🔓 PLUS PREVIEW: When to Push Through Pain, Pre-Exhaustion Training, and Conquering Cravings

0:28Welcome back to the Barbell Medicine Podcast. All right, that's it for the pitch. On to the show.

0:39Let's get into the first question. So how often should an individual be experiencing pain or discomfort related to training, if you can even attribute it to training? That's actually a good question. This person says, I sometimes experience pain or discomfort in the same areas when I'm pushing my training sessions over a training block. However, I'm curious as to whether or not there are some sort of established normal ranges of injury rates for people with a history of injury or pain. And if so, do they vary based on the different areas of the body? So low back, knee, et cetera. So just to directly answer the question, no, there's no universally established, quote, normal range for the frequency of pain or injury recurrence.

1:18That said, it is common and it's often acceptable to experience some like low level self-limiting discomfort or pain. So like less than three out of 10 on a zero to 10 scale during training that happens frequently. I don't know that it's cause for concern. So for example, a pretty gnarly case of delayed onset muscle soreness, for example, would probably be that intensity. But if it's not limiting performance, doesn't cause like fear or anxiety around the issue and it's gone within a day or two, like, I'm not just talking about DOMS, but whatever this, this is, I don't know that it's cause for concern.

1:52I mean, we know injury rates. We have that data. Right. So like two to four injuries per thousand participation hours is the general sort of range that we expect from resistance training, even for competitive barbell sports. So if somebody is getting injured far more frequently than that, I guess that would be the normal, you know, if there was a like normal range, if someone's getting like, look, dude, every thousand hours that I can log, I'm getting a dozen injuries. I'm like, that's probably more than I would expect. On the other hand, if someone has no injuries for every thousand participation hours, I'm like, I do wonder.

2:25is this person actually exercising or like living, you know, are they in a bubble? If so, like send me the bubble. Um, but probably the biggest modifying factor here. And Austin, I get you to weigh in on this is like the history of injury. Right. So if somebody has like, yeah, I had a low back tweak, you know, four weeks ago, or I've had it persistently over the course of my adult life, as far as I can remember. Yeah. I mean, it wouldn't surprise me that a person with that kind of history has more frequent sort of flare ups just because of the history, I don't, you know, there are some ways you could modify that trajectory, like probably involving a change in training, you know, priority and kind of, it's not a true rehab block, but it's more like, well, we're missing some training tolerance here.

3:09And what you're trying to do does not match up with your current fitness and training tolerance. So we need to take a step back and kind of fill in those gaps. I mean, that's how I think about it. Does that square with your thoughts on this? Yeah, I mean, I think both of us probably looking back on our own training experience personally and with trainees, we have our own little like, you can call them quote unquote problem areas, so to speak, that the things that based on our prior experiences, prior injury history, things like that, that might be a little bit more likely to get sensitive every now and then based on the, you know, relative training load and other factors that all go into the complex sort of pain experience.

3:47You know, I know that for me in the past, I've had a little bit more often like tendon issues with my elbows. I've had a little bit of some low back aches here and there, but I very infrequently deal with hip issues, for example, whereas I know that you have experienced more hip issues than I have. And those are just things that we are not like constantly ruminating over or worrying about or thinking about, but rather recognizing like when we think about them a little bit differently, probably. If I have a little bit of a hip ache, it doesn't really flag much of anything for me. And I'll probably, you know, my default will be to expect it'll probably get better in short order with maybe a little bit of modification or just some time.

4:27Whereas in your case, given that you've got maybe a little bit more significant history in that area, it might flag as something that you might want to get on top of a little bit quicker. And not just assume it's going to be fine. It's like, well, well, you have the prior history in this area. And so being a little bit more proactive in that area might make sense. So that's kind of my approach is if it's just a seemingly like a fluke thing, that's not a recurring issue for me over time. And it's, as you mentioned, not particularly severe. I'll give it a little bit of time. I might modify my next session, et cetera.

4:58But if it's an area that is kind of starting to flare up where it's like, gosh, I've dealt with this several times over the years, then I'm inclined to approach it a little bit differently. But, you know, getting back, as you mentioned, to the original question, there's not going to be like a normal quote unquote range around this. It's really like, how much are you experiencing? And is it something that's, you know, you're willing to tolerate for the outcomes that you're getting from your training? If it's like, well, I'm not making that much progress and I'm dealing with all this pain all the time, then I would say we need to modify things more significantly.

5:27if you are making fantastic progress and you're having little aches and pains here and there that you're getting better on their own i would say i mean enjoy that enjoy that ride because that's not going to last forever and then lastly i would say if you're like well i'm unwilling to deal with much of any pain well we probably need to have a conversation about expectations and then also there might still be some room for modifying your training in a way that reduces that risk further but i don't think that there is a lot of room for like the type of folks out there in the industry who promote like here's my system for pain-free training like forever that's unrealistic right so those are kind of like the different tiers that i would think of here how much are you experiencing how much are you willing to tolerate in terms of severity frequency intensity etc and then what's the context of like how much progress are you making and is it does that make it worthwhile for you or not or is it like a time limited thing where i got these aches but i got a meet coming up and i'm making great progress maybe i'll you know compete and then i'll need to change things more substantially after that.

6:22There's all sorts of ways that you can go about kind of triaging, prioritizing, deciding what your next steps are going to be. Yeah. And I would just add to this that, you know, we think about areas or particular places that, you know, get injured. We think of low back, shoulder, knee. These are all very common, but not just in like barbell sports training, just in like human existence. So, you know, it's not like the prevalence of low back injuries and low back pain after exercise or sport or whatever is very similar to what you see in non-active individuals just because it is an area that people frequently experience pain in.

7:02And so again, it only like raises a red flag if somebody's had this recurring sort of like, yeah, every five or six weeks I have like a low back tweak. And I'm like, to me, that's mostly a programming thing, right? And you notice that neither of us like initially went to technique. What's your form look like? It's like the programming probably needs some adjustment. And one thing that caught my attention here, you know, when I'm pushing it in a block and I'm like, what are we pushing? And I don't mean that in an accusatory way, but it's like if you are trying to force like weight on the bar, extra reps, more sets, you're increasing training load in an effort to drive progress.

7:39I think that's backwards. I think that's backwards. Rather, I would wait for the fitness to show up and then you get to progress all those things. So you shouldn't actually feel like you're pushing. You should feel like it's challenging. The work is, you know, does require your attention and focus and so on and so forth. But it shouldn't feel like, yeah, this session that I just did is harder than the same session I did last week or two weeks ago or three weeks. It should be about the same level of hardness. And so I do think that the pushing thing, I'm not saying that you're doing it wrong. I'm just does raise a flag.

8:08I don't know. So, yeah, I mean, we certainly need to be trying in our training. Yeah. But if we're trying harder and harder and harder every single week and and, you know, I think back to like the days when I was doing more foolish programming where I'd have to get increasingly hyped up every week to, you know, hit my new five rep max every single week. I'm like, that was profoundly dumb at the time and led to some not awesome outcomes, both mentally and physically. So I would not advise. Yeah. So my, my kind of practical approach to this, and it could differ between like a rehab setting, like somebody's like legitimately just started like a rehab training program based on some sort of injury that they were very concerned about versus like competition prep.

8:46And you're really close. Yeah, I don't, it could be different, but let's just assume that we're going to treat these things the same way. I don't think your pain should be greater than three or four out of 10. You know, it shouldn't get sharp or increase in intensity during the set, during the activity. If it is. That kind of signals that we should probably consider a modification, especially if it's still persistent after 24 or 48 hours or otherwise interferes with stuff that's going on outside of the gym. I mean, most people listening to this podcast are not like living to train, right? It's more like, yeah, this is something I do for not only enjoyment, but also for health and for performance and other sort of areas.

9:24And so I just think like most of your training should not be terribly uncomfortable. Like, yeah, you should try, but it shouldn't be terribly uncomfortable. I agree. Shoot. All right. Well, easy day. All right. Now on to the next one. This is about pre-exhaust training. Docs, what are your takes on pre-exhaustion exercises before hitting compound movements, specifically doing something like leg extensions before squats? I have found that this technique seems to help with the mind-muscle connection, but also limits the amount of weight I can use on the main lifts. Austin, you ever do this? uh not really this is i mean i recognize this is a thing that people do much more often in in the bodybuilding space um i think that i don't i certainly don't identify as one nor would i be mistaken for one that's right nobody would look at us and be like you guys bodybuilders yeah unless it's somebody who doesn't know what the difference is between bodybuilding yeah you have like muscles so yeah bodybuilder um i think that the uh probably the main situation where I might have done something like this before or thought about it or programmed it is in the context of rehab, actually, more so than more so than like thinking that it's optimizing my hypertrophy outcomes or something like that.

10:33But what about you? Yeah, the same thing. I've done this in a rehab setting for a few reasons. One, I want to do the quote rehab exercise or target the muscle directly that I'm working on rehabbing first. And then it also helps me limit the load on the subsequent exercises, which is kind of like a way to protect myself. So, but that actually kind of speaks to why this might not be the best option for either strength or hypertrophy. So we need to talk about this. So yeah, pre-exhaustion training in this case, like leg extensions before squats, or you could do like dumbbell flies before a bench press or something like that.

11:11It's a technique that is used to theoretically generate a high degree of metabolic stress and local fatigue in the targeted muscle or muscle group and subsequently use lighter weights. But it's probably not best for either strength or hypertrophy. Now, in hypertrophy, the most critical stimulus for long-term growth is mechanical tension, right? And so making sure the muscles are producing enough force and doing a lot of work there, a lot of volume there. And you would do that with a variety of different movements. They use a full range of motion, add an intensity to get you somewhere near failure.

11:47But the muscles need to be producing a lot of – exposed to a lot of mechanical tension, and then you've got to do a lot of it, right? So volume there. For strength, the most critical stimulus for long-term strength, you need some hypertrophy to facilitate that. But you also need increased neural adaptations, and these are best achieved in the specific application by maintaining a high amount of force production throughout the sets that you do. So a high fidelity, high integrity, high amount of force production throughout the set. So you wouldn't see a lot of velocity loss, for example, and you'd be using enough weight to require your muscles to produce a bunch of force.

12:26And so pre-exhaustion, by definition, induces fatigue into the target muscle or muscle group. So you're going to do less total amount of reps, so less volume, which is bad for both strength and hypertrophy. You're going to use less load, which is probably bad for strength. And you're going to get more velocity loss if you did the same number of volume. You say, look, I don't believe you. I'm going to do the same amount of volume. Yeah, you're going to get more velocity loss. It's going to be higher RPE for a given amount of training, and so that's going to be worse for strength. So I think it's worse for both.

12:55Now, in my opinion, this mind muscle connection that you're feeling is probably a result of more fatigue. So like you get a pump, like for example, you're like, oh, I'm working this muscle. It's more fatigued. I can feel it more. I'm like, well, that's great. But I don't know that it's actually helpful for like hypertrophy or strength outside of if it were to otherwise increase your training load. That's a central paradigm here. If you're thinking about how do I get stronger? How do I get more muscle or whatever? The whole thing is how much training load can you do? The more training load you can do, and that's not just weight on the bar, but it's the amount of work that you're doing in total, generally speaking, we would predict more adaptations.

13:31And if doing this pre-exhaustion training makes you do either less volume, less intensity, or both, it's probably compromising training load. Now, if it doesn't compromise training load that much, we're talking like single-digit percentages, then it's probably neutral, right? But if you're doing way less volume, way less loading, getting closer to failure for the same load, then it probably is compromising your outcomes. This is the same way we feel about supersets. That's why we like agonist-antagonist supersets or alternate peripheral supersets over agonist-agonist. And the idea is we get to preserve training load and therefore use this as a time-saving technique, but also not compromise like strength or hypertrophy to the extent that that's something we can control.

14:16But I agree it's useful in the like rehab setting. And I think it's mostly just for like load, like it's like a load constraint. If you blast your quads before you go to squat or leg press or whatever variation you're using, you're going to use less weight. And maybe that just saves somebody from themselves because they're like, you know, I could use more weight. But if you fatigue them enough beforehand, that can be useful. They can also, if the first exercise or first few exercises are more like direct focus on the joint area, the muscle area, whatever, that their person's experiencing pain, not only does it serve as maybe a desensitization, but also they can actually push that training a little harder.

14:52It's not like I'm so fatigued that I'm just going to mail it in on this work. So, yeah, the last applications I can think that would be useful here may be like CrossFit or like a muscular endurance sort of challenge where you're going to be exposed to this sort of stuff anyway. You're not really, it's more of a sports specific training than, than, than like, I'm going for max hypertrophy and max strength. You're like, I just need to get ready for the sport. Cause you'll see stuff where it's like, all right, you got thrusters right into pushups or burpees. You're like, whoa, whoa, whoa, whoa. It's agonist agonist.

15:21What am I doing here? And it's like, well, that's a sport. So you better be ready for it. Yeah. I like that last, that last one. Sometimes I've seen certain CrossFit workouts programmed in that, in that way. And I'm like, gosh, I would not write a workout like this for training purposes. But if that's the test, man, that's going to be super challenging on some, a lot of the shoulder stuff, I think in CrossFit ends up being quite challenging because of that type of thing. They might do handstand pushups and like ring muscle ups or, you know, all sorts of other, you know, agonist, agonist things that you'd have to be well trained to be able to tolerate.

15:52So if that's your, if that's your bag, you got to train that way. Yeah. Yeah. As far as like the pump, trying to do that, I have used this pre-exhaust technique in short periods of time at like the end of a hypertrophy block or something just to kind of like send it. I know that I'm compromising training load a little bit, but at that point, I'm just trying to eke out every possible sort of adaptation I can. And we're already kind of like accommodated to the training load. So it's like maybe this unique sort of stress will like it'll be maybe enjoyable and then maybe we can get a little bit out of it.

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17:27You get 15 % off your first order at wearfigs.com with code FIGSRX. That's wearfigs.com, code FIGSRX. All right. A lot of resources also for each answer in the show notes below. So check those out in agreement. All right. Next question. This is about prior dietary patterns effects on choices on food to eat today. This person asks, I find that the way I eat prior to how I'm eating today affects my cravings and appetite. If I eat pizza and McDonald's every day for the last week and then I shift to eating a different dietary pattern as more home-cooked meals, then there is acutely a higher tension on adherence for today.

18:08However, the important thing I want to note is that this difficulty feels transient, as in if I then keep eating that way for another week, the new prior timeline of eating makes eating that way easier. And reflecting on that makes this whole process seem much more reassuring. It makes me more adherent. So my question is, is this normal? I'm not saying it's easy, but it is kind of reassuring to know that you won't feel the inclination to eat a meat lover's pizza at RP10 forever. It does seem like that dies down if you give it some time. And not understanding that it gets better, I have to assume, dings a person's confidence in the process or their self-efficacy, which would cause the first day if you're shifting the pattern.

18:44It just doesn't feel super great. Interesting question. I actually think there's maybe more meat on this to chew. So to start, yeah, the transient nature of like the difficulty you experience when switching from like hyper palatable foods, pizza, McDonald's, these ultra processed foods that tend to be high in calories, not very filling and are somewhat engineered to make us eat more. That's I mean, that's because they're pleasurable and cheap, ubiquitous marketing, all that sort of stuff. Switching from that to home cooked meals. Yeah, it's pretty normal and predictable. You've had some sort of like hedonic adaptation, right?

19:17The brain has kind of been adapted to this high food reward. They're very palatable. The complex orchestra between salt, fat, sugar, mouthfeel, all these sorts of features provided by pizza and fast food. Well, yeah, when you remove that stimulus, the brain is like, whoa, I don't like this. So you can have some cravings until it adjusts to be lower with the home-cooked meals. And you're also disrupting a habit, which you've built over the past seven days. These like context, routine, reward loops. So breaking, you know, it's not a super strong habit if it's just only seven days, but like you can imagine a person has been eating this way for years, right?

19:56And so there are specific contexts associated with these eating habits, a time of day, location, emotional state, you know, just your routine. And so it takes time to build a new routine. And yeah, there's some like acute cognitive tension there. Austin's described this as like dietary RP. It's higher, like immediately upon making any change. On the other hand, I actually think there might be a little bit like lessening of that too at the same time. So like you do have some factors going against you, but you also have some factors helping you out here. One, it is likely that somebody who's eating a dietary pattern like that, a lot of pizza, McDonald's, fast food, ultra processed foods, generally speaking, may have been eating in a calorie surplus or energy surplus for that period of time.

20:38And so like the body for some folks will recognize that and say, look, I don't need to crave more food. You're sort of like above that. And so if anything, your body might be compensated by saying, I'm going to tamp down hunger a little bit. Satiety is going to be a little higher. And yeah, there's some hormonal stuff baked into that. Brelin, for example, it might be a little bit lower during that time. And so you could effectively make this switch despite these sort of like kind of crave it, little habit situation. but the body's like biological sort of feedback is like, yeah, this is fine. And I think this ease that you're experiencing in the short term, we'll call it one week, two weeks, three weeks, four weeks, even up to like, you know, a couple months, it's likely to be transient and also be affected.

21:24Like if you were to shift into a calorie deficit, I would predict that your appetite and cravings would go up. There are biological defense mechanisms here, plus like your emotional connection to those foods previously, right? Some psychological stuff there, environmental stuff, if you drive past this every single day. So like I think it's almost like multiple relationships that change over time. So initially, yeah, a little bit of elevated dietary RPE from making the change, mostly related to habit, right, and sort of like the tastiness of the food. but you're also helped out by just, yeah, you're probably overeating, period.

22:03And so biologically, you get a little support. But then over time, that kind of flips and almost everything's going against you. Biologically, you're like, shoot, I'm in a calorie deficit, so the body's going to try to adapt on some level, whether it's metabolic adaptation and you get some subsequent signaling that your hunger is going to go up, satiety, sensitivity is going to go down, and then some psychological sort of cravings and such, particularly if your diet's very restricted, for example. And then socially like, yeah, oh, well, I've been eating only home cooked meals or meals prepared inside the home.

22:32And now your friends are like, hey, what are you doing, dude? Come out to dinner. You know? So, yeah, I don't know. Does that kind of – you kind of agree with that assessment here? Yeah, I think it's a reasonable take. I would want to point out, though, that the amount of individual variation here is enormous. Yeah, it's incredible, yeah. Because I'm envisioning there are definitely people who, you know, might be listening who are like, bro, I don't know what you're talking about. I get to always house a pizza. A present company included. Exactly, right. Or those kind of cravings or that kind of drive towards those things never really goes away.

23:06And so this is a big part of our conversation around, you know, weight management, body composition management is individualizing the process and individualizing the intensity of the intervention. And so for some people, those who are quote unquote, naturally thin, lean, those who like have really trouble gaining weight, they don't really tend to experience, you know, those types of, those types of things. In fact, it's, you know, quite challenging for them because they get full so quickly and so easily without, you know, they don't choose that. That just is their existence. That is their reality.

23:38That's his willpower. Despite being in the current food environment. And then at the opposite end of the spectrum, those who feel, you know, none of those things. I recently, I don't know, you know that YouTube channel Jubilee where they just get like people and have them, you know, argue with each other. And I guess it's for the algorithm. The one that just one of the most recent ones that just came out was a pro versus anti-Ozempic episode. And it was, I only saw some clips of it that were getting passed around, but one woman who was on this, it was just absolutely infuriating to listen to her because it was a hundred percent total and complete rejection of the idea of individual variation.

24:19It was pure. I did it. Therefore, I'm a hundred percent. She said, I'm a hundred percent confident that anyone can basically do this. And I'm like, Hmm, that is a bold, bold thing. Yeah. I did it myself. Therefore everyone can do it. Uh, and I'm, you know, morally superior for having accomplished it without the use of medicines and blah, blah, blah. And it's like, okay, not the biological reality. There's just fundamental variation here. So this person's experience, I think to some extent jives with some of the things that I've felt, like maybe when I'm, you know, traveling or on vacation and going out all the time and having, you know, treats more often than I might when I'm at home and cooking my own food, you do kind of get into a little bit of a different mental state and dietary habit cycle.