I was talking with a physical therapist a few weeks ago. He has worked with everything from professional athletes to seniors recovering from hip surgery. When I asked how he felt about working with athletes, he said, “athletes are easy. It’s general population clients that are difficult.”
I have heard this repeatedly from others, and when I read through some of the questions in the groups I am part of, I notice the questions people have about specific clients are almost always related to clients who aren’t athletic and have a laundry list of ailments. Unless the movement professional comes from a therapeutic background, chances are slim any of training or systems studied explain how to work with these individuals. A level of frustration settles in, both for the client and for the coach.
I regularly work with “challenging” clients; as result, they seem to find me, either through a friend, a doctor, or my website. I was referred a woman recently who has been through more physical therapy than I could keep track of and has a personal trainer. As soon as she walked in, I saw the signs of hypermobility- the knees that buckled backwards, the arches that sink to the ground, with no elasticity holding them in place.
As we chatted, she openly told me she was a little bit skeptical I could help, given all of the therapists she had already seen. Her trainer, she said, was completely scared of her lower body- he didn’t want to make things worse, so he avoided having her do exercises that loaded her legs.
As I worked with her, I asked her questions about where she felt her body was located in space and which parts of herself she could feel against the floor. She answered, focused on what she was doing and the questions I asked. I made sure I was consistent in my cueing, in an effort for her to feel something tangible. Based on my visual assessment while watching her move, I decided to focus on the sense of her feet and where her weight tended to be in relation to her feet while she was standing.
I am going to see her once every two to four weeks, not as a strength and conditioning coach, but as a guide to helping her move in a more integrated way because maybe that’s what will help her pain. The physical therapy she had received always emphasized the body part in pain, and as I watched her perform the basic physical therapy exercises, I realize no one had taken the time to make sure she felt herself against the massage bed or floor.
There is no manual for complicated clients. As a movement specialist, where do you start with people who have a long list of injuries or trauma?
The answer, I think, is actually pretty easy. You start with what the person can feel and help the person feel more.
Feeling is a weird topic. We live in a society that for a long time issued the advice, “Big Girls Don’t Cry,” and when someone asked, “how are you feeling today?” answering anything other than “fine,” or “well,” was seen as taboo. I wonder, sometimes, if the smothering of emotional feelings has had any bearing on physical feeling. Having a high pain threshold is considered good, and paying attention to physical sensation is often ignored until it’s too late, when the whisper of pain has turned into an internal shouting match.
There are so many other factors at play as well, from lack of physical activity to feelings of anxiety and depression, to the fact that our feet, an information super highway of proprioception, are shod at an early age, leaving us to rely on where we are in space through our eyes and our inner ears, with dampened feedback from the body part that’s in contact with the floor.
Asking people, “what are you feeling” isn’t part of the normal protocol. Physical therapists, trainers, and other people who teach movement instruct. They tell you where to put your body parts and you do it, because feeling and processing the experience isn’t traditionally a part of physicality, unless you’re in a yoga class, and then maybe that type of dialogue would be okay, except even then, it’s one sided- because it’s a class, and you aren’t exactly going to blurt out how or what you actually feel in the middle of a class.
I struggle sometimes with the way movement is traditionally taught. How do we expect people who have pain and discomfort or aren’t coordinated or traditionally athletic to experience a shift in feeling if the conversation is one sided? Shouldn’t taking the time to ask questions and listen be part of the practice of coaching?
The flip side (because there’s always a flip side), is if too much time is spent focusing on articulating felt sensations no actual work gets done, but I don’t think that has to be the case. I ask what the person is experiencing a couple of reps (or a few seconds, if it’s an isometric hold), into the set. If there is discomfort, I change the position so load can be experienced differently. I ask the client if the new position feels different. If the answer is yes, in fact, it feels better and the pain is gone, the client and I have both learned something. The client has learned that shifting position can reduce or eliminate discomfort (though it might increase the feeling of work), and I have learned what position is currently sensitive for the client.
Working with clients who have struggled in traditional exercise and movement programs has been, perhaps, the most important lesson of my career. More than clearly demonstrating that a one size fits all approach to wellness and movement doesn’t always work, it has also shown me that if in order for the client to succeed, addressing physical feeling is critical. Whether it’s the physical sense of how the foot interacts with the floor, or the feeling of work that occurs when bones are placed in a specific position and load is dispersed differently up the skeleton, feeling matters. For people that are disconnected from their bodies for whatever reason, the feeling might be slower to come, but that doesn’t mean the practitioner should give up or not take the time to offer different ways of looking at the movement until the right words click. That elusive lightbulb movement could change the person’s entire relationship with a specific position- and that could be a good thing.