Episode 78: The Exercise Hierarchy Myth: How to Train With Chronic Pain Without Getting Stuck

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• Joe Gambino
• Joe LaVacca

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Summary

In this episode of the Beyond Pain podcast, hosts Joe Gambino and Joe LaVacca discuss various categories of exercises, the importance of understanding training hierarchies, and how to adapt exercises for individuals experiencing pain. 

They emphasize the significance of movement patterns and the need for flexibility in programming, highlighting the role of carries and power work in fitness. 

The conversation also touches on the psychological aspects of training and the importance of making exercises accessible and enjoyable for clients.

Takeaways

• The holiday season brings excitement for children.
• Exercise categories simplify programming and training.
• Hierarchical systems in training can create unnecessary constraints.
• Pain and training experience should guide exercise selection.
• Movement variability is essential for effective training.
• Weight is not the only factor; movement quality matters.
• Adapting exercises can help clients overcome pain.
• Incorporating carries enhances core and shoulder strength.
• Power training is crucial for all ages.
• Tempo can be both slow and explosive in nature.

Chapters

• 0:00 Introduction and Holiday Preparations
• 5:02 Exercise Categories and Programming
• 10:02 Hierarchies in Movement and Pain Considerations
• 18:03 Adapting Exercises for Individual Needs
• 26:20 Incorporating Carries and Power Work

Transcript

Joe Gambino (00:43)
Welcome back into the Beyond Pain podcast. I am one of your hosts, Joe Gambino, and I'm here with our other host, Joe Lavaca. You can find this on Instagram at Joe Gambino, DPT for myself at Shred The Motion underscore PT for Lavaca over there. You can find this podcast on YouTube, cups of Joe underscore PT and on YouTube as well on Instagram as well, Beyond Pain podcast. And if you have been enjoying the show, please drop us a review. It will help us get this out to more ears.

and hopefully be able to help them as well. Welcome back to the show, Joy Boy.

Joe LaVacca (01:17)
Good to be back.

A week before Christmas, are the Gambinos prepared for Christmas? All your shopping done, everything good?

Joe Gambino (01:24)
All the shopping is pretty much done. So we're good over here. ready. Olivia's excited. We're good to go. And then we'll be.

Joe LaVacca (01:34)
Yeah, she's at a great age

now where the Santa magic is probably really strong.

Joe Gambino (01:39)
Yes, I think this is the first year where holidays are like exciting. I think next year will be like that first like real understanding like this is all the stuff that happens. So I think next year will be one more, you know, level above where we are this year. But yeah, she's it's a this is fun.

Joe LaVacca (02:00)
Alright, that's awesome. Are the kids, or did you get Santa pictures with the kids?

Joe Gambino (02:04)
We have

gotten plenty of pictures at this point. She has seen Santa like five times throughout this holiday season at different places.

Joe LaVacca (02:08)
Okay. So she,

so she doesn't mind taking pictures with Santa.

Joe Gambino (02:16)
She sometimes minds and sometimes does not mind. it depends on her mood, how much sleep she's had, how much food's in her belly and the time of day. So.

Joe LaVacca (02:18)
Okay.

and

Yeah, yeah.

What about baby Joey? Was he... Did he get passed off to Santa's lap or anything like that or... Okay.

Joe Gambino (02:33)
He has, he has, and he just,

he goes with the flow. Only one time was he not very happy with Santa out of the five. So otherwise he's just sitting there chill. The first one, Santa was like, listen, this is a drop and run situation. You know, this way we can try to get that picture as quick as possible. And he just sat there, no issues. He would have stayed there for like 30 minutes if we let him.

Joe LaVacca (02:54)
I love it.

Gambino kids. They're just so level-headed and chill and balanced. If only we could all be so lucky.

Joe Gambino (03:03)
Baby Jo, yes. Olivia depends

on her mood. What about you guys?

Joe LaVacca (03:10)
⁓ man.

yeah. Well, similar. I thought I had bought my last gift last night. but then I realized I still had, two other people I forgot. No, I forgot. I think it was just like one of those things I was like, I kept putting off, kept putting off and it was work, work people. So I wasn't sure if I wanted to bring it in on Monday or try to bring it in Wednesday. And then because of my lack of indecision, my decision therefore had to be Monday. So,

Joe Gambino (03:25)
Meh.

Joe LaVacca (03:35)
I usually just get the owners of the gym of Osam for their kids. So that's the last thing I really technically have to do. And then whatever people are getting, they're getting. It's gotten, it's done. So we'll see how it goes. We'll see if Avery and Addison like their gifts. you know, because unlike your children, the magic is over. And now it's just pure entitlement.

Joe Gambino (03:47)
That's it.

Joe LaVacca (03:59)
And Avery was funny yesterday. She was like, you know, I made you something, but I'm not sure if it's going to be done in time for Christmas. I said, you have eight days. What could you possibly be making? And she goes, it's just a thing. And I want it to be really good, but I'm not sure if it's going to get done. And I said, OK, imagine if I told you daddy was so busy that I didn't get all the Christmas shopping done, but I'll get it done maybe in January, maybe just throughout, you know.

maybe February, but you'll definitely have it. How would you feel?" And she was like, oh, I'd be really mad. And I was like, okay, so go get the thing you're making done. you got to build in these lessons now, you know, like, how would you feel the double standard? Like that's the one that always works with clients and apparently it also works with kids, you know.

Joe Gambino (04:33)
You

Yeah, lesson learned.

Yeah,

I feel like that's it. You just gotta make them realize, hey, this is how you'd feel, right? So come on, me that gift. I don't wanna wait. Come on now. Entitlement goes both ways.

Joe LaVacca (04:54)
Yeah, exactly.

yeah, we go. Yeah, that's a good point. That's a good point. That's a good point. What are we talking about today, Jakes!

Joe Gambino (05:04)
All right, Joe, what are we talking about? jinx, jinx. I know what

we're talking about. So today we're going to be talking about overall categories of exercises, how we think about them, how we might give you maybe some lateralizations or progressions and how you can think about maybe where you should be starting and how you can make things a little bit more challenging over time. So.

Joe, we talked a little bit about right before here the category so why don't you kind of lay them out and then we'll jump in from there.

Joe LaVacca (05:33)
So your typical programming categories, and maybe we have touched on this at one point or another, glossed over it, it's pretty simple, right? We have push, we have pull, we have squat, we have hinge or deadlift, we have carry. We were talking about, you know, then the other categories could be lunge, core, power. I think you could probably dice it up any way that you want. And I think that over the course of the last

I don't know, maybe like five years or so, especially since I've really been trying to get into blending the PT rehab and the training approach much more specifically. There was this emerging thought or still a thought in the industry where maybe there's hierarchies to movements. And for example, let's use someone with shoulder pain that always seems to be an easy one maybe to start the conversation with. Well, maybe

you know, your client with shoulder pain or your client who's just starting to train, you know, doesn't bench press until they start to do pushups correctly or, you know, doesn't do a floor based pushup until they do elevated pushups correctly. And if we look at where that also I think pops up is a lot of the time with like maybe runners or ankle pain, foot pain, this idea or notion that, you

Five out of five, you when you're grading someone's muscle testing with a single leg heel raises, you don't have try to get to 20 or 25 heel raises before, you know, you can strength train or maybe before you run or before you do this or before you do that. And I'm like, God damn, that's too hard. I could barely get to 25 heel raises. So, and I overload my calves all the time with, you know, sets of eight or 10 or 12. And I'm trying to really grind them out. And it doesn't make my 20 or 25.

particularly a lot easier. So I guess the big question around the things that we're going to explore today is, you know, how valid are these hierarchical systems when we're thinking about movement? How much are they needed? And I guess do we follow them? And I would probably say big picture for me. I think they just kind of create more options for people to train.

Not necessarily that I need someone to move through step one to get to step two to get to step three. So that's my kind of high level intro. What do you think about that so far?

Joe Gambino (08:02)
Yeah, so think first thing is that I want to just take a take a step back and we talked a little bit, you you brought up these overarching themes right the the hinge the squad or knee dominant movement carries the push-pull for upper body and The reason why we bring that up right is I think when we're talking about programming all overall then having a It's easier to have like a like a system or a thought process to pull from it just makes programming easier, right like

If we had to take every, I don't know how many exercises there are in the world. mean, I'm going to say maybe 10,000 and that's the over under. I don't really know what that is. Yeah. But if you were to have to just select from that list, right? It can be very overwhelming. And I think that's where a lot of people are like, Oh, there's so many things I can do. I don't know if it's right for me. Well, if you want to simplify it, if you just took all five of these categories and just selected.

Joe LaVacca (08:38)
I'll go over, I'll go over.

Joe Gambino (08:55)
two from each and had 10 exercises for your workout, you're gonna be probably at a better starting point from a programming perspective than like 90 % of the people out there, right? So that's kind of why we bring this up. And then to your point around, know, hierarchies and this whole concept of you need to be able to do X before this and even like the whole FRC world where if you don't have the prerequisites for this, you shouldn't be able to do it.

You know whether or not we need to abide by this stuff I mean these are again we you know, especially in FRC like the whole kind of thing is You know, they talk about we've talked about this a bunch too is right like exercise like these all man-made movements, right? Like why stick yourself into kind of like a like a box, but then we create all these rules like hey we have these hierarchies we have to do X Y and Z you have to have these prerequisites before you do this and

I think that A, it just makes it more confusing for people and B, do we really need it? So I do like your thought on options for change, hey, we have all these options, you can do things. I definitely think that we should be kind of.

changing variations around just from a movement variability standpoint to make things like, you know, a little bit more new and novel for people. But I think there's a couple ways that I start to think about when I might have like a hierarchy in my brain and everything is really assessment dependent. So the things I'm be talking about here is it's not black or white. It's gonna be very, very dependent. But like,

One way I categorize things is as novice versus someone who's had a whole bunch of training experience. So if you're newer to training, it's very unlikely I'm going to be throwing that person into like back squatting and like heavy back squatting and heavy dead lifting, like with a barbell. I'm probably going to start them off with like goblet squats or kettlebell front squats. If, know, we have access to doing so, you know, I like to start with kettlebell deadlifts.

things like that, just because it helps kind of teach movement patterns. helps teach how to like connect things. And then from there, when they start to show like efficiency and also you don't need to load someone novice like very heavy to get a training stimulus. So usually that's kind of where I'll start pattern wise. And then, you know, if they do have an interest in barbell work, then we'll move there. also start with some single leg work. So split squats and step ups. like, I like to start people there to train unilaterally as well. So

You know, when we talk about these categories of push, pull, carry, hinge and squat patterns, like I also break them up unilaterally as well. So that's like one more layer. You can break them down. You should always have a bilateral and a unilateral movement, in my opinion, or programming. So novice versus expert is one of them. And then pain is the other one. So if you have like, say we're talking about the bench press, maybe we can continue down this rabbit hole of just like one movement at a time.

someone has pain with bench pressing and they have limited mobility and that mobility is painful, especially internal rotation and shoulder extension, I'm gonna say, well, maybe we should do push-ups, but I'm probably also just gonna move them to limited range of motion movements. I'm gonna do floor pressing, so we'll do it from the floor. Maybe dumbbells is a little bit of a better option, because you have a little bit more freedom for where your hands can move. So then there'll be changes to how I'm gonna be.

you know, or I might incline them if they really love bench pressing, then let's put them on an incline. So the range of motion demands are not as, as great. So those are like a few ways that I'll start to change things depending on like their training age pain. Those are probably the two big ones. If there's like no pain, they've been training for a little while. Then I really think like these hierarchies can just be like thrown out the window in a sense. Like you just want to make sure they're moving well. They're able to load effectively. Their technique is, you know, not.

total shit and go from there.

Joe LaVacca (12:37)
Yeah, so it sounds like there is a little bit more of a thoughtful, hierarchical, maybe whatever approach, we'll just kind of keep using the same terms, depending on different contexts. And I think you added a little bit of context here for us, that heavy pain, person's age or fitness level. So yeah, let's stick with the press, because that's the one that you brought up. And I think when we're...

looking at exercises or picking exercises for people, I always want sort of the biggest constraint to be successful, weakness, right? If we're gonna build strength, well then I wanna find something for you that challenges your strength, not necessarily your range of motion and not necessarily your pain. So I think if we're looking at someone with that painful shoulder and we wanna get them to bench press, and we notice that their internal rotation is quite limited,

their shoulder extension is quite limited, then yeah, maybe a heavy barbell work on the bench, on a flat bench, is not gonna be great for them, right? Like that just sort of makes sense. So I totally, totally agree with you there. At the same time, if they're having pain but they're not having any range of motion constraints and they can tolerate the bench, I often find that the conversation when I ask them to show me things would be, okay, well I was told that

You know, my back has to be flat. My hands have to be, you know, shoulder width apart. I have to, you know, do this with my wrists, you know, and there's so many other, you know, rules that they were taught and this is not their fault. But I just say, okay, well, what if you opened your hands up a little bit more? What if we just allowed you to get into a little bit more extension, right? Like stabilize your shoulders, you know.

Get your chest up a little bit higher. Maybe place your feet in a different position. How does that feel? Oh, well, that's a lot more tolerable. Oh, OK. Well, if we can tolerate this position then, OK. Well, then let's do the barbell work like this. We don't need to spend all this time building up isometric and these lower level exercises if we can make a modification that works well for you. So I think that's to me, if

the push or let's say the bench press was one of these big three movements and we talked about the big three last week. Well then why wouldn't that be enough of a stimulus to train the shoulder the way we want it if I can get a person to that position? So that's why I think when we mention a lot of the FRC worlds and this and that, it's like yeah, if there's a significant joint or range of motion constraint,

in a person really wants to bench press and let's follow that trail there. If there's a constraint and they want to do this, I don't, we told, we said this the other day too. We don't tell anybody they need to barbell bench press. They need to barbell squat. They need to lift heavy all the time. That is an option if you're comfortable. We also talked about affordances. Not many people have this like,

endless amount of weight and equipment to use. So it is their body weight. It is dumbbells. It is kettlebells. It is bands. So we can take that same hierarchy approach and okay, if they can only do elevated pushups or they can only do a floor press, like you said, how are we gonna make it more challenging for them so they can continually adapt? And then where is then the cutoff of us saying, well, hey, now you just need probably a little bit more weight.

more resistance, a little bit more of this, a little bit more of that. You got to join a gym. I mean, if you want to keep progressing, we can only go so far with a 10 pound dumbbell or a yellow band or tempo work and pause work. Also it's going to get really, really endless in volume. So yeah, I think that's kind of where I stand on it. Like I said, I think like when I see a hierarchy list or something like, dude, I'm like, cool. Like there's actually like two or three options there I either forgot about or I just haven't used in a long time.

Joe Gambino (16:20)
Mm-hmm.

Joe LaVacca (16:42)
And that would actually really work for, you know, Joyce or Tracy or Adam. And I think I'll I'll try it in their program. But I never walk it back in this sense with clients where I'm like, well, until you could do 15 push ups, you're not going to touch a barbell until you can do 25 heel raises. You're not going to touch pavement with your run. It's just going to be fast walking because I don't want to create more constraints.

Joe Gambino (16:44)
Mm-hmm.

you

Right.

Joe LaVacca (17:07)
But if we think about our buddy, Greg Lehmann, and what's always really been interesting to listen to Greg talk is, you know, these things that we want to get people back to put so much, you know, load into their system that we can't mimic in the gym or with our work. So why wouldn't that like exposure, you know, and we've said it here too, if you can't run a mile, run a quarter mile.

Joe Gambino (17:22)
Mm-hmm.

Joe LaVacca (17:31)
then build up to a half, then build up to three quarters. Like, why wouldn't that be enough to sort of like gradually stress the system as we give them other things to sort of work on quote unquote. So I think that's where I'll pause for a second. And that's kind of where I think of my mindset is sort of at this moment in time on December 19th, you know.

Joe Gambino (17:48)
Yeah, I like that. think to your point, know, any exercise that someone's going to select, right, is it's usually like a bias, right? Like I pick exercises I like for myself and technically for my clients as well. And I ask for their input and get their biases on what they like. But the exercises, they're just exercises, their movements and our body. And this is something that probably over the last

few years that's really kind of like changed in my mind is that load is just load. Like it doesn't matter if it's a bench press, a push up, a fly. Like if you're hitting this tissue, it doesn't matter the modality. Your body only knows what loads you're going in and will adapt to the loads that you put in. So anyone who's listening here and you're like, well, I don't know what exercise that I need. This is why I like this category approach of exercise.

It doesn't matter. if I have, here's an example, someone's traveling and they have their program that I created for them and they're like, Oh, what should I do when I'm traveling? I just don't have access to this one piece of equipment. As long as it's the same category of exercise, I don't really care. can, here's an example of one you can do, but you can literally do any one that you prefer or that you have access to, or maybe, Hey, this is the opportunity for you to just try something new and explore something new and have a little like, you know, just make it fun in the gym.

Because again, it doesn't matter the exercise like, you know, I pick exercises for reason, but because I selected conventional deadlift doesn't mean that it's any better than a a trap bar deadlift, right? Or doing a single leg deadlift. Like I think there's different reasons for why I program those things. But at the end of the day, similar type of loading. So again, going back, this is why I like having these categories, because you can just select whatever you want for that particular week or month and then.

Joe LaVacca (19:26)
Mm-hmm.

Joe Gambino (19:43)
hey, I have these categories here, I can now just cherry pick some exercises and plug them in and you're gonna be consistent with the inputs that you put. You're not gonna create imbalances because you're just doing all squatting or you really like deadlifting. So you do all deadlift motions and never squat or anything like that. So one reason why I kind of like this approach here.

Joe LaVacca (20:04)
Yeah. And I love what you said there. There's, are clearly reasons why you or I or anybody else might pick an exercise for someone. But I think what we're saying is that to drop our deadlift, you didn't need to do 60 hip bridges on each side, single leg to earn that right. Right. We, if we have to prop up the bar, okay, we prop up the bar. If we start you with 65 pounds, we start you with 65 pounds. But that's the whole thing about this. And that's why I've always loved.

Like almost instantly, my entry point for most people in the gym, if they're training with me, is the trap bar deadlift. I love that thing. I mean, okay, our bar is 65 pounds and I don't work with too many people who are less than 120 pounds, let's say. So this is still going to be half their body weight. This is force that they are accustomed to. And that's what I also sort of tell them. If you're getting up out of a chair, you're exerting probably a little bit more load through your system.

then maybe what I'm asking you to do right here in a controlled manner, range of motion environment. If you go up and down stairs, you have exerted more force through your spine, your pelvis than I'm probably asking you to do in this one particular exercise. If you've jogged to catch the train and your pelvis and your spine and your femur didn't explode, you have probably put more load through your system than I'm asking you to do with this barbell. So if we can accept that,

then we can realize that this is safe and something that we can use to train you to now gradually take on more and more and more stress or just break that pattern of fear. And that was another thing that we've talked about numerous times. Maybe some of these lists of exercise are just like, barbell work is really scary for me. okay, well, what about an incline? Have you tried that? Yeah, I don't know. I think it's just the barbell itself. okay, what about a dumbbell?

Joe Gambino (21:38)
Mm-hmm.

Joe LaVacca (21:55)
Yeah, I guess I could do that. But you know, I'm still a little worried about my asymmetry or whatever. Cool. What about one dumbbell in both hands? Like just press it on the incline there. Why don't we just do that? So I think again, like even looking at an apparatus like a dumbbell or kettlebell, people think I have to use it one hand versus the other hand. It's like, well, like you said, weight is weight. Weight is weight. So if we want to be a little bit more narrow with your dumbbell, okay, cool. Press it here.

Joe Gambino (21:58)
Mm.

Mm-hmm.

Joe LaVacca (22:19)
And then that's when I'll give people some, some ranges. I'm like, look, if you can only push this six times, then we know that this is a pretty, is a heavy weight for you. If you get to 12 and you still have some room in the tank, we probably realize it's probably a little bit too light. can move on. Right. But I'll give them those very clear sort of pictures in the background of picking the exercise. Like, Hey, look, I know you're in some pain. I know you're a little bit worried. So I want you to look at this and try to do this weight or movement.

six times, can you give me a minimum of six? And just kind of set the floor for them, whatever we're picking. And then if they hit six, okay, great. What do think you could do next? I don't know. All well, if you get past 12, let's agree that we're gonna add some weight here or maybe make the exercise harder, right? Look at our hierarchy list. We're doing an incline at 45 degrees. Maybe we do an incline at 20 degrees, right? Get you back to being flat. Or maybe we went from floor press to the incline, right?

just give you a little bit more freedom of the arms. So I think that's also another way that we can kind of, or I usually try to check with people to see, you know, are they ready to change position, add some weight, and then that sort of auto regulates the decision making, right? It's not like I always tell them, I'm like, I didn't pick this, you picked this. You showed us you were ready. This is not me programming. This is just your body saying, hey, I need more stimulus. And it was like, okay, let's add this.

Joe Gambino (23:44)
Yeah, no, I like that. think if I had to, like, you you're talking about like a trap bar and that's kind of where you start. know, especially if someone's new or really struggles with hinges, I tend to start with like a, like a heavy kettlebell. You know, you can, you know, lot of gyms these days have, you know, in the fifties and the sixties and seventies, right? So can, you can load up pretty, pretty decently. But if someone's like really struggles with like a movement pattern, like a hinge, like say, well, we'll just stick here.

Or they have pain with hinging right like I'll start with some of these other Modalities and then I go to a trap bar right from like from a kettlebell because it's less hinging and your hands a little bit higher and then I would progress them to either like a sumo or conventional and then if we really wanted to load these patterns and we're talking about like trying to create some adaptations and like Work on sticky points because we know the bottom is usually the hardest part of the movement then we can start talking about like deficits Things like that's like really challenge that the pattern

know, squat, talked about kettlebell front squatting or goblet squatting, and then I'd probably move them over to like a safety squat bar is actually a really great option, especially for people with shoulder issues. And then moving them to like a back squat or a front squat, that can be a hierarchy of movement, depending on what's going on with their patterns and things like that. Talking about bench press, you know, I probably just start with like dumbbells. I'm also a big fan of like having people like be really strong with like controlling their body. So I would

You know, I like to see people do, you know, good amount of pushups with good technique without their like spine breaking or like showing real, you know, like technical issues, right? From that perspective, like, so I probably like want to start someone there versus like, Hey, do we really need the bench right now? If you can't do 10 pushups, you know, but sure. You know, you can also go the other way. You don't have enough strength for pushups. So bench can be, be a bridge. So again, it's not black or white there. And then overhead pressing. If someone really struggles to get there.

Or things like that, know, like a landmine press is like a perfect way to start to initiate that that Pattern for somebody but otherwise and I also like bottoms up pressing to teach someone who's like new More struggles or doesn't have a whole lot of like shoulder strength. We need some stability. I think bottoms up anything Is like a really great way to just like get shoulders to be like activated teach you how to like irradiate Teach you how to create tension

I think that has a lot of carryover to a lot of the things that we like to do in the gym But also outside the gym since we know that Things in real life are never like hey this nice dumbbell in my hand. I can just hold it close to my body and carry it around, know, That's just kind of a quick run through of maybe how someone can think of like easier to harder depending on if they have pain if they struggle with the moving pattern Is there anything else that you would add on there or think differently around?

Joe LaVacca (26:04)
Mm-hmm.

Well, yeah, I think as I was listening to you talk, I was like, okay, cool. Like where would I go with some of these ideas? And my thought is always like, what's the easiest thing for me to coach, especially in the beginning, or what's the easiest access point for people to work with, again, given their environment, right? So with the push, know, yes, I want to look at their push-ups to see what they're capable of. It's just like a nice, easy assessment for us to do.

But I always kind of have said to me like a floor press is the easiest thing. I don't have to worry about their body, their core, their breathing, their rib cage. Let's just get your elbows to the floor, push it back up. And then we can typically find a pretty decent weight that they can handle. So for me, maybe a little bit more of an entry point with like horizontal work is has been the floor press like in the past. And then I'll give them like an elevated pushup just so they can start to think about their spine, their rib cage, maybe some head position.

When it comes to overhead press, I actually like to almost put them in more like crawl and reach positions where they can press or hold through the floor in some plank patterns, maybe get a little bit of a rock back almost like into a pike or yeah, guess that would be considered a pike. Then they press through the floor there and hold some isometrics. That has always been, again, something easy they can practice at home.

Joe Gambino (27:23)
Mm-hmm.

Joe LaVacca (27:42)
very little coaching cueing for me in the beginning. It just kind of lets them explore what they need to do. And then from squatting, yeah, mean, most people are going to be more comfortable just holding a weight in front of them. A lot of people are either going to talk about their limited ankle or foot mobility. And I'm like, all right, cool. I don't really want to talk about this with you right now. Let's just elevate your heels. How deep should they go? Well, you know what? I don't really want to talk to you about this right now. I just want you to get some fundamentals, get safe with the squat.

So squat to a chair, right? So sometimes people are doing like cyclist chair squats because I'm just like, you know what? If all of these things are clouding, you know, what we want to get done right now, which is just low to your legs, let's remove them. And then let's see how you do with just getting low to the leg. And then we can always build some of these processes around them. Yeah, with the hinge, like I mentioned, I think like I love, I love the trap bar.

Joe Gambino (28:22)
Mm-hmm.

Joe LaVacca (28:35)
Never shied away from the heavy kettlebells though. Again, I think it's a lot of the time with, do they feel a little bit more comfortable with a wider base? And then I'll let them do the kettlebell. If they feel a little bit more comfortable with a narrow base when they hinge, then I'll let them do the trap bar just because it's just a better hand placement. And then what was the other one you mentioned, Joe? Was that it?

Joe Gambino (28:47)
Mm-hmm.

Overhead press bench deadlift squat. Yeah, that's all I can

Joe LaVacca (28:59)
Yeah, okay, cool. Yeah. I think like that's just, again, like the, they're very similar, but yet a little subtly like different. And I think the context that you provided before of like their training age, the pain, what they've been coached on in the past. I just sort of like take all those things. I'm just like, look, what's your goal? You want to get stronger? You want to get back to the gym? You gave us some boundaries, these rules, this pain, this, this, this, that. So let's get rid of them. And I'll show you one of the 10,000 exercises that you can do.

and not have to even worry about anything. And we can gradually have that conversation week to week, month to month, or training program to training program. But for now, let's remove it and just get you pushing, pulling, squatting, hinging, lunging, coring, breathing, bracing, whatever the case is.

Joe Gambino (29:47)
Right, yeah. And I think just to kind of like wrap this up, because we haven't really talked about carries and we haven't really talked about power work, know, which are kind of like the, know, the carries is right, like one of the main five that we talked about, but core and power kind of being like these other ones that get talked about as well. And I think everybody should be doing some sort of farmer's carries, two arms, one arm, same way they were kind of categorizing above. And then you have a whole bunch of positions, right?

farmer's carry is at your side. You can do waiter's walks overhead. So if we're trying to like train overhead positions, right? You can do bottom's up holds. You can do rack carries to strengthen. You know, if you are doing like kind of a front squats and stuff like that, it's also a great, I think great way just core work in general, shoulder strength in general. So carries I think should always be in there. And then I think everybody will benefit from moving faster. Still, you know, it doesn't matter how old you're getting, hopping, jumping.

Joe LaVacca (30:20)
Mm-hmm.

Joe Gambino (30:42)
moving weight fast, right? It doesn't always have to be like these like RPs of eights and nines and sevens, right? That are like, hey, we're working on strength, but why don't you drop that to like, you know, an RP of five, you know, around a five and then move it as fast as you can. And then your set ends once it starts slowing down, right? Like that kind of, you know, working on a little bit more of this like moving fast, especially as we're, you know, I think, A, if you're younger, it's a great thing to do, but especially as you get an older.

And I think we'll have a whole episode diving deeper into this. It's just as important to start doing those things, especially because I think we use our age to stop playing, stop running, stop jumping and doing all these things. And we know that there's a decline in all those things as we get older.

Joe LaVacca (31:25)
Yeah. And, you know, the, will definitely do like a little episode, like we were saying about aging and power and stuff in the new year. And I think the thing I love about power when power comes up because of, you know, all the podcasts that are out there, all the information that's out there, you know, we get these buzzwords and clips go viral and all of our clients have Instagram or Facebook or social media to some degree. And to me, and I'll have to try to dig this up before we have a big talk about it, but I sort of almost remember.

being taught or telling clients that, look, a lot of the power stuff is also nervous system expression. So we don't need maybe 100,000 different varieties of weights. I need you to think about moving faster. So even if it just sit to stand, I want you to move as fast as you can for 30 seconds or until we slow down. Taking the same weight that you maybe only have a 10 or 15 pound dumbbell at home, but I want you to think about moving it as fast as you can.

and then slowly bring it back to you and then move it as fast as you can away from you. So even some stuff with, if you're not ready for jumping, getting up and down from a chair as fast as you can might be your entry point to jumping. If you don't have barbells and trap bars and 10 % of your weight, 20 % of your weight, 30 % of your weight, 40 % of your weight, well then just kind of thinking about tempo working both ways. A lot of the times I think we think tempo slows things down and adds pauses.

But for me, always tell clients too, tempo can also be explosive in nature. And then again, we don't need to Amazon gift package 100 weights to your house or join some expensive gym. A lot of this stuff can just be a mindset or just like the idea of like, what are we trying to express? So I think that gives people a lot more entry points too.

Joe Gambino (33:06)
Yeah, no, I like that. And I think, you know, I mean, there's a whole part of the fitness initiative that, you know, kind of dive deeper into like velocity based training and having these like specific metrics, like if you could move a bar or your body, like this speed, right? Like you're going to see power adaptations happen. And even if you're trying to move it fast, but the velocity is slower. you just like,

Joe LaVacca (33:21)
Mm-hmm.

Joe Gambino (33:29)
biting off too much you can chew from a power and speed perspective, right? You're not gonna be getting those same benefits. So I definitely think that it's something that I think we should much dive deeper into this and I'll see if I can even find a guess that we can dive into this even deeper.

Joe LaVacca (33:42)
Yeah,

yeah, for sure. All right, Anything else to add before we close out?

Joe Gambino (33:49)
That's it.

Joe LaVacca (33:51)
All right. Well, Joe, love you. We wish you a Merry Christmas. Listeners, we love you. We wish you a Merry Christmas, Happy Holidays and all the above. And don't forget to come back next week for another exciting episode of the Beyond Pain podcast.

Joe Gambino (00:43)
Welcome back into the Beyond Pain podcast. I am one of your hosts, Joe Gambino, and I'm here with our other host, Joe Lavaca. You can find this on Instagram at Joe Gambino, DPT for myself at Shred The Motion underscore PT for Lavaca over there. You can find this podcast on YouTube, cups of Joe underscore PT and on YouTube as well on Instagram as well, Beyond Pain podcast. And if you have been enjoying the show, please drop us a review. It will help us get this out to more ears.

and hopefully be able to help them as well. Welcome back to the show, Joy Boy.

Joe LaVacca (01:17)
Good to be back.

A week before Christmas, are the Gambinos prepared for Christmas? All your shopping done, everything good?

Joe Gambino (01:24)
All the shopping is pretty much done. So we're good over here. ready. Olivia's excited. We're good to go. And then we'll be.

Joe LaVacca (01:34)
Yeah, she's at a great age

now where the Santa magic is probably really strong.

Joe Gambino (01:39)
Yes, I think this is the first year where holidays are like exciting. I think next year will be like that first like real understanding like this is all the stuff that happens. So I think next year will be one more, you know, level above where we are this year. But yeah, she's it's a this is fun.

Joe LaVacca (02:00)
Alright, that's awesome. Are the kids, or did you get Santa pictures with the kids?

Joe Gambino (02:04)
We have

gotten plenty of pictures at this point. She has seen Santa like five times throughout this holiday season at different places.

Joe LaVacca (02:08)
Okay. So she,

so she doesn't mind taking pictures with Santa.

Joe Gambino (02:16)
She sometimes minds and sometimes does not mind. it depends on her mood, how much sleep she's had, how much food's in her belly and the time of day. So.

Joe LaVacca (02:18)
Okay.

and

Yeah, yeah.

What about baby Joey? Was he... Did he get passed off to Santa's lap or anything like that or... Okay.

Joe Gambino (02:33)
He has, he has, and he just,

he goes with the flow. Only one time was he not very happy with Santa out of the five. So otherwise he's just sitting there chill. The first one, Santa was like, listen, this is a drop and run situation. You know, this way we can try to get that picture as quick as possible. And he just sat there, no issues. He would have stayed there for like 30 minutes if we let him.

Joe LaVacca (02:54)
I love it.

Gambino kids. They're just so level-headed and chill and balanced. If only we could all be so lucky.

Joe Gambino (03:03)
Baby Jo, yes. Olivia depends

on her mood. What about you guys?

Joe LaVacca (03:10)
⁓ man.

yeah. Well, similar. I thought I had bought my last gift last night. but then I realized I still had, two other people I forgot. No, I forgot. I think it was just like one of those things I was like, I kept putting off, kept putting off and it was work, work people. So I wasn't sure if I wanted to bring it in on Monday or try to bring it in Wednesday. And then because of my lack of indecision, my decision therefore had to be Monday. So,

Joe Gambino (03:25)
Meh.

Joe LaVacca (03:35)
I usually just get the owners of the gym of Osam for their kids. So that's the last thing I really technically have to do. And then whatever people are getting, they're getting. It's gotten, it's done. So we'll see how it goes. We'll see if Avery and Addison like their gifts. you know, because unlike your children, the magic is over. And now it's just pure entitlement.

Joe Gambino (03:47)
That's it.

Joe LaVacca (03:59)
And Avery was funny yesterday. She was like, you know, I made you something, but I'm not sure if it's going to be done in time for Christmas. I said, you have eight days. What could you possibly be making? And she goes, it's just a thing. And I want it to be really good, but I'm not sure if it's going to get done. And I said, OK, imagine if I told you daddy was so busy that I didn't get all the Christmas shopping done, but I'll get it done maybe in January, maybe just throughout, you know.

maybe February, but you'll definitely have it. How would you feel?" And she was like, oh, I'd be really mad. And I was like, okay, so go get the thing you're making done. you got to build in these lessons now, you know, like, how would you feel the double standard? Like that's the one that always works with clients and apparently it also works with kids, you know.

Joe Gambino (04:33)
You

Yeah, lesson learned.

Yeah,

I feel like that's it. You just gotta make them realize, hey, this is how you'd feel, right? So come on, me that gift. I don't wanna wait. Come on now. Entitlement goes both ways.

Joe LaVacca (04:54)
Yeah, exactly.

yeah, we go. Yeah, that's a good point. That's a good point. That's a good point. What are we talking about today, Jakes!

Joe Gambino (05:04)
All right, Joe, what are we talking about? jinx, jinx. I know what

we're talking about. So today we're going to be talking about overall categories of exercises, how we think about them, how we might give you maybe some lateralizations or progressions and how you can think about maybe where you should be starting and how you can make things a little bit more challenging over time. So.

Joe, we talked a little bit about right before here the category so why don't you kind of lay them out and then we'll jump in from there.

Joe LaVacca (05:33)
So your typical programming categories, and maybe we have touched on this at one point or another, glossed over it, it's pretty simple, right? We have push, we have pull, we have squat, we have hinge or deadlift, we have carry. We were talking about, you know, then the other categories could be lunge, core, power. I think you could probably dice it up any way that you want. And I think that over the course of the last

I don't know, maybe like five years or so, especially since I've really been trying to get into blending the PT rehab and the training approach much more specifically. There was this emerging thought or still a thought in the industry where maybe there's hierarchies to movements. And for example, let's use someone with shoulder pain that always seems to be an easy one maybe to start the conversation with. Well, maybe

you know, your client with shoulder pain or your client who's just starting to train, you know, doesn't bench press until they start to do pushups correctly or, you know, doesn't do a floor based pushup until they do elevated pushups correctly. And if we look at where that also I think pops up is a lot of the time with like maybe runners or ankle pain, foot pain, this idea or notion that, you

Five out of five, you when you're grading someone's muscle testing with a single leg heel raises, you don't have try to get to 20 or 25 heel raises before, you know, you can strength train or maybe before you run or before you do this or before you do that. And I'm like, God damn, that's too hard. I could barely get to 25 heel raises. So, and I overload my calves all the time with, you know, sets of eight or 10 or 12. And I'm trying to really grind them out. And it doesn't make my 20 or 25.

particularly a lot easier. So I guess the big question around the things that we're going to explore today is, you know, how valid are these hierarchical systems when we're thinking about movement? How much are they needed? And I guess do we follow them? And I would probably say big picture for me. I think they just kind of create more options for people to train.

Not necessarily that I need someone to move through step one to get to step two to get to step three. So that's my kind of high level intro. What do you think about that so far?

Joe Gambino (08:02)
Yeah, so think first thing is that I want to just take a take a step back and we talked a little bit, you you brought up these overarching themes right the the hinge the squad or knee dominant movement carries the push-pull for upper body and The reason why we bring that up right is I think when we're talking about programming all overall then having a It's easier to have like a like a system or a thought process to pull from it just makes programming easier, right like

If we had to take every, I don't know how many exercises there are in the world. mean, I'm going to say maybe 10,000 and that's the over under. I don't really know what that is. Yeah. But if you were to have to just select from that list, right? It can be very overwhelming. And I think that's where a lot of people are like, Oh, there's so many things I can do. I don't know if it's right for me. Well, if you want to simplify it, if you just took all five of these categories and just selected.

Joe LaVacca (08:38)
I'll go over, I'll go over.

Joe Gambino (08:55)
two from each and had 10 exercises for your workout, you're gonna be probably at a better starting point from a programming perspective than like 90 % of the people out there, right? So that's kind of why we bring this up. And then to your point around, know, hierarchies and this whole concept of you need to be able to do X before this and even like the whole FRC world where if you don't have the prerequisites for this, you shouldn't be able to do it.

You know whether or not we need to abide by this stuff I mean these are again we you know, especially in FRC like the whole kind of thing is You know, they talk about we've talked about this a bunch too is right like exercise like these all man-made movements, right? Like why stick yourself into kind of like a like a box, but then we create all these rules like hey we have these hierarchies we have to do X Y and Z you have to have these prerequisites before you do this and

I think that A, it just makes it more confusing for people and B, do we really need it? So I do like your thought on options for change, hey, we have all these options, you can do things. I definitely think that we should be kind of.

changing variations around just from a movement variability standpoint to make things like, you know, a little bit more new and novel for people. But I think there's a couple ways that I start to think about when I might have like a hierarchy in my brain and everything is really assessment dependent. So the things I'm be talking about here is it's not black or white. It's gonna be very, very dependent. But like,

One way I categorize things is as novice versus someone who's had a whole bunch of training experience. So if you're newer to training, it's very unlikely I'm going to be throwing that person into like back squatting and like heavy back squatting and heavy dead lifting, like with a barbell. I'm probably going to start them off with like goblet squats or kettlebell front squats. If, know, we have access to doing so, you know, I like to start with kettlebell deadlifts.

things like that, just because it helps kind of teach movement patterns. helps teach how to like connect things. And then from there, when they start to show like efficiency and also you don't need to load someone novice like very heavy to get a training stimulus. So usually that's kind of where I'll start pattern wise. And then, you know, if they do have an interest in barbell work, then we'll move there. also start with some single leg work. So split squats and step ups. like, I like to start people there to train unilaterally as well. So

You know, when we talk about these categories of push, pull, carry, hinge and squat patterns, like I also break them up unilaterally as well. So that's like one more layer. You can break them down. You should always have a bilateral and a unilateral movement, in my opinion, or programming. So novice versus expert is one of them. And then pain is the other one. So if you have like, say we're talking about the bench press, maybe we can continue down this rabbit hole of just like one movement at a time.

someone has pain with bench pressing and they have limited mobility and that mobility is painful, especially internal rotation and shoulder extension, I'm gonna say, well, maybe we should do push-ups, but I'm probably also just gonna move them to limited range of motion movements. I'm gonna do floor pressing, so we'll do it from the floor. Maybe dumbbells is a little bit of a better option, because you have a little bit more freedom for where your hands can move. So then there'll be changes to how I'm gonna be.

you know, or I might incline them if they really love bench pressing, then let's put them on an incline. So the range of motion demands are not as, as great. So those are like a few ways that I'll start to change things depending on like their training age pain. Those are probably the two big ones. If there's like no pain, they've been training for a little while. Then I really think like these hierarchies can just be like thrown out the window in a sense. Like you just want to make sure they're moving well. They're able to load effectively. Their technique is, you know, not.

total shit and go from there.

Joe LaVacca (12:37)
Yeah, so it sounds like there is a little bit more of a thoughtful, hierarchical, maybe whatever approach, we'll just kind of keep using the same terms, depending on different contexts. And I think you added a little bit of context here for us, that heavy pain, person's age or fitness level. So yeah, let's stick with the press, because that's the one that you brought up. And I think when we're...

looking at exercises or picking exercises for people, I always want sort of the biggest constraint to be successful, weakness, right? If we're gonna build strength, well then I wanna find something for you that challenges your strength, not necessarily your range of motion and not necessarily your pain. So I think if we're looking at someone with that painful shoulder and we wanna get them to bench press, and we notice that their internal rotation is quite limited,

their shoulder extension is quite limited, then yeah, maybe a heavy barbell work on the bench, on a flat bench, is not gonna be great for them, right? Like that just sort of makes sense. So I totally, totally agree with you there. At the same time, if they're having pain but they're not having any range of motion constraints and they can tolerate the bench, I often find that the conversation when I ask them to show me things would be, okay, well I was told that

You know, my back has to be flat. My hands have to be, you know, shoulder width apart. I have to, you know, do this with my wrists, you know, and there's so many other, you know, rules that they were taught and this is not their fault. But I just say, okay, well, what if you opened your hands up a little bit more? What if we just allowed you to get into a little bit more extension, right? Like stabilize your shoulders, you know.

Get your chest up a little bit higher. Maybe place your feet in a different position. How does that feel? Oh, well, that's a lot more tolerable. Oh, OK. Well, if we can tolerate this position then, OK. Well, then let's do the barbell work like this. We don't need to spend all this time building up isometric and these lower level exercises if we can make a modification that works well for you. So I think that's to me, if

the push or let's say the bench press was one of these big three movements and we talked about the big three last week. Well then why wouldn't that be enough of a stimulus to train the shoulder the way we want it if I can get a person to that position? So that's why I think when we mention a lot of the FRC worlds and this and that, it's like yeah, if there's a significant joint or range of motion constraint,

in a person really wants to bench press and let's follow that trail there. If there's a constraint and they want to do this, I don't, we told, we said this the other day too. We don't tell anybody they need to barbell bench press. They need to barbell squat. They need to lift heavy all the time. That is an option if you're comfortable. We also talked about affordances. Not many people have this like,

endless amount of weight and equipment to use. So it is their body weight. It is dumbbells. It is kettlebells. It is bands. So we can take that same hierarchy approach and okay, if they can only do elevated pushups or they can only do a floor press, like you said, how are we gonna make it more challenging for them so they can continually adapt? And then where is then the cutoff of us saying, well, hey, now you just need probably a little bit more weight.

more resistance, a little bit more of this, a little bit more of that. You got to join a gym. I mean, if you want to keep progressing, we can only go so far with a 10 pound dumbbell or a yellow band or tempo work and pause work. Also it's going to get really, really endless in volume. So yeah, I think that's kind of where I stand on it. Like I said, I think like when I see a hierarchy list or something like, dude, I'm like, cool. Like there's actually like two or three options there I either forgot about or I just haven't used in a long time.

Joe Gambino (16:20)
Mm-hmm.

Joe LaVacca (16:42)
And that would actually really work for, you know, Joyce or Tracy or Adam. And I think I'll I'll try it in their program. But I never walk it back in this sense with clients where I'm like, well, until you could do 15 push ups, you're not going to touch a barbell until you can do 25 heel raises. You're not going to touch pavement with your run. It's just going to be fast walking because I don't want to create more constraints.

Joe Gambino (16:44)
Mm-hmm.

you

Right.

Joe LaVacca (17:07)
But if we think about our buddy, Greg Lehmann, and what's always really been interesting to listen to Greg talk is, you know, these things that we want to get people back to put so much, you know, load into their system that we can't mimic in the gym or with our work. So why wouldn't that like exposure, you know, and we've said it here too, if you can't run a mile, run a quarter mile.

Joe Gambino (17:22)
Mm-hmm.

Joe LaVacca (17:31)
then build up to a half, then build up to three quarters. Like, why wouldn't that be enough to sort of like gradually stress the system as we give them other things to sort of work on quote unquote. So I think that's where I'll pause for a second. And that's kind of where I think of my mindset is sort of at this moment in time on December 19th, you know.

Joe Gambino (17:48)
Yeah, I like that. think to your point, know, any exercise that someone's going to select, right, is it's usually like a bias, right? Like I pick exercises I like for myself and technically for my clients as well. And I ask for their input and get their biases on what they like. But the exercises, they're just exercises, their movements and our body. And this is something that probably over the last

few years that's really kind of like changed in my mind is that load is just load. Like it doesn't matter if it's a bench press, a push up, a fly. Like if you're hitting this tissue, it doesn't matter the modality. Your body only knows what loads you're going in and will adapt to the loads that you put in. So anyone who's listening here and you're like, well, I don't know what exercise that I need. This is why I like this category approach of exercise.

It doesn't matter. if I have, here's an example, someone's traveling and they have their program that I created for them and they're like, Oh, what should I do when I'm traveling? I just don't have access to this one piece of equipment. As long as it's the same category of exercise, I don't really care. can, here's an example of one you can do, but you can literally do any one that you prefer or that you have access to, or maybe, Hey, this is the opportunity for you to just try something new and explore something new and have a little like, you know, just make it fun in the gym.

Because again, it doesn't matter the exercise like, you know, I pick exercises for reason, but because I selected conventional deadlift doesn't mean that it's any better than a a trap bar deadlift, right? Or doing a single leg deadlift. Like I think there's different reasons for why I program those things. But at the end of the day, similar type of loading. So again, going back, this is why I like having these categories, because you can just select whatever you want for that particular week or month and then.

Joe LaVacca (19:26)
Mm-hmm.

Joe Gambino (19:43)
hey, I have these categories here, I can now just cherry pick some exercises and plug them in and you're gonna be consistent with the inputs that you put. You're not gonna create imbalances because you're just doing all squatting or you really like deadlifting. So you do all deadlift motions and never squat or anything like that. So one reason why I kind of like this approach here.

Joe LaVacca (20:04)
Yeah. And I love what you said there. There's, are clearly reasons why you or I or anybody else might pick an exercise for someone. But I think what we're saying is that to drop our deadlift, you didn't need to do 60 hip bridges on each side, single leg to earn that right. Right. We, if we have to prop up the bar, okay, we prop up the bar. If we start you with 65 pounds, we start you with 65 pounds. But that's the whole thing about this. And that's why I've always loved.

Like almost instantly, my entry point for most people in the gym, if they're training with me, is the trap bar deadlift. I love that thing. I mean, okay, our bar is 65 pounds and I don't work with too many people who are less than 120 pounds, let's say. So this is still going to be half their body weight. This is force that they are accustomed to. And that's what I also sort of tell them. If you're getting up out of a chair, you're exerting probably a little bit more load through your system.

then maybe what I'm asking you to do right here in a controlled manner, range of motion environment. If you go up and down stairs, you have exerted more force through your spine, your pelvis than I'm probably asking you to do in this one particular exercise. If you've jogged to catch the train and your pelvis and your spine and your femur didn't explode, you have probably put more load through your system than I'm asking you to do with this barbell. So if we can accept that,

then we can realize that this is safe and something that we can use to train you to now gradually take on more and more and more stress or just break that pattern of fear. And that was another thing that we've talked about numerous times. Maybe some of these lists of exercise are just like, barbell work is really scary for me. okay, well, what about an incline? Have you tried that? Yeah, I don't know. I think it's just the barbell itself. okay, what about a dumbbell?

Joe Gambino (21:38)
Mm-hmm.

Joe LaVacca (21:55)
Yeah, I guess I could do that. But you know, I'm still a little worried about my asymmetry or whatever. Cool. What about one dumbbell in both hands? Like just press it on the incline there. Why don't we just do that? So I think again, like even looking at an apparatus like a dumbbell or kettlebell, people think I have to use it one hand versus the other hand. It's like, well, like you said, weight is weight. Weight is weight. So if we want to be a little bit more narrow with your dumbbell, okay, cool. Press it here.

Joe Gambino (21:58)
Mm.

Mm-hmm.

Joe LaVacca (22:19)
And then that's when I'll give people some, some ranges. I'm like, look, if you can only push this six times, then we know that this is a pretty, is a heavy weight for you. If you get to 12 and you still have some room in the tank, we probably realize it's probably a little bit too light. can move on. Right. But I'll give them those very clear sort of pictures in the background of picking the exercise. Like, Hey, look, I know you're in some pain. I know you're a little bit worried. So I want you to look at this and try to do this weight or movement.

six times, can you give me a minimum of six? And just kind of set the floor for them, whatever we're picking. And then if they hit six, okay, great. What do think you could do next? I don't know. All well, if you get past 12, let's agree that we're gonna add some weight here or maybe make the exercise harder, right? Look at our hierarchy list. We're doing an incline at 45 degrees. Maybe we do an incline at 20 degrees, right? Get you back to being flat. Or maybe we went from floor press to the incline, right?

just give you a little bit more freedom of the arms. So I think that's also another way that we can kind of, or I usually try to check with people to see, you know, are they ready to change position, add some weight, and then that sort of auto regulates the decision making, right? It's not like I always tell them, I'm like, I didn't pick this, you picked this. You showed us you were ready. This is not me programming. This is just your body saying, hey, I need more stimulus. And it was like, okay, let's add this.

Joe Gambino (23:44)
Yeah, no, I like that. think if I had to, like, you you're talking about like a trap bar and that's kind of where you start. know, especially if someone's new or really struggles with hinges, I tend to start with like a, like a heavy kettlebell. You know, you can, you know, lot of gyms these days have, you know, in the fifties and the sixties and seventies, right? So can, you can load up pretty, pretty decently. But if someone's like really struggles with like a movement pattern, like a hinge, like say, well, we'll just stick here.

Or they have pain with hinging right like I'll start with some of these other Modalities and then I go to a trap bar right from like from a kettlebell because it's less hinging and your hands a little bit higher and then I would progress them to either like a sumo or conventional and then if we really wanted to load these patterns and we're talking about like trying to create some adaptations and like Work on sticky points because we know the bottom is usually the hardest part of the movement then we can start talking about like deficits Things like that's like really challenge that the pattern

know, squat, talked about kettlebell front squatting or goblet squatting, and then I'd probably move them over to like a safety squat bar is actually a really great option, especially for people with shoulder issues. And then moving them to like a back squat or a front squat, that can be a hierarchy of movement, depending on what's going on with their patterns and things like that. Talking about bench press, you know, I probably just start with like dumbbells. I'm also a big fan of like having people like be really strong with like controlling their body. So I would

You know, I like to see people do, you know, good amount of pushups with good technique without their like spine breaking or like showing real, you know, like technical issues, right? From that perspective, like, so I probably like want to start someone there versus like, Hey, do we really need the bench right now? If you can't do 10 pushups, you know, but sure. You know, you can also go the other way. You don't have enough strength for pushups. So bench can be, be a bridge. So again, it's not black or white there. And then overhead pressing. If someone really struggles to get there.

Or things like that, know, like a landmine press is like a perfect way to start to initiate that that Pattern for somebody but otherwise and I also like bottoms up pressing to teach someone who's like new More struggles or doesn't have a whole lot of like shoulder strength. We need some stability. I think bottoms up anything Is like a really great way to just like get shoulders to be like activated teach you how to like irradiate Teach you how to create tension

I think that has a lot of carryover to a lot of the things that we like to do in the gym But also outside the gym since we know that Things in real life are never like hey this nice dumbbell in my hand. I can just hold it close to my body and carry it around, know, That's just kind of a quick run through of maybe how someone can think of like easier to harder depending on if they have pain if they struggle with the moving pattern Is there anything else that you would add on there or think differently around?

Joe LaVacca (26:04)
Mm-hmm.

Well, yeah, I think as I was listening to you talk, I was like, okay, cool. Like where would I go with some of these ideas? And my thought is always like, what's the easiest thing for me to coach, especially in the beginning, or what's the easiest access point for people to work with, again, given their environment, right? So with the push, know, yes, I want to look at their push-ups to see what they're capable of. It's just like a nice, easy assessment for us to do.

But I always kind of have said to me like a floor press is the easiest thing. I don't have to worry about their body, their core, their breathing, their rib cage. Let's just get your elbows to the floor, push it back up. And then we can typically find a pretty decent weight that they can handle. So for me, maybe a little bit more of an entry point with like horizontal work is has been the floor press like in the past. And then I'll give them like an elevated pushup just so they can start to think about their spine, their rib cage, maybe some head position.

When it comes to overhead press, I actually like to almost put them in more like crawl and reach positions where they can press or hold through the floor in some plank patterns, maybe get a little bit of a rock back almost like into a pike or yeah, guess that would be considered a pike. Then they press through the floor there and hold some isometrics. That has always been, again, something easy they can practice at home.

Joe Gambino (27:23)
Mm-hmm.

Joe LaVacca (27:42)
very little coaching cueing for me in the beginning. It just kind of lets them explore what they need to do. And then from squatting, yeah, mean, most people are going to be more comfortable just holding a weight in front of them. A lot of people are either going to talk about their limited ankle or foot mobility. And I'm like, all right, cool. I don't really want to talk about this with you right now. Let's just elevate your heels. How deep should they go? Well, you know what? I don't really want to talk to you about this right now. I just want you to get some fundamentals, get safe with the squat.

So squat to a chair, right? So sometimes people are doing like cyclist chair squats because I'm just like, you know what? If all of these things are clouding, you know, what we want to get done right now, which is just low to your legs, let's remove them. And then let's see how you do with just getting low to the leg. And then we can always build some of these processes around them. Yeah, with the hinge, like I mentioned, I think like I love, I love the trap bar.

Joe Gambino (28:22)
Mm-hmm.

Joe LaVacca (28:35)
Never shied away from the heavy kettlebells though. Again, I think it's a lot of the time with, do they feel a little bit more comfortable with a wider base? And then I'll let them do the kettlebell. If they feel a little bit more comfortable with a narrow base when they hinge, then I'll let them do the trap bar just because it's just a better hand placement. And then what was the other one you mentioned, Joe? Was that it?

Joe Gambino (28:47)
Mm-hmm.

Overhead press bench deadlift squat. Yeah, that's all I can

Joe LaVacca (28:59)
Yeah, okay, cool. Yeah. I think like that's just, again, like the, they're very similar, but yet a little subtly like different. And I think the context that you provided before of like their training age, the pain, what they've been coached on in the past. I just sort of like take all those things. I'm just like, look, what's your goal? You want to get stronger? You want to get back to the gym? You gave us some boundaries, these rules, this pain, this, this, this, that. So let's get rid of them. And I'll show you one of the 10,000 exercises that you can do.

and not have to even worry about anything. And we can gradually have that conversation week to week, month to month, or training program to training program. But for now, let's remove it and just get you pushing, pulling, squatting, hinging, lunging, coring, breathing, bracing, whatever the case is.

Joe Gambino (29:47)
Right, yeah. And I think just to kind of like wrap this up, because we haven't really talked about carries and we haven't really talked about power work, know, which are kind of like the, know, the carries is right, like one of the main five that we talked about, but core and power kind of being like these other ones that get talked about as well. And I think everybody should be doing some sort of farmer's carries, two arms, one arm, same way they were kind of categorizing above. And then you have a whole bunch of positions, right?

farmer's carry is at your side. You can do waiter's walks overhead. So if we're trying to like train overhead positions, right? You can do bottom's up holds. You can do rack carries to strengthen. You know, if you are doing like kind of a front squats and stuff like that, it's also a great, I think great way just core work in general, shoulder strength in general. So carries I think should always be in there. And then I think everybody will benefit from moving faster. Still, you know, it doesn't matter how old you're getting, hopping, jumping.

Joe LaVacca (30:20)
Mm-hmm.

Joe Gambino (30:42)
moving weight fast, right? It doesn't always have to be like these like RPs of eights and nines and sevens, right? That are like, hey, we're working on strength, but why don't you drop that to like, you know, an RP of five, you know, around a five and then move it as fast as you can. And then your set ends once it starts slowing down, right? Like that kind of, you know, working on a little bit more of this like moving fast, especially as we're, you know, I think, A, if you're younger, it's a great thing to do, but especially as you get an older.

And I think we'll have a whole episode diving deeper into this. It's just as important to start doing those things, especially because I think we use our age to stop playing, stop running, stop jumping and doing all these things. And we know that there's a decline in all those things as we get older.

Joe LaVacca (31:25)
Yeah. And, you know, the, will definitely do like a little episode, like we were saying about aging and power and stuff in the new year. And I think the thing I love about power when power comes up because of, you know, all the podcasts that are out there, all the information that's out there, you know, we get these buzzwords and clips go viral and all of our clients have Instagram or Facebook or social media to some degree. And to me, and I'll have to try to dig this up before we have a big talk about it, but I sort of almost remember.

being taught or telling clients that, look, a lot of the power stuff is also nervous system expression. So we don't need maybe 100,000 different varieties of weights. I need you to think about moving faster. So even if it just sit to stand, I want you to move as fast as you can for 30 seconds or until we slow down. Taking the same weight that you maybe only have a 10 or 15 pound dumbbell at home, but I want you to think about moving it as fast as you can.

and then slowly bring it back to you and then move it as fast as you can away from you. So even some stuff with, if you're not ready for jumping, getting up and down from a chair as fast as you can might be your entry point to jumping. If you don't have barbells and trap bars and 10 % of your weight, 20 % of your weight, 30 % of your weight, 40 % of your weight, well then just kind of thinking about tempo working both ways. A lot of the times I think we think tempo slows things down and adds pauses.

But for me, always tell clients too, tempo can also be explosive in nature. And then again, we don't need to Amazon gift package 100 weights to your house or join some expensive gym. A lot of this stuff can just be a mindset or just like the idea of like, what are we trying to express? So I think that gives people a lot more entry points too.

Joe Gambino (33:06)
Yeah, no, I like that. And I think, you know, I mean, there's a whole part of the fitness initiative that, you know, kind of dive deeper into like velocity based training and having these like specific metrics, like if you could move a bar or your body, like this speed, right? Like you're going to see power adaptations happen. And even if you're trying to move it fast, but the velocity is slower. you just like,

Joe LaVacca (33:21)
Mm-hmm.

Joe Gambino (33:29)
biting off too much you can chew from a power and speed perspective, right? You're not gonna be getting those same benefits. So I definitely think that it's something that I think we should much dive deeper into this and I'll see if I can even find a guess that we can dive into this even deeper.

Joe LaVacca (33:42)
Yeah,

yeah, for sure. All right, Anything else to add before we close out?

Joe Gambino (33:49)
That's it.

Joe LaVacca (33:51)
All right. Well, Joe, love you. We wish you a Merry Christmas. Listeners, we love you. We wish you a Merry Christmas, Happy Holidays and all the above. And don't forget to come back next week for another exciting episode of the Beyond Pain podcast.