280. Will Harlow: STOP Losing Muscle After 50 (Do This Instead)

0:00We almost look at people who've got these age-related problems and say, well, what do you expect? You know, you're 60, you're 70, everyone's suffering with this. And the worst part is when people are told that so many times, they believe it.

0:12Gary Brecka:It normalizes this culture of group suffrage. And when it seems normal in your peer group, you just accept it as a consequence of aging. We think that people only lose independence in their 80s and 90s, and we just don't think about it. It's one of those things we take for granted that we start to lose a lot earlier than we realize. Independence truly is freedom. As we get older, one of the measures of independence is do you need help with the activities of daily living? The four pillars of independence as I call them are mobility, strength, so how strong you are but also how much muscle mass you have on your body, balance, and the fourth pillar is skeletal health.

0:47The age-related muscle wasting

0:49Gary Brecka:is more rapid I think than people realize. Muscle mass throughout the entire body is an independent predictor of longevity. How important is it for people that are trying to build strength but in older ages to return that strength? Do you have them draw their attention to those muscles? Do you find that that helps? So what I tend to do with people now and this is something people can do at home is... Hey guys, welcome back to the Ultimate Human Podcast. I'm your host, human biologist, Gary Brekka, where we go down the road of everything, anti-aging, biohacking, longevity, and everything in between.

1:31Gary Brecka:And today's guest, all the way from the United Kingdom, physiotherapist that I'm actually greatly interested in running this podcast with, decided at one point in his life that the patients that he was caring for that were leaving his clinic without pain were going home and the pain was starting to return. And he wanted to find a solution to how people could care for themselves outside of the clinic and make a material difference on the trajectory of their life. And this has to do with musculoskeletal pain and movement and your posture and so many things that are overlooked by modern medicine.

2:04Gary Brecka:And we're starting to treat those symptoms that actually have a chronic underlying condition that can be fixed so you can put them permanently in your rearview mirror. So welcome to the podcast, It's Will Harlow. Thank you, Gary. That's very kind. Yeah, I'm super excited about today. And as always, we usually start running a podcast before the podcast starts. But, you know, so we had a great conversation before the podcast started. But I wonder if you might just give a little context to my listeners, because you were working at NHS as a physiotherapist and having a great deal of success with the patients that you were hands-on with that could come into the clinic and actually receive treatment and guidance.

2:45Gary Brecka:But at some point you noticed that when they would leave, those gains would go away and the chronic condition was coming back. Yes. And I believe that the people that are the most driven, purposeful, like passionate and impactful are the people that are solving problems. And so that seems to be the problem that you solved. 100%. So give us a little context around that. Yeah, so I was in the NHS at one point, but I actually started in professional sport. And it was a funny trajectory for me, really, because I spent my whole childhood growing up thinking, I want to work in professional sport. I don't care what I do.

3:27I just want to be in and around the clubs and the players. And I was also really interested in the human body as well, like yourself. So when I heard about this thing called physiotherapy, I thought, great, this is going to tick both boxes. I'm going to be able to help people with their bodies whilst also working in professional sport. So I was locked on this idea of working in professional football, soccer, as you guys say. And I went right through university with this goal, came out the other side, and I got an in with a local football club, which just so happened to be the club that I supported my whole childhood.

4:01Gary Brecka:Oh, man. Yeah, so dream come true. got an interview, got the job, got in there. And within about three to six months, I was looking around thinking, this is not what I want to do at all. I'm in the wrong place. It just was a bad character fit for me, a bad fit for, you know, the environment. I didn't really like the culture. And it was almost like the world was coming crashing down for me because I thought, I've trained my whole life for this. I've got no plan B. What on earth am I going to do now? but I took the chance and left and while I was trying to figure things out that's when I went into the NHS and when I was in the NHS we were in this big kind of corporate mill-like clinic I was seeing 15 patients a day they were all referred from their primary care physician and about 90 % of them were people over 50.

4:50I never really worked with this pocket of people before so I've seen people with...

4:54Gary Brecka:Careful I'm over 50 dude so don't come at us too hard. I would never dream of it. People with knee pain, people with back pain, sciatica, all of these things. And from my training, I knew I could help these people. And I started to see these wonderful transformations. I was just giving people basic advice, telling them what they needed to do, coaching them through it, and then watching the outcomes. And I look back about three months into the process and thought, this is the most fun I've ever had. So it was at that moment, I knew this is what I was destined to do. And I don't know about in the US, but in the UK, there's a huge problem in terms of the attitude we have towards aging.

5:32Oh, no question. We almost look at people who've got these age-related problems in inverted commas and say, well, what do you expect? You know, you're 60, you're 70. Everyone's suffering with this. Yeah. And I knew from my training, it wasn't true. I know. And the worst part is when people are told that so many times, they believe it. And they go, well, the doctor said, this is it. So I guess this is just life now. But seeing people improve, I knew that there was something here and I knew the demand for it was massive. The NHS wasn't the right environment for me to take it further. We were very much constrained by how often we could see people and what we could do.

6:12I remember being given a 2.5 session average cap. That's how many times you're allowed to see people before you have to get rid of them and bring someone else.

6:20Gary Brecka:2.5. Yeah. We were marked only on our session average. Oh my gosh. Yeah. Wow. Because you've got to make room for someone else. Yeah, yeah. Because it's just a mill. Exactly. Yeah. So I knew that wasn't the right setting. So I didn't know anywhere else that was offering this kind of help for older people. So I decided to start it myself. So I left and I set up my own clinic. And it just, it really took off. Because I think the message just resonated straight away. that you know you're not just destined to suffer like this forever there's a lot we can do you just haven't had the right guidance yet yeah so that's how it started you know i think too you know with aging just in general what happens is as we move through life right like my my kids are in their 20s um early 20s to late 20s all their friends are getting married right so like every weekend there's another marriage and then you know as they're emerging from that it's like now Now everybody's having babies.

7:18Gary Brecka:And in my age demographic, and then I look at my parents, it's like everybody has similar ailments and issues going on. So it's very normal. It's like, well, you're on blood pressure medication. So am I, what do you take? Oh, I take Enderol, I take Obedablogger. Hey, we all take it, you know? And you know, my knees hurt all the time. So does my back. I wake up, I can barely move. Yeah, neither can I. It's like, it normalizes this. it's sort of this culture of group suffrage, right? And when it seems normal in your peer group, you just accept it as a consequence of aging. And I would argue the same thing that you're arguing.

7:57Gary Brecka:They're not consequences of aging at all. It's just not having the tools to put these things in your rear view mirror. Absolutely. And so you started your own clinic, but at some point you started to notice that people were also, you're making these major strides in the clinic, but afterwards, they're sort of post-care, you know, where they were left to their own devices, they started to slip backwards. Yeah, 100%. Which led to you doing this online. Yes. Right? Definitely. And so talk a little bit about that transition. Yeah, for sure. So I think looking back, and bearing in mind I was very early in my career here, so when I just started, I was very much still focused on pain.

8:41Like what's the problem this person's got that's causing pain? Great. Once you figured it out, let's fix it. Once the pain's gone, we'll send them on their way. As you say, they were coming back. And I was like, well, why is this person's knee pain come back? You know, I fixed the problem, but I hadn't fixed it because there were deeper rooted things that we hadn't yet addressed. Now, through seeing this many times, I decided that one of the better ways I could help people to avoid this cycle of almost boom bust get better then get worse again was to give them things to do in between their sessions and after they leave me and one of the best ways to deliver that was via video right so I started putting these videos out initially just to help my patients and I've seen a lot of your videos

9:25Gary Brecka:you like your rotary videos you know your glute strength videos your you know your your shoulder mobility videos um and and they're very easy to follow i mean they're they're simple routines and you're very specific about different ailments um and and having gone to chiropractic college and having a pretty fundamental understanding of of anatomy you know they make extraordinarily good sense you know because when the biomechanics get off um the pain shows up yeah and we think the pain is you know the shoulder pain is because something happened to my shoulder but it's you the biomechanics sort of led to that repetitive use issue.

10:02Yeah, definitely. And I always try and strip things back to the most fundamental basics of movement because I never think of myself as a smart guy. I'm like, I have to see something work for me to understand it. And I figure that a lot of people like that approach as well. They just want something very simple, like a really simple explanation and then one thing they can do to fix that problem. And I think that was probably the approach that really propelled the channel to getting so many millions of views. But really the mission hasn't changed from there. It's still like give people something very easy that they can do and don't overcomplicate it, strip it back to basics, figure out what has gone wrong and then a simple strategy to try and improve it.

10:45Gary Brecka:I love that. You talk about the fear of movement sometimes being as bad as the injury itself. Yes. What do you mean by that, the fear of movement? Yeah. So let's go back to pain science for a minute, because this is really, really important. We used to think that when someone was in pain, that was because there was a tissue that was damaged. And the only reason someone can have pain is because there's some element of damage there. right we now know that's not true we now know that there are many things that can cause pain and there are studies showing that people who have been through an mri scanner without pain are just as likely to have some of these injuries in inverted commas as people who do have pain so there must be some missing missing pieces to the puzzle that we hadn't figured out now one of these is a fear of movement and fear of movement is something that triggers muscle spasms it tightens everything up it restricts the movements of your joints and it's primarily driven by what's going on in the neural circuitry so like neural inhibition exactly and that drives pain up even more so i had many people come into the practice who didn't have any obvious injury but they still had a lot of pain and a lot of that was because they were so afraid to move from something having gone wrong a while ago that that was now the primary driver of pain.

12:10So figuring out what's causing that fear of movement and then slowly unpicking it can have dramatic effects for people that have suffered with this kind of mechanical pain for a very long time.

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13:33Gary Brecka:Now let's get back to the Ultimate Human podcast. You know, what's interesting is I interviewed a sports psychiatrist a long time ago, and he said one of the challenges in, especially in professional athletics, very high level athletic performance, when someone, when an athlete gets injured is very often they start to see themselves as an injured person. Yes. And the brain subconsciously will guard through this process called neural inhibition different limbs from engaging in certain movement planes because doesn't realize that the injury is over and it's safe to move again. and so very often he was like you know would it would throw their biomechanics off even though there was anatomically nothing wrong with them they had healed from surgery trauma uh you know whatever it was yeah and uh you talk about these four pillars of independence um and i wonder if you'd lay those out because you know that's seems to me a good foundation from for us to start with you know independence truly is freedom you know as as we get older one of the measures of independence is do you need help with the activities of daily living yeah um and starting early is the cure for that 100 and i define independence as being able to do what you want when you want for as long as you want without needing help from someone else unless you want it and independence is one of those funny things where we think that people only lose independence in their 80s and 90s and we just don't think about it.

15:13It's one of those things we take for granted that we start to lose a lot earlier than we realize. So when I was thinking about what actually influences independence, I looked back at the patients I've treated and tried to think, well, what were the reasons that those people had lost independence to begin with? And it came down to these four things. And the four pillars of independence, as I call them, are mobility, so how well you can move your joints strength so how strong you are but also how much muscle mass you have on your body i'm sure we can talk about muscle later but it's one of the most

15:49Gary Brecka:important things for your health i would agree with that yeah balance so how well you can stay on your feet is the third pillar and then the fourth pillar is skeletal health so i define that as the health of your joints so what's going on inside the joints and the health of your bones as well. So avoiding things like osteoporosis and osteopenia, because those lead to a big loss in independence for many of the people that I've treated, even if the other pillars are intact. So I see these four pillars almost like the four legs of a table. So you need all four to have a sturdy table. If you knock one away, the table's wobbly at best.

16:25If you lose two, the table's on the floor. So that's how I see it.

16:29Gary Brecka:Yeah. And some of your solutions I find really fascinatingly simple if they're done, you know, consistently, right? Like brushing your teeth on one foot, you know, and so standing barefoot and brushing your teeth on one foot just to get that one minute of extra foot stability and like, you know, calling your attention to your balance while you're doing something else. You know, things that I feel like everybody could incorporate into their lifestyle relatively easily. And so how much of it is under our control? So much of it. And the thing you're referring to, Gary, there is something I call exercise snacks.

17:11Yeah. Now exercise snacks, I think it's just worth bringing this to everyone. It's short bursts of movement or exercise typically 30 to 60 seconds that you do in otherwise dead time throughout the day so the classic time to do it as you say is standing on one leg whilst brushing your teeth to work on your balance you don't need to work on your balance in an exercise snack you could work on your strength you could work on your mobility you can even work on your bone health so what i tell people to do is to pick the one thing they want to improve and then build almost an exercise snack regime around that one attribute.

17:47Gary Brecka:That's cool. And you can rotate the exercises you choose. But if you have a clear goal, like let's say you wanted to build up some strength in your upper body, you might do a 30 second exercise snack of wall press ups. And then you might have a resistance band loops around a door. So next time you're, you walk past it, you do 30 seconds of rows. And before long, you are going to start building up that attribute. And the research really supports this as well. This is not just like some, you know, little thing that you can do that might or might not work this is really evidence-based you know it's fascinating to me too because i think we've been trained to think that exercise happens in one duration burst you know 45 minutes or an hour every day at the same time and then it's done yeah um where you know you're saying hey even if you have a really busy lifestyle and you have a lot going on you have these moments throughout the day where you could just draw attention to whatever it is that you want to focus on.

18:43Gary Brecka:I've got to ask you about sciatica because, you know, growing up and having graduated from chiropractic college, you know, there's so many people suffer from this and it can be, excuse me, debilitating and get progressively worse. And it's one of those things that draws people's attention away from everything else. It's sort of subconsciously on your mind, if you have it. By the grace of God, I've never suffered from it, but I know people that have had really chronic sciatica and it's debilitating yeah and eventually it can even lead to like atrophy and you know other things yeah um but what would be some of your go-tos people could do at home let's say um for for sciatica sciatica is such an interesting one it's actually one of my special interest areas really oh awesome dude i'm glad i asked then and in a in a real cruel twist of irony a couple of years ago i had it myself i picked up a nasty bout of it from a deadlift I just wasn't concentrating.

19:41I rounded my spine too much, picking up this heavy weight. I just got back from a long holiday without any weight training and was anxious to get back into it. So it was a typical case, you know, rushing in, no warm up, bad technique. Bang, I felt this pain down the back of my leg. And like any good physio, I thought, I've pulled my hamstring. Yeah. Of course I hadn't. It was probably a disc injury. Yeah. And that really brought it home for me because I've been helping people with this problem for so long without ever having suffered myself and then having that pain for three four months having the numb foot worrying if it was ever going to get better that really brought it home as to how debilitating this can be so it kind of renewed my interest in helping people with it so there are lots of different ways to treat sciatica because there are lots of different things that can cause it the most common cause is an issue with one of the discs in the spine so a disc bulge or a herniation.

20:38But really anything that presses on one of the nerve roots or irritates one of the nerve roots in the lower part of the spine can cause sciatica. So it could be a disc, it could be a joint, it could be a muscle that traps it, it could just be general inflammation. And sometimes there's sciatica and we have no idea what's caused it. There's no diagnosis there, the person just has the pain. So once upon a time, I used to try and treat sciatica based on what the tissue was that was causing it. But then I realized that was an oversimplification. So the person needs treating as a whole, not as an injury, if that makes sense.

21:16So what I tend to do with people now who have it, and this is something people can do at home, is most sciatica is linked to movements of the spine. Okay, about 90%. If you move your spine in a certain direction, it's either going to make it better or it's going to make it worse or it's going to do nothing so the first thing i would recommend people do is find out what those movements are for them so it might be that if you bend forwards that sciatica gets worse so now you know okay so when i flex that aggravates it so what you need to do then is for a moment until it starts to improve try and avoid doing lots of those flexed positions because with any nerve pain this is not a no pain no gain thing it's the total opposite you have to avoid the thing that's causing the pain of what is it increases the inflammation and the problem goes on for longer right so once you've found the thing to avoid you make sure you take note of that now you're going to test the other movements and chances are you'll find one that makes it feel maybe slightly better and that is your almost golden movement you're going to keep coming back to that almost as an exercise snack again, going back to that concept, keep repeating it.

22:27And what people often find is the pain starts to reduce when they do that. So this really helps in the early phases. Once that pain is under control, we then want to start rebuilding strength around the area because it doesn't take long after having an injury like sciatica or that pain in your leg for strength to start to reduce. So true. And with it, mobility and with it, confidence. So strengthening the glutes up, strengthening the core, strengthening the spine itself. Absolutely vital for anyone who's been through this. But you have to start by knocking that pain down a few notches first because otherwise everything aggravates it.

23:04Another good evidence-based thing is walking. Walking can really help to reduce and control the pain of sciatica for as much of that as you can. And just avoiding things that cause pain. And sometimes those things are unusual. I know for me that when I had that pain if i slightly lent one way it really hurt but if i lent right the way down no problems so i avoided any exercises where i was slightly leaning forward so anything with weight on my back that caused me to come forward slightly avoid but then other exercises even things like the leg press which people typically think you should avoid with sciatica that was fine for me so it's very individual okay so avoid what hurts do more of what doesn't keep moving and rebuild

23:48Gary Brecka:that strength do you find that most sciatica um even chronic sciatica goes away over time if if you do that yeah most of the time if you're following a good plan and it's it's designed to help you reduce pain restore mobility and rebuild strength 90 of cases get better wow and i think people's perception of it is skewed because we all hear about the awful cases that are there all the time and didn't get better that's probably only about 10 percent of cases and then there are people who have recurrent sciatica which is quite common but again i would argue that most people where it's recurrent they haven't fully regained mobility or rebuilt strength they often wait until the pain goes away then they just jump straight back into doing what they were doing before and there's still that underlying problem that might not be causing pain now but it's leaving them vulnerable to a re-injury later.

24:47Gary Brecka:So I'm sure that when you were at NHS and a lot in your clinic, you were seeing a lot of post-surgical or post-traumatic recovery, like where people had some kind of specific incident and then it led to the need for rehabilitation. But what percentage of people or how often did you see like repetitive use injuries or people that had prolonged poor posture over time and now it's just starting to manifest and you have to correct that because I think, you know, that too little attention is paid to biomechanics. 100 % agree. You know, I've talked about this before, you know, every professional golf coach would rather start somebody swinging a golf club from day one rather than unlearn somebody who's been swinging a golf club wrong for 20 years.

25:38Gary Brecka:Takes twice as long. Right, takes twice as long because those neural patterns are ingrained. And I think, you know, the way that those neural patterns get ingrained, you know, when your posture is off or your gait is off and now it's starting to manifest pain and people think, oh man, my hip is starting to go. And it's like, well, you're just starting to feel it. It's really been going for a long time. Yeah. So how do you restore like, like what is good biomechanics and how do we restore that overall? It's a really good question. And as I've moved through my career, I've come to the conclusion that probably 80 % of the cases that I treat in the clinic are what I would call mechanical problems.

26:21So mechanical pain. We used to think, as I said, everything that caused pain is an injury. Now we know that you can have pain in the absence of injury and you can have an injury in the absence of pain. So the actual injury itself is a poor predictor of how much a person is going to suffer. We even see this with people with almost no castilage left in their joints. You put them through an x-ray machine for another reason, you say, how does your knee hurt? And they're like, no, it's fine. You've got no castilage, you're bone on bone, but they don't have pain. And the reason they don't have pain, I would argue, is that their mechanics were still pretty good around that knee.