The Show Up Fitness Podcast
Join Chris Hitchko, author of 'How to Become A Successful Personal Trainer' VOL 2 and CEO of Show Up Fitness as he guides personal trainers towards success.
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This podcast focuses on refining trade, business, and people skills to help trainers excel in the fitness industry. Discover effective client programming, revenue generation, medical professional networking, and elite assessment strategies.
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The Show Up Fitness Podcast
AVM Stroke (Arteriovenous Malformation) How to train a client who had a stroke
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IG: Stroke_riser21 The boundary between certified and qualified trainers becomes starkly apparent when working with clients who have complex medical conditions. Through the journey of Jimmy, a stroke survivor with arteriovenous malformation (AVM), we examine the critical approach qualified trainers must take when designing rehabilitation programs.
Jimmy's story is particularly powerful—once a Division I baseball player throwing 90+ mph fastballs, he experienced a hemorrhagic stroke during exercise when his "ticking time bomb" AVM ruptured. After emergency brain surgery and months of therapy, Jimmy faced the mental challenge of rebuilding his identity before even beginning serious physical rehabilitation.
What sets qualified trainers apart is their approach to medical collaboration. Before designing Jimmy's program, I connected with both his physician and our team physical therapist, establishing clear communication channels and demonstrating anatomical knowledge that overcame the common stigma about personal trainers being merely "appearance-focused" without substantive expertise. This interdisciplinary approach created a safe framework for Jimmy's program, focusing on intensity management due to seizure risk while implementing strategic movement patterns.
The program incorporated bilateral squats biased toward his stronger right side (potentially creating a crossover effect to strengthen his affected left side), grip training for his left hand which remained claw-like due to muscle tone issues, and carefully monitored rest periods. The most emotional breakthrough came when Jimmy, with proper supervision, successfully transitioned from standing to floor and back again—bringing tears to his eyes as he said, "The most important thing people need with stroke is hope, and what that did right there gives me hope."
This experience highlights why proper training for special populations demands comprehensive understanding of anatomy, critic
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They all I'm already certified. I say but are you qualified? They say yes, I am. Experience without supervision does not make you qualified. That makes you lucky. Welcome to the Show Up Fitness podcast, where great personal trainers are made. We are changing the fitness industry. One qualified trainer at a time with our in-person and online personal training certification. If you want to become an elite personal trainer, head on over to showupfitnesscom. Also, make sure to check out my book, how to Become a Successful Personal Trainer. Don't forget to subscribe, rate and review. Have a great day and keep showing up. Howdy y'all. Welcome back to the Show Up Fitness Podcast.
Speaker 1:Today we're going to talk about how to design a program for a client who's had a stroke. Before we get into the programming, we need to define what a stroke is, the different categories there's ischemic, there's hemorrhagic, of which about 90% of strokes are the former, which are ischemic, and then about 10% are hemorrhagic. Now my buddy Jimmy he is three years post-AVM, which is arteriovenous malformation, and so the best way to understand ischemic, which is a type of blockage which could resort from blood clotting and so forth. That's why you want to always be in contact with a physician when you have a client who has blood clots because you don't want it to lead to a stroke With the hemorrhagic AVM malformation that he has. I think the best way to understand is to do a little self-experiment here. As we recall from our level one certification because you're a qualified trainer all arteries go away from the heart. All veins go back to the heart. So if you were to put your left arm out, pretend like that's your arteries, and then your right arm out, that's your venous return. It's going to go back to the heart. If you were to intertwine your fingers, that is a normal formation. You have your arteries into your capillary beds, which would be your fingers, and then you have a nice gaseous exchange which go to your veins, which is CO2, bringing it back to the heart. We breathe out and that's the whole circulatory process. But with AVM what happens is now your fingers are not intertwined, it's like a block. So if you were to put your right hand on top of your left hand and crumble them together, deformation is not optimal. Essentially, it is a ticking time bomb. And so then when you have a hemorrhage in his case, what happened? He was working out and blood pressure got a little too high and it's just like I said, a ticking time bomb and he had a stroke. He was rushed to the ER, had emergency brain surgery. The last thing he remembered was the doc mumbling to him if you do not get this surgery, the likelihood of you dying is very high. He signed the paperwork the best he could and had surgery. He woke up and his journey is now significantly different.
Speaker 1:It was really cool to see his transformation over the last three years, because the first year or so was really just the mental block, the negativity, the toxicity of those ants that are taking place. You used to be a division one baseball player. You could throw it 90 plus miles per hour and now you can barely even stand up. You're in a wheelchair. You have a crazy scar on your head. Your speech formation has to. You're in a wheelchair. You have a crazy scar on your head. Your speech formation has to begin from like a child. You're working with a speech therapist, occupational therapist, physical therapist on a daily basis hours, psychology, and so just everything that's going on is a huge change of landscape. One day you want to be a professional baseball player. The next day your life is completely different, and so it's interesting talking with him. The first 12 to 18 months was really just a mental discovery and overcoming those hurdles. And now the rehab process is a lot more physical. Jimmy has a great Instagram StrokeRiser StrokeSurvivor. I'll tag it so you can follow him. But his process has been really awesome and showing up doing the work that he can to the best of his capabilities.
Speaker 1:We were communicating back and forth. I said I think it's time for you to come to the gym and let's take this rehab process a little more serious. So the first thing that I did is I connected him with our team physical therapist. That's the difference between a qualified trainer and a certified trainer and it's something that you need to communicate with medical professionals. And when you do reach out, that's the difference. That's really the main difference between a certified slash influencer versus a qualified trainer. Qualified trainers are building medical teams. Certified trainers understand their body. They're anecdotal based, and so when I reached out to his physician, it was via email and we got on a call and that's one of the first things I talk about. I say hey, doc, I'm sure you're aware of the difference between a certified trainer and a qualified trainer.
Speaker 1:Most trainers study a simple textbook like NASM, ace, issa. For qualified trainers. They have a thorough understanding of movement. That's going to be NSCA. Acsm show up in a CPT, a background in kinesiology. They went to a school like NPTI. From there they go into hands-on learning, whether it's an internship or working alongside a physical therapist.
Speaker 1:Unfortunately, doc, a lot of trainers have a bad rep and I just want to put that out there right from the beginning that you're working with a qualified movement professional. That conversation leads into a lot more from my understanding of movement. So what you do in the beginning is you clear the air because that medical professional has a stigma behind personal trainers and it's that of social media, what you see in movies. We just look really good but we're vacuous. We don't understand anatomy. When an opportunity comes up to showcase my anatomical skills, that's how I verify that I'm qualified. So, doc, I know there's two different types of strokes and Jimmy had an AVM. I would love to learn more about any contraindications with this rehab process. I'm going to have him work and do his first assessment with our team DPT. He's from USC. I would love to get any contraindications so I can report back to the doc and we can work alongside one another for the best results for Jimmy.
Speaker 1:Have any questions for me? Do you have a trainer, doc? I would love for you to come to our Santa Monica location so you can check it out. You could see what we do here because we are pro movement, working alongside of physical therapists, registered dietitians. It's a value proposition slash elevator pitch that I'm giving to the doc. I'm selling him on what we offer, but I have to do it in a very quick fashion because he or she is busy.
Speaker 1:But I'm not doing it taking up all the air. I'm asking questions being professional. I want to be respectful of your time. This will only take five or so minutes. I'm setting those clear expectations from the beginning. So then, when I had to talk with our team physical therapist, I said everything is good to go. I want you to assess, do your thing and let me know what your thoughts are for the programming that I'm going to do on Saturday and this was on Tuesday. So I watched and observed the session that Doc Andrew did with Jimmy and during his intake questionnaire. It's the same as our physical activity readiness questionnaire, but his is more medical, movement-based. I'm observing, I ask questions during because I know the client and I'm comfortable with the therapist. It's a three-way conversation really. We try to make it as lighthearted as possible learn more about each other's background.
Speaker 1:From that assessment we discovered that you're really freaking capable. The main contraindication for the workouts would be intensity-based and he would be likely to have a seizure, because he constantly is having seizures. Still, it's about a three-month marker that they want to get through without any seizures. He's yet to achieve that since the first stroke and so we really have to hyper-focus on breathing. We're not going to volitional fatigue.
Speaker 1:We decided it would be best to do a CA variation, a core pattern, followed by an accessory being something that is rehab, prehab. So we're working on his grip strength on his left side. The stroke was in the right side of the brain, which affects the left side of the body. He has a very hard time opening his hands because of the muscle tone which was affected via the stroke. So his hand is like a claw and we're going to be working on improving that extension. So opening his fingers up. We could also do grip strengthening, which would be more flexion, but the mobility via the tone is affected, and so when I watched him do his assessment, he did a few exercises, walked, checked out his gait to see how he was moving, gave some suggestions there. We did some hip flexion. Jimmy was asking great questions and I would add in just for my own knowledge here what are we thinking for how many reps Rest is the big thing here.
Speaker 1:Do a C rest, do an A rest, go back to the C rest, go to the A rest, keep the volume fairly low. So we did four CAs with two rounds of each. So the first thing that we did from the doc's instruction is you can pretty much do whatever he wants, what he's comfortable with. So we're working on getting stronger bilaterally. So we did some squat variations like a B stance.
Speaker 1:But he has a brace on his ankle because he has drop foot. So he's not able to get dorsiflexion because the anterior tip isn't firing optimally, so he wears a brace. Eventually we're going to get that brace off. He also has a cane for the right side. So when we do a squat I take the cane away. He sits down onto a bench which is fairly high, but we bias more of the right side. His right side is the stronger side, but we bias more of the right side. His right side is the stronger side and his left side is probably at the maximal strength capabilities that he's ever going to achieve. And that's what the doc said is the left side pretty much is where it is. Let's get that right side stronger so there could potentially be a crossover effect, which is really neat just with the human physiology. So we are almost doing a 70% squat right side, hoping in the future that, yeah, he's going to get into pistol squats but the strength is going to carry over into the left side because the body doesn't want to have that huge discrepancy. And that's really neat with the human physiology, how the left side will potentially get a little bit stronger by focusing more on the right side.
Speaker 1:And then the second thing that we did for the accessory is we put his hand as far above his head as we could and we're working on gripping a pull-up bar. So jimmy's pretty tall, he's like six, two. So I have him stand up and his right arm is on the cable rack, left arm I'm assisting getting it up as high as he can. He has a lot of shaking. That happens and it's really neat because that is great adaptability. That will happen. His body loves it because it's not used to getting up there. He's sweating during this, but we're breathing and it's appropriate, within what I've been instructed via the doc and the therapist.
Speaker 1:We rest, we sit down, we talk about the old days. What are some of the goals that you want to do when you start working again? Have you thought about what type of work you would want to get into? Maybe it's giving a talk and doing some BHAG stuff big, hunky, audacious goals, doing like a TED Talk or something. Right now you're doing these support groups that you really enjoy leading. Maybe that's something you want to get into in the future. Could be grant writing, having your own gym or clinic facility where you specialize with stroke. There's so many things that we can do. We have to provide hope.
Speaker 1:The second CA that we did was a bar pushup into some tennis ball slaps so he can catch it easily on his right side, but the left side he would not be able to open up his hand. So I said let's use your hand like a paddle and just work on some dexterity smack the ball. Use your hand like a paddle and just work on some dexterity smack the ball. So he really enjoyed doing that, did that for two rounds and then we got into some cable rows for the third C, and then we complimented that with some grip strength on his right, and then we worked on using a tennis ball, opening up his hand on the left. That is the accessory.
Speaker 1:And then the last thing that I wanted to do, which I got the approval from, I said Doc, can we get on the ground and have him come back up? And Jimmy's eyes got big and his mom was a little nervous too, but he's like yeah, he's perfectly fine If he's comfortable. Doc says he can do it, and he saw my excitement Jimmy, we can do this. And so he said okay, I want to try it. And so what we did is I had him get on the ground and I posted an Instagram on this. It was really neat because afterwards was tear jerking, we got to our stomach and then we reversed over.
Speaker 1:I was manipulating his leg that isn't working as well and then he essentially did a pistol squat from the ground up. I braced myself and I was able to use my arm to lift him up. And then he essentially did a pistol squat from the ground up. I braced myself and I was able to use my arm to lift him up, and that's why Doc said it'd be okay to do it with me because, worst case, chris could just pick you up. It's not a big deal. That's what happens when you're a big hunk. So I got him up, sat him down on the bench and he starts tearing up and he goes. You know what, chris? That's?
Speaker 1:The most important thing that people need with stroke is hope, and what that did right there gives me hope. I'm getting goosebumps thinking about it and I was just looking him right in the eyes like man, we're going to be able to do this. We got this. My man, you are so capable. It's the mind that has to believe. You have to use that hope. And you're going to have highs, you're going to have lows, and when you're at a low, you have to remember the highs. And when you're at a low, you have to remember the highs. And when you're at your highs, you have to remember the lows, because it's not just going to be all sunshine and rainbows to the moon. There's going to be great days, there's going to be bad days, you're going to have more potential seizures and when those happen, we have to be prepared.
Speaker 1:His mom gave me this anti-seizure medication. If something were to come up, he starts seeing bright lights, take a little nozzle spray and it just eliminates the potential for a seizure, which I've never even didn't even know I was a thing. So I looked at the medication, talked to the doc. He's like, oh, that's fine, that's what it's there for If the intensity were to get too high but we're communicating and those symptoms were to present, grab the anti-seizure medication, take a hit and now it. And then we walked out to the car. We have a nice little private entrance here in Santa Monica. So as we were walking out there, I take the cane from him, make him walk by himself, but I'm there supporting. He hasn't had a fall, but it's just to give him that support and getting to where he's going to be without the cane, without the brace, it's going to happen.
Speaker 1:That's how you design a program for a special population, whether it be someone who's morbidly obese maybe they had a fall in their older or broken hip, acl, shoulder issue is you communicate with the professional who gives them the clearance. You make sure everything that you plan is appropriate. You communicate well with the client and other people maybe if it's a mom or dad, in this case the mom and then you do the work and qualified movement professionals. You who are listening to this show up fitness CPT. That's what we're providing, because you understand the human body, where a lot of trainers in this situation may just give him exercises because they saw it on YouTube. Hell, they probably didn't even get a medical clearance or communicate with the doctors. Oh, this is going to be an awesome case example that I can highlight. I'm just going to do it myself. That's what's wrong with the fitness industry. We need more team.
Speaker 1:And what happens to your confidence when you have a physical therapist, a registered dietitian? No fear whatsoever to reach out to surgeons, to doctors, psychologists, whoever it may be, because we are on the same level, we can have communication and we can implement a plan that is appropriate for the patient or client in front of us. I'm really excited to watch Jimmy's success and progressions. That will take place. If you have an opportunity to work with someone such as Jimmy who's had a stroke, you do your research to learn about the condition, anything that you're not aware of. Look online A word you don't know how to pronounce, type it in. How do you pronounce A, b, c or D? Then you hear the Google machine pronounce it and then you say it over and over and over again. So when you have a conversation with that medical professional, you don't sound like you're not educated and you may be thinking, oh, it doesn't matter. But that's what we're trying to overcome our trainers having a bad rep as being vacuous, gold T-shirt wearing muscle freaks who don't know anything about the human body.
Speaker 1:Doctors, registered dietitians, physical therapists respected careers, personal trainers, no, were looked at as a joke. Oh, what do you want to do long-term? Oh, that's a cool part-time job. You see the big three marketing companies all the time saying, oh, it's a cool part-time job. You see the big three marketing companies all the time saying, oh, it's a great part-time gig. Why not make it a full-time gig? Because you absolutely can if your mindset is right. Are you coming into this, going to master anatomy programming, assessment process, how to get your clients out of pain, connecting with dietitians and therapists, or are you just doing this because you're an influencer?
Speaker 1:If you want to turn your passion for fitness into career, don't follow what those who are doing that are struggling. They don't have streams of revenue. They're barely making ends meet. 30, 40,000 a year. Nothing wrong with that. The average income in America is like 54,000. The average income in America is like 54,000. The ability to make three, four, five times that as a personal trainer is realistic, but it's not going to be easy.
Speaker 1:I'm looking at our wall here in Santa Monica 20 muscles of the lower body, hamstrings, quads, adductors, glutes, calves Can you name all 20 of those? One of the harder conversations I have are for people that want to get our certification is they say oh, I'm already certified. I say, but are you qualified? They say yes, I am. Experience without supervision does not make you qualified. That makes you lucky. You didn't hurt someone just because you were lucky to put in some random exercises. Do you really understand what those muscles do? Is there critical thought behind your programming? Or is it just random exercises? Let's do some bench dips and some bosey ball backflips because they're cool? I saw it on Instagram. Or is there a thought process behind the reason I did the squat?
Speaker 1:First is because that's the main emphasis that we want to work on for the lower body. We did a pull, we did a push and at the end we did a transitional, which is starting from a standing position, getting down to the ground. His base of support changed and then we got up. It's like a Turkish get up, which would be classified as a transitional movement pattern, and everything from the accessory was specific to helping his condition. Now, if Jimmy were to be someone who's morbidly obese, that would just be a variation of the accessory that I would implement that's appropriate for him. Or if it was a girl who wants to grow their glutes, it's not going to compromise force production. I'm going to implement it where it's appropriate to help with their goals. That's what qualified movement experts can do.
Speaker 1:And if you want to become a qualified trainer, you need to get into a hands-on learning opportunity where you are working alongside a physical therapist. You're learning how to assess clients in pain so you can refer out if need be. I know a lot of trainers wouldn't even touch someone who's had a stroke. The beauty of being a competent trainer is you can train any body. The average trainer only understands their body. If you want to level up your career, get the certification for life. That's the show up fitness CPT. Get into the soft tissue.
Speaker 1:We're going to be in Denver the 13th and 14th at Parker Aurora Lifetime. We're going to be at the Miami Coral Gables the 27th 28th of June. Our next in-person in Atlanta is going to be June 9th. Santa Monica July 7th. Those are two month internships. You will leave those two months. The 1% of fitness professionals in the world Most trainers study a textbook. 90% quit within the first year. The ones that make it they're lucky because they looked the part, they talked the part. Maybe they have one of the three skills that is essential for longevity in this career Technical skills, people skills, business skills. Make sure to comment on the Facebook group some special populations or programming that you'd like to learn more about. Get to a seminar and remember big biceps are better than small ones, and keep showing up.