Why You Should NOT Go To An Orthopedist First When You Have Pain

Why You Should NOT Go To An Orthopedist First When You Have Pain

The world of orthopedics is riddled with inefficiency. Orthopedists are masters of their craft. Surgery, injections, imaging, medicating…but there’s very little that they can do to help you outside if these things. If most things can get better with moving differently, adding or subtracting some exercises, or better programming, why are we going to a surgery expert first for evaluations. Here are three of the biggest reasons you should choose a physical therapist or a trainer before an orthopedist when you have pain:

  1. A good clinician will take time with you
    • Good diagnostics take time. We know that pain is complex. With the exception of straightforward traumatic injuries like sprains, strains, fractures etc., we need to ask lots of questions to figure out the problem.
    • For instance, if you’re having shoulder pain doing pushups, we might want to ask things like “how many are you doing, how long have you been training, have you recently changed the amount you’re doing, how are your elbows positioned…”
    • If an orthopedist spends less than ten minutes with you, doesn’t watch you do a pushup, and has no exercise background, are they really doing their due diligence to solve the problem?
  1. What can they actually OFFER you to help?
    • Medications (pain relief), Steroid Injections (pain/inflammation), or Surgery
    • If you are dealing with a problem that has been going on for a while, then none of these are good options. Medications won’t help solve a problem that’s chronic. Steroids can help mask the pain for a while, or reduce ACUTE inflammation, but won’t fix the root cause. Surgery is a last resort and can be effective when all else fails.
    • They are going to send you to PT to try to rehab first. Most insurance companies also now require PT before they will cover imaging or surgery. So why are we still going to a doctor first?
  1. What do they actually know about rehab or training?
    • Unfortunately, next to nothing…
    • Most of them took one rehab class in Med School 20 years ago and have never looked back.
    • The majority don’t exercise regularly and are not at all in touch with why loading is important for healing, would have no idea how to program someone properly, and don’t have experience ever fixing a pain problem without rest, injection, or surgery.

THIS IS NOT AN ATTACK ON ORTHOPEDISTS. There are many systemic reasons why orthopedists have to operate this way. They don’t get to spend more than five minutes with you or work closely with physical therapists because they don’t have time. Insurance companies have drastically reduced how much they get paid, and as a result, they need to see more patients to afford to run a business. 

They are also EXCELLENT surgeons. Their knowledge, understanding and craft in repairing traumatic injuries or very bad chronic injuries is incredible. What they do is amazing. 

And I’m also generalizing which isn’t fair to the ones who are great clinicians. It’s rare, but if you can find someone that will take time with you, ask you lots of meaningful questions about your pain, and probably encourage you to try some form of activity or therapy in order to change it before considering pills, injections, or surgery, then hold on to them.

How Often Should You Change Your Gym Program?

How Often Should You Change Your Gym Program?

How often should you change your gym program is a common question we get asked. This concept is called “periodization”. The answer? It really does depend on a lot of different factors. How long have you been training? Are you a seasonal athlete? Do you have any injury history? Are you making progress, plateauing, or regressing? Are you bored? Have your goals changed?

It’s good to ask yourself these questions every so often. Sometimes we feel the need to switch it up. Maybe we want to cut for summer. Maybe we want to put on some more muscle. Maybe we are getting bored with the same routine and just need to shake it up. But is it necessary to change our training?

Traditionally, we’ve liked the idea of block programming. And to be fair, I still implement this type of system with a lot of my clients. Block programming just means cycling on and off periods of traditionally low volume/heavy work and high volume/work to allow our bodies to be adapted to different energy systems, movements, loads, intensities etc. Historically, every 12 weeks or so we’d change from a strength block with really high intensities, to a hypertrophy block with higher volume and lower intensities. I still really like this training method because it allows people an opportunity to work on different things in each 3 month block. I find it’s great to constantly give us new stimulus, work your high intensity and low intensity energy systems, try new exercises, and maybe most importantly, avoid attrition secondary to fatigue and boredom.

The counterargument is that by constantly changing back and forth, you’re not really building on all of your gains for a long enough period of time to really enjoy the fruits of all of your labor. Just when you start to really see the work pay off, you switch back to a completely different routine. I think this is a really valid reason not to work on block programming. I think some more elite athletes with very specific goals probably shouldn’t use this, and instead focus all year long on making gains exactly where you want them.

But for most amateur level athletes or weekend warriors or people just trying to get healthier, block will give you more versatility, help you to avoid boredom, and can be programmed more effectively along periods of bulk and cut that allow you too look your best during those seasons where you are wearing less clothing and get bigger during seasons where you can afford to gain a little extra belly fat along the way.

No system is right, it always comes down to making a plan that works best for you.

LOAD MANAGEMENT

LOAD MANAGEMENT

Adam Silver, commissioner of the NBA, came out last week and essentially said that load management is a bit of a farce. That actually, a lot of early season injuries can be attributed to lack of quality off-season training. 

There is a time for rest. It’s really important for in season athletes to recover properly. In the old days, we probably didn’t prioritize it enough. But there is something to be said about following basic offseason strength and conditioning principles. You should be stressing heavy work to increase your capacity for the demands of your season.

At the professional level, I see too much focus on yoga, pilates, mobility, swimming. These are great, but it goes against the fundamentals of off-season training. You should be prioritizing heavy strength, power, conditioning.

We’ve seen an over-emphasis on low intensity training in the off-season for many of these athletes. And it’s no coincidence that in season injury rates continue to climb. We can’t say it’s causative, but the data is pretty compelling that maybe we should follow the old blueprint of basic S and C to help prepare us for the demands of our sport.

Load management issues also exist at the high school and lower collegiate levels, but the problems, in my opinion, are a little different. I think it’s two fold. Specialization too early, and poor or non-existent off-season programming.

Early specialization is just becoming a one sport athlete at too young of an age. Encourage your kid to play multiple sports until they are in high school or beyond.

For off-season programming, I’ll ask a lot of my athletes what their programs look like in preparation for the season. Most of them have incredibly generic programs that are not at all preparing them for their sport. It’s no wonder we see injuries in the first month of returning to soccer, track, cross country in the fall when they’ve not been doing any work to prepare over the summer. You can’t rest all summer and expect to get fit and healthy two weeks before the season starts. 

You should be focused on getting stronger in the offseason and preparing for your season months in advance. The reason we see these kids getting shin splints, foot pain, knee pain is just due to poor off-season management. I look at the off season programs (if they have one at all), and it’s usually a 2 week prep period to get ready. No adaptation can happen in that amount of time. If you care about your athletes, especially the fall sport athletes, you should be giving them better off season training advice.

How Important is Stretching?

How Important is Stretching?

How Important is stretching to your health? And how much should time should you invest in it?

There’s been a lot of talk around stretching lately. People like me have been clamoring for many years that stretching is very overrated and takes up way too large of a role in most people’s exercise programs. There is a lot of evidence that tell us it falls flat with regards to range of motion gains (compared to loaded mobility), injury prevention (no correlation), or utility for sports or performance. You’re far better off doing some loaded mobility or dynamic movement than spending a ton of time stretching every muscle you have. Loading up your end ranges of motion serves multiple purposes: the stretch receptors that help determine a muscles “length” are more likely to adapt if there is extra stress on the muscle, load will also allow you to adapt elements of control over your body, and it will also allow your tissues to become stronger and more resilient in what is typically it’s most vulnerable position.

I myself still believe stretching has a place. It is not useless. There are others that will tell you that it’s a complete waste of time. For me, movement is movement. If people will do 10 minutes of stretching at home on an off day, a recovery day, or when they can’t make it to the gym due to time or life constraints, then that is still really great. It’s still a positive stress for the body that helps you to move and improve, even if the effects are marginal. Stretching can also still give you that really positive dopamine boost and post-exercise relaxation that makes us feel good. There’s never anything wrong with feeling good and doing something that involves moving your body.

But in the big picture, it should really only make up a very small percentage of a person’s regiment. There are far greater benefits to strength, conditioning, loaded mobility, and skill acquisition for your long term health. They will have the most profound impact on your ability to reduce/prevent injury, stave off disease and maintain a healthy immune system, look more aesthetic and ultimately feel better.

With regards to timing, it doesn’t matter whether you stretch before exercise, after exercise, or dedicate your own day to stretching. It doesn’t help performance or reduce injury risk before an exercise or sport and it doesn’t improve recovery after an exercise or sport. All that matters to see some effect is that you do it often or intense enough to see change, just like any other type of training. Time under tension is all that matters. If you do it hard enough for long enough, you’ll see more results.

What Is The Best Way To Recover

What Is The Best Way To Recover

What does recovery even mean? What is the most effective way to recover? Should I do active recovery or passive recovery?

The word recovery gets used a lot with training these days. And it is really important with regards to optimal performance and injury reduction. Recovery is the ability for our body to return to a baseline level following a training stimulus. Typically it involves a period of time for our muscles, bones, nervous system etc to repair itself and build itself back to a “normal” state”. We see tons of “biohacks” discussing the ability to recover. Ice baths, sauna, foam rolling, active recovery, sleep, massage, stretching, cupping, acupuncture, red light…what actually helps?

Quite honestly, the best thing you can do is just sleep and rest. Our body is best at repairing itself after harder workouts by just leaving it alone. I forget who I heard the line from, perhaps Dr. Mike Israetel, but “it’s addition by subtraction.” It’s really difficult to think about adding more stress to your system that somehow helps it recover better.

There is marginal evidence that any of the above modalities improve recovery. It doesn’t make that useless. Things can definitely feel better but not be better. Many of these things are giving us a transient sensory experience that can sort of distract the nervous system for a time and allow it to perform a little better in the short term. Working with athletes or lifters who train consistently at higher levels can utilize these techniques to help them perform again and again and get a little bit better performance out of them because they “feel” better or looser or more freedom of movement. But the feel good stuff is a bit of an illusion because it isn’t ACTUALLY making you any better or more recovered. Again, this isn’t an attack on any of these strategies because they can be really effective at helping those elite athletes perform better in those short windows. But for most of us average, amateur level fitness enthusiasts, we aren’t training hard enough to require it. Getting a good sleep and sitting on our a** is probably the best thing we can do after a bout of intense exercise, and usually isn’t worth the thousands of dollars in investment for cold tanks, saunas, red lights, massage chairs…there’s just no evidence that they are actually effective in helping with recovery. If you have the means or you just like the way it makes you feel, please, by all means. It may make a small difference and allow you to perform just a little bit better. But on the whole, there is no magic pill that’s going to help you more than a good night’s sleep.