Are nagging injuries and joint pain holding back your progress in the gym? Are you concerned about lifting as you get older, or simply want to stay strong for life?

Philip (@witsandweights) connects with Dr. Jordan Feigenbaum, a seasoned powerlifter, coach, and physician. Together, they tackle the reality of aging and training, providing practical strategies to help you build a resilient body that can stand the test of time. Whether you're new to lifting or an experienced lifter facing setbacks, this conversation will equip you with the tools and confidence to train intelligently for years to come.

Dr. Jordan Feigenbaum is a powerhouse in the fitness and medical fields, holding an MD, and is ranked as one of the top 20 powerlifters worldwide. He co-founded Barbell Medicine, where he and his team integrate evidence-based practice with strength training, health promotion, and longevity coaching. Through his work, he has empowered lifters of all ages and experience levels to reach their goals with resilience and confidence.

Today, you’ll learn all about:

2:52 How to program for strength, injury prevention, and longevity in lifting
8:38 Avoiding overuse injuries and common training pitfalls
13:03 The role of variety in injury prevention
20:27 Debunking myths about heavy lifting and joint health
29:11 Understanding training load and soreness Vs. Injury
39:13 Managing fatigue to train effectively for longevity
43:54 Common causes of low-back fatigue and how to address it
50:15 Maintaining strength, realistic goals as you age, and progressive loading
56:19 Outro

Episode resources:

• Barbell Medicine podcast 

• Instagram: @jordan_barbellmedicine/ 

• X: @BarbellMedicine 

• Threads: @jordan_barbellmedicine 

Injury-Resilient Training for Lifetime Strength and Muscle

Are you worried that lifting heavy after 40 might be a ticking time bomb for your joints? Or maybe you're frustrated by nagging injuries slowing your progress? In this episode, I sit down with Dr. Jordan Feigenbaum, powerlifter-turned-physician and founder of Barbell Medicine, to uncover evidence-based strategies for bulletproofing your training as you age.

The Truth About Heavy Lifting and Joint Health

One of the most persistent myths in strength training is that heavy lifting inevitably leads to joint problems, especially as we age. Dr. Feigenbaum challenges this notion with compelling evidence: injury rates between powerlifters and bodybuilders are remarkably similar, suggesting that load itself isn't the primary risk factor. What matters more is proper preparation and appropriate progression.

The fear of injury often prevents people from starting or continuing strength training, with about 40% of people citing injury concerns as their reason for not exercising. However, the research shows that being insufficiently active carries its own risks – people who don't exercise experience similar rates of musculoskeletal complaints as those who do.

The Science of Progressive Loading

Rather than focusing on constantly increasing weights or volume (traditional progressive overload), Dr. Feigenbaum advocates for a more nuanced approach called progressive loading. This method emphasizes training hard enough to drive adaptation while staying within your current fitness capacity. The key is allowing these adaptations to occur before increasing loads.

Think of it as a "therapeutic index" for training – there's a sweet spot between the minimum effective dose for results and the maximum recoverable training load. The goal isn't to constantly push this upper limit but to maintain a buffer for sustainability. This approach becomes especially crucial as we age and need to balance progress with recovery.

Smart Exercise Selection for Longevity

Training variety emerges as a crucial factor for injury prevention and long-term progress. Dr. Feigenbaum recommends varying movement patterns within each lift category (squat, hinge, press, pull), potentially using different variations each training session. This variety serves two purposes: it helps distribute training stress across different tissues and improves motor learning.

For example, instead of doing the same back squat variation multiple times per week, you might rotate between:

• Traditional back squats

• Front squats

• Safety bar squats

• Bulgarian split squats

This variation doesn't mean compromising specificity – rather, it's about finding the right balance based on your goals and training experience.

Managing Training Load and Recovery

Recognizing the signs of overuse versus normal training stress becomes crucial for sustainable progress. Watch for decreasing performance over time, persistent soreness that's out of proportion to your training, reduced motivation, and joint-related complaints. These symptoms often indicate you're pushing beyond your recovery capacity.

Dr. Feigenbaum emphasizes that training should be about development, not testing. This means implementing auto-regulation strategies like monitoring daily readiness and adjusting training loads accordingly. The goal is to make training challenging enough to drive progress but not so demanding that it compromises recovery.

Setting Realistic Expectations After 40

While it's true that maintaining peak strength from your 20s and 30s into your 70s might not be realistic, this doesn't mean you can't continue making progress. The key is adjusting expectations and focusing on three evidence-based goals for long-term health:

1. Maximal strength development

2. Muscle hypertrophy

3. Cardiovascular fitness

By prioritizing these areas while managing training load appropriately, you can continue making meaningful progress well into your later years. The focus shifts from constant progression to maintaining capabilities and quality of life.

Practical Implementation

Success in long-term strength training comes down to consistency over intensity. Rather than trying to max out every session or constantly push your limits, focus on sustainable progress. Use RPE (Rate of Perceived Exertion) or RIR (Reps in Reserve) to guide intensity, and remember that not every session needs to be a personal record attempt.

For those wanting to implement these principles, start by assessing your current training program. Are you varying your exercises enough? Are you allowing adequate recovery between challenging sessions? Are you adjusting your training based on daily readiness? These questions can help guide you toward more sustainable training practices.

Remember: Training is about development, not testing. Focus on sustainable progress rather than constantly pushing your limits, and you'll be able to maintain strength and muscle for years to come.

📲 Send me a text message!

👩‍💻 Book a FREE 15-Minute Rapid Nutrition Assessment

🎓 Join Wits & Weights Physique University

👥 Join our Facebook community for live Q&As & support

✉️ Join the FREE email list with insider strategies and bonus content!

📱 Try MacroFactor for free with code WITSANDWEIGHTS. The only food logging app that adjusts to your metabolism!

🏋️‍♀️ Download Boostcamp for free and access 70+ evidence-based workout programs

🩷 Love the podcast? Leave a 5-star review or share on social and tag @witsandweights

📞 Send a Q&A voicemail

Have you followed the podcast?

Get notified of new episodes. Use your favorite podcast platform or one of the buttons below. Then hit “Subscribe” or “Follow” and you’re good to go!

Transcript

Philip Pape: 0:01

If you're a lifter in your 40s or beyond who's frustrated by nagging injuries slowing your progress, or you're worried that adding more weight to the bar might be a ticking time bomb for your joints and you want to bulletproof your training to be more resilient to injury, this episode is for you. Today I'm sitting down with Dr Jordan Feigenbaum, a powerlifter turned physician. Bridges the gap between heavy lifting and injury prevention. Powerlifter-turned-physician bridges the gap between heavy lifting and injury prevention. You'll discover why age isn't the limiting factor you think. It is how to program intelligently to build strength without breaking down, and the often overlooked recovery strategies that can add years to your lifting life. Whether you're battling chronic pain or just want to ensure you're still crushing it well into your golden years, the practical strategies you're about to learn will give you the confidence to train hard and stay healthy, no matter your age.

Philip Pape: 0:55

Welcome to Wits and Weights, the podcast that blends evidence and engineering to help you build smart, efficient systems to achieve your dream physique. I'm your host, philip Pape, and today we are addressing injury prevention and longevity for lifters with Dr Jordan Feigenbaum. Jordan is both a seasoned strength coach and practicing physician. He holds an MD, is an elite power lifter with one of the top 20 totals of all time and has tons of experience coaching everyone from everyday gym goers to professional athletes.

Philip Pape: 1:24

Now, I personally learned about him through Barbell Medicine and the podcast of the same name, where he and his partner, austin, promote health. They promote performance, longevity, definitely with a focus on resistance training and evidence-based practice, which is why I wanted to invite him on the show Today. You're going to learn how to design your training to maximize strength gains while minimizing injury risk as you age. We'll explore the role of recovery in preventing overuse injuries, debunk some myths about lifting and joint health and give you strategies to build resilience into your training program. You'll discover how to balance intensity and volume for optimal progress, the connection between pain and tissue damage and practical ways to personalize your lifting for any limitations you might have. Jordan, it's an honor to have you on the show.

Dr. Jordan Feigenbaum: 2:07

Yeah, thank you so much for having me. I appreciate it.

Philip Pape: 2:09

Yeah, man. So we want to talk about the, I'll say, the older lifting crowd today, which a lot of people I joke about with friends is over 40, right, like as soon as you hit 40 year old. Right, You're both a lifter and a doctor, which, sadly, is not a combination we see too often. I wish it were, and I'm sure you've seen many older lifters struggle with really wanting to push the heavier weights. They want to push the PRs. Some of it's ego, some of it is like we got started late, like I did, and we're trying to catch up, and there's this fear, or sometimes reality, of getting injured. So what, in your opinion, is the main differentiator between lifters who continue making progress safely over the decades and those who experience more interruptions related to, say, injury or joint health?

Dr. Jordan Feigenbaum: 2:52

Yeah, great question. Maybe we should answer some easy stuff first, like what's the meaning of life, or like you know what's the purpose.

Philip Pape: 2:58

I'd love to set a floor for this show man. Yeah, yeah, no.

Dr. Jordan Feigenbaum: 3:02

Yeah, it's interesting. Think about what sort of predicts you know, long-term, not only like just longevity, as far as being able to participate period, right, but then also like long-term success, because those are slightly different things. You know there's definitely benefits from just participation in exercise, resistance training, conditioning both of them ideally and then actually making progress within those two pursuits, particularly like improvements in maximal strength, improvements in VO2 max. So there's a difference. You want to do both of those things, so improve those things and do it for a long period of time. So, as far as things that predict success and longevity, certainly there's a large genetic component to both which, unfortunately, CRISPR is not yet. We can't do that. So not necessarily Unless you go, CRISPR is not yet we can't do that, so not necessarily going to China.

Dr. Jordan Feigenbaum: 3:46

Yeah, right, yeah, so maybe in the future that's going to be a modifiable factor. So genetics are certainly important. Your environment is certainly important, not only like opportunities to exercise but also just what's happening around you. So some social elements, conditioning wise, as far as is this a normal thing for people to engage in resistance training and formalized exercise or, you know, culturally, for example? So it definitely varies.

Dr. Jordan Feigenbaum: 4:11

But as far as things that actually most people can probably modify or at least start thinking about, likely has to do primarily with program design, and I you know when people hear that and they start thinking about okay, so I just need to focus on how do I lay out the elements of my programming? You know how far down the rabbit hole do we really need to go to give people actionable advice on what to do? And I think varies by degree, meaning that if you're relatively new, you don't need to have, you know, a PhD in exercise science or sports performance or anything like that to kind of make heads and tails of what the research says and take that away and actually do stuff in your own training. But there are a handful of maybe pillars if you want to call it that term, or heuristics that are useful. And I think the main things are we need to make sure that the training suits you or is fitted to you or individualized to you for your current level of fitness. So that's thing one. And so, unfortunately, when you look up programs that are available online, there are internet age, they're everywhere, which is great, because back when I started lifting that wasn't the case. If you looked up, like you know, lifting program or powerlifting program, you'd get a handful of results. And I'm not being you know, lifting program or powerlifting program, you'd get a handful of results. And I'm not being you know, not exaggerating this, it just wasn't out there. And now the Google return hundreds of thousands, if not millions of things.

Dr. Jordan Feigenbaum: 5:32

And so when you're writing a program for a general audience, for their consumption, you're going to you know it's like a bell curve, bell distribution. You're going to get a number of folks, but other folks will be underdosed and other folks will be overdosed and you're kind of just hoping for the best. So that's thing, you know. Pillar number one it's got to be suited to you, the individual, based on your current level of fitness, because that will predict what's your training tolerance, so how much exercise you can do and also your needs right. So those are two things that are related. Second thing is, after, making sure that it's appropriately dosed for the individual is going to be that it actually produces the outcomes that are desired.

Dr. Jordan Feigenbaum: 6:08

So if we think about this from like a health promotion standpoint you know, health span and maybe adding on to that lifespan there are a handful of things we have great evidence on that actually promote sort of improvements in health span, reducing the risk of disease, particularly the burden of chronic disease, developing new chronic disease, and then also improves quality of life, puts life in your years. Those would be things like maximal strength, which you could tack on muscular power. To that, those things are kind of related. Obviously, muscular hypertrophy another one of those evidence-based goals and then cardiorespiratory fitness. Now, that's a pretty short list of things, really. Three things, maybe four If you say strength and power are different, which, yeah, short list of things, you know. Really three things, maybe four If you say strength and power are different, which, yeah, the scientists in me definitely would want to make that distinction. But people are going to listen to this and they'll say, well, what about stretching? Or what about?

Philip Pape: 6:51

balance? Or what about mobility Agility?

Dr. Jordan Feigenbaum: 6:55

It's not that those things are unrelated to function so how well you can use your strength, for example, or how you interact with the environment it's just that they tend to be adequately addressed by programs that improve muscular strength through ways we typically test them. And I make that caveat because it is possible for me I could put you on a program that was completely isometric, for example, where your muscles don't actually contract and extend, You're just creating force in a fixed position where the muscle doesn't actually move, and I could say, look, you got stronger, but that's probably not doing anything for your range of motion. So anyway, if you got to get really specific with you would want to say, yeah, totally.

Dr. Jordan Feigenbaum: 7:32

So you'd want to improve dynamic strength, You'd want to improve muscular size, so muscle cross-sectional area, and you'd want to improve cardiorespiratory fitness, and so that means that the program has to be individualized or adjusted in order to produce those results for people. So when we look at the response of people to exercise interventions, you're going to have the extreme responders. Those are the people that we tend to see at the top of sport. Whatever they be, they just tend to respond super well, whether that's genetically predisposed to doing awesome. Slash the environment, slash other factors, nutrition factors, nutritionally, uh, and lifestyle wise sure, all of those are related. And then there's going to be this group of people that are termed non-responders, who you know in some studies, the short-term ones in particular. They actually lose strength, for example, or lose muscle size, and you're like how is that possible? Because they're actually exercising just not well suited to that program. So even if it was dosed in a way that they could currently tolerate, kind of met them where they're at, it wasn't enough or wasn't the right type of training to elicit the responses that we need to improve health and, ultimately, quality of life. So those two things right off the bat.

Dr. Jordan Feigenbaum: 8:37

And then, when we think about how to make sure that goes on for a long period of time, we really just want to avoid the major pitfall when it comes to those who will regularly participate in exercise, which are overuse injuries. Yes, you could go down the list and say, look, acute trauma accidents in the gym. You know the things of that nature. But the biggest source of you know injury when it comes to resistance training and even in cardiorespiratory fitness conditioning exercise, is going to be an overuse injury, which is exactly what it sounds like You're doing too much of the same thing at a load or intensity or, ultimately, a training volume. So a combination of all these factors that you can't currently tolerate and that tends to be predicted by the variety, or really lack thereof, in the program. So it's a person who only does back squats for their lower extremity you know squat pattern training rather than multiple different types of things or only does the same rep range or always goes to failure. So there's like a handful of different elements within programming that can kind of predict that people will have an overuse injury.

Dr. Jordan Feigenbaum: 9:41

The last thing I'd add on this would just be consistency, which is no surprise to anyone who's listened to your podcast or any other fitness podcast, because it's the same thing you see in weekend warriors when it comes to sport A person who plays basketball on the weekends, a person who takes a ski trip every winter or something like that and they come back their knees hurt, their elbow hurt, whatever.

Dr. Jordan Feigenbaum: 9:59

It has mostly to do with being prepared for the tasks that they're asking their body to do, and so if you have these long gaps where you're not training, you're not preparing for what you're asking your body to do, yeah, that does set you up for an injury. So ultimately, you'd want the thing to be dosed properly, not only for the person's current fitness level but their actual responsiveness to the thing, so they actually get the results that we want. You'd want to make sure that the training is heavily varied so that there's less risk of an overuse injury, although not so varied that you're kind of spreading yourself too thin and then do that consistently for a long period of time, and I don't know that those things are. Any of those things are controversial, like someone's listening to this and like, wow, you just opened my eyes but yeah, you could have luck in there, but I don't know that's a modifiable risk factor either.

Philip Pape: 10:52

So, yeah, the things you can and can't control. I hear you, man Cause it's funny, you mentioned it wouldn't surprise anyone, maybe people who'd listened to our shows consistently, but every day and I'm sure you get it as well People ask how heavy should I lift, how much recovery should I get? You know this, this, this, and you're like, well, it depends, you know. Let's add like 10 assumptions or caveats. Here's a program for a newer lifter, but here are your caveats. And so you mentioned the suitability, the minimum effective dose. You know, going for the actual goal you want. Because someone says how do I train? Well, what are you trying to do? Right, like, if you're a backcountry mountain goat hunter, you know which I know a guy like that versus you know you really care about endurance. There's a huge difference there. So, looking at strength, hypertrophy, power and fitness, I do love thinking of it as that kind of pie that covers all types of fitness that extend or correlate from that. And then the different levels of response, you know, knowing that even when you start something, you may not respond like someone else. So, jordan, it's funny, I just had it came out today.

Philip Pape: 11:48

Um, as we're recording this, justin Cottle he's an anatomy expert and he was talking about what he sees like in a cadaver, related to people who lift versus those who don't. And there were two things I was going to mention. One I can remember is the genetic variation between people and their response levels, down to the, you know, sarcoplasm, sarcomere, myosin levels. You know what I mean. Down to that level, how vastly different it can be. And there was one other thing I can't remember, but oh, the variety.

Philip Pape: 12:17

You talked about variety, like there's some of the bro science about shocking and muscle confusion and this and that. But I think there is a kernel of truth to that when you talk about not getting injured right, not like back squatting every session forever, but also the neuromuscular. In a way. There's a progressive loading aspect to that, beyond just adding weight to the bar of inserting this variety. Can we segue just a little bit on that? So, for example, westside conjugate right, one of the principles there is you rotate through like six or seven variants of a main lift and they knew intuitively that if you don't do that you're going to get over, fatigued or overuse from the one lift. Can we jumpstart off of that to talk about variety and muscle confusion and that whole idea?

Dr. Jordan Feigenbaum: 13:03

Yeah, sure.

Dr. Jordan Feigenbaum: 13:05

So I think again, when we're going to kind of bring all of these sort of ideas around program design back to those core sort of goals that we're looking for.

Dr. Jordan Feigenbaum: 13:14

So again, strength, power, hypertrophy, cardio, free fitness. So when you think about exercise selection, exercise mode, so the type of exercise that you're selecting and increasing variety within those domains, what you are really trying to do is use to leverage the body's ability to learn how to move we call it motor learning, for example and so some pretty decent evidence in my estimation, particularly with respect to physical task performance, that people learn better when they have an increase in variety of physical tasks that they have to perform, particularly when they're untrained. And so if you have a person who's not very well trained in the squat, for example, you might intuitively believe that if you just have them do one type of squat, they're going to become very efficient at doing that, meaning that they're going to clean up their technique in such a way where they're maximizing muscular force production in a way to move the bar completely vertically. But and granted, none of these studies have been done on the squat per se, but I think there is-.

Philip Pape: 14:14

Of course not. It's always the leg press.

Dr. Jordan Feigenbaum: 14:16

Leg press, leg extension or even more dynamic tasks jumping, stuff like that the idea is that if you give people slight differences in the movement pattern and so, again, if we use a squat, it's a back squat and then a front squat, maybe it's a high bar and a low bar, back squat, a safety squat, bar squat or a leg press or single leg work, for example the prediction that we would make, based on the current evidence, is that people would get better and more proficient at moving their body in space and come up with additional strategies to perform the physical task under periods of fatigue or duress or whatever, which is what happens in a workout anyway, right, and so you just get better at not only like this kinesthetic awareness where's your body in space but also you have additional strategies to leverage in order to move the weight, for example. So you not only get more efficient motor learning wise, you can pick things up a little faster, but you also have more resources to kind of use. So that's thing one. You're also distributing the training load, which again, is this term referring to not only volume, but also intensity, proximity to failure, frequency, all of the variables that kind of turn the program from this idea pie in the sky. To put it on paper, you're distributing it over more and more mass of tissue, right. It's not just always loading the patellar tendon or the ligament in the same way. You're doing it in different ways, and so you give the body a greater opportunity to adapt to those things, rather than maybe outkicking your coverage by kind of specializing.

Dr. Jordan Feigenbaum: 15:44

It doesn't mean that there's no place for specialization, and so when I think about Westside, I think about okay, what was Westside like designed for? It's mostly, you know, its original iteration was for powerlifters, and so powerlifter, we know the domains of sport squat, bench, deadlift, one rep, right. And so you know, in the off the off season, pre-season, before you're like actually going into specified meat prep, yeah, you would have a wide variety of movements, but once you get closer to the meat, you really want to focus in on the. You know things you need to do on meat day, and so there's times for specificity as well. The problem I see is that people get excited about lifting, which I'm 100 in in favor of. I want you to get bit by the bug, but I also don't want people to perseverate on a particular, a single form of a lift, a single rep range, for example, because ultimately I think that increases the risk of an overuse injury.

Dr. Jordan Feigenbaum: 16:37

So time for both being relatively varied than relatively specific, but taken to extreme for too long on either end, I think, is you're missing the boat. So one example of being too varied maybe all the time would be like some iterations of CrossFit, and then too specific on the other end would be some type of like the Bulgarian training. You know where you're maxing out daily which can be useful in short periods of time, but you think about expanding that over to eight weeks, 12 weeks, 16 weeks, 24 weeks. You're like I predict that most people are not going to be able to tolerate that and the people you hear about that did well on it. Well, that's survivor bias, right? You're like you're the only person left standing right and you're able to demonstrate these great results, whereas we're all the people who didn't make it that far.

Dr. Jordan Feigenbaum: 17:22

So when I think about practical implementation of variety for your general strength conditioning enthusiast I think about, you have a handful of movement patterns. Well, we can classify them as a squat pattern, a hinge pattern, a press pattern and a row or pull pattern, and I don't know that there's much benefit to repeating the exact movement more than once per week. Now, granted, that's speculative, right, you could make the case should you repeat them more than once every two weeks. We don't know, this is just more speculation, but when it comes time for me to actually generate a program, I think about all right, this person's going to do a squat pattern, squat type pattern, two times a week. I'm doing two different variations. If it's three times a week, three different variations. Four times a week, four different variations. And again you can make them very diverse.

Dr. Jordan Feigenbaum: 18:16

So like a back squat versus a Bulgarian split squat versus a step up. You know what I'm saying. That's big, big variances. Or they can be closer Back squat, low bar. Back squat, high bar, two count, pause squat, back squat. You know you're like okay, these are more similar, but still little variety. So it just depends on what is the end goal. What are you training for? What gets you up in the morning to go to the gym, for example? So that's kind of how I think about variety.

Philip Pape: 18:36

Yeah, I love that. I think there's a lot of counterintuitive and revelatory things that you said in there. Knowing the population that I know, when it comes to lifting there are definitely camps right. There's the kind of the starting strength and the basic but boring in the strength lifts side which, again, for new lifters, almost any program could be super effective and if you're committed and you want to learn those movement patterns, get strong fast, they could work. On the other hand, you have, you know, the six, seven day a week, bodybuilding. Every single movement's different and the fact that it's not just about fun, even though that's important. It's also the fact that your body engages in motor learning and you might actually become more efficient at the patterns you ironically, are doing less frequently now by mixing it up. It's heartening to people who wonder about that and think, oh, am I just slowing myself down and then even distributing the training load. When we talk about injury, we talk about longevity. That is super important. You think of whether it's muscle weaknesses or whatever the term people want to use. You're kind of distributing and letting your body use its system and do the movement patterns all across the board and you might be surprised how I mean, I found that doing weighted dips helped my overhead press and you're like, doing weighted dips helped my overhead press and when you look at the history of powerlifters and guys like Bill Starr, you see they did that and you're wondering why. Okay, so really good stuff.

Philip Pape: 19:52

I want to dive in a little bit to the joint health topic or arguments people make. A lot of people are fearful. If they're brand new to lifting, they're fearful. They're going to get injured just lifting in general, because of bad form or what have you, or because it's too heavy, or because their bones are going to break. They're fearful. They're going to get injured just lifting in general because of bad form or what have you, or because it's too heavy, or because their bones are going to break because they're now menopausal, whatever it is. Then you have, on the other hand, you know, dedicated lifters have been doing this for years who are worried about too much repetition of compound lifts and lower rep ranges on their joint health. What does the current evidence say about heavy lifting, you know, in our kind of sphere and joint health?

Dr. Jordan Feigenbaum: 20:27

Yeah, no, that's a great question, and even like joint health, it's more of this like nebulous umbrella term. I think on the one hand, we all understand what it means You're talking about pain-free sort of range of motion and being able to use it actively and passively, and then Connective tissue.

Dr. Jordan Feigenbaum: 20:41

No tendonitis you know, yeah, great function being able to walk up the stairs. Yeah, sure, totally yeah. So you know, there's this assumption, as you mentioned, that okay, if you train heavier rather than lighter, for example, just generally speaking, same proximity to failure, meaning you're doing three reps, two repetitions left in reserve, versus 10 reps left in reserve there's a thought well, the three reps definitely got to be heavier for a given exercise compared to the 10-rep set, and if it's heavier, so you're doing the three-rep set, you're at a higher risk of injury, whether we're talking about acute, catastrophic injury or a chronic sort of overuse injury, and you would expect that to play out with a pretty robust signal in the data, meaning that if you looked at powerlifters training presumably in the powerlifting way, all right, which is generally lower reps, getting ready for maximal strength sort of test on the platform, that they would have higher injury rates than, say, something like bodybuilders, right, that are training the same types of lifts, because then that's another sort of variable that we'd want to adjust and on balance, you don't really see that. You know, you can look at different data sets and come up with slightly different numbers, but when I look at them, and just just with the understanding that across all types of training resistance training the average injury rate is two to four injuries per 1,000 participation hours. And there are some bodybuilding-specific data sets that show, oh, it's 1.5 injuries per 1,000 participation hours, and there's other bodybuilding data sets that are up to three and a half injuries. So it just varies, right, because you just need a big sample size and how you define injuries. There's a bunch of other stuff. Do a whole podcast on that, but I think it's boring, don't need to do that.

Dr. Jordan Feigenbaum: 22:12

And then you look at powerlifting datasets and you see almost a mirror image of that, right. And so then you're like, even if there was a slight, maybe benefit or reduced risk of injury in bodybuilding, in my estimation, based on the existing data that we have, it's not robust enough to feel confident in that opinion that heavier is always a higher risk, higher risk, the biggest thing here. That is not an evidence-based sort of idea. This is more practical experience and the way I think about it. If somebody is not prepared for the task they're being asked to do, I do think that incurs a higher risk. How much higher depends on how far removed that is from their preparation, how novel it is to them, and so there's this kind of like open window theory of risk, meaning that if you're doing something new, you're effectively opening a window, and that window is wide open at first until you get used to it, have some exposure, have some experience with it. And so if it's your first time doing powerlifting training and you're asked to do one repetition, for example, like pretty close to failure just to see where you're at, and you've never done a one rep challenge test before, well, that's probably higher risk compared to somebody that's done single repetition work for years and years and years. But you don't need to study to tell you that.

Dr. Jordan Feigenbaum: 23:25

That said, if it were inherently risky meaning just dead bodies everywhere you would see that in the literature and not just in the injury data. We're talking about exercise science at large, where they routinely test people's one rep max to garner exercise prescription for loads. They'll have elderly individuals, people in their 60s, in their 70s, in their 80s even and they'll max them out on a leg extension and then say, okay, for the next eight weeks we're doing, we're starting at 65%, they're going 70%, 75%. Well, where's that percentage coming from? It's a one rep max test and what do they do? How do they obtain that At the beginning of the study, when these people were untrained. And again, there's not bodies everywhere, right?

Dr. Jordan Feigenbaum: 24:02

So I think the assumption that heavier loads are always more risky doesn't make sense to me for a given exercise. Just the caveat there is you need to be prepared for that and working up to that would probably be best practices. So I personally wouldn't test somebody's one rep max day one you could. I think there is some increased risk. I just don't know how big that risk is and I think it's relatively small compared to the risk of not exercising at all due to fear of injury. But to your point earlier most people well, most people don't exercise period. And and you ask them why, 40% of them will respond they don't exercise because they're afraid of getting hurt. And then, if you ask them further, why are they afraid? And it's something learned sort of thing, whether it's through social conditioning, they've had friends who've gotten hurt or they've learned it from who they consider an expert resource usually healthcare professional. Unfortunately, doctors say dumb stuff all the time.

Speaker 3: 24:56

Expert resource usually healthcare professional unfortunately, doctors say dumb stuff all the time. Shout out to Philip Pei. I've known Philip for a long time. I know how passionate he is about healthy eating and body strength, and that's why I choose him to be my coach. I was no stranger to dieting and body training, but I always struggled to do it sustainably. Philip helped me prioritize my goals with evidence-based recommendations while not overstressing my body and not feeling like I'm starving. In six months, I lost 45 pounds without drastically changing the foods I enjoy, but now I have a more balanced diet. I weight train consistently but, most importantly, I do it sustainably. If a scientifically sound, healthy diet and a lean, strong body is what you're looking for, philip Pape is your guy.

Philip Pape: 25:44

It's true. That's why I like guys like you on the show. You know we need more doctors who know their stuff and lift yeah.

Dr. Jordan Feigenbaum: 25:49

I'm just not convinced that the load itself is particularly risky, even in like subgroup analysis and some of these studies where they look at like, well, what about just the competition period? Only If we isolate just the competition period, so at a meet or the last few weeks before a meet, where the loads are heavier compared to generalized training, is there a higher injury incidence? Not really In Olympic weightlifting, in powerlifting, and you're like huh. Well, how confident am I in this claim that heavier weights are generally more risky? And I'm like I don't think they are. I think there's a maybe a little kernel, a nugget of truth in there saying that if you compare to set going all the way to failure versus a set that's like three or four reps shy of failure, I think the set that's a few reps shy of failure is probably less risky due to the fatigue stuff that happens later on, you know, as you get closer to failure, all the way to failure, and maybe that sort of the effect that we're seeing in the injury data, if any.

Philip Pape: 26:46

But even then we're not talking about this huge like cataclysmic effect again, otherwise you'd see bodies right and you'd see people who had back surgeries and knee surgeries who got back into heavy lifting and do really well not be able to do that.

Dr. Jordan Feigenbaum: 27:00

I think I mean it's super helpful one of the most interesting studies on this has to do with people who don't exercise. They're insufficiently active. I prefer that to the term sedentary. It makes me feel better, just about. You know how I'm labeling these people. I don't say, oh, you're sedentary, it's insufficiently active, we're working on it. You would expect, if you're of this very mechanistic mindset, that heavier loading worse, lighter loading better than taken to its logical end, logical conclusion there.

Dr. Jordan Feigenbaum: 27:28

You'd say, well, if the person isn't, exercising they should have a near zero risk of musculoskeletal injury.

Dr. Jordan Feigenbaum: 27:36

But that's not the case. In fact, they did this year-long study. They took people both previously and sufficiently active two groups. Half the groups were subject to do six hours per week of conditioning, pretty like moderate intensity conditioning, I think it was at like 75% of their VO2 max, six hours a week, which is, yeah, pretty significant versus people who did no exercise. And the musculoskeletal injury complaint rate was effectively the same between groups. Because there's just this non-zero risk of being a human for injury, like, yeah, people have low back pain, they don't exercise. People have shoulder pain, don't exercise. People have knee pain, they don't exercise. And so you would expect again, if it was just really tied to loading just literally the weight on the bar, the weight on the machine or whatever, you would expect it to be significantly higher in folks who regularly challenge their body with weights. But you just don't see that. So, yeah, I'm bearish on that. I don't think it's no.

Philip Pape: 28:27

No, I totally agree. I was giving you the platform because I want people to have the confidence to get started lifting and to lift heavy. I mean, there are definitely plenty of anecdotes of people who had back pain, for example, who now started deadlifting and the pain goes away. I hear that way more often than I hear people getting injured lifting. So if that's the case, when we talk about overuse because back earlier, when you're talking about the pillars you mentioned, that was kind of the one thing and it's tied to a lack of preparation, which is, I think, a good way to think of it as a principle, because then it can apply to lots of different contexts. When you say lack of preparation right the specificity and progressively loading up to that point and so on, what do you mean by overuse? How do people know that they're overusing and how do we not do that?

Dr. Jordan Feigenbaum: 29:10

Yeah, unfortunately, you don't know that you're overusing until it's too late, which is the problem. Right, it like declares itself and you're like dang, that was too much. So people may be familiar with the term like overtraining, which you know if you're an exercise scientist Overreaching overtraining, yeah, yeah, yeah, so like words have meaning and unfortunately you got to get a little pedantic about it.

Dr. Jordan Feigenbaum: 29:27

It's like overtraining refers to a syndrome, right, Generally including endocrinology changes. So like thyroid hormone will go down, cortisol is way up, people have poor appetite, poor sleep, feel irritable, et cetera. Never been described in resistance training, not once it's been investigated. They've had people max out daily for over a month in a row, trying to like make them overtrained, and it turns out they just got better at lifting heavy weights. So like, yeah, which by definition should not happen if you're overtrained. Also, injury risk during that period was also relatively low.

Dr. Jordan Feigenbaum: 29:56

But if people are familiar with this concept maybe of overtraining, we're just doing too much. It's like okay, well, what do you mean by too much? What does that refer to? It's not just too much weight, it's a combination of weight on the bar, how close your efforts are to failure, whether it's resistance training or conditioning, and how much of it you're doing. So volume, right. And so that all encapsulates this thing we like to refer to as training load, and training load you can think about that as a sort of external sort of stress, meaning it's all the stuff that you could write down on paper that is pertinent to your program. So again, sets, reps, rest periods, proximity to failure, intensity, whatever that gets applied to the individual, okay, okay. And they experience it in different ways, and the way that they experience it can be monitored by heart rate change, heart rate variability, heart rate recovery. For example, rpe can be useful for to just tell us how hard it was, you can apply the same external stress, external stimulus in this case, to an individual group of individuals and they'll experience it differently, based on their current fitness level, their genetics, their expectations, so psychological the environment that they're in. Right, Are they in a powerlifting gym where there's death metal playing chalk in the air? You know whatever back slaps are going on, or are they doing it like a curves? You know different sort of settings.

Dr. Jordan Feigenbaum: 31:11

So, anyway, all of that is to say that when I'm talking about overuse, it means that the experience of the training, the external stimulus, is too much for them to currently tolerate and then ultimately recover from, and it's usually not a singular instance. It's repeatedly kind of insulting the body in a way that you can't sort of keep your head above water and so you drown. In this case it usually results in musculoskeletal pain. So most of the time these overuse injuries, they're kind of insidious. It's not like I did one squat and my knee started hurting. That can happen with an acute sort of catastrophic injury. Unfortunately, or fortunately, rather, those are relatively rare.

Dr. Jordan Feigenbaum: 31:47

So this sort of overuse thing is just too much training load, experienced chronically for the individual and ultimately produces this sort of these pain syndromes that people have. And so then what do you do? You're basically now you got a person who's been exercising, has pain, and you're like what do? What do I do about that? You tell them well, you're going to have to exercise still, but in a different way that's currently accessible to you. And so I just want people to.

Dr. Jordan Feigenbaum: 32:12

When they think about overuse injury, I don't want them to think about like I did one thing wrong and that's what happened. It's more of chronically. You were exposing yourself to something that you couldn't currently tolerate, whether it was due to the nuts and bolts of the program, that external sort of stimulus, or your environment. Your lifestyle suddenly changed lost your job, stressful season at work, less sleep, relationship troubles, financial stress, dietarily you now have a bunch of nutritional stress you didn't have before, For example. All of those things can change the experience that somebody has to a given type of training intervention. And so, again, if there's a mismatch between the training load being imparted on somebody and their ability to tolerate it and then subsequently recover from it, well, that portends a risk of overtraining, and in this case we would define overtraining as like the appearance of an overuse injury, even though that's not the classical definition of overtraining syndrome.

Philip Pape: 33:04

It's all right, we'll forgive you for that. Yeah, so this is really good because people, I guess, oversimplify the idea of pain and overuse or maybe they avoid training too hard, thinking that it's going to be a problem. Like you said, it's the total load or stimulus and it's too much to recover from because of chronic occurrence and it results in some form of pain, which leads to the question what types of soreness slash pain, slash some other feeling, and when should people be concerned? Because newer lifters are very confused about that. Like I talked to somebody the other day, she had a little bit of soreness and had been one day and it was something new and I said is it getting better? Oh, it's getting a little better. I said, okay, let's, I think it's gonna be fine. You're just scared. It's like a new experience to you, but color that for us yeah, no, that's a great question.

Dr. Jordan Feigenbaum: 33:51

I mean, you know there's like how sore is too sore or how often is, you know, being sore a problem. I think maybe one of the best use cases here that's applicable actually to one of the evidence based goals talked about in the beginning hypertrophy. So it variably, when people start doing resistance training or really any type of exercise, your risk of soreness goes up, mainly because it's a novel physical task that you're being asked of and if the muscles are forced to move through a dynamic range of motion so they're extending and shortening under load, yeah, your risk of having some sort of muscle soreness, whether it's delayed onset muscle soreness or just muscular fatigue or other, that goes up and that's not unusual. But in the case of hypertrophy we think that's due at least partially to muscle protein breakdown. Your muscles are made out of protein, water and some other stuff and muscular protein breakdown can increase DOMS, that late onset muscle soreness. When it comes to hypertrophy, what you're really looking to have happen is that you, over time, you get better at tolerating the exercise, you get used to it, you accommodate the stress and you get less muscle protein breakdown which allows the sort of muscle protein synthesis, the recovery efforts to outpace the amount of muscle protein that you're breaking down. And so that's why, when you look at hypertrophy studies, it's very rare, particularly for untrained individuals, that they grow muscle in the first three, four, five, even six weeks. Rather, that's like the just keep your head above water kind of deal with the soreness that you're having and then after that you start seeing muscular growth.

Dr. Jordan Feigenbaum: 35:20

And so what I predict and kind of how I think about how often should people be sore, how severe should it be, it's that initially having some soreness is fine and I would expect that on most sessions, in fact if somebody's very new to training. But that should get become few and far between as somebody gets more and more trained. Yes, if you take time off and kind of come back, I would expect a slight uptick. But again, it should be this general trend of waning soreness as somebody becomes more and more trained. And if the dose of training is correct, being actually sore from a workout should be relatively infrequent. If you're never sore, ever, to me that suggests underdosed training. So it's kind of like an artifact of properly dosed training where you're sore relatively infrequently but still sometimes, if that makes sense.

Philip Pape: 36:05

And at the beginning of that new stimulus or cycle or program yeah, yeah, or there's an increase in training load, for example.

Dr. Jordan Feigenbaum: 36:11

All of us. Yeah, that would all be times where you'd expect an increase in soreness, but it should be generally waning and getting less and less and less, with occasional upticks and as far as when it becomes worrisome, it's when the soreness is out of proportion to what you did. Like you said, I didn't really do that much yesterday. I am cripplingly sore and it's like, okay, was the environment that you were doing this in very harsh? It was really hot, humid, for example, under hydrated. This happens all the time in field athletes. Or are you actually sick and you didn't know that and you did the same training? You didn't adjust that to your current level of fitness on that day and so you actually had a much higher training stress than you otherwise would have predicted. You experienced a much higher level of training stress If you were underslept.

Dr. Jordan Feigenbaum: 36:54

That can happen too. In fact, lack of sleep or sleep deprivation is a big risk factor for injury incidents, particularly in athletes. That's been most studied in college-aged athletes, for example. So all of those things can kind of tip the scales as far as what somebody is able to tolerate, but ultimately I would expect soreness again to happen, sometimes generally decreasing as somebody becomes more and more trained, and then I only get worried about it if it's out of proportion to what happen, sometimes generally decreasing as somebody becomes more and more trained, and then I only get worried about it if it's out of proportion to what they did, very severely limiting as far as function goes, and or acute. So the delayed onset muscle soreness stuff happens the day after, two days after, may persist for a few days, even after that up to five or six days.

Dr. Jordan Feigenbaum: 37:33

But if it happens like I did one set and now my legs, both quads, for example, are you know eight out of 10 pain, that's not soreness to me that is more suggestive of like maybe something acute happened, particularly if it persists. It just doesn't go away. I recall one particular study on youth individuals. They were trying to characterize the incidence of injury risk in kids lifting weights. They recalled this one kid who had 30 seconds of 10 out of 10 quad pain. That just went away, like they didn't do anything, but it just went away and they're like yeah, well, that was an injury that the person had and we're like was it though? So it kind of comes back to definitions like what is an injury? But anyway, I get another podcast.

Philip Pape: 38:11

I hear you, I mean 10 by 10s in CrossFit. Take me back to when I was sore and probably didn't need to be chasing that soreness, so I want to piggyback off this is really good, the soreness piece, because then there's the fatigue. You know magic word fatigue that we use, and I think in one of your Insta posts recently, so I'm going to do an Oprah on you here. I've got some quotes.

Philip Pape: 38:31

Training must match an individual's fitness level that day, which you just said being hard enough to drive an adaptation, but not too hard where it drives too much fatigue. Now I would say, if you're tracking your program, if you're being consistent, like you said, with your frequency and volume, and you're progressing what you call progressive loading not necessarily overloading you should be at least prepared to know what is appropriate, in spite or independent of all these other variables you mentioned, like it's very hot or hydration's an issue. So maybe the question is how do you know that you're pushing that fatigue or driving too much fatigue, or how do you get ahead of it in terms of that biofeedback, those other variables?

Dr. Jordan Feigenbaum: 39:09

I know it's not a exact science, but you know yeah, no, it's a million dollar question, maybe a billion dollar question. You know, if we were really able to reliably predict fatigue in a quantifiable manner and then monitor it, man, that'd be cool. But there's been multiple efforts to try to do that. So people have used things like session RPE, for example, where after the end of a session you rate it one to 10, 10 was like I'm so fatigued, I can't do anything else. One is I didn't do anything, I'm at rest, right. So that's one way and you would prefer most of your sessions to probably fall in that. You know six to eight type range for like adequate sort of stimulus, but not too much, unless it was like an active recovery thing, in which case it'd be much, much less than that. If you find that after most sessions it's session RP 10, you would predict that would be a little too high. For example, other methods that have been tried and implemented variability is like this way to kind of test like oh, are you recovered or not? No data on that in resistance training, only in the endurance world, and there's a lot of nuance there. Again, that probably would deserve a multi-part podcast series, but that again, people have been trying to measure this for a long time. As far as the way I do this in practice monitoring fatigue it's more of this like subjective battery of how do you feel on average when you come into a training session. Are you super motivated to train? You're excited to do so or generally excited? Is your performance more or less holding up, despite having recent fatigue implemented from training? Are you super sore? For example, are you having any sort of you know boiling or bubbling, percolating injuries that you feel like are popping up? Your you know your joints are sore, for example, much fatigue. You would expect them to have lower training motivation. You would expect them to have decreasing levels of performance. You would expect them to have more soreness on average, more sort of joint related complaints on average. And that kind of tells you like the training stress I'm exposing myself to is a little bit too much right now. It doesn't mean you're doing too much volume per se, but maybe you're doing too much volume of stuff that's too close to failure and so practically kind of figuring out a way to get pretty close to the sun but not too close where you burn yourself.

Dr. Jordan Feigenbaum: 41:17

I think a concept that could be useful to folks is this sort of therapeutic index for training, meaning that there's a low end right Minimal effective dose, if you want to use that term and then an upper end, maybe that you call that maximal recoverable training load. You know, just to make up terms here, you don't need to be all the way at the limit to get the maximum benefit. You want to be trending that way, like on average, getting close to that, but you can leave a little safety buffer in there, and so I want people to understand that you don't have to go to the well max out, leave it all in the gym every single session. In fact, I would say that's unsustainable. Rather, it just needs to be hard enough to drive the adaptations that you want For strength training. You don't have to be really anywhere close to failure. When I say close to failure, I'm talking about one rep.

Philip Pape: 42:07

Zero one RP. Yeah, yeah.

Dr. Jordan Feigenbaum: 42:08

You can be three reps shy of failure, five reps shy of failure, in fact, if it's over about 70% of your one rep max, I think that's going to make you most people pretty strong, even if they have five reps left in the tank. When it comes to hypertrophy, particularly so muscle growth, particularly for isolation exercises, you can actually send it a little bit closer to failure, right? The thing that's important to note there is the stakes are lower. When you're talking about isolation exercises, it's much lower muscle mass, right. The weights on average are lower. The sort of risk of failure is generally lower.

Dr. Jordan Feigenbaum: 42:40

Oh, I failed a biceps curl, oh no. Compared to oh, I failed a squat, a heavy squat, yeah, much, much bigger sort of potential, the stakes are much higher there. So this therapeutic index of like exercise, as I view it, gives us a wide range to sort of get something from our efforts right and to maximize that. Sure, we want to push it towards the upper end, but I don't know that it's useful to get super close to that top end, like what's the maximum amount of stuff I can?

Philip Pape: 43:04

do Icarus threshold? Yeah, totally, totally. Yeah, I think that's yeah, a good takeaway.

Dr. Jordan Feigenbaum: 43:08

No, that's a good takeaway.

Philip Pape: 43:09

No, that's good. The therapeutic index. And again, I like how there's a system here of variables. It's multifactorial and, like you said, you might be training close to failure and that's perfectly fine. But if you're doing it to such an extent that that's the issue, it's the volume, it's the training to failure, it's the frequency, all of it together. You mentioned joint health. What about the big one that comes up all the time, low back fatigue? Right, that's like the one I hear personally most often, especially for older folks, of this mysterious low back fatigue that doesn't always seem attributable to a specific movement. You know they might squat and it's fine. Then they do an RDL and it hits them. Then they're fine on the next RDL, but it happens after their bench press and they're like maybe it's my arching. What's going on there? What's the low back mystery all about?

Dr. Jordan Feigenbaum: 43:54

Yeah, no, it's a great question I mean. So, first off, low back pain in general is super common, I think, for the lifetime risk for adults globally is like approaching 90%, so most people are going to have at least some about of low back pain. As far as the most common causes of low back pain, yeah, big question mark we don't know, because most low back pain is what's called non-specific. That isn't meant to minimize anybody's experience, right? Doesn't mean that just popped up out of nowhere, we have no idea why, or whatever. It just means that it's probably not due to a specific anatomical structure like oh, we got to go, you know, is this a ligament around the spine, for example, example? Is it a disc related? Is it, you know, related to your hips, for example? It's nonspecific, meaning that it's probably a constellation of things and your pain experience is real. It just means that there's not a pain generator that we can localize and need to work on, which, on the one hand, is good news because we don't need to wait for something specific to heal in order to get back after it, but it's also not academically satisfying, or even satisfying to the patient, because they're like well, what's wrong? Why did I have this, but this is a great example of maybe some of that overuse type injury. You know, there's this like threshold of load, training load or maybe a better way of describing it as like a physical activity load, or you could even extend that to like physical activity load in a particular environment load, right, like super stressful environment versus you know, somebody who's well-rested, well-fed and you know otherwise sleep, you know something like that. So if people kind of Icarus, flying too close to the sun, based on their training, based on their lifestyle or whatever they may sensitize themselves during particular movements right so, an RDL in this case, or a deadlift in another case, or arching on the bench press, the problem then is like, well, if I'm having pain when doing this, I don't want to expose myself to those positions which can be problematic, because if people's expectation is, you know, you lay down on the bench, you arch like ow, pain and extension. I'm sensitive to extension, particularly in this posture. I don't want to do that and it's like, okay, so now your expectation is every time that you arch in this way or you adopt that type of posture, you're going to have pain.

Dr. Jordan Feigenbaum: 46:03

People start kind of they get this condition called kinesiophobia they're afraid of particular movements, and so one of our strategies then is if somebody is experiencing sensitivity in particular positions, we want to do the most threatening type of movement that they can do, like they can currently tolerate, as their entry point back to physical activity. So in the case of like an RDL, right, somebody says all right, full weight, rdl, normal weight. They're doing sets of five or eight or something like that and they're having sensitivity at that loading level, with that full range of motion. Doing an RDL, what do? Well, we could increase the rep range, which would lighten the load. So maybe it's a load-related sort of sensitivity. If that doesn't work, maybe we slow down the tempo to lower the load even further or potentially give them chance to feel like they're maintaining a slightly different position, even if that's not really happening. It's getting sort of mind games, if you will.

Dr. Jordan Feigenbaum: 46:52

Another option is reducing the range of motion. So perhaps it's range of motion related. And if none of those things are tolerable, you're like maybe this is a no-go, we need to regress even further and so that it's like a trap bar, you know, type partial deadlift, for example, or hip thrust, you go even further back. So there are options there, but as far as what's actually happening, I think it's back to that concept of just tissue sensitization, or maybe we'll call it tissue-brain connection sensitization, because you can't separate the two things. So just sensitization due to high of fatigue, due to too high of training load in a particular environment and I know that's an unsatisfying answer for a lot of folks.

Philip Pape: 47:29

No, it's super solid to me. I mean I like the. I mean effectively, it's facing your fears in a way which it applies, for example, to people who've had surgery and they're afraid to be active again, especially when you have doctors saying don't do anything for months and months and months and maybe need to get under the bar earlier than you think Just to build up to that. I remember I had a deadlift sling when I had my rotator cuff surgery, just so I could get back to deadlifts with one arm because I was so missing it. But some people will have the opposite of like that's it, I'm done, I can never do this again. Or you know, I had knee surgery. I can never squat again. And yeah, you want to say something about that?

Dr. Jordan Feigenbaum: 48:02

Yeah, Well, what you would prefer for people to have is basically unrestricted movement potential, meaning that they could do whatever it is they want to do, even if they don't do everything right.

Dr. Jordan Feigenbaum: 48:16

But you don't want people to have these sort of limitations on like, ah, I can't do that because of this pain sensitivity. You'd want to identify those things, work on them actively and then just give people the option, like, should you want to do this or need to do this, usually in some case outside of the gym, well, you have access to that right and you're relatively well-prepared to tolerate that, and so you can go on. The biggest issue I see with lifters as they go on through time is that they keep pulling out exercises, movement patterns, ranges of motion that either ah, I had a little injury or I don't particularly like that, or whatever, and so they get more and more specific to something, to stuff that they like over the years and they're missing this whole sort of cadre of other physical development and effectively atrophying over time. And it's like which, again, is why I intentionally even with myself, I have to intentionally broaden, because, if left to my own devices, I like to squat, bench, deadlift, yeah.

Philip Pape: 49:03

Another case for variety?

Dr. Jordan Feigenbaum: 49:04

Yeah, yeah, absolutely.

Philip Pape: 49:05

Yeah, yeah, no, this is great, yeah. So the next thing I actually wanted to ask you about was kind of the other end, the folks because I know there's a lot listening who really do go all out. They love PRs, they love getting stronger. Maybe they push too hard, right. Maybe they don't have any of these fears. They do the variety, they just push, push, push.

Philip Pape: 49:22

We talked about a lot of the aspects of fatigue, but some of it comes from a little bit of ego and something you talked about recently, which is how people would love to maintain their peak, especially if they were lifting early in life, like their 20s, 30s, 40s. I didn't start to my 40s, so I don't have that exact experience, but like, hey, in my 20s I could deadlift 700 and now I'm approaching 70. Also, you mentioned that people who start lifting later in life are not gonna be able to get as strong as when they were earlier. So sometimes they maybe overreach and I've seen that. Given this reality, where does realistic goals piece of this come in for, that being the cause of, say, overuse or fatigue, if you know what I mean?

Dr. Jordan Feigenbaum: 50:04

Just aging in general being the cause of.

Philip Pape: 50:07

Yeah, aging ego wanting to be strong, keep getting strong forever.

Dr. Jordan Feigenbaum: 50:11

Yeah, yeah, I mean, we all want to be strong, keep getting strong forever. Yeah, yeah, I mean we all want to, but Totally, is it possible? Well, I think what happens in general as people age, especially if we just move like general population, right, musculoskeletal injury rates tend to go up as people get older. I view that as mostly a symptom of detraining due to insufficient activity. People just become less and less active, whether that's due to occupational demands, familial demands, the constellation of those things.

Dr. Jordan Feigenbaum: 50:35

People are tired, whatever You're, just exercising less, moving less, and ultimately their body responds accordingly.

Dr. Jordan Feigenbaum: 50:40

It adapts to what's being asked of it and so, yeah, your threshold for what you can tolerate goes down. And so people might experience that in training where they say I can't go as heavy as often as I used to and it's like, well, that's probably a function of what you've been doing the last few years, not like what's happening chronologically on the calendar. So I think that, barring market reductions in sort of training time, training resources and just activity in general, the issue that is likely to happen and this is kind of a black box there's something that's going to happen in various periods of our lives. Our performance is going to go down and we don't know why I don't have a solid answer, why I can give you all these mechanisms but, like as far as which one's causal or which ones are causal, I think there's a bunch of them and it's like you know, death by a thousand cuts. It's not just one thing that's leading to a 20% decline, it's you know, 20 things leading to 1% decline.

Philip Pape: 51:32

No man, it's my hormones, it's cortisol. It's cortisol Totally, yeah, yeah, a hundred percent.

Dr. Jordan Feigenbaum: 51:37

Probably a nervous system more than anything. But the point is people, they sort of forget what they learned along the way. Again, we don't want to fly too close to the sun, we want it to be hard enough, but not too hard. And you want to do a lot of that stuff as much as you can without outkicking your coverage. Well, if you're still hanging on to what you were doing 10 years ago, five years ago, and that's not who you are presently, again you're outkicking your coverage. It's the same thing that would have happened if you did the same thing 10 years ago. You have these overuse injuries, and so I think if you stick to the script, if you're like, okay, it needs to be hard enough to develop a training adaptation on this day and you keep clocking those wins, punching in, punching out, day after day, it is likely you're going to have lots of success in your lifting career, and by success I mean demonstrable improvements or, as you age, maintenance to the best of our ability, with performance and a relatively low risk of injury, barring terrible luck and or terrible genetics. And so we can't do anything about the genetics and luck kind of is what it is. But the stuff we can modify is mostly going to be training related, and so I think most people, if they can wrap their heads around some sort of auto-regulation on a given training session, can probably avoid most of that. Meaning that if it's a number on the bar you have historically in your brain, that's great, but is that the appropriate load for today?

Dr. Jordan Feigenbaum: 52:55

Training is about development. It's not about testing. I don't need to test you every time you're in the gym. Yes, we could do that, but we can do that intelligently at a low stakes sort of situation. So again, rather than one rep max all the way to failure, I could do it at 80%. A one rep effort.

Dr. Jordan Feigenbaum: 53:15

That would give me enough data to say here's how strong you are today. Meaning that here's the rest of your loads for this particular exercise should be to be within that therapeutic index and we can give yourself a little buffer. So that's kind of. I think people kind of mess this up, as they're attached to these historical performances, they ignore all the stuff that we talked about and they're like, yeah, well, I've been doing this for 20 years and so I can just do this right now. It's like, look man, no, you couldn't have done that 20 years ago anyway, you know. So like I would avoid kind of being too attached to a particular number in training Competition. Do what you got to do, but in training the main thing is make sure you're getting an effect and don't fly too close to the sun.

Philip Pape: 53:51

Love it, man Clocking in the winds, auto-regulation that is huge. And then I like what you said training is development, not testing. That's a really good line. Just people keep that in mind. Constant growth from where you are right now in the last session, not necessarily who you were in your 20s or even six weeks ago. All right. So as we wrap up, is there anything that you wish I had asked that we didn't cover and what would be your answer to that?

Dr. Jordan Feigenbaum: 54:15

No, I think the only thing I mean. You mentioned this progressive loading thing versus progressive overload and if people have never heard that, we do have an article about that on our website. It's titled Progressive Loading. We've got a podcast on it as well. But just as a brief takeaway, it's the same kind of messaging throughout this entire podcast, the messaging throughout this entire podcast.

Dr. Jordan Feigenbaum: 54:29

The point of the training is to provide you enough stimulus to get what you want out of it, but not too much where you can't recover from it. So with the idea of progressive loading, you have to increase either the weight, reps or total training load as you become fitter, but not before the adequate training stress is there to drive fitness. And once fitness has gone up, then you have to increase the training stimulus, but not before you get bigger, faster, stronger, so you can lift more weights, go faster, et cetera. Okay, so it's kind of a chicken and egg situation in my estimation. People want to go, increase the weight, increase the reps or increase the pace before they've actually generated those adaptations the idea that you have to overload the body and it's like it shouldn't actually get any harder. You just got fitter.

Dr. Jordan Feigenbaum: 55:14

That Greg LeMond quote. You know it never gets easier, you just go faster. Well, in this case, you know it never gets any harder, you just get fitter and so the load go up, you're able to do more reps, do more sets, etc. And so progressive loading, I think actually might actually be the key here. People are saying, I don't know this auto-regulation shit, like whatever Progressive loading might be the key takeaway.

Philip Pape: 55:33

No, I love it. You train right to the limit of your current capability, that Icarus threshold not pass, and not even into that little regime right on the hairy edge where you're just not getting anything out of it, and then that makes you bigger, faster, stronger. To do that again over and Cool. I think we covered a lot about training. I hope people got I know they did got some really good strategies out of this to modify their approach, because it really comes down to the principles more than like a specific workout program. For example, when can listeners learn more about you, Jordan?

Dr. Jordan Feigenbaum: 56:00

Sure, yeah, barbell Medicine. You search that on Google, you're going to find all of our stuff. My personal Instagram account is Jordan, underscore Barbell Medicine. You can find me there. You can find me on Twitter threads. People seem to like my threads stuff. I'm a little salty on there. It's just just that outlet for me. So if you search barbell medicine, you can find all of our stuff and we'd love to have you part of our community.

Philip Pape: 56:19

Cool man, I'll put all that stuff in the show notes so people can find you. I will, of course, keep following you as well, and I really appreciate you taking the time to come on the show.