Stop Resting Your Injury (Do THIS Instead)

moving, right? Like, isn’t that the protective mechanism? Like, pain means stop. Like, doesn’t pain mean there’s something wrong?

[6:04] Kathy: So, that is the old school way of thinking. And it does not. Not all pain means stop. And if we think about it from a purely biological standpoint, yes, pain is there to protect us. Pain is there to get us to pay attention to something. But if we stop every time we feel pain, we are going to be in a world of hurt.

[6:34] Jason: Right. And I think the problem is that most people have this very binary view of pain. Either you’re injured and you need to rest, or you’re fine and you can do whatever you want. And there’s no nuance. There’s no gray area. And the truth is, most of the time, especially with musculoskeletal stuff, movement is medicine.

[6:55] Kathy: Yeah. And I think that’s a really good segue into talking about what rest actually is, because I don’t think people realize that rest is not just the absence of movement.

[7:05] Jason: Right.

[7:06] Kathy: Right? Like, rest can mean different things. And I think that’s where we get into trouble, is that people hear “rest” and they think “do nothing.”

[7:15] Jason: Yeah, total cessation. Like, I’m going to become a couch artifact.

[7:19] Kathy: Yes. And that is not what we mean. So, when we talk about rest in the context of injury recovery, we’re really talking about relative rest.

[7:29] Jason: Relative rest. Yes. And that’s such a better term. Like, rest from the aggravating activity, not rest from life.

[7:36] Kathy: Exactly. So if you tweaked your back picking up a laundry basket, maybe you’re not doing deadlifts for a while.

[7:42] Jason: Yeah.

[7:43] Kathy: But you should still be walking. You should still be moving around. You should still be doing things that don’t aggravate it.

[7:49] Jason: Yeah. And I think that’s a really important distinction, because I see patients all the time who come in and they’re like, “Well, my doctor told me to rest,” and what they heard was, “Don’t move at all.” And that is so rarely what anyone should be doing.

[6:06] doing it, right? Kathy: Not all pain is bad. Jason: Yeah, right? Pain exists. It’s just a thing. Normalize pain. Kathy: Normalize pain. Jason: Yes. Kathy: Yes, amen. Jason: We’re normalizing pain. Kathy: Yes. Jason: And like I have patients who come in, especially with back pain, because this is the old conventional wisdom with back pain was, “Hey, get yourself in a back brace. Don’t get out of bed and it will make you worse.” Because most back pain is probably muscular.

[6:39] And so if you’re not using your postural muscles for the two or three or four days that you’re in bed, then you’re just making those muscles weaker and weaker and weaker. Kathy: And the weaker your muscles are, at least from my viewpoint, the less efficient — let’s say less efficient — your joints work together. Jason: Yes. Kathy: The weaker your muscles are, your joints

[7:09] will work at different angles. Jason: Yeah, I mean it’s like — to draw an analogy from your bag — you coach basketball, right? And that first practice of the season tends to be a little rough, doesn’t it? Kathy: Yeah. Jason: And it’s not because the players are now bad, but they just haven’t worked together for a while. But then you get to, you know, that last practice of the season right before playoffs or whatever, and you don’t even really have to tell

[7:39] people what to do. It’s like, yeah, let’s get there and play. And same sort of principles with our tissues. They’re like high school girls basketball players. Kathy: Right? They are sometimes cranky. Jason: Most of the time fun. Kathy: Sometimes they need a juice box. Jason: They do need a juice box. Kathy: They need halftime snacks. Jason: Yes. Yes. But also very inspiring. Kathy: Very — 100% inspiring. Jason: And they can also be very athletic, too.

[8:09] So, but muscle isn’t the only thing that we’re worried about. There’s another study — actually, I think it’s the same study. Let me see. Yes, it is the same study. Showed that bone density drops about 2% per week if you’re on bed rest. And so, especially if you’re already experiencing like osteopenia or some osteoporosis, a prescription for bed rest is a disaster.

[8:39] Kathy: Really bad idea. Jason: Weaker muscles, less bone density — you’re actually manufacturing your next problem even if this one that you’re trying to avoid gets better. Kathy: Right. Jason: Whoops. Kathy: The next one’s right around the corner. Jason: Yeah, totally. Kathy: Mhm. Jason: So, what should people do instead of rest? I mean, it sounds like a stupid question — not rest, do stuff. But when people are really concerned about

[9:10] Kathy: Well, and the reason people rest is because they feel like they might have a serious injury. I guess the next question is, how does somebody tell if they have a really serious injury or not? Because sometimes with a really serious injury, you’ve got to stay off it. Jason: Yeah. Yeah, for sure. This is probably one of your favorite questions, too — rate your pain on a scale of — Kathy: Jason: Yeah, it’s such a useful question. Like, I’ve stopped just asking it to patients and now I just ask it to everybody I meet.

[9:40] Yeah, like I’ll go to Fred Meyer and we’re getting checked out and I’m like, oh yes, we have coupons, and by the way, could you just rate your pain on a scale of zero to 10? Kathy: Right now, because I love the question. That’s why, okay? Jason: Always love the answers. Kathy: Oh my goodness, yeah. Mhm. Jason: Such a darn question. Um, where was I going with that? Kathy: Yeah, well, how do you know when your problem is serious and might — Jason: Is your pain constant? Kathy: Mhm. Jason: If your pain is constant and you cannot

[10:10] change position — you cannot stand, sit, lay down, and get out of that pain — that’s pretty serious pain. Kathy: Mhm. Jason: If you can change position, if you can find a position of rest, a position where you can relieve your pain even if it’s not your favorite position, it’s not a functional position, then that is not necessarily ER pain. Kathy: Yeah. Jason: It’s not one of those things where you have to completely rest it. Kathy: Right. A modifiable factor. Jason: Correct. Kathy: Right. So we can find something

[10:41] different. Well, and I think this kind of bleeds over into the posture Jason: Mhm. Kathy: conversation. Let me reframe posture for people. A lot of times people are like, oh, I’ve got bad posture, right? I’m slumping. Nobody comes in bragging about their posture, right? My posture’s terrible, it’s the worst, right? Nobody comes in and says, “I have perfect posture.” Jason: Yes. Kathy: And posture — the idea of good posture, bad posture — in my mind is a

[11:12] myth. Jason: Mhm. Kathy: The thing that you’re really struggling with is not how you’re sitting or how you’re standing, it’s how you’re resting, right? And that is the issue — it’s rest. You’re spending 8 hours a day resting at your computer when your body is built to move. And so there are all kinds of innovations to make you rest better, right? Oh, we’re going to rest you with support in this perfect neutral position. But the

[11:44] talk I go through with people whenever they tell me that they have terrible posture — and I tell them you don’t have terrible posture, and I’m going to prove it to you — is I tell them sit in the worst posture that you possibly can. And what people do is they go, “Yeah, I’m sitting in it.” They’re like, “This is how I sit.” Now, ask them, “Why do you sit like that?” And they say universally, “Because it’s comfortable,” right? And then I ask them, “How long could you sit like that?” And they’re like, “I could sit like this for probably an hour, and then it starts to be uncomfortable.” Okay, show me perfect posture. So, they

[12:14] sit up, and I’m like, “Okay, perfect posture. How long could you sit like this?” And they’re like, “Maybe an hour and 10 minutes.” Jason: Kathy: It’s like, “Okay, so it’s not the posture. It’s not the posture. It’s the fact that you are resting. You’re sitting in one position for a long time. Get up and move around.” Jason: Yes. Yes. It’s sitting in one posture for 8 hours. Absolutely. That’s the bad posture. Yes. Just vary your posture. There isn’t necessarily a universal good posture or bad posture. You know, ironically, House of Pain addressed this in the ’90s, and I did

[12:46] not know that those guys were healthcare providers, but they addressed it with their name, House of Pain, and they also prescribed the cure, which is jump around, jump around, jump around. Yes, jump up, jump up, and then get down. Everybody jump. Jump, jump. Everybody jump, right? And so, I mean, like, this is a full circle moment for me because middle school Jason sitting and reach Jason

[13:18] He did not know that one day, like, just a short 30-ish years later, we’d be having this conversation, and like, “House of Pain was right the whole time.” Kathy: They were. Jason: They were. Yeah, and so mom and dad, why did you take my House of Pain tape? Yeah, when I was bad. I was just training. I was training for my future career. Kathy: And now you’ve used it as a lesson. Jason: Yes, I think that office buildings around the country should be playing Kathy: We should Jason: Jump nonstop or Jump Around.

[13:48] Kathy: Every hour. Jason: Every hour, yeah. Kathy: Every hour on the hour. Jason: You know we talked about those weird laws. Ooh, Corrales is a weird place. Kathy: They would do it. They would do it. Jason: We just had election day. Kathy: Jason: So we should do a city ordinance. Kathy: We should. Jason: That would be fun just because it doesn’t even have to pass, but people should read it and the rationale behind it and it’s like requiring that once every hour House of Pain’s Jump Around plays in every workplace.

[14:18] Kathy: Every workplace. Jason: Mhm. Kathy: And over the loudspeaker at the courthouse. Jason: Yes. Let’s do this. Kathy: Can we write it in? Who do we write to? Jason: I don’t know, but let’s definitely find out, because that sounds amazing. I bet you that they would put us in something like, I don’t know, Time magazine. Kathy: Jason: Some fancy — or Life magazine. Is that even still around? Kathy: Advocate, isn’t that the local? Jason: Yeah, the Advocate. Kathy: The local rag. Jason: Yeah, boy. So

[14:48] yeah, so yeah, you don’t have a posture problem. You have a resting problem. You’ve got to get up and you’ve got to move around. So yeah, good. What — so what’s the advice that you give people whenever they’re talking about the office stuff and they’re like, “Hey, can you write recommendations for like standing desks and stuff like that?” Kathy: But nobody listens. Jason: Kathy: I tell that to people like, “Can you get me a standing desk?” I’m like, “I will write you a letter on our letterhead, but

[15:18] Jason: Yeah. I don’t have much pull. Kathy: Well, and then even when people do get the standing desk, it’s possible to hurt yourself on the standing desk because you’re just standing there leaning on your standing desk. You have to move. Jason: You must move. Kathy: Mhm. Jason: We should do an episode on exercise snacks. Kathy: Jason: We haven’t done one? Like how you should be snacking on exercise throughout the day? Kathy: Jason: Um

[15:49] What I tell people — you know, I guess I’m going to change your question and then answer it the way I want to answer it. Jason: Do it. Kathy: You know, people ask, “Should I rest this?” And it kind of goes back to what we talked about like the first 48 hours of, say, a sprained ankle. Jason: Yeah. Kathy: Mhm. Jason: Yeah, you should rest it because when you walk on it, it’s going to hurt. Kathy: Yeah. Jason: And that’s going to be nine out of 10 pain usually. Kathy: Yeah. Jason: Right? That’s when you know, let’s rest this thing. Sure. However, after those 48 hours,

[16:20] we want to participate in something called active rest. Kathy: Yes, active rest. What a great concept. Mhm. Jason: That means movement. Like so if someone comes in and has sprained their ankle, you know, three or four days later, we want them walking on it. Kathy: Mhm. Jason: If they can walk, maybe even get them in a walking boot if we need to. But get them up and moving and walking on it, as long as we’ve made sure that it is not a fracture and we don’t have bones sticking out of the skin.

[16:50] Kathy: Yeah, gross. Yeah. Well, and there’s actually like clinical prediction rules and guidelines that help us to determine when something is really serious. Like with your example that you gave with an ankle, there’s something called the Ottawa rules, right? Which — if you’re over a certain age and you have trauma to the ankle, we’re sending you for imaging, right? Or if you can’t bear weight or you can’t walk X amount

[17:20] of distance, we’re sending you for imaging. And so that’s why sometimes instead of deciding, hey, you know what, I’m just going to rest this until it gets better, it’s good to be working with a healthcare provider, because those Ottawa ankle rules are not a secret, right? We didn’t talk about this before, but you knew exactly what I was talking about. And so I think if you have questions about needing to rest, there’s enough resources out there. I’m not talking

[17:50] about like Google or AI, but most hospitals have like a helpline that you can call or a nurse line and they’ll give you this kind of information. They’ll ask you some questions that help you determine should I be more concerned about this, get in, get it checked out, stuff like that. So this is not a cash grab. There are free resources out there that will help you to make good decisions like that, but I think for just about any condition, if you

[18:20] give somebody a call, they’re going to give you some good guidance. Not just somebody — like a healthcare provider. It’s like, not the washing machine maintenance — Jason: It’s not Kramer answering Kathy: Yeah. Jason: Kathy: Yes, totally. Totally. Jason: What movie would you like to go to? Just tell me the name. Kathy: Yeah. Jason: You know, the standard protocol for care even in the hospital after major surgery is that you are up and walking — for my own

[18:51] personal experience, I had a hole cut in my head a couple years ago. Jason: Oh, congrats. Yeah, uh-huh. Kathy: I think Elon Musk was in the building. Jason: Oh, jeez. Kathy: But anyway, Jason: She’s got a chip, folks. Kathy: Anyway, within — not even probably 10 hours of that major surgery, you know, PT came in to get me up out of my bed and we went for a walk. Jason: Yeah. Kathy: And there was no rest for the wicked that day.

[19:22] Kathy: Yeah. Jason: Yeah. So, that is what’s become standard protocol because of the evidence that they find that bed rest is detrimental. I mean, the other thing, especially after a surgery, they want people up and moving because of — Kathy: blood clots. Jason: the blood clots. Kathy: Yeah, the clotting of the blood. Jason: Clotting of the blood, you must get up. Kathy: I have — I have one of my favorite aunts. Jason: Yeah. Kathy: That’s — that’s how she passed away. Knee surgery and then a blood clot. Jason: Get out. Kathy: Yeah. Yeah, so it’s more common than people would

[19:52] think. And so the movement is extremely valuable. I mean, like even Alston, when he had his ACL surgery, you know, initially you’ve got to rest some, because a big part of it is you’re sleeping off the drugs. Jason: Yeah. Kathy: But even still, they encouraged him to get up and move around. Jason: Mhm. Kathy: Not weight bearing, right? You can’t put weight on that, because he had a meniscus injury that they needed to let heal up. So he was a few weeks before he could weight bear on that. But that doesn’t mean that the rest of your body can’t

[20:23] — slash shouldn’t — move. Jason: That’s right. Kathy: And so if you have just one part that’s like busted, Jason: Mhm. Kathy: you should move the rest of you. Jason: Move the rest of you. Kathy: Be doing the exercise that you can do. Jason: Yes. And, you know, otherwise I think there are some very specific times where it’s like yes, rest — you do not want to load this or whatever — but otherwise, that’s how tissues heal: early appropriate loading. Kathy: Yeah. Exactly. And you know, we mentioned that in those first 48

[20:53] hours we’re resting, but tell us why we need to rest in those first 48 hours. Jason: Those first 48 hours are an important part of the inflammatory response. Kathy: Yes. Jason: And so — inflammation, bad. Kathy: Jason: Is it though? No. Kathy: And there — Jason: that’s a whole other episode. Kathy: to tell you a story, and I’ll even name the name, because I think this guy passed away. But he was a really great guy. His name was Danny. This is back when I was teaching pathology at a massage school, and

[21:24] so, like, wherever you are, Danny — thinking about you. But just a really great guy. And we’re going through, talking about stages of healing and inflammation and everything, and I was talking about all the reasons that we want to control inflammation, right? And Danny raises his hand and he’s like, “Well, should we be controlling inflammation though? I mean, isn’t it just the body’s wisdom?” I said, “Danny, Jason: Kathy: bro, that is the dumbest thing that I’ve ever heard.

[21:55] The body’s wisdom? What is the body’s wisdom?” He’s like, “Well, you know, the body has wisdom and all that.” No, it doesn’t. Like, everybody’s dead. Literally everybody who’s ever lived died because of the body’s dumb wisdom, right? You’re going to see bodies doing stupid stuff all the time. Body’s wisdom — get out of here. So I feel like I went a little hard on the paint against Danny, but with respect to Danny, Jason: Yes. Kathy: there are some reasons that you want

[22:26] inflammation. Inflammation, good. Jason: Yes. Kathy: Right? It can be. Inflammation is important because it’s part of our immune response. So if you have some sort of foreign invader or something like that in your body, your immune system needs to respond to it. So if you’re suppressing all of the inflammation, then you’re not going to be able to respond to an infection or whatever. It’s also important in the case of a fracture or a sprain, in terms of being able to remodel damaged

[22:57] tissue. So there’s a part of it where it’s like we’re eating up all the old tissue so that we can lay down new tissue. Now, the problem with inflammation is that it is a feed-forward cycle. So, there’s feedback — where it’s like, if you have a bathtub, you know, you’ve got that little hole that’s underneath the handle, and that makes it so that your bathtub can only fill so high, and it gets a feedback of, “Okay, it’s this high,” and then it starts going down the drain so that your tub doesn’t overflow, here in the 21st century.

[23:27] A feed-forward — so, that’s a feedback cycle. We’re at this high, we’re going to shut off, and no more. A feed-forward cycle is like fire — which, oh, inflammation and fire, I wonder if there’s a relationship. But fire will make more fire and more fire until it consumes everything and it can’t possibly burn again. So, yeah. Anyway, long way of saying — I went on a total tangent there. Jason: That’s a great illustration for — inflammation is good Kathy: Yeah. Jason: at times. I mean, if you want that cut

[23:58] to heal — Kathy: Yeah. Jason: you — scabs are inflammation. Kathy: They are. Jason: Come to life. Kathy: They are. Jason: Yes. Kathy: And we need it inside of us. We need it — we need it at superficial cuts, we need it whenever we have a strain, a sprain, anything like that. But we have to control it, because there is a point where it becomes the problem. It becomes the damage. Jason: Yeah. Kathy: So, that first 48 hours — one of the advantages of rest is you’re letting some of those inflammatory processes

[24:28] take their course. Jason: But — it gets — but when inflammation gets wild Kathy: Yep. Jason: is when we — that’s when we need to knock it down. Kathy: Absolutely. Jason: Yeah. Kathy: Well, and being active is actually part of resolving that inflammation. Yeah. So, because then you start building new tissue and strength and everything, and I could go on a whole other tangent, which — you know me — I probably will. Let’s do this.

[24:58] Jason: Let’s go. Here it comes. Kathy: Jason: So, another tangent is this. And this is a tricky thing with pain — what happens in the first little bit with pain, and your attitude towards it, can set a trajectory on what the rest of your experience is going to be. So, if you have pain and you are allowing it to persist and to keep you from being active, you start to hardwire some things in your central nervous system, and then your body will manufacture pain on its

[25:28] own. And that’s called central sensitization. And there is a higher incidence of central sensitization — where your body’s manufacturing its own pain — if you’re doing excessive rest. But if you’re getting active and your body’s getting feedback about, “Oh, this actually works even though it’s a little bit painful,” or, “Oh, I’m getting stronger,” and things like that, it can reroute some of that story so that you have a lower risk of central sensitizati—

[25:58] central sensitization, which if you know anybody with that, like they’ve got like CRPS — or CRPS, complex regional pain syndrome — it is miserable and debilitating. So, you have to —

Jason: You must move.

Kathy: Jump around.

Jason: Jump up and get down.

Kathy: Yes, jump.

Sit down, Raul.

Oh. Goodness. Did I — did I take us too far afield?

[26:28] Kathy: No, but I also think that’s kind of a good segue into the reason that people do a lot of bed rest, which is because of the fear of pain.

Jason: Mhm.

Kathy: And there’s actually a questionnaire —

Jason: Yeah.

Kathy: — that’s named for fear avoidance.

Jason: Yes.

Kathy: FABQ.

Jason: Yes, there are quite a — and yeah, FABQ, the fear is in the name. Yeah.

Kathy: Fear avoidance behavior questionnaire.

Jason: Yes. And that gives us our yellow flags,

[26:58] is that right? Yeah, and that’s — I think I mentioned before — the STarT Back. That’s another — that’s another similar one that’s focused specifically on back conditions or spine conditions. So, yeah, both good instruments for understanding like what’s the risk.

Kathy: Mhm. And so, here are some of the questions on the FABQ. The answer has to be — well, it’s on a scale of zero to six. Six is completely agree, and zero is

[27:29] completely disagree. So, “My pain was caused by physical activity” — do you completely agree? Are you unsure? Do you completely disagree? “Physical activity might harm my foot” — say it was a foot injury, and the person has to agree or disagree. “I cannot do physical activities that might make my pain worse.” Completely agree, unsure, completely disagree. So, those are the questions that this questionnaire — if a healthcare provider gives this to you, we’re just trying to

[28:01] figure out where do you sit when it comes to fear avoidance behavior.

Jason: Mhm.

Kathy: Do you — that helps us treat you better.

Jason: Yes.

Kathy: Because we kind of know — this gets to the bottom of what your thought process is about your injury, about your pain, and how you want to go about feeling better.

Jason: Yeah. Well, and I think the average person would be pretty surprised to find out that when you score high on these instruments, you’re actually going to get the

[28:32] opposite of what you think that you need, right? So, somebody comes in and they have a high score — how does that influence your decisions as a provider?

Kathy: Well, I will definitely be very careful about my language.

Jason: Yes.

Kathy: About how I talk to them as a patient and how we’re going to discuss pain — and I may not even ask them about pain.

Jason: Mhm.

Kathy: You know, I may not say, “Is that painful? Is this painful?” I’m probably going to avoid talking about pain at all and just encourage them on the activities that they’re

[29:03] actually doing, because we want to encourage people to do these things despite the pain.

Jason: Well, what about the body’s wisdom, Kathy? Like, shouldn’t we acknowledge the body’s wisdom and pain and everything?

Kathy: Pain is a signal. It is an alarm, okay? But again, pain gets wild, too.

Jason: Absolutely.

Kathy: And we’ve talked about this before — where pain is a decision made by the brain.

Jason: Mhm.

Kathy: That doesn’t mean that your pain doesn’t exist. Doesn’t mean that your pain isn’t real.

Jason: Or important.

Kathy: Or important. Yeah. Yes. Because I’m sure

[29:34] we’ll talk about later those patients that we have to talk to about not pushing through pain.

Jason: Yeah.

Kathy: But this is the flip side of the coin, where we have to kind of talk people into doing things despite the pain.

Jason: Yeah.

Kathy: For their own good.

Jason: Yeah. And then people who score high on these instruments — we’re also going to be focusing a lot on active care, right? And so I do a low dose of passive care with these people, because passive care — which is like your massage,

[30:05] adjustments, assisted stretching, those kinds of things, the fluff and buff — those are good for helping to control pain.

Kathy: Mhm.

Jason: And if I’m just there controlling your pain and soothing you, it’s going to make it so that you can do what? You can rest. And then I’m part of the problem, not the solution.

Kathy: Yes.

Jason: So yeah, if you score high on those instruments, active care is a priority. We’re going to get you up, moving around, proving to your brain what your

[30:36] body can do.

Kathy: Yes.

Jason: And then people who score low — it’s not like, yes, those people get more massages. No, they just get less care altogether. Right? Because they tend to have —

Kathy: Yeah.

Jason: — already the resources where it’s like they’re going to do it. And so somebody like that who scores low, it’s like, okay, we’re going to give you three or four visits. Let’s get you feeling better, get the obstacles out of your way, and you go do your thing.

Kathy: Mhm.

Jason: Tends to work pretty good.

Kathy: Mhm. We give them permission to move again.

[31:06] Jason: Absolutely.

Kathy: Yeah.

Jason: I did want to highlight a couple of situations where rest is the prescription.

Kathy: Yeah, let’s hear it.

Jason: So for example, concussion or traumatic brain injury.

Kathy: Really good point.

Jason: The old wisdom — do you remember this was —

Oh, you got a concussion? All right. I’m going to need you to sit with her. Make sure she doesn’t fall asleep.

Kathy: Do not let her fall asleep.

Jason: Because if she falls asleep, she may

[31:36] never wake up.

Kathy: She’s probably going to die.

Jason: She’s going to slip into a coma. Right? And I mean, I can understand where people come up with that.

Kathy: Yeah.

Jason: But that is absolutely not the thing with a concussion.

Kathy: The opposite.

Jason: It is the opposite, right? So if you have a concussion or traumatic brain injury, the main time when your brain heals is when you are asleep.

Kathy: Mhm.

Jason: And doing less is doing more. Doing less doesn’t just include like, hey, I’m not getting up and running around. It is: I’m

[32:06] staying off of screens.

Kathy: Mhm.

Jason: I’m not listening to loud music. I’m not being overstimulated. Your brain literally needs to rest to heal. So concussion, traumatic brain injury — the rest is critical. It is the treatment. And people have all kinds of crazy treatments. Like take this supplement or drink this juice or eat sugar, don’t eat sugar. Fast, don’t fast. And some of those things can push the needle, but

[32:37] they push it like this much, whereas sleep pushes it this much. And so resting is important for traumatic brain injury.

Kathy: I read this great book when I was in PT school. It was actually by a — it’s written by a neuroscientist who had a stroke, and it’s called My Stroke of Insight.

Jason: Ooh, I like that.

Kathy: It was really good.

Jason: She must have gotten better, cuz that is a dang good title.

Kathy: Right.

Jason: And she talks about her experience, you know, in acute care, like right after

[33:07] the stroke, and how much — how she got so little rest because they came in hour after hour checking her vitals, checking to do this, and she just said, “All I wanted to do was sleep.” And so I think she’s gone on to research the fact that after people have a stroke they need more rest, as much rest as possible. And how, you know, learning to talk again — she said, “You know, I would just do a couple speech drills

[33:37] with my speech therapist, and I’m exhausted.”

Jason: Yeah.

Kathy: And she’s like, “I just needed rest.”

Jason: Yes. You do. But you also need movement, too. You’re right. So it’s like going for a walk is good. That’s stimulating. That’s also good for your brain. So it’s not like just bed rest, but there is a difference between rest and sleep.

Kathy: Mhm.

Jason: Right? So there are people out there who they’re getting plenty of rest, but their sleep sucks.

Kathy: Mhm.

Jason: Right? And that’s amazing to me, actually, that I have people who are essentially completely sedentary, and

[34:07] they can’t sleep.

Kathy: Yeah.

Jason: And so they’re not getting rest, so their body doesn’t recover. So that’s — reminds me of — I was in the hospital a couple years ago now, and it was the same thing. Getting woken up like every 4 hours. And so fortunately Tyler, who is here, the — yeah, the cardiologist — he came in and checked on me, and I said, “Tyler, I said, ‘The biggest thing that I need is I just need to sleep. Like, is there anything that can be done to keep these people out of here?’”

[34:37] And so he was like, “Hey, let’s just let him sleep, and he’ll hit the button if he needs something. Do we really need to check his vitals every 4 hours?” And so, like, that was a turning point for me. When I could get like 6 solid hours of sleep, which is not much, like, that was huge.

Kathy: Yes.

Jason: Yeah.

Kathy: Yeah. They put those automatic blood pressure cuffs on you —

Jason: Yeah.

Kathy: And they’re like — I swear, it’s like every 15 minutes that thing would go off.

Jason: Yeah, I’m not dead.

Kathy:

Jason: Yeah, I’ll let you know if anything

[35:07] changes, right? I’ll let you know if I die.

Kathy: Can we just do something else?

Jason: So, some other things where rest is appropriate and important. So there’s the concussion TBI, acute muscle injury, which you kind of talked about, or a tendon injury. And that is local rest, right? There’s also a high-risk stress fracture. So, like, if you’re a runner and you’ve been diagnosed with a stress fracture, yes, you’ve got to get in a boot, you’ve got

[35:37] to let that thing heal some, cuz if you’re putting more stress into a stress — like, do I need to explain that?

Kathy: Right.

Jason: Yeah, okay. So, sometimes you’ve got to just unload something to let it get a period of rest, and then you load it again. And the other thing, too, is the idea of resting between heavy bouts of exercise. So, between sprints, for example. Doing that gives you an opportunity to recover between heavy sets of lifting. So, if you’re

[36:09] doing three sets of 10 deadlifts near your one rep max, and then you’re giving yourself 10 seconds and going again, you’re manufacturing an injury.

Kathy: 100%.

Jason: Yeah, and you’re not letting the muscles grow. Like, so muscle growth happens during that rest period. So there are times when you want to build in that rest, but an appropriate amount of rest is just like — I mean, like the active loading, it’s like appropriate resting. Active loading and appropriate

[36:40] resting.

Kathy: Yes. Everything in moderation, as my grandmother used to say.

Jason: Sure. There are some things that I do not want in moderation. But —

Kathy:

Jason: But it’s totally unrelated to the conversation. Yeah.

Kathy: Yeah. Can we talk about recovery?

Jason: Sure.

Kathy: Okay? Like, what are some of your favorite go-tos in terms of recovery? So, when somebody’s had a good bout of exercise, like maybe they’ve been at the gym or they just finished a half

[37:11] marathon or whatever, like what do you think is good for recovery?

Jason: So, let’s say in the case of a half marathon.

Kathy: Okay.

Jason: Right? So we’re talking about right after the race — 100%, you know, hydration, protein, electrolytes.

Kathy: Yeah.

Jason: But then the next day though, I would like you out going for a walk.

Kathy: Yeah.

Jason: 30 minutes, 60 minutes if you can.

[37:41] Kathy: Yes.

Jason: It’s not an all-rest day the next day.

Kathy: Right. And part of that is because of DOMS. DOMS, DOMS, DOMS, right? DOMS is delayed onset muscle soreness.

Jason: Mhm.

Kathy: And everybody’s experienced that — well, some people haven’t. Anybody who’s done some active stuff is familiar with DOMS. It’s that soreness, that muscle soreness that sets in like 24 to 48 hours later. And so yeah, after a

[38:12] big event, you’ve got to get moving or else —

Jason: Yeah.

Kathy: — you’re going to struggle with DOMS.

Jason: Yeah.

Kathy: Right?

Jason: It’s going to be —

Kathy: Okay, so hydration, electrolytes — and it’s replacing electrolytes. You’ve been sweating a lot, yeah. Because electrolytes is good business.

Jason:

Kathy: It’s really good business.

Jason: Oh gosh, yeah. I mean, do we need to talk about what is that — Idiocracy? Have you seen that movie?

Kathy: Yes.

Jason: Yes. It’s got electrolytes.

Kathy: We are living in Idiocracy.

Jason: Yeah. Oh gosh, yes we are. We’re so far

[38:42] past it. We are like Idiocracy

Kathy:

Jason: part two.

Kathy: If you haven’t seen the movie, the scene we’re talking about is — our —

Jason: We’ll give the background.

Kathy: Our population has grown so dense.

Jason: Yeah. Not like so many people, but like dense, yeah.

Kathy: That we’ve decided we are going to — I don’t know — irrigate our crops with Gatorade.

Jason: With Gatorade essentially.

[39:12] Kathy: And they’re not growing. Jason: What was it like? Kathy: Figure it out. Jason: Idiocracy. What was it? Like, what was it called? Kathy: I don’t remember. Jason: Yeah, something weird. But yeah, so this guy, as part of an army experiment, they’re like, “Hey, yeah, we’re going to make these cryo chambers. We want you to sleep in it for a while and we’ll wake you up.” And like the project shuts down. He ends up going deep into the future, and it’s horrible. Like the president is Terry Crews, and Kathy: Jason: he’s got this red, white, and blue suit with a vest and no shirt, and he’s

[39:42] shooting guns every time he’s talking, and you know, and what is it that they say? Like, they’re like, “Why are you putting this sports drink on the crops?” And they’re like, “It’s what plants crave.” “Why do plants crave?” “It’s got electrolytes.” “What’s electrolytes?” “We don’t know. Kathy: Jason: Electrolytes is what the plants crave.” So, yes, we’re living — we’re living in that time. It’s amazing. Kathy: Yes, anyway. Jason: Yes, so yeah — okay, yeah. So, the

[40:12] electrolytes are important to replace. You don’t need to really preload them or anything, but you need to replace — Kathy: you need to replace them, yeah. Jason: Yeah. Kathy: And what else is good? Like, any like gadgets or Jason: modalities Kathy: or modalities that you like for DOMS? Jason: There’s been research plus and minus on cold baths. Kathy: The cold plunges, here we go. Jason: What’s your take on the cold plunges? Kathy: I think you nailed it. There’s plus and

[40:42] minus. And it can be good. I — the cold plunges — I think, first of all, and people have seen this on social media, people like jumping into a bucket of ice or something like that. I don’t think that there’s a ton of value in that if you’re not an active person, first of all. If you are an endurance athlete, a brief cold plunge can have some benefits, right? It helps to control the inflammation

[41:14] and everything like that. But if you’re doing it too much, you can actually blunt some of the things that your body needs for recovery. So, prolonged cold plunges and cold plunges for the sake of social media — cold plunging — I don’t think that the evidence is there for it. But as a way to help prevent DOMS, I think there’s some efficacy to it. Jason: All college athletes are going to clip this Kathy: Yeah. Jason: and they’re going to send it to their

[41:46] athletic trainers. Kathy: Hey, coach. Jason: Hey, look — have you looked into the evidence for this cold plunge? Because there is none. Kathy: Yeah, right. Well, but I think that in the case of athletes — which, every training room in America has one of those whirlpools and stuff — the advantage is that’s somebody who has a predictable training cycle where it’s like, we did an event today and I’m expected to start training again on Monday. So Jason: I need something that’s going to help me quickly get reset. And so I think in

[42:18] that case cold plunge could be really good, because it’s moving the body to — it’s the next cycle. Massage is another good one. So we do recovery massage for the football players. They play their game on Saturday. We’re down there on Sunday and we’re doing massage, and it doesn’t feel good. It is not nice. Yeah. I have video of big tough football players screaming like little girls — like

[42:48] literally holding hands as they receive recovery massage, because it is rough. But the goal is, we have to get you back into your training cycle again because they’re going to have to do a lift in a couple days. Then they’re going to have to be doing some more sprinting and they’re right back at it again on Saturday. So massage is another thing that I really like. Any others that you like? Kathy: The boots — the

[43:18] compression boots. Jason: Yeah. I love those. Decadent. Kathy: Jason: What’s the advantage with the compression boots? Kathy: So the idea with the compression boots — it’s similar to like massage, trying to increase circulation, keep things moving — lymph, Jason: lymph, yes — Kathy: through the body, so that you can — what do I — yes. Eliminate,

[43:48] eliminate those — the — gosh, I’m losing my words. It’s hard not to go eighties and say lactic acid. Jason: Kathy: Yeah, lactic acid is not your enemy. Jason: Yeah, it’s not your enemy. Body is pretty efficient about clearing lactic acid and it uses it to create more energy. So, lactic acid is not your enemy. Kathy: No. But the compression boots increase circulation — is what — that’s the idea — is what I’m Jason: Yes, hydrate tissues.

[44:19] Kathy: They hydrate tissues, yes. Jason: What do you think about contrast therapy? I mean, if cold plunges are a mixed bag, what do you think about contrast therapy, which is you do cold and then you go to the hot tub and you go back and forth between them? Kathy: I know enough about it. Jason: Yeah, I Kathy: looked into the research on that. Jason: I think it’s got moderate evidence for it and it’s a hemodynamic thing. It’s kind of like if you don’t have compression boots. Kathy: Oh, okay. Jason: What you’re doing is by going cold and then going hot, you get blood vessels that are

[44:50] constricting and dilating and they’re kind of squeezing some of that stuff through, so. Kathy: I always tell people that if you’re going to do contrast therapy, finish with heat. The reason is because you want blood flow, right? Jason: Yep. Kathy: And too much icing actually has been shown to slow down tissue recovery. Jason: Yeah. Kathy: So, Jason: Yeah. Kathy: finish with heat. That’s going to be the title of my book. Yeah. Jason: Finish with the Heat. Kathy: My autobiography. Jason: Even physicians and some surgeons now

[45:20] are telling people not to ice. Kathy: Mm-hm. Jason: And so, I don’t know where I land on that. It’s just so old school. Kathy: Well, you know who prescribes zero ice ever — I remember Taylor Premer? Jason: Oh, yeah. Kathy: Yeah, he is — he is anti-ice. Jason: He’s anti-ice. Kathy: Yes. Jason: As we all are in some respects. Kathy: Yeah, right. Jason: But, if I could go back to another 90s hero, you know, Vanilla Ice is okay, yeah. Kathy: Vanilla Ice. Jason: Um, yo, VIP.

[45:51] Jason: Let’s kick it. What about foam rolling? You a fan?

Kathy:

I don’t think there’s a lot of evidence for it.

Jason: Mhm.

Kathy: However, our smartest guest in the world loves —

Jason: Robin? Yeah.

Kathy: — loves foam roller for fascia.

Jason: Yeah.

Kathy: For the same idea. You’re kind of squeezing the fascia and the fluid. You’re getting — you’re hydrating the fascia.

Jason: Yeah. Yeah.

[46:21] Kathy: Well, and I don’t think it’s a cure.

Jason: Yeah.

Kathy: Right? But for some people it is a really good part of the process.

Jason: Mhm.

Kathy: I actually like foam rolling as a warm-up —

Jason: Yeah.

Kathy: — more than I like it as a recovery tool.

Jason: I would agree. I know a fancy gym in town called Helix.

Kathy: Yeah.

Jason: There’s a pretty regimented foam rolling routine —

Kathy: before workout.

Jason: — the muscle mash —

Kathy: Yeah. And I’m going to admit that that’s where I learned that was from was from

[46:51] your people there. So —

Jason: Yeah, and it’s great. It makes a huge difference in a workout. So —

Kathy: I think it also gets the body kind of ready, the nervous system ready

Jason: for what’s about to go down.

Kathy: Yes, totally. Well, what about this? What about stretching?

Jason:

Kathy: Dynamic stretching —

Jason: Yeah. Oh, okay. Yeah, we could do a whole episode on this. Yeah, like our third episode ever, I think. Yeah.

Kathy: Dynamic stretching before, and I do like static stretching after.

Jason: Mhm. Mhm. Yeah.

[47:21] Kathy: Yeah. People who come in and they’re like, “I know why I’m injured. I didn’t stretch.”

Jason: Mhm.

Kathy: I’m like, can you explain that to me? And yeah, so I went and I did this and then afterwards it tightened up and so now I’m like connected to the injury.

Jason:

Kathy: It got tight and yeah, so there’s that. And it’s like — yeah, the stretching

[47:51] probably not.

Jason: The stretching is not why you’re getting injured. You’re injured because you’re in terrible shape.

Kathy:

Jason: You’re getting injured because you’re not in health. Do you remember when Laura Lee had the cryo —

Kathy: Yeah.

Jason: — the cryo chamber? Did you ever do that?

Kathy: Yeah. I liked that.

Jason: That was like a whole different experience.

Kathy: It was.

Jason: Yeah, like you — — came out of there feeling like you were alive, like really alive.

[48:21] Kathy: Conquer the world. I just stood in that ice-cold chamber for 3 minutes.

Jason: Yeah. And my problem is I’m competitive. So like I would go in and it’s like, anybody gone lower than me? It’s like what, like -200° or something like that? Which, you know I’ve said it before, that’s not my people’s temperature. Yeah, I’m competitive.

Kathy:

Jason: And for 3 minutes I could sit there. Every single time I go in that thing, I’d listen to the same song, too.

Kathy: “Ice Ice Baby.”

Jason: No, it was “It Was a Good Day” by Ice Cube. Yeah.

[48:52] Kathy: Oh, yeah, it’s good.

Jason: Yeah, it’s a great one. My problem with that though is like — if you don’t know what a cryo chamber is, you step in it and they’ve got — what is it? Is it liquid nitrogen or something like that?

Kathy: Yeah.

Jason: And so they’re —

Kathy: Pump it in there.

Jason: — pumping that in there and it gets all foggy. It looks like the “Thriller” video.

Kathy: Yeah, it’s pretty cool.

Jason: And it gets super, super cold and you’re in there. You’ve got like your earmuffs on so that you don’t get frostbite. And the thing that would get me though is there’s a bunch of like steam.

Kathy: Yeah.

Jason: And I get claustrophobic.

[49:23] Kathy: So you couldn’t see out.

Jason: Oh, I would have like the biggest panic attacks always in there. What I had to do was I had to cover my eyes and my mouth. So nobody hear that — I said my eyes and my mouth.

Kathy:

Jason: Because — yeah, it was — I couldn’t do that, but yeah, I miss the cryo chamber. Maybe the best recovery tool of all time though —

Kathy: Rest.

Jason: Yes. We come full circle, right?

Kathy: We are.

Jason: Yeah, a pillow, a —

Kathy: mattress.

[49:53] Jason: Mhm. Right?

Kathy: Some sleep.

Jason: Yes.

Kathy: Some good REM sleep.

Jason: Yeah, a little like — what, Mozart or Beethoven or whatever. Good time to mention Brain.fm.

Kathy: It is. Brain.fm is my good friend.

Jason: Yeah, if you want some good quality sleep.

Kathy: Absolutely.

Jason: I do something I call panic sleeping.

Kathy: What is that?

Jason: Yeah, if you Google this, it’s not going to show you anything. But there’s sometimes where I’m up a little bit late, like working on a project or something like that. And I’m like, “Ooh, I’ve got to be up at 6:00 because I’ve got to be at work at 7:00.” So I’m like,

[50:24] “I’m going to get 4 hours of sleep.” So I turn on Brain.fm. And like there was a deep sleep.

Kathy: Yeah.

Jason: And it feels like I’m cramming in an extra hour.

Kathy: It’ll knock you out.

Jason: Yeah, it does. I don’t know, but even on my Oura Ring, it shows my sleep is better, so.

Kathy: Yeah. Yeah, yeah. So some good sleep is super hard to beat. If you’re not getting good sleep, it really sucks.

Jason: Yeah, you’ve got a lot of problems.

Kathy: Yeah, it really — yeah, when people can’t

[50:54] sleep, you can’t heal, you can’t recover, your brain’s foggy. All the things.

Jason: Totally. Well, there’s people out there that claim that, oh, I do great with no sleep. If only they got some sleep, they would see how dumb that is.

Kathy:

Jason: Yeah, let’s see. Are we to game time yet?

Kathy: To game time.

Jason: I got a fun — a simple but fun one.

Kathy: All right, we’ve done stuff like this before, but there’s seven questions here, okay, that

[51:24] I’m going to ask of you. And they’re kind of like — it’s sort of like trivia, but the answer to all of these contain these letters: R, E, S, T.

Kathy: Okay.

Jason: Okay. So like I’ll give you — this is just an example throwaway question. Like, this is a great place to enjoy a delicious meal.

Kathy: It contains one of those letters?

Jason: It contains all four of them. Contains the word “rest” in it.

Kathy: This is a good place for a —

Jason: a delicious meal. It would be a

[51:57] Jason: Where can you go get food that has the word “rest” in it?

Kathy: Restaurant.

Jason: Yes, restaurant. Very good. Yes. Good. All right, you ready to play?

Kathy: Probably.

Jason: Yeah. Do —

Kathy:

Jason: Do you want to take a little rest before we do this? Okay.

Kathy: Now. I’m following.

Jason: All right, here we go. Okay. Question number one. This is the visual discovery social media platform launched in 2010, built around users pinning images to theme boards. Wildly popular for recipes, weddings, and home decor.

Kathy: I got this one. Pinterest.

[52:27] Jason: Very good. Excellent. Yeah, now she’s killing it. Question two. A common cardiovascular health metric measured in beats per minute while you’re seated and relaxed, typically between 60 to 100 beats per minute for adults, and often lower for trained endurance athletes.

Kathy: Resting heart rate?

Jason: Very good. Two for two.

Kathy: Okay.

Jason: All right, the annual WWE flagship pay-per-view event held first

[52:58] in 1985 at Madison Square Garden and headlined by the late great Hulk Hogan and Mr. T, who is very much still alive.

Kathy: Oh, yes. WrestleMania.

Jason: Very good. Yes. I thought that I could fool you by putting a W in there. All right.

Kathy: My younger brother is into WrestleMania.

Jason: Okay, is that Mike? Yeah, you’re right. Hey Mike, what’s up, Mike?

Kathy: He’s not listening.

Jason: All right, Mikey. All right. Okay, here we go. I almost just read the answer.

[53:28] Kathy:

Jason: All right, at 29,032 feet above sea level, it’s the Earth’s highest point.

Kathy: Mhm. Mount Everest.

Jason: Very good. Everest. That’s a lot of rest, right?

Kathy: Ever-resting.

Jason: Okay. Mitchell Hurwitz’s cult favorite Fox/Netflix sitcom about the dysfunctional Bluth family. Raul’s over there freaking out.

Kathy: Raul, you’re going to have to chime in for me.

Jason: Want to come in for the steal?

[53:58] Raul: Yeah, a phone a friend. Arrested Development.

Jason: Development. It’s such a good show. Yes, with George Michael Bluth.

Kathy: I never got into that.

Jason: Oh, it’s funny. There’s — in the banana stand.

Kathy:

Jason: Oh, jeez, and Gob. Oh, great, great, great show. Okay. What about this one? The 1994 best picture winner. I was working in the movie theater when this came out.

Kathy: 1994.

Jason: 1994 best picture winner in which Tom Hanks plays a slow-witted Alabamian. Was

[54:30] there another kind? Oh, shoot. Who happens to witness most of the late 20th century’s American history?

Kathy: Forrest —

Jason: Gump.

Kathy: — Gump.

Jason: That is Forrest Gump. Yes, very good. Let’s see. All right, here we go. This is the final one. This is the hardest probably. Ready? Hamlet’s three dying words, often quoted as a definitive Shakespearean exit line.

[55:03] Actually, it’s four. Four dying words. I don’t know why I said three.

Kathy: I don’t know. Rest in power?

Jason: Yes, that was not it. No, that wasn’t it. The rest is silence. The rest is silence.

Kathy: Wow, okay.

Jason: Wonderful episode. I learned a lot. Yeah, I thought it was very good. Thank you. Takeaways.

Kathy: Yeah. Rest can be appropriate and inappropriate.

Jason: Yes, totally. For me, it was good to

[55:35] think about my homie Danny again. Definitely. And jeez, it’s just a great reminder that I constantly need more sleep. Right? I am — I think that I’m a high performer, but if you think that you are and you’re not getting sleep, you’re fooling yourself.

Kathy: Imagine how much higher performing you could be.

Jason: Imagine that. Yeah, my wife is going to hold this episode over my head. She is going to say, “Hmm, you need to rest.”

[56:05] Oh, yes. Yeah, this is why we have good people in our lives, right?

Kathy: Thank god.

Jason: Yes, yes. Keep us sharp, so. Oh, and I think that there’s one more important thing. And that is there’s no I in PTCH.