Live With: Ryan Whited

Your host, Matt Fitzgerald, uh, live from DreamRun Camp is brought to you by 80/20 Endurance, and it is hosted at DreamRun Camp here in beautiful Flagstaff, Arizona. My guest today is a friend and colleague. I can say this about so many of our guests, work and professional life, just blessed. Yes. Yes. Ryan Whitehead of, uh, Paragon Athletics. Facility here. We'll get into this in flight stuff. Welcome, Ryan.

Thanks so much for having me, man.

Right on.

Yeah.

Um, also here behind the camera is birthday girl. Well, her birthday was yesterday. Lauren Clement, uh, assistant coach here at Dream Run Camp. We got a couple of triathletes who are staying at the camp right now, having the absolute time of their lives. Nod like you mean it.

Yes.

All right. Yeah. Loving life here at Dream Run Camp. And, uh, yeah, so, uh, Ryan and I are actually— we're co-authoring a book, um, that is going to come out, uh, who knows how far in the future you're watching this, but, uh, as we sit here live, it's, uh, just, uh, um, well, we're in September. It should come out and it will come out in December. It will.

That's right here.

So we'll talk a little bit about that, but also Ryan is just a fascinating guy with a, with a really interesting story. And so we'll delve into a little bit about that. As well. How's that sound?

That sounds great to me. Right on.

And thank you for bringing beer, by the way.

You can count on me, Matt.

Yeah, it's like— so cheers. Yeah, off to a terrible start. Uh, I like to begin when I have a guest, uh, with whom I have an existing professional/personal relationship. I I like to ask, how did we meet? How do we know each other?

We met at a talk that I gave. I forget the year it was.

Uh, 2019.

2019.

October 2019.

There you go. You, uh, were at Rob Carr's Run Camp, and some of the campers opted to come hear a talk that I was giving at that time.

I think it was mandatory. We all came.

Oh, what was the title of that talk?

Pain and Performance. What? Yes.

So yeah, which happens to be the title of the book that we ended up putting together. So it's been quite a little path.

Yes. Say a little bit more about that. I mean, and you're welcome to speak for me because I've told you about like how, what an impact that experience had on me. And yeah, so I mean, like, it wasn't that long afterward. It was, it was a little bit of a meet-cute story. Just like, absolutely, I want this guy's number. I also want this guy's number.

Yeah, that was, it was like that, just like that. So, uh, sometimes my talks, um, can be heavy on science, and, uh, which, you know, is just gripping to some folks and other folks glaze over. And you were one of those folks that it happened to land on. So Matt approached me afterward, and if I remember right— I don't know if I made up this memory or not— but if I remember right, you said something to the effect of, that was fascinating, something to that effect. Yes. And you were one of the only folks that ever, like, it just landed with where you went, this jibes completely with my experiences. So it wasn't too long after that that, um, I forget if I reached out to you, if you reached out to me, but it was sort of very mutual. Yeah, we were looking for each other's numbers.

Yes.

So yeah, and then we started compiling what has now become a book.

Yep.

Not long after that.

Yes. Pain and Performance. Subtitle escapes me because we've iterated ad nauseam on it. But that's— I mean, it is a descriptive title, which is one of the strengths of it. One of the reasons you gave that talk title, you gave it. Yeah, just to riff a little bit on what you said, like the perspective. Well, I mean, like, as a lifelong athlete and an often injured athlete, I had my share of personal experience with pain. And also, I just happened to be, you know, a dilettante, just not a scientist, an athlete and a coach who knew more than the average bear about brain science just because of— I have an older brother who as a brain scientist, um, and just would feed stuff to me. And I was like very early on board with, um, you know, Tim Noakes's, uh, Central Governor Theory. And like, you know, inasmuch as brain science was relevant to the endurance sports space. So like, that was my background. Like, I had a lot of experience with pain, and I knew a little bit of something about the role, like just the role of the brain in endurance sports experience. And, and, uh, yeah, I just had a number of injuries over the years that, um, no, none of the medical experts could fix for me. I had had completely unnecessary surgeries, completely bogus diagnoses, and like, and 3 injuries in particular had kept me out of competition for years, right? Individually, one of them just over a year. The longest was like more than 3 years, like in the thick of what should have been my prime as an athlete. So this stuff was very personal. Um, and in each case I thought, you know, when you're, when you're hurt that long, you think this could be the end, right? I might not be an athlete anymore. And, but each time I was able to overcome it. How? The same way the injury was caused, by running. Like running fixed a running injury. I'm like, there's a pattern here, right? Like, one time could be random, two times coincidence, three times something to it. And then when you did your pain and performance, uh, presentation where you explained this, you know, this newish biopsychosocial model of, of pain and, you know, talked about just like what the science says does and doesn't work for overcoming pain and injury, it's just like everything I've experienced made sense. And like I said, I knew just enough brain science to that it like, it took a while because I reverted a lot. And like, because like to fully really understand that like what pain really is, right? And to undo, because you have to undo a lot of the learning that was done, which is hard for me even though we were talking every day for a while. But like anyhow, that's, that's me saying like why it had such a huge impact on me. And it was just like, it all makes sense now. Thank you. And let's write a book.

Right. Yeah. And, you know, honestly, that's, that's, I mean, I share a lot of that, those experiences as an athlete also. I was very frustrated, uh, with that process of trying to get help with injuries, um, what I would now call, I mean, how injuries are defined by the, uh, British Journal of Sports Medicine is really loose. I think it starts with a complaint. And so, uh, but I would—

dot, dot, dot.

So, um, but I had that same experience, and I was so frustrated because it would put me on the sidelines for a couple times there in my prime, as you say, you know, and, um, where I thought, wow, if I miss a year of, uh, climbing at an elite level, uh This is a lot of time missed.

Yes. Ryan is an elite boulderer. Yeah. Shouldn't mention.

Yeah. So, um, for any athlete at any stage, you know, missing big chunks of, in your lifestyle and your enjoyment and, you know, how we live, your identity, your identity is big.

Yep.

It's hard, real hard. So I meet with folks weekly that come to tears because of this situation. So yeah. So we're not alone.

Yep. So it was fun because I, like, all I knew about you when you gave that presentation was what you presented. And you talked a little bit about, you know, like your, your journey. But then, you know, when we sort of traded phone numbers and decided to like do a book, I started to learn a lot more about your biography. And, you know, like right away I'm like, this has to be the way we— because like the message is like, people don't know this already. Like you really have to, like, you know, like people believe, people have been taught certain things about pain and injury. Yeah. And your message and the science that backs it up just destroys. Yeah, all that. So you're gonna get some pushback, some skepticism, or even just some non-comprehension from people. Um, and so I realized pretty quickly, like, the best way to get people to, like, gradually sort of, like, for these ideas to, like, kind of seep into their, um, their minds, I guess, and, and take root would be to, like, just tell your story. And like, because you didn't— you weren't born knowing this stuff either. You figured it out. Yeah. And, um, and so tell us a little bit about how— because it all makes sense in retrospect. It's like why you're so interested in pain, why you're, you're on a mission to help athletes, um, not be sidelined by pain and injury. Um, so have at it.

Oddly enough, this had to be pointed out to me. So I was, uh, I'm real smart in some ways. So, uh, I was born the son of a racehorse jockey, uh, and, uh, race— racing is so incredibly dangerous that the average career span I think is somewhere around 9 months because people realize I'm going to die this way, or I'm going to be hurt so often, or they do die this way, or they do die that way. Yeah. Um, and so it was just in my face constantly as a kid growing up, and I, I didn't— it was so in my face. And so in our conversation, um, injuries and managing health and nutrition, managing the health of the horses, managing the health of my dad, Um, and our income was, uh, dependent on my dad's health. So, um, we lived on that. Um, and it was discussed over dinner and it was, you know, it was, and I didn't even realize like how built in it was to everything till years down the road. And then as I became an athlete, a lifelong athlete, I thought there was a clear way to like diagnose pain and stay healthy. And so wanting to do that for other athletes and myself included, I just sort of launched into obsessing in a way that was maybe not even healthy at some points in my life. So I Yeah, I definitely obsessed to an extent. I remember getting done with work at a certain point in my career that I would go into the restroom and sit down beside the toilet at the end of the workday because I felt sick and I realized it was just fatigue, but it took me about 2 months to realize that. No, I thought I had something. But it ended up that I was just like so in the thick of it and I'm so obsessed that I was doing too much. So thankfully I'm not at that place now. Actually, COVID surprisingly helped with that. So we got to zoom out a little bit and like reclaim some of our lives. So my family, so yeah, it was, ended up being a good thing.

So can you just briefly give like a quick litany of some of the injuries your father experiences. So like, he wasn't just a professional racehorse jockey, he's in the Hall of Fame.

Yeah.

And like you said, the average career lasts 9 months. His career lasted 34 years, right?

At 35 years.

35 years. So, um, yeah, and he won nearly 4,000 races.

Oh, um, yeah.

So just had a few scrapes along the way, right?

Yeah, just had his jaw wired shut a couple times. Uh, he was in for a broken neck, um, and when they were looking at that, they said, well, you must have broken your back too at some point. Um, and he said, well, I didn't know about that. Um, he had broken— he's broken so many things. When he was a kid, his— the family doctor they went to, um, told the family, I think, just to my granddad would have my dad race because he was so little, and but he got hurt so many times. I think the doctor told my granddad if he broke his arm again, they were gonna have to talk about amputation. And I think it was just to scare his parents, obviously, to— but it didn't scare him. My dad just moved.

So we didn't know the doctor.

Yeah, wrong answer. Yeah, so he has had— and that was just, it was constant. Like, uh, one of the, the chair at the end of our table, at the end of our dinner table, was all scarred up, uh, because he wore a halo, uh, one of those halos that, you know, holds your head and your neck and it goes down, uh, to below the rib cage. And so that chair was all beat up from him like moving around and halo in it. So, and, but that's an indelible thing. Those are the things that you don't realize how much of an impression that's—

sure.

Yeah, it is.

Seems normal when you're a kid, right?

It's normal.

It is normal.

It's normal for your dad to duct tape his toes on. Yeah. So yeah, it was— that was just how I was brought up. No. So that was seeing hoof prints, you know, on my dad in the hospital. So it was just kind of a normal thing. Yeah. Yeah. So that was part of how I've come to where I've come to. Yeah.

Yeah. It's no accident.

No.

Um, a lot of accidents, but no accident.

Many accidents.

Yeah. Um, so, you know, one of the things we get into in, in the book we've written together is this idea that, um, you know, pain obviously pre-existed the medicalization of pain. And so, you know, your dad— it's not to say that he managed pain and injury optimally, right? But he did it the way it had always been done. And people aren't idiots, right? It's just like, you know, we do the best we can. Like, we figure out, um— and when you became an athlete, and you, I could think, are probably a lot like your dad, you take after him in certain ways, like that sort of like high tolerance, like, um, you know, just like the mission justifies the suffering required, um, and, you know, pain indifference, a term I learned from you. Yeah. So like when you get into it, you're doing— you're taking out— you're like a chip off the old block and you're getting hurt, you're experiencing pain, um, but you're just sort of like finding your own way through it, like, like with minimal reliance on experts, outside experts versus like diagnosis, treatment. And it worked pretty well, not perfectly, but well. And then you get further along and you, you go down like a professional path of like trying to serve athletes who get injuries or experience pain.

Yep.

And then, then you start getting indoctrinated into this, this modern medical model of pain.

Yeah.

Which is like really kind of like I mean, you don't want to like, you know, demonize it. Like, there's a lot of like real knowledge and learning infused in it, but it's also—

and well-meaning people.

Yeah. It's also kind of a step back on a practical level. It's just like, no, pain is pain.

Yeah.

It's like when you're hungry, you eat.

Yeah.

When you're hurt, you take a step back. Yep. Um, when you're— when you're tired, you go to bed. Yeah. You know, and then suddenly— but it's just like, suddenly it's like pain is unthinkable and like like you must eradicate at all costs and something's wrong with your body if you experience pain.

You're sick.

Yeah. Can you talk a little bit? Because this is where we get into the real meat of it. It's just like, like what pain is and, and how pain is best managed versus like the paradigm we're stuck in now. Like what, what, what athletes think pain is and what athletes think they have to do to manage and deal with pain.

Yeah, so, um, one of the things I really push back strongly on is diagnosis, um, because I think it's just, uh, well, especially the way diagnosis kind of— it's a linear idea, linear thinking of pain, and pain is not linear. It is so multifactorial. And so complex, to reduce it to a single thing is just fallacious in all respects. So, and Engel with the biopsychosocial. So biopsychosocial is kind of new again, so to speak. It's been, you know, discussed for years and years and years. Um, and it is kind of, it's sort of, it's, it's a little bit like Jeet Kune Do, like how Bruce Lee, uh, Bruce Lee talked about.

Here we go with the Bruce Lee. I knew, I can't believe we got 17 minutes into this conversation without a Bruce Lee reference.

Uh, where it's not a, it's not a, uh, it's not like a real system. It's a, you know, constantly evolving system. Um, and when we try to like systematize personalize it, it doesn't work very well. So you just have to know that each person you work with is an individual, and that's how to start it. So, but with diagnosis and the pathoanatomy model that we've used for years, like, people think that they're sick when they have pain, when really it's a perfectly normal experience that happens to all of us that we live with, like hunger. But we all experience hunger a little differently. We all know that, you know. And so some people Like, my wife actually gets a little queasy when she gets hungry, and it's one of those things that we all experience. It's a subjective experience, you know, it's not an objective thing that can be looked at. So, so we've just come at this in such a flawed way that it has caused a lot of problems. And you can see it, like we have an opioid epidemic. It very likely contributed to that, that pain just can't be present in your life at all. So yeah, that's a side note. But yeah, so it's become my mission to sort of help people understand, including athletes, that it doesn't mean you're sick, and it can be managed in many ways, not just through your anatomy. It can be, you know, managed through your sleep. It can be managed through your relationships. It can be managed through so many other things, you know, that we didn't realize that has an impact on how your tendons feel, you know. So, but it has an impact on how your tendons feel, right? So yeah, when you get a diagnosis of tendinopathy or any other sort of diagnosis, we just place the blame on that structure. Right. And that's just not how it works at all.

Yeah.

Yeah.

If your knee hurts, your knee's the problem.

Yeah. If your knee hurts, you might need to sleep better.

Yeah.

Yeah.

Yeah. So let's like be empathetic to the athletes in the room and the athletes listening to this. Live or in the future. Um, so like, you know, cause like it is a universal experience. So you're training and you experience pain, you know, and you know, maybe like more than the usual pain.

Right.

And so the athlete assumes like, first of all, this is the chain event of events because I went through it many times. Like this hurts. Something's wrong. I'm probably injured. I should call a doctor. The doctor's right. When the doctor says I have an injury, I do.

Yeah.

When a complaint— yes, a complaint. And so when the doctor makes me feel dependent on him or her, to recover, he or she is right. I am dependent. I can't do it myself. And any sort of heroic treatments that are prescribed are evidence-based and efficacious. And also, in somewhere in here, if I'm referred to a physical therapist, I'm going to learn that the reason I'm injured, that my pain equals injury, is that my biomechanics are flawed and my biomechanics are flawed because of structural imbalances in my body. So that, that whole chain of events, how much of that is true?

Oh geez. Your complaint is true. We can stop there.

It's true that you feel pain.

Yeah, it's true that you're having a, in a rough patch. So, um, yeah. And, you know, sometimes you have to say, sure, there are such things as, you know, stress fractures, um, things of that nature. Um, but by and large, the majority of our pain experiences aren't things like that. I, so this is another, I thought of this yesterday. I was working with a climber, who ruptured her biceps. So she ruptured her biceps. She is an elite climber. She's been a pro climber for many years. And so we were talking and she said, but at least my right one matches my left one now. And I said, when did you do your left one? She goes, I don't know. And so pain just isn't a reflection of the state of your tissue. It is way fuzzier than that. So she had no recollection of ever rupturing her left bicep. Somebody pointed it out to her at one point. Then 2 weeks ago, she ruptured her right biceps with a slight amount of— I don't even think she called it pain, actually. She just had some concern. Um, so it just isn't a one-to-one ratio of, you know, damage equals pain. Uh, it rarely is a, you know, representative of each other. So yeah, so that, that is the case that we end up, you know, we go to see somebody, a doctor, a well-meaning doctor in most cases, because something hurts. Um, But sadly, pain education is a very small amount of the education that a doctor has. So, and I don't know if this is still the case, but at one point in the PT world, I think it was 1.5 hours of pain education is what they got. So to even, and that's like, actual hours, not credit hours. So, um, yeah, that's a, that's kind of heartbreaking to me, you know, because that's the majority of the reason somebody goes to see, seek help, you know, is for because something hurts. So, and then when you go down that rabbit hole of your imbalances and your, you know, all of those things, your breathing and the other crazy things. Just ends up going deeper and deeper and deeper until you feel like you're on an island. You've reduced your activities, you've reduced your relationships, and all of a sudden you're just trying to fix yourself in the least likely route.

Yeah. Yeah. So the consequences can be huge. And again, I speak from personal experience where like, You know, you— that, that dependency matters. Like, you know, like you, you taught me the term pain self-efficacy. It's like when you feel empowered to figure it out, it's not that like getting help isn't allowed, right? But when you feel like I can do something about this, outcomes are better. Like there's science showing this. And when you go to see a doctor, pain self-efficacy predictably goes down. It's like, I can't do this myself. I am in the hands of this expert. I don't understand the words they're saying, but I'm just going to do. So like that, that dependency, that reduction in self-efficacy, it has an effect. Like you're going to feel more pain longer. You're going to be more restricted in your activities longer. You know, you're going to be out. It's just going to— the whole thing is going to take longer. Then the diagnosis problem, right? Most of these diagnoses, I mean, you show me the science, are bullshit. You know, not for like traumatic injuries. Like you literally broke your ankle. I'm sorry for those of you— Lauren behind the camera, you broke your ankle in the middle of a 10K race. Is that right? Yeah. That's a broken ankle.

That's an injury. That's traumatic.

Yes. Yeah. But for like the overused types of things, the slow onset types of stuff, like the diagnoses are just baloney for the most part. And even when they're like, they're valid or defensible, they don't accomplish anything. They can actually, they can, they can enhance that feeling of powerlessness. It's like, oh, I have a thing.

Yeah.

Um, so it's like, you know, all of this, this whole system is like, it's highly consequential. You know, it's not, you know, it's like a real problem. Like if you're an athlete who just wants to be slowed down as little as possible by pain, like the, the whole paradigm we're caught up in is like kind of your enemy. And like, again, like I experienced this personally, like, like an out like a surgery, like went to a doctor.

Yeah.

It's like you have chondromalacia. Yeah. You need surgery. Had surgery, recovered from the surgery, started running again, pain came back. Yep. Fantastic. Sweet. Yeah. Now the pain did go away. How did it go away? Like I just bootstrapped. Yeah. My way through it. I'm like, okay, if it hurts too much, I'm not gonna run, but I'm a runner.

Yeah.

So I'm gonna try again. And then I'm just— it's like a dance, like a relationship you have with your pain. Yep.

Like, yeah, very much. Yeah. So yeah, when I work with folks that are stuck or whatnot, we build the program together. Like, it's literally the discussion is collaborative. It is not I am the authority on this and you are just going to do this prescription. It is this is your process. And we're going to just build it together. I'll share some of the things that I think. So instead of me knowing the way, yeah, because there's not a way, right? Back to Bruce Lee.

Yeah, yeah, yeah. You find answers, you don't supply ready-made at-hand answers.

Yeah, we're all, you know, our own little person. So yeah. And what works for one person might make another person feel terrible. So you just kind of have to build your program together and figure out the recipe is kind of how I say it. It's science, like we know that, you know, like chemistry is to cooking, it's science. But we all have like a little, I like, I like cayenne. Not everybody likes cayenne. So some people like it saltier. And so you—

Lauren does not like cayenne.

So, uh, with your recipe, we would have to change things a little bit, you know, so dial it back a little bit. Meaning whatever your activities are, not an actual eating recipe, but your training, your exercises, those other lifestyle influences, um, we have to adjust all of those ingredients and work with them and then work from there as how you respond to whatever the recipe was for, you know, those 10 days or so. So, and adjust from there. But it's dynamic and that's fun because then you start— people get involved and they're getting better and feeling better, which is awesome. Yeah, that's how I feel like it should be. I, I don't bring any magic. Um, I am purely facilitating what they have on board. Like, and I— and honestly, like, they're facilitating, I'm just kind of aiding it a bit, you know. So, um, but all the magic is with, with that person that is recovering, getting better and getting stronger. They bring all that to the table. That's, that's all that's being used at that time. So that's why, like, cupping and dry needling and all those things just don't bring much to the table. Yeah, literally. So yeah, the treatment table. Yeah, if the athlete knows that they're bringing everything that's necessary, right, it's helpful.

Yeah, I mean, they feel supported, but they also feel empowered, or yeah.

Yeah, that's the idea.

Yeah. So like, you know, I know that you like, I mean, you're all about substance, less about style. Um, but you have, you've, you've compromised enough to at least, uh, come up with a name for your approach, Training as Treatment, which I love. And that was going, we, we flirted with that being the title of our book because that, you know, it It's a perfectly suitable name for your methodology. So could you kind of unpack what's behind those words? Like, you know, just kind of describe like what goes on at Paragon Athletics. Yeah.

So I like to, for people to realize that you're not sick when you're experiencing pain or when you're going through injury. You're not sick. This is a perfectly normal thing that we all experience. And so I don't want you to feel like you're being cleaved off to the side to be treated like, like, like a patient. I want people to be involved. Like, we have people in our classes that will be in boots, non-weight-bearing, working with everybody else. And so that's fun to see when you see somebody, you know, use a knee crutch and go across and they're doing the same thing that everybody else is doing, but they're recovering actively with everybody. You know, they're not like sequestered as a patient. So I, and I think there is some real value for folks to realize that that's, that's an actuality. It's not just semantics, it's real. Yeah, it's not just, you know, a case of switching some things around. When you, when you can realize that we all go through those things and we can go through them together, it's helpful. Yeah, to stay within your community, stay recovering actively. Like I know when a few years ago when Rob was hurt, he went through an injury that looked like it could be a career-ending injury. And he stayed coming to the gym. He was non-weight-bearing. I have videos of him being so out of breath from just using upper extremities, you know, where he would just But it was such a valuable thing for him to stay engaged, you know, and that's the way it is for all of us. You know, you get to stay being an athlete and being engaged in those, how we live. Yeah. So that's a big of the unpacking.

Yeah. So there's like this, um, athletes are used to, um, operating in two distinct modes with a partition between them. It's like when I'm not experiencing unusual pain, I'm an athlete and I'm training. When I am experiencing unusual pain, I'm a patient and I'm in treatment. You're trying to explode, remove that partition and say no. It's like you're always an athlete. You're always training. It's just like if pain is present. There might be certain tools that you need to temporarily remove from your training toolkit. There might be certain other tools you need to bring into play, but it's like you're, it's always the same process. It's just like, yep, you're tending a garden. Exactly.

Yeah. You're not fixing. So you're caring for, you're tending to, I like to tell folks, If you're looking for an end to this process, you're going to be really frustrated. And you're going to maybe live in a state of frustration. But if you realize that it's a constant if-then scenario, it's not an either-or, meaning if you have pain, you're not then sick. And then if you don't have pain, you're then healthy. That's just not how it works. So you just make moves and make judgments off of that experience you're living with and through, and then you get to stay much more engaged. So, and we honestly, we made that up. We made up the difference, that there is a difference. So it's a fabricated thing, really. So in a lot of ways, I don't think it's good for us.

Yeah. Yeah. We cite some of that research in the book, like looking at, obviously, I mean, we're, we're living in the year 2023. We're, we're all the same place, but there, you know, there has been research looking at, um, Aboriginal communities that have been less touched by, you know, Western. Yeah. Western influences, you know, the, the medicalization of pain. And like a lot has been learned about how everyone used to deal with pain. And like all of that, all of those concepts are absent. Like, you know, low back pain, the most common health complaint. Like they have it too. They just don't think of it as an injury or anything different from being hungry or tired. Or whatever. Yeah. Um, yeah. So can you, can you talk a little bit about, um, I mean, kind of the— I mean, for me, like, the thing that, like, forget about athletes, that just most people don't know is, like, if you, if you just make a list of all the things you can do to try to address pain and then rank them in order of efficacy? I mean, everything from exercise to drugs to grinning and bearing it or whatever, like, what is most efficacious?

Exercise, right? Yeah, yeah. Which is kind of amazing.

And how, how deep and solid is the science proving that motion is lotion in that regard?

Yeah. Yeah, strong. Yeah, strong evidence, which you rarely see something that falls with the heading of strong evidence. Usually it's needs further review, you know, but exercise is the only thing that really has good evidence behind it for helping. But, and you know, the other thing is some people have underlying conditions that Like I had, for whatever reason, in the last 4 weeks, I've had 3 runners that we work with that are elite runners, ultra runners, and have been diagnosed with RA. And we know that, okay, that is probably going to have some influence influence on your pain experiences. So knowing that, like knowing that some people are just going to experience pain more often is helpful, but because they don't have to stop what they're doing, we can just adjust, right? You know, um, yeah, to, to what they're living with at that time. So rather than being sick, being well, and being sick and being well and living on the pendulum of patient and well person. So yeah, and so it's been really helpful for those people in the last couple weeks to have these conversations. It brought some understanding to some things. And yeah, so sometimes people are going to have more pain than other people, uh, and they can still— they having this knowledge will help. Yep. Yeah. So yeah, it's just not the cut and dry thing.

Yeah. So, you know, obviously like what you do at Paragon is a little bit different, uh, like, you know, as a hands-on coach, um, is a little bit different than what you can do as as the author of a book, but we really tried to like, you know, make the book do as much for athletes kind of in that mediated fashion as you do face-to-face in your facility. Um, can you say a little bit about the, uh, that sort of like 3-step process? Again, you probably like when you're in the gym, you might not necessarily think about this is phase 1, this is Phase 2, right? But like, it is different. Like, you know, so it's like, you know, we break it up into discrete phases. Yeah. Which is like legitimate. Yeah. Uh, so I think that's like— I imagine that, um, the thing that athletes are gonna look for, it's like this that we've talked about, this like the what's in it for me question. Like when they pick up this book, like how's this going to help me? I'm an athlete, I want to get faster.

Yeah. Well, faster, like you're going to spend more time, less time missing training, missing what your activity is, right? For one thing.

But I mean, what is the, what does the process look like? Let's just say like I've got, you know, some of my injuries, like, like a, you know, like a pretty significant recurrent, like groin tendon type of thing. It's like, ooh, it compromised my ability to do stuff quite a bit. Um, and like, okay, I come to you and I'm like, I'm a runner, love to run. I've got big ambitions. Can't run a step right now without like, and I have a high pain tolerance. Like I can't run a step without unacceptable levels of pain. What, what does the process look like from like going from there to PRing in the marathon?

The process is, um, we try to shop around for some exercises. Meaning we'll like try some different movements, exercises that a lot of times just loading, graded exposure is the fancy term. So slowly putting load to the tissue that is kind of provoked, easily provoked. So we're just gently working back. Sometimes you have to like move to a different like, ask that area to just do some different work for a second and then gently start moving back into the area that is easily provoked. So, um, like, uh, if you did have, you know, like something that was, uh, osseous pubis type symptoms, then, um, slowly loading that with, um, what is the abductor exercises, um, is typically a way forward. And it's that general process, you know, accounting for all those other lifestyle influences and biopsychosocial influences, um, and just trying to ask that tissue to do what it's supposed to do, um, without getting upset. It's essentially the thing. The funny thing is people tend to think, oh, it's getting stronger and that's why the pain's getting better. But that's really not how it works at all. Like tissue takes time to change. And it's really funny because sometimes people will leave the shop and they'll say, oh, it feels much better. And I'm like, well, the tissue clearly didn't change, right? Um, so it just shows how changeable pain is. Um, and there are so many ways to come about, come at it to help. Um, typically loading the tissue with the issue as they say, is a piece of that, right? For most people, it's always a little different for every person, but, uh, usually, uh, loading the tissue that's easily provoked is a part of the process. So like Achilles, like I had a lady that I worked with 2 years ago, and she, um, a lot of the folks that I work with have been patients for so many years, and she was afraid of her knees, wearing out her knees, and she wanted to ski. And I said, well, the curious thing is, is that if you went to see somebody for a knee that hurt like you have, they would most likely ask you to load that tissue. And in my mind, skiing would be one of the best ways to unload that tissue. Um, and then like 7 days later, I got a video of her bombing down the slope. Uh, yeah. And it had totally changed her, the context of her experience, which is huge. That's one of the biggest things that helps, you know, changing, uh, contextual changes to your pain experiences.

So yeah, this is a little bit of an unfair question, but, uh, Um, because you're, you're a humble man, but I mean, one of the, one of the things that, uh, I think is like compelling about the book we've written is like the success stories, you know, where like things that look— and I've experienced these for myself, um, the things that look kind of miraculous, like where it's like looking really hopeless for an athlete and then Lo and behold, they come back all the way and, you know, in many cases are better than ever. Um, and this is like, you know, like, cause there aren't many people who do what you do. Like, I mean, you're, you're basically a strength and conditioning coach who has, you know, an expertise in helping athletes who are experiencing pain and word's gotten out. You know, and so you have all these people who like are kind of desperate and who have struck out with, you know, the orthopedists and the sports medicine physicians and the physical therapists and the weirdo ancillary types of folks. And they come to you and they're like, well, I got nothing to lose. And then, you know, you've had your failures too, but a lot of like really remarkable successes? Like, why is that sort of like— I mean, why is almost every athlete really never a lost cause? Like, how can, how can everyone come back from almost everything?

Yeah, uh, you know, that probably goes back to seeing what I saw as a kid, um, because, uh, I just saw my dad bounce back from so much, um, like all 7 cervicals broken, racing a few months later and, you know, winning races again. And so I think you interviewed me for the comeback portion. Um, and I remember you saying, do you have any comeback stories? And I was like, I live on the comeback story. I was brought up in the comeback story.

Right.

Um, And it's true. We were constantly living the cycle of a comeback. Constantly. Which I didn't realize the value of that. My dad would take the most horrendous crashes. This is not an exaggeration. He would come into the house with dirt ground into his teeth and his face sort of scruffed up. And he would sit down.

This is—

so this is before breakfast. I remember this. Um, he did some work. He was working horses around the racetrack. We had a racetrack at our farm. And this is what he had to say about his crash: you know, my shoulder didn't feel very good, and it's feeling better now. Like, crashing at 40 miles an hour is what helped his shoulder. Into the dirt. And so he just had this way of like flipping, right, um, flipping stories, uh, and I think that had a huge impact on me without realizing it. So yeah, I just always am like, now we can get better from this. So yeah, and my dad, even with his, um, injury he had at 72 with a traumatic brain injury He was just sort of written off as dead and amazingly came back from an incredibly traumatic brain injury at 72 years old where most folks just thought this guy will be gone in 6 months. We're 11 years out now and he's still happy. Going at it. Yeah, so I think that's probably the why I'm always like, now we can do this. Yep.

Yeah, well, shoot, uh, there's so much more. I mean, this has been quite a saga, you know. You didn't know when— because you reached out to me, by the way, in January 2020, and that was right before I got COVID and then long COVID, and then like this book should have been in readers' hands before now. Yeah, but it is coming, uh, December 2023, for those of you in the future or the present. Um, and yeah, I just, I just think I'm, I'm stoked because like these experiences are universal. Um, and like the kind of help that you offer is not widely available. No, to athletes. And like, we're trying to change that. So it's like, yeah, it's like, it's one book, but it's also a movement, honestly.

Truly.

It's like, we, we're trying to create a paradigm shift to get back to a better place. Um, so yeah, probably we'll have to have you back. It's like, we didn't get too much into the psychosocial part of pain, which is gigantic and something that like I, I know from my personal experience that is huge as well. Like it's like an everything matters type of thing. Um, but yeah, I'm so glad that, uh, I went to Rob Carr's camp and got to meet you and had that mind-blowing experience and that we've remained connected and created this book together.

I'm super thankful as well.

Yes. So that's it for— we've got a quiche on the way and some potatoes and salad and nibblies like a hummus. You guys are missing out, but whatever. That's why you got to come to Dream Run Camp. You could partake if you came. Thank you, Ryan.

Thank you.

Yeah. Over and out.