The Value of Self-Limiting Exercise
In your book, “Movement,” you describe self-limiting exercise and how this form of training does not allow us to mask our weakness or inadequacy. How can we imbue this form of mastery to patients and athletes in today’s fitness and sports culture?
I’ll start it with a legend that’s associated with the kettlebell move called a Turkish Getup.
A long, long time ago, if you went to a school of strength—a place where very, very strong people gathered—where the lifting of heavy things occurred and you said, “Please, master. Teach me how to lift heavy things,” the story is that they would introduce you to a Turkish Getup.
Until you could do a massive amount of weight on both your left and right side in a Turkish Getup, they would not teach you. They would say, “When you can get up with a heavy thing on this side and then when you can turn around and get up with a heavy thing on that side, come back to us and we will teach you how to lift extremely heavy things.”
In other words, “Get your mobility, stability and symmetry racked and stacked. Get your carries down. Get your flexibility right, and we will help you get strong because 90% of the work will be done. We’re simply going to demonstrate some techniques that would take you years to learn on your own.” That’s what education is—us showing you a better way once you can hear and do what we’re talking about.
There are life lessons in those old stories. It goes back to the Karate Kid (whichever version you’ve seen.) You’re not just painting the fence, waxing the car and sanding the floor. You are learning movement patterns. We will use these resources later to help you become resourceful in both offensive and defensive combative movements.
Some patients just don’t get those analogies; the reality that we’ve got to make certain things hard and we’ve got to restrict participation in the next level. Progressing could impose potential risk and you will also have poor adaptive capability on a large scale.
Very few people with your limited ability will be successful at adapting at the next level, so we’re going to restrict access to the next level of stress, the next level of complexity, the next level of capacity. You simply statistically aren’t a good place to adapt. There’s plenty more to work on right here.
It could be said of training wheels that they don’t make you a better cyclist. They simply keep you from getting injured while you’re trying to develop some volume and confidence. Training wheels do not correct your ability to ride. They protect you from injuring yourself for one level. You don’t really learn to ride until you get rid of the training wheels because with them balance is made secondary.
Think about the typical Western mentality. We prize forward propulsion over balance. Forward propulsion is important. It is how you keep the balance, but if we allow you to have forward propulsion without balance, it doesn’t work. There are going to be some falls. That’s the way we learn.
Aristotle said, “We cannot learn without pain.” When we set up environments for our children, there are going to be accidents. We can control the severity of the accident. We can control the severity of learning.
I see many older individuals going through this “stork” training, trying to learn to balance on one leg. We just throw down a small balance beam, a half-inch to an inch off of the floor. We might let them walk with ski poles, sticks, a cane or something like that, and if they walk 16 feet, pivot and turn, we’ll ask them to drop the poles. They have a perfect feedback loop. When we ask, “How many times did you lose your balance?” They will say exactly how many.
There is a perfect communication of both success and failure and that’s how the brain likes to learn.
We’ve got clearly defined competencies and when both the therapist and patient can agree on those competencies, we’ve set up a self-limiting drill. If the patient can’t get the feedback that the therapist gets from the corrective exercise, then it becomes part of the assessment. If you send them home with an exercise and don’t have a feedback loop, you’re just sending home a sheet full of numbers, sets and reps. That’s not how you get people to move.
You get people to move by creating a deliberate practice situation. Deliberate practice is a self-limiting exercise because you don’t just hit a bucket of golf balls. You hit a bucket of golf balls at a particular target; you must acknowledge when you hit the target but also when you don’t hit the target. Two highly-recommended books to read on deliberate practice: The Talent Code and Talent is Overrated.
Many exercise programs in therapy would be set up this way if you thought you were setting them up for a family member you loved. So my advice is to treat everybody as your dearest family member. You want that rich sensory environment, slow steady progress, independence and sustainability to be there and everything will be fine. I’ll treat your mom like I treat my mom. If you reciprocate, everything is going to be fine.
There is a certain ethic that I think we need to get our head around and a certain standard that we’ve got to agree upon. Then, if you ethically choose not to hold that standard, the profession will deal with you (or life, your community or commerce will deal with you accordingly.) You can drop to the minimum level of acceptable practice as is possible or you can raise the bar on yourself and watch the community embrace you.
I use these self-limiting exercises to avoid negotiation. People like to get into negotiation battles (think about the kind of battles that you would get in with somebody engineering your diet.) Well, can I do this? Can I do that? Can I do both?
Our second movement principle is “protect before you correct and correct before you develop.” I’ve got to protect you from yourself. I’ve got to protect you from me and the environment, first and foremost. Secondly, I’ve got to help you interpret right and wrong because you think you can squat and balance and, actually, you can’t.
You’re a community ambulator and you have less than 10 seconds of single-leg stance. You think you’re a community ambulator because you’re ambulating around the community and, by all practices, you are. But you’re at extremely high risk—I wouldn’t bet on you not having a fall. That’s the way we do it—just a frank conversation. Hard lines.
That’s what vital signs give us. We’ve got very hard lines on 20/80 vision. We know exactly what we do when you’re that far from 20/20 vision. When movement is far from an acceptable vital sign or norm, we should know exactly what to do. If you have compliance issues, you simply have another conversation or you can fire the patient. It’s as simple as that.
A lot of people laugh at that, but so much of what we do in therapy, coaching and training is just sound advice. At some point, if that advice is not being taken, especially if it’s going to put them at risk, it is important to demonstrate that you would prefer not to be associated with the limited value they place on your advice.
Now, do I ever have to fire anybody? No. We just simply have a conversation that goes like this. “I’m sure we can find you another clinician, who will let you run your own show, but you were running your own show when you got here and that wasn’t working out really well for you so I’ve got this. I will show you exactly what we’re trying to change and how we’re going to change it. I will be very honest with you when those things don’t change but I will also show you how we can measure change.”
“We’re not simply just measuring your symptoms. We’re measuring your function as well as your symptoms, trying to demonstrate that your function and symptoms are connected because the minute your symptoms are not connected to movement and function, I don’t know if a movement-based therapist is the right person for you. If I can’t show that there is a movement component to your symptoms, then I should probably start thinking about a referral.”