Barbell Shrugged - 8 No-BS Reasons For Low Back Pain with Dr. Stefi Cohen— Barbell Shrugged #386

Episode Date: April 10, 2019

Stefi Cohen has an extensive list of achievements in the athletic field but she is also very well accomplished in the academic field. Not only is Stefi a multiple world record holding powerlifter, she is also an exercise physiologist and doctor of physical therapy. In Olympic Weightlifting Stefi was the Florida senior state gold medalist (2015). Illinois senior state gold medalist and record holder (2015). In Powerlifting Stefi is the current all-time world record holder in squat, deadlift and total, she has 11 total all time world records so far in her career and is the #1 123lb Powerlifter in the world. Prior to strength sports Stefi was an accomplished NCAA (D1) Soccer Player for San Diego State 2009-10, she was also a member of the U17 Venezuelan National Soccer Team 2006-09.   In this episode of Barbell Shrugged we talk with Stefi about the biopsychosocial model, the old way of thinking of back pain isn’t working, shifting the narrative of mechanical causes of low back pain, why your spine is a resilient structure, the moral approach to physical therapy, why you don’t need to do more mobility, what Stefi is working on now, common myths of back pain, and much more.   Enjoy!   - Anders and Doug   Episode Breakdown   0-10: We want YOU to come to Jamaica with us, how Stefi knew she’d break the world record, and why some women have the ability to lift closer to their maxes 11-20: Biopsychosocial model of pain, the old way of thinking of back pain isn’t working, shifting the narrative of mechanical causes of low back pain, and why your spine is a resilient structure 21-30: What “move” means in the world of rehab, and suggestions on how to structure workouts for people with back pain 31-40: Stefi’s approach to new information, the 4 hour low-back assessment, and pig spines 41-50: The moral approach to physical therapy, research on flexion moments, the most common way to injure a disc 51-60: What Stefi is working on now, leading leaders, and where Stefi’s training is now 61-70: Why (in most cases) it’s important to strength train pre and post surgery, research papers are your interpretation of the information, and why you need to take into account strength when looking at the body 71-80: Pain science, choosing not to believe that your body is fragile, the importance of well educated health practitioners, and the power of the mind 81-90: You don’t need to do more mobility, the importance of knowing your goals, why feeling tight is more about perception, and why you should look at your hip and shoulder mobility, not your back   91-100: Why Stefi enjoys working on patients with low back pain, becoming a specialist, Stefi’s current training goals, and Stefi’s numbers and weight class 101-110: Common myths of back pain, the importance of making the most of your clients time, and why your time would be best spent teaching people how to properly hinge and brace 111-128: Being smart in your training, knowing how much stress your body can recover from, the shift in training as you age, and why more isn’t always better   ----------------------------------------------------------------------- Show notes at: http://www.shruggedcollective.com/bbs-cohen ----------------------------------------------------------------------- @bioptimizers: www.BiOptimizers.com/shrugged  “shrugged” to save 37% @sunlighten:www.sunlighten.com "ShruggedCollective" for $200 off + free shipping @perfectketo: https://perfectketo.com “shrugged” for 20% off @organifi - www.organifi.com/shrugged to save 20%   ► Subscribe to Barbell Shrugged's Channel Here ► Subscribe to Shrugged Collective's Channel Here http://bit.ly/BarbellShruggedSubscribe 📲 🎧 Listen to the audio version on the Apple Podcast App or Stitcher for Android Here- http://bit.ly/BarbellShruggedApple http://bit.ly/BarbellShruggedStitcher Shrugged Collective is a network of fitness, health and performance shows that help people achieve their physical and mental health goals.  Usually in the gym, but outside as well. In 2012 they posted their first Barbell Shrugged podcast and have been putting out weekly free videos and podcasts ever since. Along the way we've created successful online coaching programs including The Shrugged Strength Challenge, The Muscle Gain Challenge, FLIGHT, Barbell Shredded, and Barbell Bikini. We're also dedicated to helping affiliate gym owners grow their businesses and better serve their members by providing owners tools and resources like the Barbell Business Podcast. Find Shrugged Collective and their flagship show Barbell Shrugged here: SUBSCRIBE ON ITUNES ► http://bit.ly/ShruggedCollectiveiTunes WEBSITE ► https://www.ShruggedCollective.com INSTAGRAM ► https://instagram.com/shruggedcollective FACEBOOK ► https://facebook.com/barbellshruggedpodcast TWITTER ► http://twitter.com/barbellshrugged

We're going to Jamaica, and you're coming with us! Shrug family, Steffi Cohen is on the show this week. This is our final episode from down in Guadalupalooza. Guadalupalooza seems like it was so long ago. But guess what? We did so many shows down there that we're just wrapping that up. Up next, you got New York and Boston, that trip. And then we just got back from San Francisco.

Did all kinds of recordings up there. So, tons of content coming your way. I'm so stoked to be getting this out. I don't know if you follow Steffi Cohen on Instagrams, but she is the strongest human in the world. Kind of. I mean, she really is incredibly strong and she holds world records. It's insane. I think she holds world records in the deadlift and then the bench press, but she also squats like over 400. On top of that, she happens to be a really badass physical therapist. And this episode on low back pain

is a must listen for everybody that is in the strength and conditioning world because this eight part series that she rolls through can really change the way you move, the way you think about pain. And I think it's really important conversation that most people are not having in the gym when it comes to dealing with low back pain, which like 90% of people are going to experience in their lives. The reason we're going to Jamaica, there is a project, Stronger Experts. Please go follow them on Instagram right now. Philip Tremblay, he's French and he sounds French and it's really cool when we get to talk to him because I like listening to his accent. He's running a project.

It's called Project Stronger Jamaica. And what we're doing, we're going down, spending a bunch of time with the foremost speed and athleticism coaches. So we're going to be hanging out with the Jamaican track team. You know those people. They're super famous. Johan Blake, Usain Bolt. Yeah. And you're going to be able to hang out with them as well. So they're opening up a VIP spot. There's five spots remaining. You need to go to strongerexperts.com forward slash

project stronger Jamaica. If you mentioned Barbell Shrugged, you're going to save $100 on your trip. You're going to get breakfast, lunch, and dinner with the experts. You're going to save $100 on your trip. You're going to get breakfast, lunch, and dinner with the experts. You're going to stay in the same hotel slash Airbnb with us. We're going to be covering the event and interviewing all the people. You're going to be in the group learning, hanging out with all the experts. We've got Olympic lifting people. We've got speed training people. On top of that, we're going to have a big race and I'm going to see how many meters of a headstart I need to beat Johan Blake in the 100. That's got to be the coolest event I've ever been a part of. I think that's going to be somewhere around. I need a 40 meter headstart, but get over to stronger experts.com forward slash project, stronger America

use the coupon code shrug. You're going to save save a hundred dollars and if you are any type of speed athleticism strength coach it's almost a mandatory thing that you need to be a part of this especially if you're a coach in the ncaa or just trying to get get your break i think this is going to be a phenomenal opportunity uh to be a part of an event be around some of the brightest smartest coaches coaches and really, really cool event. I'm so excited about it. I can't believe that I get to talk to you on this microphone and I got invited to go hang out with the Jamaican track team. I'm so excited to learn from these people, watch them prepare, watch them learn and skip and do all the drills because that's really where the sweet spot is in strength conditioning is absorbing knowledge and

watching it happen, watching how these people, the best in the world prepare, um, just such an epic experience that's coming up. So that's in, uh, may. So make sure you get over to stronger experts.com forward slash project, stronger, uh, Jamaica and save a hundred bucks mentioned in the show. Also want to thank Organifi Organifi.com forward slash shrugged. Yo, I have a new, I have a new thing. I have my flavorless protein powder and I put, uh, my 40 grams of protein into the shake. Um, and then I put my almond milk and then I put two scoops of the green that gives me all the protein gives me a little bit of carbs from the from the green drink and also getting a ton of micronutrients the vitamins

and minerals we never think about ashwagandha get the ashwagandha it's so good for you but make sure you get over to uh organifi.com forward slash shrugged. You're going to save 20% using the coupon code shrugged. And then our good friends at Sunlighten Saunas. Yo, Stephanie Sharkey, if you're listening to this, shout out to you. You're going to save 200 bucks going to Sunlighten dot com. Sunlighten Saunas, the three in one infrared sauna for all the heart health. If you get in there, they have Netflix in there. So you could just Netflix and chill in your sauna, sweat it out a little bit. If you, if you need to replenish, if you need to detoxify, if you need to just get some heat shock proteins in your life, Sunlighten's got you covered. Sunlighten.com, mention Shrugged Collective.

When you set up your appointment, they're going to customize a sauna for you. So you don't even have to worry about what the right dimensions are and all that fun stuff. They've got experts to help. Sunlighten use the coupon code shrugged collective when you check out and you're gonna save 200 bucks now let's get in it's our girl stephy cohen the strongest girl in the world talking about low back pain we'll see you guys at the break beautiful just making noises uh so he has the same i had the same brain tumor that mccain had so it we he was off balance we know what's going on about a year ago then he kept falling down the house we got him in a care center and then rapidly we figured out what was going on and then we put

him to hospice and he passed just a week ago so what was how did you know this person he was my um um sophomore year like health teacher like diving coach and he just stayed in my life to make my book tour through um you know i won like an award at my high school it's called learners to leaders he's like jen can i present the award to you and i was like yeah man like whatever man and so he just has been such a an advocate like and even my book tour like he helped moderate it at the bookstore in my hometown and then his wife like had me like a little pack sack to go on the plane because i was overnighting to mark's place like they've just been in life a long time it's beautiful yeah so he's like a really special

person extremely yeah yeah and he passed away yeah um what, what's the big thing you want to get out of this? What's the big intention for the day? Basically just, um, talking about low back pain and trying to shift the paradigm of what people think usually about low back pain and just trying to dissect, not necessarily like give my opinion, but present people with the best available evidence and let them decide what camp they want to be on because this is a complicated topic and and it doesn't seem like healthcare practitioners can get to a consensus about what the best treatment is what the actual cause of low back pain is. And it almost seems to me like people are, um, they're trying to sell something.

So whatever, whatever they, whatever camp they choose to be on, it's because they're trying to sell you a treatment. And I don't mean to call people out at all, I I feel like I'm in in a unique in a unique um position position because I'm completely unbiased I'm not trying to sell you anything I'm not trying to sell you a treatment I'm not trying to get you into my office I'm just trying to understand it better mainly for myself that's kind of like how how I recently started getting into it you had low back pain yeah Yeah, for a long time. Oh, let me see.

Maybe deadlifting 5,000 pounds. You'd be surprised. I don't think it's because of that. Oh, I love it. I actually agree with her. Welcome to Barbell Shrugged. I'm Anders Varner. Hanging out with Doug Larson, Jen Widerstrom, and Steffi Cohen

inside Hybrid Performance Method Miami. We made it all the way down. So exciting. Day two. This is a gangster gym. I've been wanting to come over here for a long time. Right? It's a big sign back here.

We all just PR'd showing up. Are we filming a vlog? Yeah. Yeah, we are. When's the vlog dropping? We'll start at the end because that's usually where we tell people to go. But when's the vlog happening? I actually just started my own YouTube channel.

Nice. So I'm working on compiling a few videos so that I have some consistent content to post up. So maybe in a couple weeks, two, three weeks. Beautiful. It's a good thing I wore this outfit. Right? We got yellow, yellow, the yellow shoes. Weeder strong in the house.

Stephanie and I put some makeup on. She did some shrugs this morning. Hair done. Hair did. This is everything. Do some shrugs with your coffee. You can't lift what she lifts and like have veins coming out of my neck and not have like beautiful hair yeah it's just part of like so strong and so pretty and

gorgeous yeah dude um make me blush yeah keep blushing do it we got it on camera you're vlogging yeah this is it so the first time we had you on the show maybe year and a half ago i'll say something like that you were you were chasing the 4X bodyweight deadlift. And actually, I'll ask you, at the time, how, now that you've done that, how sure were you that you were going to be able to accomplish that? Oh, 100%. Back then, so I usually base what I can do on rep maxes, so a three or a five rep max. And so actually, there's like one rep max calculators online that you can use a five rep max. And so actually there's like a wonder max calculators online that you can use to, to get a prediction. And so I use that and also just by feel. But aren't women better at some of those, you know, that, that 70 to 85% range of weight that

you can actually rep, like do better. Like, I think that calculator would be incorrect for me. You're like, I can move heavyweight well, but the PR doesn't necessarily always translate. So, I mean, here's the thing. You usually get better at the rep scheme that you practice. And so, yeah, if you practice a lot of three rep maxes, five rep maxes, six reps or eight reps, you're going to be really good at that. And if you're not doing enough one and two reps, then you're right. You're not going to be ready for it. But I don't think necessarily grouping females in the category of, oh, we're not going to be good at higher percentages. I don't think that's totally correct, but I do get what you're saying. There

is in fact evidence that females have a higher proportion of type one muscle fibers. So we have more, a higher distribution of, of aerobic muscle fibers. So we do, we do have a tolerance for higher volume training, but that doesn't necessarily mean that. It's fascinating. It is. It's like, I can't remember the last, I think I was in college last time I did a one rep max. Okay. I'm going to step up. Let's do it. I think what you're saying is actually accurate for specifically for untrained individuals and for people that are, the less strong strong you are the more reps you're going to be able to do with a set percentage of your max so like if you deadlift 200 pounds and you're you

put on 80 maybe you get 12 but if you deadlift 600 pounds you put on 80 you're probably not going to get 12 yeah that type of thing so i think it definitely applies in a few cases but um to your point for a trained individual who does lots of low rep training, that those add a certain percentage. You're going to, as you get stronger, go from 80% for 12 reps to work your way to sets of five, that type of thing. Have you ever had your muscle fibers tested? No. Galpin.

Galpin, are you listening? We did that one time with Galpin, actually. I've heard that it's incredibly painful. To get biopsies? They're chopping your muscle out with apin actually. I've heard that it's incredibly painful. To get biopsies? They're chopping your muscle out with a scalpel. I would be curious to see her muscle fibers though. I was not hitting on you. I would love to see her muscles.

Would you mind if I just opened your leg up? It was coming out of my mouth and I thought, just let it ride. We actually don't have any pain sensors in your muscles. Like when they chop the muscle off specifically, you don't feel it. You feel a little bit of pressure, and your muscles will kind of contract. No. How weird is that?

But they'll numb the skin because they have to make an incision in the skin, but then the actual chopping of the muscle doesn't hurt at all. Interesting. So the nerves are only in the skin there. The muscle just doesn't. It's just there to contract and relax. There's pressure sensors, so you'll feel the pressure, and then the metal will interact with the electrical charge of the muscles or the ions or whatever it is, and you'll feel some contracting,

but it won't really hurt. Is that a fact, like Andy said? Yeah. Did Andy say that? Oh, if Andy said it. Yeah, yeah. I said it. It doesn't matter. Come on now. Doug L if Andy said it. Yeah, yeah, yeah. I said it. It doesn't matter.

Come on now. Doug Larson, not PhD. I've had many biopsies. I've had quite a few. Quite a few. So is there any facts to anything you just said? Did Andy back up that? What can we count on?

You have a whole thing of paperwork here. I'm the nerdiest nerd ever. How can you be so smart and so strong? How do you have this much time in the day? Yeah, be proud, girl. I actually tell you, I got a little insecure. I was like, I did not bring notes. Well, we brought you in for a specific reason, Jen,

because you yesterday were hanging out at the Gauntlet. That's the name of it, right? Yeah. How many thrusters did you do? It was a three rep max. Were you able to do it with the beer you were holding in your hand? Yeah, no, no, no. I needed two hands for that.

Have you ever done a thruster? Come on. Yeah. You should do it with one of those hats that are plugged into your mouth, like that the beer comes out of. From my PT. From my PT. You just like, you grab it with your, the weird thing is the mouth grab, you're like,

like with the handless thing. Okay, I'll work on it um you're a little beat up today yeah it was the cbd massage didn't work too well did not go through well i had so many questions for you ironically uh with you being a pt stuffy and um i mean i'm not i'm not but i've not done a crossfit workout in easily a half a year maybe more so i went to the gauntlet and And I will tell you, I was very thoughtful. I still lift. I still squat.

I still do squat cleans. I'm still, you know, snatching, but not in that format. So I knew I would kind of fade out. But it was just I literally couldn't, like, walk after the event. Also, while I was drinking a beer, I was like, let's just slow down. And I was, like, kind of, like, casually, like, stretching my psoas and, like, high-fiving my judge because I had, and I had pain in my front and pain in my low back.

And then I went to the, this, the little, the stretchy tent and it did absolutely nothing, which you still say it was great. Of course, she likes, makes me feel better. No. And, and, and, and then you kind of were correcting me right when I got in this morning. You're like, well, it's actually probably something else. So I'm kind of fascinated because, and I had a question for you too, because I called my chiropractor back in LA, Dr. Ira Schneider.

Have you ever worked with him? No. Oh, Dr. Ira. He's, he's like this amazing Jewish Yoda chiropractor. And he'll kind of look at you and you're like, yeah, my back hurts. And I'm like, okay. And you're like, he'll like squeeze your ear and like move your thumb. And then he'll like pop your elbow and you feel better.

You know, it's like not about the back. It's about something else. Or I had something with my right ankle. He's like, what are you afraid of stepping into in your life, Jen? I was like, don't, don't, don't try to, come on, dad. Anyway, but what he was saying, he's like, his first question goes, he's like, how's your menstrual cycle right now? I go, well, it's regular, but I went off birth control probably

about six weeks ago. And he goes, oh, taking the birth control out can actually shift the elasticity of your tendons, ligaments, certain like muscle groupings. He's like, so I think your pelvic floor is loose. And I thought, oh my God. But it was actually a fascinating conversation and how perhaps that there's a, just like pregnant women, um, the hormone shifts. So there obviously, so there's space for the baby to grow into. And we, we, there's a laxness in the pelvic floor, like again, like our hips shift. Right. So as I very ineloquently get to this point, I thought, is it, are my tendons just loose? Cause I stopped taking birth control or is there something really wrong with my back? Or is there an option C that you're going to tell me?

Biopsychosocial. Yeah, I mean, obviously, yeah. All of it. You had all of them in there. It seems like the chiro that you're seeing does get into the biopsychosocial aspect of low back pain, which is huge. And that's just basically your understanding of the low back pain. We'll get into a little bit more detail of all the possible theories that I've been looking into. Yeah. And that's just basically your understanding of the low back pain. We'll get into a little bit more detail of like all the possible theories that I've been looking into. Yeah. But yeah, basically. And that's it's really good that he addressed it that way and not the old way of thinking about low back pain is focusing on pathoanatomical dysfunctions and just mechanical causes of low back pain. So there is an overemphasis on

diagnostic tests and on structural damage as the main source of pain. So people looking at, people looking into vertebral damage, end plate fracture, spondylolisthesis, spinal stenosis, ligament enlargement, disc bulges, disc slips. And it's concerning. You know, you walk into the office and in the middle of the office, you see a model of a spine model with a freaking disc outside of the of the of the spine. First of all, that can happen. Your disc is not just gonna slip but the subconsciously what that causes is immediate fear mongering mmm and so I think that we really do need to shift the narrative from the only is focusing only on the mechanical causes of low

back pain and trying to look at the bigger picture so yeah one of the biopsychosocial is huge understanding that our spines aren't unstable our spines aren't weak our spines are strong resilient structures that can tolerate a lot of load and a lot of in a lot of stuff throughout our entire lives so that is huge so i'm gonna bring up another scenario i'm someone that i i don't know if i had a car wreck younger and then i was always doing sports but i had a 17 millimeter herniation up in my cervical spine c4 to 6 somewhere in there and they were me again the assessment was surgery sorry we got to do this we got to cut that chunk out we got to fuse it and everybody's getting like oh i have the fusion and it almost becomes this badge of like I had a tough.

You now have a thing you can relate to. Yeah. And I was like, I just don't think I'm going to cut into my spine. I feel like whatever. And I immediately, ironically, even though that was their solution, went to what's my mechanical regular kind of movement that I'm doing to create that kind of inflammation or issue. Because I had strength loss, all this kind kind of pain all the electricity down the arm even even in LA sitting on the 405 talking um you know to you know the hands free I'm reaching my neck right I'm yeah I'm all of that you know cross it I was like every rep you've got to like push your head through to

create a rep you know and like you have this top load and so i thought let me just restructure the way i'm moving the way i'm talking the way i'm breathing the pace of which i'm doing i started doing pilates every week to create space and i didn't have surgery and i'm still good to this day without going but i still i reassessed my mechanical. So that's what was interesting because like both based on what you're saying, both the, the diagnosis for surgery and my way that I felt like I fixed it was only the mechanical movement part. Well, I think that a lot of what you're talking about though, it's not just the mechanical piece, but it's the downregulation piece along with the movement piece. So maybe that is that component. The ability to be present and understand where your body is in space allows your body not to be in a scared fight or flight mode.

Is that a little bit what the research is showing? Yeah. So one of the main ways in which our spine creates stability or creates stiffness is through proprioception. So specific muscle spindles and mechanoreceptors and proprioceptors around the spine that tell your brain where the spine is in space. And so when these mechanoreceptors and proprioceptors, muscle spindles are damaged for X reason, it could be stress, it could be a biomechanical flaw. When they are damaged and your brain doesn't know how to orient the spine in space then you get things like muscular

co-contraction so that's really common in neck and back patients where they just start getting super stiff so think about that as a compensatory mechanism by which your your body responds hey i have no idea where you are right now i'm'm just going to tense everything up. And that's where muscle spasms come in. That's where a lot of the unexplained pain comes. Oh, my gosh. I'm just like emotionally stressed out. Does a lack of stability create stiffness? Not necessarily.

So I hate the term lack of stability, and we'll definitely get into it. It's not necessarily lack of stability. It's lack of awareness. These receptors got damaged and your your brain doesn't know where you are oriented so as a self-defense mechanism it co-contracts everything to create the perceived lack of stability so now that we're into it i think it's important that it's important to define it's important to define stability, what stability actually is, and what it means to us in terms of treatment, in terms of physical therapy, in terms of rehab. And so one interesting comparison, or not comparison, but two terms are really important when discussing this, and that is defining stability versus robustness. So, I mean, the main thing that a PTR chiro will tell you is,

oh, your spine is unstable. We have to stabilize your spine. But I mean, are patients really lacking stability? Is that really a factor? Is it important? And if they do have instability, why does it have to be painful? That was the, that was the first question that I had. And actually that was a question that I, that I started looking into and it all was motivated by this quote that I randomly saw on, I think it was like on Instagram. It was all notes for this show. You know what's great is they invented this thing

called a computer. You can put all this in and you don't have to carry it. I'm totally down with this sickness. No, dude, this is beautiful. You're just listening on audio. She just has like a whole book in front of her. This is what's in my head. It's like my madness.

It's on the mic. Thousands of pages. It's like a whole book in front of her. This is what's in my head. It's like my madness. It's on the mic. Thousands of pages. It's awesome. It's this image that says question everything, and then it says why. And that's what, seriously, I saw that, and then I started thinking about low back pain and then about stability, and that's kind of what created the storm in my head. But, yeah, so think about stability is basically the ability of a system to return back to its original shape versus robustness robustness is the ability of the system to tolerate perturbations

and to and to remain remain not stiff but to tolerate perturbations and changes in in the system and so think about it like this so a good analogy that i thought about was comparing an oak tree versus a willow tree and so if they're sitting they're standing next to each other and there's a wind that blows the oak tree is not going to move that much it's going to it's going to have this it's going to still move around, right? But it'll return to its original shape, so it's still stable. But it's more robust than the willow tree. That's going to move more. So it's still stable, but it'll come back to its original shape,

but it's less robust. But you're a diesel power lifter. You guys spend so much time in, like, extreme tension to pick up 500 pounds off the ground. Right. She's an oak tree. She's robust. You are the oak tree. Do you have some willow in you?

I do. I do. A little flow? A little dance? Do you get a little salsa in down here? I'm still trying to figure it out, man. Wait, so I've always used Gray Cook's definition of stability as not moving in the presence of potential change. Is your definition pretty much in line with that in your opinion?

For sure. So let's get like one layer deeper because you talk about the emotional and mental component of how this affects your body's perceived danger or lack of stability. So if we are physically able to be robust, do you think that we emotionally should allow ourselves to willow? Okay. You're right.

We're all going to start dancing. I just feel like. God, get a little flow in here. Well, but it's fascinating because if our body, I feel, our body truly reflects our brain. You know, all of what I see in my side, whether it's weight gain, weight loss, or body dysmorphia on the other side, it's a mental health issue.

And we're reflecting that. So in the same way, you're talking about your body's response, whether you feel pain or not, as you really interestingly pointed out does it have to be painful to be hurt does it have you know to be unstable right to yeah so and again it stems from beliefs of where low back pain is being caused so like if someone tells you hey your spine is unstable your your unstable, your spine isn't strong, and then you're going to start walking like that, right? So you've got to allow yourself. You've got to have someone to tell you, hey, you can move.

You can bend over. It's okay to bend over. It's okay to slouch on your chair. It's okay to pick up a box with your spine rounded. You know? You know, it's funny because I came in here and you said, are we going to train later? I go, ah, my back. And I was like i'm

getting old i don't know if i can do and you and what did you say you said the worst thing you can do is not move yeah because i was like oh i'm not moving today i'm gonna just i'm gonna have a beer and i'm gonna really walk slowly and i'm gonna be a health professional you know hang at the fit aid booth and just you know something and and you and what you said to me was like that's the worst thing so tell me because i, even as a health professional, aside from having what I have right now, which is just, I'm such a pansy, but it's going to be fine. I tell my clients, anybody I work with, I'm like, okay, we'll pace it back.

Your body's letting you know, slow it down. I actually encourage them to be a little more gently with themselves. So you don't agree. No, no, for sure. I just said move a little bit for 30 minutes. You can gently move. You just don't have to do a little more gently with themselves. So you don't agree. No, no, for sure. I just said move a little bit for 30 minutes. You can gently move. You just don't have to do a thruster as heavy as you can. I wouldn't, if you've come in with low back pain,

I probably wouldn't put a barbell on your back or on your hand even. But still move. Still move, for sure. Whereas I have literally been avoiding movement. Well, this gets into an interesting, you say move. What does that mean from a rehab side of things? If somebody's coming from you and they're in the powerlifting world, CrossFit space, Jen Widerstrom doing a thruster, gets into an interesting you say move what does that mean yeah from a rehab side of things if somebody's coming from you and they they're in the powerlifting world crossfit space jen

waderstrom doing a thruster and they come in with a bunch of pain what does movement mean in a in a rehab sense so this is not a black or white answer i i definitely i don't agree with boxing patients especially low back pain patients into one or another category. I think it should be an individualized answer. So I'll answer for you. If you're coming in yesterday, you had a rough session. Your low back is a little bit jacked up because you did a heavy workout. But it seems like you can still move around.

You can still bend forward. You're not super locked up. So I would focus on starting with a little bit of aerobic uh exercise uh research is very strong into uh walking walking with excessive arm swing as a as a low back treatment protocol oh okay that's not what she's talking about but keep it going yeah no Yeah, no, seriously. Shrek over here. No, it is. Is that right?

It's exactly. Do I have it right? And you look kind of ridiculous, but. Yeah. Yeah. Oh, my God. That should be it. We just named that. Shrek walk.

Shrek walk. Shrek walk. Do you want to take that? Yeah, I'll take it. You got it. It's yours. I'll take it. I'll take it.

Okay, because it was, I mean, literally, I had to pick my outfit based on what I could get on. Like, I couldn't get my foot to my hands, so I was dangling the tight. I felt like my father, Norm, getting my pant leg. I mean, and I got one foot in. What's his name? Norm. Oh, that's a good Midwestern name.

And then I shifted like on the bed, and I got the – I'm not – even now it's tough. And then I shimmied them up, and I thought, this is just a little silly. It's bananas. So then to that point with movement, because I felt pain. Like, I was like, oh, man, I'm literally, I mean, I loaded up with Advil. And then I'm going to have tequila probably by 2 o'clock. You're poking her right now.

That's why I'm asking my coach. I want to learn. I'm happy to be wrong. So that's what I'm saying. But for me, and this is, you know, we're at Waterpalooza Day too, but like for people in life, they've got stuff they've got to do though. But this is just playing fun. This is a great fitness festival.

But like people like I have kids. I have a job. I have to get to where I want to go. I want to mute it, mask it, and get on with my day because I have to. So what do you recommend for people when it's like okay we're gonna shrek rock walk but what's their way to actually move through it and really set people up in their life okay so yeah so there's eight exercise prescription targets that are pretty consistent across the literature and that anecdotally I can agree with so I'm pretty

big into and I think we discussed it into in our last, uh, Bible shrugged episode where, uh, I like to look at the research and the evidence, but I like to correlate it with, with myself and the people that are around me. So not only just being blind and, and wholeheartedly believing a research paper, but putting your own brain to work and, and making sense of the research and trying to apply it, right? So first thing, stop doing what hurts. This one is hard. It's hard for a lot of people to implement because, like you said, they have responsibilities.

They have to do X, Y, or Z. But low back pain is one of those issues that you really don't want to mess with because it can quickly turn from just a twitch to having to a chronic issue okay because of because of the mental aspect of it that's been proven the biopsychosocial aspect so stop doing what's hurting if if bending over is hurting you then and i'm not saying don't do it at all i'm saying find an alternate route to get there so for example i had for a long time i had a lot of pain bending over. And so this is called Spine Health by Stuart McGill. I read it in his book.

Finding other ways to accomplish that task. So anytime I would put on a shoe, I would put my feet, my foot up. I would launch forward and I would tie my shoe on or I would put it like that. Anytime I have to pick something off the floor, I would launch down. I was going to say you take a knee, huh? That's how you should have got dressed. I shouldn't have done the norm i shouldn't have i should have done the track walk the track walk okay keep going this is good you're good so find another route yeah and i think where the message gets lost is when we it's not i'm not saying do that forever i'm

saying do that until you're out of pain find a different way to move and don't do the exacerbating thing that's causing your low back pain. That seems like it should be common sense, but people don't do that. It really isn't. It's a different model. And this is what Brett Contreras was talking about of like the empowerment model versus the disabling model of what can you do? And let's focus on that versus your back hurts. We can't do shit.

Don't do anything. Exactly. Do you feel like even a level one or two of pain or discomfort should be avoided? Like if it's replicating the problem, to me, I always think I cut my hand. Here's a scab on it. I'm going to rip it off the moment I replicate the pain. So even if it's a level one or two, would you say avoid it until it's gone? No, not necessarily.

I mean, avoid. Okay, so let me backtrack. Yeah, we're throwing a lot at you in order in order for you to produce positive tissue adaptations to heal and to recover from an injury you're gonna have to apply a certain amount of stress to a tissue because that's the only way that we can adapt and so what happens when we're injured is that we have what's called a margin of safety and what you want to do is stay within that margin of safety and push it as much as possible, increase the tolerance as much as

possible, but staying within that safe margin. And so I always say staying below a three out of 10 of pain. Oh, okay. There you go. Where are you at? Like an eight. I'm going to let Steffi assess me later off record. So the world doesn't know what a baby I am right now. Okay, cool. Do you want to go through the other eight things? We cut you off at like one. We got to one. We got through almost the first one.

We spoke a little bit about the second one, so tissue adaptation. Don't ignore the bio. Make sure that you want to expose the tissue to a certain amount of load to make it adapt. Okay. Like a good example is a hamstring tear. Obviously, during the acute phases of a hamstring tear, you're not going to put someone to do Nordic curls. It's the most painful thing ever.

Right, yeah. Tearing anything. Exactly. But you're going to start someone – a great place to start is an isometric exercise. You know, so maybe just holding a kneeling position with someone holding you and just holding that or just lifting your leg up and like contracting that holding it do five six sets 30 second holds starting with isometrics so for the lower back it's the same and if you think about it what's the common the most common exercise prescription for the low back the

big three bird dog, dead bug, side planks. All of those are isometric exercises. So then that leads to the second question. Is that really increasing stability or are these exercises working by a different mechanism? And whatever the answer is, I don't think it really, it matters to a certain extent. It matters because once you understand the mechanism by which these things are working then you can spend you can you can spend your time better with patients doing things that are actually going to help them when they actually need it so some of these patients like i said might not be unstable right because of what i told you some of them might have um there's there's different mechanisms that lead to

impaired feedback processing from the brain to the spine, not only stability. So for some of these patients, they are already contracted. They're already too tight. Are you going to do more core exercises? They're coming to you. They're already stiff as heck. Do they need more stiffness? Maybe not. You need to allow them to move. Maybe you need to do other exercises to loosen them up. I feel like as corrective exercise came into the fitness industry really strong like 10 years ago-ish, people went too far in that direction where they were just doing bird dogs and dead bugs and side planks. They never really progressed off of those things. Yes.

And ended up not really getting that great of results because they needed to do that for a couple weeks maybe and then move on to something slightly more challenging. There's a progression involved and eventually back to regular training. But they kind of just stayed there. Absolutely. Absolutely. But isn't that what's kind of special about what Steffi's doing? You know what I mean?

We all have used techniques or tactics that we've learned, that we've seen that work, that mentors. I mean, like Cal Dietz, he teaches me things. I use them in momentum. But he's gotten so far just as Steffi has because he's questioned the system and isn't really working. You're personally saying, okay, what do I feel? What does this body feel? And you're not assigning that to everybody on the planet, just your body. So, actually, I really commend you for the research and the time you're investing to seek and to question.

And, by the way, have the courage to be wrong. You might come out the other end of some of this stuff and be like i was wrong about that and i think that's what's really neat you've mentioned mcgill a couple times and when we talk about kind of the robustness of movement he's an interesting one because he is always talking about like kind of the extreme stability in that pelvic low back region i went to see him oh let's hear about this yeah i had a four-hour eval with him tell us i want to know everything. Everything. We want your muscle tissue number one, and then we want this.

I mean, it was interesting. Did he put you in the thing? Did you see the pig spines? Is that what he tests all the things on, like how to snap spines? And it's like pig spines. He did do a lot of testing on pig spines. I'm sure he was just hanging out with them all day long. My mouth was choked open. Did I get that wrong? I have one or two.

Did I get that wrong? I have one or two issues with his pig spines. Yeah, he gets criticism for that all the time. Yeah. So, I mean, okay. I walked into. So exciting. Because he treats out of.

You actually hung out with this guy. He treats out of his house, which was cool. And, I mean, I thought it was awesome that he took me in because he's not really actively seeing patients. Okay. But I guess I'm cool. It's easy when you're the strongest female in the world. When you got the golden ticket, you know, you get in. I'm Steffi Cohen.

Do you want my last name as well? Okay. I walked in and you were like, I saw some of your recordings on the internet. Your recordings. That's so good. Wait, how old is he? Old enough to know to only have studied the spine for 40 years. Oh, yeah.

Okay. Cool. Okay, carry on. Only the low back spine. He's not doing cervical or anything. He just wants the L's. He knows about that too as well. I'm sure he does.

He's just known for the low back. Yeah. What did you do? So I walked into his house and the way that I approach any sort of theory or treatment or modality, whatever, is with a completely open mind. So I consider myself a skeptic, but I also, but I also allow myself to try to put myself on the other, on the other side and try to understand it from a different perspective. So I walked in with no expectations, completely open mind, trying to soak everything in and believe everything that he

was saying. So at the end of the day, I mean, it might actually help me, whether there's research or not, right? So the eval took about four hours. We started with just some basic assessments, like trying to replicate your pain through provocative tests, like bending forward, bending back, bending sideways, rotation. He did some neurodynamic tests. It's basically seeing the integrity of your nervous system

and the nerves that exit your spine and go all the way through your limbs. So that consists of sitting down and bending your neck and extending your legs and seeing how that affects you to see if there's any part of the nerves that exit through your legs, if they're being compromised in some way, either like stuck or stiff or irritated or whatever that might be. And then we moved more into functional stuff, so just seeing what kind of movements throughout the day cause the pain,

and then into more structural things to see. So a prone instability test, that consists of you just laying down on your stomach and then and then the examiner pressing down on each vertebra uh individually to see to try to see whether or not there's damage to either the the vertebra itself or the disc Um, so yeah, one thing I did not like about the evaluation was that he was very quick to jump into a mechanical issue again. And that was a little bit of a, um, I was a little bit disappointed because I, I didn't, I mean, that's, that's the only thing that I just like, don't believe in.

You can't, I don't think it's's fair to to without a solid proof of diagnostic test to get to a serious diagnosis like that oh and he told me you i think you have an end plate fracture at l5 is one i think you have a few bulging discs that is terrifying i don't know if someone's ever told you that but that you have that but that's absolutely terrifying you have a few bulging discs you might have some nerve damage i'm like oh okay um screwed yeah yeah you're going into this with a seemingly healthy low back you don't have currently have low back pain or you had low back pain but it wasn't anything terrible but it's been like i said i've been having on and off low back pain for about three years so i'm like you know what i'm gonna get seen by the best i want to i want

to know if is there a biomechanical cause that's leading to this? Why is it recurring? Why does it keep coming back? What can I do better? Yeah. But I hear, I mean, even when I had my herniation, I was bawling. Yeah. I was like, what does this mean?

Yeah, you think you're stuck with it forever. Yeah. It's just, it's almost, it's Kilimanjaro. You're like, what do I start? No, it's scary. And when you first get the diagnosis too. Before I forget, let's talk about the pig spines. Yeah.

Pig spines are rad. Because he does all of his testing on it. You know what's crazy? I actually have a document saved in my notes from graduate school where we reviewed that paper. And I remember being mind blown. And just kind of like repeating that over and over again, whenever someone sees, or whenever I saw someone doing like a GHC setup, I'm like flexion extension,

there's pig research. And when, when they flex and extend pig spines, 5,000 times it led to immediate disc bulges and disc herniations and damage to the vertebral end plates. I just kind of like regurgitated that information. And then I stopped stopped i stopped to think about it as i was doing all this research i looked into the paper again and there's so many things wrong with that research paper first of all the pigs are dead okay so there's you have she brings up a good point there's growth factors and there's healing there's healing enzymes that your body has that produces naturally that can prevent that from happening, first of all.

Second of all, 5,000 cycles at once of flexion and extension, when are you doing that? Yeah, Herschel Walker. So there's no adaptation period. There's no adaptation period. Tissues adapt. Yeah. Tissues are resilient. But you have to give them time.

You can't expose them without without any training or any warning you can't expose your tissues all of a sudden to 5 000 cycles of flexion and extension without allowing them to adapt yeah so that was the other one i think that those were those were my main two points i feel like the the range of motion is a factor there too like if you yes if you take your finger and you wiggle it like this yes it's going to be totally fine. But if you like take it all the way to end range and all the way to end range

and all the way to end range, eventually it's going to start hurting. I actually think in the research paper it was the opposite way. They didn't take it all the way to end range. Okay. And that might actually, if the cycle is shorter,

then it might be even more wear and tear in these particular areas than if you were to take it to flexion extension. Maybe it would have been a more natural wear and tear similar to what actually happens to your spine when you take it to full flexion full extension daily in daily life i don't know so the reason i said it like that is usually when people are talking about flexion based low back pain and bulging discs and whatnot they're thinking that under load they went to full flexion and that's when oh yeah that's

when you get some type of a disc that just gets squeezed out the back yeah yeah i mean that yeah that is a uh unknown and pretty well accepted theory about how bulging discs can happen when i have ever had so i had like this weird shoulder thing three years ago and it was like a little bulge disc in my neck. It was the most terrifying thing ever. And I went and saw a physical therapist and they were able to trace all of it back to whatever, see something that was going wrong up here. But as a physical therapist,

when someone comes in, like I would never expect Sue McGill, like the best in the world to see you that can deadlift all of the weights and squat all the weights to be like, you have a movement problem like how would you even be able to think somebody like you would have a movement problem in leading to back pain with you no he didn't i don't think he he he told me that he thought that my back pain was coming from a movement dysfunction i don't even think he told me why he thinks it's happening. He told me it could be related to movements that I do on my day-to-day

coupled with everything that I put my spine through. Do you think he just had to come up with something? Absolutely, because that's what you have to do. People expect an answer. People expect an answer. I used to struggle with that so much during my rotations in physical therapy i would tell my my instructors that sometimes people would come to me with problems that are not anything that i've ever seen on paper and i don't have anything to say and my instructor literally said come up with something and so i'm just giving answers like

randomly that's not right we shouldn't do that because you have to label somebody something and now all of a sudden now they walk around around, they're like, you know what? You know what I got? Let's talk about it. People want a diagnosis, though. Yeah. Yeah. I think that's why pain pills are not the only reason, of course.

But that's part of the reason they're an issue is because people go to the doctor and they expect to leave with something. I'm so scared of pain pills. They won't leave until they get something. I partially tore my bicep tendon. And I walk around and tell people this now because it's, I'm like part of the cool kids club. No, not exactly.

Um, but laying in bed like night one, the night that you were at my house actually, and I was just laying there and I was awake all night. It was the most painful thing. And I was like, you know what? If I chop my arm off right now,

it will be better. It will, all the pain will go away. If I just, if I take a skill saw, just don't have to worry about it anymore. But the pain pill thing is so freaky. I remember just laying there and being like, I'm not doing it.

I'll be on heroin in a week. There's no way. There's no way I'm taking an Advil. Part of it is, too. I mean, part of it is maybe I don't fully have the answer. So I want to help mute what you're feeling to create an opportunity to feel better, right? Or I feel bad. I don't want your pain. I don't fully have the answer, so I want to help mute what you're feeling to create an opportunity to feel better, right? Or I feel bad. I don't want you to pain.

I don't really have an answer, so I'll pretend I know and still prescribe it. I mean, I don't know. Yeah. What do you do with those people? Do you have to give them something in your practice? Like, is it possible to just be like, hey, we're going to get a little bit stronger? Because I think a lot of people struggle just because they're not strong. They don't have the actual muscles for the joints to move properly,

which leads to a lot of bad wiring, and then the wires get weird, and now we've got brain talking to the feet in a really weird, strange way through your low spine, and that's a weird spot. I think people are getting smarter, though, not even just in our field. If Steffi's like, you know, I really don't know what the diagnosis is right now, but let's start here, I would respect her more. more yeah like okay she's actually saying and what's morally morally i couldn't get myself to to to bullshit and answer i couldn't i couldn't and for that i always thought man maybe i'm not i'm not gonna be a good pt because i can't get myself to do that

i can't get people what they're asking you better i don't know some people might not like that and then when i'm like oh you know what i have no idea why your shoulder hurts but then have you seen that um louis ck episode by the way about the ankle no oh my gosh i was dying so louis ck goes yeah so i went to the doctor the other day because my ankle was hurting and he takes an x-ray and then he shows me x-ray and goes see you all this right here yeah it's just fucked so uh no oh poor guy he had to go back to relearn how to be funny now you're gonna have ankle jokes now you're gonna have to stretch it and he goes okay uh like for how long now this is just something you do now oh my god have you have you read any research about about flexion moments specifically being the problem a second ago i said that you know you

under load you get to end range and then then you get a bulging disc because your spine's not intended to take on heavy loading at end range at full flexion but brett contraris was talking about about specifically flexion moments like if contraris was talking about about specifically flexion moments like if you go from hyper extended back to neutral that's potentially just as bad as going from neutral to fully flexed under load so it's the fact that your spine is changing position under a very extreme load high tension that really is the problem not the actual position that it's in does that make sense yeah so two things good question things. Uh, the first one is, are we only talking about specific injuries to the disc? Because look, one to 2% of all low back injuries are, uh,

only one to 2% are serious conditions like neoplasm, cancers, whatever. And then I think it's something like 10 to 15% are actual mechanical causes and then the rest are undiagnosed. So it could be like ligaments, tendons, whatever. So if you're asking me about flexion specifically for disc pathology, then yeah, I totally agree with that. I mean, the easiest way to, the most common way to injure your discs or the most common way to injure a disc is with flexion. It's usually, it's called a posterolateral disc herniation. That means you're bending your spine forward. Bless you.

The disc is coming backwards, pitching on the nerves. So I don't know. Did I answer your question? It does. That's usually what people are talking about in relation to lifting weights. Yeah. And then you mentioned the change, someone going from neutral to flexionion versus someone wait what did you say someone starting in i was comparing like starting hyperextending going to neutral versus starting neutral and going to full flexion

oh like those could potentially be just as bad i don't know if that's actually 100 accurate but i know there's there's research that says just the the fact that fact that you're moving in the direction of flexion, even if you start hyperextended, you're flexing your way back to neutral, and that's also a problem. Yeah, I could agree with that. So like when people butt wink, you start hyperextended, you butt wink, maybe you just only go to neutral at the bottom, but you've still changed position. That's not as bad, in my opinion, as going from neutral to full flexion under load,

but that still can cause problems. Yeah. But it's not nearly as problematic, in my opinion, but it is a problem. Do you do a lot of, like, spine strengthening work now outside of just, like, pure deadlift? Yeah. Or, like, strengthening the spine while it's, like, dynamic movement piece like jefferson curls or anything along those lines no i've been staying away from that really yeah i i just think there's too much a ton of them yeah i feel like i've been doing it wrong i don't know it's just like

i don't trust it i don't trust it the the research is inconsistent yeah and hasn't been able to answer whether or not you can actually train yourself to be safe in a flexed position. And so I'm just playing it safe. I do them also like back squats. So sitting down at the bottom and rolling as much as possible and then coming back into a neutral spine. Yeah, I don't know. That seems too high risk for me. What I see. You need more tolerance. i don't know see that seems too high risk for me i'm what i see more tolerance i don't think people

careful i'm on her side pal you know i i think i see generally people not having a strong awareness of their body i um i'll teach group classes like civilians we're not even talking high level performance and whether they're hyper mobile and they can really extend or they're, they're limited in range. It's a flailing and lack of control. The amount of time I've spent learning in my own body, like you talked about the winking, but like learning about, you know, the connection of my pelvic floor, learning about my inner thighs and wrapping, learning about lighting up my glute because of my big toe versus just, you know, straightening my knees and bending them. So I think if we can teach people how to, you know, how to move their body in space. I mean, the amount of people that do like a back ascension

and their head goes and everything starts flailing and I'm, I mean, this, this hurts, but if I create length in their body, I have access to a better position. And then I start to move the correct way. But a lot of people don't know that. So I think that what I'd rather do, like people get to you, Steffi, after they've been, no one previously has taught them better. And, or another thing too, I call it physical literacy. A lot of times now we're not learning as kids how to move and be in those environments because PE is gone. But I mean, even my folks, they're both coaches and teachers. So we started, I mean, my brother is 6'5", 300 pounds, but he started doing gymnastics. It was like seat drop and walk the beam. And we all learned to start to get a hold of our bodies.

So people – I get them in their 20s, 30s, 40s, 50s that want to start to learn, and they don't really know where their body is. That's like a massive issue, I think. And that's why – and then even if they've gotten to me at whatever time, then they're into PT. Why can't we just start teaching them better sooner but a lot of people don't know well we spend a lot of time in our world as coaches saying like okay like let's get stronger we're gonna learn deadlifts but there isn't like this 20 year background knowledge of depth of understanding even where your hips are or squeezing your butt and pushing your hips through to get to a standing position so now all of a sudden you're taking somebody with zero training age and now throwing them into

great way crosswords yeah but that's the other thing these trainers need to be better qualified to do that it's our responsibility to to be able to know the body see the body in front of you i love you keep saying that but like and and and and be in them and teach them the right way i sit in gyms and i literally can't look at other trainers train their people yeah but what where are they at in their in their training like we all sucked we just kept getting better i know listen and like by the way there are things i've learned as i've gotten like oh my god i i wasn't doing it that way i wasn't i wasn't queuing it that way but it's critical that we learn that and we can do that and it's like and

then like i said then we're dumping into our pt world i mean how many pts are like i love crossfit yeah and i think that those i think the same thing happens in your world like so when you look at all of the coaches that exist or all of the trainers maybe 80 of them are never going to go anywhere and they don't even know what it takes to become good at being a coach it's the same thing in the pt world if there's a thousand of them 800 of them suck. But I think the best ones out there are willing to be students. That's what, Steffi, I think you separate yourself. You're like, how does it feel in my body?

What am I doing? This deadlift, this weight, this thing. But you know what happens with physical therapy? You come out of school with $200,000 in debt, okay? Most PTs have to work an 8 to 5 full days. How much energy do you think these people have to, one, train, to, two, read research papers? And the model is basically you get 30 minutes, insurance, check the boxes, and go. Like, that's a pretty standard PT clinic.

That's kind of like the churn and burn facility. You probably have a much more personal practice that you actually have a relationship. Yeah, absolutely. But yeah, so I mean, PTs don't have time for personal development. PTs don't have time to do this. You know, that's the reality. I hear that said about doctors all the time.

Like what role, in your opinion, do doctors play in low back pain at this point? Like you go get your x-ray, get an MRI, whatever it is. I feel like they should stay out of it okay yeah i think that i think that physical therapists and chiropractors are way more uh equipped to understand movement impairments and to understand injuries in general because what happens with doctors they not only have a hammer but they have a really expensive hammer so when you have a really expensive hammer. So when you have a really expensive hammer, you see everything as a really expensive nail and you want to just knock

that thing down. So you go there and the first thing that they recommend you when you have low back pain is surgery. You need to get under the knife. Totally. I feel like you're like 99% right about that. The, the only, the only thing that I, that I think in, in defense of doctors is that if you have low back pain, it's not always mechanical, as you've already pointed out. If you have a tumor in your spine, that might be causing it. It accounts for 1% of low back cases. That's why I said 99%. Yeah, okay, good. Atta girl. So it is good to check for that, but that's kind of like where the scope stops like pts and and you know real strength and conditioning professionals have to have their place if you're a good pt you

should be equipped to understand those red flags and know when to refer out when you're stepping outside of your scope of practice right so i'm saying all this because a lot of people they think they have a back pain i have to go to the doctor yeah so mostly they do have their their one percent so to speak but that's not that's not really where you need to go most of the time, in my opinion, especially if you're an athlete. Exactly. You want to talk about the red flags, if anyone's hearing this? Yes.

I'll save my question. Red flag me. Somebody flag me. Persistent pain lasting more than six months. Radiating pain. This is the biggest one, loss of bowel and bladder movement or loss of loss of bowel and bladder control that's a fever unintentional weight loss unintentional weight gain uh okay extreme fatigue so it's it's more systemic yeah i was gonna say

it's not just oh my it's right in your low back. It's all going to my leg. I feel a little bit of reticular symptoms, a little bit of tingling. No, it's a lot more systemic. That's helpful. Yeah. I had a different question. I kind of was changing subjects slightly. What were you going to say? Do you want to go, Anders?

You got it. So you made up a great point. I always like the behavioral emotional component of this. You said most PTs don't have the energy to read the paperwork and do what you're doing. The respect I have for you for taking notes to talk to us through today, you know, to be able to be prepared, it's a beautiful thing to see. So what do you, what do you say to anybody listening, whether especially PT, cause that's your field, but in other fields that are stretched, you're tired, you run your own business,

you have your own practice. How do you fit it in? How do you do it? I mean, I'm in a unique situation because i don't i don't have to see patients for 12 hours a day um if i do see someone it's it's it's very rare i don't work as a physical therapist most of the time i i uh all of my business is online so i do have a lot of time but i do think that there are other things and other resources i I mean, we, this day and age that we live in is incredible. There's an incredible amount of information out there that, uh, it's not necessarily, doesn't necessarily have to do with reading a research paper and having to dissect yourself and understand it yourself. I mean, look at, uh, the stuff that, uh, Greg Knuckles and Eric Helms

have been doing with, uh, strength and conditioning articles. They have a full, every month they come out with an edition that summarizes like eight to ten research articles, even with like videos and stuff. And for physical therapy, there's stuff like that too. Okay. Some of his articles are like full e-books. Yeah. They're amazing. Yeah, it's crazy, right? They're really good.

So, I mean, you were talking, you asked me what are you working on now. One of my projects is, it's called the strength school and i'm going to do it with someone and it's basically all the information that i've learned on my own that i find that is important for physical therapists new physical therapists or newly grads or pt students or anyone who wants to get more into strength and conditioning all the information that they need to know from a practical standpoint. Gorgeous. How long have you been practicing your PT? I graduated in May last year.

Nice. So May. Cool. And you're already creating a guidebook. You know, it's beautiful though because you were able to, you know, walk someone through these unique experiences that you've been through. And so here you are at the precipice in your first year as full PT. And you're like, God, there are all these things that were missing that i wish i had and kudos to you for actually creating that for others to come you know after you to start to

build and learn leading leaders i love that girl look at this um what's your training look like these days yeah are you still banged up are you still hurt a little bit yeah a little bit i and you know what's interesting i just i had a septoplasty in September, and I had to take six. A what? Septoplasty. Okay. That's when they repair your septum on your nose. And it had to take six weeks completely off of training.

Oh, God. Oh, yeah. You don't want any pressure up there. No. What'd you watch? Any good documentaries? Yeah. What'd you watch, honestly?

Honestly, I didn't watch anything interesting. Nothing? Really? No. Okay. How about what did you just watch? So, okay. For the first three weeks, I was in Venezuela because that's where I got my surgery, and there's no internet there.

No internet? No, so for three weeks. What do they do? Seriously. No Instagram? No Instagram. How do they tell people what they're doing? All of my posts during those three weeks were made by Hayden.

Oh, look at that. So, yeah, so for three weeks, I didn't do anything, and then I got back here and, yes, worked. So you wouldn't binge watch a Netflix show, nothing? What do you got on Netflix these days? You know what I'm going to start is that haunted Hill House thing. I'm getting nods in the room. I heard it's really good. I live with a bulldog.

There's not a lot of dialogue between us, and I'm a little nervous. There's a lot going out and a lot coming back. I mean, the ice tray in my freezer breaks, and I'm like, ah! Like, I have a little nervous. There's a lot going out and a lot coming back. The ice tray in my freezer breaks and I'm like, I have a total meltdown. I've been nervous to start it but I think that's where I think I'm going next. That's where I'm going next. Anyway, back to you. I was hoping there was something

really, I don't know, something good in there. I'm like Steffi, I don't watch a lot of TV. If I have time, I'm sleeping or I'm going to be with somebody. I just always feel so guilty't watch a lot of TV. If I have time, I'm sleeping or I'm going to be with somebody. Yeah. I just always feel so guilty about wasting a lot of time watching TV. Yeah. I feel like, yeah.

But I will put on like The Office. I'll put on an episode. I feel like that's my little treat. I watch the entire Office thing on Netflix. Oh, yeah. I would run my morning classes and then come home and eat breakfast and watch like one to two Offices for like a year straight. I put it on for Hank when I was so many of them. You don't. You for hank when i was straight you know what i discovered cheers cheers is on netflix starting from season one

oh my god sam malone you gotta check it out oh my god i was like this literally is a whole show in a bar and it totally and it plays i was it was hooked and then i started leaving it on for hank when i would like leave for dinner or something. Hank liked it. I liked it. He's the bulldog. We're going to take a quick break, but we're going to talk about your training when we get back.

Yep. Strongest girl in the world does for fun. I know you're stronger just by listening to this show. Steffi Cohen's such a gangster. And I don't know if you checked out her most recent Instagram posts, but chicken dance too. She's got the big quads. She's got the big shoulders. She's nice and strong. She deadlifts all the weight, but guess what? Chicken dance. Yo, I want to thank our friends over at perfect keto.

Um, they hook us up with some delicious, delicious things. I don't know. You better have tried out the nut butter. The nut butter is unbelievably phenomenal. Get over to perfectketo.com. Use the coupon code shrug. You're going to save 20%. That's 20% on all your keto. My mom came in here. I've told you this multiple times now. My mom showed up. She does the keto thing. I don't know why she does it. Carbs are delicious. And if you time them well, it's not the worst thing in the world to have some of them. But she loves the keto. She thinks it's super sustainable for her life, makes her life really easy. And I fully promote anybody doing the keto that loves the keto and it works for

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Get over to PerfectKo.com. Use the coupon code shrugged. You're going to save 20%. And I also want to thank our friends over at biooptimizers.com. Use the coupon code shrugged. Actually, you can use biooptimizers.com forward slash shrugged and then use the coupon code shrugged. You're going to save 20% as well. Man, when I'm on the road, the gut health is a serious issue. And bio-optimizers products really, really help. This is no joke. This is serious life. I always am carrying the HCL and I'm always carrying the mass times with me. There's just too many minefields out there of just terrifying food.

I don't even know what to do sometimes. I find myself at a Denny's trying to eat hard-boiled eggs because it's just frightening out there what's going on at restaurants that we get stuck at sometimes when we're out traveling doing shows. But MassScience is there. They help me a ton when it comes to digesting, gut health. If you've got a big gluten issue, they've got Gluten Guardian, which you should totally check out as well. And then they've got an awesome probiotic that is just top of the line. So get over to biooptimizers.com forward slash shrugged, use the coupon code shrugged, and you're going to save 20%. I'm a huge fan of their product.

I just got a new shipment a couple of weeks back. I've got like eight new mass signs, eight new ACLs, and a couple of Gluten Guardians, just in case I shipment a couple weeks back. I got like eight new mass signs, eight new ACLs, and a couple gluten guardians. Just in case I have a little cheat meal. Maybe I like to have a brownie every once in a while. Make sure you get over there, though. BioOptimizers.com forward slash shrug. Yo, we're going to get back in the show. Three, two, one, go.

I did not have one of those signs, though. So I feel like it's unfair. You can get around that, I feel. I can't use it either because I was a guest. No. And my account got those signs, though. I hate a can. I feel like it's unfair. Yeah. You can get around that, I feel. But you'd be shocked. I can't use it either because I was a guest. No. And my account got flagged, too. Oh, you guys are hotels forever.

Dang. There's BRBO. From Airbnb. BRBO. She's not even allowed at the Fit8 house. She can't even get set foot. You're not coming in. 1,000 feet.

There's a picture of you on the wall at the Airbnb headquarters that's kind of like a Most Wanted poster. It's just your face. It's you deadlifting 500. Like, don't let her in. Don't let her. She poops too much. She can't stay here.

When we went to Brazil for the first time, and you can't put anything, no toilet paper even, in there. That's pretty standard for international. Yeah, a lot. I had no idea the first time I did it. I was like, you want me to put what where in the trash? You want me to open that trash can and everyone's in there? This is absurd.

Yeah, but you know what? You go to the bathroom once in Rwanda and anything seems like a palace. Let me tell you what. Let me tell you what. And the thing is, is the anatomy in men are different than women, and so there's flies in the hole, and you're like, I can't go anymore because something might come up. Yep. It's a whole thing.

So we have it good, even if we can't use our flushables. Even if you can't Airbnb and somebody, yeah. Well, you can use VRBO. This is not a paid advertisement, but VRBO. What's VRBO? Her new favorite. But we're open to one. We're open to it. What's VRBO? What's VRBO? Her new favorite. But we're open to one. We're open to it.

What's VRBO? It's the same. It's vacation, rental, whatever. Buy owner. Buy, yeah. It's the same thing. Brad. It was before Airbnb, just not as cool marketing.

They own HomeAway as well, or vice versa. Okay, back to your list. Tell us about, yeah, get back to the list. Did you do three of them? Three out of eight? What did you do? Three in an hour. Let's remind everybody.

Three of what? Remember the eight signs of something? Do we do the whole thing? Do you even want to go back? Yeah, I mean. These tangents are unbelievable, right? You don't have to do that. It's 45 minutes at a time.

The first one, stop doing what hurts. The second one, understand that tissue adaptation takes time, and you need to expose your whatever is injured to a certain amount of stress in order for that tissue to adapt time and you need to expose your expose your whatever is injured to a certain amount of stress in order for that tissue to adapt and get better actually on that note is there is there a certain component of that that just like if you if you tear your meniscus you have surgery on it like they want you back moving right away like your meniscus is not very vascular in order to like push around some ovial fluid deliver nutrients remove waste etc like you need movement to get that that churn so to speak. It won't do it on

its own. Is that, is that also relevant for the low back? Yeah. Post-surgical protocols are, the main reason why it's important to start moving is to prevent tissue atrophy. So, so that you can preserve the most amount of muscle mass that you can. That's why even before people go under the knife, they, they go through strength training and in PT to strengthen and hypertrophy those muscles as much as possible. So that then, I mean, I guess you have the lowest amount of tissue atrophy afterwards because your muscles are what keeps everything stable. And this leads me to an interesting topic, actually. So I came across this really interesting study about,

that's commonly cited. So I did a pub med search on most commonly cited low back pain research papers and i actually remember talking about this research paper in school as well and all these papers that are like from the early 1900s and leading into like the 2000 all start with the osteoligamentous spine is inherently an unstable structure all of them start like that okay and this is the thing with research papers everything they say are everything our research paper is is your interpretation of it you can look at it however you want so a lot of people will read that and will immediately assume hey our spines are are weak our spines are unstable our spines are not resistant not resilient right

so that's the first thing uh and then the second thing they say so it says our spines are also ligaments spine are inherently in its unstable structure and will buckle with 10 kilograms of load uh okay first of all the osteoligamentous spine just comprises bones and ligaments did you forget to put your muscles on have you ever forgotten to put your muscles on? You wake up and you... They're just not there. Oh, wait a second. Let me...

You got to tuck them in. Right. I mean... Tuck them into the skin. Yeah. Muscles... Left in my bag. Damn.

Muscles are the main... This bicep never gets through security. Terrible joke. We have to take a commercial break. Should we start the second half over? Edit that out. We just let you eat that one too. We were like, that was pretty average. We're going to sit here and be quiet and let Andrew just

eat his shit right there. Will you please let me talk? Go ahead, Steffi. I'm sorry. They always make me lose my train of thought. Did you forget to put your muscles on? 10 kilos of inherently unstable muscles. So obviously our muscles are responsible for a lot of the stability and robustness of our spines. And so that needs to be something that you take into account and not something that you just ignore based on these research papers.

And so another research paper looked into what is the minimum amount of muscle activation necessary to stabilize your spine. And they concluded that it was about 1% to 2% of maximum contractile velocity of a muscle to stabilize against, I think it was 30 kilograms of load. So you only need 2% of your maximum voluntary contraction to stabilize against 30 kilos. So your spines are pretty freaking stable and then looking into the amount of of force that spines can tolerate under load there was a study on power lifters actually looking into how much newtons of force a spine could tolerate during a deadlift or during a squat i actually don't remember which movement and it was like up to 20 000 newtons how much is that how does that relate to pounds yeah okay so in order for so in the the previous study that

was talking about where they where they found one to two percent to stabilize the spine maximum voluntary action that created about 90 newtons okay so nine newtons is like the bare minimum to stabilize a spine but on your side can handle 20 000 newtons over 20 000 okay so it's pretty stable it's pretty robust it's pretty it's pretty it's pretty damn good so how can we explain then the the massive and what you are kind of representing is overreaction for how unstable our spines are in the community. Misinformation. Yeah. It's misinformation.

The big metadata study. What are those called? Meta-analysis. Meta-analysis. Study that came out on. You're killing it today. I know. It's still early.

I only had one espresso. What's that mega study thing? The mega. The big ones. The meta-analysis. Come on, Shrek. Let's go. Here we go. today i know it's still early i only had one one espresso what's that mega study the mega the big one the meta analysis come on shrek let's go here we go um that what was the um fuck wow i know really i am having what was the one that came out two years ago by uh about low back pain specifically and movement and strength um It was like the fuck. I can't remember the name of the company that just put it out. I don't know.

I'm not either. I don't know if I read it. Google it. Now I'm dying. Someone save me. I'll save you. Save me. Cool.

Doug's like, just stop talking and I will. So referencing back to the beginning of the show, we talked about stability and robustness. I mentioned MRIs and how doctors roles in all this and whatnot there's been plenty of research that's cited all the time that there's lots of people that have a bulging disc but no pain there's people that that have pain and not a bulging disc uh etc etc like how does that work how can you have a bulging disc and not have low back pain you think you would have some pain yeah so i think the stats is something like 30 over 30 of people will have

an abnormal finding in a in an mri but obviously a small a very small percentage of them have pain and that's not it's not well understood how that works um other than uh have you ever have you ever dove into pain science at all not not specifically give me there's a lot of pieces to more tangible example like there's some pain some pains are really good when you're working out so okay well no and then phantom limb pain that's uh that's not what i'm talking about so pain is pain is produced in your brain i'm not saying that pain is in your head but pain is your brain's interpretation to a threat and so it's context the pain is context dependent for some people and this is the perfect example say that you play the violin and you cut your finger that cut is going to hurt so much because it's

going to directly impair your performance and something that you care about. I get injured in my low back. I feel like it's the end of the world because I can't squat or pull. And so I, my brain and immediately interprets it as something that's, that's awful, like a catastrophe. And so I had heard a really good, uh, Ted talk, uh, by this guy, Mosley is his last name. And he was explaining pain and how it works. And the example he gives is imagine that you're walking in a bush and you get tripped by a branch. OK. Actually, this is an actual story of him.

He was walking into the bush. He tripped. He gets tripped by a branch. So what happens at the bio level the physiology physiological level is you got this thick myelinated fibers that are really fast conducting they're your pain fibers essentially that send a signal through your spinal cord into your brain and basically ask ask you okay so what is this have we been have we been in this situation before are we being threatened how should we react and then there's another part of your brain that goes yeah we've actually been in the situation

before you were six years old you're tripped by a branch you're safe you've been in the situation before you'll be okay not so bad yeah then he continues walking he goes to like take a they go take a dip in a in a lake and then he says that that's the last thing that he remembers apparently he got bitten by like a super poisonous snake but he didn't even it didn't register in his brain as something threatening or extremely painful and so he tells the story of another time that he was that he was walking on a on a on a taking a hike or something and he was in a similar situation where he actually he trips under he trips on a branch and the same thing happens uh thick fiber send the signal through your brain through your spinal cord into your brain hey have we been in this situation before you've just been tripped by a branch

or how should we react and then your brain says you've actually been in the situation before get the hell out of there last time you were here you're really hurt and so his reaction that second time was oh like he said he felt like he was in pain for like 10 minutes and then he looked at his shin and it was just like a really tiny scratch so pain is context dependent but do you think it's also like when you can see it coming like he didn't see the snake coming so how can you be afraid of it it's it's you know what i mean right he didn't see it but it was probably super super painful yeah but isn't there what about the science around your body's reaction to that when something like major happens? So I had a car wreck, my head split open,

I'm rolled off the highway, blood was everywhere, they're pulling me out of my car, and I'm like, whose blood is this? I feel more pain now in my scar tissue in my head. I felt more pain when they were putting the needle in to numb it for the staples. And I was like, are you sure? And literally my skull was exposed. Zero pain. Yeah. putting like the needle in to numb it for the staples and i was like are you sure am i literally

my my my skull was exposed zero pain yeah and i and i i think it was like and i didn't not pass out i was not unconscious so isn't it your body's adrenaline yeah that phenomenon is really common so how do we know the difference for example yeah where they have like high degree burns or injuries that they don't feel until until they're back in the ambulance or even in the war. People getting shot, like people have bullet injuries and they don't feel it. They don't realize it until they're in the safe territory. They don't even know it's there. So that is so interesting.

Because when you talk about, you call it pain science. Yeah, pain science. That's what fascinates me too is like how does your body not react? I felt more pain when they were trying to give me an IV than the head. I was like, lady, you're missing the vein. I was so – you know, like it's a funny phenomenon. I feel like there's a component of anticipation there. You're just waiting to feel the pain.

It's going to be even worse because you're like dreading it. I didn't see it coming. The snake, we didn't know it was coming right yeah i was talking to sonny webster yesterday he's a weightlifter yeah and he was telling me that that yeah he is that the first time he had to he had low back pain he was around 13 to 14 he got an mri and he had like three uh three dehydrated discs three bulges l5s1 was completely fused because he had no disc. He had, um, some damage to like a few nerves because of the loss of disc height. And he was barely, he was pretty much on crutches for like eight months, he told me. And then obviously all of

his doctors told him he would never be able to lift again, that he would never be able to be active and live a normal life. And he told me that he chose not to believe that and that yeah he was on crutches for for as long as his pain was acute but that he tried to get off them and try to to do some other exercises core and walking and back strengthening and all that stuff and i mean look at him now and he's still that diagnosis didn't change i bet you that if he gets an mri now the damage is still going to be there, but the pain isn't there. It's actually a fascinating thing you bring up. There's a documentary out now called Heal.

It's probably been out for six months. Have you watched it yet? I know you don't do a lot of TV, but consider this one. There's a guy in there that had this terrible, I think he was a heel, H-E-A-L. He is an avid cyclist, got hit by a car. They're like, you're never going to walk. You're never going to go through these things. And he literally just started to think about his spine, think about the healing, think about the standing.

And he came through it. And he attributes it to the mental components of him thinking about the spine and the brain really realigning this. I have a really good friend whose dad had a stroke. And they said, you'll never use the left arm at all ever again. And he would sit there with a tennis ball in his hand and just stare at it and think about how he could move it. And then one day he just like tossed it in the air. But that's it. I mean, it goes back to the first three minutes of our conversation about you have to go there first.

You have to look at the mind first. So then you see the importance of having well-educated healthcare practitioners to tell you their information. Yeah. That is my whole thing. There needs to be a paradigm shift when it comes to low back pain conversations. Have you looked into like Tiger Woods' thing at all? No.

No? I think he just, well, I know he just got, I mean, he was basically like crippled from low back pain from all of the years of his stuff. But he just went and got, at the beginning of last season, four of his vertebrae and his low spine fused together. And came back and had like the best season of the last ten years of his life. And had to like relearn how to swing a golf club, the whole thing.

But to go and get four vertebrae fused together and then come out of that pain-free and be at the top of your game, it's a really interesting just idea of like where pain and surgery and how that kind of all, how it can happen. I've been thinking about this a lot lately

and I've actually never asked anybody this specifically, but if you look at standard charts for how much range of motion you're quote-unquote supposed to have, you think about spinal rotation, and the numbers I usually see is like 60 degrees rotation in each direction. It's kind of like a good starting point. You can certainly go beyond that.

But for someone who's a golfer, if you have a very short torso versus a very long torso, as a golfer where you need as much rotation as you can get to move properly and to hit the ball really, really hard, if you have a really short torso, do you think you're more likely to get low back pain? Just in the same way that if something's long and thin, like this cord, it's easy to twist it, so it's easy to get a lot of range of motion on something that's long and thin, so a long torso just is, by the structure of it, is able to, has more potential to twist versus something that's shorter.

It's just harder to get as much rotation out of it. Length creates variable, right? So more opportunity for variables. Yeah. No, I mean, but both torsos will have the same amount of vertebra and the same amount of capacity, essentially. I think they'll have relatively the same amount of of capacity essentially i think they'll have relatively the same amount of movement i don't know do you do much rotational stuff good question i do a lot

of anti-rotational stuff and anti-extension stuff so i think that so one thing that i have learned through training at a high level is that the closer you get to reaching your full potential athletically the more specific you have to be and the better your time needs to be allocated towards the things that you actually need. And so you got to understand the demands of your sports. Sports, that's the first thing. So for me, it's being really stiff under a bar. And Stu actually said,

be really careful what you wish for. And it's true. I want a really stiff spine. Probably that's not the best in terms of longevity but for right now if I want to move the most amount of weight I need to have the stiffest spine that I can possibly have and so nowadays my training mostly consists of squat squat squat bench and deadlift I know what that is squat exactly what you're saying I'm like squat bench. Got it. Immediately. I love it. It's a new thing now. So my training mainly consists nowadays of squat bench and deadlift and back,

anti-rotation, anti-flexion, all in positions that I'm going to be tested in that directly reflect the demands of my sport. Yep. So I think, but like I said, that is as you approach your your your full athletic potential but for someone that's initially getting into strength training into powerlifting into olympic weightlifting or any other sport movement movement variability is huge are for your pt stuff and in helping or in treating people are most of them uh powerlifters that are coming to you yeah so you're and what you're kind of observing movement and pain is a very different thing than the general population as well because it's i always think that anybody that's doing crossfit and this is actually something you talked about

when you were on your show of like when you're on the biggest loser and they call home they're like i did crossfit on saturday and like everyone we talk to does crossfit yeah everyone's capable of doing that but the the lens like that's your if you're doing crossfit like four days a week in your box and you're just generally snatching and cleaning a jerk i just kind of assume you're in like the top three percent of humans yeah like do these basic principles apply to like the gen pop person that isn't coming in that can squat 400 pounds and, like, do Fran? The goals, obviously, the goals are going to be different. If there's someone walking into my practice that is just a 40-year-old mom that wants to be able to pick their kids up and that's it. Like, they're not planning on squatting a house or maybe never even putting a barbell on their back.

Then, I guess, yeah, the priorities shift. planning on squatting a house or maybe never even putting a barbell on their back, then I guess, yeah, the priorities shift. But the principles remain the same. You want to create the most resiliency in your spine. You want to create the most strength and the most endurance. We can talk about common myths about the back. That's one thing that I wanted to talk about. Oh, get into it. Do it. Definitely.

Yeah, so back flexibility. You were briefly starting to talk about it. I thought we were going to talk about. Oh, get into it. Do it. Definitely. Yeah, so back flexibility. You were briefly starting to talk about it. I thought we were going to go there. Moving into flexion. But, yeah, so... Or extension, sorry. From extension into neutral, all that. Yeah. So how much flexibility do you need?

Do you need... A lot of people spend, I don't know how long, Ramwan is, like 45 minutes? I don't know, 15, 20, 15? I could talk about yin yoga with you it's long yeah so do you need to spend that time doing mobility exercises and if you are doing mobility exercises then how much time do you spend doing stability exercises because mobility without precise control is useless so but what if it's not mobility that people are going to that for

i don't think the they're going for the down regulation and the breathing i think that's a massive piece of the the yin yoga side of it they just sell it breathing don't don't you don't need to be doing more sometimes you don't need to be doing more mobility i totally agree especially if you're a weightlifter across you're a power lifter and you need stiffness in your spine yeah you don't need more mobility in your spine you need mobility in your hips the reason i'm playing devil's advocate is that because I think that so many people in our world, high intensity, like lift everything,

do all of the things. They are so stressed out that they go to Ram Wah thinking they're going for mobility. And then they will be like, oh, so amazing. Like you could have just gone to a yoga class, bro. Like you don't need Romwa. It's not, like, the down regulation piece is so massive. So here's the problem I have.

Here's the problem I have with that. You, at the higher level, when you have a very precise goal, then whatever you do to try to accomplish that needs to be very precise. And so for me, sitting on the floor to stretch for 25, 30 minutes without any sort of goal or without any sort of just precise thing that you're working on seems like a huge waste of time. If you want to relax, go to mind space, close your eyes and meditate for 30 minutes. But don't just do mindless stretching, thinking that that's what you need when you're not correcting anything that's relevant to your specific impairment. I agree.

Yeah. I mean, we have to talk about who we're talking to right now, the demo, are we talking about someone that has something specific in mind? Are we just civilians that want to feel healthy and be a part of our life? Cause that's a different thing. I do see people getting, I think length means access, right? Mobility means access to more muscle and more, more of your body. And I think that's anybody wants to means access to more muscle and more more of your body and I think that's anybody wants to change the shape of their body or kind of feel more open truly that's helpful but it's all within this can you do it within stability so that's why I always talk about like variation of length so if I'm sitting next to you right now and I toss a ball

to you you're going to catch it and you're going to toss it to me. We're going to take a step backwards and I'm going to throw it. The more space there is between us, the more possibility for variation and us tossing the ball. So if you're at the front of the parking lot, I'm in here, I might drop the ball. Same thing with length and your muscle access to mobility. Even if you're a high professional athlete or not, if you have too much length without the control and understanding the end

range of motion, you're setting yourself up for issue with the ramwan thing that just go way off base because they're sitting there stretching and all they have no idea why listen i think any movement is good movement but i think that we have to specifically be responsible for that range because i mean i even see people people that are snatching across it i mean it took me years to get my snatch in a good spot and that's and i started when i was 18 in college and you see people doing it and they're dumping their and so they stretch they open their chest they've got a space so they can be in the wrong position because their hips and ankles aren't open so they're here and i'm like oh man they

they open up the wrong space and destabilize so that is a movement compensation right yes exactly if you were to fix that you were you gotta fix the relevant movement impairment exactly and that that's the whole thing with like with like uh exercise or corrective exercises it's not about corrective exercises about what needs to be done what do you need exactly to get to the position that you're in which is your problem like there's no specificity exactly so i guess my whole point is specific to low back people thinking that stretching is what's gonna what's gonna get them better and more length doesn't first of all if you are feeling tight that's not always uh it's not always when you feel tight it's not always that

your tissues are actually tight but it's the perceived length that your brain thinks that you have and so the the amount of flexibility that your muscles have is determined by your central nervous system. It's not a matter of tissue length, actually. So whether your tissues are stiff or, or whether they're lengthened is all controlled neurologically. And so what happens a lot of times is that people feel really stiff, stiff in their lower backs, and they start doing all this stretching, and initially does feel good because you do have these muscle spindles and mechanoreceptors there that might lead you to perceive it as something that's being helpful, when in reality, first of all, you're not changing the length of the tissue, and second of all, you might making the problem a lot

worse. So when it comes to flexibility and mobility of the low back and low back pathology, a more important thing to look at is the flexibility and mobility of your hips and of your shoulders. If there's something that's common across all Olympic weightlifters at the Olympic level, if you watch them, what do they have? Ridiculously stiff spines and very mobile hips and shoulders so you're little femurs yeah man yeah great squatters how much do you focus on movement asymmetry when you get people that have any type of dysfunction and or pain like if they come to you and they have low back pain do you look and see like is your left hip that much

more within your right hip and internal external rotation etc you do a side with like a one side and compare the time that they could do that successfully with the time they can do successfully on the other side etc so if they come to me and they start the the eval with let me show you this video of me so you can see this uh the shift that i have and they played in slow motion and i have to take my glasses and like try to like look at whatever they're talking about then that's not something I want to worry about if it's something that I can see with a naked eye put a barbell in their hands or just tell them hey what how about you do uh let's do a single leg squat let's do a single leg jump let's do a double

leg squat and I see it and it's very clear and evident to me that there is a discrepancy from side to side and that is something I might address but not if it's something minute i don't think we're not robots we're not perfectly symmetrical there is going to be like a little bit of deviation from normal whenever you do any sort of movement and so if it's not clear if it's not clear to the naked eye then it's not something that i'm going to worry about too much do you study the postural restoration institute material at all a little bit they talk about that a lot like a lot of people say like you got to be symmetrical and all that but they're they're on the other side of that as far as i can tell like they're like your body's not symmetrical like you got liver on one

side and there's not a liver on the other side like you're just not symmetrical you don't even have the same amount of organs in one side of the other so how do you expect to move perfectly symmetrically what is the experience like coming from a an elite training background and then going back into the academic world and kind of being for lack of better word just like the freaking class that can do all the things you can do and bend around movement and develop this like eye for seeing all of these things and then going into an academic setting and hearing what they talk about. You really, so you really do see the missing link

between evidence and practice. Yeah. That's why when I was in grad school, I started this Facebook group called PT Link. Such a hustler. Bridging the gap between evidence. Such a hustler. I'm impressed.

Bridging the gap between evidence and practice was the slogan and all we would do was we would it was a group of maybe 15 students that were also into strength training or were previously d1 athletes we would post research papers there and then discuss it and that's one thing that we did notice like there is a very clear discrepancy between what's being said in these research papers and what's actually what's actually happening on the field or on the platform um and so being able to actually live it myself and try to put some of these concepts into into practice has been extremely eye-opening because it's not always the way that it's not it doesn't work out the way that it's written yeah were you i can just see you

like being in class trying to be in a group project with people and you're like no no no no no this is how we load this is how we set up to pick things up i had a i had a spine professor super old school he's been teaching for like 30 years and he would roll his eyes at me anytime i would walk into a room and i'm like sweating like he knows what i was doing i was probably doing some snatches or because i used to go do one of them one of my midday sessions between in lunch so i would come back to class all sweaty and obviously they'd all know what i was doing and he'd always be like god like you're gonna break your back you shouldn't dead lifting is the worst movement that you could possibly do and i'd be like no no every time i get that argument like yeah when i was in high school and like my parents would be worried about her like you know someone that's

older that's like similar situation they're just like they just don't get it and they say you know you're doing deadlifts 400 pounds or whatever it is like you're gonna hurt yourself i'm like well kind of do you do you think bending over is bad for you just like as a category we're like no weight like if you bend over right now do you think you're gonna break your back why don't you think you're gonna break your back when you bend over with no weight because your back is strong enough to handle that loading well my back is strong enough to handle this loading done correctly it's fine it's just a function of how much you can your body can tolerate doing correctly absolutely oh it's one of the's just a function of how much your body can tolerate doing correctly.

Oh, it's one of the first exercises I would do on Biggest Loser. Deadlift, day one. We wouldn't load it 400 pounds, but it's a great way to get that ground, you know, relationship with the ground, feel their glutes, safely kind of load. You know what's interesting? And they loved it.

You know what's interesting? You know what the injury rate of powerlifting is compared to other sports? I bet it's the lowest. 0.3 out of 1,000 hours compared to, for example, football is 11 or 12. Soccer is like 7 or 8. Yeah, all the strength sports are like that. Weightlifting, bodybuilding, they're really low. Bodybuilding is even lower.

Well, they're the most misunderstood. Like, you take a snatch and a clean and jerk, and nobody understands what's going on. It's hard to tell a parent that, by the way. They'll, like, let their kids do soccer, which is, like, the injury rate's way higher than soccer than it is in weightlifting. I think weightlifting is, like, really dangerous.

My mom was never scared when I used to play soccer. Oh, so you played pro soccer, right? Yeah, I played soccer. Yeah, but that's monostructural versus polystructural, which is, like, fancy. For monostructural, like, running in a straight line or a deadlift, you know exactly the movement pattern. Polystructural is unpredictable.

So side to side could be like that's – There's contact. Contact. Oh, yeah. Someone can hit you right with their feet or whatever, with their knees. So technically polystructural sports are the ones that are going to create more variable, therefore more possibility for injury, which is obviously evident in the research or the facts, percentages. I of people that do mma and jiu-jitsu and all that

and i always tell them like if you're going to do strength conditioning which i think you generally should yeah you should always do it if you're gonna do it on the same day you do it after practice you do all the reactive stuff first and then you go to the controlled environment of lifting weights where you know exactly where you are. You can go whatever speed you want to. You can stop whenever you need to if something's hurting. But many times when I hurt my shoulder fighting MMA years ago, it's when I did a – I competed in weightlifting and MMA at the same time. I would go to weightlifting practice and then go to jiu-jitsu and then go to kickboxing and then do MMA afterward, just training hours a day. Yikes.

But almost always when I hurt my shoulder is when I did like a lot of upper body volume I would show up to practice a little bit fatigued and then and then something would would happen how come you've spent so much time on the low back versus like shoulders which I feel like shoulders are even more of a problem in the weightlifting community yeah um well mainly because of my own personal experience like what sparked most of my interest has been has been my own injury my own injury um but another thing is when i when i was done with physical therapy school i like i was telling doug i felt like i was a lot smarter but i didn't feel like i was a specialist in anything and so since i graduated i've just been kind of like dabbling between topics trying to find something that interests me to become a specialist,

maybe potentially doing a PhD and just specializing in that, being really, really good, knowing something really, really well, rather than knowing one or two things about one or two things. Yeah. Interesting. Tell us about your training. I want to hear about this thing now. What's the big goals?

So, okay. This year, if I'm healthy enough. It's like asking a brain scientist, like, tell me about the brain. Where do I start? Yeah. Well, I actually started telling this story, but I got interrupted, as usual.

Oh, that was a jab. Boom. She was talking to her handers. It's tough to tell if it's me or you interrupting her. Yeah, good. That's on record. So I had that septoplasty I was telling you about. I had to take six weeks off.

And coming out of that was the worst my low back pain has ever been. From nothing. From sitting down. Can you believe that? And why might that be? I don't know. I don't know. I don't know why.

But ever since so that was september to october and then i started getting back into training my back's been killing me and so most of my training has been directed towards restoring normal movement and getting rid of pain and stiffening up my my core so nowadays i'm i'm squatting once a week i'm pulling once every two weeks. I'm benching three times per week. My upper body is fine. But in contrast to what I usually would do, I would usually squat four times a week.

I would pull two or three times per week. I would bench three times per week. So my volume is like one-third of what it usually is. But that's what I need right now because I need to get myself to being able to tolerate a full week of training without being crippled. Real quick. We hadn't said all this yet for people that don't know you, never seen you before. Like, you know, uh, what weight class are you in? Like, what do you weigh? And like, what are your numbers right now?

Okay. Uh, so I'm a professional power lifter. My best numbers, I'll just say in competition. My best numbers in competition are a 430 back squat in sleeves and a 440 back squat in wraps, a 230-pound bench, and a 520 deadlift. And in training is a 545 deadlift. As a 114? As a 123. 123?

Yeah. That's a lot. And I don't weigh that much more. I usually weigh around 125, 128. Oh, so your walking weight is right around there? My walking weight, yep. And then is that still currently a world record for the deadlift? Yeah, squat, deadlift in total. Okay, all of them.

That elusive bench press. That girl? Killing it. Look at that bench. You're benching three times a week. You got to get them all. Yeah. Seriously.

Do you notice a lot of the back pain when you're doing the bench? No, I don't get back pain with bench. But now that I am, now that my back is a little bit iffy, I try to bench with less arch just to try to minimize the stress in my lower back. In college, we used to do two-by-four bench. So my track coach, Doug Reynoldsnolds still one of my best buddies and uh still coaching it was for shot putters but he made us all do it as a hammer thrower so you're on the bench press he takes a two by four like piece of wood and i place it down the center of your chest here and you yeah a board

press oh you call board okay and so it was more for that reactive like for a shot putter to feel that spring but it was really oh do you do it oh you do have pads oh yeah he just went and like rogue went and made it it was it was it used to be two by fours and then rogue made it my cleavage i was like we had we had towels on. I was like, oh, my God. But, yeah, that's so fun. Wait, so, okay, before we deviate too much then, we were talking about common myths. Common myths. So the first one, what did I say the first one was?

Flexibility. Flexibility. How much you need. Yeah, versus how much does your sport actually demand. Right. I mean, that's the problem with also, like, FMS screens. Have you ever taken that course? Yeah. Yeah. Great cook. I don't know. It's similar. I mean, that's the problem with also like FMS screens. Have you ever taken that course?

Yeah. Great cook. I don't know. It's similar. Like how much ankle dorsiflexion do you actually need for a back squat versus what makes you fail that test? I don't think it's the same. Well, the FMS screen is a catch-all exam. It does a lot of good, but you can go beyond it.

But you have to have a certain amount of knowledge about what you're doing to be able to apply that to the right scenario right the more knowledge you have the less you need this set assessment most of the people that i think are doing the fms either like have to report to somebody with a score and then come back three months later and be like now we're 14 yeah like the majority of the coaches i see at those seminars and watching gray speak are like just getting into the strength and conditioning world and they're going to perform better or whatever it is and it's like I need to have a movement screen because a movement screen will allow me to get a personal training client because I can show them there's a problem and then I'll show them that I made them better they're going to quantify it yeah a lot of times they're working with like 500 marines and they just need to like just get them

through this thing yeah just, just boxing people. But they, yeah, after a while, you can do your own movement screen. Like let's just do a split squat. Anytime you're watching somebody lift, you are assessing them the whole time. Absolutely. I love that. Yeah. Next up.

All right. What's next, too? Strength. So back strength. So, for example, when you see people rounding their backs in a deadlift, the common misconception is that people think that they're weak in their lower back. But a concept that actually Shirley Sharman came up with, she's a very prominent physical therapy figure,

is that your body will take the path of least resistance always. Yeah, sure. Right? And so, actually, actually no before i get into that so you're using your low back more than say your glutes that means that your your muscles in your lower back are actually stronger than your hip extensors so you're relying on them more to complete that deadlift for hip extension than you are on your glutes and your hamstrings. And so it's not necessarily a strength issue of your lower back.

It might be a discrepancy in a ratio between low back strength and glute strength, what you're dealing with. So that's the first thing. And the second thing about strength is that there's a ton of studies being done on construction workers and what they were trying to do they were trying to compare the strength versus the endurance in their lower back so basically they put them prone kind of like on a ghd and they asked them to do like max back extensions in 30 seconds or i can't remember if it was a max uh hold and then versus strength and they determined that

the constructions the construction workers that had the most amount of back endurance were the ones with the least amount of low back injuries. And that makes a lot of sense if you think about it because your lower back muscles are postural muscles. That means that they have to be turned on all the time. They're not muscle. They're not type two glycolytic muscle fibers

that are mainly in charge of producing force for a one rep max. Like say your, for example, your calves are type two muscle fibers that are that are mainly in charge of producing force for a one rep max like say your for example your calves are type two muscle fibers that are in charge of of propelling you in a sprint right your low back muscles your gastroc specifically it's always not so much yeah your gastrics mainly uh and so these muscles are postural they need and they need to be trained like so they need to be conditioned to be able to stay turned on for a long period of time. And when you think about it, they're not only exposed when you have a bar on your back or when you're doing a deadlift. They're working all the time.

So what is their actual capacity and how much is it going to take to exceed that? If you're using them all the time and then you're, you're coming here and you're dead lifting. It's not just the 30 minutes that you deadlifted is the 16 hours that you're spent on your, on your feet or spent sitting up and using your postural muscles. So how can you create more low back endurance so that when you actually get here into the gym, they're conditioned. It's kind of like what Doug said,

like he was lifting first, then doing MMA. It's like when the muscles were fatigued is when you have the injury and the pain. So very similarly, if you don't have the stamina in your back muscles or your low back to perform, not just in your life, but in the gym is where you start to have the issue. And it's not just overall strength. Yeah. Miguel talks about that as well. It's actually, Miguel talks about doing, I've mentioned the side plank,

like testing side to side and seeing what the discrepancy is there. But he also does the holds and references muscular endurance as the key factor for warding off pain. Or the potential for pain. But maybe he got that from Sarman. Yeah. Have you read all four texts on diagnosis, treatment of movement impairment syndromes? Sarman's? Yeah, Sarman's.

No, I didn't read it all. Dude, they're both fantastic. I have it. That was the book Boyle was talking about, right? They are super thick, though. So dense. I'd need the whole year to get through that text. It's like a Tolkien book.

Yeah. Anybody? Lord of the Rings? Yeah, Boyle references him all the time. Yeah, Boyle said that the movement impairment one changed the way he viewed strength and conditioning. Interesting. I remembered the name of that study. The meta changed the way he viewed strength conditioning. Interesting. I remembered the name of that study. The meta-analysis popped in my brain.

No way. It's from Vox. Vox. You should check it out. Hey, taking notes. That just popped into my brain, and I wanted to get it out there. No, no, no. I'm so happy for you.

You feel good when that happens, right? What was funny is you were leaning a little bit more funny, and he had gotten a little quiet because he didn't want to forget the name of it. So he just kept saying Vox, Vox, Vox, Vox, Vox. Not paying attention. The eyes popped up, and he was like, I feel so good. Can I tell you that you were having a hard time? Write it down. Write it down.

I did. Nice. Because when that happens, then it's almost like you're switching all of your brain energy and trying to remember that name, and everything that's happening around you is kind of like secondary i was like i know exactly what that feels like over there just really saving why do you think i have notes it's exactly it's exactly so that because it'll fall out yeah totally no i i write things on my hand into my phone so i keep it so i can actually be available otherwise it's gonna go yeah well what's the next myth okay so i have two more the next one is uh over emphasis on transverse abdominus exercises oh my gosh and i seriously i hit my head against the

wall because i used to do that so much during my clinical rotations i'm embarrassed like oh let's work on your transverse abdominus i would put them on their back supine uh with their knees bent and i would i would poke on the sides of their belly and I would teach them how to activate their transverse abdominus. And I would do that for at least five minutes. And remember every single thing you do as a physical therapist has to be built for, there's a code has to be built for your weight and you're spending someone's time that could be allocated towards something that's more beneficial for them. And that's why I think that our review of the literature is so important and understanding exactly what you're doing and why you are doing it. And so the focus on the TA came mainly from

research papers that looked at the activation of the transverse abdominus in low back pain patients. And basically what they found was that the transverse abdomin in low back pain patients. And basically what they found was that the transverse abdominis operates in a feed forward mechanism. And so that means that it's activated subconsciously, uh, even before a movement occurs. So they looked at it with arm movement and they saw that even just with the thought of you moving your arm, your transverse abdominis turns on to stabilize your spine. And what they found was that these feet forward mechanism was impaired or delayed in people with low back pain. But you know by how much?

You're going to tell us. 0.1 milliseconds. No. What? Why is that even important? You really do think that a 0.1 millisecond discrepancy is going to make the difference between having low back pain and not so why the hell am i spending five six seven minutes teaching someone how to contract their transverse abdominis yeah you know i never

think about it yeah right but i bet you know i needed to a hundred thousand thousandth of a second yes that's the difference well it kind of speaks to your body's own ability to know what it's doing. Your body is smarter than you. Your body knows. I don't have to teach you how to activate your TA. And it's not more beneficial than not teaching you how to use your TA. In fact, endurance and strength training might be way more beneficial. Actually, let's do a deadlift.

You know? Yeah. Let me teach you how to hinge. Do you spend a lot of time teaching people just how to brace? A decent amount of time, yeah. Yeah. Especially teaching someone, a powerlifter, a weightlifter, teaching how to brace with a belt on.

Yeah. Because the breathing thing has really taken off in this space as well. Do you spend a lot of time kind of focusing on making sure people are getting into their diaphragm? Yeah. That would be something for the first few sessions, absolutely, that I would cover. Teaching someone how to brace and how to use their diaphragm, crocodile breaths, and understanding how your diaphragm works and how when you take a deep breath,

you shouldn't be having it come from your chest. You should actually be engaging your diaphragm, your lower, your abdomen essentially. Because the diaphragm is part of your core muscles. When you think about the core, you don't think about the diaphragm. But the core is pretty much like a, it's like a can. The top of it is a diaphragm. The bottom of it is your pelvic floor. The sides are your obliques and your multifidus on the back.

And so just understanding what comprises your core can be a powerful tool. Absolutely. That's the most effective thing I've ever seen a monster energy can use for. I completely got it all. Tell me about the core. Well, you got any monster around? I feel like referencing your transverse abdominus and bracing, if you're doing diaphragmatic breathing, you're getting big belly breaths,

you're putting your transverse abdominus and bracing. If you're doing diaphragmatic breathing, you're getting big belly breaths. You're putting your transverse abdominus in an optimum length tension relationship to get the strongest contraction possible against that full breath. Absolutely. Yeah, but it's kind of fascinating. From my end of the world, you know, since we're kids, we get that suck it in syndrome. Like, oh, how cute aren't you? And so I'm constantly pulled in because this is more appeasing. And you're on the tvs yeah oh the oh you don't want you don't want your big strong upper abs so hard

for my like belly like my like hanging belly to get air in and it's like i think high level athletes like you get it you don't give a shit you're like yo i think about this all the time when i see like men and women when the guys on tv when I see, like... Men and women, we're all here. When the guys on TV, when you see them, and they're, like, super leaned out, and they're, like, abs, and I'm like, oh, what do you squat, like 135? You just can't do it. Like, if you're a big, strong human being,

you have, like, a thick upper gut that is, like... But, like, let's say we're not a professional athlete, and whether you have abs or not, we're all pulling it in, and I feel like the more we can allow for the natural function of breath. I mean, like I always, any kind of fit pros, and you'll appreciate this as a PT, to like, like my friend saw like his niece or something. He's like, oh, gorgeous belly breath.

Gorgeous belly breath, you know? And it's funny because like, I mean, dogs, cats, animals, and babies are the only, like, they understand. Babies get it. I like how you called it crocodile breath. I've never heard of it. I've never heard of it. But it was just like, ugh. And we all pull it in. And it's funny how aesthetics get in the way of actual performance.

And it's almost a subconscious reaction to do it. You know what I mean? Like, even people, you stand up tall and you get in weird positions. You're like, why am I standing like that? Yeah. What is it for? It's like bikini competitors when they're on stage and they have this like, and you're like, that's so unnatural looking.

But the picture looks good. Well, I don't mind that they're on stage and they hold in. I don't mind that. I just want when they're like talking, I want them to chill. You did the hand thing where they have to have the. I have done one comp. I never understood why they have the weak wrist thing. I got really chubby after college, and I did one figure show.

I'd never get it. My tan was terrible, but I won my division, and I was like, okay, I'll never do that again. It was brutal. Yeah, that abdominal hollowing has actually been proven to not be very good for core, trunk activation. Oh, right. No, and by the way, you're shrinking. The complete opposite. Right. Oh, yeah by the way, you're shrinking. Yeah. Right.

Oh yeah. So anyway, fourth myth. Sorry. Let's get it. I actually forgot where I was going, but. We had the third one.

Um, we did. Oh, okay. Okay. Yeah. Yeah. So focusing a lot on motor control exercises.

So similar to the TA, but say, I don't know for the multifidus or I don't know, other motor control exercise with like weird bands or like balls that PT, fancy things that PTs might do. There's a study that they did comparing motor control exercises versus resistance training exercises, like just basic progressive overload and tissue exposure to strength. And they pretty much found no difference in the low back symptoms between those two groups. But that was not the most interesting part of that study.

The most interesting part was that following that study, they gave the participants a self-report questionnaire about what their perceived level of stability was in their lower backs. And so the people who scored higher, so the people who perceived the spine, their spines to be the most unstable were the ones who benefited the most from core stability, motor control exercises. Perception. Perception. God. So then, so then as a PT, when someone walks into your clinic and tells you, I think my core is unstable, what are you going to do? Are you going to tell them, I understand how you feel and that your core is unstable, and are you going to disregard that? Are you going to say, no, actually, that's a myth that doesn't exist, so let's do a deadlift? I don't think that's an appropriate plan of care either. I think you should validate and empathize with them and and tell them okay hey i i i agree

maybe you do have a core stability issue we're gonna spend two minutes doing core stability exercises and then you quickly shift the narrative and start doing something else but i do think it's important to like validate and give the person language thing is so wild because the way that you talk to people and that you're like yeah you're right it's just yeah we're we're therapists as like literally like mental therapists as much as we are body people i used to yeah i used to love that when someone would come in and be like i need help with this you go okay and in the back of your brain you're like i'm gonna take you on a journey that's in the complete opposite direction of what you think is going to happen but since you said you need this and i said okay you think you think I'm going to serve you this.

It's so hard, but you really do have to shut your mouth. More than once happened where I'm sitting on the exam room and I have someone on my treatment table and they tell me what they need. And I'm just looking around at my degree hanging on the wall and I'm like. It's funny. Who has a degree? you know, at my degree hanging on the wall. And I'm like, it's funny. Uh, one of my mentors, David Jackie goes, sometimes you got to give people what they think they want in order to provide them with what they really need. And it's one of those things that becomes, I call emotional safety. It's like, okay, I hear you. I'm listening. You said empathize. It's the perfect word for that. And then you build their trust and then you can take them where they need to go, even though you're

providing what they think they want. So it's delicate. And I think that's the difference because you have to care enough to do that. It has to come from you. It's the kind of heart you have. Exactly. Wonderful. And if you don't, they're just not going to come back. They're going to leave.

Yeah. You have to be empathetic. But then another thing that I learned through my eight months of rotations was the difference between being empathetic and being compassionate. That was a really, really important takeaway takeaway especially when i worked at the hospital because compassion when you're being compassionate is almost as if you put yourself in the other person's shoe and when you're a health care provider and you're working at a hospital and someone's dying in front of you you can't be compassionate that's going to wreck you and so for the first few weeks i was totally wrecked emotionally totally drained drained because I kept being compassionate.

I kept putting myself on their shoes and almost feeling their pain, what they were going through and their emotions and their families. And I spoke to actually a doctor who trains at this gym. He's a pathologist, really, really smart guy. And I told him about it and he was the one that taught me. He's like, okay, you can't. I understand that you want to be compassionate, but can't you have to be empathetic you you you validate what they're saying you repeat it to them you understand what they're going through but your job is to help them get out of that bed you have to focus on what you need to do and what they need

to do and take the emotions completely out of it that was a really really cool takeaway yeah when you start wearing everyone else's energy that's a that tough one. No, you can't do it. It's more than energy. It's outcome. You feel personally responsible for helping them maybe redirect with the path they're on. It's really not up to any one person. It's the body. It's their response. It's the amount of variables that are not in our hands that we still take responsibility for. I think it's tough. Earlier when we were talking about your training you're talking about you know when you were feeling good you were you were squatting under dead lifting you know four four times a

week you're pressing three times a week that type of thing how much how much assistance work are you doing like single joint stuff just like bicep curls and hamstring curls and things like that uh bicep curls hamstring curls not that much was going to say, can you just see Stephanie coming to it, biceps? Yeah, with like 60s. I used to. I used to. My first and second year of powerlifting, I used to do a lot of that. And it goes back to what I was saying about movement variability during the initial stages of someone's program.

I think it is important and useful for sure. But I've gotten a lot more specific with the kind of stuff that i do and um mainly not not because i don't have the time because i have more than enough time to train but because every single thing that you add into your program is another stressor that you have to recover from so being smart in in terms of how much energy do you have available and not energy like how much energy do you think you have, but actually at the physiological level. What can your body do?

What can your body do? And how much stress can you recover from? And that has changed. I'm old now. I'm over 25. Okay. Fall apart. Seriously.

Wait until you're 36. You're going to do one thruster and you're out. After I pass 25, I swear my ability to recover has decreased. But, I mean, I can't train. You're just starting. I can't train, but I can't train the same way I was training when I was 20. Yeah. But here's the cool thing.

Right, but you have to adapt to that. Yeah, totally. That's one thing I've been doing. I've been learning that I can't. You know how much I was training? 26. You're not empathizing. Empathy.

Compassion. I'm more compassionate right now. When I was 20, I was squatting nine times per week. Yeah, but here's the cool thing. As you age, actually your skill level and your ability, the neural pathways of the movement pattern, I mean, everything gets better, so you actually can train less, and you're going to get the same, if not better results. No. And yeah, especially as you, I got a right answer. Yeah. Yes. Should we wrap?

That's another good time. Good moment for me. Um, yeah. And, and also understanding that I've also come to understand that more isn't always better. And I keep referencing like the physiology of strength, even just at the bone level. It takes about three to four days for your bone to remodel after you have a heavy squat or a deadlift session. And so it's okay to actually give yourself two, three, four days from squat session to squat session. You actually need that time in order to create the positive adaptations

at the level of your bone so that you can withstand the following sessions. When you get into transforming your bones, you're in it. You're deep. Yeah. I just think, though, how then – so if you do squatting every third or fourth day, if you do squatting every third or fourth day, but then you got a dead, which you're using a similar, obviously the same part of your body. Squat's actually kind of full body, but then you're benching. So how do you, how do you manage that programming, even with understanding your bones need to remodel?

You know what, or are you just kind of in a slight wear down process yeah well yeah it's going to take a certain amount of breakdown in order for you to to build yourself back up because but with your schedule i mean if you're doing three days a week what you're doing now is less than what you were doing when you're 20 but you're still not giving yourself just the three day no and and that's an it's almost an arbitrary number. It's going to change from individual to individual. So it's a minimum effective dose. What is the minimum amount of work that you need to do to get the maximum amount of results? And not the other way around.

More is not always better. So Tinder. Tinder. And we're back. Minimum amount of work, maximum results. Am I wrong? I'm not on Tinder. You'reum amount of work, maximum results. Am I wrong? I'm not on Tinder. You're so accurate, actually.

All right. Had to just bring it back for everybody listening. You know, this applies to all areas of life. No, that's fascinating, though. That's good. High volume. Swipe. That's a hard pill to swallow for a lot of people, though.

Especially in CrossFit. People always think you need to be doing more and more and more and more. Maybe more is not the answer. And I see in those guys, like the super racers, like the Spartan and the Tough Mudders, more, more, more, more, more. I'm like, I don't know. I don't know. I think you guys just need to take a nap. They definitely need to take a nap.

The CrossFit community needs to take a nap and hang out a little bit. They crush themselves. High intensity. Go, go, go go go every day you don't need conditioning every single day no absolutely not imagine that cool before we shut it down i want you to tell us about your gym like why did you build the gym like this so actually you were one of my mentors when I was planning on opening this gym I reached out to Doug and I think it was within our first or second year of having our online business so I'm the co-owner of hybrid performance method which is basically a virtual gym that specializes on distributing online workout programs specific to strength athletes or anyone who wants to get stronger essentially so we have 12 different programs we create our own software that distributes them week by week and so i reached out to doug

to ask him if he thought that it would be a good idea to have an actual physical location and my main concern was how much money the the gym was going to make and whether or not it was going to make any money and your answer was to look at it as a storage unit, something that you have to serve a specific purpose, but that might not yield a certain amount of money, but it's serving its purpose. And so I took his advice and I opened this gym as kind of like a showroom for what hybrid actually is,

which is basically a combination of olympic weightlifting and powerlifting and functional training bodybuilding uh and that's a place for people to come and hang out and do podcasts and seminars and meet me and and train my facility is 24 7 so that's a really cool feature that we have um i especially being a student, I, one of the, one of the most important things for me was schedule and availability. I felt like I was being deprived of gains at every other gym I went to because deprived of gains, they were depriving me. I'm telling you, because they would always close at 9 PM. And so, you know, sometimes I couldn't make it to the gym until 8 because I had to stay in the library and study.

And sometimes I couldn't make it until 11, hence why during grad school I actually took all this stuff from my living room, my couch and my TV, and I put a squat rack in a platform. God, you're my hero. Step aside, Arnold. That would be the only place I could train in those crazy hours. I bet your neighbors loved you. What is that screaming over there?

No, I never dropped the bar. Maybe a few times. Maybe once. But my neighbors downstairs were grad school students too, so they kind of understood me. They understood the struggle. They're downstairs like, you go tell her to be quiet. You go tell her to be quiet.

Is there a frat party up there? No, she's just dead lifting. Something's happening up there. That's great. That's so cool, Doug. Yeah, I actually think a lot of gym owners now open their gyms as like a studio to show what goes on. And then like Fisher, for example. Oh, sure.

It's like he designed that whole thing. Like we went to Bradley Martin's gym, Zoo Culture or whatever it is. And it was like that whole thing was built for Instagram. There's just other people training there at the same time. The lighting is right, the door, the way everything's set up. I love his gym. I walked in and I was like, oh, he just built a studio. You guys went over to Zoo Culture, right?

Yeah. It was awesome. It was a great spot. If I lived there, I would totally train there. It was really cool. Yeah. But you could tell it was well thought out exactly how If I lived close to there, I would totally train there. It was really cool. Yeah. But you could tell, like, it was well thought out exactly how he worked. What part of LA is he in again?

Woodland Hills? Yeah. He's up in Woodland Hills? That's where he built it? I think so. That doesn't seem right. That's like north. That's a valley.

That's a five-hour drive for us. That's a deep valley. Actually, I was supposed to do a podcast with Mark Bell. I don't know why I couldn't say his name right. That's funny. Mark Bill? Yep. You'll get it in the third part of the show.

Squatching. Squatching. Squatch. What was the name? And he's like, we were too far. He was late. We couldn't even do our podcast because it was like forever away. Well, they heard of NorCal, though, right?

Hmm? He's in NorCal. Mark Bell? Oh, yeah. He's in Sac. Yeah. But he was in town. Bradley Martin was in Woodland Hills. Oh, yeah. He's in Sac. But he was in town. Bradley Marm was in Cal or Woodland Hills.

Oh, yeah. He's out there. Yeah. It was a long drive for us. But his place was awesome. Yeah. Well. He's super cool.

Bill, what you want? Just look at it. Awesome. Steffi, where can people find you? How do they learn how to heal their low back pain with you? You can find me at Steffi Cohen and at Hybrid Performance Method. Savage. Right on.

Jen Widerstrom. Thanks for having me. Hi. Hi. Just my name. We've been hanging out like a whole month now. I know. This thing's getting serious.

I'm encoding the bar real shrug, guys, a little bit. I'm glad you've been chasing us. I'm just glad I got to jump in and be a part. I mean, Stephanie, we met a year ago at Strong New York, and she's one of our presenters. You came to Strong? Yeah. Last year. Why didn't you go this year? I didn't get invited. Oh. be a part of it. I mean, Stephanie, we met a year ago at Strong New York and she's one of our presenters and put on a whole demo. Last year. Why didn't you go this year?

I didn't get invited. Oh, no. Talk to Santucci. Talk to Santucci. It'd be nice if you had somebody that was in charge of invites. Talk to Santucci. Isn't he coming here now?

He texted me. Oh, he's, I think he owns Miami at this point. When Mr. Beautiful comes in town, sees a people part. He's a beautiful man, for sure.

He is beautiful. It was so good to get to see you again and hear what you're doing. Sorry, Kenny. No, but it's a pleasure to keep learning and being around people that care and are thirsty or hungry for knowledge and want to do it and let me kind of be here in the in-between. Sprinkle some Widerstrom on there. Sprinkle Widerstrom, yeah. So anyway, just my full name, Jen Widerstrom.

W-I-D, looks like Widerstrom. Have a ball. I'm Swedish. That's it. Wait, hold on. You got your new you. Oh, yeah. Yeah, new you.

By the way, you spelled it wrong. I did spell it wrong in the show notes. Yeah, I had noticed that. You said it. I was like, did he look this up? That's fine. No, but it's cool because I'm starting to... I'll change it.

Just like your podcast, like you're finding other ways to communicate and be a part of your community and help. And so the Neo You app, which is N-E-O-U, all my Weterstrom programming, I've got like motivational components to workouts. I mean, it's really just kind of a little bit of a party. I'm doing a lot of 90s R&B and hip-hop music as my playlist. So either way –

That was the last time music was good. I'm telling you, it's like SNL. All gym music. SNL and music. But, no, it's going to be a blast. I'm telling you, it's like SNL. All gym music. SNL and music. But no, it's an opportunity for me to get back out there and I've been trying

to stay off TV sets and get into the lives of people back in their homes in a better way and this is my attempt to do so for right now. Beautiful. Very cool.

Doug Larson. Right on. You can follow me on Instagram, Douglas E. Larson. I also have my own site, Doug Larson Fitness, Barbell Strugged,

every Wednesday, sometimes Saturdays, although we're pulling back on that for the moment, but we're back to Saturday soon. Possibly. By the time this airs, we'll probably be back. Yep. I'm at Anders Varner because I'm Anders Varner.

Shrug Collective, six days a week. See you guys next week. That's a wrap, team. No more low back pain in your life. Steffi Cohen says so. She even made fun of me in that show for cutting her off. It's because Jen Widerstrom was in there talking smack to me. She basically talked smack to me all weekend long at Wadapalooza. You know what?

It's Jen Widerstrom. I'm cool with it. Hey friends, make sure you get over and visit our sponsors again. StrongerExperts.com forward slash project Stronger Jamaica. Come to Jamaica with us. If you're a strength coach, you need to be there. We're going to be hanging out with the fastest, strongest, coolest humans and coaches in the world doing shows. I can't wait to meet you. I would love to travel with you. That sounds super rad to be able to share this gift of strength and conditioning with the world and coaches that are eager to learn.

Get over to StrongerExperts.com forward slash ProjectStrongerJamaica. Come hang out with us. You're going to save $100 just mentioning Barbell Shrug. So come do it. Organifi.com forward slash Shrug. Save 20%. BioOptimizers.com forward slash Shrug. Save 20%.

PerfectKeto.com. Use the coupon code Sh shrug to save 20 and sunlight and sauna save 200 on the baddest saunas in the game yo that's us wrapping up our 2019 wadapalooza next week we have halo neuroscience from our trip to san franc. I got to go bench press with the world record holder, Bench Presser. And then a bunch of shows from Boston. Tony Gentilcar, Kevin Carr from Boil Strength Conditioning. And then we have a new season launching. The new season launching is going to be so savage.

I'm going to start teasing it right now. I'm going to tease it next week. The following week, you're going to know exactly what's going on. But we're bringing in Travis Mash, who's the baddest strength coach in the game. I can't wait. We will see you next Wednesday.