I Have Insurance. Why Would I Work With A Coach?
The case for coaches on your rehab team.
I like sports so here's a sports analogy.
Rehab is best accomplished with a team approach.
Your doctor, physiotherapist, chiropractor or (insert registered rehabilitation profession); they are like the head coach.
They have a lot of responsibilities. They are extremely knowledgeable and have a unique set of skills that put them in the position of head coach. But their resources, especially time, can be limited. When they have a big team they can not spend multiple hours a week with every single person on the team. They would get burnt out.
A fitness professional who is educated in the rehabilitation realm, is like the assistant coach. They are more involved in the day to day activities. They have the time to make changes in coordination with the guidance of the head coach. They also develop the entire athlete or client, not just the problems (pain, etc) that have already been identified. They communicate with the head coach to inform them on the progress of the athlete, so that adjustments and further care can be provided.
Without the assistant coach, the head coach could have athletes (clients) who are struggling to progress. Maybe they are struggling with accountability. Maybe they are struggling to maintain an active lifestyle in their rehab.
Without the head coach, the assistant coach could hit roadblocks that become out of their scope. Maybe it's its a treatment or diagnosis they are not qualified to provide. Maybe it's knowledge about a particular issue.
When working together, fitness professionals and health care providers can all succeed. And more importantly the client succeeds.
So yes, if you have insurance you don't need to also work with a coach to solve your problem. But with a good team, I believe it to be a results multiplier that gets you a better return on your investment. Especially if you want to live an active lifestyle.
You Don’t Need To Spend Hours In The Gym
How much time should you spend in the gym?
Unless you are a competitive athlete you do not need to spend hours in the gym multiple days a week to see results.
These are the physical activity guidelines from the World Health Organization for adults age 18-64:
1: should do at least 150–300 minutes of moderate-intensity aerobic physical activity;
2: Or at least 75–150 minutes of vigorous-intensity aerobic physical activity; or an equivalent combination of moderate- and vigorous-intensity activity throughout the week.
3: should also do muscle-strengthening activities at moderate or greater intensity that involve all major muscle groups on 2 or more days a week, as these provide additional health benefits.
That's a minimum of 2.5 hours and a maximum of 5 hours of moderate intensity activity. A lot less as your intensity increases. They say you can increase those activity levels for additional benefits, but that isn’t elaborated on.
You can hit the minimums with 30 minutes of activity, for 5 days. Or by going to the gym for 2-3 days at an hour each session.
If you want to dedicate more time to the gym, that's great. But eventually there will be diminishing returns.
Maybe the additional time you spend in the gym could be spent on your recovery. Take a nap :)
Maybe the additional time you spend in the gym could be spent engaging in other enjoyable social activities that contribute to your mental health.
Maybe the additional time you spend in the gym could be spent preparing a nice meal. @hellofreshca sponsor me.
Just because you see someone else spending 2-3 hours a day in the gym, doesn’t mean you need to. Maybe they need to based on their goals. Or maybe they need another hobby.
Low Back Sore After You Deadlift?
Are deadlifts the problem?
Does deadlifting leave you with low back soreness the next day?
Deadlifts get a bad reputation for low back pain and soreness.
I often hear things like “I deadlifted yesterday and now my low back is sore, I must have done something wrong with my technique”.
Sure it’s possible that your technique could have been improved, maybe recruiting other areas of your body to assist you. Maybe leading to less soreness.
But soreness also doesn’t need to be bad. We don’t always want to be sore, but soreness is a normal response to training, including with deadlifts. I have yet to hear “My biceps are sore from pullups yesterday, I must have done something wrong with my technique”.
Deadlifts are a posterior chain exercise (back half of your body). Your low back is included in that. While we want your glutes and hamstrings driving the majority of the activity, your low back is absolutely involved.
Here are some things you could look at that could influence that soreness:
Recovery: How has your sleep and nutrition been? Are you adequately fueling your body? Were you giving yourself adequate rest between sets?
Training loads: Did you increase your training loads to volumes that your body has not experienced yet?
Movement quality: Was your movement quality better at different weights or reps?
Areas of strength: Is your low back simply not as strong as other areas of your body? Maybe it just needs time to catch up.
Soreness is normal and ok. It doesn’t need to stop us from progressing.
Chronic Intensity
Are you experiencing too much intensity?
If everything you do is at high intensity, where is your variety?
I used to coach group classes where consistently everyone would be so exhausted that they would drop to the floor, unable to form a complete sentence. I will no longer do that.
If every workout you do leaves you rolling around on the floor, is that variety? Or is it just different versions of the same thing?
Sure maybe there is variety in the movements that you do. But where is the variety in intensity?
You probably don’t need as much intensity as you think. Absolutely not every training session.
High level athletic teams don’t even constantly practice or train at high intensity. They have optional days. They have walk-throughs. They have film sessions. They have deload weeks. They even have rest days.
To make improvements in training we need to recover. If you aren’t feeling recovered from the previous day's training, you would probably benefit from reduced intensity. Especially your training is affecting other aspects of your life, like your mood, energy and sleep. And absolutely if your training is leaving you in pain.
What Comes First? Pain Or Posture?
Is posture the source of your pain? Or is your posture the result of pain?
This is a chicken or egg scenario.
Did you get injured because of your posture?
Or is your posture because of an injury?
This concept comes from @greglehman. He originally mentioned the thought process from leg injuries.
Basic idea is that people start to limp due to a lower limb injury. They don’t get a lower leg injury from limping.
So why do you have the posture that you have?
Maybe it’s because you’ve adapted to a specific way of moving.
Or maybe it’s because of a response to an event, and your body has now adopted a new position (or posture) in response to it.
Feeling Good Isn’t Enough
Does rehab stop when you feel good?
Rehab doesn’t end when the pain stops.
I’ve been that coach that heard someone was pain free after an injury and let them load a barbell with pre-injury weights. That’s not who I am now.
You strained your hamstring playing soccer on the weekend.
You are eager to get back to what you normally do in the gym. You want to get back to deadlifting, squatting, running and anything else your workout could bring. And of course you want to get back to playing soccer.
You are in pain so you go to get some rehab work done. Maybe that’s physiotherapy, maybe it’s chiropractic, maybe it’s massage therapy. Through a combination of manual therapy techniques you are able to be pain free, which is fantastic!
You can go through your day pain free now. You are back in the gym doing your normal activities.
So are you done? Are you back to 100%?
The healing time of a muscle strain can range from 1 week-6 months. Maybe you feel great at 4 weeks but your tissue healing still needs more time.
You need more time to heal and a graded return to sport or activity. You need measurables to assess your strength levels relative to your pre-injury state. This likely doesn’t happen by feeling pain free and then jumping in on a fitness class and going 100%. But this can happen with a team approach in your rehab (that includes knowledgeable coaches).
Rehab doesn’t need to be an endless loop. You don’t need to always bounce between injured and pain free.
It may take more time than you want it to. But the results will last longer too.
Mitigation>Prevention
Can we prevent it? Or mitigate it?
In the realm of injuries, mitigation is better than prevention. Because prevention doesn’t exist.
Mitigation is the action of reducing the severity, seriousness, or painfulness of something.
Mitigation accepts that there are certain things that are out of our control.
We can’t control that hidden patch of ice that you slipped on in the winter.
We can’t control that box that fell on your toe.
We can’t control the car that forced you off the road into a biking accident.
We can control the steps we take to have those uncontrollable things be less severe.
We can prepare ourselves physically to be able to recover quicker from those incidents.
We can make it more likely that a 6 month recovery becomes a 3 month recovery.
We can make it more likely that you can be less hindered in the ability to do the things you want to do.
There are those that will recommend you do some weird training to prevent injuries. Those things may look cool, but unfortunately prevention is not possible.
Because life is going to happen. We can’t prevent that. But we can make the most of it by being as prepared as possible.
When to Use a Foam Roller
When should you use a foam roller?
Let’s dive into some claims about foam rolling.
One of the big claims for foam rolling is decreased soreness. Studies have shown no negative effect of foam rolling (increased soreness) and found about a 2% improvement in perceived soreness. This was studied using a 10x10 back squat program and 20 minutes of foam rolling.
Some claim that it promotes blood flow. So does running, walking, squatting, biking, rowing, or just moving. You would have to foam roll crazy fast to match the amount of blood flow created by those activities.
Another claim is loosening muscles. A commonly spread idea is that it will loosen knots in your muscles. Unfortunately, it's not that simple. Let’s take someone who squats 500lbs. Their muscles and body structure have adapted to move 500lbs. A piece of foam isn’t going to do much to those muscles. But can change happen? Yes. But it won’t last long. Studies looking at improving range of motion showed that foam rolling prior to training can improve range of motion but that the improvement lasts approximately 15 minutes.
So how would I use it for myself or my clients?
To me, 20 minutes of foam rolling isn’t worth it for 2% improvement. I would rather manage the training volume and overall recovery (sleep, nutrition, etc) better. But for athletes, this could make a lot more sense. Athletes can’t control when their games are or how intense a game is. If it helps, do it.
For some people who feel restricted in movement, foam rolling could be useful. Let’s take someone who has very stiff ankles and it is restricting their squat or ability to run. Small bouts of foam rolling on the calf prior to training could provide a short-term window of improved range of motion. Next, we would use that range of motion. We would load it. Want to change your muscles? Load them. If we load that new range of motion, it will be more likely that that range becomes more permanent. So that eventually increasing range of motion could be less of a priority.
Lastly, the placebo effect is real. If you have been foam rolling, you enjoy it and are seeing results, then keep doing it. No need to change something that is working.
Shoutout to E3 Rehab for the majority of the content for this post. They have some great resources on the topic on youtube.
When Foam Rolling Isn’t Enough
Is foam rolling the solution for you?
You’ve got this knee pain that is affecting your ability to run. You love to run. It’s an escape for you, a part of your routine.
You see a video on Instagram of someone saying to use a foam roller to reduce knee pain. They seem smart. They run a lot too.
So you start foam rolling. You start with 5 minutes of foam rolling before your runs. It helps for 5 minutes but then the pain comes back.
So maybe more is better. You try 10 minutes of foam rolling. It helps for 6 minutes but the pain comes back.
This cycle continues until you spend 30 minutes before and after running on your foam roller.
That’s an hour of your day.
Is the foam roller the solution for you?
Maybe there’s a more appropriate solution for your needs.
It could be strengthening your hips, quads, calves, feet, etc.
It could be managing your recovery better through sleep and nutrition.
It could be managing your running volume more appropriately.
It could be a lot of things. And maybe it includes using that foam roller. But not for an hour a day.
Feel like you are spending time doing something and not getting the results you want in the time you have available? These are the problems I aim to solve.
When Advil is Dumb
That time Advil said something really stupid.
“Pain says you can’t. Advil says you can”
This quote is from an Advil commercial that popped up on my feed today.
One of their other messages is “pain will get you soon enough”.
It’s clever marketing. Saying that pain is going to get you eventually, might as well buy some Advil.
It’s also a band-aid. A temporary solution. Nothing that will address the underlying issues that would lead people to have problems doing the things represented in their commercials.
Activities like lifting a tire, walking to work, picking up your mail, playing with your kids at the park, building furniture or opening your oven.
There are issues there that Advil will not permanently solve. Sure maybe it helps short-term. But it’s not a solution.
What could be the solution?
Maybe the person is doing too much too soon and needs to address the workload.
Maybe they are stressed and have too much on their plate or are unable to effectively respond to stress.
Maybe the person has some range of motion limitations that are affecting their daily activities.
Solutions require a process, not a short-term pill.
Solutions require assessing where someone is currently at, to find the most appropriate path towards results.
Cooldowns
What’s the best cooldown? It’s more simple than you probably think.
How should you cool down?
Do you need a cool down?
Should you stretch in a cool down?
Should you use a foam roller during your cool down?
For general health I think this is a topic that has become way too complicated and overly emphasized.
Is it important? Yes.
Does it need to be long and complicated? Probably not.
So let’s keep it simple.
If you are training for general health this should be your cool down:
Do what you were doing for training, but slower, lighter, and at less intensity. Keep moving but move less and move slower.
The goal of a cool down is to bring you to the state needed to do your next thing and assist in recovery.
Basically don’t go from 100% to 0% right away. Do this gradually.
Some of this can happen naturally.
Were you lifting weights? Cleaning and deloading your bar is a part of your cool down. You are still moving things but at much lower intensity.
Finished a run? Gradually slow down to a walk and keep walking until your heart rate reduces.
Finished a CrossFit workout and then need to head home right away? If you walk to the gym, that walk is a part of your cooldown.
When training for general health, cool downs don’t need to be complicated. It’s unlikely you need any crazy foam roller, lacrosse ball or stretching routine. You need to move on to the next thing in your life. If you are spending a good percentage of your “training” cooling down, it's very likely that time could have been spent in better areas.
Cool downs become more intricate and important if you are a competitive athlete that needs to repeat their competition at regular intervals. But that is such a small percentage of the population.
What’s your cool down? Comment below.
Are You Getting Too Much Intensity?
Do you need to train harder?
Intensity is not only about how hard you exercise.
Fitness has no claim over intensity.
Intensity can be anywhere.
It can be in your work, your relationships, your responsibilities.
Intensity can be important to see some progress. But it’s even more important to make sure we aren’t getting too much and that we are managing the intensity that we have.
So do you need a ton of intensity in every workout you do? Do you need to fall on the flow after every workout? No.
Let’s say you have a very stressful job. You feel needed to be available at all times. You have stressful things going on in your life.
You already have a good amount of intensity! So it’s unlikely that you need a lot of intensity in your training.
Yes you can use training to improve your ability to respond to the stresses you face in life. But training is also a stressor. It’s important that we don’t push too hard and take huge steps back.
Monitor your training intensity based on how you are feeling that day. Adjust weights, reps, volume when needed.
You may see others go crazy in a workout. That’s ok. You don’t need to be like that. Do what’s best for you, your health, and your goals.
When Does Recovery Start?
When does your recovery start?
What do you do immediately after an intense workout? What is your post workout routine?
Do you stretch? Do you roll around on the ground? Do you hunch over and lean on your knees? Do you chug a bottle of water? Do you contemplate your existence?
Any of those things could make sense assuming there is intention to it.
When that workout finishes, when that last rep is done, when the clock beeps, what I often notice is what could be described as chaos.
That chaos often lacks intention.
When your workout stops, don’t stop.
Don’t stop functioning. Start recovering.
This means breathe, this means move, this means lower your heart rate.
Your cooldown starts as soon as your workout finishes.
It’s fine to lay down on the ground on your back or hands and knees after a workout. That’s assuming there is intention to it. Those positions are actually the easiest positions to work on your breathing mechanics. Get back to nasal breathing as soon as you can.
It’s fine to stretch after a workout. Maybe you have any area of your body that you know needs some additional attention. Maybe it helps you relax and calm down. That’s intention.
Workout ends, recovery starts.
For most of us, we are TRAINING to be healthy and fit. If we are in a position where we are consistently incapable of focusing on our recovery after a workout ends, we are likely regularly overtaxing our system.
Now if you are COMPETING for an Olympic medal (or insert athletic competition), do whatever you want, you’ve earned it.