Today, while doing my B-workout of the SSLP, I noticed during the squat that I heavily lean onto my right (healthy) leg. This happens right at the time when the eccentric portion of the move turns into concentric (which is probably understandable, as the left leg is noticeably weaker and has been injured 12 years ago).
What I did after squatting was, I took a good look at myself in the mirror (no pun intended) and tried to note as many details as possible so here it goes:
left foot - weighted more medially than laterally (kind of like if there was a very slight flat foot or arch drop);
medial malleolus more “medially displaced” if that is a term, than the right one:
When looking from above, I can see more of a red sole side of my Adidas weightlifting shoes on the right foot than on the left one;
left (bad) knee in slight valgus and, probably, patella itself displaced laterally (patella points more externally than the right one);
left hip (as a result of all of the above I suppose) is displaced more to the front than the right one, noticeable when I sit at my desk;
All this makes my squat look ever more crappy as the weight goes up. I suppose, leaning to the right is a problem, not just because it stresses my legs in different amounts, but it must do some bad things to the position of the pelvis and the spine.
I am also unable to extend the left shoulder as much as the right one. This can be seen when I step out of the rack - my right elbow is WAY higher and more back than the left one, which makes the bar lean toward the floor on the left!
Question:
should I “correct” (and how really) or just push on through with bilateral movements, letting time allow the weaker parts to catch up in strength and/or in range of motion currently unattainable?
I decided not to correct and to push on through. For now, this is proving to be a decent tactic :). I am still not all that successful in doing it correctly but if I think real hard about shifting my weight to the left side, I seem to come out of the bottom more evenly.
Apologies for the delayed response. Why do you think what you are observing implies weaker parts of your body? What promoted the increased awareness to technique?
Typically our perception of a movement and outward observation isn’t a great indicator of what is happening at the tissue level. With that said, I usually don’t recommend altering mechanics too much if the person isn’t currently working through an “issue” or having measurable decrements in performance comparatively to prior training history, Have you uploaded a video to the Facebook group for critique?
Ok, sounds like you are progressing appropriately. Keep us posted. What do you mean by correctly?
Michael, thank you for taking the time to reply to my post, MUCH appreciated!
The looks
The leg in question is smaller in size and therefore, I believe, weaker. Most of the time, I can almost feel my brain not wanting to produce as much force as it could, probably in order to “protect” the formerly traumatized area.
Altered mechanics
There is evidence of altered mechanics too:
the whole knee looks different to the right one:
square-ish;
certain degree of valgus (tip of medial condyle poking medially a bit);
the patella is:
laterally displaced;
“sunken” into the joint/not as prominent as it used to be;
cannot move as much as the right one can when the leg is extended and relaxed;
some of the tissues, most probably ligaments, are contracted - lacking ROM, flexion stops at just about the right position for the low bar squat;
horrible crepitus;
on and off pain, especially as I approached 80-85 kg (not much by any standard but the most weight I ever achieved in my training “career”);
As I plowed through the SSLP, about a month and a half seriously, my weights have gone up but also the pain started appearing in that knee. Also, at that time I switched from using the squat stand to the power rack (safety concerns - pins to save my a** if I miss the rep). It just so happened that there was a mirror in front of the rack. It was there that I noticed VERY heavy lean onto the right side out of the hole.
I completely understand this. I have read through most all of the available essays on the BBLM site, as well as on the “other” site :), the good books (you know which ones) and I even started reading the studies that you and Austin post on your social media. Therefore, I believe I have grasped the main differences between the biomechanical and biopsychosocial models of pain and the lacking of the biomechanical one.
This leaves a huge challenge for a beginner like myself - if we, as Jordan frequently says in the podcasts, “Just don’t know.”, how can I discern between the “bio-” and the “-psychosicial” parts of the bps pain model? Is there a real, accute issue to be taken care of OR is it just my brain projecting concerns caused by a previous, very bad experience?
My choices are as follows: 1. See an orthopod:
does imaging;
wants to perform arthroscopy and/or useless “joint lavage” proceedures;
advises met to stay clear of heavy weights;
See a PT:
[takes out his Bosu ball,small chrome dumbells, rubber bands and RollerBone board];
Let’s address the pain question first, as this is likely the most important question - and many others are likely wondering the same.
It is important to state all pain is real to the person experiencing it and self-identifying the correlation of pain to a particular construct (biology, psychology, and/or sociology) is quite difficult and actually a misuse of the BPS model. This isn’t a discussion of how much a single factor correlates to the perception of pain. Psychology and sociology can directly influence how a person copes with and manages situations where acute tissue damage is obvious.
Even in clinical practice it is a process of elimination, ruling out concerning “issues” which warrant further investigation that may alter our prognosis (expected clinical course/outcome). This means we need to pay close attention to research evidence demonstrating something to be a “problem” or something we should provide reassurance will improve and we don’t need to further investigate. We have far more evidence about what are not “problems” necessitating further investigation. Meaning often our primary purpose in pain based situations is education by explaining the meaning of pain, re-assurance, and setting expectations for the future while guiding the patient’s path to their goals. Even in acute trauma cases, we can’t expedite healing (return to baseline of tissue structure as best as possible and return to previous level of function prior to trauma - if possible). We (clinicians) are along for the ride in many scenarios just like the patient but the potential to do harm is present.
The education of pain can either help the patient or harm the patient based on our words utilized and even alter clinical course. See:The Iatrogenic Potential of the Physician’s Words - https://jamanetwork.com/journals/jam…stract/2661032 and Words do matter: a systematic review on how different terminology for the same condition influences management preferences - https://bmjopen.bmj.com/content/7/7/e014129).
So if education is our primary intervention as it relates to pain, what should we be discussing?
Pain is a threat perception system predicated on early detection to minimize damage to the organism. Living organisms (not just humans) have a withdrawal reflex to minimize damage and ensure survival. Think touching a hot pan or stove and without thinking you have a subconscious withdrawal away from the threatening stimulus. The stimulus is perceived as threatening based on the ability to elicit damage to the tissue. Tissue damage is relayed via nociceptors (nerve cells which sense thermal, mechanical, or chemical stimuli). So if pain is a threat detection system then the secondary prerogative is to draw awareness to the area undergoing threat - we call this somatic (body) awareness. This means pain is attentional focused and goal based. The goal is usually escape unless another goal is warranting of our attention. In scenarios where we have evidence of tissue damage, pain perception may or may not occur. Example: solider in battle may suffer tissue damage but has other contextual cues in the environment of more concern that warrant the soldier’s attention and they continue on towards their goal until the environment warrants loss of threat perception or decreased goal focus. (See: Pain demands attention: a cognitive-affective model of the interruptive function of pain. - Pain demands attention: a cognitive-affective model of the interruptive function of pain - PubMed). To take this discussion a step further, we can discuss this from a Bayesian perspective.
Our mind is regularly making predictions about the reality we find ourselves in. These predictions are hypotheses that are regularly being updated based on past experiences, beliefs, contextual cues from the environment, and our sensory input. The sensory input is incoming from our senses: sight, touch, sound, taste, and smell. Our senses can be easily manipulated to match our predictions about the world meaning we can perceive from our senses inaccuracies. Think of this like you are walking through the woods and notice an object that appears as a snake (makes sense given you’ve previously walked through the woods and noticed a snake in a similar environment). You become a bit apprehensive about walking further forward but reluctantly slowly move forward and as you get closer you realize, oh this isn’t a snake but rather a stick that just appeared to be a snake. This situation can be further compounded if you previously walked through the same woods and were bitten by a snake in your right calf muscle several years prior. This time you are walking through the woods, don’t notice the “snake” and brush past the stick in the same area where the snake bit your calf region previously. You instantly have a withdrawal reflex and cry out as if you had been bitten but when you finally look down you realize, oh this is a stick - how silly of me - and all is well. Now take this to the gym setting and let’s say you’ve had a prior history with knee pain while squatting. The expectation has been set if I squat then I typically get knee pain. This expectation can become a self-fulfilling prophecy; meaning you are in pain because you expect to be. Often, people then avoid the movement they are fearful of having pain with - this is called the fear avoidance behavior model (See The fear-avoidance model of pain.
The fear-avoidance model of pain - PubMed). This can become a viscous cycle and perpetuate the persistence of pain. This can also elicit vigilance to an area previously dealing with pain that has been attached to a particular movement. The person can become a seeker of pain, looking for it because they expect it. This also can perpetuate fear avoidance and persistence of pain. If a person is dealing with anxiety, depression, and catastrophizing (rumination and magnification of the issue - worst case scenario and learned helplessness - not in control) then persistence of pain can be magnified and develop into allodynia (non-painful stimuli become painful) and hyperalgesia (increased pain response) (See - Theoretical perspectives on the relation between catastrophizing and pain. - Theoretical perspectives on the relation between catastrophizing and pain - PubMed).
Now all pain is the same (despite our varying linguistic descriptors used to describe pain via metaphors). I’m not a fan of the term chronic vs acute pain (despite this is how it appears in the research literature). However, most label pain as persistent if there is no recent identifiable mechanism of injury (acute trauma to the area) and has lasted for more than 3 months (note this is mostly a fucking arbitrary timeframe). Once we classify a patient with persistent pain then the likelihood there is an underlying biological issue we should be concerned with drastically goes down from a correlation perspective and instead the psycho social variables should be provided more investigation. But as I said above, psychosocial variables also affect how a person copes with acute traumas. Psychosocial variables can be heavily influenced based on a person’s thoughts and beliefs about pain. Operating from the premise pain = bad = tissue damage = avoid is not a great approach and this belief needs to be reframed that pain = threat perception and then we can discuss the relevance of the threat and help guide the path to the patient’s goals. This shift in thinking is massive and once reframed changes how we discuss the topic of pain. Another belief with pain would be the person isn’t in control (learned helplessness) but then it is the clinician’s job to help with learned behavioral responses to empower the patient to take control. It is worth noting as I sit here easily typing this info out - this shit takes time and effort. Changing beliefs and behavioral responses typically isn’t easy; especially if other perceived authority figures have imprinted on the person for a long time. Those who often influence our beliefs: parents, doctors, close friends, social media/television etc. This basically becomes an epistemological discussion of knowledge acquisition and who do we trust as disseminators of knowledge. Hopefully as time goes on, many continue to trust us at BBM as disseminators of “truth” to the best of our abilities. Obviously with the understanding, even we can still be wrong but we attach ourselves to research evidence for this reason. As sufficient evidence becomes available to change our opinion then we will do so. However, if a person is staying up to date on research then there shouldn’t be major shifts regularly occurring given it takes a large amount of research to change stances.
Happy to discuss this more but ultimately there isn’t an easy answer to the question you presented. Also - you have a fourth option, trust in your ability to self-manage and realize you have far more control over these situations than perhaps you have yet realized.
Mike, I cannot possibly thank you enough for taking so much time to try and help me deal with this issue. And not just in a way of “providing the fish” but also for “teaching me HOW to fish”! I read the reply, absorbed it and this is what I did:
today, I went and re-did my “missed” workout, the one where I could not squat 80kgx5x3.
I simply did it. A bit of stationary bike, just to give the ol’ man knee a bit of blood flow, and after that on with the regular warm up as prescribed. I can report moderate pain but the overall sensation is MUCH better than it was the last time. Who’d know what is happening down there (or UP there in the brain, for that matter)!?
The more I do this and the more I read about this issue, the more I understand:
One should not try to “connect” the sensations with structural changes since not even the medical professionals can do this consistently and comfortably. On this topic, there is an excellent video lecture by Will Morris (I think that is his name) on … “the other site” … where he explains the difficulties in measuring exact forces and loads upon the joint structures and proving causality between temporally subsequent events. It would literally mean cutting you open, placing sensors inside the joint and forcing you to perform movements. So, yea, that one will not work…
I am also uploading my squat and deadlift videos to FB group for a form check, as you instructed me.
The plan is to keep moving. I may deviate from the rigid structure of the SSLP but if that is the correct way to manage my symptoms and continue training - so be it. If it’s all right with you, I will keep you posted on the progress (hopefully not REgress) via this board. It might come in handy for someone else dealing with the same sh**.
Happy to help. Definitely keep us posted. Also - I can’t recall but are you using RPE? This will help regulate load and fatigue. One of my biggest complaints with SSLP is this idea of consistently attempting to increase weight regardless of how the person feels - this leaves out a major factor of training, the human variable. This is a similar discussion to dealing with pain in the clinic and trying to treat via the biomedical model, doesn’t make sense and the evidence isn’t supportive of this approach.
Not yet. I do something similar - I simply back off the weight at my own discretion, because the program got too rigid for my situation and I cannot “simply add more weight”. Also, I have started trying to estimate what my RPE’s are but I feel I am extremely inconsistent with it. A lot of hit ‘n’ miss for now but maybe it improves in time.
I was thinking of continuing with the SSLP & RPE approach for a while and not move to the Bridge yet, what do you think?
on this subject;
… where he explains the difficulties in measuring exact forces and loads upon the joint structures and proving causality between temporally subsequent events. It would literally mean cutting you open, placing sensors inside the joint and forcing you to perform movements. So, yea, that one will not work…