Updated: Mar 25, 2021
When a client contacts me for the first time, they almost always have 1 overreaching question on their mind, “Can you help me?”. The differences in every situation allow for each person to ask the question in as unique a way as is the situation they are facing. Even though the symptom may be something we have seen a thousand times, the individual story is as unique as their fingerprints. And the story is the most important part of the therapy on the first visit. It’s incredibly important for a therapist, or a specialist, to allow the client to tell their story, their unique journey, their successes and failures alike.
A client will go to great lengths to describe the condition of their body, their ailing joints, the reason that brought them to you, who they have already seen (usually the best in the field), and may even have a course of treatment already suggested to them (usually one that scares the hell out of them). Fear of surgeries, medications, and other therapies suggested by some very well meaning professionals, causes them to look elsewhere for their treatment alternatives. They usually become experts in their condition as part of the natural journey to find relief. It’s really kind of amazing how much a client knows about their condition, and yet they feel as if they know nothing. They have very little confidence in the knowledge that they have accumulated. In my experience, the lack of confidence is directly related to the failed attempts at fixing the problem. However, good news is on the horizon. Once there is some impact on the symptom, there is a glimmer of hope that usually creates curiosity, and allows for an “I’ll give it a try” response.
However, hope is not a strategy. Hope may open the door to allow the client and the therapist the ability to begin their journey together, but results are necessary to continue with the course of treatment. The therapy process must take into account that the human is an emotionally driven, physically practical being, that needs to understand the world in which it finds itself. In other words, we are thoughtful, emotional, and physical creatures. Our clients need to be impacted in all three of these specific ways to make a behavioral change that produces pain relief. The first appointment is the place where this process begins. This is a brief summary of what that looks like…
Impact the symptom - The client must feel some amount of relief…now. Give them some exercises, and feel better. In some cases the pain has been around so long, a person will learn to ignore the symptom, making it difficult to tell that the symptom has actually gone or has changed enough to notice. Be patient. If the right exercises are given, a positional change will happen, and the body has no choice but to feel better. Feeling better, triggers other positives responses like a hopeful sense of returning to a normal life, or at least a life one thought might not be available anymore.
Action: do an exercise that addresses the mechanical problem and let the client feel relief.
Explain the cause - When the change happens, or even before it happens, the client must understand how the body will respond. When it does respond, they must acknowledge it. Up to this point, a client typically will accept silly reasons for the way they feel. They say things like “it’s cause I’m left handed”, or “it’s my age”, or even “I’m not built for golf”…etc. As if every person who is left handed hurts, or every person their age feels the same way, or every golfer has the same body. Really? If it were only that simple. We start to feel like we are defective in some way, rather than just going through a mechanical issue. Feeling better is now about to become a learned response. And the client will ask questions as a result. They will instinctively want to know WHY they are feeling better. In fact, I find that the information we share and learn together on the first visit needs to be repeated several times. We are a team now, and finding answers to questions is the job of both people - the client and the therapist. Knowledge is critical, but when combined with the physical experience of feeling better, it produces the first opportunity for the client to truly believe feeling better is possible.
Action: People learn in various ways. Some learn visually, some in auditory fashion, and others learn by feeling, touch, or experiencing something. Offer an explanation of the cause of the problem (ie… show a postural photo to the visual person, or ask the auditory person leading questions about how the pain has gone away after doing the exercise, or whether their age is still an issue…etc). This will serve as the start of the long term goal that needs to be addressed after the pain goes away.
Acknowledge the emotion - Our emotional response to pain plays a very real, and often overlooked, part in the therapy process. How we feel about a problem often serves as the primary motivation for people to take action. Clients will put up with pain for far too long before finally deciding to do something about it. The decision to act only coming after frustration over a lack of progress or even a slow healing response. We are also a mirror for our emotions. Often times we show how we feel in the expressions on our face, or in slumping shoulders, or rounding, slouching backs. When we are filled with pride or excitement, we lift ourselves vertically, often subconsciously. And by chance, our bodies are experiencing dysfunction or faulty postural positions, the emotional responses become muted to the point of impacting our overall sense of peace of mind. We experience the negatives more easily and the positives more rarely. Days become a real bummer when we have pain and dysfunction.
Action: Have the client describe how being out of pain would make them feel, and then revisit it after the exercise routine. Remind them of what they said and validate their expectations. Feeling good might be a new sensation for someone dealing with a long term problem. What would a day with no pain allow them to do that they are not doing now…etc. The generic “I feel better” is not an appropriate answer for long term success. It’s important to be more specific about how we feel. Numbness is not health. Feeling good is a little different for all of us. Words like “hopeful” or “encouraged” are great starts when we haven’t felt good for a very long time.
Most new therapists and movement specialists put too much faith, too much emphasis on the corrective exercises. The exercises are the primary physical tool used to make physical change to be sure. However, the change will only be temporary if the other areas are not addressed. Repetitive reinforcement of the exercises is critical to a lasting result. We are training new movement patterns and making mechanical changes to posture. Motivations change. The pain will go away. And if the client feels better quickly with doing the exercises, and then stops doing their routine without understanding where the pain came from in the first place…the body will figure out a new way to cheat, and create new faulty postures. This in turn leads to the possibility of the pain returning, or showing up somewhere else.