340: Should You Train Through Pain? (The Answer May Surprise You) with Dr. Susie Spirlock, DPT

Introduction 

You're listening to Biceps After Babies Radio Episode 340.

Hello and welcome to Biceps After Babies Radio. A podcast for ladies who know that fitness is about so much more than pounds lost or PR's. It's about feeling confident in your skin and empowered in your life. I'm your host Amber Brueseke, a registered nurse, personal trainer, wife and mom of four. Each week my guests and I will excite and motivate you to take action in your own personal fitness as we talk about nutrition, exercise, mindset, personal development and executing life with conscious intention. If your goal is to look, feel and be strong and experience transformation from the inside out, you my friend are in the right place. Thank you for tuning in. Now, let's jump into today's episode.

Hey, hey, hey, welcome back to another episode of Biceps After Babies Radio. I'm your host, Amber Brueseke, and today on the podcast, I have Dr. Susie Spirlock, who is coming to talk to us about a very important topic, and that is pain. This is something that I get asked a lot. Women who are starting in weightlifting, or if you've been lifting for a while, having some sort of pain is kind of a rite of passage. It's likely going to happen with your workouts, whether you're a runner, you're a lifter, you're a soccer player. Pain is a part of the human experience and working out, and knowing when and if to push through that pain. Should you immobilize it? Should you keep pushing? Do you need to pull back your weight? Do you need to keep lifting? Can be a really confusing question for people to be able to answer, so I brought an expert onto the podcast to be able to talk to us about all things pain, all things weightlifting, and Susie does a really great job of giving some really tangible takeaways that you can, if you are trying to DIY some of your own rehab when it comes to dealing with pain, she gives some really tangible takeaways in terms of a scale that you can start to use in terms of how to know when you're loading too much or not enough in the episode. If you're someone who is dealing with any nagging pain, or just someone who is lifting and is going to likely have an injury or deal with some nagging pain in the future, I guess I say weightlifting, but really if you're active in any sort, I don't care if you're a hiker, or a biker, or a runner, or like I said, a pickleballer, you're probably going to have some sort of injury at some point, and knowing how to deal with that injury is really, really important. So that's why I brought Susie onto the podcast and I'm very excited for you to listen to this episode because she has some really great takeaways and you're going to have some aha moments as you listen to her. Let's go into the episode. 

Amber B 02:37 

All right, I am so excited to welcome to the podcast Dr. Susie Spirlock. Hey Susie, welcome to the podcast.  

Dr. Susie Spirlock 02:44 

Thank you so much. I'm so excited to be here today.  

Amber B 02:46 

Yes. Me too. Can you start a little bit just giving us a little bit of your background with physical therapy, with strength training, and kind of maybe tell us a little bit of a story about what led you into those areas of focus?  

Dr. Susie Spirlock 03:00 

Of course. Yeah, so I actually grew up wanting to be a veterinarian, surprisingly enough. Love animals with all my being, and so I was like, yeah, let's be a vet. Shadow veterinarians realized I'd have to be around animals, unfortunately passing away and crossing the rainbow bridge, realized I emotionally couldn't handle that. And so I still wanted to enter a profession where I could help people. And so I then thought that, hey, what about med school? Let's go to med school. Let's become a physician. I can help a lot of people that way. And then I realized that maybe I don't want to be in school till I'm 35 and be on call all the time. And so growing up, I actually played soccer and went through my fair share of injuries there and ended up in physical therapy. 

And so when I kind of decided med school wasn't going to be for me, I said, hey, what about physical therapy? It's active, it's exercise based. I still get to help people. I still get to be in the healthcare model. And so I just kind of went for it. And that's where I ended up getting my doctor physical therapy degree from Western Carolina and then treating in the clinic for my first three years out of physical therapy school. And then decided that that wasn't for me either, in a sense that I felt pretty limited of the care I could give to people because of insurance. 

And because of just all the, you know, the words that are said to you by physicians, like stop lifting, stop exercising, you're “bone on bone”, all of these really fear-based ideals that didn't really align with me and what I believed in and what the research believes in. And so then I decided to dive into the world of online fitness and rehab coaching. And now I am fully remote and online. And then, so that's like the physical therapy part. And then the strength training part happened because growing up being an athlete playing soccer, I was pretty small. I was a very small teenager and very small in my early twenties. 

And I didn't really feel capable to handle all the things that I wanted to do in life. So I started going to the gym, started doing some strength training. And then since then have just evolved over the years of it being my absolute love and then being able to pair the physical therapy aspect of my life with the strength training aspect. 

Amber B 05:20 

So awesome. I would love to hear a little bit more because I, so I'm, I'm a nurse by trade. I don't know if you knew that, my husband's a physician, right? There's lots of different healthcare ancillary fractions and, and somehow we're like all supposed to work together on like our little piece of the pie, but you do get like this crossover with physicians saying, Oh, don't lift more than 20 pounds or, Oh, you'll hurt your back or whatever. Right. And then you come over to this other realm. And it's like, actually, that's going to make you stronger. And it's going to protect your back to like actually deadlift or to lift. And so you get these kinds of competing professionals, right? And they're all professionals and we're all professionals in our own spheres, but you do get sometimes it's like competing advice that, that people are given. And I wonder like, how, how can we as consumers, right? Consumers of healthcare, how can we balance what sometimes feels like competing advice from different healthcare professionals?  

Dr. Susie Spirlock 06:18 

That is a really good question. I'm so happy you brought that up. I usually tell people that usually each healthcare provider has their wheelhouse that they are most competent in and they have the most knowledge in and follow the research on. Physicians are so great at so many things. We need them for medical management for a lot of chronic diseases. We need them to get antibiotics when we're sick and have a cold. Heck we need them to perform surgeries, life-saving surgeries and life altering surgeries on us as people so that we can either one survive or live a better life. And so with that being said, when it comes to physicians, physical therapists, we are like the musculoskeletal experts of the human body. We know how to modify things when you're dealing with pain. We know the certain body systems and exercises and manual therapy techniques that can help decrease your pain. 

And when it comes to physical therapy school, for example, we get a small dose of pharmacology. We have a couple of pharmacology classes so that we can know what medications can interact with each other and how to just have that open line of communication with the physicians. But I don't have the capabilities of prescribing medication to someone. 

And so I like to kind of compare that to the physician side. They're so great at so many things, but should they necessarily be giving super specific exercise advice or telling someone to stop exercising? Probably not. And then that's where this network and this open line of communication between all of the healthcare providers on the team is so incredibly important because we're all really good at our own little things. We just need to mesh it all together so that we make sure we're getting the most up-to-date and helpful information to our clients and patients.  

Amber B 08:06 

That's so good. Yeah, I mean it really becomes like a team and kind of what you're saying is like, just like on a soccer field, there's the strikers and there's the defenders and you kind of have your specialists and you don't, they're both really important and you both need both of them, but they have different wheelhouses. 

And so really sticking with people and in their wheelhouses, we actually had a recent experience with this last year where I had a son who had played basketball, had an ankle injury. We went to the physician, they immobilized it, ended up like it ended up continuing to be a problem. He ended up not being able to be weight bearing. He got into crutches and finally we got a referral over to PT and I just remember I show up with my kid in crutches, the PT and the PT is like, what the heck? Get those crutches off. This kid should have never been on crutches. I would have been moving it from day one. 

Right now he has limited range of motion because he hasn't been moving. I mean, so a lot of these compounding factors and it was just such an interesting experience. I mean, I'm pretty well versed in medical knowledge, but this idea of like, do I move it? Do I immobilize it? Do I push through the pain? Do I not? I had this experience with my kid of trying to walk that balance between immobilization, movement, pain, how much pain is okay. 

And so I would love to dive into this with you because we went to PT, ended up fixing the problem and he's fine. But what he needed was not what we were giving him initially. So for somebody who has some sort of injury, I'd love to dive into your thoughts around this of how we as consumers, again, can figure out when we have an injury, what do we do next? How do we know when we move it? How do we know when we immobilize it? How do we know when pain's okay, when pain's not okay? Can you kind of talk? I know it's a broad thing and we'll probably go a couple of different areas, but can you just kind of speak to that experience? Because I know I'm not alone in this. 

Dr. Susie Spirlock 09:56 

You're definitely not alone in this. I will validate you there. The broad answer to your broad question is it depends. And diving into that a little bit further, when I say it depends, it means that if you're in a car accident or you are an elderly individual and you fell in your driveway, or you're doing a deadlift and you feel a very sharp sensation in your back and now have numbness and tingling down both of your legs, those are all reasons of, hey, we should probably go get checked out at an ER to make sure nothing serious has happened. But in the absence of those kind of traumatic events, if we are having some sort of soft tissue pain, like maybe you stepped off a curb and you sprained your ankle, or maybe you were doing a lunge and you felt a pulling sensation in the front of your thigh and now your quad really hurts, the things that aren't life-threatening and major traumatic events, all of these soft tissue injuries, and by soft tissue, I mean injuries to the muscle, to the tendon, to the surrounding ligaments, all of these things should be managed through movement and graded exposure to range of motion and more load and more intensity.  

Because we know that in order for things to heal, we need blood flow. And blood flow gets to those areas more so by moving it. And immobilizing, like you experienced with your son, is just going to decrease the amount of available range of motion and how much you can move a certain joint, which is then going to open up another can of worms. So now we have to try and get that range of motion back. And then we also have to work on strength. And it kind of sets us back a little bit when it comes to these soft tissue injuries. And I know a lot of people listening have probably heard or are familiar with the acronym R.I.C.E. when it comes to things like sprains and strains. 

And R.I.C.E. stands for, if you don't know, rest, ice, compression, and elevation. And this is the old, outdated model on how to deal with these acute or minor soft tissue injuries of where we're taking a bunch of time off and or we're immobilizing, we're icing the thing, we're compressing it with an ace wrap, and we're elevating it above our head. Then to that, I think the man who coined that was Dr. Gabe Merkins was in the 70s. He has since redacted all of that and said, okay, that's not what we know now. What we know now is that we need to rest it for a couple of days, but then we need to get it moving. We need to increase the blood flow. We need to work on some strengthening exercises, some range of motion exercises, because these things are what's going to let you heal faster and get you back to doing the things you were doing prior to the injury.  

Amber B 12:37 

So good. Yeah.  I mean, it's, it is, it's fascinating to me that that guy retracted it. Right. I think I always think that this is fascinating. And when we learn more, we do better. Uh, but I still think, I mean, that concept of rice, man, that one is a hard one to move past because people still bring that up of like, that's how you, that's how you heal things. Um, so yeah, it's, it's so good. 

So it, I, and I love the distinction that you made of like acute injury versus maybe something that is, isn't life threatening or it wasn't such an acute, uh, experience and maybe how we treat those a little bit differently. So for someone who is, who, you know, they were doing a deadlift and they, you know, their back got pulled a little bit and now they have some back soreness or, you know, they were doing a lunge and the quad is now, you know, sore or maybe feeling a little bit of pain. I know people are really concerned about like re injury. So how can we find that boundary between doing the range of motion, keeping the movement, uh, you know, not stopping what we're doing with, without, but have that peace of mind of like not re injuring, uh, the muscle, muscle further.  

Dr. Susie Spirlock 13:40 

Right. And that's definitely a valid concern. And I will say a pain experience for a lot of people who aren't well-versed and educated in pain, that can be scary when, especially when you're doing it and you're, you're exercising or you're playing with your kid out in the yard and something happens and something hurts. I mean, that's clearly a sign from the brain of like, Hey, something's going on. You might want to check this out. 

But a lot of times people think it immediately means that certain tissues are damaged within the body, which we know that you can have pain and have some sort of tissue damage, meaning you pulled a muscle or you hurt a tendon or ligament, but you can also have pain and not have anything wrong with any of the physical aspects of your tissues, which is huge. And that goes to show that pain is a very, not only physical thing, but also a social thing and a psychological thing. And when I say those two things social meaning, you know, what type of family support do you have? Um, what is your socioeconomic status? You know, do you feel financially safe? Do you feel emotionally safe in the house? Cause that can influence a pain experience. 

And then psychologically, what are your beliefs around pain and injury? Um, have you been told to fear certain movements and not do things because we're going to hurt your joints? All of these things come together and that is what kind of creates an overall pain experience. So it's not just the physical, which can make things either easier or more difficult to rehab. 

Amber B 15:07 

Or more cloudy. 

Dr. Susie Spirlock 15:08 

Yeah. depending on the person. But when I talk to my own clients, uh, that I have, and when I talk to patients in the clinic, I like to use a couple of different things to try and teach them about pain that can help us kind of rate where they are while they're exercising. 

So the two things are called the traffic light system and the ladder system, and they kind of work together. So I'll go ahead and explain what those mean. When I say the traffic light system, imagine your traffic light, you have your red light, your green light, and your yellow light. 

These are different steps in that pain response or how severe a pain response is. So think of your green as like your mild, but tolerable pain during activity, or your pain doesn't really get any worse, like two to 24 hours afterwards. There's no real change in range of motion or strength or function. Like you're still able to do all your daily life stuff, but it might just like burn a little bit, feel like a sore muscle. Um, when you're in the green zone, normally that's on the one to 10 scale of the pain rating, anywhere from like a zero to a three or a four. The only thing you need to do is continue with your current activity and consider slight increases in your intensity or your load or your volume. 

So intensity meaning how hard you're pushing load, meaning the amount of weight that you're lifting and volume, meaning the number of sets and reps you're doing in an exercise. So you can temporarily pull back a little bit with these things, but you don't really have to just overhaul your total exercise program or your daily life activities. Just don't go overboard. This is not the best time to like, start increasing your exercise and intensity or volume, but just like be aware of it because most times, if you're in the green light zone, you're good to go. And things within a couple of weeks are going to heal and you're going to be right back where you were prior.  

Now going into the yellow light zone, this is when we have more of a spike in that activity with pain. Normally in the zero to 10 pain scale, we're at like a four to a six or a seven. So things are hurting pretty good. It's a lot more noticeable during your daily life activities when you're walking about the house or about work. Pain can be like worse 24 to 48 hours after your activity. But still, we're not really seeing a big change in your range of motion or your strength or your function. It's just plainly just more noticeable. 

Now in this yellow light zone, we kind of want to take a step back from your previously green baseline. So green is like the safe space. Yellow is like, Ooh, we might want to pull back a little bit more. That might look like subbing in a different exercise. Let's say you were doing back squats with a quad strain and your quads really hurting and you're in the yellow zone. Well, I might want to modify that to either a box squat or even a goblet squat where we can decrease the overall intensity and the load that we're exercising with so that we can still stimulate the muscles in the nervous system, but in a way that just is a little bit more comfortable. We could do this for usually like two to three bouts of activities until we start to get into that green light. And then when we're back in the green light, we can kind of ramp back up and build some more tolerance within the body and within those tissues that might be hurting.  

Now the red light, the red light is a pretty kind of severe spike in pain. We're talking about the eight out of 10, nine out of 10 and 10 out of 10. So for these, most people are not going to be able to continue to perform their activities or their exercise plan. If the pain is persisting for several days or several weeks, and you're also seeing a decrease in your range of motion and your strength and your overall function. This is where I would highly recommend seeking out help from a rehab professional that is just well-versed in strength training. If you are currently strength training, and if not, just well-versed on the importance of exercise within a rehab program to begin with.  

Amber B 19:03 

That's really helpful to like have that gradation and then the next steps for people. Because I do think pain is scary. And I think when you don't know where it comes from, when you don't know what's causing it, when we have this idea that all pain is caused by tissue damage, right? You broke that myth for us, but that's a very common thing is like, if I have pain, there must be some sort of tissue damage. And yes, there can be, but there also cannot. 

And I think that's probably an aha moment for a lot of people who are listening. I would love to hear your thoughts on addressing the fear of coming back to an exercise post-injury. So I get clients who injure themselves with a deadlift or with a squat and they rehab and they get better, but it's like going back to like doing, you know, maybe they, they pulled their squats down, right. And, you know, lower weight, higher volume or higher reps. And you know, they're getting back up and they're feeling, they're feeling fine, but there's like that mental fear to go back to that, like heavy squat where they're, you know, RP nine or 10. How can people mentally walk through that fear of, of getting back to where they were on something that did injure them in the past? 

Dr. Susie Spirlock 20:14 

Right. And that's definitely a valid concern. That's something that I work with a lot of my clients on is because, I mean, you're right. Pain, pain is scary, scary. If you don't really know how it works, which most people don't, and that's okay, because you didn't go to school for seven years. Like I did, but if you don't know how pain works, pain is scary and returning to a previously cranky or spicy as I like to call it. Yeah. 

So if I say the word spicy during this podcast, I'm referring to something that's a little bit discomforting or a little bit painful. I like to use the word spicy because it's a lot less scary than the word pain. 

Amber B 20:45 

It's a good word. That's a great one.  

Dr. Susie Spirlock 20:46 

Yeah, it’s a good word. And people normally they're like, Oh, spicy. Like I like that. 

Amber B 20:51 

Yeah.  

Dr. Susie Spirlock 20:52 

Um, but when it comes to that, I mean, you know, like you said, dialing back on the volume sets and reps, either subbing in a modified exercise that is still like, let's talk about a deadlift for example, still a hinge pattern, but maybe not like your big conventional heavy deadlift. The most important thing here is to one, get to the point where our pain is back in the green light area. And if it's your client's goal too, to get back to where you're starting to deadlift again. Now, the most important thing, when we start to enter into doing the lift again, that injured us in the first place or hurt us in the first place is to form a really positive relationship with that exercise. So what I mean by that is like weekend week out, we're doing the deadlifts, but we're also doing it in a way where we're avoiding getting into the yellow zone. And we're also doing it in a way where we feel good about what we're doing. So we might put on some, you know, your favorite song that you like to listen to. You might bring a buddy to the gym with you to kind of talk with you and just get you out of your head. Doesn't even have to be talking about exercise because a lot of times, yes, we should be focused during our sets, but we can also use those rest periods to kind of distract ourselves from that “scary lift” that we're currently doing. And then the most important thing is just repeatable reps and sessions of where we're having that positive experience, because we almost as humans have to prove to ourselves that it is okay to do the thing that is scary and know that it's not going to hurt us.  

Amber B 22:23 

Yeah. It's like, it's like an exposure therapy, right?  

Dr. Susie Spirlock 22:25 

Exactly. 

Amber B 22:56 

It's like convincing yourself to do it enough times. Okay. This actually is safe, even though I thought it was unsafe previously. 

Dr. Susie Spirlock 22:33 

Yeah. And that is the huge piece to the rehab part of rehabbing movement, because yes, we're working on the physical, we're increasing the tolerance that your body and your muscles can handle certain loads. But like I already mentioned, part of that pain experience is fear and beliefs around movement. It's that psychological component. So addressing that component is just as important as addressing the physical component of what could be going on within the body and the tissues.  

Amber B 22:58 

That's so good. Will you give us, and we can say like high level, but I do think it's fascinating. And I think a lot of people don't understand the mechanism of pain. They don't understand how pain gets translated up into the brain. They don't understand like pathways and we don't have to get like super detailed, but I do think my listeners would love to like have an overview of like, when we say I feel pain, how does that happen? Like, how can we have pain without tissue damage? I'm sure some people are asking. So just walk us through what is the mechanism of pain?  

Dr. Susie Spirlock 23:30 

Yeah, of course. So according to like the international association of the study of pain, which is a publication group association, clearly they kind of really dive into the study of pain, how it happens in the body, how people perceive it. And so they actually redefined what pain was a few years ago. And pain is actually an unpleasant sensory or emotional experience associated with or resembling actual or for tissue damage. And so I know that's a lot of words, but main things I want to point out unpleasant, sensory and emotional experience. Sensory, meaning the physical part of your body and physical tissues and emotional, meaning your beliefs around pain, whether you're super stressed out about work this week, whether you just had a kid that was sick and the other kid has seven soccer games this week, and you're just being pulled all over the place. So it's both of those things together.  

And we also know that pain is influenced by our environment. So that kind of goes along with that emotional environment aspect of the pain. When it comes to how our body processes it, essentially the brain is what makes pain. So your tissues don't make pain, your brain makes pain. When let's say I step off of a curb and I roll my ankle, the brain is sensing, oh crap, something just happened down there because we had a super severe change quickly of range of motion. And there was a lot of weight on this area. So I'm going to quickly send a signal through the brain, down the spinal cord, down to your ankle to make sure we stop moving it to try and protect that area. Whether or not you actually tore any ligaments in your ankle or not, your brain is still going to send that pain signal down there to try and protect that area. 

However, your brain has no unearthly idea if anything is actually damaged. It is just simply trying to protect you and your body from hurting physical parts of your system. And so a lot of times with clients, I like to use the analogy of a smoke alarm because it can really resonate with them. So you have your smoke alarm in your kitchen, your smoke alarm is essentially analogous to your brain. So when you're in the kitchen and you're cooking something up in the kitchen, your smoke alarm can go off if you start to emit smoke. Now, if we are cooking up a really good grilled cheese sandwich, or if there's an actual fire, that smoke alarm is going to trip. 

Because we have smoke going up and it's like, hey, something's wrong, you need to check on it. But it can't tell you if there's a fire, where the fire is, how severe the fire is, if you need to evacuate the house, and so on and so forth.  

So the same thing with the brain. The brain is a smoke alarm, senses something going on down in whatever part of your body. It doesn't know if you're making a grilled cheese, i.e. doing some really fun, hard exercise, or if you actually had some tissue damage happen and you sprained your ankle. It has no clue. And so kind of breaking it down that way. It's like, most people will sit there and go, huh, that makes sense. Because when we have pain, things like foam rolling, things like deep tissue massage, things like cupping, most people are going to say, yeah, that's like a hurt so good feeling. That feels good, but it also hurts a little bit. That, my friend, is still pain. Versus I'm doing an exercise and I felt like a twinge in my knee, that's also pain. Your brain doesn't know the difference between the two, but you, in the setting that you're in, whether you're on a massage table or whether you had a twinge in your knee during a lunge, that's that environment piece that I'm talking about and what makes those pain responses so vastly different.  

Amber B 27:15 

That's fascinating. Yeah, it's so good. And I think, again, I think the more that we can understand the mechanisms of pain, the more, one, we can be less afraid of it. And we already know that being less afraid of it is going to make it hurt less. And be able to really work through the process of figuring out how much movement, how quickly do I do that movement? What adaptations can I do to be able to get through this? One question I had for you. So I had a recent experience, I guess this was probably maybe a year and a half ago. I had experience with some glute pain. And it was in the yellow, where it was kind of just like that nagging. It wasn't super bad, but it was just like nagging. Months went by, months and months and months. And finally, I was like, dang, I probably should actually do something about this. Because it's not just going away on its own. So I ended up getting a referral to a PT who was a fantastic PT. And through some sessions with him, being able to figure out that a lot of my glute pain was coming from my abs, from not bracing my abs properly, which then put it into my back, which then pulled on my glute.  

So it was so fascinating as he went through all the body systems to really diagnose what was the root cause of the pain. It had nothing to do with my glute. It was a completely different part of my body. The body chain is just where it's hurting may not actually be the actual cause of your pain. So because of that, obviously getting a professional involved is a really good idea, because I would have never figured that out on my own. That's why you go to a professional. But for people who are struggling with pain, can you speak a little bit to how our body systems are connected? And why did me not bracing my abs properly cause my butt to start hurting?  

Dr. Susie Spirlock 29:00 

Yeah. And so I think that it's a very good thing to talk about and a very good thing for people to know. And that can also help make pain a little less scary, too. Because for you, in a sense, your brain was sending pain signals down into your glute, because that was the tissue that just became the most sensitized, kind of like turning the frequency up on a radio that was screaming the loudest when it came to… Were you having pain with lifting, running?  

Amber B 29:25 

Yeah. I was squatting. Squatting specifically was always like that, left glute pain. 

Dr. Susie Spirlock 29:31 

Yeah. And so your body was sending the pain signal down there, but that wasn't even the actual body part or muscle that was contributing to this pain response in the first place. So with that being said, I do want to highlight that anyone listening, your pain experiences are real. They're not made up. They're not all in your head. I mean, technically they're on your head because your brain's responsible. But if you go to any provider and they say, oh, you're just making it up. This doesn't hurt. You need to find a new provider because everyone's pain experience is personal and it's real. 

So now that I went off on that tangent, the body is very interconnected. There are body regions, certain muscle groups, certain joints that need to perform in a way in conjunction with a nearby joint or a nearby muscle. So that's another struggle that I had with treating in the clinic is because you get a physician's referral to someone who has knee pain and the only thing you can treat is their knee. But I want to look at the ankle. I want to look at the hip. I want to look at the trunk. I want to look at the spine. There's so many things that I want to make sure we're optimizing the function of so that we can one, try to get to the root cause of your pain. And then to figure out a system to get you out of pain. 

So I know a lot of times with glute stuff, um, even with some groin stuff and even some quad related things, a lot of times the lower back is like the first place that my brain goes. The lower back has a huge, huge nerve supply. And it is more sensitive than a lot of the other body parts that we have, just because your brain is trying to protect all of your precious, precious organs that are in that area that if those get hurt, we might be in a little trouble. 

And so with the lower back, the lower back, a lot of times refers into the glutes, into the hamstrings, into the quad, sometimes even around into the front of the abdomen and the trunk. And so that's like the one really good thing you can get out of working with a professional is the fact that we know these things and we can help walk you through them, explain them to you, and then get you on a rehab and strength training plan to help mitigate these and reduce these over time.  

Amber B 31:47 

Yeah. Uh, yeah, it's, it's so, I think we think of the body sometimes in isolation, right? It's like my glutes hurt. What do I need to do with my glutes? And when you realize it's, it's really this like kinetic chain. And the problem may be like you said, up or down the kinetic chain, that's actually causing the real issue. It's why working with somebody who like geeks out on all this stuff and like, loves all loves to think about the kinetic chain, right? It looks like why you got into this is like, you love getting out on this stuff and we need this because it is, it isn't just as simple as like, okay, well, let's like strengthen the glute. It's like, I actually needed to work on like raising my abs better. So that protected my lower back so that my hamstrings didn't fire. And the, you know, it was like this whole, this whole, um, you know, kinetic chain issue, uh, that was really fascinating to be able to figure out, um, and, and, you know, get better after some work. So, uh, thankfully I'm out of the, out of the, out of the woods with that now. 

I would love for you to give, and I, and we can walk the line here of like how much you want to give in terms of advice, because I do think that there becomes like some of the time people trying to DIY treating pain on their own is not a great idea, right? It's like, go to a professional who can like help you to actually treat the pain, get the right diagnosis and give you a good treatment plan. Um, but for somebody who is in that, that place of like, they have an injury, they're maybe in the yellow zone where they don't necessarily feel like I need to go see a professional right now. I want to try and rehab this on my own. You know, we want to pull down volume. We want to pull, you know, maybe change out exercises. Is there any like specifics that you can give in terms of like percentage of volume that we should be looking for, or maybe some of the most common injuries that you see and substitutions for those exercises that people could, who are trying to do a little bit of this on their own can take and actually apply to their specific, you know, workout plan that they're doing right now.  

Dr. Susie Spirlock 33:38 

Right. So when it comes to specifics, I mean, always, it's going to depend, depend on the person, but generally speaking, um, if we're like talking about, you know, a big umbrella of how I usually approach things with clients, and if you're going to DIY at how I would recommend you approach it is we want to kind of stay in that green light. So when you are exercising, I want your pain to be let act or less than a four out of 10, because that tells me we aren't pushing past your current tissues tolerance, but we also aren't ramping up the nervous system and brain so much to where we're getting these like higher ratings of pain. So we want to keep that pain at a four out of 10 or less with that being said in regards to the intensity, the load, the reps, the sets that you have, let that be dictated by your pain response, because I don't want to necessarily say, Oh yeah, we need to drop 50% of your load because that 50% is going to feel different for from person A to person B. So if you take any, 

Amber B 34:39 

It might be too much for somebody, it might be too little for somebody else. 

Dr. Susie Spirlock 34:42 

Exactly.  

Amber B 34:42 

Can I make sure? So you're not saying we want to do it entirely no pain. And I think that's sometimes where people go is like, well, I can't do this without any pain. And so I shouldn't be doing this. And you're saying no, a low little level of pain is to be expected. We just don't want to get into those higher levels of pain. 

Dr. Susie Spirlock 34:58 

Correct. 

Amber B 34:59 

I think that's so good for people to hear.  

Dr. Susie Spirlock 35:01 

I am giving everyone listening permission to exercise with mild, but tolerable pain. So I like to tell my clients, I want it to be mild, but tolerable. And I also like, like to word it as sore, but safe. Like, yeah, you feel it a little bit, your attention's drawn to it. It feels a little sore, but like you you're also feeling safe and you're not freaking out about it. 

Amber B 35:20 

That's good.  

Dr. Susie Spirlock 35:21 

Because that's another thing too, because a four out of 10 pain for me when I'm training is nothing because I usually know it's nothing, but a four out of 10 pain for someone who is really psychologically afraid and ramped up with pain is going to feel a lot more intense. So I want you to be sore and safe, mild, but tolerable, and it is okay to have some discomfort when you are training. I cannot stress that enough because if you look at it kind of like a stepwise fashion, let's say this week we are training back squats with a hundred pounds for three sets of five, and you have a three out of 10 hip pain. Okay, great. But the next day you wake up and it's a one to two. And then the next day it's zero. Great.  

The next week you add some weight to the bar. So now we're doing a three by five steps and reps for 110 pounds. And your pain gets up to that like four, 4.5 out of 10. I'd probably say, okay, you're still safe here, but I want you to repeat that same session the next week. And let's say you do it the next week and you're at like a three out of 10 pain. Okay. Well, next session, let's increase load a little bit more. 

So think of it as kind of like either a ladder or a staircase where it is okay to have that pain for every single session you're having. But what we would should see is pain staying the same, but intensity or load or reps or sets increasing. And then finally, we're going to get to a point where loads and sets and reps is kind of staying the same. And then now pain is also starting to decrease. And I feel like that's a lot of people kind of get stuck because they do believe every single session should be pain-free when you're dealing with an injury. And if we only ever train pain-free, we are vastly underloading the tissues. And anytime we try to really increase that load and we feel that discomfort, then we're immediately going to go back to that level that doesn't elicit any pain. And we're always going to stay here because you're not giving your tissues and your brain time to adapt.  

Amber B 37:28 

Mm-hmm. Yeah. And I think that that last part of like, you have to give your body and the brain time to adapt. And it's like, if you stay away from it, if you are scared of it, you never get to that point where your body is almost forced to adapt to what it is that you're trying to do. Which is so good. Will you speak a little bit to maybe lifts that people outside of the weightlifting world would say are dangerous, right? Like nobody should be deadlifting. That's super dangerous to do. Or even like back squatting, right? Like super dangerous to back squat. We want to protect our knees. Or lunges is another one that a lot of people would be like, lunges are so terrible for your knees. 

And so for people who have maybe grown up hearing this of like, oh, those are really dangerous lifts, can you kind of talk to why we should be deadlifting? Why deadlifting is going to make your back better and healthier than not deadlifting? Because I think people are worried about their backs. They're worried about their knees, especially as they age. And I think that creates a lot of fear to where people don't do these lifts. 

Dr. Susie Spirlock 38:32 

100%. And I think that, I mean, my parents are in the same boat. I mean, they look at me lifting or they used to look at me lifting. They're like, oh my God, Susie, you need to dial it back. You're going to hurt yourself. You're going to blow out your knees. And part of that I think is a generational thing because back when my parents are in their early sixties, back when they were our age, a lot of this research that we now know about the importance of strength training, the importance of using your joints and using your joints is not going to make them wear out. It's actually going to make them feel better. We didn't have all of this evidence. We didn't have all these thought processes on how exercise and joint health is approached. So I do think some of it is a generational thing, but then you also still have people that are saying these things today.  

And one of the things I think is because when you look at a heavy deadlift, most of the time when people are deadlifting, I mean, there's usually like a lot of weight on the bar from, from the person's perspective, who has never stepped in the gym before in their life. And that can be pretty daunting looking at someone lifting a weight, their face is getting red, they're grunting, they're breathing hard.  

Amber B 39:39 

Were you watching me deadlift?  

Dr. Susie Spirlock 39:41 

No, I'm watching myself deadlift. I'm looking at my face.  

Amber B 39:45 

So true. 

Dr. Susie Spirlock 39:46 

It can be scary because I feel like a lot of the times videos online of someone hurting their back deadlifting or hurting their knee squatting are just completely taken out of context because these people who have these, um, you know, moderately severe injuries during lifting are not because the lift itself is bad for you. It's usually because they're doing too much, too fast, too soon, from what their body can currently handle. Like if I were to go out in my garage right now and try to deadlift 400 pounds,  

Amber B 40:17 

You'd probably hurt yourself. 

Dr. Susie Spirlock 40:18 

Yeah. It probably wouldn't move number one. And I increased my risk of injury, not because it's the bar and the deadlifts problem, but because my body is used to deadlifting around like the two 15 ish mark. 

Amber B 40:31 

Yeah.  

Dr. Susie Spirlock 40:32 

And so there is no one bad exercise. Lunges aren't bad for your knees. Back squats, aren't bad for your knees and your hips. Deadlifts are not bad for your back. What's bad is hopping into something and not giving your body and your brain time to adapt. 

Amber B 40:47 

Yeah. That's really, really good. So good. Uh, this has been awesome. Susie, will you kind of talk through what, if someone's like listening to this and they're struggling with maybe their own version of, you know, the lingering glute pain for months and months and months, how do they work with you or what does that process look like?  

Dr. Susie Spirlock 41:01 

Yeah. So you can find me on Instagram at @dr.susie.squats. And you can also find me on my website is moveyourbonespt.com. And that's where you can look up what, uh, rehab coaching with me and my team looks like, uh, because I just want to empower so many people to keep strength training or get into strength training because you can get into strength training at any age and reach so many benefits. 

And I also want people to know that there are, there is hope out there. Like if you've been dealing with pain for a significant amount of time, there is hope for you. And I would love to be one of those people to help you through that process so that you can continue doing bad-ass stuff in the gym and all the fun life stuff with your kids, with your parents, with your friends, so that you don't have to “ever worry about pain again”. 

Amber B 41:49 

That's so good. Awesome. Thanks for coming on the podcast. Really appreciate it.  

Dr. Susie Spirlock 41:53 

Of course.  

Amber B 41:54 

I hope that you learned a lot from that episode. I thought Susie did such a great job of talking about pain, where it comes from, the mechanisms of pain. I think understanding that not all pain equals tissue damage is such an aha moment for a lot of people. And really her reiterating that the goal isn't to have zero pain, right? That's not actually a very good goal to be having as you're rehabbing something. And so her really explaining the difference between that green light, that yellow light, and that red light of knowing where you want to sit when in terms of rehabbing something was, I thought, such a really, really helpful graphic or idea for us to understand. So hopefully you're not feeling pain, but if you are, you now have a little bit better understanding of how to be able to deal with that, how to train through it, and how to get yourself back to your active lifestyle that most of us really want to get back to.  

If you enjoyed the podcast, will you take a moment and leave a rating and review on whatever platform it is that you're listening to this podcast on that really does help the podcast to be able to find new listeners and for people to discover the podcast. So thank you for those of you who have left a rating and review because it really does help. That wraps up this episode of Biceps After Babies Radio. I'm Amber. Now go out and be strong because remember my friend, you can do anything.   

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