Mentioning injury leads to injury?

[mdelvecchio]

Hey guys,

First off I want to say I’ve been fans of yours for years, listening to you both on the SS podcasts, reading the nutrition forum, your articles on pain and other topics, and watching Thrall’s videos and collaborations with BBM. What I like best about your brand is the no-bullshit, science-based approach to training. I enjoyed the critical piece debunking woo-based therapies such as cupping, chiropractic, etc.

But I’ve noticed a trend on the BBM facebook forum when it comes to form checks. There is a vocal group of BBM practitioners who chastise anyone who links bad form to injury risk. On recent discussion members outright said you shouldn’t mention “risk of injury” when critiquing form, because even mentioning injury leads to…increased injury, due to the nocebo effect.

This seems like bullshit. In real life, there are indeed some things that lead to an increased chance of another thing. Bad form is a thing that leads to an increased chance of another thing (injury). Trying to deny it seems like a fool’s errand. YouTube channels are dedicated to poor form & injuries (Elgin Intensity, etc). My sports med clinic opened a location next door to a CrossFit gym and said business is booming. Even vets with decades of lifting experience are susceptible to injury — Practical Programming author Andy Baker recently used poor form in his DLs and is now sitting out waiting for surgery.

Injury sucks, and surgery is the worst. And for us middle-aged lifters, recovery isn’t easy and my body isn’t as spry as it was. Therefore it seems to me that injury should be avoided at all costs, including being mindful of form and actively attempting to prevent injury by using best practices for the lifts. Not just for lift efficiency, but for preventing injury. Using good form to prevent injury means being able to mention it when doing form checks. Not mentioning it because speaking the word “injury” may lead to injury seems like untested woo bullshit. I’d bet using poor form is more likely to increase injury than speaking the word “injury”.

Can you clarify BBM’s position on this?

[briangoldstein]

I think this is a case where the docs have been clear and others are incapable of accurately recapitulating what they said.

[Bear_Bryan]

That’s overly optimistic that you are going to avoid injury with proper technique. You could do everything right at the gym tomorrow and still suffer an injury, tendinopathy, etc.. I certainly don’t think obsessing about perfect form for fear of injury is particularly useful. Always strive for good form and just train. Let the chips fall where they will.

[Austin Baraki]

I don’t think we’ve ever suggested that “mentioning injury leads to injury”.

[mdelvecchio]

That’s overly optimistic that you are going to avoid injury with proper technique. You could do everything right at the gym tomorrow and still suffer an injury, tendinopathy, etc.. I certainly don’t think obsessing about perfect form for fear of injury is particularly useful. Always strive for good form and just train. Let the chips fall where they will.

I never mentioned obsessing about perfect form, or that injury is impossible with good form. I said that bad form increases chance of injury and utilizing best practices in the lifts decreases chance of injury.

But my question was about this claim on the FB group during form-check posts that identifying poor form and linking it to increase risk of injury must not be done, because even mentioning it unconsciously increases chance of injury, "because nocebo". This claim sounds like untested woo, thus my question.

[mdelvecchio]

I don’t think we’ve ever suggested that “mentioning injury leads to injury”.

Thanks. I'll chalk up those comments to people running with a concept while not understanding it and basically turning it into a new form of woo, and that it doesn't actually reflect BBM's position. I love the podcasts and the science-based approach to training, least amount of stress necessary, etc...So it was disheartening to see people using such an unscientific, superstition-like argument. I was beginning to wonder if BBM wasn't the place for me as I look for intermediate programs and approaches to training in my middle-age.

Perhaps injury is less concerning to strong young male lifters, but it's a real thing to my wife and I. Serious injury changes you, and your training. I'm not saying be a scaredy cat about it, but it's entirely prudent and wise to utilize best practices in form for the goal of injury prevention (risk reduction) in addition to the goal of lift efficiency.

[Austin Baraki]

Thanks. I'll chalk up those comments to people running with a concept while not understanding it and basically turning it into a new form of woo, and that it doesn't actually reflect BBM's position. I love the podcasts and the science-based approach to training, least amount of stress necessary, etc...So it was disheartening to see people using such an unscientific, superstition-like argument. I was beginning to wonder if BBM wasn't the place for me as I look for intermediate programs and approaches to training in my middle-age.

Perhaps injury is less concerning to strong young male lifters, but it's a real thing to my wife and I. Serious injury changes you, and your training. I'm not saying be a scaredy cat about it, but it's entirely prudent and wise to utilize best practices in form for the goal of injury prevention (risk reduction) in addition to the goal of lift efficiency.

Correct. Most of the people throwing around the word "nocebo" have failed to grasp what it actually means, unfortunately.

I would not say that injury is less concerning to one group of people compared to anyone else younger lifters. It's at least as concerning in a young, competitive population since an injury can put you out of the game for a while (see: my elbow), which can be incredibly frustrating.

There is very little evidence that we can do much to prevent injuries. There's also no evidence that there is one "optimal" way to move, loaded or not. But I agree that it's wise to use what you (and we) generally describe as "best practices" -- though even these are frequently debated -- for various reasons.

What you may be talking about is how we don't encourage hypervigilance and obsession over 100% flawless technique on every rep specifically for the purpose of injury prevention, because it often results in the misattribution of random, spontaneous aches or pains to the most miniscule, irrelevant form deviations. This can produce a reinforcing cycle of fear (as you described, being a scardy cat), as the slightest hint of knee slide becomes a catastrophic form error that inhibits training progression. We've all seen this happen as coaches.

In reality, people don't get knee pain every time their knees wiggle in the bottom of a squat. People's backs don't hurt every time they get a bit of unlocking off the floor in a deadlift. People's shoulders don't hurt every time they misgroove a bench press. Pain and injury are complex, multifactorial things. So while we aggressively coach our lifters towards what we consider to be "good technique", we also want to teach and develop resilience so they don't perceive themselves as fragile structures afraid of "moving wrong" or who can't tolerate the inevitable bit of technical deviation.

[Bear_Bryan]

If this is about your back and forth with that Anthony fellow on that deadlift form check video then you are mischaracterizing the conversation and taking what was said out of context. On yet another video you chime in again about halloween cat backs and snapping spines. It seems it's all you are concerned with. Rightly, in that second instance, someone from Barbell Medicine said in a round about way, "prove it". Leave out the cat spine and back snapping comments and offer helpful cues. I know you think you are helping people by claiming they are going to injure themselves to hopefully scare them into fixing their form, but we are saying that is not necessarily true and the negative expectations tied to those criticisms (without fixes) is not helpful.

[mdelvecchio]

If this is about your back and forth with that Anthony fellow on that deadlift form check video then you are mischaracterizing the conversation and taking what was said out of context. On yet another video you chime in again about halloween cat backs and snapping spines. It seems it's all you are concerned with. Rightly, in that second instance, someone from Barbell Medicine said in a round about way, "prove it". Leave out the cat spine and back snapping comments and offer helpful cues. I know you think you are helping people by claiming they are going to injure themselves to hopefully scare them into fixing their form, but we are saying that is not necessarily true and the negative expectations tied to those criticisms (without fixes) is not helpful.

Actually it isn't, I'm referring to another back & forth on that video where someone made these claims to "Johnny Meatballs", chastising him and saying his mentioning injury could in itself cause injury. Specifically:

"your comment does not help anything and could potentially lead to him encountering injury where he previously wouldn’t have"

"comments stating that someone will get hurt increases the chances of them getting hurt. Therefore we should not make such comments"

"Austin Baraki has talked for a long time about the nocebo effect and the power that our words have."

"Telling someone that they will get injured CAN in fact increase the likelihood of them getting injured."

...this is woo conjuring, especially since no one said "YOU WILL GET HURT" and essentially just said, 'Your form break down can lead to injury'. Mentioning form and injury prevention (risk reduction) does not increase the chances of them getting hurt automagically, and thus declaring no one should make observations of poor form even w/ regards to injury reduction *in a form check request* is silly woo.

It's your interpretation that Johnny Meatballs or myself are attempting to scare people into using good form or that we claimed they "are going to" hurt themselves. It is not fact, since no one made that ultimatum. But people do get hurt doing DL with poor form, and it's perfectly valid to mention it when seeing it after someone asks you to critique their form. Practical Programming author Andy Baker is now sitting it out awaiting surgery after getting sloppy on his DLs. Good form is best practice for reasons, including reducing injury risk. It doesn't require any proof on my part. If you wish to believe that isn't true, you're free to live in that world. But I'm not going to stop pointing out when people use a halloween-cat back on a load that is too heavy for them during training (this isn't a meet). And my form-check replies will be the same -- read SS, watch Thrall's videos, lighten the load, and perform the movement with good form and a set back.

[Nathan]

Cool, a whole thread about me, I feel honored .

I apologize if I overemphasized/misused the nocebo effect during that thread on FB.

I would simply like to state that in that thread I stated that I 100% agreed that the OP should fix his form, and that comments such as "My back hurts from watching this video" were not helpful and might provide a nocebo effect to the OP. If that is an incorrect use of nocebo, please let me know. I also stated that bad form is not always indicative of injury. Johnny Meatballs (as pointed out on the FB thread, that is an amazing name) and I seemed to come to an agreement on that thread with the help of another commenter who may have phrased my point better than I did.

[Bear_Bryan]

Nobody is arguing against good form dude, I don’t know why you keep mischaracterizing others arguments as if we don’t care about good form. I also don’t know why you are so hung up on one piece of anecdotal evidence (Andy Baker) as if that proves your point that form deviations are going to cause injuries.