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• Author of "Fixing You" series
• Author of Pain Patterns
• www.rickolderman.com

This episode focuses on addressing chronic pain in older athletes using a comprehensive "systems thinking" approach to physical therapy. Rather than treating pain as an isolated symptom with a checklist of generic exercises, the discussion highlights the importance of diagnosing the underlying root causes through a simplified series of diagnostic tests. The conversation digs into how systemic bodily compensations hide underlying structural issues, how dysfunctional walking patterns directly trigger chronic lower body pain, and how most chronic back pain is mistreated by conventional physical therapy methods.

• Immediate Pain Feedback: Effective physical therapy should yield almost immediate feedback and pain relief during testing if the correct underlying trigger is successfully targeted and adjusted.
• The "Spaghetti Against the Wall" Approach: Conventional physical therapy often hands patients a long list of general exercises without meaningful, personalized testing to determine the specific cause of pain.
• The Deception of Painless Damage: Our bodies are masterful "compensation machines," meaning structural degradation (visible on MRIs) can silently accumulate completely under the radar long before rising to the level of actual pain.
• Walking as a Keystone: Chronic pain tracking from the lower back all the way down to the feet is heavily tied to dysfunctional walking patterns; fixing the gait is fundamental to resolving this pain.
• The Over-Striding Error: A highly common walking issue involves throwing the foot too far out in front of the body with a heavy heel strike, which locks the knee and shuts off the gluteus maximus.
• Activating the Glutes: To properly engage the glutes and control pelvic/hip mechanics, walkers must focus on moving their entire body forward with the advancing foot, ensuring the knee stays automatically softened.
• The Three Body Systems and Patterns: The human frame operates on three distinct systems (movement, fascial, and reflex neurological) that get trapped in three fundamental problematic patterns: extension (too arched), flexion (too flat), or side-bending (uneven pelvis).
• The Back Crease Photo Test: A simple diagnostic test for a side-bending problem is having a photo taken of your bare back; a larger crease at the waist on one side indicates an uneven pelvis and rib cage, which typically aligns with the side of sciatic or SI joint pain.
• The Prevalence of Extension Problems: Roughly 99% of patients with chronic back pain suffer from an extension problem (an over-arched back), which is easily identified if back pain worsens when laying flat with straight legs or standing.
• The Flaw in Standard Back Care: Most traditional physical therapy methods treat chronic back pain by prescribing back-arching and prone press-up exercises, which actually worsen pain for 99% of chronic patients because it reinforces their existing extension problem.

Professional Supplements for Wise Athletes (click to see the huge "always on" discount)

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• Award-winning coach and VITALITY expert
• UCSB – Director of Sports Performance
• Brooklyn Nets Basketball – Head of Strength & Conditioning, Director of Nutrition
• Toronto Maple Leafs Hockey – Director of Sports Science & Performance
• Anaheim Ducks Hockey – Director of High Performance
• New York City Football Club – Director of High Performance
• Vitality Collective – Co-Founder

• Bettle earned a Ph.D in human performance and a master’s degree in exercise science
• from Middle Tennessee State University. He also holds earned his bachelor’s degree in sport and exercise science from
• Leeds Metropolitan University (England).

• Vitality-Collective.com

• The Core Injury Framework Injuries happen when the demands of an activity exceed the capacity of the tissue being asked to perform. Demands come in three forms: force (how hard the impact), velocity (how fast the contraction must happen), and direction (planes of movement the tissue hasn't been trained for). Training is the process of systematically raising capacity to match and just slightly exceed demands — not avoiding demands.
• "The Sport Is Not Enough" Principle Playing your sport builds sport-specific fitness but does not prepare the tissues for the worst-case demands of that sport. The athlete who only cycles or only lifts has gaps in planes of movement that become injury sites the moment life — or a new activity like pickleball — demands something different. Training must prepare the body for more than the sport itself.
• The Range of Training That Matters Four modalities, all necessary:
  • Strength training — high effort to near-failure, 8–12 reps; equivalent stimulus to heavy singles but dramatically lower injury risk
  • Cardiovascular training — continuous aerobic work
  • High-intensity intervals — critical for performance and longevity
  • Power training / plyometrics — massively underrated, but inherently risky; must be earned through the progression below
• The Progression — Sequence Matters This cannot be rushed or reordered:
  • Phase 1 — Foundation (weeks 1–8+): Core and hip training first. The core transfers force between upper and lower body — without it, every compound movement is a liability. Start with wall sits, hip work, fundamental movement patterns at 12–15 reps.
  • Phase 2 — Strength: Progress to squat (goblet squat) and hinge patterns. Move from 12–15 reps down to 6–12 reps with heavier absolute load. This is where strength, muscle mass, body composition, and bone density gains accumulate.
  • Phase 3 — Power (only after Phase 2 is established): Power = strength × speed. Sequence within this phase:
  • Slow eccentric loading first (3–4 second descent on squats, pause, fast up)
  • Fall-prevention drills: tip-toe fall-forward-and-catch, snap-downs
  • Vertical jumps in place (no box required for masters athletes)
  • Jump for distance, skater jumps side to side, single-leg jumps
  • Box jump...

Professional Supplements for Wise Athletes (click to see the "always on" discount)

• Doctor of Pharmacy (PharmD) degree from the University of Southern California School of Pharmacy and serves as adjunct faculty there.
• Hormone health influences everything from energy and sleep to mood, metabolism, and libido—yet mainstream treatments are often driven by generic protocols and limited lab interpretations. Dr. Patel has helped thousands of patients find clarity and results by looking beyond “normal” hormone levels and building therapy around how people actually feel and function. He offers a practical view into what personalized hormone care should look like—and where most systems are getting it wrong.
• He is globally regarded as an expert on glutathione, a molecule often referred to as the “master antioxidant,” and is recognized for research into its absorbable forms. He has authored a book titled The Glutathione Revolution: Fight Disease, Slow Aging & Increase Energy with the Master Antioxidant.
• Find Dr Patel here: centraldrugsrx.com and here: aurowellness.com

• The hard truth is that you cannot inject your way out of a broken lifestyle
• Sex hormone optimization is a necessary but small piece of the puzzle.
• Extra (more than the minimum) TRT is a poor solution to overcome poor lifestyle for stress and diet, and it comes with extra negative side effects.
• Find the least effective dose for your physiology; use bio-identical hormones (have to use every 1-3 days)
• How to “feel” like the young you. The solution pyramid is:
  • Sex hormones— 10% (necessary for older athletes but not sufficient)
  • Thyroid mgmt — 20% (pollution, autoimmune)
  • Diet / insulin - 30% (over eating, visceral fat)
  • Adrenals / Stress mgmt - 40% (lifestyle; sleep)
• Also have to address oxidative stress issues (glutathione).

• Episode 178 | Athletic Longevity isn't Easy | Brenden Egan PhD
• Episode 155 | Hormonal Triple Whammy | Kyle Gillett MD
• Episode 144 | Muscle for Athletic Performance | Mark Tarnopolsky MD PhD
• Episode 115 | Winning Athletic Longevity | Rick Cohen MD & Daniel Tawfik, Healthspan
• Episode 102 | Maximizing Performance Health | Jim Lavalle R.Ph.

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