Physio Reacts to Jeff Cavaliere on Huberman Lab Podcast

Añadido: 2026-06-03

[00:00:00]Good day. Welcome back to the channel.

[00:00:01]So, in today's video, I'm going to be reacting to one of the most recent Hubman Lab podcasts with Jeff Cavalere from Athleen X. Anytime I see popular people in my field on podcasts, discussing the things that I talk about and see clinically day-to-day, I'm always keen to give my perspectives and clinical insights based on being a physio for the last 20 years and someone who is passionate about trying to better understand the root causes of common aches, pains, and injuries that I see dayto-day. So, if you'd like a slightly different perspective on a lot of the things that these guys are talking about in the podcast, then please hang around.

[00:00:31]So, before we get to reacting to the podcast, I first want to say that I have the utmost respect for both Andrew and Jeff. Although social media based, they are pioneers in their field and they're great at taking complex information, distilling it down to basic principles, and they're making it easily digestible for people to understand and hopefully implement to their benefit in their day-to-day lives. There are certain things that I think I can add an extra layer to or a certain perspective to to hopefully help people better understand why certain things happen and why they may continue to happen and based on a few concepts that Jeff talks about why we even need to be having those conversations in the first place. But again, to be clear, no shade on any of these gentlemen, nothing but love, nothing but respect. But please keep an open mind if I have a slightly different perspective on things. When I was younger, prehysical therapy days, uh I did all the dumb stuff, too. And I did all the things, just the big things. and realized that it wasn't necessarily a path to longevity. Like I had knee pain then I had back pain then I had shoulder pain then. And this certainly resonates with me as a physio as well. I think it's really important for anyone who is watching this who does have any number of different aches, pains and issues that you do have some sense that things can get better. Most people arrive at being injured or sore not because they're a certain age or they've moved too much or they've overused something or they've slept funny or all these other misconceptions that we tend to perpetuate because they tend to make sense on a surface level. But when we take a step back, we actually understand that it's not that using your tissue a lot is bad for you. It's just that repetition is really good at exposing hidden underlying dysfunction that you took into that repetitive activity.

[00:02:05]Repetition is normal. It's how we learn things. It's how we get better at things. It's how our skill improves. And I think it's a great perspective to take into a podcast like this so that all the information that they discuss kind of passes through that filter so you get the right perspective on things. You mentioned back pain. We talk about a major cause of back pain not being structural back pain. Right. A lot of the times the back pain that we suffer from in our lives is not surgical. It doesn't need surgical treatment. It just needs the right addressing of the muscles that contribute to that or how we allow muscles to get tight that shouldn't get tight if we did full range of motion on certain exercises. And this is a really important perspective to take into someone who is dealing with back pain. For years, we used to think that the only reason you would justifiably have a sore back is if the tissue in your back was damaged or injured. Maybe you tore a ligament, you bulged a disc, you're pinching a nerve.

[00:02:54]Something structural in there that we could scan and see that wasn't perfect was the most likely justifiable cause for why you have back pain. But thankfully, over the last 10, 15, 20 years, we've actually come to realize that the overwhelming majority of people's back pain isn't necessarily based on structural damage. The most likely that I see is just joint irritation where a part of your back becomes overloaded. It becomes irritated. Yes, the muscles lock over the top of it, close it down. As we talk about all the time on the channel, your pain response isn't necessarily based on how bad the damage is or how bad the irritation is, but how threatened and heightened and on edge your nervous system feels in the background on your behalf. And interestingly, clinically, a lot of the true causes of someone's back pain and the things that we treat to make that back pain feel better and potentially go away for good aren't necessarily things that will show up on a scan, an X-ray, an MRI, or an ultrasound. And while what does show up like wear and tear and disc bulges and those sorts of things are obviously important because that's what the scans show as Jeff's implying, we need to go looking around that area. We need to look above it, below it, in front of it for some people to try and understand what isn't functioning normally, what's tight, what's stiff, what muscles are weak, how's your posture, how are you loading up that area as a whole, and not just look at something individually and hope that a structure is the problem.

[00:04:12]But while we're looking at those things and trying to improve those things, we still need to look at all the peripheral structures around that to make sure that the environment that that is in is also as optimal as possible. So that once that settles down, we've hopefully also addressed the cause of why that became a problem and we're not just treating the symptoms. The glute medius is is a muscle that is going to control hip position, hip movement. So if it's controlling the position of our hips, that means it's controlling our pelvis.

[00:04:37]And if our pelvis is tilted or twisted or forward or backward, obviously the spine is literally adapting to the position of the pelvis beneath it because it's connected through the sacrum, right? So all these muscles that connect to the pelvis that change its position are inadvertently going to change the position of the low back directly the lumbar spine that is going to likely cause dysfunction down the road if you don't address that. So this is probably the first thing that Jeff said where I don't disagree with but I think there's a perspective that I can add to this to flesh this concept out a little bit more. For example, Jeff talks here about the impact of glute me weakness, hip muscle weakness on pelvic positioning, pelvic control and the consequences that happen to the low back. That for me clinically where my brain goes to this kind of thing is that yes, hip control is very important in low back function. It's all connected.

[00:05:26]It can't not be relevant. But the perspective that I think is missed here and definitely missed more broadly in my industry and across healthcare is we always need to ask the question why is that muscle weak in the first place.

[00:05:38]Interestingly enough, what I actually find is that the leading cause of why hip muscles don't fire correctly or feel weak or tight is actually because of lower back dysfunction. The nerves that tell those hip muscles to be strong or to be weak or to be tight come from the spine that you know T10 11 12 L1 L2 L3 areas stiff it feels rusty it feels tight. What I find is when I test someone's glute strength, that glute me strength, that hip abduction strength, and they feel tangibly weaker right versus left without doing anything to their hip, if I lie them down or get them on a ball and try and free up those stiff restricted spots in their back and then immediately reassess the same glute me side lying hip abduction tests, quite often you find that their hip strength immediately improves. is more so likely that the hip musculature has been inhibited or sedated for one of a better term and then taking those handbrekes off allows things to function more normally. Once again, if you're taking the time to strengthen your hip muscles, you may always have to keep taking the time to strengthen your hip muscles until you take that step back, go looking through your lower back for clues as to what might be stiff, tight, or dysfunctional. Improve that so that once you've strengthened your hip, it stays strong because that's what it's designed to be. Everyone, you should watch the video. This literally erased my back pain. What I thought was going to require surgery. You lie on your side, one leg, you know, is in front of the other, toe down on the ground, you put it up and back. Um, it's essentially a very simple movement, but if you do it properly, the pain evaporates. It's wild. And I thought it was a back issue, but it was a glute medius issue.

[00:07:10]>> So again, it's really important to respect Andrew's experiences. Strengthen his glutes. It erased his back pain. His back pain went away. Plausible and very realistic for a lot of people. or getting your hips stronger can improve how your lower back functions from underneath. And if that is feeding into your brain's perception of threat, that can be enough to take away your pain.

[00:07:27]But the perspective that I'd like to keep sort of bringing back into this conversation is that it doesn't necessarily help us understand why Andrew's hip muscles were weak in the first place. And if he was to come in to see me clinically and I was to assess his back function, I'd be willing to bet that there are still potentially parts of his lower back that are stiff, tight, and restricted. definitely nowhere close to that threshold where his nervous system feels threatened enough to generate that back pain. Strengthening his glutes among all the other stuff that he clearly does to stay fit and healthy is obviously enough to bring him back underneath that painful threshold.

[00:07:57]But one of the misconceptions about pain going away, especially back pain going away, is that as soon as the pain's gone, everything's perfect again.

[00:08:04]Because the reality is that when you develop back pain, that's actually the last straw, not the start of something brand new. And if you were to take that step back and consider how you were loading up your back, how it was functioning, all the things that we talk about all the time, you would probably understand that for some period of time before that, Andrew may have been heading sort of ever so closer and closer and closer to that threshold.

[00:08:24]Some of the less good things that he does without realizing it, get him that little bit closer. Some of the really good things that he does gets him further away. And the point when his back pain started was just that last point, that last straw where his tissue and his nervous system could no longer tolerate what had come before. So again, if you have had back pain and it's now gone or it feels dormant, you are essentially guaranteed to be below that line. But we don't necessarily know how far below that line you are until we take that step back and look at how you function. How do you sit? How often do you sit? How's your hip flexibility?

[00:08:55]How's your hip strength? How's your core strength and trunk function? All the things that feed into that algorithm to then spit out how threatened or stressed your nervous system feels about some tissue in your back. But again, you can't argue with the fact that Andrew getting his glutes stronger took away his back pain because that's clearly what happened. I would just want to make sure that the other things that we can talk about later are also being addressed to make sure that he doesn't have to care about this coming back ever again. Great. You solved that area of spasm. Why do we get spasm? Often times it's because we're providing artificial stability to an area of weakness. And this is such an important concept because again, everything has to happen for a reason. So if you have any part of your body, you have tight hamstrings, tight glute muscles, you don't have to have pain per se, but if you have a part of your body that feels tighter and more restricted than you think it should, that is there for a reason. Your body is trying to get that artificial support because it's compensating for a lack of something somewhere else. It can be muscular weakness and a tight muscle tends to give more artificial support than a weaker muscle. your brain and nervous system could be asking a particular muscle to generate support to either protect or help improve the way that you load something up again because something's missing. So, it comes back to that idea that if you're tight somewhere and yes, you can get that muscle stronger to hopefully help decrease the need for that tightness to be there. But if it's weakness-based and you're not then exploring why it's weak in the first place. Again, looking back to those relevant spinal levels that may control or inhibit or sedate that function, then you may forever be stretching tight muscles and strengthening weak muscles without ever really getting any closer to permanently solving those problems long term. And again, if you test even big time athletes, we would test their rotational strength of their hips. Some of the strongest athletes, some of the biggest squatters, some of the best lungers, right? They're lunging over 200 lb. you put them in position, bend their their uh their hip into internal or external rotation of their of their bent knee, they can't resist it at all. So, they it just goes to show you that all the squatting, all the big lifts aren't enough to counteract the smaller muscles, right? There are different functions. A rotational muscle of the hip is not a sagittal plane muscle of the hip. It has a different function.

[00:10:58]So, they all have to be strengthened.

[00:11:00]>> This is something I wholeheartedly agree with. It's something that I see a lot, not just with elite athletes and weekend athletes, but just general people as a whole. We haven't necessarily given people the understanding of how to optimize the movements that we practice dayto-day. And we can often see this in two really simple exercises like a squat and a bench press or a push-up. The classic case with a push-up is that we often see people doing a push-up and we see their elbows out quite wide. And that is okay. But in order to optimize that more and engage more of those smaller muscles or those rotational muscle groups, if you were to have your hands on the ground and almost try and screw your hands in without letting your fingers move, we create this rotation through the arm and through the shoulder that then engages those rotator cuff muscles. And if you can maintain that position with your hands straight as you press down, you'll actually notice that your elbows will track closer to your trunk rather than being flared out to the side. This is a less stable shoulder position using less of your shoulder stabilizers. This is a more stable shoulder position and in theory should be a stronger position over time.

[00:12:01]Similarly with squats, in a perfect world, if you have your feet straight and create that external rotation out through your knees without letting your big toes come up, you'll actually see that the arch of your feet will lift and the rotational muscles of your hip will also engage to create two stable platforms that your ankles, hips, and knees can bend through in a more linear plane. That potentially perpendicular stability can go a long way to maximizing how that joint and how those tissues function and then how those tissues perform. If I could travel back to my teens and I started lifting when I was 16 and 20s and 30s, I would have started doing all of these things cuz I had the same I don't know if it's arrogance or just ignorance that oh you know pain like that's what old guys talk about like I have no pain I feel fine like I you know but I think by training a certain way without pain for a very long time it's almost like the spring is getting compressed because it means that unless someone has perfect mechanics the stronger stronger stronger you get you're just setting yourself up for one of these things to go and in my case it was this lower back thing and for some people it's their shoulder. I always appreciate hearing Andrew's take on a lot of these concepts because although he's definitely an intelligent man, he knows a lot about a lot of things, he is just slightly removed from this industry and this world. And I think his perspectives can still be caught in a lot of what most people think and feel about pain, whether it's old school or a little bit sort of a misconception or anything like that. and what he was saying before about training and not necessarily having a problem, but then the stronger you get, the stronger you get, the more potential you have to cause a problem down the track. One of the things that I really want to get people to understand, training is normal. Using your body is normal.

[00:13:37]Lifting things, lifting heavy weights is essentially normal for the body. Normal things shouldn't cause abnormal things.

[00:13:43]Movement is normal. Lifting is normal.

[00:13:45]Becoming injured and painful is not normal. And if you've lifted, as Andrew said, and his his back got sore, we need to take a very strong look at not just what you do when you train. We need to look at you holistically as a human being over the course of your entire day. So while someone like Andrew or even Jeff might train for say an hour and a half a day, that still leaves essentially 13, 14, 15 waking hours either side of that potentially unaccounted for. Again, for me clinically, the overwhelming majority of reasons why someone's back becomes stiff, tight, and restricted is it's just a reflection of the shapes and positions they put their spine into or that part of their spine into the most throughout their day. From watching this, as you look at how Jeff and Andrew sit, we'd want to look at them from side on. And if we found that there was a part of Andrew's back that was a little bit stiff, I'd be willing to bet that when he's sitting, when he's studying, when he's researching, when he's not being athletic, he might just be inadvertently hinging through that part of his back without realizing it the entire time that he's doing that. And yes, a heavy deadlift or something may have been the thing that he was doing that may have made his back feel sore or something else made someone's something else feel sore, but that tissue was very likely already heading towards that threshold before they even put their gym shoes on and address that bar. As I said before, any athlete, what you do physically is a legacy traditionally of what you took into that experience. And it's more often than not the sedentary stationary things that most people experience day-to-day through work, through travel, through gaming, whatever it is. The positions that we put our body into are often the things that start to explain why specific parts of our spine or specific parts of our body don't hold up to the normal natural everyday things that we deserve to do because they're fun and interesting. We look back years later and go, "Wow, I can't believe I've lost this much range of motion or I can't believe I've gotten to this state when it really was just accumulation of many, many of those days of doing things where you weren't paying attention to all the little things. You just have to be aware of what you need to do to intervene."

[00:15:40]>> And that's the point that I was making before where most people's dysfunction happens when it happens, but often there's this sort of buildup over time.

[00:15:48]And the interesting thing about it is the reason why so many people sort of allow that to happen, as Jeff said, it's often just a battle of awareness. When you feel good, i.e. you don't have pain, that doesn't mean that you're perfect.

[00:16:01]It just means that nothing hurts. You could always be hovering below that painful threshold forever and never really get there, but that doesn't mean that you're functioning optimally or functioning perfectly. It just means that nothing hurts and your nervous system isn't threatened or heightened enough. It doesn't worry enough about something that's bubbling away under the surface. And obviously when we are younger, we have no reason to care about that because we don't necessarily have pain to frame this conversation and make it more meaningful. You may need to experience some pain and injury to understand what's important to then prioritize that because you've learned your lesson. But obviously we want to make sure that we take the principles that we learn from treating people that have tipped over that edge, distill them down to their basic root elements and then make sure that everyone else is aware of them as much as possible so that we can hopefully prevent everyone from going down the same path. calling the many things that have uh reversed or eliminated pain that is very common in anyone that works out. And one of those pain at the kind of inner elbow point kind of forearm inner elbow and I figured I had an elbow problem. I had something going on with tendonitis of the elbow and turns out >> it was further away from that. It was all happening at the level of the grip.

[00:17:13]>> So again, this is another one of those really interesting conversations where Dr. humans experiences are true and real and valid, but I think we're missing a broader perspective here. A weakness through those forearm muscles changes the way that you load up the inside of that elbow. And again, that makes perfect sense. Weak glutes, low back pain. And what I find clinically is that by strengthening those muscles, by changing his grip and including those forearm muscles to support that elbow better, he is supporting that elbow function better. But if we trace the nerves that era nerve that supplies that area that supplies those forearm muscles and we trace it back to its origin, we often find dysfunction at the base of the neck. Again, that doesn't have to be a disc bulge or a nerve being compressed or anything sinister. For the majority of people, it's just that that part of the neck has become overloaded in some way. The joints become stiff and restricted and irritated or the the muscles around it are getting tight. But at the levels that supply and refer function and support function that controls how that feels. Typically, I would hazard a guess and say that Dr. Hubman also has some hidden stiffness or tightness or restriction in his neck at the base of his neck, potentially the top of his upper back. Again, why would a person have that? Everything has to happen for a reason. What we often find is that someone's getting into a position where they might be looking down or hinging through the part of that neck for long enough to ask that tissue to become dysfunctional. And that is just the expression of that dysfunction.