I recently went to a cocktail party and during the evening I noticed a woman who is all too familiar to people in the exercise world: she was rake-thin, very ripped, too tanned, too blonde, and with dreadful posture. She looked older than her years and she was clutching her martini like an old crone. She told everyone that she spent at least two hours at the gym daily and that she was phenomenally fit! Looking at her I thought how pathetic it was that she had such a rounded, evidently stiff back with all those workouts. The words of Jo Pilates: “You are as old as your spine,” jumped to mind. Upon hearing that I was a Pilates instructor, she said disdainfully: “Oh, I tried Pilates…. did nothing for me!”
The reason I mention this encounter is that this is a precise indication of a certain type of personality. Would one ever try and persuade this type to try Pilates? Of course not! This person may evolve with time, or may develop injuries which will force them to seek out Pilates, but until then it would be too exhausting to try and change their mind-set.
When it comes to clients with backache, it is important to identify the kind of personality and/or the presence of a certain mind set. This will largely affect your approach to this client in order to obtain full cooperation.
For those of you who are not experienced with teaching clients with backache, I will briefly mention the criteria which govern your decision to take on clients with backache:
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Has the pain been investigated medically?
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Were diagnostic procedures performed and has this client received a diagnosis?
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Has the client received physical therapy and/or had surgery?
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What else have they tried in the past and how did these alternatives work?
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Has the client received permission from the medical practitioner to exercise?
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What is the level of pain currently?
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What movements cause pain?
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Which movements, if any, bring relief?
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Have they done Pilates before?
If you, as an inexperienced instructor have any doubt at all, refer the client out to another Pilates teacher who specializes in backs. We all have to start somewhere, so watching the more experienced teacher would be a good beginning to gain knowledge and confidence.
Following the questions above, your ability to assess what type of back pain ‘personality’ you are dealing with, is of paramount importance. People with backache, real or imagined, sometimes require delicate handling. Emotional factors and stress are the major causes of flare-ups and it is important to understand where that particular client is coming from. Fortunately the majority of clients with backaches are just so desperate to lead a pain-free existence that often they make the most diligent clients. But then there are the exceptions and I am sure that experienced instructors have encountered precisely the following types of personalities and could add to these stereotypes.
The Complainer:
This is a client who will tell you that they are in constant pain and nothing has helped so far. Upon further questioning, you discover that the client has usually not had a formal medical investigation such as an MRI study or even an X-Ray. In some cases they may have consulted only a primary care physician many years ago. Most of them may have tried a chiropractor, a massage therapist, acupuncture, reflexology, Yoga, Pilates and every new exercise fad under the sun.
My advice is that you insist that they see a medical specialist who will decide whether this client needs further investigation. The reason why I stress this is as follows: it would stand to reason that anyone who is in so much pain would have made the effort to see a specialist. The fact that they make excuses, like they have no time, or they have accepted someone’s lay diagnosis, means that they are not in such severe pain. They avoid a formal medical investigation because it suits them to complain. They want sympathy and attention. Whatever you do will never be good enough.
As a Pilates instructor, you cannot work in the dark. If the medical investigation reveals nothing serious with no underlying pathology, you are effectively removing the enigma that the client has been using as an excuse. If the medical investigation exhibits some serious pathology, then you have done the client and yourself a huge favor. Faced with the medical revelation, this type of personality will be forced to rethink their approach to exercise. They may not like the fact that you have stripped them of the veneer which has defined them and that the onus is on now them to take responsibility for themselves. Some will try and move on from it, but many will just use the same old ruse with another teacher.
The Needy:
This is a client who wants you to ‘cure’ them all on your own. Typically they have had sessions with a physical therapist and nothing has helped their back pain since.
Upon questioning, this client will tell you that since they were given permission to exercise, they have tried one or more Pilates teachers without success. This raises a red flag immediately.
My first question is always: “Show me the exercises that your physical therapist and/or the Pilates instructor gave you to do.”
Invariably they will say that they cannot remember or that they stopped doing them because they didn’t help. This is a clear indication that they were not prepared to work on their own.
At this point it is wise to contact either the physical therapist or the previous Pilates teacher (or teachers) and hear what they have to say. I guarantee that either the client never persevered with the previous Pilates sessions or that the client was not prepared to apply themselves. Now that you have a clearer picture of the type of personality you are dealing with, you can make the decision whether you want to persevere with this client because it will take a tremendous amount of energy on your part.
First, the client has to understand that there you cannot ‘fix’ their back nor can you provide a cure. The onus is on the client to do the required exercises at home and be mindful of posture in their daily life.
I spend the entire first session with fundamentals and some introductory exercises but the emphasis will be on writing out and even drawing the exercises which they must do daily on their own. I keep it very simple and only give 3 exercises to start. We will discuss sleeping, sitting, working postures and I check several times that they understand their home tasks.
On the next visit, immediately ask them to show you their exercises. If they tell you that they did not have time or that they have lost the piece of paper with the exercises, you will know exactly with whom you are dealing.
These clients give Pilates and the instructor a bad reputation. Being forgiving and ultra- patient with this personality is ultimately a waste of time as it drains the teacher’s energy. This client wants everything on a plate and unless you can change that attitude, you will never succeed.
One client did make a concerted effort after I refused to continue with her. Another one made some progress after I gave her a very firm lecture. If one can convince this type of personality from day one that only hard work and dedication will provide relief, you may have a chance.
The Know-it-All:
This client will claim to know everything there is to know about their pathology. They will have diligently researched whatever their specialist told them and will regard themselves as an authority on their condition. They will tell you in great detail about their particular case using all the medical terms and then proceed to tell you exactly what YOU can and cannot do!
A more inexperienced Pilates instructor might very well be intimidated by this spouting of knowledge. As a physical therapist, this personality makes me want to smile inwardly.
First, they take themselves so seriously and half the time they mispronounce things and confuse the terminology! However one has to admire their dedication to researching their condition, even if it may be totally misunderstood! Secondly, they want to be in control and plan their own session, quoting all and sundry on what movements they should and should not be doing.
If one tries to proceed as one normally should with a lower back problem, you will find that they have pre-programmed themselves to resist certain movements before they have even made an attempt. They will be allowed to feel that they have the upper hand and you will be pandering to them forever.
So, how exactly does one deal with a ‘Know-it-All’? It is essential to go through the entire list of questions I mentioned earlier and establish that they have been given permission to exercise. Also check that there are no movements that are contraindicated by the medical practitioner.
I always allow the ‘Know-it-All’ to ramble on so they get everything off their chests and then I tell them that our combined job is to strengthen the core with whatever means we have, working within the pain-free range.
Then, you proceed with almost exaggerated caution. This type of personality reacts well to rules and regulations. They like perimeters. This immediately instills trust, and you, as the instructor, effectively take control and negate their preconceived ideas. Again, you will address the “do’s and don’ts” related to posture in their daily life in great detail and follow through conscientiously with each session.
One would be equally as thorough with every client, but with the “Know-it-All” one’s tone should be a tad more dictatorial. Because they were energetic about researching their particular pathology in such detail, you will draw on this same commitment to get them involved in managing their back issues.
I hope this will give new teachers some insight. I think it is important not to blame yourself or feel that you have failed certain clients with back issues, due to their personalities. There are many success stories out there and wonderful clients with back issues who progress and manage their back conditions admirably. But there are also those odd personalities which require quick recognition… and as always, knowledge is power!
- Sonjé Mayo