Look deeper for the complete solution:This week I saw a patient who had lost reps on his toes to bar and he blamed tightness in his lower back for the difficulty performing the exercise.
I won't say his back wasn't tight, but when we tested the movement there were lots of deficiencies that could be rectified in order to make the movement better. Grip, kips, posterior chain mobility, and movement skill all had significant room for improvement. We developed a plan to address each of the pieces above, ALONG with things to address the lower back tightness. If you're noticing a change or a problem with an exercise, things you do every day (walking, sleeping, etc), make sure to do your due diligence and dig down to the full soluition. Need help with the process? Work with me. Thanks for reading! Lift for Life, Dr. Paul
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The Path is Through the ObstacleThis week I ran into someone looking for relief from tennis elbow on an online forum and all the recommendations from lay people who have had tennis elbow are well meaning, but not good: Braces, sleeves, ice, and the like (I can't believe no one recommended a percussion massager). Someone recommended rest, which is a better idea than all that other stuff, but it's still not complete. Another even recommended exercises which is totally getting on the right track...but the linked article was just for cookie cutter exercises that weren't specific to tennis elbow and without a return to sport progression. In the specific case of tennis elbow, golfers elbow, and other tendinopathies, you must properly expose the tissue to load and use in a way that restores tissue health, desensitizes the area, and allow you to return to full function WITHOUT the aid of goofy devices like this one: This does not look cool or fix tennis elbow. It does get stinky with prolonged wear. The real, complete fix for most problems is working "into the pain" (in a pain free way) and building tolerance to return to full function. No pain, no gain DOES NOT APPLY...what I mean by working into the pain is that you must build to doing the things that are currently causing pain in a way that allows you to resume them progressively without pain or difficulty.
If you can't hold your coffee cup without pain, you shouldn't just stop holding cups or drinking coffee. You have a problem to fix. (and if I see you wearing one of these to be able to hold your coffee without pain I may slap it out of your hand) Physical therapy success is when we restore prior level of function (abbreviated PLOF and thrown around in PT like the word pilaf). Not when we throw on a compression sleeve and go "wow it doesn't hurt as much now" or "I just ice after I'm done to make the pain go away." The real lesson in all this is that you should seek help from people that can offer real solutions. Not internet forums full of people that are on their second year of wearing an elbow brace to drink coffee. Lift for life, Dr. Paul Are There Permanent Solutions?This week I ran across a quote from preeminent economic and political thinker Thomas Sowell: “There are no solutions, there are only trade-offs; and you try to get the best trade-off you can get, that's all you can hope for.” He is speaking about politics and economics, however I think this applies directly to fitness, health, and wellness. Often times programs and diets and equipment are sold as a panacea. [For a while foam rolling was going to save us all from muscle soreness and tightness 🤔]. But what it really boils down to is that everything you can do has a benefit...but it also has a cost: time, money, effort, energy. You must pay for the results you want. The one caveat I will offer is that there are solutions for fitness, health, and wellness issues: you can get the results you want, but the principle of trade-offs remains. Get the results you want:In order to make the best trade-offs to get the results you want you start with goals and work backwards. Want to be the world's strongest man or woman? You'll need to do nearly exclusively strength and power work [and probably steroids]. Want to set the new world record in the marathon? drop all the strongest man strength work and go all in on cardiovascular efficiency and running technique [and possibly a little blood doping]. The point I'm trying to make is you can't be or do everything, so you have to pick and prioritize the things that are important in order to get the things you most want. Make the decision on what is most important and make the trade to get the benefits you want. What about a pain solution?If you're in pain or injured I can develop a custom solution for you. (But wait didn't you just say there were no solutions?) Ahhh yes, your custom solution will eliminate the pain and solve the target problem, BUT it comes with trade-offs: time investment in homework exercises, a temporary decrease training volume, temporarily avoiding specific exercises, increasing rest days, investing more time in self treatment methods, or changing nutritional and sleep habits.
It's not easy but fixing an injury should rank pretty high on your priorities list. You just have to ask yourself: is my solution worth the trade offs? Compared to what? staying in pain and slowly getting worse... At what cost? time and money investment... What hard evidence do you have? I've done it before, I can do it again (you can check out PWR customer reviews here) Lift for life, Dr. Paul Race Fuel or Regular? If you had a million dollar supercar, would you take it to JiffyLube for your oil change?
I hope your answer is no. Would you put regular fuel in your supercar, or premium? If you answered "regular" to this please relinquish your keys and car title to me, immediately. Let's equate your body to a supercar and consider food as fuel and proper movement as best maintenance practices. Are you taking care of both? Are you willing to take action and invest time and money in your supercar (body)? You likely already train hard and eat well. But do you deal with minor issues in a timely manner? Do you ride on low tires (knee pain) or ignore the engine warning light (shoulder pain)? Is the transmission making funny noises and slipping (back pain)? Don't drive 'til the wheels fall off. It's not a good plan. (Am I a mechanic in this metaphor? How am I still a person but you're a car? 🤔) In closing I want to point out that the human body is not really like a car at all. And the metaphor is really only useful for pointing out what level of investment (time, effort, money) you are willing to put into your body. It's the only one you've got, I recommend treating it like a high performance machine. Lift for life, Dr. Paul Time yields the most results:People in fitness harp on consistency quite a bit. I certainly do myself. There is a good reason I always bring it up, an important factor underlies consistency and that is time. The best and most successful at any endeavor usually has a lot of time under his belt. (I imagine most lottery winners have "played" for a while before hitting it big 🤔🤔🤔) If you've been at your job for a long time, I bet the only people at the company better than you are people that have been there longer. Not convinced? I offer you examples:I know the 11th best disc golfer in the world (based on current rankings). How can he throw a fancy frisbee better than 7,753,000,000 other people on earth? TIME. He is a young man, but he started playing very young and has over a decade of disc golf under his belt already. He's been living the life of a disc golfer for 87,600+ hours. That's a lot. Another example? Tom Brady. His first retirement didn't stick because he has decades of time invested in a single craft - quarterbacking (is that a verb?) You've likely heard of the "10,000 hours to become an expert" hypothesis. But I think that actually falls short because Tom Brady has lived his life as a football quarterback for 262,800 hours. It kind of seems overwhelming...Luckily, it doesn't take 200,000 hours to be fit or healthy. However, it does take day after day and week after week of staying committed to the process of being a healthy and fit person.
6 week weight loss plans, 10 minute abs, 7 and 1/4 month programming cycles, and fortnights of fasting all pale in comparison to decades of consistent healthy living. If injury or pain is stopping you from being consistent with your regular healthy habits, connect with me and we will get you back on track. Lift for Life, Dr. Paul Today I want to say thanks for reading my weekly newsletter! I hope that you get some useful knowledge and value from it.
I also have a big ask: if you know someone that would benefit from physical therapy and has been putting it off for too long please recommend PWR. You can send them this link http://www.pwr-ga.com/inquire OR give them my phone # 678-778-7708 (call and text both reach me!). I hope you have a great weekend! Lift for Life, Dr. Paul ICYMI:I've got a lot of information out there intended to help you...but that doesn't mean I got the information delivered to you when you needed it most. Check out some stuff that might be relevant to you now: Sore? The DOMS solution Injured? 6 weeks off leaves you 6 weeks behind and Super Effective Injury Protocol System. Need better recovery methods? Recovery Methods Part 1 If you don't need help right now, please share with someone who does! 9 Months Post Bicep Tear:I expected it to take a full year for my elbow and bicep to feel normal after being torn back in November 2023.
At 9 months (as of Tuesday this week) my elbow feels totally normal. I can contract my left (injured) bicep as hard as the right side now and I made it through a 12 week heavy barbell strength cycle with no issues. I do still have 1 last goal to hit: 5. Complete 10 dead hang pull ups and 10 dead hang chin ups before 1 year post injury (11/15/2023) I'll report back in November! Lift for Life, Dr. Paul Nutritional BiochemistryIt is difficult to boil down the concepts in Dr. Attia's book farther than he has already. He wrote, and his editor edited, down to important information; I think if they could have made it more concise they would have. But here I am attempting to distill it further to the most poignant points. Nutrition is not eat this not that. There is no one formula that works for everyone. Just like the exercises section you must create a target and then reverse engineer the tactics and tools that will help you reach that target. Dr. Attia offers a very solid framework that strips away simplistic goals like decreasing scale weight or "getting shredded" and points to the underlying longevity and health principles of nutrition:
Answering these question will guide the choices of amount and type of food that will best suit your plan for achieving your goals. I think this passage taken directly from the book also sums up one of the concepts that we've neglected in nutrition for a while: "I also believe that we need to differentiate between behavior that maintains good health versus tactics that correct poor health and disease. Wearing a cast on a broken bone will allow it to heal. Wearing a cast on a perfectly normal arm will cause it to atrophy. While this example is is obvious, it's amazing how many people fail to translate it to nutrition. It seems quite clear that a nutritional intervention aimed at correcting a serious problem (e.g. highly restricted diets, even fasting, to treat obesity, non-alcoholic fatty liver disease, and type 2 diabetes) might be different from a nutritional plan calibrated to maintain good health (e.g. balanced diets in metabolically healthy people)." Just like when I give people exercises to bring their rotator cuff back up to normal, there is a time limit on use before diminishing returns and elimination of the exercise. There may be a time where you need to eat in a restricted way in order to create a metabolically healthy internal environment...but once you have reached those conditions maintaining metabolic health will look different than the path that took you to arrive at metabolic health. If you have questions about nutrition or Dr. Attia's ideas on working toward better metabolic health feel free to reach out. Mission 1K Week 12I'm feeling more confident in my quest than last week as my top sets this week were 330x4 on squats and 210x3 on bench press. Deadlift is 380lb for 3 (or more) reps today.
Here we go 1000lbs! Lift for Life, Dr. Paul Outlive Review: Exercise pt. 2Last week we talked the "why" and "what" of exercise as a tool for improving longevity and healthspan. This week were going to touch on the "how." For the sake of this review I'm keeping it on simple terms and examples that are easy to understand, bear in mind that there are many ways to get all of these done and you have to find the ones that best work for you. Aerobic efficiency - this is improved by completing steady state cardio done for 30-60 minutes where you are going as fast as you can WHILE breathing through your nose (so not really fast at all). I do this on the air (assault style) bike. Dr. Attia recommends bike and rower machines. It can also be done with running and walking, but it is much harder to accomplish the steady even pace if you aren't an experienced and skilled runner. Dr. Attia recommends accumulating 3 hours/week, but I find that tough to fit in if you have primary goals outside of longevity (mission 1K anyone?). Maximum aerobic output (VO2 max) - for this I'm just going to offer the 4x4 example Dr. Attia presents. On the bike (yes, the bike again) you go for an all out 4 minute interval, followed by 4 minutes of a recovery pace, which is repeated 4 times. Each 4 minute hard effort should feel very difficult, but you should be back down to or below your zone 2 heart rate at the end of the 4 minute rest interval (or you went too hard or you need to start with less than 4 intervals). This isn't a fun workout and the 4th interval is usually torture. Luckily you only need to do this work 1x week. (You could do more if it aligned with your goals, or less if your VO2 max is already well trained). Strength - for those of you training CrossFit or specifically for strength this is slightly undercooked, but remember the goal is longevity. Here Dr. Attia recommends learning how to hip hinge properly and then training it up with deadlifts and step ups. He also recommends any exercise that resembles human activities (lift, carry, pull, push) with primacy given to exercises that involve using your hands (for example: deadlifts > squats for longevity because of the primary input of the hand for the deadlift) Hanging from a pull-up bar for time is another exercise that doubles as a metric for progress and strength. The standard we're looking to achieve by training this is 2 minutes for men and 1.5 minutes for women. On the "how heavy should I go" part of the equation Attia recommends getting as heavy as you can go (again, safely) but generally limits the heaviest work to 5 rep sets (this keeps you from going above 80-ish percent of your 1 rep maximum). Stability - we talked about what stability is last time...but now the issue with offering a "how" to improve your stability is that this varies wildly from person to person especially as safety is an issue. You have to find safe ways you challenge your stability. It's pointless to challenge your stability to the point that you create a detriment to your health (i.e. fall and break a bone). For me personally activities like slacklining (very difficult balance challenge) would be a fun and mostly safe way to get in balance and stability work...that said I would not recommend that a 55 year old woman with osteopenia even go near a slackline. If you need ideas for the stability section that make sense for you feel free to reach out! Next time we're going to venture away from exercise and cover some of the other tactics and practical application of Outlive. Mission 1K Week 11Squats ruined me this week. They felt super heavy and I'm still sore several days later. I'm definitely in a over-reaching portion of the cycle. Next week's max rep sets are going to be tough!
Once I knock out week 12/12 the rubber hits the road and I've got to video a max squat, bench, and deadlift, within 1 hour. And it's got to be 1000 pounds. Lift for Life, Dr. Paul Outlive Review: Exercise pt. 1We are jumping in deep today. Straight to part III, chapters 12 and 13: Training 101 and the gospel of stability. This book is dense with information and it definitely builds the case for exercise before reaching this point in the book, but I feel we can get right into the practical side. Dr. Attia focuses on 4 major physiological characteristics that can be modified with exercise:
One of the best examples is the correlation between grip strength and cognitive decline. The connection isn't 1:1, only doing grip training won't stop your brain from deteriorating, but grip strength is an indication of how much you have done (you do nearly every activity in your life without your hands) over a long period of time. Those that did less activity overall lost the ability to do so AND experienced a parallel cognitive decline. I want to jump to how this information should affect your training:
Mission 1K Week 10My current calculated max is 1060lb based on my week 9 maxes. Theoretically a 190lb improvement...but always remember, calculated maxes don't win t-shirts.
This week the numbers feel pretty dialed: heavy, but moving fast, and soreness for days because of the volume. Lift for Life, Dr. Paul |