The Beyond Pain Podcast

Episode 35: The Keys to Good Programming for Rehab and Training

• Par Four Performance • Episode 35

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Summary
In this episode of the Beyond Pain podcast, hosts Joe Gambino and Joe LaVa discuss various topics related to fitness programming, client training, and the importance of session duration and intensity. They share insights on how to effectively program for new clients, the significance of maintaining a flexible approach to training, and strategies for handling missed sessions. The conversation also touches on sports discussions, particularly around player trades, and the emotional responses they evoke.

Takeaways
It's important to ask clients about their ideal and realistic training times.

Starting with shorter sessions can lead to better compliance and motivation.


Intensity in workouts is crucial for achieving fitness goals.

Sessions don't need to be long to be effective; quality over quantity matters.

Understanding the seasonality of training can help in programming.

Using templates can streamline the programming process for clients.

Missing sessions should be viewed as a part of the process, not a setback.

Encouraging clients to focus on what they can do rather than what they missed is key.

Communication with clients about their goals and progress is essential.

Flexibility in programming allows for better adaptation to clients' needs.

Joe Gambino (00:00.919)
Welcome back into the Beyond Pain podcast. I am one of your hosts, Joe Gambino, and I am here with our other lovely hating that Soto went to the Mets, Lavaca, and we are back live. You can find this show on YouTube, cups of Joe underscore PT. We also have this show on Instagram, Beyond Pain podcast, and you can find us both on Instagram as well. am.

Joe LaVa (00:11.898)
I'm

Joe Gambino (00:28.457)
at Joe Gambino DPT and Mr. Lavaca over there or Dr. Lavaca over there. He is at strength and motion underscore P T. Welcome back, Joey Boy.

Joe LaVa (00:39.258)
Good to be back. I feel like you took it easy on me there in the intro. I thought you were going to have some snarky comment of Joe can't read a calendar, can't organize calendar invites, LaVaca. So I was prepared. And for those listening, me and John had a little scheduling conflict today on the Google calendar. So we were trying to work through that as gentlemen. And I think we did. We're all back on track with the rest of the year and the new year. So.

Joe Gambino (00:47.819)
I thought about it. I did think about it.

Joe Gambino (01:00.653)
Haha.

That's it.

Joe LaVa (01:06.778)
to come back to Soto, I am disappointed. I don't know if I'm mad. I had mixed feelings about it. What did you think when he announced?

Joe Gambino (01:16.451)
I mean, it just tells me that he's not gonna ever have a World Series title. So that's it. I mean, I love to have kept him. I don't know where he would have went. I actually really thought he was somehow the Dodgers that seemed to get everybody. really thought he was gonna be a Dodger somehow. it is what it is. I think it be interesting because I would actually highly love another World Series Subway Series. I was really hoping for it this year.

Joe LaVa (01:31.492)
Yeah, I know. I thought so too.

Joe Gambino (01:44.803)
for two reasons, one, it would be fun and B, I thought we had a better chance of being the mess than the dodger, so.

Joe LaVa (01:51.048)
for sure. Well, I mean, I think that's like sort of the thing in the AL there's no one that's super scary in the AL right now. But in the national league, if you're these teams, like you have to be doing something to compete with the Dodgers. Right. And to your point, they just get everybody. I did not even understand how they could even sit down in the same room.

Joe Gambino (02:04.803)
Mm-hmm.

Joe LaVa (02:14.488)
with Soto wanting a six to $700 million contract after they gave another dude $700 million and another pitcher $300 million just last year. And they have four other like MVPs on their team. It completely boggles my mind. But supposedly they have already made like a billion dollars on just like Japanese TV contracts by signing Otani. So.

Joe Gambino (02:22.157)
Yeah.

Joe Gambino (02:35.425)
Yeah, that's, I mean, I'm sure they're not, they're definitely not losing money. It's just, don't know how they, they able to fit all of it into one, you know, one salary, but they must defer contracts or something like that over something like that. You know, they're making it work and I'm sure it paid off. got their world series. So, you know, exactly.

Joe LaVa (02:39.982)
Definitely not.

Joe LaVa (02:49.198)
Well, Bobby Bonilla was still going to be getting paid. That's fair. That's fair. mean, look, that's that's what it's all about, right? But I am I think if the if the Yankees could put together maybe a nice little trade for Kyle Tucker or Cody Bellinger, I would be pretty happy about that. I don't see how the Astros and the Yankees are going to do business with one another. But I remain to be convinced otherwise.

And there's still a couple of good pitchers on the market also. So there's still a lot of moves to be had. I thought we were going to make like another big move yesterday or on Tuesday when the Soto press conference came out. And I'm like, come on, here it is. Let's just like, this is our time to steal the back page again, know, like pull off a big trade, but we didn't do it. It's okay. So I'll just keep asking Santa to make the rotation better in the back end of the bullpen better. And what we saw last year was having only two people hitting the lineup.

Joe Gambino (03:23.713)
Mm-hmm.

Joe Gambino (03:31.747)
You

Joe Gambino (03:41.121)
Yeah. Yes.

Joe LaVa (03:48.462)
get you so far. When everyone else's bat's below 150, it's not really going to matter.

Joe Gambino (03:49.941)
Yeah, all the bats went quiet. Yeah, that was rough. That was just a bad season. That was just a bad series to watch in general. Now you made me upset and I need to move on. So let's jump into that. The meat and potatoes.

Joe LaVa (04:01.562)
All right, well, like I  told you I actually have a question for you And I think it'll it'll inspire a little bit of back and forth. So it came up with a client this week. It was about programming and Before I share you know the little interaction that we had I was thinking of you and My question at least to start is when you are beginning with a new client

And let's put it in the bracket of they're coming to you. They don't have a routine in place right now. They're eager to get going. They're telling you they're committed. They have a gym membership, you know, all these different things. It's great. How long do you program each session for them? And I'll just start with that for a new guy or girl.

Joe Gambino (04:55.171)
Well, first thing that is I think the biggest thing to highlight here is that we've gotten to the point where you were thinking about me all the time. huge, huge. Yeah. know, thinking about client, Joe, what would Joe do? That's maybe the new slogan of the podcast. Yeah, it's, I mean, there's no black and white answer here because...

Joe LaVa (05:05.282)
All the time, all the time, 100%.

Yeah, WWJD. Yeah, WWJD. That's what I'm thinking of all day long.

Joe Gambino (05:22.839)
that comes down to the person's goals and how much time they have access to things and, you know, like what time do they have to devote to it? So I usually will ask people two questions to kind of give me my answer to this. First question is in a perfect world, you had no responsibilities like, you know, with how motivated you are right now, what is the ideal amount of time you want to spend at the gym and how many days a week, how many, how long are the sessions, things like that.

Then they gave me that answer. And then I asked them with everything that's going on right now, what is actually super realistic to be a hundred percent compliant with whatever program we put. And then I will share why I asked that question is because in our first month together, if you hit a hundred percent of your sessions, you're going to be the snowball effect is going to be huge. You're to be super motivated. You're going to be super happy. We're to be seeing progress. If you hit 50 % of those sessions.

even if we're making progress, you're gonna feel, it almost gonna like tone down the progress that you made because you're gonna feel bad about only hitting 50 % of the sessions. So what do you feel 100 % confident that you can be 100 % compliant, not miss a session? And when they give me that answer, that is what I used to program because then it is more likely, especially our first month together, I'd rather start off a little bit less, slightly shorter sessions, maybe less days a week, have that like, boom, we hit 100%.

And then they're like, okay, I can add more. And then we just add more. So much easier to add than it is to subtract. Like we know that in almost everything in the line fight is always harder to pull things away. Always easier to add things onto your plate. So I start, I like to do it that way. I don't know how you got, how you went about it.

Joe LaVa (07:07.64)
Yeah, well, no, I guess it brings me to a few follow up questions too, just, and then we'll, we can go back and forth. But with that in mind, I think that's a very kind of well thought out way of doing it. You know, have a back and forth, make decisions together. However, as a coach, as a guide, as a, physical therapist, do you think that a session needs to be a certain amount of time for someone to get benefit?

Joe Gambino (07:36.579)
I do not. And this is something that I think so many people struggle with. I have this conversation with people all the time is that again, right? They pick these like they think a session needs to be an hour. They think it needs to be five days a week and they have this idea on their head and then they don't do it as the plan and then they get upset. And then the conversation is always well like, well, what can you do? Right. It always comes back to that question.

And that can be three days a week for 30 minutes. That can be every single day for 30 minutes rather than for longer sessions. Like whatever they're going to do consistently is what's going to reach their goals. And something's always better than nothing. So if you have to do two sessions for 30 minutes and that's like all you have and that, and they're not doing anything else, then that's where you start. And then you add to it. And I always use the story of like when we had Olivia, I didn't work out for

Maybe it like a two or three months. Like it was just hard to like find the time, like pull my, like, and I have the garage, right? Like, you know, still hard to get in there. So I was like, you know what? I'm just going to start with two 15 minute kettlebell flow sessions every single week, just in and out. And that's what I started with. Those 15 minute sessions turned into 30 minute sessions and then that snowballed. And now I'm doing four to five days a week for 45 minutes to maybe like an hour and 15, depending on like, do the kids wake up earlier or like someone come bother me or whatever.

Joe LaVa (08:33.722)
Yeah, sure.

Joe Gambino (09:00.067)
So I have some flexibility and like right now just know that my like I may not get through a full thing But I need to get through the meat of potatoes of my sessions So there's like I always think of like these things as seasons right like I had that season of I wasn't doing anything I needed to do something that snowballed and I had this season of like Super consistent got every single thing in four to five sessions a week never missed and now I'm in a season where I'm still doing four sessions a week But sometimes they're not everything that I want them to be

because there's so many things going on and now we have two kids and not as easy to navigate things. But I think as Joe is getting older, I mean, it's changing. I already feel like I have more time to do things. So that's just gonna get better and better now and that season is gonna change for me. So then programming or how I'm approaching things will change. And I think that's how everyone needs to view their own programming or if you're working with someone, how you should have that conversation with them. Like right now, this is what I can do.

I want to start here, build the habits and as the habit build, then I add to it to get to the ideal state or if they have, you know, also depends on the goals, right? If someone's just like, I just want like generally to be healthy or I want to like just have less pain, then you probably don't need as much. If they're like, I want to like compete in like a power lifting contest or like I have a marathon in like two months, right? Like that's also going to change things. Like you're have to like, wait like, okay, well you have this goal here. We need to really do all this stuff.

Like we either make the time for it to like reach that goal or you just have to be okay with not reaching that goal and just doing what you can to get as close to it as possible. all the little questions and thoughts that have to be like played into it. And my opinion, I don't know if I answered your question well.

Joe LaVa (10:41.528)
No, you did. And I share a lot of the same sentiments that I don't think, especially starting off, a session has to be a certain amount of time for it to be successful. And oftentimes when people are starting, and I know that's how I kind of frame the question to you, I'll often just pick a squat, a hinge, and a press, and I'll call those people superpowers.

If we could hit these movements twice a week, I think we can get the ball going. Then, if you're pretty consistent with that twice a week routine, we have two options. We can add a third day of maybe just more secondary lifts or different ideas, or we can extend and add a finisher circuit of some things that you want to work on within the time or within the days that you already have carved out for yourself.

So I kind of go about it two different ways there. So if there is agreement on, you know, I don't think a session needs to be a set period of time. Do you ever encourage patients or clients, again, in the framework of, you know, starting out too, we'll leave it at that, to cap a session at a certain time? Is there too long of a period of them moving, loading, lifting, in your opinion?

Joe Gambino (12:04.397)
Yeah. Yeah. I, in general, don't think sessions need to get too much more than an hour. I think if you're able to work out for like two hours straight, one, there's probably two camps that are there. One, there, you're just like a gun for punishment. You like to like really just push your body to the end and always redlining. And there's a problem with that. Or two, you're in the camp of you're just under loading. So you can go for two hours and not be toast. so intensity.

is the other conversation. you're doing like 30 minute sessions and you're half-assing them, well, you're not going to see results. But if you're 30 minute sessions, but everything is of high intensity, high intense quality movement, you're going to see benefit from it. Unless, you know, again, it comes down to goals. It comes down to the person's history, what they've been doing. If you're doing nothing, doing something is going to probably make progress. So all those things need to play in mind. So.

I think it just comes down to what really intensity is really important. And that's where I think a lot of people miss the board as well as they go in there, they pick a weight, they go through it. Their RPs are probably typically low and like the sixes, maybe sevens, they never do eights, they never do nines, they never hit a failure. and those things are the ones that like, if you're looking for strength, if you're looking for hypertrophy, like those kinds of goals, you're probably going to to get there. If you're just looking for general, I want to be able to like,

pick up a box and do things around the house or like lay on the floor and play with my kid, then you know, probably don't need to get that high. Sevens and eights are probably gonna be fine, but you're not gonna be well suited if you're doing like fives as far as RP. That's probably like doing, that's almost like doing nothing in a sense. So.

Joe LaVa (13:40.226)
Yeah. I appreciate the framework that you gave there of, know, maybe people are under loading and that's why they feel like, well, they can keep going and going and going and to actually kind of mirror that with a client that just wants to keep going and keep pushing and overexert. And what kind of sparked this conversation was with a particular client, just like that guy who loves the push and push and push.

And we've been training together now for a few months. And he wanted to recently start a little bit of a sprinting kind of program. And I said, great, no problem. We started a little sprint framework and he messaged me because we went over together in the gym. Cause I specifically said, I don't want you to really be sprinting right now at a higher than 75 or 80 % effort. Right? So you're, you're not giving it an all out. You shouldn't be gassed with your 10 or 20 yard sprints, but

want to start striding, right? Start opening up this like cadence a little bit, get used to it, establish long rest periods. And then lo and behold, you know, two weeks into it, you know, I get a message. Well, that hamstring went, All right, let's talk about it. What were you doing? He's like, Well, I was going 100 % with every sprint. And I'm like, Okay, that wasn't what we wanted to do. Right? Remember, we talked about conditioning and getting tissues prepared and

You know, you've been moving really well in the gym in particular planes under steady loads, under steady tensions. This is a much different game. He's like, well, yeah, I know I'm seeing that now. He's been doing better now. He's back to kind of running without pain and all these things. But before he left yesterday, he brought up this idea. He goes, hey, I got plenty of time. You know, I kind of work for myself. The workouts have taken me about an hour, you know, sometimes an hour and 15 because I watch the videos.

I'm very diligent about my rest periods that you give to me. Equipment sometimes on opposite end of the gym. I know that you don't know that. So I don't expect you to know that, but that's what takes up some time. But he's like, I'd love an extra circuit or two each day. And I'm like, all right, well, that's going to take us up to like an hour and a half. You just told me that pushing too hard is kind of keeping us in this spin cycle. But I said, you know what? OK.

Joe LaVa (16:04.238)
And I just gave him like a little extra round of like mobility stuff, knowing that, hey, he's already probably pushing too hard. So let's get him doing some body weight things. Let's get him rotating, doing some stretching, foam rolling. And then I'm hoping that that will also sort of take up a little bit more time for him. So I was thinking like, okay, well, did I make the right decision there? You know, should I have just actually really just sat him down and been like, hey, you know, we need to cap this at an hour, hour and 15, or we need to start thinking about things like your nutrition.

And what are we really training for? it just now general fitness or are you spiking up to think about something like competing in like a master's track and field event like in the spring? Because those are all two different conversations. So I appreciate your input there, my friend, because I was thinking about that. And as I program for people, it's so funny. And I'm sure this happens to you a lot. I'm blocking out exercises and

Some people will write me and say, wow, this is like the perfect length. I love this. I love this. Other people are like, give me more. Other people are like, hey, I don't have all this time. Give me less, right? So do you go off with your training principles? And I know you and I actually went through that training program together. What was it? We did it in perfect stride together.

Do remember the name of the program that we're doing? was like a spring phase, a fall phase. Yes, yes, yes, yes. So, you know, I kind of valued that approach and some stuff that I learned from Mike Boyle's strength certification of like, you know, at least say having like a framework, right, to kind of build off of. So do you still use like a framework for like all your clients, like they're in a power phase, they're in this hypertrophy phase, or are you kind of writing each individual program?

Joe Gambino (17:31.377)
The strength faction stuff. Yeah.

Joe LaVa (17:56.836)
from scratch.

Joe Gambino (17:59.171)
Well, so Depends so I have some templates that I kind of work off of That I will modify to whoever it is so that it is custom to them So I do you know, I mean I again going through seasons if I have depends on how long I have somebody for so and whether coming in for But if we're starting with somebody usually is because they have some sort of pain and they're trying to get over hurdles So usually our first, know, three four, you know

two to that first four months together, we're working through actually just trying to like bring down pain, build up the framework so that they can move and load more. And that usually then will kind of like almost bleed into, depending on their goal, just like into like a strength block usually, like, you know, something a little bit more. So depending on how much pain they have, you know, it tends to work out where their first two months are like really not that intense. And they always want more a little bit.

But they just haven't earned that kind of right to load that much without making things worse and then by the time we're in like Wednesday and for all of a sudden like The faucet opens up a little bit and then they're like, this is this is much better This is what I was I wanted right? So again, it comes out the seasons like with the person you were talking about You know like the season was how do we prep you for your tissues so that you can then sprint and do the things that you want? So you would have to go about that

first, right? And treat that as a season. think, you know, what I found successful with people, I'm just explaining like, this is the season that we're in, this is why we're doing this. When this happens, well, then you move to the next level. Then we'll be doing a hundred percents and we'll be varying your work to rest ratios. And then we can start working on like the actual, you know, physiological adaptations from like an energy system standpoint. And then, you know, that, will make this person feel better, right? Like, so they, they know like, this is what's coming when this happens.

but yeah, to, answer your question in short, I do, you know, I'll, I'll strength block, hypertrophy block, power block, energy system blocks. Those are like the main four. then depending on what the person is looking for or going for, right. Then those things would just be modified to, know, maybe it's a different focus. maybe they're not one, one thing is not as long as another. I also will do like GPP phases or just general preparation phases. If we've done something hard, like, I don't know if I did like a speed block with a golfer.

Joe Gambino (20:25.859)
to increase club edge speed, I'm probably going to follow that up with like a general preparation block just to like reset things, make sure movement's looking good when we've just challenged them in a specific way for a three or four month period of time. But they're usually blocked out for three or four months. So let, let that actual adaptation actually happen. That's where now we're just like separating like performance training versus just like general fitness training at that point.

Joe LaVa (20:50.522)
Yeah, yeah, that's great. And I, I take a similar approach. I think some of the benefit of having those frameworks that you can just adapt to people is I kind of think it gives me some feedback on, you know, with all the people I train, if all of a sudden I get seven messages in a training block where it's like, Hey, I'm starting to have a little bit of knee pain, or, you know, my back's bothering me. I'm like, Hmm, that's probably not a BEM issue.

That's probably a me issue with the programming. So where am I going wrong? Where am I pushing maybe too much intensity? Where did I not maybe prepare people adequately to handle loads that I thought they could? So I have a group of friends, partners, right? That kind of train with me. And one of the things they always say is like, hey, it's kind of cool. Like, you know, I'm going to the gym with my partner, but we're doing the same things, but we're kind of doing different things, right? Because one has a shoulder issue, one has a low back issue.

You know, one is just in this sort of like, how, how far can I go and strength build? And then the other one is still kind of like learning almost like basic. So even though they're all doing a front squat, someone is building up to like eccentric tempo, right? Someone's just doing it to a box because they're trying to just learn those fundamental range of motions. Others are doing some clusters, right? But I've always found it really helpful to like build out sort of those like models of a program.

And then cluster people into, all right, like you said, all right, I have a front squat, but who is better for like more of like a GPP, who's better for power block in this phase. And then that just means I just go in and just mess with numbers rather than rewriting like 50 individual programs every month. And so far, knock on wood, most people have been pretty successful with pushing away from injury minus the occasional flare that we've expected. And we've talked about on the show and we can navigate through those.

I think the other thing that you said was interesting was the compliance rate. And I usually say that too, what's going to make you most successful right off the bat. But I do give a little grace there. And I don't know if I took this from Atomic Habits or Charles Duhigg's Better, Stronger, Faster or something like that. But was all at least books about behavior change. And I remember from one of them.

Joe LaVa (23:14.434)
saying that for behavior change, we have to be at least 80 % successful. And like you mentioned too, that when people come in and they're really, really gung ho about starting a program and pushing and pushing and pushing that overwhelming like, having seven things to do in your program, or even three or four days to do in your program, you miss one. And it's like, I wasn't successful, right? But if they kind of go in with this idea of like, hey, look, life's gonna happen. I'm just I'm just getting going.

you know, a Thursday meeting might pop up. We talked about, you know, the kids and some families and stuff getting sick this week. you know, life's going to happen. So rather than go backwards, my advice to them is just look ahead to the next training day. And I wanted to know if maybe as like a kind of wrap up question for people who miss a day or miss a couple of days, whether it's illness or, you know, life circumstances.

Do you encourage them to like, hey, you when you can go back and make those up, or do you just say, hey, look, that was Wednesday and Thursday. This is Friday, Saturday, Friday, Saturday was your mobility or long run days. Don't go backwards and strike train. Just now move forward and start fresh from today.

Joe Gambino (24:31.327)
Yeah, it depends. know, I mean, if you if you have enough time in the week to still get everything like you missed like a Monday and a Tuesday and there's still five days left in the week and you have three workouts like you can still get all your workouts in so you can go back and do your start with your Monday and work your way down. So I would say, you know, there's that if we were getting towards the end of the week, like if I like I'll just give you how I personally look at it. So I never will. Like if I miss a week or I miss a few days.

Well, if I miss a week, I don't go back to that week and say, how do I have to make up that week to go on to the next week? That's not really how I look at it. just, know, okay, I missed a week. I just get back into the program. I started off where I left off and then I kind of go through it and I have someone else programming for me. So I just follow the weeks as they, as they go along. If I miss days like, I was supposed to work on a Tuesday and then I skipped Tuesday and I ended up working out on Wednesday. I'm not doing Wednesday's workout. I'm doing Tuesday's workout because typically.

Joe LaVa (25:27.343)
Mm-hmm.

Joe Gambino (25:28.163)
when things are programmed, the stuff at the front of the week are going to be like your higher intensity stuff, right? And things kind of like trail off or, know, as the week goes on. So I know like my day one and my day two are going to be my heavier upper body, my heavier lower body and my heavier upper body. So I want to hit those ones first. And then if I have time, I'm going to hit like the day three, day four, day fives, whatever.

Joe LaVa (25:35.448)
Yeah.

Joe Gambino (25:52.131)
So I will always kind of like just start from the front and work my way down in the order of sessions and if I miss one then I miss one like Not the end of the world, but I know a lot of people have a hard time with missing sessions. I have a client Where he's good. He's he's flexible enough where we talk about it. He's like, okay I get it, but he'll like do everything in his powers like go back and make sure like all the sessions are done and he's doing well It's not it's not a big deal. You know if someone's missing like it like I'm working with them and like they miss like

almost all of the days to mentally help them, I'll just push out their block one more week. So it's like, your block is here, it's almost like going backwards, but we don't have to like, you don't have to think about going backwards. Just like always look forward in a sense.

Joe LaVa (26:34.874)
Sure. Sure. I like that idea of the prioritizing those intensity days. And that might be new advice I give to people. know, I go back and, you know, take care of the front end of the week if you can. And then maybe don't worry about those secondary, you know, day three, day four. Because like you said, I program very similarly. Like, hey, I'm thinking you're fresh from the weekend. You went hikes, you did walks, you did, you know, easy long runs, things like that. And then you're coming in fully charged.

And then as the week goes on, work, stress, family life, you name it, school, all those other stresses are gonna accumulate. So we gotta make that sure that reflects in the programming. Well, thank you, my friend. I know I was asking you a bunch of questions there, but I found it very insightful. I'm sure a lot of people did too. So appreciate you, Matt.

Joe Gambino (27:22.381)
Hope so. Of course, anytime. like, I love these kinds of conversations. So keep bringing them in.

Joe LaVa (27:30.202)
All right, we good? Anything else? Any other closing thoughts? All right, all right, Joe, love you. Put you under the microscope today. You answered all my questions. It was so wonderful. Thank you listeners, we love you. And if you made it this far in the podcast, extra love to you. And don't forget to come back next week for another episode of the Beyond Paid Podcast.

Joe Gambino (27:32.131)
Well, I'll let you take us home. Now, take us home.

Joe Gambino (27:43.713)
Happy to do so.