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How to overcome pain and heal from injury – Dr. Tom Walters

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Injuries and pain are a fact of life. In his book, Rehab Science, Dr. Tom Walters walks us through the science of pain and injury and gives us some tools to work through them.


Let's Say Hello

[00:02:25.680] – Allan

Welcome, Ras.

[00:02:26.710] – Rachel

Hey, Allan. How are you today?

[00:02:28.510] – Allan

I'm doing all right. I'm doing all right. Pretty excited. Well, we still haven't gotten any rain. Much rain anyway over the course of the last few days, but things are going good. I'm feeling good. I'm healthy again and moving around and lots of sunshine. Just having a good time.

[00:02:45.960] – Rachel

Back to your long walks.

[00:02:47.680] – Allan

Back to long walks. It's slowed down at Lula's a bit because we're heading into the low season, so things just aren't quite as busy. So it gives me a little bit more time. Southern Miss is playing well in baseball. Nice. They're going to the Super regionals. By the time you hear this, the super regionals will be over and they'll probably end of the College World Series. But they're one step closer to getting into the World Series.

[00:03:11.700] – Rachel

That's exciting. That's always fun to watch. Very cool.

[00:03:15.140] – Allan

I enjoy the College baseball and football. A lot.

[00:03:18.500] – Rachel

Of course.

[00:03:19.960] – Allan

How are things up there?

[00:03:21.540] – Rachel

Good. Same thing. We haven't gotten a lot of rain either. So it's hot summer, beautiful, great to be outside as long as you get out early. So yeah, just making our way through the summer.

[00:03:33.610] – Allan

Good. Are you ready to talk about physical therapy?

[00:03:38.160] – Rachel


[00:03:39.270] – Allan

All right, let's do it.


[00:04:02.350] – Allan

Dr. Walters, welcome to 40+ Fitness.

[00:04:05.300] – Dr. Walters

Thank you so much for having me. Excited to chat today.

[00:04:08.050] – Allan

I am too. This is a book. It's called Rehab Science: How to Overcome Pain and Heal From Injury. And there have been a couple of times in my life when I hurt myself really bad, usually doing stupid stuff, but having fun while I was doing it. And then I would find myself going to a doctor who knew a little bit, and then I would end up in the office of a physical therapist who knew a whole lot and did a lot of good for me. I turned my ankle really bad when I was playing volleyball when I was in my 20s. And I went into the first doctor, he's like, It's broke. And he took X rays and it wasn't broke. And he gave me this cast or this thing to wear. And so I try to put it on. I couldn't get my shoe on. And I'm walking around elephant foot for three weeks. And I'm like, Okay, I got to do something. So I go into a sports specialist doctor and he's like, Okay, cool. He says, It's broke. And I'm like, Well, that other doctor said it wasn't. So we did another X ray.

[00:05:02.880] – Allan

He says, Man, it'd been better if you broke this thing because you've done so much damage down there. And then I went into he said, I want you to go over to this physical therapist in the office and he'll take her. And I walk in, he's like, Why don't you have that brace inside your shoe? And I'm like, Look at my elephant foot. There's no way I get my foot in the shoe. He says, Well, that brace is supposed to work with the shoe. If you don't have the shoe on, the brace doesn't do you any good. And so here's a doctor, gives me something to do, to use, doesn't really know how to use it, so he doesn't tell me how to use it. I walked in, they did ice therapy, elevation, and constriction all in one move. Put me on the table, lifted my legs up, ice water on my ankle. They got my shoe on before I left that office 25 minutes later. With that brace, I was walking around. He says, You need to be walking around on it, not those crutches. Just throw the crutches away. You need to be walking on this.

[00:05:56.430] – Allan

You need to be moving. This is what the ankle needs to heal. It needs movement to heal. The exact opposite of what every other doctor had told me, stay off of it for six weeks. So I have a whole lot of respect. And to see you put this in a book where now it's in our hands to do our own prehab, rehab structure. I just really like that.

[00:06:17.600] – Dr. Walters

Yeah. Well, thank you. You hear a lot of stories like that, right? I have a very similar story. From high school, I was an athlete and had had knee surgery. It used to be more like that where doctors would immobilize people longer. And I think the treatment of these injuries is slowly getting better. But I had a very similar type of thing where I was immobilized and not really given much direction and ended up developing a contracture. I couldn't bend my knee past 90 degrees. It really atrophied and eventually made my way to PT. And that was my first experience seeing how I was an athlete. I knew I only really thought about exercise and movement at that time for performance, getting stronger, jumping higher, all the things I was doing. I was in taekwondo, so I was kicking. That was my first experience with movement and exercise in terms of just muscloskeletal health and rehabilitation. I think these things are slowly getting better. But yeah, that was a huge goal of the book. Just like you said, of course, sometimes it's appropriate to have a temporary period of rest, but too often people are just prescribed rest and without a lot of clear direction after that.

[00:07:32.790] – Dr. Walters

And they end up resting too long. And we know now that there was actually an article a couple of years ago published in the British Journal of Sports Medicine where they looked at what are the best interventions for managing soft tissue injuries. And immobilization is not one of them. And movement, though, protection, elevation, compression, movement, all these things are really important, of course, in the right amount. You have to be smart about the movement. You don't want to just sprain your ankle. I'm just going to go jog in two days. But that was the goal of the book was to take basically what we do in rehab and create programs that have three phases and help people navigate, walk them through the process, gradually exposing the system to more stress, going from less challenging mobility exercises more and then to transition to strength and resistance based exercises to help people get back to normal function, get rid of pain. Because so much of this stuff, if you have the right education, you can just do yourself.

[00:08:38.560] – Allan

Now, I think a lot of us understand that certain people feel pain differently than other people. And in the book, you got into it. And the term you used was bio psychosocial. Can you talk a little bit about pain being bio psychosocial?

[00:08:56.530] – Dr. Walters

Sure. Yeah. The first five chapters of the book are on pain. Pain science is a really important area of science for all of us humans to know a little bit about. And that was why it was the beginning of the book. Pain is the number one symptom any of us really go seek medical care for. And years ago, we used to look at pain in the physical body from a more mechanical standpoint. It's like you think about something's broken on your car, you go to the mechanic and you get it fixed. And that was how I was trained in pain and injury when I came out of physical therapy school. And how most people were trained. It was what we used to call the postural structural biomechanical model. So all pain was looked at from posture, anatomy, biomechanics, how you moved. So it was very mechanical in that way, very physics based. And what we realized over time in the pain science research is that there's a lot of people who have pain that can't be really linked to tissues in their body or how they move. It has less to do with physical forces and things.

[00:09:59.750] – Dr. Walters

And so those studies pointed towards other factors, like how you think, your thoughts, your beliefs, your emotions, stress, sleep, things that might promote inflammation in the body, social factors. We see that people who have chronic pain, for instance, are often more socially isolated. They laugh less. It just becomes more complex. And so the biopsychosocial model came out of that and really this concept of, let's look at all of these factors that go into pain. If we're really going to do anything about pain, because we know the medical system really isn't very good at treating chronic pain, chronic conditions in general. The medical system is great at you fractured your tibia. We can pin it back together, put you in a cast or whatever and fix that thing. But if you've got chronic low back pain, a lot of people that have chronic pain that just suffer with it, and nobody really has a great answer. The biopsychosocial model is, I think, moving us in the right direction of looking at the whole person and trying to figure out what are the primary factors contributing to their pain experience.

[00:11:05.070] – Allan

And I guess the way I thought through that is you've also got into the whole idea that just because you have an injury doesn't necessarily mean you're going to have pain. And just because you have pain does not necessarily mean you have an injury.

[00:11:17.270] – Dr. Walters

Exactly. Yeah, that's so important, that one for people to separate. Chapter 6 of the book, we really separate pain from injury and talk about that because most people do are under the assumption that if I have pain, I've injured something in my body. And just like you said, we have lots of cases where most pain things that people come to see me in physical therapy for are more just irritations. They didn't have a trauma, something cute, injury didn't happen to them. They just slept funny or they tweaked something a little bit. And it's not like something… If you did an MRI or an X ray, you wouldn't see any damage. There's nothing that would be inconclusive. There'd be nothing there, but they still have pain. So for sure, you can have situations where you have pain and no injury. And then you have people who have injuries and don't experience any pain. And a lot of the pain science research actually came from those situations. A lot of it came from phantom limb pain where people have lost a limb and still have pain. So the injury isn't there anymore. You'll hear of people who have pain in a foot, even though, and maybe they've had everything from their knee down amputated.

[00:12:19.470] – Dr. Walters

So their foot is not there anymore, but they still have pain in that foot like it's there. And so those cases and research really, in a lot of ways, started the pain science research. And some of the best examples for injuries that don't create pain are studies where they do MRIs on people who are asymptomatic, who have no pain. And they'll find lots of us, almost half the population, have disk herniations in their neck and low back, have meniscus tears in their knee, labral tears in the hip and shoulder, arthritis in various joints. Those would technically get classified as injuries. If you went in that had pain and had an MRI and say, Oh, you have this injury, and your pain would be blamed on that. But we're finding more and more that it's just complex and you have to think about everything as a piece of a puzzle and see how it all works together and try not to rely too much on what your physical body looks like on a picture.

[00:13:17.320] – Allan

Now, pain is important, obviously, because if it's a signal, it's telling us something's not the way it's supposed to be, even if that's not coming from an actual injury. But in the book, you talked, and you just a minute ago talked about chronic pain, this is one of the three types, but you mentioned the three types of pain. Could you go through those? Because I think these are important for us to understand, the treatment has to follow along with the type.

[00:13:41.240] – Dr. Walters

For sure. Yeah. So when you have pain, you can, in most cases, break it down into these three types. Most people are going to have… If you've had an injury, like you're talking about an ankle sprain, like you sprain your ankle, that's going to fit into the first type, which is the most mechanical type of pain. Sometimes it's called nociceptive because it has to do with these… In our body, we have nerve ending called nociceptors that detect danger and they relay danger to our brain. And so if you turn those on and it creates pain, then that's called nociceptive pain. And that's usually what happens if you break a bone or you twist your ankle or you do something that's traumatic to your body, then you'll have that mechanical pain. You could be picking something up heavy and strain your back. It's something that happens usually in a sudden moment, and it's very localized. It's obvious why it hurts in that spot because you notice that you hurt that spot. Then we have neuropathic pain, which is the nerve type of pain. It's injury to the nervous system itself. Most people, from a general population standpoint, will have things like sciatica or carpal tunnel syndrome.

[00:14:48.860] – Dr. Walters

Even if you hit your funny bone, you bonk your all nerve in your elbow, that's in a type of acute neuropathic pain. It's a sudden stimulus to a nerve. Those are the big ones that most people will think of. That neuropathic pain is the pain that we think of as radiating or traveling. You might even have, maybe you do have a disk hernia that's irritating a nerve in your neck or your low back, and then it shoots down one arm or down one leg. A lot of people are familiar with those. That's called radicular pain. Nerve pain will often travel along the nerves path. That's another type. Then the third one is chronic or oftentimes now we use the term persistent pain because chronic carries a whole set of negative meaning with it. People often feel like you say chronic pain, that means they have no chance of getting better. So the term persistent pain is used more. But that's a type of pain that's been around longer, usually longer than 3 to six months. And it's the type of pain that doesn't do a good job of accurately telling you what's going on in your body.

[00:15:55.220] – Dr. Walters

So it tends to spread. It's more vague. People might think about fibromyalgia or a chronic low back pain or neck pain that's been around for a long time, maybe years and years. And you know you don't have an injury, but it just gets set off. Maybe you get stressed out and it gets set off, or you had a couple of nights of bad sleep, or some people even say they get a cold, they get sick and then their back starts hurting. So you'll hear these things where it's a pain that's been around for a long time, but it's not really telling you something helpful about your body.

[00:16:27.060] – Allan

This is the weirdest thing. I know I read that and that must have put something in my head because I'm coming down with a bit of a cold and I was feeling sore in the back. And it's almost like that got planted in my head. It had to have because I don't have any back problems. It's just weird. Pain is a weird thing.

[00:16:46.670] – Dr. Walters

It's super strange. I think this happens. I've always been interested in this where you might read about… This happens to me often when a patient comes in with a particular pain problem, I will sometimes experience that pain for a day or two after they've been here. We do see… You think about visualization with athletes where you can think about doing a movement and it fires those same circuits in your brain. I often think that maybe when we read about something painful or hear about someone talking about it, maybe we fire some of those regions in our brain.

[00:17:18.280] – Allan

Yeah. You talked about dry needling. And in my head, I could refill the pain of going through dry needling sessions before with a therapist. And I was like, Okay. And so you're right. Yeah, you can feel pain for no reason whatsoever. And it's important to get to the bottom of that because I don't need surgery on my back because I have a little bit of soreness to my back today when I was walking over here. I know it's psychosomatic. It's just coming out of my head and it'll probably go away as soon as I stop thinking about it. Now, when we're going to go through the process of overcoming pain, I think this is important because there were three phases that you mentioned. And I think a lot of times we actually skip the last two. We get stuck and we do the first one and then we don't really follow through. Can you talk about the three phases?

[00:18:07.920] – Dr. Walters

For sure. Yeah. I'm glad you're high telling this because I do agree. I think a lot of times people do skip the last two. I think sometimes that they feel better and so you're just not motivated to keep doing those. Sometimes it could be your insurance ends and you're going to physical therapy and you just stop doing things. And that's where trainers and PTs are such good compliments to each other.

[00:18:28.480] – Allan

And this book.

[00:18:30.180] – Dr. Walters

Totally. Yes, exactly. That was something actually my co author, Glenn and I talked a lot about was using this because we don't want to tell people don't go to physical therapy. Of course, there are times when there's a lot you can do on your own. But if you're not getting better, then you go and the book can be a compliment to that. And it could be something that helps you continue when you're done. But when you look at those phases, the first phase is really about reducing pain and reducing sensitivity, helping the system calm back down, really desensitizing it so that you don't just keep it flared up. You want to try to get rid of that acute pain state and not prolong it. Maybe you've got an injury, you're moving on it too much and you're creating more inflammation, stirring it up. Maybe it's just a non inflammatory… It's a low back pain that you've had before and you just want to try and let your nervous system desensitize and calm down. Most people are pretty good about that. It hurts so you're going to try to do things. But then after that period, as it starts to calm down, the next thing that we'll look at in rehab is addressing impairment.

[00:19:34.590] – Dr. Walters

So trying to resolve impairment, which are really things that would limit your function. So maybe a mobility loss, maybe your joint, you can't move it as far because of that pain. Maybe you've got a strength deficit, maybe you have a balance or appropriate receptive type deficit. So a lot of it in phase two, that second phase, a lot of it revolves around mobility and control, how well the person moves, the quality of their movement. And we really want to work on mobility early because… Your ankle sprain example, right? You don't want to let someone be totally immobilized for too long. And my knee example, because people can get stuck, their joints can become stiff. And as time goes on in the area of heels, it's much harder to gain that range of motion back. So we really try to start right away as soon as pain is coming down to work on mobility and movement control. And then the third phase is all about rebuilding capacity, which is really focused on resistance training. Any good physical therapy program should ultimately turn into a resistance training program where you're using your body weight, maybe external tools like dumb bells, bands, barbell, whatever you do that you eventually get back to where you are loading the system externally and building strength.

[00:20:49.250] – Dr. Walters

And that will help your tendons, your muscles, your ligaments, your bones, everything. A lot of times in the PT world, we'll talk about increasing capacity of the system. And that typically means by strengthening it with resistance training, because we know your musculoskeletal tissues are physical tissues. We're putting load and stress on them all the time. So the stronger they are, they're naturally going to be more resistant to tearing and being injured.

[00:21:14.750] – Allan

Yeah, I know this from experience because I asked for a tore rotator cuff about six years ago. And I mean, tore tore, it was not a partial tear. It was a tear off the bone. Bad, bad one. But I kept training. I kept exercising, I kept lifting. I just told my personal trainer, strength trainer at the time, I said, okay, I can't do pressing movements right now. That's just not going to happen. I can't do presses, particularly overhead. We tried some different things, and that was just a no go. The pain was there, and I knew I was just compensating too much with everything else, and I really wasn't getting any work on my chest of any substance. So I didn't do any pressing movements, but I continued to do lap pull downs and rows and dead lifts because that didn't impact that injury at all. But as a result of doing that work, I felt like I felt less pain. So there's a tie to exercise and pain that even beyond resistance training, just even you mentioned in the book, aerobics and everything else. Can you talk a little bit about that?

[00:22:13.250] – Dr. Walters

For sure. Yeah, we talk about this a lot with pain that movement and exercise are one of the most powerful modulators of pain. A lot of people probably will recognize this. Sometimes when you're really sedentary, maybe something's come up in life. Maybe you're on a vacation or on a plane or whatever. When you sit more, often people will feel worse. Once they get out and walk and just move, there's something I think our nervous system really craves, movement. Like you said, it doesn't have to be resistance training. It can just be active mobility work, whatever. It could just be going through range of motion exercises. Just moving tissue tends to really be helpful in terms of pain. What was the second part you asked on that?

[00:22:53.180] – Allan

Well, the connection of the two. I just felt like I didn't feel pain the way that I would have felt it because a full tear of a rotator cuff and you're moving in a gym doing stuff, you would think I would be in intense pain, and I wasn't. Now, at other times, I did certain movements that would cause pain. But at the same time, I was out running, I was out lifting, I was doing things. And in the end, it actually worked out great because doing those lap pull downs and those rows, the range of motion in my shoulder after the surgery was exceptionally better than it would have been if I had just put it in a sling and sat at my desk for three months while I was waiting for surgery.

[00:23:36.450] – Dr. Walters

Yeah, it made me think. Yeah, exactly. There's a couple of things there. I think we're often trying to encourage people, and I think this has been a change in maybe the last 10 to 15 years, but just that exact idea of keep training as much as you can. So if you've got an injured shoulder, you injured your rotator cuff, you found all these things that you could modify your workout and keep strengthening. And we know that people, like your example, where if they're working on mobility and getting stronger and they do end up having surgery, they recover faster. And we see that people, say you can't even work that side, working the other arm and your legs. We've seen in the research with resistance training, there's this cross transfer effect where actually people lose strength less if they keep training, even if they're not even working the side that's injured, if they work the other side, it transfers over. And I think the other cool thing about movement, especially when you start looking at more chronic, longer lasting back pain, such a good example. A lot of times it doesn't have to be real fancy specific exercise for low back pain, for example.

[00:24:37.930] – Dr. Walters

Things like Pilates, yoga, walking, aerobic exercise, just stretching programs, resistance training, they all have been shown to have a significantly positive impact on chronic low back pain. So I think sometimes people get in this mindset, again, because of probably outdated narratives, but I've just got to do core strengthening if I've got back pain. And really the research is saying more and more, you just need to move, just find something that moves. And if you do have some of the exercises that do target the low back area, that probably is good to add in. But a lot of times it's just moving. Just try to move and find something that you enjoy and isn't threatening to your system. A lot of times when we're talking about pain, that's what we're trying to help people with is you don't want to just blow past your pain, past that flair up line. You want to find something that challenges it, goes up to that line. But it's not considered really threatening by our nervous system. And over time, you can desensitize the system and help get rid of that pain.

[00:25:36.280] – Allan

But do no harm. Don't continue to injure yourself. Do what you can. Like I said, twist your ankle. You're not going out for a jog two days later, but you are walking around with compression socks or compression brace and doing the right things to help that heal.

[00:25:52.780] – Allan

Dr. Walter, I define wellness as being the healthiest, fittest, and happiest you can be. What are three strategies or tactics to get and stay well?

[00:26:01.780] – Dr. Walters

Yeah, I would say in thinking about this one, the three that I would focus on right away would be sleep. Sleep is… We know there's so much research on sleep, and it definitely applies to the musculoskeletal system. Our musculoskeletal system remodels while we're sleeping. And whether you're looking at performance in the musculoskeletal system or healing from pain and injury, just getting enough sleep should be the foundation, in my opinion, before you even think about these more physical therapy based exercises and interventions. Sleep, and then I would say exercise movement. And like we're alluding to, I always say exercise movement because we just talked about how powerful just basic movement is. So it doesn't always have to be you're getting your heart rate up or doing something that's strength based. It could just be range of motion exercises or activities of daily living that you might do around your house, just moving. But then, of course, exercise, especially aerobic exercise and strength training, can have huge benefits for helping to reduce your chances of having an injury and helping with all kinds of different pain issues. Even just aerobic exercise for people with chronic pain has lots of research for reducing inflammation and sensitivity in the nervous system.

[00:27:14.610] – Dr. Walters

Sleep, exercise, movement. Then the third one, I would say, really revolves around how you think in your psychology. There's a huge degree of stress, fear, and anxiety that comes with pain and injury. That really goes back to that bio psychosocial model. We've been trying to spend a lot of time educating people about pain and injury, the differences between them, what's going on in their system, how their pain system works. And you see lots of studies where the fear of injury, the fear of pain is almost more limiting than what they're actually experiencing. And a lot of times when you're looking at pain, fear and anxiety can actually ramp the nerve system up because you're basically telling your brain that there's something to be worried about, that you need to be threatened. There's something threatening going on, there's danger. Your brain is going to tap into that and be more likely to output pain because it thinks it needs to protect you. That piece, trying to figure out, learn about pain as a strategy for reducing fear and anxiety. Then if you don't have a lot of fear and anxiety around pain and injury, then I would say stress management, which goes in that same category.

[00:28:27.690] – Dr. Walters

Just trying to maybe it's meeting with a PT, maybe it's implementing meditation, mindfulness based things. Even just laughing, trying to find something that makes you laugh. Injuries suck. Nobody likes being injured. You see a lot of people who with true injuries like ACL tears or something, your likelihood of being reinjured is higher if you're fearful of that injury happening again. So there's a lot to be said for, I think, that your mindset and your mental framework than how you look at pain and injury.

[00:29:02.420] – Allan

That's why this book is really helpful because you have the protocols in the book where you can somewhat, let me say, self diagnose, but if you know you have an injury, you're working with a PT, or you're through working with a PT and you want to keep working to work your way through these three phases of recovery, all that's in the book set up exactly like that. So you say, okay, I hurt my shoulder. What can I do to strengthen, to resolve this problem over time and make sure that I'm at least as good, if not better for it? And it's all in the book. The book is called Rehab Science. If someone wanted to learn more about the book or about you, where would you like for me to send them?

[00:29:42.510] – Dr. Walters

Yeah, thank you. So yeah, the book, like you said, Rehab Science, how to overcome pain, heal from injury. The best places are usually Amazon and Barnes & Noble. If people are in the United States, there are groups for international individuals. Black Wells is a bookstore in the UK that's useful. And then people can always message me. I'm at Rehab Science pretty much everywhere on social media. Instagram and YouTube are the big platforms where I'm the most active. But people can always reach out to me if they have a question or want to know where to get the book or how to navigate it because there's a lot. There is a lot of content in there. And I think, like you said, most people are going to come to this for the programs because they're looking for a program, they've got some pain and they want to see some exercises they can implement. My hope is that that will then motivate them to look at the first 10 chapters, which are the science of pain and injury, and then that will give them that framework we talked about because it is so… It's like putting an armor on yourself.

[00:30:37.650] – Dr. Walters

I think if you have that education, you're probably going to have pain or an injury again in the future. The book covers the 50 most common. They're all the things that most of us humans get. So if you have that framework, that toolset to know how to approach a future pain or injury, it just makes it that much easier and it helps reduce some of the fear and anxiety about it. So my hope is though people will be interested in the science, and we try to write it in a way that we were thinking really about the regular person, just somebody who doesn't have a rehab background that wants to learn about these concepts. Of course, I think movement and medical practitioners will benefit from it, too. But we were thinking about both of those groups. And a lot of people asked me, it's not just for practitioners. It was really at the beginning just for the regular person.

[00:31:22.370] – Allan

Well, I'm going to have a copy on my bookshelf.

[00:31:24.960] – Dr. Walters

Thank you. I appreciate it. Thank you.

[00:31:27.730] – Allan

You can go to 40plusfitnesspodcast.com/595, and I'll have the links there. Dr. Walters, thank you so much for being a part of 40+ Fitness.

[00:31:37.640] – Dr. Walters

Thank you so much for having me. This is awesome. Thank you.

Post Show/Recap

[00:31:49.290] – Allan

Welcome back, Ras.

[00:31:50.780] – Rachel

Hey, Allan. Right off the bat, I have to tell you, I think having a physical therapist is just as important as having a general practitioner doctor. They can play such an important role, especially for people in my running community. We get injured a lot, so we'd rather be back on the run, and a physical therapist is the guy that's going to get you there.

[00:32:11.530] – Allan

Well, yeah, I go with the concept of fit for task. And as you try to be fit for task, if you injure yourself, guess what, you're not until you get it fixed, until you actually get out there and say, Okay, I'm going to do something about it. And it's unfortunate that most doctors don't necessarily want to stay in their lane on some things. If you're a general practitioner, I apologize, but you're not a physical therapist, and those guys can work magic. And so I don't mean anything when I say my general practitioner let me down. I just went to the wrong doctor. It wasn't until I said, Okay, this isn't getting better the way he said it would. I've got to go to an expert. And I went to a sports doctor. The sports doctor knew more but still didn't know how to fix me at that point because I wasn't in his world broke.

[00:33:07.890] – Allan

He was effectively a carpenter and there was nothing to fix. It was just, Okay, we've got to get the swelling down. We've got to get this boot on. We've got to have the pressure. And so it was just, okay, now you got to do this contrast therapy and all the things that probably are outdated today. But what I did back then, and so it was just a function of getting to the right person, which was the physical therapist when it was all said and done, that knew the thing. Same thing when I tore my shoulder, it was okay. Not playing around with this. I did not go to a general practitioner. I went straight to a sports doctor, told him it was broke. He told me it was broke. He said, Let's get an MRI. We got the MRI, it was broke. He goes in and does his carpentry work and staples me back together, shaves off a little bit of bone and says, Okay, just go do physical therapy when it's time. And I thought, Well, no, he didn't really say when. So this was Thursday. I made an appointment with a Division 1 football physical therapist.

[00:34:17.450] – Allan

He'd been with the Division 1 football team the year before. So he had seen breaks. He had seen stuff like this. And I told him, I said, I don't want to just recover. I want to be back to exactly where I was before this all happened.

[00:34:32.090] – Allan

And he helped me do that. So yeah, they are among my favorites. But what I really liked about this book was it does allow you to do some self work.

[00:34:44.550] – Allan

When the injuries not as bad as what you would require physical therapist. And if you have a physical therapist for an injury, this is going to be additional aid that will help you because you can pull this book out and sit down with them and say, here's this injury. What do you think about this workout? Because they're going to give you a little Xerox piece of paper that's grainy because it's a copy of a copy of a copy that's been around for 15 years and say, Here's your prescription for homework. Here you can say, well, this guy recommends this training. What do you think about it? And the physical therapist will say, Yeah, that'll do the same thing. But you'll have it in your hand. And so if it's a minor injury, you'll know how to recover from it. Well, if it's a more major injury, then I would say go seek medical attention. Don't be your own doctor.

[00:35:39.190] – Rachel

Yes. Well, I want to just highlight that section right there because we all go down the rabbit hole of googling this symptom and that symptom, and you can get 20 different answers of what your ailment or injury could be. And it is really important just to go straight to the doctor, the sports ortho, or if you can get a consultation with a PT and get the test done and get a proper diagnosis and then do what needs to get done because you're not a doctor, I'm not a doctor.

[00:36:10.510] – Allan

But I want to flip that a little bit. You still are the CEO and their advisors. So if you know there's something wrong and the doctor says, Well, you're just going to have to live with it, that might not be the answer that you want to hear. But get a second opinion. Or if surgery is the only way that, Oh, well, it's a partial tear of this or that. Surgery is your best option. Let me cut you open, please. No, let's take a step back. Is there a way for me to rehab this? So go get the second opinion. Have some conversations. Understand the risk, understand the likelihood that that's going to pay. I knew with my shoulder it was a complete tear. There was no not getting a surgery. I wouldn't have been able to scratch the top of my head ever. So I needed surgery because I would not have been able to lift my arm up over parallel from the floor. And so from that perspective, I knew I had to get the surgery, got it on my own terms. And when it was the right time for me, I did live with it for three months.

[00:37:15.210] – Allan

And I also did a spartan with it, and that was part of it. I didn't want to miss the spartan for the surgery. I was like, I can't tear it more, so I'll go in when it's time to go in. I kept moving my arm. I didn't brace it and hold it and nurse it. I was careful not to hurt myself because I don't like pain anymore than anybody else does. But it was just this concept of, I know I'm going to need the surgery. I'll fit it in when it makes the most sense. And then I'll do the physical therapy like a madman to recover as quickly as humanly possible.

[00:37:51.250] – Allan

And my range of motion was great within a few weeks. Reality is the strength took a lot longer to get back to the strength I had before. Now I'm a smarter man because I know there's no reason for me to be lifting that much weight over my head with dumbells. My shoulders are just not going to be able to handle it. And I assume whatever happened on my right shoulder could invariably happen on my left. And I don't want to have to go through that again. So I'm just a lot more careful. But I still weight train. I didn't stop training because, oh, I might hurt myself. I still want to be fit for task. And that includes scratching the top of my head.

[00:38:31.580] – Rachel

Yeah, that's important.

[00:38:33.290] – Allan

When it itches. When it itches. So make health care professionals your partners. They're your advisors. Put them on your team. Anytime you learn something about yourself. It's an illness, it's a cancer, it's a this or it's a that. Get some professional advice. Dr. Google is fine for you to get some base information. But if you get on one of those forums and someone says, Well, I just made this tea with ashugandha and all this other stuff in it and that cured my cancer, maybe. But that's just a bit of information. That anecdotal post out there on the internet is not a study. They might be right. But again, take it under advisement and do what you feel is right for your health care, for your well care, so you can be the person that you want to be.

[00:39:22.630] – Rachel

Absolutely. And a PT is a good guy to have on speed dial.

[00:39:26.520] – Allan

And this book is like having someone like that. So I would trust what's in this book over anything you're going to search on Google because this guy knows his stuff.

[00:39:37.650] – Rachel

That sounds awesome. Great interview. Great book.

[00:39:40.530] – Allan

I'll talk to you next week.

[00:39:42.490] – Rachel

Take care.

[00:39:43.600] – Allan

You too.

[00:39:44.420] – Rachel


Music by Dave Gerhart


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Another episode you may enjoy


Fix my knee with George Demirakos

The 40+ Fitness Podcast is sponsored by Health IQ, an insurance company that helps health conscious people like runners, cyclist, and weightlifters get lower rates on their life insurance. Go to healthiq.com/40plus to support the show and see if you qualify.

George Demirakos is the author of Fix My Knee, a guide for preventing and healing injuries to the knees.

There are two types of injuries that can cause pain in the knees. George identifies these two types as traumatic and non-traumatic. Traumatic injuries are those that occur from a hit or fall, which can include sprains, or pulled ligaments, or strains, which are pulled muscles and/or tendons. Tendonitis, an irritation of the tendon, can also occur.

For those who like to run, George recommends warming up properly by jogging in place for 5 to 10 minutes. It is also important to stretch out the muscles by holding for about one minute each time. Some people prefer to run barefoot, which can be beneficial for knee health since more foot muscles are being used and strengthened as a result.

For those who like to lift weights, George explains the importance of using good form during lunges, deadlifts, squats, and hack squats to preserve knee health. The number one mistake made during squats is letting the knees fall in, which changes the body’s alignment, puts stress on the knees, and can cause injury. Having too little of an arch in the lower back and lowering to 90 degrees or less are two other common mistakes. With deadlifts, use one overhand and one underhand grip, which will help improve grip strength. With lunges, make sure your knee does not go past the front of your foot. In any exercise, it’s important to first get the proper form and then add more weight over time.

In regards to food and promoting knee health, fatty fish such as salmon and tuna are great options. Pineapples and papayas have enzymes that help with healing an injured tendon. Green leafy vegetables are rich in Vitamin D, which can reduce inflammation. Conversely, sugar is not recommended, as it can promote inflammation in the knee. Olive oil is preferred over other oils such as sunflower oil. Smoking and alcohol should also be avoided.

To learn more about Fix My Knee or to connect with George Demirakos, visit http://www.georgedemirakos.com.


Another episode you may enjoy

Not a born runner but that can change with Pete Magill

February 15, 2016

Dealing with pain and injury

Today we'll discuss  pain and injury.  When we start an exercise program and begin pushing ourselves, most of us expect we will feel some pain. It can be difficult for people to know when enough is enough, when to carry on and when to stop.  In this episode, I want to help you identify when to push and when to stop.

When we work on our muscles, we tear the muscle fiber down.  Our bodies were designed to respond to this.  The muscles are repaired and in that process, they're made bigger and stronger.  But this can only happen when we make sure to get appropriate rest and take in the right amount of protein. The cycle entails the following: challenge, feed, and recover.  During the challenge phase, it is common to have a little bit of discomfort and pain. And it’s fine to continue with such pain.

When you're new to resistance exercise, it is not uncommon to suffer rather extreme muscle soreness. It means that you've done enough work with that muscle to elicit growth. You'll want to ensure you give the muscle enough time to recover. It takes roughly 48 – 72 hours to recover from intense resistance exercise.

Another type of pain, which is most often associated with running is called a stitch. It is a sharp pain in the lower abdomen. This is believed to occur when there is a mismatch between abdominal muscles and the diaphragm. The stitch can be very painful, bu it is nothing to worry about.

Injuries require a lot more care.  The previous pain issues we covered will go away with rest.  With injuries, that's usually not the case.

Most common exercise-induced injuries are damage to a tendon, ligament, muscle or bone.  You should make sure you seek medical attention for injuries.  The doctor will give you information on how to repair the damage and begin rehabilitation.  I can't stress enough how important it is to follow your doctor's instructions.  Injuries can put an end to exercise permanently if you don't address the underlying issue.

How you should approach pain and injury will depend on the nature of the pain. Make sure you properly asscess your pain and injury before you decide how to go ahead.   There is some pain to get gain, but you'll need to know which type of pain is getting you gains or is going to sideline you.

What is high intensity interval training?

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