I live in a bit of a bubble when it comes to training. A lot of my clients come from medical referrals, and during consults I sometimes have to get a little personal with the line of questioning, especially for pelvic health clients and folks who have a history of chronic pain or different medical conditions or medications. It’s not uncommon for me to ask questions regarding bowel movements, incontinence, intimacy, or other questions to try to form an idea of what I can do to help or whether there is a red flag saying this person has to get some medical intervention before we begin training.

As uncomfortable as the conversations sometimes have to be, they’re always in the best interest of the client and the clients tend to get a sense of relief to know that I’m looking out for their best interests if I say they need to get specific treatments and the okay to train before we start up.

So today I wanted to outline a couple of these conversations and how it would be best to bring up with your trainer, and also if you’re a trainer how you could gently ask about these issues without overstepping bounds and getting into Creepy McCreepypants territory.

#1: “Chick Stuff”

This is a statement made by one of my clients in terms of discussing female health issues that can affect her workouts. I would ask ‘How are you feeling today?’ and she would respond with ‘Chick Stuff’ which was a universal code to mean menstrual issues. Since a girl said it first, I can say it here, right? That’s how being politically correct works, isn’t it?

Different phases of menstruation can bring on different symptoms, and can vary widely between people. Some have zero difference between luteal and follicular phases, and some can become incapacitated with cramping, muscle aches and general fatigue during the day or two before and through the first few days of their menstruation. If they schedule to come train on those days, the workout could be affected, and it’s up to the client to relay that to the trainer if need be.

CLIENT: A very easy way to bring this up is just to be direct about it, simply stating you’re feeling under the weather because of your period, and outlining what feels less than physically awesome. Maybe your low back or SI joint are angry, maybe it’s abdominal discomfort, whatever it is, just put it out there so the trainer can adjust the workout accordingly.

TRAINER: If you want to check in on if this is a problem for your client, just ask what stage of their cycle they are in: pre, during, or post. You could preface it by saying cycle stages can play a big role in how someone feels during their workout, and if they’re in the pre or during phase it could explain why they may not be feeling so pumped to get all jacked and swole. If they’re pre or during, modify the workout to not include max weight stuff, limit shear force into the spine, and minimize heavy pressure on the abdomen. It might be time for something like a Bro-Style upper body workout or just technique work if it’s really extreme, or it could just mean play it by ear to see what happens. Also, try to keep this discreet and not yell it across the gym floor during peak hours.

#2: Pelvic Health

Let’s say you’ve had a couple of kids through natural delivery, and your pelvic floor hasn’t rebounded back into it’s pre-baby self. This by itself isn’t a bad thing, but it could be something that might warrant some physical therapy to help reduce some of the possible side effects like incontinence or possible prolapse.

This is something that should be brought up in an initial consult, and especially if you’re looking to do stuff like running, jumping, etc where there may be a higher risk of issues, and especially if you’ve had anything like an episiotomy.

CLIENTS: Tell your trainer if you’ve had any issues such as pelvic floor heaviness, stress or exercise induced incontinence, prolapse, or anxiety around bearing down on your abdomen and pelvic floor. Also, something to be aware of is that if intimacy is now painful or just not possible, that could warrant a referral and might mean some core exercises could cause problems or even injury.

TRAINERS: Ask your client if they’ve had kids and if they were through natural delivery or C-section. If C-section, that produces some new fun stuff with abdominal tone, but nothing that should prevent a solid training program that the client is comfortable with. If natural, just simply ask if they have any history of incontinence (especially if they sneeze, cough or exercise), and if they’ve had to have any treatments following delivery for their pelvic health. If they report things like routine incontinence or prolapse, see if they can get in to see a pelvic health doctor or physical therapist who has specialization in this area, and ideally someone who can do internal exams. That’s definitely not an area for a trainer to consider.

If they have no history of issues, and have exercised successfully without issues since then, you can proceed cautiously with what you had in mind, but check in every now and then and ask how things are going. Also, this is to be kept confidential.

If they have had issues, avoid impact activities (and especially rebounders/trampolines), heavy bracing activities, or any forced flexion movements without decent pelvic floor activation beforehand. Ask if any exercises you’re having them do cause any symptoms, and adjust accordingly to reduce the impact from those exercises.

#3: Groin Pain

This one could be for guys or girls, and might mean a bunch of different things depending on what’s going on. Some of the big things to consider are if the pain is a consistent pain or if it goes away, also what kind of pain it feels like (dull ache versus sharp stab), and also if there’s anything specific that brings it on.

Then, there’s the fun secondary symptoms, like if the groin pain causes numbness to genitals or radiates down your leg, comes on with digestive issues, or causes a loss of strength in one or both legs. Occasionally these can be local to the groin region or be soft nerve signs for something going on in the spine itself.

CLIENTS: If you have groin pain, and especially if it’s with certain exercises, let your trainer know what exercises cause it and where you’re feeling it. Describe how it feels and if doing anything makes it feel better or worse, and also if it’s constant or goes away.

TRAINER: If your client complains of groin pain that lasts for more than a couple of days, recommend they go get it checked out by a medical professional. If they say they have numbness or sudden loss of strength, get them into a doctor quickly and don’t train during that day. It’s best to be safe than sorry. Also, this is to be kept confidential.

If they only get groin pain on a specific exercise, like a leg press or a squat, try to modify the exercise (widen their stance, alter their depth, try to switch to more of a split squat, etc) and see if that helps. If not, refer out.

#4: Hemorrhoids

Yep. Hemorrhoids. This can be especially present in people who do a lot of heavy deadlifting, as something about the movement can cause an increase in rectal pressure and might make some of them rupture or ooze. By themselves this might not be the worst thing in the world, but might be incredibly uncomfortable, and a little concerning to go poop and see a bunch of blood in the bowl.

CLIENT: Mention to your trainer if you’ve been getting hemorrhoids lately, and if they’ve been getting worse on a specific program, especially if it involves heavier lifts. If you find you’re bleeding, get a check up with a doctor to rule out any potential issues with your digestive tract or maybe prescribe a topical ointment to help out. It might be time to get a colonoscopy, but they’ll be the judge of that.

TRAINER: If your client complains of hemorroids, switch up some of the heavy lifts for more single leg training, higher volume lighter resistance stuff for about a month or three, and then slowly reintroduce. if they complain of them again, maybe maxes aren’t in their future, unless they’re trying to compete in powerlifting. Also, this is to be kept confidential.

#5: Infectious Diseases

This could be as simple as a cough, flu bug or other stuff that could be spread through respiratory droplets, or something deeper like a herpes simplex infection that could be spread through saliva on water bottles or water fountains, and also some skin disorders or infections that could be spread through contacting sweat that hasn’t been removed from equipment.

Some estimates put the total percent of herpes simplex I infections at 68% in America, and as high as 78% in the UK. Much of the infections occur through direct contact with a lesion, but could also be possible if individuals are sharing water bottles or water fountains with direct contact. There is also potential contact risks on sweaty seats too,and there’s also an increased risk of contracting herpes gladiatorum through combat activities like mixed martial arts, so make sure you’re cleaning your equipment after and before each use and wash your mats if you’re involved in MMA.

CLIENTS: If you have skin lesions, and especially if you’re using antiviral medication, let your trainer know in the initial consult that you have either type 1 or type 2 and then make sure you’re sanitizing equipment after use, especially during an outbreak.

TRAINERS: Make sure you sanitize equipment after use, and make sure your clients water bottle isn’t accidentally picked up by someone else. Their risks during exercise are not really anything at all, but make sure the place is kept clean. Also, this is kept confidential.

So there you have it: 5 awkward conversations to have with your trainer to make sure you’re getting the best training possible with the least chance of risk available. While these may not be the most enjoyable the first time you have them, if approached in a professional and positive manner they can help make the training experience much more enjoyable, beneficial, and productive than if they weren’t had at all. Hopefully this helps and didn’t gross out too many people. That’s the joy of working with people, I guess.