Thread by @YujiSuzukiDC

I think being exposed to ecological dynamics framework several yrs ago has made me a less crappy rehab clinician over time. @EMERGENTMVMT has been a huge influence in that journey. A mega🧵of my takeaways from #SMSC22 from the perspective of someone who works with people in pain

- @MovementMiyagi. “Are my athletes performing because of working with me or in spite of working with me?” Asking if a patient is getting better because of me or in spite of me (natural Hx & regression to the mean powerful despite unhelpful narratives & non-evidence based Tx)

- EcoD as a worldview rather than just a concept in understanding movement. Behavior change, skill adaptation, personal growth, mindset change… ever-present question in many aspects of life is “which problem are you trying to solve”

I need to gather context around why someone is moving in certain ways, or avoiding certain behaviors, believing certain narratives etc. A lot of rehab is nudging them out of unhelpful strategies of movement, recovery, behaviors, thoughts and beliefs.

In many of these realms, separating perception, cognition/attention, and action is to remove the individual from the environment and the context they inhabit. Appreciate the complex nature of all systems and the interactions between systems.

In rehab I can ask, how is someone’s pain affecting ways they interact with their environment? No longer lifting things? Avoiding activities that are meaningful to them? And how is what I as clinician do with or say to them affecting their relationship with different affordances?

- Having another human in a practice environment is helpful in making env more representative. 1 used to think 1-on-1 rehab is the only way but mb group rehab sessions can be superior in addressing many components of rehabilitating injured humans if I can organize sessions well?

^ that could be said for field sport athletes AND anybody not living in complete isolation.

- 1 of the most beneficial things coaches can do is to communicate w/ others working with the same athlete. S&C, skills, head coach… all working to support the athlete. Sounds a whole lot like how a healthcare team can support a patient by not isolating in silos and dropping ego

Included in that discussion, is the athletes/patient. Without getting an insight into what they are thinking, feeling, perceiving… how do I expect to help them in their situation?

- @Marianne_D1 “Be interested in the solutions an individual comes up with rather than always looking to ‘correct’ them.” Movement solutions AND behaviors. Coaches and clinicians act as guides and I have to be ok with letting go of control more.

What should raise a flag in assessing movements, should be lack of movement solution options. Mechanically “favorable” movement solution should raise similar levels of concern as “non-favorable” ones if it’s the only solution they can utilize. Options > perfection

I can help with this by encouraging and supporting them to “build an ugly zone”. Climbing out of an attractor state isn’t going to be pretty and it requires some agitation of the current movement solution or macro scale behavior via various strategies.

- @karenekman some sports culturally have play and exploration engrained into them. Maybe encouraging participation in adventure sports (of different levels) can be helpful in opening up dexterity and thus help in the rehab process too.

- tough problem for us clinicians: how can we make the rehab environment more representative when the sport involves very unique sets of constraints/affordances (eg. snowboarding down a mountain vs tiny rehab space) 😓

- @Mr_Tennis_Coach “if you can’t constantly talk to the athlete during the game, why would you be talking to them so much during practice?” 🙌🏼

I can try to “teach” a movement during rehab session but the ultimate goal isn’t for them to look pristine during the session, but for them to utilize the movement options well enough when they’re not with me. They then can be attuned to new sets of affordances in their env.

- are the athletes enjoying the activity? are they exploring? are they being challenged? 👏🏼 more of this in rehab, please.

Amazing discussions this morning so far. Excited for the afternoon sessions!