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E50 | Keep It Real Talk #3: Complexity and Providing for Your Clients

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In this week’s episode, we dive into another #KeepItReal talk with Resilient’s Greg, Trevor, and Doug.    We wanted to talk a bit about some complexity when selecting interventions, and trying to keep things as simple as possible.

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Episode Transcription:

[00:00:00] Greg: Welcome to the Resilient Performance Podcast. This is Keep It Real talk number three with myself Greg Spatz, Trevor Rappa and Doug Kechijian. We wanted to talk a little bit today about some complexity when selecting interventions and trying to keep things sort of as simple as possible, keep it real and figuring out ways to cause a change that we want to make without having to make it over complicated or just too difficult for the people we’re working with to kind of grasp. Because essentially like our clients, our patients, our athletes don’t really care usually, and they shouldn’t really have to care, necessarily like what’s going when exercising or stretching or whatever intervention [00:01:00] to have it work. So we always use a test retest approach, always doing something testing and seeing if it works and it’s a constant evaluation assessment. Every time we’re seeing people. So as long as something is working we don’t necessarily care what it is or we don’t care to over complicate it. We want things to be pretty intuitive and simple for people to execute in front of us and then independently as well. So we’ll provide any of those exercise videos or instructional videos for them to do on their own. It should be simple enough for them to execute without us even being there, because that’s going to be how you essentially help people for the long-term is giving them independence and giving them the ability to help themselves.

Trevor: Okay. Yeah. I think we even kind of talking about it more and more because it’s all the stuff that you see online with different videos and things people post. They post these overly, a simple looking exercise with this overly complicated explanation. And even though like [00:02:00] there’s oftentimes, especially with the interventions we do ourselves from a treatment standpoint, they may look simple and they’re just a single line hip bridge. There is a complex rationale behind why we’re choosing that but we want to make the intervention itself as simple as possible. That’s what’s going to get your most bang for your buck and then clients oftentimes we need to give them some sort of rationale as to why doing what we’re doing. We want to keep that rationale as simple and linear as possible, not make it seem overly complicated where we’re just kind of using big words, almost make ourselves sound smart. I’m like, we know what we’re talking about. I think there’s just a big difference between making things complicated for the sake of making it complicated and sounding smart and using big words versus knowing that it’s what’s happening is very complex, but trying to make it as simple as possible. That works when we talk to other professionals too, it’s like you don’t want to make things just complicated for the sake of complicated. Like a lot of stuff gets lost in translation where you’re just making things complicated and then you start to try to speak different languages versus trying to get on the same page and [00:03:00] make the complex simple.

Doug: I think there’s a lot of layers to this and one of them is how we share information now. So a lot of information is shared through social media and kind of our space, like the rehabilitation and fitness space. People in order to gain a following, try to be novel for the sake of being novel. But the reality is like there’s only so many ways to do the same thing. So ultimately like everybody’s doing kind of the same things, but I think where people try to differentiate themselves is by providing like unique rationales for things. But sometimes people, I think it’s so deep into like why they’re doing what they’re doing or trying to explain the mechanism behind it, that you forget what it is that you’re actually trying to do.
So like, for example, if you’re working with somebody and they have anterior hip pain, when they squat and then you assess them and they have like no internal rotation in that hip, you can try to use any kind of theoretical justification that you want for [00:04:00] your intervention, but you need to get that person to squat without hand in front of their hip and get them some internal rotation.

I think on social media now people will write like almost like a thesis and they’re just showing somebody doing like a clam shell and it’s like, we can talk about whether clamshells are good or not. That’s not the point, but the point is like, you’re doing a very simple thing and there’s nothing wrong with that, but you don’t need to make a simple thing more complicated than it needs to be. I think that internally as a profession, we should probably have those conversations but where it becomes problematic is when we talk to a patient, like we would a colleague. I know I was guilty of that earlier on, because I wanted to sound like the smartest person in the room to the patient and it was more, I think, like an ego type thing, what is the purpose of our interaction with the patient it’s to serve the patient? And so now, I mean, I don’t know if this is right. It just, how my approach has changed. I try to say as little as [00:05:00] possible and ultimately the patient should be able to tell me if what we’re doing is working or not, because they know why they came in.

So it’s like, all right, why are you here? I obviously have my own outcome measures, but I also want, like I want to define the interaction in terms of like, well what does success look like to you? Because they wouldn’t be showing up at the office otherwise. So it’s like, all right, well success for me would be, I can do a squat without it hurting. So that that’s like, one of the things that we’re going to do is we’re going to go to the rack and we’re going to squat and if it doesn’t hurt, then we know that we achieved the objective. If they want more detail, I’ll try to give it to them but we really, for a lot of stuff that we do, and we don’t actually know why or how it works. I mean, it’s hard enough to figure out if it works or not. That’s why we have test retest and that’s why I think ultimately we should do defer to the patient and let the patient define the experience on their terms. A lot of what we’re doing in terms of like the mechanism is [00:06:00] speculative. So I think that you can almost incriminate yourself when you say too much and you say, well, here’s why what I’m doing is working because a lot of it is like, frankly is bullshit. So, I mean, I think we can theorize in good faith and try to determine and I think it’s important to have these conversations, but when you’re doing it for the wrong reason, and the reason is to either like brand yourself on social media to sound smarter than somebody else or try to like create sort of this like guru type phenomenon with a patient.

I mean, I say, I don’t know the patients, almost everyone they say like, what is this doing? I’m like, well, I can guess, but I really don’t know but the bigger question is like, does it matter? The biggest thing is like, is it safe? We don’t want to do any unnecessary harm and then beyond that, like, did it achieve what it is that you came in for? If it meets those two objectives, then in my opinion, it was a successful interaction and I don’t think we need to go much deeper than that, but I think there’s reasons why people overcomplicate things and a lot of it again, is [00:07:00] because like everything’s kind of already been done. So there’s only so many ways to do the basics well and even in like the continuing education space, nothing is that new, there, it’s all derivations of manual therapy, derivations of exercise and graded exposure, but people create unique nomenclature and rationales for what they’re doing and then it becomes like this new thing. That doesn’t mean that we can’t benefit from those courses, but I think that it’s important to see the similarities and not just the differences, because none of this stuff is that different.
As we’ve talked about before, I think the more important thing than like your explanation for what you’re doing is how do you piece everything together and how do you connect the dots? That’s much more subjective than it is highly definable in terms of like the words that we’re putting to it.

Greg: We have students come in every so often. We don’t always have them, but then when we do have students, it seems that students these [00:08:00] days are being sort of bombarded by social media and a lot of the stuff that you’re referring to Doug, where things are kind of, they have this long drawn out explanation and they’re sort of over complicated for that student and at their point in their career, like that’s something that’s just not helpful for them all the time. So sometimes we’ll have students who come in and they’re expecting some out there explanation or this extremely complex explanation to a lot of the things that they see us do every day and the conversations that we have. Then they then realized, like it doesn’t have to be as complex and as complicated as what it might seem like on the internet. So I think our students have expressed almost like feeling relieved that they don’t need to go learn all of these things that they haven’t been exposed to previously, because it just sounds different than like you said, it’s a new nomenclature, where they’re just, it’s just foreign to them, but then it winds up being the same [00:09:00] intervention that they may have seen before either in physical therapy school or in their own exercise endeavors. So that was definitely something that we found most recently with our students is almost like relief, where they don’t have to over-complicate and they can keep things simple and still be effective. That was kind of interesting to have those talks with them. Trevor, do you have anything to add?

Trevor: When it comes to that where you’re kind of talking about that last week? Because there is a lot of cool information that’s really like interesting to know and it’s kind of fun to go through the mental battle of learning something new and try to figure something out, like problem solving and things like that. But ultimately it’s like to a certain degree, I get that from a professional standpoint you want to stimulate yourself and you want to learn, but ultimately, like we’ve been talking about this whole time. It’s like, we’re working with people in front of us and what we’re kind of learning from the professional side of things, professional development, the content side, isn’t translating to like improving something that we do when [00:10:00] it comes to our clients or athletes, then it’s almost kind of a waste of time, in my opinion. So understanding that our rationale and our decision making is kind of always improving and changing over time is huge. But I think when it comes like the student side of thing, it’s like, you kind of also have to know where are you currently right now? And what’s the most fundamental thing that you should be trying to learn that’s going to impact what you’re doing with these clients.

So when it comes to PT, it’s like, we need to know some anatomy and if you come in and you’re talking and you don’t understand just some basic foundational anatomy, then it’s really hard to kind of make an impact with your clients. But instead of you’re learning something really, really high level, like the analogy we use last week was like, it’s like, if you’re a first year PT student and you’re coming in and you’re learning a lot of stuff, that’s kind of like on social media, it’s like, you’re going into your freshmen bio class in high school, but they hand you like an astrophysics test textbook. It’s like, oh, that’s cool and that’s really interesting stuff, but you need to learn a lot more foundational, basic stuff before we can even try to touch some of those higher level [00:11:00] concepts. So I think it’s like really important to be truly honest with yourself and know like what you actually know and what you don’t know. So you can kind of understand what is the best path to kind of get to where you want to be.

Greg: And it has to be something like you said, it has to be something that is going to change what you do or otherwise it’s just a hobby, which is also fine and it’s interesting and it’s fun to learn stuff, but then it just becomes outside of what you’re doing professionally because it’s not going to necessarily change what you do and that’s another thing we spoke about the students too is you can see all these crazy things on the internet and then if you actually have the person who’s posting these things on the internet treat in front of you, they probably do a lot of the same stuff that you would do, and it’s not going to be something that’s so over complicated or complex, they just have this long drawn out explanation of it to like Doug, you said kind of either make them sound smarter or feel smarter or whatever it is.

Doug: Yeah. I think that this process [00:12:00] can’t always be rushed. Like you need context to be able to simplify things. So like, I think we can all attest to when we first started we probably made things more complicated than they needed to be and then you realize like, okay, you’re not getting the results with patients that you could because we can’t spend every day in 24 hours a day with our patients. So we have to give them things to do at home, especially because of our model where we don’t get a lot of treatment frequency. And so now we’re always asking ourselves, how can this patient mess this up when we’re not there to supervise it and it’s forced us to be more simple with our explanations. So it’s not about like what you know, it’s about what you’re able to get somebody to do and to do without supervision and the more like layers of complication you add to something, the less likely you are to get retention and compliance and compliance is like the biggest thing because I mean, it’s not that like we’re doing anything magical. I think we’re just getting people to do the basics and more importantly, getting them to like [00:13:00] understand what the basics look like, so they can do them on their own.

When you’re in PT school, it’s a very theoretical academic type education by virtue of what you’re in a classroom. You’re not out treating except on clinicals and so there’s no context for what you’re learning. So because you’re being tested and evaluated on theoretical things and theoretical mechanisms. That’s kind of like how you think, you’re not thinking, how can I make this simpler? And so I don’t know if you can really develop this until you’ve had a lot of reps and you’ve made a lot of mistakes, but I think that a good way to kind of get some of a filter for this stuff is to read outside your field. I was talking to one of these episodes, Bill Hartman a couple of months ago and we were talking about I think skinning the game by to lab is a great book. He talks about this phenomenon called naive interventionism, which is like in an effort to kind of impress your colleagues, you create these very complicated explanations for [00:14:00] interventions and because by having these interventions, you’re signaling to your colleagues, it makes you want to intervene more and more, but there’s always second order effects to intervening and there’s unintended consequences. I think that’s the same thing in our field, like in an effort to appear like we’re intelligent to our colleagues on social media if we apply that kind of thinking to our patients, it can have second order effects that aren’t therapeutic and that aren’t with the patient’s goals.

He also talks about this thing called the intellectual yet idiot, which is basically kind of like this person who like very, very theoretically, intelligent, if you even want to use that word, but from a practical standpoint, they can’t apply that theory and ultimately this field is about application and so it’s kind of like the Dwight Schrute thing from the office where somebody asked him what have you learned from Michael that was profound and he says when Michael said don’t be an idiot it changed my life. So I’m kind of like when I [00:15:00] reflect on what I’m doing, it’s like, how do I not be an intellectual yet idiot? It makes something that’s simple way harder than it has to be because I think that there’s a downside to making things harder than they have to be and that’s that you don’t get compliance, and you don’t get the results you want because ultimately it’s not about us. It’s about the person in front of you that’s giving you their time and their money.

Trevor: I think on that point, we’ve all seen clients that come from some other, whether it’s a physical therapist or just a different profession in general, that come with this really over-complicated explanation of kind of like what’s going on with them and it makes them extremely fragile. I think that’s like one of the things that we do a good job of is trying to just desensitize people to that feeling of just being overly fragile, feeling like you’re made of tissue paper. Because the explanations we give people makes such a huge difference that, like you said, secondary consequences that we don’t understand, people go home and like kind of just rethink all [00:16:00] the different things that we tell them. If we’re telling them information, that’s not necessarily fully true that we can’t prove to them, but I think we’re really kind of leading them down the wrong road. So I think, keeping things simple and not overly abstract. Because some people do come to us and they want, they like to have those conversations that are kind of overly, they’re going too much into the weeds of things and it’s like I enjoy those conversations. They’re fun. But like you said, it’s like it’s conversation we should have together as professionals, not necessarily with clients. So even when clients kind of get expose that stuff we need to like kind of steer them in the right direction that’s going to help them meet their goals and get what they’re looking for.

Doug: Yeah. I think that’s a great point. Like, I don’t think any, I think most medical people are well intentioned and no one is deliberately trying to make a patient feel fragile, but if in an effort to show a patient everything you know, you’re like, well, you’ve got an up slip in your pelvis here and you’re rotated this way here and whether it’s an overly complicated biomechanical explanation or an overly [00:17:00] complicated, even with some of the pain science things, like, I mean, I might feel fragile if somebody told me that my amygdala was hijacked and my immune system was compromised and it’s like, all those things actually like might be true and there might be something substantive in each of those models, but people are coming to you because they’re in pain and they want to be able to do things. So it’s like, all right, how do we get you from point A to point B systematically? And if they want explanations, you could try to provide it. But even knowing that there’s a downside to some of these explanations, I’ve had imaging on my back before when I had like an episode of back pain and nerve pain. Even like knowing that an MRI is just a snapshot. When I found out that I had like a disc herniation and stenosis and bone, like it messes with your head and I know that these things are not destiny, but imagine somebody that’s not aware of that and you’re telling them all these things that are quote unquote wrong with them when a lot of them may like might not even matter.

[00:18:00] So I think focusing on function and what the person wants to do, like start with that and then if they want more, you can give it to them. But I think you can incriminate yourself when you talk too much. Even somebody who like might think that they; a patient that thinks they might want a very deep explanation just because they want it doesn’t mean that you should give it to them either because they might think they want it but then when you give them what they want, they’re like, oh, so you mean all these things are wrong with me. So you’ve got to be careful. I mean, there’s always a fine line between giving somebody what they want and kind of sharing that and also being the quote unquote expert and realizing that you know more than them and not to be like paternalistic, but imagine if your parents, when you were really young, when you were like three years old told you that Santa Claus didn’t exist. There’s a fine line with some of that stuff and that’s also clinical judgment, but, like kids or patients again, not to be paternalistic, I’m just using an analogy, they don’t need to know everything you know, because they don’t have the filter to separate what’s meaningful and what’s not, [00:19:00] and they might take what you say out of context, if you’re not careful.

Greg: Yeah. And then they’re going to take some of this stuff you give to them and probably go to the internet and search around for it if they want to understand and then who knows what’s going to happen after that, at that point. But Doug, your whole point about having imaging done, seeing your back and thinking like, okay, wow like I actually have something sort of quote unquote wrong with me, but it’s not destiny. I just thought of a case where I have a patient who; is he crying over there? Yeah sure go ahead.

Trevor: We got a baby crying in the background.

Greg: I thought of a patient who I currently have and he’s had a disc issue for a decade or so. It’s kind of come and gone with him throughout the years and he just recently had almost like a really bad flare up type of thing with it where it wasn’t getting better [00:20:00] like it usually would on its own sort of thing. So he came in, and he’s at the point now where he’s said to me, like, I am very, very happy with where I am and I have to relate it to like, again, what does he want and what are his goals? And my explanation eeds to match that and my interventions need to match that too. So yeah, if I were and his goals aren’t going to be mine, so he just wants to be able to walk and ride a stationary bike in his house for exercise and that’s great and that’s good. For him, that’s his end point so I need to, when I’m with a student explain to them like, yes, we have all these great interventions and great exercises to make somebody more resilient and do some really fun and cool things with people in the gym. But that would be very, very, very inappropriate for this patient. It could be unsafe for them in the acute phase or in the short term and then it’s also like long-term. He doesn’t really care if he can [00:21:00] go front squats, 225 pounds or whatever it is.

So we don’t need to project our goals onto something, just because we have the ability to. So that goes back to just because we can intervene and give some sort of intervention does not mean that it’s not going to be detrimental or it’s not going to be a secondary effect that could be potentially bad. So for this guy, he’s waiting for another injection and another epidural and he’s extremely happy with where he is and I have to be unhappy for him and I’m really happy that he’s getting back to things he wants to do. Not the things that I want all of my people to be able to do necessarily.

Doug: Yeah. How many people have you guys work with where we have this assumption that like, when we treat a patient, we’re working from a clean slate, we’re starting from zero, but a lot of times, like we can’t even get to zero until a couple of sessions in because we have to undo some of the thoughts that were [00:22:00] instilled by another provider.
So we’re kind of working like behind the starting line in a lot of ways. So it’s, again, I think like less is more when it comes to explanations because you have to, yeah, I think a good exercise is when you tell somebody something, how can this be taken out of context and misinterpreted in a kind of like almost toxic way and I think if you do that, you’re going to realize that there’s like a lot less than you can say to somebody because we’re humans, we’re emotional beings and not everyone is going to look at things totally objectively, totally rationally. What is the worst possible interpretation of something? And I think that would change how we interact with a lot of, a lot of patients.

Trevor: Yeah. One thing that like, we’ll talk with students about is like if you come in or you have a new person and you do an email on assessment, it’s like, you may have an idea of what the perfect session and perfect treatment plan for this person is going to look like but so does that person in their head usually. If we’re giving them only the, and if those two things like aren’t that close and we’re only going to give them what we think they need, we’re [00:23:00] kind of doing them a disservice and then they’re not going to get the experience and the result they’re probably really hoping for, because Brian’s going to be off and they are not going to believe in the process, their emotional attachment to what they’re experiencing is going to be probably more negative. So it’s like, we kind of have to find this happy medium of giving the people what we know they need and giving them some of what they want. There are plenty of things I know you guys do it too. It’s like, there’s plenty of things that patients may say about like whether it’s like about stretching and what they need to stretch or whatever that it’s like you have to choose your battles on what beliefs of theirs. We need to kind of disprove to them and which ones like, kind of don’t really matter and are negatively impacting them all that much. I think it’s like choosing your battles when you can, there’s plenty of things that somebody may say to me that the first session that I’m like, I really don’t like that belief that you have right now.

I don’t like the fact that you’re like, I can never let my knees go forward when I get into a chair or when I go upstairs, it’s like, okay, we need to address that at some point in time. But like, we don’t have a good enough relationship today and you probably don’t believe me enough [00:24:00] today that we’re not going to go there, but after a couple sessions, when we do other things and you’re feeling better and you’re starting to like trust the process, then maybe we can kind of go after some of those fragile making new fragile beliefs that you have, but I think it’s like knowing some people try to like give them all the best things right now and they may not be ready for it. Whether it’s physically, whether it’s psychologically, emotionally, it doesn’t really matter what it is. We have to meet them where they are.

Doug: I think that’s a great point. I think that the most important question you can ask a patient during an eval is if this experience goes as well as you could possibly envision, what would that look like to you? Because that’s going to kind of dictate how you’re going to approach things too. I think we would all agree, like a lot of what we do or what anybody does in an eval is like, you’re going to do the same eval pretty much with everybody, depending on they’re there their chief complaint. But the subjective part is what’s going to solidify your relationship with that person right away and even though people say, well, like that’s the placebo effect, the reality is like the more comfortable [00:25:00] somebody is with you and the more somebody trusts you, the better a therapeutic result you’re going to get, and you can’t separate the interactive effects from the interventions themselves, because the interaction is the intervention. So people say, well we’re not doing an RCT. We’re not robots. If anything, we are trying to maximize that human element to get a therapeutic effect because you know what, the better you are at that then the less good you have to be as a therapist.

Now we’re obviously trying to be as competent as we can therapeutically and again, therapeutics the interaction as part of that but the sooner you can make somebody feel comfortable, the less good you have to be and the less, if you have to do really so that’s in the patient’s best interest, because now you’re doing less than them, you’re valuing their time more. So that’s a great point. I think that’s a question that needs to be asked right away to help drive the experience.

Greg: Yeah. And like you’re saying, Trevor, there are rarely, things that people are they’ll come in for an eval, they’ll show you like, oh, well I’m doing this hamstring stretch and this thing [00:26:00] and there’s rarely a time when I’m like you’re going to hurt yourself by doing that. If that’s something like, if they tell me I really like this X stretch. I really like to stretch my hamstrings. It makes my back feel better and it might not match our biomechanical model all the time but I don’t know if they like to do that and it makes them feel better. They’re not going to hurt themselves doing it mine to tell them to not do something that makes them feel better, that they’re coming to us to feel better. So if they found something that helps them in the short term, like, go for it. Because then I’m going to give you other things to do that are more in line with what I want you to do. As long as you’re not going to hurt yourself with the things that you’re currently doing on your own. Go for it. I like it. It’s probably not doing a thirty second hamstring stretch three times in one day. It is not going to make your pelvis explode and lose the ability or whatever they call it. Again, that goes back to like, yeah, maybe six years ago, five years ago, I would’ve been and saying to people like, no, you’re doing that because I had this sort [00:27:00] of
complicated thought process of like, no, you have to do everything perfectly correct and it has to be in line our biomechanical model.

Whereas now like Doug is saying like this person has to be on my team and then you need to be onboard and we need to have a good relationship and the interventions almost come like secondary to that. But, you know, just because of doing one thing that might not align it’s okay. They’re going to be fine and like you said, Trevor, like eventually you’re going to get to a point with them, maybe it takes them till the fourth session where you’re more comfortable with them and they’re more comfortable with you and you can talk about the things that you spoke about with them on their eval about like their needs going forward when they said or whatever it is. You can find ways to show them physically show them while you’re doing this you don’t have any issues, right? No. Good. Like you feel more of this happening and you feel good when you’re done doing it. That’s awesome. So like, don’t even worry about the whole needs forward thing anymore, you’ll be fine. And it’s just keeping [00:28:00] it that simple with people and just showing them that they can do things and they’re not going to crumble and fall apart like tissue paper. I think is part of the most powerful thing that we can do with people.

Trevor: I think it’s funny, like the hamstring stretching thing because it’s like, I mean, oh, I admit being guilty of that earlier on to like a hundred percent. It’s funny because it’s like, we always want to make people resilient and robust and be able to handle stress, but it’s like, you’re creating so much for agility if you don’t think somebody can handle like a thirty second hamstring stretch without like reproducing this crazy pains syndrome that’s going on that’s equally as terrible as [Inaudible29:20] hijack and kind of giving like the much more pain science like neuro explanation behind things. It’s like, if people can’t handle, if their bandwidth is that narrow, that would actually hurt them, then it doesn’t even matter what they do with them. It’s kind of almost inevitable if they’re trying to touch their toes, that they’re going to feel some sort of pain then and [00:29:00] yes there are definitely positions that may be provocative for somebody right now, but I almost never tell somebody that I don’t want you ever doing that. It’s like, yeah, maybe not right now, because it’s flared up or we just want to leave it alone for a couple of days, but yeah, in a couple of days we’ll be able to do it. It’s going to be fine. I think it’s just so funny kind of reflecting back on that of like the littlest thing that we think is going to cause this cascade of events and just put somebody into a hole and put them on their knees. They’re not going to be able to get up from, and it’s like, do you really think that taking a thirty second to a minute stretch is going to cause this horrible, horrible, outcome. Like, there’s just no way.

Greg: Like at this point, if somebody says something and it’s like, they’re doing something that might not match what I want them to do, and it’s still safe for them, I’ll just kind of ignore it and I’ll just be like, alright, yeah, go for it, that’s fine and we’re going to also do this stuff. So it’s just like having this dance with people and figuring out what makes them tick and what they want from you.

Doug: The knees over [00:30:00] toes thing is a great example, because that would be an example of like the naive interventionism intellectual yet idiot, because probably how that myth came about was somebody did a study and showed that when your knees migrate forward in a squat or close chain movement, that it creates more patellofemoral stress, which it does, but your body can adapt to that and if you look at like any athletic, not even athletic, like just real life going up the stairs, like less than a month. I mean, there are people who when I walk up, I’ve been told your knees shouldn’t go forward. So they deliberately like keep a vertical or a negative shin angle, just like regular people who haven’t been told anything haven’t been corrupted, everybody lets their knees go forward. So till that talks abou the intellectual yet idiot, well lecture bird’s about flight. So it’s like someone who studies flight and is lecturing the bird about like, well, you’re actually doing it wrong and we’ve got to be careful not to lecture birds about flight, because it’s an; and that’s the thing is [00:31:00] well-intentioned people, but people who have gone to school have advanced degrees doctorates are telling people that you shouldn’t let your kneww go forward when like, look at all the effing birds around us human beings, this is how we fly our knees go forward.

So it’s actually, it’s kind of insane when you think about it. So a good sanity check is always like, forget what the textbook says. Just look at people and what are the chances that like billions of people are wrong when they walk up the stairs and like their knees go forward or look at people before if you have access to those kinds of things, and look what people did before we became really smart and became physical therapists, orthopedists, and trainers, look at how they moved. There wasn’t this like epidemic of back pain and knee pain and people were sitting in a full squat and letting their knees go forward and you can make a case that if you can’t do those things, you’re probably less adaptable and resilient as a human being and that part of the reason why and we’re seeing a lot of these things is [00:32:00] because we’ve been told that they’re all bad and we don’t have a lot capacity. We don’t have a lot of variability. So lecturing birds about flight thing is really funny and we’ve got to be really careful about that because a lot of that go, I mean, same thing with people like when they go to brush their teeth, it’s like, you’re supposed to keep a neutral spine. It’s like brushing your teeth is not the same as dead lifting 500 pounds. So yeah, there’s a lot of that stuff out there.

Trevor: We have talked a couple of weeks ago, Doug, about, like the whole like self-organization thing and it’s like when we don’t give anybody cues, we’re just seeing like their most pure movement they can possibly do and it’s like, I think that is so rarely the case, because whether they’re an athlete or whether they’re a gen pop person or it doesn’t even matter like their age, like they’ve probably come into contact with somebody who has made whatever they’re doing cognitive to a certain degree. So we’re kind of overriding the idea that they’re just this plastic moldable self-organizing creature in front of us. It’s like, if you see an athlete raise their [00:33:00] heels off the ground, I was getting into an athletic stance. It’s like somebody told him to do that. I can pretty much guarantee no athlete ever in the history of the world if you told them to get ready to go do something like squatted and lifted and just brought their heels off the ground. That’s an unstable position. They’re not balanced. There’s a million reasons why they wouldn’t do that. So if we see somebody do that, I don’t want to like let them continue to do a strategy that’s not optimal for them because somebody else has given them a bad cue in the past. So I think exactly what you just said, it’s like if we understand like what normal quote unquote, normal, whatever you want to call that people do and how they move. It’s like that’s what we want to kind of get everybody to be able to do and so many times, like you said, we over intervene and we over coach and we over cue that just makes everything just kind of takes away the fluidity and the rhythm of movement, which is kind of one of the things that like, I know for myself that I must read lifted heavy. It’s like, I’m always looking for those qualities with how people move whether they’re changing direction, whether they’re running linearly, it doesn’t really matter what it is. I want to see [00:34:00] like a rhythm and a fluidity and a balance and an organization to their movement.

Doug: Yeah. And that’s a great point. Is that like because there’s this whole self-organization thing, which is kind of, I mean, it’s well intentioned and I get it and the idea is like it’s to prevent people from over coaching. It’s like, look, the athlete or the patient, or the person is going to find a solution, but in a vacuum, that’s true. But most people have had access to either coaching or the internet. So like, if you see somebody and they’re squatting and they don’t let their knees go forward, what are the chances that that’s like, how they would intuitively squat or that someone told them, hey, your knees shouldn’t go. So, yeah. That’s why you can’t assume anything. You’d have to ask like, why, okay, this is great, this might be the best solution for you but why are you you’re doing it? Did somebody tell you to do it? Oh yeah, someone told me that my knees aren’t allowed to before when I squat, that’s not self-organization, that’s somebody’s instilling a belief in you that your knees aren’t allowed to go forward. I mean, I remember working with a strength athlete. He had like back pain when he squatted and I was like, all right, let me watch you squat. Like it [00:35:00] literally took like, probably a full minute before he actually squatted because he was doing this crazy, like breathing ritual. I thought it was like a free dive or getting ready to hold his breath for five minutes and it was like, almost like watching an exorcism. And I’m like, what are you doing, man? And he’s like, well, someone told me, I’m like, no, just like, unrack the bar and just sit your ass down squat. Like it’s not, you know?

The thing is he was so focused on this ritual that somebody taught him that he wasn’t paying attention to what I thought were the important points about like not letting your spine move like an accordion when you squat. So it’s like we live in 2020 where there’s an abundance of information. A lot of which is not great information. So we can’t assume people are self organizing. You have to ask the question, okay, this might be, what’s good for you, but if someone tell you to do it, why are you doing it? Are you thinking about it? Oh yeah. Someone told me every time I sprint I’m supposed to stay low. That’s why they’re falling at the hips. That’s not self-organization because. Yes, there’s no perfect way to move, but there are certain [00:36:00] similarities that we see throughout sports. There are models that I think are useful. Like we just had Shidi on talking about the track and field model and what you should do when you accelerate. If you’re violating that model that may work for that athlete, but why are you violating it if you’re violating it just because someone told you to stay low and that’s why you’re folding up the hips, that might not be a great reason. Like if you’re breaking the rules, there should be a good reason. So again, the rules are fluid, but I think that we have to start with some kind of a model of movement. If you’re violating that we need to dig deeper as to why and it’s oftentimes not self-organization it’s bad coaching or bad queuing.

Trevor: Yeah, that was awesome. It’s funny because the acceleration one is something I’ve seen with so many people that if they come in and they pulled something or whatever. And it often happens and some sort of acceleration movement, and it’s like, we’ll go and we’ll work on that stuff and it’s like you see your setup was really good, but then you just dig your shoulders down as far as you possibly can because every coach ever has always said, stay low. [00:37:00] And it’s always it results in this forward folding, not really a good flection pattern at their ankles, knees and hips, which is again, it’s another reason why like, we have people squat like they do, because it’s just getting people to do the same things. We want everyone to be able to do consistently and all the time.