The Beyond Pain Podcast

Episode 79: Chronic Pain and Strength Training: How to Use Machines and Free Weights Confidently

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Summary

In this episode of the Beyond Pain podcast, hosts Joe Gambino and Joe LaVacca discuss the ongoing debate between using machines and free weights in fitness and rehabilitation. 

They reflect on the importance of functional training and how it relates to individual goals. The conversation emphasizes the safety and programming aspects of both modalities, highlighting the benefits of blending them for optimal results. 

Additionally, they explore the often-overlooked role of resistance bands in training, advocating for a more inclusive approach to exercise that accommodates various needs and preferences.

Takeaways

  • The fitness industry has swung too far towards free weights, neglecting the benefits of machines.
  • Functional training should be tied to individual goals and needs.
  • Safety is a crucial consideration when programming workouts, especially for those training alone.
  • Machines can provide a stable environment for those with chronic pain or injury.
  • Resistance bands can be an effective tool for rehabilitation and strength training.
  • A blend of machines, free weights, and bands can optimize training outcomes.
  • Specificity in training is important for achieving desired results.
  • Clients should feel empowered to use the tools that work best for them.
  • Training should be sustainable for the long term, not just for short-term gains.
  • The conversation around training modalities should be more nuanced and less polarized.

Joe Gambino (00:00)
Welcome back into the Beyond Pain podcast. I am one of your hosts, Joe Gambino, and I am here with other hosts, Joe LaVacca can find us both on Instagram at joegambinodpt for myself and at trend and motion underscore for LaVacca over there. Podcast is on Instagram Beyond Pain podcast and on YouTube as well. Cups of, cups of Joe underscore PT. Man, a little rusty after a couple of weeks of not chatting with Joe.

Joe LaVacca (00:28)
little rusty but we're back you're healthy that's all that matters Joe ⁓

Joe Gambino (00:32)
Yeah, the voice is here,

the cough is gone, kids are good. ⁓

Joe LaVacca (00:36)
Yeah, well,

I'm happy to have you back. are, this is our first chat since Thanksgiving and we were just talking off cast, off cast, off podcast, off, off camera about that. So we hope that you, the listeners had a wonderful holiday and are prepared for Christmas. I don't really know where I stand with Christmas this year. I feel like I'm more ahead than where I was, but I've left so many little things on the back burner and

Joe Gambino (00:39)
Mm-hmm

camera

Hmm.

Joe LaVacca (01:02)
Avery loves to go to school every day and they remind me, there's only 20 days till Christmas. There's only 18 days till Christmas. And I'm like, yeah, shut up. I know, I know, I get it. I get it. And I know Amazon Prime can only do so much. So I gotta start cleaning up the little things these next couple weeks.

Joe Gambino (01:08)
Hahaha

Mm-hmm. I see Well, here's the

real question for you Joe. Have you started listening to Christmas music? Okay, okay, so then you're on track You're on track. You're like a November 1st so we can start listening to Christmas music kind of guy. So

Joe LaVacca (01:25)
Of course I have. mean, that's... What... Yeah, well we did...

No, I'm I'm not thaw out Mariah Carey on November 1st.

I typically, what'll end up happening is the day we put up the tree, I will start listening to the Elvis Presley Christmas album. That's my all time favorite. And then typically that night I will make a drink or a cocktail just to, you know, ring in the season. So this year I did that, had my Elvis music on, my tree lit, made a little Negroni.

Joe Gambino (01:45)
Mm-hmm. Very good.

Joe LaVacca (02:00)
just kind of what I had with the ingredients. Yeah, yeah, it was just a Negroni. Again, I could have went a little bit more wintery, but just looking at what I had to make a good drink, I decided to go Negroni. Yeah.

Joe Gambino (02:01)
⁓ that was going be my question. What was the drink of choice?

Mm-hmm.

Very nice, very nice. Yeah, we

did Christmas music the day that we did the tree as well, which was a couple of days after Thanksgiving. So we can't do it before. That's that's that's sacrilege in this house.

Joe LaVacca (02:25)
Yeah, same thing for us.

No, and you know what? Like,

it's too much now where we're just like going from Halloween to Christmas. And we gotta give Thanksgiving just a little bit of play, just a little bit. You know, we don't need the fanfare, the hoopla, maybe the Thanksgiving Day parade we can get rid of, but like, you know, like. All right, that's fair.

Joe Gambino (02:36)
I... I agree with you.

No, no, that's a big one here in the house. That's a big one here. And Olivia, Olivia was very into it this year, which was fun. Jen loves

watching the prayer in the morning. So it would be nice for them if Olivia continues that trend. But I was walking around the community right before Thanksgiving and some people already had Christmas decorations up like right after Halloween, the Christmas decorations up. But one house had a giant inflatable turkey.

And I saw the owner outside and I was very appreciative that he had a Thanksgiving decorations up because it's a holiday that does not get enough love for sure. So.

Joe LaVacca (03:22)
We saw the balloons for the first time this year. We took the kids, Thanksgiving, Eve in New York City. So I can cross that off the list and then say I will never go back and do that again after a three hour wait and I think maybe two or three almost fist fights because of people cutting the line and the police and the Macy's Marshals. I call the Macy's Marshals doing absolutely nothing to prevent it. So.

Joe Gambino (03:31)
Nice.

Hahaha!

Joe LaVacca (03:48)
Yeah, I think I'm good now. I think I'm good. The frustration and anger level that you're used to seeing in me went way high, way quick. And luckily nothing came about, but it was close. There was a couple of close ones.

Joe Gambino (04:02)
Yeah, that's uh, that is

that is whenever you're in the crowds of New York I can that that's just how it goes But let's let's get into it today. We'll be talking about machines versus free weights. I feel like at some point in time the fitness industry the rehab industry got You can only do free ways. You should never do machines

I feel like unless you're in like bodybuilding circus, that's where machines kind of still live. Otherwise machines aren't functional. They're probably not the things that, I guess the idea out there is that you shouldn't be using machines. So let's have that conversation, freeways versus machines. Maybe we can start when and how you program that stuff and how do you view the two.

Joe LaVacca (04:51)
Yeah, I think that your point was right on the nose. There was a big shift into functional training, whatever that meant, which essentially just put another barrier on people doing things. Because if you weren't loading the activities that you do in real life or coming up with some sort of creative way to use your cable column, spinning in a circle or getting up off the floor or performing some sort of elaborate setup.

you weren't training functionally. Now, I think when it comes to functional training or freeway training or machine-based training, I program around those things really based on environment. If you have one kettlebell at home, well, then yeah, maybe for you, we'll try to program some get-ups off the floor. We'll try to program some balance things with your kettlebell. We'll try to do some

kettlebell swings or pushes, which might fall into the realm of functional training, but we're only doing that because that's what you have access to. And it's the same thing with a dumbbell, a barbell or a machine. Machines really require people to have gym access. There's no one. I really know actually, I will take that back. There was one client I've ever worked with who had a gym in her house with

full array of machines, but you can imagine what her house looked like and The level of wealth she had to accumulate to even be able to get to that point So it's not an impossibility But it's just a very rare chance that our clients are going to walk down to their basement And have a leg extension leg curl rower shoulder press all these things lined up for them Now I do think that along the lines of that functional training

push, a lot of clients did feel, well, even if I had access to a leg extension, a shoulder press or an ab machine, I shouldn't do it because it's not going to give me benefit. And the few things that I have read recently about training machines versus free weights, when we're just looking at like muscle tissue and muscle physiology, there really isn't that much of a difference.

If you and I did a bench press program with dumbbells or we did a bench press program with our seated, you know, bench press machine at the gym that we're all accustomed to using or seeing, you know, in passing, the differences in strength are not going to be significant at all. Now, one thing that did come up recently when I was kind of thinking about a couple of different things for people,

was it might depend on the activity you're trying to get better at. So for instance, squats probably translate a little bit better to jumping than your leg extension and hamstring curl machine do, even though you'll get similar strength gains. And the reason being is that the vertical position of the squat with the barbell is gonna mimic your jump a lot more than sitting and pushing your legs forward or

curling them underneath you. So if there is a skill involved, like jumping or some sort of return to sport, then maybe there's some marginal benefit of using a barbell or a dumbbell, because you can play with angles a little bit more. You can probably prep your nervous system a little bit more to either think about that pattern or repeat that pattern over and over again.

But for our clients, if they're just looking for strength, if they're just looking for hypertrophy, if they're just looking for the volume or adaptation or behavior, I love both for them. What's your thoughts on that?

Joe Gambino (08:48)
Yeah, so I think there's a couple things you said in here that were...

I liked the first one is like the first thing you said was like functional training or like what what is it and I think it always you know you also brought in goals right and I think those are the two things that tie together anything can be considered functional right because it's you know if it's if it's tied to your goal in a sense right so if you wanted to I don't know squat 200 pounds and that was your goal and there was really no

functional reason for it besides you want it to again like squatting heavy right would be functional for that person because it fits a goal for them right I think there's a lot of other benefits for it but that's that's something else

Sorry, Joe, I didn't want the kids toy in the back. I mean, I don't know how loud it is and how much you will, but okay. Anyway, where was I? I'll just take it from the, where did I finish? Where was my last thought?

Joe LaVacca (09:29)
Yeah, no, you're good. Riverside will clean that up anyway.

Yeah,

get the functional training bit and depending on goals and if you want a 200 pound squat and

Joe Gambino (09:48)
Yeah.

And so, and then like to your point with, you know, like squatting and vertical jump, again, going back to your goals, right? I mean, the principle specificity is there for a reason, right? You know, pretty much what it says is if the more specific you can be to the task that you want to do, the better you're going to get like that, that carry over from the gym to the action is going to be there.

And then if you're going to do something that's a little bit more general, it's you're not going to get the same benefit and running versus Biking or swimming well, like those are like the easiest ways to make those comparisons, right? If you were to Get really good at swimming you're going to improve your cardiovascular system. You're to become much better You know, you can have better heart health your endurance is gonna go up But if you try to carry that over to running your that carryover is not going to be very great You're gonna feel like you're almost starting from scratch again, right?

So that's where that starts to go. We're kind of getting into now like programming, which we'll talk more about on our next episode. But going just to your point and kind of building off it, I do believe that doing things from like a fruit weight perspective has unique benefits for machines. And I'm not saying that like one is necessarily better than the other. I think there are clearly places for both. But when you start doing like single leg work with holding weights, where like I think some of the benefit is that like you have to also be able to stabilize.

So you're taking movement that may just be like a sagittal plane movement and you start to make it more like triplanar in a sense because you have to now combat forces in different directions. So I think there are unique real world benefits to having a free weight approach to training. I'm also biased on that because I enjoy lifting weights and stuff like that. So maybe there's that in there, but I think where I've been finding machine-based stuff like

There's two areas that I find are really beneficial. One is, if you're looking to train more towards failure or you're looking for like muscle growth hypertrophy, I really like doing some machine work for that. You just take other things and you don't have to worry about stabilizing. can probably push a little bit more. You can go a little bit harder, less chance of issues popping up. So from that perspective, I think if your goal is, hey, I just wanna like get bigger, machines work really well for that. The other one.

is for people who are dealing with chronic pain or some sort of flare up or really struggling to maybe, I don't know, they can't squat or they can't press because free weights are kind of irritating. You can move them into more of a machine-based atmosphere. And I've been finding some benefit with that because you don't have to stabilize as much. I feel like...

There's a subset of people who have chronic pain who have a hard time like toning down their system. And that's part of why they have like a pain response. And like when they exert pain tends to even kick up even higher. And machines is one way to kind of like, Hey, you don't have to worry about like postural holding and then moving load and then trying to figure it all out. We can actually take that step back, sit you down in the machine, have you chest press or leg press. And that tends to take care of some of that. So if someone's really struggling with pain and like,

activity and they can't really do too much in the gym, I find machines have been really helpful to start to load that process.

Joe LaVacca (13:00)
Yeah, I think the safety aspect that you bring up is often forgotten about. I know a lot of my clients train alone. So, you know, when I have them in the gym, especially with their free weights or their dumbbells, I mean, their programs very rarely, if ever, go below reps of three. And again, I'm doing that very specifically because I know a of them are alone in the gym. And if we're going to twos and ones, you know, I don't know how much

Extra benefit a lot of the clients I work with are gonna get out of that type of programming anyway And threes just seem to be a little bit safer now if there's one or two people who I know like train together partners stuff like that I might do a little asterisk and say hey you can you can try a heavy two or you can try going for a one today if So-and-so is with you. However, if not, let's just stick threes, but I do like this notion of safety and even

teaching people what it's like to exert a lot of effort in a very stable position. The other thing I like about machines for people in pain is you can be 100 % certain that every rep is going to be exactly the same, exactly in the same range of motion with the exact same weight. And you know, if you have them go in some tempo stuff, maybe it's a little bit easier to keep with tempos. But a lot of the machines

We can bias to not only have people be more comfortable and more stable and safe, but we can actually put them in their positions of strength, which to me is always fairly empowering. So with that seated chest press, I'll just do that because if you're watching on YouTube, you can see it. A lot of times people are going to have some pain in their shoulders if they're kind of dropping below parallel. We've talked about pain with shoulder pressing and the podcast and earlier episodes, but imagine if I could just position their hands here.

at 90 degree angles. Well, now they're going to be really strong here. And chances are we'll be able to start that reintegration into pushing or reintegration into pulling for that matter with a very safe parameter, something that they can repeat, something that they won't need coaching, queuing everything for. As long as they know how to pull a pin and adjust the lever and they have access to it, it's pretty much set itself up.

And now they just have to make sure that the pins on the right way. I mean, that's really it. I mean, that's basically the most entry point way that you can utilize strength rather than looking at a whole stack of dumbbells and being like, Oh my gosh, I do 20 pounds. Should I do 22 and a half? Should I do 25? Should I do 27 and a half? It's like, well, you have this right here, pull the pin and just go. So I think that from that motion to it's not only more safe.

It's maybe a little bit more approachable for people in pain, especially in the beginning part of their rehab. So if you have access to machines and you're not using them or you're purposely staying away from them, I think you could be missing out on a lot of benefit from your program.

Joe Gambino (15:58)
Yeah, I agree with that. think, you know, again, we've swung too far in one direction saying that, you you have to do free weights versus machines. I definitely think that most people, you know, at some point should be doing more free weights. And I think having a blend of the two is probably going to be the best for a lot of people. Probably you were kind of talking about people like kind of like newer in the journey and stuff like that. I think low training age.

Is another one of those like kind of good places for machines to kind of fit in so they can start building some confidence Things like that and just start to like understand like how to push their bodies and a little bit safer atmosphere but we also want to teach like You know what good movement right like you and you need to step away from machines to do that so I think having this kind of blend of the two is Will be very beneficial for people so, you know, you talked about like, know We can put people in a position of strength. They can push harder. It's safer. I

Those are like really positive things, but good programming also is like, how can we challenge somebody? So people out here, like, I don't want, you know, people to feel like they only should do free weights or, you know, if you're too nervous about the gym or there's some pain and stuff like that, that you only now, because we're saying this, like you're going to move to free weight to machine based. We really need to have this like combination of the two. And I think when we can do that and we can effectively challenge somebody that's going to, you know, obviously like within their means, right? Something that's going to

push them to move better, create better capacity, all those things, but then also give them the opportunity to use machines or something that's a little bit easier so they can ramp it up and they can push a little bit harder. We always talk about when someone's in pain, what can you do now that you can really push? So you're not worrying about re-injury or flare ups and stuff like that. If a machine is gonna be that thing, then we should leverage that thing so that this way they can get a training response, feel like they're doing something, build some confidence.

feel like all those are really positive things. And then when you're gonna say, hey, let's go try now lunging again for the first time in a while, maybe they've had knee pain, that confidence is going to be there. can probably, they've already learned how to put some load into their tissues from machines. Now when we're asking to do that in a unrestricted environment, like their knees are gonna be a little bit more tolerable to those loads. So I think we need to...

Again, right going back to goals, specificity, what's gonna carry over for that person. That's really where it all comes down to. And I think we really have all these tools. Everything is a tool at the end of the day. How can we start to put all these tools together to help the person move towards their goals?

Joe LaVacca (18:20)
Yeah. Now, maybe the one thing that often comes over too, would be especially people who are training at home and while we're just on the idea of machines and free weights, the other idea would be bands, right? And I don't know what your position on is with bands, but I do think of bands as another sort of easier access point for a lot of people who are new to training.

maybe having pain. And the reason why I typically think that there at least the reason why I tell clients like, hey, bands are okay for right now is a you can just hook them on almost anything. You can use them around your body. You can use them around anything at home. again, affordance of just being able to access something like that is great. The other thing very similar to our machines is that our bands are going to increase in tension. The more we get to our stronger angles.

So yes, while maybe again, long term, bands would be a little bit less efficient for overall training hypertrophy. In the beginning for pain and showing people that they're safe to move, hey, I have my rotator cuff pain patients, Hey, now all of a sudden they get to 90, that band pulls a little bit harder, but I know they're stronger at 90 than where they were before. It pushes a little harder. now maybe the pain sets in or maybe that feeling of cramping is too much to bear.

All right, well, that's perfect. Why don't we just kind of work within that zone and then it'll actually auto accommodate to how much resistance that they can actually move. Now bands for us, I think are harder to keep track of. you know, max tension on a band might be, you know, if it's green, I don't know, it's 15, 20 pounds before it snaps or something. So I don't know exactly where it is 16, 17 and 18. But again, I do think the training age, the safety idea, you know, the things that

Unfortunately, probably like we were saying before, kind of mocked on social media like, yeah, your shoulder pain patient has pain and you're giving them bands. Yeah, I'm giving them a fucking band because it's easy. All right, there's the same way I'm going to put them on a bench press machine or a row machine because it's easy. Why would I not want to do something easy that gives us some wins and builds confidence knowing the other thing we preach on social media? I want them to do this for the rest of their life, not for six weeks or eight weeks with me.

I want them to do this for the next 60 or 80 years. So why not take that time? I have a long runway. I can work with a person to build behavior. I'm not going to do it all in one program or one training block. So the band conversation just popped into my mind. I feel like it kind of fits into our flow here. But do you share a similar thought with bands? feel bands got pushed away also along with machines and maybe we need to resurrect them a little.

Joe Gambino (20:58)
Yeah.

Yeah, I think that's exactly, as you were saying, that's exactly what popped into my mind. Like, bands got a bad rep because physical therapy was like a chronic under loading modality in a sense, right? So bands, if you're like doing endless clamshells and like the RP is like a four and like you're only doing table exercises,

Joe LaVacca (21:11)
Yes, totally.

Joe Gambino (21:21)
then sure, because you're only using one tool and it's low level, low effort, right? Like you're really not going to get benefit of it, but you can use bands and you can create high level stresses. I mean, I use bands for my own hips and I can, you know, that's like one of those other modalities that you can take tissue to failure with, right? Like very safely, very effectively. And like you can, you know, get off the ground and have like a huge pump somewhere just from using a band. So, and you know, just because like you brought up the shoulder,

Just because like if somebody does have like poor shoulder external rotation like strength or rotator cuff strength, I mean like you can use bands to strengthen that. Like that's not, like again, right, it's going back to the goal. If you have a wife or something being in there and it challenges that person and causes them to make like a physiological change, then you're doing something good, right? Like doesn't, know, bands won't pull you away from that just because it's a band. I just think that I gotta.

PT got a bad rep for using them and I think that's kind of why the pendulum shifted there. But you made me just think as you were talking about bands, like, you know, if you don't have access to a gym, there are things that you can get that are relatively, I'll say relatively inexpensive, especially because you'll have them for a long time. Like bands is one. There are pulley systems now that you can get that just like, you know, attached to squat racks. Like, so I have one in my garage, I've been eyeing it.

Joe LaVacca (22:38)
Yeah.

Joe Gambino (22:43)
And core is one of those brands. There's no affiliation with them or anything like that But like you can now get these like really condensed ones that just go on your squat rack and even some of the machines are relatively small you can get like a pulling machine and like I could technically one of my garage monkey feet is one that I I've used before that is kind of awesome like especially for lower body like I don't have a leg press or a leg extension or leg curl machine like I can just like attach a dumbbell to my foot

Do those things now so like great for for a garage setup again? No sponsorships there are just things that I've used that I've really liked and like those are ways that you can start to recreate some of those things in like a home environment or Garage gym environment that allow you to get some of that same stuff to do get from machine if you didn't have acts to it So there are ways to kind of get creative now like if you had some means like I think like the monkey feel like $80 for like one which I think you really only need one like I usually do things unilateral anyway, I have to

Joe LaVacca (23:33)
Yeah.

Joe Gambino (23:36)
I only use one like 99 % of the time. So you can get one for 80 bucks. I've had it for years at this point. I put it to good use for lower body stuff. Ankle weights is another one. You can't go as heavy like I like the monkey feet because I can literally put my heaviest dumbbell and attach it if I wanted to. But ankle weights is another great one. Maybe if you got yourself up to like 10 or 20 pounds, you'd have more than enough load to do a lot of different things from an arm, a leg perspective.

Joe LaVacca (23:52)
Yeah.

Joe Gambino (24:04)
just to get some of that like machine like environment or you say you were doing like I don't know leg abductions for whatever reason you could load it heavier enough to like actually challenge the tissue versus just use maybe like that yellow band and you can do a hundred of them before you hit failure.

Joe LaVacca (24:19)
Right. think at the end of the day for our clients and people in pain who are listening, It's really about your intensity and your volume. Right. I mean, if you are in a machine and you are working that and you are huffing and puffing and you are feeling a six, seven, eight or more level of exertion out of 10, if you're leaving one rep in the tank or going to failure, as we were saying, that's the most important, I think, parameter.

If you're taking your bands to that same point, you can probably string out their progressions a lot more, especially if you only have one or two colors and you don't have this whole like rainbow selection like a lot of gyms do or some of these packages on Amazon. Although, like you said, it's so easy to get where a lot of companies now are making really nice bands that you can probably have some pretty good utilization with for a while. Again, it's just about matching your exertion and your effort.

to the tool you have. And I think that's kind of like my biggest takeaway with whatever apparatus we're using.

Joe Gambino (25:23)
Yeah, exactly. think the biggest takeaway is exactly that. Don't get married to one modality versus another, not just bands, not just freeways, not just machines, not just kettlebells, whatever it is, blend it. Do the things that you like. Do the things that allow you to get a training stimulus, but also making sure that you're finding some things that maybe...

Challenge you just enough where it's like, I don't know if I fully enjoy this but like I know I'm gonna get you know Like those are the things that usually will drive some some some benefits So I think having this nice blend of challenging yourself giving yourself access to things is where things are at and that's from a paint perspective all the way through a Performance perspective. I think we can we can do a lot of things with with all these different tools and just again Don't let the pendulum swing too far. Usually when you hear these things on social media Almost always the answer is like truly right in the middle

Joe LaVacca (26:13)
Yep, absolutely my friend.

Joe Gambino (26:14)
It's just not polarizing enough for social media to get

likes and views.

Joe LaVacca (26:18)
Maybe we got to change up the topics in the future. In the new year, we got to get more polarizing and more aggressive and really start pushing the agenda more.

Joe Gambino (26:27)
That's it. That's it. We're just black and white No more no more machines for anyone. We're just gonna be free weights here going forward Yeah All right, man anything else you want to add here no, ⁓ good

Joe LaVacca (26:33)
No more common sense thinking for us. We're done in a new year. All man, anything else you want to add to this? Nothing, nothing, nothing, nothing.

All right, cool. All right, well, everyone, we hope that that was beneficial. Thank you for making it this far. Joe, I love you. Listeners, we love you. And don't forget to come back next week for another exciting episode. I still messed this up, of the Beyond Pain.