Thread by @YujiSuzukiDC

Part II of my takeaways from #SMSC22. Exposing my thoughts to public is my way of avoiding bias and truly learn. Comments and criticisms are welcome. I apologize for the lengthiness 🫠

-@rob_gambardella “what are the constraints you can manipulate versus those you can’t manipulate”. There’s always a way to inject more aliveness and purposeful variability into training sessions.

Having a clear intent of an activity or a session as a whole is important in distinguishing training from pure chaos. Analogy - it’s not about letting kids go to run around on the freeway or oppositely, telling them exactly how to play on the slide. It’s somewhere in between.

In rehab settings, I encounter people with barriers (physical, psychological & social). Some can be changed, many not so easily. Some guidance to start taking steps towards lowering barriers is one way I can help them. Another is to help work around those that can’t be changed.

- What does adhering too closely to the technical model look like? Further restriction of movements and reduced authenticity. vs. a coach that can say “choose your depth, tempo, weight, reps around rules A and B” (eg. hit 3 reps in reserve)

Similar to the weight room, it’s too easy to keep things rigid and prescriptive in rehab settings. I can give some autonomy to patients but that doesn’t mean that I’m letting them do whatever (a common strawman)

Also, more autonomy doesn’t mean I’m disregarding the importance of tissue focused adaptations and how I can favor certain biomechanics to shift load to certain tissues in some situations. Evidence seems to be vague is terms of what’s required for tissue adaptation anyway.

Setting boundaries to guide their exploration within rehab requires understanding of the person’s pain sensitivity, pain triggers, pain Hx, training Hx or fitness levels, psychological/physical preparedness, anxiety around movements etc.

At the same time, I can encourage exploration within those boundaries. Eg. Pain triggered by reaching a certain joint ROM, how can I guide exploration within the ROM they can tolerate?

Inevitably, they’ll cross those boundaries here and there. But we know that P! with mvmnt can be ok more often than not. “Sore but safe” is a phrase I use a lot when guiding movement. I try to speak on this pre exploration as it is probably more helpful than post event.

I just think there’s much power in being able to direct their attention to things they CAN do within their current pain boundaries vs pointing out things they can’t. They’re already coming in since they can’t do things bc of pain!

- Being good in the wt room doesn’t guarantee you being good at sport. Similarly looking good in clinic doesn’t mean the patients are going to be successful in real life. Is my session truly for the patient or for me to look good and feel comfortable?

- getting athletes and parents to be on board with EcoD framework in training seems to be a common challenge. Same in the shift towards multifactorial model of pain vs biomedical. Change happens slowly.

Coaches seem to be having success by not expecting buy-in on day 1, finding common goals (athlete success), showing that they care… sounds a lot like building therapeutic relationship.

Info isn’t enough to change beliefs. I can preach a model of P! but if I can’t get patients to experience +ve changes, it doesn’t matter to them what the “truth” is. Less painsplaining (ie implicit learning) and more experiential. PNE only until they’re down to start experiencing

- @Coachgbaker instilling freedom and coaching confidence. It’s amazing how much creative and effective movement solutions come about when you give them a little confidence.

What happens in rehab? “You’re not moving right” “brace this way not this way” “if you keep moving that way, you’re gonna get hurt” Not only are many of these claims unsupported by evidence, but the consequentially it can limit the patients and their movement bandwidth.

- including more failing (safely) in practice environment is huge esp in sport like baseball in which failing is ubiquitous. Same with pain isn’t it? How detrimental is it to never experience pain in rehab or for me communicate fear, avoidance, and worry with every uptick in P!

How can I help improve this person’s relationship with current pain (if it’s safe of course)and situation? That’s what makes me valuable as a clinician just as how a coach can help an athlete guide how they interact with their experiences on the field.

- @StuartMcMillan1 led a great discussion on language and on the concept of “the objective isn’t for us to teach but for them to learn”

Info dumping in coach education, similar to in coaching athletes, rarely results in achievement of the true objective which is for the learner to change behavior. When I first learned about pain science, I was too excited to share what I thought I knew. No bueno

Both EcoD and pain science are difficult topics. The most effective way to communicate may be to use less technical jargons and discuss the key concepts that is going lead to an actual behavior change.

Behavior change is hard… Key question I’m asking myself - where can I simplify the main messages more?

Thanks for reading this messy thread. I’ll work on distilling and simplifying. In summary, so much of good coaching (EcoD or otherwise) transfers to being a good clinician imo. Why I look forward to the SMSC every year. Again, thanks @EMERGENTMVMT for an awesome event!