Barbell Shrugged - Is Your Knee Pain Stopping You From Throwing Down With The Squad?- Active Life Radio #6

Episode Date: August 16, 2019

 Dr. Ray is the director of staff at Active Life. He works with one on one clients and is responsible for coaching the staff. If you have heard of the Active Life Immersion program, Dr. Ray runs that too. The dude is a stud!   Knees hurt when you squat? It’s been like, three years and it seems like you just have to deal with it now? Your friends are getting all swole and shredded and you’re getting dad bod with a side of scaled workouts? Yea, this episode is for you.    In today’s episode with Dr. Ray, Dr. Sean discusses how all of the things mentioned above can be resolved, and way faster than you think.   Minute Breakdown:   0-10 - Are you in the cycle of re-injury? 11-20 - How does exercise selection affect tendon health? 21-30 - Where is the line between Physical Therapy and Active Life 1 on 1? 31-40 - Why are squats an anterior chain exercise if they work the glutes? 41-50 - Lunges are a bilateral exercise. 51-60 - Results so good that you sign your staff up to learn to coach like Active Life Staff. Work with an Active Life Coach like Ray at activeliferx.com/shrugged Find Ray at @RayGormanDPT   ------------------------------------------------------------------------------ Show notes: http://www.shruggedcollective.com/alr-drray ------------------------------------------------------------------------------   ► 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

What's up, everybody? Welcome back to Active Life Radio on the Shrugged Collective Network. I'm Dr. Sean Pastuch. I'm your host, and today we're joined by Active Life Director of Staff, Dr. Ray Gorman again. We're going to be talking about one of our star clients today. This is one of those guys who is very much your everyday kind of performer when it comes to physical performance. He's someone who lost a hundred pounds, works out for the life of it, not for the competitive nature of it. He chooses to use, well, at least did at the time,

CrossFit as a modality. I think he still does a bit of it now. Maybe Ray will know a little bit better when we talk. But the idea of this episode is he had knee pain that had been with him for years. He had tried a litany of different things unsuccessfully, and it was not because he was not all in. This is the guy who goes all in on everything. And today, we're going to talk to you about the things that he was doing wrong, the reasons why his knee pain was sticking around, and the things that he needed to do to turn it all around. So here we go. This episode of Active Life Radio is brought to you by our friends at Organifi. That's O-R-G-A-N-I-F-I dot com. And remember, if you use the code SHRUG to check out, you're going to get 20% off. If you've ever been to one of those juice bars and you've ordered yourself a shot of wheatgrass, you know that that can cost you $3, $4 for a shot of what really tastes like grass clippings from right outside in your yard.

But people tell you it's good for you, so you do it anyway. I have an alternative for you, and it's called Organifi Green Juice. Not only is there wheatgrass in this product, but they also have a litany of other superfoods that are embedded in the powder that you're going to get the nutrient blast that you're looking for in that morning pick-me-up. So head to Organifi.com, that's O-R-G-A-N-I-F-I dot com, and type in the code shrugged at checkout for 20% off. It's a good deal between

friends. Dr. Ray Gorman, live on the Active Life Podcast. What's up, guys? Good to be here. Always a pleasure, Ray. We have Ray visiting us from Reno, Nevada. I said Nevada right, didn't I? You did say it right. That's impressive. I've been... Very few people do. For those of you listening, it is Nevada, not Nevada.

Very good. Now you know. Let's get right to it. Today, we're going to talk about Vince. We can use Vince's name. I'm certain of it. He's done all kinds of- He did a podcast with us himself. He talked about us on another shrugged radio podcast. That's right. Unsolicited. He has done a professional testimonial with us. He's a fan. He sent his coaches through our immersion course. Um, yeah, he's all in man. He is all in. So when he came to you, I remember he was someone who I talked to on the phone and it was one of those situations where I was like, look, man, you've had this pain for years. You need this for at least a year. Absolutely. And that was music to my ears as a coach,

getting an athlete for a long period of time really gives us enough of a training life cycle to not have to rush through things and not have to miss steps along the way that typically are part of the problem. Yeah. And what Ray is describing, there's a lot of people who come to work with us. When they start off, they're not sure how long they need to be there. So they'll start with the month to month and hope that as soon as they're out of pain, this can be over with. The problem with that becomes that when people get out of pain, it's just like being in the moment immediately before you were in pain. You're still in the danger zone. So having someone with us who was committed for an entire year was something that is always music to the coach's ears because they know that they can do things the right way, the full way, and really help these people get out of pain

long-term. Absolutely. So for, for Vin, it really started back in 2014. Um, he was on a really high volume squat cycle, um, basically doing some 20 rep stuff. And of course it was successful, right? Successful in what regard? Yeah, it got strong. I mean, we always say that the program that works the best for athletes is the one you stick to. And just because you're getting results don't mean that they're the kind of results that you want. Yeah. One of the things I talk to people about all the time is they're like, Oh, what do you think of the Bulgarian cycles? What do you think of this? I'm like, well, they worked extremely well for somebody who made it to the Olympics and won. The problem is the scrap heap of people who got mangled trying it, who

didn't get there and win. Right. One of the big things that we kind of look at to start is what's the volume going on? I recently had another client who was on some German volume training. And interestingly enough, there's, there actually is some research out there that says half of the volume of German volume training is actually better than full volume of German volume training. And for those of you guys who are a little unfamiliar with it, full German volume training is essentially 10 sets of 10. So your training cycle for a day is about, you know, not about, it's a hundred reps plus your warmup. So it can get pretty taxing on, on your joints and, and everything going on. Yeah. It's, it's not,

it's not fun. I've done both twenties. I've done everything from small off to twenties to German volume training. And my body is not built to handle almost any of those things. Not many people are. Maybe the Germans. Maybe the Germans and the Bulgarians. So let's get into it. I mean he had tried all kinds of stuff. He did this 20 – he was doing this 20-rep squat cycle, ends up in knee pain.

This is what, 2014 you said? 2014. He pretty much ended up with a bilateral, both sides, tendon issue, patellar tendon issue. From 2014 to about 2016, he really just trained through it and kind of said, well, I guess this is my life now. So his pain above the kneecap on both sides? His was actually below the kneecap. So if you follow your kneecap down, you'll kind of find a point where it attaches to

your lower leg. And that was the area that was pretty hot and tender for him. And I remember him talking about it on his testimonial that he's the guy who likes to throw down with his friends. Like his friends are like, hey, we're going to do this. He says, yeah, let's do it with you. Yeah, he's a big community-based guy. You know, he owns a gym. And so he wants to get in there with his class and be a part of the community and show that he cares by relating to his athletes. So for a lot of people, we always have

to consider the, the psycho-emotional component that exercise drives for them. And with Vin, it was apparent that this is important to get back to. Yeah. So go on. So it wasn't 2014 when he came to you. No, it was it was uh it was actually four years later so yeah it's it's a long time and you'd be surprised how long people go with this stuff but essentially then in uh 2016 he stopped squatting all together all together said you know what not gonna squat 2017 went away he would do one intensive leg workout a week. Wasn't really getting the stimulus he wanted. Uh, so he's kind of on the mend and then eight weeks prior. So this is in July of 2018 when he came to work with us, uh, eight weeks prior to that, he started working with,

um, another site, uh, basically a programming site and it's very squat dominant. Lo and behold, right knee starts to flare up, left knee starts to flare up, and that's when he comes to us. Okay. So he had given up squatting. He obviously picked it back up again because it was on the program. Correct. Okay. What do you think it was in talking to him as his coach to actually pushed him to the point where he's like, I'm going to do this. Forget it. Like, I'm in. I think that with anything you do, there's always a choice and you have to, you have to make a decision in your training on whether that choice outweighs any sort of negative consequences that can come with it. For some people it's, it's accepting the

fact that maybe they think this is the way my life is going to be. And I like back squatting. So I'm going to make the choice to back squat and have knee pain and I'll just deal with it. And they kind of live in this cycle of re-injury. I think one of the most common things that we see in athletes that we work with who have tried other programs or tried to get back to their sport is they've kind of fallen in the cycle of re-injury. So knees feel like crap, they stop squatting. Knees feel great, they go into a high volume squat workout because they feel like this is my opportunity to train when my knees feel good. And then the next day, even though I can't walk, it was all

worth it. I know that in a month or six weeks, I'll be able to do it again. And that's just kind of the life cycle I'm going to live. It really becomes educating our clients that it doesn't have to be that way. You just have to follow the steps that are necessary to get you back to your goals. And that's going to take us six months, eight months, a year varies. Well, so I've, I've heard Vinny talk about, I heard him. I was there. We went to lunch one day up in Miniola, which is town Long Island. He was in town to do some content with me. And he said, he's like, look, after like four months, I was feeling better. I'm like, he got me. He got me for a year. And I explained to him, I didn't get you for a year. I genuinely believed that it would take a year. And after four months,

you're still not out of the woods. Yeah. And I think the thing that people miss there is the point when your athlete starts to feel the best is actually when they need your help the most. What do you mean by that? You're always trying to talk them off of the bad decision, right? Hey, I want to go out and do a workout that has a hundred box jumps in it. That's probably not a good idea. Yeah. But my knees feel great. They feel great. But do you have the capacity to go do a hundred box jumps and not flare up? Well, and so what do you say to the person who's like, I want to go do 100 box jumps.

My knees feel great. And you say, no, you really shouldn't. And then they go and do it anyway. And they're like, I told you my knees weren't going to explode. I'm fine. How do you answer that? It happens. It definitely happens.

And you play with fire enough times, you're bound to get burned. Do more people get lucky than others? Some people get more lucky than others. Yeah, absolutely. But if we're looking at kind of the way that what the research says we should do, it really says that we need to establish a workload. And so getting into some technical terms here, you have what's called a cyclic load, which something like a box jump would be considered a cyclic load. Think of things that are running, jumping, biking, running up and down stairs, body weight, fast movements. Those would be considered cyclic loads. Those are a tendon breakdown mechanism. And then you have something called mechanical load, which is weight on your back, weight in your hands, moving at a tempo that's slower down than up. That would be more of a mechanical load. So that's a tendon buildup mechanism. So the way that I like to simply explain it to people, especially if they're working with us for a tendon issue,

is that it's like a bank. If we're going to take out with cyclic loading, we then have to deposit with mechanical loading. And so you really have to, you're essentially a salesperson in the moment. You're selling them on the thought process that your plan is going to work and that their plan is going to potentially be self-destructive. Okay. So let's go back to the cyclic and mechanical loading, because this is something that I don't think most people are familiar with. And I know it's something that you ingrain in all of the coaches who take our immersion course and in our staff members. Absolutely. So can you dive a little bit deeper into what exactly is cyclic loading for people who are listening and they're like, I don't know what those things are. Is that on a bicycle?

It could be. Yeah. Cycling is cyclic. There's a pattern that's repetitive to it. So we classify things that are cyclic that are typically body weight, kipping pull-ups, burpees. Those can be tendon breakdown mechanisms. They kick off a response in your tendon that essentially puts it into what's called a reactive state. So like think of an acute, a very short term inflammatory state. So the way that I always thought of cyclic stuff based on the way I've heard you describe it at workshops is essentially it's devoid of an intentional eccentric phase. That's yeah, it's a great way to put it. It doesn't have to be devoid of it, but it's definitely a faster concentric than eccentric. So it's all relative too.

So for me, an air squat might be cyclic. For somebody with a 600 pound back squat, a 95 pound front squat could be cyclic for them because it feels like they're moving a piece of PVC pipe. So we then have to take into account what is the athlete move relative strength. And we're using that, you know, something like Olympic weightlifting. There's a lot of cyclic activity in cycling Olympic weightlifts. So there's also no eccentric in Olympic weightlifting. So we start to look at that as, as Olympic weightlifters, um, the importance of having eccentric training, which if you ask any Olympic weightlifter, they absolutely despise. But it's the veggies with the treat.

You have to eat your veggies and then you get your treat. Right. So cyclic loading, for those of you guys who are thinking of it out there, think about your movements that have little to no eccentric contraction for simple sake. Think about your movements that are repetitive over and over and over again. So for example, if you were doing hang are repetitive over and over and over again. So for example, if you were doing hang power cleans over and over and over again, that's going to be cyclic for the low back, cyclic for the elbows, cyclic for the wrists, cyclic for the biceps, shoulders, all that stuff.

If you're running, that's going to be cyclic. If you're rowing, that's going to be cyclic. On a bicycle, cyclic. Kipping pull-ups, cyclic. Those are examples of cyclic exercises. So what are mechanical exercises? What's mechanical load? Mechanical load is basically you're taking something external and applying force to it.

So a barbell on your back, a back squat, a back rack or front rack reverse lunge, a bicep curl, a bent over row, landmine press, overhead press. Something where you can control the eccentric, but it's not necessarily your body weight. Okay. So we're looking with, we're working with an external load managing the eccentric in the case of mechanical loading. Correct. Okay. So where does something like, for example, one muscle up come into play? A kipping ring muscle up. Right. Kipping ring muscle up has properties of both. It's cyclic in one regard, but if you were just to do one, you're not really living in a lot of eccentric control. So it kind of would be doing one muscle up likely isn't going to flare up a tendon in a reactive way unless you had an underlying tendon issue which then it might be a little bit positional from catching in that dip okay i

understand all right so now let's go back to vin cool so what you were saying is that he was doing some i believe you were saying he was doing too much cyclic work he was he he was basically getting what we call a reactive on degenerative tendon. So if we're talking about, yeah, we got to dive into this a little bit because it's really important that we define these terms so that we can have conversations with athletes or with friends or even with doctors saying, I think that it might not be an itis. So tendon health kind of lives on a spectrum. On one end of the spectrum, you have your reactive phases, which is essentially your old school itis. So tendon health kind of lives on a spectrum. On one end of the spectrum, you have your reactive

phases, which is essentially your old school itis. So I just did a hundred pull-ups yesterday. My bicep tendon is a little sore. If I allow my body to do its thing, my bicep tendon will revert to its normal state. If I continue to train on that bicep, I essentially change the way that my tendon structure starts to look like under a microscope and I start to become chronically or long-term overloaded. That then becomes a degenerative tendon. When we're educating coaches about this in our assessment seminars or in immersion, we're basically saying if something is getting worse as you warm up, it's likely reactive. If something is getting better as you warm up, it's likely degenerative. So take that as your general rule. Yeah. That does not mean go to

your doctor and say, you said I had an inflammatory condition. I listened to a podcast and they said you're wrong. Right. Take it as a general rule and ask yourself if what you're doing seems like the right thing for that. Yeah. So with Vin, he basically had this degenerative issue that was very easily irritable. It would basically be, I start a squat cycle, my knees flare up. So for him, any sort of knee flexion was aggravatory. So he kind of fell in this middle ground of, it doesn't matter what the load is. If I do too many things with my knees, they're going to get angry. Now the thought process behind this and the conversation that I had with him was, all right, dude, are you ready to load your knees three times a week? And he was kind of like, you've got to be kidding me. And it's like, no, this is what we're going to do to help you with this issue. So to break that down for people

who are listening, the reason why that might've been surprising is because every time he loaded his knees, he got his symptoms. So now squatting hurt. And the first thing that Ray was going to do with them was squat. But it was different. The intent of the squatting hurt and the first thing that ray was going to do with them was squat yeah but it was different the intent of the squatting was different the way the squats were performed was different so how are they different so they're different in the way that we use uh we use a protocol from a group called buyer uh at all their their research group. And we use something called heavy slow resistance. So essentially it's a 12 week program. We do it three times a week to load the area. We work at a three second concentric or down tempo. We work at a three second,

I'm sorry, three second eccentric down tempo and a three second concentric up tempo. So it's a six second rep. We work at an RPE of eight out of 10. So that's pretty high, right? When, when people think, Oh, I'm, I'm doing quote unquote prehab or whatever you want to call it. Here's my bands and stuff. No, this is for some people, it's a barbell with 315 on it. There's nothing wimpy about that, right? You're allowed to train with some pain. So again, contrary to popular belief, if it hurts, you shouldn't do it. If it hurts a little bit, it's okay to do. So we allow them to work up to a 5 out of 10 pain, 8 out of 10 RPE.

Typically, we start people at a more protective depth. So think for a squatting pattern, we might start people at a more protective depth. So think for a squatting pattern, we might start them at a box above parallel. For a lunge, we might have them put an ab mat or a plate and an ab mat under their back knee to protect the amount of knee flexion that they go into. You said it's okay to train with some pain. Does that depend on what's driving the pain? It absolutely depends on what's going on with the person. So that wasn't a call that, oh, my shoulder hurts a little bit. It's, you know, again, I heard on a podcast, I can just train through it. It's, you have to put the pieces together and know what decisions

are you making to train through? What decisions are you making to, to have some pain in that training session? Um, and ultimately is that moving you forward or away from the goal? Because if, if my client has four out of 10 pain with, um, a box squat, when they're eccentrically loading it, I'm good with that. When they're doing the HSR protocol, heavy, slow resistance, if they're doing things like kipping pull-ups in that same moment, it might not be okay. You know? Okay. So what was Vin's reaction when you were like, Hey, we're going to be loading your knees in a squat pattern three days a week.

I think he expected to be on this program for about one week and then be done with it and cut his losses with, uh, with his-year investment. But it was really interesting with after week one, how conservative he started and how quickly he began to progress. When you say conservative, you mean he was reserved or he was using lighter weights and he thought he should? Yeah, exactly. He was very reserved in his selection and interpretation of RPE, which is exactly why we use it. When you empower a patient or I'm sorry, a client to start choosing some weights, you're able to get a lot of information from them. So you're able to say one, were they overconfident and they don't really take

their injury seriously? Were they a little bit reserved and they underloaded themselves or they underdose themselves? And so now I'm able to gauge and I'm able to give him feedback based on his, his selection of weight. So you, you accidentally called him a patient and then you went to call him a client because I think that the line between what we do and what you would be doing in a clinic is blurred and people come to us having been patients in people's offices and not gotten the results that they wanted. Right. Most of the time people don't come to us and say, I just don't want to go to a physical therapist. I'd rather

work with you. Most of the time it's, I've tried physical therapy. I've tried chiropractic. I tried acupuncture. I tried all these different things and I'm frustrated. I have not gotten the results. I'm hoping you guys can help me. You're my last resort. We'd rather not be your last resort. But that's the reality right now of where a lot of people come from. Where does somebody, let me backtrack a sentence. Where does the line go from coaching to patient care?

For me, if the only thing that I need to change is the way that client is training, if I can just change their habits and they can do all of the work, to me, that's a client. That's a strength and conditioning client. That's the ultimate goal. I mean, I'd never had to meet Vin in person. I'd love to meet him in person, but I haven't had the chance yet. But all I did was say, hey, look, when your class is squatting, instead of doing what they're doing, I want you to put in this work and I want you to work at the sets and reps, tempo, RPE parameters that I've given to you. And what would be different about treating a patient than just changing some behavior? I also think it's kind of just the model that you're in.

You know, if you're in a clinical setting, you're probably doing a little bit more hands-on work. I think that's a big differentiating factor. I also think it's a lot of terminology and scope as far as do we call this treatment or are we just writing strength conditioning programming? That's a big delineating factor right there. This isn't a medical intervention. This is a strength conditioning intervention. The goal is to get stronger. The byproduct is getting out of pain.

I'm glad we went on that little side tangent. Yeah, absolutely. We've actually never talked about that between the two of us it's true not at least in public forum right, that's what I mean okay, so moving on so now Vin doesn't

quit after week one because he decides okay, this is actually not so bad right, so you know after day one of HSR and just to again give you guys a little bit more into this, it's a 12 week cycle. It essentially starts at three by 15. So it's 45 reps to start by the end of 12 weeks, weeks, nine, 10, 11, 12.

We've worked down to four by six. So in theory, the load has gone up with the decreased rep scheme. That's very important here is that we want this to ultimately look like strength and conditioning four by sixes, four by eights. While that might be considered cardio for some people, uh, definitely falls into the strength conditioning realm as far as rep schemes. Okay. So he goes through a week. It's not so bad. Is he feeling better after the first week or is he feeling worse? I mean, I think that we would both agree if he's feeling better, the likelihood is that it's more between the ears than between the femur and the tibia. times clients are going through this process alone and not having a coach or somebody to bounce off like, hey, I'm experiencing this. Is this normal? Or hey, I'm experiencing this. Is

it going to get better? Is it going to get worse the next day? So we're able to instill a little bit more confidence. But essentially by the second day that he was back squatting, so I had him doing two, you know, quote unquote, unilateral days. I had him lunging two days because he said he tolerated lunging better. I had him back squatting one day per week for a total of three days of knee loading. And by the second time he was back squatting, he worked up, he went from, let's see, one 35 on his first set at three by 15 to one 85 on his last set at three by 12. So that's a week apart. Okay. That's a day one. He went from one 35 to one 65. Again, we had depth parameters in there. So he was only, uh, his box was above parallel. How did you decide the depth for me? The way that tendons respond is they respond to tensile load as well.

So as we squat deeper, we have more compression on the patellar tendon. So I like to initially load more weight, less depth. And then as the client starts to tolerate the load better, I'm going to progress the depth and decrease the weight. Okay. We're going to take a short break. When we get back from that break, I want you to tell me why you choose that order. What's up, Shrugged Nation? Are you enjoying this episode? I bet you are. I'm going to keep this brief. We'll get you right back to the show in a moment. In the meantime, if you're interested

in anything that we're doing at Active Life, make sure that you head to ActiveLifeRx.com slash shrugged. You want to be a better coach. You want to help your clients better. You want to get out of pain, but you don't want to go to the doctor or miss the gym. ActiveLifeRx.com slash shrugged that's where you need to be we'll see you when you get there turn pro here we go back to the episode okay ray so before the break we talked about you making decisions around depth and load and the fact that you prefer higher load early on for tendon issues and less depth. And then as the client shows that they can do this, we change to less load, more depth. Why not start with more range of motion and less load? It's just way easier to flare somebody up, moving them through more range than it is to

pull back on the range of motion and start changing the actual cellular structure of the tendon with the load, because that's what's important here. So if I can start to change the tendon in a partial range of motion, if I can start to eccentrically load, concentrically load, make that change, make the knee feel better, I want more load initially than I care about depth. So the follow-up to that would be, if you can put less, are you suggesting you can put less strain through the tendon with less range of motion? You're going to put less compression through the tendon with less range of motion. So more tension, less compression.

Yeah. When the knee is fully flexed is when the patellar tendon has a lot of compression on it. And is compression a bad thing? In the case of tendons, it can be one of the aggravating things. So in my mind, nothing is ever inherently bad. It can just be bad at the wrong time. Well, what I'm getting at here is the dilemma, for lack thereof, a better term, of some people who say you shouldn't squat all the way down. Yeah. That's just not true. So what I'm looking for you to do, because I agree with you is explain to people why compression can be a potentially good or benign thing. Right. And

why that range of motion is necessary. If we can put the tension necessary at half the range. Right. It's all about becoming adaptable. So for somebody who hasn't squatted at full depth, in his case, almost a year and a half now, it would be irresponsible for me as a coach to just say, hey, let's just go full depth and not even worry about it. Let's take the win where we can get it. So squatting above parallel one gives us the stimulus we desire. I think that's really important. My desired stimulus, my intent behind this, uh, the box squatting was to initially load. The goal is to work him back into full depth knee flexion. So we're working towards that goal. But if I don't establish some baseline parameters and some baseline workload and capacity,

I'm not going to win with him. I think I might've lost this battle actually. So while you're working on his knees, let's stay there. I'll ask that question later on. The question I'm going to ask you, so don't forget, is were you working on other stuff too? We were. Yeah, we were working on other stuff. We were, uh, all right, so we'll get to it right now. Yeah. We were building his deadlift. So, you know, doing some posterior chain work, we were building some shoulders, some farmer's carries. Um, it was just kind of, Hey, if this is what we're going to do, let's keep you strong. Let's maintain strength in other patterns. It doesn't mean you have to stop doing anything besides those cyclic loading patterns like we

had talked about. All right. So I have a question for you. That's going to seem like the most remedial baseline question in the strength and conditioning space of all time. But I'm asking it because I believe that there are listeners who are tuned into the show right now who've had to hear this over and over and over again and pretend that they know what the fuck is going on. Sure. And they don't. And they would like somebody to break it down for them. What is the posterior chain?

What is the anterior chain? Posterior chain is if you cut your body in half, front to back, meaning I sliced horizontally through both of my ears, both of my shoulders and straight down the middle of my body. Correct. You'd basically have your posterior chain would be everything, um, from your top of your neck down to the back of your heels. So your back muscles, your erectors, your glutes, your hamstrings, your calves, anterior chain is obviously going to be everything in the front. The things that we think of the most are probably your rectus abdominis your abs your abs right your quads your rectus femoris one of your hip flexors yeah your your pecs right the beach muscles that's right so so how is it then because we all know that

glutes are built in the kitchen and then under a barbell and squat. Sure. How is it that squats are an anterior chain? Deadlifts are a posterior chain and the glutes are what work for squats. They're just working in different ways. So for a posterior chain, you're in a totally different position, which positions of deadlifts for squatting could be a whole separate podcast. We'll do that one too. Um, but you're essentially functioning as your glute fibers run in so many different ways that they can function in so many different ways yeah they can function as extensors they can function as rotators it's i mean they're they're really an amazing muscle group when you think about it and and not just for the look not just for the look and what i want people to understand also is that it's predominance so a back squat for example is not

devoid of posterior chain activation there you require a lot of activation from the erectors from the lats right from the glutes, which are all technically posterior chain muscles. It's just that movement itself, quad dominant, abs, it's going to cause a lot of anterior chain load as compared to posterior chain load. Correct. Correct. So I hope that that cleared things up for you guys who didn't know. So moving on. Yeah. So moving on, I mean, you want to talk about a quick progression. We basically went from, you know, week one, one 35 to week three. Now his last set is at two 15 with no pain. And when I'm making decisions on if I'm going to let my athlete continue to add weight,

I'm typically going to look at their feedback. So if he said, ah, you know, I was living at a four out of 10, um, at two Oh five, it's probably going to be, maybe we should hang at two Oh five, one more week and see what happens. But within it was kind of, Hey, let's, let's start loading this thing. So we basically went five weeks into the program with great results. And at that point, typically between week four and week six is when I'm going to start adding some depth. So I've had four to six weeks of loading on the tendon. Now I can start re-exposing new positions. With him, I started by elevating his front foot with the reverse lunge. So now he's doing essentially a front foot elevated split squat. And then we're going to bring the back squat depth to parallel with a box. Okay. So we're now to parallel with a box. And was there any nervousness from him? Was he like, Hey, uh, I don't know. This step makes me nervous. Now there was actually a lot of confidence.

That doesn't surprise me yeah so so starting with him with him yeah but there can be you know i've had some people who are they'll text me before and say hey coach are you sure you want me to do this and i always give them the option of saying look you have the choice to do it i think you're more than ready if you don't feel ready we can work on some other things to get you ready but but try your first set. If you don't like it, you can back off. And nine times out of 10, they're like, I can't believe I just did that. I haven't squatted that low in X amount of months, years, whatever it is. So was he in pain now? And were we four with him? Yeah, he was doing great. So like pain already looking at his comments right

now, no pain whatsoever. The hardest thing for him is to maintain the tempo. And so when I start to see that, I know that my clients are getting a little greedy because that means that they're exceeding that RPE. So with him, I wasn't worried about it. I didn't feel like he was going to just bust off the training wheels and head out the door. I was able to show him the light of what could be. And again, like I'd mentioned before, you become a salesperson in that moment, even though we don't think about it when you're a strength and conditioning coach and you're

selling somebody on continuing towards their goals in a way that you know, you need to help them manage. You better be good at sales in that moment or you might lose that client because they feel like they're done. Right. So you're selling them an idea. You're selling an idea. Absolutely. Now here's, I need to understand what do you attribute to him feeling so much better in four and a half weeks when I would never in a million years, tell a new client coming in that they can expect to feel better in four weeks. Ever. I would never, ever, ever, ever, ever, ever, ever tell somebody coming in that you're going to feel better in four weeks. Not in eight weeks.

Maybe not even in 12 weeks. I would never, ever do it. So how does it happen with someone like him? I think part of it is between the ears, like we mentioned before. I think it's getting over the mindset that your knees are always going to hurt. I think it's having somebody in your corner who can reassure you that this is the process and the payoff. I also think that part of it is scientific in the fact that there's a lot of analgesic effects to eccentrics, to isometrics. And so when we start to do things slower, I think your brain interprets them a little differently. And it's also education on pain

science. So someone's listening to this now. They have knee pain. They might be sitting in their car. If you're sitting in your car and listening to this and you have knee pain, switching from the gas to the brake might be hurt a little bit. Yep. The thought of getting out of your car is like, I really don't want to get out of my car. It's going to hurt.

I got to put my hands on my knees and kind of prop myself up to do this. And if you're asking yourself, Dr. Sean, are you in the backseat of my car looking at me right now no i'm not i'm not in the backseat of your car we've just seen so many people exactly like you so now what they look to do is they're like well i just heard them talk about this hsr stuff so let me go online and see if i can find some HSR stuff and do this for myself. Why would they ever want to work with a coach when they can just Google HSR and do it for free? The thing that typically happens with that is for a few people, it might work. It really might, you know? But what we typically see happen is that you don't have somebody with the experience in your corner

to help you progress past that point or to say past one point past the point of when you start feeling good. So maybe you start to feel good and then you go and do something that you think you're ready for and you're not, or you progress the depth too soon, or you try to do the depth right from the beginning. What tends to happen in that situation is the person says, well, I tried to do this by myself and all I did was cost myself time. And I wish I would have spent the money to invest with somebody who could help me out of this situation. Got it. So what you're saying is that, yes, that protocol works. The way that you apply that protocol, however, varies based on the way that your body responds to the work. Right. It's one piece of the puzzle. We still have to look at everything else,

your range of motion, the types of loading you're trying to do, the types of training you're trying to get back to. What does your lifestyle look like? Are you an avid hiker? That's going to maybe change the way that we do this because you have to do more cyclic loading than everybody else. Yeah. And so a really good example of that, as we sit here and talk on Tuesday, July 15th, I'm not sure when this is going to come out. I've been texting back and forth today with one of our favorite clients of all time, a CrossFit Games athlete, perennial CrossFit Games athlete, a good performer. And we worked with him on getting his – a litany of things better, one of them being his knees. Now here we are today, two and a half weeks before the games, and he has a knee injury because maybe the job wasn't done and things we

stopped working together because it got in the way at this point of the volume of training and the fun of training to keep working on this thing. And now here we are, the problem is back. Right. And that happens classically. Sure. You go through kind of cycles of training. Yes. So sorry, continue on. I jumped in the way. So the next big thing, the next milestone that we need to get back to is reintroducing that cyclic loading or that body weight repetitive loading to somebody's training protocol. And for me, when I'm returning an athlete to running, I actually like to do box jumps prior to running. Um, I want to kind of take that downward gravity effect out of it. So if I can have somebody jump onto a box and land like a ninja, I don't have the same ground

reactive force as if I have them jump up and then jump down or jump high and then land. And when we're returning to running, we have to remember that running is really just a series of single leg jumps. So, or falls. Yeah. Or falls. So starting with a bilateral pattern often can kind of offload the, the, um, the risk that is associated with returning to a running progression. So why wouldn't we do it in a controlled environment on a single leg? Like for example, with a step up or with a lunge instead of squatting? Um, we're, we're going to work on everything at the same time. So he's not just doing box jumps. He's not just doing running. He's doing, he's still doing heavy, slow resistance, squatting, heavy, slow resistance, stepping up, or I'm sorry, uh, lunging. Once we're done with the lunging is when I start to put, put in front, uh, front rack step ups for them.

Got it. And what's the difference between a lunge and a step up? Why? Like, it sounds to me like they're, they're half of one. What's the expression? Six of one, half a dozen of another. Yeah. Right. So obviously I've been at this company for a minute. I know the difference. What is the difference between a step company for a minute. I know the difference. What is the difference between a step up and a lunge? The big difference for me is that a step up is if done correctly, is truly a unilateral exercise. Um, a lunge, when people think of a lunge, we typically think of the leg that is in front is the one that we're training. But if somebody has a very skewed strength balance issue with their lower extremity, where let's say they can do twice the number of step-ups on their right leg as they can on their left. So they could do 10 on their right,

five on their left. When their left leg is in front, there's a good chance that their back leg, even though it's in a mechanically disadvantageous position can take over for that left leg. So when we think we're training the left leg, we're actually just perpetuating the problem. Yeah. So a great way to think about this is if you ever had knee pain or think about having knee pain, just imagine yourself having knee pain. And every time that you flex and extend that leg, it hurts, especially against load. If you're stepping up with the other leg, you're not experiencing knee pain. If you're lunging with the other leg forward, that knee is screaming at you because it's on tension, because those muscles are working, because the lunge is a bilateral exercise.

Correct. Move on. So week five, we start his return to running progression, which is really box jumping, not cycling box jumps, but jumping up, stepping off. By the time we're in, I'm sorry, that was week seven, not week five. By the time we're in week nine, we now actually start doing some jogging. So I started him with four by 200 meters at six out of 10 RPE. How did you choose 200 meters? How'd you choose four? That is the question that I always get in immersion is how do I choose? You are making an educated guess. There is no magic number. You're essentially taking what is the athletic

capacity of the client. I would rather undershoot than overshoot because if I overshoot, then I run the risk of my client not having the capacity to do so. So for me, it's let's start with less and we can always build to more. If we start with more, it's really hard to regress back to less. Yeah. This is kind of like one of those situations where when you started CrossFit in your local gym, the coach who worked you might have worn as a badge of honor or patted you on the back that you couldn't walk the next day. You're like, oh, man, second day, like after first day of working out, I couldn't even walk down the stairs. Right. And they're like, yeah, man, that's CrossFit. That's not good crossfit yeah that's that's part

of the that's part of the culture shift that we need to start making um in order to change the paradigm from training in the moment to training for life yeah and i'll be honest i was i was a coach who you know i i made that mistake the only reason we're talking about it is because we've been there yeah yeah so i want to be clear i'm not judging anybody for doing it it's it's something that i've done it's something that i've trained coaches to do and it was wrong so let's let's move on to the next step so now vin's starting to run he's gotta be fucking thrilled yeah he like couldn't believe it he's like dude that's the first time I've ran or ran and squatted without knee pain. And you know, I'm part of that journey with him. So it was pretty awesome. So the, the one thing that I want to highlight is in week 10,

as we start to add more things to his program, he starts to get a little bit of knee pain. And this is kind of the first time in his journey together that he's like, Hey, this is like, this is a three out of 10 when I squatted today. Well, remember with the parameters that we have, we're allowed to train with up to five out of 10. So this is the scenario where when you don't have a coach, you don't really know what to do. And with Vin, it was cool. You had a little bit of knee pain. Let's see what what happens let's take tomorrow off we'll get back to it on Friday we're still going to run on Saturday if it goes away

and let's touch base then lo and behold Saturday comes ran felt fine right so that's the spot where a lot of people might have been like oh god this isn't working oh god WebMD what do I have yeah okay so

he runs again on saturday everything is good now i mean at this point you've got to be like all right now this guy is not out of the woods but we are certainly able to see the outskirts of these woods right right now so so you know without getting too deep into the minutia of it, you have him for another nine months, right? What's going through your mind? Are you like, Oh God, like, right. Cause we're like two and a half months in at this point, right. Two and a half months in and you're, you're for all intents and purposes, four months ahead of schedule. Right. So yeah. I mean, good problem to have. Yes. So did you tell him though, were you like, Hey, just a heads up, like you're probably going to feel better way

faster than we anticipated. You know, it's funny. There's a, I'm looking back at our notes on him and I actually said, asked him for an update of goals. I said, Hey man, like just want to know now that you're feeling good, what do you want to do? Uh, and he straight up was like, I didn't expect to have this conversation. Give me a week to think about it. So it's always nice to have those problems. But once we, once we got out of pain and we're talking, you know, week 13, we really kind of transitioned to a regular front squat program where now we're working at five by fives. And even though we had brought the weight, uh, significantly down, the plan was just to build that front squat backup. Why not the back squat? Why the front squat? We'd just been training the

back squat for, okay. So it was just a shift. Yeah. It's a shift. And, and in CrossFit, um, there's a lot of things that relate to the front squat more. So I wanted to start having him doing front squatting so he was prepared for thrusters, so he was prepared for squat cleans. And so that's why we transitioned just from a functionality standpoint of being useful in the gym. Okay. So then it becomes a good conversation of, hey, we still have, you know, eight months at this point. Let's shift you to performance. Like, let's start seeing and taking you through our normal testing and giving you some front rack step ups. Let's test your mile. Let's test your five rep max deadlift. Let's let you build up to a heavy eight out of 10, five front squat. Um, and now we're for the next eight months, we're really building and instilling confidence in that athlete. Because remember we had a four year cycle to break, right? A mental cycle of telling

yourself, I can't squat. If I squat, it's going to hurt. I can't do this. I can't do that. Now it's we need to retrain to I can do this. I need to do it responsibly. So we're always kind of having that conversation and fighting that battle. Okay. So at what point, you know, I want to reword the way I said this. This is kind of the spot in the game where time slows down and things actually can get really frustrating. Sure.

It's if you've ever tried to lose a lot of weight, this is the last five to ten pounds. Yeah. You know, it's like, OK, I've lost 50, 75, 100 pounds. In Vince's case, 100 pounds prior to working with us. So now it's like this last fucking eight pounds will not go away. And that happens with us too. You get to the place where everything is like 85, 90% better than it was. And then it's like, I can't shake that last 10%. This is better than I ever thought it was going to be. Is this just as good as it's ever going to

be? Right. What do you do there? Uh, you keep going. So, I mean, we have some clients while, even though the HSR protocol is 12 weeks, we need to keep hammering another four weeks on him. We need to build capacity and build workload for that month, two months, three months following being done. The stars don't always align. So in the case of Vin, we were really lucky to get to a point in four months down the road where he wasn't even thinking about having knee pain. I mean, that's a significant change. But I think it's being, to go back to your question, it's being realistic with your expectations and setting that up from the start so that your client doesn't expect something that is unlikely. And the worst case scenario is you are right in your

timeline, meaning it's going to take X amount of time. It actually takes X amount of time or a little bit longer. And the best case scenario is you get to over deliver for your client. Right. Okay. So at what point was Vin like, I'm, I'm pain free, man. Like let's fucking do some fun stuff. Uh, November. So we're talking, you know, end of October, November, it was like, this isn't even, when did he start though? He was in July. Oh, so talking four and a half months yeah yeah so that that was the comment i was comment i was reading from about this was october 27th so we're talking about you know that five month mark um and he says that's three months july and october 27th he says it's been amazing to not think about it like that and And the thing that I want to point out about that

is that means so much more than somebody's knees feeling better because it solves a problem in different facets of life. So that was October of last year. And now here we are in July of this year. He must've just wrapped up as a client or is he still finishing up? He did. One of his coaches actually went through the immersion program. And so we actually arranged mentoring his coach for his last two months because he was doing so well and we had this opportunity. And so I was basically overseeing her programming for him. And she was taking him through into kind of a trial run for one of her first real clients that was post-Active Life Immersion course. That's very cool. Yeah, it was cool.

Okay. So what's the take-home message here? Because, I mean, we just went through in pretty cool detail the the how this all happened yeah and what it made this guy feel like i mean to the point that it worked so well for this client that he enrolled and i believe he paid for it yeah he enrolled one of his staff members in the course so that she could do that for his membership base. Right. Which is so fucking cool. Yeah. That is fucking cool.

That's like the best compliment you can get, I think. Yes. Somebody buys the education for somebody who they pay to take care of people who pay them because they see so much value in it. That's awesome. So, God, we need to get to a place by the way where every gym owner has a coach on staff who's doing this. I agree.

Put ourselves out of business. We'll figure something out. Yeah, we'll figure it out. I'm resourceful. What's the take-home? The take-home from this is your solution has to match the problem.

If you're dealing with a tendon issue, you have to know what stage it's in. You have to know whether to rest it, whether to load it, what that time frame looks like. You have to know what to take out of a program. So it's not just important to put things in. It's important to know what you need to take out of a program. So it's not just important to put things in. It's important to know what you need to take out. The way that I always educate coaches that I work with is I want to take out the least amount of things that I have to until I absolutely have to take them out because we all know what it's like to have to not, to not be able to do something.

It only makes you want to do it more. It only makes you want to do it more, exactly. And then it becomes what substitutions or customizations can I make to my program so that I can continue to train smart, but actually have an exercise program that's built for me, a strength and conditioning program that's built for me as a person that solves my problem and gets me to my end goal, but still looks like training. I think that's the badass win. Yeah. And that's what's, that's what to me is so cool about what we're able to do for people. Right.

Because we're not putting them on a physical therapy table. We're not giving them a diagnosis and having them go home with a piece of paper that says, I have this. We're not putting them on a physical therapy table. We're not giving them a diagnosis and having them go home with a piece of paper that says, I have this. We're not telling them what not to do. We're telling them what to do. Right. And then giving them the freedom to do it in a way that's inspiring so that they're getting fit, they're getting jacked, they're looking good and their pain is going away at the same time. Right. And I think if you're one of those people who walks into the gym and you don't feel so great walking in, but you feel great as far as in the areas of where your tendons are, you feel great after you warm up, you're perfect for this. Like there is hope for you. There is a solution for you. You just need someone on your

team who can help you manage that process. I love it. I got no further to go with that. Dr. Ray Gorman, thank you for coming back on the show. Thank you for having me. We'll do it again. Turn pro. That's going to be a wrap for this episode of Active Life Radio on the Shrugged Collective Network. I hope you enjoyed it. If you did, please head to wherever you listen to podcasts and leave us a five-star rating as well as a great review. If you really love this episode, make sure you're sharing it with the people who need to hear it. Value unshared is value wasted. And of course, if you're looking to get more from us, whether it's coaching courses, one-on-one coaching from one of our staff members to help you get out of pain without going to the doctor or missing the gym, head to ActiveLifeRx.com slash shrugged. We'll see you there.

Turn pro. We'll see you next time.