Podcast Summary
Tim Ferris interviews Eric Cressey on injury and pain management for athletes: Learn from Eric Cressey's expertise in injury and pain management, including the impact of psychosocial stress, sleep deprivation, and emerging biologics on injury risk.
On The Tim Ferris Show, Tim deconstructs world-class performers from various disciplines to extract the best practices for listeners to apply to their own lives. His guest in this episode is Eric Cressey, co-founder of Cressey Sports Performance and Director of Player Health and Performance for the New York Yankees. Eric is renowned for his extensive work with baseball players and has trained over 100 professional players. The conversation between Tim and Eric delves into various aspects of injury and pain management, including musculoskeletal imaging, radiology bias, the impact of psychosocial stress and sleep deprivation on injury risk, and emerging frontiers in biologics, stem cells, and PRP. Eric's personal best in deadlifts is 660 at a body weight of 181lb.
Understanding Back Pain Diagnosis Through Radiology Reports: While radiologists are experts in reading MRI, X-rays, and CT scans, practitioners with experience in rehab and strength and conditioning can provide further insights. It's important not to draw conclusions from a limited sample size and to consider the severity of pain alongside radiology reports.
Back pain is a complex condition that affects different people in different ways, depending on their lifestyle and activity level. While a radiologist's report can be helpful in diagnosis, it can also be confusing for a layperson to interpret. It's important to understand that radiologists go through a decade of education to learn how to read MRI, X-rays, and CT scans. Practitioners like Eric Cressey provide insights based on their experience in rehab and strength and conditioning. It's also important to understand that a radiologist's report doesn't always explain the severity of the pain, as asymptomatic people may show signs of severe degeneration on an MRI report. Drawing conclusions from a limited sample size is not recommended and can lead to incorrect diagnosis.
Importance of Physical exams and Case Histories for Low Back Pain Diagnosis: Diagnostic imaging alone is not reliable for diagnosing low back pain. Physical exams and case histories are critical to avoid false positives and misdiagnosis. Radiology is subjective, and normal images don't rule out extreme pain. Accurate diagnosis is essential, even in asymptomatic individuals.
Diagnostic imaging is just a piece of the puzzle for treating low back pain. It should be accompanied by physical exams and case histories to avoid false positives and misdiagnosis. Clinicians should refrain from routine immediate lumbar imaging for acute or subacute low back pain without serious underlying conditions. Radiology is a subjective interpretation of what's seen and might differ due to various reasons like showing patients' pictures before reading. Low back pain is difficult to diagnose as many people with normal images experience extreme pain and vice versa. Asymptomatic spines also show abnormalities, so it's essential to focus on physical exams and case histories more than relying on imaging. Elite athletes also demonstrate hidden stress fractures, which highlight the importance of accurate diagnosis.
Understanding and Diagnosing Low Back Pain in Athletic Populations: Assess population norm, have a conversation with patients, report all symptoms including prescription med side effects, use heel stomp test with professional help, and get a second read on radiology images to avoid misinterpretations.
Low back pain is not the same for everyone and varies based on population norm. Understanding our population norm is essential for diagnosing and preventing low back pain, particularly for very athletic populations. A movement diagnosis can help relate how we move to what's actually taking place in the context of our symptoms. It always starts with a conversation because people always under report. A prescription med side-effect can cause low back pain which people might think is unrelated, thus reporting everything is very important. The heel stomp test is an excellent test for compression sensitivity, but ensure that it is done with professional help. Lastly, it is essential to get a second read on radiology images to avoid misinterpretations.
Musculoskeletal Side Effects of Acne Medication: Medical professionals must have personalized conversations and screenings while considering pharmacological interventions, vitamin deficiencies, and magnesium levels to provide the best possible care for athletes suffering from musculoskeletal pain.
Athletes taking acne medication may have musculoskeletal side effects, so it's important to have conversations about past and current medications. Additionally, a postural screen can provide clues to potential issues with movement and musculoskeletal pain. It's essential to have a comprehensive team, including physical therapists and orthopedists, to address these concerns and provide proper rehabilitation. Medical professionals should dig deeper on pharmacological interventions and consider vitamin deficiencies and magnesium levels as possible contributors to musculoskeletal issues. Every patient is unique, and it's essential to have personalized conversations and screenings to determine individual treatment plans. Chronic pain can be a complex issue, and it's crucial to have a team approach to provide the best possible care.
The Importance of Proactive Screening and Correct Exercise Selection for Lower Back Pain.: Identify and address daily living struggles with proactive screening tests, addressing loading aberrant patterns and compensatory issues in the lower back. Use manual therapy and exercise selection for lasting relief.
To prevent missing any issues, it's important to have both general and specific screening tests. Proactive screens can help people identify activities of daily living they struggle with. Lower back pain can be caused by loading aberrant patterns or compensatory issues, resulting in poor motor control and glute strength. Loading aberrant patterns can be identified through an understanding of predictable patterns of asymmetry that experts talk about. By using a combination of in-house test retest and manual therapy, initial changes could be followed up with exercises to make those changes stick. Proactive screening and proper exercise selection are vital to prevent further exacerbation of lower back pain.
The Importance of Proper Hip and Spine Rotation for Body Health: Improper rotation of the hips and spine can lead to back pain and other joint abnormalities, emphasizing the need for proper mobility and avoiding hypermobility to prevent long-term movement issues.
Our body's design needs to get a lot of rotation through our hips and a lot of rotation through our thoracic spine and cervical spine, but sometimes people go to the wrong places to get it, leading to issues like back pain. Poor hip mobility can create problems due to reactive changes in the hip. Every joint in the body can have abnormalities due to wear and tear of playing any sport at a high level. Having too much movement at one joint, like rotating at the lumbar spine, can cause hypermobility, leading to a collection of different issues. Our body's variability and foundational abilities decrease over time, which can lead to long-term movement issues.
Understanding the Importance of Early Diagnosis and Training Interventions for Tendinopathy: Early identification of tendinopathy through movement diagnosis and proper training interventions can prevent musculoskeletal issues. Proper posture and thoracic mobility exercises can significantly improve movement proficiency in deskbound and athletic populations.
Tendon problems are more common than clinical diagnosis suggests. Musculoskeletal health should be viewed as a symptomatic threshold line, and it's crucial to diagnose the early signs of tendinopathy. Movement diagnosis is essential in training interventions, along with identifying postures of deskbound and athletic populations. In an athletic population, athletes extend and rotate that they arch their upper back so much that they move in the exact opposite direction, lose the conex concave relationship between the ribcage and the scapula. Training interventions for people with poor thoracic mobility should include a lot of reaching, rounding, and rotating to drive flexion, and separating static posture from movement proficiency.
The impact of prolonged computer use on posture and how to improve it.: Encourage movement variability with safe exercises to improve posture, such as the unilateral cable rows. Introducing favorable movement patterns through warmups can also positively impact posture and movement quality.
Sitting in front of a computer for long hours can affect posture and mobility. The upper back posture is crucial for creating movement, especially rotation. The challenge is that people tend to do exercises that reinforce and worsen poor posture. It's important to have movement variability and exercises that safely allow for thoracic extension, such as unilateral cable rows. Teaching the thoracic spine to rotate can be impactful. Even if you are training every day, you have more hours to get it wrong than right. Using warmups to introduce favorable movement patterns exposes the body to new movements that can improve posture and movement quality.
Optimizing Mobility and Fascial Fitness through Specific Movements: Incorporating diverse ranges of motion into daily training can improve fascial fitness, mobility, and prevent pattern overload. Using multi-joint movements and positional breathing can expand range of motion and improve functional movement.
To optimize mobility through the T-spine, it's essential to follow up self-muscle fascial release with positional breathing to expand ribcage and add range of motion. Thomas Myers suggests patience and multi-joint movements are critical for fascial fitness, and kids crave movement variability. For shoulder blade mobility, hollow back pushups, cable presses, and landmine presses are better than bench press as they allow scapular upward rotation for functional movements. Adding exposure to different ranges of motion helps overcome pattern overload. Unyielding specificity in sports needs support from training that adds varied range of motion to people's daily lives. It's important to work on significant ranges of motion and avoid being stuck with small amplitude movements for extended periods.
The Benefits and Variations of Landmine Press Exercise: Landmine press is a great alternative for heavy overhead press; it offers free scapula movement and moderated overhead press. It provides concentric training that benefits athletes who struggle with axial loading. However, it is important to seek professional guidance before performing these exercises.
Landmine press is a useful tool for those who can't handle heavy overhead press weight or have shoulder issues. It allows for free scapula movement and offers a moderated overhead press. The concentric focus in training is beneficial because it allows for high volume work without soreness and matches up with pure loading in certain sports. Athletes who struggle with axial loading can benefit from landmine press and there are many variations available. However, it's important to have a professional's guidance when performing these exercises, as there may be mobility restrictions caused by injury history that one needs to unpack. Other useful exercises include chop and lift with cables and the Proteus.
Understanding the Fascial System and Its Role in Athletic Performance: The fascial system plays a crucial role in optimizing mobility and transferring force in athletes. Training can fine-tune this system, and manual therapy from professionals can help athletes achieve better outcomes while staying within their scope of practice.
The fascial system is a web-like, connective tissue matrix that is important in terms of learning how it restricts or optimizes mobility, and helps us transfer force. Fascially driven athletes use this system to effectively transfer force, which can be fine-tuned with training. While there are many modalities of manipulating the fascial system, it's important to stay within one's scope of practice. Manual therapy from professionals like massage therapists, physical therapists, or athletic trainers can help in fine-tuning the fascial system, leading to better outcomes for athletes.
The Fascial System and Soft Tissue Approaches: Soft tissue approaches such as dry needling, pin and stretch techniques, and cupping can positively affect the fascial system in muscle recovery and injury prevention. Proper follow-up interventions can sustain these changes, resulting in improved range of motion and reduced pain.
Different soft tissue approaches like dry needling, pin and stretch techniques, active release technique, instrument-assisted approach, classic massage, and cupping can impact the fascial system in more ways than one. While the academic world is still trying to understand why these interventions work, changing the way fluids move can lead to better gliding of tissues, relieving transient symptoms. However, it is crucial to follow up with the right interventions to make the changes stick and reduce the risk of injury in the long run. When done correctly, manual therapy is an integral part of the athletic world and has numerous benefits, like improved range of motion and reduced pain. Overall, different soft tissue approaches can impact the fascial system in several ways and have a significant role to play in muscle recovery and injury prevention.
The Importance of Glutes in Posterior Chain Strengthening: Strengthening glutes and other muscles in the posterior chain is necessary for functional carryover to daily life. Deadlifts, kettlebell swings, and hip thrusts are effective exercises for hinging action, while power training is crucial as we age.
Glutes play a vital role in hip extension and terminal hip extension. Inadequate hip extension causes back pain and front hip irritation due to hamstrings' dominance. Glutes are like the rotator cuff of your hip and part of the comprehensive system. Strengthening the posterior chain, including glutes, adductor magnus, hamstrings, and to some degree, lower back, is necessary for functional carryover to the real world. Deadlift, kettlebell swings, and hip thrusts are some go-to exercises for posterior chain strengthening and hinging action. Power training is important, especially as we age because power is strength with a time component. Biomechanically efficient ways for most people to accomplish various lifting tasks are in a hinge pattern.
The Importance of Power Training and a Movement Diagnosis for Aging Adults: Regularly challenging power through activities like sprinting, tennis, or throwing med balls is crucial for preventing falls and injuries as we age. A movement diagnosis can identify underlying issues to help prevent potential pathologies.
Power training is crucial to prevent falls and injuries as we age. Power tends to de train faster than strength or capacity, hence it needs to be challenged regularly. Power training involves higher velocity activities such as sprinting, tennis, or throwing med balls. Being athletic into age is important for maintaining power and mobility, such as golfing for the older adults. The book 'Diagnosis and Treatment of Movement Impairment Syndromes' by Shirley Sarin is a landmark book in the Health and human performance realm for changing the perspective from a medical diagnosis to a movement diagnosis. It helps to identify one movement issue that could create a number of different pathologies.
Closing the Gap Between Knowledge and Implementation for Achieving Success: Understanding behavioral nature and focusing on upstream concepts like sleep, nutrition, and high-level care is essential to optimize athletes' performance. Movement diagnosis and exploring new training programs can prevent injuries and improve performance. Books by the Heath Brothers provide insightful content for decision-making and problem-solving.
Closing the gap between knowledge and implementation is essential in achieving success in any industry. Behavioral nature plays a crucial role in understanding what motivates people and getting them to buy into different ideas. It is important to focus on upstream concepts like sleep, nutrition, and high-level care to optimize athletes' performance. Even seemingly healthy athletes may have underlying medical issues that must be addressed. Movement diagnosis, derived from Sammon's work, is essential to identify and address problems early on. The Heath Brothers' books are highly recommended for their insightful content, which helps individuals in decision-making and problem-solving. Experimenting with new training programs can help overcome injuries and perform better.
The significance of a personalized approach to rehabilitation: Effective rehabilitation requires a personalized plan that includes hands-on therapy, proper coaching, and comprehensive evaluation. Identifying individual shortcomings and addressing all areas of concern, including sleep, hydration, and overall activity patterns, is crucial for recovery. Building a cohesive team of professionals and understanding normal asymmetry in athletes is also important.
Effective rehabilitation requires a personalized approach that includes hands-on therapy, proper coaching, and comprehensive evaluation. It is not enough to just do exercises; they need to be done correctly. Failure to receive proper therapy can not only prevent recovery but can also cause further damage. Successful rehabilitation involves identifying individual shortcomings and designing a plan that addresses all areas of concern, including variables outside of therapy such as sleep, hydration, and overall activity patterns. Building a team of professionals who work together cohesively is crucial. A personalized approach is especially important for athletes who experience normal asymmetry, such as baseball pitchers, where incorrectly applied therapy can cause additional injuries.
Specialized Approaches to Rehabilitation for Baseball Players: Baseball players require specific exercise selection and coaching tailored to the way the game is played. Advocating for oneself as a patient and seeking out specialists familiar with the unique demands of the sport is crucial for effective rehabilitation.
Rehabilitation is becoming more specialized for different populations and their unique demands. The baseball population was an underserved population that required specific exercise selection and coaching tailored to the way the game challenged them. The game of baseball has experienced a dramatic shift with increasing specialization among younger players, rising fastball velocity, and increasing player size. Having a generic program and doctors that don't see many baseball players will not adequately condition players for the game's demands. It is crucial to advocate for yourself as a patient and tailor treatment to your specific issue. Some subgroups of patients, like baseball players with significant elbow symptoms, may require a more specialized approach from an elbow specialist familiar with their unique demands.
Being an Advocate for Athletes: Specialization and Individualized Care: To be an effective advocate for athletes, seek out specialized care that prioritizes individualized treatment over generalized approaches. Build a network of trusted professionals and scrutinize their methods to ensure the best possible outcomes for athletes.
It is important to be an advocate for athletes by being specialized in the particular realm, especially for overhead athletes. Advocating for the athlete entails rehabilitating them instead of treating the MRI because specialization is critical in the modern era. The approach should be individualized to keep enhancing the game, network of people, and tools to recommend to become better advocates. First, ask around to align with a surgeon who has great bedside manners and strong relationships in the realm. Secondly, consider specialization in case of unique and more complex diagnoses that may require traveling to find the right specialist. Finally, it is critical to scrutinize resumes of rehabilitation specialists to make sure the model they employ adheres to individualized care.
Finding the Right Medical Practitioner for Injury Treatment.: Seek out practitioners with diverse skill sets and a focus on return to performance. Don't be afraid to look for referrals from successful sports coaches, and prioritize finding a practitioner who cares about your progress.
When seeking medical practitioners, it's important to look for those with diverse skill sets who can use different methodologies to help get you better. Working with practitioners who treat competitive athletes can be beneficial due to their high standard of care and mindfulness to timelines. When dealing with injuries, it's important to focus on return to performance rather than just being asymptomatic or able to return to play. Beyond structural abnormalities, movement diagnosis also involves understanding function and patterning. One way to find a good practitioner is to reach out to coaches of successful sports teams for referrals. Ultimately, it's important to treat injuries like an athlete and not just a patient, and to prioritize finding practitioners who have proven themselves clinically and genuinely care.
Improving Scapular Patterning to Treat Shoulder Pain in Athletes.: Adjust exercise selection and use soft tissue work to improve safe overhead movement. Avoid exercises inappropriate for certain predispositions or limitations. Table-based assessments aid in identifying movement issues.
Shoulder pain in athletes can be caused by poor scapular patterning, which can limit safe overhead movement. Adjusting exercise selection and using soft tissue work can help improve movement. It's important to be mindful of what exercises may not be suitable for individuals with certain predispositions or limitations. Exercises that involve heavy bilateral loading or compression in certain positions may not be suitable for people with discogenic issues or those with stiff hips. Table-based assessments can help identify movement issues and inform exercise selection. In some cases, what an athlete chooses not to do can be just as important as what they choose to do in training.
Understanding Ural Angle and Infras Sternal Angle for Squatting Patterns: First sternal angle width can indicate squat patterns with hinging or good form. Those predisposed to injury should focus on connective tissue remodeling and dorsiflexion to prevent compensations.
Ural angle and infras sternal angle are important measurements to consider when looking at squat patterns and predicting how people may move. Wide first sternal angles tend to hinge in their squats, while narrow first sternal angles tend to have a very good squat pattern. People who are biased towards being really strong, like weightlifters, power lifters, NFL linebackers, running backs, they often have wide first sternal angles. Individuals need to be mindful of an injury-predisposed condition, where they may have developed compensations above the ankles, leading to a rotational pattern of movement. Therefore, people should take their time with connective tissue remodeling and work on their dorsiflexion.
The Importance of Developing a Broad Foundation for Young Athletes.: Encouraging young athletes to focus on increasing range of motion, training hard with ample load and volume, and engaging in long chain compound movements can help prevent future orthopedic issues. It is important to advocate for the overall health and development of children in today's specialized era of youth sports.
Young athletes specializing in one sport year-round are missing out on developing a broad foundation and rich proprioceptive environment, which can lead to orthopedic issues in the future. To create a lasting change, get long (increase range of motion), get strong (train hard with ample load and volume), and focus on long chain compound movements. While there may be arguments about the best ways to create a transient change in range of motion, the fitness industry agrees on the importance of these two factors. Advocating for your child's overall health and development is crucial in this specialized era of youth sports.
The Importance of Warmup, Mobility and Preservation of Range of Motion for Bulletproof Athletes: Don't ignore warmup and targeted mobility, especially as you age. Orthopedic interventions can have downstream effects, so train non-injured side during rehab to preserve strength. Focus on preserving range of motion in all areas for a healthy body.
Warming up before a workout is crucial and should not be ignored, especially as one gets older. A targeted mobility initiative between sessions can also help preserve the body's range of motion. Orthopedic interventions don't just fix a specific joint, but can lead to downstream effects like lost motion and compensations in other areas. It's important to train the non-injured side during rehab to preserve strength and avoid atrophy. Creating bulletproof athletes requires attention to warmups, mobility, and preserving range of motion in all areas of the body.
Focus Areas for Bulletproof Athletes: To become a bulletproof athlete, focus on hip mobility, spinal and joint stability, posterior chain strength, single leg movements, and posture. Warm-up and gradual progression are key, and find your strengths to become passionate.
To be a bulletproof athlete, one should focus on aspects like adequate hip mobility, stability of the lumbar spine scapula, and glenohumeral joint, posterior chain strength, more pulling than pushing, single leg movements, soft tissue work, attitude, adequate deloading periods and daily posture. However, it is important to understand that these aspects are based on a joint by joint approach, where some joints are more conditioned for mobility while others require more stability. While attitude is crucial, fear when under a bar is a recipe for injury. Therefore, taking warm-up seriously and gradually building up to heavier weights is essential. Instead of following your passion, it is important to find what you are good at and then become passionate about it.
Building Career Capital Through Marketable Skills: Following your passion is not enough; developing unique, in-demand skills sets you apart from others and leads to greater compensation, work-life balance, and autonomy. Isometric training can improve tendon health for hyper mobile athletes with chronic tendon issues.
Following your passion is not always enough to make you stand out in the marketplace. It is important to build career capital by developing marketable skills that differentiate you from others in your field. Developing skills that are unique and in-demand can lead to greater compensation, better work-life balance, and more autonomy. Passion is still important, but it is not the most important factor in setting yourself apart from others. Isometric training can be beneficial for hyper mobile athletes and can improve tendon health. Dr. Keith Barr's research has shown that isometric holds have a favorable biochemical response and can be especially helpful for chronic patellar and Achilles tendinopathy.
Incorporating Hanging Exercises and Correct Breathing Techniques to Reduce Muscle Tone and Promote Musculoskeletal Health: By incorporating hanging exercises and correct breathing techniques in warm-ups, athletes with limited shoulder flexion can reduce muscle tone and maintain mobility. Using different variations and adjusting body weight while not specializing can promote musculoskeletal health.
Incorporating hanging exercises in the warmup and integrating correct breathing techniques can be effective in reducing muscle tone and deloading, particularly for athletes with limited shoulder flexion. It’s important to use different variations of hanging exercises where bodyweight can be adjusted as per the athlete's fitness level. The duration of hanging can be for approximately 5 breaths that may take close to a minute, particularly for stretching the upper body muscles. A protocol that includes a wide variety of movements is important to maintain mobility and musculoskeletal health. Athletes and parents should focus on not specializing at a young age and continuing regular movements well into adulthood. Supplementation can be helpful in promoting musculoskeletal health.
The Importance of Rotational Capacity in Athletic Movements and the Role of Good Practitioners in Preventing Injuries: Loading dysfunctional patterns without proper guidance can lead to pain and injury. Seek the advice of a good practitioner to determine the need for stretching and enhance stiffness and motor control to avoid long-term discomfort.
Rotational capacity is often overlooked but vitally important in athletic movements like golf swing, tennis, baseball swing, etc. Loading dysfunctional patterns like pushing through pain or stretching without an actual rationale can make things worse. Adding good stiffness and motor control to the system can resolve tension or protect a debilitated low back. You need good practitioners to help you determine whether you should stretch or not, just like you need a lawyer for a contract, a doctor for an MRI or an accountant for taxes. Poop throwing in exercise can lead to a lifetime of pain, which is why it's important to have a good practitioner to guide you.
Navigating the Challenge of Finding Legitimate Health and Wellness Professionals: Start by conducting a comprehensive medical intake and looking for practitioners with movement competency and an awareness of optimizing movement quality. Keep in mind that lack of licensure is a major issue in the industry, so be wary of fly-by-night operations.
It is important to seek qualified professionals when it comes to health and wellness. However, the fitness industry's low barrier to entry makes it challenging to check legitimacy. A comprehensive medical intake is a good start when considering working with someone. Lack of licensure is a major problem in the industry, which leads to fly-by-night operations and makes it difficult to determine good versus bad practitioners. Ensuring equipment maintenance and facilities are well-run is also important. Movement competency and an awareness of optimizing movement quality are key qualities to look for when choosing a practitioner. Unfortunately, there are no certifications that are more compelling than others, making it challenging to identify qualified professionals.
The importance of certifications and high standards in the fitness industry: Certifications provide a critical threshold, but most learning happens on the job. The fitness industry needs to uphold high standards and offer specialized certifications. Learning from experienced professionals can make a significant impact on one's career.
Certifications are important in the fitness industry as they provide a critical threshold, but most learning happens on the job. Specialized certifications like the Certified Functional Strength Coach and Mike Robertson's certification are well-regarded, but there is no one certification that heavily differentiates really well. However, the industry needs to be better at upholding high standards and not just have a low entry barrier. People in other professions spend years perfecting their skills, whereas in the fitness industry, people can get certified in a weekend. Despite this, motivated people can make a difference in the industry and impact people's lives profoundly. Learning from experienced professionals like Jesh Patel can also make a significant impact on one's career.
Eric Cressey discusses the importance of impacting youth sports to ensure the next generation remains healthy.: To address the injury epidemic in young athletes, strength and conditioning, biomechanics, sports science, and mental skills must work together to protect their health. Coaches and mentors play a crucial role in helping athletes succeed. Care about the athletes and build relationships to understand their condition and give their best performance.
The key takeaway from Eric Cressey's discussion is to focus on impacting youth sports to ensure that the next generation of athletes can remain healthy. The injury epidemic in baseball is becoming a major issue with kids as young as 16 throwing pitches at 100mph. Sports medicine can't keep up, so it's up to strength and conditioning, biomechanics, sports science, and mental skills to work together to address this issue. Eric Cressey believes that the big picture is the future generation of talented players and how we can help them stay healthy. Therefore, it's necessary to care about the athletes and build relationships with them on a personal level to understand their condition, to protect their health, and help them give their best performance. Mentors and coaches play an important role in helping athletes stay healthy and succeed.