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In this episode of the podcast, we discuss the role that exercise plays in the process of pain & injury rehab. We use the case of Gary’s hamstring rupture, surgery, and subsequent rehabilitation process to illustrate these principles
Transcript
This transcript is AI generated, so please allow for any mistakes or deviations from the podcast:
Gary
Welcome to the Triage Method podcast with me, Gary McGowan and my co-host, as always, Mr. Patrick Farrell. Paddy, how are you this week?
Paddy
As usual, Gary I am fantastic. It is nearly very, very, nearly Christmas, in fact. Well, depending on when people listen to this, they may have listened to it after Christmas, but we are a couple of days away from Christmas and that’s always a very nice, very exciting time. I really enjoy Christmas. It’s not my favourite holiday. That would be Halloween because, you know, I think I think arguably it’s the best season.
Paddy
First of all, autumn is nicer than winter. I think. And then I like fireworks and bonfires and I don’t think that’s a bad thing. Do you agree?
Gary
I don’t know. It’s a it’s a reasonable take. I think I’m probably lean in the direction of being pro pro Christmas myself, but I’m certainly a Halloween enjoyer as well.
Paddy
That’s fair enough. But anyway, here, look, we’re not here to talk. Well, actually, before we just get into the go to the podcast, you are finished your semester in college university. How do you feel? How do you feel to be free?
Gary
Gary Feel fantastic. Free from the shackles for a couple of weeks. So I just finished obstetrics and gynecology. So that’s the field related to pregnancy. Normal pregnancy, complicated pregnancies, all those sorts of things. And women’s issues in terms of gynecological issues. So nice, nice feels, you know, interesting. Enjoy this exam. Done. Very happy.
Paddy
Fantastic. And what are we talking about today?
Gary
Today we’re talking about me. It’s all about me. So we’re going to talk about injury and we’re going to use me as a case study because I got injured this year and we’ve been doing the medical exercise series. So we want to bring, I suppose, some physiotherapy discussion into that as well, or injury discussion into that. It’s not just about medical diagnosis, I guess you could say, because this is probably the area where I, as exercise professionals, as personal trainers, we end up having a pretty big input in terms of the role of exercise in the general rehab process, because whether someone has, you know, chronic pain or an acute injury or they’re post-op after
Gary
an operation surgery regardless of where they are and that spectrum of pain and injury, there’s almost always a role for exercise. Now, there are some cases where exercise is has lifestyle benefits, has health benefits, but mightn’t really help your pain. Unfortunately, that certainly happens, but very often it’s the case that exercise plays a role. So we want to touch on, I suppose, some of those key principles today and we’ll walk through that with an emphasis on how I got injured this year, my surgery and what I’ve been doing since to try to get back to a good state of health.
Paddy
Yeah, like what I want people to come away from this episode is not like the specifics of, Oh, how do we rehab a Garry’s hamstring injury like that. Obviously we’ll touch on a few little things there. But the real thing I want people to come away from this episode is a general understanding of, okay, this is what, you know, a very generalized rehabilitation process looks like.
Paddy
This is the kind of thought process around that, rather than the specific protocols or the specifics of the injury or whatever. You know, it’s like, okay, where does exercise actually play into rehab? You know, because this is unfortunately the case where a lot of people get injured and then exercise just becomes a no go. They no longer exercise.
Paddy
They don’t view exercise as part of the rehabilitation process. They view it as something they’ll get back to when they have rehab, if that makes sense. You know, it’s like, oh, the exercise itself, that’s that’s not part of the process. The exercise is the end goal. I want to be able to get back to exercise, and that might be the case at the start of this, you know, the start of the whole rehab process, like you might be injured in whatever capacity where, you know, exercise is just not possible.
Paddy
You know, you can’t you can’t do anything at the moment. There is like an active injury side. Exercising would be, you know, contraindicated right. But we want to view exercise as part of the rehabilitation process. And yes, that’s going to be modified. Yes, that’s going to look different than the end goal of exercise for that individual. But exercise plays a key role in the actual rehabilitation process.
Paddy
Right. And so maybe walk us through this a bit, Gary. So let’s just say again, we’re using you as a bit of a case study. Well, maybe before we go on to that, let’s actually just define was rehabilitation is if that makes sense. Like what are we actually looking for where rehabilitation and then also maybe go through some you know, different types of injuries that people could get because obviously that’s going to change things?
Gary
Yeah, absolutely. So firstly, with with rehab, like the fundamental goal of of rehab is that like the way I think of it is number one is the restoration of of normal function. Okay. And that’s, that’s normal function in general in that you want to be able to walk around, you know, do the activities of daily living and get back to what was your previous baseline.
Gary
Okay. So that’s just your ability to normally engage with the world. So you want to take your body and bring it back to that state. But in in our corner of the world, in the fitness space, we’re often looking at another level above that. It’s not just getting back to a normal, acceptable baseline that’s often a lot easier.
Gary
What we’re often looking for is getting back to that baseline, but then getting actually to a high performance state and being able to get back to a high performance baseline. And that’s where people often run into problems because for example, let’s say you, you hurt your back in the gym and you get back to the point where you’re more or less pain free in day to day life.
Gary
You can do everything you need to be able to do. You can, you know, do your bench presses, you can do your squats. And but when it comes to heavy deadlifts, it’s been six months now and they’re still at you. You know, you still you still can’t really do those. Your back is still limiting you from doing those.
Gary
So although by most people’s standards your rehab has been successful by your standard of wanting to be able to deadlift again, it hasn’t been successful. So there’s dirt are general. There’s a kind of a general goal of getting back to baseline and then more specific goals, especially for athletes. And that’s just the function side of things. The other the other component is of course pain that people want to be able to get to the point where they’re more or less pain free or the pain itself isn’t prohibitive, prohibitive of someone’s quality of life.
Gary
And the pain itself is sometimes not so closely related to the amount of damage that has been done by a particular injury or the amount of damage that exists currently. So very often you’ll have had tissue healing that has gone pretty well, but you still have chronic pain after your injury. That can happen. People and sometimes they’re very difficult cases to deal with because it’s not so clear that strengthening the tissue anymore is going to be able to get to get rid of someone’s pain or to reduce someone’s pain.
Gary
So they’re some of the the kind of challenges in the general goals. But in summary, what what I would like for any rehab processes that someone’s able to get back to a normal baseline, that they’re able to go about their life without this pain or injury being a barrier for them. And then ideally that they’re able to get back to a high performance state, if that’s what they’re looking for.
Paddy
100%. And I think it’s really important for people to realize that. Well, I think most people do realize that, but that it is a very multifactorial thing, right? It’s not just, oh, I’m going to there’s a specific tissue injury. Let’s say you’ve torn a muscle sprain, an ankle tone, whatever it is, like a specific note of noticeable injury site.
Paddy
Right. It’s not just rehabbing that. It’s also the pain that goes along with that. Any kind of we’ll call them compensations that have occurred as a result of that. Any psychological issues that have maybe come up as a result of not being able to exercise, being in pain and and so forth. Right. So there’s a lot of things going on when you engage in a rehabilitation process that isn’t necessarily just about, oh, I need like in your case, oh, I just need to get my hamstrings stronger again, you know, it’s like, yeah, that’s that’s part of the goal, but that’s only one part of the overall rehabilitation process.
Paddy
Right. But yeah, I don’t know if you want to touch on anything else there in the kind of rehab process maybe. I don’t know. I don’t know if we want to do it necessarily in this episode, but maybe just touch on a few different types of injuries.
Gary
Yes. Yeah. So you obviously have a lot of different types of injuries that can present themselves and you can think of this in terms of the the tissues is probably the most helpful way of thinking about it. So you’ve obviously got bone injuries which can be just explicit fractures that someone can get where you just breakable or you break part of a bone.
Gary
You can also get other injuries to bones like, you know, bony bruising or inflammation to a particular area, these types of things. But fractures are probably the biggest thing that people think about when it comes to bone. There are then many other tissues that would go into or that you’d find around a joint, let’s say. So for example, you can have ligaments, so ligaments connect bone to bone, and they can be strained, they can be torn, and as a result, they can be a source, a source of pain or a source of poor function.
Gary
So the classic one that people always think of is your anterior cruciate ligament. So your ACL plays an important role in the knee, and when people rupture that, they often end up with, you know, a difficult time, especially after surgery, trying to get back to sport. So you hear a lot about ACL rehab as a result of that, but you can get a ligament injury and pretty much any joint you can get.
Gary
Tendon injuries and tendons are what connect muscles to bone, so they tether your muscle down onto the bone and that’s what allows that most of the function well. And again, obviously you can rupture tendons but you can also get tendon apathy or tendinitis where you have kind of more of a chronic issue with the tendon that it’s not functioning properly, it’s causing pain and it’s not doing its job properly.
Gary
And that again, can be a problem for people. You’ve got, of course, muscle injuries where you can strain muscles, you can tear muscles or you can rip them right off the bone like I did. So that again, exists on a spectrum from something small like, you know, a a bit of trauma, like a dead leg, let’s say that’s a it’s a muscle injury or a little a little tweak, as we might often call it in the gym or a pulled muscle, these low level muscle strains that we get.
Gary
And then you can obviously have the severe cases where you tear the muscle entirely that might require surgical intervention. So there’s a spectrum there. Again, with muscle injury. There are other tissues, of course, that can get injured, things like MINUSCA and intra vertebral intervertebral discs in your spine, for example, and some other tissues as well. So there’s lots of different types of injuries there.
Gary
But the big ones that people probably most often come to also go to a physiotherapist with in terms of trying to rehab are injuries related to bone to cartilage or meniscus, those types of things, like I said, and ligaments, tendons and muscles, they’re probably the big ones.
Paddy
And so let’s use you as our case study, right? So we’ve given a little bit of a background of the rehab process, the different types of injuries. Cool, cool, cool. We’re not going to go through every single one of them. And so this is how you rehab a muscle strain. This is how you rehab a disc injury. Obviously, that’s a much, much too big of a scope.
Paddy
Right. But let’s actually go in with you guys. What happened to you and then maybe talk us through the general kind of thought process around the rehabilitation.
Gary
Yeah. So about six months ago, I tore to the proximal origin of my hamstrings. So what that means is that in your your hamstrings, you’ve got three primary muscles, so you’ve got your biceps ephemeris, you’ve got your semi tendencies and you’ve got your semi membranous three muscles and they attach proximally so close to the bottom on the back of your thigh at the issue you were cross-city.
Gary
Okay? So that’s when when you sit down sometimes you’ll feel a hard bone under your bottom and that’s your issue that you were out of it and your hamstrings attach there. So I tore all three of those off the bone during jujitsu, and that meant that I basically had no proximal attachment for those muscles. So if you don’t have anything that they’re tethered to, you’re going to have of course you’re going to have a bit of pain, you’re going to have bleeding within the bone, but you’re going to are within the thigh.
Gary
But most important, you’re going to have a loss of function, so you’re not going able to use that muscle. So as a result, that required surgical repair. And at the time, so obviously the muscles had come off. So the tendon itself is no longer attached. There was damage within the muscles as well because they had kind of been torn during the injury as well.
Gary
Then there was bleeding within the thigh. And you can imagine that all these muscles are they’re laying in close to each other and there’s all this connective tissue and fascia that’s interlinked and there’s blood vessels running through there. So I had all these pockets of bleeding in and around my sciatic nerve as well. That’s another thing that you could put into the categories of injuries, I guess are nerves, but generally it’s secondary.
Gary
And in this case I had a lot of blood around the sciatic nerve that was irritating that. So all that aside, I required surgery. That’s fundamentally it. So initially, in terms of rehab, I think it’s it’s important to you can call this pre hab because prior to my surgery I was still trying to exercise and this goes back to what we were saying about the general and the specific.
Gary
So in this case, I was able to do some very light cycling, very light just literally just trying to keep my legs slightly moving, but more importantly, just generally training my upper body. So I was still able to do certain things without a hamstring, despite the fact that, you know, my mobility was quite poor, it was hard to get around, but I was able to train my upper body.
Gary
So excuse me. That then reduced the gap between where I was and where I want to be in terms of being, you know, high performance enough to get back to my sport. So that’s important in this case. So it wasn’t just a case of waiting around, wait till my hamstrings repaired and then I’ll start exercising again. That wouldn’t be a great approach to it.
Gary
So I had my surgery that meant that the hamstring was reattached and obviously there was quite a bit of pain after that and there was also quite a bit of restriction. So I was on crutches. I was in a knee brace at 90 degrees initially and gradually opened up over the space of six weeks and eventually then came back to the point where I could begin the rehab process.
Gary
Once it got to that point, I had, you know, visibly lost quite a bit of muscle in that leg. My strength was incredibly poor. You know, I had quite a bit of pain doing anything with that leg. So it started off as like just a very slow process of like genuinely just lifting my leg without any weights, just doing a hamstring curl standing, doing a hamstring curl, allowing doing a hamstring curl with just the weight of my own leg.
Gary
So not even using any weight. I remember the first day I went to the gym, I said, Well, I’ll do some leg curls and I put on the latest ways that I could possibly use and said, right out, I’ll fire away with this. This will be fine. And I couldn’t even move it, not even for one rep. So that’s the level of weakness you’re looking at after, you know, a severe muscle injury that has been surgically repaired and then not used for six weeks.
Gary
So a lot of atrophy, a lot of weakness as a result. And therefore, just like you, you would in any training program, the core principle where you start with is, right, this is what I can’t do right now. This is what I can do right now. Let’s try to close that gap. So initially stat and things like standing leg curls were just the weight of my leg toe reps, you know, couple of sets gradually trying to build that up, then going back onto the machine and saying, Right, can I do five reps with the lightest weight and just building up from there.
Gary
Similarly with the other lower body exercises, it was very difficult initially to even do a bodyweight squat. So that’s where I started doing bodyweight squats, doing bodyweight lunges and then gradually beginning to add some more weight again over time. So all of that’s going on. And then I’m thinking, what are the other components of fitness that I need to take care of here?
Gary
Because this hamstring rehab is going to be a slow process. Like I’m still at the point where I’m trying to regain strength. Six months later, like the hamstring isn’t fully recovered by any means. It’s still an ongoing long term process, but I have still been training my upper body. I have still been improving my cardio and I have still been getting back to jujitsu and doing some drilling and trying to rebuild to where I need to be and the decline of key message here is that if I was to sit around and wait just for my hamstring to be sorted before I’d do anything else, I’d be useless.
Gary
You know, I’d be I’d be waiting until probably next summer. And there’s no guarantee that that hamstring might be that that it’ll be pain free again. You know, it could still be painful. My hip is quite sore. These things happen and for me it’s about saying, right? How can I maximize what I’m able to train while appreciating that this is a limitation that’s going to take me a while to correct.
Gary
So my upper body was trained throughout that period of time. My cardio was trained throughout that period of time. And as a result, I’m at a point where my other components of fitness are fairly well taken care of. Like my my cardio is in a very good place. I’ve been training that throughout, but my hamstring still not great.
Gary
So that’s kind of the key message here, is that you need to have the general and the specific in mind with rehab. And if you’re at that point right now where you have an injury that’s restricting you, you don’t want to just be sitting around waiting train everything else, focus on other things and set goals. Don’t just be at that point where you’re saying I’ll set goals once I’m better.
Gary
What if you’re not better? You know, unfortunately, that’s a reality, whether it be after surgery or with a recurrent injury, Sometimes things don’t get back to baseline. And that’s just that’s just life. So you have to be willing to set goals in the meantime, related to other things, related to other components of fitness. And that’s what will keep you enjoying the the process of rehab.
Gary
But it will also help you commit to the process of rehab, which is very important.
Paddy
So there’s a few things there that I just want to touch on. The first one is like you’re saying you, you should be well, maybe we shouldn’t say should, but you can be working on other areas of fitness, other components of fitness, like let’s say again, in your case, your hamstring bone just can’t do anything right. It’s very easy to fall into the trap of going, all right, well, I’m just not going to train.
Paddy
And especially with something like a lower body injury where, you know, your mobility is probably restricted in terms of your ability to get around and do stuff like, I know you have to, you know, get a few of your personal trainer friends to go through sessions, which you just hit and you weights or you stuff around because it’s not like, you know, if you go into a gym and you’re like, Oh, I just actually need to move this bench around so I can do whatever it is.
Paddy
Like your hamstrings gone, like moving something around, like you’re, you’re doing a one legged, you’re on crutches, you’re yeah, it’s very hard to do, right. So you might need a hand in the gym, but then also with that, especially with something like a hamstring injury, like you don’t realize how much your hamstrings actually or your lower body in general, how much you actually use that for like stability, like you’re doing like, say, like a dumbbell bench press, you know, like you’re using your legs a huge amount for stability.
Paddy
First of all, getting the weights up like you’re using your legs to do that. So that’s obviously a harder thing to do now. But then also when you’re even doing the exercise, you’re using a huge amount of stability. So you’re going to want to or at least you should maybe potentially keep training other components of fitness, you know, other areas of your body, like if it’s a lower body injury, like you can probably keep training your upper body, but you’re going to have to modify the exercise, You’re going to have to modify the training sessions that you’re going to do to account for the fact that your hamstring or whatever other injury you have is
Paddy
there. Right. And this is one of those things like, I know you don’t really do any like consultation calls at the moment, like sales calls or anything like that. But a lot of times when me and Ryan get on calls for people that are I want to join up with coaching for an injury, what I’ll often say is, Oh, well, I’m just going to wait till week 12 or whatever week they’ve been told in their mind of like that’s when the that’s when the physio says I’ll be able to get back to, you know, regular exercise for that injury.
Paddy
Right. That’s what they kind of think in their head. But in reality you should be, we would argue, obviously not in the stresses of work and sales pitch, but like we would argue, do you want to get started with coaching earlier in that process purely because, like you don’t want to just wait till week 12 when the physio has determined that, Oh yeah, like it’ll probably be better based on everyone else that’s got a similar injury week 12 or whatever week it is, week six, whatever they say, you know, it’s like that’s when you’ll probably be able to do hamstring curls again or whatever, right?
Paddy
You want to wait till then and find out about like, I’ve actually lost all this muscle elsewhere in my body. And then also I’ve just lost all these different components of fitness. And I’m also not actually able to do what I want to do, you know, I’m not actually able to do any upper body lifts anymore. I might be I’m somewhat so much weaker, my fitness, etc., etc..
Paddy
Like they’re all in a bad place because you’ve done nothing other than focus on not doing exercise. You’re like, Oh, I’ll wait till week 12. That’s when I can go back to exercise. So you want to start earlier in the process. You want to be working on other things that you can still work on. And unfortunately it’s going to be harder to do that because you have an injury, not just because you’re limited by whatever injury it is, but because you’re going to have to also manipulator, you know, change around your training programs so that you can still train like, again, as I was saying, like if it’s a lower body injury, that does still
Paddy
affect your ability to train your upper body, like, how are you going to stabilize? What are you going to do there? Are you going to switch to machines? What, Like you have to have a plan of action for that. And that’s where something like coaching comes in, where you’re like, okay, well, this is actually how you change the program so that you can still train with this injury.
Paddy
And like, there’s so many things that you can do that aren’t initially all that intuitive. Like if you like, I know you’ve had a few clients like this, and I know I’ve got a few clients like this that they’ve got like a wrist or a hand injury, and you go, Oh, well, upper body training and a few lower body training exercises are out of the question.
Paddy
Now, we can still do a huge amount, like we can get stuff like Grips or not grips like, you know, they’re literally straps, you know, you can have them at the elbow, You can do it like there’s so many things that you can do to keep training. The different muscles around the injured area so that you come back when your injury is fully healed, you’re now actually able to use that limb or area, whatever again, and you’re still in a good place.
Paddy
You know, like if you would just given up and gone, Oh, look, I’ll just I’ll just wait till the hamstring is good to go. And you didn’t work on your cardio, you didn’t work on training your upper body. You didn’t work on X-Y-Z right. But you come back to that place and like right now, I know you’re still somewhat in pain.
Paddy
Like, if you come back to that and you’re like, right now, I I’ll start rehabbing the hamstring and you go to do the hamstring curl and, you know, the lightest weight you’re not even able to do, right? That’s pretty demoralizing. But now imagine you also come in, you go, Oh, now I can start training again. I remember I used to be able to bench press 100 kilos for eight, and you go in your bench press, you’re like, I can’t even do 60.
Paddy
Yeah, you know, like, forget about the hamstring injury. Now your whole body has become weak. Now you’re you have a whole crisis of identity. You know, you’re like who I am? And I’m like, What’s going on here? You know? So, like, you don’t want that to happen and compound with an injury. You want to look after everything else while you still can or if you still can, and then rehab the area that needs rehab, you know.
Paddy
So again, not not that this is a sales pitch for coaching or whatever. It’s like don’t just waste. Don’t just say, oh, some arbitrary like, oh, week 16 or whatever. Like we hear it all the time. You know, it’s like this is when I’ll start coaching because that’s when the physio says I can start training this muscle group again or whatever.
Paddy
It’s like you should be training and everything else. And very often people aren’t because they’re waiting for, again, the physio or the doctor said, Yeah, like week 12 is when you can do a strike or whatever, Week six that there’s, there’s just arbitrary numbers like yeah, there’s some, you know, averages that say like all week six, this is probably when it should be healed or whatever.
Paddy
But that doesn’t mean that that’s the case for you. Like in your is a you know a case of one it’s like it’s only you that you’re healing, you know. So that’s the first thing you might need to say on that.
Gary
Gary Yeah. And I think the, the one that probably goes under the radar the most is, is probably cardio, I think because I think especially for athletes, it’s something I see so frequently where people will, you know, not training your upper body for a while AS That’s fine. That’s one thing. Let’s say like you can’t get around the gym like you were saying and you come back and your bench press is weak.
Gary
Very often people get that back quite quickly. But if you’ve gone three, four, six months without doing any cardio and you try to get back to your sport, now that your hamstring or your knee is feeling a bit better.
Paddy
So just especially, especially if it’s a lower body exercise, you probably weren’t doing even like some baseline activity, like walking around steps that back and that can look after your cardio fitness to a degree. But if you’ve done nothing.
Gary
It’s huge. I see it so often and like for especially as well as for someone doing jujitsu, like if I was to come back to jujitsu with a weak hamstring and my cardio was terrible, like I’m going to have an awful time because not only does it put you in a position of, you know, just not being able to do sport well, it’s also a risk factor for injury.
Gary
Again, because you think about it, let’s say let’s say you’re a field sports athlete, it’s more relatable, relatable to a lot of people or any sport that involves running. And you come back from an injury and you’re not at the point where you can begin to run again, but your cardio in general is terrible if you’re getting short of breath and dealing with all those things that come with being out of shape and unfit.
Gary
If you’re dealing with that alongside the the goal of trying to maintain your your running mechanics, that’s going to be very difficult. So that’s where you start to, you know, be a little more sloppy with your movements. You’re not going to be maintaining your movement quality. You’re going to be more likely to, I don’t know, trip yourself up or make a poor movement.
Gary
These types of things. And that’s when injuries happen, is when people are in a very fatigued state. So you’re going to be in a very fatigued state far more often if your cardio is quite poor. So that’s that’s what I always say to people is I know it’s boring, I know you don’t want to do it, but if your sport involves running, we need to get on a bike or something and get you cycling for 45 minutes, 60 minutes a couple of times per week.
Gary
It’s boring. People don’t generally enjoy it that much. They get into the routine of it and they listen to podcasts and things like that and they like it for initially. If it’s not something you’ve done, it can seem very boring and it can feel like it’s not training as well. You know, you sitting on a bike there, you’re short of breath, but you’re not really pushing yourself and when someone’s used to, you know, going for sprints and doing these really grueling sessions, they they don’t view this stuff as training.
Gary
And that’s why people end up waiting around. They’re like, Oh, I’ll do my cardio again when I’m better and I can put effort into it. But you need to be doing what you can. And I think whatever about the upper body, whatever, about other muscles in the lower body or wherever your injury is, I think cardio is the one that really does go under the radar for a lot of people and especially athletes.
Paddy
Yeah. And also we could get into the weeds of like the mechanistic, you know, stuff where it’s like, oh, this is why it’s beneficial for injuries. Like we can talk about like different signaling molecules in the body and being like, oh well, cardio those days and it’s beneficial for that. And maybe it’s actually helping with the injury process and the injury recovery process because of the extra blood flow, etc..
Paddy
But like all that stuff is, you know, there’s, there’s, there’s, you know, science there, there’s truth there, but it’s kind of secondary to the fact that what we actually care about with the rehab process is getting you back to doing whatever it is that you love and want to do. Yeah. So, so if you come back and you’re fit, you’re not able to do what you want to do for an extra three six months while you recover the adaptations that you could have been, you know, keeping up to date.
Paddy
Like that’s, that’s just further putting you off. And this is why people end up being out of sports or whatever for like two or three years after an injury that should have taken six months to to rehab because they just they were, oh, look, I’ll work on everything when I’m able to. And then they get to when they’re able to and that they’re at such a huge deficit with everything that it just becomes an insurmountable or insurmountable process where you’re just like, okay, I’m at the very bottom of this huge mountain.
Paddy
I just I don’t have the will to climb it, you know? So don’t don’t fall into that trap right? But then going back to your general rehab process and the kind of thoughts around that, because again, I want people to come away from this thinking, oh, well, this is the general thought process rooted in the specifics. There is some things that you noted there.
Paddy
First of all, you’re like, okay, look, this is what my hamstring is able to do right now, right? So we have to have some sort of accurate assessment of what we’re able to do currently. Right. And then you also noted that it was the hamstring is the injury site, but obviously that affects other things because the hamstring is involved in stuff like squatting, right?
Paddy
So you’re like, okay, well, a bodyweight squat right now, there’s a little bit of pain, a little bit of discomfort. I’m quite weak in it, especially because there’s one leg has been immobilized. So there’s an asymmetry in muscular development. I don’t know if you were training your leg hard much, you know, So there’s there’s some muscle loss having happened here.
Paddy
Now, obviously in the leg that wasn’t immobilized. So your good leg like you were still using that to get around walking and stuff. So there’s less muscle loss there. So we’ve got a few different things going on here. Right. But the key thought process here is you’re going to start with what you can do, right? You’re going to do a little bit of an act or an assessment of what what range do I have available to me?
Paddy
You know, like let’s say, for example, you go in and you go, right, I don’t have the strength to do a bodyweight squash to fold. And let’s just say for that, whatever arbitrary like you’re like a 90 degree or your thigh is perpendicular to the ground, you know, or sorry, parallel to the ground to a foot and perpendicular your thigh is parallel to the ground, right?
Paddy
You’re like, that’s that’s the gold standard here. That’s where we want to get to where you’re not able to get that area right. So you look at that and you go, okay, well, I still need to strengthen these muscles. I still need to strengthen this movement pattern, etc., etc.. So I’m going to do what I can do. Who cares if this is like a quarter squat?
Paddy
I’m going to do that. I’m going to get the adaptations there. I’m going to progress that by increasing the, you know, the depth that I can do that to. Maybe you also go, okay, well, actually I want to also increase the weight that I’m using here. I was doing body weight and like that’s progressing things a little bit more, even though it’s a quarter squat.
Paddy
I think I’m just going to hold like a dumbbell here or kettlebell here, you know, And I kind of goblet squat kind of position, right? Because I just want to put a little bit more stimulus on the muscle. So we’re not we’re not heavy loading, but we’re we’re adding a little bit more to the movements right? So you’re basically looking at it going, this is what I can do, right?
Paddy
And then from there, you’re going to try to progress that. First of all, back to what quote unquote, normal functioning muscle is able to do or normal functioning joint movement, whatever is able to do. And then you’re going to go, okay, well, how do I progress this more and more? Again, going back to the hamstring curl exercise there, let’s say it’s a lying hamstring curl and you’re going, okay, look, this is really hard in that like really bottom position here.
Paddy
So this stretch position, I can’t do that right. But I can do it if I set the machine. So I’m only doing the middle half of the movement, but then it gets really hard as well at the top where, you know, I’m in this like really shortened hamstring position, right? You can, you can just use the exercise and just train this kind of mid range.
Paddy
You don’t have to go fully contract it, you know, quote unquote fully contracted, fully contracting the hamstring. And you also don’t have to go to fully lengthening the hamstring here either. You can just work in this mid range. It’s something that generally what we would do when we’re training someone that has full function of the hamstring or whatever muscle, but it’s what you’re able to do right now.
Paddy
And then we have multiple progression models that we can run here. We can go, okay, well let’s actually try to get a little bit stronger in that lengthened position. Or generally, I probably wouldn’t start with the lengthened position in a an injury, especially if it was torn off the bone like like yours. I’d be like, Oh, yeah, maybe we can just get a little bit stronger in the shortened position and then we’ll start working on the length and after we feel a bit stronger, a bit more confident there, right?
Paddy
And so you have progression available to you. What the thought process here going into this is what can I do? Okay. We’ve got an assessment of that. How do I progressed so that I can get back to what I want to be able to do? Right. So you slowly progress it, whether it’s, you know, small increase in the weight, small increase in the range of motion, it all builds your confidence.
Paddy
It all builds the strength and the stability of those joints, those muscles, whatever. And then we get to a point where you’re now able to actually start loading the exercise like you could have spent. I don’t know if you did, but you could have spent ages on that hamstring curl machine going, okay, I’m just going to absolutely master this first weight.
Paddy
You know, I’m going to be like, okay, this is a perfect rep, if you will, right? And Then you just start loading that just like you would with any other exercise, you know? And this is one of those things, especially if there is an asymmetry here going on. Like I probably bit of an advocate of doing more of a like unilateral work.
Paddy
You know, you call it unilateral like a dumbbell. Bench presses unilateral if you want to think of it like that, because your limbs are independent. But I probably would favor more like that’s actually work on the limbs independently. Right. And then get to a stage where there’s no real strength deficits, you know, but this is probably going to involve you then changing the weight on the machines or using different weights for different arms or legs or whatever.
Paddy
And that’s okay. You know, generally we would say, oh, let’s just try to use the same way across these, you know, body parts or whatever. But in the injury process or injury rehab process, I should say, it’s okay to use different weights, like if your left leg, for example, is all good, you’re like, okay, I can I can load this.
Paddy
I can be doing a a leg press machine here and I can I can push hard with this leg, but the other leg, I just need to use the first place, you know? It’s just that that’s it. That’s all I, that’s all I can do, you know, I just do first the first weight selection. That’s it. You know, That’s okay.
Paddy
You don’t have to not train the other leg hard just because one of your legs can’t be trained hard. Right? So there are a few things. What are your thoughts on that, Gary?
Gary
Yeah, I agree. I’m like, I think firstly regarding like what you were saying, what range of motion in that? I think that that gets to a broader principle of understanding what training principles are at your disposal, that it’s not just increased weight until you’re fully stronger, that you’ve got these variables of modifying the range of motion. And I think especially as personal trainers, we run into this a lot where we have these these conceptions of of exercise choreography, if you will, that this is what a squat looks like.
Gary
This is what a hamstring curl looks like, and we don’t deviate from that. So if someone can’t get do it, do a squat to parallel, like you said, it’s like, okay, well we can’t do a squat, let’s do something else. Whereas if you go to you go to my Instagram or even like today when I’m training now what you’ll see is I’m do I’m still doing a squat.
Gary
That’s, you know, probably at least 15 degrees, I would say short of parallel, because when I get down to the bottom, like my hip is just very sore. It’s it’s just not a not a great position. It’s I’m still not quite ready for heavy squatting in that range of motion, but it’s just a modification that you make, you know.
Gary
So that’s, that’s one thing where it’s modifying the range of motion and that’s that ends up being quite tissue specific as well. Because if you take an irritated tendon or an irritated muscle injury, you take into its length and range and and put a lot of load on it there, that’s going to be quite, quite provocative. So very often we do end up working in those positions that are closer to the mid range.
Gary
So that’s one thing is just the range of motion side of things. Things like tempo as well are really important. So you know, you can start with a temple of nothing in the sense that you’re just doing isometrics, that’s an option for people. And I did that as well. I’m still doing that, that you just use isometrics where you’re contracting the muscle against something, but you’re not actually moving through any range of motion.
Gary
So that’s an example of tempo being used. But a more obvious example would be cases where instead of moving very explosively through the range of motion like you might normally you use like a three or two old temple, for example. So 3 seconds on the way down nice and slowly, 2 seconds on the way up, nice and controlled.
Gary
That’s something I use very frequently for tendon injuries in particular because tendons, their function is kind of to store and release energy. You know, that’s kind of their purpose, is that it? It gives you that bit of a a bit of a bounce, a bit of a boost out of the bottom of a range of motion.
Paddy
You know, they’re like an elastic band.
Gary
Yeah, pretty much like it. It’s for for nerds, it’s more complicated, but for, you know, it’s pretty simple understanding, like a bit of a bungee cord, a very tense bungee cord. So if you’re taking them in and aggressively moving your range of motion, it’s going to be quite provocative for attendant. Whereas if you’re nice and controlled it, they tend to be able to handle it a bit better.
Gary
So that’s again example of where tempo comes in. And that again is a progression model, especially for hamstring injuries. Actually this is a big one where at the end of the rehab process that’s when we really start to focus on storing and releasing energy, sprinting, high velocity exposures, you know, fast eccentrics, these types of things. Whereas early on in the rehab process, it’s going to be more slow and controlled.
Gary
And so it’s not just about the weight, it’s about all of these training variables coming together as part of the rehab process. And the other thing you touched on was the, you know, that question of should I train the opposite side with the same weight? People ask me that all the time. So let’s say I go today and I do my like curls.
Gary
I can probably do, at least I would say still probably 30% more on my strong leg because it was my strong leg anyway. So there was a bit of a deficit already, but I’d say about 30%. And if I was to just train with much less weight on my right leg, my uninjured leg, then I’m not really going to be stimulating it much at all.
Gary
But what you have to realize and what I always tell people is that when you have an injured leg or an injured limb of any sort, an injured muscle of any sort, and it’s far below your normal baseline, the rate at which you’re going to progress is going to be much faster in the uninjured are in the injured leg than in the uninjured leg because the uninjured leg is already you’ve already, you know, kind of maxed out or taken it to a much further place.
Gary
So you’re going to be progressing faster with the injured leg because you’re you’re regaining old strength. So you have to you have to think about that when you’re training. So what what is relatively the same amount of a challenge, the same R.P, let’s say, for the injured leg is might be the same now at a much higher weight in the uninjured leg.
Gary
So all that is to say that I still recommend most often that people continue to train with the weight they’re able to do on whichever limb. So you basically just lift what you can if you’re injured or if you’re not injured, because otherwise you’re just deciding not to train the other limb like it’s not. Suddenly now is going to be the point where you get runaway progress and your your other leg gets too big Like that hasn’t happened for the last five years.
Gary
So why would that happen now? And so in most cases, not all. There’s probably some exceptions. In most cases, that’s what I end up advising.
Paddy
100%. And you also brought up something there that is I think is quite important. And it kind of brings us to the next part of this. So let’s just say you’ve got to the stage where you’re kind of like where you are right now, where you’re kind of like, okay, I’m back to a relative baseline. Like you said, you have some pain around the hip.
Paddy
And so but you know, you’re not exactly going, Oh shit, my, my hamstring, I better not, you know, I have to really support myself and I’m trying to set for a stand up from this squatting position like your back to a relative baseline where you’re pretty happy. Like, Yeah, okay, over the next 3 to 6 months, it’s probably going to get a little bit better and you’re going to feel less pain, whatever, right?
Paddy
So that’s where most people can get you. That’s actually a relatively easy place to get. Well, I shouldn’t say that because, you know, some people don’t even get to that. You know, it’s a relatively easier place to get to back to kind of baseline functioning. Right. But and this is especially the case for hamstring injuries in, you know, field sports because this is very common.
Paddy
You or someone tears a hamstring go something that our hamstring etc.. Right when we want to go to or go from baseline functioning to let’s say elite sports but even just, you know, relatively high level sports, right? There is a bit more that needs to happen right? And and again, we can kind of use you as the case study here, but I know I’ve had loads of clients.
Paddy
Again, I know you’ve had lots of clients, and I know Luke has a few few clients as well that are in similar kind of position where they want to get back to running. Maybe they had a hamstring injury, I shouldn’t say running even they want to go back to sprinting. They’ve got a hamstring injury and a rehab process went well.
Paddy
You know, it’s like it doesn’t really affect them. They actually feel good in the gym, like maybe there is a little bit of a strength deficit and, you know, whatever. But they feel good in their strengthening of their muscle at length and ranges. They’re like, yes, there’s no real provocative movement. They feel like they’re they’re strengthening everything up.
Paddy
But then they go out and they go for a run. They go back to training and they go their first session. They’re like, I need to take a little bit easier. They get up to like 60, 70% of their sprint speed and they kind of feel a little bit like, Oh, okay, something’s there. The hamstring I feel about me, right?
Paddy
But they’re out there. Okay. Right. And then they try to go a little bit harder. They go up to 80% of their their sprint speed and boom hamstring is injured again. Right. And that’s one of those things that is really annoying about the rehab process. Right. There’s going be ups and downs. There’s going to be back and forth.
Paddy
There’s going to be it’s a bumpy road. That’s the way I always describe it. I’m like, right, we’re on a bumpy road. There’s potholes, there’s speed bumps. It’s just a crap road. Right? But eventually, hopefully we’ll get to the superhighway where, you know, results. It’s just easy or it’s plain sailing. But right now we’re on this bumpy road.
Paddy
There’s going to be setbacks, there’s going to be ups, there’s going to be downs. You’re going to be like, Oh, yes, everything’s going great for a couple of weeks. And then boom, we’re back five steps, right? And and this is a really demoralizing process. So first of all, I want to talk to you, the kind of mentality here and then maybe talk through like, how do we get someone from baseline functioning back to more quote unquote, elite?
Paddy
Right. And the reason I want to talk about the mentality here is because this is probably the biggest factor, like the actual, you know, bodily adaptations. I’m like they’re actually a little bit easier to understand. Right? But the mentality is a lot harder because you basically, especially with certain injuries, you basically have to teach the body how to move again.
Paddy
You also have to teach the body to feel safe in certain movements or doing certain things like I have a few clients or have or have had a few clients that have had lower back injuries. And that’s of those that you see very commonly in the general population. Something will happen, slip disc, whatever. Right? But it actually prevents them a lot in the future from doing different activities because they just feel like they shouldn’t be in these different ranges or they shouldn’t move like that.
Paddy
And that leads to worse function over time. Like, say, for example, you have a low back injury and you don’t do any hip hinging then at all like a deadlift or DL, whatever, because you’re just scared of that movement. You feel a little bit of pain when you do that movement and as a result, all those different muscles that are responsible for stabilizing that movement and actually performing that movement, they get weaker over time because you’re just not doing it right.
Paddy
And obviously that’s not going to be a great way to feel more robust, feel more functional, and actually reduce the pain that you feel in that position because you’re weak in that position. If you just ignore a lot of position or those positions. Right. And again, that’s very, very frequently experienced in the general population because most people want to move away from pain.
Paddy
You don’t move into pain, right? It’s fairly obvious intuitive way of thinking, like who wants to just move towards pain, Right? And but mentally you kind of have to put yourself in a position where you think, okay, I need to tell my body that it is actually safe to be in these positions, that it is actually okay to be in these positions.
Paddy
But you also have to acknowledge that sometimes your body’s going to bite back, sometimes your body’s going to go not not today, some setback back that you know. So I had we had we deal with that the whole mental side of this. And then how do we actually get someone back to like return to play.
Gary
It’s very difficult. And this is, like you said, probably the the most difficult barrier is for me to get to the point where I’m at now, like for most people, that that’d be a great outcome, you know, and that I’m able to walk, I’m able to go for a run if I want to go for a hike, if I wanted to, you know, be able to go around the hospital and work in these type of things, I can do anything I need to be able to do now.
Gary
But it’s about being able to do what I want to be able to do. So, you know, Jiu-Jitsu is obviously quite a chaotic sport. It involves things like wrestling and, you know, lots of lots of provocative positions that are not necessarily planned. You end up there by accident. You know, you end up with your hip in an awkward position, your hamstring overstretched, under load, etc. So it’s asking a lot to be able to get back to the point where you’re now ready to take on whatever that sport throws at you.
Gary
And it’s the exact same field sports. And I will tell this to clients very often. I’d say, you know, there’s no guarantee that you will be the athlete you were or the athlete you thought you’d be before this happened. It’s a very, very hard thing for some people to take. And you see that this ruins some professional athletes where they get one injury and that’s it.
Gary
They just they’re never able to get back to the athlete that they were for many different reasons. You know, number one, it might be genuinely that the injury just isn’t healing. But I think what happens most often probably is that they’re just not able to take the risks psychologically, that they were once able to take. So, for example, if you have a very severe hamstring injury, let’s say, and now you’re in a position where you’re deciding, you know, will a sprint win like jump, Will I tackle these little decisions that ideally you don’t want to have any second guesses as an athlete, you just want to go for it.
Gary
You now have a little bit of a second guess or a little bit of awareness. So every time you land, every time you go for a sprint, every time you jump, you just have that little bit of a check in your own head where, Oh God, I wonder if my hamstring take this or one of my ACL or one of what?
Gary
My shoulder, even though you’re going for it, there’s that little bit of a check first and foremost. And as soon as that starts to happen, that will that ends up compromising people’s performance. So they might get back to the pitch, they might get back to the court or the mats, whatever, but they’re just not able to go for things the way they were previously.
Gary
They’re a bit more of a conservative athlete compared to who they used to be, and that’s fine. It’s reasonable. It’s it’s actually rational. Like that’s the it’s the right thing to do from a safety perspective, but it’s a barrier for athletes. And sometimes sometimes you said you can’t get over it, but very often most people can get back to the point where they’re at least able to play, they’re at least able to compete.
Gary
And I think the first psychological barrier that I bring people past is understanding when pain is of concern and what’s acceptable. So for me right now, I like having the goal of training without any pain. I don’t know when or if that will ever happen. If, like I just can’t I can’t guarantee that for myself. And I always tell that to clients as well as that.
Gary
You know, when you have a especially if you have a severe injury, that area just might be a bit more sensitive. You know, you might have damaged some nerves in the area that make that that area just a little bit. It doesn’t feel the same. You know, you’re always aware of it. It’s a little bit more painful. Like I have a lot of sensory nerve damage or on the back of my thigh.
Gary
So I get weird sensations. There’s some places I can feel. I have no sensation there at all. So all these things are somewhat complex in the sense that you might have little sensations, you might have little bits of pain that you’re not entirely sure to interpret, and you’re saying to yourself, Is this muscle going to tear again? Is that dangerous?
Gary
So I always tell people during the rehab process that, you know, that awareness, that little bit of sensitivity is entirely normal and you have to be able to accept that and to be able to call yourself out when it’s getting worse. So this is the this is the the thing that other there’s too there’s two types of athletes that I think of.
Gary
Here are two types of rehab candidates. There’s the person who’s a total Penfold. They won’t tolerate any pain at all and they’re totally scared of it. And then there’s the other person. I’m probably closer to this side, so I need to call myself out on it. The person says I have a bit of pain, but sure, sure to be grand.
Gary
That’s normal. Keep pushing it, you know, I’ll keep pushing it and you push too far and suddenly you’re provoking the injury again. And that’s not not a good position to be in. So you need to be able to stop yourself and say that pain that I’m experiencing now is actually of a different quality and of a different severity than the little niggles I’ve been experiencing.
Gary
Normally during the rehab process, I might need to stop something here, and that can be very difficult. DO as an athlete, especially, you know, in a sport like jujitsu at the moment where you’re competing against someone, even if it’s just in training and you see something that want to go for, but you just tweaked your hip or you just treat your hamstring, you want to go for it, or if you’re being choked, you want to defend it, you know, even if that involves, you know, sacrificing that leg a little bit happens all the time.
Gary
So think of those two different avatars, I guess you could say the person who’s totally afraid of any pain or discomfort and, you know, reasonably so as well, like that’s not a totally rational position to hold. And then the person who’s willing to risk it again, you know, they they’re like, God of pain is fine, Let’s keep going, figure out which type of person you are.
Gary
And that’s probably the first step to trying to overcome some of these psychological barriers, because it’s not just the barrier of being scared, it’s also the barrier of being a bit too brave where you actually do risk injuring this again. So that’s step 100%.
Paddy
Yeah. There anything else you want to cover on this? Because I think like it’s quite hard to talk someone through, like how do you actually get back to elite or quasi elite movement? Because there’s no actual blueprint, you know, And obviously there’s no guarantee that you’ll get there either. And it’s more of a mental game. Like, for example, like you can just change your jiujitsu game, you know, that’s you can do that, right?
Paddy
But in some sports you can’t you can’t really just change the way you play and maybe you can like you can change your position, like, say you’re a field sport athlete and like you’ve always been, I don’t know, a a forward, but now you can play in defense or something and stuff like that. Maybe it’s possible right? But it’s the actual mechanics of how you go about it or the actual protocols that you use.
Paddy
There’s no real clear picture for that. You know, like we basically want to do the same thing we were doing at the start of this rehab process and basically go, okay, these are the things that we want to be able to do. How do we start exposing you to them in a kind of progressive manner? So again, with sprinting, for example, and a hamstring injury, you might go and do that.
Paddy
Like, okay, I’m going to go to 60%. How did I feel? Okay, there’s a little bit there. Okay, We’re not going above 60% until you have owned that 60%. Like you feel good in that 60%, you’re like, there’s no concern there, right? Or then you go to 65%. Okay. Yeah, cool. There’s still a little bit there. And we basically keep pushing that until we get you to the stage where you’re like, there’s no real pain or discomfort here.
Paddy
And some of that’s mental. Some of that’s also just like the actual adaptations that need to occur at the, you know, the tendon, the ligament, whatever was actually the issue here. Right. But again, you have to realize that some people, they just don’t get back to that kind of 100%, you know, or it just takes a long time.
Paddy
Like you might be able to get to 90% in six months. But to get to 100%, it’s another two or three years. You know, like that’s that’s relatively common, you know, And so is there anything you want to add there in terms of the actual like more physical training side of things from getting someone to to or from the baseline to elite?
Gary
Yeah, just I suppose one more note on mindset just to round this off is to like speak to a high level athlete or speak to a group of high level athletes and ask them how many of them have pain. At the moment, almost all of them will and this is, I think, something that a lot of people don’t realize is that to compete in sport, especially at a high level, there’s so many injuries.
Gary
There’s so much pain that’s just tolerated, you know, and even listened to I was listening to Roy Keane talk about this recently where, you know, he was talking about how after a game he would just be his body just be battered off, you know, and he’d be going into the next game and he’d have pain. These types of things like this happens in so many sports, even at very high levels where athletes are just kind of chronically in pain, you know, and they just get on with it and like, that’s the difference between sport and health.
Gary
And I think sometimes we fall into the trap of putting those two things together, that assuming that because we talk about exercise being healthy, because we talk about doing your cardio and lifting your weights, etc., that that is the same as the sports in which those things are involved, which is absolutely not the case. Like you speak to any bodybuilder, you speak to any powerlifter or Olympic weightlifter, almost all of them have some sort of niggle.
Gary
Almost all of them have an area that’s chronically in pain. It’s chronically at them. Like there’s so many guys that are going into the gym doing their heavy squats today and popping pain pills before like are before their session. You don’t realize how common that is, and people are rubbing on anti-inflammatory gels and creams onto their knees and taking 20 minutes to warm up.
Gary
There’s so many people in gyms around the country, around the world, and so many people in training centers around the world that are chronically in pain, but they see it as just part of their sporting pursuits. And unfortunately, that’s it’s it’s almost a necessary trade off in many cases of trying to be a high level athlete because especially if you think about competing at a high level, let’s say you have a span of ten years in which you can try to make this happen.
Gary
You know, and beyond that, you’re going to start to physically degrade. You’re not going to be able to reach peak performance. If you’ve got that small window of time. You obviously are going to look at that and say, I need to be consistently training, I need to I can ignore that, that hip. Maybe I do have a bit of arthritis.
Gary
It matter for now. I’m pushing through it because I’ll deal with that after my career is over. And that’s why you see a lot of athletes ending up with, you know, things like joint replacements and that type of thing. So don’t fall into that trap of assuming that, you know, the principles that are the the way rehab works and the goals of rehab are the exact same for the athlete and for the average person, because they’re not really.
Gary
And for a lot of athletes at a very high level, there’s a certain amount where we’re just going to say, right, this shoulder injury, if you keep training, you keep competing in the sport, it might get a little bit better. But It’s not going to get better. You are going to be in pain. That happens for a lot of people, unfortunately.
Gary
So that’s the mindset side of things.
Paddy
And just just on that as well. But it is also an area that a lot of people don’t realize, but this is a lot of the reason why athletes take so many drugs, right? Different drugs, steroids in different growth hormone and different peptides and different things like a lot of it is not to like do what people generally generally think of.
Paddy
Like people think of, oh, they’re going to take steroids to get bigger. And that’s, that’s the thing, you know, And like, yeah, for some sports that’s the case. But the vast majority of people take performance enhancing drugs so that they can recover more. Right? Like you don’t think Lance Armstrong was taking steroids because he wanted to think about, you know, like he didn’t that’s not what he was for.
Gary
He wouldn’t even carry shopping because he.
Paddy
Literally didn’t want his arms to get big. So his wife would be like, can you help with the shopping? And he’d be like, No, that looked like he was taking those drugs to help with his recovery so that he could train more. Right? So that’s something that people don’t often understand. And from that perspective, and it fits in with this conversation where a lot of the time and this is again, one of those weird like it kind of flips where taking drugs might actually be healthier for the athlete, right?
Paddy
Whereas in the general population, we’d probably say, you know, taking drugs is the unhealthy approach to all this, like health and fitness stuff. Whereas if you’re an athlete who’s exposing yourself to all these different kind of traumas and different like and things where if you could just be a little bit more recovered, you would actually have greater longevity and also greater like health span and lifespan, you know, which is a weird kind of place to be in, you know.
Paddy
But yeah, that’s I just wanted to make note it.
Gary
I know it’s it’s a it’s actually a really good point because like in some sports this becomes even more important. I think you can actually make a massive case for this in bodybuilding where if you look at like natural, natural bodybuilders like their health is terrible by the time they get to the stage, like they feel like crap, they’re dealing with so many different symptoms as a result of, you know, their hormones being out of whack because they’ve diluted to such a low level of body fat.
Gary
And you can actually correct a lot of these things by taking steroids like that stuff.
Paddy
Just be like, Oh, I’m going to give you a TRT dose. So testosterone replacement dose, you just as your testosterone, I’m just going to give you some thyroid medication and you’re like, you’ve actually increased the health of those individuals. Yeah. The result of that.
Gary
Yeah. Because you’re correcting deficiencies that are the result of the practices of the sport. And like another example of that would be relative energy deficiency in sport and fractures, low bone, mineral density, all these types of things that happen in like endurance sports, for example, like you, if you’re if you get that person to take certain drugs, you could improve their health by those metrics.
Gary
So you could deal with some of the hormonal issues that emerge in sport. So that’s that, again, is just one of these very difficult areas and that that’s definitely a topic for another podcast in future where understanding, you know, why drugs might be used in sport and what role they play beyond just getting bigger and getting stronger. Like that’s, that’s a huge one.
Gary
But also like the the ethical questions and the health questions related to drug use in sport are a lot more massive than a lot of people probably appreciate. You know. So anyway that’s that’s for an also.
Paddy
To realize that a lot of people don’t realize that I’d say maybe 95 to 99% of the athletes that they aspire to be like are on drugs. And people always say, Oh, well, the sports I like is an amateur and amateur. It’s 100%.
Gary
If they’re not getting tested.
Paddy
They’re not getting tested like people always do that. They’re like, oh, like it’s an amateur sport or whatever. Like gay men. So many of them are on drugs. I know for a fact that they’re on drugs. Right. And people are like, oh, it’s an amateur sport, not they’re on drugs, right? Amateur sports at the Olympics on drugs, 100% on drugs.
Paddy
Yeah. And people don’t realize that because they think, oh, well, steroids are for muscle building. They’re to get like, jacked. This person that I follow, they don’t look, they’re not 100 kilos jacked of mind, you know, sort of like that. They couldn’t be on steroids. They’re on steroids for recovery, for injury, rehab, for whatever. You know.
Gary
The people we were just talking about this in the in the gym yesterday with you to jujitsu. And, you know, a few of the guys we’re talking about all. Who do you think take steroids, talk more like high profile athletes and jujitsu and stuff. And, you know, people are like, oh, yeah, that guy. Because he’s huge. But what about this other guy?
Gary
Like we’re talking about this much smaller guy who doesn’t look like he’s massive or anything, but he trains 12 hours a day every day. It’s like, Yeah he’s very likely to be on steroids because that’s going to enable him to do that. And more power to you. Nothing against that, as long as it’s not a a tested federation.
Gary
And to be honest, like jujitsu, I think, and a lot of martial arts sports, it’s kind of just like, oh, yeah, this is tested, but we know everyone’s on drugs. Like obviously, why wouldn’t it? So yeah. Anyway, side note, other than that, I think that I think this covers like a lot of what I wanted to cover in this because like I think the principles are really what’s important when it comes to rehab like like that’s that’s how my thinking on rehab has changed over time is that when I first started to study physiotherapy, like, I kind of I definitely had more of an expectation that I was going to learn all these specifics about
Gary
if you just if you balance these muscles and if you do these specific rehab exercises, that that’s how you get someone better, that’s how you prevent injuries, etc.. Whereas over time, what I’ve realized is that a lot of rehab and a lot of injury prevention is just solid, well-planned, appropriately managed strength conditioning like that’s pretty much what it is.
Gary
It’s like taking all those principles that we use in healthy people and modifying them for the injured person. So when we talk about training for muscle building and strength, we talk about these things volume, intensity, frequency tempo and rep ranges, range of motion, etc. We talk about all those things and it’s exactly what I talk about in the context of injury.
Gary
We talk about, you know, volume in intensity in terms of titrating that reducing it initially and gradually rebuilding it. We talk about frequency in terms of maybe more frequent low intensity exposures for certain injuries. We talk about tempo like we did previously, range of motion, etc. It’s all the same principles, just apply it any more and a more targeted in a more clinical manner with more regular review of how has your function changed?
Gary
And that that really is, I think, the more simple and appropriate way of understanding the rehab process. There are of course more specialized considerations, like things like neuromuscular control, proprioception, balance. For some injuries, these things end up actually being quite important and they’re quite high level exercise principles in the sense that it’s not just a muscular output, it’s the input of of the joint, the muscle, the nervous system, and all of this coming together to allow you to balance or perform particular movement.
Gary
There’s other things like regaining skill in the presence of a muscle that doesn’t have the function it used to, you know, So there’s there’s definitely higher level components that require more specialized consideration in the injured case. But fundamentally, it’s the same principles applied in an inappropriate manner.
Paddy
On a present. I mean, I don’t have anything else to add to this conversation. And so. General.
Gary
Absolutely. So first and foremost, I am have a wonderful Christmas. So this is our last yeah, last Christmas episode. So I hope you all have a lovely Christmas with your family or whoever you’re spending your Christmas with. We’ll have one more episode prior to the new year. Yeah, we will. So we’ll talk to you guys one more time before 2023.
Gary
But if you’d like to work with us in a coaching capacity, obviously this is a super busy time of year for us, the busiest time of year, particularly heading into January. So if you’d like to work with us, now is a great time to apply, so we’d recommend that you apply as soon as possible, particularly if there’s like a specific goal you have or one of our particular coaches that you’d like to work with, whether it’s myself and Patty or Brian or any other member of the team.
Gary
Sometimes some of us are full and others are taking clients. So apply earlier and that will give you the best chance of working with the coach that you’d like to work with so you can find the information about that in the description box below. If you are a coach and you’re thinking 2023, you know I’m going to upskill, I want to increase malnutrition knowledge, I want to, you know, have a nutrition certification that I can say to my clients, Yep, certified nutritionist, I can help you with your nutrition.
Gary
We do have a nutrition support as well that you can get involved with. So you see the information about that in the description box below. Of course, going into 2023, we want to make sure that you’re continuing to avail of our free content as well. So make sure that you’re subscribed. Our weekly newsletter also make sure that you’re following us on social media and keeping up with all the free content we put out there.
Gary
And I hope we’ll have another great year of the podcast as well. So make sure you’re subscribed. Make sure that if you’re enjoying the episodes, you share it. We always appreciate when people do that. So yeah, I think that’s everything from us.
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