Barbell Shrugged - How to Eliminate Back Pain w/ Dr. Melissa Capurro, Anders Varner, Doug Larson, and Travis Mash #813

Episode Date: September 3, 2025

Melissa is a performance physical therapist and is heavily involved in the CrossFit space as a healthcare provider, as well as an athlete. Melissa grew up in the Metropolitan New York area, but now resides in the Tampa Bay area. Upon graduating from PT school, Melissa started working in an outpatient orthopedic physical therapy practice, but was unsatisfied with what she was able to achieve there and the level of care provided for patients. At the time, she was coaching remotely and decided to break away form the clinic altogether, and opened up her own practice. Melissa is now a remote rehab and performance coach, as well as a physical therapist with her clinic out of her affiliate, CrossFit Westchase in Largo, FL. In addition, she is a proud member of the Rapid Health Optimization team as a movement specialist. When she’s not working or training, she enjoys getting outdoors in the beautiful Florida weather with her boyfriend, Darren. Work With Us: Arétē by RAPID Health Optimization Links: Dr. Melissa Capurro on Instagram Anders Varner on Instagram Doug Larson on Instagram Coach Travis Mash on Instagram  

Shark family this week on barbell shark doctor Melissa Kapoor is back today we're talking about back pain which only affects like 112% of the population that might be slightly over exaggerating but it's an enormous number of people I don't know if I know anybody in my life that hasn't had some sort of back pain on top of that if you listen to last week's show I even say this in the show today I've been dealing with some like weird irritation that it's just kind of popped up out of kind of nowhere for no real reason, but it's annoying and I don't like it. And Dr. Melissa is here to kind of help me understand a little bit of synthesize the thoughts into an actual action plan. Well, let's hopefully provide some insight in how you can eliminate your own back pain. As always, friends, make sure you get over

to rapid health report.com. That is where Dan Garner, Dr. Andy Gallupender, who went a free lab lifestyle and performance analysis, and you can access that at rapid health report.com. Friends, let's get into the show. Welcome to Marvell Shrugged. I'm Andrew Farner. Doug Garson, Dr. Melissa Capuro. Does the doctor thing weird you out?

Yeah, I'm not. Yeah, totally. People calling me doctor. Like, people wouldn't imagine somebody looking at me and me like, Dr. Varner, go, stop it. Whatever you are eating today, reverse that. That is a terrible. Like, don't give me that. I don't want that title.

That sounds too much. it's uh it's definitely like i don't know on the one hand it's it's cool because people are like you deserve that because you earn that and i'm like yeah you're right but at the same time it like kind of like makes me cringe in the way it's like even people that are my friends call me dr melissa sometimes and i'm like no can we not like yeah i feel like if i had the doctor in front of my name it would be the thing that like my friends would only say to me to talk crap they'd be like okay doctor I'm sure you fell. I don't know.

Settle down guys. Like Doug, hey doctor. I'm like, no, no, no, no, no, no, no, wrong person. Yo, on today's show of Barbell Shrugged, if you listened last week to our show with Brian Borstein, you heard me talking about slight irritation and things that have been happening in my low back, which is the first time ever in my life,

I've ever even thought about my low back being an issue. And now we have a doctor, a physical therapy, doctor. and your i have so many questions for you because it's such a new thing to me i'm not used to it um but i guess to to kind of start um i love to kind of like dig into uh in your experience how many uh like where do you think kind of like on a large like on a broad level like low back pain starts i know something like 75% or something percent of the people are going to have low back pain but what's kind of like, why does it happen? Why is it so common?

Yeah, that's such like a loaded question because there's so many different routes that we can go. A lot of what I see nowadays, specifically working in the CrossFit space, a lot of people overtrain and put their body under so much stress, whether it's overtraining, a lot of just stress in their lives. Sleep is not great. Diet's not great. So a lot of these factors that are not optimized, a lot of people end up having, and of course, you know, put that with poor lifting techniques. A lot of people have low back pain. A lot of the times, nothing really is actually wrong. Like there's no mechanical, structural, like true issues a lot of the time. A lot of it is very related to lifestyle. I mean, of course, yes. Can we clean up your lifting technique? Yes. Is there a strength? and balance side to side, that could also play a huge role as well. Like if your right leg

is doing all the work when you do a back squat and your left leg is just basically holding on for dear life, your back is supported by both of your legs. And if one is not as strong as the other, there could be some unequal support essentially. But it really just, there's a lot, so many, so many different things that can really cause this. But a lot of what I see is a lot of overtraining and not optimizing basic, you know, lifestyle things that we need to keep in mind. Wait, walk me through that in more detail. Like if you don't have a mechanical issue, then why would you be experiencing pain? Yeah. So of course, like I said, it could be due to lifting technique, poor lifting technique, but lower back specifically are super sensitive

to essentially over-training and poor lifestyle, you know, choices, whether it's the sleep, the diet, increased stress, stuff like that. So it could even be your body just saying, like, hey, time to really kind of hunker down on some of these lifestyle factors here. So can there be something mechanically wrong? Yes, but there's usually never anything sinister when it comes to lower back pain, especially in athletes. Yeah.

How come when? So it's like particularly true if you just have like a little bit of achiness as opposed to like, if you have like a sharp pain, then presumably you have some type of a little tear or something or, or, you know, a slight bulging disc or whatever it is. But if it's just kind of like generally achy, then it's like could be just like general inflammation or something like less severe than an actual tear of any soft tissue structure. For sure, for sure. Like any sharp pain, you know, it really depends.

It really depends on the person and how they experience pain. but a lot of the achiness can really be, you know, something that can just show you to be like, hey, all right, maybe I need to start thinking about my sleep patterns. I need to get back on, you know, a clean diet, stress, stuff like that. And of course, everybody's a little bit different. So, you know, some people may have some nerve symptoms as well that accompany all of that. So it really does depend on the person. when someone goes to like a chiropractor like you say there's not like mechanical issues or like something specifically wrong for the discomfort to show up

but i feel like a lot of people will go to the chiropractor and they go you have a bold disc or you have it's like l5 s1 it's like they just go, that's where it is for sure. How much, I mean, isn't that specifically like a mechanical problem? Like something is pushing on a nerve that's causing problems? Or is that kind of not exactly what's happening? Yeah, so sure. Can that be something that is happening? Yes.

But at the same time, it's really hard for us to say that because you have an L5S1 bulging disc, that that is causing your pain. So, for example, I don't have any low back pain, but I could go and get an MRI and it could show bulging discs. If you were to take an MRI of everybody in Rapid or in any of the gyms that you guys go to and you were to look at all of them and ask them, you know, do they have back pain, you would see a lot of mechanical issues in people that don't have any symptoms whatsoever. So it's irresponsible of us to really kind of rely on. anything on an image or something mechanically wrong. Yeah. For some-

People love a diagnosis, though. What's that? People love a diagnosis. Yes, they do because it actually gives them like the, the confirmation that something is wrong. There's a bogeyman. What's that? There's a bogeyman.

Right, exactly. But kind of going back to what you said about chiropractic, a lot of the chiropractic doctors that I have resonated really well with, do kind of like a nervous system reset, like when they do any adjustments. Like, that's really what an adjustment is. And in my opinion, who I don't adjust, but what an adjustment should be is a nervous system reset. It basically brings your body's attention to an area that needs the healing and needs the attention, if that makes sense.

Yeah. There needs to be something to focus on. For sure. for sure so that's kind of what an adjustment does is it gets your body's attention and awareness to the area and helps your body do the work itself interesting like i've also uh how as a pt do you uh kind of integrate protocols into people's lives like uh one of the most terrifying places is youtube if you want to go solve back pain so like there's infinity videos on all the techniques and There's like so many very passive ways, kind of like the PRP breathing styles and you're laying down and your feet are up and you're just trying to get kind of like the stress from your upper body leaning awkwardly on your lower body.

And obviously there's some like core activation and breathing down regulation, like all the good things. But then also there's like some kind of intense techniques of like if you've ever seen one of those like soas things that like stab you. you, like, super not stab you, but what is the, what is that ball called? Oh, the so right? Yeah, that thing looks so painful. I would never use that. But, like, the levels of aggression to go solve these problems, how do people know, like, what is the right kind of, like, path or, right method to solving or finding a way to get better?

Yeah, so I think that all starts with getting assessed. Dr. Andy Galpin here. As a listener of the show, you've probably heard us talking about the Artei program, which we're all incredibly proud of. It's a culmination of everything Dan Garne and I have learned over more than two decades of working with some of the world's most elite performers, award-winning athletes, billionaires, musicians, executives, and frankly, anyone who just wanted to be at their absolute best. Arte is not a normal coaching program. It's not just macros and a workout plan. It's not physique transformation and pre-imposed pictures. Artae is something completely different.

Aratee is incredibly comprehensive and designed to uncover your unique molecular signature, find your performance anchors, and solve them permanently. You'll be working with not one person, but rather a full team of elite professionals, each with their own special expertise, to maximize precision, accuracy, and effectiveness of your analysis and optimization plan.

Artae isn't about treating symptoms or quick fixes. It's about unlocking your full potential and looking, feeling, and performing at your absolute best, physically and mentally, when the stakes are the highest. To learn more, visit Arteelab.com. That's A-R-E-E-Lab.com. Now, back to the show. You know, there's 100 million different reasons that someone could have low back pain, but without a proper assessment, you're kind of just throwing the kids. kitchen sink at what you're dealing with. So I think that getting an assessment and having someone look at, you know, your strength balance side to side. So looking and seeing like I mentioned before

is one side stronger than the other. Is there anything in your lifestyle that is, that could be optimized at that point? And what is your current activity level? That sort of thing. But I will say generally what my experience is with people that have low back pain is the more that you can keep them moving and training the better, right? Like we never really want to take people off their feet and give them, you know, extended periods of rest because that doesn't fix the problem. Our bodies heal with load and being able to load our joints and our muscles. That's what really helps any injury, truly. The back isn't any different, but the back is very sensitive to those things. if there's too much of it, that's kind of where I was going with, it can be very sensitive to

overtraining. So it's just finding the right balance. But we want to keep these people moving as much as possible. I feel like that's counterintuitive to the normal plan. If you were to go to, like a medical professional, they just say, stop. For sure. Until it doesn't hurt anymore. For sure. Yeah, there's definitely a disconnect between providers like that that I feel are more old school rather than providers now that are pro-movement. And honestly, all the research points to us being able to keep our patients moving. There's been a plethora of research that talks about how exercise is just as effective, if not more effective than any other types of interventions that are used for lower back pain. I feel like as a physical therapist, you're going to be

working with somebody helping to correct them and tweak them and, you know, work them through a progression of exercises to add strength and stability and, um, potentially even more mobility at hips and thoracic spine and whatever else, if you're just a, uh, a regular doctor and you go in there, a general practitioner, you say, my back hurts. They say, yeah, this just, just rest it. It's a, they're not going to do anything with you beyond see you in that appointment. They're not going to be training you and coaching you through anything. Like from a liability standpoint, it makes sense that they would say, yeah, I told the guy to rest. His back is hurting.

Of course he needed to rest. And there's no incentive for them to do anything else other than just to refer them to a physical therapist or potentially a strength conditioning coach. So I think it makes sense on their end. Just as a person that has low back pain, you just need to know who to go to. If you need, go to orthoic surgeon, that might be what you need. In some cases, that is what you need. But going to a physical therapist slash strength coach, someone who understands the

entire continuum, I think is oftentimes the best choice. Yeah, I definitely agree. And now with the way that you can go see different providers, so for example, there's a law now in the United States in certain states where you have the direct access law. So you can go straight to a physical therapist without a referral from another doctor. Because before, basically, you'd have to go to your PCP to be the middleman to give you all the referrals that you would potentially need. But now in some states, I'm not exactly sure which ones. So don't quote me on all of these, but you are definitely able to go to a physical therapist without a referral, and then you can get that, essentially, your plan of care signed off by a doctor to say, okay, it's, it's okay for you to

continue doing physical therapy. So long story short, essentially now people can just go directly to the right provider rather than using the middleman of the PCP and just wasting time, if that makes sense. Yeah. I'd love to see the history behind why that got set up like that in the first place. Like to think that I wouldn't be allowed to go just my back first to go find a physical therapist and someone says, no, no, no, you're not allowed to talk to that person. This person has to say it's okay.

Like, what? Someone has to tell me it's okay for me to see a physical therapist? Like, why? I don't understand how that happened. Yeah, I don't either. And why it's so recent that it actually became a thing. but yeah, that's essentially what needs to happen. And even with the direct access law, like I said, you can't just see a physical therapist.

That PT needs to then go get that care plan signed off by another doctor. So it's just like they don't, we don't have the ability to just operate solely on our own without, you know, the doctors yet. And, you know, with cash pay, you know, in the. in the realm that I work in, you know, I'm my own standalone practice within a physical therapy clinic, you know, since they're paying me directly and we're not using insurance, I don't do that and I don't need to do that because I'm working directly with the person. So in an insurance clinic, that is definitely the route that they need to go, especially with using insurance. But if you're not

using, then it's really not as much of a big deal. Got it. That makes a lot more sense, actually. So it's really the ignorance. Gotcha, gotcha. Real quick, walking through the rest of what an assessment would look like. Someone comes to you and they say, my back heard, it's like, what are all the questions you ask them? What are all the drills or movements you put them through? You mentioned like strength assessments, asymmetries, et cetera.

But what do you do like more comprehensively with somebody to eventually try to kind of uncover a root cause and a path forward? Yeah, absolutely. So when I work with someone for the first time who has lower back, pain. Our session starts off with a bunch of questions. So I'll interview them and a lot of what I'm trying to figure out is where exactly is it? What does it feel like? What makes it better? What makes it worse? We do take a deep dive into their lifestyle. As I said, how important it is to really uncover some of these things. And then we talk a lot about their activity level, what they do for work,

what they do outside of work, what their home life is like. But a lot of it is surrounded around like what exactly are you feeling when are you feeling at the most like i said what makes it better what makes it worse um from there what we do is a general mobility screen so for someone with lower back pain obviously i'm going to see can they you know touch the floor without bending their knees can they bend backwards can they rotate can they side bend and then i'll take a big look at their hips so looking a lot at hip flexion extension rotation um sometimes i'll also look at thoracic on what else they have going on, just because you really want to look at the joints above and below. So I am looking a lot at range of motion of hips, lower back. And from there,

that's when I put them through a screen of certain movements that could potentially either a elicit their pain or show a big discrepancy side to side. So I, while I'm listening to the answer to their questions, I'm coming up with movements that I want to look at. So when I see a patient with low back pain, their assessment isn't just like a cookie cutter like, hey, this is what we're doing today. Based on what they tell me, that's when I'm devising the test that I want to use. So a lot of the times what I will look at is, like we talked about before, is one leg stronger than the other. So that is usually done with some sort of like step up test. I will see, I will do a lot of hip strength tests as well. So glute strength, I will do

kind of like a side plank hip abduction type test as well, see how well that they can activate their lateral chain, usually do like a single arm farmer carry, stuff like that. So really trying to elicit anything that may, like I said, either bring out an imbalance or elicit their symptoms. And the reason why I want to elicit their symptoms is to be able to see what brings it on because that's likely how we're going to treat it. So I usually tell people that, you know, in PT, it's important that we bring the symptoms out because that's how we figure out what's going on. Like if you come and see me and I don't figure out what reproduces your symptoms, then I'm almost doing you a disservice because then I don't know what's going on, right? So I try to explain that, you know, we need to kind of figure out what it feels like and what brings it on in order to solve it.

in particular with your cross-foot athletes do you do you have certain patterns that seem to continue to to emerge where it's like yep you got the same thing that all the rest of these guys got and so here's your here's your exercises like this this very likely was the the root cause and these things tend to fix it you have like any kind of templates like that that seem to recur in your experience yeah a lot of it is like i talked about before the overtraining athlete and avatar, someone whose mobility is good, their strength is good, but they're doing just all too much and not paying attention to other things. A lot of it also is mobility related. There's very few people that I see that pass the mobility screen that I'm putting them through.

And usually that happens in the hips. So a lot of patients that I see have pain with squatting. A lot of them also have pain with deadlifting. So those are the two kind of areas. areas that I see most often that we are treating. The, yeah, I was going to say for you, for your back, for your back at the moment, what's a, what is provocative that gives you pain? Uh, sitting on my butt and staring at this computer is the biggest problem. Yeah, it's just sitting all day.

Yeah. For, for a fitness pro, I sure do sit a lot. I'm supposed to be up and moving and doing. fitness all the time. No, but we talked about it with Brian in last week's show, and it's been, and you asked about the barbell that sits behind me all day, and yeah, it's been on the rack for the better part of like three years, just as my training has gotten less intense, you could call it. I wouldn't even say it's like in a maintenance zone. I'm still lifting, but it's just not the focus of my life.

But along with that, with the lack of heavy barbells. This is the first time of my life. I've had just, like, slight irritate, just noticing low back. Like, I'm 100% one of the people that, like, just notices it. I don't need a diagnosis to it. But I know there's something that's just, like, not as strong or just slight discomfort. Like, it's like a two out of ten. It's just notice it.

But I'd love to hear kind of like your opinion on, for the last call it three years, my training has been very machine-based, which has been fine. line, lots of hip thrusters and hack squats, but very little barbell specific movements, which means I am sitting in a machine that is doing all of the work for me that my core would typically be doing to move the weights around. And my hunch is that adding barbells back into my life is going to eliminate it very, very quickly. But you're a pro. I would love to hear your thoughts on just kind of that thought pattern yeah no and that's a great that's a great way to think about it because i do agree with that however i will ask when did it start and was there

anything that preceded it starting up no that's why it's like a two out of ten it's just something that i just um uh it there's there has been no acute something that happened it's it's it's it's it's it I would even compare it to, like, if you were on, like, a road trip and you get out of the car and you're like, oh, it's just, you haven't moved. You kind of are just seated and you're not, you're not countering it with the heavy lifting movements. So over time, if you lose a quarter of a percent, one day, you start to notice some irritation. And I think that that's really just what it is, but it's something that has been, because I haven't lifted heavy barbells for a long time, that quarter of a percent or so, whatever it is, has just started to get to a place where it's like,

hey, you might want to stop doing this and start doing something that's a little bit more focused on some, like, deep breathing while you're lifting weights and building all the musculature that you can't build when your body's being held in a fixed position on a machine. For sure. And you did tell me, though, that you recently started kind of lifting a little bit again.

Did the back paint start after that? Or was it there? No, no, no. It definitely didn't start after that. That is much more me like countering the fact that I haven't done it. And it's just interesting. Like over a couple years, I would say I've done the exact same workout. I hired Mike Nelson a couple years ago to give me to run a six-minute mile.

And he designed like a two-day-a-week lifting program. and then I was running tons of sprints and lots of cardiovascular work and it was awesome. I loved it and I just kept it going. But because I have done the same thing over and over and over again for the last three years,

again, you just lose like, it's not even a noticeable amount, but you start to create a pattern over time that leads you to a place and it's probably time to go back in time a little bit and start doing some of the things that also allowed me who never feel back pain ever.

Sure. And it sounds like you need a little bit of a different stimulus too. If your body's been doing the same thing and moving the same patterns for, you know, three years, it may be time for something different. And how often do you do any rotational work, for example? Because I know in CrossFit specifically, that's a big problem is a lot of what we do is sagittal plane.

So a lot of Crossfitters don't know how to rotate. And we don't rotate very often. And even frontal plane movement, It's not something that we do frequently, you know? Yeah, this is my totally absurd answer is that I actually spend a lot of time lifting pretty heavy trees out in the middle of the woods. So, like, I am moving in very awkward and very disadvantageous positions all the time, like moving, like moving big logs relatively far, picking them up. I'm like building my own log cap. and so it's like I am I'm moving heavy stuff by myself in very weird ways

so I don't think that that's the problem I really think it's like it's the it's it's it's hard to pinpoint specifically but it has to be sitting in a hack squat machine if I had to like choose a thing not that I think hack squats are fantastic but you're sitting in a machine for sure doing what is supposed to be this very common compound movement. And I also think that hip thrusters are fantastic, but it's a very isolated to your glutes, which are important.

But if you're doing your glutes, but you're not also doing core specific work, it starts to create a small imbalance. And I never do abs, ever, ever, don't want to. They hurt bad when they cramp up. um so i think that it's it's a whole bunch of like quarter of a percent things that have just led to a place where i go oh this is like happening but it's it uh anytime like an injury or any any any any um discomfort starts to happen with my body i go where i have to start

problem solving to figure out what's going on um and that always leads to some something awesome because you just keep learning. Right. And I will say I kind of have two points about this, but the hack squat machine, from my understanding of a hack squat machine, if I'm thinking about the correct thing, you are able to move freely, right? But you're still under a machine, right? So it takes away the degrees of freedom that you're actually able to use when you're moving,

which doesn't allow your body to move on its own, right? So that can cause something like that, especially if your body doesn't want to move in that way. And I will say, I'm pretty sure you said that your irritation is like a two out of ten. You're just kind of aware that it's there. Like that is a completely okay level for you to continue doing what you're doing. So when I see someone with lower back pain, my rule, depending on the person, I'm kind of like in the four to five out of ten range. Like once it goes past that four to five out of ten, that's when we kind of want to start. adjusting what you're doing. So anything below that, as long as it, you know, stops once the

exercise is done and it doesn't linger for like 24, 48 hours, you're usually okay. So even with that level of irritation, discomfort that you're feeling, I would say keep doing what you're doing. It's not anything yet to really warrant any sort of like changes in what you're doing. Yeah. So if it hurts, it's okay to do it as long as it doesn't make it any worse or or linger beyond the acute bout of the exercise itself? Correct. Yeah. So anything, if it's that two out of ten, I'm cool with that. As long as it doesn't pass that, like I said, four or five out of ten range. And you really do have to be honest with yourself of what exactly you're feeling.

Of course, if it's creating nerve symptoms, I would want you to stop because there might be something else going on that we may have to address. But if it's within that range and it goes away once the exercise is done, that's completely fine. And a lot of the times when I'm doing rehab with my patients, I would expect some of the things we do to cause some of that discomfort. And I want that because it tells me that we're creating adaptation to whatever we're doing. So I would expect that to be part of their experience with treatment, especially with movement. As long as it's not, like I said, pass that four or five out of 10 range anything at or below that is completely okay yeah um the question that i had for

last week so four meatheads trying to be dr melissa here it just doesn't work out as well um but my one of the things that i i really think about adding the barbell in and i'd love to hear your opinion on this is like the it not it's not just the hack squats right it's the stabilizing your body through a large range of motion that I think it really is kind of when I say like you lose like 0.2% every day until it stacks up to having slight irritation. I think that that really is like the biggest problem with doing like machine based exercises over a long period of time is that when your body is like go do a heavy set of five. front squats and you realize, oh, this is like just holding the barbell on my shoulders is an

enormous amount of weight. So you're constantly taking these like little breasts and like training all these little tiny breathing muscles. Do you think there's something to that when it just comes to, call it most people having back pain slash even the progression of it of kind of losing those deep core muscles? For sure. Like even part of what I would prescribe for someone that maybe doesn't have the tolerance to doing any dynamic movement with any load yet, something I would prescribe as like a front rack hold, for example, like just to get them under some load where they're having to stabilize and they're not even moving with it. They're just they're stabilizing and breathing. So that's a great point for sure, because that is definitely something that I would use. yeah the the breathing thing is so interesting um you you kind of like don't understand how much the musculature that goes into breathing because you just do it you know however many times a minute and you don't nobody ever thinks about breathing but if you go run wind sprints like you

wake up the next day and like your whole rib cage is so sore and that's how I feel a lot of times when I'm doing like front squats or things like that it's like you can feel your body's just like fighting as hard as it can to expand to be able to just get like a little bit more air in there to really protect one your spine but two to like just have that stability for sure and a lot of people don't know how to breathe a lot yeah it's hot well at high performance is very hard yeah for sure even crossfitters just not using the appropriate breathing techniques, even with lifting, I feel like that's something that we should teach in classes more. And I think it's touched on, but I don't think people really know how to do that

well. How do you do it? Teach them. Oh, gosh, right now. How do you describe it? Yeah. What are some exercise? So I'll actually use a belt to teach people what it should feel like to get the feedback from that belt, right? So I'm not saying to always use a belt when lifting. That's not what I'm saying, but I'm saying to put on a belt to feel what it should feel like to get that belly breath, right? To be able to fill your lungs with air and stabilize and brace. Because a lot of people, when I put the belt on them, they're like, oh my gosh, now I know and I can actually feel the feedback from the belt. And it's not something that they were doing prior. A lot of what they would do is like a lot of the chest breathing.

But with the belt, they can feel the circumference and they can feel the feedback from it. So that's a good tool. I really like to use. Do you do like a scaled down version of that? Like you're putting on a belt just like, just for like you to use it as a teaching tool. So they have something to like push against with their belly. And then if they're doing like chest breathing, they can very clearly tell that they're not pushing into the belt and is it easy fixed.

What about it's like putting like just like an elastic? strap around someone's belly button, so to speak, where they can just, they can continue to feel throughout the workout, like, if they're still belly breathing, because you might get into a workout 10 minutes in, like, you're just, you're going hard and you're just, you just, you just forget all about it, you know? For sure, for sure. Even more scaled down, I've never done something like that, but what I have done is even just having someone just to kind of figure out what kind of breather they are is I'll have them

lay down, put a hand on their chest and a hand on their belly. and see which one they'll breathe into. So that's first. And then what I'll do is I'll have them take one off, leave the hand either on the chest or on the belly, and see if that hand where the hand is, if they breathe into it or if they breathe away from it. Because a lot of people will be inhibitors,

which means they breathe away from where their hand is, but some people will be the people that actually breathe into their hand, the facilitators. So that's a good way. to kind of see a good way to cue yourself to breathe properly. Mm-hmm. Go back to Anders comment about abs. Like I'm kind of the opposite boat of Anders there where I did gymnastics growing up

and then I did martial arts and wrestling and boxing, kickboxing, MMA, and I still do Jiu-Jitsu, of course. I never felt like doing abs or even not even abs specific, but just like poor in general and a lot of poor stability. I never felt like that was an optional thing, given the sports that I chose to do. You're talking about not doing a lot of rotation? Like, I've done a lot of rotation. There's a lot of rotation in boxing, kickboxing, et cetera.

And I played baseball and all that, too. Regarding low back pain and stability and core exercise, et cetera, like, what are some of your favorite exercises to either prevent future potential low back pain and kind of decrease injury and or to rehab somebody out of some type of acute injury? yeah so i love landmine rotations if someone doesn't do a lot of rotation i'll give them a landmine all the time huh he loves land rinds love those i do i really do yeah go ahead those are awesome um a lot of what i'll do is also like a tempo deadlift so even just doing like your typical lifts but adding a tempo to it because it forces people a to go lighter but it forces people a to go lighter but it forces people to control the movement. So a lot of people don't have full control through a full range of motion of a movement. That also could be a cause of lower back pain. So just missing

some control. So that really forces that that option there. Yeah, nice. You're related to that. And I'll credit Travis Mashed for this. But I haven't done this so much lately, but I did it for a long time was like just taking deadlift and just breaking them right off the floor and then just like pausing a half inch off the floor, pause for three seconds and then finish the deadlift. It just, sure is that you have like perfect technique right off the floor and then you accelerate from there after the pause. I love those. Yeah, and it exposes you. It really does. And then for people that have sort of the discrepancy and strength side to side, we'll do a lot of single leg work. I love front rack step ups. He'll tap, step downs just for that lateral hip stability. I do like Turkish

getups. I do like Turkish sit-ups. I also really like arm bars, which I will use for shoulder rehab. as well, but if someone needs to do a little bit more rotation and needs a little bit, something more dynamic as well, I really like those because it's so full body and it forces that core brace. Yeah, so that's a lot of what I do. Yeah, I remember you actually gave me some of those. We worked together a little bit, and you gave me some of those kettle of our arm bars, which I was aware of them, but I'd never really, I'd never really done them consistently and I end up really liking those a lot. That was a good addition. Cool. Yeah, I love those. I love those so much.

so diet like you can use them for really anything um so yeah have you had any low back pain yourself that you've ever stopped in a hole yeah it was awful um put your back like before wadapalooza or something this past year no that was my elbow oh that was a traumatic traumatic injury uh it was bad but i had a i had a stint on back pain for like six to eight months where I rehabbed myself out of it and I had a good friend of mine who's a chiropractor helped me out too. But that specifically, nothing happened, nothing acute. That specifically was from overtraining.

I was working with a coach that I was cleaning and snatching two to three days a week and it was just crazy load on my body. And that is 100% where that came from. I'd never had any nerve symptoms, but essentially squatting, deadlifting. like I couldn't brace to pick up or stabilize the load for months. Like it was just too painful, just all localized to my lower back 100% from overtraining. So it took a while to be able to do that again. But we made it back and it was a lengthy process to build that strength back. It takes time, obviously, as you guys know.

So it was, it was tough. It was a tough recovery on that one. Yeah. Wait, so I mean, overtraining, certainly there's some rest element. to it or just decreasing volume, etc. But what else? What else did you do to, you know, fix it and then get back to normal? What I did was a lot of, in the beginning, a lot of anti-rotational work, a lot of just basic bracing, breathing techniques. I took half of what I was doing off my training list. And I was just staying moving as much as I could. I did the things that I could do,

like a lot of machine work I did single leg stuff just to keep leg strength up as much as I could what else did I do yeah I think the biggest thing for me was the anti-rotational stuff to start and then as I started feeling better I started introducing the rotational stuff

but the biggest part of it was staying moving as much as I could have at the time because becoming deconditioned is only going to make all of that worse because the tissues then lose capacity, right? So I tried to keep my tissue capacity as high as possible. So it just supported that recovery and continuing to build strength as much as I can. I did a lot of sorensen holds, GHD hollow holds when they were appropriate. So anything just to get load to the spine that I could tolerate at the time,

which wasn't a lot for the first couple months. we're able to make any substantial progress in other areas like increasing other upper body strength or you know put some meat on your calves or just some other goal that's like completely unrelated perfect time for cabs you got got those and calves in there i tried to just capitalize on upper body strength for a while like my upper body pulling was i'm not going to say it was weak but it wasn't as strong as it is now so i really focused on that three days days a week just to make sure, you know, I was still making gains in something related to my sport, right? So a lot of strict pulling, which for a while, that was also painful. Like, a strict pull-up was a no-go for a while just because of that. Like, to be able to brace myself to do a pull-up was painful to start. So I really couldn't do a whole heck of a lot. So feet elevated ring rows, stuff like that was okay. But we were really kind of. of that, I don't want to say rock bottom, because that's not true, but we are really just

limited with what we could do in the beginning. For some of the Haslow back pain, how do they know if they should seek out a surgeon? Like, when is surgery an option? Yeah, so I would not even consider a imaging or a surgeon's recommend or a surgeon consult unless you've been doing conservative management so PT for two to three months with no improvement or worsening. Not to say like I will put in this caveat, like if you have a traumatic injury, yes, you should go get imaging. Like if you're in a car accident, you should go get imaging. But if you don't have any sort of mechanism to your pain and it just kind of came

on randomly, then I would say, you know, reach out to a PT, get with a PT, start working with them first. And then if two to three weeks, months goes by and you don't have any improvement or it's worse, that's when I would go get an MRI and then the thought about surgery could then start later down the road. But I would even start with MRI first and see if there's anything that even warrants that. Yeah. What about the less mainstream dry needle? acupunctures, cupping.

Do you think that there's value in a lot of that? Yeah, for sure. There's a lot of value and research that has shown that dry needling could be good for stuff like this. Manual therapy coupled with exercise is the gold standard, honestly. What kind of manual therapy?

That all depends on the person and what they respond well to. But honestly, if you believe it's going to work, it's probably going to work. If someone's helping you and you're like, oh, this feels great. I love this. This works. Like, you're probably going to get better, honestly.

Yeah. I had acupuncture done on my shoulder. And I swear it was like the most magical thing. I walked in there. Like, these people are crazy. You're going to stick a needle in me. And all of a sudden it just poof, it's gone. And they turn that hot light on for 20 minutes.

And it just magical, poof, all the pain disappeared. could not believe what happened. The diminishing returns were quick, but that first, that first stent in the acupuncture world was absolutely incredible. And I was like, everybody needs to be doing this all the time. That was the most amazing thing. So I think there is a lot to it, the dry needling thing. My wife's had lots of positive experience with it.

She also loves just all the massages and deep needle. like she's a big fan of those things so it's like if you believe they work they're going to work very well yeah yeah it's it's interesting to me uh that kind of like some of those more passive ways also do have some some benefits and value to them well i think they should be used in a way to calm the tissue down so that you can load it like you're not going to get much improvement if you're just doing those things because like you said it's a passive treatment um diminishing returns are pretty quick, right? So that should serve as a way to just allow you to load the tissue.

So it should calm things down enough so that you can do the work. Yeah. It's a very good way. It's a good framework for kind of seeing how it all fits into the bigger picture. For sure. Like the biggest bang for your buck is the loading that you're going to do in your rehab. That's what's going to be the thing that heals it. but you know sometimes you need some manual work just to get things to calm down so that's how

I like to look at it as why we use that sort of modality yeah do you still or I shouldn't say do you still I don't know your original position on it but things like foam rolling as far as warming up um do those things still have value do you think um that's a no that's an absolute no it depends your intent with the foam roller if you use a foam roller thinking that you like one of my heroes and he says do it every day so it and then some people are screaming what a waste of time somebody's right yeah so there's no way there's no way in this world that if you lay on a foam roller that your body weight laying into the foam roller is going to change the mechanical length of the tissue Like, that's just not going to happen, right?

But if you do it with the intent that, like, I'm rolling out, it feels good and that's why I'm doing it, then do it. I will say I use a foam roller every day for thoracic openers. And that's like the one reason that I will use a foam roller. So that's my intent with it. I like it. I think it works. So I do it. But just rolling out your quads or your calves on a foam roller, like you're not changing tissue length.

But if it feels good and you want to do it, then go for it. I love it. Where can the people find you? You can find me on Instagram. Handel is The Stoic Physio, all one word. I have a website as well, thestoicphysio.com. I just released some really cool new apparel. Called it my new drip.

So that is out as well. Oh, whoa. I know. Your new part? Is that what the kids say these days? That is what the kids are saying. I think. Hopefully not mine.

They're too young to say that. I would be like, hold on. What kind of YouTube are we watching all of a sudden? Brand new apparel. I dig it. Doug Larson. I always like that brand name. The Stoke Physio.

I got to check out some of this new apparel here. But yo, I appreciate it coming on the show every time. I always enjoy it. I am on Instagram, Douglas. E. Larson. I am Anders Varner at Anders Varner and we are Barbell Shrugged at Barbell underscore Shrugged and make sure you get over to aretaylab.com. That is the signature program inside rapid health optimization where you can go and experience all the lab lifestyle performance testing analysis and coaching to help you optimize your health and performance. And you can access all of that

over at aretaylab.com. Friends, we'll see you guys next week. Thank you. Thank you.