As a personal trainer, one of your primary roles is to help your clients develop and maintain workout routines that fit their individual needs and lifestyles. To do that, you teach clients how to exercise safely, help them develop self-efficacy and help them to find the motivation to keep going even though they might want to quit.

But what happens when you’re working with someone who’s been injured? These clients may face the opposite problem of someone having trouble sticking to an exercise program—they want to exercise, but they can’t. Physical pain and limitations are only part of their struggle. Often just as debilitating is the emotional consequence of being unable to pursue their preferred activity of choice. As a health and exercise professional, you can help clients address this common scenario and turn injury-related “time off” into a new training cycle that will help them maintain their physical and emotional fitness.

Why a Layoff Hurts in More Ways Than One

If you’ve ever been injured, you’ve probably experienced the range of emotions that can occur. Several studies have found that the typical emotional responses to athletic injury include tension, anger, depression, frustration and boredom. For competitive athletes, frustration and depression top the list of primary emotional states following an injury, with one study concluding that approximately 10% of injured athletes met the standard for major depressive disorder at one month post-injury and 4.4% at three months post-injury. The researchers also concluded that female athletes were more likely to experience depression post-injury than males.

“The four big emotions that come to mind [with a layoff] are frustration, impatience, general irrationality and depression,” agrees sports psychologist Jack J. Lesyk, PhD, director of the Center for Sport Psychology in Beachwood, Ohio. Athletes often resist taking time off, even when they need to heal—and Dr. Lesyk, a longtime runner, knows this firsthand. “I had Achilles tendonitis and I thought, ‘I’m going to take [only] two days off and let it heal,” he admits. “I wound up not being able to run for six months.”

People who rely on their workouts to release day-to-day stress are particularly vulnerable to anger and tension. “More and more research shows that people who exercise vigorously four or more times a week have a decrease in anxiety, a decrease in depression and an increase in self-esteem,” says Dr. Lesyk. “All of those things are going to be somewhat impaired when someone has to suddenly give up exercise.”

Even a short layoff can produce these kinds of emotions. An earlier study that had female exercisers voluntarily limit their regular aerobic workouts found that the women reported greater fatigue and more negative mood symptoms after just two weeks without their regular exercise. Additionally, research suggests that one of the factors determining the extent of the emotional impact of an injury is the degree to which an athlete identifies with their athletic role. While most of the studies on the emotional consequences of layoff due to an injury have been conducted on athletes, there are similar implications for people committed to regular exercise. The more important your client’s fitness or athleticism is to their sense of self, the more dramatically they may be affected by the injury.  

Helping to Heal Both Body and Mind

Your role as a health and exercise professional is multifaceted and supporting your client through an injury can be challenging. Often, one of the first steps is to develop alternate or modified workouts that match your client’s current abilities. “Especially if they’re ‘type A’ personalities, clients will go crazy [being unable to work out],” says ACE Certified Personal Trainer Bryan Lepley, personal training director at BodyBusiness Health Club & Spa in Austin, Texas. “They get depressed at the thought of not being able to work out and that becomes a real challenge.”

Workouts that accommodate the injury can reduce anxiety and depression—and help clients maintain their fitness. For example, “If it’s a lower-limb injury, do upper-body work,” says Lepley, who uses an upper-body ergometer for clients who have lower-body injuries. “I have a master’s triathlete and we’ve been able to work on the [arm ergometer] three hours per week, one hour at a time, and he’s lost none of his fitness level,” he says. “If we can focus on the upper body and maintain people’s level of fitness while they’re overcoming an injury…it keeps them in the game and keeps their minds sharp.”

Chris Gagliardi, ACE Scientific Education Content Manager, offers mixed martial arts (MMA) as another example of how to keep a client in the game during recovery from an injury. “If a client sustains an injury to the upper body, such as a fracture within the hand or the wrist,” says Gagliardi, “upper-body striking using the hands and other upper-body exercises may be restricted. However, this same situation creates an opportunity to perhaps practice and improve upon lower-body striking and conditioning.” The key, he says, is to find ways to allow your client to continue to train while also letting areas of injury to appropriately heal.

Cooperate With Other Experts

If your client has had surgery or seen a specialist for an injury, make sure you stay in the loop regarding their treatment and rehabilitation. “This is a crucial step in taking a team approach to care for a client,” explains Gagliardi. “As an exercise professional, you play an important role that is one piece of a bigger picture. Effective communication among all professionals working with a patient/client ensures that everyone is on the same page regarding helping clients return to play as soon as possible. That is the key, after all. Your clients want to return to sport participation or exercise as soon as safely possible after an injury has occurred.”

By communicating with the entire care team, you can be sure that everyone is heading in the same direction and that all aspects of your program design work in cooperation with the treatment plan from the medical team. As exercise professionals, it is essential that you ensure you are not asking your clients to do things that are contraindicated or counterproductive to the overall recovery plan.   

Keep Your Client Informed

Most injured athletes crave information about their condition—and how they can heal and prevent future injuries. Take a similar approach with your clients, and you’ll help motivate them to stick with their new routine and give them hope for a full recovery.

“Coping emotionally is a little bit easier when you have all the facts and you have a timetable,” explains Dr. Lesyk. While your clients may not make the same gains they were making from their previous training plans, “you can still [help them reap] a lot of benefits—and something is better than nothing.”

“Giving your client an overview of the coming weeks—what types of work you’ll be doing together and why—can help reduce feelings of frustration and anxiety,” says Gagliardi. In fact, sharing the recovery game plan with your clients and involving them in the design of the program can help support your clients’ autonomy and make sure they feel involved and included in their healing journey. Throughout this process, many clients will undoubtedly feel frustrated about the impact the injury may be having on all aspects of their life. They’ll probably also feel limited in what they can do. Gagliardi urges exercise professionals and health coaches to view this as an opportunity to support a mindset shift in their clients from one that is deficit-focused to one that is focused on moving forward. In other words, help your clients focus on what they can do and not what they can’t do.

Ask for Regular Feedback 

If your client is anxious about getting back to a regular routine, they may not want to admit that something hurts. For this reason, you must constantly ask for feedback. “Ask your clients to rate their level of pain before, during, after and the day following a workout,” Gagliardi says. He recommends using a 0-to-10 perceived pain scale, where 0 represents no pain and 10 represents the worst pain ever experienced, to help facilitate discussions about pain (Figure 1). “A rating of 3 can be used as threshold for deciding when to modify or select a different exercise or mode of training,” explains Gagliardi.

It is also important to establish trust when it comes to pain. Some people do not like to admit when they are in pain or are willing to push through pain, which can have a negative impact on the recovery game plan. Not being honest about pain can actually make injuries worse and ultimately lead to a longer delay in returning to activity.

Figure 1. Pain Scale

Build Trust From the Outset

Creating a trusting relationship with your clients from the outset is critical, says Lepley. “If they get injured, you say, ‘Here’s what happened and this is what happens when we get back,” he says. “My clients trust me…they understand that this is part of the game. There are injuries involved in this game we call working out. Hopefully we’ve done a good enough job of keeping them balanced that it doesn’t happen, but, of course, it does happen.”  

The better you know your client, the more customized your approach can be. “Every client is different and every client’s needs are different,” says Lepley. “You need to know them well enough to know whether you should create another workout or focus on the nutritional component of their program.”

Part of the client-trainer relationship is being honest about what clients can expect. “With strength training, I’m frank,” says Lepley. “If you’re out for four to six weeks, you’ll lose [a significant] level of fitness. But as long as we’re smart about what you do when we come back, you’re going to gain that back.” (See sidebar on ACE-supported research that revealed how fast fitness fades during a break from regular exercise.)

Focus On the Positive

It’s easy for clients to focus on the negative, so remind them that taking care of their injury now will pay off in the long run, and what may be an acute injury won’t become a chronic one. Encourage your clients to look at their post-injury period as a time not to stop, but to slow down or refocus on their program. Viewing this as a time of self-care and healing, however, doesn’t mean they have to be completely sedentary. Depending on the location and severity of their injury, a client may still be able to walk, stretch or perform resistance training. In fact, being forced to try something new may introduce them to activities they may never have previously considered.

In your role as a health and exercise professional, you have the power to help your clients view an injury not as a roadblock, but as an opportunity to work on other aspects of fitness. Workouts that match a client’s current abilities, but still provide a challenge, will help give a feeling of progress as they heal and prepare to return to the activities they enjoy. 

Expand Your Knowledge

Reintroducing Exercise to Post-rehabilitation Clients

Injury: it’s a dreaded word but an all-too-common occurrence among active individuals, whether they are performance-oriented or just looking to get into shape. This video training is ideal for beginners looking for an introduction to exercise progressions and specific techniques to help clients recover from common injuries, including sprains and fractures. This course will help you safely transition clients back to a total-body program and help them avoid further injury during phases of tissue healing.

ACE Corrective Exercise Specialist Program

As an ACE Corrective Exercise Specialist, you will design programs for clients affected by chronic conditions or injuries, empowering them to regain daily function and move with confidence. (Note: This specialist program was formerly titled Orthopedic Exercise Specialist Program; educational content has not changed.)