Active Life

Seminar
assessing principles

activelifeprofessional.com
 TABLE OF CONTENTS

01. introduction
01. Individual's hieraRchy of needs
06. The Active Life Movement Assessment
13. Load Versus Capacity
19. Understanding Pain

ACTIVELIFEPROFESSIONAL.COM | #ACTIVELIFE
 INTRODUCTION
Welcome to the Active Life Principles portion of Assessing & Programming
101!

Here we dive into the key principles Active Life uses working with individual
clients, including the Individual's Hierarchy of Needs, the Active Life
Movement Assessment, Load versus Capacity, and Understanding Pain.

INDIVIDUAL'S HIERARCHY OF NEEDS

The Individual's Hierarchy of Needs is a visual representation of factors that
contribute to pain and injury, providing us with a usable framework to form a
profile of the individual in front of us.

This profile, or functional diagnosis as we call it, is not a medical diagnosis,

more so an objective measurement of the key physical characteristics that are
learned through assessment. Once we’ve gathered enough information to be
able to create a functional diagnosis, we then are able to focus on individual
needs and have an understanding of how that will complement what they
want.

Each layer of the Individual's Hierarchy of Needs stands on the strength and
integrity of the layer below. The overall size of the pyramid is dependent on
the size and structure of the base.

An athlete who wants to develop world class movement capability in a sport

requires a large supporting base that has been robustly developed over time
and is specific to the demands of their sport.

And so, with that in mind, we evaluate each individual in the following five
categories:

1. Recovery and Capacity Balance:

This is the process of determining whether an individual has the lifestyle
factors that allow for recovery by way of physical tasks that push them
beyond their current load capacity limits.

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 RECOVERY AND CAPACITY BALANCE

Performance, or function over time, is completely dependent on managing

this balance and ensuring that the ability a person has to recover isn’t
chronically lower than the stress they are placing on the system.

The factors we’re talking about here include:

Sleep: Are we getting enough, and is the quality of that sleep sufficient
enough for things like producing the hormones we need to support
recovery?

Diet: Are we getting enough water, enough calories, and enough

nutrients to support the body’s metabolic processes necessary for
recovery?

Stress: Are we living with excessive amounts of stress from major life
events like divorce, trauma, or mourning? All stress affects the nervous
system, and we need to account for that.

Picture a functional fitness junkie who lives in a world where the goal of every
workout is to strive to reach a new level of output (or new PR) to exceed
current capability or capacity.

Regardless of how flexible, mobile, strong, and perfectly technical in all

movements this individual may be, without the ability to repair and restore the
body’s tissues after stress, the quality of these tissues will eventually decline –
leading to problems like tendinopathy, muscle strains, joint restrictions, and
more.

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 2. Flexibility & 3. Mobility:
We lump these two components together and use a nine point joint-by-joint
movement assessment to determine where an individual may be lacking in
either flexibility or mobility. We give you a basic understanding of the
movement assessment in the next section and then go deeper into how to
execute it and program based on its findings in Assessing and Programming
201.

MOBILITY

flexibility

RECOVERY AND CAPACITY BALANCE

Flexibility is the ability for a joint to passively reach a full range of motion,
with the assistance of gravity or external force.

For example: being able to hang from a bar and having the shoulders
open fully so that the arms are parallel to the rest of the body. This is
passive, assisted by gravity, making it a measure of flexibility.

Mobility is the ability to actively reach a full range of motion using force only
generated by the individual.

For example: pressing a broomstick or PVC pipe overhead while trying to

have the arms reach a point that they are parallel to the rest of the body.
This is active; force is generated by the individual, making it a measure of
mobility.

While all are important, having specific flexibility is a prerequisite for

corresponding mobility – so it comes first in the hierarchy.

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 4. Strength Balance:
Your joints’ ability to produce and absorb force is an important factor in joint
health. The question of "Does the individual have enough strength to move
this weight?" now expands to include "Can their joints distribute and share
these forces equally, in all directions?"

strength
balance

MOBILITY

flexibility

RECOVERY AND CAPACITY BALANCE

For example: Multiple people are pulling a boat through a canal with
ropes. If everyone is contributing force evenly, the boat will glide through
the canal without hitting the shore. However, if one person is contributing
significantly more or less force than the others, then the boat will travel
off kilter, potentially hitting the walls of the canal.

This is what happens to our joints when strength balance is compromised.

Staying in the current example: Consider someone much more developed

with upper body pushing movements than upper body pulling
movements – the posterior side of the joint won’t be able to contribute
equally when trying to support a load overhead. The joints (in this case
the shoulder and elbow) will experience altered stresses, resulting in
some tissues of the joint experiencing repetitive overloading and other
tissues experiencing chronic underloading and potential further atrophy.

This phenomenon would also be the same when looking at differences

between opposite limbs and how they would function when expected to work
together. Having a right leg that is much stronger than the left one will
contribute to back squats and deadlifts in an unequal manner. Minimizing
these differences is something that we always want to strive for.

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 5. Motor Control & Skill:
Consider this the process of taking the parts and making them whole. It’s not
enough to simply have full range of motion and strength; we have to learn to
sequence the parts together and feel safe while doing so.

MOTOR
CONTROL &
SKILL

strength
balance

MOBILITY

flexibility

RECOVERY AND CAPACITY BALANCE

For example: learning to ride a bike. The first time someone rides they
have limited control and skill. Over time, they learned how to coordinate
limbs, how to adjust the handlebars, and it eventually became second
nature (automated). As confidence is gained on the bike, tolerance to
speed and distance increases as well as comfort navigating bumps in the
road.

The same is true in the gym, though we only want to build that tolerance to
speed and endurance once we know the prerequisites have been met.

In the past, we have either:

allowed strength to dominate over control, ending up with a lot of power

and minimal control or expression of that power

– OR –

addressed skill as a first line of defense without considering the things

needed to achieve complex positions or patterns

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 Consider the example of using an overhead squat as an assessment tool.
While the client might have the required flexibility of the
ankles/hips/shoulders/etc. in isolation, they might still lack the strength,
control, or patterning to achieve the complex position, thus, leading us to
break down the movement anyway.

Our focus going forward is to keep motor control and skill acquisition as the
last line of defense, addressing it once a stable base for the pyramid is
already there.

We want to set our clients up for success by building their positions with the
tools they currently have, from the information we’ve gathered in our
assessments.

COMPREHENSION CHECK:
What are the five categories of the Individual's Hierarchy of Needs in order
from the base and moving up the pyramid? Give a brief description of each.
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________

THE ACTIVE LIFE MOVEMENT ASSESSMENT

With a much deeper understanding of factors contributing to the problems
our clients are facing, the next step in the coaching process is assessment. At
Active Life, we use the following nine movement assessments to assess
flexibility and mobility joint-by-joint.

STANDING LUMBOPELVIC FLEXION

This test assesses whether or not the individual
has enough passive hip and torso flexion to be
able to touch the ground. In this test, feet must
stay flat and knees must remain fully extended as
the individual reaches as far as they comfortably
can towards the floor. Fingers touching the floor
is considered full range of motion.

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 ANKLE DORSIFLEXION
This test assesses passive ankle dorsiflexion.
Using a measuring tape, we’re looking to find how
far away the individual can place their foot while
being able to touch their knee to that target. The
foot stays flat, and the knee moves straight
forward over top of the toes. A distance away
from the wall of four and a half inches is
considered a full test.

KNEELING BUTT TO HEEL

This test assesses how much passive knee flexion
and ankle plantar flexion an individual has. The
individual starts in a tall kneeling position and sits
back and down as far as they comfortably can.
The big toes must start and remain touching. The
ability to touch the butt to both heels and have
no space in between the front of the ankle and
the floor is considered a full test.

PRONE HEEL TO BUTT

This test assesses passive knee flexion with an
extended hip position for each side separately.
The individual lies prone on the floor. A helping
partner lifts their foot off the floor and looks to
press the heel inward as far as comfortable
toward the butt. A heel that comes into contact
with the butt, without any shifting of the
lumbopelvic complex, is considered a full test.

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 SUPINE HIP FLEXION
This test assesses passive hip flexion using a
flexed knee position for each side (separately).
The individual lies supine on the floor. A helping
partner lifts the knee away from the floor and
presses it as far towards the chest as is
comfortable. If the thigh can come in contact with
the ribs in any one of three slots (in line with the
shoulder, in the middle of the AC joint, or slightly
outside the shoulder), without the lumbar spine
flexing and pushing hard into the helping
partner’s hand (or into the floor if performed
remotely), and without any shifting of the pelvis
towards the resting side, then it is considered a
full test.

SHOULDER ABDUCTION
This test assesses active shoulder abduction. The
individual stands tall in the anatomical position
and lifts the arms straight out to the sides and up
leading with the thumbs, ultimately trying to
bring the biceps as comfortably close to the ears
as possible. If the individual comes up a little
short, a helping partner can apply slight
overpressure to the forearms to see if they have
more passive range available. If the biceps can
come into contact with ears – covering them from
a side view – all while keeping a space between
the top of the shoulders and the ears, then it is
considered a full test.

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 SHOULDER FLEXION
This test assesses passive shoulder flexion first for
each side separately and then for both sides
simultaneously. The individual lies supine on the
floor and lifts the arm up and then overhead,
allowing it to fall as close to the floor as is
comfortable for them. If the individual can
contact the knife edge of their hand to the floor,
without bending the elbow or moving into a
bunch of lumbar flexion, then we have a full test.

WRIST EXTENSION
This test assesses passive wrist extension with the
same method we used for ankle dorsiflexion. The
individual is going to kneel and place the hand
flat on the floor with the fingers pointing towards
the target. Leaning forward, try to bring the
shoulder as close to the target as they
comfortably can. If the shoulder contacts the
target with a straight elbow, flat palm, and with
shoulder remaining down and back, the test is
considered full.

WENIS
This test assesses active shoulder external
rotation with a shoulder flexion position. The
individual is going to bring their elbows up and in
front of their body at even height with their
shoulders. With the elbows touching, try then to
separate the hands without losing the contact at
the elbows. If there can be any space created
between the hands while the elbows remain in
contact and at the height of the shoulders, then
that is a full test.

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 There is much more to learn about these tests, including how to effectively
and proficiently execute them, how to interpret the findings, and how to
program based on those findings. All of that information is within Assessing
and Programming 201.

While we will go much more in depth on the findings of the movement

assessment in Assessing and Programming 201 and discuss how to solve for
these findings, for now we’d like you to be prepared to choose more beneficial
exercises for clients limited on any of the tests in order to provide them with
quality workouts while keeping them in ranges of motion that they have
available, thereby limiting risk for injury.

If someone is limited in the standing lumbopelvic flexion test, it would be

advantageous to elevate any hinging movements away from the ground to
match the appropriate range of motion available based on the test and be
aware of a deep hip flexion position with any kettlebell work. You will also
want to consider adjusting any pike exercises to a reduced range of motion.

If someone is limited in the ankle dorsiflexion test, consider elevating the heels
to allow for full hip and knee range of motion or limit squat depth to
accommodate their current ankle range of motion, if necessary. You could also
consider lunges, split squats, step-ups, or any other unilateral squat pattern
instead as a work-around for most.

If someone is limited in the kneeling butt to heel test due to knee flexion,
consider adjusting the range of motion of their squat patterns to match the
appropriate range available based on the test. More dynamic knee loading
exercises like rowing, running, and weightlifting variations may cause
discomfort. Choose exercises relative to the intent of the stimulus instead. If
someone is limited in the kneeling butt to heel test due to ankle plantar
flexion, consider limiting jumping and running at this time.

If someone is limited in the prone heel to butt test, movements that bring the
knee behind the hip such as running, lunging and anything resembling a
superman position may cause discomfort and therefore opting for movements
that decrease that tension may be more advantageous.

If someone is only full in one slot on each side of the supine hip flexion test, be
sure to set their feet accordingly for bilateral squatting exercises, even if it’s
not symmetrical. If they were completely limited on one or both sides,
consider decreasing the range of motion of exercises that require more than

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 ninety degrees of hip flexion whether unilateral or bilateral.

If someone is limited in the frontal plane in the shoulder abduction test,

important considerations would be adjusting their grip for overhead barbell
and/or hanging exercises to the width that is appropriate based on their test
findings. If they are limited in the sagittal plane, consider moving away from
bilateral overhead work altogether and utilize unilateral variations with
dumbbells and/or landmine setups.

If someone is limited in the shoulder flexion test, consider utilizing unilateral

variations with dumbbells and kettlebells when overhead or use either inlines
or a landmine setup either unilaterally or bilaterally to avoid that full flexion
position altogether. You should have them avoid exercises where the hands
are fixed on a pullup bar or barbell overhead.

If someone is limited in the wrist extension test, you may need to consider the
use of dumbbells or similar instead of a barbell for overhead pressing based
on the range of motion available to the client. Avoid the traditional barbell
front rack position that puts pressure on the wrist, instead utilizing straps or
other grip methods for more comfort and/or consider substituting a goblet or
even zercher position instead. Additionally, the use of dumbbells or parallel
bars will provide a better feeling in the wrists than placing hands on the floor
for push-ups, handstands, or planks.

If someone is limited in the wenis test, avoid the traditional barbell front rack
position that requires that range from the shoulders, instead utilizing other
grip methods for more comfort and/or consider substituting a goblet or even
zercher position instead.

COMPREHENSION CHECK:
What are the points of performance for a supine hip flexion test? Why do
these points of performance need to be adhered to?
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________

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LOWER BODY MOVEMENT ASSESSMENTS
Test Full Limited Discomfort Notes
Standing
Lumbo
Pelvic Flexion
Ankle
Dorsiflexion
Left
Ankle
Dorsiflexion
Right

Kneeling
Butt to Heel

Prone Heel
to Butt Left

Prone Heel
to Butt Right

Supine Hip
Flexion Left

Supine Hip
Flexion Right

UPPER BODY MOVEMENT ASSESSMENTS

Test Full Limited Discomfort Notes
Wrist
Extension
Left
Wrist
Extension
Right
Shoulder
Abduction
Left
Shoulder
Abduction
Right
Shoulder
Flexion
Right
Shoulder
Flexion
Left

Wenis

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 LOAD VERSUS CAPACITY
By the end of this section, you’re going to understand why injuries happen
and the factors that lead up to them. You will start having more meaningful
conversations with your clients (current or prospective) about how you can
help them stay far away from the cliff before they ever get the chance to fall
off.
PRoblem

CAPACITY

NO problem

This dotted line represents your capacity, or what your body can handle. If you
were to walk outside and step in front of a bus to see if your body could
handle the impact, the amount of force transmitted by that bus would
probably exceed your body’s capacity to handle that force.

What we want to make sure is that we don’t exceed our capacity. If we stay
below this threshold, we have a low potential for incurring pain or injury. When
our clients cross this threshold, they now have exponentially increased their
potential for incurring pain or injury.

The reason we say potential for incurring pain, rather than declaring this an
absolute is this: If someone has a hundred pounds of overhead pressing
capacity and loads a hundred pounds on the bar, the weight will go up. If they
load a hundred and five pounds on the bar, it’s not going to move. The
problem at hand is they want to press a hundred and five pounds and can’t –
it’s not necessarily painful or going to injure them.

When a tissue has loads placed on it that exceed its own capacity
(load/volume/speed), we face potential for injury and inducing pain. We want
to stay below this line as much as possible.

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 We all have a bunch of characteristics that take us closer to the line of
capacity our bodies can handle. These boxes represent those things.

PRoblem

CAPACITY

NO PROblem

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SCENaRIO 1

Anatomical dysfunction includes congenital anomalies, such as a difference in

how one hip socket is built compared to the other. Anatomical dysfunctions
affect ability to perform certain bilateral movements with comfort and
symmetry. Things in this box would also include wear and tear issues that have
come up over time like disc herniations, fractures, and even installed surgical
hardware. Any aspect of your anatomy that isn’t favorable based on Activities
of Daily Living (ADLs) or Activities Daily Interest (ADIs) is considered an
anatomical dysfunction.

The recovery box is often overlooked, and it includes all of the factors that
play into the base of the Individual's Hierarchy of Needs pyramid.

This is the opportunity to rest from all of the activities people want to put
their body through each week. Remember, we don’t get fit from working out;
we get fit from recovering from working out. How we sleep, how we eat and
hydrate, and how we manage stress determine whether we’re in build-up
mode or in break-down mode.

The last box here is your functional diagnosis. This includes all of the
flexibility, mobility, and strength balance metrics we talked about before.
While these boxes are present and renewed for us every day, they are not
fixed values. They differ from person to person and are also malleable from
day to day.

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 For example: a 55-year-old dad of 3, who commutes 90 minutes each
way to his desk job and lives off of coffee, energy drinks, and fast food.
This person is going to have a set of boxes that looks very different from
a 26-year-old woman who sleeps 8 hours a night, tracks her hydration
and nutrition, has a 20 minute morning and evening mindful meditation
session, and has a flexible work schedule.

Let’s cover what can happen to this graph throughout the day:

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As you can see, we’re bumping right up against our capacity line now here.

PRoblem

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SCENARIO 1

Next in the workout are kettlebell swings, taking us significantly over the
line.

After a bunch of reps, our back flares up. We don’t want to bend over to set
the bell down, and we can't untie our shoes to change for the ride home.

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 PRoblem
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H.4922,
CAPACITY
G."02,

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NO PRoblem
F%&26G'-2

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SCENaRIO 1

Too often we think about injury as the last thing – the last rep we did. This is a
straw that broke the camel’s back scenario. If we only think about the last rep
in which we felt pain, then we’re not able to understand the bigger picture of
what is too much to recover from, and what’s not.

We must help our clients see these factors and coach them through
appropriate adjustments. We all have things in our day that we must do
(Activities of Daily Living), and we all have things we want to do (Activities of
Daily Interest). The first impulse is to take the easy route – remove the boxes
at the very top of the stack. These are the activities that might sound like “the
problem” when speaking with a loved one or a doctor not trained in exercise
science.

You’ve likely encountered this before. A client (possibly yourself) was told to
stop doing kettlebell swings, to stop doing the burpees, to take the easy route
and quit participating in an activity altogether. This inaction does not create
solutions; it merely avoids the problem by rendering it dormant.

The better option is to work at shrinking the boxes, to lessen the load on the
system through improving its components, rather than removing things
altogether.

How do we affect change?

The anatomical dysfunctions are a fixed box, so we transfer those straight

across. We can't fix congenital anomalies or remove screws from someone’s
ankle that need to be there.

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 PRoblem
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H.4922,
CAPACITY
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NO PRoblem
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SCENARIO 1 SCENARIO 2

However, we can work on the aspects of recovery. With proper tools, we can
inspire people to alter their sleep habits for the better and show them
breathing techniques to tap into their parasympathetic nervous system and
buffer stress.

We can implement water and protein targets to help make sure they are
properly nourishing themselves. We can shrink this recovery box by
approximately 50% with focused effort – creating a big win towards the end
goal.

Next, we can work on improving

functional diagnosis. We can plan PRoblem
to increase the flexibility and
I2$$)2@2))6=7'"0,
mobility of the ankle joints so that H.4922,
CAPACITY
the hips and lower back aren’t G."02,

NO PRoblem
loaded with compensating stress 5%486G'-2
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We can probably shrink this

SCENARIO 1 SCENARIO 2
functional diagnosis box by 50%
with the right plan.

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 Ultimately, we have an entirely different person in front of us.

Re-add the house work, the six to ten hour work day, then the
lunges/burpees/swings at the gym. We have someone who now has the
capacity to handle all of those things without their back seizing up – and
there’s still some room to spare.

Instead of losing the kettlebell swings and the burpees (abandoning their
fitness routine), this person has gained the capacity to spend 30-45 minutes
on the floor with their toddler – something they haven’t been able to do for 18
months because their back would always flare up on them.

That’s life altering changes we’re now capable of with the right mindset and
the right approach.

As great as that feeling can be for someone, we don't stop there. Eventually
our clients will have goals to experience things they’ve never experienced
before. We assist clients in taking on challenges they’re not sure they can
complete – or have never before completed.

These goals are going to require even more room underneath the capacity
line. However, there is only so much we can do to modify these variables (to
shrink boxes), and some of the variables as we know them can’t be modified.
They’re fixed.

In order to get this person able to tackle that crazy peak they’ve decided they
want to summit – without
PROBLEM
overloading their back – we have to
adjust their capacity. CAPACITY
I2$$)2@2))6=7'"0,
H.4922,

To raise their capacity line, we G."02, NO PROBLEM

design a program for them that will 5%486G'-2
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SCENARIO 1 SCENARIO 2
up with each morning.

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 There is going to be so much more room for them to live their life – this is load
versus capacity. Decrease the load, then improve overall capacity so there is
more room for added load in the future. This is how we get people to continue
living a life they want to live.

COMPREHENSION CHECK:
What boxes on a load versus capacity chart are fixed? Describe two boxes on
a load versus capacity chart that can be changed.
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________

UNDERSTANDING PAIN
Most people underestimate the complexity of their pain. We know this
because most people THINK the reason they connect with Active Life is
because they are in pain. We’ve grown to understand that pain only becomes
an issue once it has become a debilitating problem.

Back pain is not a problem; people are willing to live with various amounts of
back pain every day. However, not being able to pick up your kid because of
back pain is a significant problem – resulting in self-reflection. Living in fear of
walking down a flight of stairs due to looming knee pain is a problem.

Pain is incredibly complex, and we need to understand the pain experience.

We define pain as “a distressing experience associated with actual or

perceived tissue damage with sensory, emotional, cognitive, and social
components.”

This definition helps us to communicate that pain is not just a black and white
concept and is going to be a unique experience for every one of our clients.
Equally as unique, there are variables we utilize to ensure that we can modify
training and exercise for clients, rather than take away.

Every individual is not going to respond to a given manipulation of a

movement variable in the same way. There are many things that we can

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 control in the pain experience, and we need to be able to make best use of
that information to service each client appropriately.

The first step in this process is to differentiate client goals in relation to

their pain.

What is really important to the client? Maybe they want to be able to squat to
a full depth for competition purposes or maybe they really want to be able to
run marathons again. Or maybe those are goals that you’re projecting onto
them based on their previous experiences.

We need to ask the right questions to match the most relevant and actionable
goals for the client.

We categorize pain into three types:

1. Acute pain
2. Chronic pain
3. Current, chronic pain

Acute Pain
Imagine an individual who drops a heavy weight on their foot or feels a pop in
their back while performing a movement. These are not pleasant feelings, and
we need to understand that as the coach, we are going to be a source of
comfort for this client.

We work to take them from a heightened fight or flight nervous system

response, decrease their fear, and reassure them that things are going to work
out alright. At this sensitive point, we also need to encourage them with
patterns that are currently painless. We want the client to continue moving as
much as they comfortably can to allow for blood flow and to give a chance for
their nervous system to desensitize and calm down.

Finally, we’re going to control the client's future exposure to the thing that
caused the pain in the first place. Once we’ve identified the trigger, we can
help ensure they don’t rush back into things that may cause a flare up – even
if the client is feeling a little better.

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 Chronic Pain
Pain that's been present for 3 months or longer is considered chronic.
Typically in instances of chronic pain, we’re going to have someone in front of
us with some form of kinesiophobia – a fear of a movement or movements in
general.

In some cases, kinesiophobia can stem from the presentation of imaging

findings. Maybe the client has been told they have a bulging disc or a
meniscus tear, and they’ve been misinformed that these sorts of findings are
the reason for their pain.

It is very important to communicate to our clients that damage does not

equal pain, and pain does not equal damage. Pain is often present in
individuals with negative imaging findings and no actual tissue damage.

With a client who has chronic pain, go back to the Load versus Capacity
discussion and consider what variables we can manipulate in order to get this
person moving in a pain free way. We must build space for capacity so we can
elevate their overall capacity line and allow them to start building trust in their
own body and its capabilities again.

Current, Chronic Pain

Clients who feel really good at times have a tendency to push hard – high
volume, high intensity – and end up falling back into a position where they are
experiencing a familiar pain. Current, chronic pain is common among athletes
who enjoy the feeling they get from pushing hard and challenging themselves
at high levels of performance.

When considering a client with these experiences, the first step is some
program auditing, as it’s common for these particular clients to be falling into
cycles of exceeding capacity. We often hear, “I just wanted to see where I was
at.” This is another way of saying, “I wanted to test myself and test my current
capacity.” This approach led to a situation where current capacity was passed
and pain ensued. They responded with rest until pain calmed down – with
intent of doing the same thing over again.

It’s important for us as professionals to make sure that we have these

constructs and guidelines in place – meaning we tell them, “Even though
you’re feeling really good, we want to make sure we slowly and methodically

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 re-introduce this movement pattern in this way – keeping you in the gym and
avoiding another immediate set back.”

Another thing we need to understand is the client's “why?”

“Why do you like to do these activities?"

"What makes you keep pushing, ending up in this pain cycle?”

There are three reasons we’ll get: health, ego, or performance.

With analysis of these reasons, we’ve found that people can only have one of
these factors at a high level or two of these things at a lesser level. We
absolutely cannot have all three.

• If we're training for health, we’re going to be sacrificing some

performance and a lot of ego.

• If we’re training for performance, we’re going to sacrifice some health

and really expose ego.

• If we’re training for ego, we’re going to sacrifice some performance and
a lot of health.

Ask the question of “Health, ego, or performance?” Get to the why our clients
are doing the things they want to do so that we can educate them as to
whether or not their actions are aligned with their goals and what sorts of
variables we can manipulate to help them find alignment when needed.

This finding could be a painful position or pattern, or it could be a weak

position or pattern. We need to begin to dose this client appropriately to start
improving whatever the metric is, without going overboard and causing a flare
up. We refer to this as finding the minimum effective dose, and we’ll talk about
this later on in depth.

COMPREHENSION CHECK:
Identify a client experiencing pain. Which category of pain do they fall into
and why?
_________________________________________________________________
_________________________________________________________________
________________________________________________________________

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 Remember the themes we discussed here when working with clients
experiencing pain through the "five Cs of returning from pain or injury":

1. Control: Focus on the things we can control – like variables we can modify –
as we get started in the process.

2. Consistency: Repeated exposure to the deficiencies found in our functional

diagnosis is key. Small investments will add up over time as long as we keep
up with them.

3. Creativity: There are endless different variables at our disposal. We can

always find a way to get productive work in, moving the needle forward for
our client.

4. Commitment: … to the process. It may be long and slow, and it likely won’t
be a straight line from A to B. If we stay the course, we will get there.

5. Confidence: Fear of repeat injury is one of the biggest risk factors for
re-injury. We are not our diagnosis, damage does not equal pain, and pain
does not equal damage. Our bodies are resilient, and we have to maintain that
truth.

With a better understanding of pain, we can categorize clients by their type of

pain and create an appropriate plan to work beyond their pain.

The Four Words and the Pain Rules

INTRO & PURPOSE
One of the biggest fears a client has when they’ve been hurt or injured is
making it worse or getting hurt again. It would set them back even further,
make them feel even more incapable, and cause more frustration and
confusion than they already have. This is exactly why these four words are
crucial in understanding what they're feeling, why they might be feeling it, and
how to make confident decisions about what to do, when to do it, and when
to stop.

These four words will help us understand what a client is experiencing so we

can make the next right decision no matter what they're feeling. There’s
always a best next thing to do - better understanding where they are helps us
decide the next best thing.

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 INSULT
The first word is INSULT. Insult is an unconscious response to a stimulus.

Some examples: Right now, your shirt is insulting your skin. The seat you’re on
is insulting your thighs. These things aren’t even on your radar most of the
time, but they are input into your system.

IRRITATION
The second word is IRRITATION. Irritation is the conscious response to a
stimulus. For example, if you were asked to “Freeze right now; no movement…
hold this for 90 minutes.” Eventually, you’d say, “I need to move,” and you’d
adjust your position.

This conscious decision that the sensation you were experiencing was
uncomfortable was in response to irritation. The moment you decided you
needed to change position, insult became irritation.

Here’s the deal with irritation. It can be as simple and benign as “I need to
move in my chair” to excruciating. It can be the kind of sensation that makes a
person want to call an ambulance.

On a scale of 1-10, it can be a “1” that they barely notice or a “10” that makes
them want a hospital and a bottle of Tylenol.

The most important thing to know about irritation is that irritation is required
for adaptation to occur. Irritation can be considered stress. Stress is only a
problem if it exceeds a person's capacity and escapes their ability to
effectively respond.

In order for a person's body to become healthy and strong so they can do
what they want with more freedom, we need to determine the appropriate
amount of irritation that is due so their body responds in the ways we’d like.

In a nutshell, intentional irritation within reasonable boundaries is not only ok

but often required for progress. Irritation outside of the boundaries we
established can do more harm than good, and we want to make sure we’re
alert to the irritation our clients are facing so we can make confident
decisions.

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 PAIN
The third word is PAIN. We define pain as the negative emotional response to
irritation, typically tied to uncertainty.

For example, the first time a child stubs their toe while running outside and
scrapes off some skin, leading to some blood and a really tender toe, what’s
their reaction?

“OWWW!” Many will cry and want mom or dad to perform some magic to
make it go away. They’re shocked and afraid and aren’t sure what’s happening
to their toe.

Now imagine that you stub your toe. Yes, it hurts and you’ll probably curse.

You’ll feel a tender sting and maybe some throbbing. However, you probably
won’t register it as an emergency. The difference is that the child hasn’t been
there before and is uncertain and afraid. The emotional response to this
creates what we call PAIN.

You, on the other hand, have probably been here a handful of times and you
are certain about how it will go: in a week or so, you’ll probably have forgotten
about your toe. Irritated toe? Yes. Pain? Depends on your reaction.

INJURY
The last word is INJURY. Injury is the decision that “I can’t.”

For example, many coaches in high-level athletics will ask players, “Are you
hurt or are you injured?” the premise being that hurt might mean they keep
playing, injured means they stop.

If we sever a tendon completely, our muscles might be incapable of moving a

limb of ours. We might be injured in our ability to perform a certain
movement.

What’s crucial about injury is that in many cases, it comes down to a person's
decision to perform a movement or not based on the irritation or pain they
experience.

If someone has a joint that hurts them so intensely that they choose not to
use it, they will consider themselves injured in their ability to perform that

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 movement.

For example, someone reports a 9/10 pain in her knee when she walks down
stairs. It doesn’t hurt when she bikes, when she walks or runs, or when she
pushes a sled.

It hurts when she gets off the toilet and a bit when she goes up the stairs. But
when she goes DOWN the stairs? It hurts so much that she only descends on
her other leg, never loading her painful knee.

We might consider her temporarily injured in her ability to go down stairs

RIGHT NOW. This means we shift her thinking away from “I have a ‘bad’ knee”
to “I have a knee that doesn’t go down stairs well.”

With a common agreement about these words, we can start to look ahead to
movement and help our clients make clear, confident decisions about whether
or not they're doing the right thing.

Comprehension Check:
What are the four words we need to teach our clients to use when describing
the sensations they feel? Explain each.
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________

There are four rules to follow as a client uses their body to make sure that
what they're feeling is okay, to identify if it’s not, and to take the next best
informed step no matter what.

FIRST RULE
The first rule is that during movement, irritation is never to exceed a 4 out of
10. We want to know that during movement, irritation registers as less than or
equal to a 4/10 according to the client.

This is important because, as we mentioned, some irritation is often due for

adaptations to happen, especially when body parts aren’t used to certain
movements or have been bothered by them in the past.

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 A 4/10 or less is what we will consider acceptable irritation. More than this and
they might be causing more harm than good.

SECOND RULE
The second rule is that as a client moves, irritation must either stay the same
or REDUCE.

For example, if a client is going through a set of eight repetitions of an

exercise and it feels like a 4/10, if they feel okay to continue, we want to know
that from rep to rep, irritation either remains a 4 or decreases to a 3, 2, 1, or 0.

If either of these is the case, great! They are clear to continue. If irritation
increases from rep to rep, they should stop and change something.

Whether it’s the range of motion, weight, or movement altogether, something

needs to be altered so they can make progress without undue irritation.

THIRD RULE
The third rule is that when movement stops, irritation stops. For example, as a
client completes their set and returns to rest, we want to know that what they
felt during exercise stops while they aren’t moving.

So, when they put the weight down, there’s nothing residual telling them that
it hurts. This is a great sign and movement should continue.

If they stop the movement, put the weight down, and feel a lingering irritation,
it means we need to adjust our approach and that there are certain tissues
that need to be stimulated in a different way or to rest altogether in order to
return to a state of greater health.

FOURTH RULE
The fourth rule is that within 48 hours, irritation should register as no greater
than how they reported it during exercise. For example, if a client is doing
three sets of high-pulls on a Friday, we want to know that by Sunday, irritation
has made its way down to a 3, 2, 1, or 0 - no higher than 4. If by Sunday they
feel muscle soreness, but none of the irritation they felt during exercise, this is
a great sign they should continue the path they're on. If they wake up
Saturday morning and it feels like there’s a knife in their shoulder, this means

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 we need to adjust the next session’s demands to more perfectly and
conservatively meet their shoulder where it is so they can move forward from
a new baseline.

Any deviation from these guidelines - especially when it comes to taking on

more undue irritation - can derail our progress and set us back.

Keeping a keen eye on these guidelines will ensure we take the most efficient
path toward the function we want.

Comprehension Check:
Summarize the four rules of pain that all clients should follow.
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________

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 STAGES OF PAIN PROGRESSION
STAGE PRESENTATION STOP EXERCISING

1 Pain upon Movement Pain that Alters Form

2 Pain at Rest Pain that Prevents Rest (Sleep)

Pain with Activities of Daily Avoidance of Activities of

3 Importance (ADIs) Daily Importance (ADIs)

4 Pain Managed with Meds Being in Stage 4

5 Severe pain ≥ 5/10 Being in Stage 5

pain levels 0 - 10
1 2 3 4 5 6 7 8 9 10

symptoms as you move

Better Same Worse

SYMPTOMS ONCE YOU STOP MOVING

Goes Away Lingers 0:30 - 1 min Gets Worse

Symptoms allowed post-exercise

6 hrs 24 hrs 48 hrs +

IRRITABILITY INDEX (OF SYMPTOMS)

Frequency of Symptoms Frequency of Symptoms

Intensity of Symptoms Intensity of Symptoms

Duration of Symptoms Duration of Symptoms

Slow down, monitor for symptoms & take it “easy”

Stop exercise, some rest is needed

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