How to be a good client / An update on Jeremy

Posted on March 18, 2013

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I went back and forth between quoting and screen shotting emails from Jeremy. The quotes are easier to read but the pictures help solidify a testimonial. Click any of the pictures to enlarge. 

In early February I wrote a post Example of a postural assessmentThis will make more sense with that as your preface.

Because of how well Jeremy has done with things in just a month I wanted to post a follow-up.

1) It’s always cool to give an example of someone feeling better.

2) Jeremy was pretty much a dream to work with. All of the things you look for in a client he exemplified. He just gets it. To all my other clients: No, this doesn’t mean you’re bad; it means Jeremy stood out and I want to use him a launchpad for what a good client illustrates.

3) I was thinking how there is so much talk what a good trainer / physical therapist / doctor / health professional is, but there is very little out there on being a good client or patient. Being a good client is just as important as finding a good health professional.

Continuing with 3): Because of how many people emailed me asking me to do the same thing for them as I did for Jeremy, I’ve been noticing some patterns.

Why you need to let whomever is helping you do the thinking for you

People who find me online are overwhelmingly much, much more analytical than those I work with in the “real world.” (Referrals and such.) This makes sense. For some of my writing you’re going to need either a fitness / health knowledge base to start with, have some level of an analytic / logic oriented mind, and probably be a foul-mouthed drinker.

For example, my post The best damn IT band stretch ever. Only certain people are going to read all that.

I sometimes run into a big issue with this personality though. I wrote in My visit to the Washington University in St. Louis: 

“From my own experience a lot of times a person who has no idea what they’re doing can be easier to correct than a person who does. The former person can be treated as, “Do this, not that, done” while the latter can be prone to overthinking and not doing the few things that are necessary.”

Seven months later, and dealing with a lot more of this personality because of the growth of this website, and I can say my belief in that statement has increased exponentially.

I literally just replied to a client’s email with this remark (in red),

Screen Shot 2013-03-11 at 2.09.10 PM

Therein lies the issue with having this excessive contemplation: The mind can only think about so much at one time, and really, it’s not much to begin with. When you’re focusing on 20 things you’re forgetting the one or two things you really need.

Here’s a specific example: In Another example of a postural evaluation I talked about how Jennifer needs to top tilting to the left. Said in simpler terms, she needs to stand up straight.

Jennifer S. Front Shoulder horizontal line

I’m working with a couple of other clients who have a similar issue. (Tilting / leaning / twisting is a common issue.) And really, the solution is not complicated. Maybe you need a mirror at times, but the main thing you need to do is make sure you’re not tilted and stand up straight. If you tilt to the right, tilt a little to the left. Or…just….stand…up….straight.

However, I see multiple people messaging me back thinking of things like which way their head is turned, if one side of their rib cage is lower than the other, should they lift one shoulder but lower another shoulder, 20 different muscles, can they rearrange their organs, etc.

STAND – UP – STRAIGHT!

You know what corrects all of those issues? I think it’s called standing up straight. And what’s easier to think about? One thing or the plethora of things I just listed?

Think of it this way: You’re a client and you have an issue with always twisting your shoulders to the right. Meaning -in regards to rotation- your right internal oblique is probably overactive, right external oblique underactive, left external oblique overactive, left internal oblique underactive. What would you think if, as a corrective strategy, I said,

“Ok, I want you to work on your twisting too much by under activating your right internal oblique and left external oblique, BUT activate your right external oblique and left internal oblique.”

If you’re smart you’d tell me to go fuck myself, as you should. If not immediately then you will after you walk into a glass door due to all that thinking overriding the fact you need to also pay attention to where you’re walking.

And while that may seem humorous and hyperbole, that’s how, as a client, you may sound to whomever is trying to help you.

As I wrote in this post, I don’t mind questions, it’s what you, the client, do with the answers that matters:

I’m not saying you shouldn’t question things. Of course you should. I love when my clients are researching things for themselves and coming back with questions. But there is an extremely fine line between being inquisitive and blatantly, pointlessly challenging the person you’re asking to help you. AND not listening to their advice to begin with.

Yes, if you come back to me with a question and I can’t justify my position to you, or why we’re doing X instead of Y, there is a problem. But after a certain point, and it should probably happen quickly, the person you’re asking for help should have proven their self to you. Once they have, let them do what they do. This is one of the biggest perks of hiring someone: They do the thinking and work for you.

Because of Jeremy’s profession -a computer scientist, I was apprehensive how things would go. A male computer scientist is about the most analytical mind you can find. Jeremy has been a breath of fresh air though. While he has fallen into the abyss at times (we all do), for the most part he asks brief questions, but trusts my answers and has implemented my suggestions beautifully.

Before delving into what’s made Jeremy easy to work with, I want to say the main reason I’m going over this is for you, the client or patient. If you’ve found someone you believe can help you (I understand this is not a given), then making that person’s job easy is one of the best ways YOU can get healthy, which is what this is really all about. It’s not about you understanding things that have taken me close to 20 years to learn (and I’m still learning everyday), no, this is about you getting healthy. Once you get healthy maybe then you try to learn all the nitty gritty.

A final example is myself. I make a living helping people with this stuff and what did I do when I had issues with my knee after my ACL reconstruction? I flew all the way to St. Louis, Missouri to get assistance. I guarantee I understood all these concepts better than most patients they’ve had walk through the door. I mean, seriously, how many patients walk into a clinic having read books from the university’s syllabus??? But that doesn’t mean I could be fully objective in diagnosing myself. There is no “objectivity” possible.

On to Jeremy.

How to email someone asking for help

Let’s start at the beginning. I’m going to address this more in another post, but suffice to say leaving a comment on a post directed at a specific issue, like knee pain, with your ENTIRE health history, consisting of many things having nothing to do with the original post, is not the way to ask someone for help.

First off, it’s distracting to the blog. Second of all, any health professional worth his salt is not going to be able to give much more of a reply then, “If I can’t see you, then I don’t know.”

Here is Jeremy’s first email to me, an example of a much better way trying to get assistance (remember, this helps YOU get healthy):

“Brian,

First, I would like to thank you for your site.  There is a lot of information there, and it is freely-available; I think that is awesome.  I will definitely donate via the Paypal link.  

Starting with a compliment obviously never hurts, and neither does a donation if you’ve found my stuff helpful. I’ve had people donate just 10 dollars (thank you -I appreciate it) but I’ll tell you that immediately makes me more likely to try and help them. It also shows the person is committed to getting better. Whenever you put money behind something incentives change. This is a big reason I rarely help someone for free. They just don’t value the help as much, so they don’t implement things as well, which can then lead to things like, “Oh that method doesn’t work.” When really the method was never given a fair shake.

I found the site by performing Google searches for various issues I have had that result in pain / injury to see what I might be able to do about them.

There was a conversation at the bottom of the article about stretching the IT band in which you criticized physical therapists in general for not knowing what they are talking about.  I have felt the same way.  I have seen a few PTs and trained with enough trainers / talked with enough people about dieting to realize that most people in these professions seem to have no idea what they are talking about.  And yet their opinions are widespread and appear to be the consensus.   It is difficult to find sound information amidst all of the noise.

Anyway, a lot of the information on your site makes a lot of sense, but because I have had so many different problems, and because, as you say, it is difficult to determine based on how I feel whether something is tight / too long / weak or whatever; I feel like I could use some help addressing my issues. I am willing to pay you for your time, because I believe value should be rewarded with compensation. Let me know if you are available to help.  You can put a testimonial / before / after photos up or whatever if you want to. 

This is fucking gold. And honestly, this is a big reason I decided to work with him. He, in his very first email to me, admits there is something he thinks  I know that he doesn’t, and is genuinely asking for help. I’ve already talked about not overthinking things as a client, and admitting the person you’re hiring knows something you don’t is a big step in listening to them.

Next, he freely says he is willing to pay for my time. This is more about the gesture opposed to the financial benefit. And don’t worry, despite sounding like a girl, I just checked my testicles and they are, in fact, still there.

Third, he throws another gesture my way by offering to let me use him as a testimonial on my website. I can tell you just by using him in the postural assessment post he has generated more clients and attention than I could handle. I worked so much after his post went up I barely remember any of February.

I am a member of Lyle McDonald’s forums (mostly a long-time lurker with very few posts) and have noticed that there are a TON of “I can’t squat because of pain” / “I got injured” / “I have bad posture” posts in the general training forums, and I feel like nobody is actually doing anything substantial to correct their issues.  I would like to be able to do full squats / deadlifts / bench press pain free.  I feel like “just stop doing those things” amounts to punting.  Feel free to correct me if I am off-base.

Lyle’s diet / training advice has helped me get and stay extremely lean while increasing in strength tremendously.  However; I am occasionally sidelined with injuries.  I feel like even though I feel OK most of the time, something is fundamentally wrong, leading to overuse injuries.

Now this is something I can’t expect many people to be able to do, but Jeremy was able to relate a common factor to me (we both follow Lyle McDonald).

However, this lets me know he took the time to look around my site before emailing me a question I’ve answered 20 times. For instance, the likelihood I want to help you get rid of your knee pain when you leave a comment on my site consisting of, “Hey, do you have any other advice on knee pain besides this post?” Because at that point my response is going to be, “Click the knee pain category.”

If you could help me out, it would be greatly appreciated.  Following are some recurring injuries I have had:

– lots of lumbosacral injuries, sometimes resulting in “pinched nerve” / leg numbness down both legs
– plantar fasciitis on the left foot
– left inner groin injuries
– right hip pops out of socket / accompanied by various pains around the joint
– right shoulder stiffness / overuse injuries during bench press

Giving me a rundown of what bothers him / what he wants to work on.

And here are some things I have noticed that I do / have:

– anterior pelvic tilt / lumbar lordosis
– torso leans to the left during squats
– left weights on the barbell hit the ground before the right during conventional deadlifts
– forward head posture (actively correcting with chin tucks)
– groin “tightness” prevents doing a “powerlifting” type squat with a wide stance
– squatting feel more natural with my left foot forward

General info:

I sit at a computer all day for work (computer scientist) and drive to and from work.  I have already changed the heights of things according to recommended ergonomic guidelines and have begun correcting my head posture and general sitting standing posture – this helps relieve lower back pain a LOT.

Again, Jeremy has clearly done his homework and researched my philosophy quite a bit. I can tell you it’s quite rare someone messages me going into details about their activities of daily living (ADLs). He clearly realizes how much emphasis I place on these things.

I am a recreational powerlifter (I like the movements), and not very competitive, but fairly strong at a lean 5′ 11″ ~170 lbs with bench @ 305, squat @ 345 and deadlift @ 475. The squat is something I have never felt particularly “strong” in and usually aggravates my lower back.  I have a decent amount of training experience per Lyle’s training guidelines, and my diet is great.  I own all of Lyle’s books and employ the principles accordingly depending on the particular goals I have at the moment.

I can send videos / pics of whatever would help you get a better idea what needs to be done so I can lift and generally be pain-free.

If I can’t see you, I can’t help you. Problem solved.

Thanks a million,

Jeremy

P.S. – I noticed you are from Morristown, NJ.  So are my grandparents and other relatives.  Pretty cool.”

Lastly, Jeremy’s email was very well structured and legible. When you email anyone who writes a lot this is important. The only exception to this is if you write me from an iPhone and you send me a few “duckings.” I understand this happening. The iPhone autocorrect can go duck itself with that one.

How to think as a client

So, for Jeremy I put a whole post together detailing what he needed to work on. While I don’t put entire posts and outline everything to that degree for clients, I do put notes for what they need to work on and will send some pictures with lines if necessary. Next, I try to be quite thorough in that I send clients a spreadsheet detailing what they should be doing 7 days a week. Literally, there is a Monday, Tuesday, Wednesday, etc. tab for each day of the week describing what to work on and think about.

To clarify, when I say let the professional you hired do the thinking for you I don’t mean as a client you don’t think. What I mean is the professional tells you what to think about, and then you go do that. As opposed to letting your mind wander on 20 other things that were never mentioned, and are probably irrelevant.

Using Jeremy as an example: I mentioned to him he needed to work on not tilting / leaning to the right. Here is Jeremy’s first email to me after this was brought up:

This is awesome, and a lot of information!  I just skimmed over it, but I will spend more time tonight trying to digest it all.  It is pretty funny how obvious some of  this stuff is when it is boiled down: everything you said I need less of are the things I have spent the most time doing, and the things I need more of are things I either have never done or rarely do.  I have made the mistake, like you said, of thinking about working x, y, or z muscles as opposed to thinking about the types of movements I was doing.  It is funny when you drew the red lines how much I look like I’m in a permanent squat / deadlift position.

As a side-note, I wonder if spending most of my life sitting on my wallet in the right-back pocket has anything to do with my higher right hip.  That and always reaching forward with my right hand on a mouse.  I only stopped doing both of those things relatively recently.

I look forward to reading this more and receiving more info in the future.

Jeremy

Do you see? One of his biggest priorities is his lower back; for his lower back I told him to think of anything where he is tilted / leaning to the right, and his very first response consists of two things immediately related to that. This is the line of thinking you want. NOT which muscle(s) should I be squeezing everyday. Because after this Jeremy emailed me saying he notices he leans when using two monitors, when using his car radio, and when sleeping. Look how many things he now has to think about correcting just based off this one movement!

This is another reason to only focus on one or two things at a time, even when it comes to your activities of daily living. Because you notice you’ll do a particular movement all – the – time.

Now, watch this, after Jeremy and I had a few long first emails, which I DO expect, he goes:

Screen Shot 2013-03-14 at 7.27.25 PM

It’s almost as if he could feel himself thinking too much / getting too wrapped into things. I then asked him how he felt after fixing his sleeping positioning, something I’d refer to as a “big win” (credit to Ramit Sethi on that term).

And what he did next is crucial:

To answer your question as to how I feel after switching my sleeping position: amazing.  I have been training myself to not roll over, which is not too big of a deal.  Overall, I have woken up rested every morning, which is fantastic. What a difference!

Finally, I could get someone to take a video of the standing posture, but I might just take your word for it that what is correct will probably feel unnatural for me. Let me know if the video is important.

He shut that shit OFF. All of our emails from this point on were dramatically shorter. They pretty much consisted of, “Here’s me doing the exercise, not sure if I did X right, let me know.”

Me: “Change Y on X, and send me a video of it back, otherwise good. Hope you got drunk after the Ravens won.” (He’s from Maryland.)

And again, to his credit, he would send me videos back practically immediately. He didn’t wait two weeks; he would send his workouts back right after doing them. I understand this isn’t easy for everyone, but I upload videos to Youtube multiple times per week. 10 minutes (max) out of your day, and maybe an awkward question to a gym goer to film something for you, is really not much to ask to get healthy.

If I can’t see you, I probably can’t help you.

Because after a certain point, and again, this should happen early, the person you’ve hired should make sense to you. In physical therapy, in nearly all circumstances, they should be able to go, “Move like this” = pain; “now move like this” = no pain. We need more of “now move like this.”

Of course, the professional has to make their case first. And no, I don’t always get this done as well as I would like. But, if you’re someone who’s been in pain for potentially years, and you’re finally hearing something that makes sense to you (I get this a lot in emails), doing things you probably haven’t done before, and feeling better, then shut your mind off and be happy.

How long it takes to feel better

I’m not going to go too far into this right now but I also want to mention any professional telling you your issue is going to take 6-12 months to feel better, is probably full of shit. (Note I’m talking chronic pain issues here, not you just blew your arm off.)

In fact, they should probably be able to do some things for you that make you feel better immediately. See Jeremy’s sleeping as an example.

Other than that, 4-6 weeks is a good ballpark for when someone should notice quite an improvement. They may not feel like God, but they should be feeling considerably better. If, and this is a big if, they have fully listened to whomever they’ve hired. You can’t keep doing the exercises you’ve been doing for 10 years, then just add a few of your therapist’s / trainer’s exercises, and expect success. Or, and this happens too often, don’t complain you’re not feeling better when a month into things you decide to reveal you refused to stop running. All you’ve done at that point is delayed feeling better by another month.

Or how you’re doing all your exercises but still twisting in your chair all day.

Or “I’m too busy. I have kids, a dog, job, etc.” Yeah, I know, it’s not like Jeremy had any of that going on,

Or how you’re still sleeping like you’re a member of Cirque de Solei twisting in 8 different directions. “Waa, I can’t sleep a different way, it’s hard, waa.” You know what’s hard? Being in pain all day. Get over it. Sleep is a habit like anything else. Either that or go to Vegas, start playing beer pong at 1 pm, get 18 people to play flip cup at 4 pm, and drink in the casino til 6 am. Never mind the fact you could have thrown at brick at my face and I wouldn’t have felt it, but I couldn’t even see half that weekend.

Because when you’re doing these things you’re not doing my or someone else’s program, you’re doing your program. And keep in mind which program got you fucked up to begin with.

Jeremy after a couple of weeks

“Thanks a lot for all of the help. I know it is probably tough to see what’s going on in my videos, but I feel like you are doing a really good job anyway. I feel like you are doing a good job because I feel better throughout the day.

Yesterday, I went to my grandfather’s house and moved a whole bunch of giant oak furniture pieces up and down stairs because his Parkinsons is preventing him from doing stairs. I felt like I had a better idea of what to do with my back and feet and all of that even from the few movements I have been practicing. I probably shouldn’t have moved furniture *at all*, but I decided to do as much as I could until I felt like it might be problematic. I was fortunate that I was able to do almost all of it without twisting and keeping everything close to my body while moving it, so it was all pretty easy. I feel great again today, so mission accomplished I guess.

Anyway, this is the type of thing that has bothered me in the past, and it feels good to not have “bitched out”  and to have really done something helpful for my Grandfather.

Muscles which attach to my spine in the lower back have historically felt really sore and tight, like there was some sort of “corpse tissue” in there with rigermortis(sp ?) or something, if that makes sense. I don’t feel much of that at all anymore. It is greatly improving. Anyway, I thought I would share that things are progressing well, even in such a short amount of time, and I am really happy so far.

Thanks again for everything. I will get you a video of the new exercise later.”

Jeremy Grandfather story

Progressing your activities of daily living

Much like the exercises / sets / reps, I like to change and progress which ADLs a person focuses on too. As I mentioned, Jeremy’s tilting was his first issue. As he got better at recognizing things of that nature we started working on his shoulders and elbows. I went over in his assessment how his elbows are too far behind his shoulders in his photos, so, he likely performs this movement (humeral extension) quite a bit throughout the day. When telling him to start focusing on this here was his response,

Also, ADLs are going pretty well. At least as far as recognizing things to fix. I caught myself: resting my hands on my hips with elbows back, walking with arms swinging far backward, carrying things with elbows back, reaching behind my car seat to pick stuff up that my daughter dropped, and laying on my side with elbows back.

Another example of how to think about things. Not “I need to stop using my lats, pec, teres minor, blah blah” (all humeral extensors) but “When am I moving my elbow behind my shoulder?” And when you find it, stop it.

The last point I’ll make here is you can see Jeremy sending me paragraphs about his ADLs and what he’s finding, which is fantastic. First, I ask people to tell me when they find they’re performing these movements because it helps me with future people as to what to tell them to look for. Second, not enough people do this. People will send me diatribes about the 3 exercises I gave them but nothing about how they’re sitting. And what’s more important, the thing you spend 10 minutes a day on or the thing you spend 10 hours a day on?

Walking, standing, sitting, sleeping. 

Jeremy after the first month

Me: “Was wondering if you could give man overall summary of how you felt / feel through the first month?

Jeremy:

“Absolutely.  I feel a little bit like “Daniel San” working with Mr. Miagi.  Not only do the movements I have been doing make me feel better afterwards (as long as I do it right and don’t revert to old habits), I feel like there is carryover into movements which “actually matter”, i.e. walking / carrying things, playing with my kids, etc., which I do much more often than the specific movements you have me do for my exercises.

A great example of this is the foot position during the hook lying heel slide.  I have found that as a result of developing that positioning, my feet generally have a “stronger” appearance, that I can walk and move better without pain in the feet and knees.  Needless to say when I am throwing my daughter up in the air or lifting something overhead, the tight abs, flat back, etc. of the overhead raises seem to be more programmed in.  Consequently, I can  have more fun without getting as achy or without having to stop short.  Of course, my muscles look a little “sequestered”, but there is plenty of time to work on that after I feel better ;)”

Me: “Great to hear! This is overwhelmingly the goal of the first month with someone like you. That is, just for life to feel better. As that’s accomplished other ancillary things, like how you look, certainly come into play. As they will for you this upcoming month.”

Screen Shot 2013-03-15 at 6.32.47 PM

And that, ladies and gentleman, is a great example of how you go about feeling better and getting out of pain.

Keep up the great work Jeremy.

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