Guest Post: The Little Things

With clients and patients from the John McEnroe Tennis Academy  the LPGA & the WTA, I am always glad to catch up with Andrew Small. The last time I was in NYC  he showed me around his place of work, the impressive SportsLab NYC, where it is not uncommon to see NBA players and other elite athletes training & being treated. 

Most will agree that the world is a smaller place. Ideas and thoughts now whiz across the globe in milliseconds to an audience of billions. Only minutes ago I retweeted a great article in the British Journal of Sports Medicine on shoulder dyskinesia and seconds ago started listening to a podcast on that exact same article.

Information is now at our fingertips, feeding into an ever growing, ever changing pool of knowledge that guides our everyday practice.

But with this increased access to information are we losing sight of the little things that makes coaches and therapists truly great?

I am writing this article from my kitchen table in New York City, Manhattan – an island with a population of 1.6 million people.  Seven years ago, I was in Brisbane, working my way through Physiotherapy School and supporting myself as a personal trainer.

Often I find myself reflecting on how I ended up here and the experiences and lessons I have learned along the way.  Some of the most influential moments of my career have come not from articles or text books, but from real life experiences, shared knowledge, unpredictable situations and from those who have been there before.

I will never forget what a professor told me during my first week of school – “5% of what you will learn in your careers will be taught to you here at University. The other 95% you will learn outside of these walls”. She was right.

Starting as a young therapist, I was suddenly let loose into the world with a tool box 5% full of evidence based knowledge. Immediately, it was real and there I was treating my first patient. I stuck to the guidelines, did all the right tests and followed the recommended treatment protocols and… it didn’t work. I felt I was in the same situation I was six years prior, training my very first personal training client.

Reflecting on the parallel, I dug deep into the lessons I had learned as a young personal trainer. I bet many of you vividly remember your very first coaching session and the mistakes we all made.  For most of us, many of the mistakes we made were not technical, but were more personal.

Coaching is an art form dependent as much on communications skills as it is on evidence based knowledge. This is a skillset I could not have learned from an article or a textbook, yet it is a knowledge base I have come to respect, and is as applicable now in my career as a physiotherapist.

Similarly, I looked to improve as a therapist by speaking and listening to my mentors. Often I sat watching them run therapy sessions and thought to myself, ” what I am doing differently to them?”  I continued to look and learn – adding to my toolbox of new techniques and experiences, always on the watch for something special.

It wasn’t until one day when a mentor of mine pulled me aside and said, ‘I don’t do anything special. I treat like most other therapists.  What’s important, is to do the right thing at the right time”. I looked at him and thought I had understood what he was saying. But it took some time to sink in. Every time I observed or learned something new his words stuck with me.

I now looked at everything form a completely different perspective.  Often these were simple techniques, simple exercises. But when performed at different stages can have very different outcomes.  The outcome of a manual technique performed in a chronic injury state can be very different to that exact same technique performed in an acute state.

Just like two athletes in different developmental stages, will adapt and develop in different ways given the same training program.  While I already knew the techniques, and didn’t learn any new factual knowledge per se, my mentor’s advice was very helpful.  It made me realise that simple things done well, and done at the right time, can make a big difference.

Evidence based knowledge is important and makes up the majority of our learning. However, in an ever-increasing world of knowledge, it’s important to remember the little things, be they the simple things or the human things, elevate our practice from good to great. It is these skills that allow one to tweak that road most travelled, and deliver the latest knowledge in a way that engages our patients and affects meaningful change.

How we deliver a message is as important as its content. Sometimes we must give to gain, divert from the status quo and find a different route to achieve the final outcome.  I have come to value these aspects of my profession as much as I value the importance of keeping up with the research. The two work hand in hand in both industries and is a skill that must be learned not taught.

Sometimes the little things can make a big difference.

Andrew Small is an Exercise Physiologist and Physiotherapist who is currently working in Manhattan, New York at SportsLab NYC. Follow him on Twitter for more info.

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