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Programming Tips for Injured Clients

DISCLAIMER:The information disseminated in the passages below is by no means to be construed as medical advice. Fitness professionals are advised to consult their clients’ physicians and obtain medical clearance prior to continuing to provide personal training services.

Two things in life are inevitable: death and taxes. Among active populations, especially those who engage in sports — either recreationally or competitively — injuries are the third inevitability.

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When injuries do arise, whether the consequence of improper programming or something entirely happenstance outside of the gym, personal trainers are faced with a dilemma loaded with logistical, ethical, and potential financial implications.

Before scrapping plans completely and shelving their clients on injured reserve, fitness professionals should take heed to the following recommendations:

  1. Maintain a training stimulus

Provided your client has been medically cleared, you can determine and work within their current scope of abilities. While bilateral exercises — a majority of which are performed with barbell exercises — are off the table if your client has sustained an injury to one of their limbs, they can be aptly substituted with a unilateral variation. For example, your client who recently suffered sprained wrist playing basketball is unable to perform a barbell bench press, which is conveniently their favorite exercise. Luckily, you can salvage a training effect by having them perform a dumbbell press variation from a flat bench or the floor to maintain strength, muscular endurance, and range of motion, in their non-injured limb all the while staving off degradations in strength of their injured, or even immobilized limb made possible via the neurophysiological phenomenon known as “cross training”. Unilateral strength training was found to increase neural drive to contralateral (or opposite) untrained muscles (1).

As it relates to cardiovascular exercise programming, if your client suffered a lower body injury, you can have them perform seated movements involving battle ropes or medicine balls to elicit improvements in or maintain cardiorespiratory fitness. Alternatively, a client could perform rotations on an arm ergometer or rattle a speed bag. Those looking to build up their cardiorespiratory fitness following a layoff could perform these in intervals, initially beginning with a 1:3 work-to-rest ratio before whittling down to a challenging 1:1 work-to-rest ratio. If upper body cardio is performed, fitness professionals should know that it will evoke a greater cardiac response (elevated heart rate and blood pressure) versus traditional forms of cardiovascular exercise such as running and biking even if conducted at similar intensities.

  1. Prioritize neglected fitness qualities

If your client is unable to perform their normal routine involving strength training and/or cardio due to injury, now would be an opportune time to address fitness qualities that may have resting on the backburner such as flexibility, soft tissue quality, and/or mobility/stability relationships of joints. For example, for your uber-competitive and personal record centric clients, you could measure passive or active range of motion of preferably non-injured limbs, program exercises to improve them, and challenge your clients for continual improvement as you would within a traditional program.

  1. Carve out time for rehabilitation

If you client has been prescribed physical therapy and was provided a home program, allocate a portion of your session to familiarize yourself with their exercises and to ensure their adherence to the program that will likely yield improved outcomes.

  1. Recognize that success is not linear

Successful athletes, investors, entrepreneurs have experienced multiple setbacks throughout their careers. Your clients are no different in their pursuit of specific fitness and health goals. Injuries crop up as do competing demands such as familial, occupational, and/or scholastic responsibilities. All can interfere with progress in the gym. Advise your client to step back and recognize that uninterrupted linearity is existent in a handful of things (i.e. age) and rarely in the pursuit of fitness goals.

Working with injured clients carries its own liability risks. Make sure you are protected with adequate insurance before taking on high-risk clients.


  1. Lee, M., Gandevia, S.C., & Carroll, T.J. (2009). Unilateral strength training increases voluntary activation of the opposite untrained limb. Clinical Neurophysiology, 120, 802-808.

About the Author

Joe Giandonato, MBA, MS, CSCS has been an educator with the World Instructor Training Schools since 2010. He also serves as an adjunct professor of exercise physiology electives at numerous colleges and universities within the greater Philadelphia area.

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