Active listening tools for clinicians and people in pain

The thing is also, I think it's probably harder in a healthcare setting to go about active listening because active listening requires a lot of cognition, and you need to be pretty intentional and vigilant about what you're doing, what is the response you're getting, and what sense you're trying to make out of it. There's a lot of parts of your brain that are involved. If that is done on top of the actual medical assessment, that's a lot. When I do active listening, that's all I got to do, right? You're listening to the Restoring Human Movement podcast, where movement experts discuss the latest evidence-based practices to help you and your clients move with mastery.

And now, your host, Dr. Sebastian Gonzales. Hey, everyone. It's Dr. Sebastian Gonzales, your host with the Restoring Human Movement podcast. Thanks for joining the Movement Movement. If you have not heard this podcast before, it is in your best interest as a clinician to go through and listen to all of the ones prior to. I can't tell you how many gold gems are back there, which have literally changed the way I practice. In the past, I mean, we're about 160 or so into these episodes. So, please go back and listen to them. They're amazing, and it really helped me improve my clinical skills by actually talking to these people and listening to what they had to say and implementing it.

Now, as you heard on that little snippet today, I have somebody talking today about communication skills, as well as he's going to share a little bit about his own personal story, and it's kind of how we came to meet. He was having a little bit of an issue, and he bought some of my digital products, and he put the hard work in. You know, it's amazing to see. Like, he sent me an email about the changes that have happened in his life over the last year, and I about teared up. You know, it was like, it was great. Like, it was really good. And so, over the past few months, I've asked people to tell me reasons why this podcast should continue to be, because like all good TV shows, something's got to stop at some point.

And so, he sent me that in September. Sorry, it was earlier than that. I'm looking at a different email. He sent me that, and it really pushed me to do this podcast even longer. So, he'll share part of that story. But also, too, as a clinician, you're going to learn some language tools, some mirroring skills, some rewording techniques, and so on. Ways you can get more information out of your patients so that you can help them better. If you're a patient, you will get information from this. And actually, most of our podcasts are very, they're not technical. I mean, at some point, we'll get into a little technical stuff.

But the attempt is to reduce those things so that everyone can understand a little bit better. And I try to play a little bit more. I'll try to play a little bit more devil's advocate for everybody, too. So, just know that this, the intention of the podcast is to improve everybody's communication, not just the clinician. So, please do share with anyone who you think is going to love this show. Clinicians, please share with another clinician. The only way this show continues to grow is if you personally share it with somebody else. So, scroll down your little deal, your iTunes, your Overcast, your Spotify, and please share it directly with somebody.

As soon as you, when you hear a moment in this podcast, because I know you will, as soon as you hear a second where you're like, dude, that's great, share it with somebody. Please do that for me. I beg you. Now, as every show, I go into a little personal story so you guys get an idea of who your host is. So, hopefully you like me as Oprah and don't hate me as Conan. Not necessarily true in that order. Either way, though, I think you should like your host. So, let me share a little personal story about myself so you get to know me, and then we'll go straight into the content. So, if you're about the same age as me, I'm 38 now.

So, I guess a couple years ago, all of a sudden, everybody around you started getting married. And the thing is, you go to enough of these weddings, and you start realizing that people have the same playlist. It's ridiculous. So, there's ones like Play That Funky Music, White Boy, Celebrate, things like that. And so, I think we should have a list of vetoed songs. And so, I started proposing this to people, to the bride and groom. I said, look, do you want me to make your wedding better? Let's get all these songs that should not exist anymore at all. Like, actually, that are never played, other than just at a stereotypical wedding.

And let's dump them all. And so, some people, I've noticed, they're really receptive to this. Other people get really offended. And so, I haven't found a good way to really approach this yet, again, with the next wedding people. But I really want to tell them, again, look, like, part of the stuff that your D is going to play, it's just because it's like this stupid tradition that keeps happening. Like, no one listens to Play That Funky Music, White Boy, anywhere else other than a stupid wedding. And by the way, when you get up into the center state, like, when they say, everyone get around and get on the dance floor, and like, I want you to hug the bride and groom, and so on.

You make this big old circle, and all of a sudden, they start playing music and trying to get everyone to dance. That's shit, too. So, let's stop doing that one, as well. Anyways, let's get on to the content. Oh, there you are. How's it going? I'm doing well. How are you doing? I'm good. That's been a long time, huh? Yeah, it's been a while. Yeah. What are you eating there? Oh, pretty cheap breakfast. Oatmeal, cacao powder, and protein powder. Okay. Cacao powder and protein powder with... Okay. So, the cacao powder makes it super bitter, but you have sweet protein powder, maybe? There's no sweet protein powder?

Yeah, but I didn't put too much in it. Okay. Mainly just for not strictly tasting like I'm drinking a protein shake. Okay. Sounds very tasty. I didn't have any breakfast this morning, but I do have a really good coffee. Pretty good. That's great. I also got my coffee, which is not that bad, too. Okay. So, I thought, actually, we would... Actually, I made this... It's not live right now, but I'm recording right now. And so, I got to let everyone know that... By the way, if there's anything you want to cut out, just let me know later. All right. So, Alex's second language is English. He made sure you wanted me to say that.

Yeah. I know I think your email English is really good, and your spoken English is pretty good, too. Well, thanks. Yeah. How did you... What's your first? Is it French, is it? Yeah, exactly. And you're trilingual? No. Only two? French and English, yeah. I thought everybody from, like, a different country was always trilingual. No. That's a misconception. I think that's true for... That's true in pretty much everywhere in the world, aside from North America. Oh, because, like, Europe has all those little tiny ones next to each other? Yeah, exactly. Because if you're living in Europe, you for sure have a German cousin, and your stepsister is Italian.

So, just, it's so packed. I think everybody speaks at least two languages. And otherwise, usually, so, for example, like, Northern Africa or in South America, everybody speaks, like, their own native language. The, like, the language of those who colonized. Is that a word in English? What is it? Well, European people came around pretty much everywhere. Is that a colony? When they, oh, colonized in America, like, European people? Yeah, exactly, exactly. I mean, that happened everywhere, right? That happened in India, in Asia, in South America, in Australia. So, this is why all those people speak either Spanish or English.

And I guess they have their own languages. And they have, like, some around other culture. So, to my knowledge, we're just, like, it's North. North America really sucks at languages, but everybody is. Yeah, pretty much. We can't even understand some people from other parts of North America. So, like, I got a friend from Boston. We're like, huh? What are you talking about? Yeah. Who is it? It's, um, it's not Joe DeFranco on his podcast. He does not accept to say water because he's from New Jersey. He's been trolled too much. So, he says agua. Oh. I like that. My grandfather used to say, he would say, instead of wash, he'd say warsh.

And then instead of creak, he'd say crick. We couldn't break him with that either. So, he kept going there. So, I thought that, so the thing that, there's two things that actually spurred us kind of talking on this podcast, I think. So, everyone, we'll give them some rough feedback or rough framing is that, number one is that we were talking recently. And you've kind of given me some suggestions on how to improve podcast interviewing as well as patient interviewing. Just kind of how to get some good information out of your patient, build some trust, and so on. And so, you sent me an email with a couple tools of what to use with people.

And I shared that with some interns and some other doctors. I'm like, wow, that's really good. So, I thought that would be a good topic of this podcast. But also, too, you have a good personal story of recovery I thought that we can cover as well. Which one do you want to cover first? Actually, I think it makes more sense starting with the recovery story because it kind of builds in how I ended up sending you those emails. Okay. So, you had originally some finger and shoulder and stuff like that, right? And I had mentioned that you bought some of those books online that I had. And then I just ended up giving them to you and you proofread them?

Yeah. Yeah, exactly. Basically, the first story of the story is maybe three years ago. I had kind of an injury. It was basically a concussion-ish, some neck pain. I had been hit at work. And I kind of never totally recovered from them. I kept having rough times with lights, and I was feeling kind of dizziness pretty much all the time. And then also, I had cramping pain in my upper back, difficulty raising my arm overhead. And I was feeling, I was getting numbness in my, sorry, my pinky. And I've been through like a few different, maybe more classical passive care physio protocol, where I was basically doing double chin all the time.

And I was told it would go away. And I eventually like lost my trust in those people. So I just figured out, well, I'll fix myself. And through doing this, I started to read way too much stuff on way too much places. And what actually happened is that I read your article on bodybuilding.com about functional gap. And I read it and I was like, damn, that was good information. And it was not about bigger bicep. Because I was pretty frustrated with the content I was getting. Because I was kind of looking to understand what were my brain problems. Because I wasn't sure if I was having problems because of my neck, which was still a source of pain.

Or it was just like I was really slowly recovering from my concussion. But I was trying to get information to solve that problem on bodybuilding.com, which is not exactly where you're going. Yeah, how did you get in there with that? My first concern was... That's actually a good question. Yeah, fixing an overhead press or something. No, no, no. My belief was that I had cramp in my upper back because I was rounding too much. And I thought that I started rounding just so I could just overflex my upper neck. So it would kind of keep still where I thought I had an injury in my neck. So my belief was that I needed to get some hypertrophy in my upper back in order to put my T-spine a little bit more upright.

So anyway, I ended up on that article. I listened to your podcast once and then I thought it was interesting. I let it slip. And I don't know why. When I was on a trip in France, I thought of it again and I re-listened to it. And from there, I ended up listening to pretty much all your podcasts. And that was pretty nice because from the first episode I listened to, I was like, I'm trying to get information to handle my own health problem. And that was basically like your podcast was meant to accompany people and to help them get a grasp of what was going on. So I was like, I wish the podcast was for me, right?

So that's what happened. I listened, like I binged to them. And at that time, it was, I've been like struggling with like, like sometimes I was just taking the bus. And if I sat in the bus ride, the impact of the bus on the road would give me like neck pain. And we need to lay for like four hours. Yeah. Not able to talk. So it was, that was like three years later, right? So I was pretty discouraged. And it's at that point I decided to write to you. And you've been really nice and you've replied. And this is where we started bouncing emails around. Yeah. How many, I wonder how many years ago was that?

I can look back on our first emails maybe. Gosh, I see, well, I see all the way back 2018 of, oh, I see 2018. So just over a year. Is that over a year ago? Seems like longer. Yeah, a year and a month. So you've done, you've made some pretty good progress since then. Just kind of with self-help. And I know that for clinicians will often tell people that, and I agree with that, and an examination is definitely needed to make sure to roll out red flags. I think it's the biggest thing that we are worried about that people are just ignoring. But when the person takes really good responsibility and they kind of absorb the information and they're empowered to do this stuff, I think you get some pretty good results.

And so how are you doing now so everyone kind of sees where you've gone over a year? I'm doing fine. I have no more dizziness at all. I have no symptoms that involve loss of cognitive function or dizziness or hypersensitivity to lights or anything that involve my eyes. I'm actually having pretty good overhead reach. I would consider myself as being resolved. I still have sometimes some numbness in my finger. I do believe I'm pretty sure I have some kind of damage to my cervical spine, which would explain. But I have no... Only times I have issue coming up is inactivity, right? Like if I do push-up, for instance, to a certain threshold, I get wrist pain.

But it's just once I fatigue, right? So if I stay under that fatigue threshold, I have no pain. I can accumulate a lot of volume. I can do pull-up. I would love to slowly build. But see, my concern is keeping good technique when I'm under exhaustion, right? So I'm pretty fixed. You're a functional gap in it. Also, too, I think this is an important part. The clinicians will probably... They'll like this part probably. So last time we talked, you were smoking. And so now you don't smoke. I think I'd say something like, oh, you're smoking? That won't help you. And so... Well, we had a call of maybe 25 minutes within which I smoked like twice or three times.

So I was like, okay, I might talk about it to him. Yeah, that was... But that was... It's surprising that... Because most people aren't going to drop it that quick. And you said you did get a personal trainer. And so you have some guides with you. So I think just this is like... You're like the perfect example of patient empowerment. You're doing all the things on your own. Dude, for real. Like, it's funny. Like, we have... Like, clinicians will see... Like, they'll tell someone to do something. And it's frustrating. You tell someone to do something. And they mean well, but they don't do it, you know?

And so just kind of the thing with... At least what I tell people is like, I don't try to be an asshole about it. But it's like, look, I've recommended this one thing to you. Do this one thing. And they come back, they're like, oh, I didn't do that one thing. What else new do we do today? And it's like, nothing. We just... Like, I need to see the data points and see what... If it improves or makes it worse with that one thing. Because you throw too many things, there's too much shit at the fan, then it's going to break the fan. So, especially when they're acute or they're spiraling the drain or something like that, you know?

But no, you've done a lot of your own work. And I think everyone can probably tell that your logical reasoning behind things, they make sense. Like, you're in control, I think is the thing, you know? Oh, totally, totally, totally. So, by the way, the hit that you got, was that from when you were working with kids? Did a kid hit you or is that... I was working... At that time, it's actually kind of sad but also funny. I was working with autistic people. And in that precise day, I was in a teenager group who were playing basically cat and mouse with one of the teenagers there, which was something like, I don't know, 250 pounds.

So, it was like a way bigger teen than I am. But it just kind of... That's the thing with autistic people. Sometimes there are a few things they don't get, they need to share. So, he decided to become the cat. I think the mouse, but I've not been told. So, he basically just like ran into me. And as I was running towards him, right, I was at an angle where my head was in front of my body. And I just hit a wall, right? This guy was probably like, I don't know, 80 pounds heavier than I was. And I did not expect it to hit. So, that's basically what happened. I had previously concussion when I was at high school for being dumb and playing football.

Without equipment with my buddies. But that's the thing. And I basically got really whiplashed hard. Because I did not add a direct hit to the head. I received basically his shoulder in the middle of my chest. And my body just like stopped. And I had whiplash. So, you don't play football anymore or rugby anymore? No, no, no. And I ruptured my ACL twice playing soccer. So, I'm going to mainly focus on climbing now. Yeah, how often are you climbing now anyways? Right now, I don't. Because I wait for my ACL. Oh, you recently ruptured that one. Yeah, like two months ago. Oh, gosh. Okay. So, yeah, we can just get you doing pull-ups only.

Just free-legged pull-ups. Exactly what I'm doing right now. I'm doing pull-ups like three times a week. That's pretty much what I'm doing right now. Dude, you're going to be like a beast. So, I'm getting good. I'm getting good. Yeah. Dude, have you done actually like mountaineering stuff? Like actually outdoor climbing, or are you just only doing indoor? Only doing indoor. Just because of the cost, right? Right. Yeah, the outdoor stuff would just be insane. So, I'm sure you've got a lot more things to climb out there than we do here. Actually, not that much. Oh, well, you're in California, right?

Yeah, southern. Okay, yeah. Everyone forgets there's different parts. There's not necessarily much in Quebec, I think. Well, I don't know. There's not a lot of hill, but it's not totally flat either. But I don't think Quebec is recognized as the holy grail of outside climbing. So, is Quebec kind of like our... I think you're in our central time zone. Is it like our Great Plains? Like there's nothing there? It's just flat, and then you hit many? No, no, no. That would be Alberta, Manitoba, and Saskatchewan, which are basically the center. Well, we call it the Great Plains, right? Oh, Quebec, you're way over on the East Coast.

Yeah, exactly, exactly. We're just in between Ontario and like the actual coast. So, we're kind of... Let me get a U.S. map. So, you're a fisherman city. No, that's the neighbors on the East. We're basically, we're like on top of New York, Massachusetts, and is that New Hampshire? Yeah, that's New Hampshire. But we're not connecting with the coast. That would be New Brunswick. Okay, good. I'm going to plan my Canadian ship pretty soon. Great. All right. So, but yeah, thanks for sharing the story. Yeah, I think your recovery was, it's like when I got the email, I'm like, dude, like you've done work.

Like you've done a lot of work. So congrats on that. It's a lot of hard work. Thank you. So I think that everybody, clinicians will be really interested in your part about communication. Because actually, it's, I know that you're in a healthcare related field too. So when you wrote me these examples, they're so specific to like what actually we would have, what I have talked about with a patient. Like Joe chose you the passive care option. Joe thinks he needs to be massaged to reduce muscle tension and cramping. And can you fix me a little bit? So like these are actually very pertinent to what we experience all the time.

And however you think we should go through these, I'm open game, but I think your communication skills and tools will be very useful to everybody. So how would you like to tackle this? You're the teacher in this. All right. So basically to set up a little bit of context, what happened was, as you said, I kind of proofread a little bit of your stuff, which at that point was real nice because I was in a dark place in regard to my health. I was feeling powerless for a long, long time, and I started to really love the info you were putting out because it was pretty much designed and meant for people to apply to themselves, right?

So it was totally responding to what I've been craving, which was sense of control. So I get this, but at some point, I spend a lot of time thinking, just thinking stuff out, and I'm listening to your podcast and a few others because you've been like my stepping stone drugs to other sources of information. And so often, I hear some problems. I just figure out what my job is, which is basically, because I'm not exactly in the healthcare sector. Right now, I'm working with young adults, which are homeless or at risk of being, and we're kind of working with what has to... We're getting jobs done so they can be autonomous in their own apartment, basically.

We're working on making sure they can remain in their places. What we see is people chronically get back in the street, right? So for whatever reason. So we're making it so they can maintain their in-home status. So basically, I'm listening to your podcast, and I'm trying to think how I can contribute and how I can give back. And I just realized also you often name problems when you talk with other clinicians. I'm like, dang, I think I could solve this. So I eventually just, I don't know. I don't remember how I did it, but I just suggested you that I could share you a little bit of tools, which were basically like basic tools of active listening.

And now I figured out it could be helpful. So that's pretty much how it came about. I don't know how you want to go with it. I think, well, I can tell you at least on my side. But reading the emails, they were useful. By the way, the English was good. They were useful. The first one, though, I think it took me like three weeks to open it. I looked at it, and I'm like, oh, my God, there's a lot of information. There's a lot to apply. I've got to put this down for a sec. And so I think I responded a couple times with, okay, I got it. I got it. I'm going to read it. Yeah, I had a sense of guilt. Yeah.

The thing, though, I think that was challenging to me to apply some, and I still don't know if I'm – I'm not actively applying it on a daily basis for practice, you know? I think I'm getting better at it, but it's still – it's like – it's so foreign to like, I guess, clinicians, or at least to me, to – you're like, you got someone in front of you right there. You think you know what's going on, and you just want to get for it, you know? But I think we forget about the person that's in front of us, and you have to play that little cat-and-mouse game a little bit to get them to trust you. So the application of it for me was challenging, and so that first one that you did was a mirroring skill one, and so you gave me a little – you gave me mirroring skills, and then the recent email, which is about a week ago, we talked about – you mentioned rewording, and so – Which, by the way, I think for boat is not a good translation. I didn't look it up, but I'm sure that's not the right translation.

For rewording. I'd probably say echoing. Like, it's – I think reformulating or reformulation is actually the right word. Okay. I like that. Wow. I did a lady the other day, actually, that she – I kept hearing that she kept talking about the – like, we were doing – we were doing something for a cervical disc, and so she kept saying she had some knots in her neck. And so she's like, but these knots are not going to go away, these knots, and like, blah, blah, blah, right? And so she kept – we did a little exercise here and there, and she would kind of wince, and I'm like, is everything okay? And she's like, yeah, I'm good.

And I'm like, well, why are you wincing? And she's like, well, it's just the knots again, but they're not going to go away. And so finally I had to – I tried to reword things a few times without her getting mentally combative about, like, I'm not discounting what she said, but I hear what you're saying. You got these knots in your neck, and they're really painful in the location where the knots are. However, knots are not always painful. And so I tried to do a little rewording with that, I guess, or reformulation. So these are the way these skills kind of come into play, but again, it takes it like an active – when students get out of school, this is not necessarily taught, but there's a lot more – like you have probably heard me interview Don Murphy a couple weeks ago.

In his book, there are sections on biopsychosocial motivational interviewing. So part of these things are starting to come to fruition in our clinical skills. But does that help you kind of lead into – that was my long-winded segue. Yeah, but basically, yeah, but – and I'm actually interested because when you sent me the email about what you wanted, you wanted to go directly about what it is. So the thing is also, I think it's probably harder in a healthcare setting to go about active listening because active listening requires a lot of cognition. And you need to be pretty intentional and vigilant about what you're doing, what is the response you're getting, and what sense you're trying to make out of it.

There's a lot of parts of your brain that are involved. If that is done on top of the actual medical assessment, that's a lot. When I do active listening, that's all I got to do, right? Yeah. I don't figure out if the tibia ends stay where it needs, or I don't see how a muscle glides or whatever, right? That's all I have to care about. But basically, I think, let's say, for example, for what's about mirroring, I think the simplest stuff is the reason why it's useful, and I'm curious to know how you feel you're doing about it, is that it gets stuff out of the way. It's kind of, I don't know, like, if there's, let's say you drip some water on your floor, if you put, like, direct sunbeam on it, it'll just evaporate.

That's pretty much what goes for a lot of feelings. Like, for your lady with her nuts in her neck, right? It would be easier if I've been there and I've seen her body or language or whatever, but it keeps going back. It could have been just you're uncomfortable with your neck and, yeah, it could have been just about, or let's just say what you've, I think what you've done is pretty good. I would just separate both. Go ahead. Just, just, meaning, like, you're getting a lot of discomfort from those nuts, for example, I don't know, answered them and said, yes, blah, blah, and you give it attention for maybe two, three minutes, right?

Or not even that much, but just then it's bothering you a lot, right? Yeah, it's, and she'll go on for why it's bothering her, right? Maybe it's when she's driving, it's hard to look on the side, whatever. And then you, by itself, it would probably be less, it would take less space, right? And then I would go about giving the information that it's not always painful, just because she would probably feel, she would give more, even though your information is of the same quality and is as relevant, because from her perspective, she has been, she had been allowed to elaborate on why it's a problem for her.

There's more sense to be made of the information you're offering, even if it's the same. You said the exact same word. You said that two minutes later, so now she receives that information in a context where she knows you know what she feels about it. Oh, so they want to, you got to let them be heard a little bit, and then you kind of, like, you can just gather information. So we call it collecting data points with, I mean, that's all relevant stuff. It's nice to know the mechanics of it, but at the same time, it's like, okay, we got enough information. We can just do something about it, and it's kind of like when they pile more and more on, it's like, okay, I got to type this, too, and so there's other things that go on during which, but the, so what I'm hearing is then let them say their piece, and then tell them your piece. Yeah. Does that sound right? Yeah, exactly, and this is where you'll use either, usually, probably, rewarding would be more useful, like that, in that case, just so you validate, I've heard your piece, and then they get a sense of what is about to tell me, takes into account what I feel, or what I believe, right? So, and this is where you gain report, right? And this is also where you, your information, the information you share is perceived as being relevant to them, right? So, because they have the knowledge, you've understood what they said. So, you basically take care of letting them, it's pretty psychological, right? But it's because I think people are rarely sensitive to the methodical way an assessment is done. Like, people have no medical training, right? So, for being involved in that process, a lot of times, when the person is just like making me do tests and move this, does that, it's painful, blah, blah, blah, blah, blah.

You don't feel taken into account as a person, right? But you have no knowledge to help you understand that the healthcare provider is actually figuring out what's going on. You don't feel, yeah, that would be the thing. So, and that's the thing, when you feel unheard or unlistened, or you don't get a sense that the healthcare provider is caring, you get a sense of resistance. When I received treatment from someone who was like basically telling me to shut up about the fact that I was feeling powerless or they were like, and moving on to the next steps, I was like, fuck these guys. I would not, the way they were behaving about my subjectivity like the way I went through my symptoms, the fact that they were not showing openness to it kind of gave me, I don't know, it's kind of, from that, it brought me to believe they were not caring.

It gave me just, it gave me a weapon to distrust their judgment. Now, a really quick break from our sponsor. Pro Chiro Online CE is a brand new platform for online chiropractic education. A lot of times through different states, many states, online hours are allowed. So if you've already been a chiropractor for a while, you probably realize, hey, I didn't get credit for that course and that course, but I need some hours, my birthday's coming, all right? And so this is a really common problem, and if you're just like me, you've gone online, and you've gone through these courses where you literally don't learn a single thing, and it's boring, okay?

So we've actually mitigated this problem. Myself, Philip Snell, Ben Ramos, all the people you already trust, curated content together with some of the best presenters on certain topics, and you get credit for it, all right? Consider, though, one of our participants did say that he would have taken the video courses, he would have watched them regardless of if he got CE credits or not. So remember that. The videos in themselves are amazing. The content is amazing. The clinical pearls are amazing, but you get CEs as well. So go check it out. I promise you won't be disappointed. Now back to the content.

So as I'm reading it then, if we, basically, the way I see it is kind of like the first barrier with person, with somebody is just to, you just got to break down a little bit of their resistance and build some trust. That way you can do what you need to do. Exactly. And that comes from using some type of active listening, responding to them like a human. You know, when they get excited, you get excited. You know, not in like a way where you're trying to manipulate them, but it's like you're trying to be friendly. Does that sound right? Okay. I think it is. You think? So yeah, did they just tell you to actually be quiet with it?

They're like, okay, that's enough. Like, we're going to do this. Or was it more of like, they kind of just kept you turning away? Really? Wow. This or other more subtle things that would manifest that you don't have time for it. For example, it would be like avoiding visual contact or just mm-hmm, mm-hmm, and mm-hmm when I had a question, right? Like, okay, you're not actually listening, right? It was not the expected answer. I asked about what was going on with my arm, and you, mm-hmm. I'm pretty sure that's not the bone you're talking about, right? It was a mm-hmm bone. We just got to make one up.

Mm-hmm, exactly. It's funny. I'm thinking of going through, like, so I can, I've noticed sometimes when I go through an exam with people, so I'll, I try to do it in the same room because it puts me in a situation where I'm comfortable. And so even like I see on podcasts, like I ask different questions to people in podcasts than I do in life. It's just, I don't know what it is about the situation, having the things on my ears. I don't know what it is, but it's like makes it comfortable for me to do my job better. In the exam room, though, I've noticed that, so I'll try to take, they'll have an intake form that is done first.

I'll know their pain scale and blah, blah, blah. And so I'll kind of write a little bit of rudimentary notes in the beginning. That way, I can just take notes on the pertinent stuff later. However, when they're talking observationally with people, like they start talking about like their hip. And so I start looking at their hip. And although they're still talking, I'm kind of movement assessing to figure out what they're doing. And so it's kind of enlightening for you to say that they're not looking you in the eye. Because sometimes I'll look down and around and, you know, actually at the office when I'm working with someone, when they're doing something on the ground face down, sometimes I'm looking at their glutes.

Because I want to see if they're using them. Yet in a normal situation, a normal world, I'm ogling them, you know. Oh, yeah, yeah, yeah. But it's interesting to see that maybe we've got to improve on, still get that trust out of the person, and then partition away the exam into like a different part where it's like, okay, I'm going to be looking at different parts of your body now just to see how you move. And just kind of... You got it right there. In the same example, if you know you're going to, I don't know, you're doing some type of special test that requires a lot of attention because it's subtle, right?

I don't know, you're testing how this nerve moves, or if you get a bigger pulse on a vein on one side or the other, I don't know what you would do, right? That would require a lot of attention. But just to state, okay, from, let's see, I don't know, Tracy, from this next part, Tracy, I want you to not talk just because I need to be really focused to really be available to detect what goes on with, let's say, your ankle, right? Tracy just, like, that's actually a great way to build a report. I've just told you, I'm going to be 100% dedicated to that task, so I'm unavailable to exchange with you because I'm involved in the care or the assessment, right?

So you don't let randomness into what's the sense going to be made of your behavior. She knows why you won't listen or you won't answer back. You know, she's not left on her own to know why, to interpret why you don't answer back, right? So that would be great. If you can't, you just, like, on that part, you need to focus on how they move, et cetera, et cetera, just state it. That would be great. I would have felt super good if I've been told, like, hey, man, I'm trying to focus on your pulse, right, on your wrist. Just keep it quiet for a moment. I would get it. Okay. That sounds good. The, like, I've gone the route of frame.

I try to frame things for people in the beginning because I'm going to be doing certain things, and I know that with, let's just say with, like, movement testing, I'm looking to dynamically test to see if, like, say they put their head forward and it hurts, and I have them do it with their arm over the head, and then it's a little different, and they might not realize the relevance of arm over head. They think I'm just making them do silly tricks. So, I'll usually start with, I'm going to ask you to do some things that are seemingly unrelated to your problem whatsoever. Please do work with me on this.

I'm collecting information, and if you have a question, stop me, but, like, if, I feel like if, like, I've had people in the past that are like, why are we doing this part? It's like, just, like, at this point, it's like, please just work with, like, this test can go very quickly, or it can take 10 minutes to explain every test to you, and it's not conducive to me helping you, really. But, anyways, I've been starting to do that a little bit more, and I think it's tended to work okay. Well, you know, in that case, if you get a sense that the, hey, just trust me on this doesn't work, I would just offer the choice.

Like, let's say, the person you're working with, right, you ask him to raise your arm overhead, and it's like, he's focus, focus for him, doesn't get what you're doing. It's like, well, I can go to a thorough explanation of why it's relevant if you want. Just if that's what you want to do, because you need to understand what I'm doing, fine, we could go about it. Just understand that's going to cut on the assessment time, right, because I can do both at the same time. If that's a real concern for you, I want to get to it roughly, right? I would go about it, and I'm pretty sure from just that, the way you would treat their concern, 90% of them would be like, no, no, it's cool. I trust you now. You've been so great. You're so nice.

How could you not do your job? I think that's because in my job, for example... That was Tracy, right, by the way? That was Tracy's voice? Tracy, totally, totally, not me. I wouldn't speak like that. But in my job, for instance, a lot of times when people are like, why are you doing this? Sorry, questioning me. I just offer them to respond, just with knowing... Because if you're straight up answer, kind of panicky, like, oh, you have a question, I'll give you the answer. It gives a sense of, not weakness, but you're kind of looking docile. But if you're just like, man, if you want to know, I'll tell you.

But it's at the cost of spending that time on something else. Most of the time, because the thing is, the person don't really want to know how raising arms overhead relates to the pain they feel in their neck. They want to feel that what's happening is good for them, right? It's not about gaining information. It's not curiosity that they're experiencing. So responding to it by giving them options, you give them power, basically. You give them control. If they don't understand what they're doing, something, there's a sense of loss of control. I went to see that guy. He's supposed to fix me. Now I'm doing circus stuff.

What's going on? I gave money in it. I want this treatment to work. That's pretty much what's coming up, right? Not necessarily in these terms. But that's what's rising. And if you go, well, just caring, just saying like, bro, if you want me to insert it, I will. But basically, I'm pretty sure most of the time your clients, your patients are going to be, no, that's cool. Go ahead. Go to me at the end of it. Yeah, I think, yeah, that's a good point. I think, yeah, I hope no one's left here thinking that, but I'm sure they have. There was, actually, the way you brought something up there, it made me think of something as well, is that, you know how like you go to the grocery store and the grocer's like, or the checker's like, did you find anything okay today? Would you like a bag?

How's your day going? You know, like they're not speaking to you like a human. They're speaking to you like a robot that works at the cashier's desk. And then there's the other cashier that goes up. They're like, oh, man, did you buy those chips? Like, I had those chips the other night. Oh, man, they're so good. Like, hey, what are you doing this weekend? And it's like a real interaction. And so I think clinicians go down the route sometimes of being the robot. And I know that I've done this quite a few times where it's like, okay, so I'm going to do this. I'm going to do this. And then I feel like they're not listening to you.

I'm like, bro, like, I don't think you understand. Like, if I was explaining this to my brother-in-law, here's how I would explain it to them. Dude, you're being a dumbass right now. Here's what needs to happen. Are you open with that? You know, and so I'll kind of say it as if I'm saying it to some other person, not them directly. But I'm trying to change my tone so they understand that I'm being serious about it. Is there something of inflection or maybe some type of dialogue style that needs to change with certain people based upon their, you know, like, you get what I'm asking there? Yeah, yeah, yeah.

Okay. Kind of like adapting. Yeah, yeah, yeah. I think one thing that really works well to break the robot stuff, because it's kind of inevitable, right? If you're going through the same stuff, like, I mean, the cashier at the grocery store, you're actually like, I don't know, like the 73 of the day, right? We're going to have the same question, bag, air miles, blah, blah, blah. So, of course, you need to have something else than what you're actually saying to break, like, the monotony. I think when you see, when you get a patient who asks a lot of questions, or is, like, kind of checking, like, what's your schooling, or seems anxious, wants to ask about a few things, like, that would have been me.

That's, like, anxiety, powerlessness. I think when those things happen, good things to do are to get more silence in your communication. That's something that a lot of people get uncomfortable with. But to pause, to take a second, to just kind of what you said once for me with emails. You were like, man, just skip a few lines. Do, like, not a big paragraph, but a few sentences. It's less, it has more appeal for the eyes, right? It doesn't seem as much. When you speak, doing the same exact thing kind of helps. It kind of helps you to structure. Like, okay, he's telling me it's going to be okay.

He's explaining to me the problem. It's just about, like, how I stabilize my hips. Now he's telling me that I should improve in a few weeks. And just to bring down the rhythm, just like I'm actually doing right now. I feel calm. Kind of helps. And I actually do, too. As I'm speaking to you, it's calming me, too. But I think that's one thing. If you feel like the patient you're working with is anxious, I think that's one thing. I think using their name, that's something. Yeah, that is a good one. If I was to talk to you and I was like, Seb, in regards to your communication, or Sebastian Gonzales, I don't know how intimate we are.

So there's some sense of hearing your own name that kind of gets through you, right? That would be one thing, to help the person focus and remain with you, with what's going on, with the assessment. And then go back and say, holy shit, am I going to be okay? What's wrong with my body? And trying to help them to stay out of their own head. That would go with that. Being calmer, using a little bit more silence, slowing down the rhythm, using their name. Visual contact, that's kind of helping. I think that would be pretty much it. I don't know. What's the typical patient you get? I guess there's the anxious one.

I'm pretty sure that that's happening. What else? There's some. So yeah, that one, there's other ones that I don't get quite as many of these. But on phone conversation, actually, we get a fair amount of them, but they don't always make their way in. We need to convert these people a little better. The patient that knows what they want and knows what they think will work for them, these are probably the hardest for us because we don't want to be argumentative. And we want to give them what they want, but at the same time, what they're asking for is probably not what they need because it hasn't worked yet.

So that's probably another common one. Okay, cool. And what you're doing with them up to now? Like, let's say you're actually converting them, right? Let's say they actually show up at the clinic. What's the, what's working? What's not working? What's your problem? I don't know if it's, I don't know if we're having a problem right now with converting them when they're at the office. Or getting them to come a couple times anyways to get the results they're looking for. There is a conversion part, which I can, I can tell you later on, on other things that we're kind of struggling with. But I've, this, this will sound kind of like, it'll sound bad, but I think it's intended to create, it'll, it's intended to create questioning on their part about what they thought was really what they need.

And so, that basically, when someone comes in, and they have something, let's just say they have a hand numbness, right? And they're like, it's my carpal tunnel. And you do a little test and stuff, and you're like, okay, you're like, thinking it's not that. And they keep talking about their carpal tunnel, and hey, what hand stuff should I do? And do you think I should adjust the hand? Do you think we should massage the hand? And you're like, okay, so that's not it. And so, through the exam, my responsibility is to prove this person wrong beyond a reasonable doubt and get them to agree with me.

Because I need them to come back for a second day to really get them to, like, they're not going to assume this overnight, I don't think. So, in those people, usually I'll do an examination which proves beyond reasonable doubt that what they're asking for is maybe incorrect. Or what they believe is happening is maybe incorrect, and that's why they're in the position they're in. So, do you have any? And when you're going through that process, are you just, like, letting, like, your assessment speak for itself? Or are you actually announcing this is your intention? I don't announce it. And so, I, like, I'll usually assume a lot of the words they say, they say, oh, this upper trap tightness is really a thing.

I'll say, oh, yeah, that upper trap, like, it's, yeah, so here's what happens sometimes, and what are you experiencing, blah, blah, blah, right? And so, I'll say, great, cool, in this test right here, I'm going to see if I can increase your trap tightness by moving your hand, right? And so, just let me know what happens, and so they're like, huh, yeah, that's, when I bring my hand back, yeah, that's more. I'll say, cool, like, curl your fingers now, and they're like, oh, in a way. I'm like, okay, that could be a coincidence, let's do this test again. And so, I'll do it three times, and it's, like, three times, like, huh, that's interesting.

I can turn your shoulder pain or your trap pain on and off by moving your fingers. There's no, the trap doesn't attach there, so what else could it be? And so, I kind of, like, go down that route with them, and then we have a little conversation. And typically, I'll have to reiterate this again later, but the reason why I do that is because sometimes the remedy I'll give them is not the remedy they're looking for. But I feel very confident it'll work, and so I need to gather the data points to figure out if it's going to work, and they need to do it at home. Got that? Yep. Okay. Was that an okay way to go about?

How can I improve that? I think, but, well, first things first, don't fix what's not broken, right? For those of you who come around, I mean, to some extent, that's nice. Your patient are trying to get information. They've been, their counselor is Google, Google, see, Dr. Google, which is not good, right? They either will, neck pain, and then it's like, oh, upper traps, and that's it, right? Finger pain, carpal tunnel, or cancer, and like, oh, shit, okay, I have carpal tunnel, right? I'll take that one any day. Yeah, yeah, yeah, but they're coming in, it comes from a good place, right? If you just go through your assessment, as you did, and they're like, oh, whatever, I thought I needed upper trap stuff, he's playing around with my rib cage, and now my ankle feels better, I don't get this shit, whatever, I'm cool.

If they're fine with it, let it go like that, but if you're having someone who's pretty firm on what they want, I would probably go, just do a little remix of what you've done that like, so let's say it's, what was she called, Tracy? If Tracy absolutely, I don't know, wants to have something done with her hands, because she has carpal tunnel, I would go about it as a, look, Tracy, from my assessment, I would tend to believe it's something else. If you're telling me, you're pretty convinced it's carpal tunnel, and I would offer her the choice of like, and I would acknowledge her. I think that would make a little, a lot of the, like, control-seeking behavior go down, just like, it's your own body, this is what you feel, this is what you believe, I want to go about it, see if it helps. If it's not, though, would you then allow me to try something else, right? So I would kind of get them involved in the problem-solving solution, right? Because if it keeps coming back, that means they have a strong belief that you're not, their problem is staying because you're not choosing the right solution, and in that case, it's totally sure, I'm sure, Tracy goes back, she will not do their, her home exercise, she will not, because she does not believe, she does, she does not trust you, and at that point, it's kind of, it is probably super frustrating from your point of view, right? Because she's like, not using the medical relevant information you have, but that, that, that is probably frustrating for you, and you, there's probably behind that frustration, a good sense of firelessness, right? Because it's like, well, fuck Tracy, do what you got to do, and I'll become a good doctor, but if, if you don't take my advice, I'm, I'm not useful, right? But if, if for those patients, I think I would go about giving them what they want, while saying, I'm not sure, you, you might be right, we're both in this, my belief is this, your belief is this, so I'll go about the adjustment, or the end care, whatever, but if, this is what we do based on our belief, it's a carpal tunnel. If it doesn't resolve your problem, we'll try something else, and I would, I would frame it, and use those words where you're both involved in it, because you don't want to get in a dynamic where it's like, I know what I'm doing, I'm an expert, I'm a doctor, and she's like, Tracy down there, like, because then you're going to get in, in certain, some sort of a fight, or a confrontation. That's, that's how we would go about it. Do you, that's how I, go ahead. Do you think on that person, then, is it, like, because we really, I would, I would love to, like, say, get super creative on each person, and give her something which is, in theory, good for a carpal tunnel, but also good for my theory, too, and so, at that point, let's just say, if I sent her home with, like, I usually see people a week later, and so, I sent her home with her carpal tunnel exercise that she wanted, but also, I give her the one I wanted, just by modifying what she wanted, and she gets better. Is this now a thing that, it's like, I know you said, don't do the he was right, she was right thing, but does it even matter?

Or do we just give her the one thing for carpal tunnel, and let her disprove carpal tunnel, and then, now we won't have as much resistance going forward? I would, I would go about it. I would go about it, probably that way, or depending, right? If someone is kind of, like, you don't get a big sense of resistance, or they're, like, you would kind of assess how you want to go about it for the in, the homework you give for in between the first visit and the second one, depending on how they responded to what you said, and how they were telling themselves the story of their pain, right? But, if we, in the case of Tracy for carpal tunnel, I would probably go, I would show a lot of interest of what she's expecting. Like, how does she frame in her head the relief she's seeking? Because that's what's going on. That's the thing. That's actually something I want to write an email to you about, but it's a, oh, that's going to be, you're going to love it, but I need to really conceptualize this quickly. Okay, basically, go about it as if human beings have, like, basically five needs, which we don't need to go all about, but basically, there's no hierarchy. It's the most, it's the lowest, the one at the lower level of satisfaction that is the number one priority, right? So if this week I feel like I don't have, I feel like I, my need of power is not satisfied, that's going to be my priority. But next week, it might be pleasure, right? There's no one that is more important. When, and we go, humans go about satisfying these needs, kind of like going to a catalog, right? When I see, and for some reason, I get a certain picture in my head of satisfying that need to an action, right? When I spend time with a girlfriend, it's not about her, it's about love, right?

It's to satisfy my need of love. But I don't go about it thinking that way, I just think she's the one for me, right? But that's also true on the larger behavior of seeing a healthcare provider going, see Sebastian Gonzales. If someone comes in your office looking to resolve their knee pain, because they're a runner, and they fucking need to run like 70k per week, you're kind of instrument, you're a tool in kind of a quest towards power, you're probably running to exert some sense of control over themselves. It's a way to control their body, probably has a direct impact on how they feel. If they could not run, it would probably have a big impact on how they do at work, how they handle their marriage, right? In that case, they want to get back on track. These patients are probably totally disinterested. If you told them like do naked jumping jack, they would go about it. They don't care. They don't feel to be taken care of by you. You're a tool. You're the guy who fixed their knee so they can go back about like being a runner because they run. That's what, if, however.

I wish everyone could see the video of you right now. Yeah. Yeah, I'm kind of using my hands a little bit. Yeah, you're going to knock that shelf down behind you. No, no, she's, I've done it myself. It's pretty sturdy. It's fine. Even though there's like actually nothing on it. You got like four L brackets for the, for the distance of about like, like three feet. It's actually, uh, no, it's further than you believe because it's actually seven feet. Oh, and, and this one was intended to be for, uh, like school books, but they're really thick. Oh, they're going to go high school trophies. Yeah, but I don't want, I don't want them to fall on me because I'm actually sitting on my bed right now.

So I've, I've, um, I'm, I'm stinging in a dilemma. Do I put deep, heavy books over my head when I am asleep? Maybe, maybe if you got some trust into it and you, uh, it listened to you more, maybe then it reworded what you said. Don't fall on me. Yeah, yeah, totally, totally. Yeah. If I ever hear my shelf feeling, I feel like you feel to my mercies, that is, okay, my shelf is understanding me now. I can lay down. But if we're going back to Tracy, right? Tracy would not be that wrong. Tracy is probably coming back with some sense. Um, like when you add a problem ongoing, a health problem ongoing, if you've been seeing other providers, you, you're probably coming in with a more of a safety issue.

You don't feel safe in your body. You don't, you, you, if you start to have a relationship with your body where you, it's kind of a traitor to you, or it's painful to have a body or to be yourself or. Or, or, or you, you've kind of getting like good buddies with the idea that, that this come physical discomfort is like the baseline from which you exist. Right. If you're just like, okay, cool. We're going to, then like this, like California dude who's like, bring your arms overhead. No, no, no. You have an numbness, but it's not your hand. Like, okay, well, you don't fit with the kind of the tone of the sense of that behavior.

Right. You kind of relax. It is good. I'm eating pistachios. Yeah, yeah, yeah. Like mismatching like the emotional, I don't know. I'm totally inventing Tracy right now, but how I would go about her with, I would frequently go with, okay, cool. What do you expect? What do you want? And of course they'll say, I want to be massaged, et cetera, et cetera. But I would try to figure what is it about that picture in their minds that makes them believe they will satisfy the needs they have, right? So I would go, okay, cool. And what would be nice with being massaged, right? Well, I would, and she might go about, I will get less muscle tension.

I will feel relief. And I would keep showing interest, like genuine interest towards what she's seeking. And if needed to explicitly specify, I want to understand what you're looking for. I want to know how I can help you to get there, right? And once you'll feel, and you'll see it. When you put your finger on it, people are like, that's the thing. That's the thing I'm looking for. Once you get to that point, then, as we said sooner, then from there on, if you're actually saying stuff like, no, no, no, but it's about your shoulder, Tracy knows. She knows that you're in it with her because she needs to get some relief.

That's what she's looking for. At that point, she knows, she feels like you have both the same goals. The sense of trust you'll get out of her will be just way more than if you, she just feels like you're getting in the office and doing your stuff, right? Because to her, at that point, it's not a medical problem. It's an issue she's having, right? So if you go about it with your medical perspective, which she can't share with you, she can't make sense of it, and she does not trust you, right? The fact that you're a doctor or Cairo is not enough to disprove how she feels for a long time about her stuff.

So once I'll get about, let's say, and I would focus on her need. Is that too much? No, no, no. Do you need a break? No. Do I need a break? I'll keep going. And from there on, I would focus on reworking to get your relief. Just to make sure that we both understood each other and to kind of let slide of the carpal tunnel. We're looking for relief. And the more it's clearer for both of you we're looking for relief, then her assumption that relief will come from treatment of a case of a carpal tunnel is secondary to the fact that we're looking for relief. And I would emphasize on this. And I would stop giving medical information on what's the issue.

No, actually, it's probably more cervical thing. Let go of this. We're looking for relief. And I will send her home with a homework that would be related to relief, right? So today, as we're testing if massaging or adjusting is giving you some relief, I would like to know, I would like to study, to observe how this relief maintains or how it stays, how it behaves, how your symptoms behave through the weeks. And before I let her go, I would suggest, usually, how long do you keep that relief? Have you been, blah, blah, blah. And if she says something like, I usually last just for a day, right? Well, let's see.

If these symptoms come back, or if you feel like you're losing it, maybe you could try this. It's complicated. The appointment is over, so I can't go about it. But I think it could give you some sense of relief. Okay, cool. And you let her go. But it's not an homework. Because if she comes back, and you ask her, have you done your homework? Oh, keep going. Keep going. Sorry. All right. Keep going. No problem. So if you give her homework, and she comes back, and she feels like she failed, or did you do your homework? No. Okay, what did she do about it? She did not do it, and now she knows she's deceiving you.

Yeah. So the homework thing, and also because it puts you in a bad spot. As the provider, it puts you in that, come on, man. Fuck you. I have one thing to do. Yeah. Where do you go from there? Like, I know it's frustrating, but so I would not give her homework, and I would question her how her sense of relief lasted. Even if that means for the three first week, she's like, oh, I feel pretty good when I leave your office, but I go, let her experience that relief, and by herself, she'll come to you about, hey, doc, what can I do to keep it? So let her come a little bit more to you. Yeah, totally, totally.

Because if the person comes in looking for relief and feeling they need security, and they just want to have, like, just some time off, they just want, they wanted to let it go. If you give them a homework, if you're telling them, it's your destiny, you have to do this, it's on your shoulder, they're like, fuck, man, I came here to take something off, to get it a little bit lighter, now you're telling me, like, it's an everyday thing? That's daunting, that's discouraging, right? So sometimes I think you just need to start by, okay, cool, we're going to be the, you'll feel better team, and once you kind of get a taste of it, oh, shit, I kind of like this, how can I keep it?

And this is where you're like, oh, active care. Alex, thanks so much for being on to part one. By the way, everyone, this is part one, because it was interesting to me, I want to keep asking questions, and we did a whole second, about 45 minutes to 50 minutes on it. So tune in next week for the remainder of that. Alex is going to, he's going to choose to remain anonymous at this point, just because he does do some social work, so he doesn't want to be necessarily searchable. However, in the future, there's a possibility that he might release some written work, or he's actually going to keep emailing me some of the stuff that he's putting together.

He might make a book at some point, he said, so he doesn't really know what he's going to do with it, but he's just really enjoying the process with putting things together. So keep in mind that if you do get that information from me, that I don't intend on proofreading it or sending it to an editor. He is English second language, but it is very readable and useful information, so please don't judge if you end up going that route. If you're interested in that stuff, just reach out to me, info at p2sportscare.com, and I'll compile stuff on a Google Doc, just as it's kind of given. And who knows later, if there's enough people who are really interested in having it, then I'll formally put something together for everybody, and I'll put it in the show notes at that point.

So, but Alex, thanks so much for being on. It was very useful. Part two, everybody, is we go even deeper into some of the stuff, and we keep doing some bullshitting. So, as always, thanks for being part of the Movement Movement, and refer this podcast to one of your colleagues or your friends who you think would really benefit from this information. The other way this podcast continues to grow and spreads the good word and improves ourselves as a profession and making us better as humans, hopefully, is if you guys individually, personally share it. I do almost no marketing efforts for this podcast.

It's growing organically on its own, and I want to thank everybody so far for doing all the reviews and for sharing it with people, because I know people are out there doing it. I'm just encouraging you to do a little bit more. Thank you so much, and I'll see you guys next week for part two.