Kyler Brown
Appearances
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
Yeah, right. And my private practice, I see this all the time. But what I always tell people to do is like, look at your kids. If you go to a coffee shop with your kids, I guarantee one of them will run and jump off a rock and like do a twist and land it. When was the last time one of us did that? Right.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
And that's why they say maintaining play and always playing games and increasing that to where it's randomized games. you're actually reacting to things because there's the neuroplastic effects as well.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
But just for the tissues, rehearsed load on the Achilles and the foot, if you go and get a job and you drive to work and you sit at your cubicle all day and you drive home and you didn't jump, that times five or 20 years is going to cause a lot of lack of capacity in your tissues that you don't want to learn the hard way.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
Yeah, three-dimensional, short, long, quick, slow. Yeah, I mean, a lot of variables there.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
For me, wrestling with my kids, which means getting down on the floor, having the flexibility, wrestling with my grandkids.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
Yeah. That's big. Just like play, right?
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
Depending on the kid. If they're my grandkids, maybe. But that's definitely a goal of mine is that bonding that you get when little kids are wrestling on the ground. And I saw my dad recently doing that and I thought that was really cool. He's over 70 and he's on the ground messing with my three-year-old and it was just cool to see. And that's how I added that to my list.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
It was hard for him, right? It wasn't easy, but he got down there and he could do it and he didn't suffer from it. That's one of mine for sure. As you know, I fell in love with rucking over the last couple of years. And so I want to be able to really crank out some mileage, especially in national parks as I get older.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
I'm not looking to be an ultra marathoner per se, but I really want to be able to hike long distances, probably with a pack on it.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
Yeah, I think my numbers will be a little distorted because I'm a pretty big guy. I'm 6'3", over 200, so I should be able to carry at least 20 pounds without worrying about too much for four to six miles.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
Yeah, I mean, I want to be reasonable about it.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
Not too technical. I'm not thinking boulders and rocks, but I definitely like to go hills, up and down, dirt track, all that kind of stuff without having to worry about it. Okay. What else? Another one is I grew up being an athlete. My youngest seems to be the more inclined to be an athlete. So as I age, I want to be able to hang with him as long as I can.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
So that means throwing, hitting a baseball as long as possible. Who knows how their careers will evolve from an athletic standpoint, but Odds are they're not going to be pros. So I really want to keep that base where I can keep playing with them as long as I can. But to me, it's all about being able to still play with the grandkids because family is one of the most important things out there.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
And if your grandpa is sitting there and can do cool stuff, I think that serves as a great role model. Whereas if you're suffering from an injury, you're not healthy, then they want to hang out with you. But at the same time, kids want to go do stuff and I don't want to be left out.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
Yeah. And if you aren't building up these areas of need or you're accidentally letting these certain athletic kind of movements fall by the wayside, all of a sudden you're like, oh man, I can't do that anymore. I love coaching my kids' basketball team. And one of the other kids on our team, their grandpa was out on the court with us one day. He was, I think, 74.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
He wasn't doing windmill dunks or anything, but he was moving and he could shoot. And every kid there, their eyes lit up. They're like, grandpa can shoot. That's crazy. That was a cool moment. That's why I put on my list of just playing with kids might be my whole CD. My wife might have something different to say about that.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
But I think for me, it's like if I can play and if I can do all those things, then I'm doing pretty well.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
To me, it's everyone's drawn to this high performance, be awesome right now. And that's like a boom-bust strategy. You might pull it off, but you're high risk and eventually you'll hit the wall for a race car. But if we're thinking long-term, then by default, if I'm going to be an awesome 70 or 80-year-old, I kind of have to be an awesome 45 or 55-year-old.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
We're going to be doing things now that make you crazy strong, that help your lean muscle mass, that burns your fat, all those health risk things. But you're also going to be way more prepared for whatever life throws at you.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
And if your buddy talks you into going skiing or going to do a volleyball game or whatever else, you're going to be way more ready for it if you're thinking long-term and building this crazy robust foundation rather than just chasing the newest technique or the newest technology.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
Yeah. There's a lot stacked against you, plus variables that we're not prepared for, or we could roll our ankle. But give me somebody who's strong all day, and if they sprain their ankle coming out of the bar, they're actually going to sprain it less, odds are. So all this insulation and capacity we put around us with the individual goals is crucial to prevent injury.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
And these injuries can stack up and cause a lot of trouble and then we get less healthy. And that's how you get these multipliers where I was on track to be really good, but this knee arthritis or this multiple meniscus repairs I had to get because I wasn't stable caused me to actually lose my hiking ability. And then all of a sudden I got less healthy.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
What do they figure is going on with you? It's funny you say that because the assessment takes two days and we're looking under the hood a lot in a lot of different ways.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
It's funny how they evolve like their perspective of it because what I was kind of forced to do in my career was I had experience working with teams and all that other stuff, but I kind of became an off-season person for these athletes. And by default, I had to almost become a strength coach
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
Not because I wanted to or that was my goal, but because these athletes needed that bridge from I'm injured to I might be injured to, hey, I've got the green light for performance. All humans are moving up and down that spectrum based on our recovery and all these variables. So what's been fun at 10 Squared is I get to do all the assessment I want, and it's not really a clinical assessment.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
On the one hand, we're of course looking at things that either have pain or that individual member has had a previous injury with, and we're accounting for that and we're making sure that's on track or could be improved and we add those things. But then I also get to play around and look at what else is weak? What is this individual at risk for?
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
So one example is we have a client who loves to surf. He's got a shoulder issue. So by default, surfing and swimming on a surfboard is a different position than a traditional freestyle stroke. So we had to make his shoulder uniquely robust in certain directions. And so that's part of his strength program.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
One of my biggest pet peeves in the rehab world is when people give someone 30 exercises that are really tedious and boring and no human sticks to that. They might do it for a week or two, but if it's not bridging to what they love and what they want to do, it won't get there. So if we can bake in ensuring that all the strength training won't make them worse and
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
And then also make sure that we're baking in their little corrective exercises or improving the gaps. That's where you make a huge difference into how someone feels, but also how they can perform.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
I think the first rule is the medical community. So your orthopedic surgeon or your neurologist and then your rehab pro have to be in sync and have a relationship. And how often is that happening? I mean, it's very rare. What's really interesting is the philosophy and the individual just spirit of either surgeon or the rehab pro. They have to be kind of committed to the service-oriented field.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
If they're just doing it for money, they're going to do scale and they're going to do like the PT mill that there's four clients with one therapist and that therapist is probably doing the best they can, but they're just kind of outnumbered and they're not accounting for those four different people all at once. So first off, it has to be one-on-one.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
You cannot tell me that you're rehabbing you the same way you could rehab my grandma who had a shoulder issue.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
Yes. Oh yeah. Typically it's a very cookie cutter approach. Usually it's an insurance model thing where they know that these certain exercises and putting ice or stim is going to be reimbursed by the insurance company. So the PT clinic is going to do that on everybody regardless of what they need. So that's one of the biggest pitfalls is it's never one-on-one. It's not custom.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
I mean, in the same way I've had pro athletes come in and we're supposed to do shoulder rehab that day and the night before they did a ton of stuff to their shoulder. So guess what? I'm not doing anything. They actually need to recover that day. It needs to be customized. To go back to your original question of how do people navigate this world?
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
I think your rehab clinic needs to do more than just offer services. They need to offer a plan. This idea that, okay, this is what I offer. I offer cupping or dry needling or whatever it could be. One service doesn't ever fix anyone and it definitely doesn't increase their capacity over time. The magic word of capacity is what it's all about. Are you building me back to what I want to do?
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
So if your rehab clinic is a bunch of passive modalities on tables and a bunch of techs doing ultrasound and stuff, that's a red flag for me because they're not going to build you to get stronger and stronger. Number two is the orthopedic needs to actually be hunting down that physical therapy.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
So a lot of times what I see in the orthopedic world is they have to give their clients something for rehab guidance because they're not totally sure if their client's going to go do rehab. Can they afford one-on-one and all these other factors? So they give them this handout.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
Well, a lot of times this handout is from 30 years ago and it's the same five or six cookie cutter exercises, but then there's no accountability. There's no nuance. So there's just a lot of holes in this path to try to get your shoulder or your back or your knee from it hurts. Do I need surgery or not built all the way back up to I can do whatever I want.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
Still not. There's a lot of environmental problems. So one of the biggest issues with all these people, and I have friends that work with all these professional teams that are great. And they're handcuffed because they only have their athlete for so long.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
So you all of a sudden get this multiple cooks in the kitchen problem where even if everyone has no ego and the best of intentions and they're most science-based people, they're still not sure, okay, what'd you do last week? What are we trying to do? Are you in a contract year? Like there's so many variables for a pro athlete. So in a weird way, professional sports is wellness upside down.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
It's how can we get the most out of this athlete, this commodity for their contract? And that's not really a long-term play. What's been really interesting at 10 Squared is we've had some pro athletes approach us with this idea of, hey, can you guys be my reliable, you're invested in me only and be my oversight? Where are my gaps? Is this okay? Should I play through this pain?
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
Because there are times you play through pain, there's times you don't. But the most important thing is this idea of having one person driving the bus who knows all your variables. Because if someone comes to us and changes their centenary decathlon, like they want to change one item, like, hey, I really want to start doing jump rope every day. And then we look at their testing.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
We're like, look, you're a high risk for Achilles. Let's bake into your program some really good articulate, smart strengthening to get you there rather than just hope it works out.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
Yeah. Other than saying that she's a saint for having signed up with you. You want me to talk? Okay. Yeah. Jill's a really great example because she had some pain when she showed up. So my job immediately is evaluate that pain. Is that a structural insufficiency? Are we worried about a real injury here? Or is that just an annoying nuance?
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
Based on the testing I did, so I did my clinical exam, but way more detailed than I normally would in my private practice because at 10 Squared, we have the time. And we want to remove confirmation bias. So we don't want me to just say, oh, your hamstring hurts, let's order an MRI. Let's test it six ways and in a smart, conservative way.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
And if all six of those indicate that, then we're going to do an MRI. So with Jill, we saw some proximal hamstring issues. She's, of course, like you mentioned, an endurance athlete. Her profile, her demographics, her running history all pointed to there might be a tendinopathy there. And then based on my testing, it reinforced that. So I said, let's get an MRI.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
Let's really evaluate this tendon because we knew in the near term, within a year, she wanted to run Boston. And as an injury person, I saw this as, look, she's okay now, but it hurts. Once we start stacking up her mileage, that thing's going to get in the way.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
Very much so. So that story perked my ears up, that history. And I saw her for knee pain and brief to get her through London and that kind of stuff. But the way runners move, a lot of people don't appreciate, but running, even though I'm moving straight ahead, it's technically a unilateral or single leg rotation propulsion drill. Explain what that means because it's counterintuitive.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
It really is. So golfers are actually the same. Their single leg actually rotates to create that torque. So what happens is my favorite term that's out there right now is called the spinal engine, which really speaks to this reciprocal movement of the spine on top of the pelvis and then my feet through the ground. So those three domains, if you will, work in unison to propel me forward.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
It's a lot like with sailing, like you put the sail relative to the wind and it points me in direction. All three of those domains have to work in sync. And so when I all of a sudden see an athlete like Jill, she wasn't new to running. She definitely added her volume in a short window, which is a great recipe for injury.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
But that right knee flaring up told me, okay, there's something going on at either her feet or her pelvis that's not in sync because she essentially with her mileage overloaded that right knee and created a repetitive stress injury. So that's why I was saying earlier, injuries don't just show up for fun, right? The great almighty above didn't say, Jillatia, right knee pain today.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
And so whenever you see a story like that, and then you do the evaluation, and the way her pelvis was rotating, the way her core and her spine were set up, and also the way that left hamstring was affecting her motion, she was basically dumping into that right knee over and over. 10 miles for someone like her, no big deal.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
You stack up two marathons pretty close with that much mileage, all of a sudden that right knee really flares up. And so the right knee flare up was actually an indicator of something else going on functionally. And it wasn't only about making her knee better, which is what traditional medicine does is like, okay, rest it, ice it, meloxicam, treatment, rehab, chiro, whatever.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
And then the knee's better. And then traditionally those people go run again and three or five months later, it comes back. So we need to look at these asymmetries everywhere else, not just the side of pain.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
Yeah, great question. I think demographically, a lot of middle-aged women, it's getting way better, but don't strength train, number one. So the health of their tendons and the muscle fibers and the mass of the muscles just aren't normally as high and as strong as someone else, especially if they're an endurance athlete.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
Runners nowadays know that they need a cross train, but how they're doing it and what it looks like is still a big gap in my opinion. So using the word cause is always tricky in biomechanics because it's always kind of like the snake eats the tail, like they're all kind of intertwined.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
But the most simple way of describing it is that tendon overuse, what we found out with her MRI is that she had a true tendinopathy damage to that proximal hamstring tendon, as well as one of the hip rotators that inserts on the same site next to that hamstring had a little damage and irritation.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
That area was a byproduct of the way she was rotating through her pelvis and the way that spinal counter rotation was happening. Jill has a tiny bit of scoliosis, which sets her up for that asymmetry. And so her brain subconsciously was basically forced with the decision of, do I jam my right low back or do I really try to pull with that left hamstring?
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
You really wanted me to come over, I think initially just doing some DNS stuff, like some routine maintenance things. And somewhere around the second or third visit, I was like, what's going on with this shoulder? And that kicked off this whole conversation because in my world, this idea of just doing one technique or providing one service isn't really a complete approach.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
And that combination over time created a little fraying in the tendon.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
I could definitely see that. And I think a lot of women feel that way. My wife had the same experience. I think one of the biggest crimes in modern medicine today is that a running back, if we blow an ACL, we know exactly what to do. And there's a protocol and everyone's like, okay, in eight months, this athlete will be back. But women, everyone cares about the baby.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
The baby's born, even the mom cares about the baby. They sacrifice their own body just to make sure this little creature grows up and gets everything it needs. And so this focus on what women need the first year after is very lacking, in my opinion.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
The complexity of what they deal with is fascinating because not only do they just add weight by adding this human, the relaxin hormone creates areas of stress and laxity that will shorten up and tighten up over time, but it affects different women differently. Some women's feet change in that environment of more relaxin and carrying more weight, the arch and the foot gets affected.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
And so in a way I always look at it as like, okay, all these areas suffered a little bit of what you might call as an injury, but let's look at it like, okay, it's a natural process, but how do we account for all these layers? No one out there is telling women to do foot strengthening when they're two months pregnant, but they should be. I wouldn't have thought of it until you just said it now.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
Yeah. Literally, women, just like we did for your shoulder, if you find out you're pregnant, you should start doing some foot strengthening things, some core stability stuff. There's a ton of things you could do. Prehab, Then after, obviously, God willing, see how it goes and get the baby good, but then you start trying to strengthen the right way.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
Oh, yeah. One of my favorite orthopedic surgeons in town, he called me and he's a hip ortho, great guy. And he's like, hey, you got to help me out here. My wife has the same issue. And she's been doing traditional PT for like eight months and it's no better. And she's about to fire me. She's like, what are you doing? But it's a very common thing. And that's what's been really cool for me to see.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
These pelvic floor specialists that are arising, it's really cool field, ton of expertise with it. I am not an expert in pelvic floor by any means, but you touched on the pelvic floor is very much a big player in how we pressurize our intra-abdominal stability. It's basically the flooring of that whole canister that we're supposed to create with proximal stability.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
And so if the diaphragm or the pelvic floor isn't doing its job, then our body's going to immediately start to compensate and create rotations and tilts around things.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
I think that's the starting point that I wish everyone could automatically understand is that if you have a really prominent rectus abdominis, that six pack, that has nothing to do with how you stabilize your trunk. especially if I'm doing things in multi-planes like tilting and rotating.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
So it's not just your obliques either, but it's the deep stabilization system that not only pressurizes with our diaphragm, the pelvic floor, but it's also all the small muscles up and down my spine, including like multifidi. Do all those muscles kick on and create stiffness in the right way at the right time?
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
I think a lot of times people are accidentally overcoached into thinking they only need stiffness because the second step to that is, okay, now I can activate that deep stabilization system. I have that bracing. I'm pressurized. I'm using my transverse abdominus, all these other structures down there. Now, can I do that with motion?
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
And that's where you start looking at someone kicking or running or throwing. That needs to be a dynamic system, not just a stiff system. And I think a lot of people, they don't have the first one. So they see a ton of these exercises like the DNS three month or dead bugs or whatever else we want to call them that create deep core stabilization.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
But they don't see the next step after that, which is, okay, now how do I maintain that pillar and that strength? And then I get a free shoulder blade or a free hip to move. And one of our shared clients, he had a lot of radicular nerve pain from a disc issue. And he was convinced he had some of that.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
But one of the most fascinating cases for me in recent memory, because with him, we were able to actually find a trigger point that referred pain that mimicked that radicular nerve pain. So when we literally pressed on his glute minimus, he got a referral that he thought was a tribute to his back. So that was a window towards, okay, that's a muscular issue. That's not your spine causing trouble.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
And then we gave him these stabilization drills, which helped that glute just relax for once. What we see all the time in the clinic setting is muscles are meant to be a muscle. My bicep is meant to contract and relax. It's not meant to be a shoulder stabilizer. But if my stabilization isn't doing its thing, then that bicep and the trap and all these other muscles try to help.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
And that's where we lose freedom of movement because your body is essentially perceiving a little threat, a little instability, and so it tightens other structures up. So then I see people coming into our office saying, will you dry needle this or work on me or do soft tissue work? They go to the stretch place. That's going to be a six hour benefit.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
But if we activate this deep stabilization system and get all the parts moving in unison and in sync, all of a sudden those movement problems go away and you're much more robust and strong.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
Dynamic stability. Absolutely. And there's a ton of analogies I've heard over the years. I'm not a car expert like you, but one of the ones I've used a lot in my practice is for a while, I had this really old truck that we were working on and it was like a mid eighties Chevy kind of thing.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
And when you turn the wheel from my hands are at, let's say nine and three, it wouldn't turn until my hands got to like 12. The steering on that thing was sluggish. So that dynamic stability, it wasn't very good. Whereas like an F1 car or go-kart, that thing moves with micro movement.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
So if you translate that to the human body, anybody listening, if I said, hey, do a skater hop where you leap laterally from one side to the other, how you land, can you stick that landing or are you falling over as you go? And there's a million variables involved there, but the big ones, of course, are your rate of force. Can you absorb that?
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
Can all your tissues, the arch, the Achilles, the IT band, the hip, your core, can all those tissues kick on at the same time to create stiffness, number one? And a precursor to that is where's your balance? To generate that first force, were you organized or did you have to like throw your head and hands a weird way to generate the force, but now I'm not in an optimum landing position.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
So what a lot of times you see in youth athletes is people rush to put strength on them, but a really good strength coach can put strength on a college athlete, you know, in eight weeks. But do they have speed? Do they have organized movement? Are they quick in all planes of motion? Is their balance really good? Because now my nervous system, my software is ready to absorb all these things.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
And then you put strength on top of that. That's a great athlete. And a lot of these genetic people that are just naturally really good, they have some of that underlying ability to where they can land and organize well. And then later they put strength on.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
Pick a sport and you can show me somebody who was really athletic and they weren't really big and strong, but you can put the strength on later. And that's one of my biggest personal passions is these 14 and 15 year olds who just get berated in the gym and then they tweak their back.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
I had one local team where it was a golf team and about 30% of their athletes had a stress fracture in their lumbar spine. Oh my, what? Yeah, it was absurd. How is the strength coach not getting fired? So I reached out to the head coach and the strength coach and to give all these people a little bit of a pass, they're not really equipped because they're managing 200 kids.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
I think it's just a bad setup. You have 200 athletes that you're supposedly managing a program for and you're not watching technique. Whether or not you know what you're talking about, it's a whole nother argument. But like the idea of, okay, we're going to do a high performance on a 14 year old and put strength on them, but no one's watching technique or teaching them the foundations of lifting.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
While at the same time, they're 14, we should be making them quick, athletic, and coordinated first. Because that's a platform you want to build an athlete on. You don't want to make a kid really slow, but really strong when they're 15. It's really hard to train speed as you get older.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
We did a ton of work. The literature and the science is out there to a degree for you stack things on top of themselves. So you start with isometrics, you progress people to more explosive or compound movements. So let's assume that I don't have any injury risks at all. And you would determine that based on just my history? No, and testing. History, testing, demographic risk.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
There's a lot of variables we look into for having concern about musculoskeletal injury. That's number one. But yeah, every person is different that way. And we've had people come in who've had multiple surgeries and injuries, and then we've had other people come in who they're high risk for injury, but overall, they're a pretty good package to work with.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
There's not a lot of medical concern, if you will. So ignoring all the medical side of it, I really like following the principle that the exercise is the test because we basically look at everything about four to five different ways. But if I watch someone do, let's say a wall squat.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
It's isometric. isometric load. It's what we all used to do in like high school practices where it burns your quads and your patellar tendons. And we can even set you up to where you're in the right position. So that's going to tell us a comfort with the position.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
Every metric we have has a qualitative and a quantitative associate. So the quantitative, we have minimums. It's either time or percentages of body weights for every test or distances, like you mentioned on the broad jump. But then there's also like, how does it look? And then the how it looks one is the vague part of the movement world.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
So you're going to have your coach and myself both looking at it. But then we have other ways where we're confirming that with our motion capture machines, with our force plates, with our videos that analyze the movement. So there's a lot of ways to confirm. You can also see these things cross over.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
So how does someone do on the double leg versus single leg gives us a really nice window to, okay, where's the lack? Great example, two leg, really strong, they're solid. We put them on single leg and they're abnormally less functional and weak and don't have the range. So I'm immediately thinking, okay, there's a balance control issue here.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
Because on two legs, I'm really stable, but on one leg, I'm significantly less stable and it's much more complex for the body. And so if their scores, even though they're strong and their quads have the capacity, but when they're on single leg, they're not strong and they can't stabilize, that gives me a window right away to saying this person has a major balance risk or things like that.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
And in the case of that individual, do you not progress them? No, we find their floor and we build from there. So some people will have really cool, robust Instagram-worthy exercises for one region, but another area we're filling in gaps, we're building foundations, and we're basically building them up from wherever those floors are.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
And the key for us is this big grid we have where we have every category movement we care about, and then we build them from their floor. So I'm really a visual person, but I always say, okay, we have this baseline floor, maybe for their upper body pull, they're on the third floor, they're badass, they're killing it. But then their core stability in one plane is like in the basement.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
Like I'm worried about a lumbar stenosis or a nerve issue. So that takes precedence first, because I don't want this person to experience pain. And I want to build them up to where they're all on the first, second, third floor of the building.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
The next step was immediately, you have to have a parts approach first. If I have a damaged part, we got to make sure, does that need intervention or not? How are we going to address that? So with Jill, we knew her foundational underlying movement patterns or dysfunctions, if you will, that were contributing to that.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
So we put a package together for her program that was all of those underlying structural functional issues that didn't make the hamstring worse. We started building those right away while we considered platelet-rich plasma. And she actually ended up going for it to create essentially regeneration of that tendon at the damaged site, which she did perfect with.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
We had to have a lot of come to Jesus conversations about you cannot run too soon. If we're going to go through all this trouble and financial costs, we want to make sure that that can heal as much as it can. So everything we did in her programming was to ensure we didn't flare that up.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
And then conversely, we really communicated with not just the strength team at 10 Squared, but also her physical therapist offsite and her running coach. And all of us had to put together this six-month plan where her running coach didn't accidentally flare it up because he does have a window to everything we're doing.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
He definitely needs to talk to the PT, as did we, to where she could, quote, get medically cleared.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
So because of her timing for the race and she wants to run Boston, we had a little extra runway. So the more healing time you can get, the better. We have a lot of people who are like really impatient, dying to get back to running. Yeah, if you're a pro athlete, you might not have that luxury. You don't have that luxury, right?
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
But that's what's been fun for me about 10 Squared is I don't have all these environmental constraints. I could just get to look at people.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
Yeah. Let's take a breath and be really detailed. And so with Jill, the PM&R docs and the physiatrist will always kind of give you different amounts, but usually two rounds for her issue. So you do one round of PRP, basically do nothing. And then you do another round about two weeks later, and then you slowly let that heal and you start to add physical therapy. So
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
With Jill, total time, we were doing a ton of stuff around the area of the injection right away. That's imperative. You don't stop everything. You just protect the area and you train everything else. So that is going to be one of the reasons why we get a lot of success with her. And then back that up with, we really did targeted physical therapy for that site to promote the healing. So
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
The physical therapy side, they're using a ton of things like BFR, dry kneeling where necessary. Everything you can to just help those parts heal, foster that growth hormone, foster that protein synthesis, build that muscle up without a lot of force in the tendon. All those things that a traditional physical therapist that knows what they're doing, they can crush that.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
Yeah, and she for eight weeks had to swim. She was pleasantly open-minded. It's hard for every athlete to not do their sport. I get that. But I've delivered that medicine over and over for a long time. And so she swam. So she didn't lose any true cardio, right? She lost a little bit of running strength.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
But someone with her background and her base and then keeping everything else really strong, she's going to hit the ground running. And she's running now and doing really well. And so I always say I have two athletes. I have an athlete that I have to encourage, like it's okay.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
Those tend to be more your traumatic, acute, like ACL type people where you got to show them in the lab and show them in the gym that it is okay. Keep pushing, you're good. And then I have the other athletes where you have to hold them back. And so Jill's going to be that one, like, let me go, let me go. And we have to play bad cop just enough where science supports that.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
So where she doesn't flare it up again, because we need her to have a nice, smooth progression. I'd rather her be really balanced and athletic and strong and feeling good on race day, not like a bunch of junk miles and that tendon in the knee starting to hurt her again and stuff like that.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
Alton did an amazing job in a lot of ways, but one of the things as a rehab professional that I really appreciated was how he didn't want to just cinch down that joint to where his liability was so covered that that shoulder would be strong, but you lost a ton of function. And I think that is one of the key things that he did for us was he did the right amount.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
That's a big part of this is when your coach is basically in contact with you every day as much as you want to help bend and twist and develop that formula. So where that person is actually encouraged to do it, they enjoy it, they like it. I've had people tell me, yeah, this core stuff makes sense, but I just hate getting on the floor. Okay, we got to pivot and change the program.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
If I just try to convince you to do an exercise that you hate doing, it's not going to last. That's number one. Number two is we want to really mitigate the risks of injury. You get some momentum going on the psychological habit side and then, ugh, I pulled my hamstring. I'm devastated. So we got to get those foundations going. But then usually we look at the medical risk side.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
So some people, the CPAT test was terrible. Their VO2 numbers are bad. In our society, you got to have a good heart. We want to get that off the table from a risk factor. So we'll probably really put that routine cardio in, in a manner in which we don't flare up the things that could create an injury. So one client we had recently, he didn't know it. He didn't bring it up.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
He's never had leg or foot issues at all. But his testing, his calves, he's a big fall risk. His calves are crazy weak. His balance wasn't good because he didn't have strength. And he's definitely a high risk for an Achilles. How old is this person? 52. You wouldn't expect to see that in somebody so young.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
Yeah, but he's just poured himself into his career and really successful, really smart, cool guy, but he just hasn't trained a lot of stuff. And he had kind of a health scare, which is what motivated him to like get organized. Let's get this stuff right. It was interesting to see his really successful analytical brain use that scare to be like, okay, I got to get sorted out.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
You can see he operates his business the same way. Problem identification, what's the solution? Problem, solution, problem, solution. So with him, he didn't know he had any of these risk factors, but he is a textbook for having a fall or blown out his Achilles because of the weakness and the lack of capacity and strength he had.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
Yeah, he's definitely in that bucket of he could have been, it's a little fear mongering, but like he wasn't set up to like having to change direction quickly or maybe trips off a curb after dinner in New York. He could have had something like that easily. Big guy too, so top heavy just like me, big tree fall hard.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
So with him, he wasn't even aware of that weakness, but the last thing we're going to do is give him a running program. We got to design his CPET stuff and his VO2 max training and his zone two training around these inefficiencies with his body. And so the workout in the gym needs to link up perfectly with those risks and also what is the most important thing for him right now.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
He put the staples and the sutures in the right places to where that shoulder would be functional. And we got to your shoulder well before it became any kind of more significant structural compromise. So it's a really important window to do so. But I do remember that conversation because you had a date several months out where you're like, I'm going to have to use my arm a lot.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
Oh yeah, a lot of people are overwhelmed, but what's been really nice is the data, but then the calibration. And so what's been really cool with some of our clients we've had for several months now is consistency is always the name of the game, especially when we're playing the long game like we are. And if someone's going on a two week vacation, we want to know where are you staying?
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
What does the gym look like? We will change your workout so that you can keep doing it while you're on vacation. And if you tell us, look, guys, I'm going to be really active in the day. I kind of want to decompress. I've been working in my basement garage really hard for three months. Great. Let's take care of the total human.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
Let's give him a 30 minute small thing to where he can almost have that lightning of the mental load just decompressed. But he's still making gains and he's still building that up. That's what's been fun for me that I almost never got the chance to do, even though I wanted to with some of my athletes, because there would be so many variables in the way.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
With this, if we get a video of your gym and we know, okay, they don't have a bench that goes to incline, but we do have TRX and they have a treadmill that goes to the incline, but they don't have a bike. We can change their workout to where they keep marching along and it's an agreeable way for them. And it's not just like, oh, I was on vacation.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
I didn't work out for two weeks because you get muscle atrophy. If you don't work out for two weeks, we go backwards.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
Yeah, I think the best way to answer that is more principle-based. So I think number one is we behave in a three-dimensional space. So this idea of only doing calf raises, my toes pointed straight ahead, insufficient. Because to your point, there's gonna be moments where my toes are out or one toe is out. So we wanna do all these strength exercises in multi-planes of motion.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
And that doesn't mean even in a static position, but that's like a lunge, lunging to the side, lunging backwards. You want to train in a three-dimensional space, number one. So all of your training should account for that. If we're just doing bicep curls and calf raises, it's like I'm on these railroad tracks, but the minute you make me go sideways or rotate, it's trouble.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
So three-dimensional, number one. Number two would be to get motor unit recruitment, to really make sure that those muscles are firing, you need to do really heavy loads or things that are really fast to get that nervous system to like wake up and respond. The problem with that is not a lot of us are ready for that. So what you usually start with is really long hold isometrics.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
So we put you in these different positions and find ways to resist that and pull and create stiffness and remodel those tendons. So we're essentially making those parts ready to start going into the danger zone that is explosive powerful movement. I shouldn't say danger zone as much as I should say like a higher ask. Yeah, risk zone. So heavy overcoming isometrics, they call them.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
One of my favorites is that mid-thigh pull. It's kind of a standard in the sports science world where you have a bar and you basically calibrate the machine to where the bar is about the mid-thigh and it's almost like the very top of a deadlift and you just pull, but the bar doesn't get to move.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
And the sensory input is like the force decks and they're measuring your balance, your force and all these other cool metrics. But holding that over time, we're now isometrically loading the heck out of my grip. You're loading the heck out of my shoulders. We're getting into my feet, my quads, my hips, and I'm just holding that for time. That sets all these tendons up.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
And you just do this with a super, super heavy loaded bar that's too big for you to lift? Not necessarily. You can actually do an empty bar, but you pull it up against the safety bars of the rack or something like that. Isometric thigh pull is the thing to look up.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
But there's a lot of ways to load these heavy isometrics because that gets your tissues ready and you build that up over several weeks and that tendon adapts and now it's ready to resist force. And then the way you bridge that is you start doing deloaded plyometrics.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
So now maybe we do some sort of like a band assisted pogo where I'm actually pulling on a band overhead, pulling down on that band essentially lightens me because the band's gonna pull me back up. And now I get to train that speed and that quickness through the ground but it's not my full body weight. And so that's a great way to bridge from, okay, now I've got the parts ready.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
Now can I deload the amount of force and train the speed? Once I've got the speed going in the parts, now I just get to become an athlete and do body weight and beyond.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
And so that's where you see these really high level athletes, even at early ages, their trainers know how to build that paradigm up and bridge it across to where you don't get any injuries along the way, but you get a really springy force resistant person. So many of us, like we touched on initially, don't train pogos. We don't train plyometrics.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
If you go out to the local men's or women's soccer league, how many people there over 40? Not very many. Now there's a lot of reasons why that is, but we're not playing games and we're not reacting to stuff. And so we need to make the gym a safe space where we can recreate these things and essentially test out these movements. So I don't lose it.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
That conversation was one of my favorites because I've done this before where if we know the big picture goal as well as the near-term surgical date, and then we reverse engineer, okay, I want to check off a certain amount of things preoperatively to where that joint is ready.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
So with you, without getting your foot out, you have a very mobile foot. Your swimming background, swimmers have really great mobile feet. Show me a soccer player who had their foot strapped in cleats for 10, 20 years versus a swimmer. Very different setups. So it really speaks to how tissues adapt over time. So your feet have a ton of motion in them. They are not restricted.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
You also do a lot of barefoot work in the gym, which is helpful for you. Your feet are actually pretty strong too. If we test your big toe and your smaller toes, you don't test outside the normal limits for strength requirements, but your biggest gap is that multi-positional stiffness and that ability to create force absorption through your tissues.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
And you're actually set up for that because you can move so much. You don't find those end ranges, either the bony end ranges or those tendons can't grab because there's so much play in that pattern. So what you accidentally do all the time is you'll go on a ruck or you'll go on a hunt where you're off road and you're getting all these angles.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
You'll slowly flare up a tendon and tendons are notorious for not hurting.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
I'm just glad your feet not at the other end. So because your feet are so mobile. Tendons are notorious for, they don't really hurt at the time, but they hurt like crazy the next morning. And what you always routinely say, which is really common if you're plantar fasciitis or patellar tendonitis is when I first get up, it's really stiff and creaky and sore and hurts.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
And that's because tendons love blood flow. They love movement and they love motion. And so all those chemicals that come with inflammation, if we're just sitting around or sleeping, that's the opportunity to get stiff and really sore and achy. With that kind of symptom pattern, you're not really lost on what it is because that's classic tendon. You can walk, we can load it. There's no failure.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
So we're not worried about a muscular strain or any other damage, but that tendon gets really hot and spicy, especially in the mornings, if you're not creating that stiffness.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
And essentially, in the most simple terms, what you're looking for in that situation, especially with the shoulder because it's such a mobile joint, is you want to make all the muscles around the shoulder just awesome. but we need to do so in a way that doesn't make the surgery more complicated or injure you more.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
Well, tendons are one of the slowest things to heal. And I guarantee if we really zoomed in and looked at all of it, you probably have a little tendinopathy in those tendons, a little damage here and there that could be contributing to that irritation. But the most important thing is understanding that tendons take months to regenerate.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
You and I have had a pretty consistent attack with it, but we finally got you on a really good rehab program you're doing yourself where we're loading the heck out of it with these isometrics and we're building the load more and more. And we're loading those isometrics in different positions. So one of the ones we do with you a lot is that front foot hover, but you're actually plantar flexing.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
So where you're driving, you're doing as much of a calf raise as you can, in that split squat position. And then we make you hold that while you do that split squat. So it changes the whole angle and the relationship.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
For you, the goal was your toe off was one of the problems. So what happens with you is when your foot, your heel lands, you're driving your body forward and your foot's behind you, you would do like a little bit of a rotation out and create like a little bit of a whip through where it wasn't nice and pure rotation rolling through the foot and the toe.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
It was complex and putting extra stress at the ankle. That times 10,000 steps a day will really pick at that tendon and make it sore, which is why you wake up the next day hurting. So what we're trying to do is put these tendons at different lengths and then putting a lot of load through them.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
And then the complexity we're adding isn't necessarily at that joint, but we're actually adding motion and complexity above with the lunge and also the requirement of you having to stabilize centrally in that mid part of your body while that foot is locked in. So someone with a really mobile foot, you tend to really use that foot for everything. And that's how you spice up those tendons.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
And so we did a lot of things where we didn't only use technology like BFR, but we also used very aggressive approaches on your core stability, the way your scapula interacted with your ribs, and all these things have an effect on how my shoulder moves.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
And I'm essentially putting that foot in a position where that tendon has to heal and it has to get stronger. But then I'm making the other parts of your body reach that complexity and meet the demand.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
that dorsiflexion or bring your toes up, the pogo, when it's a sudden like acute force like that, you probably also just create a little bit of a joint irritation. It's analogous to jamming your finger.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
If you move those two joint structures together really hard quickly and your body can't absorb that force, that'll get a lot more sore than if it's just kind of a slow repetitive stress like the rucking. The pathway is, and you've noticed the relief, like when we do the manual therapy and things like that, that's a nice short term, like, oh, it feels a little better, a little less pain. Great.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
But the bigger picture and the ask of your body is teaching it, how can it respond to this and how do I build that force in those tendons to where not only does that tendons start to regenerate and heal, but then it's also ready to react to all the things you do. So knowing for you specifically that you love to use those feet, And the more barefoot you are, like you're more likely to do that.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
We need to do a ton more quick work with you that's deloaded to train all those tendons. I mean, there are so many tendons in the lower leg and the ankle. We need to train all those tendons to get quick and stiff in different positions so you don't jam the joint or create a stress in the tendon. Should I be doing less barefoot activity? No, I don't think so at all.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
I think that's a pathway to frailty. You want to stimulate the receptors in the bottom of your foot. Do I want you running on like a river barefoot with sharp rocks? No, because that's going to cause other problems. But I think having you barefoot makes your foot mobile and strong. But then if we piggyback that with this specific type of training for where your gaps are, it's a huge payoff.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
Let's look at the other side. Most people don't have your situation. More often than not, people have a really rigid foot that's weak and stiff. So we're actually going with a whole other direction where we're trying to get motion in the foot. We're teaching that foot to separate rear foot and forefoot. How do those people present? What's the pain or what's the injury they present with?
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
And if my really mobile shoulder that has a torn labrum isn't stable and doesn't have a support infrastructure around it, you're always just going to ask for more pain. But the best thing about that is the day you got the surgery, we jumped on it really quick once things were healing from the surgery itself. All those other ancillary things were actually functioning really well.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
Interestingly, they actually get a lot of symptoms up the chain. Our foot has so many bones and all these articulations where we're supposed to comply to the ground. If that shock absorption goes away, like let's say I'm wearing these big goofy running shoes that they sell now that have the rocker where it's all just like patching holes in the boat rather than optimizing movement.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
If we have a foot that is stiff, those force factors go up through the body. So now my knees, my hips, and my spine have to figure out that force distribution because one of my best shock absorbers is the foot and the ankle. If that's not doing its job, everything else pays the price. So I see a lot of people, let's say the soleus is weak, their lower part of their calf.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
So that control of their tibia as either walk or lunge isn't there. So that ankle just walks up and then they send all that force to their knee. That's why one of my favorites is anyone with a chronic knee issue, I'm going right at that foot and ankle first. Because if the foot and ankle isn't up to the task, then my knee is going to take a beating.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
I mean, it's a good theory, but absolutely. Yeah. You're really good, wide, mobile feet. Your knees gets to be a knee.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
If that rotation, that pivot joint that's supposed to happen at the ankle isn't pronounced to the amount you want and it isn't mobile enough, then that knee and that force vector is going to happen at the upper tibia and the femur where now you start to get these little meniscus things that showed up out of nowhere. That torsion has to happen somewhere.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
Yeah, I love what you just showed there. The graph is always going to have peaks and valleys. When your brain perceives threat, whatever that could be, maybe your dad hurt himself playing football, so you're scared to play football. But when your brain perceives threat, not only is your heightened awareness up, your nervous system is kicked up, but we're more sensitive to pain.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
So certain things hurt more when we're ill or when we're stressed than if we're not. And if we stick to just movement themselves, a lot of people are afraid of certain movements because it hurt me in the past, or they heard it could hurt them, or maybe they just haven't done it a long time, so they're nervous about it.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
So you can actually empower people if you show them there's a rational reason why that fear could be there or why that pain is there. Pain does not always mean injury. Pain is your brain telling you, hey, I don't like what's happening here, but it doesn't always mean you're broken or busted. Another thing to think about is your image isn't always a death sentence.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
So now we only had to really target the shoulder itself because the rest of the human was really strong and ready.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
If we MRI 100,000 low backs, there's going to be wear and tear, especially if you're over 30 years old. Same goes for every other joint in the body. Does that mean we design your whole clinical plan around that? No. We really need to think about, okay, how much is there? What do they want to do? What are their strengths? What are their weaknesses? All those things we already spoke to.
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#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
So when there's fear involved, you really have to address that because the individual needs to know that A, you have a plan for them, that you understand their fears. And then B, we got to account for those fears in one way or another. So this is not data, but in my private practice,
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
The amount of low back flare ups, just your traditional back spasm, not a surgical candidate, just high back pain, but no damage. The amount of those people that have come in when their wife's about to go into labor or they're worried about getting fired from their job where they have like an emotional mental stress in their life. The amount of those people is infinite.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
I've had thousands of people come in and go, my back flared up out of nowhere. And then you start to dive in, like what else is going on? And they're really worried or stressed about something. The goal there is you can't always fix those external, cultural, psychological, emotional things, but we can address them and identify them. And sometimes they need therapy.
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#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
They need other things to address those. But more importantly, we need to empower that individual and give them rational reasons why you're like, hey, this might be why you flared up in that glute or in that mid back. And this is what we're going to do about it. And if you outline those plans for people and give them the tools, now you've equipped them to actually help themselves.
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#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
This whole game of, I'm going to take an x-ray view and look, oh, there's one little bone spur, but now I'm going to scare you into like a 40 visit package to my chiropractic clinic or something. That game needs to go away fast because the only thing you're doing is making people feel more frail, more afraid, and you're actually only helping the bottom line of your business.
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#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
You're not helping that individual.
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#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
Yeah, I mean, low backs are great. So number one is for the neuros out there, if there's weakness or you don't have bowel or bladder function and things like that, right away, get evaluated, right? Because the way nerves work, if there's pressure on nerves, it could over time create permanent damage. Now, a lot of nerve pain is sensory. It's that electrical sciatica type stuff.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
It's that tingling and that weird thing like that. But the real number one that you look at is do they have weakness or do they have loss of some sort of foundational control? that's when you got to get integrated with neuro and orthos right away. If we don't have that, now you're in the like decision-making domain.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
Yeah, exactly right. That's definitely on the long list of things I refer out for, for sure. So if you're in that kind of mechanical low back pain or even some disc nerve issues, but no weakness, now there's a ton of strategies we can do almost as a first diagnostic step to see how your body responds.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
Now, what I mean by that is we're not going to do some crazy aggressive therapy or treatment or manipulation of the spine, but we're going to do some sort of intervention like muscle work or McKenzie exercises for discs, which are highly researched and really effective, to see how the body responds to those things.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
If your body responds in a positive way, even for two hours, that's a great indicator. Like, let's keep going down this road. Because even the best surgeons that you and I have both talked with about mutual clients, they'll say, let's give this a little time and see what your body does. Things can heal. The natural processes of the body can take care of themselves.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
So one of my favorite examples actually is a disc herniation. She confirmed on MRI. She was doing McKenzie protocol, which again is fantastic.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
So McKinsey Protocol is a really great system that you essentially put the patient in various positions and you do this gentle arching or pumping and you're basically trying to take pressure off that disc to where slowly over time that bulge can recenter and balance out.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
Oh yeah, McKinsey Protocol is fantastic. Their website has a database where people can find people in their town. So if they have nerve pain, it's a great place to start because all those McKinsey practitioners know what I just outlined too. It's like, this is a McKinsey thing, this is not.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
But what's fascinating about McKinsey, sometimes even in the room, they'll get a reduction of nerve symptoms while they're in that position. Nerves provide very productive information. You can trust symptoms of a nerve really well.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
So if I get what they call a centralization, meaning I had sciatic pain all the way down the leg, and then you put me in this one McKenzie position, and now it centralizes to the hamstring. That's a great diagnostic indicator. Exactly. And so just because that individual might have an MRI with a disc herniation, that doesn't mean it's an injection or surgery right away.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
Obviously, part of the decision-making is what are they having to deal with in their life? What is their timeline? All those other factors. But if you can encourage a hot disc patient to wait and make sure that they're actually letting things heal and run their course, they could be much better off in four to 10 weeks.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
Yeah, we've chosen the better side for sure. But this case I was going to talk about earlier, she was a fascinating one. So confirmed disc herniation, and then she had an annular tear, which basically the annulus is a part of the disc. Best analogy to describe it is she had like a little thing that was equivalent of like a cuticle that was just kind of peeling off.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
So traditional protocol, we started her on McKenzie's. Great lady. We're actually still friends, but she was really hurting. So we worked with her for like two, three weeks. And every time we put her in that McKenzie position, it hurt her worse. And it was local pain, but the radicular symptoms reduced.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
So long story short, what we learned over time, she went back over to another place, tried that for a while, didn't work. The disc herniation was actually taking care of itself, but that annular tear was still sticking out, creating extension-based pain. So after about a year of rehab, her body was able to scar up and that healed and it was fine.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
But what was really interesting to me was she needed McKenzie's early, but then we actually had to cease the McKenzie's because we were jamming that annular tear. And so then we restored just more pillar strengthening, dynamic neuromuscular stabilization, all those other things. So it's like different things at different times played a big role.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
No, it's different. I mean, the best analogy is I sprained my wrist. I might have to wear a brace or something, but I can generally function. I can go to a movie. But when your ribs or your back is hurting, not only are those muscles much more big and powerful, so when they react in spasm, they're really good at it.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
These small muscles in my wrist, when they react in spasm, they're like, oh, that's kind of sore. But the low back, I mean, that group of muscles is really good at freaking out. The type one fibers, postural stuff, a lot of detail. The other thing is you can't do anything without affecting you. Sitting in a movie hurts, walking hurts, affects them constantly.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
And that's a big part of the rehab story is finding these little wins where they can actually do something and it either does get worse or heaven forbid, makes them feel a little bit better.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
Yeah, especially if you're that person who's suffering from that injury, then odds are you didn't perform these exercises well subconsciously, so that's what set you up for it. What is interesting is the video recognition software is getting fantastic. I've demoed a few now where the AI is actually watching someone do movements and saying, hey, you know, this was too far out that way or whatever.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
But that also goes in the bucket of everyone moves differently. My femur length is different than yours. So the angles with which I'm going to lunge are going to be a little different.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
This idea that if you take principles and you know the symptoms, and then most importantly, you know how people react to really conservative loads, that almost tells you more than did their tibia rotate three degrees or not.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
I could care way less about three degrees of tibial rotation based on AI software and care way more about, you know what, I did these lunges in this setup and we activated some neuromuscular reaction to where my glute fired a little bit better. My knee felt way better. And then when people give us that good qualitative feedback, now you know how to trim up that program.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
So I think the AI part of it's going to be more that. It's going to be less about, oh, what degree did it move? But more about how did you respond to each drill that's safe?
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
Yeah. Knowing am I going to do an overhead dumbbell in a DNS three month and all these other nuances versus the legs. There's certain cases that I'll do that one for one and the other for another. And it's really a matter of knowing what you got to start with. And then we test it a little bit. And then we test a little bit more.
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#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
And then the outcomes are dictated by how do they respond to that exercise.
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#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
It speaks to a bigger thing, which I'm really degree agnostic in the sense that I hope someday in the future, there's like a more clear certification or degree where there are chiros and PTs and frankly, strength coaches. All three of those people I would trust way more to do a rehab and get someone better. Who would I send my mom to?
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#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
I would send my mom to all three of those people if they have certain skill sets and like approaches. independent of degree or credential. Totally. Because the Cairo degree was my baseline training. That's where my license is and all that. But the traditional view of what Cairo is with the manipulations and the adjustments, that's 5% of our week at my practice.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
Our practice, we have Cairo's amputees, but you can't really tell who's who because everybody's doing what we call is active rehab. So
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
One of the things I always tell people, I don't care what their degree is, but if you're going to a rehab clinic and it's one-to-one relationships, so it's not group, but it's one-to-one, and they've got a bunch of weights in there as well as their traditional bands and stuff, now that's an indicator, okay, these guys are going to build me back up to something actually strong, not just make me come in here forever and do rehab purgatory where I do the same micro drill over and over.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
We got to build over time. So I'm really agnostic to a degree. But that said, my story, I basically tried to create a residency for myself right out of Cairo school. And back then it was really manual therapy based. I learned a ton. I was by far the lowest guy in the totem pole, which we all know how that works. A lot of time, a lot of learning, but I was there to soak it up.
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#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
Everyone always thinks pro sports is the top and it is in a lot of ways, but it wasn't really for me in terms of an official team relationship because I just didn't like that personal schedule. And it was pure chaos. Like you'd spend a week fixing somebody up and then they go out there and get blasted again. You're like, oh, that's a bummer.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
It's kind of like when my son builds his tower of magnet tiles and then his sister knocks it over. The look on his face was me every Sunday, you know? So I really enjoy the off-season side. I really enjoy more of the project. And I realized early on that when you're only doing pain relief manual therapy work, there's a lot missing. We're not building people up. We're not strengthening them.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
So that's when I just started doing this deep dive as much as I could and learning from as many people as I could about the foot and balance and neuromuscular training and all these other things to where it's a compliment at my private clinic when people are like, what are you? We actually have people come in our office now. We're like, I need to go see my chiropractor later. And
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
One of my other docs will be like, well, I'm a chiropractor. Like what? I had no idea. And they've seen us for years. So we're probably supposed to identify ourselves better, but regardless, we're solving problems.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
No, the way I would describe it is I've benefited from getting adjusted myself. Things get out of whack. Things get stiff. You sleep on a plane where like, that's a real thing, but it's a tool in the tool belt. And the really good practitioners have a bunch of tools.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
I could say the same thing about chiro adjustments as I could dry needling or active release or McConnell taping, like a million tools out there. The really good practitioners have a huge tool belt and they know when to use which one at what time. So just throwing cupping at somebody and hoping their muscles get better, it's insufficient.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
In the same way, I would say just adjusting someone over and over, it's not enough. There's more that could be done. And so what I get asked a lot, especially now that I'm older, like all my friends I've accumulated over the years, I didn't account for as I got older, there'd be more questions exponentially because they're all getting sore and hurting.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
But what I always tell them is I need someone who's got a bunch of tools in their tool belt. I need someone who's going to literally treat your case as something unique every time. It's not just like everybody here signs up for twice a month. That's a big red flag for me. And I really want everyone always building towards more strength. You have to be adding strength.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
The broader picture here is what we touched on, the liability, and it's really difficult for modern physicians and rehab pros to integrate. Professional sports tries to achieve this as well, but they have time constraints and all these other constraints with how many people they're working with, so ignoring all
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
That's what makes things stick. That's what optimizes movement. That's what makes people feel empowered and less frail. And it frankly builds more of like a moat around themselves to where if they do step off a curb weird or they sleep weird on a plane, they're less of a triage patient. They're more of just like, I'm a little sore today, but they still work out and the workout helps it.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
The most simple terms, absolutely. We say that sometimes about even cortisone injection. Like I don't like people racing to get a cortisone injection, but if you tell someone to strengthen a knee that really hurts when they do a lunge, they're going to look at you like you're a jerk. So at some point we need to do something to get that pain down.
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#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
So then we can open that door and run through it and running through it with strengthening and making them stronger.
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#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
We get that question a lot because before 10 squared, some of the athletes I would manage who travel a lot, like a couple of my golfers, they would call me and say, my back hurts from the hotel room. And I had the luxury of knowing so much about them and how they moved and what their body looked like. I could take all that and then be like, well, what are the symptoms?
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#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
We rule out the scary medical stuff and then we try some exercise. And we were able to get a lot of results for these athletes and they were about to tee off in two hours and compete. So we've taken that model and when we were designing the assessments at 10 Squared, one of the biggest themes was we need enough time to know as much as we can.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
those layers, I think the most important thing is to know, Alton and I had these conversations in detail and he was really specific about, okay, did we get the training we talked about? Is that supraspinatus, the serratus anterior, all these other muscles that help stabilize, are those really good?
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#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
A lot of people want it to be faster, but we're like, that initial step needs to be so in-depth that we are certain about all the factors of how you move and where you're strong and things like that. When I have that certainty and I'm not flying blind and someone calls me and says, you know what? My knee's really sore after doing these exercises.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
We either hop on a Zoom and just talk real quick, and I can actually test them on Zoom because the exercise is the test. So many people think they need a doctor to do like a Lachman's test and pull on their leg. The story, their profile, and then how they respond to the exercise, that is the test. And so we can program exercises really effectively in a remote way to probe the fence or test it.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
And if it responds the right way, we definitely can fix it quickly. I had a client this week, his shoulder was bugging him. We did a Zoom call, took about 20 minutes. We have our library at 10 squared. I fired him off a few exercises. He messaged me. He's like, feels a lot better. He didn't have to go to a doctor. He didn't have to go anywhere.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
Now, obviously, if the story was different and I was worried medically, I'd concierge that in the sense of I'd find him someone local and refer out. But if I'm not worried medically and we think it can respond to load, we're going to load it. And a lot of times people are shocked.
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#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
that we can make their neck tension go away with an exercise in the same way that if they traditionally got a massage or something, they'd get that relief. It has to do with what your body does when things are off. And if you load it, it'll actually respond more because your nervous system is involved as well.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
And I had some metrics I was able to discuss with him and he felt really confident in the stability of your shoulder. So if we're speaking to a general population, I would say that no sling or sling decision was based on what we knew exactly what we did. The other thing is that you followed everything to a T. One of the big complications in rehab, athlete or not, is are people following the rules?
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#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
Two things. One thing in your story, it really speaks to how pain is inhibitory. When your brain is perceiving that threat and that pain, it goes into preservation mode where it's like, look, I'm not going to have you run the fastest four to your life because I don't trust all these movements. I'm trying to figure this out.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
My analogy is like that hand on the buzzer with Family Feud, where the brain, like whenever it feels threat, it's like, I'm going to hit this buzzer and I'm going to send you a pain signal. Doesn't mean you're damaged. It's just like, I'm hovering. And if you're really stressed or it's a really high level pain, it's like, I'm going to do it for sign of trouble.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
So number one, it just really explains your story is that effect. But then it's like, okay, how do we get the brain to take the hand off the buzzer? What loads can we introduce to make these muscles one term in the musculoskeletal world's reciprocal inhibition? So if I'm going to contract my bicep like crazy, my tricep almost has to eventually get enough signals where it can't fire.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
Your brain might be trying to fire it and it's got this co-contraction going on and there's that protection going on. But the more stimulus you give that bicep, eventually that tricep has to let go. So what he was doing is he was putting you in very specific positions to where you had to load something where neurologically your brain says, I'm going to turn this other thing off.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
Are we going to take this athlete or individual out of a sling and are they going to forget about it and all of a sudden go reach for the cereal or are they going to follow the rules? And you were definitely a rule follower. So he and I had a high confidence in minimizing the risk.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
And I got to actually meet the demand of this force because force is how your nervous system responds. And so he was loading one direction so much that eventually that QL or whatever else could have been spasming with you had to eventually kind of melt and let go.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
Not only were you now activated and stable and feeling stronger, but that muscle was in this inhibitory contracted state and then it let go. One of the things I say in my private practice all the time, my first five years out of school, I was working on the QL. My thumb has got scars from it. I don't touch the QL anymore. 10 years ago, I realized you don't even have to beat someone up so much.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
In a weird way, these kinds of exercises are more gentle, they're more therapeutic, and they're more long-term. They're active, so it's long-term. You're tapping into that nervous system. Demoing an exercise or having someone do a very specific exercise based on their profile and their symptoms is actually a great way to make someone feel better, and you just got to give them the right stuff.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
I mean, one of the exercises I think we're going to cover in the gym, I have a lot of clients that come in and they're like, look, I'm nervous about the Cairo thing, or they have some fear around it. They heard stories, whatever. They're like, can you help my neck though? Absolutely. Because there's a million other ways to cook this. recipe to where we normalize the motion of your joints.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
We make the muscles strong again. We reestablish the relationships of your shoulders and your scapula and your neck. There's a million ways to make someone feel better with exercise where you don't have to do aggressive therapies. I don't care if it's stem cell or PRP or prolo or dry needling or chiro. It doesn't really matter. Exercise needs to always be the answer.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
And you can do therapeutic exercise that actually does a lot for people that drops the pain too.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
Yeah, it's really common for one. I tend to see that one of the things we want to highlight in this next session is really highlight to people, oh, wow, this doesn't look like a knee exercise, but it could help my knee. This idea of working around a structure that has pain to help that structure feel better. I think that's what we're going to go for.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
And I think the regions we selected are just really common, really debilitating. And frankly, generally people whiff on these a lot. We get so many of these cases in our practice that it's like, what were they doing? They didn't do this. They should have done. So we're going to try to go that way.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
First off, that bifurcation we talked about earlier, where do we need to consult an orthopedic or neurosurgeon? That's number one. How do you make the decision? the story, the incident, what it looks like. If we're talking knee, if they're a soccer player, they twisted it really weird yesterday, it's all swollen on the joint line, I'm more worried about the joint.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
Conversely, if it's a runner where it's been kind of off and on for a long time, no acute incident, no joint line swelling, the pain is kind of vague. Those are two very different presentations. So one's going to be more like ortho consult. One's going to be like, let's tinker around as a rehab pro and see what we can do.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
So that's the first bifurcation is basically playing doctor and being like, what's the right path? The other thing I really want to encourage is that the best orthopedic surgeons in the world, like you spoke to earlier, they don't want to do surgery or inject everyone right away. They're referring out all the time.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
And a lot of clinics nowadays have like a physical therapy clinic in-house, and there's all kinds of constraints with that. The best orthos don't just give someone a list of every PT clinic in town. They're actually referring to different clinics based on that clinic's strengths and experience. Some clinics specialize in running. Some specialize in strength training.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
If your ortho is specifically searching out different PT clinics, that's a huge win. It's a great sign they know what they're doing. If they just give you a handout and they're like, go call somebody, that means they think all PT is the same and all rehab is the same and it's not. So that's number one.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
Once we've got past that bifurcation of knowing that it's a rehab case, then the protocol really turns into what is the safest and smartest way to create a change? Maybe it's a manual therapy. Maybe it's dry needling. Maybe it's one of those treatments we spoke to earlier. Or maybe it's a strategic load. That decision is a lot of times based on the patient's comfort. Read the room.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
Are they a cattle rancher dude who wants to push through pain and they're going to go back to work tomorrow? Or are they someone who's really scared because their pain is high? We got to build trust. We got to get them some sort of pain relief. to show that we're medically being responsible and making sure we're going the right direction.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
But then once we've created that change, then we start to load it. A lot of times, if I have a joint that I know is permanently compromised, let's say someone with total knee replacement, I'm not going to actually beat up the knee a lot.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
Traditional insurance-based rehab is going to go after that joint because that's the code that's associated with it, and they know they're going to do that really well.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
What I'm going to go for first is the foot, the ankle, the hip, and their pelvis in general, because if there's a lot of low fruit there, I can enhance the pelvis strength or the foot strength, and I can actually buffer that knee to where it doesn't have to work nearly as hard, and those people get a reduction in symptoms overnight.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
Yeah, well, I really want to focus on what people could do themselves right away. They don't have to make an appointment somewhere. And so if you're looking at the three things that can go wrong in musculoskeletal, it's the tissues, it's the joints, and then it's that motor controller exercise window.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
So we're going to dive into some of these exercises that might not be expected to be helpful for your neck or your shoulder, but actually indirectly can load those structures to try to get that relief, just like you experienced with your low back. I see. So we're going to just show people a set of exercises around each of those three pillars per joint. Yeah, per joint.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
Right, right.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
We're going to dive in and show like, this is what you can do for the tissue. This is what you can do for the joint. And then most importantly, these are some loads you could do that actually help reprogram that software to where you actually stop overloading the area that hurts and get everybody else back on track.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
And very early on, preoperatively and post-operatively, We were able to do very gentle but targeted isometrics where there wasn't complexity in the joint itself, but we were loading the tissues in a very articulate and specific way. And that's how you, again, put this support structure around it. I always kind of describe it as like the roll cage in a car.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
We want all the muscles around that to be ready to absorb force. So those joint structures that are getting the staples or whatever else in there aren't stressed. We don't want to yank on those things while they're healing.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
It's a really analogous to the pro athletes I've worked with as well, where it's really interesting to see these mature athletes who've been playing their sport eight or 10 years, and they're starting to kind of look this reality that their career is going to be over. And they start recalibrating how they train because they start thinking about the long term.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
And what's really fun for me is when they start to get that perspective of it's not just about this weekend, it's about the long game here. And I think to your point, a lot of people out there have the best intentions and they're maybe even working hard. But there's no precision.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
Nothing's accounting for their specific details, their nuances of their joints and how they move and how their body feels when they move and their trust in their body and all these variables. And a lot of people either want to put in the effort and don't know where to start or a lot of people are putting in the effort, but it's not calibrated.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
Yeah, I mean, specialization is one. Some people are just born jumpers and then you train it and they practice it when they play and they get better and better at jumping. Absolutely. But moreover, it's almost like we're set up for failure.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
We're set up with this baseline norm of, I could bench press 225 when I was a senior in high school, but then that individual is not accounting for the 20 years of lack of activity, lack of practice, they've atrophied, and then they jump right back into the gym and then they hurt things or they feel like they, quote, can't do it anymore. And the reality is it's all about capacity.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
If you don't use it, you lose it. And a lot of us aren't really thinking about what have I actually actively lost from an activity standpoint? Is it jumping? Is it mass? Is it strength? All those variables that you spoke to. But I definitely see this a ton on the injury and pain side. Injury doesn't show up out of nowhere.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
It has reasons why it shows up and it's compounded by emotional stress and all these other kind of multifactorial things. When our brain perceives threat, we feel pain. Absolutely. Sometimes that's a physical threat. Like I haven't jumped in a long time. I started jump roping. All of a sudden I wake up, my Achilles is sore.
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
That doesn't mean I ruptured my Achilles, but it does mean I was not prepared for that movement because I've been on the shelf for a long time. And so I think a lot of people with that investment strategy analogy is fantastic and they should really incorporate that is,
The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
making sure they're accounting for all the buckets that their body needs to do, not just with what they want to do, but what we know people need. Demographics, Western society, age, all these things play a role to like, if you pull up the stats, a lot of people will have, oh, high risk for a low back or high risk for an ankle or whatever.