Diagnosis vs Assessment

This article was written by Michelle Berg, NAIT PFT, Provincial Fitness Unit program coordinator, and first appeared in the October 2016 edition of the Fitness Informer.

The basis of diagnosis is symptoms—the physical and/or mental aspects of a health issue. Symptoms are often referred to as subjective and related more to how a person is feeling about an illness or injury. A sign is much more objective and is the physical manifestation of an illness or injury. Medical News Today offers that a symptom is noticed by the patient, whereas a sign is noticed by the health care professional (Nordqvist 2014). An ankle sprain definitely hurts (the symptom) and often causes swelling and even bruising (the signs). Exercise professionals need to know the difference between signs and symptoms and are often called on to assist with their management—at onset and over the long term.

So, when you don’t feel well, you visit your doctor, right? After a series of questions and perhaps some routine tests, your Doctor comes back with a diagnosis and treatment plan. How about when you feel perfectly fine, but certain movements cause pain, discomfort, or just can’t be completed successfully? I would wager that there isn’t an exercise enthusiast out there who hasn’t experienced this and many may be dealing with chronic movement-related pain by trying to just “work through it” or simply avoiding those movements altogether.

Is it then the exercise professional’s job to diagnose such issues? Simply put—no. Many will argue that formal diagnosis capacity belongs with advanced health professionals, and most exercise practitioners are not covered for such duties within their scope of practice and insurance guidelines.

Select exercise practitioners with the appropriate certification can assess their clients and there are a variety of protocols at their disposal to do so. Such assessments can provide vital and varied information to assist with customized exercise prescriptions and improve the health and well-being of clients. Without proper assessment, individualized exercise prescription is just not possible, and your clients will likely continue to suffer.

The Behavioral Institute for Children and Adolescents goes on to differentiate between assessment and diagnosis with some important points (Braaten n.d.).

Assessments and diagnosis are quite different—from application to outcome—and qualified exercise professionals possess the knowledge to determine the appropriate assessments for client benefit.

Typical assessments for exercise prescription can begin with height, weight, and waist circumference, and further expand to include grip strength, posture, range of motion, and/or cardiovascular capacity. The options are almost limitless, and the resulting information crucial for exercise programs that meet and even exceed your client’s goals. But what if those assessments point toward a muscle imbalance, reduced flexibility, or a nagging, repetitive strain injury?

For example, an exercise professional may ask a client to perform a one-leg stand for assessment of their balance, aka the Trendelenburg test and their hip and leg drops or they shift their weight before lifting the leg in order to complete the stance. Their ParQ+ did not indicate any type of bone or joint problem, and they report no injury, pain, or discomfort in either hip before, during, or even after the test. Now what? Do you need to refer them to a physician to run more tests and solidify a formal diagnosis before you can proceed with their exercise prescription?

This is where a qualified exercise professional uses his or her knowledge, training, and expertise to ensure that specific exercises addressing the strength and stability of their core muscles, abductors, and gluteals are included within their exercise prescription. The exercise professional can also assess a client’s flexibility in the hip joint to see if there is a range of motion limitation further contributing to this test outcome. Is this a formal diagnosis? No, but it is using the information gathered from assessments, questionnaires, and rapport to create, deliver, and monitor the best possible exercise prescription for each client.

It is also important for exercise professionals to know and practice within their scope of practice to ensure the assessments completed with their clientele are permitted and covered within their professional insurance policy. There are numerous muscle-based assessments currently available and often used in the exercise industry, and each exercise practitioner must seek out the proper training and education to ensure personal competency when performing such tests.

Assessing and monitoring a clients’ movements, are key components to professional exercise physiologists’ / personal trainers’ practice. Pain-free movement in all aspects of work, life, and play is the best possible outcome from such assessments and integrated exercise prescription, while healthy, active living is the true payoff for clients.