Physical Therapy

By Kristin Loeer, Movement Therapist, Polestar Pilates Mentor & Practitioner @polestarpilatesuk, @kristinloeer_movement

What Is The client Really Telling Us?

There are many ways in which we can guide our clients through movement. We can use a vast variety of verbal and tactile cues to help them change their movement habits and master increasingly complex challenges. 

How often do clients tell us that unless we put our hands on them to guide them in the right direction, they are unable to replicate the experience?

And how often do they say, after a complex piece of work, that there is so much to think about? That they have to concentrate so very hard to coordinate everything? While feedback like that is common we should consider carefully what the client is really telling us. 

As a Somatic Practitioner and a Pilates teacher, my goal almost always is to help people become more aware of sensations. Sensations provide vital information about our physical and mental well-being. Being present in our body and in tune with its sensations is not just an essential part of healthy movement practice. It also adds to our overall resilience and life vitality. It alerts us of physical and emotional strain, so we can take action before problems turn chronic. It allows us to make better decisions. It makes us better at resourcing ourselves with what helps us maneuver through tough times so we are less prone to trauma. 

“There Is So Much To Think About In Pilates!”

One day one of my clients sighed: “there is so much to think about in Pilates!”. I had to pause and try to understand what they were really saying. The way in which the client sighed their words told me that the experience had somewhat overwhelmed them. When we are overwhelmed it is much harder for us to be and remain in our bodies. This is especially true if we are not used to it and trying to make sense of something new at the same time. The fact that they had to “think” a lot while moving told me they may have not been “in their body” at all during the past 20 minutes of our one-on-one Pilates session. 

Our conscious thoughts happen in our prefrontal cortex, also known as the thinking brain. This is the youngest part of our brain and also where our modern society requires us to be focused most of the time. From a young age, we are expected to understand rules, keep to a schedule, and use logical reasoning to navigate through life. The older parts of our brain, the limbic and reptilian brain, concerned with emotion, instinct, and physical sensation, become subdued and controlled by the prefrontal cortex. If we are upset we try to pull ourselves together. If we feel threatened by something that we can not logically explain, we feel ashamed and try to hide it. If we have pain, we numb it with painkillers. 

Firstly I had to look at my own insecurities that had led me to overwhelm my client. My desire was to give them all the wonderful cues, visualizations, and information that I knew. I had been driven by my thinking brain, which would tell me that unless I did everything I possibly could, I was being lazy, holding back, and not giving my client enough. 

What might this have been like if I were more in tune with the oldest, most instinctive part of my brain, my reptilian brain? Perhaps I would have been less distracted by my beliefs about my worth as a Pilates teacher. I may have picked up on the silent and physical clues that would have told me that my client was overwhelmed. That they were trying to figure it all out in their head, rather than communicating with their body. The first steps were for me to realize that I had more embodiment work to do myself. 

This experience also made me more aware of our “cueing tool kit” and how we use it. Could it be that the way we cue our clients favors addressing their thinking brain, rather than promoting embodiment? 

Dr. Peter Levine’s SIBAM Model

Dr. Peter Levine introduced the SIBAM model representing all of the elements of human experience; S – Sensation, I – Image, B – Behaviour, A – Affect, and M – Meaning.

When we have a traumatic experience, one or more elements can get split off from our awareness. For example, we might be unable to remember what we did during the traumatic event (behavior). We may feel numb when we talk about what happened (affect). Ideally, we have a fairly balanced awareness of all the elements in order to best integrate the experience moving forward in life. 

If we apply the SIBAM model to the experience of practicing a Pilates exercise, such as semicircle on the reformer, it could look like this: 

Sensation: The physical sensation of feeling the pressure of the foot bar under our feet. Feeling a sense of expansion or containment, as we reach into the shoulder rests and foot bar. The heat or tension generated by the stress our body is experiencing during this exercise. Is there intensity? Does intensity turn into tension and struggle? Is there pain? Do we feel connected? 

Image: The visualization of my spine riding a wave. The image of myself as a dolphin-like creature. I can imagine my sitting bones moving apart and closer together throughout the movement. Maybe I am literally seeing myself in the studio mirror. 

Behavior: The movement that is semicircle is essentially the behavior, but also the strategy I am using to move through this exercise is part of the behavior. In short: “what am I doing?” and “how am I doing it?” 

Affect: Any experience has an emotional component. Perhaps I feel joy at experiencing this fun, flowing exercise. Maybe there is a slight sense of unease, irritation, or fear attached to the movement. 

Meaning: The meaning we give the movement is a semicircle. As we say the word semicircle we already have a meaning attached to the movement. Perhaps the meaning is “integrated, pleasurable exercise that helps my spine gain mobility.” Or maybe I have a belief about this exercise putting me at risk of hurting myself.  

I do want my client to be aware of all the elements of their movement experience, but as mentioned earlier, we tend to learn from an early age to rely heavily on our meaning and belief-making brain. We don’t tend to be very in tune with our more subtle physical sensations.

You may find that it is not all that easy, because these sensations can be rather subconscious. However, if they were not present you would not be able to identify what you are feeling as happiness. Becoming more aware of the sensations in our bodies is what helps us become embodied. If I can feel the mat underneath me if I am confident about where I am in space. If I can detect the first level of bracing in my muscles and make an instinctive change that allows me to relax. This means I am in my body and truly communicating and working with it.

When I explain to my client that we are going to do semicircle on the reformer and give them the general instruction of what goes where I am setting up the behavior coupled with meaning. We are doing semicircle and this is how the movement goes. 

As they start moving I might notice aspects of their strategy that do not look so efficient. That is when I might offer a cue: “dive your tail through the water like a dolphin,” or “send your sitting bones to the back of your knees.” In terms of SIBAM, I am still cueing behavior with the help of an image. 

It is only when I draw my client’s attention to their proprioception (awareness of themselves in space) and even more importantly their interoception (awareness of internal sensation) that I begin helping my client embody semicircle. I may also offer tactile cues. In fact, this can initially be very helpful for those who struggle with feeling their body. It is much easier to recognize the sensation of someone’s hand on me than the sensation that comes with happiness. Tactile cueing can be a great starting point to help clients become more embodied. 

Ultimately tactile cues are only helpful if the client can be aware of the sensation of the touch, in addition to the sensation of the change that the tactile cue has caused in their body’s movement. Only then can they apply the changes internally that help them move better. Otherwise, the client will not actually integrate the changes we are making and simply go back to their old patterns. 

Awareness Of Affect In Pilates

Another element of SIBAM we hardly ever promote awareness of in Pilates is the affect. Have you ever acknowledged a client’s excitement after managing parakeet for the first time. Do you respect a client’s fear of a suggested exercise and find a compromise? We do not tend to dedicate much time to engaging with emotional responses. Of course, that may be for good reason. There is a fine line between encouraging someone to feel their pride and confidence at achieving parakeet, and the boundaries of the scope of practice as a Pilates teacher when it comes to managing more challenging or negative emotions that might be attached to a movement. 

Promoting true embodiment in our clients means having to assume less and ask more questions. I can make my client aware of sensations that I can assume they are able to feel. I can say: “feel the contact that you are making with the reformer”. “Feel your relationship with gravity changing,” or “allow your head to be heavy.” This is where our ability to assume things ends. Sensations are highly subjective and we can not know what our clients are sensing on a more subtle level. W can only be observant and ask them about the sensations they are experiencing. This also makes our clients feel seen, communicating more actively with me and taking ownership of their session. 

I can ask a relatively directive question about my client’s sensations, like: “can you feel your jaw releasing?” or “can you feel your connection through your right arm into your center change as you hold the bar differently?” The client has to feel into these specific areas in order to answer the question. I could also ask more open questions to allow the client to expand their awareness and gain new insights into themselves in the movement. I could ask: “as you are gaining more flow, what changes are you aware of in your body?” or “what was happening in your body just then, before you lost stability?” 

The Client is the Expert of Themself

Ultimately it is my goal always to make my client the expert of themselves. I am not there to tell them what they should be feeling or how they should be moving. My goal is to help them get to know their unique self in movement. I am there to help them engage with their body to learn how they can improve their movement ability. I respect that we are all different and that our experiences are also different. While I may help them orient and navigate, ultimately their experience will be different than mine and only they can experience themselves moving. 

Many clients will struggle to access physical sensations, particularly if their brain is busy with figuring out what (behavior) they are doing, or why (meaning). If I am engaging with semicircle for the first time, I easily resort to connecting with the part of me that I am most used to consulting. My thinking brain goes into overdrive trying to figure out where I am in space. How do I engage with this spring tension? What is this movement or choreography? My felt sense would be a very authentic, wise, and safe advisor in this.

It is easy for teachers to buy into this struggle by wanting to offer more clarity with more cues serving meaning, behavior, and image. This may get us some success in terms of our client being able to navigate through the movement. Telling someone what to do is quicker and easier than asking the client to be comfortable in confusion and taking the time to help them sense into their body and figure out what feels true to them. However, if we allow the client to rely on their thinking brain too much to master the exercise, we will see them putting their body through a potentially risky movement, with no or very little awareness of themselves and no deep learning that could enable authentic change or growth.  

If we provide the right environment and remain mindful of our pace, sensory cueing will make an incredible difference to our client’s experience. If we can cue and support our client in a way that enables them to be embodied from the beginning to the end of an exercise, we will see a client who is moving confidently and well, fully aware of what is happening in their body, and fully in control throughout, having a calm and enriching experience. 

All we need to do is be in our body ourselves, aware of our own sensations, as they will guide us to promote the same in our clients, without pushing or overwhelming them.

By Kristin Loeer, Movement Therapist, Polestar Pilates Mentor & Practitioner @polestarpilatesuk, @kristinloeer_movement