podcast Peter Attia 2025-05-26 topics

#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.

Audio

Show notes

Kyler Brown is a sports rehab chiropractor who specializes in injury recovery, pre- and post-surgical rehabilitation, and guiding clients from rehab back to peak performance. As co-founder of the private training program 10 Squared alongside Peter, Kyler shares his approach to injury prevention and performance optimization—highlighting how overlooked movement patterns can quietly lead to chronic issues over time. He outlines a practical framework for assessing and treating individuals, highlights the importance of understanding movement dynamics and asymmetries, and discusses personalized rehab strategies through real-world case studies. The conversation also explores the psychological side of recovery, including the role of fear and mental barriers in rehabilitation. Kyler shares actionable tools to evaluate movement patterns and implement training strategies that support long-term strength and health.

A companion video series demonstrating exercises for common problem areas—such as the lower back, neck, shoulders, and knees—is available exclusively to subscribers on the show notes page.

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We discuss:

The personalized rehab strategy for Peter’s shoulder surgery that sparked creation of a training program called 10 Squared [3:00];
Training for the marginal decade: why precision and purpose are essential for quality of life [11:00];
The Centenarian Decathlon: how training for long-term capacity enhances both current and future quality of life [18:00];
How the shortcomings of conventional rehab and performance systems led to the creation of 10 Squared, a personalized training model focused on long-term physical capacity and individualized care [23:45];
Case study: how personalized assessment and treatment at 10 Squared helps uncover the root causes of injuries [31:00];
The role of the “core” in movement and injury prevention, and the importance of training stability before strength [40:15];
The layered assessment process used at 10 Squared to determine whether a person is ready to perform dynamic movements [47:45];
Case study: the rehab plan designed to treat a hamstring injury while preserving fitness and preventing reinjury [51:45];
Training approach for clients with minimal training history: risk reduction, habit-building, and long-term consistency [55:30];
How to train foot reactivity, tendon resilience, and explosive capacity in a safe, progressive way [1:00:00];
Peter’s foot and ankle pain: how to diagnose, treat, and strengthen the lower extremities [1:04:15];
How fear and perception influence recovery, what drives back pain, and when to choose surgery vs. treatment [1:13:15];
Could AI and app technology eventually deliver an individualized rehab and training experience? [1:22:30];
Kyler’s professional evolution from traditional chiropractic care to a degree-agnostic, performance-based rehab philosophy [1:25:00];
How 10 Squared provides precision rehab and training in a remote format [1:30:30];
How Peter resolved a severe back pain flare-up using DNS-guided isometric exercise instead of passive treatments [1:33:15];
How to identify and treat common joint pain (neck, back, knee, shoulder) using a rehab framework that strengthens supporting structures and helps avoid surgery [1:39:00]; and
More.

Show Notes

Notes from intro :
Dr. Kyler Brown is a sports rehab chiropractor who specializes in sports injuries, pre- and post-surgical rehabilitation, and bridging the gap from rehab to performance
He is the co-founder (along with Peter) of 10 Squared An Austin based, private member training program focused on building and maintaining exceptional muscle capacities for the marginal decade
Originally this was a conversation that was recorded just for the 10 Squared audience, but once we saw how much the clients there appreciated it, we decided to repurpose it as a podcast for all of you
An Austin based, private member training program focused on building and maintaining exceptional muscle capacities for the marginal decade

In this episode we discuss

The principles behind injury prevention, recovery, and performance optimization Including how small movement dynamics can lead to chronic issues
A framework for assessing and treating individuals The importance of understanding (from doing movement patterns) functional asymmetries and personal rehab approaches
Specific case studies including Kyler’s work with professional athletes and others to demonstrate the benefits of individualized strategies
The role of fear in movement and rehabilitation, and how overcoming mental barriers is just as important as physical recovery
Actionable strategies for you to assess your own movement patterns and implement proactive training techniques to build strength and longevity
In addition to this conversation, Kyler also filmed a short series of videos in the gym demonstrating exercises for common issues like lower back, neck, shoulder, and knee pain These are designed to help you put some of these concepts from today’s episode into action The videos are only available to subscribers, and can be found on the show notes page
Including how small movement dynamics can lead to chronic issues
The importance of understanding (from doing movement patterns) functional asymmetries and personal rehab approaches
These are designed to help you put some of these concepts from today’s episode into action
The videos are only available to subscribers, and can be found on the show notes page

The personalized rehab strategy for Peter’s shoulder surgery that sparked creation of a training program called 10 Squared [3:00]

A few years ago, when Peter was in the throes of recovery from shoulder surgery, he and Kyler had this idea to put together 2 things that seemed unrelated His recovery from an injury The idea of a Centenarian Decathlon in a marginal decade [ episode #261 goes into detail about the Centenarian Decathlon]
Peter met Kyler 4 years ago, as soon as he moved to Austin They worked on preventative stuff: DNS and routine maintenance [ episode #152 goes into detail about DNS]
On the second or third visit, Kyler asked about Peter’s shoulder
And that kicked off this whole conversation because in Kyler’s world, this idea of just doing one technique or providing one service isn’t really a complete approach
Peter had torn his labrum before The diagnosis was made in 2009 when he had his first arthrogram done This is a MRI where prior to you going in the scanner, the radiologist takes a needle about 4 inches long, shoots the needle into the capsule and injects contrast so that it really allows the MRI to show the labrum and how much it’s detached from the glenoid fossa It was significantly torn but not as torn as it would be 13 years later
Peter had largely avoided surgery by doing as much as he could to strengthen the rotator cuff
And frankly, he was afraid to have surgery He didn’t want to trade one problem for another He didn’t want to trade want to trade pain and instability for immobility
Folks listening may recall his discussion with the amazing surgeon Alton Barron on the podcast [ episode #232 ] who ultimately did the repair
What Peter was most impressed by in that experience was that Kyler and Alton started working as a team
His recovery from an injury
The idea of a Centenarian Decathlon in a marginal decade [ episode #261 goes into detail about the Centenarian Decathlon]
[ episode #261 goes into detail about the Centenarian Decathlon]
They worked on preventative stuff: DNS and routine maintenance [ episode #152 goes into detail about DNS]
[ episode #152 goes into detail about DNS]
The diagnosis was made in 2009 when he had his first arthrogram done This is a MRI where prior to you going in the scanner, the radiologist takes a needle about 4 inches long, shoots the needle into the capsule and injects contrast so that it really allows the MRI to show the labrum and how much it’s detached from the glenoid fossa
It was significantly torn but not as torn as it would be 13 years later
This is a MRI where prior to you going in the scanner, the radiologist takes a needle about 4 inches long, shoots the needle into the capsule and injects contrast so that it really allows the MRI to show the labrum and how much it’s detached from the glenoid fossa
He didn’t want to trade one problem for another
He didn’t want to trade want to trade pain and instability for immobility

Talk a little about what you guys did 8 weeks prior to Peter’s shoulder surgery

One of the things as a rehab professional that Kyler really appreciated was how Alton didn’t want to just cinch down that joint to where his liability was so covered that that shoulder would be strong, but then have Peter lose a ton of function
One of the key things that Alton did was he put the staples and the sutures in the right places to where that shoulder would be functional (he did just the right amount)
And Kyler worked with Peter to get his shoulder well before more significant structural compromise
It’s a really important window to do so
Kyler remembers that conversation ‒ Peter had a date several months out where he was like, “ I’m going to have to use my arm a lot. I need to be strong. ”
Peter wanted to be able to hunt in September
So the surgery needed to be no later than March

It was January, and the question was should he do the surgery right away or use 2 months to prehab?

How did you think about that question?

That conversation was one of Kyler’s favorites because he’s done this before where if we know the big picture goal as well as the near term surgical date, and then we reverse engineer
Okay, I want to check off a certain amount of things preoperatively to where that joint is ready
Essentially in the most simple terms, what you’re looking for in that situation, is you want to make all the muscles around the shoulder just awesome Especially with the shoulder because it’s such a mobile joint But we need to do so in a way that doesn’t make the surgery more complicated or injure you more
He combined a lot of things Technology like BFR [blood flow restriction discussed in episode #179 ] Aggressive approaches on core stability
The way the scapula interacts with ribs and all these things have an effect on how the shoulder moves
If the mobile shoulder that has a torn labrum isn’t stable and doesn’t have a support infrastructure around it, you’re always going to ask for more pain
Once things were healing from the surgery itself, all those other ancillary things were actually functioning really well
So now we only had to really target the shoulder itself because the rest of the human was really strong and ready
Especially with the shoulder because it’s such a mobile joint
But we need to do so in a way that doesn’t make the surgery more complicated or injure you more
Technology like BFR [blood flow restriction discussed in episode #179 ]
Aggressive approaches on core stability

What Peter remembers

How much rotator cuff work he did ahead of time, particularly around supraspinatus He got that muscle as strong as possible in 8 weeks Anyone who’s gone through that type of rehab knows it’s uncomfortable You’re burning a tiny muscle that’s not used to working that hard
He got that muscle as strong as possible in 8 weeks
Anyone who’s gone through that type of rehab knows it’s uncomfortable
You’re burning a tiny muscle that’s not used to working that hard

“ The second thing that I remember and hands down the most important thing was what you and Alton decided to do postoperatively completely shattered everyone’s understanding of what we do with these patients. ”‒ Peter Attia

Peter didn’t have a slap tear, his labrum was hanging on by a thread
Traditionally a surgeon’s primary objective is to make sure that is never unstable again Cincy it down really tight The patient will be in a sling for 4-6 weeks, and that’s going to give it plenty of time to heal
But you’ll never regain mobility, never regain the healthy range of motion, and you’ll probably atrophy away
Cincy it down really tight
The patient will be in a sling for 4-6 weeks, and that’s going to give it plenty of time to heal

⇒ Alton’s goal was to have Peter out of a sling in 24 hours

Kyler points out, “ The broader picture here is what we touched on, the liability. And it’s really difficult for modern physicians and rehab pros to integrate. ”

Professional sports try to achieve this as well, but they have time constraints and all these other constraints with how many people they’re working with
Ignoring all those layers, the most important thing is Alton and Kyler had these conversations in detail and Alton was really specific about, “ Okay, did we get the training we talked about? Is that supraspinatus, the serratus anterior, all these other muscles that help stabilize? Are those really good? ”
Kyler had some metrics he was able to discuss with Alton, and Alton felt confident in the stability of Peter’s shoulder

The decision about no sling was based on the preparation they did and what they knew

The other thing was Peter followed everything to a T

“ One of the big complications in rehab (athlete or not) is are people following the rules? ”‒ Kyler Brown

If we take this individual out of a sling, are they going to forget about it and all of a sudden go reach for the cereal or are they going to follow the rules?
Peter was definitely a rule follower
So Alton and Kyler had high confidence in minimizing the risk

Peter learned a lot the hard way from his first orthopedic surgery in 2000

He’s not even convinced he received post-operative instructions And if he did, he didn’t read them
He was breaking every rule there were
And if he did, he didn’t read them

Peter’s labrum repair surgery

The stakes were higher here in a way
Peter was very mindful
When you have surgery, you tend to go on YouTube to learn all about it He wanted to see everything: the post-operative, the rehab process
He wanted to see everything: the post-operative, the rehab process

Post-surgery exercise

One of the big milestones you see for people with labral surgery is when they basically can dangle the arm and rotate a light weight Alton was really clear, “ You’re not going to be doing that for a while. We’re talking about range of motion without stress on the repair .”
Very early on pre-operatively and post, we were able to do very gentle but targeted isometrics where there wasn’t complexity in the joint itself, but we were loading the tissues in a very articulate and specific way
And that’s how you again put the support structure around it
Kyler describes as the roll cage in a car, we want all the muscles around that to be ready to absorb force
So those joint structures that are getting the staples or whatever else in there aren’t stressed We don’t want to yank on those things while they’re healing
Alton was really clear, “ You’re not going to be doing that for a while. We’re talking about range of motion without stress on the repair .”
We don’t want to yank on those things while they’re healing

Training for the marginal decade: why precision and purpose are essential for quality of life [11:00]

In parallel to this, Peter continued to refine his thinking around the idea that we’re all going to have this marginal decade one day

It comes across as a depressing thought
Nobody wants to think about the idea that there will be a day when you enter the final decade of your life
But at the same time, to act as though it’s not true won’t make it not so

It occurred to Peter that the more deliberately we can train for that last decade (as though we are athletes), the more we can enjoy it

Peter has had both the privilege and curse of watching people in the final decade of their lives, and the thing people complain most about is what’s taken away from them physically
There are lots of people in the last decade of their life that are lonely because they were miserable sons of bitches and they don’t have family or friends
There are many people whose cognition has failed them long before their body has failed them

⇒ Really thinking about this in terms of large numbers, more than 2/3 of people in the final decade of their life when they’re really thinking about what’s impacting the quality of their life, it’s the physical part that they’ve lost that they miss the most

Sometimes it could simply be freedom from pain, but more often it is restriction of activity

Kyler’s experience working with professional athletes

It’s interesting to see these mature athletes who’ve been playing their sport for 8-10 years and they’re starting to look at this reality that their career is going to be over
They start recalibrating how they train because they start thinking about the long term
What’s really fun for Kyler is when they start to get that perspective of it’s not just about this weekend, it’s about the long game here

Kyler explains, “ To your point, a lot of people out there have the best intentions and they’re maybe even working hard, but there’s no precision. ”

Nothing’s accounting for their specific details, their nuances of their joints and how they move and how their body feels when they move and their trust in their body and all these variables

A lot of people either want to put in the effort and don’t know where to start, or a lot of people are putting in the effort but it’s not calibrated

Peter began to observe that in himself

He was doing a lot of activities because historically, he’d always done them We fall in a groove, this the type of exercise I enjoy doing
We fall in a groove, this the type of exercise I enjoy doing

He had to take an honest assessment

For every activity (just like for every investment), there is a risk and there is a reward Think about how investing in your 20s is different from how you should be investing in your 60s, 70s, and beyond
Risk and reward changes over time
For example, when you’re 20, the risk is inherently lower because you have better tissue
Younger people can get away with doing things incorrectly Some of the most gifted athletes actually have horrible patterns of movement, but because t hey’re so gifted, it doesn’t seem to matter
Specialization is one example Some people are just born jumpers and then you train it and they practice it when they play and they get better and better at jumping
Think about how investing in your 20s is different from how you should be investing in your 60s, 70s, and beyond
Some of the most gifted athletes actually have horrible patterns of movement, but because t hey’re so gifted, it doesn’t seem to matter
Some people are just born jumpers and then you train it and they practice it when they play and they get better and better at jumping

Kyle points out, “ But moreover, it’s almost like we’re set up for failure. ”

We’re set up with this baseline norm of, “ I could bench press 225 when I was a senior in high school ,” but then that individual is not accounting for the 20 years of lack of activity Lack of practice They’ve atrophied
Then they jump right back into the gym and they hurt things or they feel like they “ Can’t do it anymore. ”
Lack of practice
They’ve atrophied

The reality is it’s all about capacity: If you don’t use it, you lose it

A lot of us aren’t really thinking about, “ What if I actually actively lost, from an activity standpoint? ” Is it jumping? Is it mass, is it strength?
Kyler often sees this on the pain and injury side
Is it jumping? Is it mass, is it strength?

Injury doesn’t show up out of no where

It has reasons why it shows up
It’s compounded by emotional stress and all these other kind of multi-factorial things
When our brain perceives threat, we feel pain
Sometimes that’s a physical threat I haven’t jumped in a long time; I started jump roping All of a sudden I wake up, my Achilles is sore That doesn’t mean I ruptured my Achilles, but it does mean I was not prepared for that movement because I’ve been on the shelf for a long time
I haven’t jumped in a long time; I started jump roping
All of a sudden I wake up, my Achilles is sore
That doesn’t mean I ruptured my Achilles, but it does mean I was not prepared for that movement because I’ve been on the shelf for a long time

The analogy of an investment strategy is fantastic

People should make sure they’re accounting for all the buckets that their body needs to do Not just what they want to do
Demographics, western society, age, all these things play a role too
If you pull up the stats, a lot of people will have a high risk for low back [injury] or high risk for an ankle [injury] or whatever
Not just what they want to do

Jumping is a great example

When Peter was in his training peak (age 13-20), he was training a lot, and jumping was an enormous part of what he did
He was skipping rope 25 minutes every single day Lots of those are doubles Absurd amount of plyometrics
Then from age 20 to 40, he didn’t jump at all
One of his realizations was that he’d lost a lot of tissue pliability
Lots of those are doubles
Absurd amount of plyometrics

Now something that he does a lot of is low level jumping

The importance of play in maintaining capacity

Sometimes he gets really worried about having an Achilles rupture (that’s a middle-aged man injury) Playing soccer with his kid, he’s just waiting for it
Playing soccer with his kid, he’s just waiting for it

Kyler sees this all the time in his private practice

What he always tells people is, “ Look at your kids. ”
If you go to a coffee shop with your kids, one of them will run and jump off a rock and do a twist and land it
When was the last time one of us did that? Right?

⇒ That’s why they say maintaining play and always playing games and increasing that to where it’s randomized games (you’re actually reacting to things, because there’s the neuroplastic effects as well), but just for the tissues, rehearsed load on the Achilles in the foot [this maintains capacity]

If you go and get a job and you drive to work and you sit at your cubicle all day and you drive home and you didn’t jump, that times 5 or 20 years is going to cause a lot of lack of capacity in your tissues And you don’t want to learn that the hard way
What Peter has been doing in the intervening 25 years was swimming and cycling (non impact)
Hiking is fine, but it’s still not jumping, it’s not reactive
And you don’t want to learn that the hard way

Part of what made Peter start to realize this was playing sports with his kids

When you play basketball, soccer and baseball with kids, you realize it’s not a predictable movement It’s never the same movement exactly twice There are a lot of variables there
It’s never the same movement exactly twice
There are a lot of variables there

The Centenarian Decathlon: how training for long-term capacity enhances both current and future quality of life [18:00]

This gets to the idea of the Centenarian Decathlon [ episode #261 goes into detail about the Centenarian Decathlon]
[ episode #261 goes into detail about the Centenarian Decathlon]

Give me some of the things on your Centenarian Decathlon

Wrestling with his kids and grandkids Which means getting down on the floor, having the flexibility That bonding that you get when little kids are wrestling on the ground Kyler saw his dad recently doing that and he thought that was really cool He’s over 70 and he’s on the ground messing with Kyler’s three-year-old It was hard for him, but he got down there and he could do it and he didn’t suffer from it
Kyler fell in love with rucking over the last couple of years and so he wants to be able to really crank out some mileage, especially in national parks as he gets older He’s not looking to be an ultramarathoner per se, but he really want to be able to hike long distances with a pack on
Which means getting down on the floor, having the flexibility
That bonding that you get when little kids are wrestling on the ground
Kyler saw his dad recently doing that and he thought that was really cool He’s over 70 and he’s on the ground messing with Kyler’s three-year-old It was hard for him, but he got down there and he could do it and he didn’t suffer from it
He’s over 70 and he’s on the ground messing with Kyler’s three-year-old
It was hard for him, but he got down there and he could do it and he didn’t suffer from it
He’s not looking to be an ultramarathoner per se, but he really want to be able to hike long distances with a pack on

Peter asks, “ When you’re in your marginal decade, how many pounds would be your expectation? Give me some numbers. How many miles? How many pounds? ”

Kyler thinks his numbers will be a little distorted because he’s a big guy (6’3” over 200 lbs.)
He should be able to carry at least 20 lbs. without worrying about too much for 4-6 miles Peter likes that goal
Not too technical of terrain (not boulders and rocks), but he’d definitely like to go up and down hills (dirt track)
Peter likes that goal

What else?

Kyler grew up being an athlete
His youngest seems to be more inclined to be an athlete
As Kyler ages, he wants to be able to hang with him as long as he can
That means throwing, hitting a baseball as long as possible
Who knows how his son’s career will evolve, but the odds are they’re not going to be pros
Kyler wants to keep that base where he can keep playing with them as long as possible

“ To me it’s all about being able to still play with the grandkids because family is one of the most important things out there, and if your grandpa is sitting there and can do cool stuff, I think that serves as a great role model .”‒ Kyler Brown

Whereas if you’re suffering from an injury, you’re not healthy, then they want to hang out with you, but at the same time, kids want to go do stuff and Kyler doesn’t want to be left out
Peter agrees, kids typically don’t want to come into your world; you have to go into their world You have to be able to go fishing, hike
You have to be able to go fishing, hike

⇒ People listening to us who have young kids should not waste the opportunity to observe what young kids do

There’ll be different technologies in 25 or 30 years, but the principles will be the same
Peter knows that kids like to play and therefore playing with his kids today is giving him a dry run of what he wants to be able to do in 30 years

Kyler warns, “ If you aren’t building up these areas of need or you’re accidentally letting these certain athletic movements fall by the wayside, all of a sudden you’re like, ‘Oh man, I can’t do that anymore.’ ”

He loves coaching his kids’ basketball team
A grandpa of one of the other kids was out on the court with them one day He was 74, he was moving, he could shoot (no dunks), and every kid there, their eyes lit up They’re like, “ Grandpa can shoot. That’s crazy. ” That was a cool moment
He was 74, he was moving, he could shoot (no dunks), and every kid there, their eyes lit up
They’re like, “ Grandpa can shoot. That’s crazy. ”
That was a cool moment

That’s why playing with kids might be Kyler’s whole CD [Centenarian Decathlon]

When Peter first introduced this idea of the Centenarian Decathlon to the first of his patients

One of the bits of pushback he got (especially from people in their 30s and 40s) was, “ Peter, I’m not that interested in my 80s and 90s… I want to be a kick-ass 40-year-old. ”

What’s the flaw in that logic?

Everyone’s drawn to this high performance, be awesome right now, and that’s like a boom-bust strategy
You might pull it off, but you’re high risk and eventually you’ll hit the wall for a race car

But if we’re thinking long-term

Then by default, if I’m going to be an awesome 70 or 80-year-old, I kind of have to be an awesome 45 or 55-year-old
We’re going to be doing things now that make you crazy strong to help your lean muscle mass, that burns your fat, all those health risk things
But you’re also going to be way more prepared for whatever life throws at you

If your buddy talks you into going skiing or going to do a volleyball game or whatever else, you’re going to be way more ready for it if you’re thinking long-term and building this crazy robust foundation rather than just chasing the newest technique or the newest technology

The archery analogy Peter uses

Archery is something Peter enjoys
What you’re trying to do is train to be exceptionally accurate at 100 yards
This pushback from patients is telling him that they don’t care about 100 yards, they just want to be accurate at 40 or 50 yards
Peter is telling them, “ Trust me, if you’re an ace at a hundred yards, it’s like shooting fish in a barrel at 40 yards .”

This analogy has a deeper layer of truth

It’s a very nonlinear thing
100 yards isn’t twice as difficult as 50, it’s 4 or 5x more difficult

Similarly, to be really fit and healthy in your 90s is dramatically more of a demanding feat than just to be a fit 50-year-old

Kyler agrees, there’s a lot stacked against you
Plus variables that we’re not prepared for, we could roll our ankle
But give me somebody who’s strong all day and if they sprain their ankle coming out of the bar, odds are they’re actually going to sprain it less

⇒ All this insulation and capacity we put around us with the individual goals is crucial to prevent injury and these injuries can stack up and cause a lot of trouble, and then we get less healthy

That’s how you get these multipliers where I was on track to be really good, but this knee arthritis or this multiple meniscus repairs I had to get because I wasn’t stable Caused me to actually lose my hiking ability and then all of a sudden I got less healthy
Caused me to actually lose my hiking ability and then all of a sudden I got less healthy

How the shortcomings of conventional rehab and performance systems led to the creation of 10 Squared, a personalized training model focused on long-term physical capacity and individualized care [23:45]

Back to Peter’s shoulder recovery

Peter realizes how fortunate he was to have known Alton for a while, then to have met Kyler
He asked Kyler about building a business that just focuses on the training piece that’s outside of Peter’s practice, outside of Kyler’s practice A business that integrates it with everything that’s necessary to train a person for the marginal decade
Kyler brings in all of the cardio training, all of the strength and conditioning, the coaches to integrate the whole thing
They’re doing all of these things now in 10 Squared
Peter thinks what Kyler does is the hardest for people to wrap their heads around
People understand this training will Help them get a high VO 2 max Boost their Zone 2 Make them stronger
A business that integrates it with everything that’s necessary to train a person for the marginal decade
Help them get a high VO 2 max
Boost their Zone 2
Make them stronger

How do clients look at you? What do they figure is going on with you?

The assessment

The assessment takes 2 days and we’re looking under the hood a lot in a lot of different ways
In Kyler’s career, he had experience working with teams, and he became an off-season person for these athletes
By default he had to almost become a strength coach Not because he wanted to or that was his goal Because these athletes needed that bridge from “ I’m injured ” to, “ I might be injured ” to, “ Hey, I’ve got the green light for performance .”
All humans are moving up and down that spectrum based on our recovery and all these variables
What’s been fun at 10 Squared is Kyler gets to do all the assessment he wants, and it’s not really a clinical assessment
On the one hand, he’s looking at things that either have pain or that individual member has had a previous injury with and he’s accounting for that and making sure that’s on track or could be improved (and we add those things)
He also gets to play around and look at what else is weak What is this individual at risk for?
Not because he wanted to or that was his goal
Because these athletes needed that bridge from “ I’m injured ” to, “ I might be injured ” to, “ Hey, I’ve got the green light for performance .”
What is this individual at risk for?

For example, Kyler has a client who loves to surf

He’s got a shoulder issue, so by default surfing and swimming on a surfboard is a different position than a traditional freestyle stroke
So we had to make his shoulder uniquely robust in certain directions
And so that’s part of his strength program

One of Kyler’s biggest pet peeves in the rehab world is when people give someone 30 exercises that are really tedious and boring

No human sticks to that
They might do it for a week or 2
But if it’s not bridging to what they love and want to do, it won’t get there

If we can bake-in, ensuring that all the strength training won’t make them worse and we’re baking-in their little corrective exercises (or improving the gaps), that’s where you make a huge difference in how someone feels and how they can perform

How do you help a person who is not getting better?

They’ve had a “fill in the blank” injury (tennis elbow, lower back pain, shoulder pain), that’s not getting better

How do you help that person think about whether or not there’s an underlying structural problem that needs a surgical intervention or a more direct intervention versus you are not being instructed to do the right things or you’re being instructed and you’re not doing it?

It’s a heavy lift with a lot of details

Your orthopedic surgeon or your neurologist and then your rehab pro have to be in sync and have a relationship

And that’s very rare
What’s really interesting is the philosophy and the individual just spirit of either surgeon or the rehab pro: they have to be committed to the service oriented field
If they’re just doing it for money, they’re going to do it to scale like the PT mill Where there’s 4 clients with 1 therapist, and that therapist is probably doing the best they can They’re outnumbered and they’re not accounting for those 4 different people all at once
Where there’s 4 clients with 1 therapist, and that therapist is probably doing the best they can
They’re outnumbered and they’re not accounting for those 4 different people all at once

First off, it has to be one-on-one: a therapist cannot rehabbing you the same way they could rehab your grandma who had a shoulder issue

Peter asks, “ Are you saying that in some facilities, one PT will work with multiple clients at the same time and put them through the same workouts even if they’re quite different? ”

Yes
Typically it’s a very cookie cutter approach
Usually it’s an insurance model thing where they know that these certain exercises and putting ice or stim is going to be reimbursed by the insurance company
So that PT clinic is going to do that on everybody regardless of what they need

1 One of the biggest pitfalls [of PT] is it’s never one-on-one; it’s not custom

In the same way Kyler has had pro athletes come in and we’re supposed to do shoulder rehab that day and the night before they did a ton of stuff to their shoulder So guess what? He’s not doing anything They actually need to recover that day
It needs to be customized
So guess what? He’s not doing anything
They actually need to recover that day

To go back to the original question of how do people navigate this world

Kyler thinks your rehab clinic needs to do more than just offer services
They need to offer a plan
They offer cupping or dry needling or whatever it could be

⇒ One service doesn’t ever fix anyone, and it definitely doesn’t increase their capacity over time

The magic word of “capacity” is what it’s all about ‒ are you building me back to what I want to do?

If your rehab clinic is a bunch of passive modalities on tables and a bunch of techs doing ultrasound and stuff, that’s a red flag because they’re not going to build you to get stronger and stronger

2 The orthopedic needs to actually be hunting down that physical therapy

A lot of times, what Kyler sees in the orthopedic world is they have to give their clients something for rehab guidance
They’re not totally sure if their client’s going to go do rehab, can they afford one-on-one and all these other factors
So they give them this handout

⇒ A lot of times this handout is from 30 years ago and it’s the same 5 or 6 cookie-cutter exercises, but then there’s no accountability, there’s no nuance

There’s just a lot of holes in this path to try to get your shoulder or your back or your knee from: It hurts. Do I need surgery or not?
Built that all the way back up to: I can do whatever I want

Is this taking the extreme example at the other end, which is professional athletes come with deeper pockets than others and come from leagues?

Kyler has worked with golfers, football players, basketball players, baseball players, tennis players, runners

For example, when you’re talking about the NFL players, is that problem completely solved?

No, not at all
There’s a lot of environmental problems
Kyler has friends that work with all these professional teams, and they’re handcuffed because they only have their athlete for so long
All of a sudden you get this problem of “multiple cooks in the kitchen” where even if everyone has no ego and the best of intentions and they’re mostly science-based people, they’re still not sure, what the athlete did last week What are we trying to do? Are you in a contract year? There’s so many variables for a pro athlete
What are we trying to do?
Are you in a contract year?
There’s so many variables for a pro athlete

Case study: how personalized assessment and treatment at 10 Squared helps uncover the root causes of injuries [31:00]

Example: Peter’s wife is a client at 10 Squared

Jill is a runner
Peter is very hands off anything that has to do with her

What did you learn when you did an assessment of her, and how did that impact how she works with the other members of the team (on the cardio side, on the strength and conditioning side)?

Jill’s a really great example because she had some pain when she showed up
Kyler’s job immediately was to evaluate that pain Is that a structural insufficiency? Are we worried about a real injury here, or is that just an annoying nuance?
His clinical team is way more detailed than what he would normally do in his private practice because at 10 Squared we have the time and we want to remove confirmation bias So we don’t just say, “ Your hamstring hurts. Let’s order an MRI. ” Instead, let’s test it 6 ways and in a smart conservative way, and if all 6 of those indicate that, then we’re going to do an MRI
Is that a structural insufficiency?
Are we worried about a real injury here, or is that just an annoying nuance?
So we don’t just say, “ Your hamstring hurts. Let’s order an MRI. ”
Instead, let’s test it 6 ways and in a smart conservative way, and if all 6 of those indicate that, then we’re going to do an MRI

With Jill, he saw some proximal hamstring issues

She’s an endurance athlete and her profile, her demographics, her running history all pointed to there might be a tendonopathy there
The testing reinforced that
The next step was to get an MRI to really evaluate that tendon
Because we knew in the near term, within a year she wanted to run Boston
And as an injury person, Klyer realized that while she’s okay now (it hurts), once she starts stacking up mileage, that is a thing that’s going to get in the way
Normally she only runs 1 marathon a year, but last year she ran 2 Her Boston qualifying marathon and 7 weeks later the London Marathon
After London, she started getting a little bit of knee pain for the first time ever The knee on the other side from her hamstring issue
Her Boston qualifying marathon and 7 weeks later the London Marathon
The knee on the other side from her hamstring issue

Can you explain why you didn’t think that was a coincidence?

Kyler saw her for knee pain to get her through London
What a lot of people don’t appreciate about the way runners move, even though they’re moving straight ahead, technically, it’s a unilateral or single-leg rotation, propulsion drill
It’s counterintuitive
Golfers are actually the same
They’re single leg actually rotates to create that torque
Kyler’s favorite term that’s out there right now is called the “spinal engine,” which really speaks to this reciprocal movement of the spine on top of the pelvis and then the feet through the ground

⇒ What happens is those 3 domains work in unison to propel you forward

It’s a lot like with sailing, like you put the sail relative to the wind and it points me in direction
All three of those domains have to work in sync
When Kyler sees an athlete like Jill who wasn’t new to running but added volume in a short window ‒ that is a great recipe for injury

That right knee flaring up told him there’s something going on at either her feet or her pelvis that’s not in sync because essentially with her mileage, she overloaded that right knee and created a repetitive stress injury

That’s why Kyler was saying earlier, “ Injuries don’t just show up for fun. ”
Whenever you see a story like that and then you do the evaluation and the way her pelvis was rotating, the way her core and her spine were set up, and also the way that left hamstring was affecting her motion, she was basically dumping into that right knee over and over
10 miles for someone like her, no big deal
You stack up 2 marathons pretty close with that much mileage, and all of a sudden that right knee really flares up

The right knee flare up was actually an indicator of something else going on functionally

It wasn’t only about making her knee better, which is what traditional medicine does Rest it, ice it, Meloxicam treatment, rehab, whatever
Traditionally, those people go run again and 3 or 5 months later it comes back
Rest it, ice it, Meloxicam treatment, rehab, whatever

⇒ We we need to look at these asymmetries everywhere else, not just the side of pain

If the knee is caused by the hamstring, what do you think is the cause of the hamstring injury and why are middle-aged women so susceptible to this injury?

Demographically, a lot of middle-aged women don’t strength train
So the health of their tendons and the muscle fibers and the mass of the muscles just aren’t normally as high and as strong as someone else
Especially if they’re an endurance athlete

Runners nowadays know that they need to cross-train, but how they’re doing it, there’s is still a big gap

Using the word “cause” is always tricky in biomechanics because it’s always like the snake eats the tail: they’re all intertwined

The most simple way of describing it is that tendon overuse

Back to Jill’s assessment and treatment

What we found out with her MRI is that she had a true tendinopathy damaged to that proximal hamstring tendon, as well as one of the hip rotators that inserts on the same site next to that hamstring had a little damage and irritation
That area was a byproduct of the way she was rotating through her pelvis and the way that spinal counter rotation was happening
Jill has a tiny bit of scoliosis, which sets her up for that asymmetry
So her brain subconsciously was basically forced with the decision of, “ Do I jam my right low back or do I really try to pull with that left hamstring? ”
And that combination over time created a little fraying in the tendon

Peter points out, “ The other thing I would add to this, which I suspect any woman listening to us who’s had kids will appreciate is even though Jill is tiny, she said her body never went back to pre-pregnancy. ”

She talks about how she used to run before 2008 (when their first child was born)
She ran a bunch of marathons before then and she’s run a bunch of marathons since and she weighs the same She’s been very fortunate in that regard that her body weight hasn’t changed in that period of time
She says she cannot biomechanically do what she used to be able to do
Peter assumes her pelvis was mechanically changed having kids and she feels it, but she can’t articulate it (nor can he necessarily), but she just said there’s something different
She felt like she used to float and now she feels like she runs
Kyler can see that and thinks a lot of women feel that way
His wife had the same experience
If a running back were to blow an ACL, we know exactly what to do and there’s a protocol 8 months later this athlete will be back
For women, everyone cares about the baby The baby is born, even mom cares about the baby
Women sacrifice their own body just to make sure this little creature grows up and gets everything it needs
She’s been very fortunate in that regard that her body weight hasn’t changed in that period of time
8 months later this athlete will be back
The baby is born, even mom cares about the baby

This focus on what women need the first year after childbirth is very lacking and one of the biggest crimes in modern medicine today

Peter hopes somebody’s listening and thinking of another type of 10 Squared focused on what are we doing for women immediately post-baby

Vaginal delivery and C-section are 2 totally different things
There should be really robust rehab paths to get them back in amazing shape immediately as opposed to we’ll come back to this in 10 years
Kyler speaks to the complexity of what they deal with: not only do they just add weight by adding this human The relaxant hormone creates areas of stress and laxity that will shorten up and tighten up over time, but it affects different women differently Some women’s feet change in that environment of more relaxant and carrying more weight: the arch and the foot gets affected
In a way he looks at it like all these areas suffered a little bit of what you might call an injury, but it’s a natural process
How do we account for all these layers?
No one out there is telling women to do foot strengthening when they’re 2 months pregnant, but they should be
Just like [the strengthening] he did for Peter’s shoulder, Kyler advises women, “ If you find out you’re pregnant, you should start doing some foot strengthening things, some core stability stuff. There’s a ton of things you could do prehab .”
Then after try to start to strengthen the right way
The relaxant hormone creates areas of stress and laxity that will shorten up and tighten up over time, but it affects different women differently
Some women’s feet change in that environment of more relaxant and carrying more weight: the arch and the foot gets affected

There’s something about the pelvic floor that is absolutely decimated in pregnancy (or delivery more to the point)

Peter believes (no pun intended) that is part of what has gone wrong in her hamstring
It’s a common complaint in many of her friends It doesn’t present as a hamstring injury It presents as a knee injury or an ischial tuberosity pain (which is the sit bone) and they say it’s not comfortable to sit
It doesn’t present as a hamstring injury
It presents as a knee injury or an ischial tuberosity pain (which is the sit bone) and they say it’s not comfortable to sit

One of Kyler’s favorite orthopedic surgeons in town (he’s a hip ortho) called him to help with his wife

She had been doing traditional PT for 8 months and it was no better
It’s very common
Pelvic floor specialists are rising (very cool to see)

Kyler is not an expert in the pelvic floor but it is very much a big player in how we pressurize our intra-abdominal stability

It’s basically the flooring of that whole canister that we’re supposed to create with proximal stability
So if the diaphragm or the pelvic floor isn’t doing its job, then our body’s going to immediately start to compensate and create rotations and tilts around things

The role of the “core” in movement and injury prevention, and the importance of training stability before strength [40:15]

Peter hates the term “the core” because it’s so misused
The way he talks about it is most closely aligned with how DNS thinks about it Dynamic neuromuscular stabilization [discussed in episode #152 ]
Dynamic neuromuscular stabilization [discussed in episode #152 ]

Comment on this thorough the lens that we think about the core as a cylinder as opposed to “abs”

The starting point Kyler wishes everyone could automatically understand is that if you have really prominent rectus abdominis , that has nothing to do with how you stabilize your trunk, Especially if you’re doing things in multiplanes like tilting and rotating
It’s not just your obliques either
Especially if you’re doing things in multiplanes like tilting and rotating

It’s the deep stabilization system that not only pressurizes with our diaphragm, the pelvic floor, but it’s also all the small muscles up and down my spine, including multifidi ‒ do all those muscles kick on and create stiffness in the right way at the right time?

A lot of times people are accidentally over-coached into thinking they only need stiffness
The second step to that is, okay, now I can activate that deep stabilization system (I have that bracing. I’m pressurized.) I’m using my transverse abdominis , all these other structures down there
Now, can I do that with motion? And that’s where you start looking at someone kicking or running or throwing
I’m using my transverse abdominis , all these other structures down there
And that’s where you start looking at someone kicking or running or throwing

That needs to be a dynamic system, not just a stiff system

A lot of people don’t have the first one, so they see a ton of these exercises like the DNS three month or dead bugs that create deep core stabilization, but they don’t see the next step after that Which is, okay, now how do I maintain that pillar and that strength and then I get a free shoulder blade or a free hip to move?
Which is, okay, now how do I maintain that pillar and that strength and then I get a free shoulder blade or a free hip to move?

Kyler’s experience with a client who had a lot of radicular nerve pain from a disc issue

This was one of the most fascinating cases in recent memory, because with him we were able to actually find a trigger point that referred pain That mimicked that radicular nerve pain When we literally pressed on his glute minimus , he got referral [pain] that he thought was a tribute to his back
So that was a window towards [learning] that this was a muscular issue, that’s not the spine causing trouble
Then we gave him these stabilization drills which helped that glute just relax for once
That mimicked that radicular nerve pain
When we literally pressed on his glute minimus , he got referral [pain] that he thought was a tribute to his back

Something Kyler sees all the time in the clinic

Muscles are meant to be a muscle My bicep is meant to contract and relax
It’s not meant to be a shoulder stabilizer
My bicep is meant to contract and relax

⇒ But if my stabilization isn’t doing its thing, then that bicep and the trap and all these other muscles try to help

And that’s where we lose freedom of movement because your body’s essentially perceiving a little threat, a little instability, and so it tightens other structures up
People will ask for dry needle work or soft tissue work, then go to the stretch place That’s going to be a 6 hour benefit
That’s going to be a 6 hour benefit

If we activate this deep stabilization system and get all the parts moving in unison and in sync, all of a sudden those movement problems go away and you’re much more robust and strong

Peter wishes there was another word for stability that didn’t imply static
We think of that as things that are not moving (rigid, stable, etc.)
But the truest way to appreciate stability is kinetic stability

Peter uses the analogy of a race car to explain stability

When he wrote about stability in his book, Outlive (much against the desire of his publisher who hated it)
You’re thinking, “ How does a race car explain stability? ”
One of the fundamental differences between a race car and a street car is that in a race car, you’re transferring much more of that horsepower to the tires than you are in a street car
In a street car, a lot of energy seeps out because the chassis is not very stable
And you might say, “ Well, why? ”
In the case of a car, because it’s more comfortable
Race cars are not being optimized for comfort, they’re being optimized for performance
If you’re optimizing for performance, you actually want more stability in the chassis and the suspension so that you’re transmitting more force to the tires and the tires to the surface

Similarly, when you think about an individual who has stability, they are able to transmit force much more directly to the outside world, and they are able to receive force more safely from the outside world

And that’s why no matter how long you ever gave Peter, he could never throw a 100 mile an hour fastball It’s not that he doesn’t have the strength He doesn’t have the stability to be in motion and stabilize the capsule of his shoulder and transmit force like a whip through his arm
You wouldn’t look at a pitcher and think that’s stability, but it’s remarkable stability (dynamic stability)
It’s not that he doesn’t have the strength
He doesn’t have the stability to be in motion and stabilize the capsule of his shoulder and transmit force like a whip through his arm

The analogy Kyler uses in his practice – compare steering an old truck and a go-kart

He had this really old (mid-80’s) Chevy truck he was working on, and when you turned the wheel (let’s say his hands are at 9 and 3), it wouldn’t turn until his hands got to 12 The steering on that thing was sluggish That dynamic stability wasn’t very good
Where as a F1 car, a go-kart moves with micro movement
If you translate that to the human body ‒ do a skater hop where you leap laterally from one side to the other Can you stick that landing or are you falling over as you go?
There’s a million variables involved there, but the big ones are your rate of force Can you absorb that? Can all your tissues, the arch, the Achilles, the IT band, the hip, your core, can all those tissues kick on at the same time to create stiffness, number one? And a precursor to that is where’s your balance? To generate that first force, were you organized or did you have to throw your head in hands a weird way to generate the force, but now I’m not in an optimum landing position?
What a lot of times you see in youth athletes is people rush to put strength on them A really good strength coach can put strength on a college athlete in 8 weeks
But do they have speed? Do they have organized movement? Are they quick in all planes of motion?
Is their balance really good because now my nervous system, my software is ready to absorb all these things, and then you put strength on top of that, that’s a great athlete
The steering on that thing was sluggish
That dynamic stability wasn’t very good
Can you stick that landing or are you falling over as you go?
Can you absorb that?
Can all your tissues, the arch, the Achilles, the IT band, the hip, your core, can all those tissues kick on at the same time to create stiffness, number one?
And a precursor to that is where’s your balance?
To generate that first force, were you organized or did you have to throw your head in hands a weird way to generate the force, but now I’m not in an optimum landing position?
A really good strength coach can put strength on a college athlete in 8 weeks
Do they have organized movement?
Are they quick in all planes of motion?

A lot of these genetic people that are just naturally really good, they have some of that underlying ability to where they can land and organize well

[Stability comes first], and then later they put strength on
Pick a sport and you can show me somebody who was really athletic and they weren’t really big and strong, but you can put the strength on later
That’s one of Kyler’s biggest personal passions: 14 to 15 year olds who just get berated in the gym and then they tweak their back
One local golf team, about 30% of their athletes had a stress fracture in their lumbar spine

Peter asks, “ How was the strength coach not getting fired? ”

Kyler reached out to the head coach and the strength coach
And to give all these people a little bit of a pass, they’re not really equipped because they’re managing 200 kids It’s just a bad setup You have 200 athletes that you’re supposedly managing a program for and you’re not watching technique
Whether or not you know what you’re talking about, it’s a whole nother argument
It’s just a bad setup
You have 200 athletes that you’re supposedly managing a program for and you’re not watching technique

Problem: The idea of we’re going to do a high performance on a 14-year-old and put strength on them, but no one’s watching technique or teaching them the foundations of lifting

While at the same time they’re 14, we should be making them quick athletic and coordinated first because that’s a platform you want to build an athlete on

You don’t want to make a kid really slow but really strong when they’re 15
It’s really hard to train speed as you get older

The layered assessment process used at 10 Squared to determine whether a person is ready to perform dynamic movements [47:45]

When a client comes into 10 Squared and you do an assessment, how do you gauge how far they are away from being able to do the dynamic movements?

One thing Peter loves doing is a broad jump He wonders how late in life can he still do a broad jump of his height? He doesn’t have it on his Centenarian Decathlon because he’ s strict about that only having 10 things He loves it because it combines 2 things: concentric strength (the power to leap) and the eccentric strength to land and decelerate really quickly (more important and at least as difficult as the first) [read more about concentric and eccentric strength in this newsletter ]
He wonders how late in life can he still do a broad jump of his height?
He doesn’t have it on his Centenarian Decathlon because he’ s strict about that only having 10 things
He loves it because it combines 2 things: concentric strength (the power to leap) and the eccentric strength to land and decelerate really quickly (more important and at least as difficult as the first) [read more about concentric and eccentric strength in this newsletter ]
[read more about concentric and eccentric strength in this newsletter ]

Peter asks, “ How do you know when you look at someone if they’re ready to do that, for example? ”

Kyler did a ton of work in the literature and the science

Start with isometrics, the progress people to more explosive or compound movements (assuming no injury risks)

Peter asks, “ And you would determine that based on just my history? ”

No
History, testing, demographic risk
There’s a lot of variables we look into for having concern about musculoskeletal injury (that’s #1)
Every person is different that way
We’ve had people come in who’ve had multiple surgeries and injuries, and then we’ve had other people come in who they’re high risk for injury, but overall they’re a pretty good package to work with (not a lot of medical concern)

Ignoring all the medical side of it, Kyler really likes following the principle that the exercise is the test because they basically look at everything about 4-5 different ways

“ I really like following the principle that the exercise is the test. ”‒ Kyler Brown

For example, if he watches someone do a wall squat

That’s an isometric load
It’s what we all used to do in high school where it burns your quads and your patellar tendons
We can even set you up to where you’re in the right position, and that’s going to tell us (A) your comfort with the position

Peter asks, “ Is failure constituted by pain or not doing it for a certain length of time? ”

Every metric they have has a qualitative and a quantitative associate
The quantitative, we have minimums: it’s either time or percentages of body weights for every test Or distances like you mentioned on the broad jump
But then there’s also how does it look? One is the vague part of the movement world, so you’re going to have your coach and Kyler both looking at it
But then we have other ways where we’re confirming that with our motion capture machines, with our force plates, with our videos that analyze the movement
There’s a lot of ways to confirm, and you can also see these things cross over
Or distances like you mentioned on the broad jump
One is the vague part of the movement world, so you’re going to have your coach and Kyler both looking at it

For example, how does someone do on the double-leg versus the single-leg provides information

On 2 legs, they’re really strong and solid
On a single leg, they’re abnormally less functional and weak and don’t have the range

Kyler is immediately thinking there’s a balance control issue

Because they’re really stable on 2 legs, on 1 leg, they’re significantly less stable
It’s much more complex for the body
If their scores show they’re strong and their quads have capacity, but when they’re on single leg, they’re not as strong and they can’t stabilize
That gives him a window to say, “ This person has a major balance risk or things like that. ”

Peter asks, “ In the case of that individual, do you not progress them? ”

No
We find their floor and we build from there
Some people will have really cool robust Instagram-worthy exercises for one region, but another area we’re filling in gaps

We’re building foundations, and we’re basically building them up from wherever those floors are

The key for us is this big grid we have where we have every category movement we care about, and then we build them from their floor
Kyler is a really visual person, but he always says, “ Okay. We have this baseline floor maybe for their upper body pole, they’re on the third floor, they’re badass, they’re killing it. But then their core stability in one plane is in the basement .”
Kyler is worried about a lumbar stenosis or a nerve issue ‒ that takes precedence first
Because he doesn’t want this person to experience pain and he wants to build them up to where they’re all on the first, second, third floor of the building

Case study: the rehab plan designed to treat a hamstring injury while preserving fitness and preventing reinjury [51:45]

Back to Jill

She got this diagnosis and figured out why her knee was hurting
We now have a radiographic diagnosis that completely comports with what’s being seen on the physical exam and symptoms
These are stubborn injuries

What was the next step?

First, you have to have a parts approach
If I have a damaged part, we need to determine if that needs intervention or not? How are we going to address that?
With Jill, we knew her foundational underlying movement patterns (or dysfunctions) that were contributing to that
How are we going to address that?

Kyler put a package together for her program that was all of those underlying structural functional issues that didn’t make the hamstring worse

We started building those right away while we considered platelet-rich plasma
She actually ended up going for it to create essentially regeneration of that tendon at the damaged site, which she did perfect with
We had to have a lot of “come to Jesus conversations” about, you cannot run too soon If we’re going to go through all this trouble and financial costs, we want to make sure that can heal as much as it can
Everything we did in her programming was to ensure we didn’t flare that up
Conversely, we really communicated with not just the strength team at 10 Squared, but also her physical therapist offsite and her running coach, and all of us had to put together this 6 month plan where her running coach didn’t accidentally flare it up because he doesn’t have a window to everything we’re doing He definitely needs to talk to the PT, as did we, to where she could get “medically cleared”
If we’re going to go through all this trouble and financial costs, we want to make sure that can heal as much as it can
He definitely needs to talk to the PT, as did we, to where she could get “medically cleared”

Peter should know, but doesn’t remember exactly how long she had to stop running

It was right after the first and second PRP injections
Does 8 weeks sound right? Yeah
Because of her timing for the race and she wants to run Boston, we had a little extra runway
The more healing time you can get, the better
We have a lot of people who are really impatient, dying back to run If you’re a pro athlete, you don’t have that luxury
If you’re a pro athlete, you don’t have that luxury

That’s what’s been fun for Kyler at 10 Squared: he doesn’t have all these environmental constraints

When you’re training for an event that’s 30 years from now, you don’t have to take shortcuts

“ Let’s take a breath and be really detailed. ”‒ Kyler Brown

With Jill

The PM&R docs and the physiatrist will always give you different amounts
Usually 2 rounds of PRP for her issue You do one round of PRP, basically do nothing, and then you do another round about two weeks later And then you slowly let that heal and you start to add physical therapy
With Jill, we were doing a ton of stuff around the area of the injection right away
You do one round of PRP, basically do nothing, and then you do another round about two weeks later
And then you slowly let that heal and you start to add physical therapy

That’s imperative: you don’t stop everything

Kyler’s approach to healing an injury

You just protect the area and you train everything else
That is going to be one of the reasons why we get a lot of success with her
We did targeted physical therapy for that site to promote the healing
On the physical therapy side, they’re using a ton of things like BFR , dry needling (where necessary), everything you can to just help those parts heal Foster that growth hormone Foster that protein synthesis Build that muscle up without a lot of force in the tendon All those things that a traditional physical therapist that knows what they’re doing, they can crush that
For 8 weeks, she had to swim She was pleasantly open-minded It’s hard for every athlete to not do their sport
Kyler has delivered that medicine over and over for a long time
So she swam; she didn’t lose any true cardio
She lost a little bit of running strength, but someone with her background and her base and then keeping everything else really strong
She’s going to hit the ground running and she’s running now and doing really well
Foster that growth hormone
Foster that protein synthesis
Build that muscle up without a lot of force in the tendon
All those things that a traditional physical therapist that knows what they’re doing, they can crush that
She was pleasantly open-minded
It’s hard for every athlete to not do their sport

Kyler always says he has 2 athletes

1 – The athlete to encourage Those tend to be more your traumatic acute ACL type people, where you got to show them in the lab and show them in the gym that it is okay Keep pushing, you’re good
2 – Then he has the other athletes where you have to hold them back Jill’s going to be that one like, “ Let me go, let me go .” And we have to play bad cop just enough where science supports that, so that she doesn’t flare it up again Because we need her to have a nice smooth progression
Kyler would rather her be really balanced and athletic and strong and feeling good on race day, not like a bunch of junk miles and that tendon in the knee start to hurt her again and stuff like that
Those tend to be more your traumatic acute ACL type people, where you got to show them in the lab and show them in the gym that it is okay
Keep pushing, you’re good
Jill’s going to be that one like, “ Let me go, let me go .”
And we have to play bad cop just enough where science supports that, so that she doesn’t flare it up again
Because we need her to have a nice smooth progression

Training approach for clients with minimal training history: risk reduction, habit-building, and long-term consistency [55:30]

A hypothetical client who comes to 10 Squared

They’ve never really been an athlete
They feel fine
They’re not training a lot, but they’re young enough that it hasn’t caught up with them yet

Those people typically don’t do very well on the assessment ‒ you can’t hide from not having done the work

How do you think about where to start when there is so much work to do?

Back to the building analogy ‒ we’re going to focus on the basement

1 we got to build the habit

That’s a big part of this: your coach is basically in contact with you every day as much as you want to help bend and twist and develop that formula Encouraging that person to do it
Encouraging that person to do it

You want to get to where they enjoy it, they like it

Kyler has had people tell me, “ Yeah, this core stuff makes sense, but I just hate getting on the floor. ”
Okay, we got to pivot and change the program
If he tries to convince you to do an exercise that you hate doing, it’s not going to last

2 we want to really mitigate the risks of injury

You get some momentum going on the psychological habit side, and then, “ I pulled my hamstring, I’m devastated. ”
We got to get those foundations going, but then usually we look at the medical risk side
For some people, the CPET test was terrible Their VO 2 number are bad [VO 2 max testing was discussed in detail in episode #331 ]
Their VO 2 number are bad
[VO 2 max testing was discussed in detail in episode #331 ]

In our society, you got to have a good heart ‒ we want to get that off the table from a risk factor

“ We will probably really put that routine cardio in, in a manner in which we don’t flare up the things that could create an injury .”‒ Kyler Brown

One client had a fall risk

One client Kyler had recently, never had leg or foot issues at all, but his testing, his calves [showed] a big fall risk His calves were crazy weak He didn’t know it, he didn’t bring it up
His balance wasn’t good because he didn’t have strength
That’s definitely a high risk for an Achilles [injury]
His calves were crazy weak
He didn’t know it, he didn’t bring it up

Peter asks, “ How old is this person? ”

52
Peter wouldn’t expect to see that in somebody so young
This guy just poured himself into his career Really successful, really smart, cool guy But he just hasn’t trained a lot of stuff and he had kind of a health scare, which is what motivated him to get organized and get this stuff right
It was interesting to see his really successful analytical brain use that scare to decide that he’s got to get sorted out
You can see he operates his business the same way Problem identification, what’s a solution? Problem, solution, problem, solution
Really successful, really smart, cool guy
But he just hasn’t trained a lot of stuff and he had kind of a health scare, which is what motivated him to get organized and get this stuff right
Problem identification, what’s a solution?
Problem, solution, problem, solution

So with him, he didn’t know he had any of these risk factors, but he was a textbook for having a fall or blowing out his Achilles because of the weakness and the lack of capacity and strength he had

Peter asks, “ If you were to handicap that, how many years away would he have been from something like that being quite likely? Is this something that’s going to happen before he was 60? ”

He could have been
It’s a little fear-mongery, but he wasn’t set up to [deal with] having to change direction quickly Maybe trips off a curb after dinner in New York
He was a big guy too, top-heavy Big trees fall hard
With him, he wasn’t even aware of that weakness
The last thing we’re going to do is give him a running program
Maybe trips off a curb after dinner in New York
Big trees fall hard

We got to design his CPET stuff and his VO 2 max training and his Zone 2 training around these inefficiencies with his body; and so the workout in the gym needs to link up perfectly with those risks

What is the most important thing for him right now?

Peter asks, “ Is that difficult to communicate to clients because do they ever feel like, ‘Hey, I’m not doing enough.’ ”

A lot of people are overwhelmed
But what’s been really nice is the data, but then the calibration

For clients Kyler has had for several months now, consistency is always the name of the game

Especially when we’re playing the long game like we are

If someone’s going on a two-week vacation

We want to know, where are you staying?
What does the gym look like?

We will change your workout so that you can keep doing it while you’re on vacation

And if you tell us you’re going to be really active in the day and want to decompress For instance, you’ve been working in your basement garage really hard for 3 months Great, let’s take care of the total human Let’s give him a 30-minute small thing to where he can almost have that lightening of the mental load (just decompressed), but he’s still making gains and he’s still building that up
With this, if we get a video of your gym and we know you don’t have a bench that goes to incline, but you do have TRX and a treadmill that goes to incline Or they don’t have a bike
For instance, you’ve been working in your basement garage really hard for 3 months
Great, let’s take care of the total human
Let’s give him a 30-minute small thing to where he can almost have that lightening of the mental load (just decompressed), but he’s still making gains and he’s still building that up
Or they don’t have a bike

“ We can change their workout to where they keep marching along, and it’s in an agreeable way for them. ”‒ Kyler Brown

It’s not just like, “ Oh, I was on vacation. I didn’t work out for two weeks .”

⇒ Because you get muscle atrophy if you don’t work out for two weeks (you go backwards)

How to train foot reactivity, tendon resilience, and explosive capacity in a safe, progressive way [1:00:00]

This idea about foot reactivity is so important

Peter has been much more attentive to it in the past couple of years [discussed in episode #296 ]
He’s noticed the number of times when he’s lost his footing and regained He never had a fall It’s never resulted in anything because it’s been caught
But he keeps thinking to himself, “ This is the type of slip that can be devastating .”
Because these are really type II fibers that are doing it
⇒ And the type II fibers atrophying as we age
[discussed in episode #296 ]
He never had a fall
It’s never resulted in anything because it’s been caught

Peter asks, “ Are the types of jumping things that we do sufficient to preserve it? If you’re someone like me and you who, part of our CD involves probably walking on uneven surfaces one day .”

It’s like walking on pebble gravel, you’re always going to lose your footing somehow and you have to be able to regain it

What are the most important exercises that you need to be doing to maintain all of the characteristics of tissue and nervous system to preserve?

The best way to answer that is more principle-based

1 – We behave in a three-dimensional space

So this idea of only doing calf raises, my toes pointed straight ahead [is] insufficient
To Peter’s point, there’s going to be moments where my toes are out or one toe is out

We want to do all these strength exercises in multi planes of motion, and that doesn’t mean even in a static position ‒ you want to train in three-dimensional space

That’s like a lunge ‒ lunging to the side; lunging backwards
All of your training should account for that
If we’re just doing bicep curls and calf raises, it’s like I’m on these railroad tracks, but the minute you make me go sideways or rotate, it’s trouble

2 – To get motor unit recruitment to really make sure that those muscles are firing you need to do really heavy loads or things that are really fast, to get that nervous system to wake up and respond

The problem with that is not a lot of us are ready for that
What you usually start with is really long-hold isometrics So we put you in these different positions and find ways to resist that and pull and create stiffness and remodel those tendons
We’re essentially making those parts ready to start going into the danger zone that is explosive, powerful movement Maybe not danger zone as much as a higher ask or risk zone
Heavy overcoming isometrics: one of Kyler’s favorites is that mid-thigh pull It’s kind of a standard in the sports science world where you have a bar and you basically calibrate the machine to where the bar is about the mid-thigh, and it’s almost like the very top of a deadlift. And you just pull, but the bar doesn’t get to move And the sensory input is like the ForceDecks , and they’re measuring your balance of your force and all these other cool metrics Holding that over time, we’re now isometrically loading the heck out of my grip You are loading the heck out of my shoulders We’re getting into my feet, my quads, my hips, and I’m just holding that for time That sets all these tendons up
So we put you in these different positions and find ways to resist that and pull and create stiffness and remodel those tendons
Maybe not danger zone as much as a higher ask or risk zone
It’s kind of a standard in the sports science world where you have a bar and you basically calibrate the machine to where the bar is about the mid-thigh, and it’s almost like the very top of a deadlift. And you just pull, but the bar doesn’t get to move
And the sensory input is like the ForceDecks , and they’re measuring your balance of your force and all these other cool metrics
Holding that over time, we’re now isometrically loading the heck out of my grip
You are loading the heck out of my shoulders
We’re getting into my feet, my quads, my hips, and I’m just holding that for time
That sets all these tendons up

Peter asks, “ And you just do this with a super, super heavy loaded bar that’s too big for you to lift? ”

Not necessarily
You can actually do an empty bar, but you pull it up against the safety bars or the rack or something like that

There’s a lot of ways to load these heavy isometrics, because that gets your tissues ready, and you build that up over several weeks and that tendon adapts and now it’s ready to resist force

⇒ The way you bridge that is you start doing deloaded plyometrics

Maybe we do some sort of a band-assisted pogo Where I’m actually pulling on a band overhead, pulling down on that band essentially lightens me, because the band’s going to pull me back up Now I get to train that speed and that quickness through the ground, but it’s not my full body weight
That’s a great way to bridge from: now I’ve got the parts ready, can I deload the amount of force and train the speed?
Where I’m actually pulling on a band overhead, pulling down on that band essentially lightens me, because the band’s going to pull me back up
Now I get to train that speed and that quickness through the ground, but it’s not my full body weight

Once I’ve got the speed going and the parts, now I get to become an athlete and do bodyweight and beyond

Kyler explains, “ That’s where you see these really high level athletes, even at early ages, their trainers know how to build that paradigm up and bridge it across to where you don’t get any injuries along the way, but you get a really springy force-resistant person. ”

So many of us don’t train pogos, we don’t train plyometrics
If you go out to the local men’s or women’s soccer league, how many people there are over 40? Not very many There’s a lot of reasons why that is
Not very many
There’s a lot of reasons why that is

“ We’re not playing games and we’re not reacting to stuff. And so we need to make the gym a safe space where we can recreate these things and essentially test out these movements so I don’t lose it. ”‒ Kyler Brown

Peter’s foot and ankle pain: how to diagnose, treat, and strengthen the lower extremities [1:04:15]

Peter’s biggest source of nag in the past 12 months has been foot and ankle

Why are those injuries occurring?

They’re not debilitating and don’t prevent him from doing anything
But he wants to know if this is a harbinger of something
Kyler points out that Peter has very mobile feet (swimmers have great, mobile feet) It really speaks to how your tissues adapt over time Your feet have a ton of motion in them; they are not restricted
Peter’s feet are actually pretty strong too If we test your big toe and your smaller toes, you don’t test outside the normal limits for strength requirements
Peter’s biggest gap is that multi-positional stiffness, and that ability to create force absorption through your tissues He is actually set up for that because he can move so much, he doesn’t find either the bony in-ranges or those tendons can’t grab, because there’s so much play in that pattern
It really speaks to how your tissues adapt over time
Your feet have a ton of motion in them; they are not restricted
If we test your big toe and your smaller toes, you don’t test outside the normal limits for strength requirements
He is actually set up for that because he can move so much, he doesn’t find either the bony in-ranges or those tendons can’t grab, because there’s so much play in that pattern

What Peter accidentally does all the time is he’ll go on a ruck or go on a hunt where he’s off-road, and he’s getting all these angles that will slowly flare up a tendon

Peter’s recent injury

Two months ago, Peter decided to pick up a pogo stick Just to add another activity Use it to go up and down the driveway
The second he started he realized it was not a good idea
Just to add another activity
Use it to go up and down the driveway

Kyler responds, “ Yeah, that goes in the bucket of, you should have called me first. ”

⇒ Tendons are notorious for not really hurting at the time, but they hurt like crazy the next morning

What’s common for plantar fasciitis or patellar tendonitis

It hurts and feels really creaky and sore when you first get up in the morning
That’s because tendons love blood flow, they love movement and they love motion
All those chemicals that come with inflammation, if we’re just sitting around or sleeping, that’s the opportunity to get stiff and really sore and achy

⇒ With that kind of symptom pattern, you’re not really lost on what it is: that’s classic tendon

You can walk, we can load it, there’s no failure
We’re not worried about a muscular strain or any other damage
But that tendon gets really hot and spicy, especially in the mornings if you’re not creating that stiffness

Just to be clear, Peter is at 9-10 weeks since his pogo sticking debacle

It’s no longer as bad
But every single morning when he gets up, there’s still incredible and sharp pain right at that tendon

Why is it taking so long [to heal]?

Tendons are one of the slowest things to heal
Kyler guarantees if we really zoomed in and looked at all of it, Peter probably has a little tendinopathy in those tendons A little damage here and there that could be contributing to that irritation
A little damage here and there that could be contributing to that irritation

⇒ The most important thing is understanding that tendons take months to regenerate

With Kyler, Peter has had a pretty consistent attack with it, and they finally got him on a really good rehab program that Peter is doing himself
Where we’re loading the heck out of it with these isometrics and we’re building the load more and more And we’re loading those isometrics in different positions
And we’re loading those isometrics in different positions

Example isometric exercises Peter is doing

The front foot hover

But Peter is actually plantar flexing So when he’s driving, he’s doing as much of a calf raise as he can in that split squat position And then we make you hold that while you do that split squat; so it changes the whole angle and the relationship
It’s a complex movement
A plate is in front of Peter, basically creating a step Like a 45 bumper plate; a mini step We’re 2.5-3 inches up
The ball of the front foot and toes are on that
He’s in a split squat
So when he’s driving, he’s doing as much of a calf raise as he can in that split squat position
And then we make you hold that while you do that split squat; so it changes the whole angle and the relationship
Like a 45 bumper plate; a mini step
We’re 2.5-3 inches up

Peter asks, “ What am I doing with that front foot? I’m lifting it into plantar flexion? ”

Yeah
Peter’s toe-off was one of the problems
What happens with him is when his heel lands, he’s driving his body forward and his foot’s behind him
He would do a little bit of a rotation out and create a little bit of a whip through where it wasn’t nice and pure rotation rolling through the foot and the toe

It was complex and putting extra stress at the ankle ‒ that times 10,000 steps a day will really pick at that tendon and make it sore

Which is why Peter wakes up the next day hurting

Kyler’s approach

What we’re trying to do is put these tendons at different lengths and then putting a lot of load through them
The complexity we’re adding isn’t necessarily at that joint
We’re actually adding motion and complexity above with the lunge, and also the requirement of you having to stabilize centrally in that mid part of your body, while that foot is locked in

⇒ Someone with a really mobile foot, you tend to really use that foot for everything, and that’s how you spice up those tendons

Kyler is essentially putting that foot in a position where that tendon has to heal and it has to get stronger and he’s making the other parts of Peter’s body reach that complexity and meet the demand

What Peter can do to prevent a recurrence of this problem

This is the second time Peter has had this flare up
The first time was a year and a half ago when he really started increasing rucking volume [rucking was the focus of episode #292 ]
This time, it was caused by an acute incident on the pogo stick It was extreme dorsiflexion that did it
[rucking was the focus of episode #292 ]
It was extreme dorsiflexion that did it

What do you think was driving it on the rucking side and more importantly, what does this mean for me?

While this doesn’t matter right now, Peter is concerned about the long-term If this keeps happening and he’s in his 80s, this is the difference between reacting and not reaction and being able to get around
If this keeps happening and he’s in his 80s, this is the difference between reacting and not reaction and being able to get around

Peter asks, “ How do I prevent this from being a lifelong problem? ”

That dorsiflexion when your toe is up
When it’s a sudden acute force like on the pogo, you probably also just create a little bit of a joint irritation
It’s analogous to jamming your finger If you move those two joint structures together really hard quickly and your body can’t absorb that force, that’ll get a lot more sore than if it’s just kind of a slow, repetitive stress like the rucking
They’ve noticed the relief when we do the manual therapy and things like that That’s a nice short-term, “ Ah, feels a little better, a little less pain. ”
If you move those two joint structures together really hard quickly and your body can’t absorb that force, that’ll get a lot more sore than if it’s just kind of a slow, repetitive stress like the rucking
That’s a nice short-term, “ Ah, feels a little better, a little less pain. ”

Kyler explains what the bigger picture and the ask of your body is, “ Teaching it, how can it respond to this and how do I build that force in those tendons to where not only does that tendon start to regenerate and heal, but then it’s also ready to react to all the things you do .”

Knowing that Peter loves to use those feet, and the more barefoot he is, the more likely he is to do that ‒ his prescription is

We need to do a ton more quick work with you that’s deloaded to train all those tendons

There are so many tendons in the lower leg and the ankle

⇒ We need to train all those tendons to get quick and stiff in different positions so you don’t jam the joint or create a stress in the tendon

Should Peter be doing less barefoot activity?

No
That’s a pathway to frailty
You want to stimulate the receptors in the bottom of your foot

Don’t go to extremes

Does Kyler want Peter running on a river barefoot with sharp rocks?
No, because that’s going to cause other problems

Having you barefoot makes your foot mobile and strong

Then if we piggyback that with this specific type of training for where your gaps are, it’s a huge payoff

Let’s look at the other side

Most people don’t have Peter’s situation

⇒ More often than not, people have a really rigid foot that’s weak and stiff

So we’re actually going with a whole other direction where we’re trying to get motion in the foot
We’re teaching that foot to separate rear foot and forefoot

Peter asks, “ How do those people present? What’s the pain or what’s the injury they present with? ”

Interestingly, they actually get a lot of symptoms up the chain
Our foot has so many bones and all these articulations where we’re supposed to comply to the ground
If that shock absorption goes away Like let’s say I’m wearing these big goofy running shoes that they sell now that have the rocker ‒ it’s like patching holes in the boat rather than optimizing movement
If we have a foot that is stiff, those force factors go up through the body
So now my knees, my hips and my spine have to figure out that force distribution because one of my best shock absorbers is the foot and the ankle
Like let’s say I’m wearing these big goofy running shoes that they sell now that have the rocker ‒ it’s like patching holes in the boat rather than optimizing movement

⇒ If the foot and the ankle are not doing their job, everything else pays the price

When the soleus (lower part of the calf) is weak

That control of their tibia as either walk or lunge isn’t there
So that ankle just walks up and then they send all that force to their knee

“ That’s why one of my favorites is anyone with a chronic knee issue, I’m going right at that foot and ankle first .”‒ Kyler Brown

Because if the foot and ankle isn’t up to the task, then the knee’s going to take a beating

Peter doesn’t want to jinx himself by saying this: despite all the crazy stuff he’s done, all the miles he ran growing up, he never really had a knee issue
But boy does he get these feet issues
Kyler observes that Peter has really good, wide, mobile feet
And Peter’s knee gets to be a knee
If that rotation, that pivot joint that’s supposed to happen at the ankle isn’t pronounced to the amount you want and it isn’t mobile enough, then that knee and that force vector’s going to happen at the upper tibia and the femur where now you start to get these little meniscus things that show up out of nowhere
That torsion has to happen somewhere

How fear and perception influence recovery, what drives back pain, and when to choose surgery vs. treatment [1:13:15]

Sounds like you see this fear at 10 Squared where you have clients that are just coming in for the training piece of this
Peter wonders if there is any common thread to this or does it come in all walks of life?
He’s seen it in former athletes who are injured, but the injury is so bad that they just never quite want to go back down the path, especially if they’ve had multiple re-injuries
He assumes Kyler sees this in people who are not necessarily athletes

What do you think is going on there, and how do you work up the confidence to accept that the pathway back isn’t necessarily pain-free or injury-free but it’s more of a trajectory that’s going to get better?

Kyler makes the point, “ The graph is always going to have peaks and valleys .”

When your brain perceives threat, not only is your heightened awareness up, your nervous system is kicked up, but you’re more sensitive to pain Whatever that threat could be, maybe your dad hurt himself playing football, so you’re scared to play football
Whatever that threat could be, maybe your dad hurt himself playing football, so you’re scared to play football

⇒ Certain things hurt more when we’re ill or when we’re stressed than if we’re not

If we stick to just movements themselves, a lot of people are afraid of certain movements because it hurt them in the past Or they heard it could hurt them Or maybe they just haven’t done it a long time So they’re nervous about it
Or they heard it could hurt them
Or maybe they just haven’t done it a long time
So they’re nervous about it

You can actually empower people if you show them there’s a rational reason why that fear could be there or why that pain is there

Kyler makes the point, “ Pain does not always mean injury. Pain is your brain telling you, ‘Hey, I don’t like what’s happening here.’ But it doesn’t always mean you’re broken or busted. ”

Another thing to think about is your image isn’t always a death sentence

If we MRI a 100,000 low backs, there’s going to be wear and tear, especially if you’re over 30 years old
Same goes for every other joint in the body
Does that mean we design your whole clinical plan around that?
No. We really need to think about, okay, how much is there? What do they want to do? What are their strengths? What are their weaknesses? All those things we already spoke to
What do they want to do?
What are their strengths?
What are their weaknesses?
All those things we already spoke to

So when there’s fear involved, you really have to address that because the individual needs to know that A, you have a plan for them, that you understand their fears; and then B, we got to account for those fears in one way or another

Kyler’s experience in his practice with patients who have low back flare-ups

He’s talking about just your traditional back spasm, not a surgical candidate High back pain, but no damage
High back pain, but no damage

⇒ The amount of those people that have come in when their wife’s about to go into labor or they’re worried about getting fired from their job, where they have an emotional mental stress in their life, the amount of those people is infinite

Kyler has had thousands of people come in who say, “ My back flared up out of nowhere. ”
Then you start to dive in, “ What else is going on? ”
And they’re really worried or stressed about something

The goal there is you can’t always fix those external, cultural, psychological, emotional things, but we can address them and identify them

And sometimes they need therapy, they need other things to address those
More importantly, we need to empower that individual and give them rational reasons why you’re like, “ Hey, this might be why you flared up in that glute or in that mid back. And this is what we’re going to do about it. ”

If you outline those plans for people and give them the tools, now you’ve equipped them to actually help themselves ‒ it’s really about empowerment with education

This whole game of, “ I’m going to take an X-ray view and look, oh, there’s one little bone spur, but now I’m going to scare you into a 40-visit package to my chiropractor clinic .”
That game needs to go away fast
Because the only thing you’re doing is making people feel more frail, more afraid, and you’re actually only helping the bottom line of your business
You’re not helping that individual

What is it that you would see when somebody comes in with a lower back complaint that would make you say, “ Actually, the answer is seeing a surgeon or complete and total rest. ”

1 evaluate the neuros

If there’s weakness or you don’t have bowel or bladder function and things like that, right away get evaluated, right?
Because the way nerves work, if there’s pressure on nerves, it could over time create permanent damage
Now, a lot of nerve pain is sensory, that electrical sciatica-type stuff It’s that tingling and that weird thing like that
It’s that tingling and that weird thing like that

The real #1 thing that you look at is, do they have weakness or do they have loss of some sort of foundational control?

That’s when you got to get integrated with neuro and orthos right away
If we don’t have that, now you’re in the decision-making domain

Peter asks, “ So this means you’re going to do the rectal exam, make sure sphincter tone is there? ”

Yeah, exactly
That’s definitely on the long list of things Kyler refers out for

If you’re in that kind of mechanical low back pain or even some disc nerve issues, but no weakness, now there’s a ton of strategies we can do

A first diagnostic step to see how your body responds

We’re not going to do some crazy aggressive therapy or treatment or manipulation of the spine
We’re going to do some sort of intervention like muscle work or McKenzie exercises for discs , to see how the body responds to those things Which are highly researched and really effective
If your body responds in a positive way, even for 2 hours, that’s a great indicator
Let’s keep going down this road because even the best surgeons that Kyler and Peter have both talked with about mutual clients, they’ll say, “ Let’s give this little time and see what your body does. Things can heal. The natural process of the body can take care of themself .”
Which are highly researched and really effective

One of Kyler’s favorite examples is a disc herniation

She confirmed on MRI, she was doing McKenzie protocol (which again is fantastic)

The McKenzie protocol for back pain

This is a really great system
You essentially put the patient in various positions and you do this gentle arching or pumping, and you’re basically trying to take pressure off that disc, to where slowly over time, that bulge can recenter and balance out
Their website has a database where people can find clinicians in their town

⇒ If you have nerve pain, it’s a great place to start because all those McKenzie practitioners know what Kyler just outlined (and if this method can help)

What’s fascinating about McKenzie is sometimes even in the room, they’ll get reduction of nerve symptoms while they’re in that position
Nerves provide very productive information
You can trust symptoms of a nerve really well.
If Kyler gets what they call a “centralization,” meaning, “ I had sciatic pain all the way down the leg, and then you put me in this one McKenzie position, and now it centralizes to the hamstring… ” That’s a great diagnostic indicator
That’s a great diagnostic indicator

⇒ Just because that individual might have an MRI with a disc herniation, that doesn’t mean it’s an injection or surgery right away

Part of the decision making is what are they having to deal with in their life? What is their timeline? All those other factors
What is their timeline?
All those other factors

If you can encourage a hot disc patient to wait and make sure that they’re actually letting things heal and run their course, they could be much better off in 4 to 10 weeks

Peter adds, “ It’s almost always the sign of a great spine surgeon, which is, once you rule out the acute weakness, the thing that is a surgical necessity, the ones that want to wait are generally the better surgeons. ”

Back to the case of disc herniation

She had a confirmed disc herniation , and then she had an annular tear Which basically the annulus is a part of the disc
Best analogy to describe it is she had a little thing that was equivalent of a cuticle that was just kind of peeling off
The traditional protocol, we started her on McKenzie’s
But she was really hurting
So we worked with her for like 2-3 weeks, and every time we put her in that McKenzie position, it hurt her worse It was local pain But the radicular symptoms reduced
Long story short, what we learned over time was that the disc herniation was actually taking care of itself, but the annular tear was still sticking out and creating extension-based pain
After about a year of rehab, her body was able to scar up and that healed (and it was fine)
Which basically the annulus is a part of the disc
It was local pain
But the radicular symptoms reduced

What was really interesting to Kyler was she needed McKinsey’s early, but then we actually had to cease the McKinsey’s because we were jamming that annular tear

Then we restored just more pillar strengthening, dynamic neuromuscular stabilization, all those other things

⇒ Different [therapeutic] things at different times played a big role

The impact of back pain

Back pain is common; Peter can’t imagine there’s too many people listening who down have personal or indirect experience with it
He can really relate to it being nerve-wracking It can be terrifying and just demoralizing when your lower back hurts in a way that it’s not the same as if your shoulder, elbow, knee, or hip hurt
It can be terrifying and just demoralizing when your lower back hurts in a way that it’s not the same as if your shoulder, elbow, knee, or hip hurt
If you sprained your wrist, you might have to wear a brace or something, but you can generally function
But when your ribs or your back is hurting, you can’t do anything without it affecting you Not only are those muscles much more big and powerful, so when they react in spasm, they’re really good at it The group of muscles in the low back are really good at freaking out The type I fibers , postural stuff, a lot of detail Sitting in a movie hurts, walking hurts, it affects you constantly
Not only are those muscles much more big and powerful, so when they react in spasm, they’re really good at it
The group of muscles in the low back are really good at freaking out
The type I fibers , postural stuff, a lot of detail
Sitting in a movie hurts, walking hurts, it affects you constantly

Kyler explains, “ A big part of the rehab story is finding these little wins where they can actually do something and it either does get worse (heaven forbid) or makes them feel a bit better. ”

Could AI and app technology eventually deliver an individualized rehab and training experience? [1:22:30]

Is this type of treatment scalable?

Peter feels fortunate that they’re able to take care of people and have the luxury of doing this very bespoke approach
Integrate your strength and conditioning with your cardio, with your PT rehab and all that stuff and it’s all great

Do you see a day when this could all be app and AI-driven where any person out there with any set of lower back symptoms could be provided with the feedback that they would need to take care of themselves?

If they execute, absolutely

How would you get the feedback if you have good enough image recognition software? (would that be a necessary step?)

Peter thinks the advantage of being able to do this the first few times with an actual person is that the cuing is so important A lot of these exercises are not natural
Especially if you’re that person who’s suffering from that injury, then odds are you didn’t perform these exercises well subconsciously That’s what set you up for it [the injury]
A lot of these exercises are not natural
That’s what set you up for it [the injury]

What is interesting is the video recognition software is getting fantastic

Kyler has demoed a few now where the AI is actually watching someone do movements and saying, “ Hey, this was too far out that way or whatever .”
But that also goes in the bucket of everyone moves differently My femur length is different than yours So the angles with which I’m going to lunge are going to be a little different
My femur length is different than yours
So the angles with which I’m going to lunge are going to be a little different

⇒ This idea that if you take principles and you know the symptoms and then most importantly you know how people react to really conservative loads, that almost tells you more than did their tibia rotate 3 degrees or not

Kyler could care less about 3 degrees of tibial rotation based on AI software and way more about: if they did lunges in this setup and activates some neuromuscular reaction to where their glute fired a little bit better and their knee felt way better
When people give him that good, quality feedback, now you know how to trim up that program

The AI part is going to be more about how did the patient respond to each drill that’s safe? And that’s where training the AI is much more nuanced and complicated

And less about: what degree did it move?

Image recognition is one thing, but it’s knowing what to do with that information

Knowing am I going to do an overhead dumbbell (on a DNS three month and all these other nuances) versus the legs There’s certain cases that Kyler will do that one for one and the other for another It’s really a matter of knowing what you got to start with, and then we test it a little bit And then we test it a little bit more, and then the outcomes are dictated by how did they respond to that exercise
There’s certain cases that Kyler will do that one for one and the other for another
It’s really a matter of knowing what you got to start with, and then we test it a little bit
And then we test it a little bit more, and then the outcomes are dictated by how did they respond to that exercise

Kyler’s professional evolution from traditional chiropractic care to a degree-agnostic, performance-based rehab philosophy [1:25:00]

Kyler’s training and expertise in rehab

He went to chiro school and then immediately went out and did a sports medicine thing
He worked with the NY Giants

Why did you opt into the role you’re doing now, which is much more in the PT rehab space than it is what people assume of traditional chiropractic (which is a 40-adjustment schedule)?

It speaks to a bigger thing, which is Kyler is really degree-agnostic in the sense that he hopes someday in the future there’s a more clear certification or degree where there are chiros and PTs and strength coaches All 3 of those people he would trust way more to do a rehab and get someone better He would trust all 3 of those people to send his mom to if they have certain skill sets and approaches Independent of degree or credential
Chiro was his baseline training and where his license is
But the traditional view of what chiro is with the manipulations and the adjustments, that’s 5% of Kyler’s week at his practice
All 3 of those people he would trust way more to do a rehab and get someone better
He would trust all 3 of those people to send his mom to if they have certain skill sets and approaches
Independent of degree or credential

“ Our practice, we have chiros and PTs, but you can’t really tell who’s who because everybody’s doing what we call as active rehab .”‒ Kyler Brown

One of the things Kyler always tells people is it’s about the one-to-one relationship

He doesn’t care what their degree is
It’s not group but one-to-one
If they’ve got a bunch of weights in there as well as the traditional bands and stuff, that’s an indicator that these guys are going to build me back up to something actually strong Not just make me come here forever and do rehab purgatory where I do the same micro drill over and over We got to build over time
Not just make me come here forever and do rehab purgatory where I do the same micro drill over and over
We got to build over time

Kyler tried to create a residency for himself right out of chiro school

Back then it was really manual-therapy-based
He learned a ton
He was by far the lowest guy in the totem pole, but he was there to soak it up
Everyone always thinks pro sports is the top And it is in a lot of ways But it wasn’t really for Kyler in terms of an official team relationship because he just didn’t like that personal schedule
It was pure chaos: you’d spend a week fixing somebody up and then they’d go out there and get blasted again It’s kind of like when his son builds his tower Magna-Tiles and then his sister knocks it over The look on his face was Kyler every Sunday
Kyler enjoys he off-season side ‒ he really enjoys the project
And it is in a lot of ways
But it wasn’t really for Kyler in terms of an official team relationship because he just didn’t like that personal schedule
It’s kind of like when his son builds his tower Magna-Tiles and then his sister knocks it over
The look on his face was Kyler every Sunday

“ I realized early on that when you’re only doing pain relief, manual therapy work, there’s a lot missing. We’re not building people up .”‒ Kyler Brown

That’s when Kyler started to do this deep dive to learn from as many people as he could about the foot and balance and neuromuscular training and all these other things

To where it’s a compliment at his private clinic when people are like, “ What are you? ”
We actually have people come into our office now who are like, “ I need to go see my chiropractor later. ” And one of the other docs will be like, “ Well, I’m a chiropractor. ” And they had no idea
And one of the other docs will be like, “ Well, I’m a chiropractor. ”
And they had no idea

Kyler explains, “ Regardless, we’re solving problems .”

What is the role for what most people think of when they hear chiropractic, the adjustments?

Peter doesn’t want to ask Kyler to be critical of a profession, but the fact that he’s not out there doing it 24/7 suggest something

Do you think it’s a great plan when chiropractors recommend a package of 40 visits for X number of dollars, and see patients for 8 minutes a week, twice a week annually?

No
Kyler has benefited from getting adjusted himself Things get out of whack, things get stiff (that’s a real thing)
Things get out of whack, things get stiff (that’s a real thing)

It’s a tool in the tool belt, and the really good practitioners have a bunch of tools

Kyler could say the same thing about chiro adjustments as he could dry needling or active release or McConnell taping Like, a million tools out there
Like, a million tools out there

⇒ The really good practitioners have a huge tool belt and they know when to use which one at what time

So just throwing cupping at somebody and hoping their muscles get better, it’s insufficient
In the same way Kyler would say just adjusting someone over and over, it’s not enough There’s more that could be done
There’s more that could be done

Kyler’s advice when friends ask about aches and pains

He gets asked a lot, especially now that he’s older and all his friends are older
There’s exponentially more questions because they’re all getting sore and hurting

His answer is to find someone who’s got a bunch of tools in their belt and who is going to treat your case as something unique every time

A big red flag at a practice: is everybody signed up for twice a month

Kyler’s advice: you have to be adding strength

That’s what makes things stick
That’s what optimizes movement
That’s what makes people feel empowered and less frail
Frankly, it builds more of like a moat around you to where if you do step off a curb weird or you sleep weird on a plane, you’re less of a triage patient It’s more of just almost sore today, but you’ll still work out and the workout helps it
It’s more of just almost sore today, but you’ll still work out and the workout helps it

Peter asks, “ Is it safe to say then that whatever the suite of underlying modalities are (from adjustments to taping to cupping to needling, to active release to manual, you name it), the goal of all of these (and the more of them you can utilize, the better) is to create a window in which the individual is safe and out of pain so that they may do the work to retrain a movement pattern and increase strength? ”

Absolutely
We say that sometimes about even cortisone injection Kyler doesn’t like people racing to get a cortisone injection If you tell someone to strengthen a knee that really hurts when they do a lunge, they’re going to look at you like you’re a jerk At some point, we need to do something to get that pain down so then we can open that door and run through it, and running through it with strengthening and making them stronger
Kyler doesn’t like people racing to get a cortisone injection
If you tell someone to strengthen a knee that really hurts when they do a lunge, they’re going to look at you like you’re a jerk
At some point, we need to do something to get that pain down so then we can open that door and run through it, and running through it with strengthening and making them stronger

How 10 Squared provides precision rehab and training in a remote format [1:30:30]

Peter points out that they’ve gone really deep down 1 of the 3 pillars
You now have basically 2 things you’re trying to do
1 – You’re trying to do everything you’re doing in concert with a broader agenda of creating a precision training program Not an exercise program, not a workout program A training program for an athlete whose sport happens to be life And you have to be able to do it with the strength and conditioning coaches, the cardio coaches
2 – The other thing you have to be able to do is you have to be able to do this remotely because most of the 10 Squared clients are remote
They come to Austin for two days, they do a whole bunch of assessments, they go away for 6 months, then they come back Some of them go away for less [time] A lot of them, they go away for a year because they’re out of the country and it’s just not easy for them to be here
Not an exercise program, not a workout program
A training program for an athlete whose sport happens to be life
And you have to be able to do it with the strength and conditioning coaches, the cardio coaches
Some of them go away for less [time]
A lot of them, they go away for a year because they’re out of the country and it’s just not easy for them to be here

How are you able to do this remotely? What are the challenges and what enables it to make sense? What do they need when they’re back home?

Some of the athletes Kyler manages travel a lot (like golfers) He has the luxury of knowing so much about them, how they move, and what their body looks like So when they say their back hurts from the hotel room, he can rule-out the scary medical stuff and try some exercise
He is able to get a lot of results for these athletes who are about to tee off in 2 hours and compete
Kyler has taken this model, and when he designed the assessments at 10 Squared, one of the biggest themes was, “ We need enough time to know as much as we can. ”
He has the luxury of knowing so much about them, how they move, and what their body looks like
So when they say their back hurts from the hotel room, he can rule-out the scary medical stuff and try some exercise

A lot of people want it to be faster, but that initial step needs to be so in-depth that we are certain about all the factors of how you move and where you’re strong and things like that

When Kyler has that certainty, he’s not flying blind when someone calls him about a sore knee after doing certain exercises

⇒ They can hop on a zoom and just talk real quick and Kyler can actually test them on zoom because the exercise is the test

So many people think they need a doctor to do a lock rinse test and pull on their leg, the story, their profile

“ How they respond to the exercise, that is the test .”‒ Kyler Brown

We can program exercises really effectively in a remote way to probe the fence or test it, and if it responds the right way, we definitely can fix it quickly

Kyler’s client this week

His shoulder was bugging him
We did a Zoom call, took about 20 minutes
We have our library at 10 Squared and Kyler fired him off a few exercises

He messaged Kyler and he feels a lot better; and he didn’t have to go to a doctor, he didn’t have to go anywhere

Now obviously if the story was different and Kyler was worried medically, he’d concierge that in the sense of he’d find him someone local and refer out
But if he’s not worried medically and if we think it can respond to load, we’re going to load it

And a lot of times people are shocked that we can make their neck tension go away with an exercise in the same way that if they traditionally got a massage or something, they’d get that relief

⇒ It has to do with what your body does when things are off and if you load, it’ll actually respond more because your nervous system’s involved as well

How Peter resolved a severe back pain flare-up using DNS-guided isometric exercise instead of passive treatments [1:33:15]

Peter’s incredible experience with DNS

This would have been 2018, 2019
It was the first flare-up of his lower back since 2000 when he had a botched surgery He had gone 18, 19 years without a single flare-up
Peter was working with a guy, the first person he’d ever met who did DNS
He had already learned about intra-abdominal pressure (he was doing all that stuff)
When Peter went to see him, his back was totally fine ‒ he had tennis elbow
He figured out pretty quickly that Peter’s tennis elbow was completely due to his scapular instability
Peter’s chief complaint was when he does a lot of pull-ups, his elbow hurts (he doesn’t even play tennis)
After his elbow was fixed, Peter thought, “ This is amazing. I want to know what else is going on .”
Then independent of that, he gets this lower back flare-up
He’s seeing this guy one day and he’s in the worst pain he’d had for years
This guy is a chiro by training who probably hadn’t done an adjustment in 20, he focused on DNS
Peter will never forget the exercise he had him do He had Peter lay on his back, get into an imaginary leg press position Imagine those old-school leg press machines where you’re pressing up Not the one where it moves on a slope, but the rack moves vertically Now this guy is laying on top of Peter ‒ he’s got his pecs on Peter’s feet and he’s cuing Peter through really good intra-abdominal pressure and isometric contraction (pushing) And low and behold, Peter’s back is getting better and better as they are doing sets (10-second, 20-second, 30-second) At some point, Peter is getting so strong he needs more resistance They build a makeshift thing under the squat rack where he has infinite resistance Kind of how Kyler described with the partial deadlift
When Peter walked in there, he was getting to the point where he wouldn’t have been able to push 10 lbs. away from himself (that’s how much pain he was in)
Now he was convinced he was pushing 600 lbs. of force against that immovable bar, and he’d never felt better
He had gone 18, 19 years without a single flare-up
He had Peter lay on his back, get into an imaginary leg press position Imagine those old-school leg press machines where you’re pressing up Not the one where it moves on a slope, but the rack moves vertically
Now this guy is laying on top of Peter ‒ he’s got his pecs on Peter’s feet and he’s cuing Peter through really good intra-abdominal pressure and isometric contraction (pushing)
And low and behold, Peter’s back is getting better and better as they are doing sets (10-second, 20-second, 30-second)
At some point, Peter is getting so strong he needs more resistance
They build a makeshift thing under the squat rack where he has infinite resistance Kind of how Kyler described with the partial deadlift
Imagine those old-school leg press machines where you’re pressing up
Not the one where it moves on a slope, but the rack moves vertically
Kind of how Kyler described with the partial deadlift

He couldn’t understand how that could happen – how could he limp into that guy’s gym in so much pain and spasm and an hour later, feel like a million bucks?

Kyler points out: this story speaks ot how pain is inhibitory

When your brain is perceiving that threat in that pain, it goes into preservation mode where it’s like, “ Look, I’m not going to have you run the fastest forward of your life because I don’t trust all these movements. I’m trying to figure this out. ”
Kyler’s analogy is that hand on the buzzer with Family Feud Where the brain, whenever it feels threat, it’s like, “I ‘m going to hit this buzzer and I’m going to send you a pain signal .” It doesn’t mean you’re damaged It’s just like I’m hovering And if you’re really stressed or it’s a really high-level pain, it’s going to do it at first sign of trouble
Where the brain, whenever it feels threat, it’s like, “I ‘m going to hit this buzzer and I’m going to send you a pain signal .”
It doesn’t mean you’re damaged
It’s just like I’m hovering
And if you’re really stressed or it’s a really high-level pain, it’s going to do it at first sign of trouble

How do we get the brain to take the hand off the buzzer?

What loads can we introduce to cause reciprocal inhibition in these muscles? To explain this term: if I’m going to contract my bicep like crazy, my tricep almost has to eventually get enough signals where it can’t fire Your brain might be trying to fire it and it’s got this co-contraction going on and there’s that protection going on But the more stimulus you give that bicep, eventually that tricep has to let go
What he was doing was putting Peter in very specific positions to where Peter had to load something
Where neurologically, his brain says, “ I’m going to turn this other thing off and I got to actually meet the demand of this force .” Because force is how your nervous system responds
He was loading one direction so much that eventually that QL (or whatever else could have been spasming with Peter) had to eventually kind of melt and let go
Not only was Peter now activated and stable and feeling stronger, but that muscle that was in this inhibitory contracted state and then it let go
To explain this term: if I’m going to contract my bicep like crazy, my tricep almost has to eventually get enough signals where it can’t fire
Your brain might be trying to fire it and it’s got this co-contraction going on and there’s that protection going on
But the more stimulus you give that bicep, eventually that tricep has to let go
Because force is how your nervous system responds

In Kyler’s first 5 years out of school, he was working on QL all the time

His thumb has scars from it
He doesn’t touch the QL anymore
10 years ago, he realized you don’t have to beat someone up so much
In a weird way, these kind of exercises are more gently They’re more therapeutic, more long-term, they’re active
You’re tapping into that nervous system
They’re more therapeutic, more long-term, they’re active

“ Having someone do a very specific exercise based on their profile and their symptoms is actually a great way to make someone feel better and you just got to give them the right stuff .”‒ Kyler Brown

Peter’s takeaway

Peter considers that one of the most profound experiences of his life from a physical perspective and also in how much it changed his point of view about what back pain is and isn’t
He’s not suggesting that if you have back pain, that’s the answer (to go find a guy to do that)
Instead, there’s so much more going on than we realize
So much of back pain is not surgical

So much of back pain can be healed with retraining a movement pattern and getting our nervous system to get out of the way

Kyler has a lot of clients that are nervous about the chiro thing
They want help with their neck, though
Kyler knows there’s a million other ways to cook this recipe To normalize the motions of your joints and make the muscle strong again To reestablish the relationships of your shoulders, your scapula, your neck
To normalize the motions of your joints and make the muscle strong again
To reestablish the relationships of your shoulders, your scapula, your neck

There’s a million ways to make someone feel better with exercise where you don’t have to do aggressive therapies

Kyler doesn’t care if it’s stem cells, PRP, prolo, dry needling, or chiro (it doesn’t really matter)

⇒ Exercise needs to always be the answer and you can do therapeutic exercise that actually does a lot for people and drops the pain too

How to identify and treat common joint pain (neck, back, knee, shoulder) using a rehab framework that strengthens supporting structures and helps avoid surgery [1:39:00]

Exercises for what 80% of people complain about: neck, lower back, knee and shoulder

Kyler points out that some of these don’t look like a knee exercise, but it could help the knee
It’s this idea of working around a structure that has pain to help that structure feel better
These regions are really common, really debilitating, and frankly, generally people whiff on these a lot

Kyler’s framework

1 – Going back to that bifurcation he talked about earlier: do we need to consult an orthopedic or neurosurgeon (that’s #1)

Kyler makes that decision based on the story, the incident, what it looks like 1 – If it’s a knee and they’re a soccer player who twisted it weird yesterday If it’s all swollen on the joint line; he’s more worried about the joint 2 – If it’s a runner where the pain has been off and on for a long time, there’s no acute incident No joint-line swelling and the pain is kind of vague Those are 2 very different presentations and (1) is more of an ortho consult while (2) is better for tinkering around with a rehab pro to see what you can do
1 – If it’s a knee and they’re a soccer player who twisted it weird yesterday If it’s all swollen on the joint line; he’s more worried about the joint
2 – If it’s a runner where the pain has been off and on for a long time, there’s no acute incident No joint-line swelling and the pain is kind of vague
Those are 2 very different presentations and (1) is more of an ortho consult while (2) is better for tinkering around with a rehab pro to see what you can do
If it’s all swollen on the joint line; he’s more worried about the joint
No joint-line swelling and the pain is kind of vague

That’s the first bifurcation, determining the right path

Kyler points out that the best orthopedic surgeons don’t want to do surgery or inject everyone right away
They’re referring out all the time
A lot of clinics nowadays have a physical therapy in-house And there’s all kinds of constraints with that
The best orthos don’t just give someone a list of every PT clinic in town
They’re actually referring to different clinics based on that clinic’s strengths and experience Some clinics specialize in running, some specialize in strength training
And there’s all kinds of constraints with that
Some clinics specialize in running, some specialize in strength training

⇒ If your ortho is specifically searching out different PT clinics, that’s a great sign they know what they’re doing

If your ortho just gives you a handout and they’re like, go call somebody
That means they think all PT’s the same and all rehab’s the same (and it’s not) .

2 – Once you know that it’s a rehab case, the protocol turns into what is the safest and smartest way to create change

Maybe it’s a manual therapy maybe
Maybe it’s one of those treatments Kyler spoke to earlier or maybe it’s a strategic load
A lot of times, that decision is based on the patient’s comfort Read the room: are they a cattle rancher dude who wants to push through pain and they’re going to go back to work tomorrow? Or are they someone who’s really scared because the pain is high? We got to build trust We got to get them some sort of pain relief to show that we’re medically being responsible and making sure we’re going the right direction
Once we’ve created that change, then we start to load it
Read the room: are they a cattle rancher dude who wants to push through pain and they’re going to go back to work tomorrow?
Or are they someone who’s really scared because the pain is high?
We got to build trust
We got to get them some sort of pain relief to show that we’re medically being responsible and making sure we’re going the right direction

If working on a patient with a total knee replacement

A lot of times if Kyler is working on a joint that is permanently compromised (say it’s someone with a total knee replacement), he’s not going to beat up the knee a lot
Traditional insurance-based rehab is going to go after that joint because that’s the code that’s associated with it, and they know they’re going to do that really well
What Kyler going to go for first is the foot, the ankle, the hip, and their pelvis in general There’s a lot of low fruit there He can enhance the pelvis strength or the foot strength
There’s a lot of low fruit there
He can enhance the pelvis strength or the foot strength

He can actually buffer that knee to where it doesn’t have to work nearly as hard and those people get a reduction in symptoms overnight

Goals for the exercise videos

Show people a few examples of what they can do and how they can put this into their own practice
Kyler wants to focus on what people could do for themselves right away (without having to make an appointment somewhere)

Looking at 3 things that can go wrong

1 – In the musculoskeletal tissue
2 – In the joints
3 – In the motor controller exercise window
He’s going to dive into some of these exercises that might not be expected to be helpful for your neck or your shoulder, but actually indirectly can load those structures to try to get that relief just like Peter experienced with his lower back

Kyler’s going to show people a set of exercises around each of those 3 pillars per joint

He’s going to dive in and show this is what you can do for the tissue, this is what you can do for the joint
Most importantly, these are some loads you could do that actually help reprogram that software to where you actually stop overloading the area that hurts and get everybody else back on track

EXERCISE VIDEOS

We are going to transition to show some of the stuff we’ve been talking about
Obviously, it’s a finite number of things we can show

You’ve been pretty deliberate about the exercises you’ve chosen, why is that?

It goes without saying, nothing beats an assessment
Kyler wanted to make sure the exercises we provided people are safe for almost everyone
It’s worth noting, that if you’re worried or have had an acute traumatic injury, nerve pain, or things like that ‒ get evaluated by a medical professional
He wanted to make sure these were accessible to everyone You shouldn’t have to do homework or have a ton of equipment He wanted to highlight exercises that people could do at home on the floor, or they could use minimal equipment
You shouldn’t have to do homework or have a ton of equipment
He wanted to highlight exercises that people could do at home on the floor, or they could use minimal equipment

⇒ If you have neck pain or knee pain, you can do a lot of good for those body parts by working on something somewhere else

What you’ll see as we go through this is that the neck section may have exercises in the shoulder or mid-back

We’re not directly attacking the joint that is painful, and that’s an important way to do this responsibly

Lower back

This is near and dear to Peter’s heart personally, and most people go through at least one bout of acute lower back pain in their life
We talked about how much of a cost this is to society and frankly how debilitating it can be Not just in physical pain But psychologically, this is a devastating injury for many people, and there’s a real fear of, “ I’m never going to get better. ”
We’ve learned a lot along the way about how lower back pain is treated
One thing is clear: complete and total rest is not the answer
Not just in physical pain
But psychologically, this is a devastating injury for many people, and there’s a real fear of, “ I’m never going to get better. ”

While rest has its place, a more active approach to recovery is better

How do you think we’re going to get through that?

When someone is in debilitating pain, you come across as curt or unempathetic if you suggest they go for a walk and power through it
The reality is, you’ve got to find a place to start movement, start downloading your body, and downregulating your pain
The exercises chosen are aimed at not only pulling from that DNS world where you’re generating intraabdominal pressure, but also start to load the core a little bit Which has a lot of benefits on respiration and downregulating pain
These exercises were intentionally chosen so everyone could do them, they’re really easy to do, and they’re generally very safe for the low back
Which has a lot of benefits on respiration and downregulating pain

DNS 3 month:

DNS prone 4.5 month:

Half kneeling halo:

The knee

We’re limiting this to chronic knee pain We’re not talking about the running back who gets tackled and tears his ACL
We’re not talking about the running back who gets tackled and tears his ACL

Isn’t it the case that the knee is one of those systems where if there’s a chronic pain, it’s often tied to a dysfunction at a different joint?

That’s very common
The knee is almost always the victim in those kind of scenarios
One general rule, whenever Kyler has a patient with chronic knee pain or knee arthritis, the first thing he wants to look at is everything else He’s going to make sure that foot and ankle are working really well He’s going to make sure the hip and core are functioning well More importantly, making sure there’s not an overload to one side
The 2 exercises chosen are intentionally covering a lot of these bases at once
These exercises are slow and pragmatic so that the user at home can try them out and see how they feel The videos clearly explain where you should feel discomfort or effort happening, versus the knee
He’s going to make sure that foot and ankle are working really well
He’s going to make sure the hip and core are functioning well
More importantly, making sure there’s not an overload to one side
The videos clearly explain where you should feel discomfort or effort happening, versus the knee

DNS hanging stance:

Soleus Bridge:

Neck

The neck is another one of those areas that is similar to lower back pain: when it is flared-up, it seems to consume all of your attention It can cause a great deal of physical discomfort and emotional discomfort
It’s safe to say, we are seeing an increase in the incidence of neck pain Part of that has to do with changes in posture as near work has become more frequent (phones have accelerated that) ‒ radiologists have this term called “tech neck” which describes that unnecessary flection
While diagnostics are really important, and there’s a lot of real estate in a very small area, the types of problems that can occur if left unchecked are pretty significant
It can cause a great deal of physical discomfort and emotional discomfort
Part of that has to do with changes in posture as near work has become more frequent (phones have accelerated that) ‒ radiologists have this term called “tech neck” which describes that unnecessary flection

How are you going to go through that?

It always comes down to that point of stress
If you have symptoms (structural or not), the neck is working really hard for us all the time

These exercises are targeting the areas around the neck

If your neck is already working really hard, and then you have a lot of restrictions in your thoracic spine Or your rotator cuff isn’t active and strong like it should be Then your neck and the areas at the bottom of the neck have to work even harder to help you perform daily tasks
While we can’t evaluate every person listening to this podcast to rule-out if they have radicular nerve pain, we wanted to go after their shoulder, their thoracic spine To decrease the tension in that whole chain So you can determine if that relieves your neck pain The problem might be something that’s not the actual neck structure
Or your rotator cuff isn’t active and strong like it should be
Then your neck and the areas at the bottom of the neck have to work even harder to help you perform daily tasks
To decrease the tension in that whole chain
So you can determine if that relieves your neck pain
The problem might be something that’s not the actual neck structure

Supine touchdown:

Eldoa T6-T7:

Prone W’s:

Shoulder

The shoulder is another system that is near and dear to Peter’s heart This is something he’s injured and gone through the process of getting better
It’s a special joint, given that evolution has allowed for us to have incredible mobility that’s allowed us to do wonderful things
But that mobility has come at a cost, and the cost is susceptibility to injury that we don’t necessarily see in the hip An otherwise similar joint that is far less mobile
This is something he’s injured and gone through the process of getting better
An otherwise similar joint that is far less mobile

What are we going to talk about with respect to how to deal with this joint that is so important for life yet prone to injury?

Kyler wants to show very simple ways to activate stabilization
There’s this ratio in the body where if it needs a lot of stability, and it has a lot of motion ‒ we need to make sure it’s really stable
Other areas are by default, built stable

⇒ The most important point Kyler likes to drive home: because the shoulder is hyper mobile (and it’s supposed to be mobile), you can have high levels of pain and nothing wrong structurally; and you can also have minimal pain and structural compromise

For example, Peter was fairly functional even though his labral tear was pretty significant
Kyler wanted to come up with some safe ways to activate that stabilization
People in his clinic are sometimes shocked at how the right exercise, in the right position, and activating that relationship with all that stability can drop their pain a significant amount

Plank saw:

Kettlebell arm bar:

Prayer stretch:

Selected Links / Related Material

People Mentioned

Alton Barron (Orthopedic surgeon specializing in the shoulder, elbow, and hand; Clinical Associate Professor of Orthopedic Surgery at NYU Langone Medical Center, Senior Attending Physician at the Roosevelt Hand to Shoulder Center at OrthoManhattan; and Medical Director of Pinnacle Surgery Center in Austin) [5:00]

Kyler Brown earned his BA at the University of California, San Diego (UCSD), and Doctorate of Chiropractic from Palmer West. Dr. Kyler Brown (DC, CCSP) is a sports chiropractor with deep experience across multiple professional sports leagues (including the NFL, NBA, NHL, PGA, LPGA and MLB) and has always been fascinated with optimizing physical performance for both athletes and the general population. Kyler co-founded 10 Squared with Peter.

Kyler specializes in bridging the gap from post-surgical rehabilitation, all the way back to high performance. As the Director of Injury Prevention at 10 Squared, Kyler brings his deep clinical expertise to all of the 10 Squared assessments and programs to pursue high performance while simultaneously accounting for injury history and potential risks.

Instagram: @drkylerbrown

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