Episode 78
· 26:21
Welcome back to another episode of the Real Health Podcast. I'm joined by a special guest, Dr. Andrew Cox. He is our physical therapist at The Real Health Company, and so we're super excited to be having him today just chat through recovery. So today, we're gonna talk all about central nervous system recovery and training loads, stress loads, and match that properly with recovery and what that all feels like, that all means on like a day to day basis, and this, like, hyper data collective society of OURA rings and wearables where we're tracking heart rate variability, we're tracking rest and recovery, as well as training loads and stress loads. How do we all marry that?
Dr. Barrett:How do we prevent injury? How do we feel, like on a day to day basis, we can conquer anything? So today, we're gonna talk about resiliency and overall how do you wake up daily and feel rested and recovered and ready to take on the day. Before we get into today's episode, just a reminder that on Tuesday, 23rd, here at the Health Factory from 4 to 6, we are doing our back to school event. It's a free workshop or free event for kids.
Dr. Barrett:Parents obviously come bring the kids. We're gonna do free spinal assessments. Doctor Andrew will actually be doing free backpack checks just to kind of help you understand ergonomics of backpacks and why that's detrimental to our kids' posture today. We'll do actually, we'll do adjustments, free adjustments for kids, as well as tons of giveaways. Wooden Spoon will come out for the first 50 kids, and they'll be doing will be giving away free shaved ice.
Dr. Barrett:So all natural shaved ice from Wooden Spoon. So thanks, Dylan and Paige, for coming out to that event. All right, let's dive in. So when talking through stress, training, recovery, and what we, I guess, should feel like on a day to day basis, when you wake up and you think about your training, some days you're just motivated and some days you're not, you know. And there's a lot of different factors that go into that.
Dr. Barrett:But if we just start there, if we just start with that conversation of, hey, I just don't feel like I wanna work out today. Is that stressed? Is that overtrained or overstressed? Dr. Andrew, what are your thoughts on that?
Dr. Andrew Cox:Yeah. You know, not always. Some days are good days. Some days are bad days. I think there's always gonna be a fluctuation.
Dr. Andrew Cox:There's so many elements that play into the idea of recovery and being recovered. With our more complex lives. You got family. You've got social demands. Your nutrition changes.
Dr. Andrew Cox:Your hydration changes. Things change hormonally, for the women. Maybe your sleep was off, moon phases. There are a whole lot of elements that play into it. And, to get something that's constant when it comes to your recovery and your- is it training load as easy to manage?
Dr. Barrett:Yes.
Dr. Andrew Cox:You can say, alright. I'm basically at 70 percent
Dr. Barrett:Yep.
Dr. Andrew Cox:of effort with 10 reps, 3 sets. And you can say, okay, there we are.
Dr. Andrew Cox:You can even measure it out and use in resistance
Dr. Barrett:Mhmm.
Dr. Andrew Cox:And say, okay. This is, like, this is exactly where we are. We know what our load is.
Dr. Barrett:Yeah.
Dr. Andrew Cox:But then your recovery is not always gonna be the same. So to allow ourselves a little bit of that grace
Dr. Barrett:Yep.
Dr. Andrew Cox:In that moment, I think is a really good thing. It's like, hey. If it's a good day, alright. Let's get to work. Let's have some fun.
Dr. Andrew Cox:If it's not a great day, then let's back off a little bit. It's okay.
Dr. Barrett:Yeah. Every day, I really do. I'm in the pursuit of performance, and most people would would when I when you think performance, a lot of people, I think, associate that with physical performance. Like, I'm gonna go run a PR today.
Dr. Barrett:I'm gonna go lift a PR today.
Dr. Andrew Cox:Yeah.
Dr. Barrett:But that's not really my goal. It's it's like a brain PR. I- my desire is that every day I wake up and I just feel robust mentally
Dr. Andrew Cox:Mhmm.
Dr. Barrett:And, feel healthy from a, like, a internal peace standpoint, drive.
Dr. Andrew Cox:Yeah.
Dr. Barrett:And so when I feel like I don't have the brain injury or brain energy, like, we would just- so the opposite of that's like brain fog.
Dr. Andrew Cox:Yeah.
Dr. Barrett:Or muscles are super sore.
Dr. Andrew Cox:Yeah.
Dr. Barrett:You know, it can take me to a place of, okay, how do I get back to that?
Dr. Barrett:I'm always trying to pursue and peak performance mentally. And, and so I think there is a component there that that nutrition matters and sleep matters. But talking about training, training loads, how do we know if our body is, like, physically is it- if it's close to injury? Like, is there any warning signs that says, hey, you need to back off. This is a warning sign your body's telling you.
Dr. Barrett:It's not about now about it's not really about brain, your energy levels, or your desire. We're talking about now injury state. How do I know if I'm getting close to that cliff?
Dr. Andrew Cox:Yes. Yes. So, you know, sometimes injuries just happen. Contact sports, of course. Right?
Dr. Andrew Cox:They're just gonna you're just gonna get bumped. When it comes to training injuries, though, you can decrease the chance of that by they call it, like, where do some of these injuries or pains come from? You'd be on one of 2 spectrums. You've done too little for too long.
Dr. Andrew Cox:That's a lot of the population, and then you've done too much too fast. So, really, training is sometimes going slower than we think we should.
Dr. Barrett:Yeah.
Dr. Andrew Cox:And being a little more methodical about that median of our training or maybe call it, like, the peak of our training effort, like, where that ceiling is that we're- if we're working towards some goal that you're pushing up and you're working that bar further and further up, it's going to likely be slower than you think. And so to take it, give yourself a little more time.
Dr. Andrew Cox:Start your training for the event a little slower, a little longer ahead of time. Give yourself more time. And so that way that if you have a bad day, hey. You can back it off a little bit. But you know that you've got the time to the next Yeah.
Dr. Andrew Cox:Training training day or training cycle
Dr. Barrett:Yep.
Dr. Andrew Cox:And step it up and and continue to kind of push that ball up. It's so true.
Dr. Barrett:I agree that I think where we think we should be when where we are, a lot of times are in constant conflict. And when we set a goal, usually it's shortsighted. It's a goal that we wanna accomplish in 30 days, 60 days. Let's take weight loss for instance.
Dr. Barrett:I wanna lose 10lbs in 30 days, Ain't gonna happen, nor should it even be that way. Like, healthy weight loss is probably half a pound a week. Like, that's and that's, like, aggressive and that's healthy. So when I have a conversation with a patient who's lost 2lbs in a month, I said, that's fantastic. That's amazing.
Dr. Barrett:2lbs in a month is incredible because you're nourishing your body, you're not burning your muscle
Dr. Andrew Cox:Mhmm.
Dr. Barrett:And you're losing fat as well as creating a healthy habit for longevity. So the same thing is true with training. When we think about our training load, and I think that's why it's so important to have a coach or someone to lead us in this area, hey, if we're looking if we haven't run a marathon and we're like, I'm gonna run a marathon in the fall and we're in the summer, ain't gonna happen, like, in a healthy way. You could probably do it.
Dr. Andrew Cox:Yeah.
Dr. Barrett:But we would definitely be in that injurious state.
Dr. Andrew Cox:Oh, yeah. Guy in college, he was, like, on a bet, ran a half, and, came away with stress fractures in both feet.
Dr. Barrett:Sure.
Dr. Andrew Cox:He did it. You know? But in training, made it through.
Dr. Barrett:Yeah.
Dr. Andrew Cox:But
Dr. Barrett:That's right. That's exactly right.
Dr. Andrew Cox:He was in boots after that. Right?
Dr. Barrett:That's exactly right. So are there any warning signs that even though we're on a per- let's just say we take the person who is training on a day to day basis. So they are the, you know, the weekend warrior or they are running or they're training their body. They are the mom who is working out or they're the dad who is who is strength training and they're having these symptoms of their body, like little pains.
Dr. Andrew Cox:Yeah.
Dr. Barrett:When should we think about, hey, this pain, it's been here for a week, it's been here for a month, it's been here for 3 months, is it a problem? At what point do we start to be concerned like, hey, this isn't just a little tweak, a little sense of pain. This is probably a maybe a chronic problem.
Dr. Andrew Cox:Yeah.
Dr. Barrett:What are some warning warning signs for that?
Dr. Andrew Cox:Yeah. I kind of have 2 categories there. You've got aches and pains that creep in when you're training, and then you have that general, overtraining category, where you're like, like, you have- your system is in a catabolic state instead of an anabolic state. So terms that are describing the breakdown of tissue versus the buildup of tissue. There's hormones that kinda relate to both of them.
Dr. Andrew Cox:But overtraining syndrome is a place where your body is now in a state, and there's a whole bunch of effects. There's different lenses to look at it through metabolite, hormonal, nervous system. That's one of the bigger ones that we look at where we see the balance of the nervous system sympathetic or the autonomic nervous system sympathetic and parasympathetic. And instead of there being a good balance there where you're generally in the rest and relaxation world, instead, your system is stuck in a fight or flight world. Yeah.
Dr. Andrew Cox:Hormones are more catabolic or the breaking down, side of things. In that state, we're gonna be looking at, like, fatigue, chronic stress.
Dr. Barrett:Like, your the effort is not, you don't feel like your effort matches what the schedule plan is.
Dr. Andrew Cox:Yes.
Dr. Barrett:That would be fatigue. Like, okay, I gotta run 5 miles and, like, 3 and a half, 4 miles.
Dr. Andrew Cox:Gassed.
Dr. Barrett:You're just like gassed, or... Yeah.
Dr. Barrett:I've gotta do 3 sets of 12 reps at, 80% load or 70% load or whatever it is. And on, you know, consistently, it's like the hey. I just did this last week, but this week feels like I can only get 9, 10 reps.
Dr. Andrew Cox:Yeah.
Dr. Barrett:2 reps short.
Dr. Andrew Cox:Yes.
Dr. Barrett:That fatigue, is that what we're talking about?
Dr. Andrew Cox:Yeah. Like, you're moving through sand.
Dr. Barrett:Yeah.
Dr. Andrew Cox:Like, you just, like, don't have the get up and go.
Dr. Barrett:Yeah.
Dr. Andrew Cox:You know, when you have a good day, you know it. It's like...
Dr. Barrett:Yeah.
Dr. Andrew Cox:Hey. You feel energized. You feel warm inside.
Dr. Andrew Cox:It's like you're, like, kinda percolating. You're ready to, like, let's make something happen. That should happen more often than not. Now you're running these times. Right?
Dr. Andrew Cox:And you can like, I just slept terrible.
Dr. Barrett:Yeah.
Dr. Andrew Cox:Or ate crappy because we had a big party and...
Dr. Barrett:Yep.
Dr. Andrew Cox:So you just work through it, but it shouldn't be the norm every time you get in there. It really starts to affect things. Mental clarity be one of them. And you had mentioned a time frame like a week or 2. Really, if you're really getting into the syndrome itself, we're probably talking months, like 3 to 6 months. And then that's when it starts becoming, like, don't let it get that far. Your system starts to groove this overtraining world, and it becomes much more difficult to recover that, sense of vitality that we should be living out of.
Dr. Barrett:Yeah. So if we're in this, like, chronic state of fatigue, like plateau, maybe even like chronic tension pain in localized areas for more than a month. We're now a couple months in. Hey, we're kind of in this chronic state. We gotta...
Dr. Barrett:We got to back off. We got to reassess and we gotta maximize recovery.
Dr. Andrew Cox:Yeah.
Dr. Barrett:Right?
Dr. Andrew Cox:Yes. Yeah.
Dr. Barrett:Yeah.
Dr. Andrew Cox:When it comes to local pains, maybe, give it a week.
Dr. Barrett:Yeah.
Dr. Andrew Cox:2 max. Okay. And then it's like, hey, let's start, let's start to...
Dr. Barrett:So if I have- so if I'm bench pressing, I've got a, let's just say, a chronic pain in my left shoulder that's been there for 2 weeks every time I press every time I bench press.
Dr. Andrew Cox:Yeah.
Dr. Barrett:Should I be concerned?
Dr. Andrew Cox:I'll start to ask questions at that point. Right? Because sometimes, like, again, you move funny, you push the limit just a little hard, that's good. You know, we wanna wanna push the bar up. But it's like, ow, that that's a real pain.
Dr. Barrett:Yeah.
Dr. Andrew Cox:And there's a difference between a muscle pain.
Dr. Barrett:That's right
Dr. Andrew Cox:And a pain pain, and we know what that is.
Dr. Barrett:Yeah.
Dr. Andrew Cox:It's a signal.
Dr. Barrett:Yes.
Dr. Andrew Cox:The body's just talking to you.
Dr. Barrett:That's all it is.
Dr. Andrew Cox:Pain is not a bad thing. It's a good thing.
Dr. Barrett:Mhmm.
Dr. Andrew Cox:Kids who don't have pain, they don't survive. There's...
Dr. Andrew Cox:Yes.
Dr. Andrew Cox:Terrible stories about that. So pain is a good thing, a signal for us. We- but we listen to it.
Dr. Andrew Cox:We do need to respect it.
Dr. Andrew Cox:Yeah.
Dr. Andrew Cox:And after a couple weeks, it's worth considering what's going on, asking about mechanics, asking about training load, asking about overall recovery state
Dr. Barrett:Yeah.
Dr. Andrew Cox:Where we are with that.
Dr. Barrett:That's good. Yeah. Now going on to the other side, you know, the person that isn't that let's they're not they're undertrained, which is most of our general population, undertrained, underworked, physically overworked, mentally, chemically, nutritionally.
Dr. Andrew Cox:Yes.
Dr. Barrett:And what we find here is that they're in pain every day.
Dr. Andrew Cox:Yeah.
Dr. Barrett:But it's not because of training. It's because of poor nutrition, poor movement, decreased movement, no movement, poor sleeping habits.
Dr. Barrett:They're not getting adjusted. They're not doing healthy, like, mobility programs, whatever. We can keep going on the list.
Dr. Andrew Cox:Yeah.
Dr. Barrett:So these people, now you all of a sudden start moving them and they hurt more, and they're like, woah.
Dr. Barrett:Woah. Woah. I'm not supposed to hurt more. But yet we have I have this conversation with patients all the time. We want you to move through your pain, not just always stop when you feel like, hey, this is this is hurting.
Dr. Barrett:This is hurting. This is hurting. No. It's okay to actually hurt as we move and explore movement and range of motion. It's expected that you may actually feel sore the next day. How do we how do we speak to this population group that's like, hey, okay, I'm not moving, but I feel like every time I do move, I hurt. What should this, like, next step be for this person?
Dr. Andrew Cox:Yeah. This is the chronic pain world.
Dr. Barrett:Yeah. This is the chronic pain world.
Dr. Andrew Cox:Yeah.
Dr. Barrett:Which is super, you know, neuroscience, chemistry, nutrition. There's a lot of things that go into it. And there's also the emotion we tie into the mind and how we perceive pain.
Dr. Andrew Cox:Yes.
Dr. Barrett:Is so important as well.
Dr. Barrett:Yeah.
Dr. Andrew Cox:Is it a threat?
Dr. Barrett:Is it a threat?
Dr. Andrew Cox:Or is it just a signal?
Dr. Barrett:Yep.
Dr. Andrew Cox:Because sometimes it is. Sometimes our body because of physiological processes, Hyperanalgesia or allodynia are terms that we use to describe, like, pain that's beyond what we would typically expect, and they kinda delineate it in funny ways. But but, basically, we can have pain from something that isn't threatening or harmful to our body. And people in chronic pain are experiencing that kind of thing and really got to start to start to frame life and that pain in a different way. So we're gonna say, alright.
Dr. Andrew Cox:Pain is a signal. It's not a threat.
Dr. Barrett:Yeah.
Dr. Andrew Cox:We're going to acknowledge the signal, but we need to frame it, and we need to set it off to the side over here and realize that we have the rest of life over here. That's good.
Dr. Andrew Cox:We have function. We have the things that we love, the things that we enjoy, and we know what, like, a healthy life looks like. And so let's pursue that and move towards that despite what this pain is doing over here. Oftentimes, that pain will resolve if we just stay the course, move in the direction of resilience, building strength, doing the putting the right things in our bodies, putting the right things in our minds, being healthy socially
Dr. Barrett:Yeah.
Dr. Andrew Cox:Participating in things we enjoy
Dr. Barrett:Yeah.
Dr. Andrew Cox:The pain will resolve. Not always. Sometimes it's there, and that's okay. Because now we've we've said, okay. We've got this over here, this pain, but we've reclaimed what we had lost because of it before.
Dr. Andrew Cox:That's right.
Dr. Barrett:Yeah. It's the win. Right? The win is alright. We're gonna go through this.
Dr. Barrett:We're gonna get you stronger. Fitter. More efficient. We're going to create movement patterns you haven't explored in a while.
Dr. Barrett:We're going to sit down standing up bending over reaching overhead. And what if you still had pain but had all of that movement back? Versus just had pain and had none of that functionality, anybody would take the pain then doesn't matter. It's the functionality that matters. Right?
Dr. Andrew Cox:Mhmm.
Dr. Barrett:And I think in our society, we just expect that we're supposed to be pain free.
Dr. Andrew Cox:Mhmm.
Dr. Barrett:But this is not true. We we should expect injury. Right? We should expect pain.
Dr. Barrett:We are all gonna experience trauma, injury, and pain through our life. Right? At one point in our life, we're gonna experience something of that nature.
Dr. Andrew Cox:Yep. Yep. For sure.
Dr. Barrett:But has that kept us from continuing to explore movement and functionality, and that's where reclaiming life and freedom is so important. Regardless of pain, are we still moving the direction of a body motion stays in motion?
Dr. Andrew Cox:Yes. You said it many times in the clinic. Like, someone comes in and they're the kind of person already that has that mindset, that I'm gonna get better. Like, what's the number one predictor of low back pain in their recovery? The belief that they will get better.
Dr. Barrett:Absolutely.
Dr. Andrew Cox:The mind that creates the hope and the positive expectation, drives the actions in someone's life that will build, the positive recovery. It's great. And so realizing that says, okay. Let's get back to, like, our fundamental beliefs about pain and what it is and not let that pain because it does. Right?
Dr. Andrew Cox:Chronic pain, it turns our eye inward.
Dr. Barrett:It does.
Dr. Andrew Cox:Instead of focusing outside, we're focusing inside our body.
Dr. Barrett:It does.
Dr. Andrew Cox:Yeah.
Dr. Andrew Cox:Depression kinda thing set in, and all of a sudden, our world gets smaller and smaller.
Dr. Barrett:Yeah.
Dr. Andrew Cox:And smaller.
Dr. Barrett:Yeah.
Dr. Andrew Cox:And that's not the way we live.
Dr. Barrett:Yeah. I mean, perfect example is Robert: Bob who's got the shoulder issue. And every day, you talk to him. How's the shoulder? It's better.
Dr. Barrett:It's it may be 5% better, but it's better. You know? It's better. I can go here now before I go here.
Dr. Andrew Cox:Yeah.
Dr. Barrett:You know?
Dr. Andrew Cox:Celebrating our wins.
Dr. Barrett:Yeah. But it's better. You know, it's 1% better. It's 2% better. It's 5% better.
Dr. Barrett:It's 10% better. Few weeks, now he's doing things he's never done before because he's committed to I'm going to get better.
Dr. Andrew Cox:Yeah. Yeah.
Dr. Barrett:And he's also committed to saying, hey.
Dr. Barrett:What what I'm doing is good for me regardless of how I feel. I know this is beneficial. I know this is good. I know this is nourishing. I know this is right.
Dr. Andrew Cox:Yeah.
Dr. Barrett:A lot of in nutrition, a lot of people, I say, hey. We need to go this route nutritionally, and they're like, I didn't feel better. It's been 3 days. I don't feel better.
Dr. Barrett:It's been a week. I don't feel better. It's been a month.
Dr. Andrew Cox:A quick fix.
Dr. Barrett:Yeah. It takes time and repetition repetition To create healthy patterns and for your body and nervous system to respond accordingly.
Dr. Andrew Cox:Healthy patterns. Yeah. Like, we're trying to- it's not a P 90 X...
Dr. Barrett:That's right.
Dr. Andrew Cox:thing. It's it's not just 90 days. It's how can we rebuild, healthy habits, lifestyles, routines. People come in doing rehab 2, 3 times a week. We're like, hey.
Dr. Andrew Cox:Like, you are creating the foundation for you not being in this kind of pain anymore. You can't just stop 2 or 2 times a week, whatever this routine is, you need to continue it afterwards because this is, you'll just revert right back to that state where the pain began.
Dr. Barrett:And you're- okay. So we're gonna leave today's episode with some practical applications. So in your space of recovery we're talking about how to improve recovery so that we can continue training load continue our training load
Dr. Andrew Cox:Mhmm.
Dr. Barrett:Continue our progression of whatever our desires are. What are- give me 2 to 3 things that you feel like are a necessity when it comes to recovery, whether it's nervous system, metabolic, emotional, or physical. Give me a couple things give the listeners a couple things that you love to focus in on when it comes to recovery.
Dr. Andrew Cox:Yeah. In nutrition, it's huge. We our body burns a lot. And in training specifically, we are asking a lot of our body. We're breaking things down.
Dr. Andrew Cox:We're challenging it. And if we're not fueling a well and has nothing to draw from, then have the right things to draw from. Or if our gut biome is goofed up, then there's just- you're just not gonna get there. You can train as hard as you want, but you're working against yourself. You're breaking down instead of building back up.
Dr. Barrett:That's good.
Dr. Andrew Cox:Sleep is a huge one. That period of recovery, I think it's more mental than physical, the reorganization of the brain. Because, right, it's very alive at night even though your body is still reorganizing, processing, resetting for the next day. Even an hour less than you would typically need over time has profound impact. And there's so many studies regarding sleep and, athletic performance and high level athletic performance and recovery.
Dr. Andrew Cox:In that world when it comes to training and the higher levels of training. It's a huge topic.
Dr. Barrett:Yeah. 1 to 2 hours of reduced sleep increases your injury risk by like 20%. That's significant. It's not in like a year. It's 20% increase in during risk within a couple weeks.
Dr. Andrew Cox:Yes.
Dr. Barrett:That's how important sleep is for sure.
Dr. Andrew Cox:Yep. Yeah. And other than that, you know, I think just mindset when it comes to our training, Are we being smart about it? Not letting our ego get the best of us, playing the long game. I wanna be training so that, so when I'm 70, I'm still getting after it.
Dr. Barrett:Yeah.
Dr. Andrew Cox:There's guys down here at Rhema and over at armor, and they're they're 60, 70, and they're getting after it.
Dr. Barrett:They're getting after it.
Dr. Andrew Cox:And I love it.
Dr. Barrett:Yeah.
Dr. Andrew Cox:Don't wanna, like, kill myself. I don't wanna keep on, like, PR ing for forever.
Dr. Barrett:That's right.
Dr. Andrew Cox:As if that's gonna prove something here in my, like, thirties or forties. Break everything down and then live in a chronic state of overtraining and have nothing to give later on in life.
Dr. Barrett:What I love about how you view physical therapy is you move people. You get people moving restoring function. You're not just hooking them up to a bunch of machines and and billing their insurance, 100 and 1,000 of dollars. You care about the person, you care about their mind, their mindsets, you care about their training load. And so you have a beautiful way of helping people overcome injuries, becoming resilient, and returning to high levels of function. So we appreciate everything that you do. Today's episode is really kind of framing out recovery, but also just talking about the science of what happens to the body when we are potentially in a under recovered or over trained situation. Don't let yourself get there, we're here to help. So feel free to reach out to the Real Health Company through the Health Factor or Armor Health and we'd be happy to help and serve you in any way possible.
Dr. Barrett:As always, thanks again for listening to another episode of the Real Health Podcast.
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