Friday, June 17, 2011

Interviewing and Assessing

Sorry for going so long without a post!

I've been spending the past several weeks talking to folks who are ex-runners or have problems running, and trying to form accurate assessments of their current condition and the likelihood I'll be able to help them.

It seems everyone has their own personal horror stories related to running.  When the stories are told in the present tense, I want to understand if the problem is transient or continual, and if it is due to poor running form, inadequate strength, or a deeper medical issue.

Turning stories into assessments is tough!  After the story, I ask questions to learn more, generally to separate emotional pain and frustration from physical pain, and to separate physical causes from physical effects.

An example: I had one friend going on about minor annoying knee pain that became agony when running.  I asked about his warmups, asked if he had changed anything (such as shoes, route, or duration), and asked if anything else aggravated his knee.  It wasn't until well into our discussion I asked "When did you knee start to hurt?"  His answer was informative: "Right after I slipped and fell in my kitchen."

The problem had nothing to do with running, and everything to do with letting a damaged knee heel.  He didn't need any developmental running help from me:  I told him to go to his doctor to ensure no soft tissue was damaged and no bones where chipped or cracked.

Doing a good interview isn't trivial.  I've seen many folks (help desks, doctors, physical therapists, car mechanics, etc.) ask questions until they find something "interesting", then take off on a tangent instead of completing the interview process.

To ensure I stay on track until the interview process is completed, I'm building a list of things I want to know about a problem runner, and good questions to ask to get than information.

Even with the best interview in the world, I'm still only getting the person's subjective observations.  Objective information is critical not only to establish facts independently of the person's story, but also to learn what is subjectively most important to that person, and as a chance to identify missed items for additional discussion.

So along with each subjective story, I must also ask the person to perform objective tests.  It is important these tests don't aggravate any condition:  The fundamental premise in providing any kind of training or care must be: "First, Do No Harm."

If the person can't walk without difficulty, then clearly there's nothing I can do for them related to running.  If they can walk comfortably, then a wide range of tests are possible.  Going from simplest to most difficult, the list includes:
  1. Monitor the walking gait.  Is it smooth and symmetric?
  2. Watch how the person gets out of a chair.  Can they stand up directly, or do they need to push themselves up?
  3. Can the person balance on one foot?  With eyes closed?
  4. How difficult is it to do squats?  Squat-and-hold?  How many are possible?  Is one leg favored over the other?
  5. ...

The list goes on.  The key thing is to sequence the tests in order of increasing difficulty, to learn as much as possible from each test, and then to stop when things become too difficult.

But the list of tests should not grow without end: It is important for me to employ only those tests that provide information I can do something with, and avoid tests that may reveal limitations that have nothing to do with running.  Not only do I want to avoid wasting time and effort, but I also don't want to go into information overload!

The assessment process doesn't end after the initial interview: When run training starts, it is important to continue to perform assessments with each new exercise and drill.  With repetition, the exercises and drills will stop providing new information concerning symptoms, and will start indicating progress toward the goal of creating a comfortable runner.

I've done many online searches looking for good interview and assessment guidelines and techniques, and there are surprisingly few that not only describe what an interview and assessment should achieve, but also provide meaningful guidance toward developing interview and assessment procedures, and designing the individual steps required.

The best I've found come from the medicine and psychology fields, but they are way too technical and academic for me to gain knowledge I can apply to my own run clinic.  Training and coaching guides provide lots of examples, but little pedagogy.  Or perhaps what I was searching for is just "common knowledge" in those in various fields, and not needing much in the way of discussion.

The one thing that has helped me most in developing my interview and assessment has been my experience with interviewing potential new hires, and also with being interviewed for new positions.  It is vital to get the greatest amount of relevant information in the limited time available, and to use that information to make the best decision possible.

In this case, I'm interviewing potential members of my run clinic, and hopefully they are simultaneously interviewing me as well.  I need to get the information I need to determine if they should seek medical advice instead of joining my clinic.  If I think I can help, I need to communicate that in a manner that will gain agreement and commitment from the person:  I have no reason work with an unwilling or unhopeful client!

I initially thought the target and method of my clinic was what made it unique and worthy.  I'm now beginning to suspect that the interview and assessment process will be at least as important in determining successful outcomes as the clinic itself.

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