Ep. 7 - Your Injury Isn't Just Physical

When you're injured as a coach or clinician, it can f*** with your head.

My client - a PT himself - is going through the worst hip injury he's ever had. He can't say 'yes' to doing what he wants without wondering if he'll pay for it later.

The questions he's been asking himself were very familiar, because I've been asking them myself for 11 years.

This episode is about the part of injury we don't talk about enough: the grief, anger and wondering how the hell you're supposed to help others when you can't even help yourself.

In this solo episode, I get into

• Why injury hits different when being strong is part of who you are
• Why your injury isn't your fault, but it is your responsibility to own
• My actual process for working with clients at the start of our journey, and when things change along the way

If you walk away from this episode with a new question or approach that helps your patients feel seen and heard, I'll have done my job.

Same if you're in pain right now and this makes you feel less alone.

Keep going, my friend

Links:

Book a free consult call with me: https://calendly.com/unbreakablestrengthonline/firestarter-call-1

Trying to get consistent with your own training? Get a free copy of the Consistency Catalyst guide: https://unbreakablestrength.kit.com/cac1abf5af

Wanna be more confident working with athletes in your practice? Get a free copy of the Confident Sports Clinician's Checklist: https://unbreakablestrength.kit.com/35c376acac

Follow me on Instagram: https://www.instagram.com/jared.unbreakable/

Follow me on TikTok: https://www.tiktok.com/@jared.unbreakable

Follow me on YouTube: https://www.youtube.com/@unbreakablestrength1

Transcript

SPEAKER_00 0:04

My name is Jared Maynard. I'm a physical therapist, strength coach, and in 2023 I was lying in an ICU bed on a ventilator with a 50-50 chance of making it out alive. I made it out. And what I learned on the other side of that changed everything about how I live, how I coach, and what I believe is possible for the people who keep showing. This show is for the coaches and clinicians, the people who give their all to everybody else and don't have much left over for themselves. On this show we talk about training and rehab, as well as mental health, identity, and what it costs. To be the kind of person who keeps showing up when the going tough. This show is meant to be your companion on the way. So come along. This is Unbreakable. Welcome back to Unbreakable with yours truly Jared Maynard. This is episode seven. And my question for you as we get into it is: have you ever had an injury that makes you question who you are? Ooh, we're getting into the deep stuff right off the rip. I'm talking about the kind of injury that doesn't just affect you physically, although that's probably a big part of it. The pain itself, the variability and how your body feels, maybe it's an injured body part or joint. Maybe it's your energy as a whole, and you don't trust your body the way you used to. Maybe you can't train the way you want to, or play sports the way you want to. But if you are honest and you peel back the layers, this assaults your identity, who you are, and how you've understood yourself, maybe up to this point in your life. I know I'm coming in hot. But if any of that starts to resonate, this is going to be a good episode for you. Because a client of mine who is also a physical therapist is going through it right now with his own injury. I'm not going to share too many details that are not mine to share. But if you're like him, whether you're dealing with a hip injury or a shoulder injury or a back injury or just chronic pain from something else, and you've dealt with it for a lot longer than you ever thought you would or hoped you would, you know the frustration. You know the anger. You are probably asking yourself, am I screwed? Is this my fault? Why is this flare happening again? What did I do to create this? How can I possibly help other people and claim to help other people as a coach or clinician when I can't even take care of myself this way? If you've asked yourself those questions, you are not alone. Because I have asked myself every one of those. And just so we're clear, I'm not saying, oh, I asked myself every one of those like five or ten years ago. I've asked myself those in the last three weeks. This episode, my friend, is meant to do two or three things. One, it is meant to make you feel seen if you are experiencing chronic pain, an injury. Shoot, forget chronic if you're experiencing pain or injury, period. That is stopping you from living how you want to, how you need to, and feeling safe or strong or healthy or good, you are in the right place. So speaking to the problems and the effects that injuries and pain like that cause, especially for coaches and clinicians. Two is, if nothing else, I want by the end of this episode for you to agree with me that this is not your fault. Unless you were trying to jump your skateboard over a flaming like pack of stampeding bulls or something, Kyle, that's I mean you're on your own. I can't help you there. But if that's not the case, then it's not your fault. But it is your responsibility to take action to change the situation if you're not happy with how it is. And third, I want to give you an inside look as far as how I work with people on the front end, uh, to meet them where they're at with an injury in pain and get them feeling better. And then also what happens when you're making progress and then life throws a curveball, and suddenly you're dealing with a new injury or an old injury. Because if you've been following along for this long with this podcast, and probably you've followed me since starting this podcast, because it's only been around for a month, a little over a month, you probably know what I'm about. And if you're in a place where you're looking for help, I want this to be the reason that you reach out. And if you're not looking for help or don't need help, totally cool. I want this to give you fuel for your own clinical reasoning processes. Uh, I want this to open the door for down the road if you ever do need help. And at minimum make sure there's something valuable for you here. Cool. So hearing my client talk about his hip injury flare really hit home because of my hamstring injury. I think I've talked about it here on the podcast before. I'm pretty positive that I have. But in 2015, as a newly minted physical therapist, I'd been training for a long time at that point already. And in the gym on one sunny summer day, I was pulling a deadlift, which wasn't that heavy. The form wasn't great, but it also wasn't terrible, and felt this ripping sensation right up in my left butt cheek. Dropped the weight, quickly scrambled to check myself out and see what was going on. What I didn't know was that this proximal left hamstring tendinopathy would cause me as uh lot of grief over the span of 10 years. 11 years, excuse me. Hearing my client this week tell me that his hip injury is rocking him, he's angry, he is grieving, hits home because I have had to do the same thing. He used to be the kind of guy who could just say yes to going for a run with a friend. He used to be the kind of guy who could play sports, including soccer, with friends or as part of a league and not think twice. Now he's weighing every choice. And he's asking himself, is this going to flare things up worse? Am I going to pay for this later? And on top of the logistical concerns about how is this going to affect my body right now? Is this going to impact my training? Am I going to be able to practice and work properly in the clinic with people? And can I be present? Because you are, after all, in a profession that requires you to be on a healthcare service profession where people are coming to you expecting you to hold the space, to have the answers, to have the energy, and to be with them as they're dealing with their own shit. When the weight of your own pain is weighing really heavily on your shoulders, it's very difficult to be present and to have hope for yourself. Because whether you do or don't have hope for yourself, like it or not, bleeds over into how you work with your people. Whether you are in a physical clinic or whether you work digitally or some combination of the two. So everything that he is going through is what I have gone through with my hamstring injury in a more acute and poignant way, recovering back or recovering from HLH. But like I told you at the start of this, in the last three weeks, I have asked myself, am I ever going to feel good again? Is this just how it is? Did I screw the pooch that one day, 11 years ago? Or is there any shot of me still getting strong like I want to? Because for me, I'm a power lifter. You may not be, and that's totally cool. We are meatheads. Uh, and we are really okay with doing the same three lifts in slightly different flavors over and over and over again. I have coached many lifters at the national level, both in person and even more people that I've coached from afar in Canada, in the United States, in Finland, in Great Britain. So along with that, though, I have never qualified myself as an athlete to compete at the national level. Not yet. I'll be really straight with you. That feeds my imposter syndrome. As does the fact that my lift numbers are not great from a competitive powerlifting standpoint. They're certainly not where I want them to be. So the comparison, tell me if this hits home for you, but the comparison of looking at social media and seeing the highlight reel of everybody else, people who I've followed for a long time, and then a bunch of new people who kind of come and go across my feed, some of whom I follow along, who are all way stronger than me. Men, women, people who weigh the same amount as me, who weigh more, and who weigh less. And every time I see that, there's a little part of me that pipes up, and if I'm not careful, will take over. Telling me the story of man, who are you to coach these people? You know? It's tough. And I do have to be careful. Because my answer to that question of who am I to coach these people is my track record. I have helped more people than I can remember at this moment in time as I'm talking to you come back from injury and pain that they thought was going to be debilitating and permanent for the rest of their life. One gal thought she was too much of a mess to work with me. Her chronic back pain used to get better with lifting until it didn't. And then after she and I worked together, while she was making progress and feeling better, she was on the high, her back felt like it exploded on a P a measly warm-up weight. And it was a very, very long process to stabilize her after that massive flare. She competed in her first powerlifting meet in 2024 and hit lifetime PRs. I've helped people who have suffered from chronic back pain and knee pain. I've had people tell me on discovery calls, you are my last hope here. And go on to hit PRs in the gym, on the powerlifting platform. But more importantly, I would tell you, they have gone on to recalibrate their relationship with their body and with their identity. Where they are in a place where they no longer feel so fragile. Like a strong breeze could blow them over and they shatter into a million pieces. Instead, yeah, they still have some pain. But they can do what they want to and need to do. Maybe not perfectly, maybe not exactly the same way as they did before. But they are not stuck. They are freer than before. I could tell you story after story. I have worked with 700-pound plus deadlifters. I've worked with national champions. I have worked with world-class competitors. Several. I have another one getting ready for an international competition coming up soon. I bring this up because if you are dealing with pain or injury, you are familiar with the comparison game and the imposter syndrome that pipes up. I need you to know that because you are dealing with pain or injury does not disqualify you from helping other people. But it also doesn't mean that you are in a position where you need to or even can handle your pain and your injury by yourself. I couldn't. Which is the first critical step for a lot of us as high performer, recovering perfectionists, people pleasers, people who have gone our whole lives on our merits, uh never needing anything from anybody, or trying not to. I mean, I'm describing myself here. Maybe you relate. When I opened myself up to help, that's when the changes started to stick. And I got back this sense of relief because I could see the light at the end of the tunnel. And it wasn't a speeding train coming right for me. FYI. Tell that catastrophizing part of yourself to shut it. So let's shift now into how does this happen? Yeah, Jared, this sounds nice. Cool. Hope I'm about it. I want to stop hurting. I want to feel stronger. I want to trust my body again. I want to have fun. I want to enjoy life and not be so caught up in the what if am I gonna be okay? Man, I forgot what it actually felt like to feel good. I'm with you on all of it, dude. How do we make it happen? Well, listener, let's talk through it. I'm gonna pair this with the framework that I use, as well as real life example. And the real life example is going to be me. There's a four-step framework that is the distillation of my entire coaching philosophy, coaching and clinical philosophy. It is number one, understanding where this person, your client, your patient, is now. Number two is where do they want to be? Number three is what needs to change. And number four is what is the simplest way to start now. One more time. Where are they now? Two, where do they want to be? Three, what needs to change? And four, what's the simplest way to start? Now, with where are they now? That is twofold. One is what is their current status? For me, with my hamstring strain, uh, at the time that I worked with Quinn, Dr. Quinn Henneck, who's the physical therapist who is the reason that I operate the way I do today. The dude's life changing. He probably won't accept that credit, at least not without a self-deprecating joke, but I'm gonna keep singing his praises. When I worked with Quinn, I was a year post-strain. I was highly irritable, or it was highly irritable with deadlifting off the floor and getting up to the lockout portion of the lift. It was highly irritable with full-depth squats, again, at full hip extension, that top third of the lift. Uh, it would also get pissed off as I was walking and step with my left leg, hip was in flexion, getting into stance phase, and walking over the hump of the street, crossing from the side of the street where my apartment was on to the side where the gym was. As my left foot hit that hump, that would send pain up into my leg, which was not encouraging when I'm heading to the gym to do a workout and I'm hurting just crossing the damn street. So pretty highly irritable. And we could break it down into these triggers based on range of motion, based on intensity or load used, also based on volume. I do have volume triggers. Certain, you know, above, you know, two or three reps is typically where things start to get a bit worse for me, on average. So that's part one of where are they now? For your client or your patient that you're seeing on Monday, this is part of what you're going to be thinking about. And it probably comes easiest to you. The other part is what is their role in life and what does their life look like right now? Is this a parent who's holding down a full-time job and also on solo parenting duty? Or is this somebody who is getting ready for a massive life transition and getting ready to move houses? Is this instead somebody who is trying to build a business and riding the ups and downs of the entrepreneurial roller coaster? Does this person not have much support in their lives? I am not advocating for you needing to understand every single detail of the person's life. But you do have to understand the person well enough so that when you get to the part where you make a game plan and present it to them, they feel like saying, oh damn, she listened. What you need to avoid is a situation where your plan is so mismatched that it breaks trust, and it's very difficult to come back from that. Ask me how I know. So, how do you find these things out? Your subjective history. And not just the stuff they taught you in school. That's the easy part. What are the aggravating and easing factors? What's the history of the present illness? The chief complaint, what are the mechanisms? All of that stuff. That comes natural to us, right? It's been drilled into you through PT or Cairo School or Massage Therapy School. That's that's straightforward. The questions that they don't teach you at all or don't drill in enough, in my opinion, are things like how's this affecting you right now? Is this showing up anywhere else in your life? What other support do you have with this? Where are you hoping to go? If and as we figure out what needs to change to get you to these goals, you know, uh, what's that gonna do for you? And I skipped over an important one, which is understanding very clearly what total success looks like to them. They're probably gonna say having less pain. Got it, less pain. When that happens, what will that change? What will you do? If you can get a good working basis and understand who this person is and what's going on with the area they're concerned about. There's your foundation. That's number one. Where are they now? Number two, remember what it is? Where do they want to go? Which you've also begun to understand through your subjective. For my client, he wants to be able to play soccer and do BJJ. For me, I wanted to deadlift from the floor and low bar squat without limitation and ideally without pain and lockout, but at minimum be able to train more normally and not have my hamstring be a limiting factor. Once you outline what success looks like to them, both the primary things that are easily coming to mind for them, their sport, their activity, less pain. And also tug on the thread that looks at any layers underneath that. When I can play soccer more, I'll be able to be more social and be able to nurture my friendships that come from this important social area of my life. When I am able to train normally, I'll finally sign up for that powerlifting meet. Whatever it is, that is your target. And whether or not you hit it exactly on the nose doesn't matter so much as it does that you have the right target, the right destination to punch into the GPS. Because cliche as it is, the saying of shoot for the moon, for even if you miss, you will land among the stars. I do think that applies here in rehab and in training. You do need the right coordinates and destination to aim at. Otherwise, what the hell are you doing? And you can pretty much count on the journey not being smooth or there being bumps along the way. And you will likely have to adjust course. The destination itself might change too. That's okay. The fact that you care enough, consistently enough, to check in with your patient and make sure that the destination is still the ones you entered into the GPS. Or if they've changed, go ahead and update that destination and have the path update accordingly. That shows care. It shows trust. And the longer that I practice, the more I believe that our primary roles as clinicians and as coaches is less to have all of the exact right answers and much more to build relationships of trust and to communicate really well and to do what's in our power to help people, even if it's imperfectly. Because having that trust and having that support, that's what makes people feel safe. It's what allows for honest communication and ultimately it leads to action. And action, particularly consistent action, is what we find leads to good outcomes, along with a more positive and supportive social network. Having belief and hope again. Number two, where do they want to be? Number three, what needs to change? This is your needs analysis. So this is where you look at what are their current symptom triggers. For me as a power lifter, that was deadlifting off the floor. Excuse me. It was low bar squatting to full depth. It was deep hip flexion, especially with a more extended knee, things that loaded that proximal tendon. It was also volume, things that were above three to five repetitions. Getting that lay of the land of where the triggers or where the thresholds were, then allowed Quinn to design a program that aimed below them. Still challenging enough to create change, but designed with uh it is an educated guess, enough of an educated guess to land below those thresholds so that it wasn't discouraging coming out of the starting block. But instead, I could start getting some wins under my belt. Getting some wins under my belt is what helped create that sense of hope. So for your clients, you know, if they want to play a sport like soccer, okay. There is force production demand. We're gonna have strength requirements. There's also going to be range of motion and positional demands, clearly. There's also a huge demand for rate of force development and change of direction, power, speed, agility. You want to talk about high force, high skill, sprinting. If you're trying to attack the ball, you have to be able to produce a whole hell of a lot of force quickly and stay balanced and coordinate that based on where the ball is moving and where other players are. It's a lot of biomechanical and physical demands. So using, or rather, performing that needs analysis, using your good old noggin, and also this is where there is no shame in using tools like Claude or an AI to run through a situation and not abandon critical thinking. But sometimes it can be really helpful to have a breakdown of what the needs analysis is and check it against your own thinking. More often than not, I'm willing to bet you have most of it covered and you thought of it, thought of it already. Every so often, you're going to remember something, or the AI will bring something up that you forgot. And you get to add that into your decision-making process, still making sure it makes sense to you as the clinician, which is critical, especially if you use AI, because as every AI will tell you, it makes mistakes. Sometimes it will say things that are just flat out wrong. But if you're tired, if you're overwhelmed, and you feel this pressure to get it right, I understand. Don't flagellate yourself by thinking you have to do it the pure way. It all has to come straight from your noggin. It does have to pass through you, and you do have to sign off on it. But dude, we're in the information age. Uh, why are we limiting the tools that we can use to make sure that our thinking is correct and that we've got the best basis uh from which to operate? Making sure, again, that you have that final sign-off and it works for your patient. So that's number three. What needs to change? Number four, what's the simplest way to start? For me as a power lifter, the simplest way to start was I was deadlifting twice a week. One of them was heavier. It was a block pull with a higher load. The pairing of higher intensity, but smaller range of motion, that was to expose my tendon and the rest of me to higher forces, which we needed for desensitization and for tendon remodeling. The other day was a Romanian deadlift with lower load and a tempo. Three seconds down, one count pause, three seconds up, one count pause. If it sounds soul-sucking, it's because it was. But that pairing, greater range of motion with the constraint of the tempo, made a lighter load, a not lighter absolute load, more challenging. And again, exposed my tendon, exposed the system as a whole to the positions that we also still need for the tensile forces and remodeling of the tendon. It also allowed me to keep training the things that I cared about, i.e. deadlifts. For squats, it was much the same. We stayed away from low bar squats and instead used the safety squat bar. And I believe, I actually can't recall if we did box squats or not, but we we did use the SSB through full range. We probably had a tempo on there as well for the same purpose. Squats mattered to me and my goals. So there was no reason to take them out wholesale, especially when there was a way to make them work right now. For my client dealing with the hip pain, we need to adjust the factors that are most triggering and just stabilize him first. And then we need to build up, well, we need to desensitize the hip. We need to build up his force production capacity, the rate of force development, and then also work on some agility stuff so that the next time that he's in a spot where he's saying yes to more things, whether it's on the soccer field or whether it's elsewhere, he's able to handle it more. And his ceiling, the point at which things might flare, is higher. That doesn't mean that the risk of this happening again for him is gone. The really sucky thing about chronic pain or injury in general is that the biggest single predictor of future injury is having had a previous injury. I know. It sucks. But that does not mean there is no hope. It simply means that we need to one, adjust expectations for our patients and also for ourselves. We're the ones going through it. It's also why having uh pain-free status as the only goal, I think sets us up to fail. If your patients or clients want to be pain-free, I think you need to validate and understand that. Because who doesn't, who doesn't want to be pain-free? Who's dealing with pain right now? Right? Pain by definition is negative. It is an unpleasant experience. I mean, outside of certain contexts, maybe, maybe enjoy some pain. Maybe that's what what I'm gonna stop that line of thought. Most people are wanting to be out of pain for the contexts we're talking about. So I think we need to say, got it. That makes sense. No, getting out of pain can sometimes be an up and down road. And there are some cases where pain doesn't go away all at once or entirely. What else would make this feel successful to you? Or a better way to say that is probably, got it. When you have less pain or no pain, what else does that allow you to do? And if there was still some pain that was part of the picture, but you could do those things still, would that count as success to you? Find your flavor of questions like that. But that is a really important one to ask on the front end during your assessment, or if you're working with people online as part of your intake process to make sure that you understand where they're trying to go, as we've been talking about. And then also be honest. Hey, this is where we're gonna try to get you. If things aren't neat and tidy, what other measures of success can we have on the table? Because when the shit hits the fan, you're going to want, you're gonna want those other measures. You don't have to say that last part to your patient, but that's just me thinking out loud. Now, what do you do when things flare up as you're on the road? You're working with your patient, things are going great, and then wham, something picks back up. Thing number one is hold the space. Take it, take genuine care, ask how they're doing, ask what's going on, and probably don't rush to fix it immediately. Most of us don't want to see people in pain. And we got into this profession because we want to help people. That also means that we can be overbearing and shift directly into fixer mode when something is fresh and overwhelming. Don't. My advice to you would be see how they're doing, understand first. And if you're not sure if they're ready for solutions or if they need a listening ear and a caring heart, ask, hey, I care about you, and I'm ready to help figure out solutions when you're ready. Are you ready for those, for those now, for that logistical conversation now, or do you just need some space to let this breathe for a minute? They'll tell you, and that'll make the path clear. And the good news for you, my friend, is that the process remains the same. You are answering, where are they now? Inclusive of what led to the flare, as best you can figure it out. Where do they want to be? What needs to change, and what's the simplest way to start. I hope that framework is something you can take with you into the clinic or into your interactions with your clients on Monday or tomorrow. I'm gonna wrap it up here because at the start of the episode, I wanted three things to be true. One, I wanted to normalize and speak to the experience that you have when you are injured or in pain so that you don't feel alone. Two, I wanted you to believe me and agree with me that it's not your fault and that pain happens sometimes. Number three is I wanted to give you an inside look as how as to how I work with people and guide them through this process. And hopefully this is even clearer now that I have this process, not because I am a genius and came up with it on my own, but because I went through it. And that's what most of the coaches and clinicians who work with us at Unbreakable tell us is very valuable. Going through the process themselves, even though they're going through it, not because they chose it, they didn't choose to get hurt, they much rather would have not been hurt. But going through it and seeing how it can come together for them gives them new tools, new angles, new questions, new understandings to bring to their patients and their clients, to in turn help them better. And on the clinical thinking and programming side, uh, you only know what you know. And it can be really useful and I would argue necessary to expand your thinking every so often and expose yourself to a different line of thinking. So that you can avoid that part and just skip to the good part. I hope that if you're going through pain right now, you feel less alone. The trouble, the distress, the impact that pain is having on you right now, that is real. And I understand it. You are not alone. The pain is not your fault, but it is your responsibility to change and to take action. If you're not happy with where you are right now, if you're worried about it, if you're spending a lot of time and energy wondering if this is going to get better and wishing you could get back to how you were, there is hope and there is help out there. Reach out to someone. It could be me. Obviously, that's what we do. Doesn't have to be. But if nothing else, if that is you, reach out to someone. You deserve help as much as anybody else. And if you are a helper, if you are a giver, you deserve help all the more, in my opinion. Because when you get that help, good things follow. When you have the support that makes you feel less alone, and also pairs it with the proper practical steps that move you in the right direction, that help your body change, that move you towards your goals, especially when the curveballs come, because they will. That's what makes the difference. And that might just be what brings you that sense of hope again that you've been looking for. It has been for me. If this was helpful, this episode, please consider leaving a five-star review on Spotify, Apple Music, or wherever you get your podcasts. Subscribe if you're following on YouTube. Share this with a friend who's going through it, whether they're a coach or clinician or someone who's dealing with pain or injury. And if you're looking for help, reach out. You can shoot me a message. I'm on Instagram, Jared.unbreakable. You can shoot me an email, Jared at UnbreakableStrength.net. And stay tuned because more episodes coming out every week. Take care. I'll catch you in the next one. And remember, you're not. Thanks so much for listening to another episode of Unbreakable with me, your host, Jared Maynard. If you found what we talked about today to be useful, if it served you, please consider leaving a five-star review wherever you get your podcasts. Hit that follow or subscribe button to keep up with the show. And if you are a coach or clinician, if you're running on MT, you're giving everything to everybody else, you are exactly who I built Unbreakable Strength to serve. The link to Book A Call with Me is in the show notes. I'd love to hear where you are and see how we can help you get where you want to go. Go check that link out in the show notes, as well as the links to a few other goodies. You can follow me on socials. And until next time, my friend, you're not done yet.