NASM CES Chapter 7: Client Intake and Assessment 5

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Chapter Goals:

  • Find the various assessments that are used for programming corrective exercises.
  • Find the assessments that are appropriate strategies based on the client types.
  • Describe the procedures for client intake.
  • Find the instances that warrant referrals to health professionals.
  • Find the legal and ethical considerations when working with clients.
  • Discuss the most effective and appropriate coaching and communication strategies during the client intake and after.

Introduction

The initial session with the client is the most important one.

This is when the specialist will conduct assessments that are related to the physical readiness, general lifestyle info, medical history, goals, and other physical and psychological behaviors of the client.

The professional also ensures that all of their legal and ethical forms and procedures are completed and signed off on. 

Assessments will be crucial in designing safe and individualized programs for corrective exercise and they will also include intake screening, static posture assessments, and targeted assessments for mobility.

Client Communication

Even after the development of a goal of improving balance, for example, there still are many variations of implementation of corrective exercise techniques in the industry.

One of the most important parts of using corrective exercise is effectively communicating the process to be followed and the benefits. 

The specialist is responsible for communicating well with empathy in the initial meeting with the client to create trust and understanding, reinforcing adherence over time.

The professional needs to be clear about the benefits of the individual’s plan for corrective exercise, and they should take time to work on the movements most beneficial for what that person wants. 

When clients begin their plan for working out with the integration of the corrective exercise continuum, there should be constant reminders as to how and why the program helps them to achieve their goals most safely and effectively possible.

Communicate to the clients that this is achieved through addressing the efficiency of movements addressed and through the proper muscles being recruited at the right time. 

Types of Assessments

Client Intake Screen – the client intake screen is the first step in the overall assessment process.

The screen collects valuable subjective information and notes any red flags related to physical readiness, general lifestyle, and medical history.

The subjective information looks at the potential movement impairments that might be shown in the assessment process later. 

Static Posture Assessments – static postural assessments visually observe the client’s posture when standing in place, not moving at all.

Proper static posture allows for optimal mobility and joint kinematics, while bad posture shows either a problem structurally or in the musculoskeletal system due to poor system recruitment. 

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Movement Assessments – movement assessments are designed to evaluate someone’s dynamic posture, which refers to the structural alignment of the musculoskeletal system when in motion.

Movements of compensations can be observed in a series of movement assessments like the overhead squat and other transitional and dynamic movement assessments. 

Mobility Assessments – these assessments are used to find deficits in joint range of motion and help refine observations found in the static and movement assessments used with the client.

Human movement requires a combo of soft tissue flexibility, range of motion in joints, and control of the neuromuscular system.

Any restriction in a body segment may alter movement patterns and lead to impairments within the kinetic chain. 

All of these assessments are very important for the process of corrective exercise programming.

These create a roadmap for the corrective exercise program as a whole. 

The CES Assessment Flow

This is the roadmap that is being made and individualized for each client. The flow starts with the client intake screen.

It then moves on to the static postural assessment.

Next is the overhead squat assessment and modified overhead squat assessment.

The next goes to the single leg squat and the split leg squat assessments.

We then have dynamic and loaded assessments as optional and they depend on what is found or might be found based on all of the previous steps.

Next is the mobility assessments.

And last, we have the creation of the corrective exercise program and the four steps we went over in the last four chapters. 

Client Intake Screen

The intake screen is the first step in the assessment process of the client.

It is also the most important for the client buy-in and development of a long term and profitable relationship.

The session offers many opportunities for the specialist to build rapport with their client. 

The client intake screen may be turned into a comprehensive questionnaire and be done before the actual visit with the client.

It can also be a time for the specialist to talk to the client and get these questions done in a one on one setting also.

It is up to the coach and the client to decide this. 

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Readiness for Activity

Before anything can be done in the gym, new clients must be cleared for physical activity.

The easiest and most popular method is using a physical activity readiness questionnaire called the PARQ+.

It consists of some questions to which you answer yes or no, deciding if you need further look into your readiness for physical activity. 

General Lifestyle Information

Asking very basic questions regarding someone’s occupation and how they live their life will give you a significant amount of information to work with.

Most compensations we see that are not from injuries will be from their own static posture throughout the day, and you can get a lot of insight into this based on what they do throughout their days.

Daily movement patterns, or daily nonmovement patterns, are very beneficial to look into for help with deciding on the assessments to give. 

Occupation:

We need to know things such as extended periods of sitting, repetitive movements, the use of dress shoes, heavy lifting throughout the day, and the amount of occupational stress.

Lifestyle:

We need to know things in the realm of mental stress, levels of sleep attained each night, the activities they participate in, and even their fluid intakes. 

Recreation

This refers to the amount of time someone spends doing the physical activity outside of their own work environment.

By finding this out, the professionals can design a program that better benefits their needs and what they do for recreation.

Hobbies

This refers to regular activities that people partake in but are not necessarily athletic. It provides the same level of insight and assistance to the program as recreational activities do. 

Medical History

Learning the medical history of your clients is crucial for the corrective exercise process.

This could reveal important information regarding possible cardiorespiratory problems or something to look out for.

Here we will typically ask questions regarding the past injuries of the individual and the surgeries they have had.

Both are very relevant for corrective exercise. 

Past injuries and the Kinetic Chain

Ankle Sprains – these sprains have been shown to decrease our neural control of the gluteus med and glute max muscles.

Also, the chronic instability of the ankle may lead to knee flexion and landing alterations.

This, again, leads to poor neuromuscular control and balance, which may result in more injuries of a similar variety later on. 

Knee Injuries – knee injuries can cause reductions in lumbar mobility, slower time to move, and reductions in proprioception.

If these are not addressed, there will be limitations in lumbar mobility, affecting the kinetic chain since the spine works as a functional unit. 

Other Injuries – injuries from imbalances of the human movement system will include things such as repetitive hamstring complex strains, groin strains, patellar tendonitis, and headaches. 

Past Surgeries

The ones to note will be surgeries to the foot, ankle, knee, back, and shoulder, an appendectomy, and a C-section for birth.

These have effects on performance that should be noted. 

Goal Setting

The final step to the objective postural assessments is to set some goals.

The professional should work well with their client to ensure the goals are a foundation for what they will advance on later.

These goals will help to inform how the process will go. The NASM recommends that we set SMART goals. Smart goals are:

  • S – specific: what does the client want to achieve? Consider the what, where, when, why, who, and how.
  • M – measurable: how will the goal be measured? What are the criteria we will use to find the completion status?
  • A – attainable: is the goal achievable by the person? The time and effort need to be considered for the client’s sake.
  • R – realistic: is the goal relevant to what they need in their life, and is it something that they can reasonably expect to achieve?
  • T – Timely: what timeframe would they like to complete this goal? 

Ethical and Legal Considerations

The corrective exercise specialists must meet all the laws and regulations governing their profession.

States do not regulate, so they must follow their certifier.

The scope of practice and the code of professional conduct should be thoroughly and well understood. 

Scope of Practice

This is defined as the procedures and actions the professionals will be allowed to give by national and state laws. 

Code of Professional Conduct

This is a set of policies and procedures that are made so the client safety is maximized and there is a set of unified standards for professionalism and organization. 

Client consent and record keeping are vital for almost all job parts.

Everything should be stored well and kept out of just anyone finding it.

We have to care for our client confidentiality.

When to Refer Out

Swelling – swelling of joints or other parts of the body is a sign of internal trauma of some form.

If you notice that your client has some form of swelling, you should have them cleared by a medical professional before going further. 

Acute pain – if clients have these sharp types of pains, they should be advised to visit a medical specialist to check them out. 

When in doubt, it is always better to be safe than sorry when it comes to training your clients and being unsure about their problems.

You should understand your limitations and refer to other professionals when necessary. 

NASM CES Chapter 7: Client Intake and Assessment 6
NASM CES Chapter 7: Client Intake and Assessment 7
NASM CES Chapter 7: Client Intake and Assessment 8

Tyler Read - Certified Personal Trainer with PTPioneer

Tyler Read


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