Become a Creator today!Start creating today - Share your story with the world!
Start for free
00:00:00
00:00:01
Episode 45: Injury and Safety in Strength and Yoga
904 Plays1 year ago
Welcome to Episode 45 of the Movement Logic podcast! In this episode, Laurel and Sarah talk about pain, injury, and safety in strength and yoga. We discuss what an injury is and how definitions of injury differ in research. We also discuss pain and how it is different (but also overlaps) with injury. Then we look at what research suggests about the overall likelihood of sustaining an injury in strength training and yoga. We’ll also discuss what safety is from a health standpoint, and about the relative risks to our safety that exercise versus being sedentary present. Toward the end of the episode, we offer you some valuable tips to “stay safe out there people” with strength training especially if you are just getting started.
You will learn:
- The difference between overuse vs. a traumatic injury
- How pain does not always indicate that there is an injury
- How injury does not always mean that there will be pain
- How the variety reasons it’s difficult to make conclusive statements about how injury occurs in exercise
- The difference between acute vs. chronic pain
- Why normalizing pain might be a more effective way to reduce pain than communicating that pain is abnormal and always something to avoid
- How many people conflate the perception of effort with pain
- Sarah’s experience working with clients with a team of doctors giving them contradictory advice about exercise.
- How research unequivocally suggests that the benefits of exercise outweigh the risks of being sedentary
- Why alignment in exercise is often less important than tissue capacity via adequate preparedness
- The markers of physical fitness and which we target in yoga vs. strength training, as well as how neither improve cardiorespiratory fitness (meanwhile cardiovascular disease is the leading cause of death worldwide.)
- What “failure” versus “technical failure” is and how maintaining an appropriate distance from failure is important.
- How to use RIR (reps in reserve) as well as RPE (rating of perceived exertion) to avoid pain and injury with strength training.
Get our Free Barbell Equipment Guide
Papers
Are Injuries More Common with CrossFit Training Than Other Forms of Exercise?
A 4-Year Analysis of the Incidence of Injuries Among CrossFit-Trained Participants
Relative Safety of Weightlifting and Weight Training
The Safety of Yoga: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
CDC - General Physical Activity Guidelines
Stronger by Science - The Science of Autoregulation
Recommended
Transcript
Hypothetical Birth Defects Scenario
00:00:00
Speaker
Like it went back in time and gave you a birth defect? I'm not sure. Or like you then had a baby with a birth defect? I would say yes, that one probably. That is confusing. Also how are you- Because you can't have a baby but you can't go back in time. Isn't that a country song? As far as I understand. You can have a baby but you can't go back in time.
Podcast Introduction and Hosts' Background
00:00:22
Speaker
Welcome to the Movement Logic podcast with yoga teacher and strength coach Laurel Beaversdorf and physical therapist, Dr. Sarah Court. With over 30 years combined experience in the yoga, movement, and physical therapy worlds, we believe in strong opinions loosely held, which means we're not hyping outdated movement concepts. Instead, we're here with up-to-date and cutting-edge tools, evidence, and ideas to help you as a mover and a teacher.
Injury and Pain in Strength Training and Yoga
00:01:02
Speaker
Welcome to the Movement Logic podcast. I'm Laurel Beaversdorf and I'm here with my co-host, Dr. Sarah Court. Today we're talking about injury and pain in strength training, but we're going to share some examples of this in yoga as well. We'll discuss primarily what an injury is and how definitions of injury differ when injury is studied within the context of strength training
00:01:26
Speaker
and yoga in research. We'll discuss what pain is and how it is different from injury, but also how it overlaps with injury. Then we'll look at what research suggests about the overall safety or likelihood of sustaining an injury or experiencing an adverse event
00:01:44
Speaker
from strength training and a little bit from yoga as well. We'll talk about what safety is from a health standpoint and about the relative risks to our safety that exercise versus being sedentary present. Toward the end of this episode, we're going to offer some valuable tips to help you, quote unquote, stay safe out there, people, with strength training, if especially you're just starting out.
00:02:07
Speaker
Sarah, I feel that a lot of people think that injury is this very well-defined thing, that just everybody agrees what it is. It should be well-defined, right? But it's actually not. It's not. Research looking at, for example, injury rates in weight training modalities, stuff like powerlifting, which is those three moves that you're doing with max effort, bench, back squat, and deadlift.
00:02:34
Speaker
traditional strength training which involves a lot more exercises potentially CrossFit which is a modality that includes gymnastics type movement, heavy strength training, impact, plyometrics, even speed training. And even though we're not focusing on yoga in this episode, research on injury in all of these strength training modalities and yoga offer some very different definitions of injury it turns out.
00:03:02
Speaker
Thoughts? Have you noticed this? Were you aware? Well, I'm not a researcher, so I haven't had to try to quantify what is injury, but I certainly, from an anecdotal standpoint, what I see in the patients that I see is a wide variety of actual tissue damage versus the experience that the person is having or the pain level that the person might be experiencing.
00:03:29
Speaker
and how those are very different things sometimes. I see people with the exact same injury and a completely different pain experience. Wow. Okay. Well, here are just a couple of differences I encountered when looking at some papers of, by the way, various quality.
Variability in Injury Definitions Across Studies
00:03:45
Speaker
Just simply to see, in all these cases, how researchers were attempting to define injury. I'll start with this review that compared the findings of three studies, these were retrospective cohorts
00:03:58
Speaker
studies retrospective they're looking back on what people did and what happened from that not forward and trying to predict what will happen and the question they were trying to get to the bottom was are injuries more common with CrossFit training than other forms of exercise that was actually the title of the paper within these three cohort studies that they looked at
00:04:22
Speaker
Basically cohort is just they're studying a group of people who do CrossFit, right? They got three very different definitions of injury. They noticed that these three cohort studies used three very different definitions of injury. So what they found is that one study defined injury as being only considered an injury if it resulted in total removal from CrossFit for at least a week
00:04:53
Speaker
or modification of intensity of training for at least two weeks, or a physical complaint severe enough to see a physician. So we've got somebody who's like, ouch, something's wrong, I'm not gonna go to CrossFit for a week, or more. Someone who's like, ouch, something's wrong, I'm gonna take it easy in CrossFit for at least two weeks or more, or ouch, I need to go see a doctor. Okay, that's number one.
00:05:22
Speaker
Cohort study number two. This study used an international classification of diseases manual, the ninth revision, specifically. I mean, the ninth is far superior to the eighth. Yeah, it must be. To define overuse injuries, so they use the manual to go, here's what an overuse injury is, as it's defined by this manual, and traumatic injuries. Okay, so Sarah, what is the difference between an overuse or traumatic injury?
00:05:50
Speaker
I think the easiest way to think about it is that the analogy of a rope. So if we imagine a rope and we imagine that the rope is made up of, let's say, a hundred thinner threads or whatever they're called that are wound together to make the rope, an overuse injury is something where the load or the demand on the rope
00:06:10
Speaker
is just a little bit more than the rope can handle. So you would see maybe one little thread pings, and then the next time you did it, another little thread pings. And so it's an injury that's taking place slowly over time. Eventually, enough of those little ropes or those little threads are going to ping to the point that you are then going to experience physical pain. Versus a traumatic injury or an acute injury is something
00:06:37
Speaker
to the kin of like you took a sword. I don't know why it's a sword. You took a blade and you slice the entire rope in half. It happens quickly. It's a sudden, very high level of
00:06:51
Speaker
excessive demand. Right. And even if you didn't cut it fully in half. I mean, you cut enough fibers to where you're not using that rope for much. Yeah. And the big difference is it's happened in a moment versus over
Challenges in Injury Research
00:07:03
Speaker
time. Right. One single moment. Got it. Cool. Well, here, I feel like with this definition, they must have gone to a doctor because, okay, yeah, they have pain. Of course, they know that. But how do they know it's from an overuse injury? Does pain always mean that there is an injury? Does an overuse injury always mean that there's pain?
00:07:19
Speaker
Know to both of those if we're saying you don't have an injury unless you actually have an injury as it's defined in this manual who decides What that injury is definitely not like some layman who's not a physician or who's not a PT like definitely I don't do that That's what outside of my scope of practice what I'm saying is like regular people probably need somebody who is an expert in Diagnostics to tell them what they have so it seems like this group of people had to have gone to the doctor Yeah, although you know if you depending on how much time you've spent
00:07:48
Speaker
doing any sort of physical activity, whether it's CrossFit or other exercise, traumatic injury is very clear when it happens. I dropped my motorcycle on my ankle, my ankle went at a very wrong angle, and I injured it. That was very clear that that's what happened. Overuse is a little harder to know. What's harder to pin down about the overuse is the what.
00:08:11
Speaker
has caused it, or what combination of events have caused it. But the general sensation of it is often increasing pain over time. Okay, that's helpful. My point though is that most people, unless they see a doctor, are really just working with pain. They don't necessarily know what exactly, in the case of overuse. Yes, they don't know why, but they've got pain. Okay, so cohort study number three. Here's how they define injury.
00:08:40
Speaker
anything that prevented the athlete from training for any amount of time.
00:08:56
Speaker
It's snowy and the roads are closed. Yeah, the weather is injured. The sun is having an injury. My day has been injured, so I'm gonna stay in bed. I have been emotionally injured by my terrible boss and I just don't feel like doing anything. Yeah, so this one is super, super, super broad. Yeah. As I think we're pointing out. And I mean, you know, we're obviously joking, but it's a little too broad to be particularly useful.
00:09:22
Speaker
Yeah, so I wanted to ask you what stands out to you about these three very different definitions of injury. I guess specifically like the first two compared to the third, you kind of already said like the third one's a little too broad to be useful. Is there one that you like of the three more than the others? Well, I definitely like the third one the least. I like different parts of the first two.
00:09:45
Speaker
What I like about the very first one is it's very specific, the parameters are very specific around time, like time away from training and also, or it was so severe you had to go see a doctor. That one seems the most relevant to me because it's the one that is quantifying injury as an interruption to life as usual to being able to do things that are meaningful.
00:10:06
Speaker
Right. But the second definition is also useful because the first one doesn't say the reason isn't an overuse or is a traumatic injury. But it is useful to quantify those two, or qualify rather, those two differences because a traumatic injury is something that could happen at any point. An overuse suggests there's something about the way you're doing, the exercises you're doing, or the way your body is
00:10:32
Speaker
unprepared for the exercise they were doing that's irritating to your body versus like an accident. Got it. Cool. I like qualities of each of them. I would like a version where they were melded together somehow.
00:10:44
Speaker
Right. Okay. Can you see, though, how because of an inconsistency in the way injury is defined, that already we might be noticing one of the problems with researching injury? Oh, yeah. It's hard. It's very hard to do. Okay. All right. So these studies, by the way, this one and a number of other ones found, spoiler, that CrossFit is pretty safe.
00:11:07
Speaker
It's about as safe as running. It's not really much more dangerous than any other non-contact exercise modalities or sports, right?
00:11:17
Speaker
something that was significant was that the injury rate amongst American football players was significantly higher than that of CrossFit. But that's not surprising. Yeah, not a lot of this research found that CrossFit was significantly higher than other comparable forms of exercise that don't involve context. So just FYI. So why is it so hard to measure injury rates? And or maybe another way of saying that is safety of an exercise format or modality. We already determined that maybe it's because injury is
00:11:46
Speaker
It tends to be defined very, very differently, paper to paper. What are some other limitations of research or looking at injury in more of a laboratory setting or in more of a controlled research approach? What are some of the limitations this presents for our ability to make conclusive statements? Well, some of it has to do with understanding who's researching what. Something like CrossFit, it's similar to when a particular drug is
00:12:15
Speaker
brought onto the market before it happens. It goes through a lot of research, but the people paying for the research is the company that made the drug, right? I would guess, I don't know, but I would- Because of bias, right? Well, yeah. I mean, they're really, really hoping, really hoping and maybe helping you to also hope as a researcher that it's going to prove to be safe. Right. And so CrossFit is a corporation, right, or something like that. And so I would assume
00:12:43
Speaker
i don't know but i would assume at least some of the research around crossfit was funded by a crossfit that doesn't automatically mean that it's bad or wrong but it's just always something to keep in mind always something to keep in mind the bigger issue is you know some injury research is easy because it's defined by
00:13:00
Speaker
literally tissue damage, not a personal experience. What these are is a personal interpretation of whether or not something is an injury, and a lot of that interpretation has to do with each person's subjective experience of pain. And pain is a very, I think, fascinating topic, but it can be kind of complicated and it's not cut and dry. There is not like
00:13:24
Speaker
this amount of injury equals this amount of pain. It just doesn't work that way. Right, like you could step on a nail and feel no pain initially. You can also get a paper cut and be screaming and excruciating pain. Sure. One of these injuries is more serious than the other, but the way in which we experience this pain
00:13:41
Speaker
can vary in really counterintuitive ways. Additionally, is it not true that injury is often, especially overuse injuries, quite complex, quite multifactorial? It's hard to say what about an exercise may be caused if that's even
00:14:00
Speaker
the right verb and injury, we'd also have to look at what is this person doing the other 23 hours of the day, the other however many hours in a week minus the three hours that they're doing CrossFit or whatever exercise they're doing that may have also contributed to this injury or lack of preparedness. What was it about their stress levels, their sleep, their diet? I mean, so many things. Lifestyle factors.
Pain vs. Injury: Understanding the Nuances
00:14:19
Speaker
Yeah. Right? Yeah. What's their movement, have it been their entire life? Okay. Let's look at another one. A four-year analysis.
00:14:26
Speaker
surveyed a population of CrossFit athletes, right? They're just looking at one population, so right there we probably have a weaker form of evidence, whereas the first one was looking at least three different studies. This one's only looking at one population of CrossFit athletes, but they're doing so over four years, and asking them on a survey whether or not they'd sustain any injuries. Here we also have memory bias, where now we're asking them to remember what happened to them in a span of four years, which memory can be a somewhat unreliable way of
00:14:55
Speaker
recounting what has happened, just relying on memory alone. But anyway, they defined injury on this survey as any muscle, tendon, bone, joint, or ligament injury sustained while doing CrossFit that resulted in your consult with a physician or healthcare provider and caused you to stop or reduce your usual physical activity or your usual participation in CrossFit or that caused you to have surgery.
00:15:25
Speaker
What do you think of that definition of an injury? It's different than the first three. It is different, but it's pretty specific, which is also what I like about this definition. Okay. Then we have a systematic review.
00:15:40
Speaker
So a systematic review is a little bit stronger than the previous two pieces of evidence I shared with you. So in a systematic review, looking at injuries among now weightlifters and power lifters. So now we're not talking about crossfitters, we're talking about weightlifters. Weightlifters in this study were people doing Olympic weightlifting. So something else that's extra fun is knowing that weightlifting gets used to mean different modalities, right? Depending. Sometimes it's used to mean like
00:16:04
Speaker
traditional slow heavy strength training and other times it's used to mean Olympic weightlifting which is fast actually fast strength training. They set out to review the literature regarding various definitions of injuries and here's what they found. So I'm just going to list off a bunch of what were the various definitions of injuries they encountered. So one study classified injury as severe
00:16:25
Speaker
So now we're classifying the injury. It's severe when symptoms last for more than a month. Another classified it as severe when the athlete was forced to rest for more than a week. Sorry. Another didn't try to rate the injury as severe or not severe but simply looked at how long the athlete was absent from training. One study reported only the number of injuries with no attempt to classify what even was an injury.
00:16:55
Speaker
Three defined injuries as acute or chronic. Some it was only when there was a patho anatomic diagnosis. So they went to the doctor and the doctor said, you pulled a muscle or you hurt your tendon.
00:17:09
Speaker
And in some, injury type wasn't even reported. Okay, so real quick, acute and chronic. We talked about the difference between overuse and traumatic injury. Could you tell us briefly what is the definition between acute injury or chronic injury? An acute injury is something that has happened recently.
00:17:28
Speaker
versus a chronic injury is like I've had back pain for five years. Now you're talking about pain, so is there a difference between acute pain and acute injury or chronic pain and chronic injury? Absolutely, and this is where it gets to be another layer of complexity is there are different ways to experience pain.
00:17:47
Speaker
Acute pain is generally when there has been injury to tissue that is new and your brain is trying to say, hey, hold up, like leave this, stop doing this thing because we're making it worse. Is there usually an injury associated with acute pain or can you have acute pain without injury?
00:18:02
Speaker
No, there's using an injury. There's usually tissue damage. Or an incident. And there's something. You might have stepped on attack, which is an acutely painful thing for your foot. Or a Lego, if you've ever done that in the middle of the night, those are the worst, right? So there's something that has happened recently. Chronic pain is typically over six months of having that pain, and what starts to happen in that point
00:18:24
Speaker
is the relationship between tissue damage and sensation gets really, really muddied to the point where they no longer even necessarily have anything to do with each other. Your brain can start producing sensations of pain when there's nothing at all going on with the tissue itself.
00:18:41
Speaker
All right, well let's look at a study on yoga. It was actually a systematic review with meta-analysis, which is the strongest so far of all of the pieces of evidence we share with you. This one was called Safety of Yoga, a systematic review with meta-analysis.
00:18:56
Speaker
And in this study, they actually, instead of calling an injury, they call it an adverse event. Ooh, that sounds terrible. Well, and they were defined as terrible ones. So this systematic review said it's not an adverse event if it didn't include the following. Number one, death. So it's not funny, but a little bit it is. Number two, life threatening situations.
00:19:25
Speaker
Number three, hospitalization. Number four, disability or permanent damage. Number five, and this one I'm a little confused by, birth defects or congenital anomalies. Like it went back in time and gave you a birth defect? I'm not sure. Or like you then had a baby with a birth defect? I would say yes, that one probably. That is confusing. Also, how are you proving- Because you can't have a baby but you can't go back in time.
00:19:52
Speaker
Isn't that a country song? As far as I understand it. You can have a baby, but you can't go back in time. We should keep that. I think so. Wait, what was I going to say? But how are you going to prove that a birth defect... Oh, wait, if you were pregnant while you were practicing yoga. Oh, there you go. Okay, I think we got it. Yeah. So, I mean, I really don't have any answers for you. This is just what I read. So the need for medical or surgical interventions.
00:20:20
Speaker
to prevent outcomes one through five. So even if you needed medical intervention or surgical intervention to, say, fix your knee because you heard it, that knee injury is not death, life-threatening, hospitalization, disability. Well, it could be disability. It could be disability of permanent damage. I guess it could be temporary disability.
00:20:43
Speaker
Well, what I do like about this list. Okay. Yes. Tell me, because it seems very, very different. What do you like about it? It's very different. What I like about it is, as a list, it's really ruling out that kind of overuse component because
00:21:00
Speaker
It's not saying, oh, well, you kind of, you stubbed your toe jumping back in Chaturanga and now you don't want to do that for a week. And also with a lot of time with the overuse, it's hard to prove, is it because the thing that you were doing just then, or is it because you sat in a weird position earlier in the day and then you did the thing? Or, you know, there's a lot of other conflating things. This is basically saying that it was the yoga that did this to you because all of a sudden we're in life-threatening territory.
00:21:29
Speaker
And that, you know, indeed if these things happen while doing yoga, like maybe yoga was indeed very dangerous for this person. Right. Ultimately what this meta-analysis found is that yoga is relatively safe. Right. There were some adverse events that they reported from doing yoga. Absolutely.
00:21:46
Speaker
So Sarah, we looked at a couple of different ways injury is defined in research. What do you think people really think an injury is, like regular people? What do they think an injury is? I think they think it's pain.
00:22:01
Speaker
I think they think it's just any pain experience is They might not say this is an injury to themselves, but they're certainly saying let's call it muscular skeletal pain so not like a headache or a migraine or something like that like I Turn my head. It hurts my neck. You're probably saying to yourself at some point. I must have injured my neck I
00:22:22
Speaker
I have people tell me that all the time. They say last night I injured my neck while sleeping. You can certainly hurt your neck by sleeping funny on your head. Yeah. On your head? That would be a funny way to sleep. Well, my head is on something when I'm sleeping. But it's not the only thing that's on something. I would hope not. You're not doing a Dharma Mitra headstand with no hands. And asleep. And asleep at the same time. That would be...
00:22:44
Speaker
A miracle. Nor am I doing a Dharma Mitra headstand with no hands. Awake. Awake. At no point in my life is that what I'm doing. But you can... Yeah, so I think really people just think, injury means pain. Pain is happening because I have had some sort of injury, however it may have happened. Okay, so we've already discussed briefly that pain and injury are not the same thing. You can have pain without injury. You can also have pain because of injury, but you can also have injury without pain. You can get some imaging and go,
00:23:13
Speaker
Oh wow, my shoulder labrum is in fact torn, but I have no pain with that injury. If a tree falls in a forest and no one's there to see it, did it fall? The question is, what's really important here? I feel like primarily it's probably pain with these types of musculoskeletal issues. Ultimately, we come to the understanding that we have something wrong with us when we have pain. Just because we have pain doesn't mean that we have an injury.
Pain as Part of Life and Movement in Pain Management
00:23:43
Speaker
Here's a somewhat controversial question. Do you think that pain is normal? Yes. What? You think everyone should just be fine being in pain, Sarah? Is that what you're saying? Yes. No. That's not what I'm saying. But... But it is kind of what you're saying. Well, I'm not saying... Well, here's the difference. I'm not saying people should be walking around in pain all the time their whole lives.
00:24:07
Speaker
I think we need to have a better understanding of pain. And my episode that I did with Dr. Chris, he talks about pain as a low level language, right? Pain is telling you something, but it's not always telling you the same thing. And we have to become a little more fluent in that low level language so that we can actually interpret what is the message of this pain.
00:24:27
Speaker
It's often not telling you what you think it's telling you. It's usually not telling you what you think it's telling you. And so what I mean by is pain moral, it is on the spectrum of sensations that our body is equipped to have. So it's not like if somebody came into the clinic and they said, my shoulder has been hurting for a week, I don't go, oh my God, let's go to the emergency room. You're going to, you know, like pain happens. It just does, but it's not a pleasant experience.
00:24:54
Speaker
So we don't want it, but there's a difference between it being unpleasant and we're not enjoying it, then we should be afraid of it. We should be catastrophizing it anytime we have it. It all means the same thing. It's always bad. Or a sign of injury. Or a sign of injury. Or any of those things. But what about all of the trademarked self-care
00:25:17
Speaker
companies on Instagram slash also the PTs and chiropractors, you know, basically people who stand to profit from my insecurities about pain telling me that it's not normal to have pain and that if I have pain that I really should do something about it and they have the solutions for me. Well, they're trying to sell you something.
00:25:35
Speaker
It seems like an unfair thing to tell someone. I mean, welcome to marketing. That pain is not normal because what I think it does is it sets people up to have a pretty unhealthy relationship with their pain. A fearful relationship with their pain. What does that do for pain? Makes it worse. Right. It measurably makes your pain worse if you're afraid of it. Now, I will say also,
00:25:57
Speaker
When I started as a PT, my understanding of my work was that the work I was doing to help people get better should not have pain ever. And that's how I practiced for a while. And then I learned more, which is what we're all doing, right? We're all on just this path of learning. And the studies around pain science got updated. And as it turns out, it's not something to be
00:26:21
Speaker
necessarily like, oh, avoid at all costs, but rather something to be measured and understood and used as a way to perhaps modify what you're doing with somebody, but not that everything should stop. For example, when I see a patient, if I've seen them a few times, the first thing that I ask them is, how are they doing?
00:26:41
Speaker
Sometimes somebody would let's say they they we did some exercises the last time and they'll say oh man You know like the whole day after I saw you my shoulder was really sore and when I was a newer PT In my head not on my face you keep your face calm, but in my head I was going oh shit. Oh shit. Oh shit. Oh shit, right?
00:26:59
Speaker
because I assumed that we had done something negative, something bad. And now instead of that, what I'm realizing is that there is a place for some amount of pain, right? And so I might then follow up and say, okay, well, your shoulder hurt. When did your shoulder stop hurting? Well, by the next day, it was fine. That to me is not an injury.
00:27:20
Speaker
That to me is just a response to something that your brain is saying, hey, this part of my body has been hurting for a while. We just did something that I call it hurt again, seems like a bad idea, right? But it isn't necessarily a bad idea. So it's complicated and there's a lot of nuance to it. So not only is pain normal, it's a normal experience to have on a spectrum of experiences to have.
00:27:45
Speaker
But it's also a normal part of the rehabilitation process for lots of different injuries. Yes. Cool. Absolutely. I also consider it part of my learning curve to stop becoming, in some cases, very sort of fearful and defensive around people telling me that they had pain after whatever they did.
00:28:03
Speaker
thinking, oh my God, what did I do to you? It's all my fault and have become much more actually knowledgeable of pain and how sort of weird it is and that it is potentially something that I need to know about definitely and take into consideration for how we go forward. But it doesn't necessarily mean we have to completely stop doing what we were doing. It probably means that we need to modify. Yeah.
00:28:26
Speaker
Set it aside for a while and then come back to it because the body is not a Chevy It doesn't just break down with use right the body is biological and it adapts to the loads that we expose it to it can actually change significantly in ways that make it better capable of not having pain and not getting injured so that's part of my job that is actually my whole job, so
00:28:50
Speaker
It's in my best interest as a teacher to remain calm when my students come to me with pain because I'll better be able to strategize around ways to be of better service to them during that experience of pain. I might have to refer out, but I can better help them navigate that while staying active, while using movement to
00:29:10
Speaker
increase their resilience, increase their ability to tolerate lows, and even just feel better, right? To actually get past the pain. A lot of times people come to me with a little, oh, my shoulder's a little sore, but let's do our workout, we do our strength workout, one-on-one clients, for example, and they were like, wow, I'm so glad I strength trained with you yesterday because I felt so much better and my shoulder pain is gone. Instead of like ruminating and worrying about the shoulder pain doing nothing being sedentary,
00:29:32
Speaker
Pain levels maybe potentially go up and the shoulder still hurts, right? Yeah, and I want to say as well I am NOT when people come to me and tell me about their pain. I'm not dismissing it, right? I'm taking it seriously, but what I'm not doing is Catastrophizing it
00:29:48
Speaker
And I think that is also an important role, not just for clinicians, but for anyone who's working with people in the world of movement. Again, not that you're like, ah, it's fine, because Laurel said it's okay. Also, if you're working with your own pain, these are conversations you can kind of flip in your head about your own pain. When I was rehabbing my ankle, it was right around the time that I had the conversation with Dr. Christon. He talks about how if the people that are working in his
00:30:15
Speaker
strength training and conditioning facility they say that their pain on the pain scale of one to ten is Like a six or below he's like you're fine Which is a much higher number than I had ever heard before but what that did for me was when I was because when I was rehabbing my ankle there were things that I did where afterwards I was like, ah It doesn't feel great. But I was like, is it a six?
00:30:37
Speaker
No, it's a three. Okay. So I'm okay. So yeah, you can kind of like talk yourself down off the ledge of what is this pain and have I now just made this thing worse because it hurts? Yeah. And relating all of this back to these definitions, these various wide ranging definitions of injury, a lot of times how people think of their pain or the qualities of their pain or even the severity of their pain,
00:31:04
Speaker
it wouldn't actually fulfill the definitions of injury that we read about in these studies. It's potentially the case that their pain wouldn't constitute an injury. Yeah. All right. Now, I've heard something that... Well, when I say this, a lot of people swoon. They're like, yeah. So I'm immediately skeptical of this
00:31:27
Speaker
I'll just say cliche. Maybe it's more than that. I like it too, but I've heard pain described as or defined even as a request for change. Pain is a request for change. It's nice, isn't it? You're like, yeah, it is. So I immediately want to go, but is it? So in my anecdotal experience, just talking to people, they have a little bit of pain.
00:31:54
Speaker
And their change, their strategy is to actually just stop moving. Just stop doing the thing. Don't ever go back to strength training. Don't go back to that spin class. Yoga is dangerous. I hurt my back. Never going back again. And so that's the change that they actually choose is to just stop. So this is right there where I'm like, but pain is maybe not always a request for change. Maybe especially just the type of change where you stop moving. Yeah.
00:32:19
Speaker
Because again, pain is not always because of an injury. So maybe you want to say acute pain sometimes is a request for change. That's the way that a clinician would say it, because they're going to get much more specific, and at the same time, much more vague. They're going to say acute pain, and they're going to say things like, under certain circumstances. Because our favorite thing to do is be both more specific and incredibly vague.
00:32:48
Speaker
Because there's a general understanding that it's very hard to make these very certain, these like nuts, I think why this statement makes you be like very skeptical, it's a very definitive statement. Pain is your body's request for change. If that's the case, then that completely doesn't take into account the components that go into chronic pain.
00:33:10
Speaker
I mean, yeah, maybe your request is, I'd like to not have this pain anymore, but it's not that you're doing something in the moment that's causing it that you need to change what you're doing. Isn't it true that people who have chronic pain, a lot of times they blame themselves. They're like, what am I doing wrong? What's wrong with me? Well, it is their fault. I'm just kidding. That in and of itself can make the pain worse. This idea that because you have pain, you should change because there's something wrong with what you're doing.
00:33:38
Speaker
Listen, probably true most of the time, I would say. Yes, change. Let's take a break. Let's set it aside for a while. Let's modify it. Let's change the exercise. Let's actually get more sleep. Eat better. Just get more exercise. Yes, that's true, but it's not always a request for change. It could be that you're just going to have a little bit of pain in the beginning. Just keep going. And the other thing is make it better, especially to your point about in the beginning.
00:34:07
Speaker
A lot of people, if they are new to exercise in any form, I often have to help them flesh out. Yeah. Flesh out. Yeah. Just sometimes I say something and I'm like, is it an expression? I think it's flesh out. Yeah. Okay. I have to help them figure out. There you go.
00:34:28
Speaker
what exactly they're feeling because they might be experiencing muscle soreness and they think, oh God, this is bad pain, or they might be experiencing effort in the exercise and that feeling to them is pain. Now, those of us that have had a movement diet our entire lives, you were very sporty, you played volleyball and basketball. Lots of sports. Yeah, and I was doing a lot of dance and all that kind of stuff, so we're both used to the sensation of effort.
00:34:55
Speaker
But we have been able to divvy it out different than the sensation of injurious pain. But for some people, that's not something that they've done. And especially when pain has been categorized as something that you need to be afraid of. And something's wrong with you. Something's wrong. It's not normal. You've injured yourself. Then, yeah, you're going to be looking for it and classifying things as pain that maybe actually aren't. Yeah. And probably one of the worst things to do for pain, would you agree, is to stop
00:35:25
Speaker
Moving? It depends. Okay. When I sprained my ankle real bad, I was not then going on a 45-minute walk. Were you moving other parts of your body? Yeah. Also, it depends as I'm talking about, are you moving your whole self versus moving the injured part? I mean, if you have an injury like an ankle sprain, can you continue to exercise? Yeah, around it. Right. And is that maybe going to be better for your... A hundred percent. Your healing process than just lying in bed? Yes, a hundred percent.
00:35:54
Speaker
I do love lying in bed. Okay. But yes, completely stopping everything is usually not the solution. You may be working around something and then eventually incorporating it back into what you're doing. But yeah, stopping everything, closing the curtains, putting on some sort of soap opera and eating bonbons for two weeks while incredibly fun, possibly, is not going to help your injury. The answer is not to be sedentary, in other words.
00:36:22
Speaker
I mean, that's the answer just kind of across the board.
Clinicians' Disagreements on Pain Management
00:36:25
Speaker
Believe it or not, Sarah and I do have conversations when we're not in front of a microphone together, recording podcast episodes. And in Yalapa, where we are now, we've been recording almost all the duo episodes you've gotten from us this season. We've been talking a little bit about our jobs and how we work with the people that we come across. And I know you, Sarah, told me about how there can often be disagreement amongst clinicians working with the same patient, kind of like that patient's team, right?
00:36:54
Speaker
about how they should be or how much they should be stressing or loading their bodies to help with their pain. And that sometimes one doctor is saying something and the PT is saying something very different because they both have a very different idea of what's gonna help that patient. Can you speak at all to?
00:37:12
Speaker
I can speak a lot about that. I'm certainly not trying to throw any particular type of medical doctor under the bus and saying all family physicians, all primary care doctors, any non-musculoskeletal specialist does this. However, I have had experiences where a PCP is telling someone
00:37:39
Speaker
that the best thing they can do is not exercise. And what's frustrating about that is that the evidence doesn't point to that at all. And my clinical experience doesn't point to that at all. And the tough thing becomes when you are working with someone, you know, I had a patient in particular and I talked about this patient a little bit again in that interview that I did with Dr. Chris, but
00:38:02
Speaker
I was only this person's PT for two visits and we only did any kind of movement in one of them. The movement we did was incredibly gentle. This person had a long history of repeated injuries.
00:38:16
Speaker
and had become incredibly deconditioned to the point where they were using a cane to walk, a middle-aged person, and had become so afraid of movement that they did not want to go up a five-inch step
00:38:38
Speaker
to get into the clinic right or just step over it they were afraid of pushing a heavy door right every movement everything in the world was a way for them to possibly hurt themselves again and part of the problem is that they had had a series of professionals in all different kinds of
00:38:56
Speaker
worlds, not just clinicians, but massage therapists or chiropractors or, you know, all kinds of different people. And they had just had all of these negative experiences, but what that had ultimately led to was that they were unbelievably deconditioned.
00:39:10
Speaker
to the point where it was going to be, and I wasn't saying this to this person in our first visit, but they were going to experience some pain in the act of getting stronger because that's how weak they were. And instead, so I did some very gentle exercises, nowhere near what this person actually needed, but initially I knew that what I had to be doing was a lot of trust and buy-in.
00:39:34
Speaker
You said that you did exercises that were a lot less stressful than it would have required for them to get to your office. Just walking in the door was harder than what we did. This is a bit of an aside, but sometimes when you're working with people with a long history of working with other people that have injured them, your primary directive in that moment is get them to trust you. I knew that what we were doing was nowhere near what this person needed to be doing, but I had to establish that trust.
00:40:00
Speaker
And they had some pain afterwards from who knows why. We don't know why. I would say probably not from what we were doing, but I don't know. Maybe it was. They went to their doctor. Their doctor said, you need to stop doing that. And so they never came back. And the doctor said stop doing because it was too intense. That the exercises that we did at PT were too intense. And the exercises we were doing were non-loading, non-weight-bearing. And it's deeply frustrating.
00:40:28
Speaker
I don't like to make dramatic predictions that I don't know are going to come true, but I would say if this person does not start receiving some interventions that are more functional and useful, and this person doesn't start to build some strength in their body, which is going to be uncomfortable at this point, I would not be surprised if down the road they're in a wheelchair for no reason at all.
00:40:55
Speaker
And it's one of the most frustrating things. I see a lot with PTs working with older patients that they don't give them nearly enough load to actually challenge them to the point where the PT is making them weaker. But they're giving them a lot of other things like cupping and massage and acupuncture and I really like cupping. Taping.
00:41:17
Speaker
No, but they're giving them exercises to do, but they're giving them the pink dumbbell and the yellow resistance band, and then the person's feeling worse and getting out of shape. It's one of the most frustrating things that I run into.
00:41:32
Speaker
Now, contrary to what research suggests about injury rates in modalities like CrossFit, powerlifting, weight training, yoga, in other words, it's tough to say what the injury rates are is what research is suggesting more studies are needed is really what research is suggesting. More high quality studies are needed.
Exercise Benefits vs. Risks of Sedentary Lifestyle
00:41:55
Speaker
What research unequivocally suggests
00:42:00
Speaker
is that the overall benefits of exercise vastly, vastly outweigh the risks of being sedentary. The benefits of exercise are protective against pain, against injury, and against disease, frankly. We hear this word come up a lot in the yoga community, the S-word. Shavasana. Safety. Oh. Close.
00:42:28
Speaker
I like Shavasana. I think Shavasana is, depending how you look at it, either a very safe or unsafe pose. Sure. Did that make sense what I just said after I thought about it? Okay. Safe in the sense that you're lying down, you're definitely not going to fall. You're not. But if all you're doing is lying down, you might not live that long. I mean, it is called corpse pose.
00:42:51
Speaker
It is called corpse pose. We hear this word safety a lot in the yoga community. Here's maybe an example of when you would use it. To keep your knee safe and warrior too, make sure that your knee is aligned over your heel and points in the direction of your second and third toe. Better if it points in the direction of your second toe though, safer. Just kidding. But anyway, you hear it in this context of alignment. It's really common in yoga,
00:43:21
Speaker
world for alignment to be conflated with safety. And unfortunately, it's not that easy because posture doesn't predict pain, which is also very counterintuitive. A lot of people think, like, bad posture. Oh, you're going to wreck your neck or destroy your back. Research has failed to show that that's the case. So there are other reasons to teach alignment, but I don't think keeping students safe should be the reason. At this point, alignment is an aesthetic.
00:43:51
Speaker
I would say so. Definitely in yoga. When we start lifting weights, when we start lifting weights, when we start exposing our body to higher forces and things like weight training, plyometric activity, things like that, yeah, maybe that there might be a better argument for technique. But even people with maybe the majority of coaches would go, my God, don't squat that way. You're going to wreck your back. You can actually see a lot of different, amongst even professional lifters,
00:44:18
Speaker
approaches to technique in something like the squat and notice that maybe letting the knees drift inward of the feet isn't going to wreck your knees because that person's squatting 600 pounds. Relax maybe? Or maybe just relax a little bit more around this idea that it needs to look a certain way.
00:44:38
Speaker
Well, in particular in yoga, because like, okay, maybe the aesthetic is my knee is bent at 90 degrees, which puts it over my foot. But how many other activities during the day are you loading your body weight into your knee at different angles and different positions and your knee is not exploding out of your body?
00:44:54
Speaker
my knee goes past my foot all the time when I walk up the stairs. When I kneel down to pick something up off the floor. It has never exploded. Also, there's a yoga pose, malasana, where you're in a very deep squat. There's so much inconsistency, contradiction with these alignment rules. That's not to say that alignment doesn't matter. That's definitely not what we're saying. What we're saying is that alignment doesn't predict pain and it may also not prevent it.
00:45:20
Speaker
It's got nothing to do with safety. Right. What prepares you to not get injured in a squat, let's take, is actually progressively overloading that squat over a long period of time. Maybe getting some good instruction from a professional feeling safe in the environment you're training. And these are all things that could potentially help you not hurt yourself in a squat.
00:45:39
Speaker
not doing too much too soon. And it's not the case that just doing a perfectly aligned body weight squat is going to help you stay safe under load in the squat. If you go from body weight, your form is perfect and now we're going to put too much weight on you and your form is perfect, but you hurt yourself. Why your form was perfect becomes very confusing when we start to equate posture and technique with safety because there are so many other factors at play.
00:46:05
Speaker
that have to do with something that would need to be looked at over time. I'd also like to say my
00:46:12
Speaker
squat to the ground, also known as an Astagrass squat, my form, my alignment is actually better with load. Right. In other words, the optimal technique you're going to use to perform an exercise is load specific. It's also velocity specific. People don't look like they're jogging when they're sprinting. Likewise, people don't look like they're sprinting when they're jogging. I'm going to have to use different form to sprint.
00:46:35
Speaker
And then to jog. And that's just also another way of saying load specific. All right. So Sarah, do you load your patients to increase their safety? Do you actually ask them to stress their bodies?
Rehabilitation and Strength Building Techniques
00:46:47
Speaker
And how do you actually think about load as a PT? I know as a strength coach, I'm thinking about in the terms of getting stronger. How are you thinking about it? It's the exact same thing. It's all on a, I was going to say timeline, but that's not true. But it's a graduated scale, right?
00:47:05
Speaker
I might be starting with a lower load than you would be starting with if you weren't rehabbing from an injury and you were going in to do a workout with a trainer, but the shape is the same, the movement is the same, and I am progressively overloading to get you to the point that you can do, I'm not talking about safety necessarily for my patients, but I am talking to them about the capacity to do the things they want.
00:47:27
Speaker
because a big part of rehab is getting the person back to doing the thing that they aren't doing because they're injured. But I also talk about it in a more general sense. And as far as for my older patients, especially older female patients about bone density, I talk about it in terms of just general capacity and feeling good in your body, like other health benefits that come from strength training. So I do plenty of strength training. There's several of my patients at this point where
00:47:54
Speaker
we're actually starting to do barbell work at an appropriate weight level because I know that that's going to give them this greater capacity, this greater variety of movement and strength in their body that is going to just set them up for all the things they want to do. By the way, you just mentioned barbells.
00:48:14
Speaker
And I wanted to ask you, Sarah, what do you see as being the benefits of lifting barbells over, say, like other types of equipment like kettlebells or dumbbells or working with resistance bands? I mean, what is the value of barbells as the barbell?
00:48:30
Speaker
the bell of the bar. There's lots of reasons why barbell training is so fantastic, not the least of which as you're getting stronger, it's going to be awfully hard to find a weight that you can pick up with your hand and use your arm strength to position on your body that is then heavy enough for your lower body to benefit from.
00:48:52
Speaker
Right, because you're getting stronger, you're lifting weights, you've reached a certain level of strength, and now you want to do something like a squat, and you can squat a lot. Let's say you've worked up to be able to squat your two 45-pound kettlebells. That's a 90-pound squat, but now it's getting to the point where it's actually hard to get a 50-pound kettlebell, let alone two of them.
00:49:14
Speaker
off the ground and into what we call that rack position where you're holding it at shoulder level. Likewise with a dumbbell, that in and of itself is its own complex movement called the clean. It's perhaps more straightforward and effective to just take that barbell off the rack and load it up to that 100 pound weight and then get your squat on and keep getting strong as hell. So barbells present this opportunity to set the weight up higher
00:49:40
Speaker
to be able to pick it up from that height to not have to worry about learning how to put it at that height quickly. Additionally, lower body strength can increase significantly. I don't think it's a stretch to say that somebody who's a beginner can get eight times stronger in their lower body. In a matter of a couple of years, they could get four times stronger in
00:50:02
Speaker
the matter of a couple of months, I've seen it happen. That's really cool. So that starts to become expensive. And costly in terms of space, where am I putting all these kettlebells? Yeah, where am I getting the money to buy all these kettlebells when a 26-pound one costs $100? How does that work? Yeah. So a barbell is such a versatile piece of equipment because we can add or subtract plates and get exactly the amount of load we need
00:50:26
Speaker
in more large or smaller increments. The other thing about a barbell that not a lot of people realize is actually in many cases a much simpler implement to be lifting technique wise because it's so stable. It's got that central handle, it's one weight instead of two and it doesn't have that offset load like a kettlebell which creates a lot of complexity around the wrist and the hand and how are you holding on to it and then people have sensitivity around their forearm because the bell is too big or too small or whatever it is.
00:50:50
Speaker
A barbell sort of just eliminates all of that complexity, and now you just have a really heavy weight to get strong as hell with. And build your bones with. Yeah, and because at a certain point, if it's not heavy enough, it's not building bones. No. Well, what can we say to listeners about getting started with barbells? Because I know that it can sometimes feel a little bit intimidating. There's just so much actually really confusing language around barbells and then a ton of opinions.
00:51:17
Speaker
tends to be a lot of really bro-y dudes telling other bro-y dudes what to do. Do you even lift bro? Yeah, and it's maybe not what our audience would prefer to hear this information from all of the time, or they might not think it's relevant to them. Right, because it's a bunch of bro-y dudes talking. So what can we say to listeners about getting started with barbell? Well, here's the thing, and because I started my barbell work relatively recently, like just last year, and as a movement professional,
00:51:44
Speaker
was confused by a lot of the equipment out there. I didn't know what I was supposed to get. You know, each of the things that you're purchasing isn't cheap, but the good news is you're only purchasing at once, right? So you want to make sure that you're buying the most cost effective and yet also has the greatest longevity and variety for you to use throughout your lifting lifetime. So what Laurel and I have done to help you with this is we've created a barbell equipment guide.
00:52:09
Speaker
that takes you through each of the pieces that you need, different varieties. For example, I have a rack that is adjustable and it's just two pieces that then go in the closet when I'm not using it. So you don't have to have some dedicated home gym. It doesn't have to take up a lot of space. It doesn't have to be really expensive. And in fact, over time, it's going to be less expensive than either
00:52:31
Speaker
a gym membership or buying kettlebell after kettlebell or dumbbell after dumbbell. So we've created this guide for you and the way that you get it is you go into our show notes, you click the link, you give us your name and your email and in return you will get this beautiful, very easy to read guide that I like to say has both pictures and words because people are different kinds of learners or they like different kinds. So I like pictures. I got to see it. I got to see it before I buy it.
00:52:57
Speaker
That's right. Well, we're going to link to places that you can look at this equipment on Amazon, but we also encourage you to shop around for something equivalent. If you look at it on Amazon and go, you know, this would meet my needs, and let me see if I can get it for cheaper local whales. Yeah. And we have a whole episode that is about helping you figure out what those cheaper places are as well. We don't remember what it is. We have no idea. But it's certainly, it's this season. We can say for sure it is before July. Yes. Because all of the episodes are before July.
00:53:27
Speaker
Anyway, definitely get our equipment guide, our barbell equipment guide, because why wouldn't you? I have no idea. It's free. I have another question. Sure. Okay. Sarah, what are the risks of not exercising?
Health Risks of Inactivity and Strength Training for Beginners
00:53:43
Speaker
They're a lot worse than the risks of exercising, that's for sure. Yeah. And they are lifetime chronic conditions like diabetes, hypertension, which is high blood pressure.
00:53:53
Speaker
fracture as a secondary event caused by your osteoporosis if you're not lifting heavy enough weights.
00:54:02
Speaker
Pain? Pain. Lean muscle mass. The amount of muscle on your body is a determinant of the length of your life. Wow. So you might be shortening your life by not exercising. You will be shortening your life by not exercising. Now, I'm going to ask you a question that you might not have enough information to answer, but out of curiosity, in your opinion, do you see more people injured from sports or exercise, or do you see more people injured because they're actually not doing enough of those things?
00:54:31
Speaker
Well, the clinic where I work is not a sports performance clinic. So for that reason, I don't see a lot of people with sports related injuries, but I do see a lot of people with repetitive life injuries and they are under utilizing those parts of their bodies. If we look at the markers of physical fitness, we could take some of these markers as having really been shown to be predictive of longevity, like literally how long are you going to live or actually protective against some types of chronic diseases.
00:54:59
Speaker
Things like markers of physical fitness could be strength. We know that strength is predictive of longevity. There's actually a lot of good research to suggest that. It could be one of the reasons the CDC, the Centers for Disease Control and Prevention, recommend a minimum of twice weekly strength training.
00:55:17
Speaker
There's also cardio respiratory endurance which has been shown to be a really important way to combat cardiovascular disease other things that are markers of physical fitness that are important our strength endurance. Some people would argue whether this is true or not but flexibility definitely balance right we're less likely to fall if we have improved our balance.
00:55:40
Speaker
Also, things like speed, agility, and power, which we might think of more as sport-specific capacities, but that may also at least indicate a level of fitness, a level of capacity that we've been able to build through things like exercise.
00:55:58
Speaker
I didn't mention coordination is another one. Coordination is another marker of physical fitness. Listen, there's probably more. Some people say there's less. Some people say there's more. These are just some different ideas of what it means to be physically fit. What do we gain by doing yoga? What markers might we be working on more so with yoga? Definitely things like balance, flexibility, coordination.
00:56:23
Speaker
initially maybe strength if you're not doing if you really haven't but for that's pretty quickly gonna you're gonna run out because it's just body weight but certainly strength endurance which is your ability to do something over a long period of time not the heaviest thing you can do right so yoga could be you know I'm thinking more like more vigorous styles of yoga probably not restorative yoga probably not gentle yoga those these can be very stress reducing they can be very good safer things maybe more in line with like just
00:56:49
Speaker
Reducing pain because we've reduced the chatter of our mind or whatever you want to call that stress, that psychological stress. But in terms of these more physical markers of fitness, something more vigorous might enhance these qualities and might help us actually live longer because of it. What about strength training? What physical fitness markers does strength training really target?
00:57:12
Speaker
Well, some very different ones. It targets strength, obviously like muscle mass kind of strength. It depends on what kind of strength training you're doing. Sure. Yeah. It might improve power if you're doing the kind of lifting that involves some speed related to it. There is a coordination component. For sure.
00:57:28
Speaker
Maybe you're not doing something as complicated as like a bound side angle pose But you're certainly figuring out the timing of when you lift a kettlebell from the floor And at what point are you pulling and switching to pushing if you're taking it overhead? Yeah, it's load specific as well. Yeah
00:57:43
Speaker
Also strength endurance, for sure, and maybe some agility depending on how you're performing those plyometric exercises. So as we've noticed that neither one fulfills the requirements for a total physical fitness package, right? We haven't heard cardiovascular fitness, have we? In either of these examples. So you might want to think about, right, if you're trying to stay safe out there, people,
00:58:06
Speaker
In other words, if you're trying to prevent disease and you don't get some cardiovascular endurance training in, you might want to look at that, right? And I think that's actually the case for me. I'll raise my hand. I'm working on it. Me too. I'm really working on it. But yeah, it's as important. I would say some would even maybe say it's more important. The CDC recommends twice daily strength training. They also recommend- Not twice daily.
00:58:29
Speaker
Sorry, twice weekly, thank you. Twice weekly strength training, they also recommend 75 minutes of high intensity cardio respiratory training per week. So you could put that all together in smaller chunks or hopefully you're not doing it all at once because you're not doing high intensity cardio in 75 minutes. Yeah, that's not the way intensity works. But you can also do 150 minutes of low to moderate intensity, again, or any combination of the two.
00:58:58
Speaker
if you're looking at being healthy slash safe. These are the types of things you want to consider. All right, before we go, for those of you who are interested in getting started with strength training of any kind, barbells or not, or you're relatively new to it and you've noticed like every once in a while you tend to overdo it and you're not sure what to make of that,
00:59:19
Speaker
i have a couple of tools for you to use in your strength training practice that can be incredibly valuable for actually preventing those uncomfortable sensations of is it an injury i don't know but it is uncomfortable slash i have a little pain after training what did i do wrong here are some tools for you to use
00:59:39
Speaker
So number one, we can't prevent injury. We can't say that if you do this, you will prevent injury. Injury is a lot more complex than that, a lot more multi-factorial than that, but what we could potentially say reasonably confidently is that we could potentially mitigate the risk of overdoing it. And so one big overarching umbrella piece of advice is don't progress too quickly.
01:00:00
Speaker
When you're starting out, err on the side of maybe being a little overly cautious, a little overly conservative with how quickly you're progressing, how much distance you're going out and running, how much weight you're lifting, how many reps you're doing, what height of a box you're trying to jump off of or onto or whatever it is you start conservatively and build very slowly from there. So in the context of strength training, for beginners, upper body
01:00:23
Speaker
maybe don't progress the load one week to the next more than 5%. And for lower body, maybe not more than 10%. And look, you're not going to be constantly progressing 5 or 10% every week. That's not how progression works either. You can spend maybe several weeks, even months at the same load, but know this, that if you stay consistent, progression is inevitable.
01:00:44
Speaker
using a tool called reps in reserve. It's very straightforward, so I'm going to start talking about that. Basically, you want to look at how you're feeling toward the end of a set. So for those of you who find that a new word, a set is a series of repetitions. So you're doing an exercise, let's say it's the overhead press, you're pushing the weight over your head.
01:01:04
Speaker
You're doing 10 iterations of the press. That is a set, one set of 10. Then you're going to rest for however much time you need, and then you're going to do another set of 10. Reps in reserve is when you end the set, you ask yourself, how many reps in reserve do I have? In other words, if I had kept going, how many more reps could I have done? And I think a good number of reps in reserve to have for beginners, and again, this is really
01:01:29
Speaker
As a reminder, advice for people just starting out or people really quite new is I think it's a good idea to have actually three reps in reserve. And if that's feeling like, yeah, no problem at all, then maybe two, but two to three I think is a good place to start.
01:01:43
Speaker
particularly sensitive, even for reps and reserve is absolutely fine because there is such a thing called beginner magic. Actually there's not, I made that up, but I was like, I've never heard of that. It actually doesn't require a lot to make really super rapid and positive progress in your strength. If you're a beginner, you're going to see those newbie gains.
01:02:04
Speaker
And they're gonna be exciting and super obvious and you do definitely not need to go to failure by the way i want to define failure this is a really important concept to understand so when we go to failure what that means is that you completed so many reps within a set.
01:02:22
Speaker
that you, one of two things happened, absolute failure is when you did so many reps in a set that you got to a point where despite trying to complete another rep, you could not.
01:02:34
Speaker
So you tired yourself out so much that you were unable to complete another rep despite trying. That is what's called absolute failure. Then there's also something called technical failure, which is a more conservative definition of failure, which is that you go into a number of repetitions far enough to where your form actually starts to break down. As a beginner, you can stay farther away from failure than you might think.
01:03:01
Speaker
you definitely don't need to go to failure absolute failure and you may want to go up to or even to technical failure and then notice that your form is starting to break down that could look like a couple of things like the position of your spine from the beginning of the set actually changed not that you had perfect spinal posture at the beginning that doesn't actually matter as much what matters is the amount of change that took place through the duration of the set you might find that
01:03:26
Speaker
something about your body or limb movement or position changed and so you weren't able to maintain the initial form or technique that you did at the beginning. Other things that might look like is
01:03:39
Speaker
you just got a little trembling or wobbly or you start to lose your balance. That's a big one. When you start to lose your balance in exercises where there is a balance requirement or it is a balance challenge, these are all indications that you have approached or you have come to technical failure. And so reps in reserve might say, how many reps in reserve are you going to hold back before absolute failure or even technical failure? So you could stop before your form breaks down. And as a beginner, that would
01:04:08
Speaker
Likely be enough to make a change and that's really all we're trying to do with strength training It's enough when we're able to make a change and change doesn't happen overnight It doesn't even necessarily happen over the course of a couple of weeks, but you keep consistent You're going to make a change and that's really what that's all we're trying to do is we're trying to get stronger Alright, so then there's also something called
01:04:28
Speaker
rating of perceived exertion. This is a phenomenal tool because what it does is it embeds within training. And by the way, this can be applied beyond just strength training. It can be applied to cardio respiratory endurance. It can be applied to yoga. It could be applied to any type of physical activity, even relationships that you have with other people.
01:04:53
Speaker
rating of perceived exertion embeds the respect for individuality and individual variation into a program. So it becomes less about what the coach wants you to do, less about what you did last week, less about what the person next to you is doing, and more about how am I feeling right now toward the end of the set? What is my exertion level? And using that as a marker for how much more to do or not do.
01:05:20
Speaker
RP was initially developed by I believe a person with the last name of Borg and it was developed predominantly Primarily rather only exclusively for cardio respiratory endurance. So it started off as being a way to measure exertion Subjectively, this is all subjective by the way, which by the way is its its strength rather than its weakness. So Subjective measurements are incredibly important to apply. The Borg scale is from 6 to 20 which is kind of a strange scale and
01:05:49
Speaker
So they actually modified it. I'll tell you about that later, but it's really related to beats, heartbeats per minute or heart rate. And so six is 60 times everything by 10 being average resting heart rate where you're not really doing anything strenuous at all. You're maybe just standing there.
01:06:06
Speaker
up to 200, which is a very high heart rate. You're at a maximum exertion level. Some people never achieve 200. Some people can go over 200. Some people's resting heart rate is lower than 60 or higher than 60. But for the most part, this is an average. And so from 6 to 20, we've got a rating of perceived exertion. If you're at a 6, you're barely doing any work at all. If you're at an 8, this is around 80 beats per minute. You're starting to like maybe walking briskly maybe, right?
01:06:34
Speaker
If it's 100 to 140, 120 to 140, you're probably feeling it. You can maybe have a conversation but it's tough and then upwards of 140, 160, 180, we're starting to get into those very vigorous forms of cardiovascular effort where it's going to be hard to have a conversation.
01:06:52
Speaker
This makes me think of those charts that are on like a stair climber sometimes, right? Where you look at it and it gives you like a zone, like a heart rate zone. Yeah, it does relate to zone. So heart rate does relate to there's like zone one, zone two. But all of this to say that that scale six to 20 was sort of awkward. So they actually changed it to a one to 10 because one to 10 is something people understand a little bit more easily. So one being very light, hardly any effort at all. If in fact you could just be lying down.
01:07:19
Speaker
to 10 maximum effort. So four to six is moderate, seven to eight is vigorous, nine is very hard, 10 is max effort. And so this scale can also be used for strength training. The problem is that sometimes someone who comes from one fitness modality, maybe is running, maybe they're long distance runners, maybe they're marathoners, and they know what a 10 feels like. That's the last mile of the marathon.
01:07:47
Speaker
That's their 10, right? And then they go to straight train and their trainer says, I want you to end at a seven or I want you to end at a six. And they're like, well, I know what 10 is for running.
01:07:59
Speaker
And it's really, really hard. And this is pretty easy because I'm just doing a bicep curl. And so they might accidentally go to failure because their idea of hard is really rooted in their experience with running and what that means to be hard rather than string training, which they're just kind of learning what hard means. So here's where
01:08:21
Speaker
we can connect reps in reserve to rating of perceived exertion. Remember, reps in reserve is how many reps could you have done past when you stopped? Maybe it was two more, three more, you stopped before. Completely exhausting yourself and not being able to do another rep. Rating of perceived exertion can be used incorporating reps in reserve. And this was an idea that is attributed to a gentleman named Mike Tuxurer. I'm probably mispronouncing his name anyway. He's a champion power lifter.
01:08:49
Speaker
He was also a heavily sought after powerlifting coach. And he came up with a way to combine these two ways of measuring exertion level. And what he did was he anchored RPE to the act of actually strength training so that it was not so confusing to folks who were used to strenuous activity and other modalities. And here's how it works. You take how many reps in reserve you have left after a set and you subtract it from 10.
01:09:19
Speaker
So if you had two reps in reserve, that's an RP score of eight. If you had three reps in reserve, that's an RP score of seven. And on and on, if you had zero reps in reserve, you could not have done another rep, that's an RPE of 10. That was a, you went all the way to the end, right? And so from there, you can actually be perhaps, if it's still subjective, a little bit more objective and anchor that
01:09:45
Speaker
subjectivity within the actual experience of strength training. And so this is the interpretation of exertion that I often share with my small group strength training and private clients, which is that I ask them, how many more reps could you have done? Or I tell them, go until you think you could do two or three more reps, but stop before that. And then if you subtract that number from 10, that's going to give you, on a scale of one to 10, actually how hard you were working.
01:10:14
Speaker
And with beginners, here's the deal. You don't actually have to work as hard as you think you do to make a change. And in fact, it's in your interest to not go so close to failure as a beginner because you actually need to allow your body to get used to strength training, to get used to the feelings of muscle soreness that are kind of a natural part of strength training to be able to recover more quickly from your sessions. And so it's actually in your best interest for like the first couple of months, even up to six months of embarking on a strength training habit.
01:10:44
Speaker
to maybe work within that RPE of seven. So I would say plus or minus one, six to eight. It's completely acceptable to end the set with three reps left in the tank. And in fact, you might find that you actually make more progress.
01:11:00
Speaker
faster when you take that more conservative approach because you're less likely to have the type of discomfort, maybe it's pain, maybe it's injury that arises from doing too much too soon and therefore you're going to be able to be more consistent in your strength training for longer and see results sooner.
Recap: Pain, Injury, and Exercise Importance
01:11:17
Speaker
It's such an elegant solution to combine those two things. I really like that. Yeah. Well,
01:11:27
Speaker
We hope that you enjoyed this episode and that it's given you some ideas around the complexity of some of these words that just get bandied about. Words like injury, words like pain, and the importance of
01:11:42
Speaker
exercise as it relates to this concept of safety. A note to you listeners that you can check out our show notes for links to references we mentioned in this podcast and also some really good references that I didn't actually mention but that you're gonna want to check out. You can also of course remember get our free barbell guide delivered straight to your inbox.
01:12:03
Speaker
Of course, also visit the MovementLogic website. We dare you. It's www.movementlogictutorials.com. We've got more cool stuff to give you there as well, and you can peruse our content, which includes all of our tutorials that are rich, rich resources, whether you're a student or a teacher.
01:12:23
Speaker
Thank you so much for joining us on the Movement Logic podcast. Finally, as you know, it really helps us out. It's really a strong showing of support for Sarah and my work that we do on this podcast, that we bring this content to you every week. If you would please subscribe to the podcast and rate our podcast. And if you'd like review too, because in the review you could request a topic for a future podcast.
01:12:46
Speaker
We would love that. We would love to have you join the conversation and enter it into the dialogues that we have with you here. Thank you so much. Make sure to join us again next week for more strong opinions loosely held. Goodbye.