The Trainer-Therapist model: The Future of Fitness

By Chris Carlsen

Tales from the Table

An interview with LMT Devin McGilvery.

“The skin becomes one of the primary organs for early environmental learning.”

- Carla Hannaford

Having spent the duration of my life as an athlete, I recognized what constituted good exercise form and program design. Yet this was not the case for many of my students, who could not initially perform at such an advanced fitness level. More importantly, many had pre-existing injuries and poor movement patterns, both of which negatively impacted their workouts. As a result, my expertise in strength training alone was limiting, and if I really wanted to help my students reach their goals, I needed to educate myself in the area of physical assessment. I subsequently discovered Gray Cook and his Functional Movement Screen (FMS), which is a system for evaluating ones dynamic flexibility and mobility. I learned the FMS assessment and purchased the entire Secrets Series by Cook, which was a gateway to the work of other strength coaches, including Pavel, Mike Boyle and Eric Cressey. These coaches were, and continue to be, the leaders of a larger movement towards functional, movement-based training within the fitness world. I adopted their philosophies, combined it with what I already knew and created a training system that brought my clients myriad success.

The more expertise I obtained, and the better my eye for postural and movement assessment (the power of my glance) became, the more I recognized the need for a team of professionals who could really make a difference. I had already networked with chiropractor & ART specialist Dr. Rob Silverman, as well as acupuncturist Norman Swed, both of whom served as outside referrals for my students.  However, their far proximity from the facility necessitated an in-house staff member who could participate in the daily assessment process. What I needed was a massage therapist. Upon looking, I met LMT Devin McGilvery.

Devin had recently graduated from the Swedish Institute, where he earned certification in both personal training and massage. This combination really intrigued me.  Further, Devin’s understanding of mobility and stability assessment, and its reflection on the integrity of the tissues made it easy for us to make an immediate impact on our students. He understood that the site of pain is not the source of it and sought to help people in the long term by mitigating their pain patterns. This set Devin apart in his field.  He and I firmly believe that changing your body is an internalized process.  We dont fix people; we help them fix themselves by promoting awareness, restoration of movement, strength and knowledge. Our goal is to reeducate posture by enabling others to become cognizant of their tight muscles, to feel them relax and then to find a balance in tension between synergist and agonists (muscles that work together).

There are many benefits of massage. Massage drains toxins from the body (yes, our muscles are a drainage system),releases trigger points, brings awareness to excess tension in the body and aids in parasympathetic recovery. As a performance trainer, massage is most valuable for trigger point release and a “double check” of the body; a means of assessing whether muscles are firing properly and resting at optimal length after strength training. Most people with trigger points (painful knots in the muscle tissue), or with tight muscles, tend to stretch them for relief.  But if you stretch without first relieving the knot (via massage), then the knot only becomes tighter. The excessive tension is due to a weak synergist and/or agonist muscle, and in response to this, the brain will further tighten the stretched area immediately upon movement as a protective mechanism. The take home lesson is to massage, lengthen and strengthen, in that order. The tightness will only return if we massage and dont strengthen our muscles, with correct form. As I previously noted, massages are also great “double check.”  When you move efficiently, a monthly massage will give you clues regarding your technical proficiency when lifting, and will counteract the repetitive motion of your sport. It will enable you to feel drips before they become floods.

Example:In the case of tight hamstrings, wherein you cannot initially touch your toes, squeezing a ball between your legs during the toe-touch assessment will permit you to reach 3-6 inches lower than before. Why? The groin muscles are hardwired to the core (they run along the same track and attach to the same area of the pelvis).  The hamstring is also attached to the pelvis (posterior side) and, sensing that the core is stable, can release to its full length. If you stretch the hamstrings without stabilizing the core, you could get hurt. The tightness of your hamstrings were essentially protecting your lower back, and stretching without first engaging the core could place undue stress on this area.

Many trainers and therapist work alone, but the future of fitness encompasses a team approach to treating clients. Professionals from all walks of human performance, such as strength coaches, massage therapists and physical therapists, must unite to make a difference. Therapists expedite the restoration and recovery process, while coaches strengthen and solidify good movement patterns. Upon beginning an exercise program, each new student should receive an assessment and initial movement screen from a trainer and then follow up with a massage therapist with respect to potential muscular imbalances or chronic tightness. This creates an important database for future reference. The massage therapist can validate or add to the trainers findings, and can have a reference for later work or see how much clients have progressed. Upon future massages, students can also recognize the benefits, and recognize how they are getting stronger and longer at the same time.

In the transcribed interview below, Devin and I discuss our educational approach to fitness, and the benefits of the aforementioned coach-therapist model. 

First, thank you for doing the interview and thank you for all your hard work.  You have made me a better trainer. I'm forever grateful to have worked with you. How are things? Tell the readers about yourself?

My name is Devin McGilvery, I am from Southern California, where life is slightly different than that of New York. I came here 8 years ago on a mission to find what I was meant to do with my life. Trying to help people was always at the top of my mind and I found it six and a half years ago when I started massage therapy school. Working with the body has shown me how amazing our human form is and what it is capable of. The next steps in my life are combining my most recent obsession and love of acupuncture and Chinese medicine with my education and clinical experience in massage therapy and personal training.

What made you want to get your Degree in Chinese Medicine?

After I got my license in Massage Therapy and my Certification in Personal Training I started working with you and the other personal trainers. I noticed a huge difference in tissue quality and muscle function when one of you would get acupuncture. It intrigued me and as I did some research on Chinese medicine, I immediately knew that this is what I was meant to do. The benefits of massage therapy and acupuncture separately are amazing, but adding them together can make you function and perform better in all aspects of life.

* I can attest to that. I remember when I had a tender spot in my left IT band. You had tough time breaking it up, but when I had an acupuncture session prior to our next massage session, the tissue was pliable and smooth. That year, I had a massage and acupuncture session every week.  I would see how my tissue length would change based on the programs,exercises and sports I did. That was my masters degree in body learning.

Gray Cook recently said: "if your foam roller hasn't fixed it by now, it probably won't." I think this speaks volumes about how we need a team to get people longer and stronger. Does everyone require an evaluation and movement assessment? Can we really know what's ailing them if we don't see them move?

Gray Cook has a point. There will come a time when a foam roller is just not going to work. Manual therapy is needed to take proper care of your body. But the truth of the matter is, people just do not know how to foam roll properly. The foam roller is a tool, and when the tool is used properly it can do wondrous things. There is a technique to using this device, just as there is a technique to deadlifting or releasing a trigger point. Sometimes, the tool that looks the most simple to use is actually one of the hardest. We need to teach our patients the proper way to use these things in order for them to get the most benefit out of them. In regards to the next part of the question, movement analysis is very important. The first thing I do when I meet a new patient is look at their posture, see how they walk; but I definitely agree with you that we need more than that. We need to evaluate how they move through different exercises in order to see where they have strengths and weaknesses. When first working with a new patient, we need to do a movement analysis, postural assessment, muscle length tests to determine which muscles are short/hypertonic and muscle strength tests to find their weaknesses. A massage therapy session is then needed to evaluate tissue quality and begin the healing process.

So many people don't realize that their tightness is due to a weakness somewhere else. Studying these pain patterns and dissecting each lift has allowed me to help people quicker than I ever could have imagined. Through your years of work, are you noticing the same pain patterns over and over again? For instance, serratus anterior weakness and neck pain, the glute medius relationship with the opposite oblique and the relationship between the shoulder and the opposite hip?

The most common issue that I have come across is low back pain and glutemedius/minimus weakness. When these muscles are not working properly, something needs to compensate for it and it is usually the muscles of the back. The quadratus lumborum muscle takes on a lot of stress. It is basically a posterior abdominal muscle. This is why muscle strength tests are so important for healing a patient with an issue. These tests are done in comparison to the opposite side in order to check for imbalances. The best and quickest way to get a weak muscle to work properly is with acupuncture. Acupuncture is becoming a lot more mainstream, and there are great things happening in this field.

Absolutely! I see big things on the horizon.

Using Somatics (which for me is a neuromuscular reset) with our strength program has really helped a lot of people.  Can you speak of the changes we have had in our students’ motor control and body awareness and how that has affected their tissue integrity and changed their poor patterns?

The most successful patients are those that have the mind-body connection. Somatics reeducates the body and the mind through breathing and movement to work together to accomplish the same goal. When you grasp what Somatics is really trying to do for you through performing these exercises, you have a deeper understanding of how your body works. One of the biggest issues that most adults suffer from is improper breathing. Somatics changes the quality of the tissue and these poor patterns that a lot of us suffer from because it slows the mind down and makes you breathe and move in ways that focus on making you aware of how your muscles work together to move efficiently.

Right on.

So many people don't know they’re tight until they get a massage and jump off the table. Amazing right! You think this tightness is related to stress, poor posture, or lack of efficient movement?

Tightness is related to all three of these. Lack of proper movement is the most important. People need to move, and they need to move correctly. It leads to these other issues. Stress and poor posture are mainly due to patients working desk jobs. Sitting all day, 5-6 days a week puts an unbelievable amount of stress on the joints, muscles and connective tissue. When these parts of the body are tight, they cause dysfunction in the body, whether it's in the same area as the tightness or there is compensation and it is in a different part of the body. What we need to differentiate is what is actually "tight.” Is it the muscles that are the problem, or the fascia? This is why a massage is so important. There is no other way to figure out what the real issue is unless you get a massage. We need to lengthen and strengthen our patients, and having a team working together for you is the best way to accomplish this.

Can you talk about the difference in tissue between someone who works out for the pump and isolates muscles (sarcoplasmic hypertrophy) and hard-men or women (myofibril hypertrophy) who train to be strong and move better? Good question! You know what would be a good experiment? We take two twins or two people who resemble each other quite well. In their early twenties, they look identical, they eat the same foods and roughly have the same lifestyle. We put one on a sarcoplasmic hypertrophy program and the other one on a myofibril hypertrophy program. Will they look the same? Will they function the same? Who is then more prone to injury on a daily life and when it comes to sports? More experimentation would be needed but if this would be possible to do, then we can truly see how the muscle and fascia feels, looks and functions.

There are so many variables when it comes to injuries. We have people who don't move at all or can't move well and then those who move well but do too much. People need a plan, without just spinning their wheels. Programming, recovery, and keeping the “porridge” just right are vital for people who like to move. One major challenge is overtraining. Someone can be perfectly movement-efficient, but is always training in a fatigued state, which can lead to a overuse injury.  I feel that if we track everything from movement, to sleep, to nutrition and workouts, we can narrow down the variables that may cause an injury and those that enable people be strong for life. What are your thoughts?

Life is all about balance. We could track these 4 aspects of life and make sure that they are eating and sleeping well and not overtraining. We also need to teach our patients that relaxation is just as important as movement. Meditation, Somatics, massage therapy and acupuncture; all things that can benefit a healthy training program and help prevent injury. At the very least, we can try and prevent injury by listening to your body; it usually tells you when something is awry. If you feel fatigued before a workout, the worst thing you can do is take a stimulant in order to make yourself feel like you have the energy to perform. It will never work in your favor. The body will always show signs of weakness, and working through these weaknesses causes problems in other parts of the body. That's why proper programming is important and having a team behind your back will give you the opportunity to thrive.