THERE. I said it. If you have never done BOTH, then you probably don’t have a good grasp on where I’m coming from. I’ll start with a story from my not-so-distant past.A Physical Therapist in Alexandria Virginia Working With A Patient's Knees

I was a first-year physical therapy student (SPT). Until then, I’d earned two degrees in exercise science, held several “lofty” certifications, and owned my own personal training business. I worked full-time as a trainer in a small private space and handled my school load without too many problems. I also found that my Master’s degree actually took a lot of pressure from my course load. I could more easily grasp some movement and biophysics concepts, and none of the anatomy was 100% new to me. That said, the depth in which we would eventually get into the anatomy and biomechanics study was far beyond my training. I was excited. I was now working toward my ultimate goal of obtaining the highest level of useful knowledge to maximize my ability to help people.

Fast Forward to Today

The realization is that the public has little knowledge of the depth and breadth of a physical therapist’s training compared to that of a personal trainer, athletic trainer, massage therapist, chiropractor, or any number of alternative medicine practices.

Now, I’m a cynic. I am highly critical of the poor exercise technique and progression education offered to physical therapists. I’m also embarrassed at the lack of quality and standards in personal training about formal training, work ethic, customer service, and accountability. How did my views of these once esteemed fields fall so far?

Working out the other day, I couldn’t help but have an almost visceral reaction to another jabroney trainer who was “working” with a client. At the same time, he alternated between staring at his phone and having an utterly non-verbal conversation with another member across the gym. Oh, and the entire time was sitting down. I’m sure many of you have witnessed something like this.

I’d seen this scenario many times before, but on this occasion, I literally could not help myself and loudly asked, ‘WHY IS HE SITTING!?’ Needless to say, the trainer, the client, and even I stopped in our tracks for a brief moment. I didn’t expect to have this outburst, and to ease the tension, I continued on my way. Upon looking back in that direction, the trainer was standing.

If I were only a physical therapist, it wouldn’t be my place to criticize this trainer. There was no OBVIOUS reason he needed to sit to work with his client, but not all reasons to be seated are apparent. Yes, he did stand right up after I called him on it, but that might have been a coincidence, too. But here’s the thing: my work as a trainer shaped how I feel people should be treated when purchasing a premium service like training. This brings me back to my original thesis: Personal training is more valuable than physical therapy. This client paid a premium cost for the highest level of service that this gym could offer. I have a difference of opinion as to how this service should look and feel, but that’s important to me and maybe not so to this gym.“Cost is what you pay. Value is what you GET.

The question you need to realize is, ‘Would a person off the street pay YOU, a physical therapist, the amount they would pay their personal trainer?’ Even if the above low-quality scenario isn’t the norm, how would a random person answer this question? After years of asking it, I will tell you: Most clients (in the Northern Virginia area) would pay a trainer $75-$125 per hour of their time. Ask that person about what they would pay for physical therapy, and the answer is invariably, “Well, I have health insurance, so I would have to pay my $20 copay“.And that’s it. This is the difference in value between personal training and physical therapy. We, physical therapists, are entirely to blame. We are the supposed ‘movement professionals, ’ but my colleagues often find themselves stumped by simple exercises and return to full activity questions.

Why Is Training so Important?

Physical therapists spend at LEAST 7 years in formal training, first earning a Bachelor’s Degree in a health-related field and then going to graduate school to earn a Doctorate Degree in Physical Therapy (DPT). Once you’re done with that, you study for three to six months FULL TIME to pass the NPTE (National Physical Therapy Exam for licensure). It is a proud achievement, and each grad is excited about being able to help lots of people with their pain.

To become a personal trainer, you “must” be 18 years of age; there is NO REQUIREMENT for formal education, legitimate licensure, or stringent continuing education. The number of organizations that will ‘certify’ someone to teach exercise and nutrition grows daily, and these companies have no standards.

That said, good and great personal trainers will almost always have at least a Bachelor’s degree in something. The best fitness pros concentrate from an earlier time in their development in seeking relevant education. The trainers you KNOW are a crap shoot of differing experience, training, and skill sets. I say that to mean for every “Jillian Michaels,” there are a dozen skillful and dedicated exercise pros. However, DO NOT LET THE MEDIA FOOL YOU. A trainer’s exposure has NOTHING to do with their skills or education. In fact, if you know a trainer who has appeared in TV commercials and every fitness magazine you can think of, you’re probably looking at someone who is more of a fitness model than a fitness professional. It's not a value statement, just a fact.

Another Story From My Past

I was told early on, “We train people to be physical therapists. Not personal trainers who also do physical therapy“. Aside from being told outright that I should not work as much as I did through my physical therapy education, this was one of the more unsettling blows to my future plans. Was I in school to do all my work from a treatment table? Is “making sure those knee arthrokinematics are perfect” really the thing that will get my patients back to health? I’m glad I questioned this thought process then because it proved faulty. There is a HUGE gap between personal training in the “pain-free” public and physical medicine, the pain sciences, orthopedics, and sports medicine. Since early in my career, my goal has been to focus my energy on FILLING THIS GAP. Far too many personal trainers are attempting to do this. While I respect the talent of some trainers worldwide, this gap MUST BE FILLED FROM THE TOP DOWN.

I don’t care how many times a technician has observed cardiac bypass surgery; no one would EVER be comfortable with that person stepping outside of their scope because they thought the surgeon might have missed something.

A Guru-ism

The term fitness guru is completely overdone, and anyone referring to themselves as one deserves immediate suspicion. The reality about Facebook, Twitter, the blogosphere, and all manner of TV and radio is such that, for the most part, only the highest trained 5-10% are the ones worth listening to. This is good as it means that there will always be good information to guide your way.

The problem is that EVERYONE is speaking. Sifting through the myths, fads, cults, and propaganda cleverly designed to drive revenue is difficult. If you’ve followed this blog, you have some strategies to be your own best advocate—research credentials. Look for legitimate sources. Make sure statements are grounded in solid science and logical and critical thinking. That said, I’d honestly take ANY orthopedic physical therapist’s exercise advice or opinion over ANY trainer, even if they’ve never gotten their hands dirty teaching someone how to clean and jerk. Even the most novice ortho or sports physical therapist would out-duel the most seasoned fitness pro in the realm of anatomy, physiology, health, and biomechanics. A problem therapists have is communicating this to the public in a way that genuinely exhibits the knowledge base.

Trainers have been over-inflating their knowledge base for so long (I was also guilty of this) that it’s much more natural and convincing. The reality is that most people are looking for functional power, balance, flexibility, and endurance. They aren’t looking to perfect their clean and jerk. For those who are, referring to a seasoned Olympic movement coach is wise.

This post reminds me of a recent comment I made on a Facebook thread that related to a blog pointing out some serious shortcomings of my physical therapy colleagues. The blog was a sharp indictment of the knowledge and practice of solid movement fundamentals and advice by physical therapists and orthopedic physicians. The post was by a well-known strength coach and was a well-done piece overall. Still, I fear that information like this left unchecked is poisonous to the truth about the level of physical therapy practice that is AVAILABLE if you look hard enough.

During the conversation, a therapist I respect argued a point that wasn’t well received. Still, I feel this was more a case of internet syntax error than a fundamental difference of opinion. Unfortunately, too, because I believe that these two highly educated therapists share similar views. That said, I missed an opportunity to point out a fundamental principle on which I base all of my work. That is, physical therapists MUST begin to take the formal training in movement patterning, exercise progression, and real-world biomechanics more seriously.

What’s the Solution? 

The American Physical Therapy Association (APTA) has goals for 2020. As is stated in their materials, the APTA is pushing for physical therapists to be: “…recognized by consumers and other health care professionals as the practitioners of choice to whom consumers have direct access for the diagnosis of, interventions for, and prevention of impairments, activity limitations, participation restrictions, and environmental barriers related to movement, function, and health."

As a former physical therapy student, current physical therapist, and current strength and conditioning pro, I can tell you that we are WAY BEHIND the trainers of the world when it comes to the above-highlighted portion of this statement. My discipline is partially at fault: ‘Physical therapists ‘ might think we are “above” training and trainers. This is not the case. In fact, the public has dictated the exact opposite. Good trainers demand high hourly rates and do a fabulous job transforming people’s lives. The level of customer service seen at a “physical therapy mill” (our term for the churn and burn factory-like settings that most PT is done in) stands almost NO CHANCE of creating perceived value for clients. Trainers who pick fights with physical therapists are making their point based on the amount of time afforded a client paying for a full hour of service. In some cases, training sessions can be shorter than an hour, but the difference is that the time is devoted 100% to the client. My discipline MUST recognize this value point and move toward correcting it.

Until part or all of this issue is addressed, the public will not consider us as the high-value-service provider for health, but we MUST be. Because pain is everywhere and the potential for pain is even more pervasive, physical therapists must take on a larger role in this field of influence. If our training programs don’t address it, we must seek these skills ourselves.

The short story is that while there are quite a few good/great, very vocal personal trainers and strength coaches, their knowledge base falls far short of even novice-level physical therapists.

The world of physical therapy, sports medicine, and REAL healing and performance will be inherited by the professionals who take their assessment and treatment of MOVEMENT to the level of the PHYSICAL THERAPIST / PERSONAL TRAINER. I like to believe that I am one of these pros. I work with several others and partner with as many of the rest as possible. My goal of advocating for patient healing and our powerful field of practice is paramount. The “NEW BREED HYBRID THERAPIST” skillfully combines the best parts of physical medicine with high-level, high-energy training to produce the highest VALUE movement product available. If your goal is ALL-THE-WAY-WELL, find someone who can provide this combination of care.

This group is small but growing. I’m fortunate to work with lots of students at our practice. Some have just graduated high school and are contemplating a career in PT.  Others are in their undergrad studies and getting a feel for what physical therapy will be like. The last and most abundant group is those who have already begun their physical therapy education. More and more of these young professionals already have backgrounds in exercise, yoga, pilates, sports… you name it. It’s VERY exciting for our field, the mission of the APTA, and for us as the collective movement specialists.

Physical Therapy + Personal Training = WIN

Dr. Carlos J Berio, PT, DPT, MS, CSCS, CMTPT is a licensed Doctor of Physical Therapy, Certified Strength and Conditioning Specialist, and a Certified Myofascial Trigger Point Therapist. In addition, he holds a Master’s Degree in Clinical Exercise Physiology. He has treated high school, collegiate, recreational, and professional athletes of various sports, including baseball, softball, football, hockey, tennis, swimming, golf, and martial arts. His experience as a collegiate and semi-professional athlete, as well as a professional baseball coach, make him a sought-after resource among elite-level athletes on the field and in the training room. The concept of ‘all the way well’ in his work as a physical therapist and fitness professional is what continues to drive Dr. Berio to be the best movement specialist there is. Dr. Berio is the founder of SPARK Physiotherapy in Alexandria, Virginia. A clinic and approach designed from the ground up to set the new standard for integrity and patient satisfaction in the PT industry. Carlos remains active in several sports and enjoys agility training, powerlifting, and adventure races.  He is an advocate for his patients, clients, and his fellow PT colleagues. He can be reached at [email protected].