350 ‒ Injury prevention, recovery, and performance optimization for every decade

Peter Attia and guest Kyler discuss the importance of maintaining physical health and strength throughout life to ensure a high quality of life in one's later years. They emphasize the need for a comprehensive approach to training that includes strength, cardio, and flexibility to prepare for the "marginal decade," or the last decade of life. They explore the concept of dynamic stability, the importance of tailored rehabilitation plans, and the role of various therapies and exercises in addressing injuries and maintaining overall health. The conversation highlights the necessity of a personalized and proactive approach to health and fitness, regardless of age or current physical condition.

• Emphasizes the importance of being physically prepared for aging, not just focusing on current fitness.
• The idea of preparing to be a "kick-ass" older adult involves laying the groundwork in earlier decades.
• Strengthening muscles and improving capacity now benefits both current and future physical capabilities.

"If I'm going to be an awesome 70 or 80-year-old, I kind of have to be an awesome 45 or 55-year-old. We're going to be doing things now that make you crazy strong, that help your lean muscle mass, that burns your fat, all those health risk things."

• Highlighting the need for sustainable fitness practices that contribute to long-term health and readiness for life's challenges.

• Discusses the role of rehabilitation and prehabilitation in preparing for surgery and recovery.
• The importance of strengthening surrounding muscles and maintaining joint stability before surgery.
• Collaboration between medical professionals and patients is crucial for effective recovery strategies.

"We did a lot of things where we didn't only use technology like BFR, but we also used very aggressive approaches on your core stability, the way your scapula interacted with your ribs, and all these things have an effect on how my shoulder moves."

• Illustrates the comprehensive approach taken to prepare the shoulder for surgery and ensure a successful recovery.

• Challenges traditional post-operative recovery practices by reducing time spent in a sling.
• Emphasizes early mobility and targeted exercises to maintain muscle function and joint mobility.
• The importance of patient compliance with post-operative instructions for optimal recovery outcomes.

"Alton said, 'No, we're gonna have you out of a sling in 24 hours.' And I was like, 'How is that going to be possible?' Right. Um, and yet we did."

• Demonstrates innovative approaches in post-surgical recovery that prioritize mobility and function.

• The concept of the "marginal decade" as the final decade of life, emphasizing preparation for physical capability during this time.
• Training for the marginal decade involves thinking like an athlete, focusing on maintaining physical abilities and quality of life.
• Observing and learning from older adults' experiences to better prepare for one's own aging process.

"The more deliberate we can train for that last decade as though we are athletes, the more we can enjoy it."

• Encourages a proactive approach to aging, focusing on maintaining physical independence and quality of life.

• The idea of a "centenarian decathlon" as a metaphor for maintaining various physical capabilities into old age.
• Personal goals for physical activities in later life, such as playing with grandchildren or hiking, as motivators for current fitness practices.
• The importance of diverse physical activities to prepare for the unpredictable nature of real-life movements.

"I want to be able to really crank out some mileage, especially in national parks as I get older."

• Highlights personal fitness goals as part of a broader strategy to maintain physical capability in later life.

• The challenge of balancing immediate fitness goals with long-term health and capability.
• The risk of focusing solely on short-term performance without considering the impact on future health.
• Encouraging a mindset shift towards sustainable fitness practices that support both current and future well-being.

"If we're thinking long term, then by default, if I'm going to be an awesome 70 or 80-year-old, I kind of have to be an awesome 45 or 55-year-old."

• Reinforces the importance of integrating long-term health considerations into current fitness practices.

• The unique role of rehabilitation professionals in bridging the gap between injury recovery and performance.
• The importance of personalized assessments to identify weaknesses and areas for improvement.
• Integrating corrective exercises into regular strength training to enhance performance and prevent injury.

"One of my biggest pet peeves in the rehab world is when people give someone 30 exercises that are really tedious and boring and no human sticks to that."

• Emphasizes the need for engaging and relevant rehabilitation programs that align with individuals' goals and lifestyles.

• Effective rehabilitation requires a close relationship between neurologists and rehabilitation professionals, which is often lacking.
• The commitment of healthcare providers to a service-oriented approach is crucial for effective rehabilitation, as opposed to a profit-driven model that may lead to suboptimal care.
• Personalized, one-on-one rehabilitation is essential, as a cookie-cutter approach does not address individual needs.

"The philosophy and the individual spirit of either the surgeon or the rehab pro...they have to be kind of committed to the service-oriented field."

• Highlights the necessity for healthcare providers to prioritize patient care over financial incentives.

"Typically, it's a very cookie-cutter approach...it's an insurance model thing."

• Critiques the standardized approach in rehabilitation driven by insurance reimbursement rather than patient-specific needs.

• Rehabilitation clinics should offer comprehensive plans rather than isolated services to increase patient capacity and recovery.
• Passive modalities and reliance on outdated exercise handouts are seen as red flags in rehabilitation practices.
• Continuous evaluation and adaptation of rehabilitation plans are necessary to meet the evolving needs of patients.

"If your rehab clinic is a bunch of passive modalities on tables...that's a red flag for me."

• Emphasizes the importance of active, progressive rehabilitation strategies over passive treatments.

"A lot of times this handout is from 30 years ago...there's no accountability."

• Points out the inadequacy of outdated and generic rehabilitation plans.

• Professional athletes face unique rehabilitation challenges due to multiple stakeholders and conflicting interests.
• The focus on short-term performance in professional sports often overlooks long-term health and wellness.
• Athletes benefit from having a dedicated oversight team to manage their rehabilitation comprehensively.

"Professional sports is wellness upside down...how can we get the most out of this athlete, this commodity for their contract?"

• Critiques the short-term focus in professional sports rehabilitation that prioritizes immediate performance over long-term health.

"We've had some pro athletes approach us with like this idea of...can you guys be my reliable like you're invested in me only and be my oversight?"

• Describes the need for a dedicated team to manage an athlete's rehabilitation holistically.

• Jill, a runner, presented with proximal hamstring issues and knee pain after running two marathons in close succession.
• The assessment involved detailed clinical exams and MRI to identify tendinopathy and other structural issues.
• The rehabilitation plan focused on addressing underlying biomechanical issues and preparing for future running goals.

"Jill's a really great example because she had some pain when she showed up...we saw some proximal hamstring issues."

• Describes the initial assessment and identification of Jill's injury.

"She normally only runs one marathon a year, but last year she ran two...started to get for the first time ever a little bit of knee pain."

• Explains the context and potential causes of Jill's knee pain.

• Running biomechanics, including unilateral rotation and spinal engine dynamics, play a critical role in injury development.
• Middle-aged women are particularly susceptible to certain injuries due to demographic factors and common training gaps.
• Pelvic changes post-pregnancy can significantly alter biomechanics and contribute to injury risk.

"Running, even though I'm moving straight ahead, is technically a unilateral or single leg rotation propulsion drill."

• Explains the complex biomechanics of running that can lead to injury.

"A lot of middle-aged women, it's getting way better, but don't strength train, number one."

• Highlights a common gap in training that increases injury risk among middle-aged women.

• There is a significant need for structured rehabilitation programs for women post-pregnancy to address biomechanical changes.
• The pelvic floor and other structures are often neglected in post-pregnancy care, leading to long-term issues.
• Preemptive strengthening and rehabilitation can mitigate some of the biomechanical impacts of pregnancy and childbirth.

"One of the biggest crimes in modern medicine today is...what are we doing for women immediately post baby?"

• Critiques the lack of focus on post-pregnancy rehabilitation for women.

"No one out there is telling women to do foot strengthening when they're two months pregnant, right? But they should be."

• Advocates for proactive measures to address biomechanical changes during and after pregnancy.

• Core stability is essential for effective movement and injury prevention, but it must be understood as a dynamic system.
• The core acts as a cylinder, providing stability through coordinated muscle activation rather than static strength.
• Dynamic stability allows for efficient force transmission and movement, as seen in high-performance athletes.

"If you have really prominent rectus abdominis that six-pack, that has nothing to do with how you stabilize your trunk."

• Clarifies misconceptions about core strength and its role in dynamic stability.

"Stability and apply we just we we we sort of think of that as things that are not moving."

• Emphasizes the importance of understanding stability as a dynamic, rather than static, concept.

• Comprehensive assessments are necessary to determine the appropriate level of rehabilitation exercises for each individual.
• The progression from isometric to dynamic exercises is based on individual capacity and risk factors.
• Rehabilitation plans should be tailored to address specific deficits while building overall functional capacity.

"We basically look at everything about four to five different ways...the exercise is the test."

• Describes the multi-faceted approach to assessing and progressing rehabilitation exercises.

"We find their floor and we build from there...we're building them up from wherever those floors are."

• Outlines the individualized approach to rehabilitation, focusing on addressing specific deficits.

• Key focus on addressing underlying structural and functional issues to prevent exacerbation of injuries.
• Use of platelet-rich plasma (PRP) injections to promote tendon regeneration and healing.
• Importance of communication and collaboration between different professionals (strength team, physical therapist, running coach) to ensure a coordinated and effective rehabilitation plan.
• Emphasis on patience and allowing sufficient healing time to avoid setbacks.

"We put a package together for her program that was all of those underlying structural functional issues that didn't make the hamstring worse."

• Addressing structural and functional issues is crucial to prevent further injury and promote healing.

"Everything we did in her programming was to ensure we didn't flare that up."

• Programming is designed to avoid aggravating the injury, ensuring a smooth recovery process.

• Coordination between different professionals is essential for a successful rehabilitation plan.
• The running coach, physical therapist, and other team members must communicate effectively to avoid setbacks.

"We really communicated with not just the strength team at 10 squared, but also her physical therapist off-site and her running coach."

• Collaboration among different professionals ensures a comprehensive and effective rehabilitation strategy.

• Athletes often struggle with the desire to return to their sport too quickly.
• Patience and adherence to the rehabilitation plan are crucial for successful recovery.

"We had to have a lot of come to Jesus conversations about you cannot run too soon."

• Emphasizing the importance of patience and following the rehabilitation timeline to prevent re-injury.

• Physical therapy plays a critical role in promoting healing and strengthening the injured area.
• Alternative training methods, such as swimming, help maintain fitness without stressing the injured area.

"She swam, so she didn't lose any true cardio, right? Yes, she lost a little bit of running strength, but someone with her background and her base and then keeping everything else really strong, she's going to hit the ground running."

• Alternative training methods help maintain overall fitness while allowing the injured area to heal.

• Importance of building habits and encouraging enjoyment in physical activity.
• Focus on mitigating injury risks and addressing foundational issues in non-athletic clients.

"I think number one, we got to build the habit. So that's a big part of this is when your coach is basically in contact with you every day as much as you want to help bend and twist and develop that formula so where that person is actually encouraged to do it."

• Building habits and fostering enjoyment in physical activity are key to engaging non-athletic clients.

• Comprehensive assessments can reveal hidden weaknesses and potential injury risks.
• Developing personalized training programs to address these risks and improve overall fitness.

"His calves were crazy weak. His balance wasn't good because he didn't have strength. And he's definitely a high risk for an Achilles."

• Identifying and addressing weaknesses can prevent future injuries and improve overall health.

• Training in multiple planes of motion is essential for functional fitness and injury prevention.
• Incorporating isometric and plyometric exercises to enhance motor unit recruitment and tendon strength.

"We behave in a three-dimensional space. So this idea of only doing calf raises, my toes pointed straight ahead, insufficient, right? Because to your point, there's going to be moments where my toes are out or one toe is out."

• Multidimensional training ensures comprehensive strength and functional fitness.

• Understanding the mobility and strength of the foot is crucial in addressing foot and ankle injuries.
• Implementing specific exercises to improve foot strength and reduce injury risk.

"You have a very mobile foot. So, you know, your swimming background, like swimmers have really great mobile feet, right?"

• Recognizing individual differences in foot mobility and strength is essential for effective injury prevention and rehabilitation.

• Fear and psychological factors can significantly impact recovery and rehabilitation.
• Educating and empowering clients to overcome fear and build confidence in their recovery process.

"Pain does not always mean injury. Pain is your brain telling you, 'Hey, I don't like what's happening here.' But it doesn't always mean you're broken or busted."

• Understanding and addressing psychological factors can enhance the rehabilitation process and improve outcomes.

• Initial assessment involves checking for weakness or loss of bowel/bladder function, as these require immediate medical evaluation.
• Sensory nerve pain, such as sciatica, is common but doesn't always necessitate surgical intervention.
• Mechanical lower back pain without weakness can be managed with various non-invasive strategies.

"If there's weakness or you don't have bowel or bladder function and things like that, right away get evaluated."

• Immediate evaluation is crucial for serious symptoms to prevent permanent nerve damage.

• The McKenzie protocol involves specific exercises to alleviate pressure on discs and is effective for many patients.
• It can be used as an initial diagnostic tool to assess the body's response to non-invasive treatment.
• Positive response to the protocol can indicate a non-surgical path to recovery.

"McKenzie protocol is a really great system that... you're basically trying to take pressure off that disc to where slowly over time that bulge can recenter and balance out."

• The protocol aims to naturally realign disc bulges, providing relief and potentially avoiding surgery.

• Allowing time for natural healing processes can be beneficial, especially when acute weakness is not present.
• Patients are encouraged to wait and monitor improvement over weeks, as the body can often heal itself.

"If you can encourage a hot disc patient to wait and make sure that they're actually letting things heal and run their course, they could be much better off in four to 10 weeks."

• Patience and monitoring are emphasized as crucial elements in the healing process for disc-related issues.

• Treatment should be tailored to individual needs, avoiding over-reliance on any single method like adjustments or dry needling.
• A variety of therapeutic tools should be used as needed, depending on the patient's response and comfort.

"The really good practitioners have a huge tool belt and they know when to use which one at what time."

• A diverse approach in therapy ensures that treatment is personalized and effective.

• Lower back pain is not only physically debilitating but can also be emotionally and psychologically demoralizing.
• The constant nature of back pain affects daily activities and can lead to a sense of helplessness.

"It really is it can be terrifying and and and also demoralizing, I think, is how I would describe it."

• Understanding the emotional toll of back pain is essential in providing comprehensive care and support.

• There is potential for AI and app-driven solutions to provide personalized feedback and guidance for lower back pain management.
• Image recognition software could play a role in providing corrective feedback during exercises.

"The video recognition software is getting fantastic... the AI is actually watching someone do movements and saying, 'Hey, you know, this was too far out that way or whatever.'"

• AI technologies could democratize access to personalized rehabilitation programs, enhancing self-care capabilities.

• Strengthening exercises are crucial for long-term recovery and prevention of future injuries.
• Rehabilitation should focus on building strength and resilience, rather than just temporary pain relief.

"You have to be adding strength. That's what makes things stick. That's what optimizes movement."

• Strengthening provides a protective 'moat' around the body, reducing vulnerability to future injuries.

• Remote rehabilitation can be effective if the therapist has a thorough understanding of the patient's condition and movement patterns.
• Personalized care plans and exercises can be delivered remotely, ensuring continuity of care.

"If I'm not worried medically and we think it can respond to load, we're going to load it."

• Remote rehabilitation relies on careful assessment and ongoing communication to ensure effective treatment.

• Chiropractic adjustments are one tool among many and should be used judiciously as part of a broader treatment strategy.
• Effective treatment involves a combination of therapies tailored to the individual's needs and responses.

"Just throwing cupping at somebody and hoping their muscles get better, it's insufficient. In the same way I would say just adjusting someone over and over, it's not enough."

• A holistic approach that incorporates multiple treatment modalities is more likely to yield successful outcomes.

• Initial assessment distinguishes between cases needing orthopedic consultation and those suitable for rehabilitation.
• Treatment involves creating a change through manual therapy or strategic loading, followed by strengthening exercises.

"Once we've got past that bifurcation of knowing that it's a rehab case, then the protocol really turns into what is the safest and smartest way to create a change."

• A structured framework ensures appropriate treatment pathways and maximizes recovery potential.