Barbell Shrugged - When Is It OK To Keep Going? The 4 Four Questions We Ask Our Clients - with Dr. Sean - Active Life Radio #17

Starting point is 00:00:00 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. I'm flying solo again. I'm probably gonna be flying solo next week as well. There's a few topics I want to make sure that we get out. We've been getting a lot of questions from you guys on our Instagram DM at ActiveLifeRx. That's awesome. I encourage you guys to continue doing that. And based on those questions, I want to make sure that I'm giving you some information that I believe is important for you to be able to train safely and to be able to progress towards your goals, which are potentially getting out of pain, potentially reaching PRs, whatever it might be. I want to give you some of the guidelines that we help our clients with. And that's what the purpose of today's podcast is.

Starting point is 00:00:55 It's going to be the four questions that we ask clients to make sure that we are minimizing the injury risk while they're experiencing discomfort. So the whole idea of train around it, well, it's old school and some old school stuff we're on board with, but not necessarily that. So we're going to talk about the four questions today that we ask clients to make sure that we're making responsible decisions for them. Today's podcast is brought to you by Organifi. That's O-R-G-A-N-I-F-I dot com.

Starting point is 00:01:38 They're the makers of those amazing aromatic juices that are going to make you healthy, going to make your taste buds dance, can help relax you before bed, wake you up in the morning, whatever you're looking for. My favorite, I've talked about this many times, is the gold drink. I got nothing against the greens. I got nothing against the superfoods, but I am all about the gold juice. Organifi gold juice is, it's near and dear to my heart. It's near and dear to my bedtime routine. I love to mix it with warm water and one of those frothers, you know what I'm talking about if you're, if you're like a bulletproof coffee fan, you probably have one and spin super fast or super easy to clean. I just drop it into the cup and I have myself a gold juice and a nice relaxing

Starting point is 00:02:38 bedtime. So tastes great, extremely nutritious, only the best ingredients, and you get 20% off because you listen to the show. It's pretty cool. O-R-G-A-N-I-F-I dot com. You shrugged at checkout. And I'm going to take a quick moment here to plug us, to plug Active Life. Why not? You guys ask, one of the questions that I get asked from you guys most, believe it or not, is can we work with you if we're not an elite athlete? Yes. The answer to your question is yes.

Starting point is 00:03:34 Most of our clients are not elite athletes just because we've worked with the Rich Fronings, the Jacob Heppners, the James Newberries of the world doesn't mean that all of our clients are those people. If we had everyone on our roster being Sam Briggs, we wouldn't have very many people on our roster. Those four people happen to be people who have worked with us. That's why I named them. We've shared their stories. That's why I felt comfortable naming them. But the truth is we only work with the high level athletes because it's enjoyable. It's not the way that we're going to build our business or change the industry or do anything of massive meaning. There's just not enough of them. It's their likeness and their stories that inspire you to find us and potentially work with us that we're interested in. So the answer to your question, if you are interested in working with active life one-on-one, you are in

Starting point is 00:04:24 pain and you'd like to be out of it. Physical therapy has failed you. Orthopedics have failed you. Cairo has failed you. You're still working out around, air quotes, it, whatever it is. You still believe you have a bad back, a bad knee. You can't do that because you're just getting too old for it. Yeah, you're exactly who we want to help. I'm talking about exactly who we want to help. I don't care if you can run a mile in five minutes, 10 minutes, or you're not sure because you've never run one. I don't care if you bench 200 pounds, 400 pounds, or nothing. It doesn't matter if you can squat clean your body weight

Starting point is 00:05:11 or if you can't squat to clean the floor in your kitchen. It doesn't matter. If you want to be able to use your body, get out of pain without going to the doctor or missing out on your active lifestyle, we want to help you. Head to ActiveLifeRx.com, request a call. Again, that's ActiveLifeRx.com.

Starting point is 00:05:40 Request a call with one of our staff members. We will take care of the rest. To put you at ease, we send about 30% of people who reach out to us to somebody else. We only want to work with you if we're supremely confident that we're going to be able to help solve your problem. Okay? So you can reach out knowing that not only will we make you a referral, we'll tell you exactly who to go see, despite the fact that we have no pre-existing relationships with them. We just want you to get what you need. So ActiveLifeRx.com, request a call, and let's do it.

Starting point is 00:06:16 Now, let's get to the four questions that we ask all of our clients and why we ask these questions and what the answers to them mean, so that we can help them get out of pain without going to the doctor or missing the gym. Let me preface that these four questions are predicated on the idea that pain is an emotion. So that means, essentially, is if you felt something, maybe you got punched in the arm by somebody, you tripped, you banged your shit on a box, whatever it is, you got in a car accident. The way that you interpret that is what actually defines the amount of pain you're going to be in. Think about it. You watch football, right? Or you've watched CrossFit or you've seen the movies, right? Somebody catches a helmet to the quad in football. That hurts a lot. It hurts a lot. Those guys are getting into what they would tell you are like car accidents 30 times a day. I once heard an NFL fullback talk about, his name is Daryl Johnston. He told a friend of mine who was working for Fox Sports at the time when they were on the

Starting point is 00:07:41 same broadcast crew. He said, playing fullback in the NFL is like standing 30 feet away, or excuse me, 10 feet away from your garage door and running as fast as you can into it 30 times. That's what a game is like for some perspective. Now, what I want you to ask yourself is, if you were walking next to that guy down the street and both of you tripped on a tree branch at the same time, fell down and bang into the floor, do you believe that the amount of pain you would both perceive would be the same. Remember, NFL football player,

Starting point is 00:08:28 10 plus year career, gets into 30 car accidents 16 plus times a year, plus practice, plus preseason, plus playoffs, and did it for his entire life growing up. And you, nothing against you, but the odds that you do that are very, very low. I believe it's reasonable to say that the amount of pain he experiences is different than you. And the reason for that is he's felt pain like that before, and he's able to immediately deduce that this is not a big problem. Nothing is broken. Nothing is torn. That just hurts. And his brain then shuts down the alarm bells. Another example, MMA. You ever been punched in the face? It sucks to get punched in the face. Have you ever kicked something? It sucks whether you're kicking it or being kicked by it. It sucks. Let me tell you something. I recently picked up MMA about a year ago. When I say MMA, I mean sparring in a controlled environment

Starting point is 00:09:32 with somebody who is not going to hurt me badly. But there have been days that I've thrown kicks at this guy and I felt like my shin broke in half. It really sucks. And, you know, he's like, yeah, man, you're going to get used to that. I'm like, I don't know about that. I don't know that I'm going to get used to this. But the reality is you do start to get used to it. Your shins do start to get used to. That's really uncomfortable. But I understand that when I put my foot down, my shin is not going to snap in half. I didn't have that kind of an injury. So it's exposure to things that allow us to have less pain when they happen. The first time he checked one of my kicks, I was scared shit to put my foot down on the ground after the kick because I wasn't sure if I had just broken my shin in half.

Starting point is 00:10:23 So I fell to the ground. Instead of putting my foot down, I fell to the ground. Everything was fine. Now, when my kicks get blocked, it still really sucks, but I'm definitely not going to fall to the ground. The point I'm making is that not all pain is created equal. People are not created equal and our experiences are not created equal. So I'm going to give you guys three terms that, or four terms that we use to explain to our clients what needs to happen before I get to the four questions. Term number one, insult. If you're sitting down listening to this podcast right now, the likelihood is that you're comfortable. You're not experiencing any discomfort. You're not in pain. You're comfortable.

Starting point is 00:11:15 And if you become even the slightest bit uncomfortable, you're going to move. You're going to shift in the chair. You're going to lean back. You're going to rest your head, whatever. You're still experiencing insult. Insult is what we call the subconscious intake of stimulus. What that means is atoms and molecules are bombarding your body right now. They're just not causing you any discomfort. But if you sat in that same chair and I told you you're not allowed to move for five hours or stop walking, stand still right now, you're fine. Stay there for five hours. Eventually, you're going to want to move. You feel the sensation that makes you even slightly uncomfortable. It makes you want to move. You're experiencing irritation.

Starting point is 00:12:13 So, insult is the subconscious intake of stimulus. Irritation is the conscious intake of stimulus. Next is pain. Pain is the negative emotional response to irritation. The negative emotional response tied to irritation is pain. So I'm uncomfortable sitting in this chair. A four-year-old might tell you it hurts, but you know it doesn't hurt. You're just uncomfortable. Well, they might cry. That's a negative emotional response. You're probably not going to cry. You're probably just going to move. And if you have kids, you know what it's like when they're strapped to a car seat and you're

Starting point is 00:13:10 driving and they tell you that their belly hurts. We've all been nauseous before, but adults typically don't break down into hysterics. Four-year-olds do. I promise. Or maybe it's just my four-year-old. It's possible. Unlikely, though. So pain is the negative emotional response tied to irritation. Now, the amount of pain that you experience is typically going to be tied to the amount of uncertainty associated with that pain. So what I mean by that is if you knew it was coming, you could tolerate it better. If you've ever seen people who get those branding, those brandings on their shoulder, like there's some old school fraternities that will brand their members, that still hurts, but they're able to tolerate it because they anticipated it

Starting point is 00:14:07 coming. Now it hurts, but they can tolerate it. If you were just sitting still studying and someone came over and branded your shoulder, it'd be a different story. There's certainty around it. Why is this happening? How long is it going to last for? Now, the pain after the branding. It hurts for a long time. I don't know. Is it infected? Should I go to the doctor? Is this a problem?

Starting point is 00:14:33 I don't know. All of those things lead to the pain increasing. In the gym, if you've rolled your ankle before, now you're doing double unders one day, and you roll your ankle, it's not a big deal. You've felt it before. There's certainty. It still hurts, but there's certainty.

Starting point is 00:14:50 You know how this is going to end. You're going to be fine in four days, two weeks, whatever it is. But the first time you slam your shin on the box, you're afraid to look down to see if it's cut to the bone. You know what I'm talking about. That sucks. A lot of uncertainty. If you did a squat clean, for example, and you just felt your knee pop and there was

Starting point is 00:15:12 pain. Oh shit. What was that? Pain goes up. It amplifies because you have a lack of certainty around it. I think you guys are following me on this. The more certainty around the cause of the discomfort and how the discomfort is ultimately going to end the amount of damage caused by the

Starting point is 00:15:31 discomfort, the less pain, the more certainty, the less pain. Okay. Pain is an emotion. It's a negative emotional response associated with irritation amplified by uncertainty. Lastly, the fourth term is injury. Injury is simply the decision that I can't. I have an injured back. Okay. You walked into the room, so your back is not completely injured. But if I loaded a heavy barbell, I would fall to the floor. Okay. Then you have a heavy barbell injury right now. You have a heavy resistance injury right now. My knee is injured. Okay. You're rowing. No problem. But running causes me knee pain. Okay. Then you have a running injury. You've decided I can't run. I hope you guys follow the difference. Very important thing to note, irritation is required to drive adaptation.

Starting point is 00:16:30 What that means is without discomfort, there is no progress. I think everybody understands that. In every aspect of life, you work out, you get sore, you have difficult conversations, you have valuable resolutions, you grow as a person, it sucks while you're in it, it's great when you come out of it. So irritation is necessary to drive adaptation. What that means is if you're experiencing what you believe to be pain without any definition of what pain is or how to decide if what you're experiencing is actually pain or irritation, then you could miss out on exactly what you need to be doing in order to get yourself better. The other side of that is, if you do have the

Starting point is 00:17:14 information to decide if what you're doing is beneficial, then you do have the ability to get yourself better. That should be exciting, especially for those of you out there who are listening to this who have been in pain for a long time. I mean, and you've been avoiding everything because it's like, well, my doctor said if it hurts, don't do it. And this hurts. Well, how much does it hurt? Oh, just a little bit, but I don't want to risk it. Let's talk. Let's talk. We might be able to fix some of these things you're dealing with pretty quickly. So let's get to the four questions that we ask our clients to give ourselves the best odds of making sure that what they're doing is beneficial and not injury producing.

Starting point is 00:18:07 Because let's face it, we get difficult clients. People who are in pain are emotional. People who are in pain are oftentimes in a rush. People who are in pain require a different level of expertise to be able to help them get out of it. We have difficult clients and we love them and we wouldn't have it any other way. But it is important to be able to communicate with those clients in a way that puts us on the same playing field that makes some things that are typically very suggestive or subjective, excuse me, as objective as possible, even if within a completely subjective construct. Okay. Essentially what we want to do is make decisions

Starting point is 00:18:54 more binary, take the feel out of it without getting rid of the feel. So how do we do that? Let's talk about it right now. Four questions that we like to ask clients to determine if they should keep doing what it is that they're doing that's causing them pain. Maybe. First question, on a scale of one to 10, how bad does it hurt when you do that?

Starting point is 00:19:32 Is a 1 bad or is a 10 bad? Because if a 1 is bad, then no, no, no. 1 means you're sleeping at night completely comfortably underneath nice, heavy, warm blankets. Ten being you are passing a kidney stone or having a baby naturally. Got it. It's a three. It's uncomfortable. It does not elicit any fear.

Starting point is 00:20:03 It's just uncomfortable. I wouldn't want it to get much worse. Okay, great. If your discomfort is a four out of 10 or less, we are typically comfortable moving forward. That means continue doing the thing that's causing the discomfort. Now, I should probably make a disclaimer here before we go any further. This podcast, specifically this episode, should not be mistaken for medical advice. This is not medical advice. This is how we make decisions with our clients who we're working with after extensive conversation to make sure that they are a fit to work with us

Starting point is 00:20:47 in the first place. Many of these people have already seen chiropractors, physical therapists, orthopedists, whoever. The idea being these are not people who need to be on a surgical table or in a physical therapist's office. We've already figured that out. If you're not sure,

Starting point is 00:21:14 go to one. If you've been to a physical therapist, you've been to a chiropractor, and they've told you, yeah, this might be the best it's going to get, but you can work out, just work out around it. Reach out to us. We'll take you through these questions if you're fit.

Starting point is 00:21:38 So question number one, scale of one to 10, how bad does it hurt? Three. Great. If it's a four out of 10 or less, we want you to continue. A four out of 10 or less, we're going to consider irritation. Okay. Irritation is necessary to drive adaptation. So we are going to continue if it's a four out of 10. One caveat, all of our reps are strict with a controlled eccentric. We would not have you continue doing kipping pull-ups if your shoulder pain was a three out of 10 on kipping pull-ups. Irresponsible, risky, not necessary, certainly not worth it. I hope you guys understand that. All of our movements are strict with a controlled eccentric. That plays a role in what I'm describing here. So pain, discomfort, four out of 10 or less, continue. Five out of 10 or more, we're going to stop and refer that out. Or we're going to reduce the weight or we're going to reduce the range of motion.

Starting point is 00:22:35 That's where the one-on-one coaching comes in handy is when, yeah, the movement is a six out of 10, eight out of 10, but the doctor told me I don't need to be in the doctor anymore. I just got to work out around that. Well, okay, then let's reduce the load. Let's reduce the range. Let's figure out what we can do to still do this. Question number two. If you said four out of 10 or less, we're moving on to question number two. As the set goes on, does it get better or does it get worse?

Starting point is 00:22:58 Or does it stay the same? If it gets better or stays the same, we want you to keep going. What that's telling us is that you're not driving any kind of damage in the moment to the tissue. You're not experiencing an increase in inflammation. You're not increasing the increase in what we call nociception. Your body is not saying, hey, bad idea. You're not continuing to tear the structure.

Starting point is 00:23:22 This is a good thing. Let's continue. Irritation drives adaptation. Caveat to that, if you just had a cortisone shot, a lidocaine shot, you're on Advil, you're taking Tylenol, you're on Percocet, whatever, Vicodin, this is no drugs in the system. Okay. So it's getting better or it's staying the same. Keep going. Question number three. When you stop, does the discomfort go away? If the answer is yes, that's phenomenal news.

Starting point is 00:24:01 What it means is that the load that we're putting on the structure is driving the symptoms. And without the load, the symptoms are gone, which means the structure was highly unlikely to have been damaged when we loaded it. Now, remember, we start light. We're going to start off with a lot of tolerance testing. We're not just going to go to a 300-pound back squat on someone who has a knee issue it's not responsible there is a method to the madness start light when it comes to pain perceived discomfort is always going to supersede load reps frequency rest perceived discomfort is always going to be more important than those.

Starting point is 00:24:48 So your pain is a four to 10 or less. It gets better or stays the same as reps and sets go on. As you warm up, it gets better. As soon as you stop, the pain is completely gone. This is awesome. All of that is what we would consider irritation. The last question, 24 hours after the episode, do you have any onset of symptoms? So 24 hours later, do you have any discomfort? I'm not talking about soreness from the workout. I'm talking about, yeah, acutely where I have my problem, I have a bigger problem today. The reason that we take this into account, even if the first three questions are answered less than a four out of 10, better as I go, pain totally gone when I stop, is because we want to take into account adrenaline. We want to take into account delayed onset muscle soreness

Starting point is 00:25:46 that could be more acute than it should be in a damaged tissue. We want to take all sorts of factors into account. And if 24 hours later there is an inflammation spike that is noted because of an increase in discomfort, we want to reduce the amount of load reps, increase the amount of rest, something. We want to change the variable next time that we do that. We just pissed it off. Now, those answers, those questions should give you a ton of clarity. Does your knee hurt when you go to the gym? So you've been avoiding doing things that hurt your knee when you go to the gym.

Starting point is 00:26:31 But when you do those things, it hurts a four out of 10 or less. If you do those things strict and it gets better as the set goes on, those actually might be the things that are exactly what you need to do to get out of knee pain. Wild, right? That's why I thought that this podcast was so important. So many of you guys, and I appreciate it. I can't tell you how much I enjoy getting DMs from you guys at ActiveLifeRx on Instagram about questions you have about the podcasts. How do we know it was okay to push Brittany, who we interviewed, I believe it was episode eight or nine, with her coach Larry?

Starting point is 00:27:15 How do we know it was okay to push her when doctors told her that they wanted to do a third surgery? How do we know it was okay to work with a rugby player without an ACL, even though some of the things that we did caused him some discomfort? How do we know it was okay to work with the rugby player without an ACL, even though some of the things that we did caused him some discomfort? How do we know it was okay? That guy's got a professional sports career on the line. How did you know it was okay to work with the client whose name we took out with Dr.

Starting point is 00:27:41 Not Dr. Larry, excuse me, with Larry the first time we went through it. I think we called her Esmeralda. How do we know it was okay? How do we know that the problem was more between the ears than between the joints? These questions. These questions. Now, remember, pain is going to be driven. Amplitude of pain is associated with the amount of uncertainty around it. So what that means is if somebody tells us, oh my God, it's an 8 out of 10. You all know the person.

Starting point is 00:28:16 They're like, it's like an 8 out of 10. It's a 10 out of 10. It's so bad. You're like, it's not a 10 out of 10. You're so soft. Those are going to be what we call outlier cases. They are cases if you are somebody who says my pain is an 8 out of 10 or a 10 out of 10, 7 out of 10, whatever. But you're still going to the gym. You're working out around it. Sometimes it hurts.

Starting point is 00:28:39 Sometimes it doesn't. But when it comes on, it's really bad. Reach out to us. ActiveLifeRx.com, active life, rx on Instagram, reach out, ask us the questions that you need to ask. Let's see if we can help you. We're going to be able to help you because we're either going to take you as a client or we're going to send you to the physical therapist, orthopedist, chiropractor, acupuncturist, whatever, coach, then you need to be going to see. But let's do something about it.

Starting point is 00:29:15 I love the questions. I love the comments. I love seeing you guys share this stuff on your stories. So please keep that up. Increase that. I want to see more of that. If you have somebody in your family, a friend of yours that you feel needs to hear this podcast, make sure that they hear it. How many people have to deal with pain that don't need to deal with pain? And how many of you listening to this, you don't have to tell me now because you can't,

Starting point is 00:29:43 it's a one-way conversation here, but how many of you listening to this, you don't have to tell me now because you can't. It's a one-way conversation here. But how many of you, just ask yourself, are you in less pain already just from listening to this episode? It's not uncommon. That is a common occurrence for people who learn about what pain is, how it's created, how we identify it, what we do about it, it is common for them to immediately feel less of it. So if you already feel better, even just a little bit, it's pretty cool and extremely important. That's it. If you know anything about me, you know I'm a big fan of the quicker you can get somebody outcomes and results, the more valuable your service.

Starting point is 00:30:34 So, consider this outcome and results in 32 minutes. 30 minutes, 31 minutes, whatever. Remember, you want to talk to us active life rx on instagram active life rx.com shoot me a text a dm i'm not giving you my phone number shoot me a dm inquire on the site whatever you need to do we want to help you see you on the other side. Turn pro, guys. That's going to be a wrap for this episode

Starting point is 00:31:08 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

Starting point is 00:31:24 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 truck.

Barbell Shrugged - When Is It OK To Keep Going? The 4 Four Questions We Ask Our Clients - with Dr. Sean - Active Life Radio #17

There aren't comments yet for this episode. Click on any sentence in the transcript to leave a comment.