Rule #1: Do No Harm

May 2020

Health, performance, and rehabilitation professionals share one common rule: to do no harm. Our first and most important duty is to keep the person safe while they are in our immediate care. This also applies to what they do while completing recommendations we have given them out of our direct supervision. To keep someone safe from injury is no small task.

To keep someone safe means that two things are accomplished. The individual is safe during the process of training or rehabilitation. Movements are performed efficiently and the client understands what to do and how to do it. They are safe while in your care. This also means that they are well-prepared for future tasks. Sports, daily life, and work all place unique demands on an individual. It is the job of the coach, trainer, and physical therapist to ensure that people are prepared for life’s demands.

This concept is commonly discussed, with limited practical framework as to what it means. To do no harm is interpreted differently depending on the person’s perspective. There are many examples that clearly break this rule.. As education material has become available and easier to access, it seems that our ability to do no harm is somehow getting worse. How could this be? What does it mean to do no harm in a professional setting?

Education and Teaching

The professional’s ability to keep others safe depends on their knowledge and ability to communicate expectations. The process starts with a clear understanding of what is to be accomplished. The professional can then, and only then, begin to demonstrate and explain the details of exercise performance. The ability to teach is limited by our level of education and ability to critically think. This is our greatest asset and there are no exceptions. While experience is important, the ability to teach will always depend on the understanding of the concept and one’s ability to clearly explain it.

Unlimited amounts of educational material are available to us today. Our job is to filter through it and utilize only what is beneficial and safe. Filtering through information allows you to extract what you need. It is important to read everything that you can and to discuss concepts and methods with people in the profession. Discussions with experienced professionals is beneficial to you (as the professional), and to your clients or patients. Watch videos to figure out what needs to be improved.

Teaching depends on what you know. Your education determines your effectiveness as a teacher. These two variables are dependent on one another. You will not be a great teacher without education and a deep understanding of your craft. Knowledge is dependent on what you read, what you watch, and who you talk to. The sources of information matter. You will limit your ability if you attempt to improve through practice alone. Teaching ability is limited if you do not constantly challenge yourself to learn and understand at a deeper level.

Observation

Watching and analyzing a client’s performance is crucial in keeping a person safe and doing no harm. Observation is dependent on your knowledge and education, as well as your ability to teach. You will only be able to notice what you know and have previously studied. There must be clearly defined standards of performance of execution when performing movements. Safety depends on how an exercise is performed.

Professionals must be exceptional observers to help people and keep them safe. They must first define their expectations through education and teaching, then analyze the performance of the prescribed movement or exercise. It begins with knowing what they want, and then being able to see it in others. The ability to break down a movement in this stage is critical. All exercises can be broken down into smaller, simpler movements. Small deviations in technique and performance need to be watched and assessed. View your client from different angles. This gives you the best idea of what is going well and what is not.

This is serious business. Doing no harm means seeing and identifying what could do harm. You must know what is harmful, and what is not, to know when the client is at risk. Observing the details of performance is key to their safety.

Correction

The next step in the process of doing no harm is correcting an exercise. The practitioner’s job is to correct movement and to help improve efficiency. After teaching and observing has taken place, feedback must occur. This includes positive feedback for what is being performed well. It also includes feedback on what needs to be improved. To give feedback in this order allows the person to continue doing the good portion, and focus on improving what can be improved. Explain what is being done well, then what they can work on.

Effective correction depends on our ability to teach and effectively observe movement. If we fail to deeply understand what is happening, we cannot possibly begin to correct. Through years of education and experience, we can begin to formulate the goals and standards of safely and effectively performed movement. This is in both our best interest and that of the client.

A simple piece of advice related to correction begins before it is necessary. Simply, do not teach or include any exercise that you are not confident in demonstrating and explaining. The goal of any physical exercise or rehabilitation program is to set people up for success. If there are not clear expectations before beginning, there is a high chance of the exercise being dangerous and poorly performed. If you do not understand it, they will not understand it. The exercise will have no chance of being performed successfully before it is even attempted. Do not waste your time, and do not waste theirs. This is easier said than done.

Modification

The ability to modify is closely related to our teaching ability. To modify is to correct, or to improve. To take something as it is and improve an aspect of it. As it relates to the performance of an exercise or movement, it is to make it safer and more efficient. Movements will need to be modified if they are being performed in a dangerous manner or if they are not efficient. They might also need to be modified if there are individual differences. A particular movement may not be best for the individual, and should be modified accordingly. This ensures that your client is performing a movement safely and efficiently.

A movement performed dangerously needs to be stopped immediately. There is nothing to debate. If you, or someone that you observe or coach, are in danger, there needs to be an immediate stop in performance. Safety is our top priority. Anything that is not safe should be stopped and corrected. This can take place by changing the exercise completely, reducing load, adjusting speed of repetition, or explaining and demonstrating it in a different way. There is always another way. One that might work better for the individual. Modify and stop at nothing to achieve safety during performance. There are no excuses for unsafe exercise execution.

It is possible for a movement to be performed safely, but not optimally. Safety is achieved, but the performance of the movement might not be optimal for that individual. They may need a slight variation, a different load, or a different training goal. These are all slight modifications to the training programs of advanced clients or athletes. Exercises, and the training program, can be slightly modified or re-focused to accommodate different individual development. Everyone is unique, and they will adapt at different rates to different demands.

Loading and Progression

Modifications are the slight alterations that take place in a training program as a person progresses and becomes better able to handle the demands of training. When training an athlete or client long-term, more factors must be considered. True coaching and expertise is required when you are with a person long-term. Development during a college or professional career requires a deep understanding of the mechanisms behind training and achieving specific adaptations.

Proficiency has been achieved in performing exercises and now the person must be challenged. Challenge, or increasing demand, occurs through variations in load, volume, frequency, and exercise selection. These are the variables to consider when creating a training program or rehabilitation plan. Training programs based on these variables have options to be progressed or regressed in difficulty. These options give us the ability to adjust the program long-term and change the focus so that results continue to be achieved. Remember, everything will work for a short amount of time, but nothing works forever. It is our job to adjust the training program to achieve results long-term.

The number one rule in the health, performance, and rehabilitation professions is to keep people safe. People are kept safe through proper performance of exercises and adaptations from the training program. Safety is a process that is refined and improved over many years. It is a continual process of education and teaching, observation, correction, modification, and loading and progression adjustments. I hope that this sheds light on the process of proper exercise performance and planning. It is not enough to say that our goal is to do no harm. We need a system and a process to achieve this result. I hope this gives you something to think about.

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