Managing pain and injuries can be tricky. Sometimes we get banged up; we have hip pain, shoulder pain, knee pain, back pain, etc. BUT, we still want to maintain our training and push the gas pedal. Joining me on the show today is Dr. Ryan Summers, a doctor of physical therapy and certified strength and conditioning specialist working with fitness professionals from around the world. He is the Vice President of Coaching Operations at Active Life, a company aiming to bridge the gap between fitness and healthcare.
Managing pain in your training becomes especially complex when we’re looking at it from a fragile mindset. Humans are not fragile, and our goal at Rebel Performance is to help you find your peak performance so you are living your most active life even in the midst of training setbacks. Ryan and I dive into the general principles behind pain and how you should modify your training before you eliminate your training. We then steer the conversation to passive strategies versus active strategies you can use to manage pain and injuries. Ryan shares his hierarchy of needs methodology breaking down active and passive range of motion. Listen in as we unpack the different strategies and tactics you can use to empower yourself and put you in a position where you can be really successful.
What You’ll Learn in This Episode:
- [04:12] An introduction to Dr. Ryan Summers
- [09:50] General principles behind pain
- [12:48] Modifying training before eliminating training
- [15:44] The spectrum of uncertainty
- [18:30] Passive strategies versus active strategies
- [21:05] The relationship between rehab and training
- [34:03] The hierarchy of needs
- [41:24] Blood flow restriction training
- [42:44] Principles over methods
- [51:35] Where to find Dr. Ryan Summers
James Cerbie: All right, there we go. Doctor Ryan Summers. What’s going on, man? I’m so glad we get to do this. We haven’t really got to connect since the Grand Canyon trip.
Dr. Ryan Summers: Yeah, man. What was that? April. I can’t remember, like, it’s so long ago, yet it just happened, like a few weeks ago. It was weird. It was like in this other dimension of time and location, it just happened. And now I can’t even get back to my normal life. But, yeah, I think it’s been a few months, man, and excited to be here and connect with you and catch up on all the things. Yeah.
James Cerbie: I was talking with my wife, Kelsey the other day about that. I was just looking at the calendar, kind of looking at business stuff, thinking about Q2. Q3. We’re in Q4. Just looking how everything has been going. I was like, Christ. Well, a long time ago, I was like, that feels like it just happened.
Dr. Ryan Summers: Yeah. Well, I think also, as we were talking about before this call, I just had Doug Larson come in and talk with my staff about all the things that Doug knows about. And so just seeing him again, obviously, he was on the trip with us. I feel like I still see your face pop up a lot. So that makes it feel more recent, seeing all you guys doing all your things and then you remember. Oh, wow. It’s actually been like five months since we were all together, but yeah, man, that was just such a blast of a trip.
And honestly, it’s still just like sitting with a lot of the things that came up on that trip, both emotionally, socially, physically. There’s a lot of value in that trip that I think is still going to take probably another six to twelve months to really work through. But yeah, good times.
James Cerbie: It was a fantastic diamond. But let’s do this here. So anybody tuned in that doesn’t know who you are, what you do, let’s bring them up to speed on all those key variables.
An Intro to Dr. Ryan Summers
Dr. Ryan Summers: Yeah, man, for sure. So as with most of your guests, I feel like there’s always this identity crisis and how we describe ourselves, but I’ll keep it as simple as possible. I guess, by nature and by trade, I am a doctor in physical therapy. I’m a physical therapist, but I don’t really operate the way that most physical therapists do anymore. Anytime I go out to dinner, conversations, meeting new people, we have a physical therapist, but I work entirely remotely, and they can’t really understand how that works.
How do you deliver anything of value if you’re not touching people and scraping on people and cracking their backs and whatever other thing I’m like? Well, what I actually do as a physical therapist, I work for this company called Active Life, where I am the vice President of coaching operations, and we have figured out a way, a model to help people, primarily those who are in need to receive services dealing with pain and injury and really, anything that is holding someone back from living an active lifestyle.
We’ve created a coaching model, a methodology that was created by physical therapists chiropractors. But we also have plenty of personal trainers and strength coaches on our staff now as well. But that’s now how I operate as a, quote, unquote physical therapist. So that’s how I spend my day to day. I oversee our remote coaching staff, but I also do a lot of mentorship. I do a lot of education for, as I mentioned, physical therapists, chiropractors, but primarily coaches in the fitness and strength industries. So we are pretty heavily immersed in the fields of CrossFit and functional fitness coaches who are looking to be able to better serve clients again, talking about pain and injury, that’s kind of our bread and butter.
That’s our niche. But I guess one of our mottos is to professionalize fitness, but in addition to that, it’s also to humanize health care and empower the individual. So those are three pillars as a company in which I wake up every day looking at my board and saying, if I do those three things, if I humanize health care, allow people to see physical therapy and health care, the entire industry in a more humanized way. Great, awesome. If I am professionalizing fitness to see for people to now look at personal trainers as potentially an access point into fitness and health care to be that primary care provider.
Great. I can check that box and then finally empower the individual. And I feel like we’re probably going to talk about that quite a bit today. But for all the clients that come to work with us, that is the number one staple. If we’re going to do anything in working with clients as we’re onboarding them, as we’re creating these different plans of attack and plans of care for them, we need to make sure that they are an active participant in that plan. And I think if there’s anything that health care gets wrong and probably fitness as well is that we make clients rely upon us.
We make them more of a passive individual in that plan. It’s just like, well, do what I tell you. And if you don’t do it, then you’re screwed and things are going to work out. If you were to ever cancel your services and membership and work with me, good luck, because you’re going to get fat and lazy and out of shape and hurt again, that is just the complete opposite of what we’re trying to do. So by empowering
the individual, having to become more of an active participant in what they’re trying to do, help them better understand that the body is strong, it’s resilient.
We can adapt. We don’t need to be feeling like we’re constantly disabled and that there’s all these different things that are holding us back from really living our lives to the utmost true potential. That’s what we’re trying to do. So that’s me, Dr. Ryan Summers, and that’s what I try to do on a day by day basis.
James Cerbie: I love it, man. That’s a hell of an intro. Well done. That’s good.
Dr. Ryan Summers: There you go.
James Cerbie: So I think there’s so much good stuff there that we can start with to unpack. I think this concept of empowering the individual is important because with what we do, there’s a fine balance of like, yeah, I want you in my coaching program because I want to be able to help you. I want to be able to get you the support you need. But there’s also the expectation that you are probably going to outgrow us at some time. You’re going to reach a point where you may not need me anymore or you need somebody else.
And that’s part of this process. It’s training, but also educating, so we can empower these people, like you said, to actually live these very active lifestyles for us. We talk about living at your peak. We get a lot of former athletes and people who just wake up every day to find out how I can try to get better in all these different aspects. And so what I would love to circle back to is this pain conversation, because I think especially people listening to this, who push the gas tunnel right the way that I like to describe our clients that come on board. They tend to be like souped up cars on the highway, going about 160. Right.
Like, tons of effort and energy. There’s just no direction. Usually there’s not a GPS. It’s not clear. Take this exit, then take a right and take a left. We’re going to get you where you want to be. And so a lot of them do end up in this position if I work my ass off. I train really hard. I’m pushing the gas pedal, but eventually we get this.
Dr. Ryan Summers: Yeah.
James Cerbie: And now I got this nagging shoulder pain and like, my back’s a little of this and my knee and my hips. So would love to dial back in this pain conversation you guys work with and see so many different both athletes and coaches. Are there some very common presentations that you tend to see again and again and again? And maybe what are some ways that people can start to work on this themselves if we want to use that bulletproof analogy that’s so popular nowadays?
General Principles Behind Pain
Dr. Ryan Summers: Yeah, for sure. I think it’s a really valuable question and topic overall. And I’ll start a little bit more generalized and talk a little bit more about, I guess, general principles rather than deep diving into the methods, the people that come to work with us. I would say, on average, we are usually like a last ditch effort. And what I mean by that is that they have to talk about the typical clientele type A go getter mentality pushing the gas pedal, maybe not really adhering to the model of training.
Smarter, not harder. I have to continue to train harder to get to where I want to be. They’ve probably already been dealing with a lot of these different aches, pains and injuries. And they’ve tried traditional healthcare. They’ve gone to maybe see their local PT, their local physio. They’ve maybe gone to see a local chiropractor and typically. And obviously there’s a lot of really good clinicians out there. But I would say, on average, generally speaking, a lot of those solutions are going to be very passive in nature.
And I know I’ve used that term a few times already, but when I’m talking about being passive, it’s lying on a Flint and getting those hands on manual therapy modalities. And the issue with that is that as soon as that person, that patient, that client then pops right back up, they’re now living that active lifestyle again. So there’s very little carryover in transition from lying on the plants, getting those things that may or may not make you feel better. You get a low back adjustment, you pop up, hell yeah, feeling like I’m 50 years old.
But I feel like I’m 30 again, that’s the feeling that we get. But the problem with that is that usually it’s very transient in nature. Those effects, those improvements, if we don’t do anything afterwards, they’re going to go away within, like, 30 minutes. And that person, maybe they’re getting that adjustment, having that session at 08:00 a.m. Well later that day, maybe they’re going to a group class, or maybe they have a personal training session at 05:00 that day. Those effects are probably going to wear off.
So the problem with that is that there’s again, very little carryover to living that active lifestyle. And so for the people that come to us, they’ve tried the thing and they might get that improvement. But it’s not
something that’s very long lasting. And they continue to feel those pain, those side effects of pain. And when they’re living their daily lives, they might be perfectly fine. But when they’re doing the things that are very important to them, whether that’s being able to do a push press or being able to do a handstand walk or being able to do whatever thing they want to do with their upper body to use that example.
Modifying Training Before Eliminating Training
Well, they still have the same symptoms of pain and discomfort because there’s very little carry over to that. So we then provide the model that allows them to work in not going to use the word the term rehab, because that’s not really what we’re doing. We’re providing a service that still allows them to train and operate in the gym. And so one of the things we always try to do is modify training before we completely eliminate training and provide those modalities, provide that service, provide those exercises, whatever the medium is that allows them to do those things better more effectively and then therefore be able to do it without the discomfort.
And so we say, ADIs a lot. And what I mean by that acronym is activities of daily importance. And for those same people to go back to that model of health care, maybe let’s say, James, you’re dealing with some knee pain and you go to your doctor and you’re talking about it he’s like, well, what do you feel? That knee pain you’re like? Well, usually when I put about 365 and I’m doing five by five front squats, it starts to get a little bit irritated. What’s the doctor going to say in that scenario? Well, I don’t know if we’re a lot of cuss on this. Why the F would you even be trying to do that?
James Cerbie: Just stop squatting.
Dr. Ryan Summers: Yeah. Just stop squatting, bro. Like, obviously, the easy solution is to stop squatting. Does it hurt when you’re walking? No. Does it hurt when you’re running? No. Does it hurt when you’re coming down the stairs in the morning? No. Well, then just stop squatting. And the reason why that’s not okay is because squatting for you not even talking about the fact squatting is good for long term resiliency and to be a functioning human being. That’s beside the point. But the point is being a really heavy, strong squatter is important to you.
That is an activity of daily importance. And so for someone like you who finds a lot of meaning in being able to backslide a brick shithouse, being strong and being a fit guy to then be told, well, just stop doing it because that’s the only thing that’s causing your knee pain. That’s not a good enough solution, right?
James Cerbie: It’s a cheap way out.
Dr. Ryan Summers: It’s a cheap way out. It doesn’t make sense. And so for the people that come to us, they’ve heard those things time and time again. It’s not good enough for them. They want something a little bit more. But one other thing that people come to us with. And when we’re talking about this idea of, like, empowering the individual. Yeah. They might have been dealing with some pain for a while. And let’s use your example again. Let’s say that that’s the only point in time where you have any of that anterior knee pain.
You’re squatting a full depth of 365. Maybe the first set of five feels okay. Second set, getting a little bit more accomplished. Third set, man, you’re really starting to feel it. That’s week one, it starts to continue going down this cascade. And now, not only does it hurt when you’re squatting, now it starts to hurt when you’re walking down the steps in the morning, maybe you do a five K run every Saturday. I know you’re not a big endurance guy, but let’s say that that’s the case. Now it even starts to hurt when you’re doing some running.
The Spectrum of Uncertainty
Let’s say you have a three year old kid or maybe someone there’s a master’s athlete. Listen to this and deal with some back pain every time they deadlift. When it goes from being predictable, it only hurts when I squat only hurts when I deadlift. Now it’s gotten to the point where I bent over to tie my shoes, my back starts to lock up. I go to the local Zoo walking with my grandkids. I have to sit down on a bench every ten minutes because my back is locking up when we start to shift to the other end of the spectrum of uncertainty.
That’s when people start reaching out to us, pain when it’s predictable, one thing injuries. Well, now I know I hurt my shoulder. I went for one rep max PR, after three really heavy days back to back to back. Obviously, my shoulder starts to hurt. But now when I’m reaching up in the cupboard, it feels like there’s a lightning Bolt shooting down my arm that doesn’t feel very good. Doesn’t feel very good. Physically doesn’t feel very good mentally and emotionally, either. That uncertainty. That’s what we’re now trying to solve.
Yeah, you don’t feel very good, but it’s that uncertainty. And so now we’re not only unpacking the physical limitations, the musculoskeletal problems, but now we’re really starting to talk more about the biopsychosocial model of things. And what we’re trying to do is, yeah, a lot of the programming we’re giving people is you need to get stronger. You need to improve your strength. You need to improve
your range of motion. You need to improve things like strength and balance upward, high pulling versus overhead pressing to talk a little bit more tactically, whatever the thing may be.
But again, through traditional fitness, traditional healthcare sales depreciate. There’s a lot of things going on up top. Mental, emotional. Wellbeing, where people are injured, they’re really screwed up, man. And so to take someone like that, that is that type A go getter. Let’s use the idea of CrossFit when they’re a part of the community, something like CrossFit. And then a doctor says, Well, just stop going across it. That’s what resonates with them. That’s a part of their profile to remove them from their friends, that community and be no longer a part of that.
Good luck. One, they’re not going to do it. And two, and even if they did, they wouldn’t be very happy about it. So these are the things we need to better appreciate. And so when we’re looking at that and we’re onboarding people, it might even be, like a month into our program. And we actually start having people move. We’re just asking questions, like, how do you feel right now? How are you in your head space? You’ve been dealing with chronic pain for six months. Let’s just talk a little bit about that.
Let’s Journal about that. I don’t think we become like, counsellors, but our coaches are educated enough to be able to understand, like, hey, this has been a really rough patch for you. You haven’t been able to do all those things that you find joy and you find value in doing. Let’s start there. We can move later. That’s a lot of what we feel like. We need to focus on a lot more, because, again, those clients that come to us, they’ve failed. They haven’t been asked those really deep, meaningful questions.
They haven’t been asked to Peel back the layers of the onion and really figure out what’s going on and get to the root cause of why they’re not feeling the way they should.
Passive Strategies Versus Active Strategies
James Cerbie: Absolutely, man, so much good stuff there. I’m going to zip back to the very beginning because he brought something up that I really liked that we’ve talked about before on the show, which is these more passive strategies versus the more active strategies? Passive strategies being like, I’m stretching or somebody’s scraping me. I’m getting soft tissue work. I’m foam rolling, right? It’s not that none of those things can work. They can have an impact.
Dr. Ryan Summers: Right.
James Cerbie: But at the end of the day, what we’re attempting to do is open a window of learning opportunity to get you on your feet to then actually move. And this is a really important distinction. We talk a decent amount about using external restraints and references to help people get on their feet and be successful with this. Right.
For example, if I lay someone on the ground or I put them on a bench or if I give them something to hold on to, I’m giving them these external reference centers and restraints to actually start to work on this movement, saying in an active manner so we can make positive change, then I can take those away over time and say, okay, how are we doing now when we have none of that, you’re just a human in space. Can we be in good positions? Can we appropriately stabilize whatever word you want to use there? Right.
Can I get a shoulder blade moving on a rib cage or does everything fall apart once I remove all of these external, essentially safety wheels, if you want to call them that, right? Little training wheels. The thing is, though, I feel like a lot of people miss that whole middle step. They just want to say, I’m going to do these passive things, and then I’m just going to jump over all of that. And I’m going to go right back to what I was doing, and then they’re like, man, well, it’s still a problem.
It still hurts. And the one that I used to see more when I spent more time training a lot of baseball players. You get a lot of guys with elbow and shoulder issues, so especially in pro ball, it’s gotten better. But it used to just be, hey, we have enough money. We just sent you to the orthopedic surgeon. We’re going to pop in there, do some surgery, we’ll get you right back to what you were doing, but they’ve never addressed the underlying problem. So, like, six months down the road, the same thing they went in to have surgery for starts hurting again.
The Relationship Between Rehab and Training
There’s this total lack of appreciation for the work to be done in the middle. And I’m really glad you mentioned the fact that it’s not rehab. And this is a really big buzzword at one point in time, right. Like rehab is training and training is rehab, that whole thing. And it is right. It is.
Dr. Ryan Summers: Okay.
James Cerbie: There’s a distinction if you tore your ACL and we got to get you back from ACL, there’s like, a very rehabby component of that.
Dr. Ryan Summers: Right.
James Cerbie: But normal, everyday people where we’re just managing this movement based problems because that’s what this all comes back to. It’s like rehab and training are a very integrated, married relationship. It’s not just two separate worlds entirely.
Dr. Ryan Summers: Yeah. To clarify my point with that, I guess my issue with the word rehab is that it paints this picture that only licensed medical professionals can make people feel good. And I have a huge issue with that. Anyone listening to this knows that that is simply not the case. So when people are not feeling good, then they have to go to rehab. And that is the only medium from not feeling good to feeling good. There’s a lot of people out there that are very smart and that have the education and expertise to move someone from not feeling good to feeling good.
And it’s not through rehab. Maybe a better term would be reconditioning, perhaps, or building resiliency. You use the word bulletproof. I love that term. I really like the word resiliency, because now that paints more of a model of, I guess, awareness rather than being careful. I really hate saying hate the strong word. I really dislike when people say, be careful, especially coming from a medical professional. Hey, you just had a shoulder injury. Be careful when you’re going overhead again. How does that make you feel insane?
James Cerbie: Psychology. It’s just mental terrorism, right?
Dr. Ryan Summers: Exactly. The term that I would use now puts a thought virus in your head, and that thought virus is. Well, I’m about to do something super sketchy, and I’m not confident in doing it because I was told to be careful. So now you have this fear of avoidance when you’re going into a snatch or overhead or whatever the thing is or throwing something really fast, like a baseball. Well, I got to be careful, because if it goes wrong, then I’m going to re-injure myself versus being aware, understanding the risk versus the reward.
Hey, right now you’re doing a workout that has a lot of volume, has a lot of intensity. You’re doing it for 30 minutes. The goal is to do as many rounds as possible. Also, you had a really tough week at work. I know you and your spouse aren’t getting along real well right now. You’re probably under hydrated. There’s a lot of factors to be aware of right now. I’m now going to let you make the decision for yourself and how hard you want to go in this workout versus here’s the intended stimulus.
Here’s the intended outcome of what we’re trying to do. We’re looking at things with a big picture, more macro. Now asking the question is this something that’s going to move the needle towards that goal? Or are you thinking more from a workout versus training perspective? And the difference between those two is training? Looking at the big picture, does this move me closer in that direction or not work out? I’m just going to fucking do whatever I think is best and just run my body in the ground. Not really understanding the implications of that.
There’s a lot of risk to that. So anyway, the rehab is not a fan. I don’t like telling people to be careful going back again. That idea of being active, empowering the person. Here’s the factors we need to consider risk versus reward. How do we need to go about it? And in providing guidance? And I think that’s probably something else we can talk about. But just that idea of being more of a Sherpa. I really liked that term Sherpa. I think that was the Body Knowledge podcast.
Dr. Andy Galpin and those guys. I think it was on the Barbell show, multiple shout outs to the Barbell show. And Doug Larson on this call. I think they had, like, a ten episode series on this idea of being a Sherpa. I really like that idea. You’re guiding someone. You’re not carrying them up the mountain. Here’s the path. There’s something over there. If you walk too close to the edge, you might fall off. Best to stay over here. I went on a White-water rafting trip a couple of weeks ago, and you have a guy.
Hey, as you’re approaching a class five rapid, he’s telling you. All right. If anyone goes for a swim, meaning you get kicked off the raft and you’re swimming down the Rapids. Don’t go that way. You’re going to get stuck under a rock and probably die swimming this way instead. He’s not swimming for you. But he’s telling you here’s the best course of action. So anyway, I think that is what allows us all to operate together. Physical therapist, strength coach, PT Chiropractor, medical provider, functional medicine provider.
And it all comes back to empowering that individual. I know that’s not how we started that little talk there, but that’s how I’m going to end it. Good.
James Cerbie: I like it, man. No, I think the concept of the thought virus is really important also. And this is one that really references the family guy that really grinds my gears.
Dr. Ryan Summers: Right? Right.
James Cerbie: Doctors are so well trained. One of the things that they are horrendously trained in is the language they use when they’re speaking to the person sitting in front of them on a table for people that are interested in this realm. Really good book called Explain Pain. Totally blanking on the author’s name right now.
Dr. Ryan Summers: Is that Moseley? Maybe. Is that Justin Mosley? I’m blanking on it as well.
James Cerbie: We can do a quick little David Butler and Lorimer Moseley, phenomenal book in this realm. And just like, how important what’s going on between the ears is for people when they’re on this journey. I remember being in College and having a stress fracture in my back. And the guy I said, the doctor, I was saying he was like, Well, you’re never going to squat again. That’s off the table. You’re never going to do it. I’m just not like most people. I’m just obnoxiously stubborn. I was like, okay, I just got up and left.
I was like, I don’t value your opinion. So I’m going to leave. I think you’re wrong. But most people aren’t as stubborn as I am. And a lot of people get this thought virus implanted, and then they start to think of themselves as broken, or they start to think of themselves as weak or endangered or sick, or they start walking on needles all the time, like you mentioned, right. Well, be careful when you go back to do this. So you know this as an athlete, the last thing you want to be is hesitant and cautious and having to really overthink things all the time.
That’s the fastest way for you to get injured because you’re just going to be holding back as opposed to having somebody be the Sherpa and guide you on this path. So you can be confident that when it’s time to go, you can kind of shut your brain off and rely on the fact that, hey, I’ve done the work necessary to be able to do this thing. Well, that’s a big one for me that gets mismanaged a lot.
Dr. Ryan Summers: Yeah. Well, I mean, you’re speaking both from the anecdotal evidence of how important that is. But I can’t tell you how much research and literature there is looking at confidence in returning to sport. You have to have confidence. So I have these. I guess it’s a checklist of what I call the five C’s of returning from injury. And that last sea is confidence. So, I mean, you’re preaching to the choir here, man. And so let’s just talk about ACL reconstructions. But if you’re working with a soccer athlete, a soccer player, and they’re maybe month eight, typically for those who don’t know, ACL is anywhere from, I would say, six to twelve months of a recovery.
If you’re really interested, go back. And the high level athletes like everyone talks about West, Welker he got back in, like, five to six months. He’s an outlaw. If you can take twelve months, take twelve months. The reason being yes. Now you’re going to get your full range of motion, you’re going to get your strength bounced back. You’re going to get your quad firing the right way. You’re going to allow that tissue to actually heal. But the other issue with the main issue with that is that whenever we’re working with that kind of athlete and you’re talking about maybe dealing with a medical doctor or a surgeon, they focus a lot on those timeline progressions.
And so people have come to us, and they’re like, Well, I saw my doctor and I had this labor tear, and I got surgery for it. And it’s been six months. So he said I was good to go. And he said just to take it easy or that soccer player. Well, it’s been twelve months, and he said I was good to go and have a full range of motion. So I’m good to go back and do non-contact drills. Well, that timeline doesn’t really give us objective benchmarks to say you’re ready to go.
But more importantly, they don’t take the time to ask the questions. How do you feel about your leg right now if they’ve been doing anything, if they’ve been running or jumping or doing anything overhead, they’ve probably had a brace on there. They’ve had a sling or a protective mechanism like you’re describing something that provides them a little bit more support. Well, now they take that off and they’re running around if they don’t have that level of confidence. So much research shows us that the risk of re-injuring that tissue, of having a setback drastically increases.
So confidence gives people the blanket of confidence. What I mean by blanket is that, yes, you can have all the range of motion strength as you want. But if people are empowered and they have that confidence, they’ve been doing all the things they need to be doing, and they actually go from that plinth where, yeah, they’re doing quad knee extensions or whatever straight leg races. Well, now are they actually on a field with a physical therapist looking at how they’re cutting and doing dynamic stuff.
You do that for three months? Of course, that’s going to build confidence because you’re not giving them that fear of the audience as we’re describing. One other thing I want to touch on when you’re talking about bedside manner or potentially lack of communication from medical doctors. I always want to make sure it’s very clear there’s good and bad doctors out there. There’s good and bad with anything. But what we see a lot is that there’s a lot of great clinicians, a lot of great physicians that can’t operate the way that they should, because the health care model just simply doesn’t work.
And so what I mean by that, or just give an example is if you go to your primary care physician, they might be seeing 30, 40 patients that day. And as a result, you’re going to go in there. They’re going to spend ten minutes with you, ask you a couple of questions, and then give you either they’re going to say, Stop doing the thing. As we discussed. They’re going to give you some Pharmaceuticals. They’re going to maybe recommend an injection or maybe get some imaging and then potentially surgery.
There’s not a lot of holistic models to it. Or maybe they’ll refer you out to a local physio. Whatever the case may be, that ten minute session of course it’s going to feel rushed. Of course, they’re not going to be able to really unpack this to the degree that it’s warranted because they don’t have the time, they don’t have the bandwidth. And that’s not their fault at times. That’s just because the healthcare model that we have is completely broken. It’s a trash can fire and we have to fix it.
We all understand that. But I just want to make sure it’s clear. Like, oh, don’t go see your physician because they’re not going to listen to you. There is value in doing that, especially if you’re presenting with a lot of these red flag symptoms of, like, I wake up in the middle of the night and I’m curling over with stomach pain. You got to go see someone, obviously. But just to talk more about the model itself and not just say that physicians don’t listen to you. It’s a systemic effect, I guess. Yeah.
James Cerbie: It’s a complex problem. There’s a lot of issues going on there that people are actively trying to improve, which is a good thing because it does need improving, right?
Dr. Ryan Summers: Yeah.
James Cerbie: But one thing I would like to circle back on here, well see we’re at a little over 30 minutes here. Come back to one concept here to try to leave people with some real, maybe more actual advice that they can go and work on on their own. And so when people start asking me questions around this realm of pain, discomfort, injury and training, when I try to Whittle it down as simple as possible, it’s okay. The first question is this, do you have the requisite range of motion available passively in a very safe environment?
Is it there if I lay you on a table and we’re just going to have a Gander at what’s going on? Do you actually have shoulder flexion? Do you actually have hip flexion? Do you have hip extension? These are very basic range of motion parameters if you don’t have it passively, if you’re just one of those really stiff individuals, and this is where the classification is going to come. If you’re one of those super stiff people that on the table does not have access to it, then we got to spend time with you getting access to that, right.
Because that’s the limiter. But then on the other end of the spectrum, and this is where I think of it as stiffness and laxity. On the other end of the spectrum, you put the people on the table and they’ve got a range of motion for days, right? You’re high lacks individuals. That just they have this end range feel, and it just keeps going forever. You’re like, oh, this is just never going to stop. And we’re going, that population has the requisite range of motion. But that population, on average, from my experience, at least, tends to have a very hard time orienting and controlling and stabilizing in space.
They are just kind of, like lost. So they need more actions and activities that are going to help them figure out where they are in space, how to appropriately stabilize and control this preposterous amount of range of motion they’ve been given, as opposed to your big stiff jacked Bros that have this much shoulder flexion. Those are the two camps I try to push people into to keep it as simple as possible. You either got to figure out how to better control and stabilize, or we need to spend some work winning back some range of motion for you, because if you don’t have it passively, you’re not just going to magically reclaim it.
When I put you under load and high stress, it just doesn’t work that way. So I don’t know if that classification works for you in terms of how you guys start to maybe try to simply put people in one or two buckets.
The Hierarchy of Needs
Dr. Ryan Summers: Yeah, 100%. So I think one of our overlying principles or methodologies is what we call the hierarchy of needs, and it’s really what you’re describing. I’ll try to not get too far into the weeds with it, but basically everything the hierarchy looks at it as if it’s a triangle. The base of that is going to be flexibility. And as you’re describing flexibility, as I would define, it is passive range of motion. Can you
take your finger and bend it back as far as it can go? And I use that example because if anyone’s listening to this and they do that, if you’re driving a car, maybe pull over, don’t do it right now.
But bending your finger back, what you’re going to feel is that there’s a little bit of a stretch on the front. If you don’t feel that that’s an issue because you should feel a stretch. And when we’re talking to these different terms and these different definitions, I bring this up because you’re talking about someone who’s maybe lacking a little bit of hyper flexibility. Well, they can still present with something that feels tight. And so when people are looking for help, like, well, let’s say someone’s doing an overhead workout, and before they go and they do it, they’re in the gym and they’re hanging out on a band and they’re hanging out like, oh, yeah, it feels like it’s really tight right through here.
It feels really tight. It feels like it’s irritated. Maybe. Well, you lie down and see if they have full shoulder flexion. That’s not the solution. They don’t need to continue to stretch. They have full range of motion. They have full flexibility. The next layer to that what you’re also alluding to is what I would define as mobility, meaning active range of motion. Can you move through that range of motion? So the flexibility is the window. Okay, mobility is how much of that window can you actually access using a little bit of strength to reinforce it more or less.
And so that same example, bending your finger back. Now, can you get to that same range of motion without pushing it by actively bending your finger back? And so what we’re looking to see typically, you’re not going to have more mobility than you do flexibility. But how close you can get to that in range of motion is really what we’re looking to see. And then the next layer from that is what we would define as strength balance. So, generally speaking, we need to have balance across the joints.
We need to be as good at pushing versus pulling. We need to be as good anterior versus posterior, deadlifting versus squatting. There’s these different ratios that we like to look at, and it’s not the end all be all. And so one example might be what we would like for most of our athletes, is to squat about 80% of what they deadlift. Not from a one rep Max, but looking at like a load volume reps times weight. Looking at about 80% squats and deadlifts. That’s one example of that.
Now, if you’re squatting 85%, that’s not to say. Oh, well, we got to just now start deadlifting more. It’s a piece of the puzzle. Strength binds upper body, lower body. And then from there, we’re looking at work to rest ratios. So if you’re doing a lot of shit not recovering from it, stress plus recovery equals adaptation. You’re putting a lot of load on your body, not allowing it the necessary time to recover and adapt from that. Well, that might be the low hanging fruit. We’re not going to work on flexibility.
We’re not going to work on mobility. You just maybe need to take a week of de Loading because you build up this big cycle. October. A lot of people going through swattober, maybe starting to feel a little bit beat up as a perfect example. Right there.
James Cerbie: Chronic work through the roof load spike.
Dr. Ryan Summers: Yeah, I’m starting to feel a little bit achieved. One of the first questions is, well, just tell us about what the last month looks like for you. Well, I took all summer off from squatting, and then I decided to switch over and I’m feeling like I got a little bit of a pinch in the front of my hip. Guess what we’re not going to do. We’re not going to be doing hip flexor stretches. We’re not going to be doing couch stretches. You probably just need to cut back on the squatting a little bit.
So really keep staying simple. And then finally, at the top, that hierarchy, we’re looking at what you’re maybe talking about a little bit of mobility, but skill and motor control. And so it’s just a really simplified way to better understand someone who has all the range of motion in the world. Full shoulder flexion, full hip flexion, full ankle Dorsiflexion. They have all those. They meet all those requirements, all those prerequisites, but they still can’t do an overhead squat. Why can’t they piece those things together?
They can’t combine this to this, to this, they can’t brace effectively. Maybe they don’t have the technique, the coordination, or the motor control. Maybe they’ve only been doing it for a month. Well, you just need to practice a little bit more. That’s what we feel to appreciate. So that’s one of our guidelines. That’s one of our onboarding methodologies to say, hey, here’s what we’re going to start yet. There’s a lot of other things we are going to consider. But for coaches that are coming to work with us and go through education, is this a really good way to keep things simple?
I’m a big believer in Occam’s razor. Usually the most simple solution is the best solution. If we can keep things simple, then start there. It allows us to really start delivering immediate value and just at least start moving things in the right direction versus just kind of looking at things. You started a call by saying pain is very complex 100%. But if we allow it to be complex and try to deal with it with very complex solutions, well, it may or may not work, but the issue with that is if it does work, we don’t know why it works.
It’s not standardized. It’s not repeatable. Or if it doesn’t work, then we’re just like, oh, well, we tried this and this. I don’t know what the next step needs to be.
James Cerbie: Yeah, absolutely. I think simple always wins. Try the simple solution. Always go simple first. If simple doesn’t work for you, then we’ll try more complex things. But simple tends to work the vast majority of the time. And that’s one of the things that we see a lot. And it was funny. I was talking to Mike Dola earlier today from Stronger in Nutrition, and we were talking about the simple verse complexity. And humans just have a way of always wanting to try the most complex. It’s like we have two options.
This option is really simple and boring, but it’s a high likelihood of working. Then there’s this other option that’s super complex and fancy and sexy, but the likelihood of it working is low. But I’m going to go with the super fancy complex thing over here.
Dr. Ryan Summers: Give me that. Especially if I saw an influencer. Talk about it. I definitely want it. If someone has 150,000 followers, they talk about it. Yeah. Give me that all day.
James Cerbie: Yeah, because they obviously know what they’re talking about.
Dr. Ryan Summers: Exactly.
James Cerbie: It’s not genetics. It’s definitely not genetics. Whatever it is, it’s not genetics. This is one that drives me insane because I’ve been seeing more and more of this on Instagram where there are these people selling these stretching range of motion programs, and you just watch these people move. And I’m like, Bro, you literally tick every box for the high laxity individual. Your range of motion is genetic. You hyperextend every joint in your body, your stretching program is not going to be the solution. We’re probably going to cause more harm than good.
That’s when this one drives me nuts. Recently, I see it more and more where these people I’m like, Jesus, you’re going to wreck these people. You’re going to get them stretching all day long. They’re probably not going to get any better. And then they’re going to wonder, why am I not getting better?
Dr. Ryan Summers: Right. Well, let me ask you this. How often do you have your clients that are reaching out to you or other coaches saying, hey, I saw this quote from this guy, and I want to see if that’s something that would work for me. Should we include that in my programming? Does that happen to you frequently?
James Cerbie: We actually don’t get that that often. And I wonder why very rarely we will like it. I had somebody post one on our forum the other day because they ask me anything every Wednesday with all of our clients. And one of the posts was, hey, I saw an article that Chris Hemsworth did this training for one of the Thor movies, and it was just blood flow restriction training.
Dr. Ryan Summers: Right.
Blood Flow Restriction Training
James Cerbie: And I was like, yeah, so there actually is a decent amount of literature that’s going to support BFR training. If we think about hypertrophy, we’re just getting more metabolically stressed. You have metabolic stress on one side and mechanical tension on the other. You’re taking a more metabolic stress emphasis to drive hypertrophy. It can work for sure. But it’s not like the only solution, and it also tends to be more. The literature is in that rehab, return to play, realm where, like, load can’t be high. So I need to somehow put more stress on the system. We don’t need to go into my answer to the BFR, but that’s the most recent one I can remember.
Dr. Ryan Summers: Yeah, I can talk about BFR all day. That stuff is sick. You can get jacked and improve tendon capacity by being passive by literally doing nothing by just applying BFR. It’s crazy how cool BFR is, but it’s a different topic another time.
James Cerbie: It’s a very powerful tool, very powerful tool, the signaling mechanisms that you get right?
Dr. Ryan Summers: Yeah.
James Cerbie: We could do a whole other podcast on blood flow restriction all day.
Dr. Ryan Summers: Yeah, but I was only asking just from the standpoint. We actually get it pretty frequently. And I don’t know if the topics of pain and injury are more sexy in the Instagram worlds or whatever. We get it all the time. And I think the most common answer to it. We talk a lot about principles over methods and obviously going to name any names with these different influencers. But
there’s a lot of people that say this exercise is going to solve all your problems. This exercise is good for knee pain.
Principles Over Methods
If you drive your knees over your toes more frequently, it’ll build resiliency in your patellar tendon the way that we always combat it. Yeah. 100%. That’s a great exercise. But based on our assessment data, based on what we’ve figured out at this point, we actually need to be doing these things instead, based on these overlying principles. That’s one method that currently doesn’t fall within this overlying principle. And I just think there are so many fancy golden things out there where people are trying to grab on to them, that’s going to make me stronger.
That’s going to make me look better. That’s going to give me the six pack. But for what we’re talking about, I guess self-proclaimed experts in these things, it’s simple. If you want to lose weight, guess what you got to do. You got to eat a little bit less and you got to move a little bit more. It’s not that hard, but there are a lot of methods out there to say. Here’s the foolproof plan for it. And I was just curious how you, I guess, address those questions or like, what about this thing?
I saw it floating around. Is it something we’re going to corporate? I want to look like Thor. Well, yeah, that exercise is what it may look like, Thor, but guess what he did. He trained, like, 5 hours a day and bulked up on, like, 50,000 calories. And that’s how he built mass. It’s really not that hard to do. But anyway.
James Cerbie: I was just going to say our response to that usually is a lot of things work. There are a lot of tools in the toolbox. Our job is to determine what tool is the best tool for you right now, based off of you, your presentation, where we’re at in your program, our assessment. This is the tool that we think is going to work best for you for X, Y and Z reasons. It’s not that this tool can’t work or it doesn’t work. It most definitely can. It’s just, in our opinion, not the best tool for you right now. It’s something that we can use later on. Right.
Like once we get these other core principles in place that we’re working on, that’s usually how we try to approach it, because we’re very much a similar thing where we want to think about principles. There are things we want to see as you’re able to demonstrate these things that open up the toolbox. We can try more things, but we have to get to the basics first before we start trying all this super fancy stuff, right? Because you just potentially are not ready for that input or that stimulus yet. That’s usually the way that we approach it if it comes up.
Dr. Ryan Summers: Yeah. 100%. Man, I would say everything works. Nothing works all the time. And in addition to that, there’s never going to be a perfect recipe. You can take the box of the thing and put all this stuff in it. But what sets them apart? An expert coach understands. Ok, a little bit of taste testing here. We’re gauging the response to that external stimulus. And really that to me, is what coaching is if you really want to break it down. I gave your body an external stimulus and load.
We’re gauging the internal response to that to see what changes we need to make. And you can never do that very effectively if you’re just focusing on the method. So it’s like you’re saying, building consistency, building a foundation, keeping things simple, and then afterwards you can get as creative as you want. But, yeah, that’s the starting point. Thinking more from a principal standpoint of the why are we doing these things versus the what.
James Cerbie: So let’s wrap with just two quickies. So the first one is for people that have listened to this. If they’re going to walk away with just one thing, just one nugget. What is one thing that you would really like for them to walk away with? Because we’ve had a lot. We’ve definitely had a wide expanse here.
Dr. Ryan Summers: I don’t know if I’ve ever said it this way before, but I’ll put it this way. The human body is strong and adaptable until proven otherwise. I don’t know if I’ve ever said it that way. So I don’t know if that really makes the amount of sense that I think it does. But what I mean by that is to unpack it a little bit more. I’ll use that ACL analogy like we were talking about earlier. A lot of people are like, Well, it tore my ACL. What should I be doing to keep things simple?
What I do tell people is the main thing you should be working on post off ACL is improving your quad strength. The number one thing is quad strength until it’s no longer quad strength. And so when people are coming to us, when we’re working with someone like you, when they’re going to their medical provider, a physical therapist, it’s really coming at it with that pre framed mind-set of the body that is strong and adaptable. And when we’re talking about the idea of injury or pain the majority of the time, it’s about sensitivity.
It’s about irritability. The body has, for whatever reason, started to not like a certain movement or activity. It’s telling us that. And I’m not going to get too far into pain science here. But that’s really what pain is. Your brain’s. Number one job is to protect you from doing something stupid that’s going to kill you. And what starts to sense that there’s something out there it doesn’t like. And that makes sense when you’re getting bit by a rattlesnake or putting your hand on a hot stove, remove yourself from that situation as quickly as possible.
But sometimes that alarm SHORT FIRES a little bit, and then you’re walking or running, and it’s like, oh, my calf starts to not feel good. Well, it doesn’t mean you strained your calf. It’s just yours. A little bit of sensitivity there to that running at that volume at that speed, we can make some changes to that. But as long as we have that mindset that I’m strong, I’m resilient. I didn’t break anything. I’m not damaged. The body is strong and adaptable until proven that it’s not that’s really the mindset we’re trying to create and to unpack it until it’s not.
Obviously, there’s a lot of red flags that are out there that tell us, hey, you really need to take a step back and maybe get some imaging. Maybe you actually do need surgery. And so red flags number one, that’s like the precursor to that. If you’re listening to this and you’ve had some pain, and I used the example of waking up in the middle of the night, pain. That’s one of the trademark signs of cancer. I’m not trying to scare anyone here, but those are things we need to get assessed from a medical provider.
If you’ve had pain, that has been going on for three weeks, and maybe you’re having some pain from squatting, and you’re like, I’m just going to chill out and rest a little bit. But that pain is still there, or it’s worsening. That might be a red flag. You want to get that checked out? Pain shooting down your limbs, and it’s something like sciatica, and it’s causing numbness. It’s causing tingling. Maybe there’s things that are coming on and off for no reason whatsoever. As you’re sitting in a computer chair and your whole arm goes numb and you can’t fill the side of your face, you probably want to get that looked at.
But otherwise, once we get rid of all those red flags and it becomes a little bit more about that sensitivity, the body is strong and adaptable. And again, when we’re talking about what we see out there a lot, it’s painting this picture that people are frail. People are very fragile. We want to make sure that people understand they’re not fragile. The body is resilient. The body is adaptable. And when we’re looking at things as the idea of reconditioning and looking at training, training is the pathway.
Being strong. Resilient is the pathway to get back to being asymptomatic. It’s not something where we feel bad and we just remove ourselves from that equation. We want to keep people moving and active as much as we can. And through the variable manipulation by making some small alterations to their programming in their daily lives, the more we can keep people moving, the better off. Awesome. Yeah.
James Cerbie: I love that you’re not fragile if you’re a human being. I think I posted this at one point. If you’re alive today, you had an ancestor at some point in time, that was a Savage. The only way, the only way that you are alive today. If you had an ancestor at one point in time, that was an absolute Savage. We are not fragile. If human beings were fragile, we would not have made it through evolution in the last, however many thousands and thousands and thousands of years.
Dr. Ryan Summers: Yeah, well, that might be different here in 50 years as we continue to devolve as a species. But we’re not there yet. As we continue to start lifting, moving, caring, heavy, doing everything, we might get to the point where we might get to the point where we look like all the people in Walley, where they’re just on Hover graphs. That might be a different scenario at this point. But today, as you’re describing, yes, I guess another way of putting it when you’re saying, like, squatting. One of the ways I describe it is that you don’t have a knee problem.
You have a squatting problem. We can make alterations to that squatting. We can change tempo, volume, depth, intensity. We can change the front squat, the back squat. We can use a box. There’s a million ways to still allow you to still keep squatting. It’s not because you have a knee problem. And the more we can take that idea that model and apply it to whatever other thing it is. That’s what we’re trying to create.
James Cerbie: Awesome, man. So last one here, easiest one. Where can people go to find more about you and the awesome work that you guys have going over there?
Where to Find Dr. Ryan Summers
Dr. Ryan Summers: Active Life I appreciate it. You can follow me on Instagram. That’s my primary hub @DoctorRyanSummers. I have a website, drryansummers.com for actively, and you can go to my Instagram and my bio. All these different things are there activelyprofessional.com. We also have a relatively big influence on Instagram. Active Life RX at Active Life RX and Active Life Professional. Everything we have going on, we put it on there. But perhaps more importantly, I think we do a really good job of just educating people.
Dr. Mesa Henow. I think I said that right. Sorry, Mesa. If that’s not the case, she runs all of our social media and does a fabulous job of taking a lot of these different ideas and principles and talking about it in a way that’s really easy to understand. So followed up the Active Life RX. That’s probably the best way to learn more about what we do, our mission, our values. Yeah. I think that’s probably the number one resource right there.
James Cerbie: Excellent. Dude, thank you again. So much for coming on. I’m really glad we got to do this. Everybody listening, go give Ryan a follow. Check out all the cool stuff they have going on, have a fantastic rest of your week. And, yeah, it’s all we got for you will be back next Monday.
Dr. Ryan Summers: All right. See you guys. Thank you.
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