Botox and Burpees
Botox and Burpees
S05E103 - Beyond RICE: Modern Approaches to Athletic Healing with Kayla Andrews
The way we've been taught to treat athletic injuries could be completely wrong. In this eye-opening conversation with certified athletic trainer Kayla Andrews @kay__wellness, we challenge the decades-old RICE protocol (rest, ice, compression, elevation) that has dominated injury management since 1978.
Kayla reveals why immediate, extensive icing might actually impede your body's natural healing processes and how complete rest can lead to longer recovery times and poorer outcomes. Instead, she introduces modern recovery frameworks like MEAT, PEACE, and LOVE that emphasize appropriate early movement, controlled loading, and allowing the inflammatory response to do its critical work in tissue repair.
What's particularly fascinating is how counterintuitive some of this advice feels. We've been conditioned to think that an injury means stopping all activity, icing constantly, and taking anti-inflammatories around the clock. Yet Kayla explains why this approach may be robbing our bodies of the signals and resources they need to heal properly.
Through practical examples of ankle sprains, hamstring pulls, and shoulder injuries, we explore what "appropriate movement" really means - finding that sweet spot where discomfort is tolerable but movement is possible. Kayla also shares valuable insights about compression (never sleep with it!), the power of mindset in recovery, and why working your uninjured side can dramatically benefit your injured side.
Whether you're an athlete, coach, or someone who occasionally tweaks something at the gym, this conversation will transform how you approach injury management. Listen now to learn why "movement is medicine" and how you can take a more active, effective role in your own recovery process.
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Welcome back to another episode of Botox and Burpees. I'm here with my very special guest, kayla Andrews. We are going to talk today about debunking outdated acute injury recovery methods. I know a lot of people have talked about rice and that's what I've always learned and, almost more recently, have realized that rest ice compression elevation may not be the best thing for all the injuries that I've sustained over these years and I sustained a whole bunch, and so we have a talk today about some of these new protocols, what people should be doing if they've sprained something or hurt something, and I have with me probably the person that I know who have seen more of these types of injuries than anybody else in an acute setting, and that's Kayla Andrews. Welcome, kayla Andrews.
Kayla Andrews:Thanks for having me.
Sam Rhee:All right, tell me a little bit about yourself, kayla, and what you do in terms of your experience with acute injuries.
Kayla Andrews:So my name is Kayla Andrews. I'm a certified athletic trainer. I work at a high school, so I work at the Hackley School. It's in Tarrytown. This is year six, I believe.
Sam Rhee:Wow.
Kayla Andrews:Yeah, year six Been athletic trainer for seven years, and so I work with anywhere from seventh grade to up to 12th grade. I have collegiate experience. I used to work at a college and then, obviously as a student, I started in a collegiate setting. So I'm also a CrossFit coach at CrossFit Bison, which is awesome. I'm also a nutritionist, so I have my master's degree in nutrition and dietetics so I integrate that into my job as well. I have some clients on the side, the whole K wellness business on the side, which I like to integrate, both that mobility and preventative aspect of just treatment and nutrition as well.
Sam Rhee:So how does someone get a hold of you? What's your Instagram handle, by the way?
Kayla Andrews:Oh, I'm really bad at Instagram, but it is kwellness. You can find me there, is it kwellness? I'm pretty sure it's that I'm a bad business person, but yeah, you can find me there. And then kwellnessnutrition is my email. If you wanted to email me at gmailcom, you can also do that, and then just text me.
Sam Rhee:That's awesome. So I mean my personal experience with injuries have all been ones that I've sustained myself, and I think I've done just about everything in the 11 years of CrossFit that I've been an athlete. I've done my shoulders, my hamstring, my ankles, my wrists, and I've never really learned. But I haven't really seen people very often Maybe one or two times in my life have I seen someone for low back or something like that, for low back or something like that.
Sam Rhee:And so a lot of us, when we sprain an ankle, when we pull a hamstring, when we, you know, feel our shoulder give out a little bit, we think we know what we're doing, but maybe there are ways that we have been managing ourselves that have actually slowed down how we recover, and so what I want to do here is talk about how we used to sort of manage injuries like this and then how there might be newer ways of doing this which might be more helpful, especially acutely. And just as a reminder, this is not medical advice. I'm not telling anyone what to do per se. This is mostly anecdotal and also our own experience and discussion. Obviously, you should see your own medical provider and if you have any questions you need to seek professional treatment, but this might just give people more of an interest and then maybe they can start figuring out some of this stuff on their own. Have you ever injured yourself during doing anything?
Kayla Andrews:Yeah, it's more the tweaks and aches. There's never been like a. I've never had like a surgery, but I have problem spots like a handstand push up my strain, my upper trap. And it's, you know, debilitating. You're like this, you can't move your neck. I think it stems from like way back in high school.
Kayla Andrews:I did it while I was dancing, kind of did a flip and landed on my neck and then it's been like a problem spot since. But, um, here and there a little bit banged up, um a little bit of like from the upper trap going to my mid back. Um, every now and then that'll get a little tight, but um, never anything surgical.
Sam Rhee:Yeah, that's a blessing. Same for me too. So let's talk a little bit about rice first, and, as I mentioned, it's rice ice rest ice, not rice rest ice compression and elevation, and this was actually a protocol developed in 1978 by Dr Gabe Merkin, and this is sort of how I've actually managed pretty much everything I've dealt with. When did you realize, or that rice wasn't necessarily the way to treat every sprain or acute, you know, athletic injury that you might have seen right away?
Kayla Andrews:Actually, they started to introduce it in my last year of college, so that's when my professors were really taking on to this new. Like hey, this doctor, Gabe Merkin, came out and said I was wrong. Ice is actually not the thing to do. Rice is not the best protocol. It actually impedes the healing process in some ways. So it actually impedes the healing process in some ways. So, yeah, we started implementing this in college. So for me it was an opportunity to, before I even started practicing, start using some of these techniques that are a little more healing promoting.
Sam Rhee:So yeah, I guess seven years ago, seven years ago now, I still see people at the gym, though, who who'd follow this pretty consistently in terms of like rest, so maybe they tweak their hamstring so they won't go to the gym for like a week until they feel like it's the pain is almost completely gone away, or for a shoulder or for something else, and I think that that was the thing that, um, why I wanted to talk about it? Cause I saw so many people at our gym. They tweak something and then they don't do anything for literally like four or five days, and that's something that, um, I'm sure that you, with your students, uh, and your other athletes, sort of poo-pooed at this point. How hard is it to get people because you know sometimes they don't really feel awesome right afterwards to like say, okay, now let's try doing something rather than nothing.
Kayla Andrews:Right, how hard is it to get the athletes to come in and do it? I mean, some, it depends on the athlete. Some people are like I need to do something right away, I need to fix this, I need this to go faster. And then some people shy away because they're in pain, and I think that's one of the biggest downfalls of this whole. Rest ice compression elevation is that we've really as like a profession, and it was very well understood that we want to make the patient or the person as comfortable as possible. Right, take the pain away.
Sam Rhee:Right.
Kayla Andrews:Get rid of all their pain, flood them with NSAIDs, flood them with ice, so it kind of numbs the area and make them as comfortable as possible. But at the end of the day, the injury process is not a comfortable process and there's going to be some pain involved, especially within that first month or first couple weeks. So what I try to do to get them to come in is talk to them about a plan and about what to expect and why you're feeling this way, so they have some autonomy to say, okay, well, I can control this. Just sitting on the couch and doing nothing, watching Netflix and sobbing over your hamstring strain, won't be the solution. There is absolute benefit to movement versus just sitting and in place and doing nothing. Even just going over like knowing the inflammatory process, like some of those like science-y words and like breaking them down, could even be a helpful start to allow some people to like realize what's going on. So if you wanted to break that down, we could do that.
Sam Rhee:Right. So yeah, I mean, the first thing is is I think one of the things that we don't do properly and I've seen this even in my patients post-op for not even just athletic injuries but just other operations when I'm operating is they want tobs it. So the thing that we've learned, and you can comment on it, is that they say trainers should say only use ice for the first hours of pain relief, maybe six hours or so after the injury, and no more for than about 10 minutes at a time, and it's really to help reduce pain. But, like you talked about, we don't want to remove all of the inflammation, inflammatory processes that are happening, because that's actually part of the recovery process right, absolutely, yeah.
Kayla Andrews:So to go back on your like, when to use ice within that, first I say just hour of injury. I shorten it, I try to shorten it as much as possible, and a lot of times I'm seeing athletes on field and it's to the point where they can't walk. They're in a lot of pain, so uncomfortable that we need to numb the area. So that's where I'm like okay, 10 minutes of ice only at a time, and then if it starts to feel better after that, let's ditch it as soon as possible starts to feel better after that, let's ditch it as soon as possible.
Kayla Andrews:So it's no more 20 minutes on, 40 minutes off for days and days and days out of injury. It's all right the first day if you can't tolerate it. It's better than using NSAIDs, it's better than using some of the anti-inflammatories and relying on them, because that can also be a slippery slope. So if we can get them to ice instead in place of that, temporarily for the first day, then okay, that's when I'll say, I'll quote unquote allow it. We also don't want to add heat within that first 48 hours because they're still going through an inflammatory phase or the initial phase of the healing injury. So all of that blood flow is going to that area. So he is just going to exacerbate that a little bit more. And so that's where the term like walk it off, like the old school method of, you know, rub some dirt on it, is kind of coming back. There's a more eloquent way, an elevated way of doing that, but movement, which we'll get to, is going to be the key at some point.
Sam Rhee:Yeah, let's get to that. So the first protocol acronym I heard of was MEAT, which is crazy, m-e-a-t, which stands for movement, exercise, analgesics and treatment. And so you talked about movement. So I read and this was mostly from a Wall Street Journal article gentle, pain-free movement as soon as possible to maintain range of motion and muscle activation. So what does that look like? What does that mean exactly?
Kayla Andrews:So it means a lot of different things depending upon the scenario. Let's take an ankle sprain, for example. Someone rolls their ankle or falls, twists their ankle off a box or on the athletic field and they're swollen, they're puffy but maybe they can bear some weight. But it hurts and they feel better with it propped up, but they can move it, it's not broken. Or maybe we ruled out a fracture already. They got an x-ray, we know it's not broken.
Kayla Andrews:That movement could literally look like ankle pumps, meaning pointing your ankle down, flexing it up, making it turn in, turn out, inversion, eversion or going in circles. Okay, really basic way of movement. It could also mean an isometric contraction. So you're squeezing the muscle, letting it relax. You're creating some sort of blood flow to the area by using external load or internal load. So internal load being you contracting your muscle. External load could mean some sort of massage technique, instrument, assisted technique, some sort of load in that way. But whatever you currently have range of motion wise, that's relatively pain free. I'm okay with discomfort. You're going to be uncomfortable within these few days, maybe even month of injury. But if it's not excruciating pain, use it all right, or else you're going to lose it.
Sam Rhee:How about analgesics? So that was movement, the M A analgesics? So they do say to use some anti-inflammatories but not to block it entirely. It's really to manage the pain so you can stay active. What is that, like you said line where you're sort of keeping that pain at bay so you can maybe do some of these isometrics or gentle range of motion type exercises but you're not like knocked out. Yeah.
Kayla Andrews:That line is really going to be athlete specific, it's going to be dependent upon the person, and a lot of times what I'll ask them is are you looking for the most pain-free treatment? Are you looking for the most effective long-term treatment? And some of that is going to be a little bit of discomfort, but if it's sharp shooting pain, they're wincing, they're unable to perform the treatment or they're getting worse after the treatment. Or if the next day they wake up super sore, more swollen, more stiff, those might be red flags of you overdid it at that point.
Kayla Andrews:And more stiff, those might be red flags of you overdid it at that point but going back to, like, the analgesic part, I think just knowing some of those, like the reasons why this is where it could be controversial, Like some people like to use them, some people don't. But the healing process is a. The inflammation process is really a normal part of the healing process. It's a necessary part of the healing process. At Cookie Cutter Way we have three phases the inflammatory phase, which is day zero, when the injury happens to day six, Um, and that's when you know, you see that redness swelling, um, you see the, the pain, um, the four cardinal signs of injury, Um, and I'm missing one redness swelling pain. It'll come back to me at some point.
Kayla Andrews:Heat, that's the other one. Um, some point heat, that's the other one, but you have. So it's a normal part of the process and we want that process to happen. Initially because you have all of these, these molecules, these cytokines, these macrophages, these, these fancy terms that they come in and they start to repair the tissue Tissues don't understand that once they start to heal, like in the fibroblastic phase, they start to heal in this pattern that's disorganized, it's kind of like a webbed net and we need some sort of external load or external force to align those fibers to let them know like, hey, we need to prevent that scar tissue formation, but if we flood the area or if we flood your body with analgesics or anti-inflammatories or a lot of drugs, that process gets impeded.
Sam Rhee:It gets blocked off. Yeah, it's almost like there is evidence, for example, that ibuprofen and other anti-inflammatories can impair muscle growth, because muscle growth are basically micro tears in the muscle and then you're getting an inflammatory process and then you're getting the rebuild and it's on a greater level. When you have an injury like this, you're getting a rebuild due to that inflammatory process. So if you're using a lot of anti-inflammatories, it stands to reason. Same with ice or anything else. It sort of knocks down that process. I mean, in my experience for injuries I've never really used anything more than ibuprofen and I really hate trying to. I hate using it. I will use it because it makes me feel honestly really good, but maybe only for a couple of days. Tops, what other drugs or anti-inflammatories have you seen used in addition to, say, just Tylenol and Advil Meloxicam is a big one, oh wow.
Kayla Andrews:Yeah, meloxicam is a really big one right now. You know a lot of providers that at least I like. Within my circle I've seen providers basically every athlete who walked into their office walked out with Meloxicam.
Sam Rhee:Oh, wow.
Kayla Andrews:Like regardless of the injury. And yeah, I don't think there's a one-size-fits-all, I don't think that just one anti-inflammatory drug is the solution to the problem. I think it could be, like I said, limiting their long-term progress.
Sam Rhee:So we got the MEA Movement Exercise Analytics Treatment. So articles I've read suggest that you can get more targeted treatments, say maybe from a physical therapist or an athletic trainer, like joint mobilization, soft tissue massage, acupuncture, guided exercises. What are the kind of things that you've seen athletes do in terms of their treatment that seem to help for these type of injuries?
Kayla Andrews:Well treatment sessions would be like going back to the range of motion. So let's say we get them on an exercise bike, some sort of low grade exercise, get the heart pumping. It's not very fancy, it's not painful. We need to get blood flow to all of your body. Instead of just heating and localizing that one area. I think the best way is to get blood moving with some sort of general exercise that they're able to tolerate. And then we move into some of the soft tissue work.
Kayla Andrews:I like soft tissue work or some sort of manual therapy, because work. I like soft tissue work or some sort of manual therapy because I think one. It's a good time for you to connect with your athlete or your patient and not everyone, but most people respond well to physical touch. In some way. It's that like okay, it reduces my pain, whether you're pushing the swelling out or not, I still think that it allows that physical touch. It feels so good, like why do we foam roll? We're not necessarily breaking up scar tissue, but it provides an opportunity or a window for you to get more work done. So some sort of manual therapy. I like instrument-assisted soft tissue mobilization. I like just good old, using your hands, some sort of cupping that could also be beneficial things that I don't typically, or I don't do something like dry needling or acupuncture, like you said, some of those, they're all tools or pieces to the puzzle. There's no one thing that's going about two more protocols here.
Sam Rhee:Peace and love, which I thought were so hilarious, because peace is for the immediate aftermath after an injury and then love is the longer-term rehab. So let's break those down a little bit. Peace, which is usually a protocol you would do for the first one to three days post injury. Again, these are not like crazy concepts. They actually make sense. You told me you actually do all these things, but you didn't know like they had these crazy little acronyms.
Kayla Andrews:Peace and love baby, that's right.
Sam Rhee:But I guess if you haven't really heard of them, then it might just help like jog the memory a little bit just to know what these acronyms are. It does for me. So the first one piece, p. So the whole acronym is protect, elevate, avoid, anti-inflammatory, anti-inflammatories, compression and education. That's the piece. So let's break it down real quick. P, protect, shield the injury in the very early phase. That means avoiding movements that cause sharp pain for one to three days, but not total inactivity. So what does that really mean? To do some, but not too much.
Kayla Andrews:To do some without doing too much, and avoiding total inactivity is the key here, and I'm going to keep beating a dead horse. It depends on the injury and if you have, let's say, pain-free range of motion and it's passive, there's no weight involved and you can let's take your shoulder, for example lift your shoulder over your head, it's not painful, I can do it. A little bit of discomfort Okay, awesome, let's run with that. Then we can maybe move to the next step of figuring out what is painful and what is not painful. It's going to take a little bit of teetering back and forth.
Kayla Andrews:In this same phase we could also introduce things like maybe it's band work to that shoulder injury, some light load, but for the most part I would say it's a safe bet to start on loaded first. Once you check those box and all the ranges of motion, mobility work instead of just sitting and stretching like a classic sit and reach for like a tweaked hamstring. We want to avoid just stretching in prolonged positions for a prolonged period of time because you just overstretched your muscle so you don't want to stretch it more because at that point it doesn't need it More. So the range of motion that you have, that's relatively pain-free, use it.
Sam Rhee:And this is important because I think and I've actually done this where I've injured it and then I've tried to say, oh, I got to keep using it and I pushed it too much. So we will actually break down three of the most common scenarios. I think that most people see is either an ankle sprain, hamstring sprain or a shoulder sprain. We'll break those down after we go through these protocols and sort of kind of figure out what that means in terms of motion, because I've done exactly that thing Hamstring hurts yeah, let me keep stretching it, and you know, because that's what I'm supposed to do.
Kayla Andrews:So we don't want 10 out of 10 pain Like that's what we're trying to avoid.
Sam Rhee:Or even five, I know I don't.
Kayla Andrews:I don't love that scale because it's so different. Like with athletes, I'm like all right, what's your pain level? Like one to ten. Ten is bear eating your leg off, like unbearable, like hospital.
Sam Rhee:Yeah.
Kayla Andrews:Like I want to be around. You know one to four, one to five. It's dependent upon what they how you know the athlete.
Sam Rhee:That's right. If they're telling the truth, too, that's right. We got some wikis at our gym so I could figure out who's what there. So protect, elevate, and that to me still makes sense. Obviously, like when you are sitting, for whatever reason, you keep that injured limb above your heart level. Try to get that fluid and swelling to come down a little bit.
Kayla Andrews:Yeah, let the gravity do the work. Pull that swelling down and out of the area as much as you can. It might be temporary for the time that you're elevating, but any bit counts. It's better than just keeping the limb below the heart or not doing it.
Sam Rhee:It's really hard. I mean I've had ankle sprains and then I've had to stand for six hours, right. So I mean I've had ankle sprains and then I've had to stand for six hours and right.
Sam Rhee:So I mean and we'll talk about that in a second because that's the C part, but let's talk about so that's PE Protect, elevate, avoid, avoid anti-inflammatory. So this is similar to what we talked about in terms of not popping high dose ibuprofen or constant icing. Let's just let the inflammatory process go, not to the point where, like you said, bear eating, leg off pain, but a dull roar, but let the recovery process happen yes, absolutely.
Kayla Andrews:I kind of added to that anti-inflammatory response before, but I agree with this full-heartedly. I think it's hard to watch some of our athletes, especially it's baseball season, so this is fresh in my mind. And and um, you have the. They're like Skittles. It's like pouring the, pouring the jar of ibuprofen, and down the hatch and off to practice. They go, and it crushes my soul and they know it too, so it's.
Sam Rhee:It's whatever they got to do to be on the field it's terrible, and I've only I've seen this at our gym too, where I've seen some of our older athletes like I take 600 of advil every time before I come to the gym and I I'm like that's how long Months and I'm like not a great idea. It bothers me. That bothers me a lot at our gym. And then also anyone who takes an energy drink every time they work out. Yes, Like before they work out. I'm like probably not a great idea.
Kayla Andrews:Yes, I have my reasoning on that. I want to know yours.
Sam Rhee:Mying is, when you get addicted to the, you become dependent on the caffeine or you become tolerant to the caffeine. So whatever bump you might have gotten, it doesn't really bump you anymore. You need increasing doses to get that same bump and then at that point it also is not helpful. It jacks up your heart rate. There are all sorts of other things in most energy drinks which are probably not good for you in the long term, and it's expensive too, and it also it becomes a part of your routine, which I don't think you necessarily need. I remember we talked about this on a podcast about dopamine hits and getting motivated for workouts, and if you need to get motivated by a workout by chugging that Celsius, well, now you've started associating working out with chugging a Celsius, and I think that's bad.
Kayla Andrews:Yes.
Sam Rhee:What is your motivation or thought behind it?
Kayla Andrews:Yes to all of those. And also if you're trying to make your heart rate peak mid-workout. If you've already elevated your heart rate, let's say I don't know, right before your WOD or your workout or your competition, and you've now elevated it. Maybe it's 200 milligrams of caffeine plus your typical energy drink's around 200. Yeah, you've already started the workout with your heart rate elevated. It's like this little mountain. You've already climbed that chart. So now you're going to peak too soon. So then you hit that wall. You're forced to rest earlier, or you're forced to come off the field earlier to let your heart rate come down because you didn't let it peak, naturally.
Sam Rhee:Right.
Kayla Andrews:So that's one of my biggest reasons. I mean, I work with the adolescent population. I actually had a student. It's hard to tell if it's actually from the energy drink or not, we'll never know, but their heart rate was. Supposedly they had an energy drink beforehand. Their heart rate was in the 240. Oh my God, and climbing oh my God, 275. This is when I called the ambulance.
Sam Rhee:Yeah, this is where I had to send them to the hospital, absolutely. I mean that's a heart rate that's going to send them into an arrhythmia.
Kayla Andrews:Yes, and it did, and that's where you don't really know if they had other medical history too. But where? You don't really know if they had other medical history too, but at the same time it's hard to say, well, that could have been a factor.
Sam Rhee:I'm sure it probably was. That's a very, very likely factor. I mean, it's a really good point. I will say I've worn my heart rate monitor and I know I don't need it because I know I feel like I'm about to have a heart attack if I'm in the 180s. I just know it, because I know I feel like I'm about to have a heart attack if I'm in the 180s. Like I just know it, I'm like, all right, heart attack, feeling I'm in the 180s. So most days I can keep it into the 160. Something maybe pops into the 170. That's just sort of where I sit for these high intensity workouts, yeah. But like, I know, like, and so I mean I think younger people, athletes, have more tolerance for those higher heart rates, which is why they feel like they can take these energy drinks. But, like you said, there are limits and once you start pushing them that can get extremely dangerous.
Kayla Andrews:Yep.
Sam Rhee:So P-E-A-C compressed compression. I really do, really believe in compression, especially. I remember I jumped off I was doing toes to bar and I jumped off the rig and I had a little mat like a six inch riser and I came off of it like I just hit it off the edge and both my ankles like twisted on it and for probably about six weeks I had to wear, while I was standing at work, like really tight compression because if I didn't my feet would swell and look like you know, oh my god, so uh.
Sam Rhee:I wish I could have just sat there and elevated all day, but like if you can't you, you have to live your.
Kayla Andrews:You're a surgeon. You have to live your life.
Sam Rhee:So what do you think about? How do you compress? What are your favorite ways of, you know, putting compression on for people?
Kayla Andrews:I go back and forth with compression. Some people I find the, if they're in acute phase or an acute type injury, like they roll their ankle and they're super swollen. Some athletes actually respond poorly to it. They feel like it makes them in more pain. So it might have actually reduced some of the swelling but they're in more pain because of it. So the following day I can't get as much done.
Kayla Andrews:There could be other factors in playing a role into that as well. And then I've seen it go the opposite way, way where they really like that feeling of compression and if we're we're squeezing like the swelling out of that area and we're trying to push the swelling up and out to allow for a decrease in swelling in return, allow for a decrease in pain. Um, I, that's also fine too, I think I I use it. So I use sometimes I'll use a compression wrap, but I'm kind of I'm trying to get away from it actually, because I'm getting better results without it. It's just letting that natural healing process take place. But different forms of compression I really like the Normatec boots. I know we'll touch on tools later using that for recovery, for the lymph to move throughout your legs, or they have that for upper body as well could be beneficial. Things like knee sleeves I know people really love them.
Sam Rhee:I was about to ask you about that, because they don't have any acute injury, they just like wearing them.
Kayla Andrews:Right. So I'm never going to say, hey, you can't squat with your knee sleeves on, but at the same time, there is some sort of dependency there and if we can use it or use your body without depending on the form of compression or the form of support, that would be the ideal. If you're going for like these max lifts, where you're putting your body at risk, and you're more gearing towards the side of sport, then I'm like hands-on. But if you're training all the time with your compression sleeves, I think you should probably re-evaluate why you need them. Is it a psychological thing or is it like a? No, I need this because it decreases my pain and increases my range of motion. A lot of times I think it decreases range of motion just because they're in the way. Maybe I'll feel differently as I'm aging into my 30s, but that's my scientific take on them is it's one of those use them sometimes. I don't think they're the worst thing in the world, but I also think that going without them is also beneficial I think it depends on the reason.
Sam Rhee:I agree with everything you said, um, one of the things I have seen are people have structural issues, um like real knee instability that they can't control because of a damaged meniscus or some other issue, and, you know, torn ac ACL in the past. So they're literally using that compression to limit instability, which is limiting mobility and limiting range of motion. If that's the reason, then by all means use it. If you're using it not because there is some sort of, you know, pure structural problem, uh, psychological um.
Kayla Andrews:Strength deficit. Yes, you have to work on it without the sleeve.
Sam Rhee:Then that's an issue because that's like a weight belt. So for me, you use a weight belt to increase your core um strength because you're pushing against something and knee sleeves have been tested and studied and they do take strain off of your knee and you know the connective tissue and your muscles around the knee, and so using it for everything is a problem, just like if I see someone who's using a weight belt for everything, including their warmups, you know. Then I'm like, okay, there's again. If there's a structural problem, I understand, but if you're doing it because that, just like you said, provides a psychological crutch, you're actually reducing your body's ability to adapt and get stronger because you're using this thing to take the load off for you, and that's that's a problem.
Kayla Andrews:Absolutely yeah. One last thing about compression If you do injure yourself and you get maybe you went to an urgent care and they wrapped you in that compression bandage do not sleep with it. Our healing process the majority of it happens at night, when we sleep right, our deep recovery. So if you're sleeping with it, it's actually restricting blood flow. We want healthy blood flow in that area. Throughout the night we're propped up, our legs are up, we're not standing like we are throughout the day. So that's the number one thing I tell my athletes if I'm using it is don't sleep with it. Use it tomorrow, you can put it back on, but you will impede the healing or delay that recovery process.
Sam Rhee:That's a really good point. Yeah, I didn't even realize it, but you're right, People might be sleeping with their compression and that's an issue. And then the last one is E, which is educate, which is basically again letting professionals help you in terms of guiding your treatment, which is why they have people like you. They're paying people like you to help them with that. So that's peace Protect, elevate, avoid, anti-inflammatories arise, compression, education, Love, peace and love. So love is the day three and onward, where you're guiding recovery in the subacute or chronic phase of your injury. And the first part of love is load starting to reintroduce load or stress to the tissue gradually. So you mentioned some of these methods which I really love. Touch on it a little bit more in terms of like. What does that mean in terms of stressing out that tissue?
Kayla Andrews:Right Load is we kind of touched on it with. Load really happens in two ways it's the internal loading, with you making it work and you contracting it, and then that external load, so internal force and external force. External force could be the manual therapy, the massage, maybe that's in a company with the strengthening exercises. Like I said, those fibers don't really know how to heal until you apply load. Okay, especially the fibroblasts.
Kayla Andrews:That's what I'm talking about is they respond to load, and that's why it's so important, so they can heal in an organized fashion, and that's why, if you've ever been to a PT clinic right, I'm not a physical therapist, but we do a lot of that corrective exercise in the athletic training room, and that's the boring three sets of 10 of I don't know quad sets or doing some sort of single leg work. If they're progressed to that point, it looks like some of the bodybuild work that you do in the gym just loaded, either with no weight or loaded a little bit differently, or in conjunction with right, you start them on the table and you're manually loading through some sort of massage. I think it's a component to it. Most of all, though, the load has to be done, and should be done with you moving your body. That is the moneymaker, that is the end-all, be-all is you have to. Once you get to that phase of that strengthening type exercise, it's really important to do.
Sam Rhee:I think you know I was just thinking Cooper Flagg, who's a basketball player on Duke's team we're not going to talk about.
Sam Rhee:I didn't want to bring it up. I know I didn't want to bring it up but it did make me think because he did roll his ankle in a game during the ACC tournament and it was a pretty bad roll, like it was a lateral buckle and all that and a lot of what. And actually I do know the orthopedic surgeon who helped him through that rehab, ned Amendola, who's the head of Duke Sports Medicine. I interviewed him a while back on one of my podcasts but he's a really awesome dude. But they were talking about how his rehab went and some of it was like forced play testing to see what his jump and you know what load, what felt appropriate for him. So I think at the very highest level of sports medicine now, these guys are measuring, you know very scientifically, what kind of load they can place on these injured tissues, what that looks like is it symmetric to the other side, how that movement pattern is going. So definitely that's a huge part of it.
Kayla Andrews:You just triggered a thought that I love to do is training the other side the uninjured side.
Kayla Andrews:There's benefit, there's science and research behind. If you can't move your right ankle, you should be training your left ankle and your left leg. Let's say it's immobilized. Let's get your body moving in some other way because that is going to translate over. It's going to translate in some capacity because if you go up the kinetic chain into your knee, into your hip core stability, if the areas above and below it are stronger, that's going to translate to better outcomes for your long-term healing.
Sam Rhee:Absolutely, and it's a little counterintuitive, like why would working on my right shoulder help my injured left shoulder? But there is really good evidence and I've heard that time and time again from multiple providers, so that was an L load O I love is really good evidence and I've heard that time and time again from multiple providers, so that was a load. Oh, I love this one Optimism Believe in your healing. A positive mindset has shown to improve rehab outcomes. Do you believe in that?
Kayla Andrews:Absolutely. What we say as clinicians matter so much. You can really pave the way. This is an opportunity for you to get better and stronger. This injury, it's an unfortunate opportunity, but use it in a way that you're going to come out better on the outside, on the other side, and when you start to see because I see athletes every day, I have daily contact with them and you can really change the course of their mindset and if your mental health and your mindset around the injury is just a little bit lighter, they can start to see the light at the end of the tunnel.
Kayla Andrews:Because it's really hard when you're sidelined and you don't have any sense of purpose sometimes is how people feel or they can't do what they actually love to do, or in an adult situation it's really hard to be a parent, be a mom, a dad and run around, or you can't run around and it's crushing you because you can't be how you normally would with your kids. So optimism I think just the whole psychological component, it really does matter. And I think interacting and really getting to know that person and what drives them and how they tick is super important. Because if you can give them little personalized like hey, you know, let's do this at the end of our session or go home, let's make a plan so it's clear on how to progress, I think it makes the world a difference. Yeah.
Sam Rhee:I agree a thousand percent. I know I've had rehabs where I was very down for whatever reason a lot of external circumstances and others where I, like you said, I got little small wins or there was the support from people around me. And it's hard because some of these recoveries, especially at my age, it can take six weeks, three months and you despair like am I ever going to be where I was? And I think remembering that mindset matters is important. It might not. That might not just make you feel good suddenly matters is important.
Sam Rhee:It might not, that might not just make you feel good suddenly, but you know, over time, thinking about that can can help.
Kayla Andrews:There's a way to go to go about it. You don't have to be like a rah rah, here we go. Cheerleader, it's be empathetic. That is a huge part of this. Listen to what they're telling you.
Sam Rhee:And be disciplined, stick to your plan. If you're the one that's injured, you have to not give up. You have to say listen. Maybe I feel really down right now, but I'm going to trust in the process and let me see where this goes. And once you start seeing some because almost everyone will see it that makes such a difference. It reminds me of Tom Keeter. He had a heart attack at the gym. He was told some pretty depressing news and he was down, but once he started to see some real improvement and recovery, it made such a world of difference to him. I see him at the gym. He's such an awesome guy, and so there are so many ups and downs to any of these types of processes, but yeah, having that O really really does help.
Kayla Andrews:Shout out to Tom.
Sam Rhee:Yeah.
Kayla Andrews:He goes. Yeah, I mean, I'm just happy to be here and just like having that mindset.
Sam Rhee:Oh my God that gratitude that I see is of him being able to do all the things he does, and he does a lot.
Kayla Andrews:I know he does. He's really busy, he's awesome, he's crushing it. Yeah, totally agree on that point, though Good.
Sam Rhee:Vascularization, so get the blood pumping with safe cardio. So you mentioned this a little bit. With the bike, I see a lot of other people doing some sort of aerobic activity and I think this is overlooked by a lot of our members at our gym. So if they hurt their back they're doing nothing, or their shoulder. And then I see a few people who that has happened and if they hurt their shoulder maybe they'll do C2 bike. They'll come in and they'll just do C2 bike and it kills them because everyone else is wadding, but they're at least getting their aerobic conditioning in, and so this is something I think I've been terrible at, but I think it's something that bears repeating.
Kayla Andrews:Oh yeah, totally agree on this. A lot of times I'm starting my rehab sessions with athletes on the bike go warm up some way. Um, sometimes that's the only thing that they can do in in a situation where maybe you're by yourself and you're not receiving treatment yet, or it's not that bad, but coming in, getting on the c2 bike will make a difference. Getting on, if it's your lower body and you can't use the C2 bike, using the ski, using the rower, if you can, totally 100%, your lymphatic system starts to pump, which is your lymphatic system, carries nutrients and delivers nutrients and fluids around your body, and that's also moving with your blood. So you're circulating your blood from your heart and your lymphatic system, which is removing waste from that injured area or that beat up area. If you're not quite injured, and it's only going to make it better, especially if it's not that bear eating the leg off pain.
Sam Rhee:You know this reminds me of Katie Miller because she's had like an arm issue or elbow issue. But she would still come in and she would scale the workout and modify it. Where she didn't have to use that arm or sometimes it was just not her shoulder, she would. You know, she would do deadlifts instead of a clean or a shoulder to overhead and her recovery, I am convinced, was accelerated by a tremendous amount, One because her mindset, but two, she was so dedicated at just finding ways to move without worrying or, you know, risking injury to her arm. Sorry.
Kayla Andrews:Absolutely. Katie Miller and Matt Aquino oh yes, both of them.
Sam Rhee:They are just grinding my hero.
Kayla Andrews:Yes, Both of them. They would come in day after day and just grind and get after it and change and modify over and over and over again. Sometimes it'd be a completely different workout and they'd still show up and I think they're better because of it. I am like blown away by math's progress.
Sam Rhee:Dude, the guy crushed the open.
Kayla Andrews:Crushed it.
Sam Rhee:And I think a couple years ago he had back surgery. He had a blown bicep or no pec.
Kayla Andrews:Yes.
Sam Rhee:So this guy is the epitome of being able to, like you said, mindset, recover, keep moving. I've known people who've had both just one of those and never were the same people again ever after that, because they gave up. They gave up. And so he's inspiration to me in terms of like if, if anything like that were to happen. Neither of us have had surgery for injuries, right, but if we did like, I'd be picking his brain all day about like how he felt, how he approached it, how I managed it, and a lot of that is humility, it's not having an ego, it's like not caring, like what other people think when you're at the gym. And then I just saw him at the Open and I was just like holy cow, this guy is better, like he's better now than he was probably in his prime. I don't know, it was amazing.
Kayla Andrews:So awesome.
Sam Rhee:Yeah, exercise. So L-O-V-E. Again, this is really about a structured exercise program to rebuild your strength and flexibility. Again, this is really experts. You could almost put expert in here as well. Unless you chat GPT, you're not going to really develop your own structured exercise program unless you're a trained athletic trainer. These things can be helpful. What kind of programs do you develop? Like, suppose you had, I don't know, you probably have people, um, I don't know, pick a sport and like, what kind of structured exercise programs do you, you know, work?
Kayla Andrews:with uh for them so let's say it's a soccer player, lower body hip flexor is a big one, just because the repetitive volume of which they have contact with the ball and how much they run Exercise program like in a whole set like an ACL. I mean, we talk about hip flexor but ACL, like prevention programs, do exist. So that's all about prevention. But even just like let's get them on like a hip flexor protocol. Or with our long distance runners we have a shin splint protocol, like where they have pain in the front of their shin, like that anterior tib pain just from running, and I mean those are all more preventative type protocols where we're they're a little bit more blanket, where we can implement them right away, um to like their warm-ups.
Kayla Andrews:We've done that with like a lot of band work type exercises. It's a lot of single leg work um, a lot of a lot of calf work, um. But in terms of like the exercise portion, I'm reading this and the motion is lotion baby. I said this. Try saying that in front of a group of teenage boys. It does not go well.
Sam Rhee:I can only imagine the giggles and the off-color comments you would get by saying something like that, but it is so true though, so does that answer your? Yes, yes, yes. Exercise protocols.
Kayla Andrews:That's more on the preventative side, because I don't really it's hard to give a protocol. There are certain protocols for, like, an ankle rehab, but none of them are cookie cutter. I try not to give cookie cutter like classic rehab programs just because everyone is so different.
Sam Rhee:That's so true Because everyone is so different. That's so true. I was going to go through scenarios, but I will say if you are interested in what you know, say what you might think about doing for an ankle sprain or a hamstring sprain or a shoulder sprain. Let us know, send us a message. We can go through that with you. Just what we, you know what, like you said, cookie cutter type of protocols might be. Obviously there's a lot there that can be very honed in and specific for those types of injuries. I've had all of them and I was reading the suggestions and I was like, oh, I did none of these things About. The only thing I did do was with the shoulders, was the crossover symmetry.
Kayla Andrews:Yeah, huge.
Sam Rhee:Yeah, and they're basically bands that you do a number of exercises with, uh, and I have to say that, you know, I was literally like almost frozen, like I had to keep my shoulder in one position which I could actually operate with, because you don't really need that much. Yeah, you don't need too much shoulder for a lot of stuff, like if you can keep like as long as I didn't have to bring it up, which I don't for operating, if I could bring it forward and back, I was good. Like there's no outside, like chicken wing motion, for Do you tell your?
Kayla Andrews:patients, this no.
Sam Rhee:But I will say I'm good. I'm good. I will say there were some days where I really had to build up for some of my surgery just to make sure I could do everything that I needed to do. But the thing that got me going the fastest in terms of recovery, which I was so skeptical about, was crossover symmetry.
Kayla Andrews:I know I mean. Someone that comes to mind who's been consistent with that is Karen.
Sam Rhee:Yes, every day yes.
Kayla Andrews:Every day she has a shoulder thing going on and she just she kept at it. She's like I see her in the back warming up, coming in early, whether it's 5, 10, 15 minutes early, getting back, and if you have no idea what to do, the great thing about those is that that shows you. Yeah, you can literally read it step by step there's a card yep, and you don't have to do all of them.
Kayla Andrews:But if you do two to three sets of 10 of, maybe you're doing just. I'm going to pick these four exercises and however long they take me, I'm going to get them done before class or after class. I think before is more beneficial because it'll warm you up for class.
Sam Rhee:It's really bad. I hate seeing her because it just reminds me of how I'm not doing them and it makes me feel terrible. It's like when you see someone who's really good and you know you're not good and you're just like and, and happens every day, so I know that's why I feel terrible every time I say I'm like, oh there, she is being really good and protecting her shoulders when I'm not.
Kayla Andrews:Screw you, Karen.
Sam Rhee:But I will say that it just reminds me. I will say that it just reminds me and you know what it reminds me of is that I hated doing them, even when I realized there was real benefit. It's just so tedious. So there is a special mindset for people that you just have to do it. And I will say, once I was really regular about it, it was easier to do. Really regular about it, it was easier to do. But once you have that acute injury and you're going through that, I think the hardest thing to do is to do it on a regular basis, because you don't necessarily see it that first day or even the second day. It takes like a week, two weeks, three weeks and then suddenly you're like whoa, this is like I feel so much better with this, yeah.
Kayla Andrews:It's like weight loss or saving money. It's like you don't see the progress at first and that's where people give up. Yeah.
Sam Rhee:All right, this just re-motivated me to go back and do my cross.
Kayla Andrews:I'll be there with you.
Sam Rhee:So and I have no excuse I'm there. I could certainly get there 10 minutes early and certainly on the days I coach, I could certainly be doing plenty of that after I coach. So that's one tool. What are other tools that you like to use for your recovery or in terms of you or others, in terms of what you like to do for them?
Kayla Andrews:Tools, again, they're tools, they're all pieces of the puzzle. There's no one thing that's going to be the end, all be all. I really like I mentioned it before instrument-assisted soft tissue mobilization. Some sort of physical touch and just even light touch can be beneficial. You're not necessarily breaking up scar tissue but you are stimulating that lymphatic system, pushing that fluid in and out of the area. Other tools I like. I like the Normatec boots. I think they're a tool.
Sam Rhee:I love those.
Kayla Andrews:Yeah, they're just, you know, they feel good, they feel nice, and there is science behind lymphatic system Crossover symmetry for sure. Other tools the body is our biggest tool, so I tend to be number one. Move your body well through space.
Sam Rhee:How about something like K-Tape?
Kayla Andrews:Oh, kt Tape, so I don't do a ton of it. I'm not certified in it, like I know how to vaguely do some of the tapings, but I don't use it a ton. I think there is a good time and a place, just because it provides that sensory feedback to the body and it's also not necessarily supporting the joint, but it's more so going back to the lymph system, taking some of that fluid and pushing it elsewhere.
Sam Rhee:What do you think about? You said you don't like using heat in the acute phase but, what do you think about heat other times?
Kayla Andrews:Awesome, Love it. So acute phase, like the first 48 hours, I tend to shy away from heat for various different things that are really swollen. But if it's just like oh, I tweak my neck and it's a little sore, apply heat sooner than 48 hours, that's okay. But yeah, after that, 24 to 48 hour period, love it. Whether it's a hot pack or some sort of hot bath, Epsom salt bath, sauna, that would also be beneficial. It gets blood flow flowing in short terms. So if you think about going back to the ice and heat discussion, If you bury an acute injury in ice it's like that classic ice bag your athletic trainer comes and wraps it on and then you're walking out like a mummy because you can't move your knee.
Kayla Andrews:Your blood vessel. What does ice do? It vasoconstricts. So it vasoconstricts the blood vessel and if you're doing that for long periods of time, you're not allowing the fluid to enter into that healing space or that injury. You're constricting it. So what heat does in the opposite is it vasodilates. You're allowing more healthy blood flow and more nutrients to flow in and out of that area, and then you're pairing that with your manual therapy and then your exercises and really completing the rehab session after that.
Sam Rhee:I mean, this is outside what we're talking about, but what's your take on ice baths in general?
Kayla Andrews:Do you?
Sam Rhee:like them, do you do them?
Kayla Andrews:So ice baths, I say great, but it's really a different thing than icing an injury. Some people love them, some people hate them, and I'll talk about when to use them and who should be using them. But it's different than that classic ice wrap it on really tight. It's more of a hormonal effect and more of a systemic biological effect and it's putting you in a controlled stressful state so then you can then endure more stress at a later time. So if that makes sense with someone like a CrossFitter I mean, there's multiple things that do this. Exercise is one of them. When we work out really hard, it's also producing endorphins and hormones, a systemic reaction in our body. But extreme cold and extreme hot can also do this. So for the athlete who is using it for short periods of time three minutes at a time at a really cold temperature Awesome, great mental benefits, great, more recovery type benefits. It's not the same as bearing an injury for ice for 10 minutes at a time. Got it when to use.
Kayla Andrews:What was I going to say? The person that should not be using it. If you're already a really stressed out individual, that's me Not like your daily stress of like work and like I have to eat well and I have to walk the dog. It's like that's. We all have those things.
Sam Rhee:OK.
Kayla Andrews:But if you are the athlete who's already at their tipping point you're already, your cup is full and you get into any sort of stress Sometimes it could be good, good, good or bad stress and that's just going to send you over the edge then that's the athlete. I would say hey, we don't need to apply any more stress in this point.
Kayla Andrews:We need to do things that actually feel good um, if you're already adrenaline depleted, yes, yeah, okay yes, that's where I would shy away, because then you get those like really bad reactions out of getting out of the cold tub. But if you're, you know, regulated, I would say, then have at it. Do I do them? I have done them. I live in an apartment right now so I think they would be really mad if I set up my ice bath around my balcony. I like the way I feel when I do it, but I don't get to do it all the time.
Sam Rhee:Got it All right. So I think we've covered most of the topics in terms of new ways to recover. I just wanted to throw out there this is all basically self-management. For pretty minor injuries, you should seek professional evaluation, obviously, if you think there's a bad injury I mean, loud pops can't bear weight something that is like a severe tear or a fracture, like you got to go see somebody right away. Have you seen patients or athletes where it wasn't getting any better after like five days a week and you're like this is not sort of going the right way, absolutely.
Kayla Andrews:All the time it happens all the time. For me that's where I refer out. Looking at it, by now I know like, yes, I'm referring that right away or I'm going to wait. Sometimes the two week mark with some of the chronic type things that have been lingering for a period of time, maybe it's like months, or it's been on and off for years and I'm like, all right, well, let's if we can just treat it for two weeks and let's see how it goes. But if I can't get you to budge or improve at all, I'm referring you out.
Kayla Andrews:But if you're, yeah, dave, that one week period of an acute type injury it's about one week to two weeks is my time frame. And if I'm not seeing any trend upward, definitely going to refer you to a doctor or a specialist or somebody that needs that I can't give you answers for. Or if you're in that position and deciding that for yourself, definitely the inability to bear weight, it's really swollen, it's not getting any better. At least seek advice. Like, yes, go seek some advice, go get some professional help, because I'm sure you will not regret it.
Sam Rhee:I think the other thing is and I've seen this a lot is someone who keeps re-injuring a certain thing, like I've known, like people whose back are they're constantly getting re-aggravated, like after the third or fourth time of you know doing a heavy cleaning, oh man, I just got laid out again and I couldn't come back to the gym for you know two weeks Like get, even if you can recover from it. I think there's something there that you got to like address and and think there's something there that you got to like address and unfortunately there's so many warning signs that we don't always pick up on. I had to get burnt a bunch of times before. I was like which is easier said than done can make a huge difference, absolutely. Any other takeaways at this point for us, kayla, in terms of Move it.
Kayla Andrews:Move your body Movement is medicine, move it often. Move it. Your body movement is medicine. Um move it often, move it. You know, I think one thing we didn't touch upon is like the nutrition component, with injury um feeding yourself. Well, yeah, there are. That could be a whole nother topic oh yeah like hey, like every single athlete, I see like I'm talking about nutrition with them and what they can do. There's certain things um herbs, more non-traditional things that are anti-inflammatory, so I think eating is a huge component into that.
Sam Rhee:A lot of people take turmeric every day.
Kayla Andrews:Yes, turmeric. I was just going to say that Make sure it has some sort of black pepper with the turmeric, because that's what makes it more bioavailable in our body.
Sam Rhee:Interesting.
Kayla Andrews:If you're doing supplements, they usually have it in there. If you're cooking with it, make sure you're adding some cracked black pepper. Tart cherry juice has been researched so, especially if you're a surgical athlete. These are the things that inflammatory process, Things like garlic, ginger there's one that's escaping my mind but all of the different types of things that you can easily add in. People don't always think of them because it's like, well, what's that going to do? I'm like, well, did you try it yet? At least give it a try.
Sam Rhee:Right right, right, right right.
Kayla Andrews:So making sure you're adequately hydrated as well is a huge component. Seek medical advice and help sooner rather than later, and then stop icing every single injury. I'm going to shout out one of my athletic trainers that I really admire. His name's Mike Stella, and he has a course called End of the Ice Age. It is so great. It's really not that expensive, and if you're just a lay person wanting to learn more about why ice and is not the answer anymore, head over to his page. It's the Movement Underground and go learn.
Sam Rhee:I love that. Just remember those protocols. Meet peace and love. Keep that early mobility. Keep a super positive attitude. Kayla, it's been such a pleasure. Everyone can reach you at kwellness on Instagram.
Kayla Andrews:Yeah, I'm pretty sure that's what it's called. If you don't know, just email this podcast and I'll let you know.
Sam Rhee:Thank you again, and I really appreciate it, taylor.
Kayla Andrews:Thanks, Sam.