Philip Pape: 0:01

If you've been pushing through knee pain, nursing a cranky low back, or avoiding certain lifts because your shoulders complain, you need this episode. My guest today reveals why these three areas fail together, not separately, and how most training advice makes the problem worse. You'll discover why stability in one area affects pain in another, how to modify movements without abandoning your goals, and what actually builds resilience instead of just managing symptoms. Stop choosing between results and pain-free training when you can have both. Welcome to Wits and Weights, the show that helps you build a strong, healthy physique using evidence, engineering, and efficiency. I'm your host, Philip Pape, and today we're discussing why the joints that handle some of the most load, your knees, your low back, your shoulders, tend to get beat up and how you can achieve a pain-free approach to your training and movement. My guest today is Dr. John Russin, a physical therapist and strength coach who's worked with everyone. He's worked with athletes from the MLB to the NFL to the Olympics, powerlifting, endurance sports. He founded the pain-free performance specialist certification, which has certified thousands of coaches and clinicians since 2018. He is the author of the new book, Pain Free Performance, which I've had the pleasure to read myself. And he was even named a top 50 health and fitness expert by Men's Health. Today, you're going to learn from John why your body, especially the hips, the shoulders, the core, tends to thrive as a system, how to modify movements without abandoning those precious strength goals that we all have. What actually builds joint resilience versus just treating symptoms and how to progress and still train hard? Train hard. We want to train hard while staying healthy. Whether you're currently dealing with pain or want to prevent it before it starts, listen up to the entire episode because John is about to drop some wisdom when it comes to training longevity. John, welcome to the show. Phillip, that was one hell of an intro. I appreciate it and I'm absolutely buttered up. All right. You're psyched. You're psyched. That's what we want to do here. We want to talk about how to stay healthy. We got a bunch of lifters listening in. We have a bunch of people that want to lift. We might have an 80-year-old grandmothers who were just told that if they don't start lifting, they're going to be in a convalescent home. You know, we've got everybody who needs to get healthy and fit. And I want to start with thinking about the body as a system and what you call the pillar, kind of the hips through the core to the shoulders and why that's so important. I know, I know when I'm doing my deadlift, why it's important, but really I want to understand the big context here. Let's start there.

Dr. John Rusin: 2:43

There's this big misconception when it comes to strength training or health and longevity training today that we just have to get isolated strength. You get isolated strength at your abs for lower back pain, isolated strength at your biceps to look better, isolated strength and hypertrophy at the butt if you want to fill out your genes. But that's not how the body is engineered to move. And it's definitely not engineered to function. What it is engineered to do is an integrated movement model, which is central lines of tension and stability, which puts us in the best possible position to stay healthy and also optimize performance. And we get at that central line of tension with something called the pillar, which is essentially the shoulders, the hips, and the core working synergistically together to give us the best possible result, no matter what the goal set is.

Philip Pape: 3:30

Okay, cool. Okay, so you're you're one of those guys that gives nice, concise statements. I could tell you've been on a million podcasts. I love it. Okay, so so a center line of tension, central line of tension. I think that's great, especially the word tension because it it reminds me of various queuing protocols with, you know, whether just today I was doing T bar rows. I don't know if you saw it on Instagram. Not sure if I'm prop holding the proper line of tension, but that's kind of what I think about.

Dr. John Rusin: 3:56

I thought you were Arnold. I had it wrong. That's right.

Philip Pape: 3:59

Yeah, actually, you're supposed to have a little rounding on that one. But, you know, so let's talk about that a little bit more. When we say the central line of tension, are we are we talking about the context of everyday movement as we're walking around thinking about our posture and such? Are we applying this specifically to protocols in training, protocols in rehab? Like where does it apply practically?

Dr. John Rusin: 4:19

Well, for my clients and my athletes that I've worked with, the first skill that I try to teach them and at least have them hone in on some sort of requisite skill and connectivity of the pillar complex is being able to teach breathing and bracing. You know, breathing and bracing is super unsexy. The fact that we're sitting here talking about it on a podcast means that, wow, it must be important because that's the last thing that people want to do in their training. But we get it wrong when it comes to breathing and bracing. Specifically for pillar bracing, we never connect the ball and socket base joints to the spine. Every time we hear, hey, if you want to protect your spine while strength training, especially going heavy, brace the core, use your core, get your abs tight, all these cues, but they're incomplete because without managing the shoulder joint, which is the most mobile joint in the body, and then the hip joints, which are the second most mobile joints in the body, we never have that central line of stability. We essentially just have a little bit of tension through musculature that cannot connect to the ground, it cannot connect to weights, it cannot connect to your human movement system. So simply by going through and connecting these three integral areas, we give ourselves a superpower to be able to create internal tension, meaning that mask much musculature can create tension to be able to stabilize and centrate, essentially get those joints into optimal positions in order to function, but also in order to not take the wear and tear of your strength training, no matter the movement or the exercise. And instead, we direct that force and we direct that load right into the key musculature or the movement patterns that we want them to.

Philip Pape: 5:54

Yeah, and that that's definitely speaks to me from a physical perspective of creating that solid end-to-end system of transferring load. When I think of physics and biomechanics, I'm a very nerdy engineering guy. And our listeners are as well. So they do love this stuff. They do find it sexy, by the way, breathing and embracing. Okay. Love it. So I'm kind of jumping around my notes here, but I guess when it comes to breathing and embracing, is there a universal set of steps that could apply to anything anytime you need to do this? You know, we hear terms like intraabdominal pressure. We talk about using lifting belts sometimes versus not when training. Um, I know there are misconceptions when I see someone squat and they're like breathing out as they come up instead of holding the breath and things like that. Yeah. But are there are the universal tips somebody could take away, whatever they go and do in the gym next week, that they could apply?

Dr. John Rusin: 6:40

So the first thing that we need to do is have that connection point, be able to create tension around the shoulders, then the hips, then breathe in, brace around the core, and have this central line of tension. But from there, many times people come to me and they go, Oh, yeah, I know how to brace. Well, why are you visiting me with lower back pain and chronic shoulders that don't move immobile and are causing you pain on bench press? It's a matter of being able to actually take the activity at hand and brace the tension to that activity in a smart and common sense way. You know, the way that we're gonna deadlift for a one repetition max is far different than the way that we are gonna go in for a 25 rep goblet squat. We need to be able to have a dimmer switch on our tension and our overall bracing strategy. And that will be polar opposite for what our breathing is. So, breathing and bracing need to go together. It's like peanut butter and jelly. When you're going for a one RM deadlift, of course, we want to be able to brace maximally. We want to hold our breath and we want to move that load because we don't want a whole lot of moving parts as load-centric loading is going to be the focus. But as soon as we actually have to take in oxygen in order to survive a set or into survive our lives, we need to be able to make our pillar tight, be able to have common form and technique that holds up against the stress. But we also need to make sure that we have oxygenation that does happen indeed. So we go through different breathing and bracing strategies. Essentially, as load goes up, your breathing capacity goes down. As load goes down, your breathing ability goes up. And it's all about minimal effective brace in order to keep optimal mechanics.

Philip Pape: 8:22

Great. So effectively, there's I'm picturing an inverse set of curves, somewhat like a spectrum between full bracing, fully holding your breath because the load is near maximal, all the way to more of a work capacity, endurance, you need the oxygenation. So you, you know, the you don't need to brace to that extent. In fact, it could be counterproductive, which reminds me of my front squats this week, you know, whereas doing sets of 10 to 15, very different experience where you're getting a little bit winded versus sets of three to five on a back squat or something. So actually, I remember in your book, guys, anybody watching the YouTube, I was joking, that's kind of a tome coffee table reference book in all the best ways. His new book, Pink Free Performance, because I did read through this and I do, I do appreciate how you go over very specific context for each of these. You know, you have like ladders, you have different level types of movements and rep ranges where you breathe in different ways. So we don't have to go through all of that on the show today, but I do want listeners to understand that context matters and the breathing embracing matters. What I want to get into next, John, is training hard. I think you said in the book something like training pain-free doesn't mean training easy. It's it's training in ways that make you resilient without breaking you down. And a lot of people here modify for pain. I've got pain, I'm rehabbing this and that, and I'm gonna take it easier. I'm gonna go light. And unfortunately, a lot of doctors give advice that they don't specify what they mean, which side tangent, by the way. My my mother-in-law, her doctor just said, you need to start lifting now and heavier the better, or you're gonna be in a nursing home before long. So I appreciated a doctor saying that. But uh, what's the relationship between like training hard and training smart, if that's the terms we want to use? You know what I mean?

Dr. John Rusin: 10:01

Our industry has had a pendulum swing, I think, over the last decade or two. We went from, hey, just go out and kill yourself in the 60s, 70s, 80s, up until the 90s, hypertrophy at all costs, big lifts for strength and muscle building. Don't warm up, don't worry about anything. It's all gonna be good as long as you're as big as humanly possible. And then I think like late 90s into the 2000s, we got into this like quote unquote functional training trend. And everyone wanted to become a physical therapist. Everyone wanted to be a corrective exercise specialist. And all of a sudden, strength coaches and personal trainers were doing pseudo-physical therapy on the floor of the gym. And we forgot to actually train for the physical capacities that give us that health and longevity, strength, muscle, cardio and endurance, all these things that are heavy hitters. And at pain-free performance, we are the middle ground on almost every single thing because I've been at high performance athletics and sports, I've been in physical therapy, uh, working with people that are out of surgery or having market pain responses. And I do believe that halfway between many of these extremist polarizing swings is going to be the right approach for many. But really, what it means is that we need to be training as hard as possible in a concentrated and a focused way. And we need a standardized system in order to just do all the right things that we need to be doing for our health longevity orthopedically and systemically. But more so, we need to be avoiding the wrong things because it's avoiding the wrong things that actually push us forward in terms of our momentum decade by decade.

Philip Pape: 11:38

And what are those wrong things? What are those wrong things, John?

Dr. John Rusin: 11:41

Wrong things, man. There's a laundry list of these wrong things. But I think the number one thing that people tend to neglect is their well-roundedness in terms of just being a functional human being. Like I do believe that there are things that every single human, no matter if you're a child all the way up into an active ager, should be able to do with your body in terms of their movement patterns. But I also believe that there are physical capacities and characteristics that need to be able to be trained and maintained for a lifetime if we are gonna indeed thrive. And many times we don't have that mindset when it comes to our training. We have, hey, I am a hobbyist. I'm only interested in this one thing, and I'm gonna deep dive into this one thing until it breaks me down, burns me out, or leaves me with an injury that I have to then take a break from. We call that the planned meathead deload. We want to avoid all of these things and just simply be a little bit more well-rounded in our training so we can have the ability to be pain-free, not suffer injuries, but also just function more normally in our lives, being able to do things with physical autonomy that we were meant to do.

Philip Pape: 12:48

Physical autonomy. I love that. Yeah. Seriously, man. This lack of well-roundedness, we're all guilty of it, myself included. Some of it comes from time, right? Like, how can I do all the things? Some of it comes from, you know, passion where you get into something and you go all hog wild in it. Some comes from the dogma in the industry, I think, where the different camps say, like, this is all you just need strength. That's all you need. You know, like you don't, which, and and I've come from some of that. And the more I get exposed to these things and talk to guys like you, the more I start to integrate all this. But what I want to be careful of, because I could see it happening if you like, if you read your book and you have these train strength training or you have these training templates at the end and there's different days per week, different levels of experience, it can seem overwhelming if you've never done all of that. You're like, oh my God, I gotta do the warm-ups and I gotta do the foam rolling, I have to do this and that, the other. Where do you meet people in the middle when they're starting from that mindset?

Dr. John Rusin: 13:40

I think at the entry point is important. Like people are gonna have different entry points into the industry. Maybe cardio is your entry point, maybe doing a progressive powerlifting program is your entry point. But if you train long enough, you're going to be humbled. It is not a matter of if, it's a matter of when. And that humbling usually happens through injuries. It happens through performance plateaus. You can't quite get what you used to get. And then all of a sudden, people make the mistake of going, hey, you know what? I'm dogmatic. I believe in this one thing. What's the fix to this one thing? I'm gonna double down on this one thing instead of maybe going right or left of that one thing. Maybe if you're super into powerlifting, moving a little bit of hypertrophy and mobility will probably do you some good. If you're a cardio bunny, actually going into some functional strength training is probably the thing that you need. The rule of opposites definitely applies when it comes to hobbying inside of our industry. And I think that over time, people are pushed to become more well-rounded if they want to continue to do the thing that they love to do, which is training. I know that clients that I work with and many of my athletes, they're not worried about just training today. They love this. They are doing it every day because it's become part of them. And they want to make sure that they can do it into their 40s, 50s, 60s, 70s, and beyond. And that doesn't happen by changing what you're doing at 70 when you're all broken down and hurt. It it changes with what you decide to do today, just little by little, to be able to incorporate base things that, again, we should be able to do.

Philip Pape: 15:15

And I like the lateral. You mentioned lateral, I think in the previous response, but the the, because I think of lateral thinking, like getting out of the box, same thing, physically lateral, which means start from where you are today and then branch out. And it reminds me of some guys I follow who I'm actually running some of their programs for that very reason, like Jeffrey Verity Schofield. You know, he'll throw in cardio two days a week to his training programs. And it's like, it's in there. So if you're a lifter who's used to following programs, you're like, cardio's in there. I'm just gonna do it. It kind of gets you to do it. Or Brian Borstein, who's into more of the, I guess, the high rocks kind of level of a little bit more elite hybrid athleticism, Cody McBroom. We had Chris Gethin on the show. I think his episode's come coming out right before yours. And I think it's important because for a while, I personally was in the like the starting strength world, and there's a lot of value there for sure. I mean, I credit that with a lot of strength development. But then there is looking down on a con condescension against, you know, anything else, right? Like, you know, and I talk bad about CrossFit sometimes, but only from the perspective of when people do it, you know, have bad form and they're slamming out reps and they're getting injured, you know, there's something to be said for that. So with this context, then going back to the pillar, maybe that's where we can start. And we talk about like referred pain and why people have injury and why people have pain. Is this a compensation thing going on that's important to understand? Or where do we start breaking this down?

Dr. John Rusin: 16:38

I think 30 years ago, when you look at the greater body of evidence and research, and then you look at professionalized education within the universities, spent way too many years there. We thought that this pain thing was just a pure mechanical approach to movement. Hey, if you move in this way, you will have pain and you will get injured. And today that's laughable. You're just like, what? You know, like a biomechanics course showed me how to be pain-free for life. If that was true, we wouldn't be dealing with the chronic pain and injury cycle that we are currently seeing amongst our active population today here in America. So I think that pain is definitely a more complex conversation that we need to be having. But calling it what it is, I think the first line of being able to write yourself is being able to move well. And what moving well essentially means is moving well for your body, your particular body, your limb lengths, your joint types, your body size, and being able to take that and look at your skill set and be able to customize your positions and know very well that not everyone is going to look exactly the same way as they squat. Not everyone is going to be able to deadlift from the same height with a neutral spine. And not every running mechanic is going to be the same gate locomotion cycle. We are unique beings. And I feel like in every other aspect of the industry today, everything's so unique, the functional health cycle of unique blood testing, so we can get on supplements and drugs. And then it comes to strength training, starting strength, squat like this, overhead press like this, bench like this, deadlift like this. That's a great starting point. And I'm so happy that there is a strength emphasis coming into our industry today. But strength is more than just three or four cookie cutter textbook exercises. Strength is a physical characteristic, strength is not a specific exercise. And just having the epiphany of making that realization is huge for people's long-term health.

Philip Pape: 18:39

So when it comes to moving well for your body, then what I know some people will interpret that as okay, a squat's gonna look massively different. And I have to, where am I trying to go with this? People always go kind of to the extreme of this. And I think I think what you're saying is because of your anthropometry, because the angles are different, the principles you're trying to adhere to, which are universal, like I don't know, vertical bar path or efficient movement, yes, are going to translate to a different, you know, different angles between the hinge points or something like that, right? So maybe elaborate on that, thinking about the squat specifically. How does that how should someone be thinking about this when they're they hear this episode? They're like, okay, I'm finally going to start squatting, and now I want to practice in my living room without a bar. You know, what are they thinking here?

Dr. John Rusin: 19:26

It's cool because over the last 10 years, a pain-free performance specialist certification has certified over 20,000 personal trainers, strength coaches, physical therapists, and physicians in person in two-day certification courses. So, in that amount of people, you see a lot of different movement. And you not only see a lot of different movement from people, you see it from experts in movement, people that know their shit, people that have been training their entire lives, people that do this for a living. And I think when we first started running the certification, the squat was the first movement pattern that we were like, I know that there's some diversity in the squat pattern in terms of identifying somebody's most optimal squat pattern, but wow, after 10 years, the diversity that we see weekend to weekend in terms of our certification courses is absolutely wild. But this is where people tend to go wrong right off the bat. They go, okay, squat, only a barbell on your back, low bar position, and I'm gonna go feet shoulder width apart, and I'm gonna toe out slightly, I'm gonna look down at the ground, and I'm only gonna go to parallel because that's how real men squat. And it's like, no, hold on a second. You know, we've seen this with definitely a lot of the avatars that go through some of our screening and assessment protocols for the squat. So we're either trapped into, hey, I've been hurt from the squat before, therefore I'm gonna modify my movement patterns. And it usually turns into I'm too wide, big base of support, very low little range of motion, and kind of the parking break on the system. Or on the opposite direction, we see that people are like, hey, I've squatted this way for my entire life. Maybe I've developed it with a coach over time, and this is going to be a specific squat exercise for maybe a barbell sport goal. And neither of those are going to be optimal because again, we're talking about the squat pattern itself. When I say squat pattern versus squat exercise, I'm talking about somebody taking a shit into a hole in the most opportune position possible with joints stacked, centrated hips, angulation at the knees that makes sense, looking at ankle mobility, looking at spinal position and neutrality, and being able to organize the shoulders over the hips. And all of a sudden you're like, oh, okay, that is the squat pattern. But many people deactivate that squat pattern in chasing only exercises. So we tend to see that there are a couple key variables in people's squats. Yes, the stance is going to be wider or more narrow, the foot ABduction position is going to be out or in. And then we're going to see the knee is going to be forward or more vertical shin. And then we're going to see the torso angle is also going to be more forward or more erect. And then the thing that usually gets lost, because what I just described is very sagittal, plane and unidimensional. What gets lost is hey, what's underneath the skin? You know, what's underneath that glute? What is the hip type actually look like? Because that's where we tend to see the most amount of success in unlocking people's ranges of motion, getting them out of pain at their knees, at their hips, at their lower back, and being able to actually be strong and stable in their best squat position. And this is something that we go through in the pain-free performance book and also the certification course called the hip quadrant test. Essentially, we are able to type your hip in a matter of one to two minutes. You can even do it on yourself from the protocols in the book to be able to look at where you should actually be at the bottom of your squat and what the glass ceiling is for you to be able to get in this position and be able to build a skill set up so you can get into that position under load. And then the goal from there is to be able to train and maintain that at least one time per week in your programming forever. And then the other two or three times per week that you're doing a bilateral squat pattern, go into specialty, go in for some different muscular targeting, go in for some load capacity work at partial ranges. You know, the sky's the limit in terms of diversity. But what people are missing is that they're not doing the foundational pattern. And instead, they're only doing the partial pattern with specific goal sets, losing the pattern in its essence itself.

Philip Pape: 23:30

Yeah, what you talk about again in the book, and I'm happy to promote this book only because, guys, if you if you check this out, whether you get the digital or physical when it comes out, there's a lot of progression and context and building from essentially nothing up the ladder, not just with what John mentioned, range of motion and your own biomechanics, but also the types of movements and making it as accessible as possible and kind of working your way up. Like I could see myself on those different spectra where, okay, right here I'm close to the top. I'm pretty confident. Here I would probably step back a bit and work my way up. And then you also mentioned targeting different muscle groups and things like that. You know, I've had Andy Baker on the program several times. I love Andy because he he came from the starting strength world, but then has branched out and realized the importance of variety effectively, not for its own sake, but because of what you just mentioned. And we had a whole discussion about squatting and ultimately the million ways you could squat and different types of exercises. It's not really about that, right? It's achieving the right movement pattern. And look, if you have the right movement pattern and you progress over time, you're gonna get massive results, whatever squat patterns you decide to do. And a lot of that comes down to what's fun to you and what do you want to train with too, right? So anyway, I don't know where I'm going with all that, other than to say it makes sense to be methodical about this, whether it's buying your book, reaching out, going to YouTube, listening to podcasts, practicing thinking, being mindful. Let me ask you, John, when you're in the gym and you're training, do you listen to music or do you think with your thoughts? How do you, how are you mindful about your listeners?

Dr. John Rusin: 25:05

I've been uh quote unquote raw dogging my sessions lately. I know that was a popular term of like guys going on a transatlantic flight and not listening or watching anything, but that's what I've been doing. But I follow my own programming. I go inside of the Unbreakable app and I subscribe to it just like every one of my other members does. And I find liberation in that because I know I'm gonna be getting the diversity of movement patterning that I need. I get the distribution of volume throughout the patterns and the exercise selection that I need. And I also kind of have the same goals as everybody else. You know, nearing 40, being a dad that coaches baseball and basketball, you know, being a husband and a business owner, I got 60 minutes to hit it. And I know that I need to be focused. I need to be on rest periods. I have different key performance indicators, strength movements that I'm chasing, but I also want to have that feel of moving well, being mobile, and also like tapping into an athletic potential, even at my age, where I never want to lose track of athleticism and power. So, like the programming that I do right now, I stay very focused in on it because I just follow the app and I do exactly that. And then I track it. And there's a reason that that works for accountability and just staying on track because today it's super easy to go to Instagram and lose 10 minutes between a set. And it's definitely easy to program hop while you're doing an actual program just because of all of the very superficial resources that we have at our fingertips.

Philip Pape: 26:26

Yeah, so raw dogging it, following a program, making judicious use of your rest periods and not getting distracted while you lift. And I can raise my hand being guilty of that sometimes, where I'm like, okay, I'm an entrepreneur and I'm losing weights. Go, do both at the same time, you know? But uh, so okay, maybe roping back a little bit to the framing of this episode on pain, specifically where people get a lot of the pain, which is low back or shoulders or knees. Maybe, maybe looking at the low back, that comes up a lot. Low back fatigue, low back pain. And then sadly, a lot of people just have something go, something pop, have to have a surgery. I know someone, she's a power lifter. I've always thought she's she's lifted great and and she's been competitive and she had to have a microdyskectomy recently, but she also got a lot into running and rowing, which she hadn't adapted to as much as her lifting. So who knows where the issue was? People are like, what do I do? Where do they start thinking about protecting? I even like the word protecting sometimes because it sounds like too much in a shell, like safety, but basically fortifying back.

Dr. John Rusin: 27:31

Two patterns that are going to be super back intensive and also back sparing are going to be the hip hinge pattern and the single leg pattern. We call it the lung at pain-free performance. But when it comes to knee pain, when it comes to lower back pain and really shoulder pain, those are going to be the big three in our industry today. Like we have to have a good foundation of biomechanics. Like we've already talked about the foundations of finding your unique biomechanics that work for you. But I didn't add the next layer to this, which is once you find your unique biomechanics, cool, that's your central line on a spectrum. Be able to add diversity and range of motion and different muscular targeting and different rep ranges and different rep speeds and all these different methods and modalities that we can start throwing on the system strategically over time, not all in one single training week, is going to be the recipe for long-term success. But with the lower back specifically, I tend to see that people neglect the hip hinge pattern because they go, I've hurt myself deadlifting before. Well, what's a deadlift to you? Well, it's a conventional stance with a barbell on the ground, of course. And I am hoisting that thing up at all costs. And in our research at pain-free performance, we've seen that people are unable to keep a neutral zone of spinal neutrality 93% of the time when doing a conventional barbell deadlift off the ground. And this is out of a more pure hip hinge pattern. So essentially what happens to people is that they think this arbitrary exercise is the be-all end-all of everything. But what if you're one of the 93% that can't even access that bar off the ground? You're going to be doing one of two things. You're going to be using mechanics from the squat, pushing your knees forward, rounding your lower back, dumping your pelvis in order to get yourself wedged into that position. Or you're going to be going through and putting undue stress directly on the spine, being able to try to force in a hip hinge that you simply don't maybe have the range of motion or the mobility or the hip structure to be able to achieve. And there's very rarely a time where we bring somebody right from, hey, you had pain, hey, you had an injury. Let's go right back to picking something up off the ground. Many times this is the pattern that is in dire need of a rebuild because people have not just pain and injury backgrounds mechanically, but it really fucks with your mind. When you blow out Your back and it is deteriorating to your lifestyle, not just your training, but your lifestyle, you're going to think again before you go back in and train that, or you're just going to be lost and able to really take the most out of the highest yielding movement pattern that we have. But I would say about 40 to 50% of people today attempting to strength train are neglecting, if not disusing fully the hip hinge and the deadlift. And this is really problematic because we say that it is the most injurious movement pattern, but it is also the movement pattern that will protect the most. So where do we go on this yin and yang? And it's back to a strategic rebuild of trying to put the pieces together stronger and healthier and more customized to your specific needs.

Philip Pape: 30:46

The yin and yang is a great way to describe it because I sometimes have trouble communicating to people that a deadlift done wrong could hurt you, and a deadlift done right could save you, right? It's the same principle. And of course, and you called it the highest yielding movement pattern we have, which again, I I strongly I love the deadlift. Personally, I love it. I think my body is built for it way more than the squat, and that could just be an excuse not to get my squat up. But it is, it is a fun lift. When you said the, I think you said the safe zone around the line of neutrality. Uh, in your book, in your book, you have diagrams showing, for example, somebody hinged over and you have this zone with different colors, and there's that safe zone and then the buffer zone. And it's it's quite liberal. It's not like you have to be super afraid that it's just this rock solid line. And once you go out, spring your back falls apart. But you said 93% of people can naturally stay or have trouble staying.

Dr. John Rusin: 31:40

They are unable to access the bar for a conventional deadlift with spine neutrality. But the interesting thing in that section of pain-free performance about the neutral zone of stability of tension around the spine is that there are many different factors. It's not just a biomechanical model. Our zone of neutrality goes out and it comes back in based on your preparation at hand, based on your skill, based on your sleep cycles, based on your past injury history, based on your training loads and volumes, based on an exercise being a mismatch for your unique biomechanics versus something that actually is a good match for you. There are many different variables that actually affect your neutral line of tension and your zone of neutrality. And this is something that I was super proud of in the book because I haven't heard a whole lot of people talk about this before. They're so they're so black and white when it comes to spine neutral at all costs. You know, you hear the kettlebell community going perfect spine neutral while kettlebell swinging. What do you mean? There's 17 to 24 degrees of spinal flexion at the bottom of a kettlebell swing, even in perfect quote unquote execution. So, what are we really talking about here? What we want to be able to mitigate the risk away from is having rapid force, eccentric flexion of the spine under load. What that essentially means is like, hey, you're out fishing, you got a fish on the line, the line goes like this, it bends the line and it bends your hook, and all of a sudden you're like, whoa, okay, I got that fish. But you don't want to do that to your spine. That is something that when we do see injuries, they can happen in many different types of ways. But I tend to see the injuries happen specifically on the hip hinge pattern with that rapid force, eccentric moment as we're coming up out of the hole off the ground. Usually that first like two to five inches off the ground is where people tend to lose their central line of stability. They lose their spinal tension, they lose that zone of neutrality, and they end up, if they are having all those other factors line up correctly, unfortunate for them, they end up with an ache, pain, injury, flare-up, whatever you want to call it.

Philip Pape: 33:46

Okay, that's really important. So we want to avoid rapid force, eccentric flexion on the spine. Is that dumbing it down rounded back?

Dr. John Rusin: 33:54

When you're quick pulling rounding of the back. And it's usually going to be anywhere from like the lower back or the L and S spine. That is where the vast majority of these are going to happen. There's a natural fulcruming point that happens in the lower lumbar spine. And that is something that is, again, natural, but we don't want to be loading it and we don't want to be losing that line of tension, especially under load. And I think that as like injurious as that may sound, this is really easy to avoid with what we started with, with just being able to brace and breathe properly.

Philip Pape: 34:27

Brace. Yep, for sure. Yeah. So L4, L5, S1 is where you hear a lot of these injuries and issues. And if you look at the spine, you can kind of see that S shape occur around there. But you also mentioned that it moves with your adaptation, with your recovery capacity. And I get attest to this. We talk about, you know, the differences between fat loss and when you're not in a deficit, when you train of being even more attentive, not that you shouldn't always be, but that you're more susceptible to some of these things because of the fatigue and the recovery capacity. I know personally when I get distracted or I go in and I try to be, you know, do an ego lift, right? You kind of get the same thing. So the adaptation I wanted to ask about because you hear a lot of criticism or hot takes on Instagram. You know, look at this guy who can deadlift 900 pounds, but look at that rounded back. That's awful. And I'm like, okay, he's adapted to that and he's doing it and he hasn't injured himself, but is he about to snap his back? Like, what are we talking about?

Dr. John Rusin: 35:21

Taking these people that are absolute beasts, probably a world record holder has been deadlifting for 20 or 30 years at this point. There's really no huge young guns in the game. They've been able to again adapt and stress the system in a strategic way, extraordinarily strategic way, in order to again go at a specific goal for a sport, which is totally different than lifting for health and longevity. But I have personal clients that I work with that you would look at their deadlift form and be like, oh, he just hoisted 950 and he had a rounded and kyphotic spine at the thoracic. And then maybe he's probably even rounding at the lumbar spine. But the big difference between that rounding setup for these guys that are absolute anomalies, if I'm just calling it out, is that they never get pulled into deeper flexion rapidly. They maintain that flexion point and they don't have a net positive flexion point at the spine. I think that's the big differentiation factor. That, and they've done deadlifting so much volume with so much intricate technique work that they are masters of this specific skill out of this specific position. And their body has normalized it in terms of the way that they have callused their system.

Philip Pape: 36:38

Yeah. Yeah. The the speed at which the angle changes and the force gets applied is a direct function of the maximum force that's getting applied, right? F equals MA. I think about discussions I've had recently with lifting buddy of mine, how much we love pauses these days. You know, we're both in our 40s and we like pausing at the bottom of a lot of our movements. Take out the stretch reflex, only because sometimes that is where you're prone to have those high levels of force from the stretch. Not that it can't be also beneficial and you can build the resilience and adaptation, but it's it's what came to my mind.

Dr. John Rusin: 37:09

Anytime that you take a movement pattern, whatever movement pattern it is, squat bench, deadlift, whatever, and you take it to its X amount of available range of motion, and then you play and you dabble between compensatory range of motion and an authentic range of motion, you're in this intermediate range where all of a sudden you don't have the active stability neurologically or mechanically that you probably should have. And you're using compensation, whether that be momentum, whether that be using like the tendoosseous junctions to be like rebound and ramp up out of a squat. Whatever it may be, those are things that maybe not line up well for your long-term health. You know, people are always like, oh, well, what do you think about the butt wink in a squat? Like, I hate it. Like if your goal is to feel awesome and just like be jacked at 45, like probably the butt wink has no place in your programming. But if you're gonna go to the CrossFit games at 45 and try to compete for a medal, like that's a totally different story. So there's always two sides of the coin, but I do believe that anytime that we can be a master of our movement and then we can dominate a movement and then diversify that movement little by little to be able to add variance. And that is gonna be a more well-rounded spectrum of the human movement system.

Philip Pape: 38:22

For sure. Yeah, no, I I love that. And you also mentioned the lunge when we talk about the hip and shoulders and the that pillar. And it's funny because I just I just started a new cycle of a program that does have walking lunges in there, which I like, but I also they also have one and a half walking lunges, which I like quad burners, right? You go go down, go down, come up halfway. You know what it is. Just explain for the listener. Go all the way down, come up halfway, go back down. So you've just like use the lengthened position without relieving much tension, and then come back up into the walk. And you'll find you can't do nearly as many of those as the full as the single walks. But where does the where does the lunge fit in here? Because it is one of your six.

Dr. John Rusin: 38:59

The lunge is the most detrained. You know, the hip hinge, nobody wants to do. Yeah. Ignore our ignore. Uh Dave Tate, an ex-client of mine and a mentor of mine, said it best when I was working with him at Elite FTS. He goes, John, this sucks. I had him doing split squats. He goes, This sucks because it's half the amount of weight and it's twice as hard. And I'm like, man, you just said it. You just said it. And that line is right in the book, too. But when it comes to the lunge, I think it's misunderstood and it's also neglected because it's going to be hard every single time. Uh, unilateral-based lower body work is going to be very demanding in terms of the muscular system, the stabilization system, the neurological system, and the sympathetic system is really going to be heightened up because the balance component to it. But I think just from the mechanics alone, it differentiates itself. It's not just a squat on one leg. It's not just a hip hinge on one leg. It actually is its own distinct pattern. So the lunge pattern has all the best properties from the squat, which is associated with a positive shin angle, a knee forward uh position, and be able to have quadricep dominance. And then also it's a hip hinge at the hips that integrates hamstrings and glutes and lower back. So we actually have maximal amount of load capacity in single leg with many of these patterns, like the Bulgarian split squat, walking lunges, that feel natural to the body as well, because when we function on single leg, that is where we spend 85 plus percent of our movement lives on. You know, we're not functioning in our daily life doing bilateral positions at the squat or at the hinge. We are definitely maneuvering in asymmetrical lower body stances. So this is one that I tend to put the most amount of volume distribution in for almost everybody I'm working with. Probably the highest with athletes, the second highest with like the 35, 40 plus population, and then the third highest amongst people that want to get super strong unconventionally, usually coming from more of a barbell background. But usually with a lower body day, we're distributing anywhere from 50 to 70% of total volume in asymmetrical lower body stances, which is essentially our lunch pattern from pain-free performance.

Philip Pape: 41:12

Okay, yeah. And that is definitely higher than the traditional most people would see. Oh, yeah. Um, and it sounds brutal, but I get it because reverse lunges, I don't know if you put step-ups in there, but to me, those are hard too. And, you know, what split squats, we all there's there's memes galore about split squats, you know, being the worst of the worst, right? But again, we have to change our mindset and think like how beneficial that is. I mean, you mentioned stability and balance and everything. It's like raise your hand if you're listening and you've tried a walking lunge and you like, you know, are just trying to stay up straight, let alone with a bar on your back, if you're not doing dumbbells. So yeah, I thought that was interesting because a lot of people reduce the movement patterns to exclude that. And I think it I I am coming around to your way of thinking here. I think it's really cool.

Dr. John Rusin: 41:56

Yeah, like just going over the years, chasing like we we call it functional meat head. Functional meat head is we're gonna take some like easy-ish exercise, something that you'd see in physical therapy, and we're gonna push it to the absolute limits. The chase over the last like five years or so has been Bulgarian split squat five RMs. How heavy could you possibly go out of different loading positions? I've gotten it to the 150s in each hand for five reps down to the side, and I've also goblet Bulgarian split squat 190 pounds in front of the body for five reps. So when you do things like that, you're like, man, that doesn't sound fun. But you learn a lot about the body's natural stability points and where we can actually maximize strength recruitment from in those particular patterns. Knee forward position plus the hip hinge is gonna be strong, it's gonna be stable, and it's also gonna be able to be able to mitigate risk of knee pain long term because we get into the deep knee flexion, and it's gonna be able to spare the spine because we are on an asymmetrical stance at the lower body, and essentially our pelvis can rotate in opposite directions, and the stability factor is far different than in the bilateral counterpart. So when you think about doing stuff like that, you're like, yeah, this is where this pattern makes sense. If you're just setting up for a Bulgarian split squat for a set of five with a 10-pound dumbbell, and you're like, oh, this seems easy. I can keep a vertical shin, I can put my knee forward, I can do whatever I want. That's fine. But when you actually push things to absolute maximal load or maximal challenge, your body will find its natural, natural writing mechanism, put you in a strong and stable position. And the thing I want people to take away from that statement is where you are most stable is probably where you're gonna be the strongest. And where you are the most stable and the strongest is where you're likely to be the safest.

Philip Pape: 43:38

Right. Got it. Okay. Yeah. And so again, we have to train hard, is also part of the uh part of the equation. And that was a good segue to knee pain because you mentioned the knee flexion and how this supports the knee. We talked about Pateller, you know, the tracking and the knees forward. There's a lot of, I'll call it mythology around that because people will reduce the, you know, form check to, oh, your knee's traveling too far forward, not thinking about the system. So, what are your thoughts on that? And in general, knee pain, maybe the use of knee sleeves, like the whole ball of wax.

Dr. John Rusin: 44:08

One of the biggest mistakes that people will make if they have that generalized chronic front-sided knee pain is that all of a sudden they'll go and Google it and they'll be like, oh, I need a knees over toes program. I need to be forcing my knee forward in the most biomechanically disadvantageous position possible while it's hot, while it's hurting. And sissy squats. Yeah, yeah, sissy squats. Uh, there's a bunch of different exercise variants with that. But that's the opposite thing of what we would recommend that pain-free performance. If you are dealing with hot knee issues, like, hey, this thing actively hurts right now and it's been kicking my ass for a number of weeks, if not months. That's the time where we pull back and we actually back down into some simple biomechanics. If we can manage where the knee is relative to the ankle, that is going to take the distribution of our loading through our body and it's going to put it onto different key musculature into different patterns in different ways. So the more vertical we can keep the shim, the more the posterior chain is going to be involved. Hamstrings and glutes, if we can get stronger at both of those places, that is going to be putting us in a nice position long term to have pain-free knees. But we don't want to just stay there because I think many times people just end up staying there. Their squats are vertical shins, their lunges are vertical shins, everything that they're doing is vertical shins. And guess what? When we walk, we don't have a vertical shin. When we run, when we sprint, when we change the direction and being an athlete, there is never a vertical shin. There's a knee forward position and there's a dominancy of being on the toes versus the heels. And that's something that we need to grade and scale back into. But naturally, we need to be moving back into a more knees over toes position in a graded and concentrated way, maybe week by week, program by program, and being able to have access to that because long term, that is going to be huge. But going back to just like being able to get your knees healthy, managing that knees over toes position is going to be huge. Strengthening the posterior chain that actually supports the stable line of tension from the knee is going to be huge. So hamstring work, ton. I see that super neglected. And then gluten, hamstring work together. That posterior chain emphasis is going to be one of the best things that we can do for our knees. Once we do that, then we can start to scale some of the stress back in with novel positions of the knee actually translating forward.

Jerry: 46:27

Hey, you just wanted to give a shout out to Phillip. I personally worked with Phillip for about eight months, and I lost a total of 33 pounds of scale weight and about five inches off my waist. Two things I really enjoy about working with Philip is number one, he's really taken the time to develop uh a deep expertise in nutrition and also resistance training. So he has that depth if you want to go deep on the Yes with Philip. But if also if you want to just kind of get some instruction and more practical advice and a plan on what you need to do, he can pull back and communicate at that level. Also, he is a lifter himself, so he's very familiar with the performance and body composition goals that most lifters have. And also, Philip is trained in engineering, so he has some very efficient systems set up to make the coaching experience very easy and very efficient. And you can really track your results and you will have real data when you're done working with Philip and also have access to some tools likely that you can continue to use. If all that sounds interesting to you, Philip, like all good coaches, has a ton of free information out there and really encourage you to see if he may be able to help you out. So thanks again, Philip.

Philip Pape: 47:40

Cool. Yeah, gluten hamstring work. Everyone loves that, especially the ladies. Hamstring work is is definitely fun because there's there's ways to isolate it both with extension and flexion. And I know I've been doing length and partial RDLs lately, and those can be brutal because you can some people can overload them, some people actually find them heavy, heavier. It's kind of kind of interesting how that works between individuals. What are your favorite hamstring movements?

Dr. John Rusin: 48:02

RDL is gonna always gonna be the king. I would argue that the RDL, if you're to do one exercise for the rest of your life, probably has the highest yield. You get that stretch on the hams, you get the flex on the glutes at the top, you're able to have mobile full range of motion down through the posterior chain, and you're able to have a connectivity through your upper body. Like it is awesome. And it also gives us the ability to train the core and the spinal position at an isometric. Like it is a super high yield. But I'm a big fan of hamstring isolation work as well. Like, not always going to be jumping into the machines doing a machine circuit like it's global gym. But when you go to seated and line hamstring curl machines, those are two of the only machines that I will routinely be able to program in because there's really nothing else like them in terms of open chain mechanics at the hamstrings that will be far different in terms of the mechanics and the properties of the joints and the stabilization patterns than standing on two feet and doing something like an RDL or a split squat with a hinge emphasis or something that lengthens out the hamstrings. But really, we like to also have diversity in terms of our tool sets there. Anytime that we can get sliders out, anytime that we can get suspension, bandwork, that is gonna be huge for hamstrings. And remember, the hamstrings aren't just one muscle. The hamstrings are hamstrings, and then we have adductor groups of the hamstrings as well. So anytime that we can get out into the lateral planes of motion, that is gonna act for hamstring stabilization at the hip down into the knee even more. So you really can't go wrong having big, strong, meaty hamstrings because they're not only aesthetically pleasing, but they are so functional for almost every goal, whether it be trying to mitigate low back pain, being able to bring up your glute hypertrophy, or just protect your knees long term.

Philip Pape: 49:48

And they make your legs look good. Uh, let me tell you, because it's like the triceps of the legs, right? You know, people think it's the biceps, it's the triceps that make your arms look big. But uh no, that it's funny you mentioned the sliders and stuff. Because I, again, I used to do CrossFit and they had the rollers and stuff. My my daughter's doing a little physical therapy for her. She dislocated her knee not long ago. And they're like, Dad, have you ever heard of sitting in a chair and pulling with your legs? I'm like, Yeah, I bet that hurt that you feel that in hamstrings, don't you? Because, you know, it's just even doing that, it's you can see how weak you are sometimes when you do those. Uh, that movement, which is more like the leg curl type movement. I know we're getting low on time. I did want to talk about the shoulders, honestly, because I personally have had rotator cuff surgery. There's probably a lot of things I could have done different myself over the years. I am where I am, but it's a very epidemic thing among lifters who are older, bar none. I mean, shoulder issues all over the place. Some people avoid overhead pressing altogether. Some people are in, you know, shortened range of motions, using the pausing, using having to vary up their grip and width and all this. Um, trust me, I know. So when it comes to the shoulder pain, are there, again, movement pattern issues that people are doing too much? Or is it trying to go too hard on overhead doing it the wrong way? Like, where does all this come from?

Dr. John Rusin: 51:00

We have an obsession with the mirrored muscles. I think it's as simple as that. The mirror muscles are gonna be your abs, they're gonna be your biceps, and of course, the chest. And if you're not training chest on Monday, are you really strain training? And as funny and as stupid as that sounds, if you go in and watch any single gym across the world as I've been to, you're gonna see that the bench press is the number one exercise for every male in that gym on any given day. And all of a sudden, you go years, if not decades, of overtraining the push and neglecting the backside of the body with the pull pattern. And we tend to run into some problems, especially now because we are so glued to handheld technology with our phones, we're on our computers, we're sedentary more than ever before. And we have a bigger need to actually reverse these sedentary postures with the pull patterns that put us into extension, external rotation, and AB duction at the shoulders. And this is the opposite of what most people are training. One of the first things that I do with clients is that I audit their volumes. I audit their volumes across squat hinge, lunge, push, pull, and carry patterns. And when it comes to the upper body pushes and pulls, if I see anything that's under like a two to one ratio between pull and push, I'm like, yeah, that's the first thing that we're gonna go after here is we're gonna redistribute the volume to put more volume on the backside of the body in terms of rowing and pull downs and push-ups and direct lat work. And then we're going to probably keep the volume about the same or pull it back a little bit in terms of your push pattern. And the push pattern is gonna be more diversified than just the barbell bench press on a flat or if you're functional, going up to a 45 degree angle. And that tends to really be humbling for most people because they go, oh shit, you know, I need more face pulls, I need more rows, I need more unilateral work in the pull pattern. And I need to be able to diversify away from just the barbell. I love barbell bench pressing, and I would say 60 to 70% of my clients will barbell bench press. But we also are training many different uh ways in terms of landmine pressing and dumbbell pressing and working with bands and having kettlebells. And there's so many different ways to be able to train the push pattern. And the easiest one is the most accessible to everybody, is simply doing push-ups in a closed chain, getting your hands on the ground and allowing your shoulder blades to actually start moving again. That is going to most likely be the pattern where we start the rebuild process from if you're dealing with shoulder pain and past injuries.

Philip Pape: 53:26

So much wisdom here, guys, if you're listening. I mean, I'm just like smiling inside, John, because a lot of what you're saying, I've had to learn through hard knocks. And I, you know, I'm not saying I know everything you know, but it just resonates so hard with me because for me personally, for anyone listening who's been following my shoulder rehab journey, you know, things things got kind of acted up about a year after my surgery and things started to take a turn with bursitis and issues like that. And I'm still working through, but a lot of the advice I got and talking to guys like you, not you, but guys like you, were trying to do more pulling movements and try to really strengthen the back part of the upper body. And, you know, just today I was doing neutral grip pull downs and T-bar rows, and like I'm really getting into more of that. I like that two to one ratio because it's a nice prescriptive way to think about it, where you, you know, if you're doing six movements, then four of them should be pulls rather than pushes. And what are what are your thoughts on like barbell rows and yeah, let's, you know, movements like that that have other translation to the posterior. Do you find them even more effective? Or can they be kind of limiting because of the weight? Like, what are your thoughts?

Dr. John Rusin: 54:32

I program almost everything. I do not program traditional barbell bent over rows.

Philip Pape: 54:37

I saw that in your book. I saw that in your book. I wanted to ask about it.

Dr. John Rusin: 54:39

One of the reasons that I don't is not that I think everyone's gonna be injured first time that they do it. That's not the way the body works. But I do think that it's just not the best way in order to train the back directly. When we're thinking about holding a hip hinge, we just mentioned that a lot of people have trouble hip hinging in general, but now I'm gonna ask you to hold it for 30 to 60 seconds in a hard isometric and not give up the position whatsoever. And then I'm gonna put your hands in a fixed position on a barbell in an arbitrary distance apart, and I'm not gonna allow natural rotation to happen at the hands nor the shoulders. And then I'm gonna put it into a bilateral stance that is gonna be dependent on your lower back position and you staying upright. And then I'm gonna put max load on because anytime we see a barbell, it's like, how much can we load up on this thing? And many times it just turns into a sloppy movement, it turns into half rep ranges of motion, a lot of momentum being used, a lot of the recruitments happening at the lower back versus the musculature of the upper back and the lats where we really want to target. And it's something that there's just like so many other awesome variations that we could possibly go into for muscle, for strength, for resilience building of positions, that it just doesn't make a whole lot of sense for me. I will absolutely use positions and I will use different variances of bent over rows, whether it be single arm, whether it be supported, whether it be chest supported. There's a lot of different ways to do it. But the standard barbell bent over row, I know this seems like sacrilegious to many people listening, but that's just not a high risk-to-reward exercise for a vast majority of people for shoulder health and for lower back health.

Philip Pape: 56:18

Yeah, I wanted to ask because I saw that in there and I don't totally disagree. I mean, I've spent years trying to follow people like Alex Bromley, for example, who takes it very seriously on how to do the position and making sure you're up above the ground so that you could properly get in the form and everything. And then guys who, you know, are like, Loyal, let's use the easy car, let's easy bar, let's increase our angle and let's do power versions of that so that you go to a dead stop. There's lots of things. And maybe there are some other benefits like the isometrics, but you get that from deadlifting as well. So I hear you, man. And I personally have really started to enjoy like T-bar rows and cable rows and things like that, and really feeling it hit those spots more directly. But teach his own, obviously, if you can progress safely and do it and you want to do it, we're not saying not to. As we wrap up, and we're a couple minutes past, apologize. Is there anything else you wish I had asked? I know there's a lot we didn't get to, but in this context of just pain-free with those key joints, anything we didn't cover that's on your mind?

Dr. John Rusin: 57:16

I think that as we get older and as we have more mileage on our system, we will all be pushed to be able to evolve and change so we can continue to do what we love to do. And you said something that really resonated with me. It was like, yeah, I had to gain this wisdom because I had shoulder pain. I had to go into surgery, I had all these injuries over the years, but I love training and clearly we do. But I think pain-free performance is a 600-page resource on things that I have made mistakes with, things that I've been mentored by, and the system that you could simply run to plug and play a pain-free performance model that simply keeps you healthy and works for your body uniquely. We don't have to give up what we love to do. I would never tell anyone that. Leave that to the doctors and the poor physical therapists out there. What we want to do is be able to line you up to do what you want to do forever, but it does take a little bit more concentrated work and a smarter system to achieve that.

Philip Pape: 58:09

A smarter system to do what you love to do forever. Love it, John. All right. On that note, where do you want people to find you besides? I'm going to promote it for you again. Pain free performance, the book. I think it's still available for pre-order because it doesn't come out till, well, around when this episode comes out. So look look it up. We'll include the link to that. Uh, any anything else where you want them to reach you, John?

Dr. John Rusin: 58:28

Any social media is at Dr. John Russin on Instagram, on Facebook, also on YouTube. And you can check out our websites over at painfree training.com and also drjonrusson.com.

Philip Pape: 58:41

All right, we'll include those links and uh the handles in the show notes. Thank you, Dr. John Russin. It's been a pleasure. Really, this was even better than I expected. I expected a great conversation, but we really covered a lot of unique, helpful areas for the listener, and uh, they're gonna love it. Take home some good action from this. So thank you so much, John.

Dr. John Rusin: 58:57

Thank you so much for having me. This was fun.