Now What? What to Do After the Breakthrough

You know that moment when your client’s pain is gone, they’re finally moving better, or they’ve made that shift you’ve both been working toward—and you’re left thinking, “Now what?”

In this episode of Three Questions, I’m sharing what I look for in that moment, and how I decide when it’s time to progress, when to pull back, and how to turn a breakthrough into something that actually sticks.

I’ll walk you through:
 ✅ How I know when it’s time to progress (and what signs I’m watching for)
 ✅ What I do if a progress ion makes things worse (and how I learn from it)
 ✅ Why I don’t see regression as a setback, but as a tool for sustainable change

If you’ve ever felt stuck after a client’s progress or worried you’ll lose the gains you worked so hard to create, this episode will give you practical ways to build on breakthroughs without burning yourself or your clients out.

Resources mentioned:
My Website
Connect with me on Instagram
Connect with me on Threads

Chapters

• 0:00 Now What? What to Do After the Breakthrough
• 0:37 Episode Inspo
• 3:20 Q1: How Do You Know Whn It’s Time To Progress
• 14:34 Motivating Change
• 18:08 Q2: What If The Progressions Makes Them Worse
• 23:35 Q3: What Do You Mean When You Say Regression

Transcript

Meghann Koppele Duffy: Welcome to Three Questions where critical thinking is king, and my opinions and research are only here to support your learning and hopefully deeper understanding. Hey, I'm your host, Meghann, and I'm so honored you clicked on Three Questions today, and I'm joined by my little buddy, Willie. Now, if you're listening to this podcast, you can't see this adorable face, but go over to YouTube and check him out.

I mean, I know I'm biased, but what a little prince. All right, Willie, I'm gonna let you down because I need to talk to these guys about now. What? Now? I am so excited about this episode, and one of my favorite students asked me this question the other day, and I know I say favorite students a lot, but this one holds a special piece in my heart.

So shout out Diane, and I'll tell you why she's my favorite student. She practices what she preaches. Now Diane is one of our level three neuro studio teachers, and she also happens to live with Parkinson's. That's probably the least interesting thing about her. But what is so amazing is she does the work, she follows the protocol, and she is, I feel like I'll, I'll get choked up talking about it.

She is. Living with a lot less symptoms of dystonia and Parkinson's. And she often compliments me and tries to give me credit, but it's her doing the actual work. It's really easy to learn new concepts guys, but to implement that is a whole nother story. So, um, on behalf of Diane, I want us all to commit to kind of.

Whatever we say a lot at work or in our personal lives to maybe practice what we preach more. And going back to the question now, what, this is something I get asked a lot. So what do I mean by now? What? Now I'm gonna be kind of talking to my movement pros today, but this translates, so what do you do when you reach a goal?

So say maybe you are trying to help your client decrease their spasticity. Maybe you're trying to decrease the symptoms of Parkinson's. Maybe you're trying to get rid of back pain. Maybe you're trying to get your kids to listen more. Maybe you're trying to get your husband, wife, or partner to help a little bit more around the house, or, you know, fill in the gaps that you need.

So this translates in life. Like what is the next step when a change is facilitated? And I get two questions a lot. Now what and how do I start? And I feel like it's the same question, just with different words. So what I wanna do is introduce the three questions first, and then we'll break them down, get into the minutia, and hopefully you'll walk away with some better strategies.

So question one is, how do you know when it's time to progress? Question two, what if your progression or suggestion makes things worse? We've all been there, everything was going smooth, and then we said one thing and everything got derailed. And last but not least, what do you mean when you say regression?

Okay. Now, let's start right from the top. So how do you know when it's time to progress? Well, bad news first, there is no perfect time. Every person is uniquely different. But what I'm gonna do is give you some, I don't know, maybe share how I do it and more explain my whys so you can figure out how you want to do it.

So what are we looking at? Are we looking to decrease pain? Are we looking to improve, improve focus? Are we looking to help with what I call their tells? Okay. So like, say you talk to your kids and every time you talk to 'em, they roll their eyes. That's a tell. Um, maybe when I'm working with a client who has significant pain and I'm like, Hey, how does that exercise feel?

And they're like, oh, it, it feels fine. Okay. Notice how my voice changed. Or they'll make a face or they'll scrunch their, their kind of mouth. They're gonna have a tell. Now, I am not a great poker player. I have a terrible poker face, but tells are what people do when their, can we say their nervous system is not ideally safe.

I think I like those words. Uh, let me try another way. Um. Because sometimes when we say nervous system, it's too vague and people are like, what the hell are you talking about? When people do a tell, there is something that's making them uncomfortable. Now, what makes me uncomfortable might not make you uncomfortable and vice versa.

There's a lot of things that don't make me uncomfortable, which is sometimes why I'm an open book and I say shit, and people are like, I cannot believe she said that. Okay, but that can cause a problem sometimes if it's not a problem to me, but it's a problem to you. Oh, I better know that. Okay, so what do I, how do we, what are we doing with all this information?

I'm gonna use pain because we've all experienced it, whether it's physical, emotional, mental pain is serious. And when somebody says they're in pain and we are doing the same thing and we're not in pain, people tend to roll their eyes or diminish it. And we don't do that because we're asses. We do that because I don't understand how that is causing you pain.

Okay? Some people are super empathetic, they kind of feel everybody's pain. So that's like your, that's your superpower, but it's also a curse. I realized that through a little bit of therapy. Uh, thank you Rhonda. No lie. My therapist that I went to, um, in my thirties, her name was Rhonda, and don't think I didn't somehow help me.

Rhonda, help help me, Rhonda. But anyway. She said to me with all do I don't think you're empathetic. You are sympathetic. And we broke that down. And she's like, I think you assume what a lot of people are thinking or feeling. And you know what I said? I'm like, yeah, because I'm usually right. Now that might sound like I'm an ass, but I have the confidence to say it because one of my favorite clients, not students, says that too.

And she's right. She is right a majority of the time. But just because we're right and are good at reading people, that's not it. We have to give people time to figure that out themselves. And I might be right, but I am missing their why. It's easy to judge people's why, but we don't do it. Okay, so getting back to pain, how do you know when it's time to progress?

Well, number one, are they out of pain? Now, when I say out of pain, I don't mean decrease pain, I mean out of pain. And you might look at me like I'm crooked, but with the methodology I teach at the neuro studio using the four quadrant stability model, it's checking brain safety first. And it's a way to assess.

And often when we use that assessment, people who are in tremendous amount of pain, their pain disappears. They feel shocked, they have increases of hope, but that isn't it guys. Great. I was able to get that person out of pain. But how do I progress that? Because let me tell you, as soon as they move or do something that we didn't train, they will be in pain again.

Okay? So how I manage progressions is using the scientific principles, accuracy verse precision. Stay with me here. I know people hate words with no meaning. So what does it mean to be accurate? Okay, so if you're watching on YouTube, I am touching the center of my nose. So if we use my face, oops, I just hit my microphone.

Sorry Joe. My sound guy is a freaking legend because I hit and touch things all the time, so sorry if that made a noise. Guys, going back, let's use my head as a dartboard. Don't get any ideas. The nose is the center. So if I am hitting my forehead, okay, that's where I'm starting from. That is not so accurate.

Getting closer to my nose is accurate. Okay. That's easy to understand, but how does that relate to pain or, um, focus? Okay. Well, if I'm in a tremendous amount of pain, the movement pattern I'm com that I'm currently using is causing me pain. And people get confused. But if you look at pain science, there's often not tissue damage at the place of pain.

It's at tissue aggravation, neuromuscular aggravation. And what I, how I describe it to clients is, yo, that's your most efficient movement pattern. That's what your brain thinks is the best choice. We can't disagree with your brain, but we can give your brain other options. Okay? So if my accuracy, if I'm trying to move my hip and it gives me back pain.

And I watch this client move and I say, oh, we got some brain map muddiness. They're moving their hip joint, their lower back, their SI joint, and a little bit of their pubic synthesis. So that is not differentiating the hip. So by moving all those joints together, that pattern is causing them pain. So that's not accurate.

What I want to do as a teacher is I want to improve their accuracy of isolating the hip joint. I wanna show their brain that their hip is the second most mobile joint in the body. It's got a lot of range. We don't need to steal from the lower back or SI joint or pubic synthesis. We might if we're doing weird things like dancers do or athletes do, but that ain't the thing.

So what am I gonna do? I am going to give a sensory intervention to improve their accuracy. Maybe I'll ask them to touch their lower back and ask them to do the movement and say, Hey, did you feel your lower back moving? And they'll say, yeah. And I'll say, okay, can you do it again without increasing the pressure in your hand?

And they'll look at me and they'll try it and they go, oh, no, no, I'm, I'm, I keep pushing into my hand. I said, well, keep trying. Now, that is a simple. Simple explanation. I'm not going to go in all the ways I assess low back pain. That's not what this podcast is about. What I'm doing is I am bringing awareness to their movement era.

That's different than what a lot of people do, but you can do. You pointing out what people do wrong only brings them awareness in an auditory way. Now they know they're doing something wrong, but how can their cerebellum understand that movement error if it feels the same? Okay. It's the same. Same. So we need to bring awareness via touch or other senses, like the visual and vestibular system to improve their accuracy.

Okay, hang tight. Quick review. Client is moving multiple joints. When they're moving their hip, it's giving them tremendous amount of, of pain. They now have, um, arthritis in their hip joint. They might have torn their labrum. Big mess. Okay. If we can bring awareness via touch, let's just talk touch right now to help their brain feel the difference between coupling those joints and uncoupling, we can improve their accuracy.

Okay. So by improving their accuracy, they are now isolating their hip more. Notice I and say they are isolating their hip with no lower back movement. Let's, everybody's got a different margin of error. If I can improve your hip joint mobility by 20%, that's huge for your brain. So the biggest problem I see with using accuracy is people think they have to hit a bullseye.

Nah, it ain't that. Guys, if you can improve the accuracy, so if we're looking, using my faces, a dartboard, say I started on the right top of my forehead, right by my hairline, and now I'm down to the inside corner of my left eye. I am closer to that bullseye. The client goes, oh my God, my pain is gone. We stop there.

You have improved their accuracy enough to decrease the reason why they're there. Stop trying to get that bullseye. We're gonna talk about that in the next question. Now, here's where it gets tricky. Stay with me. I've got you. Once we improve that accuracy, you guys start getting kooky. You start doing all different weird shit and totally moving away from what improved the accuracy.

So I want you all to ask yourself a question, what did I just do to improve the accuracy? Was it using an auditory queue? Was it touching them? Was it having them touch themselves? How did you bring awareness to that movement era? Then you better use that same sensory input for precision. So now let's define what the difference between accuracy and precision.

Accuracy is getting closer to the bullseye. Precision is nothing to do with that bullseye. Precision is hitting the same mark repeatedly. So technically, if I didn't improve accuracy, say I'm still at my forehead. If I can hit that same spot 10 times in a row, that's precision, baby. Precision is not getting closer to the bullseye.

It's replication. To me, that is the secret sauce of neuroplasticity that nobody's focusing on. How do we replicate things? Well, we need the same sensory focus to have the best chance. If you start saying, okay, now, move your arm like this and put your hand there, or look at this and do that. They're going to increase their repetitions, but not with precision.

They're gonna have repetitions all over that bullseye. Some with the hip, some with the hip and foot, some with the hip and knee, some with the hip, and the lower back. And in that moment we have high risk of hitting question two. What if that progression makes it worse? Okay, so hold that thought. Quick review.

Whatever we do in our sessions or in life, I'm gonna use a different example. Your kids aren't doing their homework, okay? They're lying about it. My husband told me this thing that kids do where they submit a blank assignment on the online platform because it says submitted and Brian gives them a zero.

My husband is a high school history teacher in special ed. The parents get pissed at Brian, why you giving my kid a zero? And Brian goes, they, they didn't submit the project. The parent goes, yes, they did. And they screenshot it and Brian goes. Oh yes, they submitted. But look, they submitted nothing. So the parent's not wrong.

And Brian's not wrong. Okay? That's a problem. Okay. Ugh. But all, let's talk about homework in another episode. So what can you do to help improve your kids' ability to do their homework? Maybe you bribe them. I'm not saying it's the best way. This is about you, not me. My dad used to bribe me with money. He was like five bucks for every a, he did it with my sister.

It didn't work. Kim wasn't motivated by money. School wasn't geared to her learning style. My sister is probably a lot smarter than me, but I did better in school 'cause it was geared towards my learning style. Don't tell her I said that. So when my, I heard my dad did that for Kim and I was like, yo, yo, yo.

Same. Same. We equal in this house. You give her five bucks for an A, I get five bucks for an A. I did the math. Yo, if I get five A's that's 25 bucks, you know how much candy and gum I could buy with 25 bucks? I'll be candy rich. Okay? This is what motivated me as a kid. I'm not saying it's the best way to motivate.

Okay? Maybe you motivate them with. Taking away their devices or maybe spending more time with them. I don't know. I don't have kids. I'm not a parental expert. It's your job to figure out how you can improve their accuracy of getting their homework done. But then once they start doing their homework, you better enough lift that script.

You better keep it consistent. You might wanna bring in a little novelty there, but stay focused on what created that shift. So how do we know when it's time to progress? When we see a change in our client, partner, kids, whatever, when do we see a change? Does it need to be a big change? In my opinion, no small changes equal bigger results, and they're easier to integrate.

Once we find that change, we need to ask ourselves and critically think, what the hell did I do to get that change? And if you don't know, ask. Hey. I'm noticing your back pain is different. What do you think it was that changed it? Hey, Anthony, that's my nephew's name. I notice you're doing your homework more.

What's that about? Ask people when you don't know. Ask questions. Then whatever caused that change, continue using that specific thing to work on progress. Okay, so when it comes to movement. You can progress using an increase of load, an increase of repetition or increase in complexity. Yeah. All you progressive overload.

People read the research. There's a new emerging research that does that says it doesn't just have to be load or repetition. Complexity in a sensory environment can also count as progressive overload. So figure out your goal. How do you want to progress them? Is it increase load repetition or complexity?

But make sure you focus on the thing that created that change. Okay. We spent a lot of time on question one. Let's get through question two and three and bring this bad boy home. What if the progression makes it worse? Well, I kind of answered that in question one. Sometimes we get over eager with accuracy.

I want a bullseye every time. Can I tell you something? Super honest. I travel a lot doing evals for people. And I love my students, but they act like the freaking Dalai Lama's coming to town or like the next Messiah. Oh, she's great. Like as if I'm gonna change people's world in 90 minutes. Right? So they, they set these expectations high.

And I always think of my mom, Maureen Koppele. The first time I traveled to teach it was in California. No offense, California, my mother likes the East coast. I'll leave it at that. And I called her. I felt there was a lot of hype of me coming there. And I went outside and I called my mom and I said, mom, I'm weirdly a little nervous.

And you know what my mom said? Why mind you, my mom's from Queens. Why? Who gives a shit with those people? Think about you. You're not staying in California, you're coming home. And it made me laugh 'cause she was so right. I'm not there to impress them and do a dog and pony show. I just need to do what I do.

And if they hate me, well, I never have to see them again. It's all good. So keep Maureen Koppele on the back of your mind when you're trying something new or, or you're, you know, trying to progress something. I want you to think about my mom. Who cares? You are not marrying this person. You are not staying there.

You're coming home. You've got your life. Okay? So take the pressure off. But number two is when we're trying to have these groundbreaking sessions. Here's what I hear all the time with teachers. It's actually at another studio recently and um, I could overhear one of the teachers. Yam Yam. Yam. Yam? Yeah.

Okay. That's me talking yammering on. She was over explaining to her clients as if she was giving a TED talk. And I'm thinking, is she trying to prove how smart she is for this client or is she trying to get results here? Okay. I'm not gonna tell you why I think she was doing what she was doing, but we all know those people who have to talk to be heard.

Okay? Maybe I'm one of them. Sometimes I guess we all are a little bit right? But so if your progression gets worse, do less. So something. This was the secret I was gonna tell you, and then I got derailed. Every time I'm in a session, when I travel every time I'm like, okay, let's just do one more thing. I always regret it every single time.

Every time I say, okay, that's it. Let's just keep this going, or let's call it, those are the best sessions. Those are when clients call me and say, I think you changed my life. I will give you an example. I worked with this amazing woman, was having issues breathing, um, a lot of neurological symptoms. Um, she had a double mastectomy, uh, no reconstruction.

So again, there's a lot of trauma there in different ways. Um, we found some reflexive stability because I believe scars should not be addressed until their nervous system is safe enough to do so. I assessed both of the breast scars and one. Was moving in an indication that it was ready to be released. I released it.

She felt much better, but I wasn't gonna see her again and nobody else did. The scar tissue technique I use, which is the McLaughlin Scar tissue release technique, if you're interested. Um, and if you wanna learn how to do it, Cindy George, who is based out in um, Gilbert, Phoenix area, is the best. So take the training with her.

Okay. She kind of asked me to work on the other breast tissue. I. My brain said, don't do it. My heart said, do it. Now, here's the thing. When I worked on the other breast, she did not get worse, but the feeling of being able to breathe again only lasted a day. I think we aggravated her nervous system and gave her brain too much to integrate.

When I worked on that second breast, the interesting thing was I had just flown in from the east coast and went right to the session, so I wasn't at. My most awake best. And this woman was so lovely. I kind of fell in love with her a little bit. Um, and I was kind of like, God, I hope I am that awesome when I am 83.

Okay, so no harm, no foul, but I just wanna share with you that doing more, more is not better. More is just more. So if your progression makes it worse, back off, go back to what worked. Take a beat. Maybe ask the client to get up, change the sensory environment, shake it up, give them a vestibular challenge.

Go back to what worked and call it a day. I am not mad if you make people feel worse in the short term, but I want you to learn from it and critically think, when should I have co? When should I have stopped? Was I going for too much accuracy or was I not paying attention during my precision? Because it's one of those two problems, I can guarantee that.

For me, it's usually never not focusing on precision 'cause I'm kind of obsessed with that. For me, it's always trying to improve the accuracy too much. And last but not least. What do you mean when you say regression? I actually Googled this before I did this podcast episode because I had to think, what do I mean about regression?

So I'm gonna pause right now. Wherever you are, I want you to say it in your head or say out loud, what does it mean when you say regression? Go.

Maybe you're thinking. I, I mean, I know what I mean. It's just, I mean, um, well, it's making something easier. Um, going back, breaking down an exercise, what does it mean to you? Because words mean different things to different people. So I'm not gonna give you a definition. I want you to decide what you think it means and then figure out a way how to use it.

So for me, a regression is not a step backwards. To me, a regression is. Changing the strategy to get the same result or a better result. So I guess in this case, a regression, we would need a better result. We wouldn't regress if we didn't need a better result. Right? Look it, I just learned something. So to me, the regression should be based more off the concept, not the exercise.

Here's what I see a lot with regressions and I'm not mad at it. I just want you to think about it. So maybe somebody can't. Um, do a roll up like a Pilates exercise. So then they take 'em over to the tower, they have 'em hold the bar, and they do a roll up. That way, maybe somebody can't do a rollback with their knees bent feet down on the floor, so they straighten the legs.

Now here's why. That's technically not a regression, but could be. When you're dealing with regressions, I want you to think of three things. Number one, what you're currently doing. Is it open or closed chain. Or open chain with specific sensory input. Let me give you an example. So if I'm doing a rollback, you know when your, so your legs are on what's called like hook line.

Your knees are bent and your feet are flat on the floor and you're trying to roll up or roll down. That's kind of hard. That's an closed chain environment on the feet with not a lot of pressure under the feet. This is why I get so aggravated when people only teach glute activation with heavy pressure on the feet.

Um, yeah. We don't always have heavy pressure under our feet. We sit, we lay, we need variety. Okay? So if you are ha a client can't sit up all the way or roll back with their feet flat, that's a closed chain environment. Can you make it open chain where the foot is not touching anything? Maybe you rock back on your heels or straighten your legs all the way.

That might not be it. Maybe you need an open chain environment with sensory input. So sometimes if I still wanna keep the same exercise, I put a towel under the arch of people's feet. Some people, these are people who love orthotics, those are people who need sensory input from the arch. Then there's those people who get orthotics and they always say, well, I didn't really give them time.

And I'm like, because they sucked for you. Your brain doesn't like sensory and foot at the arch. Let it go. Okay, so what we can do is what if we just change the environment in a closed or open chain or open chain plus? But here's the thing that is only helping them do that movement in that environment, but we need to win my friends.

So now they're rolling up and down. Now they've built confidence. How can we then progress them to a more closed chain environment? Okay. Maybe we keep their foot at that same angle and put a box. Or, what I like to use is my fuse ladder backboard, so it's closed chain, but at a different angle. We train the feet to respond to a closed chain situation with that same amount of pressure.

Okay. Another thing to think about when you're regressing is what's the sensory environment is on the ground. There is a lot of sensory information coming in from the backside of our body, and the floor is flat. When people lay on the ground, they don't feel flat, but your body is flat, so your ribs have to be shifted up naturally because the floor is flat.

Our butts get flat. So what we want to do is can we take that same sensory environment In other situations, maybe we have them sitting up, but we have a board against their back. Okay. Or we change the sensory environment completely, take away all the sensory information from the back of the body. Maybe we bring it to the front of the body.

If we get a win, they were able to create, change their motor output and do the movement good. So then take that same sensory environment and work to get them to do the thing in the other exercise. Okay, and last but not least, what is the concept? Okay, so if I'm rolling my spine up and down, what do I need?

I need to flex my spine and I need to move my pelvis around the leg. All right, so what if they can't move their pelvis around their leg in any position? Take the concept, teach them to do the concept. So teach them pelvis around the leg in any position, right? Even in cacao, people think they're moving their pelvis around their leg, yet they're bending and extending their knees or wobbling their feet.

We need stability. We need stability in the knee and foot so that femur stays still, so the pelvis can move around the leg. So teach them that concept. And then bring it back to the original exercise. So what I want to challenge you about your regressions, what do you wanna focus on? What part of the environment?

We wanna just focus on the concept and say, Meg, oh, that closed chain, open chain sensory shit. My brain just hurts. All right. Make it easy. What is needed to do that movement? It's kind of why I love Pilates. We do the same exercises in different sensory configurations on your back. Sitting on your belly, right?

So this way we can find the sensory environment that works for our client the best, and we could then teach it to them elsewhere. Same thing in weight training. Pretty much we're doing the same shit in just different ways. So figure out how we can get the concept we need if it's pelvis around the leg, or more intersegmental, spinal mobility in the neck, rather than just flexing at C seven.

What's the concept? Teach the concept and then whatever sensory input. So like. A visual cue or touching their chin to their sternum or focusing on not changing their knee angle for pelvis, round leg, whatever. Got your increase in accuracy in that concept, you bring it back to the original exercise. Okay?

Or if you're one, our level two neuro studio teachers, we have been digging deep into this open, close chain stuff. Oh, it's been so cool. I've been loving the conversation and the wind. Maybe you just work from there. And last but not least. Maybe you just change or maintain the sensory environment. Okay, I threw a lot at you in 30 minutes.

Let's just pull it all together. What do we do next? Or how do we start? Well, what's your goal? Are you trying to decrease pain, improve focus, or get people to do something they're not doing? Okay. How do you know when to progress it? Well. Did you get them to improve, decrease pain, improve focus, and people always go, how do you know if they're focused?

Oh, you'll know my clients with a DD or stuff like that. It's almost like they become a robot. They're so focused. All those clients who y yap, yap, yap, yap. They stop talking. How do we know when our kids are husband or wife or partner starts doing things, you'll know. Just stop looking for perfect. And once you get that small change, figure out how you can get repetitiveness using precision, focusing on the same sensory input, and drive that shit home and get creative.

And last but not least, if you're having trouble progressing or your progression makes it worse, take a deep breath. Cut yourself slack. I applaud you for trying and you gave your client a chance to make mistakes. Too many teachers act like they're clients. Cerebellum, stop. Stop. Not allowing people to make mistakes.

They need mistakes to build awareness. So when we make those mistakes, let's take a step back. Let's learn. Let's adjust and create a regression. Based off the sensory environment, the open closed chain environment, or the concept. And if you follow any of these questions, I promise you, you will feel less stressed and more in control of your life or how your sessions go.

So I hope you enjoyed this episode, and I know there's gonna be follow up questions. Ask me any question you have is I guarantee a question someone else has and it can lead to an even better conversation. So thank you guys so much for being here, and I can't wait to see you in the next episode.