Episode 66: Programming Around Pain with Justin Farnsworth

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• Joe Gambino
• Joe LaVacca

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Summary

In this episode of the Beyond Pain podcast, Joe Gambino interviews Justin Farnsworth, a seasoned physical therapist and educator. They discuss the intersection of rehabilitation and training, emphasizing the importance of movement in pain management. 

Justin shares his personal experiences with pain and how they shape his approach to therapy. The conversation highlights the significance of building trust with clients, effective communication, and the need for tailored programming in rehabilitation. 

Justin also introduces his courses aimed at educating coaches and clinicians on how to integrate training and rehab effectively.

Takeaways

• Rehab and training are interchangeable concepts.
• Pain is influenced by multiple factors, not just physical injury.
• Movement is essential for recovery and pain management.
• Education is key for both clients and professionals.
• Building trust with clients enhances outcomes.
• Programming should be tailored to individual needs.
• Pain and muscle soreness are different and should be distinguished.
• Effective communication is crucial in therapy.
• Exercise can be a powerful tool for rehabilitation.
• Creating a supportive environment fosters learning and growth.

Transcript

Joe Gambino (00:43)
Welcome back to the Beyond Pain podcast. I am one of your hosts, Joe Gambino, and I am not here with our other host, Joe Lavaca today. He is helping Courtney, his fiance, move today. I am here with Justin Farnsworth. He is a sport certified physical therapist for the last 14 years and an educator as well. He is located in Rochester, New York. Welcome to the show.

Justin Farnsworth (01:06)
Joe, what's up man? Thank you so much for having me. Pumped to be here.

Joe Gambino (01:09)
Yeah, I'm excited to have you. We did get a little bit to chat before we hopped on here, but why don't you take a little time, let our listeners know a little bit more about you and all that fun stuff.

Justin Farnsworth (01:20)
Yeah, I'll give the the Cliff Notes version. um, a little bit about my life. So I've been a physical therapist going on just about 13 to 14 years now. Um, but I always tell people I was a coach before I was a PT. So I'm going to be 38 this year and I started my coaching life at 12 years old. So I used to be a pretty high level athlete, ended up playing professional soccer and it was just right place, right time. Had a coach that owned a training facility where I worked out.

and asked me if I wanted to work there. So I ended up working with the Western New York sports team. So like the Bills and the Sabres and some of those guys were in and out of that spot. the way I even think about rehab now, I use rehab and training interchangeably, because in my mind, it's kind of the same thing at different time points, maybe of acuity. But you work with clinicians, clinicians are like, yeah, I work with people that blew their back out yesterday. You talk to coaches, they're like, yeah, I got this guy who's got back pain for 20 years. It's like, we all end up seeing people who have pain and it's just.

When do we see them? So, the way I tend to think about training and rehab actually still very biased from the sports performance world. Not that like everyone's doing hand cleans and freaking box jumps and sprinting, but the, the principles and the adaptations of what a human body needs. I tend to be a little bit more like in that world from, from my previous biases. So, I've done that. And then, since 2026, I've actually led the most in-person education courses of anyone in the industry period.

Two to three times a month off traveling everywhere teaching Saturday, Sunday, 16 hour course. And then that brings me to where I am now, which is I run my own online and training business. So I work predominantly with coaches, rehab professionals, people that can execute an online programming delivery. And what I do inside of that also is provide heavy education so that the clients I work with can downstream the knowledge down to their clients.

because ultimately, end of the day, man, all of us are in pain. All of us have a thing and all of us needs a customization and tweak ability around what we do. So I predominantly run that. And then I have two courses that I run in person. One is called programming around pain. Basically my way to help coaches think more clinically, not to diagnose, not to treat, but to realize every one of their clients has a pain point. How can we be more successful at to utilize exercise as medicine, keep people exercising and moving?

When the fact of the matter is most of America doesn't exercise or move, unfortunately. And then I have another course launching called Rehab Rebuilt, which is a way to help clinicians think a little bit more like coaches. So filling in the gaps of all the stuff we all know, we complain about, we never got in school. I'm not sure about you, man, but like no one in school ever taught me how to squat. It's wild. No, I don't even think we use the word deadlift once. Like, I mean, I could tell you, I could tell you attachment of every rotator cuff muscle. Like that's cool.

Joe Gambino (04:04)
Yeah, I would say that's accurate.

Justin Farnsworth (04:09)
And then you go work with real people and you're like, all right, well, that's like foundational stuff. I need to know it to pass the boards, but man, no one cares what the infraspinatus attaches to help me actually solve someone shoulder pain. It doesn't work. So it's to help kind of meld that word a little bit too.

Joe Gambino (04:23)
Yeah, I would say, I mean, I love that. would say one of the biggest things, and I'm very similar with you, my mind is more, I'm biased more towards the strength world, the fitness world. My background was, I was a personal trainer. Before that, I worked in strength and conditioning at the college level for a while, all before I got my PT license. So I think we are very much on the same page with, I think that that experience really shaped what I do, how I coach and made life easier for me to.

process and, you know, implement physical therapy stuff that I didn't learn in school. So I think it was a huge advantage for me in a sense when I got in there from a, from an application standpoint. I do have a couple of questions for you, but we do have one question that we ask everybody at the top of the show since we do have a loose coffee theme here. So my question to you is how do you take your coffee?

Justin Farnsworth (05:12)
Uh, Black with a little bit of cream. And heavy. I'm an espresso guy. I can't tell you the last time I actually had coffee. So we have an espresso machine here in the kitchen. That's my go-to. That with like a little bit of foam on top. Perfect. How do you take your coffee?

Joe Gambino (05:13)
That'd be the hardest question I ask you today.

Okay.

Okay.

Perfect, that's nice and simple.

I am a coffee black if I'm going hot or I'm like an ice latte guy. I'm much more on the ice, so give me a cold brew black or give me an ice latte and I'm good to go.

Justin Farnsworth (05:36)
Yeah, ice lattes are money.

The only thing about the ice lattes is you just can't, like when you go to Starbucks and get an ice latte, you literally have to be like, yo, don't put any ice in there. Or like just put a few because it just waters it down and then you're just drinking caffeinated water like by the end and it's not good.

Joe Gambino (05:56)
The biggest hack

I've learned is get your ice on the side. That was the biggest hack I've learned. So I'm going to say, you got it. Yeah, exactly. All right, man. So we always ask this question as well for people is what is your experience with pain? And based on that, how has it shaped what you do, how you educate and how you.

Justin Farnsworth (06:03)
Can I take an iced latte with ice on the side, please?

Yeah, my personal experience, yeah.

Joe Gambino (06:22)
Correct.

Justin Farnsworth (06:24)
Oh man, I'll tell you the biggest thing that I think has shaped my personal experience with pain. So when I was, I mean, I don't know, was like 27, maybe 28. I mean, I'd had already 15 years of training underneath my belt. And I remember I was at a crunch fitness in Hoboken, New Jersey, where my wife and I lived at the time and we worked in New York city. And I was doing a straight bar deadlift and I felt a thing in my back.

that I'm sure a lot of people have felt over their life. And it was the ultimate like, shit moment. Like did I just blow a disc? You have that like moment of fear. You feel your back. I actually couldn't stand up and I couldn't even, I couldn't even sit comfortably for more than like three minutes for about a year and a half. And

Kudos to like my job. Thankfully, I didn't have a desk job. I was a physical therapist treating full-time patients. I lived in the most walkable city in probably the world. Like you're walking everywhere. And at that time, I found a few really intelligently put together programs from some coaches that were very like, we'll call them spine friendly on their setups. It doesn't mean we're just sitting on machines, but just how you...

use specific setups actually worked really well for your back and have it hurt and allow you to still push a little pretty heavy. And I lived a year and a half of just like this really debilitating back pain. Thankfully nothing down my legs, but just it hurt. Never got it checked out. couldn't sit comfortably for more than three minutes, but the more I moved, guess what better felt. And I just think it's interesting. And it's always hard to empathize with people in pain.

Joe Gambino (07:58)
Mm-hmm.

Justin Farnsworth (08:11)
Like I haven't experienced what you experienced because pain isn't just the thing that happened, right? It's how many factors influence someone's pain experience. All right. We're talking about the cup analogy, right? We have this cup and you have, um, you know, anxiety, depression. have, uh, how much you sleep, you have what you eat. I you genetics, right? Sometimes you got to pick your parents wisely, right? You have all these factors that come in and, know, at some point, like the cup overflows.

Joe Gambino (08:41)
Mm-hmm.

Justin Farnsworth (08:41)
And then

we say, now you have pain because there was just too much inside the cup. And then what you start to figure out is the stronger you are, not the more weight you can lift, but like the idea of getting inside the gym, getting fit, getting strong builds resilience. It allows your cup to be larger. Right? So the more resilience I have as a human, the more stuff I can actually start to handle. But that has to start with just a general like movement profile.

so I know for me and even working with patients that I'm sure people listen to this either have back pain. It's a number of cause of disability worldwide. And it's the thing that's so scary because like, your spine's there. Am I going to be paralyzed? Your disc is out. That has to be the reason that you have back pain. And this thing that's like really scary is actually really simple in the sense of the more we can promote.

You just need to move. need to find an entry to exercise that works for you. That doesn't make it worse. And we just have to like support and realize like this stuff's going to get better. But the more you downward spiral it, ⁓ the more it's going to get worse. I'm like, I live that. It'd be like, finally my back feels good. And then two days later I wake up, be like, it hurts again. And I didn't even do anything. And it helped me educate people on the journey of their recovery. It's never linear. It's always like.

Joe Gambino (09:45)
.

Justin Farnsworth (10:00)
two steps forward, sometimes one and a half back, but you're always moving forward. And all you and I see right now, like if you're in pain, you see today. You don't see tomorrow and the next day, maybe last week when you had a good day. You just see, this is how I feel right now. And I think from just a front-facing perspective of me working with people, it has helped tremendously with just like helping them get over and maintain, basically getting on those mental hurdles that people have, like when it comes to pain points.

Joe Gambino (10:28)
Yeah,

I like to I like what you said a lot here, the whole two steps forward, one step back, the whole you you could do, you know, you don't even have to do anything and your pain comes back on and and how can you help people navigate those things is quite important because the way I describe it is pain is such like a subjective in the moment, you're always feeling an experience and it's sometimes hard to kind of see if you're even on the right path forward in the sense. So I really like how you kind of break it up. You did mention

A kind of like a spine friendly setups for how you kind of went about how you were training. What kind of things were those and how have you kind of like, you know, educate on that stuff now and how would you help clients that you were seeing with that stuff?

Justin Farnsworth (11:09)
Yeah. So I think when it comes to like something like a programming perspective, right? When I look at programming for people, I look at like, here's what the human body has to do. Right? We squat, right? We get off toilets, we hinge, we lift laundry baskets. we lunge, we spend a lot of our life in asymmetrical stance, not necessarily standing on one leg, Captain Morgan, but like we're, we're asymmetrical with how we get up and down off the floor. Right? we push and we pull and then we carry, right? We, we locomote or we carry all the grocery bags into the house.

Joe Gambino (11:37)
It's gotta be

Justin Farnsworth (11:37)
in one trip, because that's the freaking rule, right? One trip.

So when I think about that, it's like, okay, that's the big picture of you. We have to do these things. The exercise doesn't really matter. Like when you squat, whether you're doing a belt squat, a barbell back squat, a goblet squat, you're squatting. Your body doesn't like know, ⁓ today it's the best. It just knows you're putting emphasis and load, right?

Joe Gambino (11:56)
and

Justin Farnsworth (12:01)
So we talk about things like low back pain, and yeah, we could dive deeper onto, well, is it a movement bias position? It hurts to touch your toes, feels better when you lean back. Is it axially sensitive when you put load on it? It doesn't feel good, right? You have that little test, you can sit in a chair and just like pull on the chair really hard and see if someone's back hurts. Like all that aside, it's basically positions that don't put a ton of load on the spine. So think about what that could look like. So we could take something like a barbell back squat, which

for most people is a horrible exercise choice. Simply because most people don't have good access to the squat position at all. And then all of a sudden we're taking this high center of mass, long lever thing that has a ton of load inside and a move you can cheat. But you know a move you can't cheat? Freaking goblet squat. Think about something like a goblet squat. Like you have this load in the front of you.

Joe Gambino (12:47)
Mm-hmm.

Justin Farnsworth (12:52)
which basically automatically self-corrects everyone's problem with the squat. You know, that's because you worked with enough people where everyone just dumps themselves forward. It also forces you to have to brace and generate some stability and tension in the system because the weight's in front, right? And if I don't brace, I will actually fall into the floor. Also, the weight in front forces you to have to do what with your hips? You have to shift back, which means your trunk stays a little bit more upright, which generally, in my experience, tends to make low backs feel better.

Joe Gambino (12:57)
Right.

Justin Farnsworth (13:21)
I'm not talking about spine neutral. Like that shit doesn't exist. We know this, right? But I don't want you like a, you know, that high school kid we've all seen on Instagram who looks like a dog going to the bathroom, like that same low back position. Like we know we probably don't want that, right? So that's another simple one. mean, belt squats are another good opportunity. have a squat pattern, but you're not loading someone's back. In fact, you're distracting the spine because you're getting a pull from the bottom to the top and like, Hey, that actually feels pretty good.

Something like a deadlift, right? We can swap out a barbell for a trap bar. We can elevate the trap bar. We put the weight within your center of mass versus having it little bit in front of you. So again, the ask from the low back is less when the weight's within me than when it's a little bit in front of me. This doesn't make something like the barbell deadlift bad by any means. It's just right, the right thing for the right person at the right time. And then really when it comes to things like training around low back pain, I mean, I think the lunge, the single leg position,

is probably the best opportunity for most in terms of getting a heavy leg stimulus without your attain the low back. something like a reverse lunge, a Bulgarian split squat or a rear foot elevated split squat, whatever word you people would like to use, right? I think those are the big opportunities. And then just reinforcing, you know, the fact that I think a lot of stuff with low back, the research is pretty consistent on telling us if you get stronger around the low back.

Joe Gambino (14:30)
Thanks.

Justin Farnsworth (14:44)
it's probably gonna also feel a little bit better, right? It's kind of funny, we do this in medicine. It's like, hey, your shoulder hurts, get stronger. Your knee hurts, get stronger. Your back hurts, my God, no. Don't ever load it. Breathe into a balloon, roll, run on the ground, do some yoga and pigeon pose and your back will feel better. And it's like, no, we have really good data that says your back has muscle around it. And guess what? If you load those, they get stronger and there's a very good chance.

Joe Gambino (14:56)
Yeah.

Justin Farnsworth (15:11)
Right, not all pain is just biomechanics, but there's a very good chance it'll help be part of the puzzle of maybe just making your back feel better and possibly even stay better.

Joe Gambino (15:21)
Now I really like everything you said there. I'm just curious because I mean, we're definitely on the same page as far as how we think about things. You definitely get the person who comes in where, you know, they're somewhat married to the movement. You know, they love back squatting or they love dead lifting or whatever it is. So how do you have those conversations with people to...

Justin Farnsworth (15:36)
.

Joe Gambino (15:40)
educate them and move them in a direction saying, this is better for you in the now and, you know, this is where we're going to be working towards in the future.

Justin Farnsworth (15:47)
That's a great question. first of all, I love those people because at least they exercise like again, they're already the unicorn. So like, yeah, actually I want to go to the gym. You know, like, awesome. You're my person. Right. honestly, man, I think it's just having the basic conversations around reminding them, look at, we are all about chasing adaptations. So if you have someone that comes in and says, I want to feel better, move better and get stronger. Those are three adaptations. The tool literally does not matter.

It's the education around, hey, you're going to get stronger and feel better. So if you would like to do that, this is going to be a better option. But also here's why. Like, so, you know, some clients or patients you work with, they're like the engineers and they want, I need the exact scientific reasons on why the, and then you have some people that just go, yeah, whatever you say, I'm going to do that. Like, okay, cool. So I think it's also as reading that person's personality. but you know what sells the best?

doing a thing that used to hurt in a different way, have it not hurt. And then I don't have to say a word. I just sold it. And they're like, oh, that felt really good. So I think from a clinician perspective, it's just finding their entry point. Again, I'll use the goblet squat as an example. That's just an entry point for a squat. It doesn't mean we do that forever. We can easily scale that up with how we take the tool. We move the center of mass. We make the lever longer. We basically rebuild those patterns from the bottom up.

Gradually expose people it's not the load that breaks you down as the load you're not prepared for right create preparedness and eventually just build them back But I'm telling you I think doing hard stuff and have it feel good is the best selling point like that exists

Joe Gambino (17:29)
Yeah, I would agree with that. And I love this thought process. think anyone listening to this right now, the stimulus is the stimulus. doesn't matter the variation as long as you're loading those tissues, right? Something's going to happen if your goal is strength or whatever it be, right? So I'm a big fan of that. Now, you you've been successful by creating kind of a buy-in around the idea of training kind of equals rehab and training as healthcare. So tell me more about how you've kind of

Not necessarily positioned yourself, but how you kind of go about this and I get, you know, going back to education and creating buying and all that stuff with, using more fitness based approach for, from a rehab perspective, because I find it extremely valuable. talk with people about this all the time.

Justin Farnsworth (18:08)
Yeah. So I guess I think when I think about this, I think of it like, what's our biggest return on investment, getting someone to move, right? Is it, once someone's bought into like movement is medicine is our biggest return on investment looking at little basic rehab exercises. Like here's a clam shell. Here's a sideline dumbbell external rotation. here's a classic standing band row for three sets of 10 with a pink band that probably wasn't here. Anything that required an adaptation, right?

Or is our biggest return on investment taking these ideas of fundamental movements, using them as complex global positions, like a squat, tell me what muscle a squat doesn't hit. Right. And then just customizing the position around underlying pathology and then underlying access. Right. So here's what that means. It's like, cause that's, that's a very up in the clouds idea. Like here's what it actually means. Right. How do we use, um, training as rehab?

So let's just create a case scenario. Let's pretend, okay? Let's pretend we're seeing a patient that has hip pain. They got some underlying FAI and they have a diagnosed labral tear, which a lot of, I have one, like a lot of people have them if you played sports and it's this thing that doesn't always predict pain. Okay, fine, cool. And then all we do is take a position. Let's use the squat as an example. It's very common for people that have hip pain to have issues going deep onto a squat. Usually it causes the hip to pinch.

So the old school model would be to say, okay, we're not gonna squat. You scored a zero on your squat, therefore we're not allowed to do it. Instead, we're gonna do all these correctives around the pattern to then allegedly rebuild that back in the squat. So what we're gonna do is we're gonna get on the floor and roll, because that looks like a squat, right? We are gonna be doing a bunch of sideline clam shells, because you gotta get your glutes stronger. We're gonna do a bunch of straight leg raises.

Joe Gambino (19:56)
Thank

Justin Farnsworth (20:04)
And then like, maybe we'll stretch out your calf a little bit too, cause that's tight. And then eventually in six weeks, I'm going to lie to maybe try body weight squat again. That's like your typical, when you're a new clinician, that's kind of what you learn, right? You break it down and then you try to rebuild those individual pieces. And then finally, let's recheck the thing that hurt. Okay. Now go with me. What if we just took the thing that hurt, coached it better, found a better position.

that they can do right now and then give that position that doesn't hurt load. And all of a sudden I'm working on all the components at once in one global pattern. That's going to give me a bigger return on investment. So for example, right, you'll find this very commonly people that have hip impingement generally, generally not all the time, right? We have to speak in generalizations because everyone's a unique individual, right? Generally they tend to lack a little bit of internal rotation of their hip.

That'd be fair. If I lack internal rotation of my hip, the more I try to flex my hip, the more I'm not going to be able to cause IR and flexion go together, right? But everyone comes in and squats the same way. They're like, I'm going to squat this way. Cause this is what the textbook said and it hurts my hips. So squatting is bad for me. It's like, what if we just realize that maybe the hip impingement side has to be a little bit forward, a little bit rotated open relative to this because your anatomy is different on your right versus your left.

And now all of a sudden they're in front of you squatting with a 35 pound kettlebell. And they're like, my hip feels great. I know it's a very long explanation, but like that's how you use training as rehab. Now you walk into the clinic and you're like, these people are squatting and hinging and lunging. And by the way, that's func like their foot's on the ground and look at a stronger muscle in isolation is still a stronger muscle. Right.

It's our job as clinicians and coaches to reintegrate that into a functional pattern. But if you just start with a functional pattern and coach it better, all of a sudden we're not doing four sets of 10 of all this corrective exercise. That's neither corrective nor exercise. We're actually just using the big fundamental pattern and loading it and getting those out of patients we want. And like that is how training equals rehab. It's the same thing. Just customize around pathology.

Joe Gambino (22:22)
Yeah, no, I like that. I mean, I view it as a continuum, right? Honestly, there's almost no difference in my mind between working with somebody who is injured and working with someone at a higher level performance level. It's just where they are in their journey and how you're going to load them at that point in time. You know, I'm a big fan of the parks the whole, you you look at a movement, you break it down, whatever's popping up that might be irritating something or that seems off, you can work on those things, but you always have to bring them, in my opinion, to

the actual movement pattern, how can you modify those things to give them success now so that this way, maybe someone can't squat, it's really painful for them no matter what you do. But what can you do in that perspective to continue to keep them moving, active, loading, I think is really important there. So I do think.

Justin Farnsworth (23:02)
And really what

you can do too, like if you find weak link stuff, that just becomes your prep for the squat. Like that doesn't become the session. Like the clam shells, the ankle stretch, whatever. I mean, can tell you right now, I, you've worked with enough people. I've worked with enough people. There's a position everyone can squat in. We just have to find it. Even if it's the highest freaking box squat someone's ever done. But then what do you do? You just supplement with single leg work to still get them into deeper ranges of motion without their pelvis being locked.

Joe Gambino (23:11)
Exactly.

Exactly.

Justin Farnsworth (23:31)
Right, because now there's more degrees of freedom and we can like angle the front and the back legs a little bit more. Like we have options.

Joe Gambino (23:37)
Right. Exactly. I mean, you said it perfectly there. There's nothing else extra I have to add here. with that, say you have somebody, they start feeling better and they say, hey, where do things kind of go from there? What kind of guidelines do you really have around health and fitness for people? So like they go through the whole rehab process. Where are your guidelines as far as fitness goes?

Justin Farnsworth (24:03)
So one of my biggest goals with people is when they finish their rehab, they want to go join the gym. Or they want to hire a personal trainer or whatever. So I mean, if you look at the minimum, what's the minimum activity guidelines? 150 minutes per week of moderate. And I know if it goes to vigorous, I think it dumps down to maybe 75 minutes. But let's like the normal human, it's like 150 minutes a week.

a moderate physical activity. I'd have to relook at this stat and I'm probably going to get it wrong, but it's something like 70 % of Americans don't even meet that, like at all. Yeah, I could Google it right now and find what it is. It keeps kind of changing, but it's like, it's well over 60 to 70%. I mean, you have 80 % of American adults that are obese and like, I think it's 75 % of kids. So the...

Joe Gambino (24:43)
I'm even behind on that.

Justin Farnsworth (25:01)
The bar is not that high, right? Now what I don't need, I don't need people to be maybe me who like to train seven days a week. I don't need them to be professional athlete. lot of the coaches that I work with, even the coaches I work with that know a training, you know, four to five days a week. I think what it really comes down to it, if I can at least get people meeting the minimum, like if we can strength train full body twice a week, and then we can sneak in.

some, you know, we'll call it zone two work, which again, I think is not over obsessed about like, if you're walking around and training, you're getting zone two work. Like I don't need you to go slog away in a treadmill for 150 minutes a week, because you know, some really guru people on social media said is the best thing for your long term health. I'm like, unless you're bed bound, like there's some other conditioning things that probably have a better return, right? But if I get someone weight training twice a week, I can get them doing some cardiovascular work for maybe 30 minutes twice a week.

I mean, that's a bare minimum for me. And I think educating people on like, cause maybe like, maybe they went from nothing to something. That's awesome. But still, if you're not meeting certain thresholds, it's very, it's very hard conversation to have, right? It's like, I'm glad that you're doing something versus not doing anything, but you're also kind like, but kind of what you're doing is kind like doing nothing. Like it's, it's like the bare bare minimum. I really like getting people at least training three to four days a week.

Like ultimately, that's my end goal, and I think if we can expose them to the power of exercise and not just how it makes them look, like how it makes people feel, and that becomes addictive, right? And as soon as you're like, being strong is really cool. And like, I get the benefit of like psychologically, emotionally, spiritually, I feel really good and I'm happier and I sleep better.

And because I sleep better, I want to move more. When I move more, I feel fantastic. It's like this whole cycle of like baby steps getting there.

Joe Gambino (26:56)
Yeah, that's, I, that's well put there. as far as I like those, I'm actually really curious. I'm going to just switch gears here. you know, you mentioned on the top of the podcast that you, you travel a bunch, you teach other physical therapists, other, other trainers. I'm really curious. Like, what would you say with all that that you've done? What is kind of like that? The biggest thing you've learned teaching, like what have you learned from other people that you've been teaching? Like, is there any like big takeaway that you've gotten?

from all of your time and experience working with other practitioners.

Justin Farnsworth (27:25)
Yeah. yeah. Relationships are everything. And sorry, I tend to get a little, a little aggressive sometimes when I speak, sometimes There's no other way to put it. Showing people you actually give a shit about them is probably the most powerful thing that you can do to help another human. Like, you know, the whole saying like, you know, people don't care, you know, how much you know until you show them how much you care. And it sounds so dumb, but I am,

telling you, The more as a human being that you can provide value to someone else, not only is going to be great for your business, you'll stay busy, but you will truly get people to buy in. Like I think too often, and we'll see this a lot of times in the training and the coaching world, where people will come in for training. And we do two things. Number one, we show them how broken they are, everything they suck at, which is so disempowering. It's actually, you should never do that.

At all. Like, yes, there's stuff you want to work on, but the amount of effort it took for that person to probably walk in the door in the first place. Like we have to respect that. And then the second thing that we do is like, we just want to crush them. We want to show them how much we know. So I'm going show you everything you suck at. And I'm going show you how much I know and how out of shape you are. And like, if you put, and the same thing with education, like when you're in front of a room of people.

you automatically have this like pseudo expert status. And you can do two things with that. You can be like a jerk and show everyone how much you know, or yeah, you can show them how much you know, but in a, in a way of like, I'm trying to help you get better so you can help the clients who come down. I've had so many, I mean, I've taught 7,000 plus coaches in the past six, seven years. And one of the biggest points of feedback I always got was like, Hey, I really appreciate how

You made the complex stuff seem really simple and like how you were open to people asking questions. Like, I'm not sure if you've ever been to a seminar with like a big guru and you're like afraid to ask a question because you're like, there's going to rip apart there. it's a freaking dumb question. I'm like, well, then how are you helping anyone there? Like if you don't have an environment that allows people to express how they feel and ask. Like questions, cause they don't know the answer. That's not a good learning environment. So it's a, it's like a completely different way of thinking when you're approaching a room of people.

where it's like, don't really care if they think I'm smart or not. What I care about is they feel open to learn. And if they feel open to learn, they can accept information. And when I can accept information, can now tomorrow on Monday apply that info to my client. And as soon as I apply that info to my client, I can change that client's life. Cause all of a sudden they had a good exposure to what exercise and movement can actually do for them. And it started with a good interaction.

Joe Gambino (30:04)
to.

Yeah, no, I love that. Joe and I talk, I don't even know in terms of this podcast about how, you know, just having a good relationship and trust between you and the person that you're working with can really just make or break, you know, how much you can actually help that person, right? Because if they don't trust you, don't like you, you know, you're not really going to be able to, I think, even believe that you can help them at the end of the day. So I like that. I really love this concept of what you said about how we can make people, you know, look broke and talk about all the things that they don't do.

correctly. So what are ways that you, at least when you were working with people, or how do you teach other physical therapists to go about flipping that script and allowing them to have a better conversation, build a better relationship with clients?

Justin Farnsworth (30:55)
love that question. And I'll make fun of, yeah, so the last thing you want to do is have a patient come in and go, yo, here's all your zeros, and here's why you can't exercise. And here's how you feel broken and fragile. So if you look at some of the research around outcomes in physical therapy, there was a great, it was three articles, and I think there was a systematic review. And don't ask me to name the authors, because I can't frequently remember. So maybe I'm making this up, I don't know. But there's a great.

Joe Gambino (31:00)
Yeah

Yeah.

Sure, Joe is right, think Lavaca can do

that at a will.

Justin Farnsworth (31:22)
Yeah, there's a great article that talked about basically the patient practitioner relationship and trust being the largest predictor of an outcome in physical therapy, good or bad. So when I teach them, like, it doesn't even matter the stuff you do. It literally doesn't matter until you get the patient to buy in. And the way you don't get them to buy in is being like, yo, Joe, your squat freaking sucks.

Like your back hurts because your core is weak. Obviously. I don't even know how you didn't explode walking into my building. And I have heard in like, we use that as a way to fear people into signing up and showing up, but that doesn't create trust. The biggest thing you can do is like, all right, what's the hardest thing you can do well today? And like, let's just do that because exercise has a lot of redundancy. Like if you can squat.

Joe Gambino (31:57)
you

Justin Farnsworth (32:20)
there's a better chance your hinge is going to get like a touch bit stronger. There's a good chance you're going to sweat a little bit. There's a good chance you're going to get like all the highs of what exercise feels like. So I know for me, it's like, yes, as a clinician, it's like, I need to diagnose patients first time. I need to educate them on what it is. I need to show them the opportunities that we have to help them improve. But also why can't we just like move an exercise and sweat?

and not necessarily have it to be obsessively targeted towards the stuff that they really suck at. But when you use big patterns, like imagine this, right? If you've got someone that has, I don't know, give me a diagnosis of the lower body, something, right? And you have them squat, like what diagnosis on the lower body could you justify using a squat in? Oh, all of them? Okay, cool. So it's like, you have this thing where it's like, we can use big fundamental patterns to rebuild function, but also just to like start loading a little bit.

That's how I've always tended to approach it. I think, our language, I hate being that guy that's like languages, I think that matters the most, but how we frame it kind of matters. It's not, it's not here are your dysfunctions. Here are your freaking zeros. Here's this screen I ran that I'm going to run on you. And by the way, we're never going to run this again. It's just for me to show you how much you stink at stuff. It's like, no, like here's the opportunities we have. I think your hip, you know, it might be painful because of these things, but frankly, a lot of times we can't tell you.

But I know for a fact that we start exercising and moving and finding positions you can do it in and feel good, your hips gonna feel better. And by the way, you're gonna get jacked and tan. Like, let's go.

Joe Gambino (33:56)
Exactly. No, I love that. I think one of the biggest things I've learned is the way you say something can really have a huge impact on how somebody accepts it, perceives it, things like that. we took something like just like, you know, someone had this degeneration, you just said somebody to somebody, hey, you have, you know, this dis degeneration that's happening and you should never squat again. Right. Someone's going to take that a very different way. If you said, Hey, you know, sure, this stuff pop up on an MRI.

But let's go, let's go squat and see what you can do. Right. Like I think those are two very different things. Like you can still give the education around the diagnosis and what they may look like long-term. I mean, for us, I think we both know that those things that pop up on MRIs are kind of normal things that happen as we age. Not necessarily something that's necessarily bad. But the way that you say, Hey, look, you can still do these things. You go take them into the gym or you get them moving a little bit and you show them that they can move. And especially if someone's fearful, like especially if someone

for a long time, they're afraid to move. And you start to show them, look, you can do this, you can do that. I think that buy-in becomes much higher and it starts to allow them to give them self-permission to move a little bit more, do a little bit more and kind of go down that pattern.

Justin Farnsworth (35:03)
Yeah, you just you are saying they can do well to do it. Show them what you can load it, have them sweat and all of a sudden, like, it's like the car break, it just gets turned off. And it's just like, and that's where like, even with interventions, man, with a lot of people, I don't think they need to be super specific. Like, for people that haven't moved at all, it probably doesn't actually matter what you do. You just have to as long as it doesn't hurt, and they're getting an appropriate level of muscle soreness. Awesome.

Joe Gambino (35:30)
But let me ask you here, go ahead.

Justin Farnsworth (35:32)
Right? It's the same thing like with, same thing with

joint mobilizations, right? Remember we all learned, well, if it's stuck this way, you have to push it that way. And then you go take all these mulligan classes and whatever else. And you're like, yeah, it doesn't work that way. Just push it the other way. Okay. So it actually doesn't matter. Cool. Good to know. Glad I got a memorize. Glad we. Yeah. Glad we memorized all those freaking concave convex rules in grad school. Yeah. Really happy about that.

Joe Gambino (35:37)
Yeah.

Yeah.

Right. Yeah, just do something and see if get a positive test out.

We have fun, right? I'm going to ask you here, because we talked a bunch about finding the pain-free movement, the pain-free pattern. Let's get the movement into something. But when it comes to pain, how are you navigating when that stuff happens? How much pain do you allow to happen before you're saying, no, maybe we should definitely modify this or maybe we should keep this in and test it out?

Justin Farnsworth (36:00)
Thank

Love that question. And there's a little bit dependency. Like, we loading tendons? Are we loading soft? Like, because tendon rehab, we're allowed to maybe let it get up a little bit. So I'm just going to take that and throw it off the table. Just like, pretend we're not talking about that, all right? I think for everyone else, so the clinic I used to run, I had a little light, stoplight on the wall. I actually have them around the clinic. And it was red light.

yellow light, green light. Cause I'm in like, was in Western New York, man. I'm treating four patients at once every day, all day. So it's like the quicker I can have people be able to give me feedback quickly. Like we can just continue to do more versus having to walk across the room and like converse, right? So inside their green light was zero to four. These are just pain scale numbers, right? So I'm like, so I just had, I would educate people on what these lights meant. And when you see them, it's just a reminder.

Your yellow light, That yellow doesn't mean stop, right? It just means proceed cautiously. It was like a five to six, a red light was a seven to 10. So when I look at those, it's like, yes. Um, having a little bit of pain when you move is actually fine. In fact, it's probably expected, you know, if, you have a pain point and you're moving and you don't feel that pain point, you're probably just not alive. Like the concept of pain free doesn't exist. And I think as soon as we start understanding that pain free doesn't exist.

Joe Gambino (37:30)
Mm-hmm.

Justin Farnsworth (37:38)
people can make more progress because if the goal isn't always a zero out of 10 at all times, there's another parking brake that kind of gets turned off. I don't want you to freaking seven like needing to pop Advil, but if we can remove the barrier of this has to be pain free, I think it should just be like, yo, if we're at a zero to four, it's green light. This is all go, right? And then I think also what matters is what's their response in the first 24 to 48 hours.

And this is one thing that every new clinician, no offense if you're listening, you guys just aren't good at, because you don't get it in school. Like the literal, like this is what you should tell your patient. It's like, okay, we did squats today. We came on back to squats. Let's just use it again. We did squats today in the clinic. You were at a two out of 10. So I'm expecting over the next 24 to 36 hours, your symptom you're seeing me for should be staying there.

and not getting more, but the muscles around your knee, you better feel that, right? Muscle soreness and pain are not the same thing. And how many times have you had a patient call like I'm worse and you're like, you're worse. tell me what happened. Well, my knee feels fine, but my quads are really sore. And you're like, my God, like you are literally feeling muscle for the first time in your life. Right. so I think having those conversations to give people, here's what you should expect.

Joe Gambino (38:57)
Right.

Justin Farnsworth (39:03)
If it didn't spike in the clinic, it's not going to spike after. haven't really had that ever happen. It's, it's rare and occasional. And usually when it spikes after it's cause they did something dumb and they just didn't want to tell you on the phone. but those are my general rules. And like, that gives us the exposure of like, much more do we do next time? Right? If you have someone that comes in, we train today and the quad still sore three days later, we need to bump the load or intensity down probably by 10%. If they felt nothing after.

Joe Gambino (39:19)
Hmm.

Justin Farnsworth (39:30)
and they had no increase in pain, I can now change the volume on it. need to work a little bit harder. So pain and muscle soreness, these are the two volume knobs that we track. And that's literally just telling you about their readiness and their response to the stuff that you're doing.

Joe Gambino (39:45)
Yeah, no, I like that. That's every, again, right on par with themes on this podcast, but I'm curious, actually, this question is actually based off of someone I was chatting with yesterday and based on our conversation right here. You just mentioned about people who have a hard time distinguishing maybe between pain and soreness and different things, maybe because they've been dealing with pain for a long time or maybe because they just never really been active or for whatever reason.

But when you have somebody when you're getting these kind of like not clear signs of, know, if it's pain, if it's soreness, you're kind of like, you know, they're having a hard, you're feeling like they're having a hard time distinguishing. How do you go about having that conversation with them, educating them and making sure that you're guiding them in the right direction?

Justin Farnsworth (40:13)
.

Yeah, I think I like getting the patient's feedback at that point. Hey, how does this feel? Like if you felt like this for the last couple of weeks, would that be okay? Or would that be like really limiting and you don't want to feel that? And that answer is going to direct everything else. Cause there are some people that'd be like, you know what? No, it's fine. Like I'm good. Okay, cool. Because like, I know when we act, I'm not breaking your body by exercising at all. Like we're not breaking tissues. That's the thing. Like

Joe Gambino (40:41)
Yeah. ⁓

Justin Farnsworth (40:56)
The thing a lot of people experience has nothing to do with what we do in the clinic and a lot more to do with what we do outside the clinic. So if I've got patients that are like, yo, I know I'm good. Okay, cool. If I have someone like, nah, I don't really like how this feels in my head, I'll just be like, okay, fine. like front facing you, like, okay, then we need to make a change, right? And again, that's the great, know, pain is the body's request for change. That's all it is. So I think it also depends on a diagnosis. Like I got someone with a hot disc.

Joe Gambino (41:01)
Mm-hmm.

Justin Farnsworth (41:25)
and a radiculopathy, I'm probably gonna be a lot less aggressive when things are like, I'm not sure if this is more tingling or what, because you're like, well, let me just not let that happen. But if you've got someone with neo-A and like, I know I'm not gonna break that and make that worse. Like it is what it is on the image. I might tend to be a little bit more aggressive because I think sometimes on some of those specific orthopedic diagnoses, he's pushing through a little bit of pain, actually lets you get like a little bit higher that next step, because I'm not.

I'm not going to break your knee by having you do a leg press. You're always not getting worse by doing a leg press at all. In fact, I know I need to build your quads for your knee to get offloaded a touch and maybe not even have those symptoms in the first place.

Joe Gambino (42:00)
Mm-hmm.

Yeah, I like that and I think it's very complicated and definitely person to person. I think it kind of goes back, you when you ask that question and someone says, yeah, you know, I really don't like how it feels. And then you're empathetic towards that and you make the variations and changes, right? That also builds that trust, right? So I think that's a great way to think about it go about it. But I do want to be a model for your time. I this is a great conversation. I do want to give you the floor to talk a little bit more about your course, what you offer, how you help people.

find you if they want to learn more.

Justin Farnsworth (42:38)
Yeah, sweet. So best ways to define me is on Instagram. That's at Dr. Dr. Dr. Dr. Justin Farnsworth, which is my name down when it comes to what I do. So I have two main things. So I work with healthcare professionals and coaches with an online delivery of programming, all custom with education built in. And then a bigger thing I do is I get, have a course called programming around pain.

And another course called Rehab Rebuild. The Rehab one isn't public facing yet, but hoping to get that into New York City probably next April. The Programming around Pain course, I'll be running here twice a month, probably through next April. So I will be in, I mean, shoot, I'm going Louisville, Kentucky, Detroit in August. We're going to have Boston in New York City. Going to be in September. October will be Tucson, Arizona, Albany, New York that I'll drive to right from here. November will be Bay Area and I'll be in Chicago, potentially Pennsylvania, Portland, Maine. So.

All that stuff is a little link on my Instagram, uh, that'll pop you through that. It's two days. It's not 16 hours because people start falling asleep at our six. So I taught enough. I'm just like, 16 is kind of a lot over two days. So it's about six to six and a half hours. And really what the course is about it's, it's four big things. Number one, it is a discussion on programming, whether you're a coach, whether you're a clinician, whether you're just a regular human. One thing that most education systems don't give you is how to program. Like it's three by 10, five by five.

Joe Gambino (43:36)
Yeah.

Justin Farnsworth (43:58)
And like, that's kind of all you get. So we're going to have a discussion around how do we fit in all the patterns and how do we fit in all the characteristics that humans need, right? How to be athletic, mobility, conditioning, strength, hypertrophy, all those aspects. And if I'm a coach, it's like, I got to figure out how to do that. And a client coming in twice a week, that's what most coaches see, right? This client's twice a week, same thing with a clinician, usually two times a week for six weeks, right? For most insurance models, at least. So it's a discussion on how to do that.

And then we dive in specifically on the four most common areas that people complain hurt. Hip, shoulder, low back and knee. And we have sections of basically what I just talked about. How to say, no, no, no, we're not going to squat as bad for your knee. instead find the perfect position based on an intake that allows you to find their best output onto a squat pattern. So we have.

Yes, I talk, I try not to talk too much, but it's going to be all 60 % lab work, hands on. You we work with people in real time. You can't learn real time skills on a computer or from a textbook. You have to be with real people in real time. So a lot of lab work, ton of takeaways, um, ton of resources. The feedback I've gotten from it so far has been, I mean, selfishly really, really good. Um, but biggest thing is like usable systems. You can apply patient client come Monday, um, and feel confident in it.

Joe Gambino (45:23)
Mm-hmm. Yeah. Yeah. I love that. All right, man. Well, thank you again for your time and hopping on the podcast. I'm sorry Joe wasn't here. He missed out. might be a little bit better without him. We'll find out. We'll let the listeners determine that. Got to a little shade his way. But yeah, man, thanks for coming on and enjoy the rest of your day.

Justin Farnsworth (45:42)
I appreciate you. Thank you.