Ep 178: Leading from every chair, with Dr Nicol van Dyk

[00:00:00] Hello and welcome to JOSPT Insights, the podcast that aims to help you translate quality

[00:00:09] research to quality practice. I'm Claire Ardern, the editor-in-chief of the Journal of Orthopaedic

[00:00:15] and Sports Physical Therapy. It's great to have you listening today.

[00:00:22] How much time do you allow yourself to work on real skills as Seth Godin likes to call

[00:00:29] them? We spend years honing our clinical skills, but how much time do we spend thinking about

[00:00:34] and practicing skills like listening, working in teams and making decisions?

[00:00:39] Today, Dr. Nikol van Dyke, physiotherapist and assistant professor at University College Dublin

[00:00:46] is here to make the case for real skills as keys to expert musculoskeletal rehabilitation

[00:00:52] practice. Don't forget the JOSPT and the Young Athletes

[00:00:56] Hip Research Collaborative are co-hosting a webinar mini series with La Trobe University.

[00:01:02] You'll hear more from experienced clinician researchers including Drs Josh Heary, Joe Kemp,

[00:01:07] Kate Yockelmsen and Mike Reiman. Dr. Lindsay Plass and Luke Kearney who both have lived

[00:01:12] experience of hip pain limiting their sporting careers will join the webinars to bring

[00:01:17] that important athlete perspective. The first webinar was on the 1st of May and the

[00:01:22] second is happening on the 5th of June. You'll find all the details in the show notes

[00:01:27] along with links to the resources Nikol mentions. Okay, here's today's episode.

[00:01:32] Dr. Nikol van Dyke, welcome to JOSPT Insights or should I say welcome back to JOSPT Insights,

[00:01:39] Nikol van Dyke.

[00:01:40] Thank you very much Claire, it's great to be here.

[00:01:42] It's a pleasure to have you back on the podcast Nikol and today we're talking

[00:01:46] a bit more about your perspectives from many years of working in sports medicine

[00:01:51] and in sports clinical practice. You've worked across a range of different sports medicine

[00:01:56] and sports physiotherapy settings especially in high performance sport. Most recently you've

[00:02:01] been in Irish rugby. What are the most important skills that you have developed for your sports

[00:02:07] physiotherapy sports clinical practice?

[00:02:09] To be completely honest I've always valued being a good clinician and I still do.

[00:02:15] So before I dig into the skills I think it's important to say that it really continues

[00:02:21] to be important to master your craft. You need to be able to hone those skills as a therapeutic

[00:02:28] interventionist as a clinician but then what really will make the difference is these associated

[00:02:36] skills, these essential skills if you will, the real skills that ends up creating your

[00:02:42] ability to really make a difference in your patients or the people in your care lives.

[00:02:49] For me the probably the biggest one that stands out is the ability to build relationships.

[00:02:54] By that I probably mean trust. Trust is fundamental to all of our relationships across the many

[00:03:00] spectrums of our life and certainly in the therapeutic environment it's the foundation

[00:03:05] on which we build all the others. I've really learned this from my relationship with Phil

[00:03:10] Glasgow and through many of his years of clinical practice I think I'm just at

[00:03:15] that stage now about 20 years in. I feel like I can say this with some confidence now

[00:03:19] that underlying principle of trust allows you to build rapport and relationship with

[00:03:25] your patients and then we want to on top of that create engagement, we want to have

[00:03:32] clarity around our roles and responsibilities and then hold each other accountable to

[00:03:35] those and then the content, the exercises, the techniques become important and will

[00:03:41] remain so but really having that foundational layer of trust is key.

[00:03:45] Are we talking about the art versus the science of clinical practice? I hear people talk in

[00:03:52] these terms a little bit as if there is a scientific way to do things and then

[00:03:56] there's a less scientific, more learning on the job kind of approach. How do you

[00:04:01] feel about that characterising art and science in your work as a physio?

[00:04:06] Yeah I get that but I think that's a false dichotomy. We have loads of science

[00:04:10] to back this up. People think of leadership to use the term really broadly as

[00:04:15] someone that's born with an innate set of skills. You're suddenly just immersed into

[00:04:20] the world with the ability to lead but they are skills that are learnable,

[00:04:25] they are skills that you develop over time and then leadership events or

[00:04:29] leadership really is an event so often we think of I'm South African,

[00:04:35] I can't help but default to Nelson Mandela who I think hopefully the whole

[00:04:39] audience would know but if you don't he led the freedom movement in South

[00:04:42] Africa. He was incarcerated for 27 years before he became the first president

[00:04:46] of a democratic South Africa and it was the right time, it was the right

[00:04:51] country, it was the right message and the right person that really allowed

[00:04:55] that whole event to take place. I'm convinced if it wasn't him at that

[00:05:00] time in that place it probably would have looked very different and so I

[00:05:04] think with your therapeutic interactions it's good to be conscious of the

[00:05:08] fact that you are also prone to making a connection with someone intervening at

[00:05:14] the right time. How often have we been the third or fourth physio and the

[00:05:18] person often thinks you're the absolute genius who solved this but you've

[00:05:22] just been the right person at the right time and all the physios before

[00:05:25] you have also contributed to that development. I really do think it's

[00:05:31] the skills that are learnable that we need to invest in and we probably don't

[00:05:34] do enough in our higher education institutions to develop those skills but

[00:05:39] as individuals I think these are the true skills that will help you to

[00:05:44] accelerate your therapeutic interaction. So then what are the skills that

[00:05:49] you have observed leaders consistently doing well? I'm going to default here.

[00:05:55] I love this piece in the Harvard Business Review by Deborah Ankena and

[00:06:00] I'm not sure how to pronounce her last name but the title of the piece is

[00:06:03] In Praise of the Incomplete Leader and so essentially they're identifying four

[00:06:08] skill sets that leaders possess. So the first is sense making, your ability

[00:06:13] to explain complexity, to make something really complex, really

[00:06:18] understandable. The second is relating so that's building those

[00:06:22] relationships and trust. The third is visioning so leaders are great at

[00:06:26] giving us a clear view of the future. What is our goal? Where are we going to

[00:06:30] get to and then often how do we get there is the question and then inventing.

[00:06:35] So being able to enact that vision then making sure we're able to take

[00:06:39] the steps necessary to get to our goal. We have the opportunity to enact

[00:06:43] those skills every day in our therapeutic practice.

[00:06:47] I love that you make that point about the every day and it leads me to

[00:06:51] I'm going to build on your point about leadership being an event and then

[00:06:55] add that my sense is leadership can happen from anywhere. So we all have

[00:06:59] capacity to lead from our different places rather than looking to a

[00:07:04] leader all of the time and saying, oh I'm not in that position.

[00:07:08] I'm not experienced enough. I'm not this. I'm not that.

[00:07:11] So how do you think about leadership in terms of the event

[00:07:16] versus the person versus where it can happen from?

[00:07:19] I've been privileged to experience both where I've been in organizations

[00:07:23] that's very hard kill, very authenticity poor.

[00:07:28] I mean, I think what we're really trying to say is we want you to be authentic

[00:07:31] in your interaction with me and that will naturally allow these opportunities.

[00:07:37] If you are in an organization,

[00:07:41] you know, the easy thing to say is leave and that's an honest comment.

[00:07:44] But that's not really an option for a lot of us.

[00:07:46] I think if we make that statement too loosely, you know, for a lot

[00:07:51] of people, their job security and family commitments and student loans

[00:07:55] and a lot of reasons why. So if you are in a position, it's good to try

[00:08:00] and identify those opportunities as physiotherapists.

[00:08:03] We are absolutely blessed because every patient we see,

[00:08:06] every interaction we have with the clients is an opportunity to have that manifest.

[00:08:12] And I can tell you this.

[00:08:14] Some of the greatest physical leaders I know got to their positions by

[00:08:18] I want to say that the rule of the crowd, so many of the players in a team

[00:08:23] or the patients in a practice when I really think, you know, this particular

[00:08:27] physio is doing a great job. That's not a popularity contest.

[00:08:30] And I think it's those physios are often the ones who are really early

[00:08:33] to recognize this relationship is not the right dynamic for you.

[00:08:36] I'm going to help you by bringing in one of my colleagues

[00:08:39] or I'm going to refer you to someone with more knowledge.

[00:08:41] So it's not trying to be popular.

[00:08:43] It's about being efficient and productive and really connecting

[00:08:47] with the person.

[00:08:48] I think that recognition in and of itself will allow you to have a greater voice.

[00:08:54] A really useful way to kind of build the language and the narrative

[00:08:57] for the leaders are to say, what I'm experiencing is a lot of people

[00:09:02] having a different story about what's unfolding.

[00:09:04] You think it would be beneficial to us maybe sit down and understand

[00:09:08] what's driving this different narratives and how we could collectively

[00:09:11] understand that better.

[00:09:12] That's a great way of the pressures of the leader is part of the process.

[00:09:17] And in many of the best institutions I've been in,

[00:09:20] there has been these horizontal leadership structures.

[00:09:23] And what that means is everybody kind of operates at the same level,

[00:09:26] but you rise up when you're needed to take a lead in your area of expertise

[00:09:32] in your field of concern or in a particular matter.

[00:09:34] So and then once you once your leadership, once that has fulfilled,

[00:09:39] you're sinking back in, right?

[00:09:40] And everybody takes on their own responsibilities and that can be shared.

[00:09:44] That's not to say you have to always do a certain task,

[00:09:46] but it certainly is a helpful way to think about it in terms of everybody

[00:09:50] pulling the momentum forward.

[00:09:53] You talked about trust, Nikol and building trust.

[00:09:56] And I think that relates to there's a phrase variations on the phrase

[00:10:01] it takes a decade to build and a moment or a day to lose trust

[00:10:05] in those sorts of relationships, whether it's with your colleagues

[00:10:08] or whether it's with patients or athletes with whom you're working.

[00:10:11] And I think these sort of interpersonal skills that we use when we're building

[00:10:15] relationships often get a derisive label of quote unquote soft skills.

[00:10:21] And you argue that it's time to rename these skills.

[00:10:24] Why is that?

[00:10:26] I have to give the credit to Seth Godin.

[00:10:28] I've completely ripped this off his amazing blog series.

[00:10:32] And what's led to their company called the Kimbo, if you're interested

[00:10:36] in that kind of thing, they do a really great job at a Kimbo

[00:10:38] and they have these real skill conferences.

[00:10:40] But the name that they use are real skills.

[00:10:44] And what I think the emphasis is, is when we use language like soft or interpersonal

[00:10:49] even, we kind of that does feel like a skill that's less valued than our hard

[00:10:54] skills or our vocational skills.

[00:10:57] But that's really not what these skills are.

[00:11:00] You know, imagine you're good at your vocation, you're a good physiotherapist,

[00:11:03] you're productive, you're experienced and you have a whole resume

[00:11:07] that can prove that.

[00:11:08] Okay, that's fine.

[00:11:09] That's like, that's the baseline.

[00:11:10] You're an absolute excellent practitioner.

[00:11:13] Now, if you add on top of that, that you're perceptive, that you're charismatic

[00:11:17] and driven, you're focused and you have clear goal-setting ability.

[00:11:21] You're inspiring and motivated.

[00:11:23] You're interactive, a deep listener with patience when you're interacting

[00:11:28] with someone.

[00:11:29] What does that look like when you show up like that?

[00:11:31] The I hear people argue that I do fine without these.

[00:11:35] I'm a really great therapist clinician.

[00:11:37] I do a really great job.

[00:11:38] My patients get great results.

[00:11:40] And my argument would be, well, imagine if you had all of this developed as well.

[00:11:44] How much more would you be able to give the people in your care?

[00:11:48] And that's why I think Seth's group and this whole momentum is building

[00:11:52] around us really valuing, appropriately valuing the ability to develop these skills.

[00:11:57] So if you think about what those skills might be, I mean, we could come

[00:12:01] up with a whole list of what our leadership skills to you.

[00:12:04] I'm going to highlight a few because I think they're helpful.

[00:12:07] Think of self-control.

[00:12:09] Right?

[00:12:09] So you're doing stuff that might not have an immediate effect, but will have a

[00:12:13] long term part of a long term solution.

[00:12:15] You're able to have that delayed gratification in the outcome.

[00:12:18] I think physios often have to deal with that, have that skill, because

[00:12:22] you're dealing with rehabilitation that you know might take a long time.

[00:12:25] And you need to help the person and understand that productivity.

[00:12:30] So really being able to getting the non vocational tasks done.

[00:12:35] So helping you're not just doing the interaction with the patient.

[00:12:38] Well, but helping them plan their rehab, understanding how to engage

[00:12:42] with their life, their carers, those that they interact with the regularly.

[00:12:47] If we think about wisdom as the lived experience of knowledge.

[00:12:50] So really, really understanding that experience of how we become

[00:12:54] greater therapists, interacting with our patients in a meaningful way,

[00:12:59] being perceptive, seeing things before they play out.

[00:13:02] That's not that's not trying to predict the future, but that's trying

[00:13:06] to know what you are attending to.

[00:13:08] What do you pay attention to when you're?

[00:13:11] Can you hear someone when they're really trying to ask for help?

[00:13:14] When they're not responding to a treatment, are you falling back

[00:13:18] in your default mode of trying to do something even better?

[00:13:22] Or are you listening or caring and really looking and listening

[00:13:25] can be more than just verbal?

[00:13:27] It's really understanding that perceptive piece of it and then influence

[00:13:31] being charismatic.

[00:13:32] Now, people think of extravagant kind of behaviors or extroverts

[00:13:36] when they hear charismatic.

[00:13:37] That's not necessarily true.

[00:13:38] Some of the most charismatic folks I know are introverts,

[00:13:41] which may say very little, but it's how they show up.

[00:13:44] It's how they act that really is an influence.

[00:13:46] So if you think about those sets of skills and how we develop them,

[00:13:50] I think it intuitively comes clear that this will

[00:13:53] play a major role in our ability to deliver our service.

[00:13:57] You talked about charismatic, motivating, listening.

[00:14:02] These are the characteristics that sound a bit intimidating,

[00:14:07] if I'm honest to me.

[00:14:08] It sounds like a wonderful person, a person I want to know,

[00:14:10] a person I want to work with.

[00:14:11] I'm not sure that it's me.

[00:14:12] I don't I'm not sure that that's that I can develop those skills.

[00:14:15] So where would you suggest people start to develop these skills

[00:14:20] and to find these sorts of of characteristics and traits in themselves?

[00:14:25] Is this something that's innate?

[00:14:26] Or is it something that we can develop?

[00:14:28] Absolutely a learnable skill.

[00:14:30] You're right, but that does sound kind of nice.

[00:14:34] I wish I was always embodying all of that

[00:14:37] as well as I want to.

[00:14:39] It's the way to say that because I don't.

[00:14:41] But I think the foundation of all of this is this.

[00:14:44] It's the confidence and permission to talk to one another

[00:14:48] and not to manage or be a little intimidated or control.

[00:14:52] That's where that might be seem intimidating.

[00:14:54] But if we move away from that and all you're doing is seeking to understand

[00:14:58] and do the work to be able to understand someone.

[00:15:02] So in the in essence, then, and we are editorial on this,

[00:15:05] which will share with the listeners on listening.

[00:15:08] And that's a great place to start for me.

[00:15:10] It's it's the fund.

[00:15:11] It's the foundation of communication,

[00:15:13] which really is the bedrock of a lot of these.

[00:15:15] Well, any relationship, right?

[00:15:17] It really relies on good communication.

[00:15:19] And there's different ways of listening.

[00:15:21] And we kind of dig into this.

[00:15:22] This is some work from Otto Schwarmer as well.

[00:15:24] But so sometimes we need to download information.

[00:15:27] That's when you're sitting in a lecture or you're absolutely,

[00:15:30] you know, really making sure you're just collecting all the information.

[00:15:34] We have lots of technology to help us with that now, which is kind of great.

[00:15:37] The second thing is factual.

[00:15:39] So you're fact checking.

[00:15:40] Now, this is where we get caught out, I think myself for sure,

[00:15:44] because I quickly want to check with the patient.

[00:15:45] Hang on. I'm just going to check.

[00:15:47] Is that what I heard?

[00:15:48] Is it did you say and then we interrupt their flow and their story

[00:15:51] and we have to be really careful about those interruptions,

[00:15:54] but be mindful of fact checking because you do want to make sure

[00:15:57] about some of those more factual parts of the information.

[00:16:01] A level down would be empathetic listening.

[00:16:03] So now we're really connecting with the person's story.

[00:16:06] And trust me, I'm sure we've all been in those situations

[00:16:10] where you felt that the person listening to you is or isn't connecting to you.

[00:16:14] Good way to do that is to rephrase the words you're hearing and to say,

[00:16:18] OK, I get it. I think I get it.

[00:16:20] I want to understand more, help me.

[00:16:22] And that's really when you are showing your empathy

[00:16:26] and really trying to connect with that person.

[00:16:28] And in the last piece in that, I think is to be generative.

[00:16:32] Now, this is hard for physios.

[00:16:34] And I think generally in health care, it's difficult

[00:16:36] because we all want more time.

[00:16:38] We want more time to be really to really understand someone's story.

[00:16:43] But whatever time you have, if you get to that level

[00:16:45] of where you're open to this person that you're with,

[00:16:48] learning with you, becoming a co-creator of what's that event happening.

[00:16:52] I guess we're back to art and science a little bit.

[00:16:54] That is where the art does come in because you are emergent.

[00:16:58] We don't have a research evidence on everything we do.

[00:17:02] A lot of our clinical intuition is exactly that.

[00:17:05] And it's there for a reason and it's part of an evidence based practice model.

[00:17:11] So really being generative in your listening,

[00:17:13] you're really concerned, you're really open to the possibility

[00:17:18] that you are going to learn from this experience.

[00:17:21] Go and have a conversation with your next or try and record

[00:17:24] if your patient is open to it or do it with a friend

[00:17:27] and just record a conversation where you are asking questions

[00:17:31] about someone or something with someone and listen back at your own style,

[00:17:37] your habits, the way you're engaging with someone and their story.

[00:17:42] And look, there's no magic formula.

[00:17:44] There's no hack, right?

[00:17:45] There's no like halfway through you start crying and then they feel

[00:17:48] you're really connecting with.

[00:17:49] There's nothing like that.

[00:17:50] It's about really seeing someone and making them feel that they belong.

[00:17:55] And it sounds like flexible having a flexible approach is also really important here

[00:18:00] because the person in front of you is going to bring different life experience,

[00:18:04] different personality, different wants, different expectations for that

[00:18:08] for that interaction and having the flexibility of mind to

[00:18:12] to then bring a different style or a different approach to that interaction.

[00:18:17] Yeah, we've got to we've got to allow ourselves to be vulnerable.

[00:18:21] You know, so the wonderful work by Briney Brown and I'm sure a lot of listeners

[00:18:25] will be familiar with her work, a fantastic Canadian author.

[00:18:27] If you've never read this book, The Power of Now, it is absolutely

[00:18:31] incredible to being present to the moment and knowing that each interaction

[00:18:36] will be different. I'm so guilty of that.

[00:18:38] You know, once you build an expertise in a certain area,

[00:18:40] you suddenly feel very comfortable.

[00:18:42] You get a little formulaic and it takes one or two patients or persons.

[00:18:47] Doesn't have to be patients, your staff members or colleagues who go,

[00:18:50] hey, hang on, can we think differently about this?

[00:18:53] And you realize that you really have to be open to that possibility.

[00:18:57] So that's not to say you don't have a structured way of thing

[00:19:00] of approaching something, but certainly allowing some emergence

[00:19:04] in that situation, I think.

[00:19:06] And that's back to that kind of generative type of listening again.

[00:19:09] And it reminds me a little bit of that we're the researchers at now

[00:19:13] on leadership styles and we're much more in the realm of there are

[00:19:18] many different styles and that's OK.

[00:19:21] And you're going to need different styles having that flexibility

[00:19:24] to then bring a different approach and a different style

[00:19:28] to your listening, to your leadership, whatever it is, I think is important.

[00:19:33] And knowing your own strengths and weaknesses,

[00:19:36] great leaders are super attuned to what are they really absolutely amazing at

[00:19:42] and what are they average at and building a team of people around you

[00:19:46] that can help you expand that when you need to and acknowledging that.

[00:19:50] I think I've had so many experiences of where I thought like,

[00:19:55] I just didn't connect with someone.

[00:19:57] Like there's no reason I can't really explain it.

[00:19:59] And then I have to own up to that and go,

[00:20:01] do I need to work at this?

[00:20:02] Do I need to change?

[00:20:04] Can I be more adaptive and flexible around how I use my language or my approach?

[00:20:08] Or do I need to to consider what's best for the person in front of me

[00:20:12] that might be calling in a little bit of help, not even always referral.

[00:20:16] Just a bit of consultation, just someone to help you reshape

[00:20:19] the narrative around something could be very useful.

[00:20:22] So I think knowing and developing the knowledge of your own strength sets

[00:20:27] and then, of course, we can develop things,

[00:20:29] but there are things you will naturally lean towards.

[00:20:31] And that's OK, as you say.

[00:20:33] I think just being able to acknowledge that is an important first step

[00:20:37] and then building the building the support network around that is crucial.

[00:20:41] Now, we've been talking in the more general sense of what these skills are

[00:20:46] and how you might think about applying them

[00:20:48] and developing them in your clinical practice.

[00:20:51] I'd love to hear from you, Nikhil, a couple of examples

[00:20:53] of where it might have worked well and where maybe you didn't do a great job

[00:20:58] and you can self reflect now and say, oh, this really didn't work out.

[00:21:02] And here's why or here's what I think went wrong.

[00:21:07] Yeah, well, channel in a briney brown vulnerability.

[00:21:12] So I'm happy to be vulnerable with you, Claire.

[00:21:14] Yeah, that is.

[00:21:16] I think clinical practice is a wonderful just learning school for all of us.

[00:21:22] I remember having a patient with long standing neck pain

[00:21:26] and it was just she was convinced it was a nociceptive structural issue.

[00:21:30] And we spent a lot of time and I felt like what I needed was

[00:21:35] to show her an expert, not me, that is able to clear the structural issues.

[00:21:41] So I was very fortunate, one of my mentors

[00:21:44] and an absolutely amazing therapist in South Africa,

[00:21:47] probably the best metal therapist I've ever known.

[00:21:49] And so I took her to see this person and she was amazing.

[00:21:53] We did the whole session.

[00:21:54] We did everything.

[00:21:55] And she even manipulated some of her joints,

[00:21:57] you know, cervical joint manipulations, really safe, really good.

[00:22:01] You know, it felt like she was really calming down the anxiety around us.

[00:22:05] And there were, you know, later we did discover

[00:22:07] the true source of these anxieties were different than there were other issues

[00:22:11] for this person to deal with.

[00:22:13] But at that moment, that's all I needed.

[00:22:15] And I think the patient said to me, but I'm still worried that it might get worse.

[00:22:20] And I think I said something like, she have neck pain every day of your life.

[00:22:24] How much worse could it get?

[00:22:25] Now, I just thinking about that statement now, right?

[00:22:29] But that that just destroyed the last hour and a half we did.

[00:22:32] A few weeks, actually, that put us back away.

[00:22:35] She immediately felt I didn't understand what she was trying to say to me

[00:22:39] and reflecting on that now, I was trying to make a declaration to her

[00:22:44] that I wanted her to buy in.

[00:22:45] And as my coach, Ron Bartoya would say,

[00:22:49] that which you discover you will own more deeply than that which I declare.

[00:22:53] So if you take your patient on a we were busy with her going on this journey

[00:22:57] of discovery towards the things we really needed to address

[00:23:01] and to give her a good quality of life.

[00:23:02] And I just by making that declaration, I just shut that door completely down.

[00:23:07] So that was a hard lesson.

[00:23:09] But another example, maybe of where in recent times I've been helping

[00:23:12] with an elite track and field athlete and their physio

[00:23:16] really struggling to communicate with the coach.

[00:23:18] And he wanted a certain type of exercise to happen.

[00:23:22] And they were really worried about some lagging pain issues

[00:23:26] with the player with the person's return to to running.

[00:23:29] And so so, first of all, you can we reshape the narrative around these exercises

[00:23:34] and still incorporate the things that we feel is necessary?

[00:23:38] Can we if the coaches narrative is about performance

[00:23:42] and we know that this will feed into performance, let's speak that language.

[00:23:45] We can reshape the language we use around our exercises

[00:23:49] to fit the performance narrative.

[00:23:50] And we did that with some success.

[00:23:52] And then when the player had to return,

[00:23:55] you know, people who are involved in elite track and field

[00:23:58] will know that these athletes really get to know their bodies pretty well.

[00:24:01] And you do want to pay attention.

[00:24:03] But can we just bring the anxiety?

[00:24:05] Can we see the competition if it's a low level meat

[00:24:08] and he's returning to athletics as a training run?

[00:24:11] Could we ask him if he could run at 60 percent or 70?

[00:24:14] So we're completely taking the pressure off.

[00:24:16] You don't know, it's not a qualifying event.

[00:24:19] By reshaping the narrative for the athlete,

[00:24:20] we were able to make him really comfortable.

[00:24:23] And it was part of his confidence building

[00:24:25] because we were absolutely certain that he was OK.

[00:24:28] You know, like we've done all the checks and balances.

[00:24:30] We really felt he was ready by de-escalating that situation

[00:24:34] and changing the narrative.

[00:24:36] I think sometimes it's it's really about paying attention to what you're hearing.

[00:24:41] And if it's a coach or a patient meeting them where they are

[00:24:44] to you create a shared starting point

[00:24:47] to allow you to build the goals into what we need to achieve.

[00:24:50] That's an absolutely wonderful way to try and see what we would

[00:24:54] would you see as conflict, but really an opportunity to create a shared narrative.

[00:24:59] Dr. Nikol van Dyck, thanks for joining me on JOSPT Insights.

[00:25:03] Thanks for having me, Claire.

[00:25:04] That was a really great conversation.

[00:25:11] Thanks for listening to this episode of JOSPT Insights

[00:25:15] for more discussion of the issues in musculoskeletal rehabilitation

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