Welcome to Episode #13 of the Healing Pain Podcast with Debra Atkinson!
The Healing Chronic Pain Exercise Prescription: How to Choose a Fitness Professional and Program You Can Trust
Today we are joined by Debra Atkinson, M.S., CSCS.
Finding an exercise or fitness professional can be a challenge. Where does one begin? The gym? A personal referral? YouTube? Should they be certified or have a degree?
If you have an injury or disease caution should be taken when beginning an exercise program.
Debra Atkinson joins the Healing Pain Podcast and provides tips and a “GPS’ on how to navigate the sea of exercise professionals, credentials and offers advice for those recovering with pain. Exercise and movement is vital when recovering from pain.
Debra earned both her B.S. and M.S. in Exercise Science and Exercise & Sports Psychology, respectively, from Iowa State University where she later served as a Senior Lecturer for 14 years. She taught core courses for Kinesiology majors that prepared students for leadership roles in fitness and continued to supervise internships for Kinesiology majors after she left the classroom.
In This Episode You Will Learn:
- How to find a qualified fitness professional.
- How to interview a fitness professional.
- How an exercise prescription is different for someone with chronic pain.
- How to overcome fear and begin and exercise program, even if you have pain.
- The relationship between medical fitness professionals, physical therapists and physicians.
Thank you for joining me for this week’s episode of the Healing Pain podcast. I’m your host doctor Joe Tatta. As a physical therapist exercise is one key modality that I recommend for almost every single patient who has chronic pain. So this week on the Healing Pain podcast, I have Debra Atkinson who is a medical exercise specialist, a personal trainer and a [inaudible 00:00:23] with over 30 years of fitness experience. She works with groomers around the world to a pro-aging and agree that slowing down is abnormal. She is a fitness presenter for the International Council of Active Aging, IDEA and the NACA. She has authored hundreds of articles and four books, including her most recent called, You Still Got It Girl-The after 50 Fitness Forum for Women. She’s also a subject matter expert for the American Council of Exercise, Medical Exercise Specialist exam. Debra Atkinson, welcome to the Healing Pain podcast, it’s a pleasure to have you on this week.
It’s an honor to be here Joe.
I’ve so been looking forward to talk with you on the podcast because exercise is really my first love. And as a physical therapist you know, you really are, it’s our prime modality that I would use. You have a really intersting background into, not only how you got into exercise and exercise you know, physiology but also your degree. So tell us about your degrees, because they don’t always mean everything but I think your combination of the two degrees are really really fascinating.
Thank you. I thought so too back in the day. It wasn’t so popular. In fact I could remember my dad saying during Grad School at some point … I made it almost all the way through, “What excatly is your major?” You know he needed to know what he was proud of at coffee in the morning. He didn’t really get it. So I was an undergrad in Exercise Science, is what it was called then. We know call that department Kinesiology. So really the physiology, the bones, the muscles and what’s going on for exercise prescription. And when I decided I need to go back … There’s so much more that needs to be done in our industry to elevate the standard to give people better choices.
And I did not want to be a lab rat, you know. And that’s kind of how I saw it. I did not see myself doing muscle biopsies but I felt like, we really need to work still on the behavior change. So I majored in exercise and it was still Exercise in Sports Science or Psychology. We hadn’t yet realized how important behavior change was, so sports still had to be in that title. But Exercise Psychology, so it’s figuring out how do we get motivated, how do we stay motivated?
Which I think is so important because nowadays everything I mean, we really know to make people healthy and vital for the duration of their life whether they’re young or very old. The behavior change aspects that are involved, whether it’s chronic pain, whether it’s heart disease, whether it’s depression are so key to coaching a client on that transition.
That’s so true. It’s often where we have a gap, you know. We don’t stop and really consider, here’s what you need to do with cardio and the exercise and that’s the easy part really. And then the complexity is you know, what are your personal preferences? How do you need me to coach you? Do you need a Jillian or do you need someone who’s going to have their hand on your back? And that’s really the, it’s an art and a science. Yep.
[inaudible 00:03:29]Beautifully said. I think that the art and science is really [crosstalk 00:03:33] where it kind of lives. You also have a very unique pain story about yourself. When I talked to you, I said everyone has a pain story. And everyone’s pain story is unique to them because pain is a unique experience to the person so just tell us a little bit about that
Well very early on you know, I was cursed and blessed … I call it. So at that point you know, I certainly did not think it was a blessing. But right before grad school I made the big decision that this is what I going to do. I know it and I’m in. And it was June and in August, I was about to start my grad assistantship where I would be teaching two or three times a day, physical fitness classes. You know to the clinic population, the faculty, the staff and the community. So that was before we realized over-exercise was a thing. So grad students probably no longer have to do that. But that was going to help me pay for college and I was thrown off a horse … Onto a pile of wood. And so I had a back injury that laid me flat.
I was out of state at the time that it happened. And I don’t know that I moved off the bed except to go to the bathroom and boy did I not want to do that because that hurt … For three days. And it was a while before I could even drive back you know, ride as a passenger back in a car. And I spent three months with the handicap sticker and not being able to get in and out of the car. And realizing you know, just how hard it is for people to deal. So with, there I was 24 and had learned a really good lesson. So I came back really slowly you know, and kinda rehabbed, rehabbed myself. And learned you know, all of the mistakes we make with ab exercises and with our jump to solve a back pain problem so fast, before we really know all the facts.
So I feel blessed that I have, I had that rapport really early on with first knowing pain. But also you know, how many thousands of people that we’ve seen over the decades have back pain. Or are going to. So learning how to prevent it or to help it, if somebody is in that stage … That was, it was amazing to me. And I can still feel twinges you know. So I have a little reminders you know, forever that are there that take care of this.
Yeah awesome. I think having your own pain experience makes you a better you know, coach, practitioner wherever you are as far as working with pain goes. Once you’ve been through yourself, you now know how to relate on a different level to someone who has never had pain before. I think I probably treat thousands of physical therapists and my career. And always the ones that either have been through an experience themselves or have coached someone like a family member through an experience, are always completely different than those who have had just studied and have a degree basically.
Right … Yeah. When you, you don’t want to do it but if you’ve been in those shoes, you have a totally different perspective. Yeah.
So what kinds of clients with pain have you helped throughout your career? You’ve helped you know, thousands of people at this point.
Yes and and even going to the point where you know focus on training trainers and helping them to do it. And probably not so much the science but helping them build that rapport. And see the difference between with working with a client who’s apparently healthy than someone who’s got a chronic problem. That big piece but fibromyalgia you know, is common now but 15 years ago you know, I would have these one or two people that just felt lost. There was nothing out there. There was no help and they were getting told, “Well nothing’s wrong.” You know, where do we start and then so that was a big learning curve for me. But people with osteoporosis typically, I don’t think of that as a pain centered thing. But some people it can really be a thorough, already compromised with posture or fractures in their back. And then it’s the emotional piece too, Joe.
It’s just not the physical stuff but depression, anxiety, people who might have insomnia because of some of those things and or that’s causing some of those things so it’s both the physical emotional piece. Back pain is a big one. I think today we deal with a lot of you know, upper back neck pain and or it may manifest as headaches that’s the complaint and they don’t tie the two together. Joint pain, either pre-operations, pre-replacement or post you know, coming through that. And then there’s just the [inaudible 00:08:26] you know, so coming back to that experience. You and I experience pain, we get hyper alert the idea that you know, do not work through that. That little whisper will become a scream. Right.
So we try to you know, put together the clues that that kind of pain before it’s actually a diagnosis, you know. And they’re not seen somebody yet it’s like you know, I rather get them before they come to you, right. And then they have to come back in transition to the real world.
Yeah they are great points and I think you know, people who watch my podcast who tune into this, they’re both conditions and there’s people obviously looking for solutions for pain.
People who look for solutions, I’ve talked a lot about nutrition function, medicine. Like you said exercise and movement. [crosstalk 00:09:10] What really is the top of my list as far as getting someone back to where there should be as far as their health and getting them out of pain but, fear is that brick wall that kind of stands in the way though.
How do we start to talk to people about their fear, get them over their fears, so they can really start to move. And again it doesn’t have to be a lot of movement in the beginning and just be a little bit of movement. But movement is critical not only for your body but also for your brain [crosstalk 00:09:34]as far as recovering from pain.
Right. Yeah and I think a big part of that getting over the fear is the blessing and the curse of the internet. And the access to all of the information I call, infobesity, right. That’s another disease we are suffering from, all of us.[crosstalk 00:09:53] Yeah it can put you in a place of fear and also in a place of power. So you can gather information but enough to be dangerous sometimes. But I think finding the you. Finding Joe. Finding Debra. Finding an expert that you trust, that you can follow. That you can build some rapport with even without taking that leap to calling or emailing or walking in the door.
That I think is a start. So I would say seek information because you’re empowered by that and it can go both ways. It can male alarms go off unnecessarily too. But that’s the key to finding somebody that you trust. Starting with your own circle, you know. You know somebody and I know somebody who is probably a great referral. An if we can you know, find someone from my doctor or from a physical therapist, from a friend who’s had one. That’s a great connection because you have that primary referral and we all trust those people a little bit more. That’s a first step and I would say the first time you’re going to meet with a trainer when is going to help you with exercise, go in your street clothes, you know. Stay comfortable, stay control. You can ask questions and you’re hiring them so interview them.
Right. So the first session doesn’t have to be let’s put your gym clothes on and get all hot and sweaty basically. [crosstalk 00:11:22] The first day tell me about you, tell me about your experience. What kind of credentials? [crosstalk 00:11:26] Let’s say I’m going to walk down the street to the local gym or to local fitness facility or a box or whatever it is. What kind of credentials> Or how do I screen someone? Because there’s a lot of different types of exercise specialist out there.
Yes oh boy yeah that’s a loaded question. So hoe much time do we have. You know there are over five hundred certifications in fitness and they are sound really good so you got to be careful but some of these certifications are you know an hour online. And you get to try over and over till you get the test right and pass. Some are weekend long some are much more in depth so you got to screen and you do need to know what you’re looking for. There are some agencies that really float to the top the American College of Sports Medicine is always probably going to be clinically accepted as they wrote the bible. If we looked at guidelines we’re still referring to them. So its nice to know someone has taken the time and invested, they’re not going to get through that test without studying. And it use to have a clinical component which I think they’ve done away with that too which I was sorry to see. But knowing somebody’s gone through that’s more rigorous than others.
The American council on exercise had a lot of certification, one that I really, I’m actually a subject matter expert for so I write the test questions and its called the Medical Exercise Specialist. So those people who have passed a test like that or ACSM clinical exercise specialist, they have studied how do I treat back pain specifically, how do I work with someone whose going through cancer treatment, how do I work with someone with risk factors for heart disease, stroke , hypertension, diabetes. They have specifically, not just the level of okay your healthy but you want to get more fit. They’ve actually gone that was but deeper into a dive specifically for what you’re looking for. So I would always look for the depth of certification. I love to see when I hires people I love to see a four year degree at minimum. You know its not mandatory, you know there is the school of life and that serves as great trainer for those who don’t have a four year degree, and I font mean to offend anybody. I think if you have opportunity and they’re available, I prefer to have that depth of knowledge first.
I think the medical exercise part is so key especially as we have the rapidly, you can talk about this because its your area` of expertise. This rapidly aging baby boomer population. Who a lot of them have pre-existing issues or have an issue that’s going to develop as you’re working with them. I think that medical exercise piece is so key for trainers.
Yes, that’s so true. Its funny when we look back, I’ve been doing this, I want to hear a big gasp right, for thirty two years. But fifteen or twenty years ago what we used to call “special” populations. We all have it, we’ve all got a knee thing, we’ve all got pre-diabetes. If we don’t have it we are “pre”. Its not the anomaly anymore we really need to go deeper. So you’re not, unless you want to stand up on this stage nearly naked looking really good and that’s a whole different mindset than the medical fitness expert.
And a whole different style of training as well, correct?
Yes, absolutely, absolutely. It doesn’t have hurt, and that’s something I really wanted to get out. That it doesn’t have to hurt , back to that fear and overcoming it. No pain no gain, when your fifty or sixty you did hear that and exercise meant go for it and we hear a lot of extremes but sometimes its the lighter stuff that actually makes the biggest difference.
You know when we talk about exercise, a lot of different types of exercises. Cardiovascular exercise, flexibility, mobility training. There’s obviously strength and resistance training, there’s high intensity interval training. Where does all that fit and and how does all that differ for somebody who has chronic pain?
Its such a great question, we don’t want a textbook exercise prescription. If you’ve got chronic pain, its not about a check mark of okay are you doing three to five cardio workouts per week. Are you doing two or three strength training workouts a week and are you stretching most days? That’s the real ABCs, we need to go to D, E and F you know, if not X, Y, Z. And we need to go all the way in and its really about you. So I hate to be the bearer of bad news but you even as good as you look, you’re not symmetrical. We really start with the person with the individual. So there’s no blue print for here’s your exercise prescription, go do that.
We need to start with lets look at your mobility, lets talk about what you’re feeling, where is there pain, where do you have limited range of motion. And maybe it shows up in daily activity or just thinks that bring you joy. You’re not able to do those, what are those things and talking about that. And we take a look at posture in your standing and posture in simple movements to look at from right to left what’s going on with weight bearing.
If there’s pain the fact that your not symmetrical alone is not a probable, none of us are. So we don’t fix it if its not broken, but we pick up clues. So that if we get feedback along the way we get another clue. We can put them together to say okay wait something here might need strengthening something on the other side might need stretching. Lets bring you back into better alignment before we ever add more movement and load movement.
Exercise and fitness kind of goes in trends, so we know. We’ve been thought many different decades many different types of trends.
Obviously there’s no one prescription for everyone, it’s individual. What do you say are people doing too much cardio are they not doing enough strength training, what do you really see in people. That one missing ingredient. People say, I currently exercise, I exercise four times a week but Debra really talked about me paying attention more to this one thing. Especially as people age there are certain things that are key for them.
Right, I like to say that every body should be doing some strength every body should be doing some component of cardio, and every body should be doing more mobility. What we use to call flexibility. I don’t care of you can touch your toes, and I don’t think you do either, except of you cannot put your shoe on. That’s important, but what’s important is that you can move through your full range of motion. You can do all your activities of daily living and you can do the activities you love pain free, and move without having to think twice. That’s important, particularly as we age mobility becomes the big one. We don’t want to lose that. That’s probably the most neglected.
If you look back twenty years if you’re short on time, you’re going to shorten the warm up and skip the cool down. I’m going to do that later, I’ll do that when I get home. Not so much. We skip it, even those of us who know better skip it. We fit in the intervals I’m going to get that. So were seeing a lot of probably a little less so I think people are getting smarter about intervals, so we heard. We heard that’s the best for fat burning. We know that there’s a piece of that that’s true but there is also more need for recovery. When you do high intensity work even cardio. So doing a little of it, a small dose of the right thing but giving yourself a little rest. You’ll actually get better results and have less risk of injury. So I think that’s where we tend to go wrong. We are still a all or nothing society. So if its good all right, give me more. I’m going to do that all the time because that will help me, but that gets us in trouble.
Yeah I think the pints of recovery in your exercise program in and of itself is an enormous topic and I’m glad you touched on it. A lot of time for athletes I use to treat professional dancers for them over training is a huge problem. For a lot of them that’s their pathway into chronic pain actually.
Yeah. And I think that that’s true of a lot of people and there are a lot of people potentially watching this who are guilting themselves for not exercising enough. And the truth is that rest between when life gets too busy, and you cannot do it may actually be helping you stay away from injury get better progress and feel good. So it’s not always about doing more. It’s about doing the right amount for the right thing going on with you right no and that could change, day to day, week to week.
Yeah, it changes throughout your year. It changes with stress level, it changes with your work schedule. Exercise is not, people prescribe it as a constant. It’s really not a constant in your life. My exercise routine changes dramatically sometimes, does yours?
Oh definitely. Definitely, so imagine this. Today before I was like okay, you know. I could shower now or I can do 20 minutes and then shower. And I was like okay, I’m gonna get it in. And you know ,so to a lot of people that might seem like, I don’t have time for an hour, it’s not even worth it. But it’s so worth it. That consistency is your best friend. You know and I think that will be the mantra I always come back to. So because it did it today, that’s in my head. That’s who I am. I’m somebody who exercises regularly even though it might be just a little today. You know it might be more tomorrow. Or it might be something else tomorrow. That’s important.
I love that, it’s almost tweetable. That’s who I am. So basically you’re saying, exercise is part of my being. It’s part of my core. It’s been with me my entire life[crosstalk 00:22:21] It will always be there.
Right. And even that’s true when days when you’re stretching. Or you’re consciously … And I ask people to do this. Take your calender, look at your week. Your work week, your stress week, your family obligations. And put those in there too, because that’s a stress on your body. And then put your exercise in there and plan it. But make sure you’ve also planned day off. This is my rest day from exercise where you’re not worried about distance or heart rate or load. You’re moving. But that’s valuable. We need to realize there is value in the the rest and recovery. And as we age it’s even more true. We can do as much. Some people can do more than they did when they were younger but might need more rest between.
Right. So physical therapy unfortunately, insurance companies have cut visits down, down and down. When I first started practicing, a patient would come in for about 60 visits of physical therapy. Today it can, depending where you’re in in the country and what your insurance is, it can be a real struggle to get even 10 to 12 visits for a patient. So I really thing that the exercise specialists, physiologists [inaudible 00:23:36] trainer or whoever they are, is really integral in that kind of rehab transition for people.
Yes. I agree. And I think my relationship with you right, is really important too. So you’ve got to trust me. And we need to have a lot of communication. That’s another piece of it. Of course the patient. Your patient, my client you know, the verbiage is really important there. But they have to be the one who feels cared for. And it’s kind of a three legged stool. We’ve got to be working together with great communication back and forth about you know, where are they? If there’s a handoff from you to me. Or if it’s a medical doctor. You know, what’s going on with medications and current treatment. And what kinds of things they want to see. And a report back you know, about here’s what I’m noticing during our session. Here’s evidence of change, one way or the other. And having that, somebody quarterbacking is really important. And a lot of times that falls on the trainer because they’ve got just a little bit more time to do it.
Yeah, excellent. So this has been a great interview. I can talk to you for hours about exercising. That’s one of my favorite topics to talk about. But please tell our listeners and our viewers where they can find information about you. I know you have a great website. I know you have a YouTube channel, some wonderful and fantastic exercise videos on there.
Thank you, yes. So the website is foreverfitandfab.com and you can find a checklist to go through habits of the fit and fabulous, if you’d like. And take that. See how your are doing compared to someone else. And just, it’s a great benchmark. My YouTube channel is all ages fitness. No spaces between. And there are some talking head but there are also some exercise things if you’ve got knee issues, Or need to roll out foot pain or some that address back pain with the caveat, it’s a one sided conversation. So that’s a drawback maybe from online. If I don’t know you it can be hard to you know, get advise. That would be a takeaway for listeners. You know I love that people often find me online and I’m sure that’s true of you. But I often encourage them, screen me just as hard as you would screen anyone else because it’s just me talking. And I can’t get feedback back from you to know if this is really right for you. So really important.
Well, I want to thank you for being on the podcast tonight. High recommend you. I think this interview is a great way for someone to screen you because you have great information to share. So I recommend [crosstalk 00:26:19] you know everyone watch the video. Please share it with your friends and family on Facebook. Share the video with your friends and family on YouTube, twitter. Whatever you use and I highly recommend Debra, she’s really amazing and incredible.
Thank you. Back at you. Thanks for having me Joe.
So check that[inaudible 00:26:36] on her YouTube channel, on her website. Stay connected to me on the Healing Pain podcast at DoctorJoeTatta.com and we will see you next week the Healing Pain podcast.
About Debra Atkinson, M.S., CSCS
Debra Atkinson, M.S., CSCS is America Boomer Babe’s Fitness Expert. As a Medical Exercise Specialist, personal trainer, and wellness coach with 30 years fitness industry experience she works with boomers around the world who are pro-aging and agree slowing down is abnormal. She is a fitness presenter for the International Council on Active Aging (ICAA), IDEA, and NSCA and author of hundreds of articles and four books including You Still Got It, Girl! The After 50 Fitness Formula For Women, Navigating Fitness After 50: Your GPS For Choosing Programs and Professionals You Can Trust (2013). Debra is Subject Matter Expert for the American Council on Exercise (ACE), item writer for ACE’s Medical Exercise Specialist exam, and has served as selection committee member for IDEA’s personal training fitness award and NSCA’s Personal Training Conference planning.
To learn more about Debra Atkinson visit foreverfitandfab.com
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