The remote client process

Posted on June 20, 2013

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This and all posts are always up to date. I’m always accepting new clients and try to never have a wait list of more than a week. If it’s ever longer than that, it will be posted on the site. 

One of the emails I write the most is detailing the remote client process. Because I’ve written the email so many times I figured I’d write it in a post so I can email potential clients the link. Here is a good look at the system / process I use. I suppose this is also my “pitch.”

To past clients, you may see some things here you didn’t receive. I’m constantly refining this process. I’m better at this now than I was 6 months ago, and will hopefully be better than I am 6 months from now. If there’s something here you don’t remember receiving, it may be I didn’t know of it at the time, hadn’t integrated it yet, or your situation didn’t warrant it.

Here’s how this goes:

Quick advice on filling this out: Think of it like a first date. You don’t need to send me every detail you can possibly remember. Instead, we’re just getting to know one another. Usually every question can be answered in one to a few sentences. I’ve had people turn this into a four thousand word response. That’s too much. I promise I will ask you for more information if I need it. 

  1. I have the person first go over any current issue(s), then any past ones.
    • Does anything currently hurt?
    • When does it hurt? Be very specific. “During the day” isn’t sufficient. When during the day? What time of day? What movements? When during those movements?
    • On a scale of 0-10, nothing to you’re ready to go to the emergency room, what’s your pain like?
    • On a scale of 0-10, how satisfied are you with your current function? (10 and you probably wouldn’t be emailing me; 0 means you probably feel like ripping your limb off.)
    • How long have you had the issue(s)?
    • Anything you think makes you better?
    • Why do you think this started? Are there any injuries in your past you feel are relevant?
  2. What’s your routinized life like?
    • What are you doing on a regular basis? What’s your profession?
      • Sitting in a chair 8 hours a day, commuting 2 hours a day, typing a ton, do you have kids, hobbies, etc?
      • How do you feel about your current life? Are you content, distressed, on antidepressants, or anything else?
      • If you’re having issues with pain, how has it affected your life?
    • What position(s) do you regularly sleep in?
      • Do you sleep well? Or is getting a full night’s sleep rare?
    • How do you feel from an eating perspective?
      • Are you content with your habits, feel you need to work on something, etc?
    • Are you on any medication(s)?
  3. What does your current exercise life consist of?
    • Exercises, sets, reps, times per week, etc. Be specific. “Legs 3 days a week” doesn’t cut it.
    • What equipment do you have access to? (If you do things at home, that’s no problem.)
  4. What are your goals?
    • Prioritize here. If your knee has been bothering you for 10 years that’s more important then wanting to see an extra ab.
    • At the same time, if you have 50 pounds to lose and you’re prediabetic, being able to do any exercise is more important than an achey joint.
  5. Send over some postural photos
    • A front, side, (other) side, and back photo.
    • Make sure I can see everything from your toes to your ears.
    • (Examples of how I assess people posturally can be found here and here.) 
  6. Photos are normally sufficient to get the ball rolling, but I’ll often request videos as well. (You’re welcome to send any videos you feel may be pertinent.)
  7. Where are you located? (I send programs on Mondays; first to those most ahead of my time zone, so they don’t get it too late in the day.)

From here I decide on a couple things. First, is this someone I want to work with? Not everyone is a good fit. Second, is this someone I feel I can help? It’s rare I don’t think I can benefit someone, but sometimes I may suggest something like getting bloodwork done before I’m comfortable continuing.

If we both decide to work together I formulate a spreadsheet. These are the tabs (individual pages) of the spreadsheet:

1) Miscellaneous notes

-> Rundown of the routine.

-> General health comments. Some pain education where I use metaphors and analogies. (For reasons found here.)

-> Rationale behind the plan with links to: Why I prescribe the sets and reps that I do,  why there’s no massage or manual therapy advocated, how much thinking to do during an exercise, how long to feel better, current things the person is doing which need to be eliminated, and other minor notes.

2) Goal(s) of the program

3) Strategy

-> If the person’s primary goal is something pain related, like shoulder pain, I’ll give a brief synopsis of what’s causing their issue(s). Using the person’s photos and videos, I’ll go over the primary movement issues and some quick anatomy of which muscles are at play. If I have something poignant I’ve written on the site, I’ll link them there as well.

4) Activities of Daily Living (ADL)

1) Sitting

2) Sleeping (This is pretty much cuts from my ebook on sleep positions.)

3) Standing

4) Walking

5) ADL timeframe

-> All ADLs aren’t covered immediately. Much like the exercises, which ADLs are focused on changes over time. If you’re someone who sits down 10 hours a day, we’re going to spend a lot more time initially talking about how you sit versus how you stand. Or if you have more pain when you wake up, gradually feeling better during the day, then we’re going to talk more about sleeping. You can only focus on so much at a time, but everything important is hit within 6 weeks or so.

6) Exercise form notes

-> All the exercises for the month are listed with links to videos. Exercises are listed in order of appearance throughout the month.

-> Videos usually contain voiceover from me with proper form cueing. I’ll also add text notes for things that person should specifically focus on.

-> I make the exercises work for whatever equipment a person has access to. If you don’t go to a gym, that’s fine. We’ll make it work.

7) Monday

8) Tuesday

9) Wednesday

10) Thursday

11) Friday

12) Saturday

13) Sunday

-> Details of what to do every single day of the week are provided.

->Normally 6 of 7 days consist of corrective exercises.

-> I always ask people to let me know if the schedule doesn’t fit with their life. We can always adjust.

-> One day of the week is dedicated to only ADLs, along with visualization exercises.

-> Sets and reps are provided, as well as progressions. “3 sets of 10” isn’t optimal. Some of this information can be found here: How many sets and reps to correct muscular imbalances?

->There is a mixture of days. I often give a few days where the exercises are done in a workout, circuit like fashion. Have 5 exercises? Do all 5, then repeat for the allotted number of sets. I also have days where the exercises are spread out. Three sets of three exercises for the day = one set of all three in the morning, one set in the afternoon, one set at night.

-> There are specific reasons to this madness. The body responds best to a certain frequency of exercises, at a certain rep range, and responds differently to others. It’s just like training for muscle / strength. Some exercises can be done more often than others. You wouldn’t bench press 7 days straight, would you? But you could stretch your lats everyday and not worry about it. (See the adherence notes at the end for more on this.)

14) Footwear

-> The cruciality of this is based on the person. You have foot pain? This is going to be a more extensive discussion. Knee or hip pain? We’re going to talk about footwear (like I did here), but you can’t assume changing your shoes to Vibrams is going to evaporate all your joint issues.

15) Supplements

-> There is a reason this is listed last: It’s the least important. Just like what shoes you wear, you can’t presume to add a few pills to your diet and all your pain will resolve. That said, any little bit I think can help a person, I’m going to use. Things covered include,

-> 3 supplements which can help alleviate joint pain.

-> Which pain pills are beneficial, which ones should be avoided, and the timing of when something should be taken.

-> Couple small items. Vegetables, fruit, protein levels, etc.

-> Nothing is fancy or expensive. If a person took everything listed it may amount to ~$35 a month.

Other notes and some FAQs

Handling your data

Full info in this post.

Follow-up

After the spreadsheet is sent the client and I go back and forth through email making sure things go smoothly. I ask the person to send me videos of them performing the exercises quite often in the beginning to make sure their form is on point. (It doesn’t have to be anything special. If you have a phone, you can usually place that next to something, hit record, and that’ll be good enough.) Any problems or adjustments needed as time passes are accounted for as well.

I try to get back to people within 36 hours, but with weekends and me traveling this isn’t always guaranteed. 48 hours is a very good bet though.

Number of exercises

A common reaction after the initial spreadsheet is sent is “Oh, I was kind of expecting more than this.” Then after trying some of the exercises the person will come back a a day or so later, “WOW! Some of these things are way harder than I thought.”

Because of factors like this, and the fact people are often doing things they’ve never done, I start with very little. Week 1 I give no more than five exercises, Week 2 another 2 or 3, and Week 3 another 2 or 3, for a total of no more than 10 exercises the first month. This is more than enough for anybody. Most people don’t nail the form of the Week 1 exercises til at about Week 3. The hope is as someone is starting to get comfortable with one exercise (they’ll do it 3 times a week -give or take), I add some more.

Lastly, per the order of the spreadsheet, the ADLs are more important than the exercisesand they often are an exercise in themselves. Therefore, most people are doing new “exercises” all day, everyday.

It’s not about one exercise

One of the common themes in my email inbox is people searching for one exercise. Everyone thinks there is some holy grail. That one stretch they’re missing. That one muscle they haven’t been attacking voraciously.

Based on how extensive all the above is -hopefully- this gives some insight into how things aren’t that simple. Exercises / stretches are important, but the principles behind what’s causing a person’s issue is what’s most crucial. Every single thing detailed on the spreadsheet revoles around that. It’s not one exercise that matters, it’s the exercises, the technique, how you sleep, sit, stand, walk, etc. There’s a lot to consider.

Adherence

I mentioned above there’s a “reason to the madness.” A big reason for why things are the way they are is increasing one’s adherence to the program. Some principles of adherence:

  • “Can you do it at home?” The more of this you can do at home, the easier it is for one to do, the more likely you’ll stick to it.
  • Gradually increase duration and intensity. Another reason to start off with a small amount of exercises.
  • Social support: For our ADLs, I often advocate getting friends or family involved. Always lean to the right? Get your spouse to help you notice this. Also, by hiring someone you right away have somebody to talk to and understands what you’re trying to accomplish.
  • Based off what day of the week it is one is going to be able to adhere to the schedule differently. For example, sometimes people do better adhering to 3 mini workouts a day compared to one long workout. When do people have trouble adhering to exercise? On the weekend. So, when do we have people do short, multiple workouts instead of one longer one? The weekend.
  • Have a goal: One of the first questions I ask clients is their goal(s). You always need something to strive for.
  • Get routinized: I’m not sure one could have more of a routinized plan than something like this. Literally everyday of the week is spelled out.
  • No pain: Anything that hurts you is, naturally, not something you want to stick with. I’ve heard many physical therapists go, “We’re going to need to put you in pain at times.” Phrases like this make my head want to explode.

“How long til I’m better?”

My generic answer to this is in ~6 weeks you should be noticeably better than you’ve been. This depends on a plethora of factors though. How well the person follows direction and how quickly they pick up things. Some people just won’t believe me no matter what. I’ve had people who took 6 months to believe a word I was saying and follow my advice. For some, this is genuinely a trust issue. They’ve had so many therapists and doctors tell them untrue things that I’m immediately grouped with them. (This is a big reason I attack these people at times, they’re making life for others incredibly hard.)

Other people have issues that just take longer. If you’ve had a fucked up lower back for 20 years, I can’t guarantee you’ll feel wonderful in just a month. 3 months? Ok, that’s better.

Then there is the aspect of this being a remote process.. Things can take longer when I can’t see you in person. If you only email me videos of your form once every few weeks, it may be 3 weeks til I catch you doing something wrong, which may be setting you back. However, I’ve had some pretty good success with people doing things this way. Maybe it takes a bit longer at times, but progress is better than the alternative.

For a more technical discussion on this topic check out this. 

Examples of remote clients

Here are some of my favorite testimonials from recent memory:

Rob:

My dude, of course I don’t mind. If anything, I’d wish that my case would help the next person avoid the common mistakes that I’ve made in this never-ending recovery. This post makes complete sense. It’s ridiculous how such simple concepts are overlooked…. Which I’m definitely guilty of.

Before coming across your site, I found myself sticking to what previous therapists were selling me… Telling me that it’ll just take time, or that I wasn’t working hard enough. Yet, I was following their protocol to a “t.”

Since my surgery, I was constantly told that my rhomboids were weak, so I needed to work on retraction, isolating the muscle, but never touching my upper traps because I wouldn’t want a hike with retraction. To be honest, before I took those pictures, I never knew my scapula was so stuck in adduction. From the time I’ve followed your protocol, I’ve experienced more relief and have regained more function than I ever did in almost a year of unsuccessful PT.

Rob

improving scapular motion

Mark, all the way from the UK, who is easily one of the funniest clients I’ve had:

Mark testimonial lower back pain

Jeremy, whose experience is more detailed here,

Hey Brian,

As usual, I would like to say thanks for everything you’ve done so far.

My daughter woke me up last night and I had a tough time getting back to sleep so I thought I might check to see if there had been updates to your site and I saw the recent post about my progress.  I am a bit floored that I apparently made enough of an impact to prompt a lengthy post detailing ways in which I have been helpful.  It is a great reminder of how important it is to be positive, a good listener, generous, etc.  It’s a sad state of affairs that my behavior has been remarkable, if that makes sense.

Anyway, I know I am paying you, but in a sense I can’t help but think that the impact you are having is lifelong; and how much is a lifelong impact worth?  I will never forget that hypermobility in my lower back is a problem, that posture matters, where my knees should be in relation to my feet, that my feet should point straight, etc.  These principles will be taught to my children.  They will move better and avoid injury better because of the work you have done with me. 

I already have people at the gym asking me if I got taller (I stand straighter).  The girl who videotaped my IT band stretch tried to do it herself and I cued her to pull her stomach in to get her back flat.  That cue has stuck with her in other movements.  So there’s another little bit of positivity that has spread.  

Many people saw me lifting big weights and then saw me doing all of these weird movements and not lifting any weight and had to ask what was going on. When I answered, a lot of these people remarked that I should become a trainer because I am able to explain well a lot of the things you have said.  Perhaps they will remember bits and pieces and get healthier based off of that input.  For example they may remember next time they aggrivate a back injury “I might be injured because I am moving my back too much throughout the day”, remember their odd sleeping or sitting positions, make corrections and get better.  You may never find out about these things.

The purpose of this email is to be a (semi) permanent reminder of the positive effect you are having on the world.  You mentioned you worked pretty much all of February, and I am not sure how much positive feedback you get with all of that tireless effort, so I hope this helps fill the gap, if there is one.

On a tangent, I have turned down a lot of “hot” Silicon Valley / Hollywood type jobs and am getting paid a little more than half of what I have been offered in jobs I have turned down.  The biggest reasons I have done this is because I feel that the idea that I will be happier with a significant amount more income is a lie.  It is more important to me to make less, if that means I have more time to spend on things that are extremely satisfying, like being a dependable husband, being a good dad and being a good person to the people I am around.  These personal impacts last far longer than the money.  I sense that you share my general priorities in that seeing other people being healthier is more important to you than becoming fabulously wealthy.  That being said, when I get my tax refund I am going to tip beyond what you are charging to signify that the effect is beyond what is common.

Stay positive and keep your chin up!

Jeremy

Jennifer:

“Hey Brian

I’ve been doing really well. I think this is technically week 4 for me, and I can’t remember the last time my shoulder felt this good. I’ve had way more good days than bad, and have been following all your exercises, as well as adding back in cycling.

I stand taller, on ‘two’ feet, and just feel better in general. I also don’t find myself hiking my right shoulder up toward my ear anymore. I finally feel like I can get past this and over come it, without it affecting my career, or being something I’ll just have to live with the rest of my life!”

Jennifer update

Some more general testimonials can be found here.

Interested in working together? Email me: b-reddy@hotmail.com and we’ll get the ball rolling.

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