The Beyond Pain Podcast

Episode 60: Busted or Backed? Breaking Down the Top 10 Rehab Beliefs

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Summary

In this episode of the Beyond Pain podcast, hosts Joe Gambino and Joe LaVacca explore various fitness myths and realities, discussing topics such as the importance of prioritizing health, the role of pain in exercise, and the effectiveness of stretching and weightlifting. 

They delve into common misconceptions like the 10,000 steps rule and the impact of posture on pain, while emphasizing the significance of movement and recovery techniques in achieving overall well-being.


Takeaways

  • The importance of routine in daily life.
  • Prioritizing health can be challenging due to life responsibilities.
  • Pain does not always equate to injury; understanding this is crucial.
  • Stretching alone does not prevent injuries; strength training is essential.
  • Weightlifting is beneficial for joint health, contrary to popular belief.
  • Running does not inherently damage knees; activity is crucial for health.
  • 10,000 steps is an arbitrary number; more movement is generally better.
  • Posture is not the sole cause of pain; variability in movement is key.
  • Recovery techniques should complement, not replace, exercise.
  • Manual therapy can be beneficial but should not be the only focus.

Joe Gambino (00:43)
Welcome back into the Beyond Pain podcast. I am one of your hosts, Joe Gambino, and I'm here with the other co-host, Joe Lavaca. You can find us on Instagram at joegambinodpt for myself and at strength and motion underscore PT for Lavaca over there. This podcast is on Instagram. my goodness, Beyond Pain podcast. And it's also on YouTube, cupswithjoe underscore PT. There is an application form down in the show notes. So if you do want to reach out to us, you're more than welcome to do so. One of us will get back to you.

And Joe, you did say in the last episode, I know it two weeks ago, and I did remember this one, not the other one. You did say you were going to set up your coffee game on our next episode. So the question is, did you actually step up the coffee?

Joe LaVacca (01:16)
I know.

I did say that. No. No, the answer is no. I totally forgot that I

said that because you see, when you throw me off the rhythm and we skip a week, my mind goes to mush and then I don't remember anything that we talked about. It's, know, I'm very regimented in my life now. I eat the same stuff. I wear the same like five shirts, same pants. Like there's nothing that's not routine in my life. And you know, when you throw me off, everything gets a little bit, you know, messed up. So.

Joe Gambino (01:30)
Mm-hmm.

Yes.

Joe LaVacca (01:50)
I would say, no, I have failed horribly in that endeavor. And I do apologize to you and the listeners because I want to live up to the things that I say that I will do. And I will do my best. Cause I said something about the frother. said, have a, I have a Ninja coffee maker and as a frother, could have easily frotted some milk, thrown it on top. Even if it was just frothered milk in my coffee, that's a step in the right direction. But

Joe Gambino (01:53)
That's all right.

You

that's Mm-hmm.

That's right.

Joe LaVacca (02:18)
Just totally forgot, totally forgot everyone.

Joe Gambino (02:19)
I

had forgotten too, I only remember because we're back. After we got back from the trip, I just made a batch of cold brew for the first time in a while. So, made me think of it. Made me think of it.

Joe LaVacca (02:22)
Hahaha

Maybe

that's my goal. Next week I'll be in Colorado, but two weeks from now, maybe that's the goal, is to show up with a nice homemade cold brew. know you've given me just the ingredients. You haven't really taught me the process yet. You've just sent me a list of ingredients. I know, I know. Yeah, I know. I feel like this is like that grandma recipe though. know, where grandma's like, it's so easy. You just do these two things.

Joe Gambino (02:40)
I gave you, I told you, you just literally stick it in the pot, you put it in the fridge 24 hours, done.

Hahaha

Joe LaVacca (02:56)
and then it never tastes the same. And then you watch grandma make it and there's 17 other ingredients or ways to go about doing it. And it's like, why didn't you tell me that? And you're like, well, those steps aren't important. Or I just figured you would know those steps. And the whole coffee goes to.

Joe Gambino (03:09)
Now, this is

actually a very, very simple process, Joe. So I think you'll be able to get it, you know, maybe if you can get it in two weeks, you can let us all know live how that process went and if I led you astray or not. But the key is getting good beans. So make sure you go to a good coffee shop and get some decent beans or some beans that you know you're

Joe LaVacca (03:23)
Fair enough.

Yeah, okay. Alright, that works.

Joe Gambino (03:32)
All right. All right. Well, I did tell you I had a surprise for you. It was not the surprise I originally intended because I completely forgot about that. But I do have a surprise episode for for you today. I also did not look at any of these prompts yet. So it would be somewhat of a surprise for me as well. But we have ourselves we're going to we're going to rank it or rethink it. That's the segment today. And I had a little.

Joe LaVacca (03:36)
You dead?

Mmm.

Rank or rethink?

Joe Gambino (03:58)
One thing prompted me to think of this and it's kind of the notion of everyone says they don't have time for it. And then a lot of providers will say, well, no, it's just a lack of priority. And so I figured, you know, maybe we can have conversations around some of these things that pop up in every day. I had, I put that one as an example. let chat GPT select the other nine for me. So we will rank them. Yeah. So there's 10 of them. There's 10 of them.

Joe LaVacca (04:21)
Nine. Wow, okay.

Joe Gambino (04:24)
So pretty much all we're gonna do is we're gonna we'll both rank them scale from one to five and then we get to talk about it a little bit and say do we believe in it do we not believe in it and why and

Joe LaVacca (04:35)
What

is the ranking system? What's one indicative of and what's five indicative of?

Joe Gambino (04:38)
that's a good question. Yeah,

we'll call one as we do not believe it and we'll call it more mythy and we'll make five as it is legit.

Joe LaVacca (04:45)
⁓ okay.

Basically true. Fact, facts and myths. Okay, so the more we lean toward one, the more skeptical we are. The more we lean to five, the more positive. Okay, so then I got the rules. Listeners are on board now. They can play along. What about this re-think it?

Joe Gambino (04:50)
Yes, yes, yes.

⁓

Yeah, rethink it would be if we're skeptical, we just give a little elaboration on how we reframe it or rethink it.

Joe LaVacca (05:14)
okay. Got it. Okay. So we have 10 topics. Rethink it, reframe it. Okay. I got it.

Joe Gambino (05:18)
time zone.

Okay, here we go.

Number one, I already told you, because that's the one that I didn't know. I'm too busy to work out and then coaches or someone saying that it's a lack of priority.

Joe LaVacca (05:31)
and then one is this is something I don't typically believe it in five is I do believe in it. I am going to go with a hard one here. I don't necessarily think it's a lack of priority. I really think it's hard as a coach to put yourself in someone else's shoes with kids, work, life, relationships.

Joe Gambino (05:37)
correct.

home.

Joe LaVacca (05:59)
You know, you name it and then have us step in just on a random Tuesday at three o'clock. Never met this person before. And then basically say the reason why they're in pain or the reason why they might have anxiety or some sort of negative emotion is just simply because they are not prioritizing their life. To me, they are prioritizing their life because they're putting other things first.

Joe Gambino (06:24)
Mm-hmm.

Joe LaVacca (06:27)
the things that are probably important to them. You know, as well as I do, I think we are all better at giving advice than following advice. So when I think of my life, I probably think of three or four other people at least before I think of myself when I am filtering decisions. Now that not saying that's good or bad. That's just a choice that I make. When I see people come in,

and they feel guilty about not doing something or not following through with, you know, some maybe lifestyle, nutrition, movement, regimen that we agreed to. I usually will reframe it and say, well, isn't this great that you haven't had to stop anything to live the life that you want. Now I understand you're a little bit in pain.

Joe Gambino (07:07)
Mm-hmm.

Joe LaVacca (07:22)
I understand that maybe you were feeling a little bit anxious or sad or depressed at times. However, your life went on. What does this tell us that maybe these symptoms aren't stopping you as much as we perceive them to be. And maybe we can reframe them as more as a minor inconvenience, but you have the tools to press forward. And I think that that is a pretty valuable lesson to take away from.

So when people say or coaches say that it's just a lack of priority, I would say, no, maybe we haven't given them enough of a reason or plan or approach to rank exercise lifestyle as a higher priority as anything else. And maybe we never do. What then is your number of Mr. Joe?

Joe Gambino (08:12)
Mm-hmm.

My number, John, this is probably our first disagreement on the podcast, John. I'm putting it as a four. A four. And I'm gonna take one thing you said, right? You mentioned the word, it's not as important, right? So, and that's how I look at priority, right? And someone, a parent and a job, I have a business, I have a wife, I have other things, right? A lot of things that go on in my own life. And every time...

Joe LaVacca (08:19)
Mmm. Ooh, a four. Wow, that's pretty certain. That's pretty certain.

Joe Gambino (08:43)
I just actually came off a four week hiatus of not lifting. This is the first week back. and there were two, you know, I mean, I wasn't sleeping well with the baby. I had some travel. things were just a little difficult to navigate. So what fell off the wagon was my workouts, right? Because other things took higher priority in my life. It's not that I wasn't prioritizing my life. This is kind of, you know, I'll kind of go back. We do really agree on this. think we're just talking about differently.

Other things took priority and that's okay. And I think no one should ever feel guilty, right? It's always okay to have other things prioritize in your life where you can't work on your fitness or your mobility or your pain. And it's just that. And then you just try to get back on track whenever, whenever you can. The other thing that played into it is it started getting really hot here. So I have to work out in the mornings now. Otherwise my garage feels like I am working in the New York city subway system in a hundred degree weather.

being down on those platforms, it is miserable in there. So, and then now on top of that, Olivia can get out of her crib. So she comes down at six during the morning when I'm about to start to work out and she wants to hang out. So again, a lot of hurdles, but we're getting back on track here and that's the kind of point. So yes, I do think it's priority and in your life you have to prioritize what you need.

And then on top of that, it's perfectly okay to prioritize other things outside of your health. But I would try not to let that happen for too long because without your health, without the ability to move with pain and stuff like that, it can impact your ability to do other things. So at some point, I think for people, does need to get bumped up on their list. it's our job to help them figure out how they can do that in a sense.

Joe LaVacca (10:20)
All right. Very cool. I do think to some degree that the prioritization stuff also to, a coaching standpoint, right? Like when you say this to someone or I say this to someone, it is sort of like the things I believe are then all of a sudden more important than the things that you have to do day to day. And I think that's where my ranking of like,

Joe Gambino (10:22)
Cough

Joe LaVacca (10:46)
being tours of one was, you know, maybe a little aggressive, but I do think that there is this fixer mentality that a lot of coaches and therapists have. And because they have the fixer, my advice is the best. My technique is the best. This is the way out of your pain and to your goals. And then therefore, if you don't follow it, you know, I can't help you.

I think if we shifted that mindset to the more of a guide, then our conversations are much more like this. They're sort of flexible. you didn't get a chance to do it. Was something standing in your way? I know we have talked about TrueCoach as an instance, as an example on this podcast. I think it was a couple of weeks ago when we were talking about technology and technology failed last week for TrueCoach. They were having login issues. The videos weren't popping up. So now.

Maybe someone did try to prioritize something. There was another barrier to that behavior. And when you put a barrier on a behavior, even if it's something as simple as a glitch versus not touching an app and having to log in through a website, that's another problem. So everything comes back to this idea of, think just us being maybe more flexible in our approach, being more guides rather than fixers.

And then just like sort of like having a little bit of patience with people when they don't get it right the first time. And if we read some stuff in psychology, it might be the first seven times, the first 30 times, the first hundred times, but people will gradually move at their own pace. And I think that's what I've realized more over the last 15 years is I can't make anyone do anything that they are not ready for. can continue to coach them and give them advice.

However, that's about it. Really that accountability piece falls onto them.

Joe Gambino (12:46)
No, I think we're on the even though our numbers are different. I think we're talking about things very, very similarly. So let's move on to number two, Joe. No pain, no gain. The age old saying.

Joe LaVacca (12:53)
Let's do it.

no pain, no gain. so, I, I'm to go with a three. I'm going go right down the middle because, I think there's two sides to this. think there is the no pain, no gain from a rehab standpoint. And then there's the no pain, no gain from like a performance, maybe even coming back to our first point, lifestyle modification, some sort of improvement, right?

Joe Gambino (13:02)
Ooh.

Mm-hmm.

Joe LaVacca (13:21)
So from a rehab standpoint, no pain, no gain. The more I'm reading about this and a couple of newer articles that have come out, I don't actually believe people have to work into pain anymore to be successful with getting out of it. So if you are comfortable with your three out of 10 pain, four out of 10 pain, cool, I can educate you and say, this is not harmful. We can push forward. You're going to be okay. And yet if people are like, I understand that.

I just don't really want to have pain while I do X, Y, or Z. I say, okay, great. That's fine. Totally understandable. Why don't we try this approach instead? Maybe take your squats into deadlifts or just have you work upper body for a little bit. We can do isometrics for your lower body or vice versa. So fine. I can meet you where you're at because again, as I've been reading a little bit more, I've become a little bit more lenient on this idea that you have to be at a three or a four or tolerable. And again, everyone's nervous systems and perceptions are

bit different. So I will now give you the choice. If you're comfortable, we're safe. If you're not comfortable, I understand. Let's deviate around it and try to get to our goals in another direction. From a pain gain performance standpoint or pain gain lifestyle standpoint, yes, making changes to your nutrition, your sleep schedule, your relationships is hard. It is tough to do.

Therefore you need some pain in order to make those gains and same thing with performance. I wanted to literally kill myself today with the workout that I was doing from Ross. And I'm pretty sure there was a typo in the sets because I did the math and it would have taken me over two and a half hours, I think, to run through, um, this program for as many times as he wanted. But even in the sort of timestamped, you know, uh, 45 minutes I gave myself, I was like, this is miserable.

I literally felt like I was going to die half the time. And then I got upstairs, had some coffee, breakfast, and I feel more alert and more energized than I have in the last week after workout. So that's my right down the middle three, which is probably the worst cop-out answer I could have given in this whole thing. But that's my answer. I'm sticking to it. What do think?

Joe Gambino (15:31)
Mm-hmm. ⁓

Yes, I am putting it at two and mainly I'm putting it at two because I believe that most people will ignore signs of pain and discomfort when they are working out and being active and doing things and they'll let that go on for long a long time until it becomes a bigger issue. Right. So I do think that people need to understand just listen to your body a little bit more and prioritizing recovery and mobility and other things that

they can do whether at sleep or nutrition, to, combat those things. And I think recovery goes overlooked. So because of that, the whole no pain, no gain thing, I'm going to lean on the side of it being not necessarily myth. yeah. We've called it myth. because I think the slogan goes, you have to push through pain, right? Like pain, pain, not like discomfort of, know, the workout, right? Like if we're talking about that pain, then sure. I'm giving it a five, right? If I were in the rehab process and we have to go through a little bit of pain, I'm giving it a five.

Like those things are perfectly fine. But if you're just like, know, every time I finish a workout, my knee is, you know, bothering me for like three days. no pain, no gain doesn't really fit into that. I'm almost almost putting that out of one, right. And two, it's just kind of like, I'm just not going to give it a one cause I don't need to be that far on the, on the, on the opposite end of the spectrum there. So that's where my thought is. but I think, I think you covered it pretty well there. So we'll go to number three.

Joe LaVacca (16:44)
Yeah.

We're cruisin'. We're cruisin'. I where I say we're cruisin'. We're cruisin'.

Joe Gambino (16:55)
Stretch. Oh, go ahead. What was that? Yeah, we're cruising baby. Let's

go. Number three. Stretching will help you prevent injuries.

Joe LaVacca (17:08)
yeah, I don't know. Maybe a two here. don't, and again, there's the context is it's like, can stretching help you? Yeah. It's a force, right? I mean, like I put force in my body with bicep curls. we put force into our body with isometrics. So again, if I'm just passively stretching, it is a force for tissues. I think the question really is.

Is it the force you want to get better at accepting? And unless you really have some sort of range of motion block or tissue limitation, then the answer is probably no. You only need as much motion as you need for the things you want to do. And as the weather gets nicer, for instance, I've been meeting more runners, more people who are doing things outside.

Joe Gambino (17:49)
Mm-hmm.

Joe LaVacca (17:58)
And, know, again, one of the things that comes up a lot is, well, you know, I'm looking at my ankle mobility and my toe mobility and, know, half the time they're coming in and these like rocker shoes anyway. And I'm like, well, it doesn't really matter what your range of motion is. The shoe is going to help you get there anyway, but let's assess it. put their toe to the wall. I'm like, Hey, here's the drill. You have enough to walk and run if your knee can touch the wall. And they're like, Oh, don't I need like four inches or five inches or 40 centimeters? I'm like,

Yeah, I guess if you want to do a front loaded bar pistol squat, you do. We're talking about running and walking. So 10 degrees is probably cool. 15 degrees is probably cool. So I think as much as the mobility conversation on social media and maybe with certain classes and gurus that we know of, it has, think helped people just establish a different way of moving. But then when we come back to prioritization is that.

the force that you want to get better at. And I think so many people are stuck in stretching land because they have to earn something to do something else. Whereas we also know that strength training and moving consistently, any sort of movement practice, dancing, yoga, Tai Chi will improve your range of motion. So it really comes down to the point, the point of maybe if there is a surgical consideration.

Joe Gambino (19:01)
Mm-hmm.

Joe LaVacca (19:25)
is there an acute trauma that you're recovering from and we're really, really trying to get localized nitty gritty into these tissues, then okay, sure, stretching one, two times a day will help you over the course of eight to 12 weeks get more range of motion. But then it just means that you're better at getting in that position. Are you better at controlling that position? Are you better at producing force in that position? And...

Even if you got more range, how does it make you better at what you want to do? Right. So I'll say it too, because I think you can still get range of motion any other way. And nothing I seem to have read is like earth shattering for we should maybe prioritize stretching to reduce injury risk.

Joe Gambino (20:08)
Yeah,

yeah, because the terminology in this sentence was prevent, I'm just going to drop it all.

Joe LaVacca (20:16)
Hehehehehe

Joe Gambino (20:17)
Both of us know, I don't know if everyone else listening

knows that you can't prevent injury. Especially if you already had an injury, we both know Joe, that once you have an injury, once your likelihood of getting it again is increased, right? So we're not going to be able to prevent anything. Stretching, if we took it into vacuum, probably isn't going to change things too much for somebody. And again, it all comes back down to what you said. Is it actually, why are you doing it and what are your needs, right? If you have full passive.

Joe LaVacca (20:23)
That's a good point.

Joe Gambino (20:46)
flexibility, just because you feel tight stretching, does not probably want to make too much more of a difference for you. It's probably gonna be something else, whether it's strength or more control or stability or whatever that looks like. And even my own viewpoint on mobility has changed over time where honestly now all I'd really do is it's strength training, but just at my end ranges. I just load all the ranges of motion and that helps me.

build more mobility, helps me feel better. And honestly, it makes me feel better than just doing stretching or even just some isometrics alone. So I do more eccentrics or a combination of both, just hanging, but going through like an absolute full range of motion. So there's that. And then you see, I think what you just said, you're like, will it actually help you get better at what you want to do? That's all that matters at the end of the day. So if you're doing stretching, if you're doing strengthening, it doesn't matter what you're picking. If you go...

Joe LaVacca (21:30)
Yeah, sure.

Joe Gambino (21:34)
a few weeks down the line and there's zero changes to how you're feeling, how you're moving or the goals that you have set out, you're probably going to need to shift your approach. And I think that's just a good role to have that you should see some sort of change in a short period of time. It's not going to be like nothing or things getting worse. That's a pretty good sign that something needs to change.

All right, number four, are you ready? ⁓ Lifting weights will wreck your joints.

Joe LaVacca (21:54)
Ready.

I mean, is there a negative one? Is there zero? No, it's only one. ⁓ yeah, I mean, this is a hardcore one. again, like we have too much data now to suggest that strength training is not only one of the gifts of life. Maybe it is the fountain of youth, the importance of bone mass for women as they get older, lean muscle mass really, you know, for both sexes.

Joe Gambino (22:04)
Yeah

Joe LaVacca (22:29)
power for both sexes as we age. think again, this notion that if you lift too much, it's going to be bad for you. If you run too much, it's going to be bad for you is keeping people stuck with two light loads, not getting enough steps, trying to play it safe. And it's a pendulum. If you don't move or load your body too much, it's going to degrade faster. If you take it to the nth degree,

Joe Gambino (22:54)
Mm-hmm.

Joe LaVacca (22:57)
it's going to probably degrade faster. If you're in that middle ground, you're strength training two to three times a week, you're working hard. If you're hitting those aerobic numbers, 20 minutes, 30 minutes a day, know, huffing, puffing a little bit, you're going to get some of the most maximal benefit from exercise that we can possibly offer. If you have light weights at home and that's what you want to do, fine. You just still have to take those light weights to a point

that's going to make you work really hard. And that's been a conversation that is helpful for certain people who are maybe fearful of heavier loads. So they have their adjustable dumbbells at home. They're going to the gym on their own and programming for them. give those people just sort of as many rep as possible sets. Go until you feel fatigue, go until you feel tired. And then we can gradually say, all right, well, I don't know. Do you like doing 25 reps of goblet squats with 20 pounds or?

Joe Gambino (23:36)
Mm-hmm.

Joe LaVacca (23:56)
Do you think now we can maybe go up a little bit, up a little bit, up a little bit, and then get them to a point where, well, they know they can manage light loads, and now they've taught themselves how to manage heavier loads. So I don't care if it's your knee, your back, your shoulder, your hip, your toe, load it up. Don't be scared. Work to effort, and you will be much better off than your friends or family who do not.

Joe Gambino (24:22)
Yes, yes. I am on a power. You know, I'm going to take number six here and, uh, and slide it in with this cause it's a running will, uh, will destroy your knees. Um, so they're kind of both falling the same thing. And the reason why I'm going to just tie these in is because, uh, I've seen like all the, uh, you know, they've done the imaging on, um, runners on their knees and then they've done an honest head and Terry and the, their runners and these, um, someone who's been doing it for a, for a long, long period of time, their knee looks way healthier.

Joe LaVacca (24:32)
Mm-hmm.

Joe Gambino (24:51)
and better than someone who has done almost nothing their entire lives. so lifting weights, running, being active, they're all going to be a thing. I mean, you can definitely over push, right. And do too much where, as you said, right, you can cause breakdown and pain and injury, or again, on the opposite end of spectrum, if you're not doing anything at all, it's also going to have a negative impact on your health and, and, and drive pain and discomfort and poor movement as well. be active, do what you enjoy. Lift weights, go running.

Do whatever, and I think you'll be better off for it in the long run. Number five, you need, I guess four five, this would be number six, because I'm skipping, I tied four and six together. I skipped number five, so yes, yes, yes. Because, well, this is the numbers here, okay? We're at six now.

Joe LaVacca (25:23)
percent.

No, I thought we number seven.

⁓ you threw, ⁓ you threw four and six together. Man, you see, I told you, I'm very regimented.

And then you jumped to, I just told you in beginning of episode, I'm very regimented. Everything goes in order. All right, number five, here we go. Yeah, I'm sure, I hope listeners got confused too. I wasn't the only one. And then we're going, so now we're going five to.

Joe Gambino (25:43)
Yeah, well, I'm sorry, Joe. I gotta keep you on your toes. Okay, this is brain training for you, Yes, yes, no, we're at six now, we're six.

We're gonna go from five to seven after this. We're just going all over the place. Yeah, yeah, yeah. All right, five. You need 10,000 steps a day to be healthy.

Joe LaVacca (26:00)
Okay, that's what I said. Okay, okay, now we're everywhere. Okay, five.

All right. So the easy answer to this is, you know, is a one. and court writing her book, sharing data with me, the more steps, the better, but it's really fascinating to see her share these statistics where, Hey, if you're taking three to 5,000 steps a day, you're getting that kind of bare minimum in, you're going to reduce your overall mortality risk. It's going to be healthier for your cardiovascular system.

If you're getting closer to maybe eight or 9,000 steps, that's where you're going to end up reducing neurological risk in the longterm. So really cool stuff coming from court and her team as they dive into walking and, you know, putting the finishing touches on their book, that whole 10,000 step per day thing was, a large Japanese study.

And the device they were using, the pedometer only went up to 10,000 steps and then it had to be manually kind of reset. So that number was a little bit arbitrary. Now it ended up working out. mean, 9,000 is pretty close to 10,000, but it's not like you have to necessarily like squeeze in an extra 10 or 20 minutes if you're hitting your 9,000 steps a day. So I like that like kind of straight angle up.

Joe Gambino (27:19)
You

⁓ Yeah.

Joe LaVacca (27:30)
Right? The more steps today you get to about eight or nine, you're probably getting really significant benefit. Once you start going over that by all means, keep going. The more you walk, the better. However, we'll probably just see that progression or that benefit line just flatten out just a little bit. So in the truest sense, no, you don't need 10,000 steps a day to be healthy. Healthy is also very subjective. So you can get away with eight or 9,000 meet a lot of research parameters. So if we're going to be really nitpicky.

has to be a one on my end.

Joe Gambino (28:00)
Okay. Yeah, for me, I'm putting it at a three

and mainly a three means I just don't care. It doesn't sway me in either direction. It doesn't mean it's legit. It doesn't mean it's a myth. It is just a neutral answer for me. Mainly because I actually just looked it up. The average step count per day is between three and 5,000 steps.

Joe LaVacca (28:08)
You

I don't care.

Mm-hmm.

Joe Gambino (28:28)
You know, I think having an arbitrary guide there that is proven to make changes from a health perspective. And actually I didn't know about the nine to 10,000 more from a brain neurological standpoint. I mean, if you have some data on that and it's not necessarily just like an arbitrary number at that point, it is a beneficial for people. And I think if somebody has a goal like that, they're just gonna be more likely to do more steps, even if it takes them from 3,000 to 5,000 or 5,000 to 7,000, right?

That little bit of a difference is going to make a big difference for somebody. And this comes at the end of the day, right? The more movement you do, the better you're going to be, the healthier you're going to be. So it doesn't matter. mean, there's other ways you can be healthy, right? You don't like walking, you can go run bike, right? It doesn't have to be walking, which is also why I'm a very neutral three on this. But again, the more we move, the more we get our heart rate up, the more we do things, the better off it's going to be. And I always bring back the story.

Joe LaVacca (29:04)
Totally.

Joe Gambino (29:22)
with Jen when she started her dog walking business and she went from doing, you know, eight to 10,000 steps a day to like 20,000 steps a day. And she felt better. had more energy. She lost weight without even trying. Like it was, it's, you know, it's a very, very underrated form of activity. So do more. And again, don't set a limit at 10,000. If you're already doing 10,000, you want to do more, make the goal 15 or 20 or whatever it is. have a friend back in New York and

Joe LaVacca (29:33)
Yeah. Yep.

Joe Gambino (29:51)
This guy has done like 50,000 steps in a day. You know, like he's like 20,000 is like his minimum in a sense. They'll like walk everywhere to work. And he used to be very, very heavy, like 300 plus pounds. And the guy now sits and for a very, very long time and like the one sixties, one seventies in great shape. Um, and a lot of it is because of the lifestyle change that he's made. And that's one of them, uh, which is it's, it's a very impressive story. Uh, maybe we should just have him on the podcast and talk about his journey. Uh, I think that would be, that would be a fun one. Uh, all right.

Joe LaVacca (30:16)
That'd be great.

Joe Gambino (30:20)
to number seven, number seven, bad posture. That's it, that's it, perfect, right? Perfect, that's how Olivia counts sometimes, so. All right, bad posture will cause pain.

Joe LaVacca (30:23)
1, 2, 3, 4, 6, 5, 7.

That's it. That's it, yeah? Got it.

God. Let's say, let's say maybe not, let's not push too many buttons, even though I'm reading a really fun book about posture right now. And I'm going to say, I'll say it too. I think you kind of have talked about this a little bit. And again, it made me a little bit less, maybe abrasive about the topic where it's like more of like,

Joe Gambino (30:47)
Push the buttons, Joe.

Joe LaVacca (31:00)
Can certain positions over the course of time become sensitive? Sure. Doesn't necessarily mean that there's a good or bad posture. However, when your back hurts sitting a certain way, makes you feel better. When your shoulder hurts or your neck hurts, maybe sleeping a certain way just makes you feel better. So I don't think that bad posture or bad positions even exist.

But prolonged positions in any state, standing, sitting, lying down, they're all going to end up with the same complication of increasing pressure strain on certain tissues, reducing blood flow and oxygen to other tissues. And we just have to keep moving. So rather than thinking of that posture as a fixed point, maybe

putting it on that spectrum that yes, and again, loved when you said this, like, yeah, there's positions that can be sensitive. It doesn't mean that postures are bad. And if we pull away from things that are sensitive when we need to, it can be helpful to get us out of pain faster. So we'll give it a two. What are your thoughts there, buddy?

Joe Gambino (32:16)
This might be the first one where you put the same number on the exact exact on any of these so far. So yeah, I'm giving it a two. You know, I think when we look at it from a biomechanical standpoint, you know, it makes sense, right? Where we're finding positions that just put less stress on the body. So if you do have pain or you're trying to avoid pain, you know, being a better posture is probably not a bad thing. But again, if you only spend time in good posture.

Joe LaVacca (32:19)
Alright!

You ⁓

Joe Gambino (32:42)
And you never leave it. you know, you do your job, right? You're still going to have the same issues, right? If you, and it all comes back down to variability for me, right? It doesn't matter if you're sitting eight hours a day. It doesn't matter if you are working repetitive job or you're an overhead athlete or whatever it is. Once you lose the ability to get out of those positions and get into other positions, that's when I find the most issues happen. So anterior pelvic tilt, everyone's like, my God, it was the worst thing in the world. it's only a problem when you.

really struggled to get into a more neutral position or we really can't even access like a posterior tilt or depress your ribs or any of those things. Right. And that's when the problems start to arise. Right. It's not just because you are in an anterior tilt. It's actually a very advantageous position and make, you know, most people who are athletic will, kind of live there. Right. It kind of helps out and our bodies do like ways that use less energy. so for energy conservation standpoint, we're going to utilize it, especially as we're getting tired.

But again, can we get out of these positions? Can we access everything when we need it? Can we do it? And that's kind of really the main piece of the puzzle when it comes to posture for me.

Joe LaVacca (33:48)
Mm-hmm,

mm-hmm, totally agree.

Joe Gambino (33:51)
All right. I was almost tempted to skip a number for you, Joe, but I'm not going to do that to you. Yeah, so we're to go to number eight. Ice baths are a good recovery tool, and I'm even going to add on this one using ice for for pain injury.

Joe LaVacca (33:55)
No, don't do it. Don't do it. We're already confused.

Yeah, you know, again, I think this is pretty, this has been pretty much, you know, debated a lot in the, you know, more probably athletic training industries and things like that. had our good buddy, Mike Stella on the podcast. you know, he is very famous for his course end of the ice age, you know, reducing the use of ice to, you know, battle athletic injuries and stuff like that.

Joe Gambino (34:10)
and

Joe LaVacca (34:33)
The cold water stuff I'm seeing or cold water immersion, again, it just seems to be more training your body for like just different stresses, not necessarily helping muscle growth or recovery in any stretch of the imagination. I'll throw a two at it. I still think that if you have pain, if you have injury, try heat, try ice, try vibration, try massage, try...

pressure, right? I mean, all of these things are just going to attenuate your nervous system when we're thinking of symptomatic relief, right? And you can get temporary symptomatic relief from almost everything because we're highly adaptive and sensitive beings. So that's good news. I don't think that ice will necessarily delay the healing process. I know we have some cellular stuff. mean, again, long-term, there's that

really impact the cellular function on like a nine month schedule. If it reduces it a little bit, you know, again, what in our bodies sort of overcompensate and then sort of like ramp up cellular activity or blood flow or oxygen to that area anyway. again, when you we're looking at all these things in a, in a vacuum, yeah. Okay. Ice might delay cellular processes, but if it helps pain and therefore it helps me move a little bit more or get more range of motion or isometrics into, you know, my regimen.

I'd still say that's a net positive and the cellular recovery is going to come back. right. So cold water immersion. Haven't read a ton about it. I don't like it. I'm not, not a fan. Joe's not cold water bath guy, cold shower guy. my stress comes from managing my schedule, New York city exercise. I don't need to throw myself in an ice bath to just try to teach myself how to get better at the cold.

I'm not expecting another ice age, right? mean, everything we read in the climate crisis, things are getting warmer and everything's melting. I'm like, so why do need to get better at the cold? I'm not for it. I'm out. I'll give it a two for people who like it. You don't necessarily have to stop. I don't think it's hurting or harming, but I just don't think it's necessarily doing the things that you think it's doing.

Joe Gambino (36:43)
Yeah, fair, fair. I'm going to give it a three against one of those neutral, neutral things to me where I don't care. about her. I will say after we did that, that Wim Hof course, I did the cold, cold showers for like, know, I think I worked my way up to like two minutes and I will say that the cold shower, you know, starting my day, having some coffee, like the energy levels were higher for my days that like definitely kickstarted you and

Joe LaVacca (36:47)
I'll just say, don't care. I don't care.

Yeah.

Joe Gambino (37:11)
woke my ass up. but other than that, I mean, once I stopped doing it, I don't know if I'll ever be able to do it again. Cause you now I know like this is torture. Um, and I don't know if I really want to go through that, that prop that, that trouble. Um, but yeah, I think, uh, when it comes to recovery, there are just so many other things that people could and should be focusing on, like sleeping more and drinking water and eating more protein and little things like that, that

Joe LaVacca (37:19)
Yeah, of course.

Correct.

Joe Gambino (37:38)
prioritize those things first. And if you're doing all that stuff and you want to add more recovery and things like that and start biohacking and using cold and all that stuff, then go for it. But until you are sleeping well, eating well and drinking well, I don't, there's just a low hanging fruit that you should be attacking first. And probably I should give it a lower number, but that's why I'm very neutral on it. Like if you like it, go for it. If it feels like it's giving you more energy throughout your day, I think it's if you, if you like it, you prefer it, it's helping then do it. If it's not, then don't do it. It doesn't matter to me.

That's why I'm giving it a three.

Joe LaVacca (38:08)
Right. Yeah. And you know, it's like, and

to your point too, it's like, you know, if you and I were going to Vegas and we were playing roulette and we saw three big pieces of black, you know, they were like a third, board, we wouldn't put our money on red because statistically it's much better to think the ball's going to land on this space more often than not. So when you have your nutrition dialed in, when you have your sleep dialed in,

Joe Gambino (38:20)
Mm-hmm.

Joe LaVacca (38:35)
When you have, you know, this maybe even like proper programming dialed in. Okay, cool. Then move on to whatever you want hunt, gather, pick apart what makes you feel a little bit better. And probably again, all of that stuff is going to be mostly subjective, non falsifiable. So I'm not even going to argue with you, but if you're like, I do cold baths and I do lasers and I do this and I do a cupping and you know, my back still hurts. And then you get four hours of sleep.

You eat like shit and you know, strength train seven days a week. Yeah, sorry. That's not going to help you.

Joe Gambino (39:10)
Yep, I'm with you there. think those are both, again, always comes back to basics first. And when you're really good at basics, you can add and nuance on top of that. right, number nine, I'm actually gonna tie this back into our earlier conversation. The...

Prompt here is if you can't squat ass to grass, don't squat at all I'm gonna just bring this to Movement like do we need to have these prerequisites for movement and should that? Not necessarily deter someone or make them think twice about about moving in a certain

Joe LaVacca (39:43)
no, I mean, again, I'd like to give this a negative. this is a one. If I can blow her rank it lower, I would. If you can't squat as the grass, I don't care. So maybe I should put a three here because I like this, ⁓ idea of, just don't care. but no, this is definitely a one. You can squat to a chair. You can squat to, a stool. You can do partial squats. You can do wall sits. You can do step downs from three inches. Whatever.

Joe Gambino (39:55)
Yeah

Joe LaVacca (40:09)
Find a way to load your knee, load your quad. It doesn't have to look perfect. It doesn't have to look like me or you or anyone else. The only thing I care about when you're done with that exercise is you point right to the front of your leg and you're like, wow, this was working. And then we're good to

Joe Gambino (40:24)
Right. Yeah. So we're we're we're going to say the same things again, but I'm going to be on the opposite end of the spectrum here and just call it a four mainly for these reasons. Right. If you have pain that's preventing your hip from going into a deep squat or you have pain or pinching in your shoulder when you're going up overhead, it's probably best to avoid it as you're working on those qualities to give yourself the range of motion. But exactly what you said, we need to find the variation as going to light have success. So overhead pressing is painful or hard or you just really restricted in range of motion. A landmine press is a perfect substitute.

Joe LaVacca (40:52)
Exactly.

Joe Gambino (40:53)
If

you can't get into a deep squat, you're lunging, you're stepping up, you're doing a box squat, you're doing whatever. I've had plenty of clients who love squatting there. When they get to the bottom, it's pinchy. It causes some discomfort in their hip or their back. like, why don't you just box squat? Like, let's just, this is take away five degrees and you feel good. Like, why do we need to do the extra five degrees? Just, just live in the land that you feel comfortable. If we can open it up and give you more space, let's take it. And then you, can train those. But if we don't get it, I mean, you're still.

get into parallel if you were to go power lift if you wanted to you're gonna you're gonna get the you know you're not gonna get the red lights on it you know so go for let's make those modifications and load it and enjoy it versus struggling and like you know every time I try to load now my hip bothers me like no just just back off a little bit find that modification enjoy training it's just gonna be much better for you in the brain right and it's just another stressor that goes away

Joe LaVacca (41:44)
Okay. Yeah, it goes back to that.

Joe Gambino (41:47)
You're more confident,

you feel good, can reach your goals much easier, much faster that way.

Joe LaVacca (41:52)
Right. And again, like it goes back to that whole prerequisite thing. It's either, you know, you need to be able to squat your body weight full. You need to do a body weight squat full. You need to be able to do this and you need to be able to do in order to train. And then that keeps people not training. So yeah, I don't care what your range of motion looks like. If it's a little bit painful, we can talk about it. But if it's something deterring you from getting your strength work in two, three times a week, getting your work in.

Joe Gambino (42:06)
Right.

Joe LaVacca (42:19)
Hell, let's ride the elliptical for all I care. Your heart does not care what exercise you're doing. Your shoulder doesn't care what exercise you're doing. So just find one that works. And then in six months or a year, I don't know, maybe it changes, maybe it doesn't. Maybe you fall in love with the elliptical. Go for it. Again, what's gonna keep us healthy is the goal that I try to push people toward now.

Joe Gambino (42:41)
All right, last one, Joe, number 10. Manual therapy, soft tissue work is needed to get out of pain and move better.

Joe LaVacca (42:43)
Number 10.

Yeah, I'll go to three here. go with I don't care. You know, if if you like manual work and that's what your body responds to terrific. Again, there's plenty of studies that say A plus B or exercise plus manual therapy better than exercise or manual therapy alone. So it could be additive. It could be adjunctive. I think as a person receiving care, know what you respond to as a clinician giving care, know what you prefer.

Right? Again, it goes into this idea that I think nowadays there's too much pressure on you and I and everyone else to do manual therapy, think biologically, consider social elements, try to help people cope with their psychological elements. And it's just not possible. And it's not possible in any one session. So if you have a client that you've been working with for a long time, sure, you can move through those phases. You can move between those phases and really kind of get to know that person on an individual level.

But if you don't want to, you kind of tend to be more exercise behavior driven, then stick with what you know, that's going to be your best way to help people. If you've only tried manual therapy and think that's the only way out. Well, again, are you empowered enough to really kind of do things on your own, take matters into your own hand? Can you have your therapist teach you some techniques? That's what I try to do with people. If they respond to a manual therapy intervention, get a loved one involved.

Joe Gambino (44:11)
Mm.

Joe LaVacca (44:15)
get a foam roller involved, get a massage gun involved, and see if you can recreate that input at home. And that's what I would say. So I'm giving it a three, I'm not for it, I'm not against it. Just know as a clinician what you wanna do and know as a client what you respond.

Joe Gambino (44:30)
Yeah, where we're 20 % on our numbers, John, giving this a three, a three as well. I just don't care. You know, if you enjoy it, you enjoy it, go do it. But it shouldn't be the only thing in your arsenal. So even as a provider or as someone who's doing it, if you're only, there's actually probably been like three people I've had conversations with this week is what they've done in the past is all manual based. It's the tens, it's the heat, it's the ice, it's the...

manipulations, is the massages, it is the acupuncture and none of that ever included movement and this person's been struggling for a very, very long time. So if you like that stuff and you are getting the short term changes, that's great. Capitalize on that and build on it with the movement routine that's going to address those underlying issues that that combination will be much stronger than the manual therapy alone. And I think is, you know, for this person here,

If I think if they added that, that would be, I think that would be the difference maker for them, you know, getting more, more fitness in there, getting more movement in there. I think that's, that's the game changer for a lot of people who are only manual. and if you're on the opposite end and you're only movement, I think you can get away with all that stuff. I mean, use a foam roller, use a massage gun, go get a massage every now and again. I probably get one now every like two months or so, cause they just feel good. My body feels good. It's part of my recovery process at this point. de-stresses me.

I fall asleep during them half the time, you know, something I enjoy. So that's what I add them in there. Yeah, yeah, exactly. Listeners, treat yourself. Bonus tip of the day.

Joe LaVacca (45:56)
There you go, buddy.

Love it. And you should. You should enjoy it. You should treat yourself. You should treat yourself. You deserve it.

Treat yourself. Yeah,

I really, my reflection is I'm really, guess, take a very pessimistic viewpoint. I don't know if I gave anything above a three, which kind of fits my personality. Yeah, you're very positive, very positive. I don't think that's surprising to anyone who knows us or the listeners at this point. Joe, me no Mr. Positivity, Joe Lavaca, Mr. Sadness.

Joe Gambino (46:10)
Yeah. And I'm on the opposite end, right? I'm the, yeah, so I'm very positive.

Yeah, but you know what, Joe, after I started doing the threes of not caring, I see you moved off the needle and you went to this, you know, ambivalent place.

Joe LaVacca (46:30)
Yeah, yeah, I started like, I like that three I was like, yeah, you know what, maybe,

maybe I'm so angry about it. I just stopped caring about

Joe Gambino (46:38)
It's interesting though because we it's like we say the same things but the way we view it on the scale is differently which is which is quite funny it's like now you screw this you know we don't I'm putting this as myth because I believe it this way and I'm saying hey you know what I believe it's actually true but I spit it in the same exact way that you're talking about. So yes.

Joe LaVacca (46:43)
Yeah.

Yeah.

man, all right, buddy. That was a fun list. We should play more games. That was good. Maybe

some listener feedback too would be great. But all right, we ran through our list a little bit out of order, but we did it. Is there any other numbers that we need to jump around to?

Joe Gambino (47:08)
No, no, there's no other numbers here. We got it all. We did it in the Olivia counting order. So it's still done sequentially. But that's it, man. Take us home.

Joe LaVacca (47:15)
Hahaha

All right, man. All right. Well, Joe, love you. Thanks for this game today. Listeners, we love you. And don't forget to come back next week for another exciting episode and maybe more games at the Beyond Pain podcast.