This is about me as much as it is about you…
Maybe this article has more to do with some reflections I’ve been going through over the last few months about how to be a better communicator with each and every one of you. It wasn’t until a few years into my career that I realized a large part of my job is to be a teacher. Sure my job is to assess movement, evaluate injuries, construct rehab programs, and treat with manual techniques but it’s also to motivate, communicate and teach. If I can’t effectively communicate to you what the problem is, how to solve it and how to move better, what’s the point of all the work we are both putting in?
Perfecting how to teach is a two way street with each client. Sometimes I forget not everyone learns in the same way. I’m a big advocate for body awareness, constantly trying to get people to attach their heads onto their bodies in an attempt to gain familiarity with the sensations their body is telling their brain and where their body is in the spaces around them. That being said, everyone moves their body in different ways and understands how to move in different ways. How I see your movement is different than how that movement feels for you. Teamwork!
I was listening to you, but I’m still confused.
Have you ever walked away from a therapy session, a workout class, a bootcamp, a yoga class where your therapist/instructor went on for a few minutes with well articulated instructions only to say to yourself, “Ok, so you want me to do what?”.
Have you followed our detailed cues and your movement gets worse or you get completely confused about the steps? This might be your therapist’s fault for not working with you to determine how you best understand how to move.
You and I have to work together to optimize communication of what I say and what you hear. You and I use two different languages which does make it difficult to communicate from time to time. I think, “I want this person to activate their serratus anterior as the prime stabilizer of the scapular so when they move their glenohumeral joint overhead, they are recruiting all of the scapular stabilizers and rotator cuff while getting appropriate scapulohumeral rhythm through full range”, whereas you think, “I’m going to press this weight over my head”. We have to work together to figure out how best to understand one another. What is our common vocabulary?
Have you experienced that “ah-ha” moment when you understand exactly what your therapist wants you do to, how to move and you execute the movement really well!? How good does that moment feel?! Proper cueing and attentional focus achieves these moments. These moments of good communication and understanding have staying power. That’s how you best transfer the skill/movement into your everyday life as compared to leaving it at the gym. I want us to have more of these moments.
Let’s focus in…or out.
If you feel like you’re not getting through to your therapist, it’s tempting to think they aren’t hearing you or they aren’t understanding what you’re trying to tell them. Communication falls apart and you might feel your therapist isn’t paying attention. Another possibility could be happening – your therapist might not be using the right cues to get you to focus attentively on the task at hand.
Attentional focus can be defined as a conscious effort to focus attention through explicit thoughts in order to execute a task with superior performance. Attentional focus can be either internal cuing (directed towards the body) or external cuing (targeting something beyond the body):
As examples, your therapist could guide you how to do a single arm chest press:
- Internal cuing: “focus on squeezing your chest muscle while extending your arm out front of you”.
- External cuing: “focus on explosively pushing the cable to the wall in front of you”.
Many studies have found external cues produce better performance with less errors of movement than internal cues indicating a higher degree of automaticity and less conscious interference meaning you, the person receiving the information, will have greater success with the movement when external cues are employed. This means you will have a much higher likelihood of long lasting results, a bigger bang for your buck, you’ll leave your session with a much better understanding of how to move efficiently. And isn’t that the point?!
Why does External Cuing work?
Researchers have proposed a theoretical explanation as to why external focus can be beneficial while internal focus can be detrimental. This hypothesis suggests mentally focusing on our body movements restricts the motor system by interfering with automatic motor control processes than would normally regulate the movement. If we focus on an external movement goal the motor system can naturally self-organize, unconstrained by the interference caused by conscious control attempts. (Wulf, McNEvin & Shea 2001) This means external focus allows for a more natural or automatic movement, while internal focus seems to interrupt the movement.
External focus allows you to naturally play around with the coordination of the movement until your body has figured out how best to achieve the goal. Pointing or focusing on the environment and the intent of the movement reduces uncertainty and allows you to explore until the intent and the outcome of the movement are achieved. Internal focus wants you to focus on one aspect of the movement at a time while at the same time remaining aware of the movement as a whole. Your brain gets overloaded and can make movement achievement more difficult to accomplish. This means using external cues does the better job of communicating the most important aspects of the movement.
Now the question becomes how do we best use external focus and cues to achieve the best outcome from the movement? How do we individualize and modify the cues to compliment where your ability level is with each movement? How do we make sure each movement is purposeful with maximal effectiveness for you?
The 3 D’s of External Cueing
We, as therapists, can work within 3 key features of external cues:
- Direction: which way to target a movement
- Distance: how far to go
- Description: word choices using active verbs and creating mental imagery through analogies
Cues should tell you which way the movement has to go. Using the example of the tall plank (ie. plank from your hands not your elbows), I could say “drive your back towards the ceiling” or “drive yourself away from the ground”. In both examples the direction is the same but the frame of reference is different. This is where personal opinion comes into play. Not everyone processes these two directional references in the same way. Some prefer to push towards or push away, this is personal preference or what jives with you at the level of experience you are currently successful with.
If I asked you to push pass a ball away from your chest versus pushing the same ball towards a wall 20 feet from you what would you do differently? How effectively would you push the ball at the wall 20 feet from you vs. pushing it away from chest? We can use close proximity cues or far cues depending on what we need the movement to accomplish. Pushing away from your chest is a close cue, whereas pushing at the wall is a far cue. Choosing which distance cue works best for you is dependent on level of experience with the task at hand. I’ve found when I teach a new skill or movement using distances closer towards the body, movements are more successful.
As your experience with the task improves, we can add additional elements like speed and power, and it may be appropriate to increase the distance of focus (ie. moving towards the ceiling instead of away from your body).
Verbs are words of action. Movement is an action. Using the right verbs when describing a movement only makes sense. Words like explode, push, press, drive or accelerate can be used to describe how the movement should be performed.
Analogies are equally as important when describing a movement. The two together, verbs and analogies, tell you the pace and the execution of the movement. “Accelerate off the line like a jet taking off”.
Choosing words that evoke a more distinct image or visual memory are much more effective than recalling words or concepts. External cues that use active verbs, analogies and words that evoke images will be significantly more memorable and easier for you to apply to the movement when you’re on your own at home, in daily living or at the gym.
The Language of Movement
Effective communication is a two way street. Communication has three components:
- Instructions from me as to how to perform a movement
- You provide feedback to me so I can refine the movement cues
- I continually provide short cues that remind you about key aspects of the movement pattern during the movements.
For this to work, you have to be paying attention to what I’m saying and I have to pay attention to what you’re doing and saying in response.
Bottomline, you and I need to work together to make sure we are understanding one another. I need you to come in ready to give your attention to the tasks for 45 minutes, you need me to be adaptable based off of your responses. This is how we will get the most out of our time together. Stay focused!
These ideas also apply to an article written earlier this year about the crossover effect (insert link). If you are sidelined with injury or you are noticing you are more in control of a movement on one side but not the other, read the article on crossover effect to learn more about how your system adapts from the power of attentive and focused thought.
What are your thoughts on these ideas? Have you found yourself responding more effectively to certain kinds of cues? Have you noticed you move more effectively with certain therapists or instructors because of how they cue you to perform? Let us know your thoughts on these ideas and especially let us know if there are ways that we can be more effective.
Robyn Edge is the therapist leading the charge of Movement Lab. She has an extensive background in her own athletic pursuits, and injuries, as well as an extensive background in functional rehab, functional training and injury prevention. Employing modalities such as acupuncture, myofascial cupping, and active release, she manages pain and promotes healing in addition to her active style of practice.