Bonus Episode: Dr. Feigenbaum on Volume vs. Intensity, Training Frequency, Peptides, and More!

[SPEAKER_00]: Hey, it's Jordan from Barbell Medicine. [SPEAKER_00]: Now this episode preview is from exclusive content that regularly goes out to our Barbell Medicine Plus subscribers. [SPEAKER_00]: In addition to exclusive content, Barbell Medicine Plus subscribers get early access to episodes and products, ad-free listening, discounts on products and services, and the ability to ask Dr. Barakie night questions all for about the cost of a cup of coffee each month.

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[SPEAKER_00]: All right, thanks for your consideration, onto the show. [SPEAKER_00]: All right, RDP asks, in terms of high purtrophy, how important is volume intensity and proximity to failure and in what order? [SPEAKER_00]: Um, they're all important. [SPEAKER_00]: And so one sort of relationship that I'd like to maybe impress upon you is that the training load, right, the external training load is made up of all of the nuts and bolts of a training program, what your body sort of is exposed to.

[SPEAKER_00]: So the volume, the rest period, the exercise selection, the intensity, the proximity [SPEAKER_00]: is to exercise as energy balance is to nutrition and weight management so when it comes to weight management energy balance rules all effectively that determines whether or not somebody's going to gain weight, maintain weight, lose weight and training load is pretty much going to determine how you would predict how you would predict somebody would respond to exercise.

[SPEAKER_00]: So [SPEAKER_00]: And for hypertrophy, you can't really discuss volume without intensity and without proximity to failure because you're just missing information and doesn't really work like that. [SPEAKER_00]: I would say that training volume provided the other parameters are held the same is probably the most important factor there if I had to pick because that is really the biggest

[SPEAKER_00]: Intensity, there are a wide range of viable intensities that can work to grow your muscle or give the muscle the stimulus to grow, so you could use anything from 30% to 1RM all the way to 90% of 1RM and everything in between, obviously you'll do less reps as you go up there, as long as it gets somewhere close to failure and I'm talking like four to five reps,

[SPEAKER_00]: Some signal that for isolation, exercise is single joint exercises going closer to failure is a little bit better, particularly in untrained individuals, but yeah, training load overall is like the most important thing, the goal of a coach and of exercise programming is to get somebody to do the maximum amount of training load that they can. [SPEAKER_00]: and the two limitters, the two bottlenecks are logistics so time and then physiological tolerance.

[SPEAKER_00]: So how much can they actually recover from? [SPEAKER_00]: And so you'd want to maximize that. [SPEAKER_00]: I think people come at this maybe from a little from different sort of understandings of how exercise works and maybe even different sort of questions like, oh, what's the minimum effective dose? [SPEAKER_00]: And it's like, oh, pretty much any exercise, any dose of exercise can be beneficial particularly in the short term.

[SPEAKER_00]: Even like a minute of exercise can show you some benefit, but we're trying to figure out is how do we get somebody to do the most amount of exercise because that's going to have the biggest effect and so the last thing I'll leave you with is that intensity and proximity to failure kind of determine the type or the nature of adaptations that you get from from training and volume kind of determines the magnitude of adaptations you're going to get from exercise.

[SPEAKER_00]: Obviously, they're interrelated, but yeah, that's a way that I kind of look at things from a 10,000-foot view. [SPEAKER_00]: M. Pollis 320. [SPEAKER_00]: Muscle memory is their adequate evidence suggesting that it does, in fact, exist, and have you seen it occur in athletes you've worked with? [SPEAKER_00]: Yes. [SPEAKER_00]: So muscle memory is quite interesting.

[SPEAKER_00]: There is evidence that it does exist, and so we're going to define muscle memory as the tendency of a previously trained muscle. [SPEAKER_00]: having experienced some period of detraining, so not actively training the muscle, exercising the muscle formally. [SPEAKER_00]: It will tend to return to an increase in size and also increase in strength faster than the initial sort of acquisition of that size and strength.

[SPEAKER_00]: And so, yeah, there's ample evidence and humans that this exists. [SPEAKER_00]: We don't know the exact mechanisms. [SPEAKER_00]: There are some hypotheses that seem reasonable. [SPEAKER_00]: And we also don't know how long that this persists, because long-term studies on this haven't really been done.

[SPEAKER_00]: So, we think that the cells that are responsible for maintaining muscle mass maintain the actual proteins in the muscle, these are called myonuclei, myon for muscle nuclei, like a cell nucleus, your skeletal muscle fibers have many of them, and they produce protein, they're involved in, again, maintaining the protein of the muscle itself.

[SPEAKER_00]: When a muscle is detrained due to immobilization, due to injury, any sort of thing that keeps the other gym, we're just not training. [SPEAKER_00]: The size of the muscle will go down after some time. [SPEAKER_00]: The strength of the muscle will go down after some amount of time. [SPEAKER_00]: And usually it's not proportional. [SPEAKER_00]: They go in different phases. [SPEAKER_00]: But then the myonucleid themselves are more of them in a trained muscle than an untrained muscle.

[SPEAKER_00]: And they persist despite detraining for some period of time. [SPEAKER_00]: Again, we don't really have long-term years, long longitudinal data on this state to see like how long do they persist. [SPEAKER_00]: But in any case, they do seem to persist. [SPEAKER_00]: And so when that muscle is re-exposed to training, that muscle protein synthesis, you get way more of it.

[SPEAKER_00]: And so there's a restoration of muscle size and muscle strength much faster than the original size and strength was acquired and so yeah good evidence for that There's also some neural muscular adaptations that seem to persist as well So as far as how long they last [SPEAKER_00]: And do they persist in all cases?

[SPEAKER_00]: So for example, with a neurological injury, with frank immobilization, like cast, do it an injury or something like that, TBI, or spinal cord injury, we don't know. [SPEAKER_00]: There's not enough data there to feel super confident, but overall my view on muscle memory is that yes, it does exist.

[SPEAKER_00]: We don't know how long and we don't know to what extent, you know, all the mechanisms that are going on, but yeah, we have a article on this anopod cast discussing this, what happens when you stop working out and detail that and it's heavily cited as is most of our stuff too, so check that out.

[SPEAKER_00]: Hey, it's Alan, what is the reasoning behind the heavy single after the top single and back offsets in the low fatigue, uh, second generation template? [SPEAKER_00]: Yeah. [SPEAKER_00]: So this is one of our newest templates. [SPEAKER_00]: So in the PDF, it's like a 100 page program, treat us on program and that I included with all those templates. [SPEAKER_00]: I actually discuss why we do, um, fatigue singles.

[SPEAKER_00]: That's what we're just calling them, um, basically a single repetition set. [SPEAKER_00]: after the main work has been done or in addition to a heavy single done at the beginning of the workout. [SPEAKER_00]: So doing singles period is good practice at getting better for getting better at a single repetition effort. [SPEAKER_00]: So if someone is a powerlifter, you want to expose them to multiple singles. [SPEAKER_00]: And this is one way to do that.

[SPEAKER_00]: Doing it afterwards is another good exercise in sort of projecting or predicting how strong you are and a given time, which is also useful for going to a powerlifting, because the sport of powerlifting sport being used very charitably there is trying to maximize your total on a given day. [SPEAKER_00]: Yes, it helps to get very, very strong and to be your strongest self.

[SPEAKER_00]: But every day is different in human performance varies day to day and being able to predict this is my top effort or this is a sub maximal effort that's good skill to have. [SPEAKER_00]: So both skill acquisition actually performing a single rep set and also being able to predict how strong you are on a given day those are both the goals of having singles and programming and they can be placed in multiple different places.

[SPEAKER_00]: in this case, before a lot of work is done, so some volume sets and after. [SPEAKER_00]: You can also put them in the middle, sometimes I've done that. [SPEAKER_00]: Sometimes I've done a whole work at where it's only single. [SPEAKER_00]: So tell somebody or myself to do nine singles, for example, that's one way you can approach programming depending on the context, the goals, the person's preferences, and so on.

[SPEAKER_00]: Barbell therapy, UT. [SPEAKER_00]: You think that's Texas, or you think it's Utah? [SPEAKER_00]: What is the TLDR on peptides seems super popular? [SPEAKER_00]: Yeah, I think part of my annoyance here and I'll try to be clear is that there are many FDA-approved drugs that are peptides that have great evidence for their benefit, for example, insulin. [SPEAKER_00]: So maglu-tide, turns that peptide.

[SPEAKER_00]: So that's the anti-obesium medications, [SPEAKER_00]: Zepbound, Monjaro, and more. [SPEAKER_00]: There are plenty of peptide drugs that have great evidence. [SPEAKER_00]: But most of the time when people are talking about peptides, they're talking about things like BPC-157, D-T-B-500, some growth hormone secretotoges that were usually used to diagnose like a condirplasia or growth hormone deficiency stuff like that.

[SPEAKER_00]: can be used dignastically, the evidence for those particular peptides, which is what most people are talking about when they say peptides, is either non-existent, like the case of BPC-157, or very, very, uh, uh, scant, not a lot of human evidence showing not only safety, but also efficacy. [SPEAKER_00]: So I think just in general, rather than trying to think about peptides as like a group

[SPEAKER_00]: Let's just go back to, you know, just, is there good evidence of not only safety, but also efficacy in a population that is representative of the person who would be taking this agent and are there, you know, medication, medication interactions, or what are the side effects, or the adverse events, and risk benefit analysis, there's same thing you would do with any sort of medication because that's really what these are, their medications.

[SPEAKER_00]: Yes, you can get them from compounding pharmacies. [SPEAKER_00]: I have mixed feelings about that, particularly when there's not good evidence of safety or any evidence of safety. [SPEAKER_00]: A for example, you can get research chemicals, which I have even more mixed feelings about because I worry about the purity of that product and the people using them are likely not being monitored for adverse events and side effects and we don't really know what you're getting.

[SPEAKER_00]: So yeah, you know, on the other hand, and maybe this is. [SPEAKER_00]: a tepatek or a hot take, you know, peptide medication that actually does have great evidence of not only safety, but also efficacy would be like some agulotide, right?

[SPEAKER_00]: Orcher's epitide, technically a peptide drug, and it's very expensive to get through legitimate channels, going to your doctor, getting up, you know, the brand name prescription such, and so [SPEAKER_00]: Many people who would benefit from this medication do not have access to this medication and so a compounding pharmacy could potentially bridge that gap although that's some legal issues there.

[SPEAKER_00]: Same thing with a research chemical and so is it a net benefit to take a compounded version or a research chemical compared to the risks. [SPEAKER_00]: I don't know. [SPEAKER_00]: I don't know, but so it just gets a little trickier there. [SPEAKER_00]: So in any case, I just think looking at what is the evidence of not only safety, but efficacy for particular agent and compare that to the risks for particular individual.

[SPEAKER_00]: And where there is no evidence, I feel pretty strongly that people should probably not self-experiment on themselves. [SPEAKER_00]: Don't be the guinea pig. [SPEAKER_00]: And if there is good evidence there, ask your doctor about it. [SPEAKER_00]: I know, not, not, not like a super sexy answer. [SPEAKER_00]: So, Tony flex 225. [SPEAKER_00]: More volume tends to lead to a bigger hypertrophy response, but what's the cutoff in terms of sets?

[SPEAKER_00]: Yeah, this is a great question. [SPEAKER_00]: This is probably where a lot of the debate over exercise frequency, training frequency kind of comes into play. [SPEAKER_00]: So training frequency is a way, the way I view that is the way to distribute the training load over the course of a week based on a person's preferences. [SPEAKER_00]: So let's say, for example, somebody wanted to do squats only one day a week, and they were going to do five sets of five.

[SPEAKER_00]: Or they'd say, look, that's a lot of squatting in one particular session that takes me a long time.

[SPEAKER_00]: I'd like to spread it out. [SPEAKER_00]: And we do that. [SPEAKER_00]: Sure, you could squat one set of five over five days. [SPEAKER_00]: I would predict similar results between both, because the volume is the same, right? [SPEAKER_00]: There's some thought that there's maybe a point by a past which more volume doesn't actually lead to, in this case, more muscular growth or hypertrophy.

[SPEAKER_00]: It's been estimated to be somewhere around this 10 to 12 to 15 sets for a particular muscle group in a given workout, although the evidence there is not awesome. [SPEAKER_00]: The evidence for increased frequency once you get to that 10 to 15 set range is not great, but it can be a reasonable tool, particularly from a logistical standpoint, like doing 25 sets of biceps and a single workout, maybe split that up.

[SPEAKER_00]: I'm just not super confident that the evidence really bears that out. [SPEAKER_00]: It's more like a personal preference. [SPEAKER_00]: One thing I will say is that when you're starting to get into the 20 plus sets per week for a muscle group. [SPEAKER_00]: Yeah, you could make the prediction that increasing volume would lead to further growth.

[SPEAKER_00]: But I start wondering about how hard most of those sets are, and rather than adjusting volume up further, I would consider adjusting proximity to failure, up getting closer to failure for those sets, at any as a way to increase training load. [SPEAKER_00]: Because again, training load is, you know, that's what you're really focusing on here too. [SPEAKER_00]: increase the training adaptations, and so volume is one lever, but so is proximity to failure, so is average intensity.

[SPEAKER_00]: So I think that once you start getting north of 15, 20 sets for a given muscle group per week, you know, maybe more. [SPEAKER_00]: This is mostly theoretical. [SPEAKER_00]: Getting closer to failure would probably be a better move than jacking volume up further. [SPEAKER_00]: For straining fight, I feel a little bit differently, but we're talking about hypertrophy here.

[SPEAKER_00]: All right, if Sudena Phil slash to Dallafil, so, uh, Cialis and Viagra or Viagra works for a patient, does that mean there's likely a problem or concern with the cardiovascular system? [SPEAKER_00]: Not necessarily.

[SPEAKER_00]: I mean, one of the biggest risk factors for erectile dysfunction is certainly going to be reduced, cardiovascular fitness, and cardiovascular disease metabolic disease is also a risk factor, and those are related, so you can just call it cardiovascular metabolic disease. [SPEAKER_00]: Outside of that, there are some psychological or psychogenic sort of causes of erectile dysfunction.

[SPEAKER_00]: And so I wouldn't say that somebody who benefits quote unquote from using Cialis, Viagra, or similar. [SPEAKER_00]: Nessarrily has cardiometabolic disease, but it's certainly possible. [SPEAKER_00]: Yeah, even people without any sort of frank disease seem to have a benefit from these agents. [SPEAKER_00]: So yeah, I wouldn't necessarily say that somebody who sees that benefit necessarily has cardiovascular disease. [SPEAKER_00]: I don't think that's a little bit too reductionist.

[SPEAKER_00]: Jade's underscored GS underscored Z14 underscored zero. [SPEAKER_00]: Would you recommend Merff from CrossFit as a good overall fitness exercise? [SPEAKER_00]: No, I would not recommend it. [SPEAKER_00]: Like if somebody wants to do it because they feel, you know, [SPEAKER_00]: attached to the work that they want to do it. [SPEAKER_00]: It celebrates, you know, particularly how holiday, believe it's on Memorial Day, usually, fine.

[SPEAKER_00]: I am concerned that most people are not in good enough shape to actually generate a significant fitness benefit from it because it's just too high of a dose risk of rabdomylysis, which you do have an article about new article about on the website, is likely higher and

[SPEAKER_00]: But if you want to do it, it's fine. [SPEAKER_00]: It's kind of like, does running a marathon a good workout? [SPEAKER_00]: Well, there's some benefit there, but maybe not a lot compared to just training for the marathon. [SPEAKER_00]: You know, it's more of a performance measure than anything else than like an actual fitness building workout, so to speak.

[SPEAKER_00]: So I generally don't recommend it unless somebody wants to do it in which case I want to make sure they're adequately prepared for that particular workout. [SPEAKER_00]: oblivious peninsula. [SPEAKER_00]: Can I still build muscle while running 70 kilometers per week?

[SPEAKER_00]: Sure, you're likely going to build less muscle than if you were running less per week, mainly because your training resources have to be so spread out so that you can run all this and recover from those runs and then you still have to train resistance train. [SPEAKER_00]: But you can't do as much because you're doing all this running and you need to recover from that. [SPEAKER_00]: So yeah, your overall training load from a resistance training standpoint is going to be less.

[SPEAKER_00]: can you still gain some muscle? [SPEAKER_00]: Sure, particularly if you're eating enough. [SPEAKER_00]: So my two concerns would be total training load. [SPEAKER_00]: How much of that is dedicated towards resistance training? [SPEAKER_00]: Probably can't be too too much because you're doing a lot of running. [SPEAKER_00]: Got to recover from that.

[SPEAKER_00]: And then also nutritionally, are you actually really supporting not only that amount of running, but the additional resistance training.

[SPEAKER_00]: You can gain some muscle, but certainly not as much muscle as if you're following like a bodybuilding type program for example Just like you wouldn't gain as much strength as if you were following a legit strength strength training program So it's a bit of a compromise but Somebody's running 70 kilometers a week really likes to run wants to be better running and so maybe that's a good tradeoff How to kind of sus that out for yourself?

[SPEAKER_00]: Maxwell underscore rose is it realistic? [SPEAKER_00]: to have three weekly sessions lasting half an hour and hits the low end of the recommended volume for a late novice might be taking on school and want to keep up a training. [SPEAKER_00]: So there are no like definitive volume recommendations for novice intermediate advanced and in fact I don't really like those classifications for individuals because [SPEAKER_00]: I don't know what they mean.

[SPEAKER_00]: I know people have tried to make up definitions based on how quickly someone adapts to resistance training, but I don't think those are based in evidence. [SPEAKER_00]: I think they're just made up, meaning that a novice could gain strength within 48 hours of a previous training session.

[SPEAKER_00]: That is not compatible human physiology for any extended period of time by extended. [SPEAKER_00]: I mean, like a month or so, say, an intermediate. [SPEAKER_00]: They can gain strength every week. [SPEAKER_00]: That's incompatible with human physiology. [SPEAKER_00]: So I don't like those definitions. [SPEAKER_00]: I also don't think that there are distinct volume recommendations for each phase that are generalizable for most folks.

[SPEAKER_00]: I think that people can meet the current guidelines from a muscled strengthening standpoint with 30 minutes, the 45 minutes of session, a couple times a week, yes. [SPEAKER_00]: But that's likely not enough training load to maximize strength, high-perrophy power, sort of resistance training adaptations. [SPEAKER_00]: Any more than, you know, doing 30 minutes of conditioning two or three times a week would be sufficient for maximizing cardiovascular fitness adaptations.

[SPEAKER_00]: There's a proportional relationship between how much training low that somebody can acquire or accumulate over a given period of time and the fitness adaptations they're going to get from exercise and so the more you can do the better.

[SPEAKER_00]: So in this particular scenario, you're thinking about going back to school, maybe going back to school. [SPEAKER_00]: Look, I've been there, going to medical school. [SPEAKER_00]: I probably trained more in medical school than I did before medical school. [SPEAKER_00]: Residency was a little bit different, but I tried my best to kind of maintain my training load. [SPEAKER_00]: And ultimately got stronger, got bigger, you know, gained fitness.

[SPEAKER_00]: And so, [SPEAKER_00]: I think that with some good time management and good programming, you're likely going to be fine, but I would not go into it thinking I should only train 30 minutes per session or that that would be enough to sort of maximize your fitness trajectory. [SPEAKER_00]: It's better than nothing, for sure, and it may be enough to gain a little bit and or maintain your current sort of [SPEAKER_00]: expert friendly man.

[SPEAKER_00]: I took a long break from lifting and came back to squatting with some lower back pain. [SPEAKER_00]: My deadlift were feeling fine, but this morning I hurt my back. [SPEAKER_00]: I d-loaded a lot, but I guess not enough. [SPEAKER_00]: Yeah. [SPEAKER_00]: I mean, generally speaking, you know, one, sorry that this happened.

[SPEAKER_00]: Unfortunately, injuries do happen, whether we're exercising or not. [SPEAKER_00]: One of the, one of my favorite studies, they took two groups of previously inactive individuals. [SPEAKER_00]: Believe it was a hundred in each group.

[SPEAKER_00]: One group was, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh

[SPEAKER_00]: You know, put into this exercise arm where they did, I think it was six hours per week of conditioning and the other group didn't do any exercise and then they did this for a year and at the end of the year the injury rate was the same between both groups despite one group doing a lot of exercise and one group effectively doing no exercise and so, you know. [SPEAKER_00]: life is not, you know, zero risk for injuries. [SPEAKER_00]: The human condition we are going to get injuries.

[SPEAKER_00]: So when saying all that, look, I'm still sorry. [SPEAKER_00]: I know it's frustrating. [SPEAKER_00]: Fortunately, most injuries from exercise, especially resistance training are not catastrophic. [SPEAKER_00]: They tend to resolve on their own without any sort of special care within about two weeks.

[SPEAKER_00]: They don't require, you know, [SPEAKER_00]: Uh, that doesn't change the fact that they're frustrating and annoying and, you know, you got a modified training in the interim because if you just avoid exercise that tends to not only delay your return to unrestricted activity, but also increases disability risk, can he's a phobias of fear of movement and ultimately detraining because you're not actually exercising.

[SPEAKER_00]: So the point is here, you have to find a way to be active right now. [SPEAKER_00]: that also doesn't increase sensitivity of your injury. [SPEAKER_00]: And so many different options, mostly involving reducing weight on the bar. [SPEAKER_00]: So adding a tempo, for example, slows down the movement, reduces the amount of weight you can lift. [SPEAKER_00]: Adding reps, so a higher rep range, also reduces the amount of weight that you can lift.

[SPEAKER_00]: You could also change range. [SPEAKER_00]: motion, change the exercise, go to a single, a unilateral type exercise, switch to machine, based stuff to change how the particular area is being loaded. [SPEAKER_00]: All of these are options, but you have to find an entry point and then gradually progress back to what you were doing before.

[SPEAKER_00]: with unrestricted activity and so we have a number of articles on the website about this pain and training what do, three most common mistakes that people make during rehab, a number of podcasts on this, a number of low back pain related resources as well. [SPEAKER_00]: And so if you are still experiencing significant pain during training in low back, I suspect that the exercise selection should be changed.

[SPEAKER_00]: I suspect that the loading of that exercise [SPEAKER_00]: you will not have pain while you're doing this, doing the exercise, and that's your starting point, and then you progress from there. [SPEAKER_00]: So if you're still having pain, would back things up a little bit further, and then start your progression gradually from that point.

[SPEAKER_00]: And if you need some help, we have the best PAN or rehab team in the industry, and we're available, and she doesn't email, support at barballmedicine.com. [SPEAKER_00]: Routy stick, I'm trying to decide on an off-season template. [SPEAKER_00]: I percher fee two or power building two. [SPEAKER_00]: I just finished strength to next competition in seven to eight months.

[SPEAKER_00]: Yeah, I mean, I don't know that this is actually the off season, because you do have a meet coming up, technically, but yeah, if you wanted to change a pace for a brief period of time for you jump back into power lifting specific training, I would probably pick a high-perature fee to it's further removed from power lifting and power building and so it gives you a little bit of a break. [SPEAKER_00]: You don't have exposure to single rep efforts, which is what I would.

[SPEAKER_00]: do in an off-season, the exercise variation is higher, the conditioning component of the total training program is higher than it is in power building. [SPEAKER_00]: And so that would probably be my preference if I wanted an actual off-season. [SPEAKER_00]: But if you wanted to stay closer to legitimate powerlifting training or training for a powerlifting meet, powerbuilding to would be a better option.

[SPEAKER_00]: Yeah. [SPEAKER_00]: So if you just use your preferences to pick the template, do you want to actually have an offseason where you're going to spend six to eight, ten weeks doing different stuff and then come back to powerlifting training or do you just want something that's not, you know, super 100% specific to powerlifting and but gradually kind of work your way back to powerlifting.

[SPEAKER_00]: If it's the former, you want to complete break, do the high-perch fee to template or body building [SPEAKER_00]: if you want something that's closer, but not quite 100% powerlifting pick the powerbuilding template. [SPEAKER_00]: You can't really go wrong here, just depends on your personal preferences. [SPEAKER_00]: So, Jenner, 82, it wasn't not a name of a spacecraft in, was it the expanse or for all mankind? [SPEAKER_00]: I think it was for all mankind.

[SPEAKER_00]: Great series on, I think it's on Prime. [SPEAKER_00]: Maybe it's Apple TV, anyway. [SPEAKER_00]: I've had neat tenonitis for like two years. [SPEAKER_00]: It's starting to improve, but still isn't normal. [SPEAKER_00]: I feel like I've tried anything. [SPEAKER_00]: but ideas. [SPEAKER_00]: Yeah, it's, look, if you've had this thing for two years and it hasn't resolved yet, my thought is that the management has been inadequate so far.

[SPEAKER_00]: Tenonitis, tenonopathy, it's a somebrella term for pain coming from what we think is related to the tendon, usually an overuse type injury. [SPEAKER_00]: And so if you're still having sensitivity when you're squatting, jumping, boxed up ups, split squats, running, stuff like that,

[SPEAKER_00]: yet it's been adequately managed and I think it's likely most likely due to loading minutes too heavy what you're doing right now and or too much volume and or taking sets too close to failure and so I would back way way off try to get to a point where while I don't actually have any sensitivity or symptoms when I'm doing these workouts and that's like oh this is a good entry point and gradually progress back to unrestricted activity towards your previous

[SPEAKER_00]: Because this has lasted for two years, I have concerns that maybe your approach is not good enough. [SPEAKER_00]: Yeah, and that's not a personal thing. [SPEAKER_00]: I'm not saying hey, this is your fault. [SPEAKER_00]: But I think that your approach in these modifications, and we have articles on a website, pain and training what do, three most common mistakes people make during rehab.

[SPEAKER_00]: And if you can't theme to parse all this together, let one of our pain and rehab professionals help you out. [SPEAKER_00]: They're really good at this, and it would sort of cut that learning curve off for you. [SPEAKER_00]: You're ready to be pain-free, you know? [SPEAKER_00]: So, if we can help, we're here, just let us know. [SPEAKER_00]: Support at barbalmedicine.com, we'll get you sorted.

[SPEAKER_00]: Alright, that is a wrap on this free sample of our bonus content that regularly goes out to our barbalmedicine Plus subscribers. [SPEAKER_00]: Again, to join head over to barbalmedicine.com slash plus and sign up to be a barbalmedicine plus member today that's barbalmedicine.com slash plus. [SPEAKER_00]: Thank you so much for listening. [SPEAKER_00]: We'll catch you guys next time.