Context is King

by Mitch Hauschildt, MA, ATC, CSCS

This past weekend I was having a great conversation with my buddy Mike Stella.  Mike is a fellow Athletic Trainer who works in a setting that isn’t typical for ATCs.  He is a bright rehab mind and I appreciate our conversations because I always come away smarter.

Context: the circumstances that form the setting for an event, statement, or idea, and in terms of which it can be fully understood and assessed.

One of the things he mentioned was that “Context is King”.  As I think about it, I couldn’t agree more.  Having a contextual background to every question or conversation is extremely important to what we do.  Before I get to how context affects what we do in the rehab world, I would like to take a minute to explain what I mean by context.

If I ask someone to walk across a 2 x 4 board that is lying flat on the floor, most people will step onto the board and walk across it quickly and without hesitation.  But, if you take that same board and put it 10 feet in the air, suddenly the game has changed.  Most people won’t walk across that board.  If they do, they will be much more focused and take their time to move across it.  That is because as soon as you elevate the board, you have changed the context.  The environment has been changed and suddenly when it is 10 feet in the air, it becomes a lot more challenging.

Along the same lines, I was sharing with my wife recently how now that I’m in my 40s, am married with 4 kids and the primary breadwinner for my family, I don’t like getting up on ladders nearly as much as I once did.  I grew up working in the construction industry for my father and we used to run up and down 40 foot extension ladders with walking planks suspended in between them all of the time, just like we were walking on the ground.  It didn’t bother me a bit.  But now that I have so many people depending on me and I know more about the risks that exist if I fall off of a ladder, I’m not nearly as excited a out performing tasks at a high elevation.  I can tell you that the ladders haven’t changed and I’m actually quite a bit lighter than I was then (I was playing offensive line at the time), so physically I’m probably at a smaller risk of being injured.   But, the context has changed.  I have a lot more to lose now than I did when I was when I was 20.

I also notice that sometimes at work that I will perform the exact same thing that one of my younger coworkers does with the same patient and I get great results and they don’t.  Does that mean that I have some magic variation of the technique that cures them of all of their issues?  Not likely.  Sure, there may be a few subtleties and nuances that I am able to recognize and perform because of my years of experience, but by in large, I am more successful with the same approach because I am considered the rehab expert in our facility.  When I perform the same exercise or intervention as our graduate assistant, I am more successful because our patients have more confidence that I know what I’m doing.  The context has changed for that patient.  Suddenly they are no longer being told to do something by a young person with very little experience.  Now they are being told how to do something from an “expert.”  Right or wrong, it is reality.  Its the same movement but with different context so the likelihood of success has changed.

When the context arounds something changes, so does the everything else.  This is why in my courses when someone asks a question about a specific patient or case, I usually begin my answer with, “it depends.”  There are so many variables to consider that that it wouldn’t be fair to answer with an absolute.  I need to understand the context that surrounds the issue at hand.

So, what does this mean for those of us that are in the rehab and fitness industry?

It means that we need to consider a ton of factors with our patients and clients.  We need to look at their mood and attitude, just as much their physical make up.  Someone’s pain changes if they didn’t sleep or if they had a stressful day because the context around the pain has changed for them.  Sometimes adjusting their physical environment can make a huge difference because it changes the context and gets their brain to recognize things differently.  Simple things like changing a postural position changes the context of an exercise.  Now the brain recognizes what appears to be the same movement differently.

Every variable matters.  Every.  Single.  One.

We need to understand as much as we can about our patients and clients in order to maximize their odds of success.  The context that surrounds their training sessions, injuries or whatever, plays an important role in how they got to you.  That same context and how we handle it also significantly affects our the likelihood that we succeed with them.  This is both physical and psychological.

If you are having trouble seeing results, consider changing the context.  If you can’t find the answer you need to help them, learn more about the context in their life.  Context really is king.