Ian Kaplan: Navigating the Complexity of Pain

You cannot remove the pain experience from any one of those components. You can’t remove it. You can’t remove the brain and say it’s in there. You can’t move the body and say it’s in there. You also can’t remove social environmental context in which people experience pain.

To address that in its entirety to help people develop that plan that they can be confident to move forward.

Welcome to the “BarBend Podcast,” where we talk to the smartest athletes, coaches, and minds from around the world of strength. I’m your guest host Jake Boly, and this podcast is presented by barbend.com.

Ian Kaplan is the current Chief Officer of Operations at Hybrid Performance Method with a background in training, and research. When it comes to synthesizing research and understanding how to apply advanced topics into the context of our day-to-day lives, Ian is one of the best personalities I’ve ever spoke to in doing so.

In today’s episode, I talk to Ian about a variety of topics, including what it means to be evidenced-based, how to interpret the latest research on pain, and much more. Seriously, if you love nitty gritty details of research and training, then I think you’re going to love this episode.

As always, we’re incredibly thankful that you listen to this podcast. If you haven’t already, be sure to leave a rating and review of the BarBend podcast in your app of choice. Every month we give away a box full of BarBend swag to one of our listeners who leaves a rating and review.

We are here at Hybrid Performance Method in Miami, Florida. I’m joined here with Ian Kaplan, who has an incredibly deep knowledge of fitness training research and I can’t wait to pick your brain. Thank you so much for coming on the podcast, man.

Thanks for having me on. It’s good to be here.

Just to kick off this conversation and to get right into it, I would love to hear a little bit more about your background, how you came across hybrid, and how you got intertwined into the whole system here?

OK, yeah. That’s a good story because a lot of people probably don’t know who I am unless they’ve seen me in the hybrid stuff. I’ve been in fitness for a while. I’ve been coaching people either one-on-one or working at different gyms. I enrolled in chiropractic school a few years ago and got super into understanding both pain and rehab and training. That entire continuum.

Getting more involved in really figuring out what I know, what I don’t know, and how to learn new things because there’s always limitations to learning new things.

You get people with different opinions, people who continue to believe things that you think might be wrong or don’t confirm your own experience.

At least my experience in chiropractic school was learning to appraise the research evidence a little better. Gathering as much knowledge from that as I could and comparing it against what I was learning in school, and also what I was practicing with clients in a training environment.

That led me trying to develop networks with people who I thought were like-minded and also interested in learning more about this thing that we do every day in the gym. Steph was a good example of that. Someone who’s also local and someone who was putting out good content that I resonated with.

In my time at school between all the other things I was working on, I would start some communication back and forth. Since we were on the same page, a lot of things were in good alignment. That conversation evolved over time. Also, since I’m here, I came to some events and we’d see each other like Wodapalooza and stuff.

Eventually, that turned into, “Hey, we’re looking for writers for a blog. Would you be interested?” “Of course, I have all the time in the world.” We continued to have this conversation and more and more things snowballed from there, and now I’m here, COO. I run the blog. I do a bunch of other stuff.

I’ve helped with a bunch of the other content in a lot of the education that we’re developing and working into more of an organizational role helping grow the business in general.

That’s awesome, man. That’s cool that you’ve grown to wear multiple different hats. What has been the toughest skill to learn so far in terms of just taking on multiple roles in the company? What’s been that struggle for you to pick up on?

What’s interesting is we had a conversation about what a COO position would look like because that’s the most poorly defined executive position typically. Sometimes you get…the feedback is, “Oh God, I don’t know what a COO is or I didn’t know that existed.”

I mean that some people don’t know anything but CEO, but there’s generally a C-suite of several [indecipherable 05:13] executives.

But for this business, a COO made sense because it involves a deep technical knowledge of what the business offers to help optimize that, as well as a knowledge of organizational management to help things run smoother and to help speed up the process of developing quality work, because it’s a highly creative business with multiple product and service offerings.

It’s in a fast evolving market with new things developing and emerging trends need to be on top of those, need to coordinate efforts. Also, it’s a smaller company in terms of manpower so we need to divert resources appropriately as things come up.

For me, the last couple of months have been a lot of going back to my…My undergraduate is actually in hospitality management, which is what I finished at FAU prior to going chiropractic school because I was always interested in the business side of things.

Going back into organizational management textbooks into HR textbooks into the new things people are writing about in terms of management strategy, in terms of executive coaching, in terms of how to work with people so we can all do our best work together, and how to build systems that scale beyond the individuals in the system so everything runs smoothly whether or not you’re propping it up or not.

Putting those things in place will allow us to scale to the next level, which we have all the key ingredients to deal which is the question of lining up the troops and the resources to deploy those things.

Awesome, man. That’s really cool. I love that. I love that background. It’s like you manifested a lot of the stuff you do based off of your hard work and be willing to take on more. That’s really cool.

Speaking of being on top of emerging trends, I want to pick your brain on the background you have, which is in chiropractic school, and focusing on the spine, focusing on how we perceive pain especially in the gym setting.

What do you think, over the last three to four decades, has been something that needs to go away in terms of like a trend that needs to die, I guess you could say, that we’ve learned to maybe overemphasize to the point to where now it’s almost needs and [indecipherable 07:32] I could overcorrection? Does that make sense?

Yeah. It probably depends on what circle you still run in, but probably this narrative that exercise is somehow unsafe for the spine.

I think with the growth of powerlifting that’s fading, but people still get visceral reactions when they see a rounded back deadlift, one rounded back deadlift, God forbid, someone deviated from neutral.

The idea of neutral is kind of funny because we know it’s a huge range, and especially at the base of the spine, at the sacrum of the lower lumbar segments. Even when it looks neutral, there’s a ton of flexion. It’s like what is neutral anyway.

There’s might be more or less efficient positions to generate a lot of stiffness and tension into the deadlift but those vary from person to person.

The idea that a certain way to do a lift is inherently dangerous because of the way you did it adjusting for other factors like preparation and training age, and current training volume, and all the other things that you don’t see that might be contributing to risk or to the lack of progression.

That constant needs today and that’s reflective of a whole other problem with the way we think about training in general is that the one thing that we think follows from one thing else. You say, “Oh, that person has weird technique.” They also seem to have pain. Therefore, and this because of that, right?

Instead of imagining all the other possible things it could be and being OK with saying, “Hey, I don’t really know, but I think I’m more confident in one explanation than the other, but nothing is settled in my mind.”

That’s hard for people to do, especially when they only know a little bit because the barrier to entry is super low in fitness as a professional. It’s hard at the lower level and at the higher level you want to be perceived as an expert. You want to be even more certain.

There’s a ladder of fall certainty in the entire industry. That’s not unique to fitness, but it’s in a complex human behavior like exercise. It’s particularly not useful.

I guess my question for you is, how much do you think social media plays into that?

If you had to come up with a perfect…Let’s not say the word perfect, but an ideal plan to overcorrect this, and get us away from that kind of ideology, and how we’ve over developed some of those thought processes, how would you go about that in a perfect world…not perfect, but in an ideal world?

That’s an interesting problem because a lot of people do get their information on social media, and also a lot of people do get their beliefs from their provider, who also got their beliefs from social media. There’s a socially learned culture around what is acceptable behavior and what is our acceptable norms how we approach those things.

They’re more socially conditioned than hard-earned knowledge. The first thing to address that would just to be to bring awareness to the consumer because there’s only so much you can do from the other end of it.

Regulating what goes out on social media because that involves regulating big tech companies, which is an entirely different conversation, which they are more or less unwilling to do, especially in issues as minor as telling people that their back is hurt for this reason. That they’re concerned with terrorism and violence. They’re concerned with bigger things.

You wouldn’t rank rounded-back deadlifts at the same level of importance as violence and terror on social media.

I don’t think Mark Zucker or Susan Wojcicki of YouTube are watching YouTube videos or posts, and saying nope, that’s a nocebo. [laughs]

[laughs] Until they do something with their back deadlifting, they’re not going to be interested. I like that. I like that approach a lot. I guess my question is now, what do you think will eventually shift that rhetoric over time?

We’re seeing some shift now, and there’s a lot more I think experts getting the platforms that they need to actually get the correct messaging across of how do you think about this stuff. In the next couple of years, how do you see that progressing? Do you see that continuing to be a big shift, or how would you combat that if you had all the say in the world to do so?

Well, I think because everyone has a microphone. I literally have a microphone in my hand right now. There is a market opportunity to be the person who is uncertain. People can go through the progression, and the growth that comes with I know almost nothing. There is this person who seems really sure. They must know something. They actually only know very little.

They only know a little bit more than you about the topic, and then you eventually experience something that this confirms that belief, and now you go and learn more. People work through this progression of eventually appreciating the fact that there is a little bit of nuance and complexity to these things. It’s hard for people to make blanket statements about them, nor is it really necessary.

There’s no real substitute for the individual work that you have to do to figure out what works for you. That just takes time and people don’t want to take that time, but eventually they will have accidentally taken that time and because that will be clear to them in hindsight. I think it’s just about positioning in the marketplace because you can’t take out voices. You can only add more voices.

It’s about giving people access to the voices that may be less attractive to people who are looking for certainty and for the clearest answers about what they need to do. I think there is clarity in confidence, but not certainty. When you say, “Hey, there are multiple contributors.”

These contributors can be part of your picture, but let’s do the work together to figure out what the best option is for you. That can be done at scale now because of new media opportunities. A lot of people don’t need to work one-on-one with someone and go through months of that kind of relationship or coaching or therapy or whatever. People can do that work on their own if they’re motivated enough. It’s a question of getting the buy in on the front end.

Yeah, I get that. Something you said earlier piqued my interest. You referenced briefly how you went through school, and then you picked and chose which views to challenge, which to look more into and so forth, and which that need to be rejected.

As someone who’s super invested into research, and trying to stay up with the trends, how do you go about as a professional choosing who to listen to, who to give merit to? Do you consider everything, and then look at the rational standpoints?

How have you built up that approach to weeding through all of the noise to figure out where you see best practices going and where you’re interpreting some of that data we just talked about being on a big scale social media? Then, integrating that into a new way to think about something.

Maybe looking at an old way that needs to go away, and then realizing like, “Oh. That was said because of this, but now we’re seeing more of this.” My question for you, as a professional in the fitness industry or just in an industry really, how did you learn to develop that muscle and skill to pick and choose which voices to kind of challenge and base your own ideologies on?

 I think you need to preface that with the fact that no one can really escape their own bias. You need to surround yourself with people who challenge your views, but who challenge them authentically, and with the goal of resolving that disagreement, and coming to a common understanding, a common mutual understanding, and that’s tough. That’s part of why I’m here because these people do it.

We get access to people who will do that. We need to agree on a common set of fundamental axioms, or an epistemology of how we actually derive knowledge. I can’t say like, “Oh, my experience is my truth so therefore you can’t change my truth.” It’s like, “Well, we have this thing called the scientific method where we assume that everything happens because of chance.”

We have to prove that something will follow another thing or one or two things are related with the greater than chance probability, and that says something about their relationship. Now we can then investigate further. That is statistically derived, and we know the likelihood that it might be wrong based on that specific experiment. There’s limited generalized ability.

There’s a certain amount of validity to that statement that’s confined to that logic. There’s inherent logic to the way we appraise knowledge and having that basic science literacy I think is really important. If someone doesn’t have that you can appreciate their experience and what they’ve learned, but you can’t ask counterfactual questions. You can’t ask what if it had been different.

What if he did this or what if he did that? Because he didn’t do this or that. Experiment is a counterfactual question. You set two things, and so when a control group is basically saying if I had not done my intervention, this is what would have happened. I now know the difference between my intervention and my control. I now have a better idea of the effect of what I did in the world.

If we don’t do that, we reliably fool ourselves about our influence on the world. That I think is fundamentally important, and if it’s clear that people are sourcing their knowledge in that way and always questioning their knowledge because there’s always misleading…Because that’s a philosophically sound argument, but there’s always practical constraints to those statements.

That’s why we’re constantly refining them. When people are always looking to be less wrong, and developing basically the next experiment their head or asking the next counterfactual question, because there’s a never ending series of questions, those are the people that you want to be around because you can actually begin the conversation with them.

There’s a whole host of people that you can’t because they actually don’t ask those questions. They actually don’t ask any questions.

It’s like when you read comment threads on certain posts, and you’re just like, “All right, you’re not even worth engaging on” but then you actually get some great questions. “All right, let’s actually talk this through, and engage.”

Something you said in there to pique my interest. We have a trouble challenging on biases, I think, especially with fitness, like you said. I guess my question for you is this.

If somebody wants to start doing a little bit more of what you just spoke about, and truly looking at everything around them, and challenging what they previously thought, and improving their knowledge, and basis and ideologies. Giving tips for people who want to find folks in their community that will challenge ideologies.

How did you find stuff, for example, to create a hybrid? Why do they resonate with you? How did you find them? What are some methods that you would recommend for other trainers, coaches, or other just industries in any professional sense to build up that community?

 That’s a good question. I think the problem is, it’s hard because I don’t know without my advanced education I would have been able to do it to the same level. It’s one thing just to ask a question, it’s another thing to honestly investigate the answer.

I don’t want to say just go to school, but if you don’t go through that exercise of one being just endure with information and trying to sort out what makes sense and what doesn’t. Also, learning the basic tools of how to appraise that information, that’s a whole tangent.

There was that Joe Rogan “Game Changers” interview and they’re both talking about research and Chris Kresser was a little…I like some of his stuff, but they don’t know what the graph is they’re looking at and they both misstate what a confidence interval in the forest plot is. It’s like, how can you present information if you don’t know what you’re looking at?

You’re just looking at the summary of the study. When you can have a conversation based on a common basic skill set of just…This went fine…but of understanding probability and the basic math required, then you can begin to essentially find people who are also doing this thing.

My conversation with hybrid was…I mean, obviously, you just get exposed to content because you chose media account, but then on the back end, you get this content about this study said this, but there was these limitations. There was whatever, 10 fat-melting exercises or 3 stretches for your IT Band because like, “Why? How do you know? Does that make sense? Why wouldn’t I do something else?”

Those things are red flags to me, and I never saw any of those. I saw things that most people aren’t uncomfortable posting. It’s like we don’t know how important a slight knee valgus is. What’s another good example? Tempo doesn’t seem to be that relevant for hypertrophy.

It used to be all about time, and attention, and tempo. I used to think that too, and then when you see evidence, it’s like, “Yeah, when you control over tempo, it doesn’t make a difference.” That seems pretty convincing.

I do think that’s a muscle you exercise over time because you learn, especially the field of research you’re looking at is like, “What are the common limitations. How does that affect outcomes? What is a good site design look like versus the bad ones? What are the levels of evidence which you’ll learn in schools?

“What is the history of the literature on this topic? How is this new thing you’re looking at different? What value does it add to the current body of literature? What is the consensus among experts and what are they looking to improve in their own field’s body of literature?”

I was like, “What questions are the experts asking?” Not what the experts believe is like, “What are they commonly investigating?”

I love that.

When you dive deep enough into a field…Sports, science, and exercise physiology in the US, is a small field. You can get a good sense of the position of it.

Especially when people who are just looking at hypertrophy and strength, there’s even a smaller field like endurance, exercise physiologists, its own thing and transfers over to medical, cardiovascular health pretty quickly. There’s a lot of literature on disease populations and cardiovascular health, which is outs. Some are very valuable, but not totally in the scope.

But people looking at healthy young college students’ [indecipherable 22:37] programs, trying to get bigger and stronger, that’s not a huge body of evidence. You can read all the med analyses and all of the very large randomized controlled trials and get something out of that.

It does help you understand the real-world practice. It’s not a one-to-one transfer, but it will inform your decision-making that you learn on a day-to-day basis. We’re working with people because there is no substitute just to going out and working with people.

There are practical things you learn that aren’t validated by double blind-randomized placebo-controlled trials. Also, those don’t exist in exercise because you can’t…There’s no placebo exercise intervention. I think people also struggle with that, too.

It’s like, “Well, how do I learn research in a way that helps me in my training business or in my coaching or my own training?” If you’re just an enthusiast, it’s probably not even a conversation for you. It’s find someone you trust to learn from, or find several people you can trust to learn from.

If you really want to be a professional, I think you really have to invest more time than you think, in gathering a basic science knowledge because this is a science. The application is creative, and you can say that science is an art, but that doesn’t mean it’s an excuse to not know the science.

100 percent. I actually really love that point. You segued perfectly into what my next question for you. I think there are different camps within coaching obviously, right?

Yeah.

You have the folks who only go by the research. You have the folks who don’t even look at the research, like, “This is my way of doing it and that’s what works.” How do you walk that line and combine the two? I know you’ve alluded to it, but I want to talk specifically with coaching athletes.

How do you personally, Ian, walk the line of using scientific trends and what we know and what we have a better idea of at this point in time versus your direct interactions with athletes, with your own training? How do you combine those two? How do you navigate them? Do you have any tips for other coaches and trainers trying to flex that muscle?

Yeah. Again, when you only go by experience, you run the very real risk of fooling yourself, which is almost unavoidable. The challenging part is people just tend to get better with training so pretty much everything works. You can validate your own effect. It’s the same thing in chiropractic care or physical therapy for back pain.

Most people get better so that doesn’t validate your treatment approach if someone gets better. The only way we can test is with experiment. Again, these things are very complex and hard to test experimentally, which makes the research challenging. The research sometimes does say things that would influence your practice, and also it influences probably more so what you wouldn’t do.

It gives you constraints rather than prescriptions. There’s a lot of room for your own filter to apply these principles or these models of what we think drives training adaptations. There’s a lot of ways to apply that in a training program, but it also creates constraints on how much affect you think you have, what the differences may or may not be.

For example, in periodization we don’t really know whether random periodization is better than highly structured periodization. With a lot of people, no periodization might be exactly the same as a highly structured periodization program. We just assume more is better, periodization is good. Daily undulating periodization is the best. That might be true.

It might just be easier to think that way, but to convince yourself that there’s something inherently special about the way you structure training is a mistake. It leads to false certainty, and it leads to…It might inform decisions in the future that don’t serve you well. If that makes sense.

I think of research as providing a bandwidth of options that you can then choose from because evidence-based practice in medicine, which we don’t really get as personal trainers, is the research evidence, clinician, or practitioner experience, and patient preferences.

The idea is those all inform decisions that go into how you deliver a training program or are in medicine how you deliver therapy or treatment. They all influence the ultimate decision making, but they influence to different degrees. The idea is you can’t just take one without the other and expect to be doing evidence-based practice.

The idea is if people are just using evidence and slapping whatever the experimental design from an auto regulation training study onto a client saying this is evidence-based, it worked very slightly better than a percentage-based program, which is barely statistically significant and or barely detectable in real world terms.

It’s like, “Well, this equals a better program so I’m giving it to you.” That’s also not evidence-based practice because it doesn’t have the other two components.

Yeah, totally. I guess when looking at those, do you have a hierarchy of how you structure them when pulling options? We know that maybe these couple of options would be best based on the research. I’ve seen this in training and what trends best with my clients.

When combining the best case for the person you’re working with, how do you structure that hierarchy of choosing, whether it be the modality, the way you’re going to have them adapt, or so forth, to their practice?

Yeah. The tough part is when you apply it to real people. People are not averages. They’re not a sample of college students in an exercise physiology program that are getting paid to do a study. They’re real people with a current level of ability. They have a real training background. They have real skills and holes. They have goals that are often unique to them.

They have constraints in the life that are unique to them. They have beliefs and attitudes and preferences that are unique to them. In a group training program, those are less relevant, but they’re still relevant. Also, there’s other influences that might change the way you write a program.

It’s whether it’s informational constraints or equipment constraints or time constraints or some sort of assessment of the population you’re working with. In a one-on-one scenario, it’s all about the person in front of you and the program that they will do and respond to, and the program they’ll get the most out of.

Keeping in mind that some decisions might be influenced by what the literature says. Again, tempo’s a good example. “Well, I could still use a slow tempo to help people learn a movement or to actually reduce load in the beginning of a training cycle or in the off season so they don’t overload the system or don’t progress too fast.”

I want to create a longer period of time to load a tendon or something. Limit rate of tendon loading because that could be irritating. There’s a lot of reasons to give a tempo. That it creates more hypertrophy is not a reason. If the goal is hypertrophy, a tempo prescription doesn’t make sense, unless it unless it’s to remind them to control the move then create more mechanical tension.

That’s a good example. A 10-second lowering tempo makes no sense.

Basically, what you’re saying is you structure it based on the individual in front of you, and there’s a lot of undeveloped individuality that goes in there. That’s really cool. I like that approach a lot. I think that’s great information for especially for newer coaches and trainers getting into the game.

That’s one thing I think is emerging in clinical practice that really applies to training is that we’re so uncertain about the objective tests we have, how unreliable they are, and how often not useful they are. Even the most sensitive testing, like advanced imaging, is just not useful in the vast majority of cases with people of pain.

What can we fall back on is people’s own experiences, conversations, questions, and helping them develop a plan towards their goals or towards their recovery in the clinical case. The same thing applies to training because essentially clinicians are realizing, “Hey, we’re just coaches.” We’re just coaching people in pain.

Coaches need to realize that we’re coaches, and we’re coaching people, and that’s what patient-centered coaching is. That just means you have to be the person to ask the questions, who understands where the person in front of you is coming from, what their beliefs are.

If you’re unsure of those to create that open dialogue, and to not come at it with your own set of expectations beliefs and biases.

Cool, man. I love that. Something, I want to talk to you about, and something I think you have a lot of knowledge on is something you kind of just briefly said, but pain. There’s a lot of cool research coming out right now, and a lot of cool rhetorics coming out on how we perceive pain, especially in the gym setting.

I would love to just hear your take on, a top level down, of how pain was perceived, and how it’s shifted in terms of more of a clinical setting of how we’re now seeing and understanding it and going forth from there. Basically, how has pain changed over the last five decades let’s say?

That’s a good one. There was a really good paper came out by…It’s probably the paper of the year. It’s really philosophy paper. It’s not even an experiment. This kid, who’s a chiropractor, is a PhD student, but they outline the history. If I want to look at it, it’s an inactive approach to pain, beyond the Biopsychosocial model, beyond the BPS model.

They outline a history of pain science essentially. They start with [laughs] voodoo cults and inhabited spirits, and then it goes to Descartes. “I doubt therefore I am” kind of duality of mind. This mind body dualism led to the belief that pain was transmitted via wires to the brain that released animal spirits.

That was the dominant belief until the ’50s and ’60s when we understood more about neuroscience, and we thought pain must be somewhere in the brain. There was also a different school of thought that was like, “Well, body pain or somatic pain must be transmitted in the nerves to the brain and the brain just outputted pain.” You had two competing ideas.

As the end of the century evolved, they were looking for a brain-centered region because some of the gate control stuff…If pain comes from the body, and when we move, we reduce it a little bit that means that we’re blocking the pain signal. Some of that data was…That model was broken a little bit because you can still perceive pain for a lot of other reasons.

There was clearly not a clear relationship between the input coming from the nerves, and the pain experience that was coming out. People were looking for the place that that was processed to drug it or to surgically alter it, like a pain center. Idea is no one ever really found a pain center.

There’s some conditions where people don’t process pain the same way, but they have pain and avoidance behavior. They don’t feel pain, but they behave as if they felt pain, which is very interesting. The problem is much of the 20th century medicine is based on finding, diagnosing, and fixing pathology. There was an assumption that noxious sensory input from the body caused pain.

If people had pain, you must find the cause of the sensory input or reduce the noxious stimulus so that we can then reduce pain or eliminate pain. We knew that was a flawed model because there’s just so many circumstances where the amount noxious stimuli doesn’t predict pain. It doesn’t predict the amount of pain. Reducing it doesn’t reduce pain.

Other therapies might reduce pain without influencing the noxious stimuli. Doing nothing reduces pain without changing the synapses. The entire model is broken. In came George Engel, and this thing called the Biopsychosocial model, which means that he basically said within a medical context, it’s like, “Hey, there is a person here.

“The status of the tissue or the biology is important, but it’s not the only thing that influences this person’s experience or their treatment. Their psychological state, their thoughts, attitudes, beliefs, and emotions influence their condition and their perception of the condition and their prognosis and their beliefs about treatment, and their social behavior, which people don’t really get.”

Again, those conditioned behaviors, those socially learned responses, those expectations set by their tribe also influenced their behaviors around their condition, or illness, or health status, and also their expectations of treatment. People learn about pain very early.

A good example is, if your dad had a bad back and he didn’t ever get out of pain, and he never lifted anything heavy, and he always got in the car very slowly. He always went to the doctor all the time is like,” Wow, oh, my dad has a bad back.” That’s what you do when you have a bad back. That’s a good example of that.

It’s like, “Oh, if my back hurts, I must have a bad back too because it’s genetic and I should also protect my back as much as he did. Now, he had one spine surgery and he could have had seven, so I only want to have one spine surgery.” I think people underestimate that socially learned component.

Even that model is limited, one because people end up talking about one of three things like, “Oh, this is a bio.” There’s something wrong with that person’s disc or fascia joint, if we’re talking about backs, or their elbow. You’re still dealing with the tissue and not the pain, or not the entire experience. They’re not the pain in context. It’s like, “What are they doing?”

What is the history? What is their total level of stress or adaptation? What are their concerns about the history of this condition? Are they afraid it’s going to get worse? What are their expectations of relief? Are they totally unrealistic about the expectations of relief? What do they think the pain means to them? Do they think that they’re hurting themselves every time they experience some pain?

All these things influence even a very simple movement triggered or tissue-entered pain experience. Patella, knee pain is a good example too. Front of knee pain. It’s like, “Yes, you’re almost always very easily triggered by some sort of movement.” It’s very clear that there’s a biological component to that.

Again, it’s never the only component because pain, by definition, is not only a biological experience. Nociception is which is just bad, which is the nerve stuff. But when we experience pain as a threat assessment, as behavior that influences other behaviors, as this emergent sense-making tool, it is more than just the bad sensation.

It is a belief and a behavior pattern. It’s a useful tool in terms of navigating potentially threatening situations, so there is a utility to it.

The idea is when we extend that BPS model or that Biopsychosocial model into someone’s environment and understand their pain in context, then we get a better sense of how we can help them move back towards the things that they love doing. Like, get back to living in a way that’s helpful for them regardless of the amount of pain they experience.

That might require reducing pain a good amount. It also might require changing the predictive value of pain. The idea is essentially we manifest pain often irrespective of the amount of damage, which might be because we anticipate damage, which is helpful to avoid death.

Sometimes that threat assessment becomes too sensitive and writes an alarm that won’t shut off. The idea is, how do we help them shut off that alarm?

That comes through desensitization and conditioning and general movement, and showing people that they can move and that they are strong, and maybe even touching pain and getting people moving through a little bit of pain.

Again, that’s in a therapy environment with the go-ahead from people who have ruled out anything potentially serious, but for people with more serious and ongoing pain. For people with a little bit sensitivity, maybe working through it a little bit and seeing it reduce, proves to you that it’s not related to any underlying damage, that you are making it better with movement.

Then over time you can, you can get back to challenging yourself and loading yourself more. You can feel confident that you’re working through any issue you had and you’re now stronger than you were prior to that pain experience, which a lot of people don’t ever get to that point.

The idea is that it was all related to how this pain experience influences an individual’s relationship to their environment. In our context, environment is their training environment. You cannot remove the pain experience from any one of those components. You can’t remove it. You can’t remove the brain, and say it’s in there. You can’t remove the body, and say it’s in there.

You also can’t remove the movement, social environmental context in which people experience pain. They need to address that in its entirety to help people develop that plan that can they can be confident to move forward with the right set of expectations and kind of empowering beliefs.

That was a lot. That was impressive as hell. My question for you as a coach…I hear where you’re coming from. Looking at the bigger picture from every angle, working with athletes who say like, “Oh. My knee is giving me a little problem when I’m squatting”, but they’ve never had let’s say an issue with their knee, but they’re associating it with pain and whatnot.

What would be your first step for approaching the getting them out of that mindset of this is what’s triggering it? It’s actually something that’s not even related to your knee. How do you approach that from a first…?

It is related to their knees because…

Well, yeah. You know I’m saying though?

Yeah.

How do you how do you approach the first step of trying to get them over the hump of associating pain where there might not actually be, let’s say an underlying actual damage to the joint itself or the mechanism of which the pain is stemming from?

There’s two things I like to caution people about. I don’t want be the person that says that…When someone says, “Oh, my knee hurts a little bit when I squat.” I say, “Your pain isn’t real. It’s nowhere.”

Rub some dirt in it.

Can you even quantify it? The other thing people say is, “Oh, it’s not in your knee. It’s actually in your shoulder because your shoulder doesn’t move right.” I’m not chasing pain. I’m chasing function, and I don’t buy that either. We can give people tools to reduce their apprehension about what the pain might mean. It’s like, “Hey, a little bit of knee irritation is normal. What have you been doing for your training? Did you ever have a big spike in training volume?”

It’s like, “Yeah, I’ve been squatting a lot more than the normal.” Sometimes those aches and pains pop up when we do a lot more than we’re used to for a lot of reasons. If nothing’s changed, maybe the stuff kind of emerges sometimes. I want to focus more on what can we do about it?

One, is it intolerable? Especially with knee pain. If it’s less than a 5 out of 10, and it doesn’t limit your training. You don’t feel like you have to reduce the weight. It doesn’t flare up immediately after. It resolves once you’re done. You can probably continue to work through that.

I wouldn’t worry about it too much unless it starts to progress, and then you want to think about potentially getting some help. I’m a little bit more confident in people’s ability to do that than maybe some other people are. Some people are more cautious with people. Like, “Hey, you experience any pain? You should go see someone.” I don’t necessarily believe that.

I think people can work through a lot of stuff on their own. If it is limiting, and it flares up a bunch then it’s OK to modify. It’s OK to use one of any number of variables you have to reduce your training load whether that’s changing the movement variables. Like knee pain’s a good example, and maybe you can box squat for a little bit. You’re still even training your lower body.

You could do other movements that very heavily load the muscle that you trying to load, like lunges. Sometimes compressive loads of the knee just irritate the patella a little more, especially when it’s sensitive and just the idea that that’s temporary and will go away and you should continue training is really important to reinforce.

There’s ways to do some basic training modification so you’re not too far removed from the training environment. That’s probably the most helpful. That involves some sort of movement modification a lot of times, but not because people were moving wrong or it might be because I think people are moving inefficiently.

I don’t like to tell them, “Oh, you’re moving wrong,” because then people might associate that type of movement with pain and might fear what moving in a certain way means and might now have reduced confidence in their body to handle training, which is not the goal.

Instead saying you can probably tolerate a whole host of movements that people feel like are unsafe, as long as you’re prepared to do them, which might be harder than some other things. If you really wanted to…I like to say that the body is almost infinitely adaptable, but not totally infinitely adaptable. There’s probably some positions that will just break you. You throw enough 100 mile an hour fastballs in a row eventually you’re going to tear something in your shoulders because those structures don’t adapt that fast.

In theory, if you spread out your throwing volume enough, and you were careful enough with your progression, you would be able to create enough strength in your ligaments and tendons to handle an enormous amount of human rotation that comes with throwing a baseball 100 miles an hour, which is the probably the most violent thing you can do with your shoulder.

 I’ve couple more questions before we wrap this chat up because this has been a lot to take in. I worry that we might lose some people.

My next question for you, and I know this might be another big question, but how much different is it working through pain with somebody who has a previous injury? I’ll just give you an anecdotal example.

I ruptured my quad back in 2017, and now I am seeing more and more how I associate pain that I’ve had from that with my training, when there’s probably nothing actually going on for the most part. I’m very tuned in with my volume, and intensity based on what I’m able to handle now that know a better idea of that.

When working with clients and athletes, who have had previous injuries and have pain in that area through training, how do you navigate whether that is actually related to the injury itself? That maybe something hasn’t healed or been rehabbed to its fullest extent versus somebody that they learned from the injury? I’m not going to lie.

I did it while I was squatting, and when I get to a certain weight there’s always I thought my head, I’m like, “Well, fuck. This is what did me in last time.” How do you navigate that? I feel that’s a very tough question, and it comes around to a lot of the rhetoric you have with your client.

That circles back to having that conversation and doing patient-centered coaching. For you, it was a quad tendon rupture?

Yeah, I couldn’t lift my leg.

There was a full rupture?

It rolled up my…It was bad. I went to the doc. I was like, “Oh, Doc. I feel no pain. This must not be that bad.” They go, “Flex your quad.” I went like this, and extended and flexed and the whole quad muscle rolled up like two inches, and I just about passed out. I was like, “Huh.”

They probably got you into surgery pretty quick after that?

Oh. I was I was in surgery two days later. It was wild.

Yeah, within two weeks.

We can’t have this rolled your leg otherwise you’re screwed.

That’s a good example of understanding the fear is real, and it’s useful. If you almost killed yourself tearing your quad, you’re going to protect your quad way past the minimum safe time you need to protect it. A good way to think about that is the body heals, the brain remembers. The trauma is something you have to work through almost like a psychologist.

You have to expose yourself to the same environment, the same cues. The injury happened in an environment. You almost need to slowly re-expose yourself to those triggers, and also provide some sort of safety and support, which is the goal of someone like me, or a therapist or a coach or clinician is to make you feel safe so you can learn to navigate those potentially triggering environments.

To not relive the same sort of emotions and experiences that you had even though you’re not going to have that same injury again.

Also to work at a pace that people are comfortable with that challenges them a little bit. That’s all involved in a quality rehab process. If the rehab wasn’t so good, then you need to start where people are and understand just like, “Hey, it’s going to take a little longer.” First of all, the serious injury is like you had a serious injury.

We know that the more preparation you do, and the more patient you are, and the better strength we can develop in these certain movements or positions, and the better whether it’s limb symmetry or jump metrics, or whatever objective measures we’re having based on the evidence like the best tools we have, then the better off are going to be for you to go back to doing the things at the level you want to do them.

We’re going to go and set you up. We’re not going to make any guarantees, but we’re going to set you up for success by doing all the right things and taking the right amount of time.

Got you. Yeah, I feel like that. It only adds to the level of complexity of understanding it, but that’s really cool that I think one of the big takeaways, and correct me if I’m wrong here is having a little bit more mindfulness as coach and trainers over the rhetoric we’re using with some of the athletes and clients we have.

It’s maybe not babying them to a certain extent but also being very understanding an individual with their needs and anything else.

Yeah. We, kind of, gone to the weeds a little bit which is going to like [indecipherable 50:31] . I think circling back to the fact that words really matter and clinicians don’t consider how much their words matter. I don’t think trainers have ever considered how much their words matter.

You don’t need to tell people what’s wrong with them. You just start telling people what’s right with them and focus on that, and focus on delivering an empowering message. Providing accountability were needed but not projecting authority by creating a false sense of your own knowledge.

When you’re going to explain something to someone or tell someone something about themselves, you should ask, “How do I know that? How confident am I in what I’m saying? What are the potential consequences of me saying it?”

If we understand pain as a global experience or a behavior that has emotions and prior beliefs wrapped up into it, your words affect that experience.

Well, dude, thank you so much for the chat, man. That was a lot to take in, and we’ll definitely have a part two at some point in 2020 and follow up on some of these topics.

If you’re listening, and if you enjoyed this podcast, share a comment down below. If there’s anything that we should follow up on in the next rendition of having Ian Kaplan on. Ian, man, tell the folks where to follow you, where to find you, where to ask more questions that they have some based on the podcast?

You can follow me at kaplanfitness.hybrid. That’s K-A-P-L-A-N. That should be spelt in the notes fitness.hybrid. Reach out if you have any questions.

I’m happy to respond to anything I might have with a good thorough answer.

Thank you so much, man. Obviously, listeners will have everything linked down below to if any of that is unclear, but thanks for the time, man. I’m looking forward to having you back on.

I appreciate it. That’s fun.