Fix It So I Can Punish It

Here's the humanized version with timestamps:

Ever heard this one? "Doc, can you fix my shoulder so I can get back to tearing it apart?"

That's exactly what Bugs asked me last month. He wasn't joking.

Bugs' a 43-year-old software guy who lives for Brazilian Jiu-Jitsu. Second shoulder injury in 18 months. Same story: did his PT, felt better, went right back to training five days a week, and... here we are again.

But here's the thing – Bugs didn't want rehab. He wanted permission to keep doing exactly what broke him in the first place.

Sound familiar?

This episode is about that messy space between wanting to get better and being terrified of changing who you are. Because for a lot of us, how we train isn't just what we do – it's who we are.

Timestamps: [00:00] The question that stopped me cold: "Can you fix my shoulder so I can get back to tearing it apart?" [01:00] Why most recurring injuries aren't really about the tissue [02:00] Meet Bugs: 43, software engineer, BJJ competitor, and repeat shoulder injury victim [03:00] The hard truth – most people don't want rehab, they want a reset button [04:00] When your sport becomes your identity (and why that's dangerous) [05:00] The shift: from surviving training to actually getting better at it [06:00] How Bugs learned to measure progress by how he felt, not how often he trained [07:00] Why volume and intensity are tools, not goals [08:00] My own wake-up call at 40 – when I had to choose between ego and longevity [09:00] The paradox of loving something that's slowly breaking you [10:00] Quality over quantity: what "training smart" actually looks like [11:00] Final thoughts: Let's stop fixing people just so they can break themselves again

The real question isn't "Can you fix me?" It's "What am I willing to change?"

If you've ever felt stuck between loving your sport and feeling like it's slowly destroying you, this one's for you.

Got your own "fix me so I can break myself again" story? I want to hear it. Seriously. Message me – I read every single one.

And if this hits home, share it with that friend who's always training through pain because they think recovery is for the weak.

Thanks for listening to Talking Rehab. Sometimes the strongest thing you can do is the smartest thing you can do.

Transcript

Speaker: 0:00

What is rehab or rehabilitation? My name is Fred, be Garris, a board certified sports and spine medicine physician in Virginia Beach, Virginia. After 10 years of practice, I still find musculoskeletal medicine both fascinating and challenging. I. This podcast is about the lingering thoughts and questions I've had after residency and fellowship. My hope is to spark discussion, challenge, dogma, and share my experiences in musculoskeletal medicine. Welcome to The Talking Rehab Podcast. I. Can you fix my shoulder so I can get back to tearing it apart? That question was from, let's call him Bugs Bunny, or I'll call him Bugs. A 43-year-old software engineer sitting in my clinic. His shoulder was injured and taped up after a recent, jiujitsu tournament, and he was asking me, pretty much dead seriously. It's the kind of question that makes you stop and think because it reveals everything about why rehab actually fails. I'm Dr. Fed Begar and this is a Talking Rehab podcast. Today we're diving into the psychology behind that question and why fixing the tissue might be the easy part. Bugs trains jiujitsu approximately five days a week, sometimes twice a day. He's been at it for eight years, competes regularly and describes rolling as his quote unquote, meditation. for those of you who don't know me, I totally get this because I've been training jujitsu myself for just about 10 years, and it's definitely one of the very few things that, I'll honestly call it like an addiction, but at the same time, it's, it is my happy place. It's the only place I've found myself. Being able to slow my mind down. And, in this particular case, this was his, second shoulder injury in the past 18 months. The same shoulder, same exact story. And he told me that he took three weeks off, last time. And he did his physical therapy, felt great. and then he went back to training normally. And here we are. Eventually I ordered an MRI, which looked fine and there were no obvious, surgical red flags, no massive rotator cuff tear, things like that. But there was some subtle findings of essentially an overused type injury. But I could see the real problem was ridden all over his face, he wasn't here to change. He wasn't here to change how he trained. He was here to get permission to keep training exactly the same way, Does that sound familiar? I think if anyone does juujitsu, I think we all know what we're talking about. Here's what I've learned over the past 10 plus years in the field is that, most people don't actually want to rehabilitate things. they they all essentially want a quick fix, something that just, gets to the good part, if you will. They want someone to tell them. That everything's gonna be okay to wave a magic wand and say, Your body can handle anything that you throw at it, but that's not exactly how the body works, and it's definitely not the way that shoulders work. So I asked him, simple question, What would happen if you didn't return to training the way you used to? He looked at me, like I'd asked him to give up his, essentially give up breathing. That's not really an option. He said, this is who I am. and there is one of the major, I guess points of the discussion, not necessarily problem is that for a lot of people, this is their identity. I. how they define themselves as a person, as an athlete. there's a lot tied up into, the physical activity, the athleticism, the day-to-day stuff that is now painful. it's really part of our identity and. he wasn't necessarily just protecting his shoulder, he's also to, he's also trying to protect his sense of self. Ju Juujitsu wasn't something that he did it, it really was who he was. the guy shows up five days a week. He's a competitor. he's the one that never really backs down from a role. Here's the thing about identity. sometimes it can be our prison, and I see this pattern everywhere. The runner who can't imagine running less than 50 miles a week, the CrossFitter, who won't scale back the weight or the repetitions. The weekend warrior who thinks recovery is for the week. The all stuck in the same loop. Their identity demands, they train hard, but their body can't keep up with their identity. They end up in my clinic asking me to fix the body so they can keep punishing it. This time I tried a different approach with him. In instead I of asking him to do less, I asked him to do better. So I said, what if. We could find a way for you to train that actually made you stronger, not just temporarily, but for the next 10 years. his ears obviously perked up. So we redesigned his training around one simple principle, the minimum effective dose, instead of five days a week. We went to training three times per week, but we added targeted strength work. We fixed his sleep. And he was averaging five hours a night. we added yoga twice a week for mobility. Most importantly, we also changed how we measured his overall progress. Before it was based on how many days did I train this week, Now the measurement of progress is how did I feel during the actual training? How's my technique improving? How's my breathing? Three months later, he told me something that stuck with me. I. I actually feel like I'm getting better at Juujitsu, not just surviving it. his shoulder pain dropped from a seven out of 10 down to a one. His overhead reached improved by 40 degrees, but the real wind was that he stopped waking up in the middle of the night, to toss and turn, only to wake up in the morning feeling, really terrible. So here's what I want you to understand, whether you're a patient or a clinician. Rehab isn't about stopping people from doing what they love. It's about helping them to do it better. The body isn't a machine you can just fix and forget. It's more like a business with a balance sheet. You can spend aggressively on high intensity training, but only if you're investing equally in recovery, strength, and smart programming. Most people are spending like there's no tomorrow and wondering why they're going broke. If you're listening to this and thinking, but I need to train hard to improve. I get it. I used to think that too, but here's what I've learned. Volume and intensity are tools, not goals. the goal is long-term performance. The goal is to still love your sport. In 10 years, the goal is to train because you want to, not because you have to prove something. If you're dealing with a recurring injury, ask yourself these three questions. Number one, am I training to get better or just say I trained? Number two, what would change if I focused on quality over quantity for the next eight weeks? Number three, how do I want to feel about this activity in five years? And if you're working with someone stuck in this identity trap, don't ask them to do less. Ask them to do better. Frame it as an upgrade versus a limitation, because the best athletes aren't the ones who can handle the most punishment. They're the ones who've learned to train smart. Now, this particular story really resonates with me because I've been training for about 10 years and I have, I started off when I was about 35, 36 years old, and I'm now turning 46 this year. And I still love being on the mats, but how I trained today is completely different from in the beginning. in the beginning I was going six to seven days a week. And training, not super hard, but fairly consistently. But with time, I just started to notice I was gathering injuries or things were starting to take longer to recover, and I really had to, come to a point where I decided to just, I. I had to start to train differently. my body, particularly after 40 years old, really started to change. And I just realized that my body needed a little bit more recovery, needed a little more strength in certain places. And once I took that time off, and modified my training program, it really made a huge difference. And as my skill level started to go up, in addition to my age, I started, picking and choosing how many times a day. I started picking and choosing how often I would train presently. I'm now training probably two to three times per week, and sometimes it's just training on my own because I really have had to make it a point to listen to my body, and I just realized that. This is the quote unquote journey as all jiujitsu people talk about. But so is rehabilitation. It's rehabilitation is not really about getting back. It's about coming back better. And I think if we think of our jiujitsu this way and we think of our injuries this way, it's I think a more positive way to look at the circumstance of an injury. It's. it's, I think Jiujitsu in particular is unique because the goal, of the submission often puts us in, injury and prone positions. And so it's so much fun that we want to do it again, but we're constantly putting our joints in jeopardy. we have, we just simply have to, we have to get better at training, just, I'm at the present time. I was training this past week and I. I suffered an injury from something that I've done a million times and, I have to take a listen to my body, even though things are feeling better. I just know that I need to give my body a little bit more time, to recover. And although I want to get back, as soon as possible if I want to do this lifelong. and have it a fun ride. I need to do, I need to do the recovery part now, because recovery in the later years isn't usually faster. It usually takes longer. So it's either now versus later, and I would refer to do it now, so I can do this much, much longer and for the rest of my life. Next time someone asks me, can you repair my shoulder so I can get back to tearing it apart? I'm going to say, I can help your shoulder recover, but let's make sure the plan forward builds you up instead of breaks you down. Because healing isn't just about fixing what's broken, It's about creating something stronger than what was there before. If this resonated with you, I'd love to hear your story, send me a message. I like to hear from my audience. Until next time, this is Dr. Fred Erris reminding you that sometimes the smartest thing to do ends up being the strongest. Thanks for listening. Have a good one. Thank you for listening to The Talking Rehab podcast. I hope that this podcast stimulates you to question your own practice and how you approach rehabilitation. I truly appreciate your time and attention. If you enjoyed listening, make sure to like and subscribe to the podcast. I wish you a movement filled day. Take care.