My Brain Hurts. Reconciling Different Training, Mobility and Rehabilitation Approaches.

The more I study exercise science, pain science, rehabilitation, the more my brain hurts. Figuratively that is, don’t get to excited pain science adherents. Let me try to explain my dilemma.

My path was not unlike many others. A skinny kid wants to get bigger. In my case I started a little earlier then most and was little more interested in reading the science behind why things work the way they do so I could optimize my results. This meant I started as most do with bodybuilding literature and training approaches. I learned a ton about muscle physiology and training approaches focused on adding strength and mass.

In college this led me to discovering the broader fields of exercise science and athletic training. My studies in exercise science expanded my understanding of physiology bringing in concepts such as biomechanics and motor control. My athletic training studies introduced me to concepts of tissue healing and rehabilitation.

Both inter-related fields fit nicely with my early influences drawing strongly upon accepted principles such as progressive resistance and adaptation to imposed demands. Everything from my early bodybuilding influenced days dovetailed nicely with my growing knowledge of rehabilitation and more advanced physiological exercise science based concepts.

As the years, and decades, went by I continued to add to my experience and education with concepts that continued to fit nicely with this paradigm. This structural, mechanical perspective continued to drive my evaluation and programming decisions. As I learned more neurological concepts, they continued to fit nicely into the framework I had developed.

When I started this journey strength coaching was something that existed almost solely in college and professional sports. Personal training was in its infancy and beyond a handful of celebrity trainers you could walk into just about any gym and not find a single trainer. Over the next two decades fitness blew up and became an everyday part of our existence. Personal training became a common profession and elite strength coaching became available to every high school athlete and amateur triathlete that could afford a few lessons.

I thought of myself as someone on the front end of the curve. While I have always been slow about professionally adopting the latest fad, I considered myself far more grounded in the science of what we do then the average fitness/strength professional out there. It wasn’t uncommon for me to be one of if not the most experienced person in any facility I worked out of.

As the field grew from just a handful of trainers to nearly 300,000 individuals, I found more and more professionals whose knowledge and understanding I was downright jealous of and far more that made me lament the low barriers to entry that we allowed the field to have. Considering that much of my personal education came from the world of physical therapy and rehabilitation and much of my teaching was focused on less experienced trainers with limited academic backgrounds I found myself constantly teetering between professional awe and frustration.

Over this period where the profession grew tremendously the economic opportunities meant that all sorts of new training approaches were introduced. Each with a philosophy behind them and a robust educational path that needed to be followed. We saw the introduction of every sort of training approach from spinning to cross fit to Pilates to yoga to kettle bells to body weight training and on and on. Each competing for the consumers fitness dollar and for the trainers continuing education dollar.

Now I don’t have a problem with most of these approaches. Not every modality is right for every person but most of them have value for someone and whatever gets the public to move and exercise is generally a good thing. The problem as a professional interested in growing and learning is that every approach has its own scientific interpretation of the research and you must decide what is correct, or more likely what pieces are correct and what you want to incorporate into your approach.

Ah the research. That itself is a major issue. As more and more people were drawn into the broader exercise science fields the support for solid research in the field began to grow and today between the rehabilitative, medical and exercise science areas the amount of pure research being produced is mindboggling. And even then, because of the nature of how quality research is conducted, we have still only begun to scrape the surface of answering many questions about how our physiology works and constantly debunking long held beliefs.

So, where does all this blabbering leave me. For a long time, I found myself trying to find balance between developing my knowledge in rehabilitation and strength training. Both drawing upon the same foundational science but applied along different points in the training continuum. As time went by, I found myself more and more frustrated by the lack of progress my clients were making. Some of this was my fault, a lack of focused programming and support. Some of this was my clients fault, a lack of dedication to doing their work and a desire to just show up once or twice a week to follow directions and then forget about all of the things they really needed to do to change their bodies and improve.

While I continued to attract clients with injuries because of my background I became less interested in being a rehabilitation-based trainer and more in just developing strength. This urge was constantly pulled back by my client’s actual needs as well as my own injuries that kept me interested in learning more about treatment and rehabilitation. These days I would say most of my work is dealing with clients who have injuries. Despite my one-time desire to move beyond this population they just keep showing up and I’ve embraced that I bring something to training them that a lot of my colleagues do not. And my personal educational journey continues to be focused on how to better help these individuals get past their pain, move better and be stronger.

In 2011 I had the chance to start providing continuing education for TRX. I was asked to teach their sports medicine course. I had taught sports medicine classes at the college level and was nearly two decades into my career and jumped at the opportunity. While the class was originally conceived for more advanced rehabilitation professionals and we have a lot of these individuals turn out, a significant number of our attendees are average personal trainers who deal with injured clients on a daily basis.

My biggest take away was how little the average trainer really knew about the foundational sciences that underly our field. That became part of what is so fun to teach the class, the opportunity to share a little knowledge with my colleagues and help them grow as professionals but it has also been a source of personal debate. Just how much should someone know in order to call themselves a professional and go out and coach others on how to care for themselves. I’ve had more then one conversation in my various workplaces with other experienced trainers who call themselves experts on various things and then sat and watched them go out and do things that based on our current level of knowledge and research are contraindicated for the issues they claim to be experts on. It doesn’t take decades of study and training to teach basic exercises to relatively healthy people or even to give some good guidance to injured or more complex clients. I don’t think we need to set some unreasonably high standard for exercise professionals, but we do need some standards. And my level of respect for those less experienced trainers who spend their free time and money on attending seminars and trying to develop their craft has grown immensely.

But how are these less experienced trainers supposed to make sense of the myriad of training approaches and philosophies and competing scientific interpretations if someone with my background and education is struggling with it. And that is what brings me back to my initial reason for writing this.

About four years ago another equipment company, Rumble Roller, asked me to do a little consulting and teaching. Again, I jumped at the opportunity to collaborate with some colleagues I respected, influence the educational content that is being shared with up and coming professionals and just the simple variety of doing something different. I found myself having to be able to interpret and explain the foundations of self-myofascial release. Being the science geek that I am it immediately led me dive into the research literature on foam rolling and lead to one of the early articles on this blog .

Before long I found myself going down the rabbit hole of fascia research and gaining an entirely new appreciation for tissue I had previously given very little though and concern. To the experts in this field fascia is life and vastly more important and fundamental to what we are as living creatures that have structure and move. So many more issues, problems and solutions can be found in a fascia-based explanation.

The fascia experts gave some outstanding explanations for their interpretation of how the body works and what is important. What was so appealing to this was it fit nicely into my structural, mechanical view of the body. Of course my two decades of study and experience tempered my excitement. The human body is wonderfully complex with an interplay of so many different systems that any explanation that is to narrow and clear while often holding a tremendous amount of truth, often still lacks a full appreciation for these other systems and their contributions.

Flash forward to a few months ago. Rumble Roller asked me to participate in a lecture at a large fitness conference. The focus of the talk was on how the nervous system was involved in the development of mobility Our goal was to introduce the concept that the driving force behind many of the changes that happen with foam rolling, and mobility training in general, are really derived from the nervous system. While the target audience for our workshop were trainers who did not have a strong foundation in neurology and we didn’t go into too much detail, it made me start to think more about the role of the nervous system.

We think about the nervous system in some capacity in most of the work we do, though usually in the context of motor outputs. Our talk touched on the idea that sensory inputs were a much more important component to change then most of us have been giving them credit for. And a much more ignored element of our treatments and programming then they should be.

Teaching this workshop led to my being asked to participate as a student in a workshop on dermoneuromodulation. Besides being a mouthful so say, and write, dermoneuromodulation (DNM) is a therapy approach that focuses on the nerves, their health, movement and stimulation. It usually falls under that broad category of what we call pain science.

In preparation for this workshop I began reading a fair amount of the underlying theory of and arguments for some of the rationales behind this and other related aspects of pain science. And this is when my head began to explode.

Many of the main pain science adherents don’t completely dismiss and throw away the structural, mechanical perspective that underlies so much of how we look at the body, training and rehabilitation, but they do quite eloquently and supported by much research point out how much our current common perspectives fail to achieve the results that we think we are achieving with them. How much of the research literature shows what we think is happening really isn’t. How when we do get positive outcomes it isn’t because of how we have changed tissues. Just how often our normal approaches don’t produce positive outcomes. How often people aren’t getting better, experiencing less pain and more function.

The more I read pain science explanations, the more it seems so much of how we are looking at the body and trying make changes to it is wrong. Now this doesn’t mean that everything based on a structural, mechanical perspective is wrong. Much of it is right. You only have to watch a few minutes of sports on TV, walk through any gym or turn on Instagram for a few minutes to see that so much of what we do is correct. But what about all the people who are injured and experiencing pain and disability who are not improving as we would expect them to. Clearly there must be more that we aren’t seeing or doing.

And this is when my brain starts to hurt. How do we reconcile all the different approaches to movement, mobility, pain relief, tissue healing, growth and adaptation? There are more and more “systems” being offered as explanations and pathways every year. You could spend a fortune taking classes on every different approach to changing and improving the body. Most of them have research that is presented to support them. Many of them share lots of common concepts and principles. But each has its own take and even the most seasoned of experts who looks at these different systems and the theories behind them can be confused about which ones are correct, let alone the best (if even only for specific populations and problems). If it’s this confusing and challenging for well educated professionals to find a way to balance these competing (and sometimes complimentary) approaches, how does the average fitness or rehabilitation professional make sense of it all.

Sure, it’s easy to just embrace one philosophy. To follow one expert and base all your training and treatment on that approach. Many people do it that way and they come across as experts. Sure, they have a lot of people that seem to do amazing with that approach. If you take a large enough population, you can come up with a lot of individuals who do well with any one particular strategy. But in real life that just doesn’t work for everyone. You aren’t going to help every client or patient practicing just one way. And this makes me brain hurt.

Which approaches are best? I can offer up a half dozen different schools of though as to how to improve mobility off the top of my head. Yes, they all have similarities, but they also have differences. They all offer the promise of decreased pain, better movement and function but surely they can’t all be equal. And some of them may just be wrong and achieving results not because of the system but in spite of it because other mechanisms are still at action.

So, I sit here reading more and more. Trying to find balance between the different approaches. Not saying that anyone is wrong, but not prepared to say any of them are right either. In a few weeks I’ll be equipped with a new set of skills and a stronger foundation in a school of thought and approach towards caring for my clients. I may find a new philosophy that will underly all my future work. More likely I’ll find a way to incorporate a new set of ideas into what I already know and believe. I’ll probably have to throw away a little of what I have held to be true as I discover new research that proves what I thought and learned was wrong. I’ll probably have new approaches that work better than some of what I have been doing. For some of my people, probably not for all of them. And my brain will continue to hurt as I learn more and challenge the notions that underlie my 25 years of work.

Stay tuned. It’s going to be an interesting journey no matter what and who knows what body of literature and ideas I’ll be eager to write about and share as the weeks and months go by.

A Roadmap To Fitness

Olympic weight lifting, running, powerlifting, cycling, CrossFit, yoga, Pilates, swimming, body building, high intensity intervals, classic strength training, functional training, kettlebells, bodyweight, suspension training…the list goes on for different training techniques and approaches.  It’s difficult enough for an experienced professional to determine the best path for a client.  For the average individual it’s a confusing mix of names and sometimes very conflicting approaches to achieving fitness, or whatever someone’s individual goals are.

Most trainers/coaches tend to take the “I have a hammer, every client is a nail” approach and train whoever comes through the door with whatever techniques they tend to emphasize and practice.  If they teach yoga everyone needs yoga, if they coach kettlebells then that is tool that everyone is going to be driven towards.  Even multi-modality approaches like crossfit which use a mix of bodyweight/gymnastics/Olympic/power lifting still have a particular flavor that uniquely defines them. More educated and experienced trainers will have a larger variety of tools and approaches to pull from and have a more flexible approach towards training different types of clients but still tend to have approaches that define how they work and train clients.

If professional coaches have a hard time successfully adapting their training style to best meet the individual needs of a client, how do we expect the general public to intelligently pick the right trainer for them, let alone pick the right type of fitness practice to pursue either with a coach or on their own?

After nearly 25 years of coaching a wide range of clients I’ve begun thinking of choosing the right path to fitness like my drive to work.  I drive approximately 18 miles from my home to my gym.  That distance allows for a variety of different routes that I can choose.  Of those countless choices, there are three main highway routes that I can most logically take.  Regardless of all the other options, the quickest, most efficient path is always going to be one of these three routes.

For each of these routes there are multiple ways I can get from my home to the highway however for each main highway route, there are usually two most logical, efficient routes to the highway.  Under normal circumstances picking any way except one of the two main routes just doesn’t make sense.  Still, there are many times that local traffic blocks my first choices and I have to circle around another way.

Once I’ve made my way to my preferred highway path I may encounter any number of problems.  Heavy traffic, an accident, road work, bad weather, flooding or a lack of visibility (ok my drive to work isn’t that fraught with danger but in theory it could be and there is a great chance that traffic and accidents will certainly be a factor).  So on any given day I could choose to get off at any number of exits and take any of dozens of surface streets around the delay and get back on the highway further along or even take those surface streets all the way to my final location.

Usually I will get to work fastest if I stay on the highway but other times one of the side routes on surface streets will be a quicker, more sensible path for me to take.  Now that you’ve all learned about my horrible commute to work, what does it have to do with choosing the right type of exercise for you?  Well, it has a lot because whether you are choosing a type of exercise, a specific trainer for that technique or are coaches choosing the right approach for your client that decision is just like my decision about how to get to work.

Instead of starting from geographical location, your home, you are starting from your current level of fitness, or lack of it.  And instead of heading to work, your final destination is your fitness goal.  It may be a clearly defined objective like losing 25 lbs, running a marathon, bench pressing 225 lbs or a more subjectively defined goal like not having back pain, being able to go for a run without losing your breath, fitting into clothes that used to be tight, performing your favorite sport better or just feeling stronger and fitter.

Now that we have a starting point and a destination the first big question is what main route are you going to take?  If your end objective is a clearly defined activity like running or swimming then it is pretty clear that the path you should be taking most of the time involves performing that activity (don’t worry, there are still reasons to use the other routes to support your main path, we’ll get to that in a further down).  If you happen to love doing a particular type of exercise and are drawn to it than that will be the main path.  If you want to do yoga then any reason I give for doing a different form of exercise is secondary to your desire to do yoga and you should be on that route.

If your fitness goals would best be served through some form of resistance training then you are going to follow those routes but there are still multiple ones to choose from leaving the question, which one is most efficient?  Which one is right for me?  Unless your final location clearly reveals that one path is the optimal one or you happen to have enough knowledge on the subject to analyze the options then you are probably going to be steered onto a particular path by whatever outside influence you happen to consult .  It could be a friend, family member or trainer at your local gym.  Whatever approach they prefer using is the path you are going to be put on.  For the professional coach deciding what to do with a new client we would like to think that they would do a careful analysis of your situation and choose the route best suited to you but in reality they are going to put you on a path and train you based on whatever their education, experience and personal preferences are.  It might be a great path for you, it might be totally wrong for you or more likely will have some benefits but not necessarily be the quickest or optimal path for you.

The reality is there probably isn’t going to be one optimal route to follow but like my choice of three main routes to get to work, there will be a number of different main routes that get you from your starting point to your objective and they will all be roughly equally effective.  It doesn’t matter which one you take but you will probably find a preference for one over the other.  Now you are most likely sitting there thinking “Seth, you just spent two pages telling me it doesn’t really matter which path I take.  I want those five minutes of my life back”.  Yes, we just took a non-optimal route getting to this point but don’t worry, things are about to get much more complicated.

Even though I’ve just said you can pick any of a few main routes to get to your objective, and that you are going to pick one primary path there are still benefits to sometimes taking the time to drive one of the other routes.  Just like an event at a the local arena or road work may make you choose to drive a different way to work, you are often best served by getting off your main exercise approach and spending some time using a different approach.  Just like an alternative driving route to work avoids certain temporary problems and has different scenery, a different training path offers different stimulus to your body that may allow you to work around problems, emphasize some other elements that improvement in will serve you on your journey and the variety, the different scenery, is helpful in keeping things mentally stimulating.  Sometimes you just need to spend a short period of time driving this other fitness route, sometimes it will be a longer period of time and often you will be choosing to drive one main route some days of the week and another route other days.

Now what about those multiple routes to get on the highway in the first place?  Just like you need to take a little time getting from your house to the highway, you can’t just get in your car, step on the gas pedal and start driving highway speeds in the middle of your residential neighborhood you can’t go from sitting on your sofa to exercising at full intensity with great form.  You may have injuries that need to be addressed before you can do certain exercises.   You could have movement limitations that need to be addressed.  There might be painful issues that need to be first corrected and you need to learn the basic techniques of the movements you are going to be doing.  And don’t forget your muscles and neurological system need time to adapt to the new demands you are placing on them.  We’ve all been sore from doing more than we were ready to do at some time.

Is there just one way to do this preparatory work?  Of course not.  There are a few main ways to get to the highway from your house and there are going to be a few ways to break yourself back into exercise.  They will probably involve the activities you are going to ultimately be performing, the exception being correcting movement limitations and addressing necessary rehabilitation prior to regular exercise.  For most people this drive to the highway, the preparatory work is going to be a fairly quick process lasting just a few weeks though for many individuals these activities are going to be the main routes to their goal.  There are no shortages of people with significant injuries, pain and limitations and resolving them is the big final destination.

Now let’s say you have done your preparatory work and have made it to the highway of fitness.  Some days you take you main route; in this example let’s say it is a classic strength training approach.  Because you are smart and carefully read everything above, one day a week you take a different highway route, perhaps a yoga class.  There are also days when you are only doing the short drive to the highway and not actually getting on.  These would be days that we might consider “recovery days” where you are focusing on just that preparatory work, mobility and taking care of your body.  But we mentioned that you can get off the highway at any point and take any number of surface streets.  In this example if classic strength training utilizing barbells and dumbbells are your main highway path, those surface streets might be a workout designed around suspension training, bodyweight or kettlebells.  It could be using the same tools (barbells/dumbbells) you were using but applying them differently doing a period of powerlifting or Olympic weightlifting.

For the experienced athlete or coach these changes would be planned out and part of a periodized training program.  Planed periods of time in the overall training plan that are designed to train different elements.  Elements that are related but still different and ultimately build upon each other to help the person maximize their results.  Traditionally we talk about hypertrophy (muscle growth), muscular endurance, strength and power but as time has gone by the list of objectives has grown to include other elements.  For the average person trying to improve their fitness there are benefits to training these different skills and objectives but they can be a bit more relaxed as to how they are integrated into the overall program. Instead of a carefully planned detour onto another path for a prescribed set of weeks it might just be the occasional change in route to mix things up and present something new to the body.

So even if you drive a particular main road to work, take a different highway once or twice a week for different stimulus, there still may be times you pull off to take those surfaces streets.  It would be great if it was always like the above paragraph and a well planned detour onto those roads but very often it is the result of unplanned consequences.  Just as weather and accidents and the like force me off the highway on the way to work, gym closings, holidays, work and family conflicts and injuries will force you off of your chosen path.  Force you to take some surface streets.  Change your training focus for a day or period of time.  You can be upset and curse at the traffic gods or see this as an opportunity to address something different.  To pay some attention to some aspect of training that you normally would not focus on so much.  If you are lucky it is just a short term detour and you get back on the highway fairly quickly, hopefully better for your detour.  Sometimes however you can’t get back on the highway.  Perhaps your make and model car are suddenly forbidden from driving on that highway (yes I know, that doesn’t happen, just go with the analogy for now).  No matter how much you want to drive that Jeep Grand Cherokee on the highway you are just not allowed and every time you get on it the police pull you over and force you off.  On your path to fitness it won’t be a car model that is forbidden but perhaps an injury that changes things for you on a permanent basis.  You might have been a runner before, or enjoyed heavy squatting and deadlifting but a particular knee injury could mean that you can never do those activities again or do them at the intensity and frequency with which you previously did.  Usually with an injury we hope the temporary detour onto surface streets allows you to rehab and get back to normal but sometimes there is a new permanent normal that doesn’t allow you back on the previous road.  For some people this injury might have happened before they even began their exercise program and certain routes are off limits to them from the beginning.  In these cases you either need to be on other highways or able to get off of a particular highway at the same point all of the time and take those surface streets the rest of the way to your destination.  It may be slower driving but you will still get there.

Many people never get off their main highway path.  Doing the exact same things day in day out, week after week, month after month.  Something we are starting to clearly see is a problem.  Many trainers have the opposite problem and they never clearly define a route for their clients to take and every day is a new search through the map and a totally random path taken.  As there has been a proliferation of new, less educated and experienced trainers/coaches coming into the field, many without a solid background in exercise science this has become a bigger and bigger problem.  It is not difficult to pick some exercises and make someone do them.  It is not difficult to make someone work hard and feel intense effort.  Doing those things for clearly defined purposes, with a clear path towards an objective however is becoming a rarer and rarer thing.  You don’t generally drive somewhere without knowing where you are going and how you are going to get there.  Your training shouldn’t be completely random either.  Now this doesn’t mean that general workouts, random boot camps and the like are all bad. Quite the opposite, they can be very stimulating, fun and contribute towards reaching your objectives.  You just have to recognize them for what they are, a stand alone good workout.  If you want to get somewhere specific you can have some of them as part of your plan but to do nothing but them, while still a particular highway path, is not going to be the most direct or effective one or even get you all the way to where you want to be.  And if you are choosing a trainer, one who only trains this way, is probably not the most educated, experienced or effective trainer.  They may make you feel like you are working hard but we’ve established, that is not difficult to do.  This doesn’t mean that younger and less experienced trainers aren’t good. I’ve met countless amazing ones.  What separates them from the pack, their desire to know not just things to do, but also why they are choosing those exercises/movements, how they work on a physiological level, how they are applying those exercises for specific objectives and how they are best integrated into a well thought out plan.

So there you have it, a roadmap to fitness.  Long, complex, often confusing and full of different elements that sometimes seem conflicting (sounds more like a relationship then an exercise plan).   Is there one best way to go?  Absolutely not.  Do different people need different paths?  Without question.  Do the best plans include different routes and a plan to use them?  Yes.  Do you have to be flexible and able to change routes for unforeseen issues? You better be.  Do fitness professionals know the best way to get you where you need to be?  Sometimes but often not, they can be as lost and confused as you.  The best of them, and there are plenty of good ones, do know how to read the map and more optimally guide you.

Now get up and get moving.  You can’t reach that destination sitting there.