Is Online Rehab Coaching a Thing?

You certainly have been impacted by the current planet wide COVID crisis.  Have you made adjustments to your business?  Online training, coaching, and rehab needs to become a permanent and significant fixture in your business.

While we hear plenty of comments like “people are fed up with Zoom” or “clients are so happy to be back at the gym” and those are valid, but don’t negate the fact that online options for training and rehab now need to be part of your repertoire.

Our industry is slowly recovering from the crisis and closures, and the changes that these have brought about.  This has had a significant impact on client retention and acquisition.  I still have gym owners and trainers telling me that some of their members are still not comfortable coming back to the gym.  All of our Rehab-U clinics are in-gym clinics.

Even when the clinics were closed, I was still seeing clients because online rehab wasn’t something new for me.  I have been doing online rehab coaching with people all over the world with tremendous success for various cases: recovery from cervical and thoracic fractures, fixing low back and shoulder dysfunction, and even correcting movement patterns.  It has helped people to unleash their full performance potential!

 

Online ultrasound

 

Those who were able to adapt quickly and swiftly to build an online option also fared better.  But by adaptation, I don’t mean online consultations and support.  I mean actually being able to book and bill clients, complete full assessments, provide structured rehab programming, provide support, feedback, form checks, entirely online.

 

Where to Start with Online Rehab

Movement-Based Assessment

Is online rehab possible?  Absolutely.  Remember that manual therapy alone is not rehab.  In order to be effective at rehabilitation programming from the clinic to the gym, online or otherwise, we need to understand that rehab and training are not two different entities but are a continuum.  That’s why Rehab-U’s founding vision is: Rehab is Training.

The gap that currently exists to take an individual from injured to strong involves providing a structure within the rehab process so that you can protect your clients from further injury and expose them to sufficient stress to help them with recovery.

 

Successful online rehab starts with movement-based assessments

 

that can provide valuable information on behavior, willingness to move and quality of fundamental movement patterns.

Let’s take the following video as an example.  This is an online rehab client of mine.  In this video, he is asked to film himself performing a multisegmental flexion screen.  What do you see?

 

 

The multisegmental flexion screen is used to assess lumbopelvic rhythm.  We should see the hips flex (shift posteriorly), the pelvis tilt anteriorly, the lumbar spine flex.  It is quite easy to see in this video that there is a deficit in normal lumbopelvic rhythm, as the hips, pelvis and lumbar spine exhibit little to no movement.

This screen also allows us to observe the client’s willingness and ability to bend forward in a relaxed pattern.  An inability to do this may indicate apprehension due to prior injury or pain and/or excessive protective bracing, and even both.

Can we help this client virtually?  Of course!  For example, his movement tells us that we need to get him into positions that decrease threat and apprehension in order to create opportunities to mobilize the lumbar spine.

Observing excessive bracing this early on in a flexion movement pattern tells us that we need to find positions that allow the lumbar spine to give up it’s ant-gravity role.  Typically, that means doing work from the floor in either the supine, prone or quadruped positions.  One of the first exercises I programmed for this client was a low cat-camel to mobilize the lumbar spine.  This is essentially a cat-camel exercise done in quadruped position down on the forearms to focus movement more on the lumbar spine that the thoracic spine.

Watch this video to see how this exercise is done.

And this is with just one test.  Imagine with all the rest of your assessment, including your intake info and all the other tests you can do!

 

Structured Programming

Providing structure is key to a Rehab is Training approach.  People typically seek treatment for a musculoskeletal injury.  They FEEL better but they don’t GET better and that’s because they’re not getting rehab.  They’re getting treatment.  And at best, they are being given one or two generic “rehab” exercises without any specific structure or further modification of their activities.  Granted, there are certain exercises that everyone can benefit from.  For example, almost everyone with a shoulder issue can benefit from a scapular control exercise.  But no one will benefit from ONLY a scapular control exercise or the SAME ONE.

An efficient virtual video assessment also allows you to identify loads, movements and postures that are pain-triggering to prevent ongoing irritation of sensitive or sensitized structures.  This in turn helps you to identify pain-free loads, movements and postures to avoid underloading healthy tissues and progressively load the injured tissue.

Your virtual movement-based assessment provides you with information to help you build a program to restore fundamental movement and ensure strength in the continuum of care, both of which are key to successful rehab.

 

Support, Feedback and Form Checks

There are an infinite amount of ways that you can provide ongoing support and feedback for your online clients.  I work with email and even direct messaging for feedback, but also use a shared Google sheet for programming, pain monitoring and load management.  I ask for videos of exercises so that I can do initial form checks on the onset of a new program.  All of this is easily accessible and highly effective using technology that we already have (which we will discuss later in the article).

 

Accessibility and Familiarity of Online Coaching

Habit-Forming Accessibility

In most of the world, fitness facilities and clinics were closed for at least 10 weeks which is long enough for clients to form the habit of accessing virtual training. It doesn’t mean they aren’t happy to be back to a bricks and mortar facility, but it means the convenience of going from home-to-training in 90 seconds flat will remain a valuable option in their minds. Parle de gym

With “lack of time” being one of the biggest obstacles to regular training and rehab programs, most people will likely fall into a combined approach to our services.

 

The Comfort of Familiarity

Before March 2020, online training consisted mostly of celebrity workouts or offers from Instagram fitness influencers, but now most facilities and pros have stepped into the virtual world offering an array of free and paid opportunities for their clients and the general public.

Trainers and therapists worked through the challenges with technology and used their incredible resourcefulness to create sustainable training and rehab options virtually.

This means that clients were able to see, and dare we say feel, the familiar face of the coach and therapist who understood their needs and goals, their aches and pains, their likes and dislikes. During a time when everything felt different and every day brought a new challenge to face, they were able to find some comfort in virtual services.

 

Want to know more?  Watch our free 1-hour Masterclass on Going Virtual with Rehab!

 

What This Means from a Technical Standpoint

Set-up and Services

You need to create opportunities for comfort and success in your set-up, cues and coaching to ensure clients leave their sessions feeling like they’ve connected with you and the best of themselves.

Having a repertoire of videos for your assessments is your most important tool.  This ensures that you can gather the exact information you are looking for and helps the client know exactly what to do.  Having the client watch the video and then film themselves doing the assessment is easier and less awkward than trying to get the right angle to view an assessment on a live video call.

After the initial intake call, I send all the necessary videos to the client and have them return them to me so that I can complete my assessment and build their rehab plan.

A repertoire of exercise videos is also important so that your clients can always refer to them for an explanation and demonstration of proper technique for each exercise.

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Technology and Technique

Make the technology you already have work for you; the camera and microphone on your phone are likely all you need to get started. Know that you can’t buy your way to success, you’ll have to grow your way there.

Test and practice your set-up repeatedly and work on coaching through a camera; utilize your auditory and visual cues to connect with kinesthetic learners to ease your concerns about their technique.

You’ll have mishaps with technology; what’s critical is how you recover and move on.

Energize your delivery and ask for feedback and guidance from your mentors, colleagues, and clients.

 

Build Your Online Rehab Business

While our industry may be recovering from the crisis and closures, some of the changes that these have brought about are here to stay. With all the talk about a second wave, online rehab needs to be an integral part of your business.

Not only is successful online rehab possible for your clients who wish to continue along that route, but it is even possible to assess and help new clients.

Movement-based assessments are a valuable tool, with the added advantage that they can be taken online with the right services and technology.  The key is building an effective online strategy for rehab assessment and programming to set you and your clients up for success.

 



 


Article by: Mai-Linh Dovan M.Sc., CAT(C)
in collaboration with Nathalie Lacombe, M.Sc.

 

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