The Healthy Post Natal Body Podcast
The Healthy Post Natal Body Podcast
Navigating the Scope of Practice: Personal Trainers, Physios, Dieticians, Doctors..What can a personal trainer do?
One of the ongoing discussions people in the health space (I'll include everyone in that; Doctors, Physios, Dieticians, Nutritionists, Personal trainers etc) keep having is about "scope of practice".
For instance; Someone who is not a registered dietician can not give out personalised meal plans, telling you exactly what to eat. It doesn't matter whether they're a personal trainer or a GP, they don't have the qualifications to do so.
You will often hear physio therapists say the same thing; "If your client has an injury then you should refer out to a physio" and technically they are correct.
However, there are some grey areas in this. What about a minor niggle? Can/should a personal trainer refer out? I mean, you don't go to A&E with a small cut on your finger, do you?
And what happens when a qualified professional is seemingly incapable of helping you but someone in an adjacent profession does have the solution?
I give the example of my knee pain which physiotherapists kept messing around with and nothing was resolved, then I saw my sports massage therapist and he diagnosed the cause in 2 minutes and fixed it within 3 sessions. Should I not have listened? Should he have sent me away, back to the physios that didn't have the solution the first time?
All that, and more, in today's episode;
As always; HPNB still only has 5 billing cycles.
So this means that you not only get 3 months FREE access, no obligation!
BUT, if you decide you want to do the rest of the program, after only 5 months of paying $10/£8 a month you now get FREE LIFE TIME ACCESS! That's $50 max spend, in case you were wondering.
Though I'm not terribly active on Instagram and Facebook you can follow us there. I am however active on Threads so find me there!
And, of course, you can always find us on our YouTube channel if you like your podcast in video form :)
Visit healthypostnatalbody.com and get 3 months completely FREE access. No sales, no commitment, no BS.
Email peter@healthypostnatalbody.com if you have any questions, comments or want to suggest a guest/topic
If you could rate the podcast on your favourite platform that would be a big help.
Playing us out this week; "Keys to the castle" by Salon Dijon
Hey, welcome to the Healthy Postnatal Body Podcast with your postnatal expert, peter Lapp. That, as always, would be me. Today I am talking scope of practice. You hear this a lot, especially online. Personal trainers have a scope of practice. Physios have a scope of practice. Doctors have a scope of practice. Registered dietitians have a scope of practice. Can personal trainers give meal plans? Can they give specific diet plans? When does rehab type exercise? When do injuries fall under the physio rather than the personal trainer? Or when you see a doctor? All that type of stuff. It's going to be a controversial one, but it'll be fun, I promise. Here we go. Hey, welcome to the Healthy Postnatal Body Podcast for the 26th of January 2025. And I was originally going to bring you an interview about urinary health and urinary incontinence and leakage and all that type of stuff, but that will now be next week. That's an interview I did with Dr Nigel Brayer, which you're going to love, by the way. It's great You're going to like that guy. And then the week after that, we'll do eating disorders in children and teenagers, especially how to prevent them, and all that type of stuff.
Peter:But today I wanted to talk a little bit about scope of practice. It's something you see a lot right? Basically, scope of practice means what kind of say? For instance, stick to personal training to begin with. What can a personal trainer do and what can't they do? Right, they talk about this a lot.
Peter:A lot of people, online especially, like to pretend that these things are always crystal clear, and I would argue that they're not necessarily right. Certain things are right. Personal trainers can't do individual meal plan. You can give generic eating advice, Sure you can, but you can't do specific meal plan. So you can say I recommend you eat your fruits and your veggies, and you know, because it's good for you, that's completely fine. If someone comes to you for I don't know weight management type thing or just healthy living and all that sort of stuff, you can say, hey, you know, eating five a day of fruit and veggies is really, really good for you, right? But as soon as your client then goes, well, I need someone to write down exactly what I'm going to eat, need someone to write down exactly what I'm going to eat. You should be referring them out to a registered dietitian, or in some countries, a nutritionist is always also completely qualified. I prefer registered dietitian because that's how it works in the UK, someone with a nutrition certificate who's done a nutrition course and I have done a few of them is still not qualified to, it's not within their scope of practice, right, that individual meal plans and all that type of stuff.
Peter:Now that doesn't mean that those people aren't useful, right? Having a nutritional qualification or being a nutritionist and all that type of stuff, having a nutritional qualification or being a nutritionist and all that type of stuff those people can add a lot to your health. Right, you go to them, you see them. They can say, hey, you know this has been eating five a day is very beneficial. They can help you with your eating habits. Let me put it that way. They can help you with your eating habits. Let me put it that way. They can steer you in the right direction. They can guide you and you can give them your food diaries, if you're that way inclined, and all that type of stuff, and they can steer you into making better choices for yourself. That doesn't mean they can give you personalized meal plans. Now, I'm personally not a big fan of personalized meal plans. Anyways, I think it's ridiculous. I don't think they're necessarily that great for most people, and I'm talking generally speaking. Right, I much prefer the standard, just rough advice eat a bit better, that type of thing. But if you're looking for specific meal plans, you want to go to a registered dietitianian.
Peter:Personal trainers are not allowed to do so. Technically, personal trainers in the uk, at least if they belong to the reps organization, the register of exercise professionals and I'm not a member anymore because, well, I'll explain now why I'm not technically they're not allowed to sell you supplements either, right, so herbal. You see a lot of personal trainers sell Herbalife it's used fast and all those type of things. Or they sell protein powders. That is well outside what you're allowed to do as a personal trainer, which is why I'm not a member of registered exercise professionals anymore, because they don't enforce any of that. Right, it is a completely useless organization that does absolutely nothing other than make people go on useless courses all the time. They're basically one of those organizations that's there to provide courses and sell courses, right, until they start enforcing the rules, then there's no, there's no point in in being a member. Um, as all of you will know, I don't sell supplements and I don't sell. Well, I don't sell anything really. Um, right, I just do my little thing, but it's, it's the um. A personal trainer is not allowed technique to sell you SlimFast or Herbalife or any of that sort of stuff. Technically, that is in the rules regarding what you're allowed to do as a personal trainer and that is one of the no-nos, so you're not supposed to do it. Everybody seems to ignore it now, but there you are and that is one of those things that that annoys me tremendously. Most of the scope of practice stuff that annoys me centers around what you're allowed to do with supplements and meal plans and all that type of stuff.
Peter:The supplement industry is, is, is not, is not unregulated, as someone, as people like to point out. There's not, there's no regulation in it, it's just way too loosely regulated and you can basically start selling supplements as long as you don't make silly claims and long as the stuff doesn't kill anyone. Right, when your supplements start killing people, that's when the in america, the fda, in america the fda and in in the uk the food standards agency and all that. They all that they would start pulling, they would start investigating. After a few years they would pull the supplement off the market. But predominantly, there's very loose regulations as long as you don't make any claims saying that.
Peter:This is why you see a lot of vitamins advertised Wellmans and Wellwomans and all those antibiotic type companies. They say helps with the support of a normal functioning immune system. Because it doesn't mean anything. Right, there's no health claim to that, it just, yeah, it may help. It's been shown to help a little bit, maybe. Right, they don't say this will cure diseases, this will make you feel better. All that sort of stuff that's not allowed. They usually have a vague claim that says, um, by whichever celebrity they plunk on the ad saying I have never felt better since taking than when I started taking these, uh, these supplements. That's how they sell it, right, they don't make a specific this will help with your health sort of claim. It just has been shown, vitamin C has been shown to be useful in the support of a normal functioning immune system and all that type of stuff.
Peter:When it comes to medical conditions and injuries, it gets a lot trickier. You know, a lot of personal trainers always work with normal clients. A lot of normal clients have niggles right, bit of back pain, bit of knee pain and all that type of stuff, and that is where scope of practice becomes a lot more vague, because technically right. If one of my clients has a, a sore shoulder or a shoulder injury, let's call it an injury and we don't know what it is but say it is not too severe, but you know it's, it's, it's an injury, it's uncomfortable Technically, you should be going to a physio. No one does that, I mean I do. If the injury is done, I'm like, yeah, there's something not right here. I'll refer out to a physio and have a network of people that I'm comfortable referring out to and they refer back to me and all that type of stuff. I tend to go to specialists, right? So if shoulder injury occurs, I send them to someone who I know is good with shoulders. Same with knee pain. I know a guy who's really good with knee pain and I know a lady who's good with back pain and all that sort of stuff, and that's who I then refer to, anyway.
Peter:So I was doing this interview with this physio a few months ago, maybe a year ago, maybe a bit longer, I don't know and he was quite combative and I told him this story about how I used to have tremendous knee pain. I used to be angry and I saw physios about it and all that sort of stuff and they weren't helping, they were just not that useful. And I went to see a sports massage guy, um gareth, who I haven't seen in a while now, but he stays, he stays near me, he's absolutely wonderful, um. And and he said, yeah, the problem with your knee pain is actually I can feel it your hamstrings and your glutes. They're just, they're dysfunctional, right, and by dysfunctional he means they're not working well enough. Now, this um, so he started working on it and, you know, my knee pain disappeared after three sessions because what he did and the exercises I I could then do started working.
Peter:And this guy was talking to lost his mind, right. So you went to someone who was unqualified and and was working outside the scope of practice and he told you something that clearly wasn't true. Blah, blah, blah, that type of thing. Right, he, like I said, he lost his mind. There's no such thing as dysfunctional muscles, that type of that type of thing. Now, technically, of course, he was right. Right, there's no such thing as dysfunctional muscles.
Peter:What we mean when I say? When I say dysfunctional, I mean it's not doing the right thing at the right time, right, that's what I mean with it's not functioning as it should. That's what dysfunction means. With regards to being outside the scope of practice, right, this is why people go to people, because those if you're working as to being outside the scope of practice this is why people go to people because those, if you're working with someone who's in their scope of practice so in this case, physios and they don't listen to the client, they don't listen to the patient and they don't fix stuff, then people will start listening to people who might actually go with that, and I think this is what the solution is. Shall we try this Right In this case? You know, the massage therapist started working on my hamstrings a little bit and, okay, there's a lot of pain involved because, as is usually the case with sports massagers, and you know it helps. It helps Sometimes people who are professionals in a related field and, like I said, I'm not going to a car mechanic who says these are the exercises you need to do but who work in a related field, are actually really good at just saying, hey, you know what, what you're suffering from is not that big a deal.
Peter:This is just what we need to function on. Work on Right. Quite often we forget this. If I have Um, and this is why I don't particularly get that bothered about scope of practice, unless it comes to like medication and all that type of stuff. It matters. Of course you need to be qualified, you kind of need, you need to know what you're talking about.
Peter:But if we use, for personal trainers and physios and all that sort of stuff, scope of practice really narrow, then you know people are going to get stuck and they're not necessarily going to find a solution quickly, right? Every professional you have to work with, first of all you have to hope that they're going to be good. Like I said before, 30% of every person in any profession is at the bottom 30% of their profession and they're just not very good at what they do, right? So if you're working with a wonderful personal trainer and you have a bit of shoulder pain and all that sort of stuff, and the personal trainer knows through experience where that shoulder pain emanates from, because he knows you very well, because you've been working with him or her for years and all that sort of stuff, they know exactly what the deal is, what exercise caused the problem, what movement caused the problem, what you were doing when the issue flared up, and all that sort of stuff. Quite often they can just say, oh, this is what we'll do and we'll help ease that off, right?
Peter:If it's an injury that flares up all the time, like my knee was painful as in agony, painful for years and physios just weren't helping, right, and then, because they were looking at the wrong bit, they were constantly looking at the wrong bit, even though I told them that is not where I think the pain comes from. I kind of know, right, people know their own bodies to some extent. Right, you can, quite often you can feel where pain is coming from when something isn't quite right. Or at least you'll be able to say, when a professional says, hey, this is what the problem might be, you can say, yeah, but this feels different, right? Especially when it comes to NHS professionals that see a tremendous amount of people every day.
Peter:It's difficult to relay, to be clear, with someone if they don't know you and you only have 10 minutes or half an hour to speak to them. When you're dealing, for instance, with a personal trainer that you work with three times a week for years, that person is simply going to know your body better. So there is a bit of overlap. There is what I'm saying If you have really strict scope of practice, focus, then as soon as you go I have an injury here, the PT is supposed to go I will refer you out to a physio, which usually means waiting for a few months and all that sort of stuff before you can actually see anyone. And then, like I said, you have to hope that your personal trainer is well enough connected that they can refer you to a good one. But the problem is, the good ones are all they're all going to have a waiting list.
Peter:Everybody I refer people to have a waiting list and quite often I have to call in favors, I have to say, listen, I've got this woman or this man and they need to see someone sooner rather than later. Can you do me a favor? And I'll do you a favor when you refer people back to me and all that type of stuff, right? Or when you need, I don't know, presentations done on postpartum stuff. That is how that one works. But if you have no strings to pull, right, if you don't have that, then people need to wait for a long time, right? If you don't, if you don't have that, then people need to wait for a long time. Um, so for any pts listening, my personal trainers listening you need a network of people, for sure. You need registered dieticians and all that type of stuff in in your, in your network, um, and ideally a couple of doctors as well. Um, I, I definitely do.
Peter:But there is an element of I know what the problem is. Let's fix this that you will see with personal trainers, and there is nothing inherently wrong with that. I don't know any personal trainer that doesn't do that, and I know physios will lose their mind over this, but you know, that is kind of just the way it is. And the same goes for physios, right? Physios have a scope of practice and all that type of stuff that they should stick to, and you see them overstepping it regularly as well, in a good way, right? They know what they're doing. And then the client says, hey, you really helped with this. Can I keep working with you? And instead of saying no, quite a lot of them, even though they're not qualified as personal trainers or strength and conditioning coaches, will just go yeah, sure, because it's fundamentally is exercise. It's not that difficult, right, and there's nothing wrong with it. A physio has a tremendous amount, or should have a tremendous amount, of anatomical knowledge.
Peter:When it comes to training, strength training and all that sort of stuff, it can easily be argued that they should be allowed to do that even though it's technically not within their scope of practice, right? The only time, the only time I don't argue with or I don't disagree and this really is the only time I don't disagree with medical, with people for something that's outside my scope of practice is when it's so far outside of the field that I'm just not familiar with. Medical with people for something that's outside my scope of practice is when it's so far outside of the field that I'm just not familiar with it, or when the person at the other end of the discussion has a medical degree when it comes to medication and all that type of stuff. So lifestyle, we can debate. Lifestyle, I'm more than comfortable saying because I know we all kind of know what eating healthy looks like, right? And if a dietician were to come in and say I think you should eat 10 donuts a day, which they don't do but you know, if a dietician comes in and says I recommend the carnivore diet even though you don't have medical conditions, then we're going to have a disagreement, right? Then I will argue with the dietician. If a physio says, like is outside of my scope of practice, because I get asked these questions a lot what do you think of this medication, that medication, all that type of stuff? And even though I'm familiar because I've trained one or two older people and people who have had like TIAs and mini strokes and strokes and heart attacks and all that type of stuff, and of course I'm really familiar with postpartum conditions, the only time the only thing I will say then is that's outside my scope of practice. But I get a second opinion and in the UK a second opinion is hardly ever. I know it's really common in the States, but in the UK it's unheard of. Nobody asks their doctor for a second opinion. You're just lucky you got to see a GP.
Peter:I have a fairly decent network of private GPs that are. A lot of my clients, especially my face-to-face clients, have a bit of money right, so they can afford a £180 fee. Clients, especially my face-to-face clients, have a bit of money right, so they can afford a £180 fee. I know I give away healthy postnatal body stuff. Well, three for three months and then afterwards blah, blah, blah. Right, I know that's very cheap and for my personal training. I'm not ridiculously expensive for some people, but for a lot of people the fee is significant, just because you know I'm at that level now. But a lot of my clients can easily afford it. That is where I am. It allows me to fund HPMB, so to speak. That's what I tell myself to justify it. But they can afford a private GP, so I can tell them just get a second opinion from another medical professional, because I don't argue with people over medication.
Peter:Whether someone puts you on to warfarin or statins or whatever, or statins or whatever, I am not nowhere near qualified to argue that. Whether you should get your COVID booster or flu shot or not, I am nowhere near qualified enough to say yes or no about these things. Right, and no personal trainer is, no coach is. I know one or two that have a medical degree, but you know, if you just if unless they are qualified and have a medical degree to back that up and work in that field. So in other words, they stay up to date with the latest research and all that type of stuff. They are nowhere near qualified to say that. And that's what I mean with scope of practice. Some things are so far inside your scope of practice that you just should not be touching on it. Individualized meal plans, argument about medication, all that sort of stuff.
Peter:Minor injuries we treat them all the time, right? My shoulder hurts a bit, ah, let me fix that. That's like putting a bandage on a scrape, right? If you have a small cut, you don't go to A&E, you put a plaster on it yourself, right? That is not a scope of practice discussion for me. And it could well be that people sometimes like I experienced with my knee well, be that, people sometimes, like like I experienced with my knee find that those working, those people that you're unfortunate enough to come into contact with, who are qualified technically, they have to pay, they have to pay for the piece of paper, don't have the solution.
Peter:And someone who is working in a related field right, who is very close to say being qualified but isn't qualified my massage guy is a rehab guy, right, so he's remarkably qualified. He's just not a physio, right. So he would be my first point of contact. Is it outside the scope technically? Yeah, but I ask him to have a look. He has a look. Hey, I've come across this before. I know what this is. And then he explains it to me in language that I understand, because I'm not a very smart guy, right, and he's saying things like you have a dysfunctional hamstring and I do this on the podcast a lot, right? Technically the phrase isn't correct, but I know what he means. It's the same as when personal trainers say toned, or clients say I want to get a bit more toned. We know what you mean. It's fine, right? We can then argue about whether toning is actually of muscles, is actually a thing, but predominantly you're talking at the level of your audience and and it's fine, and that is what is happening here as well. And he fixed it. And at the end of the day, unless somebody has dangerous procedures and they're doing dangerous things, if they fix it, they fix it. That is how 90% of the population thinks, and that is the controversial bit for a lot of professionals. A lot of professionals are very stuck on the. But you should see me about this.
Peter:One of my clients is currently working with someone who has 15 years of knee rehab experience. I only know the person briefly, not my client. I've known them for a couple of years, but they got in. She was in an accident and the knee just wasn't recovering. And again outside my scope. So I said go work with a physio. This was accident recovery. Accident recovery that's not me right now. That's that's not what I do. Accident uh, rehab, this, um, this is. She found someone who I did have some conversations with and he's not. He doesn't have a piece of paper which is concerning for me, but the physios she saw weren't working and this person has given her some stuff to do and seems to be improving. He's got 15 years of experience dealing with, like rugby players and elite athletes and all that sort of stuff and their knee pains and rehab, and it mainly comes from having had a bad knee injury himself. So I would have preferred there to be a qualification there, but I can't crap on it. If he's not doing anything dangerous. Nobody else is helping and this seems to help. We have to be a little bit more open about working slightly outside scope for me.
Peter:Again, this does not mean your personal trainer or your coach can tell you to stop taking cancer medication. I hope that that is obvious. I'm not talking about that type of thing. I'm not talking about personal trainers recommending GLP-1 meds. They're recommending Monjaro and all that type of stuff. I'm not even talking about personal trainers recommending supplements. We know about protein and creatine and all that sort of stuff. That's not what I'm talking about. I'm talking about NMN, nat+, all that sort of stuff Usually all the stuff they sell.
Peter:You're not allowed to sell stuff as a personal trainer. You can sell gloves, you can sell kettlebells, you can do all that type of stuff. You can't sell supplements because you don't know how these things actually work. That is the case for nine out of 10 personal trainers, 99 out of 100 personal trainers. The obscure supplements that they're selling they don't know how they work, they don't know what the provenance is, they don't know where they come from, they don't know the factory. They've never been to the supplier, all that sort of stuff.
Peter:Anyways, a very convoluted episode. I get that it's very confusing, but I hope you know that's just my opinion on it, because I was asked about this. Scope of practice is important, of course. You know where you are when you stay in your lane. Every now and again you can also look out of the car to see what's on the side and you go hey, I know that as well and it's not going to hurt if I step into that lane a little bit. Just don't move into that lane permanently and, for God's sake, whatever you do, if it gets dangerous, go back to your lane, right? Anyways, that's enough waffling for me. You have a great week Next week, next week, urinary health, and you know that should be fun. Right? You take care of yourself. Bye now, thank you, thank you.