Thread by @BioLayne

How to prevent & recover from injuries/pain?

Yesterday I posted a video of my deadlifting 645 x 3 with relative ease, pain free at 42 years old

This is after I have endured 2 herniated lumbar discs, 2 bulged lumbar discs, 2 herniated cervical discs, torn muscles in both hips, a partially torn pec, & a partially torn adductor over the last 9 years

So how did I do it? Surgery? Special stretches/mobility work? Cold plunges? Stem cells? Peptides?

I did none of those things. I used evidence based pain management & recovery methods

But first off, let's get one thing straight, there is NO SUCH THING as 'injury prevention.'

Even people who are completely sedentary deal with pain & can incur injuries. There are things you can do that can reduce risk of injury but no 'prevention.'

And for athletes who push hard for a long time, injuries & pain are not a matter of 'if' but 'when'

First thing is first. What actually helps reduce risk of injuries? Probably not the things you think

Stretching & increased flexibility has NOT been shown to reduce injury risk (PMIDs: 26642915 & 15782063)

Additionally, 'good form' has little evidence to support injury risk reduction for ex round back lifting did not increase injury risk (PMID: 31775556 & 35098885)

Unfortunately, these have become dogma in the fitness community with virtually no evidence

So what actually does reduce injury risk?

1) Sleep reduces injury risk by up to over 200% when getting 4 h vs. 8 h (PMIDs: 25028798 & 32061551)

2) Psychological stress reduction has been shown to reduce injury risk (PMIDs: 34803856 & 34525450)

3) Repeatable warm up that increases heart rate & body temperature (PMID: 35627873)

4) Belief that you are NOT fragile (PMID: 37240482)

5) Appropriate load/volume management. Training that exceeds recovery increase risk (PMID: 29943231)

Hopefully you have noticed 2 themes: 1) Maximizing recovery and 2) your mental state MATTERS

We used to view the mind & body as separate & if you had pain you must have tissue damage & vice versa

That is a very outdated view of pain. You can have tissue damage & no pain while having pain with no tissue damage (PMIDs: 35669019 & 22341140)

This is known as the Biopsychosocial model of pain & I don't have the space to cover it all but @hubermanlab did a GREAT podcast on it with @DrSeanMackey that I HIGHLY recommend listening to

A classic example is this study in young adults with no back pain: over 50% had disc herniations, annular fissures or nuclear degeneration (PMID: 35669019)!

That's right. They had 'degenerative discs' but absolutely no pain. Pain is more like an emotion that you can sensitize or desensitize yourself to

I'm NOT saying if you break your leg it might not hurt. Pain is a warning system but it can be dysregulated

This is why people can have chronic pain well after any tissue damage should have healed

In fact high levels of stress, inactivity, & poor sleep are strong predictors of chronic pain (PMID: 35061825)

Additionally, expectation of pain, fear, & belief the body is fragile can increase pain sensitivity (PMIDs: 30243037, 23850095, & 27548244)

So how did I heal my injuries? The short answer is I didn't worry about 'healing' them. I managed the pain

I reminded myself continuously that my body is strong & resilient. Just because I have pain does not mean it will last forever. It will not unless I don't manage it

I focused on reducing psychological stress & getting good sleep

I did NOT avoid activity. Avoiding activity increases pain (are you reading orthopedic docs?)

Now, in the short term I did avoid activities & positions that triggered my pain at more than a 4/10 but at minimum I walked or rode the bike & lifted light

But the real game changer for me was exposure therapy. Exposure therapy is where you expose yourself a something causing a SMALL amount of pain & over time you increase the stimulus

Example, I had such terrible hip pain for YEARS that squatting below parallel with almost any weight was unbearable

I started with a high (probably 6" above parallel) squat to pins at a slow tempo with a pause at about 80% of the load I could probably do if I went all out. It triggered a small amount of pain. Each week I added weight or lowered the pains as the pain allowed

After 16 weeks I was back to doing full heavy squats to depth with almost NO PAIN. Recovery was NOT linear & there were weeks I had to back off but I simply told myself I was resilient & did not catastrophize setbacks

That's why at age 42, I am mostly pain free & strong AF