I spend more time with some clients because they are heavily invested. They have paid their fees, did their homework, but the results were subpar or maybe took longer than expected.
That happens. I’ll be lying if I said it didn’t.
It’s humbling to be a chiropractor.
When I work with clients and they don’t seem to be getting better, it’s a good reminder that we don’t know everything. For that reason, I am thankful for clients who are slow to respond. As an evidence-based chiropractor, I keep up to date with scientific research so I can provide the best clinical care.
It’s really a process because if nothing works in 2-3 months down the road, it is okay. We can try something different. If not, I can refer you to someone else who may be able to help you.
Clients who never get to 100%
I do have clients who never fully get better. It’s really interesting because they usually blame themselves for not being fully pain-free.
They could attribute their imperfect recovery to laziness, poor discipline, lack of determination, poor physical fitness, or their own clinical history. I do not condone such narratives.
Interestingly enough, these clients never blame me.
According to them, 80% or 90% improvement means all the world to them. As for me? I want more.
While I do acknowledge that some chronic pain patients will continue struggle with recurrent symptoms despite receiving best evidence care, I don’t believe that we should give up prematurely.
As long as the client is willing, I always push towards 100%.
So, here comes client X.
Client X saw me for a total of 7 times last year for neck pain. We did two follow up reviews after to see how things are going because his recovery was not 100%.
Since then he has been largely pain-free.
He attributed his bad days to poor exercise programming. The concerns were:
• What do I do if the exercises hurt? Do I keep going or stop?
• How do I know if the exercises are what I need?
• What if I do the exercises wrongly, how would I know?
These are really good and valid questions.
When it comes to the barriers towards long-term recovery, most clients cite the lack of knowledge or understanding to be able to advise themselves or self-manage.
The assumptions of solution-focused coaching
I am a big believer in coaching because coaching facilitates change that is driven by the coachee themselves. In that sense, the coachee is not dependent on the coach in the long-term.
The most important point is that coaching is not therapy. Coaching is designed to facilitate effective, long-term change.
For solution-focused coaching to work, we have to at least accept the following assumptions:
• Clients are always cooperating.
• Clients are the experts of their own lives.
• Clients have innate capabilities and resources that can be identified and utilised.
• Clues to the solutions are often right in front of us if we can recognise them.
• Small changes can lead to a larger change.
They may not seem like much but that certainly changes the dynamics between the client and myself.
Once we have accepted these assumptions, I no longer become the source of information and answers for my clients.
Within this framework, the client observes, learns, understands, and acts on events that occur within their internal or external environment with facilitation from the coach. In doing so, they are able to find their own solutions to a given problem.
This is where the magic truly begins.
Point of clarification: I DO NOT assume the client knows everything and whatever they do is right. The assumption is that they have access to resources which can be utilised to help them achieve their goals. To some extend, I can be one of these resources.
Step 1: Know where you want to be
I often ask clients how confident they are of achieving full recovery by themselves and what do they need from me to increase this confidence.
I find this line of questioning to be more empowering and more process-focused than if I were to ask how was their pain experience for the last week. After all, this is the solution-focused — not pain-based — approach.
So for Client X, he established that he needed:
• The knowledge and skills to determine if he should continue or not continue with an exercise if it hurts
• The knowledge and skills to determine what may be the right exercises and the right execution
These are briefly the goals that he had set out for himself.
It was clear to me that Client X understood the dynamics of a coaching relationship or what it would take to achieve long-term results.
He didn’t ask to be told what to do so he can find freedom from pain. Instead, he asked about he could build on so he can tell himself what to do in his pursuit of pain-free living.
Step 2: Know your strengths
If you are a new client, this may be harder to apply at the early stages of recovery.
It’s about trying to identify — not understand — what has been working for you.
Most of us intuitively do things that help us feel better without the awareness of what these may be. Part of this exercise is to tap into what is already working for you.
Client X had worked with me for seven sessions last year with two follow-up reviews a couple of months later. He has been doing really well with mostly pain-free days.
In short, whatever he is doing is working.
So, I asked client X what has he been doing that is working well or have always worked out well with him.
“I don’t know. I think of doing it and just do it.”
You may find yourself in a similar position. You simply don’t know what is going on!
Here’s the thing: It’s totally okay! I am here for you — should you need it — to help you find clarity with your recovery!
After several prompting to encourage self-reflection, we managed to get down to ten things that are working out well for him.
It’s important to note that these observations and evaluations are 100% from Client X (zero contribution from me):
• I am good at motivating myself
• I am good at positive framing
• I am good at getting the results I want
• I am good at managing time
• I am willing to explore new things, to explore options/help
• I am proactive at asking for help (e.g. ask fit colleagues for advice)
• I am determined to learn/do my own research to have a good understanding of what I don’t know
• I take a wholesome approach to overcome my problems
• I know how to priorise tasks/activities that are important to me
• I have learnt how to manage load: exercise vs rest/recovery
Personally, I think this is an impressive list.
Especially if you take into consideration that Client X is not a superstar patient with outstanding 10/10 results! He was definitely putting in the effort and digging deep to came to these realisations on-the-go.
Step 3: Make your strengths relevant to your goals
By this point, it became clear to me that Client X has enough to drive his own recovery.
Remember our assumptions? The client has innate capabilities and resources that we can tap into to bring them closer to their desired goals.
My follow-up question then was if these 10 things are enough to help himself move forward.
He answered no.
I encouraged him to share more about the barriers that could potentially hinder his progress. Following which, I prompted him to consider what in his strengths could overcome these obstacles that he identified himself.
Obstacle 1: I still don’t know what to do.
Solution 1: Ask people for help
Solution 2: Do my own research
As Client X started to realise that it is possible that he already had what it will take to reach 100%, he quickly moved into his second obstacle.
Obstacle 2: Aiyah! Maybe I know what to do but just not confident enough.
Solution 1: Try new things, see what works
Solution 2: I am good at positive framing
For me, his realisation that perhaps he already knows what to do is a big step from the “I don’t know” headspace.
What do you think?
Interestingly, as he shared more about his perceived lack of confidence and the possible solutions he could apply, he came clearer of what he was struggling with:
Obstacle 3: With so many possible exercises, I don’t know which one will work for me.
Solution 1: Do it and then see how
Solution 2: Asking people for help
Remember, these are not my suggestions! The only prompts I gave are to encourage Client X to consider how he could apply what was already working as well as what he was good at to the obstacles he had highlighted.
Step 4: Exploration-based learning
This is by far my favourite part of recovery!
I asked the client for examples of exercises that he was struggling with. Particularly about those that he wasn’t sure was done properly.
He listed the deadlift exercise as well as another exercise (which we did not explore during the session).
This client have had some previous experiences with deadlifting. He wanted to check-in to see if he’s doing it right.
If we worked in a chiropractor-patient framework, I would have asked him to demonstrate a couple of repetitions for me, critiqued it, and gave recommendations on what he could do better.
This wouldn’t help my client learn how to work things out for himself.
Because we were working within a coaching relationship, I refrained from passing observations or providing advice.
After he he had done a couple of deadlifts, I asked how was his experience. He was able to tell me a few things but it was evident that there wasn’t a clear self-critique process.
I encouraged him to try a few more repetitions. This time focusing his attention to making observations of his own movement, physical sensations, and thoughts.
Following which, my prompts were:
• What do you like or not like about the observations you have made?
• Were there anything within what you have observed that may be a risk for injury or decreased performance?
He shared that he could tell his toes were flaring up during the deadlift and that there was a soreness/tension in one of his calves.
He did another couple of repetitions to see if he could address the findings he made. With this set, he was able to keep his toes down. However, there was still some sensation in his calf.
One problem down, another to go.
He wasn’t sure if the sensation was a risk for injury. He felt that it was possible that the sensation was nothing but yet at the same time it could be an early sign of over-training or injury.
He simply wasn’t sure.
That’s totally fair, isn’t it?
Clients often share that they aren’t really sure what they are doing at home with the exercises but they did it anyways. Even when working with a professional, uncertainty is normal.
In traditional healthcare setting, this is probably when we’d do a mini-lecture to “educate” the client on the relevant information and perhaps what to do next.
I was determined to facilitate self-directed change so I held my tongue and asked Client X, “what can you do to be sure/to increase your clarity of the issue?”
At this stage, he mentioned that it was possible he was paying too much attention on the calf during the second set given the prior sensation in the first set. He suggested trying the deadlifts again while trying to defocus on the calf to see if the sensation is still there.
If the sensation was gone, it’s likely that he was over-thinking or over-focusing on the calf.
If the sensation is still there, then perhaps it is something more serious and that will need more testing to get to the cause of it.
We ended the exploration-based learning at this point due to time constrains.
Step 5: What you practise grows stronger
The client was tasked with two homework:
1. Continue with the deadlift and exploration. Once he has more confidence with the observe, interpret, test, and apply process, explore other exercises with the same framework.
2. Set a physical well-being goal and program a 12-week exercise plan to help himself achieve that.
In a perfect world, I would have preferred for the client to come up with their own tasks or homework. Unfortunately we were tight with time and I did have another client scheduled after him.
One of the solution-focused assumptions is that small changes can lead to a larger change. Prescribing Client X with homework that was decided by me does not undermine the progress that he had made within the session itself.
Arguably, this was the biggest success we have had in the last six months.
At the end of the session, we did have a hypothetical discussion (initiated by the client) on what are the possible ways to execute various testing.
We went through a couple of examples:
Sensation on the calf could be a risk for injury and possibly from lifting too heavy.
Testing: reduce the weight to see if sensation resolves or reduces. If so, it is more possible that the weight is too much.
Sensation on the calf that only starts in the next morning. Potential risk for injury and possibly from lifting too much.
Testing: reduce the volume during the work out next week to see if sensation resolves or reduces. If so, it is more possible that the volume is too much.
Client X’s goal was to be able to self-manage his own recovery/workouts moving forwards.
While he may not have left my office with straight answers, he certainly understood how to better apply load management principles to his own training.
He also left with a practice that will help him develop the competencies necessary for him to achieve goals attainment.
You are enough
Don’t let anyone tell you that you need chiropractic adjustments three times a week for the rest of your life.
You have innate capabilities and resources that can be used to help you attain the goals you desire.
Sure, maybe you don’t have what it takes right now but, through this blog post, you know that there are ways that we can facilitate the change required to help you get there.
The fact that you have made it to the end of this blog post shows that you have access to resources and that you know how to find help!
If you have been 100% dependent on your chiropractor for your pain relief for the past years and you are looking to take a leap of faith to managing your own pain, book in an appointment with me via the form below to discover the difference the right care can make. I promise Square One Active Recovery offers pain solutions unlike any you had seen before. Let me help you find your own freedom from pain.