The Subjective Matters.

I had an epiphany this weekend as I was teaching a group of Pilates Instructors about client assessment, and how to teach the body in front of them. Inevitably as we were talking about protocols for assessing, comparisons between our approach as Movement Educators and that of the medical community arose. What came out of this discussion was eye opening.

Science tells us that there must be hard tangible evidence to prove that something is right, accurate, true or even exists. When working with people, we have two types of “data” that we look at: subjective accounts of the client’s experience, feelings, sensations, pain level, etc; and objective evidence of quantifiable measures to explain or confirm the person’s injury or pain. Too often in the medical community the subjective experiences of the client (in this case, patient) are discounted until proven objectively through clinical tests and imaging, or in some cases, the objective measures are used to discount or disprove the patient’s subjective experience.

As Movement Educators, who are not tied to the confines of the medical model, we are in a very advantageous position. We have the ability to listen to our clients and take their word as fact. In all honesty, it doesn’t matter if evidence shows us that there is nothing visibly wrong with a client’s knee, hip, shoulder, back or anything else that plagues them. If that client will not move or believes that they can not or should not move because of the pain or dysfunction that they feel, then they have a movement impairment, period.

So how can we best help our clients move better, feel more confident in movement, and break the pain cycle? First and foremost, always teach the body in front of you. What does this mean?

  1. Listen
    In the initial session, and every session thereafter, take the time to listen to the client’s experience with their pain or feelings and experiences with movement. Some come with injury, while others may lack confidence or have fear around movement. What words do they use to describe their experience? Ask them lots of clarifying questions. For example, when you move this way is it painful or are you feeling reluctant or apprehensive? Why?
    Make it clear that you take the client’s account seriously, and that you are listening. Many people feel discounted from a previous experience with their physicians, and this can be demoralizing and even exacerbate the movement dysfunction. One client said to me: “My doctor won’t help me, they say it is nothing. I don’t know what to do so I just stopped moving.”
  2. Observe
    With additional training beyond your Pilates certification, you have the opportunity to learn a wide variety of tools that you can use to assess your clients posturally and in movement. However, before you begin to teach them how to move “correctly” by cueing and correcting their movements, just watch them move and how they move. The bracing that you will see with certain movements reveal everything you need to know to figure out where to start and to make smart exercise choices for that client. For example, when you ask them to balance on one leg, do they immediately reach for a support? When you have them move a limb, do their eyebrows furrow or do they grimace? Is there tension somewhere in the body that is not necessary to accomplish the requested movement?
  3. Empathize
    For just a moment, try to put yourself in your client’s shoes. How would this experience affect you, mentally and physically? If you can imagine this just briefly, you will be able to feel in your own body where they might hold tensions in theirs. For example, imagine the frustration of not being heard or helped, of being fearful or in pain everyday? Notice the immediate tension that arises in your upper body, shoulders and neck. When they walk and you see an altered gait pattern, try to imitate or replicate that pattern in your own body. Where do you feel tension and guarding?
  4. Be creative
    Working from a protocol or formulaic approach where you implement the same tactics and strategies with every client likely will not work well in this situation. This is a great opportunity to step out of the box and perhaps your comfort zone to find creative ways to work with this client in a way that guarantees success. If a client is feeling apprehensive about movement, the resulting tensions will limit their range and ability to perform the exercise. In this case, try simply changing the breathing pattern. Likely they will hold their breath during movement, however inhaling may also stimulate the sympathetic system and heighten the heart rate and feelings of anxiety. Exhaling calms the body and relaxes unnecessary tensions, so perhaps have them exhale through both directions of movement. For example, in shoulder bridge, start the exhale and let go of tensions, then lift the pelvis. Inhale at the top, start the exhale, release tensions and lower. Other creative options include assisted and/or passive movements with your guidance, using cues that promote calm versus effort like float, glide, roll, make space, etc, or using various props to support the body in movement.
  5. Progress
    Now that the client is moving again, and most importantly has established a level of trust with you, you can begin to progress them into more challenging or strengthening exercises. This is a step-by-step approach that takes them to their limit without going beyond in any particular exercise. At Body Harmonics, we call these Progressive Sequences. As a starting point, choose an exercise or movement that the client is comfortable with then layer on one step at a time by increasing the lever length, range of motion, adding coordinated limb movements, and on and on. The client needs to feel that they are progressing to truly break the pain or fear cycle, but also to feel capable, strong, empowered and successful.

Watching a client progress from pain to pain-free movement is one of the most rewarding aspects of our job as Movement Educators. Customized programs designed from the assessment phase help to keep the client motivated and challenged, but also keep you interested in your work. It’s like putting together a puzzle until the final piece is in place. It’s a collaborative approach that ensures that both you and the client are invested in achieving the end goal of better movement.

Written by
Holly Wallis, Certified Movement & Rehabilitation Specialist, PMA®-CPT
Director of US Operations, Body Harmonics Pilates & Movement Institute
Studio Director, ReActive Movement, 6200 LaSalle Ave, Oakland, CA 94611

© 2019. All rights reserved.

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