's speech, movement, eyesight and

confidence have all improved.

" Pretty much my whole lifestyle has changed, " he said. " It's given me

the confidence to try things I normally wouldn't. Now it's like whatever

I want to do. "

While he still spends most of his time in a wheelchair and still cannot

walk much independently, he said he plans on continuing to train, with

one of his passions, hunting, as motivation.

He already has a permit to shoot from a vehicle, but plans on hunting on

foot, in the open, with his family next fall.

" Hopefully, I won't even have a cane, " he said with a smile. " I'll walk

through the woods like everyone else. But, even if I do have a cane,

it's still a hell of a lot better than how it is right now. "

Ty Keeter PT, DPT, MHA

Boulder Colorado

> >

> > Lance,

> >

> >

> >

> > What is troubling about this, is not so much scope of practice, but

> rather

> > scope of relative expertise. Although (D)PT's are longer trained

> (at a

> > clinical doctoring level at that) and better equipped to help

> osteoporotic

> > patients than personal trainers . . . because as a profession (D)

> PT's don't

> > generally market themselves as direct-access practitioners and

> market to the

> > public as such, several things are beginning to happen:

> >

> >

> >

> > 1. Personal trainers are marketing themselves as portal of

> entry

> > providers for patients that are more appropriate for physical

> therapy than

> > personal training.

> >

> > 2. Massage therapists marketing themselves as portal of entry

> > providers for patients that are more appropriate for physical

> therapy than

> > massage therapy.

> >

> > 3. Athletic trainers are marketing themselves as having

> equivocal

> > rehabilitative skills as physical therapists.

> >

> > 4. Chiropractors are marketing themselves as having equivocal

> > rehabilitative skills as physical therapists --- and at the same

> time having

> > temper tantrums whenever PT's use the full scope of their clinical

> abilities

> > and manipulate the spine.

> >

> >

> >

> > The bottom line and end result is that although several of these

> > (para)professions overlap in some skills and scope of practice,

> they do not

> > overlap in their areas of relative expertise. Although some

> professions are

> > better than others in respecting scope of practice, no profession,

> including

> > our own, is terribly good at respecting lines of scope of expertise.

> >

> >

> >

> > Your situation is an issue not of practice scope, but rather scope

> of

> > relative expertise. I can't think of a single osteoporetic patient

> that is

> > appropriate for DIRECT training by a personal trainer without

> having seen a

> > more appropriate professional (e.g. physical therapist) to start

> the program

> > first. It is troubling that as " good " as you claim this group of

> trainers

> > to be, they don't understand the limits of their own abilities. If

> you have

> > a relationship with them, why aren't they asking you to do some

> kind of

> > pre-training physical therapy assessment and post-rehab exercise

> planning

> > for what should be MEDICALLY SUPERVISED personal training?

> >

> >

> >

> > Dr. M. Ball, PT, DPT, PhD

> >

> > Doctor of Physical Therapy

> >

> > Charlotte, NC

> >

> >

> >

> >

> >

> >

[Guest guest]

There are so many issues that this story highlights: direct access,

cost, marketing, scope of practice, ethics...

I totally agree that this is outside of your typical personal

trainer scope of practice. However, there are individuals who

either have many years of experience to provide effective treatment

programs, or are enterprising risk takers who are ignorant of the

medical, neurological, physiological aspects of a case like this but

attempt it anyway and then get great press.

I see this as another opportunity for PT to lose ground to these

other professions. Let's face it, a month with this trainer likely

costs less than a week of PT. That may not be a factor for an

insured patient, but what happens when the benefits run out?

(Especially in today's economy) There are those of us who work in

organizations were we have no control over pricing and cannot be

competitve.

I agree that we need to more effectively market our expertise

to further differentiate ourselves from the copmpetition, be

proactive rather than reactive, and establish professional

networking relationships with these other professions to help guide

practice patterns as much as we are able to in our local markets.

Thanks for stimulating discussion about threats to the profession,

otherwise we grow complacent.

Greg Hamilton, PT

Decatur, IL

> > >

> > > Lance,

> > >

> > >

> > >

> > > What is troubling about this, is not so much scope of

practice, but

> > rather

> > > scope of relative expertise. Although (D)PT's are longer

trained

> > (at a

> > > clinical doctoring level at that) and better equipped to help

> > osteoporotic

> > > patients than personal trainers . . . because as a profession

(D)

> > PT's don't

> > > generally market themselves as direct-access practitioners and

> > market to the

> > > public as such, several things are beginning to happen:

> > >

> > >

> > >

> > > 1. Personal trainers are marketing themselves as portal

of

> > entry

> > > providers for patients that are more appropriate for physical

> > therapy than

> > > personal training.

> > >

> > > 2. Massage therapists marketing themselves as portal of

entry

> > > providers for patients that are more appropriate for physical

> > therapy than

> > > massage therapy.

> > >

> > > 3. Athletic trainers are marketing themselves as having

> > equivocal

> > > rehabilitative skills as physical therapists.

> > >

> > > 4. Chiropractors are marketing themselves as having

equivocal

> > > rehabilitative skills as physical therapists --- and at the

same

> > time having

> > > temper tantrums whenever PT's use the full scope of their

clinical

> > abilities

> > > and manipulate the spine.

> > >

> > >

> > >

> > > The bottom line and end result is that although several of

these

> > > (para)professions overlap in some skills and scope of practice,

> > they do not

> > > overlap in their areas of relative expertise. Although some

> > professions are

> > > better than others in respecting scope of practice, no

profession,

> > including

> > > our own, is terribly good at respecting lines of scope of

expertise.

> > >

> > >

> > >

> > > Your situation is an issue not of practice scope, but rather

scope

> > of

> > > relative expertise. I can't think of a single osteoporetic

patient

> > that is

> > > appropriate for DIRECT training by a personal trainer without

> > having seen a

> > > more appropriate professional (e.g. physical therapist) to

start

> > the program

> > > first. It is troubling that as " good " as you claim this group

of

> > trainers

> > > to be, they don't understand the limits of their own

abilities. If

> > you have

> > > a relationship with them, why aren't they asking you to do some

> > kind of

> > > pre-training physical therapy assessment and post-rehab

exercise

> > planning

> > > for what should be MEDICALLY SUPERVISED personal training?

> > >

> > >

> > >

> > > Dr. M. Ball, PT, DPT, PhD

> > >

> > > Doctor of Physical Therapy

> > >

> > > Charlotte, NC

> > >

> > >

> > >

> > >

> > >

> > >