Newsletter

August is Just Breathe Manual Therapy’s birthday! Throughout this past month, I’ve been organizing the most important lessons I’ve learned during my first year in business. The lessons came fast, but only one made a real philosophical difference in what I do and how I think of my practice. Here I’ll tell you why manual therapy is a framework, not a gospel.

What matters in manual therapy?

When I opened the doors of Just Breathe Manual Therapy, I thought it was going to be a pretty straightforward operation. I do a specific type of bodywork, called Be Activated, and it would work like this: I’ll inform people what Be Activated is, they’ll realize they need it, and they’ll hire me.

I quickly learned that my original approach was totally inflexible.

My thought was simply, “This is what I do,” and when a client walks in the door, that’s the work I’ll do. I realized through working with my regular clients, as well as with people who came in once and didn’t come back, that the role I wanted to play is much more dynamic. I was presented with a simple question: what’s more important, the sequence or the client?

What’s the difference between a framework and a gospel?

If the sequence is the most important, it becomes a gospel. Like a religion, it becomes dogma. It becomes the mold into which all clients are forced. The space for individualization and interpretation gets reduced.

There is truth… But the doctrine you desire, absolute, perfect dogma that alone provides wisdom, does not exist.

– Herman hesse

If the client is the most important, their experience becomes the focal point. The sequence then shifts from a gospel to a framework. The sequence remains the road we travel, but we take detours based on what works, what doesn’t work, and where we see opportunities.

Which method of manual therapy works best?

Rigid frameworks have their place in our world. They are repeatable, they have defined feedback loops, and they are scalable. In the medical field, I would rather receive a physical therapist’s gospel as I recover from an ACL replacement, or a cardiologist’s gospel when recovering from a heart attack. However, in less defined areas and with less acute issues, gospels do not serve us. In these cases, a framework can be more useful. For example, I have clients who initially come in for back pain and as we begin working together, we may work specifically on their back, or we may work on breathing, or we may find out that the real driving force to their becoming a client is managing stress or anxiety.

What drives manual therapy?

No man ever steps in the same river twice, for it’s not the same river and he’s not the same man.

Heraclitus

In my shift to frameworks, I begin by acknowledging that the client is a complete human being with their own history, and their individual mental and physical states. This makes them central to the work I do. The same person never enters the room twice. The person in front of me is the culmination of their circumstances on that day – the next day they will be different. The relationship between client and practitioner will influence the outcome of the treatment, which is why it’s important to understand a client’s singular circumstances. With all this in mind, what I bring to each session is what I think is possible and embrace the reality that we are going to forge our own path together.

This path takes input from both of us. What is my client experiencing and noticing? What’s being felt? What am I finding? Is there a new and unexpected road that might be useful to pursue? What other tools in my toolbox may help here?

These questions are typical to my sessions because I am constantly assessing and reassessing how my client is responding through their felt experience. In a practice where the work is inflexible, these questions may be left unasked.

Where do you want manual therapy to take you?

In a gospel-based practice, an individual’s unique needs may be put aside in favor of efficiency.

In a framework-based practice, the work may seem less efficient when measured by gospel-based metrics. However, in a framework-based practice, the only metric that matters is the progress and satisfaction experienced by the client. In a world that’s focused on productivity and efficiency, discarding tightly held gospels in favor of loosely held frameworks is to actively take the road less traveled. The road less traveled, in the words of Robert Frost, has made all the difference.

Gluteal Amnesia.

Compensation Patterns.

Dysfunctional Breathing.

These are three phrases I wish fitness and wellness professionals could banish. On their own, they’re just words, but my problem is that each of them frames the client as deficient. Sometimes deficiency is worth noting, but in a clinical or general fitness setting, each of these cases our clients “compensation” or “dysfunction” is done completely under the radar. What’s the point in telling someone they’re wrong about something they didn’t know they were even doing? What if, instead, we could take the stance that our clients are capable, that they have strengths, and that they have strategies to use those strengths? By simply shifting our framing, would our outcomes be different? My stance on this is a firm yes.

Today, I’m going to describe how our words choice can influence the outcomes we see, detail why deficit-based language flies in the face of good practice, and propose alternatives that get our point across without the same baggage.

If you’re a healthcare, fitness, or wellness professional, I hope you’ll come away considering your choice of language. If you’re a client, patient, or athlete, I hope you’ll come away from this with new words to apply to yourself and a new filter that you can apply to the words your coaches or practitioners use.

The Power Of Words

The words we choose as practitioners have immediate and direct impacts on our clients. You can see this for yourself with one of my favorite examples. I want you to find a partner and do a general nervous system response test. You’ll do the same test with three different scripts.

• The first one is just like in the video: “I’m going to press on 3-2-1-Go and I want you to hold here.”
• On the second one: “I’m going to press on 3-2-1-Go and I want you to resist me.”
• On the third one: “I’m going to press on 3-2-1-Go and I want you to try and resist me.”

“Do or do not, there is no try.” – Yoda

If you’ve had the same result I’ve had every time I did this, the first test was the strongest, the second test was worse, the third test was worse still. Pretty odd, considering that nothing else has changed. We’ve applied no interventions aside from the prompts, yet our outcomes are different.

So what’s happening here? Our word choice is subtlety influencing the outcome of the test. While “hold” is a pretty neutral word, “resist” and “try” both seed our client’s mind with the idea of failure.

When a couple words like this can make a difference, what can we expect when we tell someone they’ve got a compensation pattern in their hips? And more to the point, if we know that our words can have a negative impact on our client, why wouldn’t we choose words that could have a positive impact?

Bad Medicine

I agree that we need to use words to draw awareness to the things we want to change. I also know there is real empowerment that happens for folks who receive a diagnosis when they’re working through chronic conditions. Fitness professionals, and many healthcare and wellness professionals are not qualified to diagnose anything. We are qualified to identify, theorize, and create interventions. None of those require us to tell our client that something is wrong with them.

So if we don’t need to tell our client that something’s wrong with them, why do we choose to do so?

First, there’s an element of ignorance. If we don’t know the effect our words have on our clients, we can’t know to choose them wisely.

Second, there’s our point of focus. It is very easy for us to be focused on our method, rather than who we are applying our method to. This makes a lot of sense given our education model which is built around comparing someone to an ideal. If we are looking for 120* of range of motion in a test and we find 90* – we will (rightly) focus on the gap that we are looking to fill. Unfortunately, we may also project that gap onto the person. We do not see a person, we see a lack of range of motion.

Third, is the worst. It’s laziness. We can so easily reduce our client to a collection of symptoms and attributes. In a course I’m currently taking, we build a lot of our work out from the angle of someone’s ribs (a narrow or wide infra-sternal angle or ISA). When we review case studies, oftentimes other participants in the class will say that “My client is a narrow ISA.” Not true. That person is a fully-formed, functional, and independent human being who has a narrow ISA.

The Body Reading courses from Anatomy Trains do a great job of drilling this with participants. In each review, we start with a statement of strengths. Even something as simple as “your posture looks very confident.” Almost ten years after my first experience, that sticks so strongly in my mind. By leading with what’s right for the person, rather than what’s “wrong” we reinforce their humanity.

Strategy, Not Compensation

If we start by acknowledging that our clients are fully-formed, functional, and independent human beings whose agency in their lives brought them to our practice, how would we choose words differently?

This is where I think we have a lot of easy growth that’s possible and ready for us to take advantage of.

Here’s the way I phrase it with my clients: we do not have amnesia, compensation, or dysfunction. We have strategies. Here’s why I like that word so much more.

• It’s accurate. Words like “amnesia” and “not firing” are misnomers. If you don’t have a spinal cord injury, your glutes are there and they know how to fire. However, the strategy that your body has for the task of hip extension may not take full advantage of them. That’s cool, let’s see if we can give your body awareness of a different strategy!
• It’s neutral. Strategy does not have judgment built-in like compensation or dysfunction do. Calling someone’s breathing “dysfunctional” neglects the truth that this person in front of you is … well … breathing. The function of breathing is respiration and if they’re not on a ventilator, it’s functional. Could a new strategy for breathing be applied to help them find more efficiency?
• It’s not reductive. It acknowledges them as more than the problem they have. As far as I’m concerned, this is the most important part.

People come to us because some part of their life isn’t going the way they want it to. Maybe they’re dealing with stress, anxiety, or depression. Maybe they’re dealing with chronic pain. Maybe they’re trying to get an invite to the Olympic trials and they’re looking for a 1% improvement. While maintaining our scope of practice, it’s important to acknowledge that the person in front of us is so much more than the reason they came in.

I would love to hear from you. What words or phrases do you find helpful? What words do you want to never hear again?

Times of transition can be really difficult. And now, as businesses begin to open up and we start to experience what “the new normal” feels like, we’re stacking a lot of transitions on top of one another. Add into that the change of seasons and you’ve got a recipe for feeling overwhelmed, undermotivated, and undisciplined. For me, that means feeling a little bit empty, overdrawn, and out of sorts.

For some people, change is exhilarating. Building new routines and exploring new options bring them joy and vitality. If that’s you, I’m happy for you! This article may not be for you directly, but I hope it will help you understand and empathize with someone who’s feeling a little bit conflicted or down.

If you’re like me and change throws you off and the uncomfortable feeling is sometimes a little bit too much, I hope you’ll feel seen in reading this article and towards the end I offer some strategies I use that might help you find your footing more easily.

Disruption.

Disruption has been the overarching theme of the past year. And it was a specific type of disruption: one where our options were reduced or eliminated altogether. We got things taken OFF our plate. It’s easy to look around and see the emotion that some people respond to that with – anger, fear, and lashing out. In my experience, that kind of disruption is relatively easy to manage. In some ways, it feels relieving to have fewer options. However, now we’re facing a new kind of disruption: one where options are added and we have to choose between them. For me, that’s like writing when looking at a blank page: it’s nearly impossible. 

The perfect illustration of this is my martial arts practice. Through the pandemic, I was doing Brazilian jiu jitsu at MassBJJ here in Arlington. We had training pods to mitigate risk which meant I could only train on Tuesday, Wednesday, and Thursday at 7:00am. Was it ideal? Objectively, I’d say no. The decision involved however, was incredibly simple. If I’m going to do BJJ, I’m doing it at these specific times.

As Massachusetts has changed restrictions and allowed places like MassBJJ to reopen fully, I can now choose to train whenever there’s a class. I have options! I can train on Sunday at 10:00, on Friday at 6:00, and any time in between.

Objectively, that’s a much better situation. However, my experience of that situation is pretty different. I feel pressure to choose the right times to go in. I feel anxious when I walk into a class with an instructor I’ve never met before and training partners that I’ve never worked with. I bargain with myself before morning classes, “I’m feeling pretty tired, I can just take it easy now and train tonight.” All these feelings were easy to dismiss in the previous environment. Sleep in = no train.

Choices may not make it easier.

In his book The Paradox Of Choice, Barry Schwartz talks about two archetypes of decision-making: Satisficers and Maximizers. Satisficers choose the first available option that meets their needs. Maximizers choose the best option after weighing all qualities. We all play each role in different situations, but there’s one common theme. In each case, increased options do not correlate with better overall satisfaction. And here we are at the beginning of June 2021, on the heels of a year and change of upheaval in our world, and now with a whole spate of new options available to us.

It makes perfect sense to me that we’d be overwhelmed. It makes perfect sense to me that we might feel unmotivated. It makes perfect sense to me that we feel stuck.

So what can we do about it?

Here’s what you can do:

• Notice. Pay attention to how you feel. Are you feeling overwhelmed? Are you feeling extra tired? Make time to just pay attention to how you feel.
• Name it. Say it out loud. Write it down. Talk to a friend. Just that simple action of saying it to another person can make a big difference.
• Reflect on your routines. Is your sleep schedule regular? Is your eating consistent? Are you hydrated? Are you making time for physical activity/ Are you making time for mental space?
• Cut what doesn’t work. In that reflection, are there things that you know actually don’t help anything? Maybe you’re spending a lot of time on instagram right before bed (guilty!). See what would happen if you just let those things go.
• Do what does work. If going to the gym is serving you, double down on it. If taking walks with your significant other makes you feel good, make sure they know!
• Schedule the good stuff. I live in my calendar, so I’m biased. I block out the time I’m going to do the stuff that matters. Gym time? It’s in there. Writing things like this? On the calendar. Scheduling isn’t just for obligations either. Beach time? On the calendar. A walk in the woods? Block the time. One thing I’ve found is that I need to have about a 1:1 work to rest ratio. If I’m doing 90 minutes of hard, focused, intense work I need to have about 90 minutes of time to decompress and think. 
• Hold yourself to the schedule (within reason). Even the best laid plans will be laid to waste without discipline. Something about what paves the road to hell. There are two things I do to hold myself to the schedule. First, I copy my day schedule from my calendar to my reminders app (so it’s obviously on my phone and computer). Filling the calendar can be passive, copying my day’s plan to another place is active and helps me plan for my day. I know what to expect. Second, I tell my wife what I’m up to that day. A 30-second calendar review actually makes a world of difference in terms of both keeping myself on track AND keeping household harmony. Some plans do change, of course, but most don’t. I’d rather plan for the majority case than resign myself to luck.

Getting Started.

I know that list is long. When I’m feeling overwhelmed, the last thing I want to do is go through all seven of those things at once. Here’s the great part though: you only do one step at a time. The best thing about little habits like this is that they add up quickly. Before you even realize it, you’ve broken that inertia and you’ll be feeling like yourself again.

Pick one of these and give it a try for a couple days. Let me know what you notice!