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  • RVR
    replied
    Originally posted by sjalbrec View Post

    As I mentioned in an earlier thread, what is your sample population for this anecdote? I wouldn't think of older youtube personalities as a cautionary examples for myself. Guys who used performance enhancing drugs to get their lifts into astronomical numbers might be dealing with nagging injuries now, but I'm in my 50's and have never been stronger. Just came in 2nd (in the open class) at meet last weekend against guys half my age. The entire point of RPE training is to get stronger with a healthy amount of stress. Age isn't a factor in a good training program.
    I tried to reply there but it's moderated and my posts weren't approved.

    Yeah that's a good point. A variable that seems to pollute the data is PED use, definitely, and it's difficult to get a good handle on injury rates in non-competitive or casually competitive lifters. Couple that with self-selection in various sports and the many variables surrounding proper programming, RPE use, etc and it's difficult to draw conclusions. It does seem to be safe to say that powerlifting the way BBM advocates is likely pretty safe in the long run, especially the way some would practice it via adding variations, higher rep phases, etc.

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  • sjalbrec
    replied
    Anecdotally, a lot of powerlifters do seem to be beat up by the time they're in their 50's.
    As I mentioned in an earlier thread, what is your sample population for this anecdote? I wouldn't think of older youtube personalities as a cautionary examples for myself. Guys who used performance enhancing drugs to get their lifts into astronomical numbers might be dealing with nagging injuries now, but I'm in my 50's and have never been stronger. Just came in 2nd (in the open class) at meet last weekend against guys half my age. The entire point of RPE training is to get stronger with a healthy amount of stress. Age isn't a factor in a good training program.
    Last edited by sjalbrec; 08-06-2021, 04:05 PM.

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  • RVR
    replied
    Originally posted by Jordan Feigenbaum View Post

    This is true, but the symptoms of the over 90% of "injuries" documented during RT resolve in under two weeks. We agree that how you define injury matters, which include some metric of severity and consequence in most, but not all studies.

    Just wanted to clarify this.
    If you'll indulge me:

    I'm trying to make sense of the fairly large discrepancy between cross-sectional studies and the RT's you're referring to. I'm aware of the issues with retrospective studies like recall bias and the resulting data being generally of low quality, but the BMJ systematic review (https://bjsm.bmj.com/content/51/4/211.full) cites a study that recorded much longer periods of symptoms:

    In the study by Raske and Norlin, the athletes self-reported that 25% of their injuries were chronic, 20% were acute muscle injuries and the rest were not defined. The authors did not report any difference between weightlifters and powerlifters. Raske and Norlin also reported that 93% of the shoulder injuries, 85% of injuries to the low back and 80% of the knee injuries resulted in symptoms that lasted for more than 4 weeks.

    Now the obvious are the definition of injury, the severity of symptoms, and to what degree they affected training, but I don't have access to the full study. I read another similar analysis that indicated chronic/recurring injury being somewhat common (adjusted OR 1.54: https://www.strongerbyscience.com/po...es-background/), as well as a cross-sectional study indicating some injuries (I think it was around 40-50%) having symptoms lasting more than a few months, although I frustratingly can't find it now. I don't know if that caused significant alterations to training but in the realm of "this constantly hurts and sucks" as it pertains to longevity, it does leave me somewhat ambivalent.

    Now I also don't know if this is an issue of specificity (many powerlifters seem to only train a handful of exercises), or purely load, but even load and intensity seemed to not be as predictive as thought in some of the literature. Do you have a rundown of the RT's anywhere? Or did I just miss it in an obvious place? This is probably more relevant to my thread on deadlifting, but my current conclusion is mainly that powerlifting elicits more injuries due to load management (obviously) as a result of training volume/intensity but also "system load".

    Anecdotally, a lot of powerlifters do seem to be beat up by the time they're in their 50's. But on the other hand, likely a personal bias from sport-specific training, the goal of powerlifting training is the movements done in powerlifting; we rarely had athletes in pain or injured in the gym, but then the point of the gym in their case (hockey players, fighters, etc) was to build capacity for their sport in which they were obviously injured at one point or another.
    Last edited by RVR; 08-04-2021, 06:38 PM.

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  • Austin Baraki
    replied
    Originally posted by RVR View Post
    I imagine significant fatigue during heavy loads being a risk falls into the "load management" category?
    Yes, that is how we view it. "Load" as a broader concept than just external ("absolute") load, but inclusive of internal load as well.

    Originally posted by RVR View Post
    There is evidence "core" work relieves LBP more quickly in the short term but is no more effective in the long term, is that correct?
    Compared to what?

    Originally posted by RVR View Post
    Thanks again, this is coming together in a more cohesive frame.
    Sure thing.

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  • RVR
    replied
    Originally posted by Austin Baraki View Post

    You seem to be continuing to think about this issue in a similar way.
    I appreciate your patience, it does take some time to dramatically reframe ideas. I was not unfamiliar with DST, movement variability, etc but they are still somewhat new concepts for me and trying to shift a biomedical approach to one accounting for complexity takes some time. I appreciate your time on this.

    I work in a military setting. The overwhelming majority of folks I work around do not regularly train in general, much less train with specificity towards the goal task of a PT test. Historically, lots of young, otherwise healthy folks could get by for the typical run/push-up/sit-up by either doing nothing, or doing a few practice sets 1-2 weeks before the test. Throw these folks into a timed, semi-competitive setting for max reps and it is trivially easy to exceed an individual's tolerance/capacity. The same applies for running, push ups, and essentially any other physical pursuit. If you have not prepared to do what you are trying to do, and/or are not doing the thing that you have prepared for, you are likely at an increased risk for pain/injury compared to those who are better prepared for the task demands.
    That was my experience in the infantry, oddly, and PT was usually run by someone by virtue of their rank, not whether they had the first clue about what they were doing. The train-past-fatigue Crossfit-esque mentality that was present certainly didn't help so load management certainly makes sense.

    I thought I recall you or Jordan mentioning fatigue relating to injury -- I imagine significant fatigue during heavy loads being a risk falls into the "load management" category?

    Now, the other aspect of this issue is that the timed max sit-ups is arguably a stupid test with little relevance for their occupational demands (an argument which I would agree with). So I am in favor of the elimination of this particular test for reasons independent of any injury risk.
    I recall a study on JTF2 or CSCOR candidates (here in Canada) showing that leg strength correlated more with course success than did max situps/pushups, V02 max (I think), etc, so I'm glad qualifications and training are finally heading in an evidence-based direction, because the dropout rate I personally witnessed even on basic courses was monstrously ineffecient and likely quite expensive.

    I can find cross-sectional studies finding associations between any number of things and back pain. The better/more pertinent question is whether specifically targeting core endurance improves LBP outcomes.

    We do not have evidence that specific modalities of exercise (such as "core"-focused exercises) provide unique benefit compared to general/non-specific exercise for LBP outcomes. Mike Ray has written a fair amount about this.
    In this case I thought it would relate to fatigue since the sample pool was all athletes, but then there was no separation of athletes based on any fitness metrics that would reliably control for general fitness. There is evidence "core" work relieves LBP more quickly in the short term but is no more effective in the long term, is that correct?

    Thanks again, this is coming together in a more cohesive frame.
    Last edited by RVR; 07-30-2021, 04:59 PM.

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  • Austin Baraki
    replied
    Originally posted by RVR View Post
    I wonder if the nature of the ROM of situps combined with the load (often going to failure and then some) is why numerous military divisions cut situps out of PT tests, including the US Army, the USMC and the Canadian Forces as far as I'm aware.
    You seem to be continuing to think about this issue in a similar way.

    I work in a military setting. The overwhelming majority of folks I work around do not regularly train in general, much less train with specificity towards the goal task of a PT test. Historically, lots of young, otherwise healthy folks could get by for the typical run/push-up/sit-up by either doing nothing, or doing a few practice sets 1-2 weeks before the test. Throw these folks into a timed, semi-competitive setting for max reps and it is trivially easy to exceed an individual's tolerance/capacity. The same applies for running, push ups, and essentially any other physical pursuit. If you have not prepared to do what you are trying to do, and/or are not doing the thing that you have prepared for, you are likely at an increased risk for pain/injury compared to those who are better prepared for the task demands.

    Now, the other aspect of this issue is that the timed max sit-ups is arguably a stupid test with little relevance for their occupational demands (an argument which I would agree with). So I am in favor of the elimination of this particular test for reasons independent of any injury risk.

    Originally posted by RVR View Post
    Speaking of which, I'm not sure if I've encountered yours or Jordan's thoughts on the association between core endurance and LBP (if you have time):
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4886801/
    I can find cross-sectional studies finding associations between any number of things and back pain. The better/more pertinent question is whether specifically targeting core endurance improves LBP outcomes.

    We do not have evidence that specific modalities of exercise (such as "core"-focused exercises) provide unique benefit compared to general/non-specific exercise for LBP outcomes. Mike Ray has written a fair amount about this.

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  • RVR
    replied
    Originally posted by Austin Baraki View Post

    Not really, as exercise selection primarily relates to individual goals.

    If I had a military trainee who needed to prepare for a military physical fitness test (which has historically included max sit ups for time), I would certainly be programming them sit ups, although the dosage would be individualized based on their level of fitness, tolerance, training response, and ultimate goals. While sit-ups may have been "decried" for those reasons, it is hardly universal; that reasoning is completely made up and unsupported.
    That makes sense.

    I wonder if the nature of the ROM of situps combined with the load (often going to failure and then some) is why numerous military divisions cut situps out of PT tests, including the US Army, the USMC and the Canadian Forces as far as I'm aware. There doesn't seem to be hard data pertaining to situps specifically. Training for it certainly makes sense if it's something that will be tested, however.
    https://www.bonati.com/blog/us-army-...pine-injuries/

    It can be somewhat difficult to merge observation and research data as patterns are rather complex. Regardless of injury risk, it seems a step in the right direction as they're mostly a useless exercise (or at least I haven't heard a compelling case for them in most contexts). If one is going to spend time doing core work, stability based endurance exercises seem to be more applicable to general weightlifting.

    Speaking of which, I'm not sure if I've encountered yours or Jordan's thoughts on the association between core endurance and LBP (if you have time):
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4886801/

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  • Austin Baraki
    replied
    Originally posted by RVR View Post
    PS: Are there any exercises you guys don't ever program due to needless load, or is it mostly because they're useless? I.e. situps have been universally decried as useless and a risk for injury due to repetitive end-range flexion (as have high-volume or high-weight upright rows), but it may well be better to view it as a relatively useless application of load.
    Not really, as exercise selection primarily relates to individual goals.

    If I had a military trainee who needed to prepare for a military physical fitness test (which has historically included max sit ups for time), I would certainly be programming them sit ups, although the dosage would be individualized based on their level of fitness, tolerance, training response, and ultimate goals. While sit-ups may have been "decried" for those reasons, it is hardly universal; that reasoning is completely made up and unsupported.

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  • RVR
    replied
    Thanks for the response.

    That's quite interesting, and I may well be one of those people. Anecdotally I've found that to be the case with me, in hindsight. I never used to be able to shoulder press but I seem to be able to do so just fine now for reasons I'm unsure of. I'm not sure if increased movement variability is a factor. When I was younger I had rather painful joints that I suspect were related to diet; I had my CRP checked twice when I was about 21 and it was at about 8.1 but more recently it's around 1; never thought to address joint pain with dietary modification but it seems to have worked for generalized joint pain. I know CRP is somewhat related to pain sensitivity in the literature but that's still a very loose hypothesis as it relates to shoulder pain during pressing (and I suspect it has more to do with movement variability).

    PS: Are there any exercises you guys don't ever program due to needless load, or is it mostly because they're useless? I.e. situps have been universally decried as useless and a risk for injury due to repetitive end-range flexion (as have high-volume or high-weight upright rows), but it may well be better to view it as a relatively useless application of load.
    Last edited by RVR; 07-26-2021, 09:27 PM. Reason: Forgot to add

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  • Austin Baraki
    replied
    But I suppose when it comes to pain, is it safer to simply treat it as individual/iterative rather than general? It's difficult to make generalizations about pain, but for some people, some of the time, certain strategies may be suboptimal and/or may lead more quickly to overuse based on programming and load.
    We certainly do not treat it (or recommend treating it) as general. Regarding whether it should be treated as individual/iterative: to a point, yes.

    The only challenge here: we work with people *ALL THE TIME* who come in either for performance coaching, or for rehab purposes, who tell us about their training history and how there are certain movements or programming strategies that they absolutely cannot tolerate. Things like "every time I've ever done high bar squats I get knee pain" (often paired with a narrative about how forward knee travel results in "shear" on the joints, and other associated nonsense), or "every time I do conventional deadlifts I get back pain, so I need to sumo", etc. etc. We often find that their prior attempts to train these movements involved poor programming/loading decisions, or were occurring in the context of other issues like poor sleep, high life stress, etc. We can typically get them to tolerate these movements just fine using a different programming strategy.

    So yes, there are tons of individual variations in people's tolerance and response to a given movement or training strategy. Training should be adjusted based on this tolerance and response, and always in the context of the individual's goals. For example, if the goal involves a specific competitive task, you must find a way to train the competitive movements regardless, and we would continue to experiment and trial strategies as long as needed to figure that out. On the other hand, if an individual is training simply for their own enjoyment or for health goals, we would spend far less time doing this -- although we would still discourage the idea of a particular movement or activity being "bad", "dangerous", or otherwise intolerable under all circumstances.

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  • RVR
    replied
    Originally posted by Austin Baraki View Post

    Roughly, sure. This is a reasonable take, although the aspect of "efficiency" and which strategies are "better" is a more complicated topic. The load management and exposure piece hold primary importance, in our view.
    Definitely agree. And I understand the desire to move the conversation away from elusive "perfect technique" in terms of injury risk, when strategies like RPE, adequate recovery, movement-based warmup and proper programming are the front lines of "defense". I still find it hard to put in simple terms, but watching some additional videos on other topics has (I think) given me a better understanding of "what we believe" vs "changing the conversation" (and that you're not "movement nihilists").


    1) When you claim that the patellar tendon is less "suited for load" than the glutes, what specifically does this mean, and what is it based on?
    Fair point. Will clarify next.

    2) We should keep separate the discussion of sports performance - in which there is no debate regarding the relevance of mechanics and technical execution - and pain.
    Good point, and I agree.

    In your example, I would not dispute that bringing a lifter into better balance will likely result in improved performance, and I cue this sort of thing all the time for that purpose. When it comes to pain, the question/idea that we are continuously battling is whether that forward position is inherently "bad", "dangerous", injurious, likely to induce pain, or should be avoided. To these questions, we would argue no. It is absolutely possible to train and adapt to tolerate substantial amounts of load through the patellar tendon without pain - and indeed this is necessary for certain athletes or individuals with certain goals.
    Right, and I think there is some room for distinction between "practical" and "technical" there. But I suppose when it comes to pain, is it safer to simply treat it as individual/iterative rather than general? It's difficult to make generalizations about pain, but for some people, some of the time, certain strategies may be suboptimal and/or may lead more quickly to overuse based on programming and load. In my case, there are very obvious squat strategies that consistently lead to pain that worsens and others that don't, and similarly for strategies with i.e. bench press.

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  • RVR
    replied
    Originally posted by Jordan Feigenbaum View Post

    This is true, but the symptoms of the over 90% of "injuries" documented during RT resolve in under two weeks. We agree that how you define injury matters, which include some metric of severity and consequence in most, but not all studies.

    Just wanted to clarify this.
    Thank you. I'm not sure how I missed that but that adds a great deal of clarity.

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  • Austin Baraki
    replied
    Perusing the links and discussions, there does seem to be a consensus (at least between mods and other practitioners on here) that technique does contribute somewhat to injury/pain risk, but is more appropriately framed by considering it as a matter of load management, efficiency and exposure rather than an objective right or wrong "technique", resulting in a spectrum more than a dichotomy. So load management referring to volume/intensity of load on particular structures, efficiency referring to which strategies are betterfor lifting higher loads (rather than "best"), and exposure being what the various structures have been exposed to previously (obviously implying adaptation). Am I understanding roughly correctly?
    Roughly, sure. This is a reasonable take, although the aspect of "efficiency" and which strategies are "better" is a more complicated topic. The load management and exposure piece hold primary importance, in our view.

    As a practical example: someone squatting forward onto their toes displaces load from the posterior chain to the knees, and this consistently induces knee pain. Getting them to change their foot positioning and drive with their midfoot/heels better loads their posterior chain and results in the usual knee pain being absent. In this case, more efficient technique not only allows the individual to use more weight due to load being distributed more evenly/"appropriately", but also reduces load on structures less optimally suited for load (i.e. patellar tendon vs glutes, as a crude example). In this case and most it seems to be a combination of factors, but the correlation with pain and "technique" comes from managing all 3 dimensions adequately.
    1) When you claim that the patellar tendon is less "suited for load" than the glutes, what specifically does this mean, and what is it based on?

    2) We should keep separate the discussion of sports performance - in which there is no debate regarding the relevance of mechanics and technical execution - and pain. In your example, I would not dispute that bringing a lifter into better balance will likely result in improved performance, and I cue this sort of thing all the time for that purpose. When it comes to pain, the question/idea that we are continuously battling is whether that forward position is inherently "bad", "dangerous", injurious, likely to induce pain, or should be avoided. To these questions, we would argue no. It is absolutely possible to train and adapt to tolerate substantial amounts of load through the patellar tendon without pain - and indeed this is necessary for certain athletes or individuals with certain goals.

    can movement variability be seen on a spectrum of sorts as well? Too much and you're in "unpredictable force and load" territory and too little and you're in "no resilience" territory
    Probably, yes.

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  • Jordan Feigenbaum
    replied
    Originally posted by RVR View Post
    Re: Low back pain.
    The problem I have with the "2-4 injuries in 1000h of training" idea is that it tells you precisely nothing about the severity of the pain or injury.
    This is true, but the symptoms of the over 90% of "injuries" documented during RT resolve in under two weeks. We agree that how you define injury matters, which include some metric of severity and consequence in most, but not all studies.

    Just wanted to clarify this.

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  • sjalbrec
    replied
    Hi, I've read through your posts and am still not exactly sure what you are asking? Are you worried you are going to get injured training with a barbell because your form isn't perfect? Everyone's form is a little different and injuries are very rare. I would recommend you just train. Start with a manageable low weight and follow a Barbell Medicine template. As long as you avoid really extreme ego lifting, you will be fine.

    I suppose I could be wrong, but I have never seen any evidence that being a bit on your toes while squatting has any negative effect on your knees. Squatting is not bad for your knees. Being on your toes feels awkward and will limit the amount of weight you can move, but it won't cause an injury.

    Barbell training is a multiple years long (hopefully lifetime) pursuit. Getting really strong takes a long time and a lot of dedication. I see a lot of people worrying too much about the perfect optimization of their training. You will make great progress, make a few mistakes in your programming, and sometimes life will cause you to take a few steps backwards. I would recommend avoiding overthinking the minutia and just dive in slow and steady. and have fun!
    Last edited by sjalbrec; 07-22-2021, 05:22 PM.

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