- Anybody who works out will get injured at some point. That's just a fact, but here's the truth. You don't have to let pain derail your progress. In this podcast, I'm gonna challenge the outdated idea that pain always means you have to stop and that you're hurting yourself. And I'll share a practical approach to managing your pain, adjusting your training and getting you back to doing what you love. Let's get started. Welcome back to "In Truth and Building Love" I'm Jordan Wrennke. Thanks so much for stopping by, I really appreciate it. We haven't met yet, my name is Jordan Wrennke and I'm a dual board certified physician in family and sports medicine. And the goal of this podcast is to keep you active and healthy for life through actionable evidence for education. Today we're talking all about how you should train when you have injury or any sort of pain. So let's get into it. So first and foremost, we all have these irritations, right? They're annoying, but everyone's gonna get these. And today we're talking about these annoying type injuries. I wanna specify these are kind of chronic. Chronic meaning they've been going on for a while or insidious means they've just kind of like eked in there. I am not talking about big trauma, like your shoulder popped out or you can see a bone, nothing like that. Like this talk does not apply to that. Go to the hospital if that's happening. But these are the ones where most of us have, right? These kind of nagging pains, they're just kind of comforting, oh, my shoulder's hurting or my hip or whatnot. This is what we're talking about in these chronic type injuries. If something really, really bothers you, like where you can't walk or anything like that, then you should get that checked out. But most of these injuries are kind of annoyances and how do we work through them? Like that's the main idea behind this talk today is like how do we work through them, work around them, kind of rehab them. So that's what we're diving into. So first of all, I wanna start with kind of over idea of what is pain. So pain is super complex. If you take one thing away from this talk, it's that we don't really understand pain. Like we kind of understand it a little bit, but we definitely don't fully understand it. It is complicated. The current idea behind pain is what we call the biopsychosocial model for pain. So back in the day, we'll step back a little bit, back in the day, it used to be the biomedical model, meaning that damage from some structure led to pain. That was the leading idea that, hey, there's some structure that's wrong and that's what's causing pain. And it really kind of led us to this idea that we tried to find one cause of pain specifically. It's like, oh, it's this specific thing or that specific thing and that's really what it came down to. And what we've learned is that that's kind of outdated and it's shown to be incorrect. For an example, what we'll see in studies is that we'll get MRIs in people's low back. So we'll have half the group that has symptoms, half the group that doesn't have symptoms. We would expect with the biomedical model that if someone has pain, then they have to have confirmed findings on MRI, right? We think so, that is not the case. Oftentimes we have clean MRIs with pain or the other way around, we have people with disease, degenerative disc disease or herniated disc or something on MRI, but no pain. And so if it were as simple as, here's the cause that causes pain, it would correlate kind of one-to-one and it doesn't. And so that's kind of how it is. A lot of people, even in today's world, they'll view the body as like a machine, right? So that, hey, these parts have worn down and you can just fix this thing here and there. It's really not really complete model. And so we can't reliably predict who's gonna have pain and when we're having it. So that's kind of the idea. That's the old monocle was bio and biomedical model. Now we have the biopsychosocial. And this one is pretty much, we kind of pulled our hands like, I don't know, but no, we do know that pain is incredibly complex. It's not easy and it's not just one thing. Now we do understand, like I said, that it's very complex and it's more related to the perception of threat and a need for protection than actual tissue damage. So I'll repeat that. The idea is that pain is probably more related to the perception of some threat or protection of the body than an actual tissue damage. So for whatever reason, your body is saying, hey, this position causes me quote unquote pain. Like this is a threatening position. Maybe I'm worried it's gonna hurt me or it's gonna lead to something. And that is what the idea with leading to pain and not necessarily straight on tissue damage. And so I do wanna reemphasize that pain it doesn't always equal damage. And if we kind of take a step back, biopsychosocial, bio is biological. So I'm also here to say that you can absolutely have biological things wrong or structural things wrong that can cause pain 100%, right? So things like inflammation, those are biological. Structural issues, a tear in your muscle, that is very valid and that may cause you pain. That is very, very valid. So I do not wanna remove bio. I think a lot of people do that in the world. They kind of throw everything out and they say, oh, the biomedical model is old, like it's biopsychosocial. And they blame everything on psychosocial as opposed to bio. Stuff still happens. You break your leg, you tear a muscle, you tear your tendon. Like that's gonna hurt. That is absolutely gonna hurt. And so the bio side of things, the structural side is still very, very important, but not everything. So that's really important. From a psychological perspective, things like fears, anxieties, anxiety or fear about getting injured, stress, the mood you're in, all those things can play a role. And social is reactions from others, right? So it's kind of like as a kid, when your kid falls down and you look at them and say, hey, you're all right, you're safe, like I would say safe, like baseball, safe, you're good, that can change their reaction, right? But if you go up there and tell the kid like, oh my gosh, are you okay? You should be scared, then they're gonna get scared. And obviously we think we're better than that as adults, but we aren't necessarily. If someone says, this thing that's happening, oh, it happened to me, caused me lots of pain, that's already imprinted in your brain that it may cause you. And so you might have worse expectations and other things like that. So all these things play a big factor on that. I really just wanna emphasize that pain is a real experience and should not be diminished. So a lot of times, a lot of times we've gone from one side of the spectrum all to the other, where it's just completely psychological, it's in your head, we're not on us. I really don't like when people say, hey, it's all in your head, like this is all in your head, we can't find anything on MRI, it's all in your head. Like that is not a helpful thing to say. And also it doesn't matter, like pain is real and people experience this very real pain. I see it all the time as a sports doc where MRI is quote unquote clean, right? Okay, what does that mean? Do we just give up now and say, okay, well, your MRI is fine, so you're fine. No, that person is still experiencing pain. So how can we go in there, re-modulate things and help someone out? So a pain discussion is probably like literally an entire like series of discussions to have, but I just wanna say this is where we're coming from and that it's no longer one-to-one like biomedical, this is what's going on. This is kind of the general framework we have that I like to use as well. But what is the biggest cause of injuries? Specifically these long kind of insidious onset ones. I think it's something I kind of described as a volume mismatch. If I had to pick one thing, I'd say it's this volume mismatch meaning you're doing more than your body is ready for. And this is hard to know, but this is kind of the framework I have to kind of help make our treatment make sense. I think of a seesaw. So if you're watching the video version, we have a AI-generated image of a seesaw. And I think of stress and recovery on the seesaw at all times, right? So we always have stresses in life and we always have recovery, right? So that's what's going on. We want to stay in balance. However, when we're injured, we need to get back into good order. So if you think about when you get injured, you have way more stress than recovery. We need to kind of tilt the scales back so we have more recovery and that evens us back up. That's kind of how I explain things to people. So when we have a volume mismatch, what I mean by that is a lot of times we've done more than our body was ready for. We've either gone too far, we've done too much, we ramped up too fast, but for whatever reason, we just weren't ready. Our tissues are like, mm-mm, I'm not having it, or just not ready for it. And so I think of when we're injured, when we have this seesaw mismatch, it's all about getting it back. And so what do we do? If you had someone theoretically who weighs more, and they're gonna go down on the seesaw and they're gonna raise the other person up, how do we get that person back? Well, you either push them off on the bottom in terms of how a seesaw works, or you start lightening that bottom load. And that's what I tend to think about. I start lightening that load, which is the stressor in your life when you try to get back there. And the stress can be lots of things. It can be physical, it can be what you're doing in your workouts, it can be your life, it can be stress, anxiety, all these things, lots and lots of things, so it's really comprehensive. But that's what I think about in this stress and volume over matches, how do we tilt those scales back? In a timeline for recovery, I do wanna mention as well, it's very, very individualized. No one's gonna know for sure how long it's gonna take to get back from an injury. Some aches get better in a few days. You just take a rest off and say, "Hey, that's weird," but then you go and you're fine. Some take multiple months to like even a year, or like big, big catastrophic injuries more than a year. That's another discussion. But a chronic and nagging injury probably won't get better in just a few days. If you've been dealing with this for months and months, I would not expect that, "Hey, this is gonna get better in a couple of days." And so this is really important as well is understanding expectations, right? So take for example, patellofemoral pain syndrome. I have a previous podcast on that, we talk about it. One of the most common things I see, some people do a little bit of physical therapy are better in a couple of weeks and like that's it. Other people, this takes a long time. I've actually had this myself and I did physical therapy on and off for about a year till I got back to where I feel like I'm almost where I need to be. You know, I'm not 100% ever, maybe I won't ever be, but it took a long time. And that's the kind of thing I want you to understand. I'm not saying 12 months, hopefully that's not the case at all, but most people, they get to go to the doctor, and the doctor says, "Hey, here's some physical therapy." And they try physical therapy for like four weeks, and they say, "Hey, I'm not better." It's like, well, yeah, you're not getting better 'cause you've had pain for six months, like I wouldn't expect you to be better necessarily in four weeks. Maybe we should start seeing some trajectory at four weeks, but either way, I always tell people, think in terms of months, not weeks or days. Like that's the biggest thing when this is happening, chronic injuries, think months and it might take longer than you want, that's less than ideal, but that's the reality of the situation we're living in. So first, before we do this, I also wanna get people and kind of have this understanding idea of a baseline evaluation. So I kind of use either a pain score or a stoplight model, kind of depends on who I'm talking to, but I'd like you to evaluate your pain at three different time points. So this is understanding where your pain is at a baseline for your day-to-day stuff. So you wanna get your levels of pain during your exercise. So right as you're exercising, does it produce pain? Yes or no. And the obvious answer is probably yes, 'cause you're talking about how to get out of pain, but looking at during exercise, then I look at the gap of like right after your exercise, to the next couple of hours for the rest of the day. So it's like, how does that feel? And then also looking at the next day. So the reason I say this is 'cause sometimes you're in the moment, you say, hey, this feels good, it feels good. And then all of a sudden a couple hours later, you're like, oh my gosh, I'm in a lot of pain. But that tells me when I use these kind of models that, okay, the load that we did there was a little bit too much. We weren't cart ready for it. That's kind of how I think about it. And also maybe the next day, right? So you feel good all day, all day, and the next day you're really sore. That's kind of what it is. So if we have an increase in pain during any of these tests during right after or the next day, I kind of count that as a positive meaning, hey, probably gonna have to pull things back just a little bit. And I kind of, yeah, I use this in rehab as well. So I think goal overall in a normal day-to-day life is not have pain. That's the goal. But in a rehab context, the goal is to not necessarily make your pain worse. I think you'll probably have some baseline pain. I don't expect no pain. That's the biggest thing. I don't expect no pain in rehab setting. But over the course of time, I want that pain to get better, but I also don't want you to flare that up when you're doing things. Will that happen? Absolutely, that's rehab. It's gonna happen. But that's kind of the goal and the reason why we talk about these pain rules is that, hey, you have a general guideline there. But once again, the goal is to kind of rate your pain and then rate it again after the rehab exercise. If you can't do it, if they're worse than it, then we may have to kind of tweak it a little bit. And it's helpful 'cause it gives you kind of a numerical increase in pain. And that just gives you a goal line. I typically say that the allowable pain is anywhere in like a three to four out of 10 range. So if you think 10 mean the worst pain you've ever experienced or could ever experience, I shouldn't say worst pain you experienced 'cause some people say 10 and it's not necessarily 10, but 10 is like the worst thing ever. I think of like snapping your femur, something like that. And then zero is I don't feel pain. Three to four is kind of that, okay, I feel a little bit, it's not debilitating. That's kind of the goal and what I allow for pain. And I also use a stoplight analogy as well. I'll tell patients, hey, green lights, like zero to three in kind of in that area. Yellow lights can be four to six and then red lights can be seven above. And seven, I don't mean to scare people with the red light, green light analogy, but I'm pretty much saying it gives them a binary. If your pain spikes up to a seven, stop doing that. Like that's not helpful in a rehab process where if it's four to six, that's a little more nuanced. Saying, okay, we might be able to push it a little bit if it's a little lower. Getting them towards six, probably don't want it. But it gives them a reminder of, hey, this doesn't feel great. I may need to change my strategy here. Whereas green, like, hey, if we're doing that, good. You're doing your thing. So I give a lot of people just for general rehab, the stoplight analogy that, hey, I'm okay with a little bit of pain while rehabbing. Understanding it's gonna take a while and we may never be pain-free for a while while rehabbing this is something to consider. So that's kind of my general framework. And then step one here of getting out of pain and kind of the first thing is just if we really want to, have we tried any rest? So this is more for like, hey, I've been having a nagging shoulder injury for the last week or so. This is not something like, hey, I've had like months and months and months of this. I don't think that'll work. If you've had months and months and months of pain, I don't think it's gonna work if you take a couple days off, not gonna magically get better. But I do see this occasion when people are like, ah, my shoulder's bothering me. And they just take a couple of days off from that specific body part or upper body or whatever, and they feel better. So that's something you can do. If it's irritating, you can do that. And yeah, at that time, it's also nice to kind of analyze the basics in your life. How are you sleeping? How's your diet? How's your stress? All those things can play a significant role. And quite honestly, we see all the time when people are stressed that they tend to have more injuries. So think about examples are like college athletes during finals week, there was a higher rate of illness and injury 'cause you're just stressed. So maybe if you get rid of that stress, you can just get going back to what you normally want to do without having to change too much. And for me, I'm really a minimalist. I really wanna be like, hey, what's the least amount of intervention we need to do to get you there? I'm the same way for like injections and all those things. At least amount of things we need to do is I think ideal 'cause if we muck around and you might find out and do something wrong or you might be wasting time and not being able to train as hard as you want to because you think so. So that's the kind of the big thing is we can take a couple of days off. What I'm not telling you to do is to just stop doing anything. So let's just take, for example, your shoulder, right? Take a few days off of any sort of movement that irritates you in your upper body. But you could still continue with other upper body things. So maybe rows feel fine, all your pulling work, everything's fine, great. Keep lifting, I don't care. That's fantastic, but just avoid some of the irritating things. So you can also work on other ways, right? So taking a break from your normal scheduled programming, kind of make it variable a little bit, just give yourself a little bit of break, see if that does it. And as I mentioned before, what I am not saying is to not do anything for a month, right? I see that all too often. People say, oh, like I had some shoulder pain, I just stopped working out. That's not ideal. It's really not ideal for multiple reasons. One, we don't want you to lose your conditioning, meaning like we want you to be healthy and in shape. And that's a good thing for just general human health. But also we don't wanna lose your tissue tolerance. So what I mean is you get used to a certain amount of level as you kind of get going and do more and more, you're able to do more, you're able to tolerate more. If you just all of a sudden stop, your body says, whoa, I don't need to get used to this anymore. So it kind of drops down and takes a while going. So yeah, that's kind of what it is, but a few days is not gonna harm anything long-term. If you take a couple of days off, like you're gonna be fine. I think if COVID taught us anything, it's that you bounce back quick. I'm not saying do that, like COVID lockdowns where you can't work out, but I'm saying, we're gonna be okay if you take a couple of days. And then if you take a couple of days, just slowly start where you left off, right? Maybe have a ramp up day or so, so it's not like right back into it, but you can kind of trial to see where you were and see if that's helpful or not. And hopefully we've kind of passed on and gotten better with our stress and our lifestyle and all that stuff, but you can kind of look at it. And then while jumping back in, do the assessment, right? Do the during, post and next day pain assessment. If there's no pain, awesome man, rock on, you're good. Continue to train, that's what we're talking about. And once again, I want the least amount of intervention possible, but if you have pain with this, then we may have to tweak some things and now we kind of go into our next steps here of troubleshooting. So what do you do though, when you have persistent pain? This is where we start to get a little more creative and utilize different approaches for training. And overall though, the idea is that we need to tilt the favor of the scales, right at the seesaw, back to the recovery side. So that's the big thing. So we need to bring down the stress overall in our life. If we can't do it from a lifestyle thing, like if it's more than just a stress thing or a sleep thing or whatnot, we've tried those things and we're not there, well, then we got to start manipulating how we work out. So the big things we can do is looking at manipulating the volume or stress kind of through the week. There's many different ways to do that. Specifically for my resistance side of things like lifting, you can decrease your sets, your reps, decrease your intensity or use a different RPE level, meaning rating and perceived exertion. So if say you're used to working at like eight or nine where it's like pretty darn hard, maybe dropping that back to a six might be beneficial for you. You also may need to change the exercises themselves, meaning, hey, I have pain when I do a just normal barbell bench press. Well, maybe I need to do dumbbells or an incline or something like that. Changing exercise can be helpful. Changing range of motion. If you get into a deep squat and that's what causes you pain, we might have to raise up that squat a little bit for the time being. Or another thing you can do is introduce tempo. So tempo is something we talk about all the time in terms of, it's a really great tool for kind of throttling you. When I mean tempo, what I mean is if you are doing a squat, think about like going three seconds down and three seconds up, that really, really challenges you. You can do way less. You cannot do the normal weight you can do when you're at that tempo, but that can be a nice way to kind of change things up, make things challenging, but still get a good stimulus in. On top of that, from an endurance perspective, a lot of times you're gonna decrease the total time you're doing your training or mileage if you're a runner specifically. Maybe also the intensity. If you're used to doing intensity, you might pull it back a little bit. And also another thing you can do is that maybe it's your different modality. Like we talked about, running bothers you. Maybe you can continue to bike and row or swim and do something like that, but you can cross train. And yeah, another big thing we can both do though is reduce frequency, right? So you normally have done it three days a week. Maybe it's down to two. That's kind of what it comes down to. Another point I do wanna make though, once again, is in this whole process, I still want you to exercise. You do you. If it feels okay, keep working out. And we just have to tweak the things that really bother you. So it's very, very important. But at this point, if you're saying, hey, I tried these things, not getting better. Maybe we need to kind of help you find some non-irritating positions and things to do. So like most people though, who are just trying to be healthy, unless you're a very specific athlete, I think about like a power lifter who has to do squat bench deadlift, it may be a good time to explore new things and take some stress off. So if you've been doing the same routine for a while, it might be a good idea to kind of switch it up and kind of see. But that's like a general heuristic for, okay, something's going on. Like you can just start manipulating those variables. Hey, like right now, I just wanna reduce how many days a week I do it. That's great. You can go from there, but you can kind of move some things around that work for you and see if that's helping. Next, the big first point of when we're here is finding a entry point. So I say the kind of first step is finding an entry point. And as I mentioned before, I don't want you to disrupt everything in your life. I wanna make it as minimally invasive to your life as possible. Meaning, hey, if you love doing something, I love squatting or running, you don't necessarily have to stop. We just may have to find an entry point to that activity. One general rule of thumb I give is think about reducing your load or what you normally do, about 50% to start. And that may seem enormous, right? So it kind of take your normal volume and kind of volume and reduce it by 50% or even more. The goal is really to get under threshold. Kind of how I explain this is if you think there's a certain pain threshold, it's like a horizontal line, I'll explain it for people who are listening. Horizontal line of pain threshold. Right now, for whatever reason, your pain threshold is low. And when you do things, you are above that pain threshold and it's hurting you, hurting you, hurting you. What rehab is, the goal here is to get below that pain threshold, start doing an exercise. So, okay, building confidence and yeah, I can squat, like it's okay. I'm not, I'm way less than, I'm at the bar instead of, you know, doing 225 or whatever, but I can do it. And then slowly but surely inch and creep up towards that pain threshold. And then you come up to it and you touch a little bit and you come down and you just do little by little. The way I explain is we gently increase that pain threshold by going underneath it and slowly progressing over time. That's kind of how I think about it. I say 50% as well, that is completely made up. Completely made up. There's no data on that. I just find that it's a big number and it shocks people. And you may have to go even more than that. Like literally you might be squatting 315 and then have to go down to like the bar. And that's okay, that is okay. But if 50% is too much, see how it goes. We can go back down. But if you start a good spot, you know, run that for a week, I know your normal routine, but way lower and then start to go up by about 10-ish percent per week, maybe five to 10% per week. And yes, that is very slow. That is intentional. I'm very cautious to say like any number 'cause it's gonna be very different for some people, right? Some people will say, hey, I just needed to scale back a little bit for a couple of weeks and we're able to ramp up faster. As I said, everything's gonna look better when you do this in with a professional, right? With someone who can walk you through this, someone who's done this before, it's gonna go better. But I kind of send these general guidelines just to let you know, like, hey, this is gonna take a while. So if we just take, for an example, you decrease by 50% and increasing by 10-ish percent per week, that is, you know, five weeks. If we do 5% per week, then that's 10 weeks. And once again, kind of fitting in that rehab of gonna take months to kind of do this. But yes, I intentionally say it's gonna be slow 'cause that's the goal, right? We kind of just slowly inch up towards that pain threshold and increase it so we can tolerate more and do more and more. So that's kind of what it is. However, though, if you're trying to do these things and it's bad and we're not feeling good, we need to reassess what's going on. If we just decrease the volume, meaning, hey, decrease by 50%, but that's not working, then it's time to adjust our exercises potentially. This is where I love tempo in a situation or like lifting specifically. It throttles the weight you can do, but still makes you feel like you're getting a really good workout and it really helps you in doing not too much, right? You can't do as much as you want it to. And this is also a made up heuristic by me, but this is kind of, I think, about when changing the order. So first is the frequency, right? How often are we doing things? So if the first thing in change is, hey, I'm squatting four days a week, five days a week, or I'm doing lower, like something like that, can we drive that back to two? Is that all we need? 'Cause once again, that's minimally invasive in your life. You're doing the same things, the same reps, the same sets, the same intensity, all that stuff, you just need less. That's one way to do it. That's like, I think the next is kind of volume 'cause volume then starts becoming a little more invasive, right? Okay, I'm not doing as many sets and reps. Maybe I'm worried about my hypertrophy or whatever, but sometimes you gotta do what you gotta do. So frequency first, then volume, then I start manipulating tempo. So I like this 'cause it automatically throttles your intensity as well. I can still get some good quality work in, but it still gives you those regular movements, but it can be, yeah, it can be a lot nicer on people when they're having pain. Then I'll decrease the range of motion if need be. And then if need be, we can also change exercises, right? So the reason I have that one last is because presumably you wanna do these specific exercises, right? Like you'd like doing them. If you don't, if you have no tie to your exercises, then we can change them earlier, it doesn't matter. And all these, like none of these matter. Like if you wanna continue to squat four days a week, but you wanna decrease your range of motion, or you want to use tempo, like that's totally fine. This is literally like the ingredients and you can make it however you want. Artistically, the rehab program can be however your artistic interpretation is, but these are the general things you can kind of try, right? So you can kind of try and say, hey, was it this? No, okay, maybe it's this. And ideally you were doing kind of one of these at a time, but sometimes you need to do all of them together. When someone's really, really angry and worked out, you kind of throw everything at them. So it can be a lot and that can be intimidating. So I'm not trying for it to be like that, but I just wanna give you, that's the general idea of what we're thinking is how do we make this more tolerable? How do we continue to keep training? 'Cause that's ultimately the real goal, right? And then after we've done that, and we kind of found that entry point, now it's time to ramp up or progress. And once again, I mentioned about five to 10% increase per week, not a hard and fast rule. Some can do it faster, some can do it slower, which is a target that is admittedly safe and conservative because that's, yeah, general justice, I'm a pretty conservative guy when it comes to getting people back, so I wanna do that. But you may not even need that, right? May just be helpful guide for some people, but you might just be like, oh, I'm cool, I just go up by an arbitrary amount per week and that's fine, that's great. I like going slow and having small wins, it builds confidence, right? So if you're able to, before you have pain and squatting at 225, and you're like, oh my gosh, like, I got a lot of pain. And then you get down to 135 or let's say even 95. And then you say, okay, I can tolerate 95, like my knee doesn't always hurt when I'm squatting. And then you bump it up and you're able to 115, 135, you're getting there, you're getting these slow wins and these slow wins build confidence and that's what I love. Although I do wanna say, this is not gonna be linear. So there's a picture on the slide here of the stock market. Not the stock market recently, the recent events here, it's April, 2025 and the stock market is taking a plummet. But in general, in general, the stock market, I like using this analogy is over time it goes up ideally. But you do have these ups and downs, right? You're gonna have these good times and bad times and you'll have good days and bad days rehabbing and that is totally fine. And you may just be stagnant for a while too. Maybe it takes you, you spend a couple of weeks kind of the same spot feeling like, hey, I'm making progress and you break through. I really care about the trend lines. I tell people all the time, if your trend line is heading up, that's what I care about. Some people it's really steep, meaning they're recovering fast and that's wonderful. Some people are much less steep and it takes a while. As long as we're heading in the right direction, that's all I really care about. But there are gonna be good days and bad days and that's normal. That's the normal part of the progress. Maybe you didn't sleep as well, maybe you got more stress, who knows, but stick with the trend lines. And so how do we kind of put this together? I think overall, this is just a general example of like for squatting. We'll just say, let's say normally you're squatting a three by 10 at 225 pounds at baseline, but your entry point is three by 10 at 135 with tempo. So that's where we can do it. Next week, maybe increase up to 155 with the same tempo. And then once you hit that eight out of 10 RP, meaning, hey, this is challenging, then we can maybe ramp up the intensity. Then the week after maybe we're going 185 at a slower tempo of two, zero, two, zero. So we're going two down, two up. And then we can go 185 at normal tempo, just 'cause that means the intensity's coming up a little bit and sneak up to 205, 225. And this is about four to six weeks it's gonna take to kind of ramp up. And that's really on the smaller side of things. Those are numbers where we didn't go way down or you didn't have any enormously high squat. So if you're a strong person or you had to go way back down, it could take way longer. So it could be much, much further than that. And it's never gonna be that smooth, right? You're always gonna have some pain here. And as I mentioned before, I'm okay with that pain around three to four out of 10. Just follow the pain rules and your trajectory and follow that trend line and we should be good. But that's just an example of how we scale back, slowly build up and it's never that simple. It's gonna have up and downs and that's okay. So if we're having issues though, how do we problem shoot? So the biggest things that I see, if you're really struggling here, here's a couple of things I want you to consider is one, did we pull back far enough? Did you really stop doing stuff or did you not do it long enough? Meaning, hey, did you actually scale back far enough where you didn't have pain or you just said, hey, I feel like I'm weak now and I just wanna keep going and pushing through it. Like, did you honestly scale back enough where you're giving your body the offload that it really needs? That's something to think about. The next question is, did you ramp up too fast? Sometimes it needs to be painfully slow, but slow progress is still progress. Next is, do we need a new exposure? Maybe the specific exercise may not be for you right now and we need to take a break to calm things down. I do see this quite a bit where people love a certain motion and they're just like, I love deadlift or whatever. And for whatever reason, deadlift just really, really bothers them when they get to a certain point. The question you have to ask them is, is there a reason we have to deadlift from the ground for you? Is it for sport? Then yeah, we gotta do it, we gotta figure it out. But if you're just like, nah, I'm not trying to be healthy, can we mix it up? Can we elevate that a little bit? Can we try sumo stance? Can we try trap bar? Can we do RDLs? I mean, there's just so many things we can do for general health that there's just lots and lots of options that we have. And so we don't have to be dogmatic about the things we're doing. So we could just, maybe just need a new exposure. All the things as always is stress, depression, all those things, anxiety, those can play a huge role in confounding. We find mental health and recovery and pain, huge tie to that, that people tend to struggle with depression, anxiety will also have higher levels of pain. But every once in a while, you just can't break through and that happens, right? It's confusing. I'm saying this like I'm simplified terms, but in reality, it's very confusing and that it can be challenging and not everyone has the understanding or the wherewithal to do it. And that's totally okay. But if you've been doing this for a few weeks or a few months with no success whatsoever, I think it's probably smart to reach out and get some help. On the image here is the classic Thor and Loki get help. So this is them saying, hey, sometimes you need to get help. But if pain is getting worse, that's also reason to probably get a consult with someone. If you're saying, hey, I'm trying this and it's getting worse what's it getting taken care of? If you can't find a starting point, everything hurts, probably another good reason to get a consult as well. Or if you're just like, hey, I just need more hands-on, I need a coach, that's what I need and we get to go for it, that's also very valid. Or just for any reason at all. If you say, hey, I want to consult with someone that's totally great. Most people are trying to do it themselves on the internet just 'cause hey, they don't have time to go to see a physical therapist, it costs money, all that stuff. So I'm trying to give you the tools you can use yourself, but at any time, if you need to get help, that is a reasonable something you can do. And so once we get through that, let's say, hey, we did it, we feel better. Go back to your life, go back to training with a new tool in your toolbox. You feel good, everything is great, you can do that. You can always have these principles in your back pocket if you need them, right? But I don't think you need to continue to do necessarily any prehab exercises, right? A lot of times people say like, after you get back, do these exercises, XYZ. I don't necessarily know the validity to that, that maybe it's a good idea if you continue to have recurrent issues to incorporate some things if need be or avoid some things if need be. But if this is your first time ever, like I would just say, go for it and go back to training and then if you have recurrence, we can talk about doing it, implement some routine kind of maintenance. But yeah, once you're there, go for it, enjoy life. But we need to consider one thing, if you continue to get injured, we may need to reevaluate the program. Maybe your tolerance for a certain volume or exercise is not as good as we hoped for, but that's, once again, that's more for having recurrent things, that's a more nuanced discussion. But hopefully this was a helpful heuristic for you. I just wanted you to have this kind of outline to say, hey, when I'm having injuries, I don't need to be scared. First things first, I do not want you to just stop doing everything and just taking time off. Usually that doesn't do it 'cause we need to build up that tolerance, right? If we've learned that we need to adapt over time and that stress versus recovery kind of ratio, we need to tilt the favor back to so it can get even, right? So we can recover well, but we need tolerance, right? So you can't just offload, expect to jump back. So continue to work out, modify if need be, modify any of the things I talked about and then hopefully we can slowly ramp you back and get you back to doing what you love. That's my main goal. But that's gonna be it for today. Thanks so much for stopping by, really appreciate it. If you did like this, it would mean the world to me if you either liked the video on YouTube, subscribed in a podcast feed, or if you share with a friend, that would be a huge compliment. But we are done for the day. Now get off your phone and get outside, have a great rest of your day.
