Strength Training: Myths Busted, Benefits Unveiled!
Welcome to the Counter Culture Health podcast. I'm doctor Jen McWaters. And I'm coach Kaitlin Reed. We're here to help high achieving women overcome mental blocks, find freedom from anxiety, create an abundant life, and build the body and life that they deserve and desire. In this weekly podcast, we'll uncover the raw truth about mental health, nutrition, fitness, and beyond. Let's get to it.
Kaitlin:Hey, friends. Welcome back to another episode of Counter Culture Health.
Kaitlin:Today, we have a repeat guest on, Jordan Reed, who is a doctor of physical therapy who specializes in movement and optimizing physical function across the lifespan. So we brought him back again today, because we have more questions from listeners that we wanted to get detailed and professional answers from. So if you haven't listened to the last episode, you can go back and listen to that where we talked about, importance of warming up before workouts, knee pain, training through injury, lots of good stuff. And today, we are going to cover a lot of other great topics. So welcome back, Jordan.
Kaitlin:Thanks for joining us again.
Jordan:Yeah. Thanks for having me back. Must must have been okay the first time. So, appreciate you guys having having me back on.
Kaitlin:People enjoyed it and learned a lot. So we are look looking forward to learning some more today. And first, we wanna start off with a big one. Debunk the myth that strength training is dangerous.
Jordan:Yeah. That's a that's a big one. I hear I hear that a lot. And I think when people ask me this, my my response is like, well, what do you mean by dangerous? Because, like, lots of things that we do are dangerous.
Jordan:You know, riding in a car is dangerous. Walking across the street is dangerous. So what do you mean by dangerous? And I think what most people, mean by dangerous when they say strength training is dangerous is they're afraid that they're gonna get hurt, and and they're afraid they're afraid of injury. And so one of the things that I talk to, patients and people about a lot is is just how low injury risk is with strength training just to just across the board.
Jordan:Probably the largest study to look at this was actually a study done by the by the US army. The army does lots of really good, studies on strength training and physical fitness. Number one, because, soldiers need to be physically fit. So that's very important. But number two, they have a bunch of, people that basically have to participate in the research studies as a as a condition of their their, employment with the army.
Jordan:So they have a good captive audience of of people, to put through these. So there was about 5,200 people, in this study with the army. And what they found was that the injury risk was about two point six injuries for every one thousand hours of weight training. So that's an extremely low injury risk. You know, if you follow the American College of Sports Medicine's recommendations for strength training, so that's two strength training, workouts a week of thirty to forty five minutes, you're gonna strength train for about seventy eight hours a year.
Jordan:So you are way under that one thousand hours. If you compare that to other popular forms of exercise like running, runners have about one injury for every one hundred hours that they run. So much, much, much lower, than than running is. So I think if you're looking at forms of exercise, strength training is extremely low risk, with a little asterisk that if done properly. So one thing I would say about that is if you are not comfortable, you know, training on your own or coming up with with a type of program, really seek a qualified professional out to help you set that up, and make sure that they're prescribing you, exercises that are appropriate.
Jordan:They're prescribing you a program that's appropriate, for your kind of baseline, you know, activity level and for your training history. You know, setting up a program for somebody that's a complete novice from for from for, from strength training is completely different than, you know, if you're looking at somebody who has a history of strength training even though they might have been away from it for a while. You know, if they were a high school or college athlete or engaged in a good strength and conditioning program, have some training years built up. Those are two very different things. And so, you know, a a professional that's setting up a program should be asking you those types of questions.
Jordan:You know? How comfortable are you with strength training? What's your history with strength training? What's your baseline physical activity like? You know, asking asking you, you know, about your musculoskeletal health and any injuries, you know, those types of things and then creating a program for you around that.
Kaitlin:Where do you think the myth came from? Why do people think it's dangerous?
Jordan:You know, I don't I don't really know where that comes from. I I think I think a lot of people just see the activity and think that it's dangerous. They think lifting weights is dangerous, you know, which, you know, you you compare it again to running. So, you know, when you're running, you know, peak peak force through your lower extremities is gonna be, like, three to four times your body weight. You know, put three to four times your body weight on a bar and try to squat it.
Jordan:Like, you know, it's just it's not gonna, you know, it's not gonna happen. So, I I think people just look at the activity. I also think that the strength training that people are exposed to, a lot of times is, like, the most dangerous types. You know, you see bodybuilders who engage in hours and hours and hours a day of of weight training when most people only need to do sixty to ninety minutes a week. You know, you see that.
Jordan:You see power lifters, who are really you mean, they're lifting multiple times their body weight. You know, you see the the, CrossFitters or or things like that where, you're lifting high loads at high velocity for high repetitions, which is going to expose you to increased risk of injury. So, I think people see a lot of that. I also think, you know, there's probably, a lot of bias in people's assessments because they they have, like, a very few amount of friends that weight train. And then they have one or two of those friends that get injured, and then they just assume that every single one of every single person that lifts weights get gets injured.
Jordan:So, I I think that's a big a big part of it too. You know, and I think too that there's probably some important things like it you know, when you take an exercise testing and prescription class or, you know, you sit down to get your ACSM certification or your CSCS certification. You know, there's some things that, when you're looking at a program, it's really important to pay attention to that can actually really reduce your your risk of injuries. And so some things that we kind of already talked about, but, like, frequency of weight training. So, you know, most people, two to three times a week is what you need.
Jordan:That's what you need to maintain strength levels. That's what you need to maintain bone density. That's what you need to maintain metabolic health. You know, so looking at that frequency. And then then also the time, you know.
Jordan:So how long are you spending per session? You know, again, most people need thirty to forty five minutes of weight training. You know, you don't need a two hour long marathon session. You know, you're not trying to build 20 inch most people aren't trying to build 20 inch biceps. You know, you just wanna be strong enough to be able to, you know, do your daily things and reduce injury risk and, you know, lead a healthy life and and be metabolically healthy.
Jordan:So time is something to pay, attention to. And I kind of already hit on the other one, but but it's tight. You know? So with weight training, there's like a load force velocity relationship. So, you know, you can think of that like with with low weights, you can move that weight, you know, faster.
Jordan:With higher weights, you're gonna move the weight slower. But what a lot of people see is they see people trying to move high weights fast. You know? So you think about those explosive Olympic lifts and things like that. And those do carry some injury risk, especially if you're not, you know, trained in them and and doing them appropriately.
Jordan:Those also take a lot of, knowledge and experience to be able to load and progress correctly. If you see somebody who's training Olympic weightlifting, they're doing very little, Olympic weightlifting. And what they're really training is they're breaking that movement down into, its various parts and they're training those parts just because those activities are, very demanding on your central nervous system and you'll fatigue very quickly. You know? So you weren't meant to do, you know, 30 overhead snatches in a row.
Jordan:You weren't meant to do, you know, 50 cleans in a workout. That that's just not what those, exercises were designed to do. You know? They were designed to produce power. And if you think about the energy systems in the body that produce power, you know, those are, like, less than ten second type of deals.
Jordan:You know? So people are using them to train energy systems that those lifts just weren't trained, to develop. And so that's where injury comes into play. And then the last thing is progression. So I'm a I'm a big fan, for most people of just linear progression, and that just means you're just gonna slowly build up your weight over time.
Jordan:And and what I tell people is you really wanna look at your total load that you're lifting, and you wanna keep that to 10% or less as you start to progress. When you start to get over that 10%, then you're really going to start, to expose yourself to a little bit more injury risk. You know, take it slow and, progress slowly, and you you'll be just fine. In my own in my own training, you know, I still use kind of a percentage of one rep max, you know, to to base all of my lifts off of. But when I do my calculations for my lifts, I start them at 90% of my one rep max.
Jordan:So all of my lifts are based off of 90% of my one rep max, so I'm always I'm always below, you know, kind of that one rep maximum. And you can get good strength gains, you know, lifting, you know, 80 between 6080% of your one rep max. You know, you don't need to be, you know, at at 85%, you know, for for very long, or for for a lot of reps to get strength gains.
Jen:Can I ask a quick question here? Yeah. Jordan and also for Kaitlin too as you guys are in this world, but, it sounds like you're talking about the traditional way of identifying appropriate weight and doing that specific weight for multiple reps. They have also heard a philosophy of starting with a lower weight and then working up until you basically are fatigued or, like, you can't lift anymore. Is that no more longer recommended?
Jen:Is that are you more prone to injury if you do it that way where you basically lift until fatigue didn't go up in the way until the max that you can lift? What are your thoughts on that?
Jordan:I think it all depends on the exercise that you're doing. You know, some some exercises are going to have, I think just kinda more injury risk just based upon, the the characteristics of that lift. You know? So we talked about Olympic lifts. You know?
Jordan:You never wanna do Olympic lifts to failure. I just think that's a really bad idea. You know, when we talked about the, you know, you talked about the snatch or the clean and jerk. I mean, you've got weight above your head. You know?
Jordan:So you don't wanna be you don't wanna be in a position where, you you're reaching muscular failure, there. You know, things like the squat, you know, you definitely wanna be careful with. You know, bailing on a squat is a skill that you should be taught. You know? But if you're lifting machines or lifting, like a Smith machine or a cable column or a weight stack or a selectorized machine, there's much less risk of of going to failure on those.
Jordan:One of the things that I've always told people in the past is you should, I call it the 10, not 12 rule. You know? So you should pick a weight. You know? So if you're if you're just looking for general muscular health, you know, you want the metabolic benefits of lifting weights, pick a weight that you can do 10 of but not 12 of.
Jordan:And then, you know, so if you're doing that weight and you can do 12, then it's time to add more weight. So that that's the 10, not 12 rule. Reps in reserve is kind of a big, philosophy in in strength and conditioning where, you know, trainers or or strength conditioning coaches will tell, you know, clients or athletes, hey. Keep two reps in reserve. Meaning, you're gonna lift a weight and you're gonna stop when you think you can do two more.
Jordan:So that's kind of another strategy that you can do, and that's very similar to, like, the 10, not 12, you know, type of thing. So, those are kinda two two ways that you can you can program. You know, generally, you know, if you're lifting for for strength or you want some you're doing compound movement. So if you think about doing, you know, squats, dead lifts, bench presses, overhead press, I always tell people, you know, four to six sets of four to six reps is kinda where you wanna be at. You know, and then when you hit those assistance lifts, so you're talking about machines or dumbbells or or that type of thing, you know, you can follow that 10, not 12 rule or those two reps in reserve.
Jordan:And then that'll that'll get you, you know, pretty good results, you know, especially if you're slowly progressing that over time.
Jen:Very helpful.
Jordan:Yeah. And I think too, like a big thing with strength training, you know, a lot of it depends on your goals. You know, so if you're if you're looking like, if you're an athlete looking for some type of, you know, performance improvement, you know, you need to be working with somebody that that understands the sport and can program you to the demands of that sport. If you're somebody that's looking for some type of aesthetic benefit to working out. You know, you need to be with somebody who understands, you know, how to program exercises to to get aesthetic benefit, to to get muscle mass in the right places, and then also diet's a huge part of that.
Jordan:You know, but if you're if you're someone who who just wants to be healthy, who just wants to be strong, who wants to, you know, have longevity, then that that's a little bit different. So, you know, finding people to help you work on your goals, it's really important to find those people that understand understand what your goals are and have the knowledge and experience in those areas.
Kaitlin:Yeah. I think the interesting thing is that, you know, smart strength training actually prevents you from getting hurt and injured rather than contributing to and causing it.
Jordan:Yep. I have my my number one rule of of training, especially when you're over 35, is, like, don't get hurt Because because it it number one, it keeps you from training, which is probably more detrimental, you know, in my mind is more detrimental long term, than an injury. You know, so that's really like my number one rule is don't get hurt. So, you know, like when you hit 35, like there's no ego lifting anymore. Like there's no, like, you know, like, I have a thirteen year old son now, and, you know, all him and all of his friends wanna know, like, how much you bench?
Jordan:You know, how much you squat? And I'm like, I don't know because I don't do that anymore because, you know, the last thing I want is the is the Terra Pak, you know, trying to trying to ego bench press or, you know, something else. So, you know, when in doubt, you know, keep it light and, you know, maybe get an extra rep or two. But, yeah, no no ego lifting. You know, don't get hurt.
Jordan:So
Jen:That's my motto in life right now since I'm almost 40. Just whatever you do, don't get hurt.
Jordan:Yep.
Kaitlin:Don't recover like me used to. Definitely don't.
Jordan:Oh, and and one last thing. I'll I'll get on my soapbox a little bit, and this is probably, another topic for another time. So there's this whole thought around strength training, just being dangerous in general, but where you really hear a lot of information is strength training in in youth. You know, and you hear a lot of those old wives tales about it's gonna stunt their growth or it's gonna damage their growth plates or that type of thing. There's just so many, myths around youth strength training, and I hear a lot of that now because I've got a a 13 year old, a 10 year old, and a and an eight year old.
Jordan:And so I hear I hear that a lot. The American Academy of Pediatrics in 02/2008 came out with a stance that strength training is safe in children. They revised that opinion in 2024 and said it's not only safe, but it's effective and necessary. And they said it was necessary to combat childhood obesity and the sedentary lifestyle that a lot of children have now. So, we can talk about this at a different time, but strength training is definitely safe for kids.
Jordan:And I would even go one step farther and say most kids should be strength training in some way, shape, or form.
Jen:I love that. I see my thoughts on that one. Yeah. That's interesting. That can be a whole another episode, so I'm gonna
Jordan:episode on that.
Jen:Yeah. Go there.
Kaitlin:Love that. Yeah. Let's jump into the next one, that kinda goes along with, injury. And I think we kind of all know that the most common injury with aging is falling and breaking a hip, never recovering, and then it, you know, can lead to unfortunate circumstances. So how important is strength training as we age?
Jordan:Yeah. So I guess I'll just talk about hip fractures for just a little bit because I think, kind of understanding hip fractures really gets at the importance of strength training as you age. So, I live in a rural area where the population's a little bit older. I work at the largest hospital for a hundred miles. We have a great, orthopedic surgery team and orthopedic surgery practice in the community, and we see a ton of hip fractures, just because of our our location and our our population.
Jordan:So it's something that I have worked with a ton, in my career, and I have lots and lots of experience working, with patients post hip fracture from, like, immediate post surgical, like, all the way through the rehab process. So, I've I've seen this a lot through my career. I've probably rehabbed hundreds of people, post hip fracture when you talk about both acute, and outpatient rehab. Eighty seven to ninety six percent of all hip fractures occur in people that are 65 and older. So it's very rare to fracture your hip below sixty five, very common, if you're a hip fracture patient to be over 65 years old.
Jordan:One year mortality, for patients that fracture their hips is twenty seven percent, so it's pretty high. And your risk of mortality, after, having a hip fracture is three times higher than the general population. So really important that we try to do what we can to prevent hip fractures because the the morbidity and mortality following hip fractures, is is extremely high. So it's a significant life event, when it happens to these people. And so number one, we wanna prevent them.
Jordan:And then number two, once it once it happens, we really wanna do a good job of, rehabbing these patients, reducing their fall risk, getting them healthy, so that, you know, we're really reducing those those, mortality factors. No.
Jen:We're getting can I inter sorry? I interrupt you. Is there a difference in gender with the risk of hip fractures? Is it more common in women versus men?
Jordan:Well, that's interesting. So it's more common in women, but the risk of mortality is higher in men. Okay. Why do
Jen:you think?
Jordan:Well, I think, men tend to have more comorbid health conditions. And so and that that's a big that's a big thing when it comes to hip fractures is, comorbid conditions. So a lot of people think, well, it's you know, they had a hip fracture and, they just kinda get weak and pass away after a year. Well, a lot of it just has to do with complications of their comorbid conditions. You know, whatever they had underlying prior to their hip fracture just got worse afterwards.
Jordan:And so it's really important when we talk about, like, causes of falls. So, you know, obviously osteoporosis is a cause of fall. You know, we'll get a handful of patients every year where actually the hip fracture causes their fall. The fall didn't cause their hip fracture, so they were standing up or doing something, and they had immediate sharp pain in their hip, and then they fell down. And they actually just fractured their femoral neck, just doing normal activity because their osteoporosis was so severe.
Jordan:So, you're looking at osteoporosis. Obviously, loss of balance. So, as we age, our our nerves don't fire as faster as well as they did when we were young. Our muscles get weaker. And, what that does is that really your joints get stiffer, and that reduces your ability to recover from a loss of balance.
Jordan:So if you think like, hey. You know, you turn around quick in the kitchen or something, you lose your balance, you can take that quick step and recover. As you get older, that quick step isn't so quick anymore. And so, you know, before you know it, you know, you're you're on the floor. And then really the last cause of falls are a lot of those comorbid conditions that we talked about.
Jordan:So if you think about, like, pulmonary conditions, so COPD, emphysema, reduced lung capacity, people get short of breath and they get fatigued, and they get tired. And so if you think of if you think about, hey. You know, somebody might walk from one house one end of their house to the other, and by the time they get to that other end of the house, they're so winded, that they just collapse and fall over. So that can be a risk. All kinds of circulatory problems, that can be anything from blood pressure issues, you know, arthrosclerosis, cardiac issues, can cause people to fall.
Jordan:So if you can't regulate your blood pressure or you have really high blood pressure, people will actually, they'll pass out or they'll lose consciousness in standing, and they'll fall and they'll they'll, have a hip fracture. Nervous system disorders. So, those can be, you know, neurological diseases like like Parkinson's disease. Very common to see people with Parkinson's disease fall. Also, you know, complications of diseases like diabetes.
Jordan:You can have peripheral neuropathy from diabetes, and so you can't feel your feet. So if you think about, you know, trying to walk around with numb feet, that's a huge fall risk. So you you see that. Cognitive issues can be a big thing. You know, as people age and if they suffer from, you know, a poor cognition, one of the things that happens is your ability to multitask goes down.
Jordan:So if you think about, hey. You know, I can talk and walk on the phone or I can, talk on the phone and walk pretty easily, but that the that ability might go down in in age. Or as you're walking and you get distracted, people can lose their balance. That's actually an intervention that we use very commonly when we're working with patients on balance is multitasking. So we'll ask them to do a cognitive task while we're working on balance activities.
Jordan:You know? So that may be something like, just saying the alphabet, counting to 20 by even numbers, you know, asking them to, you know, sort things or, visually recognize things while they're doing a balance task. That's all multitasking. And then poor vision is a big cause of of loss of balance. So, your vision is an integral component of maintaining your balance.
Jordan:And so if you have anything that's affecting your vision as you age, that can cause falls. So you think about cataracts, glaucoma, macular degeneration, a lot of those, eye diseases that that people, can suffer from as they age can be a big contributor, to to loss of balance. So, I just don't think a lot of those comorbid conditions, kinda get enough attention when we're talking about preventing preventing hip fractures. And that's just kind of, the importance of being healthy in strength training. So you think about all the benefits of strength training and how they limit, those comorbid conditions.
Jordan:So, you know, you talk about osteoporosis. Well, strength training is great for helping to maintain bone density. It's not the only thing, but it's a large contributor, to that. You talk about, you know, nervous system decline. Well, one of the best benefits of lifting weights that nobody ever talks about is how it's really good, for maintaining efficiency of neuromuscular conduction.
Jordan:You know? So nerves that nerves that fire together wire together. So, if you're not firing those nerves on a regular basis, your body just doesn't maintain those connections. So you talk about, like, response time. There's been some great studies done of the effect of strength training on recovery from loss of balance and reaction time.
Jordan:So maintaining your strength levels can, improve your your reaction times and help prevent falls. So that's another great benefit. And then, obviously, you have the pulmonary and cardiovascular benefits of exercise. You know, heart disease is the number one killer of people in The United States. So anything that you can do to maintain that cardiovascular system, is gonna help prevent those cardiovascular causes of falls.
Jordan:Lifting is great, for the blood pressure response, because as you lift and peripheral, pressure goes up on your on your vascular system, your body has to regulate all of that. And you get a lot of blood pressure changes during exercise. So, that's another really good, benefit of strength training.
Kaitlin:I think that's one that a lot of people don't realize, the benefits of strength training of how well that translates to cardiovascular health, not just cardio.
Jordan:Right. Yeah. I mean, you know, we we talked about kind of doing, like, a max effort lift, you know, on the previous question, but, like, do a max effort lift and tell me how your cardiovascular system feels after that. You know? It it it can be cardiovascular exercise.
Jordan:Yep. Yep. And you do have to be you know, and, again, you have to be a little bit careful about that, you know, just because, you know, one of the things with with strength training and the effects on the cardiovascular system is it'll it'll actually increase the the thickness of the left ventricle so that muscle in your heart gets thicker. Now most people aren't going to lift to the point where that becomes a problem, but you wanna balance that with some cardiovascular activity because actually what the, you know, cardiovascular exercise increases venous return. So actually what it'll do is it'll help dilate that left ventricle.
Jordan:So if you do strength training and you do cardiovascular exercise, what happens is you get a really strong heart wall muscle, and you also get a heart that accommodates, blood flow really, really well. So you can get a essentially, a big strong left ventricle to help, pump blood really efficiently.
Jen:So fascinating. Yeah. I love that stuff. Like, those are the things I think about when I'm struggling with my own motivation. It's like just thinking about the internal things that are happening.
Jen:I like that stuff. Yep. Especially that you mentioned osteoporosis since you were linking that to women are more likely to fall, break their are more likely to break their hip. And osteoporosis obviously is more significant in women, the hormone changes in menopause. So I think that's such a great thing to highlight since a lot of our listeners, most of them are female, but also, often older and just that's usually the population that struggles with weight lifting and training.
Jen:I mean and even when, you know, younger women too that I work with talk to, it's like cardio is the go to thing. Caitlin and I spent hours talking about that in our podcast, personal weight lifting. So I just love hearing more perspectives and science on why it's important, why it doesn't have to be scary, why you're not gonna get injured by doing it. And And if anything, you're gonna prevent injury by doing more of that. So I just love that you brought that up and tied that together.
Jordan:Yeah. I think, when you look at the cumulative effects of of strength training when it comes to, you know, things like, a hip fracture. You know, one of the concepts, that that we talk about a lot in in medicine is a concept called physiological reserve. And so physiological reserve is just your body's ability to maintain homeostasis when your body is challenged. So when you think about, hey.
Jordan:When I get sick or when I'm injured or whatever, how much capacity does my body have to keep doing what it needs to do to keep me alive? So when you talk about a hip fracture, well, hip fracture is a big deal. You have the injury, but you also have, like, a pretty significant surgery afterwards. So at the least, you're gonna end up with, a really nice screw in your hip. You know, at the most, you're gonna end up with a total hip replacement.
Jordan:Those are big surgeries. And then you have the anesthesia and and everything on top of that. So, if you've been if you've been strength training or you've been exercising and you have some physiological reserve, so you've increased your body's capacity to maintain homeostasis, which exercise and strength training does, your recovery and your mortality after something like that is gonna be so much better than somebody that is sedentary, you know, and has a lot of comorbid conditions. Those comorbid conditions really chip away at your physiological reserve. So they make they make everything harder.
Jordan:And then especially when you have a big event, you know, like a hip fracture, recovering is gonna be very, very hard. And that's why you see that mortality risk so high is, you know, people's bodies just cannot overcome that challenge, you know, to to homeostasis. And so you're just you're you're at a runway at that point, you know, and you start to see, people decline.
Kaitlin:Yeah. One of my favorite parts about exercise is that it increases your ability to tolerate stress and just makes you more resilient.
Jordan:Yep.
Kaitlin:Yep. Okay. Our next question, because this is also very common among, you know, the general population is back pain. So what contributes to this back pain, and what can we do to fix it and relieve it?
Jordan:Yes. You're talking about sciatic pain here?
Kaitlin:Could be or yeah. Or back pain in general. Yeah.
Jordan:Yeah. So, you know, sciatic pain is is something that, you know, we we see a lot in, outpatient physical therapy. It's it's I won't say I don't I don't know how common it is. It's common to me because we see it a fair amount. So, it's one of those things that that that comes in.
Jordan:But really, sciatic pain is just it's an irritation or compression of that of the sciatic nerve. And the sciatic nerve is the largest nerve in your body, and it's comprised of, nerves that come out of your spine. So the l four level through the s three level. So it's, like, five levels of nerves. When we did our gross anatomy, cadaver dissection in physical therapy school, dissecting the sciatic nerve is pretty cool.
Jordan:It is it is a big honking nerve. So, I mean, it is it is like I don't know. People can't see, but it's like this it's like this big around or can be this big around. If you've got some large males in your anatomy lab, I mean, it's it's like approaching garden hose level thickness. Like, I mean, it can be it can be Like
Jen:a quarter. It looks like a quarter roughly or bigger.
Jordan:Yeah. About a yeah. It's probably a pretty good that's probably a pretty good, size. And so it's a it's a big honking nerve down the back of your leg. So, and and once those nerves come out of your spine, they actually go down through your pelvis.
Jordan:They they exit, a opening in your pelvis called your greater sciatic foramen. It crosses underneath a muscle called the piriformis, which we'll talk about a little bit later, and then it goes down the back of your leg, k, kind of between your hamstring muscles. And then when it gets behind your knee, it splits. So it splits into two branches and, one branch is called the tibial branch that goes down the back of your of your lower leg, like your calf area, and then it splits into your common peroneal nerve, which kinda goes down the side of your leg into your foot. So if you think about something that starts kind of at the level of your belly button and runs all the way down the back of your leg to your big toe.
Jordan:So that's your that's your sciatic nerve. And like I said, it's a it's a big honking nerve, really cool structure. You know, if you ever go to, like, a body exhibit or you have a chance to go through, a, anatomy lab or whatever, check out that sciatic nerve because it it's it's it's pretty neat. But the function of that sciatic nerve so it's both a motor nerve, which means it conducts, signals from your spinal cord to your muscles, and it's a sensory nerve, so it picks up sensation. It innervates all the muscles, so it controls all the muscles on the back of your of your thigh and in your lower leg, and it provides sensation over or kinda your lower leg and your foot.
Jordan:So if you look at your, you know, everything below your knee, it's kinda like everything on the outside and the back and the top and the bottom. There's just a little portion on the inside of your lower leg that's not, where the sensation isn't covered by your sciatic nerve. So big nerve, does lots of things, and so there's lots of opportunities for this nerve to kinda get irritated. And so when we have somebody that comes into the clinic, you know, sciatic nerve pain is always kind of, I guess it's it's not fun for the patient, but it's fun for me. It's an interesting thing for me because, because it's so big and it does so many things, you really get to do kind of an in-depth examination to look at, okay, like, what's affected and what might be causing this this patient's problems.
Jordan:So if you've ever gone to a physical therapist, hopefully they've done, like, a lot of sensory testing on you to kind of figure out maybe, like, hey, what branches are affected, and where might that, problem be coming from? Because it covers so much area. The sciatic nerve can have, be affected many different places. Most of the time, it's a low back issue. So you've got something going on in your lumbar spine that's impinging on those nerves.
Jordan:It's usually the l four, l five level. You know, that could be, like, maybe a little herniated disc. It could be some, stenosis where the opening in your spine that that nerve comes out of is just a little bit narrowed. Could be some irritation in your lumbar spine, that type of thing. Most of the time it's a low back issue.
Jordan:So, you know, we're moving into our, you know, interventions for the low back trying to figure out, hey, is it a is it a stenosis issue? Is it a herniation issue? You know, trying to get you into movements and exercises to to help with that, doing some manual therapy, those types of things. Occasionally, we'll get, what we call, like, a piriformis syndrome or the the piriformis is actually, affecting that sciatic nerve. So the piriformis is a little triangle shaped muscle.
Jordan:K? It connects on the anterior aspect of your sacrum. So your pelvis is kind of formed of, it's got three bones, so it's got kind of the two big pelvis bones on the side, and then it's got this this triangle shaped bone in the back called your sacrum. The piriformis attaches to the front side of that sacrum, and then it comes out of your pelvis and attaches to the back of your hip. And so what your piriformis does is it kind of rotates that hip, a little bit, or it can move that hip kind of, from the middle to the outside.
Jordan:So think of, like, you know, making a snow angel or doing a jumping jack, you know, type of motion. So that's what the piriformis does. Why that piriformis is important pertaining to the sciatic nerve is because in most people, when that sciatic nerve comes out of the pelvis through that greater sciatic foramen, it goes underneath that piriformis muscle. So what can happen is if that piriformis gets tight or it gets irritated or it gets inflamed, it'll affect that nerve. And then you end up with kind of that low back, buttock, radiating down the back of my leg type of pain.
Jordan:So if we're doing tests, in the clinic to see if it's coming from your low back and we clear your low back, which means, hey. I don't think good news. I don't think your, leg pain is coming from your low back. Let's see if it's coming from your piriformis. That's kind of the next thing that we check.
Jordan:And so, the sciatic nerve kinda has also has some really cool, anatomic variations that can predispose people, to, like, piriformis syndrome. So most people, the sciatic nerve, comes out from the pelvis, in a singular piece, and it goes underneath that piriformis. Some people, it splits. So you actually have two portions to your sciatic nerve, and the one portion might come above or below the piriformis, but the other portion actually goes right through that piriformis muscle. So anytime that piriformis muscle gets tight or it gets inflamed or you have a problem, their sciatic pain flares up.
Jordan:There was actually, two cadavers in our cadaver lab in PT school that had this anatomic variation. So it was kinda neat to be able to see. But those people that have, it's called, like, a a type two, a type three, or a type five sciatic nerve, they'll be a little more predisposed to, sciatic nerve pain because they're a portion of their nerve actually goes right through that muscle, so it can get more irritated.
Kaitlin:What would you say contributes more to this, like, activity or a sedentary lifestyle?
Jordan:It can it can be either or. You know, like I said, most of the time, it comes from some type of of lumbar issue. You know? So that could be a a you know, a a lot of, lumbar issues are just kind of degenerative in nature. You know?
Jordan:They just they just happen over time. But, you know, people do get them in responses to certain, you know, activities or or injuries or things like that. I mean, you know, you think about the person that, you know, bends over really fast and they herni you know, they herniated disc. They can get sciatic pain from that. You know, so so it can be it can be either or, you know, related to related to that.
Kaitlin:Any thoughts on that, Jen? Questions? Well, it was kind of my
Jen:my question was, are there certain types of things or occupations that would make you more at risk to have that kind of injury? But it sounds like it could be could be both could be that you, you know, are really weak, don't have good strength, don't have maybe core strength, you're more prone to back issues, overweight, and or if you have a very physical job, I'm thinking about, like, contractors I know who have, you know, injuries or athletes, right, where then they because of repetitive motion or activities, they probably are more at risk as well. I mean, that's my assumption.
Jordan:Yeah. Yeah. And then and then as a PT, you know, again, you're just you're trying to to tease out in that exam, you know, where that sciatic pain is coming from. Like I said, most most patients, probably eighty percent of patients are it's a it's a low back thing. So, again, it's it's the low back pain.
Jordan:You know, so we're just trying to figure out, hey. Well, what's causing your low back pain? You know? And then we have interventions that are aimed, you know, aimed at that, you know, manual therapy, soft tissue techniques. Of course, we're doing a lot of, positional exercises.
Jordan:So people usually have kind of a preferred position, whether it's, like, low back extension or low back flexion that'll kinda relieve their their pain. So we're doing some exercises, kind of to the direction that they prefer. And then as that pain, gets more manageable, then we're starting to move them opposite. You know? You know, so if you came in and flexion felt really good and that relieved your pain, then as that nerve calms down, we're gonna start moving into extension a little bit more, vice versa.
Jordan:If it was extension that aggravated your pain, we're gonna we're gonna start with some flexion and then move you back into extension. So, and then again, you know, I think, Jen, you mentioned it. You know, do a lot of core strengthening, you know, for people that have, sciatic pain. A lot of times, it's flexibility issues too. You know, people, will get muscular imbalances.
Jordan:You know, it's kind of that. We see a lot of, like, you know, tight hip flexors from from people sitting. So, you know, it's a lot of, hey. Let's get your hip flexors stretched out, and let's also strengthen them because a lot of people, their hip flexors are tight and weak, just because they're not doing things that typically strengthen hip flexors. You know?
Jordan:So, most people aren't sprinting or, like, jumping or doing, like, high knee running or anything like that. I mean, those are all things that are gonna strengthen your hip flexors. So, a lot of people think, well, my hip flexors are tight and they must be strong. Typically not. You know, they're typically tight they're typically tight and weak, and so, you know, you get people with that really kinda, anterior tilted pelvis.
Jordan:You know, they got a really big arch in their low back, and it kinda looks like they're, you know, sticking their butt out when they walk and, you know, that that type of thing. A lot of times that's just really tight hip flexors. So we need to get those stretched out and strengthened and, tight hamstrings are a big thing, you know, too. So, a lot of lower extremity, flexibility exercises coupled with, core and glute strengthening, is usually the the ticket for a lot of these a lot of these folks.
Jen:My last question on this topic is, is there a gender difference on this specific injury? Is it gender specific or does it not discriminate?
Jordan:I don't I don't really notice much of a difference, when it comes to to sciatic pain. You know, I think I had a a patient one time that had, like, chronic sciatic nerve pain. This patient had had been dealing with this like twenty plus years, you know, and so, and that was a male, you know? So, yeah, I just don't I don't know if you ever, if if there's any, you know, gender differences related to to sciatic nerve pain or not. But
Kaitlin:It's amazing how strength training creeps back in there as a as a remedy.
Jordan:Movement is medicine.
Kaitlin:Yep. Alright. Onto the last question, and I'm really excited about this one. I mean, this is something that I have come across more and more as I start to work with more, menopause menopausal women, and that is frozen shoulder in menopause. What contributes to this phenomenon, and, how can we prevent it or treat it?
Jordan:Sure.
Jen:And what is it? Because, actually, I'm not familiar with this.
Jordan:Yeah. I was gonna cover that. So let's talk about what what a frozen shoulder is. The the medical term is adhesive capsulitis. Frozen shoulder is kind of a a common term for it, but there's a there's a connective tissue around your shoulder.
Jordan:It it's shoulder capsule or a joint capsule. Most most joints in your body have a capsule, that surround them. And what happens is this capsule around the joint will actually, thicken and tighten around the shoulder. So, you know, I I kind of the common demonstration that I do for patients is, you know, if you have a t shirt on and you take your hand and you grab your sleeve of your t shirt and kinda kinda hold it to the body of the shirt, and then you try to lift your shoulder, try to raise your arm, you you can't do that. It pulls on the shirt.
Jordan:That's kinda how your joint capsule is. It kinda covers the the top and the front and the back, and it comes underneath. And it actually does double over on itself a little bit, like, underneath the shoulder area. And it's it sticks to itself and gets really tight and thick. And so what happens is you get a lot of pain with that, but you also get a really significant decrease in shoulder range of motion to the point usually where, what we would call activities of daily living, are very difficult.
Jordan:So putting on a shirt, very difficult. Putting a bra on and off, very difficult. Like, even be being able to, like, brush your teeth, apply makeup, you know, groom your hair, like, almost impossible. So, it gets very, very, very challenging.
Jen:Why is it, connected to menopause more so?
Jordan:It's a really good question. So frozen shoulder, it can be, what we would call you know, it can be idiopathic, meaning it has no specific cause at all. I have seen a few cases of that over my career. A lot of times though, it's secondary to, like, a surgery or an injury. I can almost I can almost guarantee that, a woman between the ages of 45 and 55 who has a shoulder surgery will get frozen shoulder.
Jordan:It almost always I found it almost always happens. And a lot of this has to do, with the hormonal changes that occur in menopause. So, the the declining levels of estrogen in women in menopause, affects connective tissue. And so a lot of women see that. You know, they'll see it like, they most commonly notice it in their skin, you know, but if your skin is if your skin is affected by menopause, so are your tendons and your ligaments.
Jordan:You know, because there's similar types of of connective tissue and collagen, in your skin as there are in your in your, connective tissues in side of your body. Because that estrogen declines in menopause, inflammation also typically increases. And I think that's really the connection with surgery and injury. So if you have an injury where maybe you fall on an outstretched arm and sprain your shoulder or you have a surgery, there's lots of inflammation surrounding that. And so, that just menopause just exacerbates the effects of that inflammation and you can end up with adhesive capsulitis.
Jordan:You think about women in in the postmenopausal or the the the perimenopausal or menopausal, ages, typically you're starting to, be less physically active. And so I think that also plays a role, especially, like, in the idiopathic onset of frozen shoulder. So you think about, hey. My estrogen's declining. I'm having connective tissue changes.
Jordan:Inflammation in my body is going up, and now I'm not as physically active anymore. Kind of a recipe for developing frozen shoulder. And there's certain health conditions too, that, people can begin to experience at those ages. Type two diabetes increases in people after age 45. Hypothyroidism can happen kind of around that same time.
Jordan:And so, diabetes and hypothyroidism are also risk factors for developing frozen shoulder. So those are also things that you have to pay attention to, when it comes to that. So that's kinda really the causes and why, you know, perimenopausal or menopausal women are at risk of, frozen shoulder.
Kaitlin:What about
Jen:With the yeah. I think prognosis is complete.
Kaitlin:Go ahead.
Jordan:Go ahead.
Jen:You go ahead with your question.
Kaitlin:I'll I'll online. Women that start to strength train during this time, because, okay, they're now noticing these changes in their body. They want to do something about it. So now they're starting to strength train for the first time in their life during menopause. And then we start to see these shoulder issues.
Jordan:Right. So, again, we know that, this, like the thickness and the tightness of the shoulder capsule is likely caused by inflammation. The inflammation is a contributing risk factor there. And so, it's possible that strength training so we all know that strength training produces some inflammation, like low levels of inflammation. And so it's possible that in some individuals that inflammation could caused by strength training could contribute, to, adhesive capsulitis or frozen shoulder.
Jordan:I don't think that's a reason not to strength train because we also know that physical activity is a risk factor for frozen shoulder. I just think you have to be really careful, about, you know, the type of, exercises and the prescription that you're doing around, upper extremity training, especially when, women don't have a lot of experience with strength training. So, you know, if I was training a perimenopausal or menopausal woman with no training experience, I would probably keep upper extremity exercises to, probably the, you know, sagittal plane exercises. You think like pushing, pulling type of exercises. I would probably limit weighted overhead movement.
Jordan:And any overhead movement that I would do would kind of be more range of motion and mobility exercises and less, like, strength training exercises. So just to be clear about that, like, with a perimenopausal or menopausal woman who has no history of strength training, I probably wouldn't be doing a ton of overhead pressing. You know, but that overhead pattern is important to train, so things like overhead pulling might be good things to include. So, you think about, like, like a lat pull down or something like that. Probably doing a lot of single arm work too.
Jordan:So, you know, I probably wouldn't prescribe a woman at risk for a frozen shoulder like a double overhand lat pull down behind the head, but I might do, like, a single arm lat pull down, you know, would would be better. Lots of rowing. Probably wouldn't be doing, like, a ton of closed chain exercises. So, you know, push ups, and and things like that, I'd probably stay away from. But, like, a one arm dumbbell bench press, you know, would be something that you could do.
Jordan:Actually, like, a standing cable column press would probably be even better. And then mixing in a lot of, like, multiplanar functional movement with this population is also a pretty good idea. So, if people are familiar with, like, PNF patterns, you know, doing PNF patterns with this population is is really good because you're combining, like, shoulder flexion, adduction, and internal rotation or shoulder flexion, abduction, external rotation. So you're really working the shoulder through multiple planes and multiple positions throughout the exercise. And in order to to do that, like, you can't really load those exercises up a lot, but it it they're great functional movements for long term shoulder health.
Jordan:So those are things that I I would probably take a look at doing, with that population just because you do have to keep in mind the fact that, like, hey. I I probably don't wanna do, like, a bunch of lateral raises and, you know, thing things like that that just aren't putting the shoulder in a in a great position. If I'm gonna load the shoulder in this population, it's gonna be I'm gonna try to limit, the planes of motion that the shoulder is working through, if I'm gonna load a movement and otherwise I'm doing really multiplanar functional movement, you know, types of things. That was a lot of PT jargon. I hope that made sense.
Jen:We got it. More to Caitlin than to me because I got the idea. My last question for you on this topic, Jordan, is what is the prognosis for folks that get this? Is it like a repeat thing? Are you able to recover fully?
Jen:Like, what happens with this, like, long term?
Jordan:Yeah. So that that's a really good question. When I get a patient with frozen shoulder, I always kinda feel bad, talking to them about their frozen shoulder because, it's a really long process. So somebody that gets frozen shoulder, there's there's three stages to it. The first stage is called freezing, and that's the that, comes with, like, a gradual onset of pain in the shoulder and decreased range of motion.
Jordan:That stage can last anywhere from six weeks to six months. So it can be kind of a a long process. And then you have the frozen stage. So in that stage, there's not a lot of pain going on, but there's pretty pretty significant limitations in range of motion. That stage typically lasts four to six months.
Jordan:And then you have what's called the thawing stage, where you don't have a lot of pain and your range of motion starts to come back, but it can be very slow and gradual. And that's about four to six months. So these patients, we get to know really, really well, because you're really probably looking at, you know, on the on the very low end, nine months of rehab. And then sometimes you're looking at, you know, 18 to to 24 types of type, you know, month rehab, for the for these individuals. Everybody's a little bit different.
Jordan:I can tell patients, hey. You're gonna go through a freezing, a frozen, and a thawing stage. I can tell you that. What I can't tell you is how long each one of those stages is gonna last for you. So, you know, it's we have to kinda work through that, and that's kind of a shock to people because I think they you know, a lot of times they'll they'll go to see their their, you know, primary care provider, and they'll be like, oh, yeah.
Jordan:You got frozen shoulder. Go see PT. You know? And then we have to explain to the patient, like, what that means and, what it's gonna take to to get their function back. So it can be a pretty pretty long process.
Jordan:Physical therapy really concentrates on on manual therapy and exercise. So you really wanna make sure that you're continuing to move your shoulder through its available range of motion and strengthening it, in its available range of motion because, otherwise, your upper extremity is going to be significantly limited when this whole process is over. And you definitely wouldn't wanna be in that situation. We're also providing a lot of education to these patients, And that's everything from, hey, how do you adapt your activities of daily living so that you can still function? So helping them solve some of those problems.
Jordan:But number two, it's a lot of health and wellness information, a lot of information on hydration, a lot of information on diet. So if we know that inflammation is a large contributor to frozen shoulder, one of the best ways to help combat that is, trying to eat healthy foods that are going to decrease inflammation in your body. So we're being like, hey. Like, what types of foods are you eating? Oh, well, you know, I'm driving through here, and I'm getting takeout from there and whatever.
Jordan:I'm like, okay. Well, you know, can I connect you with our dietitian at the hospital? Because what we need to do is we need to get you, like, eating at home, and we need to be eating, like, fruits and vegetables and whole grains and lean meats and drinking lots and lots of water, because your diet is probably, like, exacerbating your condition. So it's a lot of education around that. There's some varying levels of medical management.
Jordan:So, have seen some patients have some success with, like, steroid and analgesic injections with frozen shoulder. That can just help with some of the pain. A lot of times, it makes rehab a little more tolerable. I haven't really seen anybody ever, like, get a steroid injection and it, like, cures their frozen shoulder, but it can certainly help speed up the process a little bit. In rare cases, you you may see somebody undergo, a surgery for this, but haven't really seen that.
Jordan:I think, anymore or most surgeons have really good understanding that, you know, frozen shoulder, the the preferred course of treatment is is conservative. It's physical therapy and it's just it's gonna just has to, like, run its course. And I don't think you'll find a lot of, orthopedic surgeons anymore who are willing to operate on a frozen shoulder, because I think they recognize now that, hey. Like, actually, one of the, risk factors for developing frozen shoulder is actually a shoulder surgery. So, you you know, operating on these is probably gonna make the patient's condition a lot worse.
Jen:Always interesting how so much ties back to having a really, really balanced, healthy, unprocessed diet and Mhmm. Weight lifting and hydrating. I mean, not that that I don't wanna oversimplify things, but Right. Always interesting how in so many of our topics, like, doing doing those things reduces your risk, right, of these things and can help you recover if that thing does happen, which is also, like, a nice reminder because those are things that are in your control. You can't always control the injury.
Jen:Right? But you can definitely control probably the speed of recovery and the
Jordan:Yep.
Jen:The intensity and, severity, all those things by lifestyle choices.
Jordan:Yeah. Having frozen shoulder can be like a very helpless feeling, because you're gonna have a PT explain to you that, like, hey, we're gonna do PT for a really long time. And, you know, we just kinda have to let this process run run its course. But what I found is educating patients on some of those wellness and lifestyle factors gives them a little bit of control over their situation. You know?
Jordan:So, you know, it's like, hey. You know, we can look at this frozen shoulder as, you know, something that happened to you that's really, really bad, or we can look at it as an opportunity to, like, develop some habits that, number one, are gonna help your frozen shoulder, but number two, are gonna help you, like, after this is over. So, that can just be kind of a helpful strategy too, for these patients.
Kaitlin:Love it. Any other questions or things you wanna chat about today? I think we covered a lot. Lots of, really fascinating, great information, helpful information. And like Jen said, you know, ties back to lifestyle, strength training, nutrition, taking care of yourself, doing the things to make you more, able to tolerate stress and be resilient to stress and just building your body up.
Kaitlin:So thanks for joining us again today, Jordan. Appreciate all your knowledge and, sharing with our listeners. So
Jordan:My pleasure.
Jen:Well, thank you, Jordan, again, and thank you guys for tuning in. We will be back in a couple weeks. And if
Intro:you guys wanna get ahold of us, check out our show notes and links there. But then till then, we'll see
Jen:you guys in a couple weeks. Stay healthy, and we'll see you then.
Intro:Thanks for joining us on the Counter Culture Health podcast. To support this show, please rate, review, and share with your friends and family. If you wanna be reminded of new episodes, click the subscribe button on your preferred podcast player. You can find me, Jen, at awaken.holistic.health and at awakeningholistichealth.com. And me, Caitlin, at Caitlin Reed wellness and CaitlinReedwellness.com.
Intro:The content of
Kaitlin:the show is for educational and informational purposes only.
Intro:As always, talk to your doctor and health team.
Kaitlin:See you next time.
