Ep. #606: Paul Ingraham on the Art and Science of Staying Injury-Free

Mike: 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. And getting seriously hurt, getting really injured. That sucks even more. We can deal. 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 together, 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 Jim goers are going to face are what are called repetitive stress injuries, RSIs. And in today’s episode, I talk with the. I would say number one expert on RSIs, and that is Paul Ingram, who is the founder of pain science.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 rsi.

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.

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Hey Paul, thanks for taking the time to come talk to me. Hey, Mike. Glad to be here. Today’s discussion is gonna 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’re 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 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 gonna experience, we may not, 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 gonna be in the less than people think. Yeah, exactly. That’s something I have written and 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 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. True. So that’s why I thought it’d be and I just know having heard from, in here continuing to hear from so many people who are not just following my programs, but just doing this kind of stuff generally.

Paul: This of course is a topic that comes up a lot. Yeah. 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. It’s the, probably the most common kind of sports injury. Most sports aren’t all that prone to acute injury, although you see it, a awful lot of blown knees and muscle strains and sports like soccer.

Yep. But overuse is the most dangerous thing about being active is wearing stuff out or encountering biological vulnerability, doing something that isn’t, 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 

Mike: a key point, right?

Because I know hearing, 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 af 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 gonna use ’em up faster if you lift weights. 

Paul: Yeah. And we have this idea that joints, 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 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 or what cause joints to slowly degrade over time. As opposed to being used too much. In fact, if anything, there’s evidence that it’s the opposite, that using your joints helps to mitigate the consequences.

Infl of inflammatory incidents, that exercise is anti-inflammatory to some extent, but it’s, it’s all in the dosage. The dose makes the poison too much. A spike in loading is probably inflammatory. Yeah. So it’s a, 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 a, of an RSI as a kind of, almost more like an illness than an injury. The tissue has. An issue and it’s 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 into 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. 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. Yeah, we’ve all had those days at the gym where it’s just harder. Yeah. It’s just, yeah, Hey, Why is this a problem today? This wasn’t a problem last month, and it may be in those states that were particularly prone to overuse injury, but the very same use as before.

It’s not the amount of loading that changed, but the state that we were in. So that’s a really interesting idea that I’ve been trying to think about more and more as I write and work on these topics. 

Mike: Yeah, that is interesting. I, that’s something that I can’t say that I’ve come across or I haven’t had this discussion with anybody, but the concept is interesting and it does seem to align.

When you were saying it, I was thinking back to, I have a lot of years in the gym now and just thought of some times where, Cause I haven’t order it much in the way of rsi 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’ve 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 and, but I was still trying to maintain my performance in the gym and I was actually was trying to really continue progressing anyway. Yeah, so that’s an interesting concept. So constant 

Paul: loading, but a change in your vulnerability. Totally. And sleep’s a big one.

Yeah, I know. And that definitely has an effect on immune function and all kinds of other stuff. There’s very little that sleep doesn’t impact, and I suspect that’s 

Mike: very, Unfortunately, it’s we, we need to spend whatever it is at 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 

Paul: most common repetitive strain injuries for lifters? I would say you 

Mike: have shoulder pain. I don’t think there’s a fancy name for it, right? But shoulder pain is certainly an issue. Golfers 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 and easy bar curling patella 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. 

Paul: Actually, I’m a little surprised to hear you say it, band syndrome. I certainly would’ve said patella ephemeral pain.

But I don’t think of it band syndrome so much as a lifting thing. I would say 

Mike: 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 confirming So there may actually minor too, so 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 

Paul: it band syndrome and emeral pain get constantly confused.

Yes. Those two are 

Mike: awfully, When you said that, I was like, actually it’s hard to know unless you really know. What 

Paul: about carpal tunnel syndromes 

Mike: that come up much? No, that’s not something I hear about very 

Paul: much. That’s interesting. We’ll throw in an interesting thing about carpal tunnel syndrome here, right at the start, cuz it’s one of those tantalizing clues about the nature of RSIs that they carpal tunnel syndrome has a history of occurring in epidemics.

It’s where populations experience flareups of carpal tunnel syndrome, and then that dies down, then it crops up somewhere else. And 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, it’s not inconceivable the, the disease model I was just talking about then, 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. It’s, Is it extra hand ringing? Exactly. . There should really be a big outbreak of it right now then . Yeah, 

Mike: I know. 

Paul: Yeah. It’s just a very odd characteristic, 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.

Mike: 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 Yeah. If they understand the underlying mechanism and how sensitivity plays a role in that. Yeah. 

Paul: 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, the mind over pain stuff, which is, 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 oversized and have a, lower pain threshold or increased pain.

Worst problem with less provocation thanks to your brain, but telling your brain to back off is, eh, 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, 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 gotta 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 it will in a and 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 and 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 are 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. It probably not, but almost, if you have chronic pain, you are probably sensitized.

Not necessarily, not a hundred percent, but almost certainly. And the longer it goes on the funer 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 is the same basic problem with pain. And what 

Mike: else can you do? Take strength training, for example, or exercise more broadly? Can that help in certain situations where there’s chronic pain?

Cause 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.

Paul: , Yeah. Load management is for two reasons. You want, you wanna manage load for two reasons, the tissue tolerance, but also your percept tolerance because chronic pain is usually by the, by the time you’ve had a repetitive strain injury for two years. You’re freaked out , right? 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 need both. It’s just like training a kid to ride a bike. If they get too scared, it’s not gonna go well, so they’re fine, but you gotta go at a pace where they don’t get too spooked.

And it’s the same with sensitization. You gotta go slow for the sake of the tissue. You also gotta go slow for the sake of scaredy cat brain. And it depends on your, make a bit of a judgment call yourself about how much of a factor is that people whose careers depend on, Deeply affected by that injury.

It could be, way higher stakes, 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 

Mike: 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.

Paul: 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, 

Mike: it’s all has been for not.

Paul: My dreams are going to die . And it’s a really tough dilemma. 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 play head games.

If you’re in that situation, you’re gonna have a probably a lot more sensitization, so precisely the same tissue situation as that other person. But you gotta worse 

Mike: problem. Makes sense. And I think that’s a good segue into ways to treat RSIs because we’ve talked about some of the common ones that lifters are gonna run into and that I’ve heard, or I’ve just heard about and I’ve experienced a couple, I’ve experienced some patella 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 teller issues eventually went away as my right quad was not as, Tight. 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 bi groove, and then the subscap in the beginning of my subscap was very tight and it was very uncomfortable to have it worked on and in time.

I also had to lay off the A, the what? What was aggravating the issue, which I’m sure you’re gonna talk about. But that plus getting those tissues to just move and unstick them, I guess you could say, was enough to resolve that. So my experiences limited to those two cases, but there are obviously, again, the most common that I hear about our 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’d be, I’d be very curious to hear is 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, yeah. And 

Paul: prevention is the flip side of the other side of the treatment coin. 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 defense of reaction to the problem? That concept defense versus defect comes from a, an old dog, a physical therapist, a good expert to Barrett dco, 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 inflam. 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, 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 crookedness 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 vulner.

Mike: It’s interesting. I just think of right when you’re saying 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 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 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 wouldn’t be the case.

It would’ve been pretty a lot closer 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 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 cuz this was like a new minor little niggling thing that I was like, Oh, okay, this is interesting.

Yeah. Hadn’t 

Paul: quite gotten to the level where you were gonna seek an expert opinion on it. Exactly. 

Mike: 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 repeat that often enough with enough weight and things start to get activate. 

Paul: Yeah, let’s start with the inflammation cuz it’s interesting and it’s easy.

Mike: And it’s important because that’s what a lot of people they turn immediately to is whether it’s the first, Yeah. It’s the, whether it’s NSA IDs or they try natural anti-inflammatory solutions 

Paul: or they succumb to the temptation to accept an injection of corticosteroids, which definitely nukes pain is 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, Ah, 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, where an example of where it might be the most obvious Achilles tendonitis. Very superficial tissue, very easy to. Touch and manipulate the affected tissue and see it. And outside of the, 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, reflexive, actually RSIs aren’t inflamed. And for years you would hear that, and there were all kinds of papers about how it was not tendonitis, it was tendonopathy that is condition of the tendon as opposed to inflammation of the tendon.

So that was phase two was 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, Oh, yeah, no, it’s definitely inflamed

It’s just not, 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.

Like 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 this more advanced inflammation, but certainly is real and. 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 a 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. 

Mike: Interesting. That’s news to me. Cause I, when, in my case, I didn’t take any drugs, I just dealt with it, worked through it and let it go away. But of course that’s through A lot of people go first in many cases just so they can keep going to the gym if nothing else.

First, 

Paul: second, last, middle. And like there are people who take anti-inflammatories like candies. Yeah. Which by the way is bad. These are dangerous drugs in regular usage. They’re not dangerous drugs in brief, 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. , you really don’t want to take these like gies, It’s a bad idea to say nothing if they’re 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 Volter has finally become an over the counter drug in the US just recently.

So it’s finally more accessible than it used to be. And this is basically just ibuprofen in a tube and you can rub it directly onto 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. 

Mike: 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. 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 okay, you have an issue, right? First, let’s start here. And then plus just a really 

Paul: 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.

Really great example of what that flow chart 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. Yeah. To take the risk of the medications. Or, 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? And now that cause benefit analysis says no, but when the stakes are super high and you only need temporary relief, 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. If you’ve got, let’s say, a gluteal tendinopathy, a greater chi pain syndrome, 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, desperate people who, if if I don’t pass this physical, I don’t get to, start my dream career. There’s a right time for 

Mike: everyth. Makes sense, and that’s not gonna be the case for most of the people who are gonna listen to this, right?

Yeah. So where should they start and where does it go from there? In the 

Paul: inflammation department? Definitely, start with the volter. 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 you pretty much, 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 don’t become, even if it works, even if it helps, even if you think this stuff is great, don’t keep taking it. Use it to control flareups.

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, are, they might be involved, but they’re probably drowned out by loading. Loading is almost always going to be a much bigger factor. The reason that I, 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 street light fallacy. We look where the light is good and we can literally look in the mirror and say I seem crook. And these things get an enormous amount.

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, not just the surgery. 

Mike: 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 gotta do, but that should really be the last resort unless there is overwhelming evidence. Yeah. So this is the only way.

Paul: Yeah. 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 this 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 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, RA 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 crooked misses.

So lots of chiropractic therapy, lots of massage therapy, that $2,000 course of RO thing 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.

At in, this is the critical part at the expense of what actually matters, which is in two words, load management. Load management is what matters and it gets neglected because of this. There’s so much attention focused on, oh my right foot sure swings out. That’s gotta be the reason my knee is messed up.

Now probably. It might constitute a minor vulnerability, but basically, 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. It’s just not there. 

Mike: 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 gonna cause even worse problems, and then it’s gonna be even harder to fix, if not impossible, eventually, et cetera, et cetera.

Yeah. You’re talking about managing load now. What do you 

Paul: mean by that? Yeah. Load management is the, 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. 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 goldilock zoning. It’s just making sure that you are 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 wholeness, 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 gonna design your rehab program around the wrong stuff. Oh, by the way, another example of being seriously distracted. 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 a foul 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 when we’re really, what you need is just to be in the goalie lock.

That’s much more simple in principle. All that corrective exercise stuff is just as much of a distraction as as the, therapies and surgeries. A lot 

Mike: of that is also promoted as preventative. Yeah. 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. , . And that 

Paul: also by the way, ramps up hyper vigilance, which probably contributes to the head games. I have many times I have seen, 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. 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 a important idea that I’ve hammered on my website for many years. Yeah. Let’s 

Mike: get into that because let’s say right now there’s someone, listen. 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.

Paul: I’m gonna as opposed to unofficially . Yeah, 

Mike: exactly. Like I have to admit now this kind of sucks. Yeah. So what do I do? And cuz that point of that you don’t want to completely just stop stimulating the tissue altogether is, you’re gonna 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, then they’re just gonna do nothing with it and wait for the pain to go away.

Paul: . 

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. 

Mike: This is like pain with capital P. 

Paul: It’s a proper now. Now, 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 gonna be okay with a. Okay. Or two, or even three. But that initial step should be really to just really take it easy, more than, 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 norm?

No, stop. Just stop. Oh, you mean 

Mike: 80% or Right, Right percent. 

Paul: Yeah. I’m just gonna say exactly. 

Mike: I’ve heard from so many people where I’ve. They’re like, Oh yeah, I rested it for, a week. And then what it turns out is Yeah, no, the, instead of 10 sets of bench press, they did seven.

Yeah. Okay. That’s not rest. 

Paul: And I’ve heard a million variations of this over the years, and it is like really classic pattern that, 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. Like the average runner’s idea of taking it easy. , I only ran 30 kilometers instead of 35 . It’s, and that’s not gonna 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, 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 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. Yeah. 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 ver quite a different scenario than the person who comes to me after 18 months, or God forbid, five years and says, I’ve had this the entire time and I have, quote unquote tried everything. The resting strategies are gonna be different there, but mostly just in scale for the relatively fresh one, for the, where you’re just for the first time taking it 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 when the more chronic it gets, the higher the stakes and you run into this basic dilemma in resting, which is, this is 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 you 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 gonna gamble cuz it had, 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 

Mike: that’s, Just to chime in. That’s what I had to do. And this also just brings to a question and I wanted to ask you about rest is, so in the case of this biceps tendonitis, it took, ooh, it took probably a couple of months because I stopped doing the activity that was aggravating at 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, 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, felt better, but not right. And I was like, Nope. Go back to what I was doing. And I probably would’ve gotten back to normal faster if I and I’d be curious to ask your thoughts on that if I would’ve maybe avoided even these other exercises.

They didn’t annoy the biceps tend in like the bench press, but it did probably aggravate it a little bit. So that was my kind of compromise I guess. That worked out well. Pretty 

Paul: good. That sounds just right to me. That’s, 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 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, this is another one of those devil in the details things simple and principle, very hard to execute and 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 gonna irritate my knee? What about this? And usually the answer is, Does it use your knee

I know, 

Mike: and that’s the trouble with it. There also was side raises. I had to, I used 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, 

Paul: Yeah. Sometimes you can get away with working around it closer. It depends.

It depends on the situation. Not every. Activity. Not everything you do with your knee is equally stressful for the knee or as if you’re dealing with a very specific injury like Patel, ephemeral pain, some knee things are just fine. They’re not really gonna stress the Patel ephemeral 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. You have to avoid. And for these, for particularly desperate cases, 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 decide that these activities are verboten for three months and these ones are verboten for two months. And these ones, I can go back to them after a month cuz they’re, they cause a little bit of knee loading, but probably not too bad.

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. Because you’re not challenging your knee the moment you do, you could set yourself back. So I just wanna put an upper bound on this.

Resting doesn’t always work. There are good reasons for this. 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.

So you have to put, this is, I tell people that 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.

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 step carefully getting back into it, and you still end up right back in trouble two or three weeks later.

Oh, you’ve established that rest probably for whatever reason, isn’t gonna do 

Mike: it for you. That’s 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 ba basically, like I was willing to experience a little bit, but not very much.

And so I, 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 I, 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. 

Paul: Yeah. Or honestly, even. Even longer, right? It, 

Mike: yeah, exactly. It doesn’t really, at this point, I’ve talked about this where I’ve gained pretty much all of the muscle and 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 three 15 on bench, the four plates on squat 4 0 5, 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 cause there’s not much muscle left for me to build and I’m not too concerned with the strength side of things cuz I did that. So yeah, I, if I couldn’t bench press for six months, I would have no problem with that.

You can even, 

Paul: 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, if you really are serious about resting in a good resting experiment, it’s, 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, first six weeks, that’ll just destroy my training schedule. 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. And 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 to take your medicine, come on, take your medicine. Usually when I put it to people like that, I like, Oh 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.

For most people it’s eh, three weeks, just back off from that for three weeks or a month, and that’s good enough. Or even just two. 

Mike: And I don’t want, I wanna 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. As interesting as it is, I’m just, I’m cognizant of the time. Okay. And I wanna 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 or, Yeah, 

Paul: it partly, it’s caused 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. 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 it, 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. 

Mike: Okay, that makes 

Paul: sense. So that’s probably the main reaction to, so what if resting doesn’t work? That’s what 

Mike: 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. Yeah. And let them check me out. . There’s one usual 

Paul: 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 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 attendant, 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 sense of spots in muscle, but they are certainly there and it is surprising how much good a little rubbing can. This would be a very good 

Mike: reason. Yeah. I’ve experienced that. I’ve used a massage gun for things like that and found a couple spots that if I just 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 cuz it was on my back. Yeah. There was a portion of the longissimus muscles and hard to say which of the rotator cuff muscles, cuz they kind all, what was it? The, one of the Terry’s muscles, not the infr 

Paul: is a common problem. 

Mike: Yep. And 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 bilar 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 gonna keep doing it. Yeah. And as 

Paul: long as it, like virtually the only thing to watch out for is just, especially at first, don’t go nuts.

I’ve seen people attack their sore spots in a way that is, seems likely to 

Mike: 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, quote unquote resolve what I was feeling. It was. 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. Not that it was too severe to begin with, but by the end of a couple of months of doing this, it almost was, the discomfort was almost completely 

Paul: gone.

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 shins splints very often they have just a tremendously sensitive point in the thickest part of the shin muscle.

Yeah. Shins do have muscle, believe it or not. There’s quite a thick muscle there, and man, is that. So sore in some people and just, 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 it’s still there.

You can still, 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. That’s the game. You just solved it . And in those cases, most likely the overuse was to the muscle not to attend in or a joint or some other anatomical structure.

So we can segue from that straight into prevention. Let’s do it. So muscle , can those, 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 risk that much. So just a little bit of attention. Yeah, I 

Mike: went with the massage gun just cuz he is a guy who has helped me.

I was like, all, you don’t have to massage me here. We’ll use this thing. Just put this, Yeah. You don’t have to beat the shit of me. Let’s just go easy on these spots and that’s it. Yeah, 

Paul: and 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. Yeah. And pretty cheap. If 

Mike: 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.

Paul: That’s it. Yeah. And it’s not a life sentence. Typically, once you’ve taken the edge off, it takes a lot less to maintain. 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 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 

Mike: five minutes of Were you able to do that yourself? Oh yeah. So you’re just reaching back and you just had to hit the different spots? 

Paul: No, no reaching. Just to use a nice. It’s the the good 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 yet 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, what we’re talking about here is why foam rolling is so popular. It’s, this is what foam rolling is all about. Yeah, I 

Mike: was gonna comment on that because it’s something that I get asked about now and then, yeah, 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 

Paul: think it pr I think it’s probably not quite as hot right now as it was for a while there. But my big complaint about I don’t have any problem with home rolling in principle, except that it got a little too faddish and the claims got a bit outta control.

But the main problem I have with, it’s just if you’re gonna do it better. A foam roller is not that good. It’s too blunt and object. It’s very good for certain 

Mike: muscles. And that’s why I got away from it for that exact reason. It’s yo, I guess my hamstrings, my quads, but it’s pretty limited.

Compared to, I got one of these spiky balls that I would 

Paul: use. So an analogy that I like is imagine if your massage therapist’s 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 ruler is just, it’s just too big and little foam balls.

In fact, even very tiny ones. So for example, for the very com very common example of shoulder pain, as you’ve mentioned a couple of times, the infr muscle on the back of the shoulder blade is very difficult for us to reach with our pause. But very easy to reach with a little ball. And I use a squash ball for that one very.

And that’s a little bit tricky for the DIY thing cuz I know exactly where I’m headed. But the point is, if you know where you’re going and exactly what spot you wanna press on, you may want the very opposite of a foam roller. 

Mike: You gotta put away the chainsaw and get out the scalp. Yeah. 

Paul: Yeah, just a tiny little ball that gets right on the right spot can be perfect.

Mike: And for people wondering, Okay, so how do we find these spots? Is it just trial and error or does it require special anatomical could get so it’s just, 

Paul: it’s trial and error. There’s I publish a series of articles on paint science.com called the Perfect Spot Series because there are certain classic spots that crop up again and lots of people that are fairly common in the population.

But bottom line is people get to way too obsessed 

Mike: with now you have to share some of the perfect spots cuz people are gonna be like, Oh I 

need 

Paul: to know that. Yeah. And I was just talking about one of them on the back of the infr potatoes. Yeah, you probably have experience with another one in the bottom of the lateral quadriceps.

So just above into the outside of the kneecap and the thickest bulge of the 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. Yep. For those of you with the tennis elbow, the top of the arm muscles where they attach to the to the bump near the funny bone nerve.

So just in the thick bundle, the 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 

Mike: gonna get three 

Paul: in.

For anyone who doesn’t know this about your guest, 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 wanna say is don’t get obsessed with trigger point charts. There are charts out there that, show you ev, allegedly every single spot in the body.

That is a trigger point. And it’s not like that. Yeah, 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 and 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 

Mike: 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. Yeah. That they should just do along alongside their training. Really? Yeah. To stave off the rsi, I’m gonna, if this is weird, 

the 

Paul: brain is weird.

I don’t understand why I’ve never written about this. I’m gonna 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 pain paints 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 though. You’re doing a bench press, you get a twinge in your pecks.

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. 

Mike: Interesting. Yeah. I’ve done that many times myself actually.

And who knows ultimately how well it worked. But yeah, objectively the, I’m thinking of a couple instances squatting, deadlifting, bench pressing where I did just that and was able to carry on without issue. Yeah. And then there were some times where I was. Nope, that still doesn’t feel very good.

And so then I just, that was it for that workout. But anecdotally, I’ve done that. I sometimes just intuitively, because that’s something I’ve recommended for a while, is if you hit pain or strange then , 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. Nodding your head to that as well, 

Paul: and thinking about how half arched the science is . Yeah, I know. Yeah. 

Mike: 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 

Paul: preventing? It does. Yeah. I think a lots of people overtrain and got, a whole bunch to say about, how much and how hard you have to train to make progress.

And it’s just gen 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 times. 

Mike: 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. 

Paul: Oh yeah. It’s right in the name, you know it’s wrong. That’s true. But 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 

Mike: 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, that’s, And they’re not like brand new weight lifting and easing into it.

You know what I mean? They’re pushing theirselves pretty hard and they just refuse to not even take a week off. That’s, just take it easy. Cut your volume down. Yeah, just a light week. Yeah. 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 get going to be well received. I 

Paul: hope so. It’s tough to make this stuff practical. It’s tough , it’s a lot of the lessons, especially with so much debunking. It’s hard to make it, Okay, so what do we do then? 

Mike: 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 gonna take two years of chiropractic and massage and corrective exercises before you can ever hope to possibly squat properly again.

That alone is valuable information for people to have and that it just, how simply you laid out that chances are rest alone is gonna fix this issue is, I’m sure a lot of people are relieved right now who are dealing with , some degree of rsi and they go Googling and everything just 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. No, 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 in 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.

Paul: 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 Pain sci. Pain science.com/rs. I 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, 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 manage to, to stay focused on this for 12 hours a day for almost 20 years. So if you have an interest, that’s great. Go visit the site and do a read.

There’s tons of free reading, lots and lots of free reading, but buy a 

Mike: book. Think you said 2 million 

Paul: words. Yeah, something like that. It a lot depends on how you account and what, whether you include the bibliography and things like that. But yeah it’s a lot. I remember when I crossed the 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 that’d be him. Yeah. . Yeah. So it, basically everything I do is on pain science.com and I’m also quite active on Twitter at 

Mike: pain side. Awesome. And yeah, the books, they range from stuff on headaches to frozen shoulder trigger points, it band pain, low back pain, neck pain, patella pain, a lot of the stuff we’ve been talking about.

Just to let everybody know that there’s some, you, 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 

Paul: advanced guides about very specific problems and good job listing. Were you looking at those when you listed them? Yeah. 

Mike: Yeah.

I was I’m not that 

Paul: I can’t list them all. It’s been at least, a decade that I’ve had this many and it, I can’t ever list them all at once. I always forget one unless I’m looking at them. 

Mike: If you just practice it every day. Then 

Paul: eventually right after my phone rolling, I I practice listing windows.

Oh no. Yeah, 

Mike: you can multitask. Do it while you’re . 

Paul: 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 

Mike: this. Yes, absolutely. I appreciate. All right. That’s it for this episode. I hope you enjoyed it and found it interesting and helpful.

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That is the best way to get ahold of me, Mike, at multiple life.com. And that’s it. Thanks again for listening to this episode, and I hope to hear from you soon.