Muscle for Life with Mike Matthews - Paul Ingraham on the Art and Science of Staying Injury-Free

Episode Date: August 5, 2020

Nobody likes getting hurt. Well, besides masochists, of course. But seriously, getting injured sucks. Pain is annoying at best or excruciating at worst, but that’s not necessarily even the worst part. If you try to work through the pain, you’ll usually end up even worse off. So, injuries not only prevent you from working out comfortably, but they often keep us out of the gym altogether. In turn, this slows down your progress or even brings your fitness goals to a complete halt. Most people fear serious, acute injuries from lifting weights. The truth is weightlifting isn’t nearly as dangerous as many people think, and one of the most common issues us gym-goers face is repetitive stress injuries (RSIs). That’s why I called in a true RSI expert, Paul Ingraham, the founder of PainScience.com who spends all day writing about pain and injuries. In this episode, we chat about ... The underlying mechanisms behind overuse injuries How you can prevent RSIs and treat chronic pain Why you might not want to take anti-inflammatory drugs The best ways to fix an RSI and whether topical medicines can help The important of “load management” When it’s time to see a doctor And more ... So if you want to learn about how to avoid RSIs and how to make them go away when they do occur so you can keep training and live pain-free, hit that play button! 7:36 - What is repetitive stress syndrome? 19:22 - What can you do to help with chronic pain? 24:24 - What is your protocol for resolving repetitive strain injury? 34:29 - Under what circumstances would this be a good idea to try topical medicine? 42:01 - What do you mean by “managing load”? 59:00 - What should you do if your body hasn’t recovered after 6 weeks? 1:03:43 - How can you prevent repetitive strain injury? 1:08:02 - How do we find the spots where our muscles are irritated? 1:12:14 - Can deloading help prevent repetitive stress injury? 1:16:14 - Where can people find you and your work? --- Mentioned on The Show: Paul Ingraham's website and mentioned articles: https://www.painscience.com/about https://www.painscience.com/RSIs https://www.painscience.com/ArtOfRest https://www.painscience.com/structuralism https://www.painscience.com/pain_is_weird Paul Ingraham's Books: https://www.painscience.com/books.php Paul Ingraham's Twitter: https://twitter.com/painsci Shop Legion Supplements Here: https://legionathletics.com/shop/ --- Want to get my best advice on how to gain muscle and strength and lose fat faster? Sign up for my free newsletter! Click here: https://www.legionathletics.com/signup/

Hello, hello, hello, and welcome to a new episode of Muscle for Life. I'm your host, Mike Matthews, and thank you for joining me today to talk about getting hurt and how to not get hurt and how to get better when we get hurt, because getting hurt sucks, right? Most of us don't like to get hurt. We don't like to be in pain. Masochists do, but most of us do not. getting seriously hurt getting really injured well that sucks even more we can deal with pain which can be annoying at best and excruciating at worst but we can figure out ways to work around pain right so in the case of working out if an exercise is making something hurt,

we can just do another exercise. But in the case of an injury, we don't have that luxury. We often have to stop working out altogether or stop playing the sport that we're playing altogether or depending on our work, stop working. And a common mistake people make that turns pain into injury is just trying to work through it, just trying to push through it. No pain, no gain, right? Wrong. I would say no pain, all gain is what we're going for. And another misconception that many people have that really is the essence of today's episode is that the injuries that most commonly occur with weightlifting are serious acute injuries. That's not the case. Research shows that weightlifting isn't nearly

as dangerous as many people think. And the most common issue that us gym goers are going to face are what are called repetitive stress injuries, RSI's. And in today's episode, I talk with the, I would say, number one expert on RSI's, and that is Paul Ingram, who is the founder of painscience.com and who spends all of his time researching and writing about pain and injuries. And in this episode, we get into the underlying mechanisms behind these overuse injuries, how they happen. We talk about how you can prevent them and how you can treat them using very simple methods, very low tech methods. We also talk about why it's not necessarily a good idea to just immediately turn to anti-inflammatory drugs if you are dealing with pain or RSIs. We talk about the importance of managing load and volume and how crucial that is over all the other

fancy, sophisticated things you could try to do to prevent injuries and improve recovery. Work, the amount of work you're making your body do is paramount. And of course, we talk about quite a bit more in this episode. We explore the topic in detail. So if you want to learn all about how to avoid these repetitive stress injuries and how to know if you have one and what to do if you have one to not only make it go away, but to keep it away, to prevent it from quickly coming back when you get back to doing what you were doing that caused the injury in the first place, you want to listen to this episode. Also, if you like what I am doing here on the podcast and elsewhere, definitely check out my sports nutrition company, Legion, which thanks to the support of many people like you is the

leading brand of all natural sports supplements in the world. And we're on top because every ingredient and dose in every product is backed by peer-reviewed scientific research. Every formulation is 100% transparent. There are no proprietary blends, for example, and everything is naturally sweetened and flavored. So that means no artificial sweeteners, no artificial food dyes, which may not be as dangerous as some people would have you believe, but there is good evidence to suggest that having many servings of artificial sweeteners in particular every day for long periods of time may not be the best for your health. So while you don't need pills, powders, and potions to get into great shape, and frankly,

most of them are virtually useless. There are natural ingredients that can help you lose fat, build muscle, and get healthy faster. And you will find the best of them in Legion's products. To check out everything we have to offer, including protein powders and protein bars, pre-workout, post-workout supplements, fat burners, multivitamins, joint support, and more, head over to www.buylegion.com, B-U-Y legion.com. And just to show how much I appreciate my podcast peeps, use the coupon code MFL at checkout, and you will save 20% on your entire first order. So again, if you appreciate my work work and if you want to see more of it, and if you also want all natural evidence-based supplements that work, please do consider supporting Legion so I can keep doing what I love, like producing more podcasts like this.

Hey, Paul, thanks for taking the time to come talk to me. Hey, Mike. Glad to be here. Today's discussion is going to be about injuries and pain and how to avoid those things. And when they do happen, how to make them go away as quickly as possible. And I wanted to have you on the show because this is something, obviously, you are very much a subject matter expert here and I've been familiar with your work and recommended it and I've liked your work for some time now since coming across it years ago. Thank you. Yeah, yeah. So this is a topic that I have written and spoken a little bit about, but I haven't had an in-depth discussion or written this article. So I figured, well,

let's start with a podcast maybe in the future. I'll write an article on it too. So here we are. And I think a good place to start, and just to be specific, the type of injury and the type of pain that I wanted you to talk about is the repetitive stress injury, the RSI, because that's what most of us lifestyle bodybuilders, I guess, if you want to call us that, or just fitness enthusiasts are going to experience, we may not, you know, knock on wood. I don't have any wood around. Oh no, there's some wood. We may not experience much in the way of acute injuries, but if we're going to be in the- Less than people think. Yeah. Yeah. Yeah, exactly. That's something I have written, spoken a little bit about. This stuff is not as dangerous as some people would have you believe if you know what you're doing and you quote unquote listen to your body.

You don't try to push it too far and you take your deloads and et cetera, et cetera. But I think it's fair to say, and this would be a good place for you to just take the ball and run with it. I think it's fair to say that if you spend enough time in the gym and especially if you're doing a lot of strength training, which a lot of the people listening are, and they're wanting to push themselves, they want to achieve, let's say, at least 80% of the strength and muscularity that's available to them genetically. They're almost certainly going to experience repetitive stress injuries and hopefully not many. Less than running anyway. Yeah. Yeah. True. So that's why I thought it'd be, and I just know having heard from you know or in here continuing to hear from so many people who are not just

following my programs but just doing this kind of stuff generally this of course is a topic that comes up a lot so let's i think a good place to start would be what is a repetitive stress injury just so people understand the term beyond what's right there in the name. Yeah, sure. I mean, it's probably the most common kind of sports injury. Most sports aren't all that prone to acute injury, although you see an awful lot of blown knees and muscle strains in sports like soccer. But overuse is the most dangerous thing about being active is wearing stuff out or encountering biological vulnerability, doing something that isn't, you know, it's not exactly that you've used it too much is that you've used it too much for your biology. And that's a key point, right? Because I know hearing, I remember years ago before I really started to educate myself,

I remember years ago before I really started to educate myself, I remember hearing that weightlifting was just bad for your joints because your joints can only joint so much. And by putting them through a bunch of repetitions, the analogy was like the heart. You only have so many heartbeats. Your joints only have so many flexions and extensions, and you're going to use them up faster if you lift weights. Yeah. And we have this idea that joints, you know, inexorably degrade with use and the arthritis model is basically an overuse injury model. The more you use the joints, the more prone they are to, to break down and fail. And it turns out that's not actually how arthritis seems to work. It's more about biological vulnerability. Cumulative inflammatory incidents are what cause joints to slowly degrade over time as opposed to being used too much. the opposite, that using your joints helps to mitigate the consequences of inflammatory

incidence, that exercise is anti-inflammatory to some extent. But it's all in the dosage. The dose makes the poison. Too much spike in loading is probably inflammatory. So it's all about that Goldilocks zone. So an RSI is, it's a collision of loading with vulnerability usually. And the nature of the vulnerability is, seems like it's rarely appreciated. That part of the equation is most people don't think about it. So more and more in my career, I try to think of an RSI as a kind of almost more like an illness than an injury. The tissue has an issue and its threshold of tolerance for strain and stress and load is a little lower than it should be. That could even be, and I'm just suddenly veering off in speculation here, it could even be almost literal that, for instance, when we are fighting off infections, when our immune system is a little

aroused, maybe it's a minor infection, not a major or scary one. And just, you know, what we're always doing, we live in a soup of microorganisms and we're fighting off organisms all the time. And our immune systems are constantly fluctuating in their levels of activity. And we've all had those days at the gym where it's just harder. It's just, hey, why is this a problem today? This wasn't a problem last month. And it may be in those states that we're particularly prone to overuse injury, but the very same use as before. It's not the amount of loading that anybody, but the concept is interesting. And it does seem to align when you were saying it, I was thinking back to, you know, I have a lot of years in the gym now and just thought of some times where, because I haven't run into much in the way of RSI's fortunately, but the, I was thinking to the couple of times that I have

and the training that led up to that, at least the last incidence of this, which would have been a couple of years ago, I had some biceps tendonitis. And leading up to that, I remember that I wasn't sleeping so well. I was sleeping a little bit worse than usual, but I was still trying to maintain my performance in the gym. And I was actually, I was trying to really continue progressing. Anyway. Yeah. So that's an interesting concept. So constant loading, but a change in your vulnerability and sleep's a big one. Yeah. I know.

That definitely has an effect on immune function and all kinds of other stuff. I mean, there's very little that sleep doesn't impact. And I suspect that's very common. Unfortunately, it's, uh, we, you know, to spend whatever it is, about a third of our life in bed to live a good life. But that's just the way it is. There's no way around it. What are the most common repetitive strain injuries for lifters? I would say you have shoulder pain. I don't think there's a fancy name for it, right?

But shoulder pain is certainly an issue. Golfer's tennis elbow, golfer's, tennis elbow, golfers slash, you know, tennis elbow, probably not too much. I've come across that with people newer to lifting when they start doing heavy curling, but it usually just goes away. And that's, and I actually experienced that myself many years ago when I started to do heavier barbell, whether it was a straight bar or an easy bar curling. Patellar issues like knee issues are pretty common. IT band syndrome or IT issues. I would say those are probably the major ones. And what you don't see is like running, you see a lot of shin splints, but obviously not in weightlifting.

Actually, I'm a little surprised to hear you say IT band syndrome. I certainly would have said patellofemoral pain, but I don't think of IT band syndrome so much as a lifting thing. Well, I would say that I hear from a lot of people who talk about having IT band issues. That's certainly, and as you say that, it's not like I'm there to work with them and confirm it. And there might be runners too. Yeah. And there may be other issues and they might think it's that, or like you just said, they're also doing other things. And IT band syndrome and telethemeral pain get constantly confused. Yes. Those two are awfully similar. When you said that, I was like, you know, actually it's hard to know unless you really know. What about carpal tunnel syndrome? Does

that come up much? No, that's not something I hear about very much. That's interesting. We'll throw in an interesting thing about carpal tunnel syndrome here right at the start, because it's one of those tantalizing clues about the nature of RSI. Carpal tunnel syndrome has a history of occurring in epidemics. It's where populations experience flare-ups of carpal tunnel syndrome, and then that dies down. Then it crops up somewhere else. A lot of people complain about it for a while. And it's almost like it's fashionable. And I don't think there's, I doubt there's a pathological mechanism for that. But maybe it's not, you know, it's not inconceivable that, you know, the disease model I was just talking about that, you know, who knows, maybe

there is an infection that makes us prone to that one. I have no idea, but it's not inconceivable. But it's just weird. I mean, it's, you know. Is it extra hand wringing? Well, there should really be a big outbreak of it right now then. Yeah, I know. I know. Why would it behave almost like a disease and occur in outbreaks? And I'm confident that the mind game in pain and injury is probably playing a role there. And that's something I've written a lot about that whenever we're injured, whenever we have any kind of pain, we have significant modulation of that coming from the brain and the spinal column.

Let's talk about that. That's something that I've read what you've written on it, and it's very interesting. And I'd say it's also encouraging for anybody who's dealing with pain to understand the underlying mechanism and how sensitivity plays a role in that. Yeah. Well, I mean, it directly implies a solution. If this pain is affected by what's in my head, then maybe I can change what's in my head. And you get into the mind over pain stuff, which is, you know, unfortunately, a little bit of a bit of false

hope there. It's really hard to boss your brain around. It turns out if it's true, it's the nature of chronic pain, particularly, your brain is calling the shots. And you can get oversensitized and have a, you know, lower pain threshold or increased pain. Worst problem with less provocation, thanks to your brain. But telling your brain to back off is, that's not easy to do at all. Brains are, the pain system is really primal. It's got its roots deep into our system. It's an incredibly important alarm system that has been around in biology since biology. I mean, you can see basic features of the pain system at work in even the tiniest

and simplest of organisms. And the reason, the basic reason that we can't just kill pain is because it's so intertwined with us. You can't take out the pain without taking out the person, which is why fundamentally anesthesia is really the only way to truly kill pain. You got to kill consciousness at the same time. So to get a little more practical here, you can't boss your brain around, but you can certainly understand the basic nature of the system, which is that it's very protective and it tends to be very overprotective. Sensation is the simpler part of the equation. It's when there's trouble in the tissues, information about that is sent to the brain for evaluation. And in straightforward acute injury, it will almost always be taken at face value. The brain

will say, okay, got a problem here, sound the alarm. In chronic pain, that relationship starts to break down, it gets messier, more complicated. And the role of perception, as opposed to sensation, starts to become ascendant. And the brain makes more and more complicated decisions about whether or not you're in pain and how much based on a large number of variables other than just what's going on in the tissue. And when you have a lot of pain that is out of proportion to what's happening in the tissues, we call that sensitization. It's a broad umbrella concept. And sensitization is extremely common in all chronic pain to the point where it's almost

synonymous. Probably not, but almost. If you have chronic pain, you are probably sensitized. Not necessarily, not 100%, but almost certainly. And the longer it goes on, the funkier it gets. And understanding that mechanism and having some informed confidence about the things, the kinds of things that might alleviate it might tame it to some degree. It's not quite mind over matter, but there are things that you can do. And the number one is just understanding what's going on might have some benefit. So it's not as dreamy an equation as it could be. It'd be so great if our minds get us into chronic pain and our minds can get us out,

but it's not really that. And it's mainly because of that mind versus brain distinction. You think of, can you boss your brain around to stop having dreams or to stop having anxious thoughts? You can try, but it's really hard. And it's the same basic problem with pain. And what else can you do? Take strength training, for example, or exercise more broadly. Can that help in certain situations where there's chronic pain? Because sometimes it can be counterintuitive to, and I've experienced this working with people where they were surprised that something was hurting and then they go and start loading it and training it, which they thought would make it worse. And then now structurally, whatever was wrong is

still wrong, but all of a sudden it's just not hurting as much anymore. Yeah. Load management is for two reasons. You want to manage load for two reasons, the tissue tolerance, but also your perceptual tolerance because Because chronic pain is usually by the time you've had a repetitive strain injury for two years, you're kind of freaked out. Some people get pretty alarmed at the possibility of pissing it off. And so you're managing the load as much to placate that alarm system as you are to control the effect, the mechanical effects of load on the tissue. You kind of need both. It's just like training a kid to ride a bike. If they get too scared, it's not going to go well. So they're fine, but you got to go at a

pace where they don't get too spooked. And it's kind of the same with sensitization. You got to go slow for the sake of the tissue.. You got to go slow for the sake of the tissue. You also got to go slow for the sake of scaredy cat brain. And it depends on your, you know, make a bit of a judgment call yourself about how much of a factor is that people whose careers depend on, you know, are deeply affected by that injury. It could be way higher states, way scarier. And the perceptual modulation of the pain could be a much bigger factor than it is for a purely recreational lifter, say. Not that recreation isn't super important to people too, but when your career literally depends on it, the freak out level. When you can't just take a couple of weeks off because you're feeling a little bit off,

it's just not an option. Right. Or the one that always breaks my heart is just, and I get a lot of these emails and it's just always so poignant. There's a number of careers, dream careers for people getting into an elite military unit or becoming a fireman or whatever career, the careers that are gated by physical fitness screening in one way or another. And I'll hear from people who've been working towards this goal to start a career for years. And two months before the all-important entry exam or whatever it is, they develop an RSI. And they write to me and they're like, how can I get over this overuse injury in the next six weeks? Because if I don't, it's all, it all has been for

not right. My dreams are going to die. It's a really tough dilemma. I mean, that is just hard because if there's one thing you can't do with RSI rehab, it's rush it. That's a very inflexible requirement of RSI rehab. So yeah, the freak out level can be highly variable depending on the context. And that is why I constantly say that RSI is play head games. If you're in that situation, you're going to have probably a lot more sensitization. So precisely the same tissue situation as that other person, but you got a worse problem. Makes sense. And I think that's a good segue into ways to treat RSI's because, you know, we've talked about some of the common ones that lifters are going to run into and that I've heard, I've just heard about, and I've experienced a couple of the common ones that lifters are going to run into and that I've just heard about.

And I've experienced a couple. I've experienced some patellar issues, which in my case, what helped there was on my right knee and my right quad was generally just tighter than my left. And by working on that consistently, whether it's, I guess, by causation or correlation, the patellar issues eventually went away as my right quad was not as tight. I mean, you could feel the difference just like massaging it myself. So I've experienced that. I experienced the biceps tendonitis and what helped there was getting the tissue worked on in the bicipital groove and then the subscap was getting the tissue worked on in the bicipital groove and then the subscap. In the beginning, my subscap was very tight and it was very uncomfortable to have it worked on. And in time, I also had to lay off what was aggravating the

issue, which I'm sure you're going to talk about, but that plus getting those tissues to just move and kind of unstick them, I guess you could say, was enough to resolve that. So my experience is limited to those two cases, but there are obviously, again, the most common that I hear about are shoulder issues and knee issues, maybe some hip stuff, like some SI joint. I've run into a little bit of that. That wasn't so much RSI, but yeah. So I think it would be, I'd be very curious to hear is like, what's your protocol for resolving these things? And then we could probably talk about how to prevent them from returning because once it's gone, it's so nice and you just don't want it to come back, you know? Yeah. And prevention is the flip side of the other side of the treatment coin. I mean, you went right to the heart of one of the most important

issues, which is defense versus defect. Was that tight right quad a defect that was causing the problem, or was it a defensive reaction to the problem? That concept defense versus defect comes from an old physical therapist, a good expert, Barrett Durko. And it's a really important concept. Our very strong assumption is that RSIs come from defects, right? That there's something's pulling too hard. The rigging is imbalanced. So that is not a very safe assumption. And so the step one of the protocol is deprogramming, ideological deprogramming. There are some very popular ideas about what the nature of RSIs is that need to be debunked

before you can get on with what actually matters. Usually there's super strong impulses in both patients and professionals to lunge in certain popular directions that are probably not a great idea. So to summarize very quickly, RSIs are not so very inflamed. So anti-inflammatory treatments, which are extremely popular, are not particularly useful. And for the most part, RSIs are not biomechanical failures. They are, in fact, you know, those defects are not defects, they are defenses that the things that, you know, the apparent problems associated with the injury are probably reactions to it as opposed to the causes of it.

And in general, our various asymmetries and crookednesses are either totally irrelevant, just completely normal, anatomical, kinesiological variability that gets the blame completely unfairly, or they are a factor, but they're relatively trivial and basically drowned out by the much greater importance of loading and biological vulnerability. You know, it's interesting. I just think of right when you're saying that, that something around the same time period when I was having this knee issue, it wasn't too bad. I was able to work out through it. It was just kind of obnoxious is I noticed that I was tending to favor my, I'm right legged that I was tending to favor my right leg in the squat in particular later in a

set when it's starting to get hard. And I'm really just trying to focus on like maintaining proper form. And I then started to consciously change that as well, where it felt like I had to almost favor my left side, but I've experienced this through playing sports growing up and more recently with golf in particular and what it takes in terms of what you think you're doing and the changes you think you're making to actually achieve even slight changes objectively, like when you're on camera looking at what you're doing with your body. So it felt like I had to actually almost favor my left side, but if I were on like power plates, I know that that wouldn't be the case. It would have been pretty, a lot closer to even than it was previously. So that kind of speaks to what

you're talking about, where I was doing both of those things where I was like, okay, my, and I, and at this point I hadn't spoken to someone like you, I hadn't gotten a real expert insight into what could be going on. Cause this was like a new minor little niggling thing that I was like, oh, okay, this is interesting. Hadn't quite gotten to the level where you were going to seek an expert opinion on it. Exactly. So at the time of working on my right quad a little bit more, just so it could be looser to just less muscle tension in their residual, like if I'm just sitting down, for example. But then I also, in my workouts, started to consciously favor my right side a little bit

less and try to keep it more even, which would speak more to what you're talking about where, okay, so now could have just been an issue of overuse if I was loading this right leg too much compared to the left leg and, you know, repeat that often enough with enough weight and things start to get aggravated. Yeah. Let's start with the inflammation because it's, it's interesting and it's easy. And it's important because that's what a lot of people they turn immediately to is. It's the first, yeah. Yeah. Whether it's NSAID that's what a lot of people they turn immediately to is. It's the first. Yeah. Whether it's NSAIDs or they try natural anti-inflammatory solutions. Or they succumb to the temptation to accept an injection of corticosteroids, which definitely nukes pain. It's very good at that, but quite a price.

Definitely some significant adverse effects associated with those things. So the idea that repetitive strain injuries are inflamed has gone through significant evolution over the last 30 years. Once upon a time, we all just said, oh yeah, that's inflamed. Some inflammation you got there. And then probably starting about 20, 25 years ago, experts started pointing out that there were basically absolutely no signs of classic acute inflammation in these injuries. So take a, you know, where an example of where it might be the most obvious Achilles tendonitis, very superficial tissue, you know, very easy to touch and, and manipulate the affected tissue and see it. And outside of the, you know, maybe bad, acute, fresh cases, there's just no sign of obvious inflammation. The classic signs of

inflammation aren't there. Redness and heat and swelling, and the more chronic it gets, the less obvious signs of inflammation there are. And so it became this very, you know, sort of reflexive, actually, RSIs aren't inflamed. And for years, you would hear that there are all kinds of papers about how it was not tendonitis, it was tendinopathy, that is condition of the tendon as opposed to inflammation of the tendon. So that was phase two, was years and years and years of smug experts, including myself, saying, oh, those RSIs, actually, those aren't inflamed, so don't treat them for inflammation. But very recently, phase three began. Finally, someone got around to looking at the more subtle biology of tendonitis and basically said,

more subtle biology of tendinitis and basically said, oh yeah, no, it's definitely inflamed. It's just not acute classic inflammation. And the basic biological lesson here is that immune function is really complicated and inflammation is not one thing. There's a huge spectrum of biological reactions to stress. And you can certainly be inflamed this away instead of that away. But it's all still relevant. The objections to it's not inflamed, so don't treat it like it's inflamed. The most straightforward example is, yes, it is technically inflamed, but it's not inflamed in the way that you can treat with over-the-counter anti-inflammatories. Because those drugs were selected throughout history for their effect, classic acute inflammation, not weird, subtle, chronic tendon stuff,

Not weird, subtle, chronic tendon stuff, not this more advanced inflammation that certainly is real and exists. So the biology of chronic inflammation of an overuse injury probably overlaps with the biology of classic acute inflammation, but only somewhat. And how subject to the effects of those standard medications like an aspirin or ibuprofen, vitamin I, how much is it affected by that? Not that much. People don't get very far trying to control RSI inflammation with standard anti-inflammatories. Interesting. That's news to me because in my case, i didn't take any

drugs i just kind of dealt with it worked through it and let it go away but of course that's where a lot of people go first in many cases just so they can keep going to the gym if nothing else first second last middle and you know like there are people who take anti-inflammatories like candies, which, by the way, is bad. These are dangerous drugs in regular usage. They're not dangerous drugs in brief, you know, small doses and temporary usage, but they have really significant side effects in chronic use, including everybody perk up and listen carefully, including they actually seem to impair tissue healing. So you really don't want to take these like candies. It's a bad idea to say nothing of their more familiar effects on your gastrointestinal tract and so on. One of the most practical pieces of advice that I can offer in this interview is use

the topical anti-inflammatories, which nicely has just finally, Voltaren has finally become an over-the-counter drug in the US just recently. So it's finally more accessible than it used to be. This is basically just ibuprofen in a tube, and you can rub it directly onto an Achilles tendonitis. And that way you're not soaking your entire system in the drug. You're just delivering it to where it's needed. If it's needed, it may not be, it may not have much effect on the weird inflammatory state of a chronic injury, but at least you get to try without literally applying the drug to your entire

system. So that's a huge advantage for experimenting with that treatment. Yeah, that makes sense. If you like what I'm doing here on the podcast and elsewhere, definitely check out my sports nutrition company, Legion, which thanks to the support of many people like you is the leading brand of all natural sports supplements in the world. When would you, and under what circumstances would you say, yeah, it's worth trying and then what else should be done? And maybe also just in terms of how would this, if you were to turn this into a flow chart, like, okay, you have an issue first, let's start here. And then.

This is a really great example of evidence-based medicine in action because evidence-based medicine has always by nature included the patient priorities, as well as the practitioner's experience in addition to what the scientific evidence tells us. So, you know, a really great example of what that flowchart looks like is, hey, does your dream job depend on you being pain-free for the next three days? Then this might be a good time to take the risk of the medications. Or, you know, even more dramatically, this might be the one situation where the corticosteroid shot is indicated. Whereas for virtually any other patient, I might say, you know what, an hour that cost benefit analysis says no.

But when the stakes are super high and you only need temporary relief, well, bingo. That's the time to take that chance and use that kind of a treatment. And by the way, corticosteroids are magic with essentially all forms of inflammation. They will nuke immune system activity, which is synonymous with inflammation, across the board. Broad spectrum, very good at controlling that. So, you know, if you've got, let's say a gluteal tendinopathy or greater trochanteric pain syndrome, you know, that's a condition that often responds very well to corticosteroids for a while, and you're right back in trouble again. But that's exactly what you need. If you're one of those, you know,

desperate people who if you know, if I don't pass this physical, I don't get to start my dream career. There's a right time for everything. Makes sense. And that's not going to be the case for most of the people who are going to listen to this. So where should they start and where does it go from there? In the inflammation department, definitely start with the Voltaren, see what that does. It's a great way of controlling the dose and doing a little experiment. And the biology is so complex that we can't be very well guided by evidence.

So it just comes down to empiricism. Give it a try. Keep an open mind, but not so open that your brains fall out and see what happens. And whatever you do, don't become, even if it works, even if it helps, even if you think this stuff is great, don't keep taking it, you know, use it to control flare ups, use it when the stakes are higher for you, for whatever reason, maybe a competition, right? By all means, there's biological and scientific justification to experiment with the anti-inflammatories, just control your expectations and control your dose. So that's

where you start. Next step in the deprogramming is to not obsess over crookedness and anatomical abnormality and form and posture and ergonomics and gait and so on. All of these things, as I've said already, they might be involved, but they're probably drowned out by loading. Loading, loading, loading is almost always going to be a much bigger factor. The reason that it's important to understand this is because so much therapy and surgery is based on correcting alleged biomechanical defects. I call this basic, this paradigm structuralism, the belief that the problem is with how you're built or how you move. And a lot of it is just classic streetlight fallacy. We look where the light is good and we can literally look in the mirror and say, hmm, I seem crooked. And these things get an enormous amount of attention

from both professionals and patients. And they are the justification for expensive, risky surgeries that don't work. And we could go on a whole tangent about how bad surgeries are and how badly they work for this kind of stuff particularly. But that's not all. It's not just the surgery.

I had Stuart McGill on the show some time ago and he was, yeah, he was talking about, obviously in the context of the back, but yeah, he spent a bit of time just thoroughly describing why you should avoid back surgery at all costs. And he acknowledged there are some cases where, hey, that's what you got to do, but that should really be the last resort unless there is overwhelming evidence to like, this is the only way.

Yeah. And it happens. I had a buddy who had terrible chronic back pain for three years before a tumor was finally discovered, nestled up against his spine and boom, take it out. He was better. So it depends. But in general, yeah, it's absolutely the last resort. The part of this that really gets me though, and I see far, like, I mean, surgery is a big industry. Orthopedic surgeries is obviously a huge industry and a lot of it is misguided, but the alternatives to it are just as messed up. That gets lost. It's easy to get people on board ragging on surgery. Like that is not a hard sell. Almost anyone will jump on board with that and go, yeah, those surgeons, man. But the problem here is that the alternatives, the popular alternatives are just as misguided in their attention, correcting alleged imbalances and crookednesses.

lots of chiropractic therapy, lots of massage therapy, that $2,000 course of rolfing to release your fascial restrictions and straighten you out, all that kind of stuff. It's all predicated on the assumption that there's something wrong with you that needs something that can be straightened out. And unbelievable amounts of money and time are spent on that, and this is the critical part, at the expense of what actually matters, which is, in two words, load management. Load management is what matters. It gets neglected because of this. There's so much attention focused on, oh, my right foot sure swings out. That's got to be the reason my knee is messed up. No, probably not. It might constitute a minor vulnerability, but basically, you know, the 30 years of intensive research to identify risk factors for these injuries has totally failed to cough up any clear signal that the way we're built or move is a critical factor. It's just not there.

Well, that's encouraging because what you're talking about, movement screening is a buzzword that you'll find in the fitness space, right? Where there are some people who they sell people on doing that before they even get into working out. And because if they're not moving the correct way and then they go and start loading it, then they're going to cause even worse problems. And then it's going to be even harder to fix if not impossible, eventually, et cetera, et cetera. You're talking about managing load. Now, what do you mean by that? Yeah. Load management is the dirty little secret of rehab is that it's incredibly simple. It really all just boils down to taking baby steps back to normal function. But the devil's in the details. Exactly how, what pace, what do you do? What do

those baby steps actually consist of? So most people need a good coach who's focused on the right thing to help them with that. But in principle, rehab is crazy simple. It's just Goldilocks zoning. It's just making sure that you're always stimulated because it's absolutely important to have some kind of stimulation or activity for the tissue, but it's equally critical that it's not too much. And this is routinely screwed up because of the no pain, no gain culture, because of our general gung-ho-ness, particularly in North America. There's a long tradition of too much too soon in rehab in North America. And it's screwed up because of our preoccupation with that other stuff. If you're convinced that the real problem is the way you pronate too much, then you're just not looking at the right thing and

you're going to design your rehab program around the wrong stuff. Oh, by the way, another example of being seriously distracted, you know, even if you leave the sort of weirder world of chiropractic and massage therapy and you go straight to totally conventional rehab with a good physical therapist, you can still run afoul of structuralism with this incredible obsession that the industry has with corrective exercise. With the idea that you need to do a whole bunch of fiddly little exercises, very specific and quote-unquote advanced, that will correct you, that will fix you, that will make you better. Really what you need is just to be in the goalie lock zone. That's much more simple in principle. All that corrective exercise stuff is just as much of a distraction as the therapies and surgeries. A lot of that is also promoted as preventative, especially I've seen it with high-level athletes

that it's not enough for them to do basic strength training. They have to do all this corrective, but it's presented as preventative stuff so they don't mess themselves up doing the front squat, you know? And that also, by the way, ramps up hypervigilance, which probably contributes to the head games, right? I have many, many times I have seen, you know, people in rehab who the flip side of their obsession with good form is fear of bad form. Fear, like proper anxiety about it. And that is not good for sensitization. So there's just a,

there's a whole bunch of ways in which the structuralism misleads people from what really matters, which is mostly just load management. And the number one thing that people get wrong about load management, even when they do it is not enough rest, especially right up front. That's an important idea that I've hammered on, on my website for many, many years. Yeah. Let's get into that because let's say, let's say right now there's someone listening who is having shoulder pain and it's getting in the way of their bench press. And I've been there myself again. Like I was that guy who I was pushing through it until I was like, all right, this officially feels really bad.

As opposed to unofficially. Yeah, exactly. Like I have to admit now this kind of sucks. So what do I do? And because that point of that, you don't want to completely just stop stimulating tissue altogether is, I mean, you're going to talk about this, but that's also something that I've seen a lot of people where they think that, oh, something, if something's hurting, well, then they're just going to do nothing with it and wait for the pain to go away. Yeah. And it's both, right? You start

with any official pain with anything that's gotten to that level of, oh yeah, okay. This is a problem. This is like pain with capital P. It's a proper noun. Right, yeah. I have an issue here and I need to take it seriously. Once you get to that stage, probably the first step every time should be just back off completely for at least a week. Stimulation is really important and no tissue will thrive without some stimulation, but you're going to be okay with a week or two or even three, but that initial step should be really to just really take it easy more than, I mean, I shouldn't even use that phrase because when I say take it easy, most people hear, oh, so you mean only do 20% of my normal? No, I mean, stop, just stop.

Oh, well, you mean 80%. Right, right. 80 normal? No, I mean, stop, just stop. Well, you mean 80%. Right, right. 80%, yeah, right. I was going to say that. I've heard from so many people where I've asked, they're like, oh yeah, I rested it for a week. And then what it turns out is like, yeah, no, instead of 10 sets of bench press, they did seven. Okay, that's not right. And I've heard a million variations of this over the years. And it is like really classic pattern that, you know, people will insist that they have taken it easy, quote unquote. But when you drill down into the details and get them to admit what they've actually been up to, it's often shocking. The runners are the worst for this, you know, like the average runner's idea of taking it easy. owner's idea of taking it easy. I only ran 30 kilometers instead of 35. And that's not going to cut it for dealing with an overuse injury. So step one is always to just back right the heck

off, completely stop stimulating the tissue. And the reason for that, you know, virtual stoppage for a little while, it's the first baby step. And even though total rest is not generally favored in rehab, the reason it's important is because especially in a flare up, your envelope of function is very, very tight and narrow. The tissue is extremely intolerant of loading at that point it will change rapidly in most cases if you just back off that threshold will rise quite steadily as you rest but initially when you're right in the middle of a flare-up it takes almost nothing to piss it off. So it's that super low threshold for irritation that is basically why you have to begin with good rest. There's a big difference between your first episode,

you're only three weeks in, it's barely subacute. We're not talking about a truly chronic thing. That's quite a different scenario than the person who comes to me after 18 months or God forbid, five years and says, you know, I've had this the entire time and I have quote unquote tried everything. The resting strategies are going to be different there, but mostly just in scale. For the relatively fresh one, for the, you know, where you're just for the first time taking it seriously, you seriously, a week or two is almost certainly as much rest as you need before you begin, before you start taking baby steps back to normal function. The stakes are higher. The more chronic it gets, the higher the stakes. And you run into

this basic dilemma in resting, which really gives people a lot of trouble, which is that you start resting. And how do you know that it's better until you test it? And the only way you can test it is by risking annoying it, by risking irritating it. And so the longer things go on and the higher the stakes get, the more courage of your conviction you have to have and say, I'm going to gamble because there has to be some gambling. There's no way to avoid it. Mostly take it easy and avoid the aggravating activities for four to six weeks. And that's- And just to chime in, that's what I had to do. And this also just brings to a question I wanted to ask you about rest is, so in the case of this biceps tendonitis, it took probably a couple of months because I stopped doing the activity that was aggravating it the most, which was any sort of barbell bench press just did not play well with what was going on.

However, something like a low cable fly was fine. A dip was actually fine. And maybe one or two exercises. So I wasn't completely resting it. So I maybe prolonged the rehab slightly because of that, but I did have to stop doing what was directly aggravating it. And I had to stop for a bit until I was able to, and I, and exactly what you just said is what I did. And because it was annoying enough and it's not that big of a deal, I can work around it, whatever. And when I did finally come back to the bench, I came back slowly. Okay. How does it feel the first time back?

It still didn't feel, feel better, but not right. And I was like, Nope, go back to what I was doing. And I probably would have gotten back to normal faster if I, and I'd be curious as to your thoughts on that, if I would have maybe avoided even these other exercises that they didn't annoy the biceps tendon, like the bench press, but it did probably aggravate it a little bit. So that was my, my kind of compromise, I guess, that worked out. Well, pretty good. I mean, that sounds just right to me. I mean, that's, you were juggling, you were juggling the priorities quite well, I think there. You get selective with exactly what to do and not do. And the worse the situation, the more selective you have to get. We call this relative rest, where you, it's kind of a weird term, it doesn't really work for me actually.

But what it means is that you rest the part that needs to be rested and you exercise everything else as much as you can, also known as working around the problem. And that, you know, this is another one of those devil in the details things, simple in principle, very hard to execute practice. And I get an awful lot of email from people, you know, saying, what about this? Can I do this? Does that, is that going to irritate my knee? What about this? email from people saying, what about this? Can I do this? Is that going to irritate my knee? What about this? And usually the answer is, does it use your knee? I know. And that's the trouble with it. There also was side raises. I had to use less weight and I couldn't do what I normally was doing with side raises. There were other exercises that I had to modify or just stay away from in

addition. And the barbell bench press was, the flat barbell bench press was the key exercise I just had to stop doing for several months. But yeah, when you're in the gym and if it's something like your shoulder or your knee, it can be difficult to work around without just stopping, okay, I guess I'm not doing any of this major muscle group

for a bit, you know? Yeah, sometimes you can get away with working around it closer. It depends. It depends on the situation. Not every knee activity, not everything you do with your knee is equally stressful for the knee. Or, you know, if you're dealing with a very specific injury like patellofemoral pain, some knee things are just fine.

They're not really going to stress the patellofemoral joint specifically very much, but other things like a squat are going to in a big way. So it can get pretty gnarly trying to figure out exactly what you have to avoid. And for these, you know, for particularly desperate cases, you know, I teach people to go through quite an extensive experimenting phase where you test things systematically. Is my knee okay with this? Is my knee okay with that? And you rate them and you, you know, you decide that these activities are verboten for three months and these ones are verboten for two months and these ones, you know, I can go back to them after, after a month because they're, you know, they cause a little bit of knee loading, but probably not too bad. So, you know, the higher the stakes, the more serious and detailed you get about exactly what you rest

and for how long. There's always this perpetual dilemma with the resting of if it's working, you can't really tell because you're not challenging your knee. The moment you do, you could set yourself back. So I just want to put an upper bound on this. Resting doesn't always work. You know, there are good reasons for this. You know, like a simple classic example would be some cases of IT band syndrome are not truly overuse, but caused by something like a cyst that is in the way. And it is actually, you could call it an overuse injury, but it's a perfect example of overuse or usage colliding with a vulnerability. It is overuse for that low threshold caused by the cyst. And you can rest that sucker for a year and it'll flare right back up again as soon as you

get back into it. So you have to put, you know, this is, I tell people that it's a, it's a very important experiment to try because there's an awful lot of tough repetitive strain injuries that will back off if you rest them. And many people think they've tried taking it easy, but haven't really. And if they actually do it well, they may get a really happy surprise, it, well, they may get a really happy surprise, but you may also find out that no reasonable amount of resting seems to have any impact. And so I give a rough upper limit of six weeks. If you give it, if you give a good, hard resting try for six weeks and you go back to it, baby stepping carefully, getting back into it, and you still end up right back in trouble two or three weeks later, well, you've established that rest probably, for whatever reason, isn't going to do it for you. But that's a good guideline. And again, in my case, that's something that I didn't rest it

the way you're talking about. I still was using it. I just set a low threshold for aggravation, basically. I was willing to experience a little bit, but not very much. And so I prolonged the return to normalcy. But I was also still able to get in the gym the way that I normally did and changed a couple workouts. I was still able to get good workouts. So going back, I may not have changed anything because do I really care that much if I can't barbell bench press for a couple of months? Not really. strength that I'll ever be able to gain. And before the virus, I was working back towards some previous PR numbers on strength. But even that is like the average natural limit for men.

I've talked about this, the 3-4-5, the three plates on bench, either so 3-15 on bench, the four plates on squat 405 and the 5-4-95 on deadlift. And that's about where I was at with my previous PRs. And I think that's a fair, a goal that most guys will be able to get close to if they train long enough and train well enough. So I'm just not concerned with the muscle growth side of things because there's not much muscle left for me to build. And I'm not too concerned with the strength side of things because I did that. So yeah, if I couldn't bench press for six months, I would have no problem with that. You can even, you can rebuild it. You can always rebuild it. You do it once, you can do it again. Very often the initial reaction to being told that, you know, if you really are serious about

resting in a good resting experiment, it could take up to six weeks. The first reaction is usually six weeks. I can't abandon my blank, fill in whatever it is for six weeks. You know, that'll just destroy my training schedule, drama, drama. And the answer is really simple. You know what? The only thing that's worse than not being able to do that workout or that exercise, even that one specific exercise for six weeks, not getting over your injury and not being able to do it properly for the next six years. That's worse. So usually when I put it. Take your medicine. Come on.

yeah, if I have to choose between six weeks of taking it really easy versus six years of constant frustration and semi-disability, I guess I'll try the resting. And it really is that. The consequences of overtraining and not rehabbing properly and suffering indefinitely from an injury are severe. You don't want that. And so it makes all kinds of sense. And of course, most people aren't, they're not in a situation where they need to dedicate six weeks to a really rigorous resting experiment. You know, for most people, it's like, ah, three weeks, you know, just back off from that for three weeks or a month, and that's good enough, or even just two. And I don't want, I want to get to prevention before we wrap up. So I don't want to get off if it would normally send you in another direction for a while. There's rabbit holes everywhere.

I know. I know. As interesting as it is, I'm just cognizant of the time. I want to make sure we can talk about prevention. But okay, so six weeks of rest and that's not fixing it. What should they do at that point? Is it time to see a good PT and look deeper into what's going on? Yeah, partly it's cause for more investigation.

That might be where you would first consider imaging, for instance, depending on the problem. In some cases, it wouldn't make much sense. In others, it would. Depends on the specific injury that we're talking about. But yeah, that's where you start to say, you know, we can recover from practically anything with careful load management. There's very little that the human body can't bounce back from. So if it fails to bounce back from it, that is basically a trigger for more intensive

diagnostic investigation. Okay. That makes sense. So that's probably the main reaction to, you know, so what if resting doesn't work? That's what I thought. Yeah. And that's what I would do personally is it's okay. It's time to find somebody who knows a lot about this stuff and let them check me out. There's one usual suspect that I think I can wedge in here before we move on to prevention. And this is certainly a rabbit hole. It's one of the deepest rabbit holes there are, but I can summarize easily. And that is that often one of the unsuspected and relatively treatable causes is the phenomenon of muscle pain, sensitive points in muscles that are associated with stiffness and aching. A lot of so-called overuse injuries

are either greatly complicated by that or even entirely caused by that. And that can be, even though we don't understand it, we don't really understand the nature of this injury. You can basically think of it as it's not a tendon, it's not a joint, it's not bone, it's muscle that's overused. The muscle has been injured by fatigue or overuse. I'm not saying that's how it actually is. Staying away from the rabbit hole here, the science behind this is really tricky and just not there. So we don't understand sensitive spots in muscle, but they are certainly there. And it is surprising how much good a little rubbing can do. This would be a very good reason i've experienced that like um i've used a massage gun for things like that and found a couple spots that if i just when when i was in

the office with people back when that was a thing there were a couple spots it was i would do it myself but i couldn't because it was on my back like there was a portion of the longissimus muscles and hard to say which of the rotator cuff muscles, cause they kind of, you know, what was it? The, one of the Terry's muscles. The infraspinatus is a common problem. Yep. And so, but there were a couple spots that we would massage gun every day and it just felt good on my shoulder. And it helped with just keeping the, keeping any sort of bicipital groove discomfort at bay. And so it's interesting that you say that. And I didn't have a good explanation for it. All I knew is that it did something. I'm like, I don't care. It takes 10 minutes and it works.

I'm just going to keep doing it. And as long as like virtually the only thing to watch out for is just, you know, especially at first, don't go nuts. You know, I've seen people attack their sore spots in a way that seems likely to make them worse. I read about that. So what I did is I just did it until it was no longer as sensitive. I didn't even try to, you know, quote unquote, resolve what I was feeling. It was just.

Yeah, just take the edge off. Exactly. And that's it. We do it every day. And I found that the sensitivity, assuming that's what it was, is probably more perception, but who knows, is that what I was feeling became less and less severe. And not that it was too severe to begin with, but by the end of a couple of months of doing this, the discomfort was almost completely gone. Right. Yeah. And that's a really common experience. Very often when people first start to have a problem, those sensitive spots are really acute. They're super

sore to press on. A really good example of this would be when people have shin splints. Very often they have just a tremendously sensitive point in the thickest part of the shin muscle. Shins do have muscle, believe it or not. There's quite a thick muscle there. And man, is that spot so sore in some people. And just, you know, you don't have to go crazy, hammering on it, just a little bit of rubbing each day. And two weeks later, it's just not that bad anymore. It's still there. You can still, you know, if you pressed harder, be like, yep, still sore, but it's nowhere near as outrageously sensitive. And for some percentage of cases, that's it. That's the game. You just solved it. And in those cases, most likely the overuse was to the muscle, not to a tendon or a joint or some other

anatomical structure. So we can segue from that straight into prevention. Let's do it. So muscle, control those sore spots, be aware of them and do a little bit for them. This is very lightweight. It is not good science-based medicine because we just don't understand what's going on here, but it is a perfectly fair experimental therapy because it's really safe. It's very easy and super cheap to do for yourself. There's plenty of DIY massage that you can do that seems to be surprisingly effective at taking the edge off of this stuff. And if it doesn't work, you haven't lost that much or risked that

much. So just a little bit of attention. Yeah. I went with the massage gun just because he is a guy who has helped me. I was like, all right, you don't have to massage me. I will use this thing. Just put this. You don't have to beat the shit out of me. Let's just go easy on these spots. And that's it. Yeah. And while I'm a huge fan of actually going to see a massage therapist that's got wonderful benefits for me, the stakes go way up as soon as you start paying someone more than a buck a minute. Self-massage option is excellent because it's pretty safe and pretty cheap. If you're doing what you're talking about, you find your spots and you just know and you spend five, 10 minutes and you're on the couch and you're done. That's it. And it's not a life sentence. Typically, once you've taken the edge off, it takes a lot less to maintain. So, you know, for an example, I had a very persistent back problem for about two years, was never severe, but it did get up to super annoying in a few patches. And the initial phase of taming those sensitive spots took about, well, let's just say too darn much time every day for

about three weeks to a month. It was a good investment of 15, 20 minutes a day. And now once I was done with that, it's more like five minutes. Were you able to do that yourself? Oh yeah. So you're just reaching back and you just had to hit the different spots. No, no, no, no reaching. Just use a nice ball. It's the good old ball against the wall trick. I have a nice selection of foam and rubber balls of different sizes and densities, as every person should. And yeah, you just trap the ball between your back and the wall or the

floor and roll around. It's basically foam rolling with a little more pointed an object, a small sphere instead of a cylinder. Same idea. And by the way, that's a hot tip because the, you know, what we're talking about here is why foam rolling is so popular. It's, you know, this is what foam rolling is all about. Yeah. I was going to comment on that because it's something that I get asked about now. I feel like I'd have to look on Google trends. I don't know if it's as popular now as it was several years ago. There was a time when I would get asked about it all the time. Now, not so much. Yeah, I think it's probably not quite as hot right now as it was for a while there.

But my big complaint about, like, I don't have any problem with foam rolling in principle, except that it got a little too faddish and the claims got a bit out of control. But the main problem I have with it is just like, if you're going to do it, do it better. A foam roller is not that good. It's too blunt an object. It's very good for certain muscles. And that's why I got away from it for that exact reason. It was like, yo, I guess my hamstrings, my quads, but it's pretty limited compared to, I got one of these spiky balls that I would use. An analogy that I like is imagine if your massage therapist hands were two feet across and their thumb tips were six inches across. You don't want that massage therapist. You want a

more accurate set of hands. And the foam roller is just, it's just too big and little foam balls. In fact, even very tiny ones. So for example, for the very common example of shoulder pain, as you've mentioned a couple of times, the infraspinatus muscle on the back of the shoulder blade is very difficult for us to reach with our paws, but very easy to reach with a little ball. And I use a squash ball for that one, very tiny. And that's a little bit tricky for the DIY thing because I know exactly where I'm headed. But the point is, if you know where you're going and exactly what spot you want to press on, you may want the very opposite of a foam roller. You got to put away the chainsaw and get out the scalpel.

Yeah. Just a tiny little ball that gets right on the right spot can be perfect. And for people wondering, okay, so how do we find these spots? Is it just trial and error or does it require special anatomical equipment? So it's just... It's trial and error. I publish a series of articles on painscience.com called the perfect spots series because there are certain classic spots that crop up again and again and lots of people that are fairly common in the population. But bottom line is people get way too obsessed with it. Now you have to share some of the perfect spots because people are going to be like,

oh, I need to know that. Yeah, yeah. I was just talking about one of them on the back of the infraspinatus. You probably have experience with another one in the bottom of the lateral quadriceps. So just above and to the outside of the kneecap and the thickest bulge of the quads.

There's another one. Pit of the low back is another one. The top of the glutes where the gluteus maximus hits the back dimple just below that. You know, for those of you with the tennis elbow, the top of the arm muscles where they attach to the bump near the funny bone nerve. So just in the thick bundle of muscle there, that one's directly analogous to the one that I mentioned in the shins, the top of the shin muscle. That's another classic. I think,

man, I can almost rattle these off top of my head, but I know I'm missing. Yeah. I'm impressed. They're all very familiar. I thought I was going to get three. For anyone who doesn't know this about your guests,

I used to be a massage therapist. So that's, that's why I know this stuff like the back of my hand. But what I really want to say is don't get obsessed with trigger point charts. There are charts out there that, you know, show you, you know, allegedly every single spot in the body that is a trigger point. And it's not like that they move around, there are patterns and trends. But when people get really, I see a lot of people getting really obsessed with the anatomy and trying to figure out exactly where to press. And that's probably not the best way to go about it. The best way to go about it is just to explore and find your own sensitive spots,

wherever they happen to be. Just, of course, always exercising common sense with your intensity. And if you're noticing that your eyeball is very sensitive, don't press harder. It's your eye. It's supposed to be sensitive. So yeah, other than a little bit of prudence in where you press, virtually any obviously muscular spot that is a bit sore, that's your trigger point. It doesn't matter what the chart says. That's great. And all right. So that's a really good tip for prevention. Are there any other key ideas that people should understand or other just simple strategies like that, that they should just do alongside their training really to stave off the RSI? This is weird. The brain is weird. I don't understand why I've never written about this. I'm going to throw something that I really like and really believe in, but I don't think I've

ever written down. 2 million words of content on painstaking.com. I don't think I've ever written this thought down. Let's call it micro resting. I think there is a great deal to be said for immediately backing off when, you know, for being self-aware and having a quick rest, like I'm talking two minutes in the middle of a workout. When you notice an issue, don't push through warning signs. And that of course applies on the macroscopic as well as the microscopic scale. But my point is you can be very granular with this. So you're doing a bench press, you get a twinge in your pecs, put it back on the rack right now. If it's fine in two minutes, great. Go back to it. Resume your set. But I think there's something that happens that if you try to push through warning signs, it often escalates rapidly.

And I think that you can quite easily stave off a lot of trouble by just quickly, nimbly responding to warning signs. If you get a bad twinge in your knee while you're playing ultimate, get off the field and don't go back on for 15 minutes. Give it a chance to recover. You might be totally fine and you can go back out and play just as hard as before, but don't ignore the warning sign. Interesting. Yeah. I've done that many times myself actually, and who knows ultimately how well it worked but objectively the i'm thinking of a couple instances uh squatting deadlifting bench pressing

where i did just that and was able to carry on without issue and then there were some times where i was like no that still doesn't feel very good and and so then i just that was it for that workout but anecdotally i've done that sometimes just intuitively because that's something I've recommended for a while is if you hit pain or strange, then just stop. Just stop, take a rest, try again and see what happens. But it's interesting that you're saying that given how much more you know about this kind of stuff than I do. But it's interesting just again, that even this point that you made regarding finding your trigger points, where there are people who come, a lot of people who

come to these conclusions intuitively and they go, okay, that makes sense. And they do it and they go, that seems to work. And that's about it. And then though you have someone like you, who's very well-versed and just steeped in the science of it all, where you also are nodding your head to that as well. And thinking about how half-arsed the science is. Yeah, I know. Yeah. It's a mess. But no, that's great.

Those are great tips. Something to be said probably for deloading, right? Making sure that you're deloading properly, at least often enough in your training. Does that have any relevance here for preventing? It does. Yeah. I think lots of people over-train and got a whole bunch to say about how much and how hard do you have to train to make progress? And it's just, the simple version is less than you think. I think a lot of people actually fail to make progress. They're actually fighting themselves because they're always training before they've recovered, allowing adequate recovery time. Yeah. That's probably more common with endurance athletes in my experience than

recreational weightlifters or lifestyle bodybuilders. Yeah, probably. That's what I've seen is like you had mentioned that it can be very upsetting to a runner to be told that they're supposed to dramatically cut back their volume. That seems to just, I don't know, that seems to be more of a thing with endurance training. Oh, yeah. I mean, it's right in the name, right? It's all about the endurance. That's true.

I can keep going. Yeah, no, it's definitely more of a thing, but it is definitely a thing with lifting as well. I see it in not deloading. That's how I often see it, where if you were to look at their training volume, it might actually be reasonable, but they haven't deloaded in 11 months. And you're like, okay, well that's, and they're not like brand new to weightlifting and easing into it. You know what I mean? Like they're pushing themselves pretty hard and they just refuse to not even take a week off. That's not, you know, just take it easy. Cut your volume down.

Yeah, just a light week. But okay, great. And yeah, I think that those are really the major points, my bullet points that I wanted to hear your take on. And it's been super helpful, super insightful and practical. I'm sure that this is going to be well received. I hope so. It's tough to make this stuff practical.

I mean, it's tough. It's a lot of the lessons, especially with so much debunking. It's hard to make it. So, okay, so what do we do then? But that's part of it, though. Like you said, understanding is a key part of it that you understand. And some of the debunking, I think, is great because it will give people some peace of mind. Just that point of, okay, it's not that you are structurally deficient and now it's going to take two years of chiropractic and massage and corrective exercises before you can ever hope to possibly squat properly again. That alone, that alone is valuable information for people to have.

And that it just how simply you laid out that chances are rest alone is going to fix this issue is I'm sure a lot of people are relieved right now who are dealing with some degree of RSI and, you know, they go Googling and everything just, just, uh, comes crashing down around them because there's a lot of bad information out there about what's going on and what you should do about it. So yeah, I know. I really appreciate you taking the time. And why don't we wrap up with where people you've mentioned your website a couple of times, but just in case for anybody listening now who didn't catch it or let's wrap up with where people can find you and your work. And if you have any projects you're working on right now that you want them to know about anything new and interesting? Let's make sure that they know.

Sure. And I have no doubt this will be in the show notes, but this entire interview I've been cribbing from my own article about repetitive strain injuries, which is at painscience.com slash RSI is a shortcut to that. I'll take you right there. I am always working on lots of projects. I have 10 books and the moment I'm holding steady at 10. I'm not working on any new ones for a while yet, but I'm always building those up and improving them and keeping the science current.

And there's a thought, I mean, that's just a never ending job. And I think roughly half of those books are about repetitive strain injuries. And that's those book sales is how I managed to stay focused on this for 12 hours a day for almost 20 years now. So if you have an interest, go visit the site and do a read. There's tons of free reading, lots and lots of free reading, but buy a book. I think you said 2 million words. Yeah, something like that. It sort of depends on how you count and whether you include the bibliography and things like that. But yeah, it's a lot. I remember when I crossed the line where it was bigger than Game of Thrones.

I've written more than George Martin. Who has sold more books though? I think it'd be him. Yeah. So basically everything I do is on pain science.com. And I'm also quite active on Twitter at pain side. Awesome. Awesome. And yeah, the books, they range from stuff on headaches to frozen shoulder trigger points, IT band pain, low back pain, neck pain, patellar pain, a lot of the stuff we've been talking about just to let everybody

know that there's some, you know, I like the specificity as well. So people, they go, that's the problem. Please help me with that. So definitely. Yeah. They're all advanced guides about very specific problems and good job listing. Were you looking at those when you listed them? Yeah. Yeah, I was. I'm not that good. I can't list them all. It's been at least a decade that I've had this many and I can't ever list them all at once. I always forget one unless I'm looking at them. If you just practice it every day, then eventually... Right after my foam rolling, I practice listing my books.

No, you can multitask. Do it while you're... Well, thanks very much for the interview. It was fun. I can talk forever about this stuff. I'm amazed at how much ground we covered in 90 minutes. Thanks for this. Yes, absolutely. I appreciate it. All right. Well, that's it for this episode. I hope you enjoyed it and found it interesting and helpful. And if you did, and you don't mind doing me a favor, please do leave a quick review

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And of course, you can email me if you have positive feedback as well, or if you have questions really relating to anything that you think I could help you with, definitely send me an email. That is the best way to get ahold of me, mikeatmusclefullife.com. And that's it. Thanks again for listening to this episode. And I hope to hear from you soon.