It bears repeating that I am not a doctor or physical therapist.

It bears repeating that I am not a doctor or physical therapist. If only because I am routinely presented with “doctor-y” type questions that are way outside my scope.

My ideas and methods are largely born of experience on the gym floor after 10 years and under the guidance of a series of fantastic mentors with dozens of years of experience to pile on top.

As often as I am able, I ground what I do and say in the exercise research body. But, after 10 years on the floor, you will start to notice things that simply aren’t reflected in the greater body of literature — especially as you search relentlessly for solutions to your client’s problems. I tread often in uncharted territory with purposeful “observe and report” to determine if a novel approach can offer relief where a tried-and-true approach has fallen short.

I am personally very often “Patient Zero” to solve a problem that I have myself encountered. Success leads to additional implementation. Multiple successes grow confidence in creating program frameworks to help a broader audience and share ideas on social media. This is the intersection where I typically get the most push back — and I don’t disagree with their face value assessment. I would disagree with me too if I hadn’t been there every step of the way.

I have heard Exercise Science referred to as “Exercise History” which I think creates a tug of war between what “should” be done and what is observed as helpful but without yet having academic support.

I believe a decade of boots-on-the-ground experience working with 1000s of clients and hundreds of thousands of reps (and conferring with other coaches with their 1000s of clients and hundreds of 1000s of more reps) will afford insights not otherwise available.

My specific target in discussing and resolving pain is actually quite narrow amongst the huge landscape that can fall under the umbrella of pain.

Pain can be chemical — inflammatory metabolites that cause pain not receptive to manual therapy or exercise. Think of the acute aftermath of a bad injury like an ACL tear.

Pain can be a complete fracture of a system — think of a car accident. No number of wiggles and tweaks to your squat will mend a freshly broken bone.

Pain can be psychosomatic — pain without a pin point origin sending signals to your brain without rhyme or reason.

Pain can be neurological — related to the above, your nerves are inflamed, severed or dysfunction in a way that is understood but unreasonable. Think of phantom pain associated with a limb that is no longer there.

Pain can be further neurological by way of withdrawal symptoms of a substance.

Pain can be mechanical to the degree that a tumor is pressing on a nerve.

Pain can be indirectly mechanical because invariably all nerves must pass through the neck. Insofar as the neck is mechanically problematic, you may experience pain downstream with otherwise healthy local tissues.

All of the above won’t be the least bit responsive and possibly antagonized by doing exercise.

What CAN be addressed? Mechanical pain that is musckuloskeletal in nature that is ALSO receptive to stress and local in nature (that is, not a result of problems in the neck). If a tissue cannot be stressed (broken leg from above — still mechanical, but too far gone) then we can’t do anything. If the pain is originating from cervical problems, then we must start there before anything downstream will have meaningful resolution.

I will concede cervical problems are not an area that I am particularly confident, but to the extent that pain resolves upon introduction of ordinary exercises and doesn’t have the downstream radiating characteristics pain originating from cervical dysfunction, we can be reasonably confident that it is productive to proceed. Likewise, often downstream pain that originates at the neck accompanies local neck pain whereas a bum knee from too much running is very likely to be specific to the running and uninvolved with the neck.

This is pretty narrow. It essentially encapsulates “sometimes my knee hurts when I run” — that is my wheelhouse! Even though it COULD be elements of the above, for the large majority of people it plays in the domain of “structural balance.” That is, when things are balanced they tend to hurt less. When they are unbalanced, they tend to hurt more and be more susceptible to acute or repetitive stress injury.

So for the critics that would wish to assume I am purporting to cure cancer with squats — let’s put that firmly to rest.

Furthermore, we are simply taking this narrow context of pain and reframing it as ability. That is, if people have low levels of ability on certain movements they often have predictable outcomes in terms of pain and performance in other elements. In that way we assess not pain per se, but the ability of a movement with pain as an outcome. Pain is our measuring stick, not our focus.

With pain as a measuring stick, we have a pretty reliable tool for assessing ability. Things that are painful — even a little — show a deficit in ability. The tissue is maladapted from previous injury, there is an excess of mechanical stress on a joint from muscular imbalance or there is mechanical stress on tissue from lack of muscular tension on others.

When we improve the musculature and connective tissue, my observation again and again is that there is improvement with self-report of pain. When we mitigate pain, we also mitigate the desire for medications, surgical interventions or other therapies whose express purpose is to mitigate pain. Surgery is not for the aesthetic outcomes of the internal knee tissue — it’s because it hurts so damn bad I can’t walk.

If someone comes to me with knee pain, we do exercises to address the presumed imbalance of mechanical tension on or around the joint, the pain subsists and they can resume their activities without pain then I have done my job. That is the summary of my focus in “Pain Free Ability Training.”

Turns out, I am pretty good at it.