Chris Blake:

Even though we push the envelope with training our high level athletes we are still in control of the training environment and how we monitor training. We use Polar heart rate monitors when doing any type of training for conditioning, we weigh our clients and athletes before and after training (especially in hot, humid weather) because we know if there is weight loss during conditioning it is because of water/electrolyte loss, and we go out of our way in having a complete and thorough understanding with our athletes that if they experience anything unusual or something along the lines of an injury..we need to know about it ASAP!!! In the rare occasion that an injury or medical emergency does occur we have a medical emergency action plan that we follow. I am a certified and licensed athletic trainer as well as having certifications in CPR and First Responder through the American Red Cross. So if there is an injury I can examine and assess the injury right away and determine what level of care is needed at that time. We have a system where we always have a phone on hand in order to call 911, we have certain people already in place to be able to guide the emergency crew to the scene...we have direct access to 4-5 different hospitals all within a certain milage and we have directions to these hospitals already printed up for parents or legal guardians if needed. We also have a referral system in place with orthopaedic specialists, chiropractors, physical therapists, athletic trainers, sports psychologists, nutritionists, massage therapists, trauma surgeons....you name it. We go out of our way to make sure that all bases are covered and each and every athlete/client has the appropriate medical clearance before training with us. We need to know every medical aspect as much as possible before they happen so that we can address the issue as fast and appropriate as possible and help prevent injuries from happening. But, accidents do happen and we are prepared for the worst.

Steve Payne:

Good question. Fortunately, I have never had a client who has injured themselves seriously in the gym. Of the two or three incidents that inevitably have occurred, I took responsibility for their injury and saw to it that they were cared for by the professional most recognized for their dilemma. I'd like to state that all injuries were muscle strains or bruises which involved compromised technique and form or just plain not paying attention on the behalf of the client. One was doing leg presses on a 45 degree incline and added a dramatic amount of weight while I went to the restroom and suffered a strained neck, which led to headaches and neck discomfort. Another did not keep a tight back and strained it doing partial deadlifts on the seventh rep of the third set. The last client simply dropped a 25 pound plate on his foot in an attempt to place it back on the weight rack while simultaneously telling a tale. In all of these instances I saw to it that they were taken care of by medical professionals and were compensated by session replacement. Even though it wasn't my "fault", they were under my tutelage and guidance and therefore my responsibility.

Rick Karboviak:

First, I'd establish how the injury happened and go through with the client on what felt wrong with the exercise. This usually happens in most cases where either too much weight or the improper form is used, or a combination of the 2. Typically I try to avoid this by using the least weight possible in the movement and take them through it step by step. Now if we use a light weight and something unfortunately goes terribly wrong, its my responsiblity to take action in helping the client out, admitting to the client that I chose the wrong load or did not instruct them on something correctly.

Sometimes you can be patient, take your time, and still, something could go wrong. The client loses focus and pretends to hear you but doesn't hear you. (Somehow like when you were a child, you'd pretend to hear your parents give you instructions but you didn't really hear what they said, you just agreed to it. The same can happen in a PT situtation) Now, if you gave specific instruction and hands-on guidance and something still went wrong, either the client didn't hear you or totally ignored the steps instructed. I've had this happen just this week where I thought someone could get hurt because of not paying attention. I was showing a new exercise in Boot Camp class, and the lady was chatting with another lady when I was giving instruction. She viewed me demonstrating the exercise, but didn't pay attention to the key points of leg position, arm position, and hip action of the drill. I knew there was trouble when she came to the exercise in the circuit, so I once again paid close attention and told her to not rush into it, take it step by step, and instructed "so you don't get hurt going too quickly in the wrong way." Try to instruct safety as best you can, and make it a key priority, and less injury possibilities will happen.

Narina Prokosch:

This is an excellent question and a situation I am sure that all of us as trainers dont want to see happen but depending on the training situation is a distinct possibility.

My training clientele may differ from the majority of contributors to this roundtable. I own and operate and private personal training studio and for the most part am not involved in training performance athletes. Although with some of my more appropriate clients, I do include a demanding regime that may cover aspects of Olympic lifting, plyometrics, power training and general strength conditioning, I am not looking to improve performance in a sport environment that may have specific training parameters or time frames for competition..

In our studio, besides the general fitness enthusiast, I also work with clients that are referrals from local physicians. Most of these clients will have undergone some surgical procedure and it is my responsibility to reintegrate them back into their fitness regimes safely. With that in mind, the possibility of injury is very real. With these clients I am not so concerned with a sports injury, but an injury to the surgical site during the healing process.

Also, because of my Nursing background, I have a larger percentage of clients that arrive with various medical conditions that may impact their training programs and can make the possibility of an event or injury a distinct possibility.

There are very specific protocols in place in my studio for dealing with injury and also very specific training programs for post surgical clients that cover all the different surgical procedures that I may be working with. I feel in my case specifically, it is definitely the trainers responsibility if a client is injured during a training session.

Depending on the type of injury or event that occurs during a clients session, again specific protocols must be in place to deal with all eventualities. In my studio, documentation is a must. I have a separate communication book that is used specifically for recording purposes of any injuries. Recording must be time specific and cover all details leading up to the event and also all action taken by the staff. It must also cover attendance by any emergency medical personnel and outcomes.

Depending on what has occurred, referrals to appropriate health practitioners is done. Follow up with the client is done either later that day or at the latest, the next day. As owner and Director of Trainers, I follow up with the health team on the status of the client. Also, if necessary, discussion with the family physician will follow and a release from the physician allowing the client to return to their exercise program is obtained.

Vince Burke:

Dealing with injuries before they occur is the best method of treating one. Whether it be a client, patient or a club member there is always an assumption of risk that one has to share with the provider (trainer) which does not include who is responsible for an injury, only to say, one can get injured.

Responsibility can only occur if responsibilities are given and confirmed by the trainer to the client. Whether it be through your policy and procedures, contract, theracise demonstration with confirmation of comprehension and form which all should be done like any on the job training. For example, if you hired a stock boy and never trained him properly in lifting techniques, body mechanics and/or given the proper shoe wear such as metal tipped shoes and he were to get injured than the responsibility is more on the employer (trainer) according to the Occupational Safety and Health Administration (OSHA).

Well, I view personal training the same way. Both parties need to take responsibility at all times. However, in order for the client to share any responsibly it is the trainer's responsibility to minimize the client injury potential. It is through not only teaching the do's and the don'ts of training but through continuing education course work in order to keep abreast of the most current and innovative techniques that will not only provide the most optimum outcomes for the client but one that is as safe a possible with sound scientific rationale. Another responsibility to avoid injury is the trainer must have a contract along with a policy and procedures manual which will allow the trainer and client to get more familiar with each other along with the known expectations. The trainer must also ask detailed questions about present/past health, injuries, surgeries, limitations and goals. Through a thorough history each party (trainer/trainee/ parent) will know what is expected in a reciprocal manner; trainer to trainee and trainee to trainer. Prior to testing/training it is important to discuss what is expected to feel prior, during and after each session especially with a new theracise which typically causes soreness or tightness about the areas trained. It is also the trainer's responsibility to inform the client that he /she must report any pain prior to, during and/or after..this is their (client) responsibility and they need to know that you are not amind/body reader. This is one of the most important responsibilities a trainer has to give the trainee. However, if the trainer is taking an attitude such as it will go away or if I don't ask about it, it is not my responsibility this is where the irresponsibility lies. Taking this type of trainer attitude is not only unprofessional but shows negligence and is irresponsible. This kind of behavior is the worse thing to do and would never fly in a legal situation. Having a denial and/or ignorant attitude shows total negligence on your behalf which gives a strong case of irresponsibility and liability in any court setting. It also would not fly with your insurance company who will be reluctant to pay out a law suite without a fight against you, their own client.

On the other hand, accidents do and can happen to anyone, at any given time from doing house chores, playing with a child to lifting weights and/ or running. The key to any incident is that it needs to be dealt with right away and professionally doing whatever is best for the client. Part of being responsible is being prepared to handle an emergency. Often trainers don't think of an emergency situation but always remember it can happen. First, one always needs to keep the clients medical information with them such as a doctor's name, medications the client is on, emergency number and hospital one wishes to go to in case of an emergency. Next, whether it is a contusion from training from a fall off a stepper to a jammed finger, you always need to document it and communicate with the client about the situation. If he/she is a minor, than a parent/guardian needs to be notified immediately after the incident. After writing the incident report (detailed: who, what, why, where, when and how and what was said, along with any signs and symptoms noted) up you need to discuss it with the client and have them or parent sign it. This needs to remain on file for everyone's records. If you have to call 911, it is important to know all the relative information about the client so the medical people can treat this client appropriately. If the client can't drive than get a family member or a friend to take them home. I would not offer to drive the client home it is better to send for a cab that you will pay for, no matter who is responsible. It is also important to never leave the client alone and always follow up with a phone call at home to see how your client is doing. This gesture has nothing to do with responsibility but all to do with being professional and caring. As for your personal insurance policy, it is best to report any and all incidents. This is why you have insurance to assist you if anything unfortunate ever were to happen. Most incidents/claims need to be notified within 24 hrs.

After any incident it is best to advice the RICE Principle: REST, ICE, COMPRESSION, and ELEVATE. Discuss the basic first aide treatment and typical expectations of recovery if you feel comfortable. If you feel this client needs to see someone than try to assist them in anyway possible. It is always important to express how sorry you are that something had happen and that you are commited to do anything and everything to get them back on track of training. You may even want to share a similar story in order to build confidence for a safe and rapid recovery. You also need to inform them if they were to feel worse with any signs and symptoms they are to immediately seek medical attention whether it be calling their doctor and /or go to the emergency room. As an addendum on your incident report you need to add everything you say and what was said to you with the time and date of the call. In some instances you may need to put aside the ego and focus on the needs of the client. Always call them hours after to check up on them and at that point continue to recommend if they get worse or any changes take place for the worse go to the hospital.

It is your responsibility to make each and every session safe for not only you and your client but everyone around you.

John Izzo:

I think the first importnat thing is to assess the situation--is client conscious? What degree of pain is the client in? Should advanced medical response be summoned?

The responsible thing to do is educate the client and carefully assess the degree of injury we are talking about. Does it need a band-aid? Or does it need a splint? I have had clients suffer minor injuries during sessions: med ball bounces and jams nail...client pulls groin...client jams finger...or client scrapes knee. Every response has been the same: communication. The client is made well-aware of injury and what restrictions it imposes on our training. It is then up to the client to continue on with the individual session or package.