Episode 80: From Rehab to Real Training: How to Exercise Smarter With Chronic Pain

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• Joe Gambino
• Joe LaVacca

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Summary

In this episode of the Beyond Pain podcast, hosts Joe Gambino and Joe LaVacca discuss the intricacies of programming for performance and rehabilitation. They explore how to tailor training based on individual goals, available time, and intensity levels. The conversation also delves into the importance of aerobic training and VO2 max, emphasizing the need for high-intensity work to improve overall fitness. The hosts provide insights on structuring workouts, managing training volume, and the significance of setting realistic goals for clients.

Takeaways

• How many days a week realistically are you going to be able to be successful?
• Two days a week is kind of like minimum.
• It doesn't matter if it's two sets or four sets or eight sets.
• You have to elevate the heart rate response.
• If you're looking to be able to have a better VO2 max, you need to work hard.
• You can't be like, hey, I'm gonna like one ORMs and really work on strength and then really work on high level cardio.
• I want the wins. I want that positive momentum.
• I want to make sure that those programs are kind of neat and clean.
• You have to do your zone threes and your fours and your high intensity stuff.
• If you're on a time crunch, like go hit your zone threes, your zone fours.

Chapters

• 0:00 Introduction to Beyond Pain Podcast
• 1:00 Programming for Performance and Rehab
• 9:20 Aerobic Training and VO2 Max Insights

Transcript

Joe Gambino (00:43)
Welcome back in to the Beyond Pain podcast. I am one of your hosts Joe Gambino I am here with the other host Joe LaVacca You can find us both on Instagram at joegambino dpt for myself at strength and motion Underscore PT for LaVacca over there podcast is on Instagram Beyond Pain podcast and on YouTube cups of Joe underscore Pt got this time around y'all

Joe LaVacca (01:04)
Got it. You nailed it. It was perfect. You're yeah, very good. All the unders all the underscores, all the pages, all that good stuff.

Joe Gambino (01:06)
Now that short and sweet, we're back, we're back.

We did it.

If you are been listening for a while, we would really love the review. Just take two seconds while you're listening here and drop it for us. It really helped to show, us get this into more ears, it's out more people. But let's dive right into today. We're be talking about programming overall. This is gonna be a really touch a little bit on rehab, but we'll make this one more kind of performance driven, how you can look at things high level.

the different qualities of training that we can kind of go through and talk maybe a little bit about, you know, what happens if you have less time or more time and how training should go. I'll have you kind of, kind of kick things off. We will start with like the overarching view, like when you're programming for somebody, they're closing into their end of rehab and they want to do more performance stuff. Like how are you starting to like plan out or think about what goes in their program, how you're tying it back into the goals, all of that.

Joe LaVacca (02:05)
Yeah, for sure. I think it always starts for me with, well, how many days a week realistically are you going to be able to be successful at the gym? And I want to know that right off the bat because if it's only one or two days, then I probably need whatever we're going to do to be fairly high intensity. I probably will need to give you a little bit more density or volume in your sets, at least the very least, to get you stimulated as much as possible.

versus someone who's gonna have like three or four days at the gym where we can kind of really maybe spread this notion out a little bit more. So if someone's been training with me, I generally have an idea from a rehab perspective, you know, what they have been doing leading up to this transition to performance. So if they've been, you know, sort of milling around fairly active, not, you know, coming into this as a training age, as we always said on the show at absolutely zero, then I'm probably gonna want to start them.

on this like nice two day week program, making sure that we probably hit about, I don't know, maybe like eight, six or eight sets in the beginning of push and pull and squat and hinge. And their two day program, at least, you know, for me, and I'd love to get your input here, is probably gonna really consist of like the first day is gonna be like a bilateral position. So it's gonna be like a pretty typical squat. And then maybe on day two, it's a single position leg or squat. And then I'll do that the same way, like with a deadlift. ⁓

two legs on the floor versus one leg on the floor, like in some sort of like mixed position. And then your day one stuff, I want you to push and pull horizontally. And then on your day two stuff, I'm gonna have you push and pull probably vertically. If there are extra bits of time for people, depending on what they wanna work on, you know, I've had people who want bigger biceps or arms or whatever. I people who want to work on their core a little bit more.

⁓ you know, people with lower extremity injuries are always like, Hey, you know, how can I work in my calf work or my balance work, in the air? And then that's where I think everyone's ending circuits change up a little bit. So maybe you're trying to chase the pump. We're going to give you a couple of arm days versus someone else who is maybe a runner has a harder time, you know, stick into some strength programming just in general. So we're going to give him or her more calf work or more isometric work in different positions or single leg work in different positions. But I think generally.

starting off, that's how I would initially go about it. Two days a week is kind of like minimum, I hope, want, expect, desire, need, know, wish for people to be able to do. So I want to make sure that those programs are kind of neat and clean, hitting the big things and that people are kind of in and out without doing too

Joe Gambino (04:43)
Yeah, I think just to like how I would do, what you said with like a two day split is likely going to be, I'm just going to pick like a push or pull for lower body. then like usually I just like give you like, like day one would be squat day and pulled like upper body pull and like so knee dominant and pull upper body. And then the second day would then be upper body push and then lower body hinge. And then this way you can just stack.

Joe LaVacca (05:08)
Mm-hmm.

Joe Gambino (05:09)
stack volume and then like, I would admit like you can do density work, you can just like do RPU work, but like it kind of goes back to what you said before, like it has to, like your intensity has to be there. If you're gonna be doing like less than hour sessions or you're only gonna do two days a week, whenever volume at like the overall volume is cut down, the intensity needs to bump up to match it. But I think there's a lot of different ways that you can work programming like that.

I just want to find the way where I can get the most volume to a given area in one session as possible and then let them just get after it so that this way you can make adaptations to it. So that's kind of where my brain goes with that. But like we just said, fit it into that person's life. Time, what do they have access to? What equipment do they have access to? One thing I tell everybody that I work with, we've talked about this on the podcast before, but my first question is,

How much time do you have to devote to training? And then how much time do you have realistically that you can get 100 % of your sessions in? Because those two answers are not always the same. Sometimes it is and sometimes it isn't. And I always like to take that second one, especially when starting with somebody because I want the wins. I want that positive momentum. I don't want to be like, only did like, you know, someone doing 70 % of the work and 100 % of the work, the mindset, very different going into the second block, third block. And that can really make or break someone's like,

Joe LaVacca (06:03)
Right.

Joe Gambino (06:26)
trajectory going forward and seeing progress so I Love that that we talked about that and you talk about goals I feel like we talk about that in every episode, but those are always the most important things It doesn't matter, you know anything we talk about from a program perspective here doesn't really matter without the context of your goals. So Would you do you

Joe LaVacca (06:43)
Well, that in mind,

quick question for you. So with that in mind, right? Like, again, a lot of the things that I've seen or I try to push clients to is like, you know, trying to get to like at least somewhere around like that minimal viable sets of like maybe eight per week per body part to start off and then pushing them into like 12 and 16. And that means like, you know, I'm going to do like just for if we're going to stick to a two day program, then I'm going to up building up to like five sets of 10 squats on one day, five sets of 10 squats on my other day.

And then if you have an extra third day or fourth day, this is where like you can make more of those gains the more consistently you work out because you're able to stack the volume and the intensity throughout the week without it being too overwhelming. But do you feel like there is a minimal viable thing that you try to chase your clients and a maximum like, hey, you don't really need much more than this or is it kind of case by case?

Joe Gambino (07:29)
Yeah, it's case by case because it's goal dependent. if someone's just like, I want to have less pain and I want to be able to play with my kids or go for a round of golf, that's like, is there, you know, does it matter if it's eight sets or six sets or 10 sets or 12 sets? Like as long as they're like, again, like I'm always like, we're looking at the objectives and we're making sure that we're A, from like the things that I'm tracking from like an objective testing is moving in the right direction.

And then also subjectively, which I also think is objective, but like what they are saying, are they actually feeling the transitions from whatever they are doing in the gym to whatever they want to be able to do. So at the end of the day, that's all that matters. It doesn't matter if it's two sets or four sets or eight sets or 15 sets. It doesn't matter. If your goal is like, I like, I want.

a bigger chest or a bigger arm or I want more toned legs and we're looking at more like aesthetic, then yeah, we're probably going to need to up the volume as much as we can in order to achieve those things. And two days a week, I mean, we could probably do some, but I think you're gonna be capped at some point and nutrition's gonna probably have to be pretty dialed in to free to gain any sort of muscle and things like that. That's kind of where my mind is with that.

You know, far as like stuff like that too, like I like density sets, just like, Hey, here's 15 minutes. Here's two or three exercises. We're not just going to do three sets of 10 years. Going to do as much as you can to challenge yourself in that block. And then every single month, every single week after you're trying to do more. So more load, more reps, more sets, whatever it is, we're building up volume over that time. And that's one really great way to, again, move somebody from like, maybe they're only doing like, they can only really get in like.

six sets for any area of the body and then all of a sudden maybe towards the end of that block they're getting 10 or they're getting 12 because their capacity is getting better and that should account for the changes that we want to see.

Joe LaVacca (09:18)
Yeah, for sure. For sure. All right. So cool. So we can spread out sets. We kind of have a generic template that we like to use. Now, what about aerobic stuff? The things that we're always taught on social media is that everybody should be doing zone to 150 minutes a week. Mixing in some high intensity work. How do you go about that with your clients?

Joe Gambino (09:37)
Yeah, again, it's so it depends on goals and it depends on Kind of like the season so like when I'm planning for somebody I do plan out and like longer longer blocks I also tried to like change qualities over the course of a year. So like say someone's graduating from The rehab stuff and we're like getting to high-level loading maybe we'll spend you know a few months and like a shrunk block and then we may move to

depending on goals like a power block, right? Like we can use some power work and then it will move to like energy system work. Like those cycles will lend me to put more and more stuff. So if it's usually like we're working on like strength is the major stuff and we just want to get the heart rate up, then I'm probably gonna have more like, you know, maybe sprinkling some hip work or have them do some like higher level, like, you know, zone threes and stuff like that to really kind of get the heart rate up.

because we don't have a whole lot of time to kind of dedicate to multiple energy systems and we want to, you know, get them moving and kind of build that stuff. Again, also depends, like maybe someone doesn't really like that stuff or maybe they're a runner and they want to, and then we can maybe blend some zone two, zone three running, you know, depending on the person's goals and what they're, they're trying to accomplish. If they have races coming up, whatever that looks like for that person. If we are focusing on energy systems and I might mix a whole bunch, we may do some really high intensity stuff like all out efforts.

You know depending again goals that person what they're trying to accomplish I would probably pick like a major characteristic over any given month like hey I want the higher intensity stuff or maybe we will do some zone 2 because I don't know they want some some weight loss and maybe they just can't do Sprints or high level stuff. So then I think we're gonna kind of just like piecemeal here. So again kind of comes down to goals time, right

things like that, so I will kind of play with those things throughout. But usually, if we're working on other qualities, you're probably just gonna have one session throughout the week that's just going to be, get your heart rate up, we're gonna get it to spike, you're gonna let your heart rate come back down till you feel like you kind of caught your breath, and then you're go back into the next circle and get your heart rate back up again. So we'll play around with little things like that. I don't do a lot of measurements, so a lot of the people that I work with, where you're just using breath like.

Are you out of breath or can you, can you, talk test, like, can you talk and have a full conversation? Like that stuff starts to let me know like, okay, what kind of zone is somebody in? If you're like, if you're forced to mouth breathe, breathe, then we know you're going to probably be in like, you know, closer to maybe like a zone three. If you can have a full conversation, you're probably going to be in like zone two. if it's below that, you're probably doing not much here. You're down in the zone ones. It'd be very, very light, easy cardio, like you're walking. and then if you're like really, really out of breath and we're going to be seeing like the fours and the fives.

Joe LaVacca (12:11)
Yeah, yeah, absolutely. And I think a lot of it, like ⁓ we were saying is really about time. And one of the things that has been buzzing around too in social media in the industry is your VO2 max, right? Which is essentially how well your body utilizes oxygen during strenuous efforts or just day to day. So this is a very low level tactic. So I can talk to you and move my hands and think and, you know, look up some research and all this other stuff and it's not leaving me out of breath.

And to your point, all these different zones, right? I think people are too obsessed with, especially since the dawn of your Garmin watches and your Apple watches, and everybody can look at their heart rate 24 seven. And I think that's slowly shifting into a curse rather than a gift. And a lot of my clients now want to do all this zone to work because they think it's going to improve their VO two max, but

One of the people I follow online who I'd love to get on the podcast, she might be too big for us, she might be too big for a celebrity, is Alyssa Olnick. And she had this wonderful post last week, or maybe it was this week, but regardless, she was kind of saying how to improve your VO2 max, you can't start by doing all this lower level work because you're just not conditioned enough for that yet. So you have to do your zone threes and your fours and your high intensity stuff. even then cross-referencing a few things, I just like picked up a little handy dandy guide on VO2 max.

A lot of people's VO2 maxes aren't improving because of the zone two work. It's improving or a lot of the research I've seen is on high intensity work over the course of 6, 8, 10, 12 weeks. So I've been trying to relay to clients that, well, if you want this VO2 max, you got to work hard at it. And then when you improve it, that's what makes your zone two more accessible. Because I know when I started trying to do this zone two work, I would literally start jogging one block. My heart rate would be at 175.

Like, ⁓ like, and that's what my garment would say, but it would cross this threshold so far where I was out of zone two. So then I have to walk again and then get my heart rate all the way back down, start jogging back up to 170. Then I'd be all pissed off and then I don't want to do it anymore. And then by the time I had like, like three or four cycles, my, time was up to work out anyway. And I didn't sweat at all. I was just aggravated. So what did I get out of that? So really what helped me and what's.

kind of helped a lot of clients is, hey, you know what? I'm just gonna do the suck. I'm gonna do the suck. I'm gonna do my minute sprints, my three minute sprints or my four minute sprints or whatever. I'm gonna block these out a couple of times a week. And now when I do a zone two work because, you know, just feeling a little tired or it's a beautiful day outside, I want to stay outside. Well, I can. And I can actually be on the phone or I can actually talk to someone because I spent time building that up. So I think from your aerobic stuff, everyone.

Yeah, your 150 minutes is great if you can have the time for that as well as go to the gym twice a week. But newer research out there is also pushing us to think that your heavier intensity exercises make up for a lot of minutes in your lower sort of like zones. So if you're hitting your zone four or five, I don't know, 10 minutes a week, 20 minutes a week, that might be enough for you. might cancel out your zone one and zone two, at least for a while until you can.

make some time, make some space to really get the benefit there. So I know that was a little long winded, but I wanted to sort of just throw that out there for you and give the listeners a chance to think about that and you to retort or accept or whichever you want to go with that.

Joe Gambino (15:39)
No, I accept it again right always going back to someone's goals, right? It's a

Joe LaVacca (15:41)
Hahaha

Joe Gambino (15:45)
If you're just looking increased heart health, it doesn't matter, like zone two is probably gonna be great, but at the end of the day, if we're talking about VO2 maxes, you have to elevate the heart rate response. There are like, you're referring to it as like the lactate threshold, and there's like another one even after that, the anaerobic threshold, where if you're not exceeding those, you're probably not going to be making major changes to your VO2 max, to like your overall endurance, things within that nature. So you have to have...

this combination, it's great. Like, hey, if you're on a time crunch, like go hit your zone threes, your zone fours, your zone fives, you're to get like an equivalent of doing like a whole bunch of zone twos. But if you're looking to be able to have like a better VO2 max, better heart health, like lower your resting heart rate, do all those things, like having a layer of like hitting those higher heart rates are going to be necessary. And again, it's not like you're not going to do it all at the same time, right? Like you're going to probably want to plan like, Hey, this is going to be where I'm doing like.

A lot of my zone threes, my zone fours, my zone fives is gonna be where I'm doing my zone twos. Like if we're just talking about aerobic work, it's also gonna be kind of coinciding with like maybe what you're doing in the gym, right? Like you can't be like, hey, I'm gonna like one ORMs like really work on strength and then really work like high level like my zone fives for cardio because you're just not gonna have enough in any given body part to be able to sustain that.

Again, you just need to pick, if cardio is what it is, these are gonna be my higher ones, maybe trading is like, we're gonna be working more like GPP and how do get you moving good and all that stuff. And then when we're doing more like the zone two, zone three work, we're gonna have the ability to also work on power and things like that. And we have a whole lot of different ways we can go about that.

Joe LaVacca (17:20)
Sounds good, brother. All right, well, we'll leave that one short and sweet. I think this one will probably be around like Christmas time. People are getting busy. People are looking forward to different things. So, Joe, thank you. That's it. That's it. Oh, there we go. There we go. Well, Joe, thank you so much. I love you. Listeners, we love you if you made it this far. And don't forget to come back next week for another exciting episode of the Beyond Pain podcast.

Joe Gambino (17:28)
It's ready to plan for the new year in your training.