Today, we're going to get a little more comfortable with being uncomfortable. If you're someone who has a bad back, tricky knees, a recurring injury, this interview is for you. If you've got some baggage and fear around movement because you're worried you might get hurt, this interview is for you. If you love being sore or hate being sore after a workout, or just aren't sure what it means if you aren't sore after a workout, this interview is for you.
To sort through all of this stuff, I called my friend
, who is a doctor of physical therapy. Dylan and I worked together for almost two years, and I learned so much from him about pain. Now I should say before we start that this interview is not medical advice. And if you are dealing with pain or an injury, the best guidance, of course, is going to come from a medical professional who has actually examined you.But I do hope that you learn something here that helps you better understand pain and discomfort, and just find a little more optimism in movement.
Here we go.
(Note: The transcript below has not really been edited! Apologies for any weird spelling or misplaced commas. If you prefer a cleaner experience, listen to the audio above.)
Anna: Hi Dylan, tell us who you are and how do you describe your work?
Dylan: So I'm Dylan Peterson.
Um, I am trained as a physical therapist. I got my doctorate in physical therapy uh But I also, you know, I started as a philosophy student. So I bring a lot of that kind of attitude to my work. I'm also someone who's just been really active throughout my life and I had a dad that was also a physical therapist, but he was a person that raised a lot of fear in me when I did sports.
So I was always the one that was really, I was always worried about getting paralyzed and like had these like more neurotic thoughts about how things could go really badly. And so I feel like that's kind of, Colored my journey as I become a physical therapist, because I've kind of gone from having a lot of neuroticism to kind of making me really dive into the research and understand this.
And that's really helped me actually gain a lot of confidence in how I deal with injuries and pain and, and my own kind of activities. Um, and so these days I do a lot of trail running, a lot of lifting, A lot of just playing pickleball and, and moving with friends. And so that's a big part of my life.
And so, yeah, I, I, I use that, both that, that movement background and my, uh, physical therapy training to talk a lot about pain and injuries at different parts of the body.
Anna: That was so interesting. I mean, so for those listening or reading, Dylan and I like worked together for quite a long time. Um, and I did not know any of that about you.
And it makes so much sense. And that sort of background and your personal story and also your interest in philosophy. I feel like it all adds up in my mind. Why, like Dylan, is one of the most thoughtful people I've ever worked with expert wise in terms of pain and movement. And that is why I really wanted to talk today.
So in our work together, we worked at a digital musculoskeletal clinic, and what I was doing was a lot of words about like, what should the cues be? How should people be feeling? What do we want people to understand about
the movement. And I came into that work with sort of the perspective of, movement should never hurt. It should never be uncomfortable. Something might be challenging, but you should never feel pain. And I think I got quite a very compassionate, but, but a really thought provoking kind of reeducation from you Dylan about that.
So I'd love for you to start there talking about pain. What is sort of our cultural relationship to pain and movement and how do you want to see that evolve?
Dylan: I think there's a bit of a attack on movement and just this dialogue within the culture that's kind of feels like it's trying to raise the risk profile of what it is to run or do movement.
There's a lot of red X's when you go on YouTube, or on TikTok, or Instagram of people talking about how to move correctly. And, you know, some of that can be really helpful. But I think that also places in people's minds that This is an inherently dangerous thing to do is move because we're seeing all these red x's everywhere or people are talking about the negative side effects without realizing like exercise might be the best thing that you can do for yourself.
It's the thing that both adds years to your life and life to your years. So, It's interesting that there's this dialogue and cultural mindset that's maybe slowly shifting towards, uh, feeling a little bit cautious as they start activities, as they start running, or playing pickleball, or doing these things.
“People are talking about the negative side effects without realizing exercise might be the best thing that you can do for yourself. It's the thing that both adds years to your life and life to your years.”
Because, one of the things that we know is just like, when you start something, you're gonna have some aches and pains. You're gonna, your body's not used to this, you know? Our bodies are so interesting. If I paint a room, you know as much as I like run and stay healthy And do all these things if I don't paint every day and then all of a sudden I paint my room I'm like totally wrecked the next day.
Like my body's just not used to that. And so These feelings can be really hard to understand because it obviously doesn't feel good in the moment sometimes or the next day. And so trying to understand, is that a good thing? Is that a bad thing? Can be really hard. Um, especially on top of this new kind of cultural dialogue where we're just feeling a little bit more fearful .
Anna: I want to dial into that a little bit. There is this common fear when people are looking into starting exercise, whether it's running or I think, especially with lifting weights, maybe lifting heavier weights that they're going to get injured. And I would love to hear you unpack that a little bit.
Dylan: If you think about like a construction worker or a landscaper starting a new job where they just haven't dealt with like using their hands a lot and like moving stuff around, if they do like a full shift and they're not wearing gloves, They're just gonna have blisters, like, all over their hand from, like, digging, you know, holes, from carrying rocks, and all these things.
So those blisters are a sign of, like, you probably were not used to this and you overdid it. But if you slowly did it a little bit more, a little bit slower, and over time, You can develop calluses and develop resilience to all those things that you're trying to do. And so I think if we think about a lot of the activities like lifting, a lot of people kind of think about how much weight or load is going on the body and think that's a bad thing.
But All parts of our body, including like the discs in our spine, our bones, our muscles, our tendons, like adapt to get stronger and more resilient. So as long as we're like appropriately gradually moving into these movements, our bodies are amazing at like adapting to these. And it's really, really healthy and really, really helpful for, um, again, for helping us be.
Healthy in the now and healthy as we age. There's definitely a big attack on Lifting and it can be confusing because you know The World Health Organization tells us that we should be lifting twice a week doing some type of resistance training but again, we see a lot of fear, being built by some of the ways that we talk about these activities.
“All parts of our body, including the discs in our spine, our bones, our muscles, our tendons, adapt to get stronger and more resilient. So as long as we're appropriately gradually moving into these movements, our bodies are amazing at adapting.”
Anna: Yeah, and I, I feel like so much of that goes to this like all or nothing mindset that a lot of people carry, which is like, Oh no, I'm supposed to be doing this lifting routine. I haven't been doing it. I had to jump in and do it. Yeah. Um, and it kind of erases the really important, like, easing your way in and doing that really gradual working your way up to, where you want to be.
So I would love to talk about how do you help people work their way to A practice that feels good.
Dylan: There's this LIFTMOR study where they took, older men and women who either were at risk of having like low bone mineral density or had actually been diagnosed with osteoporosis and some of them even had findings in their their back that might be might think that it would be a bad idea to lift like a you know a part of like a Fracture or like a disc bulge or something like that and They had them slowly gradually build them up to lifting like 80 percent of their one rep max Which is if you think about like how much you could lift one time to exhaustion, like they were really close to lifting at their max.
So, but they started very slowly. They just got used to, to the movements, started practicing those with no weight or very little weight, and then gradually over each week, just kind of added a little bit, you know, sending these signals to the body that, this is what we need to get used to.
These are the movements we're going to try. And those are the kind of things, those signals are the things that made a lot of these men and women actually build bone and, reduce a lot of problems that can occur because of osteoporosis and bone mineral density. And so you'd think this is kind of a group you'd think You would never have lift really heavy.
And they might've had a few back sprains or a few of these things, you know, few mild injuries, but they had no like severe injuries that you'd think be like, a red flag for oh, maybe this was actually a bad idea for people to lift heavy. So this is where like a personal trainer or an expert can come in. I think the great analogy is go from couch to a marathon.
What is like a couch to heavy lifting look like, you know, some people when you're starting on the couch, you do one mile and two mile and you kind of build up towards being able to do that marathon. And we can do the exact same thing with lifting weights. But sometimes it just takes an expert to kind of walk you through what those movements or what those variations look like.
Anna: Yeah, totally. I mean, it depends on the person and their starting point, but it's, it can look like, okay, no, I'm not going to put a loaded barbell in your hands to do a front squat when you haven't been exercising at all for years or ever. But like, maybe we start off, you're sitting on a chair and you stand up and you do that like 10 times and then.
Maybe you go to a slightly lower chair. Maybe you start adding like lightweights, you know, you really work your way up gradually and build that, that resilience.
Dylan: Exactly. Exactly.
Anna: So we talked about the fear of injury. Let's talk about the inverse of that, which is that when you have an existing injury that maybe you feel like is holding you back from exercise.
So what are some of the more common injuries that you see that, that leave people with a fear of movement?
Dylan: Probably the biggest one is just when you hurt your back. A lot of people have heard a lot of stories of people that hurt their back, and then it
slowly gets worse or impacts their life in bigger and bigger ways, like impacts their work, their sleep, their ability to kind of do the things that they love. So I would say that back pain or hurting your back is probably the area where we see The most fear, but it definitely doesn't stop there. And we see that kind of any place in the body that kind of impacts the ability for you to do the things that you love or impact your work.
You know, there can be a lot of stress when you get an injury and you're trying to think about like your next paycheck. Like, can I get to my job to do the thing? I want to do, you know, whatever the job that is, you know, if you, Sitting at a desk and write all day like having neck pain or shoulder pain that impacts your ability to concentrate in the same way can be really scary and so that can be fearful for anyone and , as much as I have this knowledge, it's easy for my mind to go to those places as well when like, I injure my ankle or knee and I think about like, Oh, like, am I going to be able to do, you know, trail running in the way that I've always wanted to?
So I think back pain for sure has a lot of fear just because there's so much, there's so many stories we've heard from people, but it definitely doesn't stop there at different parts of the body.
Anna: You talk a lot about, the difference between avoiding pain entirely during movement versus I think you sometimes say, like, nudging into pain versus, like, pushing through or grinding through pain.
So, if you can give sort of, a framework for people to understand, like, how much pain should they be experiencing during an exercise sort of movement if they do have an existing injury.
Dylan: So nudging pain is kind of this place between avoiding pain and grinding through pain where we open up a lot more options for people to, to recover. And that can be a big difference for people who have pain with a lot of activities and where things might be just shut down so much that they just don't have a lot of options to, to get healthy, to get stronger, to get more Their body more resilient.
So yeah, nudging into pain is kind of just, if you're going to look at research, they'd say that's like four to five out of 10 pain, but you know, everybody's four out of five out of 10 is a little bit different. So nudging into pain is kind of a way for people to uh, figure that out a little bit and see what that is over time.
So it's not super precise on purpose.
Anna: It reminds me of another thing that we've talked about that I've, I've learned a lot through our work together, which is what happens to your nervous system when you've experienced pain or, or chronic pain.
Of course we'd like never want to tell anybody that their pain is all in their head or something like pain is real, but there is this like cycle that people can get trapped in when they have pain. where their body's sending them these pain signals that like don't actually indicate that something bad is happening at that time.
So I would love for you to just talk through that a little bit.
Dylan: Yeah, yeah. And it's a healthy normal response after injury for your pain system to get really protective. So if like I sprained my ankle. Like pain's gonna help me move a little bit more slowly and keep me from running as many miles as fast as I want to.
It's really healthy that your pain system sends these signals to kind of slow you down. Um, What we know, even, even in that phase, like it's pretty safe to nudge into pain, like with my ankle sprain, you know, the first thing we do as a physical therapist or doctors is rule out any serious medical stuff to feel comfortable with whatever pain you have, whether that's mild, moderate, or severe.
And so once we do that, whether it's, a new injury or an old injury. We can just feel really safe with the pain that someone's feeling and it can kind of it can guide us a little bit And like how much to push or how much to pull back, but it's still really important even in those early phases to nudge and keep moving and keep doing things.
What happens is sometimes people when We've had pain for a while. Is that That really healthy pain system that has made pain available stays really high and keeps like over protecting your body. And so if you're like years into a back injury or even just months into a back injury, we know that sometimes for a lot of different reasons, Truly, it's kind of every system.
It's not just your nervous system. It's your immune system. Your nervous system the muscles, tendons, like, all the things that kind of relate to the pain system might just be Overdoing it a little bit, kind of like if you think about some people who get like a bee sting Have just a little reaction and some people who get a bee sting can actually suffocate or have a lot of swelling or have all these different reactions.
So some people will have a bigger response naturally to their injury There's a lot of things to correct that with, that we were starting to understand more and more with physical therapy research and, and just muscle and injury research.
Anna: To take it to like the simplest essence, it's, We often think that if we're in pain, we're being harmed. And so there's this little bit of re education that , I think you've said it before, like hurt does not equal harm.
Like just because you're in, you're feeling that pain doesn't mean that you're making something worse or going to make, make this injury last longer. I think that like kind of reassurance can be helpful.
Dylan: Yeah. That's a good point. Sometimes it's over said because obviously we've all experienced when hurt does equal harm.
But we know that we use our reasoning and use our physical therapy and doctor skills to rule out the bad stuff to feel very comfortable that when you're hurting during this rehab process it's not doing harm. That actually can be really healthy and really helpful.
Anna: To switch gears a little bit into a different kind of discomfort, culturally, it feels like we've kind of gone from the like no pain, no gain during a workout mindset to, Something that's maybe too much on the other extreme, which is like, your exercise should always feel really good, and you shouldn't, you don't have to push yourself.
You don't have to ever feel uncomfortable. And I think You know, if it depends on the goal, of course, if we're just looking for activity and moving your body, like, no problem. But if we're looking for the progressive overload that is what we need in order to lead to increased strength and bone mineral density and those things we do have to get a little uncomfortable, right?
So I would love to just hear your thoughts on, on. What is the right level of discomfort in maybe specifically a strength training setting?
Dylan: Yeah. Yeah. Maybe, uh, just throwing a question back at you first, you know, I've definitely heard that. And do you, what are some of the reasons that the culture kind of is talking about, like, it should always feel good at this point is, is there certain themes that kind of drive that at this point?
Anna: There's so much nuance here, of course, but I think that for people who maybe had a disordered relationship with movement maybe they were pushing themselves as a way to punish themselves or They were taught that they have to, like, really, really push for anything to even count as movement.
Um, they're kind of pushing back on that idea, which, like, again, like not in all situations, that doesn't necessarily a bad thing. But I think I'm hoping to help people get a little bit more comfortable with a little bit of discomfort.
Dylan: That makes sense.
Anna: And feel a little better about like, okay, if I'm, if I'm struggling, if I'm really feeling a burn, like that's maybe a good thing.
Dylan: Yeah. Yeah. Your body's gonna have different things happen as you push more or push less and pushing more isn't always better But but there is some really really important things that the body will do When you do push harder and and this maybe goes back to you like Even that first, one of the first studies we talked about, that LIFTMOR study with the older men and women.
What they've seen is like, if they didn't teach these men and women to push really hard up to that point where they were lifting close to , the biggest weight they could lift for a few different lifts, then they weren't going to get their bones to get more dense. And we see that in a lot of different ways , whether it's heart training or muscle training uh, to that bone training and some of those things.
It's actually really important with tendon stuff we see in rehab that to, for tendon rehab, we actually have to push so hard. Otherwise, we just don't get the changes in the tendons that, that we're hoping for that can help people get a little bit more resilient to the movements and activities that they're having pain might be having pain with.
So I think there's definitely a balance, in, in endurance activities, we always say like 80 to 90 percent of what we do needs to be pretty easy. Okay. Especially if you're going for longer runs or longer bike rides, you just have to have it a little bit easier, but I definitely, one or two days a week push close to, my max with a few different workouts because it's so.
Um, helpful for both like my health and what I want to do with running. But it's really good for our mindset too. I think that like, it's really empowering, but I know that maybe it's not true for everybody. I think there could be ways to like tap into that and find funner ways to do it as a community or like.
I know a lot of people talk about spin class, with the energy and the instructor kind of pushing them and taking some of that mental load of like telling them what to do, they're able to tap into some of those higher intensities and make it a little bit more fun.
You know, I think back to like gym class and to kind of come back to what you're saying like there is some like some truth to this should feel good a lot of the time because maybe like we were on the wrong side of that when we grew up where like People just pushed us to do it because this is going to be good for you 40 years from now but like I think we just weren't creative enough to make so many of these activities like more fun.
And there's just so many opportunities to do that. Whether it's like doing something with friends or using music or using something that, that can do that. But yeah, I definitely think there's a huge benefit to pushing hard with different activities every once in a while, both for just our mind and our body.
Anna: I love that balance of 80 or 90 percent of the time it should feel good, but then, there is this value in pushing yourself and exploring that in a way that feels like satisfying and not punishing. That's the golden ticket. Um, I guess the other thing within the.
Discomfort of exercise kind of umbrella is soreness. You know, whether it's immediate or delayed onset muscle soreness, I think this is something that maybe for people who are new to exercise or trying something new that, you know, for the first time in a long time, um, can throw them off a little bit like, Whoa, I, I suddenly can't.
You know, go up, go down the stairs without wincing, you know, I, I think there's a lot of misconceptions about that kind of soreness. And I'd love to hear just your general thoughts about how people should understand what's going on when their bodies are sore.
Dylan: Yeah. I just did a 33 mile trail race and I couldn't sit down like I couldn't bend my legs.
It was probably one of the most extreme soreness I had, um, and, you know, it, it can be pretty scary it's definitely a weird feeling when, like, all the activities that you used to be able to do, all of a sudden you're not, either you can't do them or they feel pretty bad doing them.
It's definitely Like something that we all deal with and you know, one thing we know is that like just as you Start anything new you're going to naturally feel more sore at the beginning and that can be Unfortunate because like that can be a barrier for people to maybe stick with it and push through Because a lot of people a lot of times you'll just find after a few weeks that you're feeling a little less sore to the activities that you're doing so but at the same time, sometimes you start to push a little bit harder because you're getting fitter and you'll get that soreness.
Is there certain myths that like kind of predominate the soreness , what are some of the bigger things that you hear about soreness?
Anna: The biggest misconception I hear is that like, if you're not sore, it means you didn't get a good workout. But so I, I think there's like a little bit of like, oh, myth busting about like, what, what causes soreness? Do you have to be sore after every workout? And if you're not sore, does it mean your workout was bad?
Dylan: Great question. Yeah. Yeah. Soreness is really just like a side effect. Expert bodybuilders, expert, like elite athletes try to avoid, like, they're not trying to get more sore and their workouts because it actually keeps them from doing their next workout at a higher level.
That's not actually what's getting you fitter is when that, that like micro tears, like repair, it's a lot of the other things that are happening that actually make you fitter or make you stronger and all these things, but.
But sometimes you have to have a little bit of soreness to, to do those things to get fitter. But a lot of times there's a lot of creative ways you can avoid that soreness. And I actually think good trainers, good physical therapists try to find as best as we can to , make that soreness less where I think kind of to your point, like some trainers might tap into that psychology of like, Oh, the more sore I get the better.
And that's actually , that trainer is probably, it's probably not a good thing that they're making you super sore every time. Like that's not necessarily smart training. Um, yeah. Any other thoughts or questions off of that from your side?
Anna: Just if you are really sore, you know, whether it's because you just did a huge trail run or, , because you're starting something new or, or doing some exercises you haven't done in a while, what's kind of your go to like toolkit for managing soreness and then how, and how do you approach like the next workout if you're still sore?
Dylan: So over the last few days after my trail run, I've just been eating a little bit more protein and doing a lot of just like easy activities. So a lot more easy walking and, you know, I haven't done any big workouts yet. Um, some of it for me running, like I've just avoided like doing running itself and like got on the bike and elliptical to just keep myself moving.
Get some of that blood flow and that stuff, but also not tear myself down at any moment Sometimes if I have it, I'll jump in the ice bath if it's really bad Sometimes I might use a leaf but you know for the most part I avoid that. Most of it is just waiting like time time out and using things to kind of make yourself more comfortable in the meantime.
So.
Anna: What about things like, um, stretching and foam rolling and things like that?
Dylan: Great options to just make yourself more comfortable and move a little bit more easily. I would definitely use those, , and definitely those are some of the things , I've used. It, again, it doesn't really make , the recovery time any faster, but it makes you just more comfortable, , in the days that you are sore, , and trying to work and move and do all the things we have to do,
Anna: before we go, just any other advice for people who are, again, maybe starting Work out for the first time ever or in a long time or trying something new.
Dylan: This kind of comes back to the beginning of our conversation is like every part of our body adapts, like it's amazing and it can be scary. And I know that like, There's a lot of people out there maybe talking about some of the bad things that can happen, but every athlete I've worked with has had 10, 11, 12 injuries every year that they're an athlete, you know, it's, it's a common thing. I almost think of it as like, most of us all get sick like once or twice a year.
Or a lot more than that, or a lot more than that. Children . Right. You know, and that's not necessarily a sign that you're like, immune system is weak or, or anything's wrong with it. There'd have to be some other signs and symptoms to, make you think that and the same thing with our bodies is like, you know, if you're getting injured and, um, having some of these aches and pains, like I have aches and pains.
every week with running. With this kind of optimization culture, we've normalized or tried to push that, like our body should feel excellent all the time. And that is just not something that is true for anybody's bodies. Like ballerinas who try to do hold perfect form, get injured just as much as anybody else, it's just a, that's just a fact of like what it is.
“With this kind of optimization culture, we've normalized or tried to push that our body should feel excellent all the time. And that is just not something that is true for anybody's bodies.”
And so. Just trying to find some encouragement that your body will figure out how to be stronger as you work through this and just adjusting, you know, avoiding kind of what you said, that all or none kind of mentality where it's like, Oh, if I can't run three miles, like a half mile is a great way to get my body started starting used to that.
So yeah, just starting to have some optimism and like our bodies, uh, resilience and strength to figure out the things that you want to do, whether that's pickleball, running, Pilates, you know, whatever it is.
Anna: I love that great note to end on. Can you tell folks where , they can find you or follow you if they're interested in learning more about your work?
Dylan: I don't do a lot of social media, but I did just start a, a sub stack. My blog is back pain recovery examples. And so there I just find different, people that have gone through sometimes many years of hurting their back and try to unpack what were some of the things that they did.
Using research to back some of these things, some of the patterns we see , on why they maybe were able to get through their back injuries better than other people. So yeah, back pain recovery examples on sub stack.
Anna: Awesome. We'll link to it and it's, it's a really great way to just dive deeper into some of these, this shift in thinking around pain.
Um, and Dylan also is a master of simple, but really helpful, um, visuals. So good little, good little graphics. So definitely look out for that. All right. Thank you so much, Dylan.
Dylan: Yeah. Thank you.
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