The Beyond Pain Podcast

Episode 23: Do You Really Need to Earn the Right to Move?

• Par Four Performance • Episode 23

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Summary
In this episode of the Beyond Pain podcast, hosts Joe Gambino and Joe LaVacca discuss their favorite home gym equipment, the importance of building strength with limited mobility, and the significance of movement variability in rehabilitation. They explore joint health, loading strategies, and how to adapt exercises for individuals with specific limitations, emphasizing that movement is essential for overall health and well-being.

Takeaways
Kettlebells are versatile and space-efficient for home gyms.

Building a home gym can save money on memberships.

Movement variability is crucial for joint health.

Loading tissues appropriately can improve strength and function.

Not all individuals need to meet strict movement prerequisites.

It's important to adapt exercises based on individual capabilities.

Strength training can enhance quality of life, even with limitations.

Joint health involves more than just mobility; loading is key.

Social media influences can create unrealistic expectations for movement.

Finding what works for each individual is essential for progress.

Joe LaVacca (00:01)
Hello again, everyone, and welcome back to the Beyond Pain podcast with myself, Joe Lavaca and Joe Gambino. In today's episode, Joe and I start off by sharing our favorite at -home gym equipment and how we started building our own sort of situations in respect to the space that we have. We then further our conversation by sharing a story that actually happened to me in clinic this week.

And we discussed this idea of do we really need to have certain movement prerequisites in order to start a strength and conditioning program? We hope you enjoy this episode and all future episodes of the Beyond Pain podcast. And if you do, please remember to like and comment, but most importantly, share this episode with someone who you think it can.

Without further ado, here is episode 23 of the Beyond Paying podcast.

Joe Gambino (01:46)
Welcome back into the Beyond Pain podcast. I am your host, Joe Gambino, and I'm sitting here with the having too many mic problems over there. Joe Lavaca. can find us on Instagram. I am at joegambinodpt and Dr. Lavaca over there is at strength and motion underscore PT. You can find us on YouTube, cupswithjoe underscore PT. And this podcast is on Instagram as well. Beyond Pain podcast over there.

Joe LaVacca (01:54)
Self -inflicted bike problems.

Joe Gambino (02:16)
If you do need help with pain and you would like us to help, is an application form in the show notes. Just fill that out and one of us will get back to you. And as always, we love conversations with our audience. So please feel free to shoot us a DM on Instagram. And we're more than happy to have a conversation there. Joe, how are doing today?

Joe LaVacca (02:36)
I am doing well, well my friend. I'm looking forward to our conversation because this is actually inspired by a interaction I had with a client this week. So I'm excited to share how that's been going with all of you and then get your opinion on how to hopefully proceed with his care or help others proceed with theirs. But other than that, man, I'm doing well. How are those beautiful girls over there?

Joe Gambino (03:05)
They are all doing very well over here. We're maybe three weeks away from baby two being here, which is exciting. So, you know, we'll see how that goes. But today, I think this, this episode, we're going to call it a double question of the day. Double question of the day. We have a question here from Morden, a little quick hitter here. Some of our favorite home gym equipment.

Joe LaVacca (03:11)
I know.

double question at the day. Love it.

easy, easy kettlebells. For me, I am in a small, let me emphasize small, two bedroom apartment in New York City, well, out in Long Island, but they're all pretty much the same when you clump them all together out here. So the living room and even the kitchen, which I'm in right now, has multiple meanings and multiple purposes.

Joe Gambino (03:54)
Yeah

Joe LaVacca (03:55)
So I really need to prioritize. Like I shift this chair here with the doors behind me, whenever I'm doing calls or the podcast with you. And now the kitchen becomes the studio. When I'm not doing this, the chair flips right back over here and just becomes part of the dining room table again. So when I'm in the living room,

Joe Gambino (04:07)
Mm -hmm.

I see.

Joe LaVacca (04:16)
I really need that living room to be a place to read, a place to watch TV, a place to hang out with Avery, a place to host, and I need it to be my gym. So depending on where I'm pushing things, to me, the kettlebells offer you the greatest variety and they take up an eezy, beezy, teensy amount of space because I really, you don't even really need a rack either. They just sit on the floor.

They're very nice. Once you're done, you don't even really need pairs a lot of the times. If you just, you just get singles, which I also like. so I feel like if you're going to be starting a home gym, get comfortable with kettlebells. That's my bias. you can throw in a pull -up bar and then maybe just like a TRX or some sort of like a suspension system that you can just put into your door. And I think with a pull -up bar, a few kettlebells and a suspension system, you are going to be looking pretty, pretty good.

Joe Gambino (05:03)
Mm

I like that. I mean, I think that's, I mean, that's how my home gym started really was kettlebells. The same thing in New York, New York apartment, you know, maybe 800 square feet and, you know, just a few kettlebells. I think I created some parallel bars and that's kind of really what I work with at home. huh. I built those some PVC pipes.

Joe LaVacca (05:25)
Mm -hmm.

I remember that. Yeah, you built those, you? There was a craze in New York City for a while where people were running the Home Depot, building their own parallettes. And I totally forgot about that, yeah.

Joe Gambino (05:42)
Mm -hmm. Yeah. Yep. They did not make it to North Carolina with me because I stopped using them. So, but it was like 15 bucks to make. So it was not too bad. got plenty of use out of it when I first created them. Yeah. It's a luxury being in a house now. You know, mean, obviously if you can get a squat rack and all that stuff in your home gym, that would be, you know, it's ideal. You know, I plan on making a few additions because the rogue racks have so many accessories. So I plan on trying to get a little pulley system in there at some point this year. Black Fart is coming. So.

Joe LaVacca (05:54)
Yeah.

Sure.

Joe Gambino (06:12)
kind of my favorite time to buy equipment because there's usually discounts, shipping is usually free and shipping is usually where the majority of costs for kettlebells, buying Black Friday, Cyber Monday. I usually get from Rogue or Kettlebell Kings, but when shipping's free, it makes kettlebells significantly more affordable. So a little two cents there.

Joe LaVacca (06:17)
Yeah.

Yeah, dude. The last, yeah, the last, I think piece of equipment here, ironically, it was actually two dumbbells. So I bought two 70 pound dumbbells and you know, I'm on Amazon or wherever I was. forgot where I bought them from. And I'm like, wow, cool. Like these are on sale. I think they're like only like 180 bucks or something. And then by the time I went to check out, it was like 420. I'm like, my God.

Joe Gambino (06:58)
Mm -hmm. Yeah.

Joe LaVacca (06:59)
yeah, because I'm shipping 140 pound box to the front of my apartment. Yeah, I would imagine that poor guy or girl who had to carry this up my steps. I feel so badly for you. But thank you. Thank you for getting it here. no, think and again, like the biggest piece of advice too is for people who are like, well, what if I buy something too heavy or too light or too this or too that? It's okay. Iron doesn't go bad, baby.

Joe Gambino (07:06)
You

Ha

Joe LaVacca (07:24)
All right, so that that that 50 pound dumbbell is always going to be 50 pounds no matter how many times you use it. And trust me, you will end up using it eventually. So like you said, just little pieces. I mean, I really probably started growing the gym like everybody else during COVID. I got what I could when I could. And then I just use that. And then once I was feeling a little bit better, OK, cool. I'm going to add this one piece at a time, this one piece at a time. And then before you know it,

Joe Gambino (07:24)
Mm -mm.

Exactly.

Joe LaVacca (07:53)
You end up having a pretty reasonable gym and you can string together a couple days a week, very easy. And now you're saving yourself money on a gym membership. And to your point, that would be now traveling with you wherever you want to go. So apartments, homes, I think one of the best things people can do is invest in ways to make movement and health easier. And what better way to do it?

Joe Gambino (08:10)
Mm

Exactly.

Joe LaVacca (08:18)
Just by looking over and being like, yeah, I have kettlebells. yeah, I have a bench. I have the, I have a pull -up bar. Maybe I should just do one today, you know, and then just build from there.

Joe Gambino (08:25)
Yeah, no, I love it. I would say, mean, bands is already a super common one. But I think having like a pair of ankle weights or like those monkey feet is super solid. mean, just for from a mobility perspective, like kind of loading all these like in range positions and little things like that. And, you know, it's great. And there you can take him anywhere. You can travel with him if you want to. You you could put bands in the same mix. Like, so if we're going like.

Joe LaVacca (08:34)
Yeah, totally.

Joe Gambino (08:52)
hotel gym or you can just be in a hotel room and you don't have any equipment, super easy to, to just get in some light loading, some, movement. I use them probably every single session these days. So I would probably say that that's one of those things outside of some main, you know, the main kettlebells, dumbbells, bench, you know, like kind of some of those basics, I think having some ankle weights or

I actually do like the monkey feet to just kind of add some load to, know, could strap my dumbbell directly to my foot and do a whole lot of different things. So I find that fun, very, very useful. Let's shift to question of the day number two, which is yours. I'll let you take it away.

Joe LaVacca (09:31)
Yeah. Yeah. So my question, and it was funny, I was thinking about you and the podcast. So I was having this conversation with a client, this client I've been working with for a while now. Great guy to talk to super hard worker. He's really a great mover. He unfortunately had a traumatic hip dislocation, a while back in his life when he was much younger.

now that he's older, this is probably, you know, a 30 or 40 year old injury. Now at this point, I'd say 30 is hip is having a really hard time moving. All right. So it's one of those hips that you feel and you felt, know you're doing mostly virtual now, but I'm sure you can remember. Maybe there's a few people out there that can relate when, when a joint is arthritic or has a lot of structural changes to it, you know, due to age or trauma, it's really stiff. It's like really, really, really hard to move.

Right? Like it almost feels like it's like stuck, right? It's like this really tough end feel. You're really not able to find like a good stretch anywhere. A lot of times these people are just limited by pain too. Most of the time, people are, you know, trying to cope with those types of injuries or cope with those types of mobility restrictions until eventually, at least for the most part of my experience, they, you know, they end up getting like a hip replacement or a knee replacement to just improve their function again. Right.

So this is something that we have chatted about, this idea of a replacement, we're trying to put it off. A lot of the things that come up though in our sessions over the last few months has been this need for, well, Joe, I get that you want me to squat. I can't, I can't squat because I don't have, quote unquote, the tissue or the meat in the hip to accept a squat.

I don't have the rotation of the hip. I don't have the foot pronation. I don't have this. I don't have that. So then when I then kind of open -ended questioning back to say, well, how do we build all those things? What are you doing? What have you been doing even before we met and over the last few months? And then just like you mentioned before, hey, I'm doing end range training.

I'm going to get down on the floor. I'm trying to do a hip lift. I'm trying to work on my hip internal rotation. I'm trying to do a 90 -90, right? I'm trying to correct my pelvic shift. And a lot of the references that he's bringing up or he's learning from, or just probably like a lot of people listening,

It's a lot of social media influence, right? And, you we can name names, but I'll just stay broad and stay with systems. So it's a lot of FRC. It's a lot of PRI. It's a lot of DNS. It's a lot of all of these philosophies that you have to strip down all of these movements almost to a developmental level before you can build them back up again.

And granted, I haven't been certified in all of these systems, but I know a lot of people who've taken each individual one. So my question to you is also having taken a few of them, is this something that you share? we've taken some of the same courses, some different courses. Do you think that there are true, true prerequisites for people in order for them to start loading or exercising?

Joe Gambino (12:53)
yes, and to answer your question shortly, I do believe that there are prerequisites for movement. It doesn't mean that you can't move, if that makes sense. I don't know if that's like a very contradictory sentence right there. But if you have a shoulder pain and you like shoulder overhead pressing and it's uncomfortable for you,

Joe LaVacca (13:03)
Okay. No, roll with it. Roll with it.

Joe Gambino (13:15)
Well then, and you don't have the full range of motion, well yeah, maybe we need to start to make a modification to that exercise. You're doing an incline press or something that's going to take away that heavy overhead flexion component of things. And we can build up the capacity for your shoulder to be overhead, right? That's one way we can look at it, right? So the shoulder needs to be able to go overhead. You're going to need shoulder rotation or you need certain things to be able to achieve those positions. And does it make sense if you have a

A shoulder that's painful to just kind of stick it up into overhead flexion and irritate the shoulder, right? Like there are other things we can do. And if it's really something you want to get back to, we can start to do that. And the case of this client where like, you know, there is something to be said with the thought process and you still see people talk about this in the fitness space where full range of motion strength training is still mobility work. And I do also agree with that, you know, so if someone's trying to get back to squatting and they have

Joe LaVacca (13:52)
Mm

Joe Gambino (14:14)
bum hip and they don't have good rotation and they don't have good hip flexion. Well, if you put them in like a deep squat with 15 pounds, like a goblet squat, and it's not painful, but helps open them up, well, there's no harm in that, right? Because A, it helps them feel better. It's starting to build some of that ability for them to tolerate squatting again. And maybe they can't go all the way down. Maybe it starts parallel and works its way down as they open up.

But loading those particular positions that you're trying to get you can't just say well I want a better squat so All I'm going to do is I need hip internal rotation to do it. So I don't have good hip rotation That's all I'm focus on is hip Internal rotation at end ranges and just really open that up if you're not squatting with it Well is the carryover gonna be there? Maybe it does maybe it doesn't but you're also gonna need a squat at the same time So I think there needs to be this balance between the two. I'm probably going to

If someone has no pain, no issues, I'm not going to stop them from squatting and I'm not going to squat them from stopping from overhead pressing, but sure I might work on some things that's going to build a more robust tip or a more robust shoulder to help them manage those stresses better. It only really, if we're running into issues of pain, things like that, would I say maybe we need to take a back seat, but in this case I would probably have them deep squat as much as they can.

With light load to kind of help them get into those positions and then still work on some of those quote -unquote prerequisite movements to Support a better hip to give them more joint health To help them feel like they can move a little bit more freely to bring down some pain and kind of pair those two things So I don't think it's black and white I don't think you can say you need to have X Y & Z before you can do this But it doesn't hurt to make sure your body has the capacity to even just actively move into those positions

We've talked about movement variability on this podcast a number of times, right? If you don't have the ability to move that and you're kind of forcing yourself into those positions and you're doing it with high volume, high load, it can cause issues. And I'm not saying that it will, but it can cause issues, right? So, but in this case, I mean, if you're just trying to get someone to squat again and they're fearful of it, Hey, let's squat.

Take this 15, 20, 25 pound kettlebell. Let it help you sink into this position. Let's spend some time. Let's do some temple work. Let's let your tissues kind of get adapted to the squat. Let's also work on the ability to give you a better hip since it's arthritic and not moving well. I think that combination would serve this person specifically well. I don't know if that answers your question or not, but that's.

Joe LaVacca (16:45)
Well, no, it does. And I think that, you know, the question for me that that still remains or, know, that continues to come up and something I've shifted my mindset on over the last, you three, four years or so, guess, right. Kind of just diving in a little bit more into like the fitness space and trying to gather up a couple more certifications and strength and conditioning and things like that. It just doesn't seem to be.

You know, one to one across the board, like we're running with this rehab idea that, okay, you need to have like optimal biomechanics for you to squat effectively or efficiently. But then at the same time, when we bring up movement variability and there's 8 billion people in the world, no one's probably going to look the same, act the same, train the same, have the same capacities, you know, so on and so forth. When we then pare down this particular individual where I don't think

there's a lot of space for improvement with his hip. I just, and I've told them this, I think there's too much structural deviation. So why waste time trying to build something or fix something that probably doesn't have a good likelihood of success to adapt because of the changes. And even if it did, we get what, four more degrees of hip flexion?

two more degrees of hip internal rotation, I don't see that being clinically significant or clinically meaningful for his life and for him to achieve the things that he wants to achieve. What we do continue to agree on though is that, I need to build this soft tissue strength or this soft tissue capacity or muscles or this. And I keep telling him, then the only way to do that is to put you in positions that tells muscles to grow. So for those listening,

Hey, you don't have hip internal rotation or flexion or your knee doesn't bend that much. That's okay. Why wait for that when I can simply say, why don't we make you do a wide box squat? Why don't we make you do a split squat? Why don't we elevate your heels if you're lacking pronation or supination or dorsiflexion? Because when I'm programming for people,

And a lot of them will come in and then say, Hey, want to, Joe, I want to get stronger. Right. Cause that's a lot of them think that, you know, if they get stronger, you know, it'll, it'll magically cure their pain. And I'm sort of okay rolling with that because I think getting stronger is going to be really good for their livelihood and their longevity. So, Hey, let's, let's push this. Why can't you get stronger? I have limited hip internal rotation. I don't have dorsiflexion. Okay. Let's get it out of here then. And let's elevate your heels. Cause what's the point of the squat?

Like fundamentally, if you and I were gonna say, what's the main goal of a squat? Number one for me is not building ankle dorsiflexion, right? It's getting strong quads, it's getting strong hips, it's getting a strong trunk. So if your limiting factor is dorsiflexion, I don't care about your dorsiflexion. Maybe it comes back, maybe it doesn't. But why am I training it and then delaying the opportunity for load? And I think that's more...

of the question. So are you okay with while you're trying to build a shoulder or a hip or a knee making these types of modifications? Or do you feel that maybe these little modifications are what's kind of keeping people limited?

Joe Gambino (20:08)
So I would say there's a couple of things I think on this. If you have someone who you don't really think is gonna get better or maybe they can get better either way, it doesn't really matter. You do what they can, right? So someone who has limited dorsiflexion, heel raising, great option, right? You want to give them something they can do now while you're attempting to restore what we all think is normal. And if someone has, I mean, there are some people whose ankles won't move, right? They're just...

Joe LaVacca (20:36)
Right.

Joe Gambino (20:36)
Driven to be a certain way, especially high level athletes, right? It's almost a beneficial thing for a high level athlete to have really stiff ankles because it makes them more explosive. You're probably not going to really open those things up. So make the modifications to allow them to load and do the things that they need to do. so that's always it. If you're trying to build, I think also another thing that people need to know is that if you're trying to improve soft tissue in general, right, you need to load it.

Joe LaVacca (20:45)
Exactly.

Joe Gambino (21:05)
Right. It's just not the massage component of things that's going to improve your tissue quality. mean, massage is a force of load going into the tissue. So we can do things to strengthen it. So the other thing I would say, even if you don't believe that the hip is going to open up, I would still load rotation. would still load hip flexion. I would still load like the end range training.

Joe LaVacca (21:08)
Mm -hmm.

Joe Gambino (21:29)
because all he's going to do is make him better at what he has. And you're not going to have that fall off, right? If you just say, well, you're not going to get better. So we're not going to train rotation at all. Well, the chance of his rotation getting worse is probably relatively, this is probably a good chance it's going to get worse. So I would just try it to just maximize the ability for him to move there and how much strength and load he can take into those positions that he has. And then just leave it at that. And then just start to make sure a wide.

squat, box squat, single leg load is probably gonna be the best thing for this person. Can you reverse lunge him? Can you step up him? Can you Bulgarian split squat this person? Can you do those things? Because he's going to be able to bolster his strength and do a whole lot of things within that realm as opposed to box fitting this person into a squat. And if you want to work on the squat because he needs to squat and a goal of his,

Well, then you can play with wide box squats. You can even do a more narrow, like I said, just temple hold at the bottom as low as you can go. Who cares if your spine rounds, it's low load. You're not putting 300 pounds on this person's back where it's going to be a problem problem for this person. As long as it's not painful. And as long as it's not causing a whole lot of pinching and irritation to the joint, you can go all the ways down. mean, I could, you know, that's part of the like, astro -grouse squat. Like you can just spend some time in the bottom of the squat without load.

It doesn't matter if respond rounds or things like that. It really shouldn't be an issue for most people. so I think whenever we're looking at somebody and that's where, like, if I'm assessing somebody and I'm saying, Hey, because of pain or because of how you're moving, it doesn't make sense for us to do these things right now. But these are a thousand other options that we can do where you can have success right now and train from a fitness perspective and get enjoyment out of the fitness side of things while we make an attempt to make your body feel and move better.

So again, right, it's not this black and white. You shouldn't just be like force fitting movement because you want to squat. Well, maybe for some people, squatting just isn't a good option. So therefore the heavier loading should be single leg work or deadlifting or whatever it is. Right. And then the squatting work, you're just doing some work to maybe improve how it feels and kind of build up some tolerance there. And if it fits into the movement plan and sure it fits into that person's goals and sure. But otherwise there's no movement that's

100 % needed for anybody unless it's something that's directly tied to a goal or something that are doing on a daily basis.

Joe LaVacca (23:51)
And yeah, and I think the last part there, I think kind of solidified maybe what some of the thoughts I had here too, because I know you mentioned, hey, well, if you don't train rotation, then maybe there's a good chance that your rotation is going to get worse. But I don't know, how do we know that? If we jump back to this idea of what is joint health? What makes a joint healthy?

What are the properties that we're actually trying to influence within a joint? And it's things like chondrocytes, it's synovial fluid, right? There's other structures, but we'll keep them there. We'll keep them broad right now. So if I can squish these cells, if I can move around fluid,

Well, wouldn't it be beneficial to actually have the path of least resistance to make the most load happen to this joint, to make the most movement happen to this joint, and then sort of see what happens, right? Because from a structural sense, with a lot of these joints that have maybe degraded over time, and they should, right? Whether it's from activity or age or anything else, it's a normal part of the process. But when you build a bone spur in one area,

or you lose, you know, articular cartilage, right? Things are gonna happen to the joint that I don't think are repairable from our side of, you know, the coin. And even if they are repairable on, let's say, a surgical side, unless it's gonna drastically improve your function, what's the point, right?

So I think that's kind of where I'm standing with him and a few other people because of the influences of social media. Like I said, of all these things of like, I have to be able to do a 90 90. I have to be able to do this before I earn the right to squat. And I'm like,

That's ridiculous. Why don't we just see what we have? And even if we all agreed on some baselines, and I have a couple of baselines for people, right? Hey, I really like for men to come in and do like 15 body weights, body weight pushups, or, you know, half their body weight in a squat, right? And same thing for women, right? Maybe it's 10 pushups and maybe it's 35 to 45 % of their body weight for the squat. But if they can't, I don't say, hey, guess what you're stuck doing, you know, joint mobility work until you somehow magically get stronger.

It's, you know what, we're going to take a percentage of this. I think this is really worth pushing. And if you can't do 10 pushups or, you know, half your body weight in a squat, this might be an input we want to put in twice a week for you. Right. If you're rowing or pulling, okay. Or you're doing a deadlift. Okay. Cool. Then do it once a week. If you're, you're, pressed for time. Let's maintain that, but let's make sure that stimulus is good. Where do we want to build? And can we do that more than one time a week? And.

You know, I think again, it's hard when you see all of these videos and things and that, and these sort of like hierarchies of movement when again, fundamentally for me, it's how do you squish cells? How do you move fluid from a joint perspective and what's going to give us the best opportunity for that? And I'm going to just keep pushing to take out the things that limit you so we can load you as safe and effectively and not anything that was your point too, as possible for you and like what shapes you can make.

Joe Gambino (26:59)
Yeah, no, I, a hundred percent agree with that. I do think the pendulum has swung too far where like you it's like, there's all these rules for movement, the movement is movement. mean, you just do what feels good for your body and more often than not, it will work out well. I will definitely say though, you know, and this is like an internal strength model type of philosophy where it's like tissue is tissue, right? And like the way that you load it is, all different, all the same really. So like, you know,

this person who has, say you have them on their back and their hip is flexed at 90 and they have like negative hip internal rotation. Like they can, I don't know, not even just get to zero. Maybe they're like off by 10 degrees or so. If you were to put them in that position and just, know, a little bit of band resistance and they'll have them like load that tissue. And oftentimes with this model that they bring it to failure, right? To get that tissue to adapt. You're just teaching those tissues how to produce force.

I found it very valuable for my own training where you have your meat and potatoes you're doing, or your strength training, you're doing everything that you've talked about as far as like loading the body in ways that you can load it. but then you're also just taking like these little nuanced tissues that don't get direct training and you're just loading the hell out of them. And it's not a lot of load, but tissue's tissue, right? If you're taking a specific tissue to failure, and, kind of working at a really hard or high level, I mean, you're going to get, right. mean,

internal rotation, external rotation, hip flexion, right? All those muscles, they're going to grow, they're going to get stronger, they're going to adapt and make some change. So that's probably where I would also go with this person in particular is just how can we just load tissue and challenge that tissue and get those particular positions strong, as opposed to thinking about how can I expand and find all these nuanced ways to really create like a more movable hip.

So it might be some like little fun things to try and see does it change how this person feels does it change how they can get into positions I'm always a like let's test this and let's test that kind of guy So you can go through a couple blocks and just loading it strength work Don't even play around thinking of stuff and then what happens when you start to load these structures and doesn't make a change for this person like You know if you do some of that stuff like wow I never felt this stuff before and then they get up and they're moving around like you know I feel like I can get into a deeper squat now and I can do X Y and Z

and it's just a subtle difference, then it's something that you might want to stick in their programs and give them these inputs. Because any time I feel like you do something and then it makes whatever you're testing or they want to do a little bit better, the more input you put in there, the better it's going to get. And maybe there's definitely going to be a wall and a cap to it, but why not explore that and see how much you can give this person back, especially if you're trying to push off a surgery as long as possible. So I would just continue. And again, write all these little things that you do.

Joe LaVacca (29:35)
Mm

Joe Gambino (29:48)
And if they do have the surgery down the line, it's going to make the recovery on the other end significantly better. So I would just keep loading him in all sorts of different ways and just find how can you just make it move better in general. I just love, mean, basic strength training will definitely do the thing. And we talked about it last episode. I don't think I did on this episode with OA and just osteoarthritis. If you just load it with strength training slowly over time that the,

Joe LaVacca (30:09)
Mm

Joe Gambino (30:15)
quality of life significantly improves. You may not get this person completely out of pain, but they're able to do more with their body. And that's exactly what needs to be done in this particular case, whether or not the end range loading or mobility work does anything at that point. I don't think it hurts to try some of that stuff, but does it need to be the meat and potatoes? I would definitely say it's not like you need to do this before that 100%.

Joe LaVacca (30:38)
Well, thank you for your input there, Mr. Gambino. I greatly appreciate it. And I think it's definitely something that we can continue to touch on because I would like to dive into, again, this idea of like when we're trying to position a tissue, like with hip internal rotation or something like that, how do I know it's not getting appropriate load with a deadlift in a modified position? How do I know it's not getting an appropriate load with a squat? Right? Because if I'm able to intensify the load,

with more weight in a squat or a deadlift than I could with a band, well, wouldn't that require the hip to produce more torque in that position anyway? So things that I really want to kind of dive into, but maybe we can save that for some future episodes.

Joe Gambino (31:19)
Yeah, you know, for a long time I've fallen off like the, you know, like band hip abduction work and clamshells and all that stuff. And I'm kind of going through this stuff, just like some of these smaller tissues, just loading it to failure feels good. And I think has carried over well to the strength work that I'm doing and also to me just feeling better overall. Because what also intends to happen because I'm doing all this stuff, the volume that I need from

deadlifting, from squatting, from benching. And like all like the really heavy work doesn't need to be as high as it used to be for me to get the same progress that I used to have. We'll see as I'm starting to like kind of get closer now to my kind of one RMs and trying to get back to being really strong, I'm probably gonna need to up the volume a little bit to kind of, you I mean, I'm really close to deadlifting 300 again, but like if I want to get to 350 and stuff like that, I think I'm gonna have to up the volume a little bit, but.

I do think that, it's easier on the body also to just take some of these tissues to failure versus like, okay, well, let's do five by five on deadlift when, or five by five on squats, when it might be something that's like a somewhat irritant for that person. So I think it just kind of is a unique way to, to load things and just bring someone. And just sure, you know, maybe they are getting it from a deadlift, but if you want to pull back on some of that volume and still like challenge all this tissue, then you can do that too. and I think, some of these sets to failure, if you can actually

Joe LaVacca (32:31)
Mm -hmm

Joe Gambino (32:48)
do that well because not a lot of people can actually go to true failure. think it's a skill. If you're not going to failure, then you're going to need multiple sets of things in order to get the volume and intensity that you want. it also, it just depends. And I would just challenge you to kind of play around with some of these things because I had gotten off of it for a really long time. And Grayson, who was just on, I'm doing his programming and there's a lot of that stuff in there. And it makes sense even from like,

It kind of all goes back to kind of like bodybuilding and stuff like that. A lot of the principles, I think that fall under the internal strength model. And I've just been finding it valuable for myself to keep me feeling good and just like, I'll do some of these things and I get up on my while, like, like I'm smoked from that, but I feel good at the same time. Like my body feels more underneath me, so to speak. So just interesting, you know, challenge your biases on that.

Joe LaVacca (33:38)
Yeah, well yeah, we'll keep diving into it then, brother.

Joe Gambino (33:42)
I'll let you outrise this time, Joe Boy.

Joe LaVacca (33:46)
look at this. That's a big responsibility. Well, Joe, I love you. Listeners, we love you. And if you've made it this far in the episode, extra love to you. Please join us next week for another exciting episode of the Beyond Pain.