Diagnostic Doomspeak
Let me make this clear: I respect all medical professional’s work, experience and knowledge. I respect their diagnoses and I respect their opinions. Whether it be a doctor, chiropractor, physiotherapist or voodoo priest, I always take other professional’s opinion into consideration.
But I fucking hate medical diagnoses for painful symptoms.
I fucking hate medical diagnoses for painful symptoms.
Let me make this clear: I respect all medical professional’s work, experience and knowledge. I respect their diagnoses and I respect their opinions. Whether it be a doctor, chiropractor, physiotherapist or voodoo priest, I always take other professional’s opinion into consideration.
In some cases, people need these medical diagnostic approaches; ACL tears, spondylolisthesis, rotator cuff tears, etc. The big nasties. Those have their places and can be long-term injuries that require careful planning and potentially surgical approaches. I like those ones.
But, for some reason, it’s SUPER TRENDY to diagnose people with sciatica, SI joint dysfunction, upper/lower cross syndrome, piriformis syndrome, scapular winging, and whatever doom-speak Instagram fitness gurus throw out. It doesn’t make sense and can be downright harmful to emphasize conditioning, instead of what they’re lacking and causing their condition in the first place.
Lets look at something like sciatica. Sciatica is a radiating pain that zings down your leg. It can be caused by:
Lumbar Stenosis
Disc Degeneration Disease
Spondylolisthesis
SI Joint Dysfunction
Pregnancy
Pelvic Floor Dysfunction
Hypermobile Thoracolumbar Junction
Bone Spurs
Hip Position
So, when someone comes in to see me and they say their chiropractor told them they have sciatica, I explain to them what sciatica is: a symptom of a greater problem. We need to dig deeper and find a reason, not a label, for their pain.
Lets look at a specific example of a client of mine. We’ll call him Harold. After a tragic surfboarding accident, Harold has a combination of rib and back pain on the same side.
Harold’s chiropractor told him he has SI joint dysfunction and gave him back stretches and lower body exercises to strengthen and stabilize his lower back. Good stuff. Pretty standard affair for SI joint dysfunction. Release the lower back and strengthen the hips to keep the SI joint pieced together. However, he was still having bouts of crippling pain and dysfunction. So he decided to book an assessment with me.
When Harold saw me, I found he had close to zero hip internal rotation and that he was missing a ton of segmental mobility at his lower back. We started working on the things I noticed, and guess what?
He started feeling better. His relief was lasting longer.
Did I do anything crazy, wild or out of left field?
Nope.
Do I think I know more than the chiropractor?
God no.
Am I motherfucking sorcerer?
Maybe.
All I did was listen to what he was experiencing, what felt good / what didn’t, and let him lead my assessment. From there, I created an individualized mobility and training program based off what I found
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Is it a Fair Comparison?
I met with a woman recently looking to get stronger and improve her endurance. On the surface level, those are both simple tasks. Lift some things with various number of reps, and give her an on-her-own cardiovascular program.
After going through her injury history, I could tell that there was something more to her goals than she let on.
I met with a woman recently looking to get stronger and improve her endurance. On the surface, those are both simple tasks. Lift some things with various number of reps and give her an on-her-own cardiovascular program.
After going through her injury history, I could tell that there was something more to her goals than she let on. She was diagnosed with a major back injury 7 years ago and has since developed osteoarthritis in the affected area. She used to be an elite performer in dance, and since the diagnoses has gained weight due to inactivity.
I could feel there was more to her goals than just to be strong as heck and run real far. There was something she believed she could be better at by achieving these things. I inquired in what ways she felt limited by her injury, currently.
She told me about when she goes on hikes with her boyfriend. She recounted how easy it was for him. How he could run laps around her. How different they were. I asked,
“Has he been diagnosed with spondylolisthesis?”
No.
“Has he been diagnosed with osteoarthritis?”
No.
“Then why in hell are you comparing yourself to him?”
Her response told me everything I had suspected. She was busy comparing herself to those classified as “healthy”. She related her current ability to her previous self. To this woman, she wanted to get stronger and improve her endurance because she felt like that would help her get back to the way things used to be.
But she was wrong to do that. She is two steps behind everyone else, and she should celebrate her willingness to overcome her condition. By looking at the perfectly “healthy”, all she’s done is create frustration and resentment internally. It has helped her create motivation to seek more help, sure, but I wanted her to start internalizing the goal of training with me.
With this discussion, we agreed that it wasn’t that she wanted to get stronger and run farther, but to improve her quality of life. To bring her back to a level of function she was at previously, irrespective of the situation she’s currently in.
So, I ask you, dear reader. Who do you compare yourself to? Is it a fair comparison?
Why I LOVE Coaching
It’s no mystery that I love my job. Ask any of my clients, peers or friends and they’ll tell you how easily rambunctious I can get when I coach, talk about my systems, or discuss my clients’ progress. I live, breathe, and sleep on a bed of love for my field.
But, where does this love come from?
It’s no mystery that I love my job. Ask any of my clients, peers or friends and they’ll tell you how easily rambunctious I can get when I coach, talk about my systems, or discuss my clients’ progress. I live, breathe, and sleep on a bed of love for my field.
But, where does this love come from?
On paper, my job is simple: Design fitness plans for people to help them reach their goals.
In reality: Coaching is a complex combination of interpersonal skills, critical thinking, research, trial-and-error and daily flexibility all under one umbrella of individualization.
Everyday I go into work and coach a motley crew of people with polarizing goals. I can go from an post-surgical ACL repair to an accountant looking to lose weight and hit a body-weight bench press to a woman who wants to resolve chronic elbow pain and also get stronger or a student with a history of lyme disease or even a doctor who really likes to deadlift.
When these clients win, I win. Celebrating the success of my clients is something I’m proud of doing. Their hard work amounts to feats of strength they never thought possible. Crushing deadlifts and smashing bench PRs are all fine and good. They are causes for celebration, but there is NOTHING that compares to when a client tells me how much better they feel because of what we do. I’ve had people come in shocked they did something without pain, joke about having to buy new clothes because they don’t fit, recant how their surgeon was surprised at their pre- and post-surgical outcomes.
I am changing lives for the better. I’m proud of the things my clients can do, I’m excited to see the things my clients will do in months time. I am proud of what I do.
An Open Letter to My Clients in Pain
I had a discussion with a client of mine the other day. She’s had tennis elbow for years. The physiotherapist she was going to prior had cleared her for exercise and she came to me. Still in pain, not feeling like her issues were resolved.
I had a discussion with a client of mine the other day. She’s had tennis elbow for years. The physiotherapist she was going to prior had cleared her for exercise and she came to me. Still in pain, not feeling like her issues were resolved. Nothing was working, and she felt hopeless. She used to love deadlifts, but due to her pain can’t pour milk into her cereal.
After 6 weeks of working with me, she said to me: “I feel frustrated.”
My heart broke.
Today’s post goes out to her, and extends to any one else in pain.
How are you feeling today?
It’s something I often ask you at the start of our sessions. It’s an important question because it helps me to modify the session and my energy.
Above all else, how you feel is important to me because I care about you.
Your pain is heartbreaking. I hate hearing how you struggle with daily tasks. It distresses me to see you see you melancholy and defeated. I care about resolving the pain and have emotionally invested myself into your success
When we train, I know I get excited about the seemingly simplest things. I celebrate when an indicator exercise feels better. I dance and joke when a perceptually easy exercise is difficult. I turn and combo-high-kick-fist-pump when you come in and say that your pain is less. You deserve to feel like a winner. You deserve to have your own personal cheerleader celebrating your successes and motivating you through the difficult tasks.
Your pain has become engrained into your identity. So much, that, pain and disability is your new normal. I want you to say this next part with me. Read it out loud to yourself and scream it to anyone around you:
“FUCK THAT. It is my right to be without pain!”
You are beautiful, strong and resilient. Now’s the time to start acting like it.
If you don’t believe me, I will remind you at every given chance. I will prove it to you, and I will force you to believe that it is your right to only feel like a winner. I will hire a motherfucking mariachi band to serenade you outside your office when you get off work.
Thanks for everything, and I’ll see you soon.
Your friend,
Kieryn
P.S. New homework next week :)