The Peter Attia Drive
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
Mon, 26 May 2025
View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter Kyler Brown is a sports rehab chiropractor who specializes in injury recovery, pre- and post-surgical rehabilitation, and guiding clients from rehab back to peak performance. As co-founder of the private training program 10 Squared alongside Peter, Kyler shares his approach to injury prevention and performance optimization—highlighting how overlooked movement patterns can quietly lead to chronic issues over time. He outlines a practical framework for assessing and treating individuals, highlights the importance of understanding movement dynamics and asymmetries, and discusses personalized rehab strategies through real-world case studies. The conversation also explores the psychological side of recovery, including the role of fear and mental barriers in rehabilitation. Kyler shares actionable tools to evaluate movement patterns and implement training strategies that support long-term strength and health. A companion video series demonstrating exercises for common problem areas—such as the lower back, neck, shoulders, and knees—is available exclusively to subscribers on the show notes page. We discuss: The personalized rehab strategy for Peter’s shoulder surgery that sparked creation of a training program called 10 Squared [3:00]; Training for the marginal decade: why precision and purpose are essential for quality of life [11:00]; The Centenarian Decathlon: how training for long-term capacity enhances both current and future quality of life [18:00]; How the shortcomings of conventional rehab and performance systems led to the creation of 10 Squared, a personalized training model focused on long-term physical capacity and individualized care [23:45]; Case study: how personalized assessment and treatment at 10 Squared helps uncover the root causes of injuries [31:00]; The role of the “core” in movement and injury prevention, and the importance of training stability before strength [40:15]; The layered assessment process used at 10 Squared to determine whether a person is ready to perform dynamic movements [47:45]; Case study: the rehab plan designed to treat a hamstring injury while preserving fitness and preventing reinjury [51:45]; Training approach for clients with minimal training history: risk reduction, habit-building, and long-term consistency [55:30]; How to train foot reactivity, tendon resilience, and explosive capacity in a safe, progressive way [1:00:00]; Peter’s foot and ankle pain: how to diagnose, treat, and strengthen the lower extremities [1:04:15]; How fear and perception influence recovery, what drives back pain, and when to choose surgery vs. treatment [1:13:15]; Could AI and app technology eventually deliver an individualized rehab and training experience? [1:22:30]; Kyler’s professional evolution from traditional chiropractic care to a degree-agnostic, performance-based rehab philosophy [1:25:00]; How 10 Squared provides precision rehab and training in a remote format [1:30:30]; How Peter resolved a severe back pain flare-up using DNS-guided isometric exercise instead of passive treatments [1:33:15]; How to identify and treat common joint pain (neck, back, knee, shoulder) using a rehab framework that strengthens supporting structures and helps avoid surgery [1:39:00]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube
Chapter 1: What is the focus of Peter Attia's podcast?
Hey everyone, welcome to The Drive Podcast. I'm your host, Peter Attia. This podcast, my website, and my weekly newsletter all focus on the goal of translating the science of longevity into something accessible for everyone. Our goal is to provide the best content in health and wellness, and we've established a great team of analysts to make this happen.
It is extremely important to me to provide all of this content without relying on paid ads. To do this, our work is made entirely possible by our members, and in return, we offer exclusive member-only content and benefits above and beyond what is available for free.
If you want to take your knowledge of this space to the next level, it's our goal to ensure members get back much more than the price of a subscription. If you want to learn more about the benefits of our premium membership, head over to peteratiamd.com forward slash subscribe. My guest this week is Dr. Kyler Brown.
Kyler is a sports rehab chiropractor who specializes in sports injury pre and post-surgical rehabilitation and bridging the gap from rehab to performance. He is the co-founder, along with myself, of 10 Squared, an Austin-based private member training program focused on building and maintaining exceptional muscle capacities for the marginal decade.
Originally, this was a conversation that we recorded just for the 10 Squared audience. But once it got out there and we saw how much the clients there appreciated it, we decided to repurpose it as a podcast for all of you. In this episode, we discuss the principles behind injury prevention, recovery, and performance optimization, including how small movement dynamics can lead to chronic issues.
Discuss a framework for assessing and treating individuals, heightening the importance of understanding from between movement patterns, functional asymmetries, and personalized rehab approaches. Talk about some specific case studies, including Kyler's work with professional athletes and others to demonstrate the benefits of individualized strategies.
the role of fear in movement and rehabilitation and how overcoming mental barriers is just as crucial as physical recovery, actionable strategies for you to assess your own movement patterns and implement proactive training techniques to build strength and longevity.
Now, in addition to this conversation, Kyler also filmed a short series of videos in the gym demonstrating exercises for common issues like lower back, neck, shoulder, and knee pain. These are designed to help you put some of these concepts from today's episode into action. The videos are only available to subscribers and can be found on the show notes page for this episode.
So without further delay, please enjoy my conversation with Kyler Brown. Kyler, wonderful to have you. Yeah, thanks for having me.
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Chapter 2: How does Kyler Brown contribute to injury recovery?
marinating around this idea of a centenary decathlon in a marginal decade and why we decided to kind of put the best ideas or the themes of these together. So how does that sound? Sounds great. All right. So let's see, you and I met four years ago as soon as I moved to Austin. I don't even remember what we worked on because I think it was just like preventative stuff.
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.
That's right. You're right. We were probably a couple months in maybe, and it was clear that I was nursing this bad shoulder. Um, And I knew what was going on because I had torn the labrum before. The diagnosis, I remember, was actually made in 2009. I had my first arthrogram in 2009.
For folks listening who don't know what that is, an arthrogram is an MRI where prior to you going in the scanner, the radiologist takes a needle about yay long, like four inches long. shoots the needle into the capsule and injects contrast so that it really allows the MRI to show the labrum and how much it's detached from the glenoid fossa.
And so it was patently clear at that time I had a torn labrum. It was significantly torn, but not as torn as it would be 13 years later. But I had largely avoided surgery by doing as much as I could to strengthen the rotator cuff. And frankly, I was afraid to have surgery. That was the bottom line is I didn't want
to trade one problem for another, meaning I didn't want to trade pain and instability for immobility. And I saw that as the trade-off. Folks listening probably recall that I had a podcast. I did a sit-down discussion with Alton, who is the amazing surgeon, Alton Baron, who ultimately did the repair. But what I was most impressed by in that experience, which turned out to be wildly positive, was
that immediately you and Alton started working as a team. And maybe you could talk a little bit about what you guys decided to do in the six, I think it was eight weeks we knew prior to surgery. We scheduled it such that you could do something before then. What was that discussion like?
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.
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.
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Chapter 3: What is the Centenarian Decathlon?
Yeah.
And so tell me how you thought about that.
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.
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.
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.
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.
So now we only had to really target the shoulder itself because the rest of the human was really strong and ready.
So the things that I remember, which are probably fewer details than what you remember, is one, how much rotator cuff work we did ahead of time, particularly around supraspinatus. So we really got that muscle as strong as possible in eight weeks. Anybody who's gone through that type of rehab, which I'm sure many people listening have, it's uncomfortable.
I mean, you're burning a little tiny muscle that is not used to working that hard. The second thing that I remember, and hands down the most important thing, was what you and Alton decided to do post-operatively completely shattered everyone's understanding of what we do with these patients. So the traditional view is, especially, this wasn't a slap tear. The entire labrum was hanging by a thread.
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Chapter 4: How can personalized rehab strategies prevent injuries?
You'll never regain the range of motion you want, the healthy range of motion you had. And frankly, you'll probably atrophy away. And so Alton said, no, we're going to have you out of a sling in 24 hours. And I was like, how is that going to be possible? And yet we did. There's no way he could have done that if you guys weren't partnering on this. How is that even possible?
And why does that fly in the face of everything we would think of?
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
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?
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?
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.
Truth be told, I learned a lot of that the hard way from my first orthopedic surgery back in 2000 when, A, I'm not even convinced I received post-operative instructions. And if I did, I didn't read them. And I was breaking every rule there was. The stakes were higher here in a way, and I think I was very mindful.
For example, people, myself included, when you have surgery, you tend to go on YouTube to learn all about it.
Right, right.
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Chapter 5: What role does the core play in injury prevention?
We're talking about range of motion without stress on the repair. Right.
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.
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.
So in parallel to this, I'm continuing to sort of refine my thinking around the idea that we're all going to have this marginal decade one day. And it does come across as sort of a depressing thought. Nobody really wants to think about the idea that there will be a day when you knowingly or unknowingly enter the final decade of your life.
But at the same time, to act as though it's not true won't make it not so. So I think it occurred to me that the more deliberate we can train for that last decade as though we are athletes, the more we can enjoy it.
Because as I watch people in the final decade of their lives, and I've had the both privilege and curse of seeing a lot of it, I believe that the thing people complain most about is what's taken away from them physically. Now, there are lots of people in the last decade of their life that are lonely because they were miserable sons of bitches and their family, they don't have family or friends.
All of those things. There are many people whose cognition has failed them long before their body has failed them. And that can be very distressing. But if I'm really thinking about this in terms of large numbers, more than two thirds of people, I would say in the final decade of their life, when they're really thinking about what's impacting the quality of their life,
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Chapter 6: How do we assess readiness for dynamic movements?
It's this, it's the physical part. That's the thing I've lost that I miss the most. And sometimes it could simply be freedom from pain, but more often it's restriction of activity. Yeah, totally. And that's my biased experience. You see much more of this. Tell me what you think.
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.
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.
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.
Yeah, and I kind of even began to observe that in myself, which was there were a lot of activities that I was doing where I was doing them because I'd historically always done them. We fall in a groove. This is a type of exercise I enjoy doing. This is a type of workout I enjoy doing.
And then I had to kind of take an honest assessment of some of these and say, okay, for every activity, just like for every investment, there's a risk and there's a reward. And the way you might think about investing in your 20s is probably different from how you maybe should be thinking about investing in your 60s or 70s or beyond. And similarly, the risk and reward changes over time.
So for example, when you're 20, the risk is just inherently lower because you have better tissue. We could go through all the reasons why, inflammation, senescence, everything that changes as you age reduces tissue quality. And younger people, I'm sure you see this all the time, can just get away with doing things incorrectly.
In fact, would you agree that sometimes some of the most gifted athletes actually have horrible patterns of movement, but because they're so gifted, it doesn't seem to matter? Yeah.
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.
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Chapter 7: What common mistakes do rehab professionals make?
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.
Yeah, the jumping is a great example because if I go back to when I was in my sort of training peak, so basically age 13 to 20, call it those years when I was training a lot, jumping was an enormous part of what I did. There wasn't a day that I wasn't jumping. So for example, I was skipping rope 25 minutes every single day. You know, lots of those are doubles. So you're really up there.
Absurd amounts of plyometrics. And then from basically 20 to my mid 40s, didn't jump at all. Not a single jump. That became one of the realizations was, oh, you've lost a lot of tissue pliability. As one example, now something that I do a lot of is low level jumping. You're right. Sometimes I get really worried. I'm like, oh man, I don't want to have an Achilles rupture.
Like that's the middle-aged man injury. Oh yeah. Playing soccer with my kid and I'm just waiting for it.
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.
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.
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.
That's right. Because all I'd been doing in the intervening 25 years was swimming, cycling- Non-impact, non-impact. Hiking, which is fine, but it's still not jumping. It's not reactive.
And so part of what made me start to realize this was as my kids got old enough and I was now playing sports with them, when you play basketball, soccer, and baseball with kids, you realize exactly what you just said. It's not a predictable movement. It's never the same movement exactly twice.
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Chapter 8: How can we improve athletic performance as we age?
Which actually gets to this idea that people listening to us are probably very familiar with, which is the centenary in decathlon. Give me some of the things on your centenary in decathlon.
For me, wrestling with my kids, which means getting down on the floor, having the flexibility, wrestling with my grandkids.
Wrestling?
Yeah. That's big. Just like play, right?
Yeah, yeah, yeah. Not a pile driver.
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.
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.
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.
When you're in your marginal decade, how many pounds would be your expectation? Give me some numbers. How many miles, how many pounds?
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