You Don't Need More Information You Need Better Behavior | Doug Kechijan

Kechijan describes this as the biggest lesson from his career evolution: early on, he talked to patients as if they were colleagues — loading them with information and theory — and found it did not produce change. The switch to patient-led intake changed his results. The question "how can I help you" rather than "here's what you need to do" signals that the patient owns the agenda, which dramatically increases the probability that any recommended change will actually be attempted.

Kechijan frames this as taking responsibility for prescription design rather than blaming the patient for non-compliance. If someone has tried and failed to implement a plan, the question is not "why won't they do it" but "was the prescribed change appropriately sized for where they actually are." Going from zero exercise to 13 hours of zone-2 cardio per week is never going to happen — prescribing it is a failure of calibration, not a reasonable starting point. The right target is the smallest change that moves the needle in the patient's stated direction.

The financial fragility analogy is precise: you don't need to be a billionaire to not be financially fragile, but you need slightly more than your monthly expenses. Similarly, a recreational runner does not need the positional range of a circus performer, but they need more than exactly what running requires. The amount of reserve needed scales with goals: the more varied and demanding your activities, the larger the buffer you need to maintain.

Kechijan defines power objectively: the ability to produce force quickly. This is distinct from how hard something feels subjectively. 90 pounds on a 100-pound max is high intensity by this definition; 50 pounds for 20 reps is not, even if the 20th rep is uncomfortable. The gear-shift analogy: if you can only operate in first gear you are fragile even at slow speed because you cannot shift up when the situation demands it. Preserving multiple gears is the goal — and for aging adults, even a very small gear above first is far better than no capacity to shift.

Kechijan describes the PT field as split between two extremes: movement optimists who say position does not matter and the body finds its own solution, versus biomechanical determinists who prescribe sub-millimeter corrections and claim they affect symptoms in remote body parts. His clinical answer is in between: some foundational positions genuinely matter — without them, patients cannot safely do the things they want to do — but the goal is functional sufficiency, not mechanical perfection. The key insight is that the body adapts specifically to what you ask of it, so if you only ever run, you will only have the positional capacity that running requires.

Kechijan's honest self-assessment: early in his career he talked to patients like colleagues — covering theory, interesting mechanisms, things he could not even fully prove. He found that this approach produced admiration, not change. The shift was recognizing that the goal is not to impress the patient with depth of knowledge but to find the one behavior they can adopt today. This is especially important when the patient comes in with confusion from the information environment: the internet has given everyone access to contradictory expertise, and the clinician who adds another layer of complexity is not helping.

The information-application gap shows up in every domain Kechijan names: nutrition (everyone mostly agrees on the 95% that matters, they only fight about the 5%), training (most people know they don't do enough), supplementation protocols. The practical implication is that a clinician's job is not to add more data to the patient's mental stack but to find the smallest behavioral lever that moves the patient toward their own stated goal — and hold that one thing steady until it sticks. Kechijan explicitly says he now starts every initial evaluation with two questions only: "why are you here" and "how can I help you."

The concrete clinical move is: change one or two things at a time, let the patient do everything else they already want to do, and treat incremental progress as a win. Kechijan frames this as a responsibility on both sides — the patient may not be ready to hear advice, and the clinician may be pitching changes that are too large a behavioral leap for that moment. The honest audit is to ask whether the prescription was appropriately sized for where the patient actually was, not where the clinician thought they should be.

The running example is precise: running doesn't require high end-range position, so if running is all you do, your body adapts to exactly that range and nothing more. When you then run, your joints are at their positional ceiling rather than operating with a reserve. The fix is not necessarily more flexibility but maintaining capacity slightly above functional demand — and that minimum buffer changes depending on your goals. A circus performer needs much more positional range than a recreational runner, but both need some reserve above their floor.

The gear-shift analogy captures the mechanism: if you can only operate in first gear, you are fragile even at low speed because you have no ability to shift up when needed. Rate of force development — the speed at which muscles can produce force — is precisely the capacity you lose when you stop training explosively. In older adults, the practical version is not maximal sprinting but any movement done quickly and intentionally: a step-up done with snap, a box jump onto a very low box, a medicine ball throw. The neuromuscular quality of the effort matters more than the absolute magnitude.

The movement optimist framing is appealing because it removes the burden of prescriptive movement standards, but Kechijan finds it oversimplified — some positions genuinely matter for both health and performance. The biomechanical determinism extreme is equally problematic: no human body is perfectly symmetric, and correcting .005 degrees of calcaneal inversion as a headache cure is not evidence-based practice. The useful framing is foundational positions: a set of positional requirements every human should roughly meet regardless of sport or age, with those standards scaled down appropriately as people age, not eliminated.