Podcast #39: Three Doctors Talk Injury Risk Reduction (it's NOT what you think)
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- čas přidán 18. 11. 2018
- Citations:
Eckard
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Jones
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I feel like this should be required watching/listening for coaches and lifters alike. Thanks for tuning in.
Thank you! This is much-appreciated!
Yes, it absolutely should. Thank you very much for your efforts!
that's just like...your opinion maaan
I wish I could force-feed this video to every fitness personality on CZcams somehow.
Yes This should be required for all the pu$$y lifters out there now. C'mon this video would be totally unneeded 20 years ago. What I hear from this video is "don't be a pu$$y". Well no kidding.
Basically... the biggest problem with injury isn't form, it's doing too much, too quickly, or too hard.
Makes sense.
What do you think is compromised when you do too much, too quickly?
@@Luke-ih1oc cns
That is a great way to summarize this conversation/information.
@@Luke-ih1oc Does not matter. at least, according to this video it doesn't:
i.e. too much, too quickly or too hard...even with perfect form...is the MORE likely causal factor of injuries, in comparison to imperfect form done in at WHATEVER intensity level, duration or speed.
Thanks, I was looking for TL;DR
Thank you for providing this content for free.
You're welcome.
I agree...however. It costs an hr of your time. We become fan. They get our attention. Our eyes and ears. That's worth a lot. Even if you never watch anything else of theirs. But I bet we will/did? Enjoy today.
Love you guys! What you're doing for the community is so valuable.
I feel like you missed the opportunity to call this video “Three doctors and a casting couch.” 🤣
BBM is my fav category.
The world needs to watch this videos so badly. So satisfying to hear this topic summed up. You guys are awesome.
Another great broad/pod cast - with every one I get more confident I'm on the right track training with the knowledge you guys share. The 'session RPE' was a new concept for me, so I'm glad you came back to it at the end of the discussion.
Amazing. Just amazing! 5 Stars. You all consistently impress me with your pragmatic and data based approach to assessing health, strength and physical culture. You also pursue novel subject material as it relates to lifting. Everything you all covered in this video aligns with my unremarkable lifting experience. I’ve spent time in the HIT camp training every session @ 10. Unsustainable. My results ultimately leveled off. Then I spent time trying to master the wonky Starting Strength lifting technique and programming models only to be grinding it out again. This approach is so much more rational and practical. I feel annoyed for buying into the mobility mantra for years, but I’m thankful for all the content you all produce. I would love to become a Barbell Medicine coach one day! God Bless
Great information guys and it was an amazing experience to finally meet you all in Colmar last week! I've started to forward a lot of your stuff to my team and slowly introduce your evidence-based findings. Not too much too fast so their heads won't explode. Because, as you know, most professionals on all levels have been misinformed and it's refreshing to hear this information delivered as well as you guys do it. Thanks again for the lifting tips and seminar lectures. **For those of you who haven't been to a seminar yet, it's 100% worth it. See how they do it, hear their passion, and know it's the real deal. Plus, you get to train the four main lifts. I've spent alot on multiple certifications, college, and other CEC/CEU courses over the years and nothing was as close to what is covered as they do on a professional level. It's about time a change is made :-)
Thanks, Jordan, this was VERY helpful!
The quality of this video is outstanding.
Well now i know why my knee hurts.Every squat session was a 10.Damn linear progression program!Looks like i'm buying that new knee template😂
I really like this psychological aspect of pain. I've used something similar as an explanation model for and a way to deal with an anxiety disorder. I describe my anxiety as part of my nervous system, a protective mechanism, that for various reasons has become exaggerated. So like pain, I don't necessarily need to get rid of it completely(would be nice tho), I just need to put in into context and then figure out whether to heed it or set it aside.
You just blew my mind
Can I major in barbell medicine 😂
Man, this was... truly mind boggling. So many points that I've never heard before and I doubt I will hear anywhere but on BBM.
The best moment *by far* was when Austin said "that used to be us!" when talking about the technique -> injury narrative. Somehow that was just awesome.
This is exactly what I needed to hear today. I've entered squat failure city on a 5x5 linear progression program. Squatting 3x a week at the intensity I've been keeping up has me dreading my workouts. Needless to say, I've been looking at moving to an RPE based program such as The Bridge soon. Thank you for this video!
Really great stuff. I had not heard the session RPE and it's really illuminating to me because I've been going 5 days a week for the last year and a half and really grinding it out and even with the occasional missed day or short vacation I still feel beaten up like I haven't missed a day even when doing simple stuff like walking up stairs, tying my shoes etc.
Links to the articles mentioned (that are available to the general public) in the description would be a nice addition.
Organic verse experiential. Ongoing shifts create ongoing perceptions. You guys are delving deep and providing useful content. Thanks.
Awesome content, you guys are changing lives. Thank You!
Fanastic discussion. I’m a chiropractor in Ontario, Canada, and I hope stating that doesn’t automatically put me on the opposite side of this discussion because I believe the majority of conversations I have with my patients are echoes of this exact conversation. A patient of mine told me to check this out because after a conversation we had he said this podcast/CZcams video hit most of those points. Every non/traumatic MSK injury/pain syndrome/etc is a failure of load management is one of my mantra. Keep up the good work guys. There are some of us out there trying to use these strategies as empower patients and avoid improper language and fear mongering. Cheers, great stuff
Funnily enough I had this thought while watching - "that's probably why things like chiro are apparently effective for some people". Because when pain is viewed as an output instead of an input, the healing process can be a change in thought, rather than a change in biomechanical properties. In other words, placebo can be used to heal patients of their pain by getting them to believe they are healed, potentially because there's nothing actually wrong with them.
That's not to devalue chiro in any way shape or form. If this is true then it only serves to validate something like chiro, homeopathy, etc. I honestly don't know much about chiro so this may come off as ignorant.
Fantastic stuff, definitely the best in the world I've seen so far in this space.
Thank You that was very enjoyable and helpful discussion.
Had to dig for this one, but this is my favorite podcast episode that you guys have put out.
Just call dead lifts "pickups" - that's hysterical, love it
I wish I had this podcast 6 months ago! I had only 315lbs in my homegym, and was deadlifting that for 4-5 reps for NBD. Then I went and bought a couple more plates and decided to test my 1RM. Got to 380 and bam, acute pain and “injury”.
Been following your advice though, and I’m almost back to those weights again.
When I started SS, my shoulders became very sore, to where it would take a lot to unwind after squating. I continued squating, ate more protein and now they feel so much better, didn't quit.
Great content as always. Thank you. I would go farther and say that this should be required viewing/listening for everyone.
love these docs. great contributions to "the cause".
Great content. Helping with my training. Interesting stuff!
What a phenomenal discussion / awesome stuff guys !
I love this video. I really like the idea of there is optimal performance techniques that do utilize physics and there is everything else which doesn't necessarily mean you'll get hurt, only that if your tissues aren't ready for the stimulus you may experience injury.
I am a proffesional swim coach and deal with a lot of injuries on a day to day basis. So, just wanted to say thanks for this awesome content - you are changing lives and shaping careers!
Also the Danish Sports Federation: "Team Danmark", is advising for the whole RPExSession length thing as well. So you're not alone!
Incredible as always, thank you! Is there any chance to add in the references to the different research/articles you guys spoke about here? Would really love to read them myself as well. Again - thanks for the great content.
Best video so far! Absolutely amazing
Thanks for sharing your knowledge for free, the field of fitness needs the scientific method so badly. I spend so much time watching youtube videos on fitness but you're some of the few who can actually back it up with your own/your direct colleagues' scientific research, knowledge and a shitton of training as well as coaching experience. I'm glad I found your channel via untamed strength, its a real goldmine.
I don't know how I missed this! it took me two years to find this gem
Now this makes me question lot of things I fill my head just before I go for a heavy set. You should do it more. Thanks.
brilliant! everyone involved in training should listen to this and more
Very informative and cool stuff here! Nice job guys.
I seriously think you are on track with load management especially to more senior and untrained individuals. I am a 51 year old person who bought into the whole "linear progression" sales pitch. And of course I assumed that the point at which one would switch from "LP" to "intermediate" would be the point where the bar wouldn't move anymore. However what happened to me is I am now rehabbing a mid back tweek and considerable "shoulder impingement" pain from trying to grind through things that felt super high on RPE and failing on every set for weeks... just too heavy.
The sad part is I was perfectly happy with the programming I was doing before without injury and still making progress... though perhaps slower.
it honestly feels like you guys are just fucking with us listening to this.
Barbell Medicine content always 11/10.
This is a priceless public health message and I love y'all for spreading it however, as with all of your work, your dismissiveness towards important injury risk reduction approaches and rehab professions undermines those of us who operate in the realm of nuance. Examples of well established modifiable injury risk factors that dont have to do with training load:
Ankle sprain
- best predictor of a future ankle sprain is a history of ankle sprain
-those who have sustained an ankle sprain utilize less ankle strategy balance after the sprain prospectively
-this impairment can be ameliorated by specific graduated exposure to tasks that are constrained to demand ankle strategy balance and results in decreased risk of re-sprain
ACLR
- quads performance asymetry (strength RFD etc) is common over 12 months after surgery and is a good predictor of re-injury
- inadquite quads function underlies observed increases in knee stiffness, asymmetrical weight shifting, or gluetal dominant landing, running, change of direction and deceleration strategies. You can restore quads function but if graduated exposure to constrained tasks that require high demand eccentric quads specific movements are not performed than initial compensations may not be fully ameliorated in a timely fashion. In dynamic field sports environments you become vulnerable if the required task places constraints that preclude you from using your limited repertoire of movement strategies.
- Obviously dynamic valgus is both predictive and demonstrably interveinable although effect sizes are not huge. I suspect effect sizes would be larger if you intervened in a subpopulation that was in the upper quartile of people demonstrating this movement strategy.
Running bone stress injuries
- peak loading rate (often associated with impact transient) as well as peak positive tibial acceleration are strongly associated with bone stress injuries. Increases in cadence, a change in foot strike, and cuing for quieter footfalls are all validated ways of reducing these parameters. Of course for most people training load management is the best way to reduce bone stress injury however there are a myriad of patient specific behavioral (unwilling to decrease load, time constraints prevent ideal acute:chronic loading, must train for approaching race, etc.) and physiological (recurrent bone stress injuries, female triad, osteoperosis, approaching upper limit of adaptive capacity, etc.) reasons why adjustments to training load cant be the only solution.
Fall risk in elederly
Lower extremity strength is irreplaceable however a host of other skills are demonstrated to be required and modifiable targets of intervention especially for particular subgroups: vestibular specific challenges, proprioceptive specific challenges, reactive stepping strategies, duel task challenges etc.
Again, I love your work and always look forward to more content but I just wanted to give some more depth for peoples' perspective. And ill admit some pettiness, while I feel your dismissive of physical therapy is warranted at a public health level, it also undermines people such as myself who strive to practice with ethical and intellectual integrity. Probably more my problem than yours.
Nathan, thanks for the post and I hope you didn't take it as dismissive given that we weren't discussing any specific joint or injury. To your points, the first bullets for ankle sprain are non modifiable and the 3rd management portion is in line with our recommendations. For ACLR, the first bullet point IS strength (which is discussed explicitly as a modifiable risk factor). Your second point are mostly management strategies that don't indicate a prevention strategy other than gradual loading, which is what we said. You will need to cite your source for valgus knee and knee pain and reliability of measurement as well. For bone stress, your 1st bullet point is entirely load management so I'm not sure your disagreement. For fall risk, I think as a general rule you could lump those interventions under strategies to improvement force production, though whether some work better than others is another topic. That said- again- we discuss strength development and load management as the two main modifiable risk factors for injury prevention.
I'm sorry if that wasn't clear, but I don't think your response is fair to what we actually said in this video. Cheers and keep up the good work!
Very interesting content very mind opening
Thanks guys
Very timely for me this video. I've just hurt my upper lat (or something like that) deadlifting. I felt that fatigue management is exactly where I'm getting wrong. Too much, and too long for me to handle I guess. Thank you for all the info.
This is the best lifting video I've ever watched
Great talk!!
So, how does 1 manage fatigue and what's the best way to go about it? Great talk!
How does this video only have 16k views? I’ve watched it 28k times myself alone!
Amazing content.
Great stuff guy's just wondering what can I do about piriformis pain it's been at me on and of for the past year has not really effected my lifts but it can be very painful
Thanks for this!
the background music coupled with the echo audio was a bit distracting
I am experiencing the exact same pain that Austin described in the beginning. Feels like mid trap and it hurts like hell every time I low bar squat or pull. But it doesn´t result in decreased weights.
Love the outtakes :) .
Do you have any articles on session rpe?
What would your recommendation be for tight muscles? Example being a situation where doing a movement causes you to feel more pulling on one side of your body than the other? (Like your upper glute or adductor during a squat)
I agree with everything here bar movement specificity not being a contributor of permitting injury for the simple complicated fact the brain warrants pain to areas it deems unsafe Paradox?
Barbell Medicine is a godsend
Dr Ray is a superb addition to your squad. Cheers
The black box that is pain. Like these docs, I almost never change my training. I am just more strict in my performance, and that serves a rehab function, to recover more quickly.
Wow. This is great stuff, here.
18:05 Does anyone know what podcast is Austin referring to?
This is amazing
A bit of perspective that hit me listening to this... the person that assumes pain = injury has probably never taken into account that pro athletes train and perform through pain regularly. There is no way you can ever perform physical activity regularly and NEVER experience any discomfort. Of course they have pain. They just see and perceive pain differently.
@8:00 That beckons a question, in a “what came first the chicken or the egg format:” were you potentially experiencing the pain as a result of the psychological overloading and “excitement” for the upcoming meet or was it because of the overall fatigue from the stress you were accruing leading up to the meet?
What's the podcast Austin mentions at 18:05?
So if form doesnt matter benching with my elbows sraight out is fine?? Thought that caused shoulder impingement
What do you guys recommend for hernias? Early medical intervention I would assume before it gets worse and if so what type? Those bloody testicles.....
36:50 is that a dig at Barbell Logic and/or Starting Strength?
On the topic of the stress-recovery-adaptation model: What do you guys think is a better/more appropriate model?
When I graduated from PT school in 2016, I was an ortho guy working in inpatient rehab with people after a stroke, traumatic brain injury, etc. I never understood how patients seemed to rarely complain of general back pain, shoulder pain, typical “pains” you see in outpatient. The brain picks and chooses what it wants to experience, and it has the ability to flip pain completely off.
Perception is everything. Thanks for sharing all of this information. This is the real “weird simple trick”
If I have pain in my back but I still can move and stretch, it then I train, and the weights I can handle do not change. If the pain is so bad, even if I WANTED TO, I just can't train, and this situation has never happened, FROM TRAINING.
Though I have hurt my back doing some other shit outside the gym and I can't train.
Dr. J.Feig says "Its like Die-betes....call it live-betes." Hilarious! Although, I think that is a pull from an old Man Show, Jimmy Kimmel as Carl Malone sketch. Either way, made me LOL. Good job fellas. Fantastic content.
That IS an awfully nice shirt... IF ONLY IT WERE AVAILABLE FOR PURCHASE
THATS ONE DEEP ASS INTRO BOYS
Thumbs up just for the intro and tense music.
Guys, any tips for people dealing with pilonidal cyst?
This is so legit. Thanks guys.
T as liens du podcast de rudy coia?
So caloric surplus doesnt help reduce injury, but is it correct to say that if you are in a caloric deficit and get injured you should come out of that deficit to let your body heal better?
Two of those links in description are bad...
how do I get that shirt?
Did the links work well for everyone? I only got one link to work..
That is some pretty extra background music.
About the camera work: search the 180 degree rule. Basically if 2 person talks, it's confusing for the brain if the camera jumps from one side to the other.
en.m.wikipedia.org/wiki/180-degree_rule
P. Nagy Bálint we know about it. Just not enough room where we were shooting.
Is not experiencing DOMS after a workout or the next day a sign that not enough stress was applied during the workout?
Not at all. Most people who are regularly training with reasonable programs RARELY experience DOMS.
Getting mic'd up for this would be much better
Lavalier Mics are on sale for Cyber Monday!
The body can adapt to "poor" biomechanics. If you manage loading properly you can jefferson curl 200kg. It doesn't mean it's not waaay off optimal.
That's the difficulty with correlating injury and biomechanics. Plus there's so many confounding variables when it comes to pain and injury.
People who work in this field love to be dichotomous for some reason.
As a physio for many years you e this all the time. The pendulum swings.. Right now in physio the pendulum is swinging towards the pain science and psychology side. 10 years ago it was too far into a biomechanical medical end.
Ultimately it depends on the kill of the practitioner to interpret the patient/client as to what you emphasise.
watched the entire Tai Lopez ad before the video as a warm up.
1 of the 18 dislikes is from Kelly Starrett lolol
"I guess I'm third" lol
Lol...Flat feet and inwardly collapsing knees definitely injured me, not 'too much volume too soon' or 'too much intensity.' Excessive spinal flexion under load is definitely unnecessarily dangerous for the majority of trainees. Excessive volume and intensity may well be the main drivers of injury- this is a valuable take-home from the video. But form is definitely a massive factor in avoiding injury. For everyone, but all the more so in those whose training will subconsciously inform their movement patterns outside of the gym eg. a warehouse worker (who could likely avoid an injury caused by unavoidable high volume movement patterns by performing those movement patterns with better form). I guess repeating the same old unsexy basics doesn't make for a good business plan though- for BBM as much as for those they criticise. 'Unless I wanted to sell you something...powerful sales tool'...the irony, especially when the basics of safe form are EASILY ACCESSIBLE FOR FREE.
Oh but noone has done a peer reviewed study where they got a bunch of people to squat or deadlift in dangerous ways...OK, must be perfectly safe then. Incredible. Professions are often conspiracies against the laity.
Benny TheGent Yeah I can’t believe that I’m hearing deadlift form isn’t related to injury risk... we don’t need a RCT to confirm this
So in terms of right or wrong ways of picking say heavy boxes up; are you suggesting the health and safety signs and instructional diagrams describing bending knees and showing "safe" ways to pick up boxes are all based on zero evidence? Or does bending at the back with "poor form" or "bad posture" increase the risk of injury?
Vhalarox Gaming its all about about being adapted to the movement. Sure, if you’ve never trained your lower back to handle loads, you are probably at an increased risk of injury if you bend over and pick up something relatively heavy. It’s not because the movement is bad, it’s because you tried to do to much of something you aren’t adapted too.
It literally does not matter. I am a house hold goods mover...we break all the rules...walk backwards upstairs with our entire upper body twisted perpendicular to our hips and rarely do we see injuries at work...usually injuries occur when someone drops something and breaks their toe. If you practice movements enough you get used to them. There is no proper way to lift. I have never been injured and have lifted heavy things over my shoulder from the ground like an atlas stone whilst rounding my back etc for 7 years...some guys have done this for 40 years and had 0 injuries
@@patricklown3388 The problem is that various tissues and muscle groups have a much higher ceiling before mechanicap failure or injury. Attempting to adapt your lumbar to lifting heavy boxes is going to be significantly less effective than utilizing your hips because your hips are very obviously more useful for moving larger loads.
Lord Feigenbaum and King Baraki confirmed meme lords.
fix the panning please
2 of the citations you posted are not working
27:58 I just noticed how insanely huge Baraki's lat is.. Look at his left (our right) side.. His lat is huuuge haha
Dude on one outro of a bbm video Austin and Jordan are jogging on the beach. I thought Austin had ILS lmao. He actually has huge lats.
Lol I had to laugh out loud when I saw his lat literally going past his shoulder.
Don't throw the baby out with the bath water. A key part of load management is technique.
People perform 90% of their volume submaximally with 1 form, then their maximal form changes. It's impossible to manage your load if your not consistent with technique.
It sounds like there was a mic on Jordan's camera but not on the camera on the other two and the first camera was just picking them up from across the room. I had to keep turning the volume way up and down. Great video content though.
@@ajasen Wow, what a difference. I'm using stereo speakers connected to my laptop, so I don't know what's going on with my system here, but it sounds great in the headphones. Thanks for mentioning it. I should say further that I appreciate the effort (and success) to make these videos pleasing to the eye and ear.