Which sets/reps should you use?

There are few things I love more than an intense discussion on which set/rep scheme to choose.  Optimizing for performance is an art more than a science.  True success takes into account:  body type, % fast twitch to slow twitch fibers, mindset, experience, technique, health history, THEN goals.   There isn’t an equation where you can plug this information in and come out with your personalized answer.  It takes years and years of your personal trial and error in the gym.  You can often speed that process along by hiring and working with a professional.  The skill of the professional will directly relate to how fast they get you on the right track.  But even the best ones will need regular sessions in order to see what works, make changes, and progress based on rate of progress.  

So, the reality is if you’re hoping to reach success you’re going to need both passion, time, and resources to make that happen.  But that’s true in any field.  The great news is you can achieve a huge number of health benefits without any of those things (cultivating a passion towards your own health is highly encouraged though)!  You can lower your risk of all cause mortality by 25% if you expose your body to 60 minutes of heavy strength training COMBINED across a calendar week.  That's it!  You need to actually make sure the training is heavy though.  The strain is what is beneficial.  If you’re unable to expose your body to heavy strain you’ll need to spend more time.  But the end goal is very achievable even with the busiest lifestyles.   It’s important to note if you have an injury, lack of experience, or aren’t confident in your technique you should, without question, consult a professional to help you get going.  Heavy resistance training is potentially dangerous.  But what i’m hoping to convey is the end result is worth it! 

Motivational comments aside.  The basic outline you can follow is below:

For Power:  1-3 reps   4-6 sets

For Strength:  3-8 reps   4-6 sets 

For Hypertrophy:  8-15 reps 2-4 sets

This all assumes you are working at or near failure for each set.  Most people are either unwilling or unable to go to true failure.  But if you stop at 10 reps each time hoping to build muscle and in reality you could have gone for 8 more reps you aren’t challenging your system enough to generate a muscle building response.  

Lifting doesn’t have to be an isolated penance you pay to have good health.  You eat with family, you go out for drinks with your friends, you walk the dog with your spouse, you can workout with other people as well!   Success is all but assured if you can bring one of the people who you enjoy spending time with into your workouts. 

Exercise = Freedom

The word ‘exercise’ somehow has reached the status of a trigger word we collectively roll our eyes upon hearing as the solution to our problems.  It’s a tragedy!   This word should be synonymous with empowerment and freedom!  Exercise is the solution to 99% of pain relief.  What you will never fully understand unless you go through it is the liberating knowledge that pain is under your control once you have conquered it with exercise.  Your body is built to move and interact with the world.  Pain can be paralyzing and frequently cause the fearful reduction of movement.  Uncountable societal and family factors play into how pain is interpreted and expressed.  But the lowest hanging fruit (exercise) is also the most successful.  

Without question, other things can be completed alongside exercise:  chiropractic manipulations, dry needling, massage, cupping, even surgery!  But none of these things will solve your problem by itself.  They are universally paired alongside intelligent and purposeful exercise.  Where we often get lost is when we start with those things instead of exercise.  The number of issues that can be solved with exercise alone is staggering.  Yes, surgery is sometimes required.  But what happens after surgery?  What is recommended before?  DId the physician write you a script to watch TV for 12 hours a day?  The majority of the time they recommend actual physical therapy; the other they advise slow return to activity.  In both scenarios you’re going back to activity!  

Teach a man to fish and he will eat for a lifetime.  If you use surgery or any quick fix by itself you have effectively eaten for a day.  If you learn what caused your pain, how to fix it, and how to prevent it from coming back you now have the tools to eat for a lifetime!

Partnering with a professional who understands this relationship between your physical AND mental health is absolutely critical.  Truthfully they can be a Physical Therapist, Personal Trainer, Chiropractor, Surgeon, Masseuse, or anyone in the healthcare profession.

How do you know if You’re Getting Good Physical Therapy?

I’ve been told more times than I can count “I’ve tried physical therapy” when someone is describing a pain they’ve been having for years to me. A lot of the time, the conversation stops when I start asking followup questions, “What did you work on? Who did you see? How many times did you go?” Certainly, Physical Therapy does not solve all life’s ailments. But not all physical therapy is created equal. When you go to one restaurant, do you then tell everyone you’ve tried restaurants? Maybe you went to a Michelin star restaurant and you left hungry. Maybe you went to AppleBees and you left wishing they served things that weren’t different shades of brown. Why is it that healthcare providers get a free pass when it comes to discussing the quality of their services? 

Well, let me posit a few rhetorical questions for you to think about.  When you buy a car do you stop into multiple dealerships to make sure you’re getting the best car?   When you buy a house did you look at more than one house?  Even if you didn’t, did you use other houses to get a reference point for price? 

You can’t fault a Ford Salesmen for wanting to sell you a Ford car. It’s what they do. When you walk into a surgeon's office do they give you suggestions on how to avoid surgery? Maybe. More likely do they offer you a solution centered around surgery (or do they offer conservative options only as a way of delaying the inevitable surgery)?   Surgery is a wildly skilled service. To become a technically gifted surgeon you need years and years of training.  What would compel someone to go through sacrificing decades of their life, working long hours, enduring back pain, and giving up all hobbies?  It’s an interesting question to think about.  What would it take to convince you to go down this pathway?  Would it be money?  Authority?  Status?  Or would it be something more altruistic like the belief that people need better surgeons and it's worth it regardless of profit.  

One of the biggest problems to objectively assessing your healthcare options is…pain!  People don’t see physical therapists or surgeons unless something hurts.  That pain tends to turn your thought inward and create a sense of urgency that subdues your normal rational thought.  You are much more likely to listen to anyone who claims they can take your pain away because you want it gone yesterday.  The unfortunate reality is surgeons in particular, but most health care providers, don’t have enough time to get to know you.  Physical Therapy is often plagued by this same obstacle. This leads me to my first and most important criteria: (Yes i’m finally at the point where i’m answering the question)

1. How much time did they spend with you? 

1. If your provider sees 20 people a day (or 50 if they’re a surgeon) how much time do you expect them to spend with you?  Most insurance restrictions result in the necessity of providers working in teams.  Did you spend your time with the PA and not the surgeon?  If you were completing physical therapy did you spend your time with a tech or PTA?  

2. Is the solution presented multi-factorial?

1.  Diagnosing a problem can be easy, if you have a torn rotator cuff you need to fix it….right?   Maybe.  The human body is complicated.  We didn’t survive for thousands of years by shutting down the body and waiting for death whenever an injury is sustained.  Knowing what the injury is certainly is important but why did it happen?  How do we prevent it from happening again?  Does your solution fit you specifically or is it the same solution everyone else was given?  If your goal is to get stronger does everyone get stronger doing 5x5 set/rep schemes?  As with all things, it depends.  It depends on your composition of fast twitch to slow twitch fibers, your lifting history, your attitude towards lifting, your current fitness level, the list goes on.  

3. What is Plan B?

1. If the surgery didn’t go well, what's the plan?  If the PT isn’t working for your low back pain what’s next?  Any good provider is well equipped with the next plan not because they don’t think plan A will work but because humans are so complicated it is a certainty it will not work as expected.  Plans needs to have the capacity to evolve.

4. Did they recommend any other professionals? 

1. Any good therapist should know a good massage therapist, a good chiropractor, a good personal trainer, a good nutritionist and a good surgeon.  Nobody can solve everything alone.  The best scenario for any patient is to know they are a part of a community of skilled providers who trust each other and all have the patient’s best interest at heart.  Any good surgeon should know a good physical therapist (in and outside of the clinic they own).  If either professional does not provide these resources it may be worth considering another professional.   

Easy 3 Steps to a guaranteed better day!

First off, if you’ve decided to read this blog you already know your maximum energy and performance throughout the day is going to require some actual movement.  Get sunlight, get stretched, get your heart rate slightly elevated and you’ll be getting a cocktail much more potent that the passive list i’ve assembled.   For now, lets keep things simple and focus on the points from the post.  

Step 1:  Hydrate

Coming off a full night's sleep is more than just an unconscious fasting window.  You also haven’t had water for a long duration of time.  While you were sleeping your body was repairing itself:  removing inflammation, removing toxins, etc.  This requires energy and…water!   This might be the lowest hanging fruit on the ‘make my life better’ check-list.  90% of people just don’t drink enough water.  The recommended amounts vary depending on your source but a good rule of thumb is to get 10 ounces each hour after you wake up for 10 hours.  Scale accordingly based on body size, climate you live in, and types of foods you eat.  Your body can live for long periods of time without food but it absolutely cannot live without water.  That alone should underscore how important this is.   

I am willing to concede this isn’t glamorous.  There isn’t any special product you need to buy.  Nobody will follow you on instagram for drinking water.  But that does nothing to diminish how useful this is.  

Step 2:  Caffeinate

This is much more of a personal decision.  Caffeine is a widely studied compound and it has been proven that people respond to caffeine in vastly different ways.  The measurable dose of caffeine to generate a sports performance improvement has varied from 300mg to 900mg based on the individual. That’s a massive number!   Caffeine works much more efficiently after cortisol has been removed from your system.  So, wait 90 minutes (on average) before having your first cup for maximum effect!   For a mental boost or a normal work day you can start with something as small as 50mg (1 cup of coffee). If you don’t believe me try drinking a cup of coffee right when you wake up then the next day wait 90 minutes (drink water during that 90 minutes) and drink the same cup of coffee. Guarnateed you will notice a difference. As a natural diuretic you’ll find this effect is again amplified if you hydrate beforehand.  It extends beyond the scope of this brief blog post but there is fascinating biochemistry that is well documented regarding caffeine’s effects.  For a very well put together summary I would recommend checking out Huberman Lab’s episode on caffeine for more detail.   

Step 3:  Dominate 

Ok this is mainly intended to underscore how much better you’ll feel if you complete steps 1 and 2 BUT…this is also an action based concept.  While steps 1 and 2 are passively preparing your body and mind for optimum function you need to willfully engage in pursuit of your goals once you have your body primed.  Routine by its very nature breeds a sense of complacency.  It has been inspiring to me personally to quickly glance at my 1 or 5 year goals list to remember why I’m getting up and going to work today.  Some of you may need zero additional inspiration but for the others; move forward with intention!  Even if you aren’t immediately successful in your daily goals (generating more income, completing a job, or making a connection) you will have taken a big picture step forward towards your long term goals!

Inflammation Management Starter Pack

This has been coming up a lot lately and the initial treatment is something everyone should be able to do without going to a healthcare professional.  When you’re dealing with inflammation you really only have one goal; let the body heal itself.   This seemingly obvious statement is amazingly ignored by most patients as soon as an area of their body starts to hurt.  

Your body has a natural healing response that triggers after injury which often will cause a normal amount of swelling, heat, redness, and reduction in function.  Just imagine an exceptionally hard lifting workout.  That delayed onset muscle soreness is exactly that.  Damaged muscle tissue, loss of capacity to perform, heat, and some mild swelling.   While a lot of these principles would apply to a lesser degree the inflammation response I'm referring to in this post is one following injury that results in an inability to complete the task and severely damaged or strained tissue.   In this case you’ll want to hit these important steps to allow your body natural time to heal. 

1. Remove the hammer - Give the body a chance to actually heal itself without you constantly re-aggravating the tissue.  In athletics this may mean sitting out from sport for a bit.  For most adults it can be modifying your work posture, hobby, or lifting regime to avoid anything that continues to exacerbate the inflammation response.  

2. Ice - Hilariously, this has come under fire on instagram a lot with people suggesting ice is bad for you.  I can’t stress enough how incomplete and inaccurate this statement is.  Ice itself has not been shown to have nearly any effect on muscle temperature in the muscle.  The main positive effect is a reduction in blood flow (helpful for an area with massive blood flow stimulus following an injury), immobilization of the painful area (because you have to while icing) and some systemic hormone release triggered to counteract the cold your body is being exposed to.  All very positive.   If you stick to icing 10-15 minutes at a time several times a day you have nothing to worry about.   

3. Unloaded Movements - The implementation of this should be regulated by your therapist or athletic trainer who is seeing you for your acute injury. But for chronic injuries this is a must.  This will bring non-inflammation causing blood flow to the area (because you aren’t loading it and because you’re moving it through a range that doesn’t hurt).  Super helpful.  Seemingly contradictory to ice but it’s quite helpful if done before icing or any other part of the day.   No warm up required.  

4. Sleep - A good argument could be made that this list should start and stop with sleep.  There is nothing that currently exists which is more effective and naturally healthier than sleep for removing inflammation.   There is massive literature out there on the benefits of sleep so I'd encourage you to dive into that if you aren’t willing to take my statement as fact.  

Once you’ve done these you can start to introduce progressive load and functional activity.  That will be the biggest variance between chronic conditions and acute conditions (and acute conditions with actual severe damage vs strains).  Inflammation is normal and often healthy so don’t be afraid of the word or the concept.  But understanding what it does and in which cases to manage it are key for any successful recovery! 

The picture isn’t intended to be misleading. Coffee has some nice inflammatory properties. Nutrition will play a massive role in long term inflammation which exceeds the scope of this post.

Why aren’t we all working smarter?

As odd as it may sound, this does not necessarily mean you have enlisted the help of the finest minds in the world to create a goal and plan to get better.  To me, this is intended purely to represent thoughtfulness and understanding.  You can apply working smarter to any pursuit but let's keep it Physical Therapy focused for now.  If you wanted to work as smartly as possible, we can probably agree some form of the following checklist would have to be hit:

• There is a purpose to each recommended exercise

• The recommendations are centered around your goals, experiences and limitations

• The plan takes into account your available time, finances, and access to equipment

Nothing here should be a shock to see on paper.  But if you can’t say your workout program takes into account each of these variables you aren’t working smarter.  You may be working exceptionally hard.  But smarter…no.  Experience, knowledge, and thoughtful consideration go into preparing programs that take all these variables into account; especially if an injury is present or a concern about technique during the performance of any of the exercises. 

By far the most common reason someone wouldn’t think to hire a physical therapist or personal trainer is the expense.  I consider the question rhetorical but ask yourself, how much money would you pay right this moment to magically attain your fitness goals?   Would you pay $1000?   $2000?   $5000?  $50?   Maybe think of that amount as a percent of your annual income.  Would you be willing to spend 10% of your yearly income getting healthier?  Getting stronger?  Getting out of pain?  Improving your quality of life?  If you’re like me that number sounds laughably small when you say it.  You’re only willing to spend 10% of the money you’ve earned on improving the only vessel you get in this life?  How much of your earned money do you spend on nice clothes, a car, a trip, taxes?   Not to diminish those things, they are important (and required in some cases), but would you enjoy them if you had unrelenting back pain (physical therapy)?  Would you enjoy them more if you dropped 5% body fat (personal trainer)?  Would you be able to do them at all in your 60’s if you avoided building up plaque in your arteries right now (eating better/dietitian)?  Yet every time I'm faced with an option to spend money on myself I hesitate.  And I'm a professional therapist and trainer!!  10% of 50,000$ is 5,000.  Your income may be notably more or less.  But use that as a reference.  Almost nobody will spend 5k on their bodies who isn’t a professional athlete.  You are spending money, I guarantee it.  Ask yourself where your health ranks on the list of things you are spending money on.   

Circling back; working smarter is simply looking broadly at your goals and making sure what you’re doing is in line with achieving those goals.  A massive number of variables go into achieving your health goals without taking into account the very likely scenario of not being able to accurately assess yourself.  To me, working smarter is making sure the right plan is in place.  If you can do that yourself, huge credit to you.  For the vast majority of us who need some help, consider hiring someone to help get you on the right track so when you put in the effort to start the train, it goes to the station you want.   

Demystifying Program Design

Program design can be tricky but it doesn’t have to be.  To get a measurable amount of actual strength gain you need to hit between 10-30 sets a week.  Yes, 30 is a lot.  You likely won’t run into that range unless you’re in exceptionally good shape, have very specific workout goals, and have a lot of free time.  So lets assume 10 sets is the target for most people.  Three sets of an exercise that hits a muscle group 3 days a week gives you 9 total sets…so one of those days toss in an extra set and you’re good to go.  Example, if you want to target your quads you can try to isolate them with a split squat movement or a leg extension.  Even if you set it up to be 3 sets of 10 (which is a traditional beginner series) you’d see notable strength gains if you would not have been able to complete an 11th or 12th rep during each of those sets. 

One thing you have to take into account is that number 10 comes from a high RPE (rating of perceived exertion) challenge.  You won’t get the strength effect if you’re leaving a lot of reps in the tank each set.  If you complete a set of 10 but you could have done 15, your quad isn’t going to get stronger.  You have to be stressing your system for all 10 sets.  Otherwise you’ll need to add more sets or change your set structure to more reps or pick a different exercise where you can exert yourself more forcefully.  Given the high strain of these required 10 sets make sure you’re warmed up property before you start counting towards the 10.   

The huge number of variables to consider when making a fully program can be intimidating but keep this one at the top of your list and you’ll start to see clear progress in 4-6 weeks.   So, give it a shot!  Shoot me a message if you get stuck along the way.

When is dry needling appropriate?

Stim current about to be applied to a needle in the left lumbar multifidi

Answer:  For a huge number of conditions.  Maybe a better question would be when is dry needling NOT appropriate.   

When thinking about if dry needling could be useful for you it’s necessary to know what it’s often used for. The goal of dry needling is to create a very controlled local trauma to an area not getting good blood flow.  These areas often manifest as muscle knots, trigger points, or other pain generators.  The currency of healing is blood flow…there is no second currency.   You have many important biochemicals in your body relating to the exact science of how tissue is healed but none of them can get to the damaged tissue without blood flow!  Surgeons can’t perform surgery if they can’t get to the hospital!  All exercises, modalities, prayers, seances, (whatever you’ve got going on) are considered to be physically successful if they bring blood flow effectively to an area.   

So, if you have an acute injury, surgery, post intensive lift, or any condition where the body already has a natural high flow of blood to an area you are unlikely to benefit from this aspect of dry needling.   In a similar vein if you’re already successful getting blood flow to an area with massage, hot pack, etc. you likely won’t see an appreciable benefit from dry needling for this specific function.    

Enter the second major benefit; turning on/retraining a malfunctioning/nonfunctioning muscle.  This is maybe the best tool physical therapists have in their toolbox for this specific problem.  It’s the only modality that gets below the skin (electrical current the exception, but even this is not specific).  There are some extraordinary therapists out there who can use their hands to do some amazing things.  But they are limited by having to push through the skin, fascial layers and any superficial muscles before they can impact any deeper muscle tissue.  Often times simply getting the needle into the right area is all you need before the muscle ‘wakes up’ and starts responding to targeted exercise.  

Once you have the muscle turned on and well supplied with blood put it to work!   All good dry needling sessions are followed by use of the muscle in question.  Doesn’t have to be heavy lifting, but you’ve now got blood flow and a very awake muscle primed for movement.

When deadlifting, is it a problem to have the shoulders in front of the bar?

As with all things; it depends on what you’re trying to accomplish.  So let's take a look at what’s happening during the lift before deciding if it’s acceptable for each individual person.  

In this example there are two main variables at play.  What is in front of the line of the bar and what is behind?  The further away a body part is from the midline of the bar the more work it has to do to reach full extension.  Leaning forward over the bar shortens the distance from the hips to the bar, reducing the amount of work required by the hip extensors to lift the weight.   Everything else behind the bar is likewise also exposed to less force.  So, each level of the lumbar spine now has less torque to deal with moving on up the thoracic spine until the point of the weight center.   On the front side of the bar the knee provides the driving vertical force. 

So here’s a question:  if the shoulders move back to the line of the bar and the knee stays the same distance in front of the bar, is it doing the same amount of work?   

The total mass in front of and behind the bar now becomes relevant.  The short answer is “no.”  Imagine doing a wall sit and how hard that is for the knees.  Now imagine doing a bodyweight squat.   You don’t feel nearly the same tension in the knee.  The reason is the shifted body weight of the torso serving as a counter force over the knee during the squat.  

Final question:  If the knee is doing less work then where is the extra force coming from?   Again, look at which major players are in front of the line.  As with all deadlifting form variations, the shoulder is the dynamic stabilizer connecting the bar to the body.  So the missing arrow in this picture is the line from the shoulder to the midline of the bar.  The lats are strongly firing along with the posterior deltoid to provide the missing force required of shooting that bar weight back towards the hips for full extension.   

Now the personalization of the lift starts to matter.   What is your goal for performing this lift?  Is your body doing this as a compensation movement?  If so, what’s not firing the way it should?  Does that change your ideal sets and reps?   You better believe all these variables matter!   As long as you’re performing smarter you can rest easy knowing your effort is translating to results that are important to you!