What kind of physical health professional am I looking for?
October 10, 2023 11:10 AM Subscribe
I'm a couple years shy of 40, and I want to get serious about physical health. I have a connective tissue disorder (Ehlers-Danlos syndrome) which gives me over-flexible joints, leading to flat feet, poor posture, and surprising pain when I over-exercise. But I want to exercise. I think I want to pay someone to help me set and accomplish some long-term goals, but who is also knowledgeable about posture and joint issues. What kind of professional am I looking for? A trainer at Planet Fitness? A moonlighting physical therapist? A Lifestyle Coach? A body mentor?
I have been to physical therapy several times over the years and I have all the exercises they gave me written down somewhere, but that support was very expensive for what I got, and it was always targeted at the specific pain-point (wrist, hamstring, etc) instead of holistically.
My goal is to be able to keep going on adventures my whole life. That would include the endurance to go on long walks or bike rides; the core strength to lift boxes, furniture, luggage, kids, etc without hurting my back; and the skill to use my body without injuring myself.
My barriers are my joints and ligaments. I'm told a key issues is that my hamstrings are too tight or short, which pulls my posture into an unstable alignment, which contributes to straining my muscles.
In the past I've tried to do yoga, calisthenics, jogging, biking, and squat/pushup challenges. Each time, I've hurt a joint or muscle, took a break from the program to recuperate, and lost the consistency my ADHD brain needs to keep going. If I could snap my fingers and do a self-guided program, it would be Hampton's hybrid routine and a deadlifting program. But, I've got a terribly difficult time getting beyond the entry level before hurting myself. I gotta get the core strength and joint stuff done first.
I don't know what is offered, but I feel like my dream helper would help me understand the physical way my body works and doesn't work, would help me explore interesting ways to build strength, would assign me recuperation time when needed, and would keep me coming back to fitness when I get distracted. Maybe it would start out once per week for a few months, and then once a month for a few years after that?
I'm in Portland Ore, if that matters.
I have been to physical therapy several times over the years and I have all the exercises they gave me written down somewhere, but that support was very expensive for what I got, and it was always targeted at the specific pain-point (wrist, hamstring, etc) instead of holistically.
My goal is to be able to keep going on adventures my whole life. That would include the endurance to go on long walks or bike rides; the core strength to lift boxes, furniture, luggage, kids, etc without hurting my back; and the skill to use my body without injuring myself.
My barriers are my joints and ligaments. I'm told a key issues is that my hamstrings are too tight or short, which pulls my posture into an unstable alignment, which contributes to straining my muscles.
In the past I've tried to do yoga, calisthenics, jogging, biking, and squat/pushup challenges. Each time, I've hurt a joint or muscle, took a break from the program to recuperate, and lost the consistency my ADHD brain needs to keep going. If I could snap my fingers and do a self-guided program, it would be Hampton's hybrid routine and a deadlifting program. But, I've got a terribly difficult time getting beyond the entry level before hurting myself. I gotta get the core strength and joint stuff done first.
I don't know what is offered, but I feel like my dream helper would help me understand the physical way my body works and doesn't work, would help me explore interesting ways to build strength, would assign me recuperation time when needed, and would keep me coming back to fitness when I get distracted. Maybe it would start out once per week for a few months, and then once a month for a few years after that?
I'm in Portland Ore, if that matters.
Context: I'm about to hit 39 myself, and I have not your physical limitations, but some nontrivial ones of my own, due to a combination of how I was born and how my life has treated my body since then.
You're looking for a personal trainer who is also knowledgable about these and similar limitations. I don't think this is as rare as you might be imagining. My own trainers (I go to a weightlifting-focused gym) mostly have degrees in fitness education and have been extremely understanding and helpful about reworking their 'generic' or 'standard' approach for my own limitations. For example, a lot of the other folks I work out with have longstanding injuries that limit what they can do (or do without pain), and this is just... pretty normal for the trainers to work around. Similarly, a woman works out near me most days who's got a heavily tweaked - but still very serious - lifting regimen because she's quite pregnant. The training team takes this all in stride.
Very few people in the real world are without some kind of significant limiting factor in how they exercise. If nothing else, a lot of fitness enthusiasts working with trainers are themselves former serious athletes who have often had some kind of injury affecting ligaments or muscle, forcing or preventing certain movements.
I suspect you'll have to audition a little more carefully and reject a couple more folks than somebody else, as you look for a trainer. But I want to assure you that "I have a kind of unusual body and I want to accomodate that but not be totally limited by it" is not actually that unusual for a professional trainer.
I do think that your PT may be a great place to start - some of those folks also do training, or they may have a recommendation. Otherwise, I'd suggest looking first at independent or smaller gyms, rather than the "Huge, cheap, dumb" model of Planet Fitness and its ilk. But everything that you've described is something that I and/or my wife are getting from our own trainers - myself needing more physical adjustment; my wife needing more structure and ADHD-oriented accountability.
posted by Tomorrowful at 12:03 PM on October 10, 2023 [5 favorites]
You're looking for a personal trainer who is also knowledgable about these and similar limitations. I don't think this is as rare as you might be imagining. My own trainers (I go to a weightlifting-focused gym) mostly have degrees in fitness education and have been extremely understanding and helpful about reworking their 'generic' or 'standard' approach for my own limitations. For example, a lot of the other folks I work out with have longstanding injuries that limit what they can do (or do without pain), and this is just... pretty normal for the trainers to work around. Similarly, a woman works out near me most days who's got a heavily tweaked - but still very serious - lifting regimen because she's quite pregnant. The training team takes this all in stride.
Very few people in the real world are without some kind of significant limiting factor in how they exercise. If nothing else, a lot of fitness enthusiasts working with trainers are themselves former serious athletes who have often had some kind of injury affecting ligaments or muscle, forcing or preventing certain movements.
I suspect you'll have to audition a little more carefully and reject a couple more folks than somebody else, as you look for a trainer. But I want to assure you that "I have a kind of unusual body and I want to accomodate that but not be totally limited by it" is not actually that unusual for a professional trainer.
I do think that your PT may be a great place to start - some of those folks also do training, or they may have a recommendation. Otherwise, I'd suggest looking first at independent or smaller gyms, rather than the "Huge, cheap, dumb" model of Planet Fitness and its ilk. But everything that you've described is something that I and/or my wife are getting from our own trainers - myself needing more physical adjustment; my wife needing more structure and ADHD-oriented accountability.
posted by Tomorrowful at 12:03 PM on October 10, 2023 [5 favorites]
I have similar issues due to fibromyalgia and my doctor recently suggested I see an occupational therapist. I haven't started yet but I'm hopeful that will help and it may be the right answer for you too!
I would NOT start with a personal trainer - this is really above their pay grade. (Speaking from personal experience with some very good personal trainers who were not equipped for a client who injures themselves easily!)
posted by lunasol at 12:07 PM on October 10, 2023 [4 favorites]
I would NOT start with a personal trainer - this is really above their pay grade. (Speaking from personal experience with some very good personal trainers who were not equipped for a client who injures themselves easily!)
posted by lunasol at 12:07 PM on October 10, 2023 [4 favorites]
I would be looking at kinesiologist and other credentialed exercise professionals that offer active rehab. Clinical Pilates is another alternative.
posted by shock muppet at 12:40 PM on October 10, 2023 [3 favorites]
posted by shock muppet at 12:40 PM on October 10, 2023 [3 favorites]
Like Tomorrowful, I have had great luck working with trainers at a lifting gym, so I'll second that advice. But also in my vast experience of PT I've noted that some PT places are more medical, and some are more athlete-centered. The ones that are centered on athletes & athletics tend to look more like a gym than a medical PT office, and I've had some really great experiences getting just the kind of advice/training/direction you're looking for. I'm sorry that I don't have one to recommend in your area.
posted by BlahLaLa at 12:59 PM on October 10, 2023 [3 favorites]
posted by BlahLaLa at 12:59 PM on October 10, 2023 [3 favorites]
Response by poster: These pt gyms - are they typically billed through insurance and require a medical referral? Are pt/ot prices similar to gym membership / trainer prices?
posted by rebent at 1:16 PM on October 10, 2023
posted by rebent at 1:16 PM on October 10, 2023
Best answer: I was coming to third the lifting gym suggestion, and actually do have a local suggestion if you're in Portland! Josh at Beyond the Barbell (https://www.barbell-rehab.com/) is a PT and a certified strength trainer.
I don't have a connective tissue disorder, but I do have very mobile joints that led to a knee injury and he helped me rehab it while continuing to lift. Even if he ultimately isn't the right fit, I bet he'll have a good idea of who locally might be.
posted by emchap at 1:26 PM on October 10, 2023 [2 favorites]
I don't have a connective tissue disorder, but I do have very mobile joints that led to a knee injury and he helped me rehab it while continuing to lift. Even if he ultimately isn't the right fit, I bet he'll have a good idea of who locally might be.
posted by emchap at 1:26 PM on October 10, 2023 [2 favorites]
Good Health and New Heights p/t in Portland say they have EDS- and hypermobility-informed staff.
posted by Iris Gambol at 2:05 PM on October 10, 2023 [3 favorites]
posted by Iris Gambol at 2:05 PM on October 10, 2023 [3 favorites]
I've been thinking about this very question recently. I have a family member with hypotonia who has similar issues to those you are describing.
I do not think a typical gym physical trainer would be safe for you to work with. You need someone who understands and can work with the specific limitations of your body. The suggestion by Iris Gambol looks very hopeful.
Have you checked your insurance benefits? Insurance will often pay for the bulk of PT if it is medically necessary. You would need your doctor to write a prescription for it, but I hope that would be possible. This is important for your long term health.
With my family member, I have thought that it would be useful for them to work one-on-one with someone who can help them learn about their own body: learn what is safe to do, and what is not. Learn how to work with it and strengthen it. Learn how to sit and stand in a way that doesn't cause problems long term. I don't know who that person would be, but I've thought perhaps someone who is trained in Alexander Technique, or maybe one-on-one pilates or yoga sessions.
Good luck, and please report back and what you find!
posted by Winnie the Proust at 2:38 PM on October 10, 2023 [1 favorite]
I do not think a typical gym physical trainer would be safe for you to work with. You need someone who understands and can work with the specific limitations of your body. The suggestion by Iris Gambol looks very hopeful.
Have you checked your insurance benefits? Insurance will often pay for the bulk of PT if it is medically necessary. You would need your doctor to write a prescription for it, but I hope that would be possible. This is important for your long term health.
With my family member, I have thought that it would be useful for them to work one-on-one with someone who can help them learn about their own body: learn what is safe to do, and what is not. Learn how to work with it and strengthen it. Learn how to sit and stand in a way that doesn't cause problems long term. I don't know who that person would be, but I've thought perhaps someone who is trained in Alexander Technique, or maybe one-on-one pilates or yoga sessions.
Good luck, and please report back and what you find!
posted by Winnie the Proust at 2:38 PM on October 10, 2023 [1 favorite]
Have what used to be called EDS hypermobility type. The advice I got from the physiatrist who diagnosed me, and PTs after that, was:
- twice weekly strength training at a low weight, that is, 2 x 15 reps with lots left in the tank.
- Pilates
- for cardio, anything with variation in movement (like low impact dance). Steady state cardio is to be avoided, because it’s repetitive - high repetition or high intensity or impact are risks for injury. Or if you’re going to eg swim, switch up your strokes frequently within a given session, and alternate it with different forms of cardio to minimize how much stress your joints are getting from particular angles.
- start with what feels too easy and progress slowly.
posted by cotton dress sock at 5:53 PM on October 10, 2023 [2 favorites]
- twice weekly strength training at a low weight, that is, 2 x 15 reps with lots left in the tank.
- Pilates
- for cardio, anything with variation in movement (like low impact dance). Steady state cardio is to be avoided, because it’s repetitive - high repetition or high intensity or impact are risks for injury. Or if you’re going to eg swim, switch up your strokes frequently within a given session, and alternate it with different forms of cardio to minimize how much stress your joints are getting from particular angles.
- start with what feels too easy and progress slowly.
posted by cotton dress sock at 5:53 PM on October 10, 2023 [2 favorites]
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This goal sounds amazing - enjoy the journey!
posted by Silvery Fish at 11:23 AM on October 10, 2023 [3 favorites]