Art of Prevention
Our mission is to decrease the prevalence of preventable injuries and athletes therein optimizing performance by decreasing the time that our athletes spend benched due to injury. We are going to distill information and practices from experts in the field of injury prevention. High level coaches and top performing athletes. We believe this information should be accessible to everyone so that we can reduce the rates of preventable injuries.
Art of Prevention
Optimizing Performance: Insights with TJ Williamson DC MS CSCS on Training, Pain Management, and Health
Embark on a journey to elevate your understanding of the human body with TJ Williamson, a chiropractor whose mastery extends from the clinic to the gym. Over the course of our chat, you'll uncover strategies for load management, training variable optimization, and the importance of a well-rounded approach to health that transcends physical exercise.
As we navigate the recovery landscape, you'll learn to differentiate between pain types and heed what your body's trying to communicate. Beyond the physical, we delve into the psychological—exploring how fear and past injuries can shape our movement and performance. This episode offers a treasure trove of insights for those seeking to understand the complex dance between mental and physical well-being.
We round out our discussion with the art and science of warm-ups and program design. Say goodbye to convoluted routines and hello to the simplicity and specificity that lead to peak performance. Whether you're a lifter seeking to conquer new personal bests or a runner chasing that elusive personal record, this episode promises tactics tailored to your athletic endeavors. Don’t miss the opportunity to enhance your fitness journey with knowledge that could redefine your relationship with pain, training, and overall health.
Learn more about Dr. Williamson on his website:
https://www.resilientphysicalmedicine.com/
Get in contact with him via email:
resilientphysicalmedicine@gmail.com
Check out his book on Strength training
https://www.resilientphysicalmedicine.com/programs/p/sound-body-plan
If you have listened to this podcast for any length of time you know that strength training is crucial for runners. However a major obstacle for many runners is not know what to do once they get to the weight room. This PDF seeks to change that. It will arm you with the tools you need to effectively strength train to get the most out of your runs.
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Okay, welcome to the Art of Prevention podcast and yet again, as always, we have a very special guest, and today I'm talking to TJ Williamson, who is a chiropractor as well as does a lot of things in the sporting realm with sporting populations.
Speaker 1:And I know TJ because we were in the same class in chiropractic school and we hit it off from there and, unfortunately, we've been friends ever since. So TJ also was the lead author, a well-deserved lead authorship, if I may say, because he literally brought this project back from the dead at one point, literally in a paper that we co-authored that was published in a peer-reviewed journal which I take a lot of pride in and I really hope that TJ takes a lot of pride into. And since then you've gone to author a bunch of other things and other peer-reviewed journals and now you are one of the only actually the only chiropractor at the University of Colorado Health System. ["the Chiropractor"]. So, tj, I'll let you take it away now. Give us a little bit more, or give our listeners a little bit more, of your background information, and then we can get into some of these awesome talking points that we've got today.
Speaker 2:Sure, thanks for the intro. Yeah, I'm TJ Williamson. I'm a practicing chiropractor at University of Colorado Hospital, also known as UC Health. I work in their spine center, so I'm the only chiropractor there, but my colleagues are physical medicine and rehabilitation specialists, orthopedic spine surgeons, neurosurgeons and anesthesia pain medicine specialists. So I kind of fall in that category as the guy who sees everybody who doesn't want an injection, a medication or a surgery, or maybe co-manage patients who are receiving those sorts of therapies. I also own my own private business, so I have a practice where I'm in Boulder and I see, again, chiropractic patients for the most part, but a lot of athletes in the Boulder community. There's a lot of rock climbing, a lot of cyclists, distance runners, a lot of sports-related injuries that we'll treat here, and then, yeah, I'm also soon to be opening up another location in Denver, so I'm kind of spreading out between three different locations currently.
Speaker 1:And you also have a lot of really great online resources that individuals can take and they're very low-cost but very high-level information resources, right?
Speaker 2:Yeah. So with my clinic website I also have begun offering online strength coaching for people who want individualized care. Maybe they want a little bit more specific training programs that tailor to a history of surgeries or injuries or rehab where maybe someone in that realm can offer more insight. So I do online strength coaching and then I'm also just trying to pump out programs that people can buy, because not everyone wants to do one-on-one coaching. They would prefer just to have like just download a quick PDF and then self-guide, self-manage. So I have a whole store that I'm building with programs I've used for other ex-athletes, programs I've run myself, where I've done like a couple months of following these programs and they're all just tailored to a lot of different needs. I specialize in powerlifting, bodybuilding, I'd say those are the two ones. I got into Olympic lifting as well, so anything that includes a barbell I've dabbled in at some point in my life. I've jumped around from multiple different training regimens and tried to experience everything, so I know what I'm talking about when I'm working with athletes.
Speaker 1:I mean you've been powerlifting for quite a while. I know that when we started in chiropractic school it seems like eons ago you were really big into the powerlifting space and strength training space. Right, because you started that really in undergraduate, right.
Speaker 2:Yeah, as an undergrad I was a certified personal trainer and a strength and conditioning coach and that's where I did a few powerlifting competitions one like State of Missouri for my weight class and then it just a branched out from there. It's pretty boring to be just the strength trainer, but yeah, it's very basic, foundational skills that I think we should all have and we'd all benefit from.
Speaker 1:Yeah, I think later on we could really expand that topic into how strength training prepares us all for life and for longevity, as well as the new term health span. Absolutely yeah. When you were back in the day doing all this high level training, you were also working with physically demanding jobs and you had a couple of injuries. Is that right?
Speaker 2:Yeah, so in undergrad I was actually pouring concrete and working construction in between flasses and kind of managing all this heavy load on my body a lot of wear and tear, a lot of like accumulative stress I'm lucky to say not a lot of significant acute injuries where something just kind of like for lack of better words broke or snapped or tore, but just a lot of like cumulative, like overloading over, doing it on a weekly basis. So that's actually where my first experience with chiropractic care in sports rehab came in too is how do I manage this nagging back pain that just keeps bugging me while I'm trying to get stronger, get through work, get through sitting through class, where just sitting in a chair was excruciatingly painful, and it taught me a few things about training variables and weekly load and volume and certain things that I probably should take a little time and energy into measuring just to treat myself from a rehab standpoint.
Speaker 1:I do remember a specific incident. Sorry if you hate me for bringing this up, but walking out to the like student gym or whatever at Logan and just seeing you like, laying on the ground in the parking lot on your back, oh, yeah. Can you hear that?
Speaker 2:That's a? Yeah, you know, I guess we can call that a strain, sprain, injury. I remember that happening. But you know we bounce back. You know with if you're gonna play with fire, sometimes you get burned. So if you're lifting heavy weights all the time, sometimes you push your limits and your body says, no, I'm done for the day. And so that was an incident that happened. Yeah.
Speaker 1:And I think a lot of people would really like to know, like, with all of your experiences, like you've been there, you've done that, you've had these injuries where you have these acute manifestations, that it's like God I gotta like lay on the ground literally in the middle of a parking lot, but you've also had those nefarious kind of slow builds. How'd you get yourself out of that hole?
Speaker 2:Great question. Yeah, it really comes down to most of these like incidents. I'm hesitant to call them an injury because injury, you know, makes you think of damage to your body, but perhaps it was more like you know, an onset of a muscle spasm or just these, these pains, that kind of you reach your limits. They normally would happen to me when I got a little lazy on tracking my training variables and I was over. I was over training, to put it. Put it simply, so, yeah, I, you know, lucky to say, never really had much of like a fracture, never had a disc herniation. I'd say strain sprain is the the main category that gets me from time to time.
Speaker 2:But it's important to remind ourselves that, even if you're a spine specialist or a strength coach or you know, historically you're an athlete and you have a dense training background, like we're all prone to unexpected injuries too.
Speaker 2:And so, yeah, digging back out is more important than, I would say, completely preventing all injuries. You know, we can work to make a very resilient body and Do our best to train smart, but accidents happen. But coming back out of it is that's the fun part too, because there's a lot of psychological barriers I think we all overcome as injured athletes. We suddenly we have a fear of that particular movement that's done us in. A few times we we may feel hesitant to get back under the bar, we might feel concerned about causing further injury.
Speaker 2:So I think psychological approaches were all all rehab starts right Just kind of wrapping your mind around what you need to be doing, what is okay to be doing, what is probably not the smartest thing to be doing right now. And you know the, the education I have in anatomy and neurophysiology and you know exercise science was my bachelor's degree before my chiropractic Education and then I did the masters in sports science and rehabilitation. So it's easy for me to say it's just right there in the back of my mind. But sometimes that's where coaching and guiding others who don't have this education can be helpful.
Speaker 1:I Totally agree and I love that you talked about being proactive and things like that. I actually interviewed one of our mutual friends, alec Draglin, a couple of months ago, and he actually has a really, really cool story because he was preparing for a CrossFit Competition and he had an acute disc herniation whoa and he literally like dropped to the ground and In his mind the first thing that he thought of was my rehab starts now.
Speaker 1:Yep you know, and just taking that really like mental-sided approach, like kids, a lot of times you, you know, in the very acute Stages of that injury you can't do a lot of physical stuff. You know you really have to Majorly modify your loads and movements etc. But you can tackle things from the mental standpoint immediately. So, yeah, I'm really glad that you brought that in. I also had a sports psychologist, lucy Haynes, on the podcast talking about the mental side of injury and all the things that correspond With those mental issues that occur with injury. Now, another thing that you talked about was a lot of the variables that you're monitoring Regarding load. What kind of things should we be monitoring? Should we be monitoring our Overall intensity and how we feel about the session? Should we be monitoring only the weights that we're lifting? Can you give me some insights on that?
Speaker 2:Yeah, so I guess, some of the more important training variables. Maybe we can just like briefly define them. You know, every, every exercise program should include some measure of you know, frequency of exercises, how many days a week you're doing something, the intensity, which, in the exercise science world, intensity doesn't necessarily mean like your exertion levels, like how hard you would rate this workout. It's really about like the weight being lifted or the, the amount of push you know you're delivering in your body.
Speaker 1:There's also oftentimes like a percentage of your one rep maximum Maybe exactly.
Speaker 2:Yeah. So in the powerlifting it's how much weight is on the bar, is your intensity, for the most part? Duration, so how long each session lasts I think that's where I got myself in trouble sometimes is pushing into that like hour and a half, two hour training session mark and just reaching neuromuscular fatigue. Um, so all these are are smart variables. So frequency, frequency, intensity, duration, there's the tempo of your rep, like how much time you spend under tension. So one second down, one second up, versus four down, four up.
Speaker 2:That that places additional load, and so Load on a weekly basis too is going to matter. So you know, three high insensitivity Sessions throughout the week can equate to the same volume and load. As you know, seven days a week, but you're doing less each day. So from an injury prevention standpoint, I think weekly load is going to be important. So just how many times you're exposing your muscles to contraction and tensile forces? Um, and there you know there's ways to get around that, there's ways to be smart about it, and that's that's everybody's different. Everyone's got their own schedule. Some people can train seven days a week, other people they have to spread it out into two or three days a week.
Speaker 1:Um, yeah, and then, you know, age can become a factor too. I know for myself, I'm I'm not exactly like old, but the my frequency and intensity of training Definitely has had to change relative to me when I was like 18, you know exactly, yeah, we, we got to think about Not just what's happening during that training session but what's happening in the other 23 hours of the day.
Speaker 2:Get retake. So recovery you know some people over trained, other people under recover. So If you're getting, you know, three or four hours of sleep at night or just, yeah, like you said, age alone like our testosterone, peaks in our 20s, so we're able to bounce back from things and rebuild muscle a lot quicker than we will in our like 40s, 50s and beyond. So these are things we have to take into account when we structure not only our our training program but our recovery programs as well.
Speaker 1:Yang, that's like such a quotable Some people over trained, some people under recover. I love that. Um, now, what about those other 23 hours of the day Like should we be monitoring any other variables there? I mean, we know that, you know from the literature. It's like yes, of course, like we have the training variables that we need to monitor, but also psychological stress can add to Our overall stress as well.
Speaker 2:Right, yeah, I think this is a these these are good questions. That's probably gonna lead into Something we kind of previously discussed is the difference between injury and pain, right? So sometimes we experience training related pain, we'll call it but maybe there's no anatomical damage. I think this is what better defines a lot of the pains I've I've had in my life, so I can speak to experience. If we're talking about true injury, I think that's where we take more of an anatomical approach, more of a physiological approach, and we think about things like, you know, protein intake, hydration, nutrition, things.
Speaker 2:We're actually building our body Physically right and repairing from any sort of damage occurred during a training session, whereas there's additional variables that I think matter, that they affect performance. They also affect pain sensitivity, right? So sleep hygiene comes to mind. Sleep hygiene is a really important variable that we need to look at and I think the you know we're getting better at this. You know a lot of fitness watches and brands and trackers are Paying closer attention to our sleep, because we know Somebody who's getting five, maybe six hours of sleep they're going to be more likely to experience an injury We'll call it or a sudden onset of pain during training Versus somebody who got a good like eight, nine hours of sleep. Nutrition, again, like getting our protein intake, is going to be important. Hydrating I'm not a big fan of like supplementation or multivitamins and all that fun stuff. I think they they might add that one or two percent and might be a little bit more important for, like, elite level athletes trying to Make those marginal gains.
Speaker 2:And then psychological wellness yeah, mental health plays a large role. So we talked about a fear component. So if we have a history of injuries, say Once or twice a year we go Back squat and we pull a muscle in our lower back and we develop this fear of back squatting and that that could alter our motor Motor programming and the way we move under the bar too, we might try to find Alternative ways to pull off this, this movement, and that could put stresses on other parts of our body that aren't necessarily adapted to it. So these these sudden shifts or sudden changes in which tissues are under load If we're powerlifting, we're, we're getting near the, the peak of our, our body's capability of moving away like it matters where you're placing the stress. And so psychologically, yeah, if we're trying to change our movement patterns, that could put us at risk of injury or sudden onset of pain.
Speaker 1:Yeah, I do have a little anecdote of I do a lot of work with the crossfitters up here and some of the local like crossfit gym owners. One of them asked me like hey, nick, what supplements should I be taking? And I kind of thought for a second because I know that these, these, they're taking you know Good supplements and stuff like that you know, and I just go, how much are you sleeping at night? And they're like, what do you mean? I don't sleep. You know I'm a gym owner who also works out seven days a week, like and they also have like a lot of kids, so they're they're very busy with family stuff and also like running a business and Trying to have this awesome community and help that community proliferate in the area.
Speaker 1:And a lot of times, like sleep is the thing that gets cut out because they're just so incredibly busy.
Speaker 1:I was like, well, sleep is going to be the number one thing for you then, and then just Making sure that your meals meet your protein requirement, whether that's one gram per pound of body weight or two grams per kilogram of body weight, etc.
Speaker 1:And they're like, so I should take protein supplements and I'm like that's kind of missing the point here, like we want to try and get as much as we can from our food sources and then if we're not meeting those needs, then we can think about supplementation, right, and I think that the next thing that I really want to touch on that you mentioned was our brain's perception of information coming from regions of the body, whether that be muscles, tendons, ligaments and other tissues, and the brain's a compensating machine. If you develop a fear of a movement, then you have to sort of unlearn that fear in order to move appropriately again, so that then you're not compensating around that fear, right, right, and what can that process look like for somebody who maybe has a back strain, like the one that you experienced, or like for me, like my hip or my Achilles, things like that? Like, how do we unlearn these processes of what we would call fear avoidance?
Speaker 2:Right. Yeah, Well, the word unlearn is debatable, right, Because there's nothing that we can't. Just we can't move something into our trash bin and delete trash, right. Like everything we learn in life, every neural connection we make, it's there and it's up to us to decide if we want to strengthen that connection or if we want to let it damp in. We don't use it much, so it kind of fades away and we override it with a stronger, healthier neural connection, let's say so.
Speaker 2:A prime example, and something I see clinically a lot, is say, a 30-year-old person with a history of back injuries, and maybe they got a history of x-rays and MRIs and they showed some bulging of their discs, right. And so the doctor tells them well, you have a disc bulge, you shouldn't be doing heavy lifting or heavy forward bending because you're at risk of herniating that disc. Obviously, when an authority figure says, don't do something, you're going to harm yourself, it's hard to question them. It's hard to say I don't think that's anatomically appropriate or correct. I'm going to choose to buy their words and I'm going to suddenly be afraid of heavy lifting and so a lot of it. Yeah, it does start with the psychology of education, right? So having a good understanding of how the body works, I think is step one. Like understanding that a disc bulge today does not mean a protrusion tomorrow. Like bulges come and go, just like you can develop a bruise and then the bruise goes away, Like things heal, and I wouldn't even consider a bulge an injury to begin with. It's not something that requires healing. The other side of it is your tissues adapt to what you do every day. So we need to have a strong understanding of the disc itself.
Speaker 2:The anatomy there Is that it's ligamentous tissue right, it's basically a hockey puck of ligaments and then inside it we always compare it to a jelly donut with that jelly inside the middle, but I like to use the analogy of it's more like a tractor tire surrounding chewing gum. So it's really thick, strong material. It's not this goopy like ready to explode the first time you bend forward. So having, yeah, reframing your understanding of anatomy can be helpful. And then we talk about like, how do we implement this? How do we take this information? We're now gaining this better understanding of our bodies. How do we practice it? How do we apply it to rehab?
Speaker 2:And I think that's where graded exposure therapy can be very helpful. So if someone's afraid of heights, I don't say, well, I want you to find the tallest skyscraper in the city and go right up to the top floor. Like, let's go one or two flights at a time, spend a little time out of your comfort zone, but we're not pushing the envelope too far too fast. So with exposure therapy as it applies to back injuries, this could be doing what feels safe but also challenges our beliefs about our backs. So maybe doing some active pelvic tucking or things where we're bending our lower back and choosing to understand that this is not painful, this is not causing any damage to my body, and then that can progress into things with an empty barbell and start loading up the weight on the barbell and there's going to be some hesitancy and some discomfort along the way. But that's how we grow is when we're outside of our comfort zone.
Speaker 1:Yeah, and do you look at the discomfort, as in? I always like to use that traffic light metaphor of green light, yellow light, red light Discomfort during versus that latent discomfort later in the day or in the next day? Is that something that you cue your patients and some of your athletes in on?
Speaker 2:I have mixed feelings about it. I think someone with a history of chronic pain or pain from an injury with a lot of fear associated with their injury, they're more likely to feel pain during the exercise. And then we talk about other comorbidities like comorbid anxiety, depression, post-traumatic stress disorder, other things, that kind of mess with our wiring. From a neurological approach we're less able to dampen pain Like you're feeling good, you're going for a run, you kind of block out the pain because you're just having such a good time, whereas other people with histories of pain they're not able to dismiss pain, so it's there and they have to train through it. So it's hard to sometimes navigate what is comfortable, acceptable pain and what is pain that indicates I am actually doing more bad than good. So sometimes we'll use it, sometimes we won't.
Speaker 2:I think one important element we could potentially use is the difference in the pain quality. So pain is described as dull and achy and kind of feels like muscle soreness or that kind of like everyday muscle and joint pain. That is more like this is innervated by like C fibers, which is kind of on the lower end of the spectrum of nerves that carry a pain signal to our brain, so things that are stimulating C fibers. These are things that are probably less threatening than something that carries pain that's described as sharp, intense, lancinating, maybe get like a jolt of pain or something that just really like awakes you up. This is carried by those like large diameter myelinated afferent neurons, and so these are more often stimulated. When maybe there is some injuries that we're trying to avoid maybe like re-tearing a pulled muscle or irritating a sensitive part of a joint and you get that like jolting, shocking pain. I may say let's steer away from that or keep it to a minimum, whereas the dull, achy pain I'm a lot more likely to say yeah, you can train through that.
Speaker 1:Yeah, and what TJ is talking about here are the different types of nerves and how they can transmit different types of information. So when he's talking about large 1A afference, he's really talking about if we think of it like a highway, he's talking about like a very large highway like I-70, where a lot of information can travel very quickly and this is very important information to the body, versus like a little side street in your neighborhood. Those are like those small type C nociceptor, sometimes called nociceptor fibers, that these can carry some of that dull, achy type of pain that can be more related to just activity or muscle soreness et cetera. Is that about right, tj?
Speaker 2:Yeah, and from some of the research you and I did and we dove into a lot of like functional MRIs and studying like brain activity for people in pain, we know that chronic pain it does have a higher tendency to stimulate these pain fibers, but also they're strongly connected to areas associated with emotion and motivation and behavior. So if you have an overstimulation of these C fibers we could also talk about how this actually can. This can have a domino effect on inducing fear, inducing changes in motivations to exercise, because we're wired to avoid pain right, so it's a survival instinct when we feel pain we avoid it. But we've also learned with a lot of sports medicine research and pain research that sometimes some activity is better than none. So I think there's always a happy medium where we wanna tiptoe our way back into movement and exposure to these fearful stimuli, but we wanna overstimulate.
Speaker 1:Yeah, and something that I mean we definitely got a lot from one of our mentors, the famous Norm Kettner way too much of a genius for his own good.
Speaker 1:I mean, not too many people get a building named after them while they're still alive, or an entire wing actually of a building.
Speaker 1:But he would say he would talk about how tissue damage was not necessary nor sufficient for pain to occur, and pain is not even truly just a signal, but it's really an interpretation of a signal.
Speaker 1:So we can look at a signal like. The classic example is the story of the construction worker who jumps off a ladder and he sees a screw pointing straight through his shoe and he sees this signal with his visual system and he interprets it as an extraordinarily painful stimulus. And then they go to the hospital and he's in excruciating pain. They cut the shoe off around the screw and it had gone in between his big toe and his second toe and it actually hadn't caused really any tissue damage at all. So it was an interpretation of that signal, whereas if we get something like a paper cut or oftentimes like people will have these massive traumas and injuries and because our body goes into these modes, like some people call it the fight or flight response. Whatever that are designed to dampen the pain response, we can have large levels of tissue damage but no pain at all, correct yeah?
Speaker 2:Yeah.
Speaker 1:Yeah, it's.
Speaker 2:Go ahead.
Speaker 1:Oftentimes it's. You know, this is maybe a segue to something we might talk about later a reprocessing of these signals. Seeing these signals, seeing maybe the fire alarm is going off, but, like for me, I've got a fire alarm that's like really close to my kitchen, so unfortunately it's going off like all the time, even when I've just like got a stake in the oven or something like that and it's like, oh so my fire alarm is going off. But these are just normal processes that are occurring and sometimes we need to reprogram ourselves to interpret the signal that's coming through not as damage and pain, but we need to just recognize that it's not really hurting my oven or my one bedroom apartment, that this fire alarm is going off right. And I love what you discussed about the graded exposure therapy and how it can really help us reprogram and change our processing and our interpretation of these signals.
Speaker 2:Yeah, and I know the name of your brain is art of prevention and we think of prevention, we think of injury prevention. But I think pain prevention is it's its own realm and it's actually what's burdening most people in the world too, Like, yes, we're people pull muscles, people herniate discs, people tear meniscus and ligaments and any other parts of anatomical damage that I think riddle the sports world. But yeah, pain prevention is its own ballgame as well, Because, with or without prior injury, there's always overcoming that sensitivity issue, as I like to call it. So we can view things as hypersensitive, like your alarm going off.
Speaker 2:Your smoke alarm is too sensitive, right, the alarm. Once it goes off, it goes off and all the noises are there and you maybe have that sense of urgency like I need to act now, I need to do something about it. But if you're able to interpret the signal and to ask yourself is this a true alarm or am I okay? Can I keep hanging out cooking in my kitchen or do I need to evacuate my building right away? Same thing, pain. That's where this pain reprocessing therapy that's taken over some of the research world and the pain world is helpful because it's helping people to realize once an alarm is going off, I still have the power within my own mind to ask myself if this is an alarm worth listening to or doing anything about.
Speaker 1:And I love that you mentioned pain reprocessing therapy and you just enlightened me on this new, like in vogue therapy that's getting a lot of attention and a lot of research right now. What are some of the components of this pain reprocessing therapy?
Speaker 2:Yeah, so it's a new name that's been coined in the last few years and I would say it falls in the realm of mind-body therapies or even talk therapy, like psychological therapies, but definitely something that I think you and I have been aware of and practicing in our own clinics for years, and they just finally slapped a label on it. But cognitive behavioral therapy is probably another term that most people are familiar with, where we can break down cognitive behavioral therapy into, like our thoughts, our emotions, our behaviors and how there's this triangular, bi-directional relationship between those three things. Right, so we behave based on our current emotions and our actions. Our actions can dictate our emotions. Like you know, there's this back and forth, and so, rather than focusing on behaviors and actions, I think pain reprocessing therapy is more of a cognitive exercise.
Speaker 2:It's just reframing how we view the pain we're experiencing, and this can actually have a very beneficial outcome on the amount of pain we experience. So there have been a few small trials I think the one I had sent you that was published in JAMA was somewhere around 60, 50 to 60 participants, but a large percentage of them were people with chronic pain who, at the end of this trial, had little to no pain and it sustained for over a year at follow-up. And this was just a trial where people they had video calls with a psychotherapist twice a week for two months, I believe, and it was just a matter of education, talk, therapy and just like we've been talking about this whole time like reframing pain, understanding how to interpret pain, maybe debunking some myths or some harmful beliefs we have about our bodies and what's safe and what's not and I think just that alone is a very powerful tool that we can have in our toolbox because, at the end of the day, all we have is our perceptions.
Speaker 1:And we've really we've kind of discussed the two ends of the spectrum when it comes to pain and these pain signals, right. So there's the actual structural damage which I know it's it was for a while it's kind of invoked to be like, oh no, your pain is not because of this, you know, it's not because of that tear in your meniscus, it's not because of that discarnation. But you know, I'm sure if we called up, you know, our mutual buddy Alec, and we asked him how that discarnation feel, when it happened it's like, yeah, you know, some tissue damage and in the acute sense can have some significant effects and can be processed very well as pain. Because that's an accurate representation of what's going on and how we need to maybe not do the CrossFit competition this weekend.
Speaker 2:Right.
Speaker 1:On the other end of the spectrum, though, we can have kind of top down pain processing. That's more of that interpretation of of those pain signals, even after the acute tissue damage has occurred. Now, this is a loaded question here. So we should be just telling patients that their pain, if it's chronic or over three months, is in their brain.
Speaker 2:All pain is in the brain, acute and chronic. Yeah, yeah, I think that there's a negative connotation when you say your pain is all in your head and you're making it up. Right, that's. That's not what we're saying. I think it's just a very misinterpreted phrase that we, poorly, sometimes we don't deliver that message very well. But, yeah, at the end of the day, like you can't experience pain until a signal reaches, you know, higher centers in the brain, and so this is where we talk about. You know, sometimes really severe injuries happen and we don't feel it at all, and so we look down and see, like our wrist bent backward further than it needs to be, or you know bone being broken, and then we start to feel it and then, on the flip side, when there's no anatomical damage, what we experience, the pain, and it really just comes down to how much activity is occurring in these centers where we bring pain signals to our awareness.
Speaker 2:It's very easy to stimulate pain when, when we're actually like triggering these, these nerves in our body with, you know, an acute injury like this disc herniation example, you know there are nerves in that area where the disc is located, and so when the herniation occurred, those nerves were stimulated mechanically and chemically and that, you know, assuming a properly functioning nervous system, it reached the brain. He felt the pain in his back and that was appropriate, because we want to feel pain. It's a way to tell us hey, stop what you're doing or you could make things worse. Maybe assume what we call sick behaviors, kind of lay down, rest for a little bit, heal, recover. Kind of dedicate all of the calories in your body to repairing that area and not like running a marathon and burning it all out.
Speaker 2:But you know, sometimes, sometimes that leaves an imprint and that imprint suddenly makes your ability to feel pain easier. Just like learning an instrument, like once you've learned to play the instrument, even if you put it away for a few weeks or months or years, like you'll probably pick it up pretty easily the second time around. Then you did the first time. And pain is no different. It's a learned behavior and it's a learned skill in our nervous system and it's a permanent imprint.
Speaker 1:Yeah, and I was kind of like teeing that up just for that exact discourse right there. And if you're like a clinician or a coach or an athlete and you just tell somebody it's all in your head, then really we're just trying to say shame on you, because this is a much more complicated thing than just blaming the person for being a lunatic. You know, like this doesn't mean that you're crazy if you're interpreting signals as pain, like that's a normal thing. Low back pain is still the leading cause of disability in the world. I mean, I remember when we were fresh out of school and I was like, oh man, the leading cause of disability, we're going to put a dent in it.
Speaker 1:And then COVID happened and like the whole world went to crap. So you know, that was us coming out of school. So we talked about graded exposure therapy. We've talked about that pain reprocessing therapy. And then, when it comes to training, how can we avoid or reduce the risk of pain happening? And then, can you give me some insights as far as what signals do you take from your body as well? I need to look at my training log and I need to look at my variables as far as, like my psychological stress and change some variables, because I'm getting a little bit too high my pain signal. How do I decrease that?
Speaker 2:Yeah, I think this is where a pre-written training program can fall short, versus weekly check-ins with a coach or, you know, a clinician or somebody kind of guiding you through. You know, life happens. You know, sometimes I randomly wake up at 3 am and I can't fall back asleep and so I'm sleep deprived for the next 24 hours and so I need to be smart that day with my training or a stressor can happen. So you know, there's a day, it's a day by day process there's. You know we want to have some program where we look at these training variables we mentioned and trying to decide which variable matters most to us. If I'm trying to get stronger, I should probably increase the intensity and be lifting weights in that like 3 to 5, 3 to 6 rep range, because exposure to high weight is how you get strong. Naturally. If I'm trying to put on muscle, I'm trying to do a high volume training program, so I'm just trying to maximize the number of times I'm squeezing a muscle throughout the week. But we want to do this in a. You know, there's going to be some overload, there's going to be some progression to the program week by week, and so if you have a history of injury and maybe you're shifting from active rehabilitation to getting back to like athletic training.
Speaker 2:I would advise what's called linear period period is I can't say it linear periodization. So linear periodization is just week by week. You're just gradually increasing like a little bit at a time. So if I'm, say, 100 pounds this week, I'm doing this exercise, next week I'm going to increase a little bit, maybe 105 pounds and then 110. Whereas there's other programs where they're nonlinear. So I could do 100 this week, 110 next week and then I back down to like 95 pounds in week three and but we see a net increase over time. There's larger, larger valleys. Yeah, it's more of a sine wave that's tilted. So you know you, you have really intense weeks followed by pretty like laid back weeks. But with a history of injury, you know you do want to think about tissues that are actually healing and you're you're better off doing a linear periodization program until you feel structurally sound again and I think it also psychologically easier to work in a linear fashion.
Speaker 2:But yeah, I look at total load for the week. So take the weight you're lifting, the number of sets and reps that you've done, and multiply that to get like a total gross number of work or energy output and monitor that. So let's say I lift 500 pounds for two reps versus 100 pounds for 10 reps. It's going to equate to the same amount of weight lifted. It depends what your goals are. If I'm trying to get stronger, maybe option A is better. I'm lifting 500 pounds. I got to expose myself to heavy weight.
Speaker 2:But these high repetition, lower weight programs like aims more toward, say, hypertrophy or muscular endurance, you're at a risk of overdoing it there as well. You can still reach neuromuscular fatigue and you can still get to a point where muscles can strain under light load. I won't name this particular person, but I have a friend who can bench press well over 250 pounds and he tore his pec while warming up with 135. And that's nowhere near his max right. So I think for him he would also agree that he wasn't sleeping well. He was cranking out a ton of stimulants, caffeine through the roof, stressful week it was around finals week in school for him. So a lot of other variables at play. Injuries aren't always just maximum force production and then suddenly you tear.
Speaker 1:Load is load, no matter what it looks like, whether that's load on a barbell, whether that's heavy load on a barbell, high velocity load on a barbell or the psychological load that you just talked about. And even like I think one thing also is good stress is still stress If you're moving, getting married, having a kid. All of these things are potentially good things depending on how you interpret them right, but they're all stressful things that will add onto that overall cumulative load.
Speaker 2:Yeah, that's a good point. Even positive stress is a stressor.
Speaker 1:Yeah, Now talking about some of the set and rep schemes, kind of segueing over to the exercise Fizz stuff, why just say that we should if I'm trying to get strong, isn't strength only associated with cross-sectional area of muscle?
Speaker 2:Well, it depends who I'm talking to. If you're a beginner, if you've never touched a weight in your life, maybe you've done a little bit of it, but not much. You consider yourself a beginner to the weight room. Most of those early what we call beginner gains are actually neurological in nature. So it's just much like learning to ride a bike or any sort of coordination of body movement. It's your brain and your muscles working together to figure out how to actually accomplish a task. So beginner gains and strength are through what we call motor unit recruitment, which is We'll take the back squat, which is probably a terrible example, because every muscle, head to toe, is pretty much engaged in the back squat, but we'll say it's a leg workout. So you've never squatted much before. You've got to figure out how to start squatting heavy weight because you want to get stronger. A lot of those early gains is how do I tell every muscle in my body to co-contract with the right ratios and percentages so that the bar goes straight up and down? I maintain my balance, I maintain equal pressure through my heels and my toes. It's a lot of coordination. Training is what it is. So most people with beginner gains, they're just learning how to fire their nerves and tell their muscles how to squeeze appropriately. Now, once we get past those beginner gains and we start to notice a plateau or actually a slower progression in our strength gains, this is where, yes, cross-sectional diameter of a muscle matters, because a larger muscle is a stronger muscle if we're equal in motor unit recruitment. So, yeah, if you're a trained athlete and you're pretty coordinated, you're already hitting the gym a couple times a week. You know how to squat.
Speaker 2:Step one is start inching your weight toward those heavier weights. Start entering that three to six rep range. I rarely go above three rep or I would say heavier. So one to two rep range and that's just out of random stuff happening and honestly, my joints feel better when I don't. But yeah, you got to spend time with that heavy load and learn how to move that heavy load.
Speaker 2:And then you got to think about hypertrophy is kind of phase two. So muscle hypertrophy if that's your goal, you're going to have more strength. But there's a way to get stronger without getting bigger. I think this is another concern some people have. It depends what sport you're in If you want to win same light weight like cyclists, rock climbers, runners, people who don't want that extra weight that they're carrying around because they use their body weight works against them. This is where power training can be a little bit more important than strength training. So the differences in definitions is strength, you might think more about slow, controlled muscle contraction, whereas power is more explosiveness, popping, adding more load to the tendons of your muscular skeletal system, so kind of thinking about turning your body into a rubber band, rather than these like contractile muscle fibers that lengthen and shorten, using a lot of extra energy and burns more calories. But yeah, power training might be a little bit better if you're trying not to gain weight.
Speaker 2:Yeah, so like if I'm a runner like.
Speaker 1:I definitely don't want to go into the gym and do any weight training because then I'll get huge right Not?
Speaker 2:necessarily. You know, at the end of the day weight gain is a matter of calories in calories out right, but there's also the stimulus for it. So if we're performing reps and sets, I think it's conjecture to say that hypertrophy is gained in that 6 to 12 rep range. That's not necessarily true. That's classically that's pretty bro science, kind of classical knowledge. But you gain hypertrophy through working a muscle through a full range of motion, especially adding some contractile load at that lengthened end range of a muscle and trying to work that muscle to near failure and near exhaustion.
Speaker 2:And that should happen within a range of as little as, in theory, one rep, but I would say more like three to five reps and all the way up to a higher end of like a 30 rep set. Now the reason I wouldn't go beyond a 30 rep set is you're probably using a weight that's too light to put enough tensile load on your muscles to stimulate it to grow. And then, on the flip side, if you're, if you're trying to get bigger muscles in that like one or two rep range, there's a big difference in energy output in like whether or not you do that one extra rep there versus a few extra reps around that you know if you're aiming for 20 and you do 18, 19, 20. Like you can squeeze in a few more in that range than you can like it's it's all or none with that third rep in a heavy, heavy set.
Speaker 1:So yeah, and especially with like a runner or endurance person, like a cyclist or triathlon athlete or a rock climber, like we have competing energy systems, that we're prioritizing our endurance training. That endurance training is gonna compete with the gains or in muscle size or hypertrophy. So, like, gaining muscle mass is like not easy. Like people go to the gym with the sole goal of gaining muscle mass and enlarging their muscles and it's still difficult. So if you're prioritizing endurance training and the other exercises that you're doing are strength training, then you will get a lot of gains from that strength training, but they won't necessarily be in terms of Muscular gains.
Speaker 1:I mean, there have been like large studies done on running populations and looking at the amount of mass that they put on in terms of like kilograms or pounds that they gain and Literally I almost laughed, like reading this one paper because they said that the participants had significant improvements in their lifts but, more importantly, improvements in their running economy.
Speaker 1:And you know there are potential ramifications in terms of injury reduction or risk reduction and, on average, like, most people didn't gain anyway and some people gained like 1% of their body weight, right, which if you're a 100 pound person, that is a pound Like, like that is not going to have a significant change in your VO2 max equation or a significant ramification in your Running economy and in fact, running economy has been shown to go up Between 4 and 8%, which it's like cool, so we can strength train and we can reduce our risk of injury. Or we can spend, you know, $200 on a pair of 4% super shoes with the carbon fiber plate and everybody's like get, let me get the super shoes. And it's like, oh god, there are so many other things that we can be doing here. Or a heck, what if we did both? You know.
Speaker 2:Right, yeah, I think, and this is actually. This was years ago. But when I was deciding on a name for, like my, my strength and conditioning brand, I ended up with hybrid elite strengths and conditioning. And this is exactly why is like, you need to be a hybrid. If you're trying to be elite, like you need to delve into not only endurance and anaerobic or, sorry, endurance and aerobic training, but also strength training, power training. You need to Kind of spend time in the entire spectrum of physiological training.
Speaker 2:You know, I I have a bias, like I I prefer heavy, late, heavy weight. I like power building in that that realm. But you know, for the sake of my heart health, I also hop on the the peloton and I'll do like 45 minute zone 2 training, everyone small. Or I'll go for runs when it's warm out and I'm huffing and puffing, even at a very slow pace. But you still need to do a little bit of everything. So I would, I would advise anyone who is more of an endurance athlete, who who does they want those gains and power output or athletic performance, maybe like think of things as being on opposite ends of the spectrum. So if, if, endurance and more like fat burning type Aerobic exercises. Maybe you just want a little bit more improvement in those those fields.
Speaker 2:Then I would say, do some power training.
Speaker 2:So that's not the same as raw strength training.
Speaker 2:I mean power training is using it, accommodating weights like bands and chains and things that actually increase in in weight as you move through the rep.
Speaker 2:So a classic example is if you perform a bench press while there's chains hanging on either end of the bar, like at the bottom when the bar is against your chest, like most of the chains on the ground, but as you push toward the ceiling it lifts more and more the chain off the ground, so it gets heavier and that actually increases your ability to contract harder and harder and harder through the rep. This this does have a approximately a three-fold Decrease in shoulder pain, which we talked about. A recent study on that. So power training can actually reduce Hard to say if it's an injury rate or a pain rate, but shoulder discomfort is less when we use accommodating resistance and it's a way to train that explosiveness, that like that really hard squeeze that loads tendons and then if you get better loading a tendon, that's going to translate to being a better runner with better economy and less metabolic, you know, burn or expenditure while you're running.
Speaker 1:Maybe you won't have such a Long history of tendon injuries like myself. Would you say two chains is enough with the bench press?
Speaker 2:Who chains? Yes, well, that's the thing. You have a history of tendon injuries, but your tendons are like Incredibly strong, you know. Like it charges to the game, like injuries come with training and push in the envelope. So your, your range of motion and your mobility is much less than someone who Does, you know, stay out hyper to feed training. Maybe they're trying to build big muscles, so they, they use resistance through forward range of motion, whereas you, as a runner, if you want, like better economy, you kind of have to be stiffened up and have that soft tissue Elasticity. So you're, you're just a rubber band from the waist down, so, but it makes you runner.
Speaker 1:That's how I feel when I try and touch my toes. You know hard segue here, TJ. How many hours a day should I be warming up before I exercise?
Speaker 2:Oh man, again, I think this is individualized right. This is why I'm I this is what I spend my my time talking to clients about as a coach. Do you have injuries we're trying to overcome, you know doing to throw in any sort of great exposure type warm-ups that gets you mentally prepared for a lift? I think everybody should start off with something that's low load, you know like. If I'll give you an example of what I did this morning today, I was doing overhead press. My warm-up was I had a little stiffness in my upper thoracic spine and this is also the area that I've had probably the most muscle strains is kind of right in between the shoulder blades. So I did a quick yank to the left and felt some pops of the deal. Quick yank to the right, felt some pops. I did a little shoulder shrug and then I started overhead pressing the empty bar. That was my warm-up.
Speaker 1:Now a graded exposure to the specific movement that you're going to be doing while you work out right.
Speaker 2:Right, yeah, I mean, social media is filled with all these fancy exercises and these, these personal trainers who have something to sell and you know, unless you work with me, you're never gonna get. This weird exercise is correct, where there's stuff tied to them head to toe and restricting their movement.
Speaker 1:But blindfolded on a boce ball with Like.
Speaker 2:I won't say any names, but there's, yeah, there's people who are like famous for that. They're even seeing pro athletes because it's there's a significant buy-in to that kind of stuff. It looks sexy. No, at the end of the day, like the best warm-up you can do for a particular exercise is probably that exercise, but a low amount of it, high repetition, right. Just start greasing the wheel, get the joints lubricated well, start getting blood Perfusing that area at a higher rate so that there's a faster delivery of nutrients and oxygen and things that your working muscles are gonna need during the workout.
Speaker 1:Yeah, I can. I'll use my girlfriend as an example because Lord knows she's probably not gonna listen to this podcast all the way through. But so she was, you know, doing this like climbing warm-up that she got off of like the internet, right, and I was like you need to be doing like some others because she was, like you know, rehabilitating our strength training in the presence of injury with a couple of things and she was having trouble with like basic, like climbing things and she needed to work on these climbing specific thing, like Movements and aspects of climbing that are specific to only climbing, and I'm like you need to work on this, this and this. And she's like, well, I just I can't spend, you know, four hours at the gym. I'm like huh, like, why don't you just do it like as part of your warm-up, wouldn't she? She's like, well, I've already got like my warm-up that I do, and it was like 30 minutes of mobility, like literally like doing a lunge with a twist and Like stretching the hamstrings and stretching the shoulders, and she's a very like mobile and like flexible person, like mobility is not the Like limiting factor for her. So I, you know, she, let me, you know, create a warm-up protocol for her for her climbing, and since then she's had really nice gains in these sports, specific factors that have really improved her climbing performance. And she's a mobile person. So her mobility has not like she's not like oh, I feel so stiff on the wall. You know she's already mobile, like on the flip side.
Speaker 1:I like that you talked about the specificity to the individual, because I am the opposite, like I Love to go in and I love to strength train my fingers, I love to work on the fingerboard like weighted hangs, stuff like that, and I hate mobility, I hate stretching and I, you know, about a year ago I signed up for a training program where they take my data for finger strength, for An aerobic capacity for my fingers, etc. And my mobility and they compare it to other climbers of my like climbing level and other climbers that are above my climbing level. And my finger strength was there, my shoulder strength was there, all that stuff was there, and then my mobility was like Literally not even on the charts. It was so bad.
Speaker 2:Yeah, I mean that's. That's specific adaptations to impose demand. Right, the said principle you're a runner, which requires you to you know, if you're less stiff, I'm sorry. If you are more stiff, you're, you're burning fewer calories with every step you take, but if you also want to be a rock climber, you need to be mobile. So this is a trade-off and this is where we get specific to what are your goals, what are your desires and like athletic performance.
Speaker 1:So yeah, and so I think that that specificity is where, where someone like yourself, or reaching out to your Provider why that be like a provider who can also coach you or your coach and figuring out like, what are those specific things that I need to Decrease my you know, improve my limiting factors, what are my weak points that I can improve upon that are gonna give me huge gains in my overall performance? Yeah Gosh, well, the time has just blown by TJ. I mean, this is definitely not the last time we're gonna talk. I think, you know, maybe we should just do an entire like pain science episode and I just, yeah, I'm just gonna sit back with some popcorn, let you. Let you learn me something you know.
Speaker 2:I.
Speaker 1:Get a lot. I get, I learn so much every time that we chat, even if just offhand or text message or whatever. So I mean I'm definitely gonna, you know, record you talking again in the future so that other people can admit it as well. Now, this is the part of the show I guess we're a show where I Bring up the you know the Benjamin Franklin and his infamous quote an ounce of prevention is worth a pound of cure.
Speaker 1:So, tj, we've talked about so many different things as far as, like, how you dug yourself out of a hole, training wise, some variables to look at as far as training load, recovery tactics and some things to monitor with recovery. We talked about graded exposure therapy. We talked about PRT. We talked about gains in strength, and also gains in strength without gains in mass or muscle size, and then we got to finish off with our how long your warm-up should be. Now, if we could Distill all of that information into a super important talking point, what would you say that your ounce of prevention would be for individuals listening to this podcast, whether they're an athlete, a coach or a clinician trying to give really good advice to those other populations?
Speaker 2:Yeah, I think, in the context of prevention, and you know, continued wellness and continued Growth and improvement and whatever anyone's goals are you use the phrase already but strengthening strengthening our weak points or, you know, finding the weakest link in the chain and focusing on those is probably my, my biggest philosophy on my own health. And that's not, that's not just in regard to physical wellness, so we're talking about all the different pillars of wellness. So you know there's physical, spiritual, nutritional I'm not gonna be able to name them all sleep hygiene, you know mental health. So Always monitoring and reflecting, you know Allocating a little bit of mindfulness at some point in your week and reflecting upon like what, what elements of my health are at the lowest, how do I boost those? Because you know integrative care, multidisciplinary approaches, are, you know, the best way to live a, you know, fulfilling life.
Speaker 2:So, yeah, one, one week, I might be focused on my strength and my, my, you know, musculoskeletal health. And then other weeks, maybe I it's a mental health week, or I'm Doing things to improve my sleep quality, or I haven't been social or hanging out with friends much. So I need to focus on my social life. You know the art of, you know to use your, your, your, slogan. You know the art of prevention it's, it's, most multifaceted.
Speaker 1:So yeah, and it is. There's a little bit of art to it, you know. It's definitely art mixed with the decent amount of science. So we bring the science, but we recognize that it's not black and white, it's a lot of gray, just like pain is, just like Physiology is, you know, like physiology doesn't always work in that linear fashion, and sometimes we need to recognize that there are other factors at play that maybe don't show up with the pen in the paper. So, tj, thank you so much for you know giving us your time today. Where can people find you for resources as far as like your awesome ebooks, your General programming, as well as how could somebody work with you if they really want some good specific programming?
Speaker 2:Yeah, so my website is my, my brand name, which is resilient physical medicine, calm. From there, you can branch out however necessary. I have training programs up there ready for download or purchase. I have an ebook that's on Amazon Kindle as well. The name of that is the sound body plan, which is as a subtitle of a beginner's guide to weight loss, muscle gains and improved physical performance. Yeah, I have Clinics in Boulder, colorado, denver, colorado, as well as Aurora at the Anschutz Hospital campus, so, depending on whether or not you want to use insurance or pay cash, we could. You can see me at any of those locations. I also do online telehealth consultations, so this were to get out to somebody you know, across state lines or even in another country. We can still discuss a lot of what we talked about today through telehealth appointments gosh dang.
Speaker 1:Where can I not find you, you know? But this is really great and I think that if anybody has any questions, what's a good way to reach you? Tj, like you want email Through your Instagram? Resilient physical medicine or what?
Speaker 2:yeah, emails probably easiest. Or resilient physical medicine at gmailcom and everything can be found on my website as well. So I have a business phone that goes honestly, it goes straight to my cell phone. So it's like Like I give out personal information. But yeah, email probably easiest and I can get to it most convenient times.
Speaker 1:All right. Well, this is certainly not the last time that you're gonna be on the podcast and I appreciate you again and I'll I'll be speaking to it with you again soon.
Speaker 2:Awesome. Thank you for the time.