Dr. Jordan Feigenbaum: What We Get Wrong About Pain

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.

Today, I’m talking to Dr. Jordan Feigenbaum, who, in my opinion, is one of the top strength coaches pushing the envelope for improving current training practices. Dr. Feigenbaum received his doctorate of medicine in 2016 and is the founder of Barbell Medicine. Mind you, this is all on top of being an accomplished power lifter.

In today’s episode, I talk to Dr. Feigenbaum about a variety of topics within the world of strength and conditioning, including things like bridging the gap between exercise and medicine, what the public gets wrong about pain, and much, much more.

We’re incredibly thankful that you listened 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.

Today, we are joined on the BarBend Podcast with Dr. Jordan Feigenbaum, the founder of Barbell Medicine, and an accomplished power lifter. How’s it going?

 It’s good, JA. Thanks for having me, man.

Of course, man. I’m pumped to have you on. You’re one of my idols in this industry. It’s a pleasure to have you.

To give a little bit of context into who you are, would you mind sharing a little bit of your background and your upcoming, for other athletes out there who may not know you yet?

Sure, yeah. My name is Jordan Feigenbaum. I started Barbell Medicine, that’s my company in 2012, when I entered into medical school. My background from a training standpoint is, I started powerlifting in 2010, I think, is when I did my first meet.

I’ve been competing ever since in this sport, if you can call power lifting a “sport” anyway. [laughs] My best total as a 198 lifter raw is 1795. It’s 640 squat, 440 bench press and 725-pound deadlift at 198. I keep trying to improve upon that. I’ve got a meet coming up in three weeks, and we’ll see.

At some point I’m going to have to switch sports. The only other thing that I did athletic-wise before this, I used to race dirt bikes for a long time at a pretty high level.

That’s actually how I got into lifting, not through training for motocross, but rather I had a nasty crash the summer between my first year at college and the second year in college and I dislocated my hip. Once they reduced it, I actually had trouble, I had some loss-of-function, I couldn’t really stand on my own and walk or whatever.

When the home PT came to my house she said, “Hey, we’re going to start your PT,” and I said, “Neat, what are we going to do?” and she said, “Stand up off the couch, stand up. Sit down and then stand up,” she said, “We’re going to do these,” I forget how many sets and reps she told me to do but this seems like squatting.

I had never lifted weights at that time but that’s what got me into it because I went into the gym. I didn’t know that you could actually squat anything between the empty barbell and 135. You look around and all you see are people putting 45’s on machines or leg press or whatever.

I’ll put 45’s on there, meanwhile a few weeks earlier I was having trouble actually standing up off the couch without assistance. At any event, I got under the bar with 135 and I walked it out and tried to go down. I’m sure I was high, a mile high but then I couldn’t stand back up so I had to dump it.

Think about how traumatizing that is, the very first time you’ve ever tried a squat you dump it. That was my introduction into lifting weights, but got on YouTube and tried to figure out how to lift weights.

That must have been 2004 and then stuck with it ever since, did some different stuff before I actually found that I wanted to compete in power lifting. I did that, I still am competing, I have a meet three weeks from now.

I don’t know when this is going to go up but if it’s after October 12th, I’ll have competed. Maybe you can check my social media and say, “Hey, you had a good meat,” or not.

That’s amazing, coming back from an injury teaches you a lesson that a lot of people don’t necessarily get unless they go through that. That’s really cool that you found strength from accomplishing and overcoming that.

To spin off of what you said, how you had an indirect intro into this whole world of fitness, coaching, strength coaching and even medicine for that matter. One of the things that is most intriguing about your background is your educational background.

I would love to start there and talk about how you went from biology to a doctor of medicine and the route you went down that road down getting there.

At least for me personally a lot of questions I often see on your social media is about education and if you think it’s worth having those bigger Master degrees, doctorates, behind your name. I would love to hear your thoughts there.

Yeah. The running joke, especially in my own family is that I try to find the most indirect route to the final goal. That’s how it was with the strength training. Certainly, then with my education, I actually started out.

I originally went to school to be what I guess most universities would call a philosophy major. Anyway, that didn’t work out. I went to a small school in Arkansas for a year and a half. Actually, Greg Nuckols went there too.

We didn’t know each other, and because I think he’s much younger than I am, but we ended up at the same place, but I left and I switched my major to biology because I just thought science. I wanted a science degree, but I wasn’t like pre-med or pre — anything — I just wanted a science degree.

Graduated with a biology degree from Truman State, and it turns out, you can’t do anything with the biology degree. There’s really nothing for you to do except for going to a professional school, get your master’s, PhD at a medical school, whatever.

I ended up working in a lab at a company called Vitek Systems, which they basically are a microbiology company. I think they’ve rebranded. Anyway, Boeing owns them. I worked there for three months and I hated every minute of it. Because I was just pouring plates that you would stain different bacteria on. I hated that.

I ended up trying to figure out a new way to make money, and I was like, “What do I like to do?” I was like, “I love training, and I love researching and that stuff, so I’ll work as a personal trainer.”

I got a job doing that and I loved it, fell in love with it. My business took off, which is probably one of the best things that ever happened to me. I had this imposter syndrome thing going on where I was like, “I don’t think I know enough. I know how to lift weights, I know how to coach this stuff.”

Which at that point was based on trial and error because there were no resources back in 2007, 2008 on how to really do this. I was like, “I’m just going to amass as many different credentials as I can because that’s going to make me feel better.”

I was like, “OK, I already got my CSES. I’m going to get my ACSM HFS cert, I’m going to get my USAW cert, I’m going to get CrossFit certified, I’m going to get my RKC, I’m going to get CISSN nutrition cert.” All these different things, which in hindsight didn’t prepare me to train anybody. It really didn’t. It just gave me more letters after my name.

On the flip side though, it did allow me to move into a position with the company I was working for as a coach, as more to educational role, which got me further ingrained in, “I need to learn more if I’m going to be responsible for teaching these trainers how to train.”

Which ultimately, led to me thinking about higher education because I was like, “Should I go get a PhD degree? Should I go get a master’s in something, should I go to medical school?” I had this conversation with a couple of close friends and mentors.

Basically, the only thing that was worthwhile for me, given how old I was, I was 24 at the time. What I was doing in my career already was medical school, but I had been out of school already for a number of years. I needed to figure out a way to shore up my resume, my application.

I ended up getting a Master’s in Anatomy and Physiology from St Louis University School of Medicine. I actually taught anatomy to their med students and PA students, as well as neuroanatomy. That was fun, a fun experience for me.

After that, I applied to medical school, got in, went to medical school, and then ended up doing a residency UCLA in family medicine. I spent some extra years in there working and getting a master’s.

If I would have gone to medical school right after undergrad, I think I would have had a much different experience. If I even would have been successful applying and going through it in the first place.

Again, there’s very indirect route, but having all that educational experience, I do think it gives me some insight when people ask those questions like, “Should I go get this professional degree?” I don’t know that. There’s one answer for that. It just really depends on what do you want to do.

If you need additional professional licensure to do what you really want to do, hey, knock yourself out. On the other hand, if you just want more education to know more things, I don’t know that you always have to pick a formal route for that.

For instance, for a lot of adult learning programs, there’s a lot of masterclass, or mentorship programs that may be more suitable. It really just depends on what you want to do. Spending a whole bunch of money, both it costs money to go to school, and then opportunity costs of actually going and not working and stuff, might not always be the best solution.

For me, going through medical school and stuff like that was a good trade off.

Yeah, I totally understand that. Something you said in there stuck out to me that was on the topic of Impostor Syndrome. I think that something that a lot of coach has actually experienced is actually when they’re younger in the game because you don’t have the years with the tons of athletes.

You haven’t nailed down what you fully believed in. You’re testing it out, bunch of different methodologies. Can you speak to that and how you work through that along the way especially as you went through maybe your education, you started to build more of your client base, your business itself?

Sure. I think when you start out, you don’t have any experience or much experience at all. You can go one of two ways although I do think you end up experiencing both. The first way you could go is be an overconfident like, “I know all these things. I’m the expert.”

You almost feel like you need to have this confidence in order to not only sell your services to people but also make sure that they trust you. On the other hand, I think, if you experience that initially, then, the more you learn or even if you’re not like actively seeking knowledge, you end up coming across things that challenge your beliefs.

You start thinking like, “Oh, crap. Maybe I don’t know this stuff so well.” You get insecure about your knowledge base, your skill set especially when you come into contact with people who may have, either have more experience than you or more education or both.

At that point, you start to doubt yourself and it’s a struggle. Alternatively, you could start from the very beginning. You may not be very confident in your skill set which is almost appropriate because even if you come out, you have a degree and you’ve had some personal experience, if you’ve not any experience, for instance, coaching people, you lack that.

It’s hard to be like, “I’m an expert right now. Really, though how many years have you been doing this with other people? Where’s your pedigree?” The best advice I can give for people, I would prefer that folks come out and be a very self-aware of where they’re at on this curve.

It is not so much a learning curve, it’s more a career experience curve. If you’re just starting the knowledge base, the fund of knowledge that you have is a good primer for how to critically assessed things. How to think about things, how to interpret new data, new knowledge, new skills.

It’s not like, “Well, I got this knowledge. It’s never going to change. It’s very dynamic.” One of the funny things is said at the medical school is, at the very beginning, there were like, “Look, 50 percent of the stuff that we’re going to teach you at the next four years is going to be wrong. We just don’t know what’s 50 percent.” [laughs]

From the outside, that statement is like, “Oh, gosh. That’s incredibly daunting.” When you start thinking about your education is a way to critically think, assess, interpret things, and gain new knowledge from your personal goal-directed education then it becomes a much less stressful situation.

I wish for the people come out, want to start in a new endeavor, be self-aware of your own limitations. That’s fine. You don’t have to be overconfident. It’s much more beneficial to tell somebody when they ask you a question like, “I don’t know.” Or “I’m not sure. I’m going to investigate.”

Versus this making something up on the spot especially on the Internet where people can do so anonymously and make egregious claims and not have bunch of repercussions.

Also, familiarizing yourself with the Dunning-Kruger Effect is would be [laughs] super useful because the less you know about a topic, the more confident you’re likely to feel about your own personal knowledge.

Another great little quip is, everybody thinks that they’re above average driver, for instance, which is statistically impossible, just like everybody thinks that they’re above average trainer, coach, doctor, whatever. Again, statistically impossible.

It’s highly likely that you have an average skillset and average fund of knowledge. That’s OK. Trying to improve from there, is the main thing that I would advocate for.

Then finally, try not to get personally invested in a pet theory, or pet understanding of things because things change so often, so frequently that you should base your opinions on your experience as it combines with the current evidence.

Since that’s all going to change, I don’t know that making super confident claims and being adversarial towards other individuals who share different views is helpful. All it’s going to do, is frustrate you. In addition to, you’re probably both going to be wrong in 20 years.

One thing that Austin and I, Dr. Baraki, another physician at Barbell Medicine, we always joke about, 20 years from now, most of the stuff that we say right now is going to be wrong in some way or another.

That doesn’t mean that I feel that imposter syndrome anymore right now. It just means that I’m more comfortable being either uncertain, or potentially being wrong. I’m comfortable with that, but when I say things, I try to provide the right caveats.

I’m not marrying myself to a certain theory or certain statement. I don’t want somebody to come back and say, “You said that, without a doubt, always it’s like this,” and I’m like, “Yeah, that was wrong.” That’s tough to swallow. [laughs] It’s easier to be a little more skeptical, a little more subdued with your opinions, I think.

I agree. I love all of that, man. That is a perfect segue into my next question for you, which revolves around Barbell Medicine, how you founded it and the principles that stands behind.

I want to know along the way when you thought of that idea and you started to accelerate it, because over the last couple of years, Barbell Medicine has taken off, and it’s been awesome to see. You guys are across every media platform now, which is phenomenal.

The content you put out, is the perfect example of what you just explained, of being objective enough with what you know, but also understanding that things could very well change. Here’s the best of what we know and we’ve experienced in the moment. To go off there, man. How did you come up with Barbell Medicine and the principles behind it?

That’s a good question. I liked the way you describe what we’re doing because that is honestly the goal. Barbell Medicine. To be honest, the way it started when I went to medical school, I had gotten out of this educational position that I was at another company in St. Louis where I’m from.

I had a lot of clients and trainers who are reaching out to me for information. They were like, “Hey, we’re willing to pay you to continue on remotely.” I was like, “Oh, that’s a thing? I didn’t even know that.” That was about 2011 or 2012, something like that.

I decided just to start this company, and I was trying to come up with a name for it. I was in medical school and I was like, “I’m pretty under resistance training.” How it’s called Barbell Medicine. [laughs] It was just a coaching/educational company at that time. It was mostly one-on-one consultations with either lifters, jump-up trainees or coaches.

For instance, I would do a weekly call, like regional call with all these trainers and managers from Gold’s gym once week, where they would literally just pepper me with questions for an hour. It’s like an Instagram Live before Instagram Live was a thing.

What happened was during my — I remember this — during my first year of medical school…The way medical school is set up, if you guys aren’t aware, is the first two years are all clinical work or sorry, pre-clinical work, so it’s all in the classroom. Whereas, the second latter two years, third and fourth year are all like in the hospital, you’re on rotations and stuff.

You’re learning all these subjects — your typical gross anatomy, pathology, immunology, all this stuff. You learn these core scientific principles, but there, when it comes to actual management of a disease or condition, you get basically the pharmacology.

There’s some lip service paid to lifestyle change, like, “Oh, yeah. If you lose weight, people do better. For instance, with diabetes, or if they start exercising people with diabetes, do better.”

My own personal experience with coaching folks with these medical conditions, with high blood pressure, with diabetes was that exercise particularly resistance training and nutrition modification could have this huge, huge impact.

I was like, “Why is this not a thing that we’re learning? Is there like an organizational group who’s trying to bridge the gap between ‘strength conditioning’ and medicine?” and there wasn’t, there isn’t. I was like, “Well who better to do that then me?”

At that point I had been coaching for a number of years at a reasonably high level and then I was also about to be a physician. At that point we kind of pivoted, we’re still doing the coaching, but our main thing we wanted to expand on our educational content to provide medical practitioners with the knowledge on how to implement different lifestyle changes with their patients and how that could benefit their patient outcomes.

For instance, each doctor should be familiar with the current exercise guidelines, how to recommend them and the relative benefit they can have for certain conditions, because we feel like that knowledge base would improve the recommendation rate, or the counseling rate, for exercise.

Just as a side, a statistic is really kind of telling at where we’re at, although admittedly this is kind of outdated at this point, we just haven’t had new a study that’s come out to give us new rates. Less than 10 percent of all primary care physicians are familiar with the current exercise guidelines, and of those, 10 percent-ish less than half of them actually recommend them to their patients.

It’s a huge need here considering the potential benefits, and also considering that the World Health Organization and the American Medical Association both rank sanitary as one of these huge risk factors for nearly all diseases. It’s in the top five. I thought, “Wow. That’s something we should do here.”

We wanted to give physicians and healthcare practitioners a resource that they could trust and that they could get information from. Then we also wanted to give strength coaches or personal trainers or both resources for how they might want to manipulate these lifestyle interventions that they’re in the trenches administering for their patients who have high blood pressure, who have type 2 diabetes, who have these other conditions because there is some nuance there.

We really wanted to serve both groups and then also just bridge the gap. That really started maybe 2013 and since then we’ve been off to the races. It’s funny because when I was in residency, I was working 80 hours a week or so at the hospital.

Or depending on the rotation that I was in, 60 to 80 hours a week. I was trying to do part-time medicine on the side, and production suffered they’re as far as putting out podcasts, putting out articles, putting out other information.

Since leaving clinical practice, we’ve been able to do a whole lot more, which is why now we’re across all these social media platforms, and we’re really trying to extend our reach. At some point I’d like to reach influencer status.

I don’t know how many followers I have to get or how [laughs] or what I have to do to do that. As our audience continues to grow will be able to make a positive difference in both those gr

That’s amazing. To go off of what you said, there will be a shift in the fitness world and strength coaching world where people are going to start to acknowledge the work that you guys are putting in some of these bigger coaches that are really trying to broaden the scope of everything that’s going on and everything that’s changing from an objective point of view.

Going off of that, has it been a little bit slow, in your opinion, or has there been any resistance or push back from more the medical practitioners that you’re trying to educate about the guidelines? I feel like it must be a little bit frustrating at times, especially for maybe some of the older pops who are resistant to change. Have you experienced any of that?

It’s not something I’d thought about actually until now. It’s funny, each one of our seminars we get a handful of doctors like MDs or DOs who show up. If they are coming to Barbell Medicine Seminar, they’re obviously at least somewhat familiar with our stuff.

Those folks are completely bought in. They’re like, “I want to take away as much from this seminar as possible so I can bring it back to my patients,” which is super cool. No pushback from them.

Interestingly, as I appear on more and more podcasts or more and more media goes out, I get people who are less familiar with our brand who reach out. What’s most interesting, I don’t know if it’s just like a selection bias thing or just the older individuals have more time to write emails, but the emails I get from these folks, man, they’re big supporters.

They’re like, “This is great. This needs to be promoted so that more people know this.” I actually haven’t gotten — and I should knock on wood because this has been a positive thing — much, if any, pushback from the healthcare field outside of what I would consider fringe providers. I don’t mean that they are in some crazy specialty like radiology/oncology, not that.

What I’m saying is that there are some providers out there who are hard core like Keto for example. They have some other kind of hat, their diet or exercise protocol they love. We’re like, “The evidence out there, for example, on Keto is not that great. Let’s adjust what we say about this accordingly.”

They’re like, “No. Keto does this, this and this.” We’re like, “Hmm. It’s really hard to hold that opinion.” We get some pushback there, but not really from healthcare providers. They’re pretty accepting on this. I think the biggest limitation that we have is that we’re not in front of enough healthcare providers.

The way we were combating that, one thing we did, we wrote the two very extensively cited articles on strength training and primary care that were published in an online journal called UpToDate. UpToDate is the doctor’s Google.

Effectively, hundreds of thousands of doctors across the world now have access to what we think about primary care, what it can do for different conditions, and how to prescribe it. Which is cool.

Another thing that we’re doing is working on getting our seminar approved for continuing medical education. That way you’re doctor who may have no real interest in learning this stuff, but who needs to get his or her CNUs to maintain their licensure. It’s like, “Well, I can go get 20 contact hours at this seminar.”

The final aim of this is we’re getting involved with the American College of Physicians, ACP, so that we can present at their annual conference and have a booth so that doctors can just come up and talk to us and try to be this peer-to-peer learning thing.

What I suspect will make this going to kind of take off is that, instead of there just being Austin and I and a handful of other folks, that there’s hundreds of us. Not necessarily working with Barbell Medicine, but just people who have been infected with the training virus or whatever so that there’s just an army.

I think that’ll help trickle out to more and more physicians. No real pushback there. The bigger pushback we get is from the strength conditioning field when we start talking about modern medicine concepts.

Specifically, things like statin therapy when indicated to reduce atherosclerotic cardiovascular disease risk or different medical management of common conditions like high blood pressure, type 2 diabetes, obesity, even using weight-loss drugs.

We get a lot of pushback from people who are in the health fitness field because they have this sort of negative view of big pharma, big medicine, and all this stuff. It comes from a place of wanting to help. They want to help people, but also from a place of — and I hate to say this because it’s kind of inflammatory, but a place of ignorance.

Because they don’t actually know what the data says on this stuff and that we’re really all just trying to help people. We need to stick to the data on some of these topics. Twitter wars ensue regularly when people find out like, “Oh, these guys actually recommend statins when people need to lower their atherosclerotic cardiovascular disease risk?”

We’re like, “Yeah, because the data says that right now.” People are like, “How can you do that?” And it’s like, “OK. Well, there’s a long list of evidence that we can go through.” The bigger pushback comes from probably the strength conditioning field if I had to pick one.

That’s really interesting. I would not have predicted that…

When you think about people who have big platforms in this rare condition field and most of them, it’s a general rule, are not what I would call medical, a high amount of medical training.

A lot of this comes from either no knowledge or misunderstanding of what we’re actually saying or what the current guidelines are. A common theme is, “Oh, doctors don’t know anything about nutrition.” It’s a thing that people say.

While I agree that the overall nutrition knowledge, fundamental knowledge, is not great in most physicians, the recommendations that are put forth by the American Heart Association, the American Diabetes Association, the USDA, etc., that are pushed upon physicians to recommend are all reasonable.

Even if they don’t know as much as a registered dietitian or someone who has been extensively working in this field for a long time, the recommendations aren’t wrong. People will say, “Yeah, but we continue to get more obese. That shows that the recommendations are bad.”

It’s like, “Not really. If people stuck to the recommendations we’d be in a pretty good place for example.” While your doctor may not be the best person to talk about with respect to dietary change, for example, they probably know what the recommendations are or at least could lead you to the right place.

I don’t know that it’s helpful to say doctors don’t know anything about this, that or the other. In the same breath I probably wouldn’t go to my doctor asking for exercise advice. “My squat has been plateaued for the last three months, what to do?”

I don’t think that’s something you should necessarily care if your physician knows about, but also doctors should most certainly not be putting bad narratives in patients heads about the risks of resistance training or something like that.

That’s a big misstep that is one of the most egregious errors I see. In that case I am more on the side of the strength and conditioning coaches who are saying these doctors don’t know what they’re talking about. In that case, yes, and I’m as mad as you are.

It sounds like it’s a lot of figuring out where that line exists between people and trying to bridge the all or nothing sides. That…Sorry, go ahead.

Sorry. That’s a perfect way to sum it up. If you’re all or nothing. “These people are all bad or these people…” That’s probably not a logical position to hold, and we’re trying to fight stigmas on both ends.

Overall, if I had to pick where are we getting more push back from it’s probably the health fitness field rather than other doctors. Other doctors are like, “OK. You guys made an argument, you provided evidence, and you appear to be learning, seems good.”

On the other hand, you have that same type of interaction with a strength conditioning coach, you make an argument, you provide your evidence, and then your recommendations. They don’t read the resources provided, they don’t provide any evidence to counter your claims, they go, “No, I don’t believe that.” You can do that, you are free to do that but it’s not really a useful engagement.

Something you said in the last bit that you were talking about is about narratives. One of the narratives that I love that Barbell Medicine has been talking a lot on, and especially writing a lot of content on, is on the concept of pain and more specifically chronic pain.

I’m not an expert on that. I would love to pick your brain on how you guys are trying to change the narrative around chronic pain, and where people are getting it from. I would love to hear your thoughts on that.

I know it’s obviously a very broad topic to tackle right now. Could you give me the cliff notes of everything, because you guys are putting out so much content on that. Even now, after reading so much of it, my head still spins when reading some of it.

Pain is an incredibly nuanced topic, but it’s such a common issue. We don’t even bother asking people in our seminar, “Hey, who in here has experienced pain?” It’s part of the human experience.

Nietzsche and DMX both said, “To live is to suffer, but to find meaning in the suffering, there’s something to that.” DMX and Nietzsche have like the same [laughs] outlook on this, which I always find funny.

Here’s how this went down. In 1977, this physician, Dr. George Engel, came up with this new theory on how pain actually occurs in people who experience pain. They called it the biopsychosocial model which basically means there are biological, psychological, and social inputs into the pain experience.

This is suggesting that not only biological causes, which we could categorically discuss, like tissue damage, or nociception, which is basically the nerve endings that carry stimuli to the brain being stimulated, and thus causing pain. Those are biological causes.

Psychological causes include mood states, depression, anxiety, attitudes towards different activities, etc. Social inputs include social learning, conditioning, cultural understanding of pain and that experience.

All these things come together to manipulate the pain experience that people have. Different contexts, even with the same injury, can cause different amounts of pain.

Prior to that, we had this biomedical model which basically means, if you had pain there was some tissue damage, some structural abnormality that caused pain. It didn’t really account for all of the wide variety of different pain symptoms that people had from the same “injury” or defect.

It didn’t account for people who had a limb amputated yet still had pain in the amputated limb. We call it phantom limb pain, so conditions like that. We needed a better model to represent like, “What the heck is going on?”

This was in the ’70s. The problem is, the average time it takes to adopt a new medical change is like 17 years. That would have put us in the mid-90s before the biopsychosocial model really gained traction. It hadn’t gained traction until the mid-2010s, like teens. We’re still fighting an uphill battle.

We were actually exposed to this in medical school our first year, but we were too dumb to really even conceptualize it. We didn’t have a mental model to accept like, “Well, this pain’s super complicated. Maybe there’s more to it than just lactic.”

“Oh, you’ve knee pain because there’s tissue damage.” Maybe it’s more complex than that. “You have low-back pain because it’s always a herniated disc,” when, in fact, it’s usually not a herniated disc that’s causing low-back pain.

What happened was, we had both graduated from medical school. We were out in residency and working with people. We just got sucked into the rabbit hole of pain science.

In the field of pain science, this stuff has been researched and been discovered for years, and years, and years. We basically uncovered a mountain of evidence that was always there, but we weren’t familiar with it.

What’s happened then is our ideas of what caused this pain and how people experience pain, and then therefore, how to treat quote/unquote pain has all morphed. We feel this is such a huge issue, especially as far as it goes to people, being a barrier for people participating in exercise.

We are charged with bringing some of this knowledge to the masses. Then also, in the context of injury rehab, return to activity, huge, huge deals.

We feel we’ve got to put out good information on this. Then, in addition to that, we also feel compelled to prevent the spread of misinformation, which we feel again just builds these false narratives and harmful narratives around people.

Like, they’re fragile. If you do things wrong, you’re going to get hurt. You should be afraid of these exercises because they’re particularly injurious. Anything that creates a barrier to people participating in exercise.

Right now, we think that pain is a complex experience that has biological, psychological and social inputs. That combined with the person’s environment and their own personality, they experience pain in different ways.

Which means that you and I could have the same injury, “same” biological issue, but given different contexts and different experiences and different previous social learning and conditioning, we could have completely different symptoms.

We could both have, for example, three-level herniated discs. The L4-L5, L5-S1, S1-S2, all herniated. You could have debilitating pain that you can’t walk, whereas I could go pull a deadlift PR than that or vice-versa based on different sort of context and experiences.

Putting out this information has been cathartic in a way. It helps us understand it and then also be able to express frustration with treating pain previously. In addition to that we feel it’s really helpful to the field for what I would consider the initial step of management.

What do you do with somebody who’s got pain? One of the first things you do is education. That’s literally one of the first recommended treatments for many of these pain issues. We get to start to get the ball rolling there early on.

We have a lot of resources, and we continue to put out more resources to give people more information that they can internalize. That will help them on their journey.

That’s a brief — well, not so brief — way of talking about how we got here and then what we’re trying to do. It’s a huge topic, and I think that we’ll be writing about this until Barbell Medicine is no more. Which is fine by me because I like this stuff, it’s super interesting to me.

Speaking to that helpfulness, to anyone who has not checked out Barbell Medicine’s content, and especially their educational stuff on pain, I would highly suggest doing so.

I know for a fact that how you guys educate coaches and athletes to work around pain and kind of test different variations to keep progressing forward. That personally has helped me a ton, especially from my coaching point of view. Highly recommend checking that out.

To go into a lighter topic, the Barbell Medicine podcast. You guys have a podcast, super fun, it’s always a good time. I would love to ask you about the growth of the podcast and when you officially started that in relation to Barbell Medicine starting up.

Sure. Barbell Medicine started…I think the first time, actually like I registered for the LLC, was late 2011. The first podcast we recorded was on, I think, osteoarthritis. That had to be my intern year during the spring. So, 2017?

There was some years in the middle that I was so resistant to doing it. One, because I know with how most people do podcasts, they just start them and then they die off, because you stop recording and stop putting out material.

Also, we felt like every time we do a podcast we can’t just talk. I can’t just call you and be like, “Hey Jake. What’s up, man? How’re you doing?” Nobody is listening to our stuff just for pure entertainment value. I wish that were the case.

I wish [inaudible 40:01] funny enough, or engaging enough. [laughs] That was the case. Each time that we do an episode we have to do a lot of legwork as far as organizing our thoughts, organizing research, making sure the show notes are detailed enough that people can go off and learn on their own.

I think the first episode we did, like in the first month maybe got, I don’t know, 2,000 downloads, or something like that which is not a lot. Which was initially kind of discouraging, but also expected, because I know when you start launching new social media content, it’s going to take a while to get traction.

Now, every time that we release a podcast, in the first week we get about 20,000 downloads. On average, our podcast is in the 100,000 downloads per month range, which is cool. That’s great.

I always feel bad when people come up to me and they go, “Hey, I’ve listened to all your podcasts.” I’m like. “Oh.” [laughs] Like, “Sorry.” I don’t know. I feel like I should apologize like I need a better radio voice, or something like that.

It’s cool that people have started listening to it and it continues to grow. One of my big goals for the podcast is to get more and more guests, actual experts in their field who don’t participate as much in social media.

We want to get people who are doing the primary research to come on and talk about, “Hey, you did this study. What did you find?” or people who don’t have a voice on social media as much, at least we share their thoughts.

One guy that immediately comes to mind is, Alan Flanagan. Alan Flanagan is really smart guy. He’s getting his PhD in public nutrition, I believe. He’s also got a law degree and he’s registered. He’s an RD. In any event, his big thing is public policy as it pertains to nutrition in the UK.

He’s on social media, but he just never posts. He says he’s so frustrated with it. It’s like when we get him on our podcast, we’re just picking his brain like, “Hey, what do you think about this?” He’s got so much material to share. I’m like, “Cool. Well, we’ll give you a platform to share it.”

It’s cool. I like the podcast a lot. It’s much faster to put out content that way than writing a 10,000-word article. What I’ve noticed since I started doing these, I do narrations now for articles. Meaning, I just read them to people and then provide us an opposites at the end.

Podcast we’ll get more downloads than the article gets downloads, which I don’t know if that’s just the way people choose to consume information or something like that, but it has been interesting in finding.

That’s interesting. I wonder if it has to do with people just being on the go-more often, or being able to play it wherever they’re at and so forth.

Yeah, instead of having to sit down and read a 40-minute read, or just listen to me talk for that, that maybe it’s easier, or again, this is me hoping it’s true, maybe they just like the sound of my voice. It’s like, “Hey, soothe me.”

“Give me.”

I don’t know. That’s exactly. I listened to this podcast every night before bed, so I could see it that’s right.

I put you to sleep and I’ll put you to sleep, yes.

In a good way. I have my favorite Barbell Medicine Podcast episode of mine. It was the one on strength coaching. I want to know what your favorite podcast to date has been.

It’s a good question. One of my favorite ones was probably with Dr. Nadolski. We did a two-part series on obesity. Spencer Nadolski, I’ve met him in medical school. We were both living in Norfolk, Virginia at the time.

It was myself, Austin and Spencer. We just talked about obesity, both diagnosing it and treating it including all the different medical management, surgical managements and then just a bunch of misconceptions.

The thing is, Spencer’s such an expert on this. He’s board certified in obesity medicine. He’s also a board certified family medicine doc. He actually does this so he’s got a lot of practical experience in addition to straight up his academic knowledge.

That was probably my favorite, because we’re all good friends, and then it was just knowledge bomb after knowledge bomb. While he was talking, I was like, “Huh, yeah, I never thought about it like that. Huh, I never thought about it like that.”

I think that one, it’s probably my favorite from a content standpoint. As far as the most fun to record, it was probably a Q&A that we did in Seattle of last year, which we put up on a podcast. Here’s what happens with these seminars. We’re lecturing for 16 hours over two days, and it’s just a long weekend.

What happened afterwards, you have a nice cocktail and people are asking you questions. I might’ve had an extra cocktail. I was not under the influence, but I was probably a little more disinhibited than normal. I’m more funny when I…

People, they were asking us about the current…It’s actually science. I found that the responses were true, entertaining and then also informative as far as how I think people should go about getting knowledge in strength conditioning field. That was the most fun one to record.

The most informational one was the one with Spencer Nadolski. If you guys are interested, we can do some tour podcasts. It’s fun. We could always use the traffic.

Final question on the podcast. If you could add any guest alive, dead, anyone at all, who would it be and why?

That’s a really good question. It has to be somebody who’s not coming up on the podcast. For instance, we’re going to do a podcast with ZDoog. If you’re familiar with him. He’s a physician ZDoogMD. He puts out a lot of good public health information.

We’re already doing that so he can’t be the one that I wish that we could get on a podcast. One of the people who I’d love to get on the podcast is David Epstein. David Epstein wrote a book called The Sports Gene, which was super interesting if you’re interested at all in strength conditioning and the science behind it. Super fascinating book.

His recent book Range is also extremely good. I’m not getting any money from this, he doesn’t like [inaudible 46:19] . The way he thinks about problems with respect to training and exercise performance and athletic performance it’s fascinating and his fund of knowledge is out of this world.

He said in an interview that when he goes to write a book, what he does for a year prior to starting writing, he reads 10 papers a day, which, sounds like a lie, but maybe not because when I hear him talk, that seems it’s got some potential.

It would either be David Epstein because I think that would be a really fun episode or Paul Offit. Paul Offit is another author who I read all of his books. His latest book called “Bad Advice” is fantastic and also “Pandora’s Lab.” Great books.

He is a Pediatrician. He invented the rotavirus vaccine. He’s big on public health as far as from a vaccination standpoint, and not taking mega-vitamins.

The guy’s been on Good Morning America all over the world. His biggest thing now is science communication. How do you communicate science to the general public to get them to change what they’re doing and so I think talking to him about that, given his experience with the mainstream media and communicating scientific ideas. That would be cool.

Then finally wildcard, I know you asked for one person and these are all alive, I can’t do it. Neil deGrasse Tyson would be fantastic.

I have a man-crush on him just from a science standpoint and I know that he’s not big into exercise or fitness or health nutrition but his fund of knowledge is excessive and I listen to his podcast all the time it’s a StarTalk Radio.

He does have a radio voice and that is very soothing to me so I think that having him on podcasts would also be great. There you go. Three pics, probably not as juicy as maybe you were expecting but that’s who I pick.

I think those are plenty juicy, especially for the context of what you do. One final thing that we like to do on our podcast it’s ask a little bit more of rapid-fire questions. My first question for you is, what’s your biggest social media pet peeve right now? Try to keep this one breve.

It’s probably when people post up infographics on pain and there’s a mushroom cloud, don’t bend over like this and there’s a mushroom cloud coming out of somebody’s back or text neck or texting is the new smoking.

It’s usually infographic with a terrible caption. The thing is, they’re trying to be informative and try to help people but they’re missing the boat from a paint science perspective, and they’re building this harmful narrative and I think that’s doing a disservice, even though they’re trying to help people. It’s more harmful than good.

That’s probably the most annoying. Also, I share these between ourselves. People tag us. They’re like, “Oh, what do you think?” I’m like, “I can’t get into this. I can’t get sucked in.” That’s probably my biggest social media pet peeve.

Going off of that, what is your favorite — well not necessarily going off of that — but what is your favorite movement to coach?

My favorite movement to coach is lifting other people’s spirits. No, [laughs] . No, the favorite one to coach is probably the deadlift. Mainly because, like at our seminars, again. If we get a handful of physicians each time, we get a handful of people who have never lifted before.

Think about teaching your mom or dad or grandparent how to lift right. You’re going to have a deadlift. Their narrative or their preconceived notion about the deadlift is, “This is inherently dangerous. I’m picking something up. I’m stressing my back.”

Teaching somebody who has never really lifted anything from the floor how to do that and showing them that they’re resilient. They can do it safely and that they can train this is super rewarding.

The deadlift is probably my favorite one. Super simple, the squats, got some more stuff going on, but the deadlift itself is probably my favorite movement to coach.

All right. What exercise is glorified, and it really shouldn’t be? Do you have any in mind?

Dang. I’m going to take a different approach here. One exercise that’s probably gets a bad rap, particularly in powerlifting strength conditioning circles, but it probably shouldn’t, is the Sumo Deadlift.

People say, “Oh, the Sumo, they pulled that, but Sumo doesn’t count,” or “It’s a worse exercise than the conventional deadlift. I’m just like, “What is making up stuff.” Everything is arbitrary. Strength is specific to the specific range of motion and joint angles and contraction velocity and everything else. How you train it.

If somebody prefers to pull Sumo, that’s fine. The most over-rated exercise, maybe it’s the trap or deadlift. People are like, “Oh, I can do this, and it’s inherently safer.” It’s not. Or it’s inherently better. It’s not from a training adaptation standpoint like Harper [inaudible 51:25] strength.

It’s just different. I think that answers your question. It’s got to be one of those two.

You’ve answered it well enough. I always lathered it up. Some of the comments we get when we write on Sumo Deadlift especially world records. We get some…

Oh, and Sumo doesn’t count. Oh my gosh, man. Don’t even get me started here. It’s like why doesn’t it count. It’s within the rules of the competition. By definition, it counts. Two is it not hard. If someone only pulls, I say only because just different worlds that we live in, someone only pulls 500 pounds conventional. They’re not going to pull 800 Sumo.

Just go try. You’d prove it to yourself. It’s a different exercise. It’s a different carryover. It’s a different thing. Here’s the final piece of this. Now imagine that you’re just a sweet old lady, living at home, trying to be an independent woman who doesn’t need no man. I’m not trying to be sexist. This is the culture we live in.

You have to pick up something that’s awkwardly shaped. How are you going to do that? You’re probably going to take a wider stance and try to pick it up in between your legs which looks a whole lot like a Sumo Deadlift.

Perhaps the transfer over to activities of daily life might even be higher than a conventional deadlift. If you wanted to make that argument. I don’t necessarily know that I care enough to make that argument, but it is an argument.

I know. It’s one of our top hot topics on our Instagram page whenever we share deadlift videos, which is great.

Yes, I’m sure. Fun for you.

Fun.

Next question for you. What has been your favorite coffice today? Now for listeners, coffice is, correct me if I’m wrong, a coffee shop/office that you spend your day working in,

Yes. If you go to a coffee shop and you set up your laptop to do work all day, then it’s your office too. It is coffice. The favorite one, that I’ve actually gone to frequently enough that I wasn’t just mesmerized by the scenery the first time — I actually went back over and over and over again — got to be Rose Cafe in Venice, California.

One, they served my favorite coffee, which is Verve Coffee Roasters. That’s a brand out of Santa Cruz. It’s amazing coffee. It’s great. The ambiance in Rose Cafe is great. And finally, one time I was there I saw Jerry Seinfeld.

Wow.

 I know, right? I was like, “I can’t say anything” so if I go, “Hey, Jerry!”, he’s like, “Who are you?” But at the same time it was pretty cool.

I think once you hit influencer status you can probably approach Jerry.

Yes, if I get a blue check mark, I can approach him. In LA, having a blue check mark is better than having an MD. No one cares if you’re a doctor. They care if you’ve got that blue check mark.

Next question for you and this is because you and I both share Missouri roots. What is your favorite thing to do in St. Louis?

Oh. Man. It’s a good question. We were just in St. Louis and so doing a little taste of St. Louis and doing a foodie trip was the most fun. I got to take all of the crew [inaudible 54:41] seminar staff. Allan Thrall, myself, Leo Lutz, Tom Kemp Kelly, Dr. [inaudible 54:45] .

I took them to Emo’s. Square beyond compare. If you’re from St. Charles County…Are you from St. Charles County?

 I grew up in St. Charles.

Then you’re like, “You should take them to Stefanina’s or Cecil Whittaker’s.” The city — It’s Emo’s. Fair enough. Emo’s was square beyond compare. It’s this really thin-crust pizza with cheese. If you haven’t had it, you should do it. Don’t app me if you hate it because I’m fragile. Then I took them to Ted Drewes, which is…

In St. Louis, that’s probably a tape showing people where to eat. That’s probably my favorite. The runner-up was…We went to Pappy’s. They have great barbecue. If you’re in St. Louis you got to eat your way through the city. That’s probably the best thing to do.

A hundred percent. I think Ted Drewes and, honestly, I feel like Fitz’s, too. The Concretes are amazing.

People could really be like, “Hey, these guys sound like they are endorsing all this junk food”. It’s like, “Well…” [laughs]

Within context

Within context, yes.

On top of the food, you also have to check out the City Museum. That is, hands down, one of the best times. [crosstalk] It’s hard to explain.

Yes, the City museum, you’ve got to check out, you’ve got to do the arch. Here’s a little known thing. Right by St Louis University’s campus there is the motorcycle museum. If you’re at all into motorcycles, they have all these old bikes and new bikes as well, and all this memorabilia.

It’s like walking into a Cracker Barrel but for Gearheads. It’s really cool. The only other museum that we have that’s a national museum or something like that, is the bowling museum, which I would not recommend, unless you’re a big into bowling.

Yeah, motor museum, the art museum, and then checking out the arch. If you did all that while you were in St Louis, that’s pretty good. You’re missing the Botanical Garden, you’re missing going to Forest Park and checking out Art Hill. Yah, I’ve given you the key to the city.

 I agree with you. Three to four days, good with St. Louis.

Yeah, you got it.

That wraps up our podcast. A big thank you for coming on, man. Would you mind sharing where people could follow you and find you if they want to learn more?

Sure. For all our content, it’s archived and posted regularly over on our website bardellmedicine.com. I’m on Instagram, jordan_barbellmedicine. We also have a main account which is barbell_medicine.

I’m on YouTube, Barbell Medicine, and then our podcast you can find on iTunes, Stitcher, Spotify, etc. It’s the Barbell Medicine podcast, check us out. If you like our stuff you should subscribe. We put stuff out there regularly.

 Sounds good, and a big thank you. We will have everything linked down below in this podcast when it goes up on the site. A big thank you for coming on the podcast. It was great having you. Hopefully, some folks learned some things. We will hopefully maybe have you back for a part two down the road.

Thanks, Jake. I really appreciate it.