The Hidden Muscle Loss Problem No One Talks About (It Starts Earlier Than You Think)

Summary

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Podcast Summary: The Hidden Muscle Loss Problem No One Talks About (It Starts Earlier Than You Think)

Podcast: Rena Malik, MD Podcast
Host: Dr. Rena Malik
Guest: Dr. Jordan Feigenbaum (physician, strength coach, powerlifter)
Date: April 29, 2026

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Episode Overview

This episode delves into the rarely discussed but incredibly important topic of early muscle and strength loss—sarcopenia—and why it’s a pervasive health threat that starts much earlier than people realize. Dr. Rena Malik and Dr. Jordan Feigenbaum address misconceptions around aging and muscle loss, the critical distinction between muscle size and muscle strength, effective prevention strategies (with emphasis on resistance training), tackling gym anxiety, and busting several common myths about injury risk and “perfect technique.” The discussion is practical, science-based, and empowering, with advice that’s relevant for all ages and fitness backgrounds.

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Key Discussion Points & Insights

1. What Is Sarcopenia and Why Is It a Concern?

• Definition & Misconceptions
  • Sarcopenia is classically defined as age-related loss of muscle, but Dr. Feigenbaum explains this is misleading—it’s really a loss of muscular force production rather than just size.
  • “Over the age of 50, you lose strength three times faster than you lose muscle size.” (Dr. Feigenbaum, 01:22)
• When It Starts
  • Strength decline starts surprisingly early—typically by the mid-30s—unless actively mitigated.
  • The underlying driver is neurological: motor neurons (especially those serving fast-twitch, type 2 muscle fibers) die, resulting in the loss of these high-force fibers.
• Activity Isn’t Always Enough
  • Even highly active individuals (e.g., endurance runners) still lose these fibers if they’re not doing targeted resistance training.

2. The Role and Unique Value of Resistance Training

• Why Walking, Running, and Light Activity Fall Short
  • “Running isn’t enough and definitively walking isn’t enough.” (Dr. Feigenbaum, 02:36)
  • Non-resistance activities don’t provide the necessary stimulus to preserve type 2 muscle fibers.
• What Kind of Resistance Training is Needed?
  • Resistance training must be “relatively heavy” for your current capability—not just light weights unless those are challenging for you.
  • “It just has to be relatively challenging. What that does is it gives the nervous system a signal to say, look, these muscles, I need them.” (Dr. Feigenbaum, 03:06)
• “Physical 401k” Analogy
  • Building strength and muscle early is akin to “making deposits” into a retirement account—start high so you’re better off with age.
  • “You want people to have a high level of bone mineral density in their 30s, such that by the time they're 60 or 70, you started from a higher place.” (Dr. Feigenbaum, 03:47)
• How Loss Typically Accelerates
  • Most people experience loss not just from aging but from periods of illness and inactivity, compounding muscle and strength decline.

3. Is Recovery Possible After Sarcopenia?

• Potential for Reversal
  • Lost motor neurons can’t be recovered, but remaining muscle and neural capacity can be strengthened significantly—even in the 90s.
  • “We have data up into people in their 90s showing they get, their muscles grow and they get stronger.” (Dr. Feigenbaum, 05:08)
• Barriers to Recovery
  • Purely age/disuse-related sarcopenia is more reversible than sarcopenia complicated by chronic illness or medications.
  • “If you’re in that population, just give up? No. It's just the degree of effect that exercise is going to have.” (Dr. Feigenbaum, 05:32)

4. Overcoming Barriers: “I Don’t Like the Gym” & Starting at Home

• Finding Enjoyable Fitness
  • Dr. Feigenbaum encourages starting with what you like—"What would you like to do physical activity wise?" (06:12)
  • If the gym is a barrier, there are home options (sit-to-stands, wall push-ups, resistance bands), though these may be more limited.
• Atomic Habits & “Exercise Snacks”
  • Emphasize small, easy habits: “The biggest effects on exercise happen from zero to something rather than like something to wow.” (Dr. Feigenbaum, 07:39)
  • Dr. Malik adds that making starting incredibly easy increases success.
• Social Support
  • Example: Dr. Feigenbaum brings his dad to the gym after knee replacement, guiding him from minimal fitness to deadlifting “295 for sets of five at 75.” (Dr. Feigenbaum, 11:06)

5. Gym Anxiety, Community & Dispelling “Perfect Form” Myths

• Fear of Injury and Judgement
  • Both hosts share stories about feeling intimidated in gym settings.
  • “One of the biggest comments is...fear of injury...usually learned from healthcare professionals, which is unfortunate for us.” (Feigenbaum, 13:16)
• Injury Risks Explained
  • Lifting is relatively safe: “2-4 injuries per 1000 participation hours, compared to 30, 50, 80 in sports like soccer or rugby.” (Dr. Feigenbaum, 13:59)
  • Most gym injuries are mild overuse, not catastrophic accidents—and driven more by training load (doing too much) than by small technique differences.
  • “The way I think about technique: is it repeatable, is it efficient, does it meet the points of performance? Then it's probably good enough.” (Dr. Feigenbaum, 18:42)
• Perfect Form Is a Myth
  • There is no single “perfect” form—it varies with anatomy and should be tailored to the individual.
  • “Our bodies are very adaptable… given a stressor at an appropriate dose, we can adapt to just about anything.” (Dr. Feigenbaum, 19:25)

6. Addressing Common Lifting Myths

• Are Deadlifts or “Knees Over Toes” Dangerous?
  • The injury rate for deadlifts is not higher than other movements; the “rounded back” deadlift isn’t inherently dangerous—it’s about dose and personal adaptation.
  • “If deadlifts were uniquely injurious, you'd expect to see a spike in power lifters...as it turns out, just humans have a couple hotspots for injury anyway: shoulders, knees, backs.” (Dr. Feigenbaum, 21:16)
• Lifting with “Imperfect” Form?
  • Variation is normal, and focus should be on building up to tolerate the loads and positions relevant to your life.
  • “If you have to get into a position where your knees are over your toes for sport, for life or whatever, you prefer to be prepared for it.” (Feigenbaum, 25:54)

7. Weighted Vests: Useful or Overhyped?

• Not a Replacement for Resistance Training
  • Weighted vests are not heavy enough to replace lifting weights, and studies show they don’t boost bone density or muscle mass meaningfully.
  • “Weighted vests can be useful for a few things...but doesn’t really increase bone mineral density.” (Dr. Feigenbaum, 29:49)
• Potential Niche Uses
  • Can be helpful to increase exercise intensity in walking or bodyweight moves at home, especially if other options aren’t available.

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Notable Quotes & Moments (with Timestamps)

• On Early Strength Loss:

  “Over the age of 50, you lose strength three times faster than you lose muscle size...this starts early. We start losing our ability to produce force in around the middle of the third decade of life.”
  — Dr. Jordan Feigenbaum [01:22]

• Resistance Training Must Be Challenging:

  “It can't just be the pink dumbbells, unless the pink dumbbells are heavy for you...It just has to be relatively challenging.”
  — Dr. Feigenbaum [02:56]

• Make Early 'Deposits':

  “Build up your physiological or physical 401k...make all those deposits earlier in life and then you can withdraw as you need later on.”
  — Dr. Feigenbaum [03:34]

• On Starting Small:

  “The biggest effects on exercise happen from zero to something rather than like something to wow. I'm training like an elite athlete.”
  — Dr. Feigenbaum [07:39]

• On ‘Perfect’ Form:

  “Is it repeatable, is it efficient, does it meet the points of performance? Then it's probably good enough. Technique perfect? I don't know what that is.”
  — Dr. Feigenbaum [18:42]

• On the Body's Adaptability:

  “Our muscles adapt by getting stronger and bigger. Our ligaments and tendons adapt by getting thicker and more resilient. Our bones adapt by getting more dense.”
  — Dr. Feigenbaum [19:25]

• On Weighted Vests:

  “Weighted vest: definitively no. Like, hard no [for bone density].”
  — Dr. Feigenbaum [29:51]

• Not a Car, Not Brake Pads:

  “We're not a car. We’re not like brake pads that wear down. You gotta replace them every now and again. In fact, it'd be like...your tires would get thicker as you drive. That's how we respond to exercise.”
  — Dr. Feigenbaum [24:19]

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Timestamps for Major Segments

• Sarcopenia Defined & How Early It Starts: 00:59–03:23
• Why Activity Isn’t Enough (Need for Resistance): 02:36–03:23
• Can You Reverse Sarcopenia?: 04:55–06:07
• Barriers and Alternatives to Gym Training: 06:07–09:49
• Social Support Stories (Host & Guest’s Families): 09:49–12:30
• Gym Anxiety, Community, and Getting Started: 12:30–13:09
• Fear of Injury & The ‘Perfect Form’ Debate: 13:16–20:31
• Deadlifts, RDLs, and Injury Myths: 20:31–25:54
• Weighted Vest Science and Practicality: 26:49–30:39

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Tone and Style

Straightforward, non-judgmental, encouraging, and rooted in evidence. Both Dr. Malik and Dr. Feigenbaum focus on removing shame and obstacles to getting stronger at any age, with a blend of personal stories and down-to-earth motivational advice.

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Summary Takeaways

• Sarcopenia is more about strength than muscle size, starts much earlier than most people think, and isn't just “an old person problem.”
• Heavy-enough resistance training is the only proven way to delay—not avoid—loss of strength and function with age.
• It’s never too late to get stronger; even those with sarcopenia can improve function and independence.
• Technique and form should be “good enough”—perfection is not necessary and varies between individuals.
• Start where you are, do what you can, and make it enjoyable or social if possible.
• Weighted vests are not a substitute for resistance training for muscle or bone health.
• Most perceived barriers to resistance training are surmountable with the right mindset and support.

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For anyone concerned about aging, independence, or staying functional for life, this episode offers myth-busting, deeply practical advice—plus plenty of actionable first steps to take charge of your muscle health, starting today.

Transcript

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[Interviewer]

I want to switch gears a little bit and talk about sarcopenia. I think that people don't really see it coming, but let's. Like when they're, when they're about to be diagnosed with sarcopenia, what is sarcopenia and why is it dangerous?

[Dr. Jordan Feigenbaum]

Yeah, great question. Especially with the aging population. Sarcopenia is classically understood to be age related loss of muscle, which is fundamentally wrong because people just think that their muscles are withering away, you know, going from a grape to a raisin. The reality is that the muscular force production, your muscular strength, is what's actually being compromised. In fact, over the age of 50, you lose strength three times faster than you lose muscle size. Right. But to your point, this starts early. We start losing our ability to produce force in around the middle of the third decade of life if there's no sort of outside intervening force. And so the issue with sarcopenia, which is probably better called dynapenia, reduction in force is a neurological event. The nerves that supply your muscle fibers, especially your fast twitch, type 2 muscle fibers that produce a lot of force, a lot of power, they start to die. And what happens when they die is that the muscle that they would otherwise connect to that muscle is either going to shrivel up and also die or it gets re innervated by a nearby muscle motor neuron. And unfortunately, most of those motor neurons are type one slow twitch. And so what you see in older individuals who have been diagnosed with sarcopenia is that they've lost a lot of their type 2 high threshold, high force producing muscle fibers. And even if they're like runners, like master's level Endurance athletes, you still see that same loss.

[Interviewer]

Really?

[Dr. Jordan Feigenbaum]

Yeah. So like, running isn't enough and definitively walking isn't enough. So you're like, why do people surprised? Well, it started way earlier than they thought. Right. And then there were no mitigating factors.

[Interviewer]

And some of them may have been running and doing the doing.

[Dr. Jordan Feigenbaum]

I'm active, I do Pilates, bar, whatever. Right. And it's like, all that's well and good. You know, all that's well and good. But they're the. What they should have been doing in order to prevent this loss is actually resistance training, specifically resistance training that is relatively heavy based on their current strength level. Right. So it can't just be the pink dumbbells, unless the pink dumbbells are heavy for you. Right? No shade to the pink dumbbells. Some people need them. That's, that's all well and good. It just has to be relatively challenging. And so what that does is it gives the nervous system a signal to say, look, these muscles, I need them.

[Interviewer]

You need to keep, keep them, keep those fibers.

[Dr. Jordan Feigenbaum]

And we see a big time slowing of that decline. Like, we can't beat Father Time. Time is undefeated. Right. But, but as far as the actual strength loss, it seems to be going down far slower in individuals who lift weights compared to those who don't. So much so that you might not notice a decline until somebody's in their 60s or 70s. And that decline is a relative decline. They're like, well, I can't lift this much anymore, but I'm still functionally independent. I can do everything I want to do. Sarcopenia is not coming for me. What you would want somebody to do earlier on in life is to build there's sort of physiological or physical 401k, make all those deposits earlier on, and then you can withdraw as you need later on in life. The same thing we see in bone mass, right. For osteopenia, osteoporosis, you want people to have a high level of bone mineral density in their 30s, such that by the time they're 60 or 70. Well, look, you started from a higher place, right? And so, yeah, it does seem to be a surprise. It's generally this sort of dual hit thing where, yeah, there was some age related loss that happened, but because we weren't really lifting weights and then somebody gets sick and so then there's a period of excessive disuse where that's accelerated. Right. And so, and then they kind of, I can't get out of bed as quickly or as, you know, briskly as I once was or I can't quite do all the things I need to do around the house as much. And so yeah, it's that the diagnosis of sarcopenia continues to increase and I think some of that's age related and other is environmentally related. People just not lifting.

[Interviewer]

If someone's sarcopenic right now.

[Dr. Jordan Feigenbaum]

Yep.

[Interviewer]

Can they get back to it? Can they like once you've lost those motor neurons, is there anything you can do?

[Dr. Jordan Feigenbaum]

Well, the motor neurons can't come back. Yeah. But we can strengthen what you still have and preserve further loss so reducing the burden of disease and then further. You know, we have data up into people in their 90s showing they get, their muscles grow and they get stronger. So the actual functional capacity seems to increase markedly. Now to your question of can you like reverse it? It really depends why somebody has sarcopenia if it's purely age related, just age related disuse, for example, that has a easy, it's easier to come back from that than if somebody has that layered on top of like a chronic medical condition that prevents them from exercising, for example, or they have to take a medication that actually interferes with exercise related adaptation. So if they have an autoimmune disease that you know, they have to take prednisone or something like that, it's not to say that one, you should stop your prednisone or two, if you're in that population, just give up. You know, it's just the degree of effect that exercise is going to have,

[Interviewer]

you know, because you just can't do as much.

[Dr. Jordan Feigenbaum]

Generally speaking, you don't respond as well. Doesn't mean you have no response though. Right. So 10 out of 10 would recommend resistance training.

[Interviewer]

So for people who, look, I hear this all the time, I don't like going to the gym.

[Dr. Jordan Feigenbaum]

Sure.

[Interviewer]

I don't like, like resistance training is not fun for me.

[Dr. Jordan Feigenbaum]

Sure. What do they do ideally, you know, when exploring fitness with clients or patients, I generally ask them like, what do you like to do? You know, what would you like to do physical activity wise, exercise wise. And you know, they usually give you some ideas, but I hear that all the time, I don't want to go to the gym. Right. One, I don't, I don't want to pay for it. I don't want to go there. I want to deal with all these chads, you know, no offense to people listening to this name, Chad. So what should I do? Can I do this at home? Yes, you can find ways to stress the musculoskeletal system at home. The issues are as follows. One, if you don't have equipment, you're going to be really restricted on what you can and can't do. And that's complicated by if you already have like relatively low strength levels, potentially low mobility levels, then trying to get you to do these restricted movements because you don't have machines, you don't have dumbbells, you don't have whatever is going to be even harder. Right. Like I could tell you to do squats at home or split squats, but can I tell that to my, you know, 74 year old mother?

[Interviewer]

Yeah.

[Dr. Jordan Feigenbaum]

Like it doesn't mean that she can't do it, but probably would be better off with a leg press. Right. Or at least access to that. It, it makes it more accessible.

[Interviewer]

Yeah.

[Dr. Jordan Feigenbaum]

So it's easier to do. Yeah. But I will say this. I don't let, don't let perfect be the, you know, get in the way of doing something because anything's better than nothing. Even we, we have this new emerging area of research and exercise where they're looking at what are called exercise snacks. It's like 30 seconds to one minute of just activity. Pretty big effect. The biggest effects on exercise happen from zero to something rather than like something to wow. I'm training like an elite athlete. You know, right now I spend a

[Interviewer]

lot of time talking to my patients about like the atomic habits model. Right. Like just do something that's so easy you can't ignore. It doesn't have to be hard, it doesn't have to be even long. Like just start it.

[Dr. Jordan Feigenbaum]

Yep.

[Interviewer]

And then after a week or two you can add to it. Right. Once it becomes just so easy. But just trying to be like, I'm going to go from sitting on my couch to the gym every three times a week. It's not feasible for most people to do that successfully and maintain it.

[Dr. Jordan Feigenbaum]

Yeah, yeah. You know, ideally, in a perfect world, a person gets introduced to exercise in a way that they enjoy. They get bit by the fitness bug. Now they're like, well, not only do I know this is good for me, but I like it.

[Interviewer]

Yeah.

[Dr. Jordan Feigenbaum]

And you get hooked. And that's my, one of my roles. It's like let me identify, you know, particular fitness kink that you like and let's, let's get you into it.

[Interviewer]

I like that fitness kink.

[Dr. Jordan Feigenbaum]

Yeah, yeah, yeah. It's PG show. So sometimes, sometimes with people at home, you know, if they're again very. I can't, I can't, I just won't, you Know whether it's, I don't want to go in there, I want people to see me like this, or they feel self conscious or they just don't want to do it all fine. If you think about an individual with sarcopenia, problem with the muscle quality, how much strength do you have? One of the diagnostic tests, functional test is a sit to stand. Can you sit to stand without using your hands getting out of a chair five times in, you know, less than 30 seconds? I believe so that you could use that to train at home. Hey, get on, on the couch or out of your chair. You got to do sit to stands, you know, five sets of five, whatever. Don't use your hands. Take as much time as you need, but start there. You can do push ups against the wall. You could do wall sits, you can do isometric type stuff. You can get some, you know, elastic bands, you can get some dump. I mean, whatever you want, right? The world is your oyster here in the fitness world, I just think that if you put too many constraints on a person, meaning, like, look, I don't want to go to the gym, I don't want to get any equipment and I won't do these things. It's like we're running out of options here relatively quickly. So what I do with my dad, my Dad's in his 70s, he's had a knee replacement is I was like, you should go, you need to go to the gym. After you complete your pt, you have to go to the gym.

[Interviewer]

And he's like, was he a gym goer before?

[Dr. Jordan Feigenbaum]

No, no, no. In fact, I've been my whole life. After I got into fitness, I was trying to get my dad in fitness one. I want to hang out with my dad. But also I'm like, look, dude, you're getting older. Let's like, let's help you out here, you know? And he does think he does a normal dad thing. Well, I mowed the grass today and I'm like, okay, well walk today. I would do a walk. Great. Love that energy, love that for you. Keep doing it. But we need to make your muscles work hard. Relatively hard for you. Not the same as for me, but relatively hard for you. And so when he got his first knee replacement, the way I got him into the gym was he sort of was self motivated. He's like, look, I don't, I feel like I lost a step. And I'm like, yeah, you need to get stronger. And he's like, would you take me to the gym with you? So that's how I kind of bridged that gap. There was no information gap for him anymore because I was with him. Yeah, exactly. And he felt more comfortable just being with his son. Same thing. This time he came in and, you know, if people are gym goers at home, this may be meaningful to them. He, after second knee replacement, he started his deadlift. 135 pounds, which, you know, it's one plate per side. Everyone was like, already stoked. Look, this guy's in his 70s. He's deadlifting. Hooray, that's great. And I'm like, yeah, it's not heavy for him yet, though. It's just he's going through the motion at the end of his progression. Before, before he moved back, he was 295 for sets of five.

[Interviewer]

Amazing.

[Dr. Jordan Feigenbaum]

Yeah. At 70. 75. Yeah.

[Interviewer]

That's amazing, right?

[Dr. Jordan Feigenbaum]

I'm like, well, now I know where I get it. I thought it was all my hard work. Turns out, maybe just genetically predisposed. But yeah, I think that he was open to it and I leveraged that sort of where he was at in his behavior change process to take in the gym. Not everyone's going to have that access. Not everyone's going to have a son or offspring that's willing to do that. But I just think people's aversion to going to the gym. I understand. I just would. I would like to maybe push back on that a little bit. There's just so many options if you can do that and ultimately give your muscles a signal to give your nervous system a signal to stick around. Harder to do it at home. Not impossible, just harder.

[Interviewer]

Yeah. Yeah. I definitely. Every time my parents are in town, I take them to the gym.

[Dr. Jordan Feigenbaum]

Yeah.

[Interviewer]

But they don't live with near me, which makes a little bit of a challenge. But I think there's a lot of fear there and I think there's just need to, like. I think it's helpful to have some help. But knowing that the gym community is pretty helpful.

[Dr. Jordan Feigenbaum]

Totally.

[Interviewer]

Like, I've had people come to the cave that you might hurt yourself, like, be careful or whatever. And if you asked me even five years ago if I'd be a regular gym goer, I would have said no.

[Dr. Jordan Feigenbaum]

Are you a gym rat now?

[Interviewer]

I am. And I started going because my husband was going, and so I went with him. And I was like, look, I've always been a little nervous about going to the free weight section. Come with me. And so we did it together. Now we take our older son with us, and our younger son can't go to the weight section yet, but now he's into it and it's become like a little bit of a game. Like, oh, how can we see ourselves progress?

[Dr. Jordan Feigenbaum]

Right. That's cool.

[Interviewer]

And so I just tell people, like, you would have asked me. I would have been zero chance. I'm going to be a gym goer. And now I'm a gym goer.

[Dr. Jordan Feigenbaum]

How did you. I know you're supposed to ask the question. How did you end up getting into the, like, what was the final. What brings you in the office today? What puts you in the gym for the first time?

[Interviewer]

Well, I think I was doing like peloton. I was doing other stuff. I had gone to, like, gym classes. I always wanted to lose weight. Right. But it became obvious to me, me, after watching, learning from people on social media and learning from colleagues, that muscle mass was super important. And so I said, well, you know, gotta practice what I preach.

[Dr. Jordan Feigenbaum]

Yeah, right. Love that.

[Interviewer]

Yeah.

[Dr. Jordan Feigenbaum]

Fear of embarrassment. No,

[Interviewer]

but I think for some people, having perfect form is concerning. So what does that mean? Is there a perfect form?

[Dr. Jordan Feigenbaum]

No. That's a great question. Yeah. In fact, you look at survey data on people who are currently insufficiently active, which is a nice way of saying they don't go to the gym. If you ask them, hey, why don't you go to the gym? One of the biggest comments is going to be, I don't know, time. And then this right behind that is fear of injury. And you ask them where they learned that fear of injury from. They say, usually healthcare professionals, which is unfortunate for us because most of the time doctors like you should exercise. And if you ask doctors about concerns,

[Interviewer]

the whole conversation though, you should exercise by.

[Dr. Jordan Feigenbaum]

Yeah, exactly. Right. Sorry, we're on a clock here, by the way. I know I was late to the appointment and also you got to go because I got another person. Yeah. So it's unfortunate. So, yeah, there's this fear of injury that does prevent a significant amount of people from exercising or at least doing certain exercises. Right. And there's this idea that, well, if you do the exercise perfectly with the correct technique, that it's less injurious. Right. So that is a very interesting argument. Fine hypothesis. So then you have to define, well, what is perfect form? And to date, it's only been described once in the literature. It's a 2009 paper and it's a. A circular argument. It's like, well, look, if you do the exercise with the correct range of motion, the correct velocity in a way that achieves the most optimal Fitness adaptations and does not produce injury. That's perfect form. And I'm like, that seems vague. It seems like a tautology. And also. Yeah, like, very vague. So doesn't make sense. So then when we look at, like, how do injuries actually occur in the gym? What is the injury risk? And like, how does perfect form or form in general tie into this? Well, all right, going to the gym, lifting weights, relatively safe. Two to four injuries per thousand participation hours. Compare that to like walking, we're like one. Cycling is like one and a half. So, like, it's relatively low. You compare that to things like football, rugby, soccer, you're, you know, up towards 30, 50, 60, 80 injuries per thousand participation hours. Okay, so relatively safe to lift weights. Most injuries are also not catastrophic. They resolve on their own within about 14 days. Any medical care. So already people should be thinking, well, look, maybe this injury thing shouldn't be as big of a concern. And that should also tell you because most injuries resolve that quickly, don't require medical care, and are not catastrophic. That should give you an indication of what is the nature of most of these injuries. Are they a muscle tearing or a ligament snapping, something like that? Well, no, they're overuse injuries, chronic overuse injuries. And so then we keep going down this rabbit hole and we're like, would a form particular type of technique cause an overuse injury independently of how much exercise you're doing? Unlikely. It's kind of like rotating your tires here, right? So you rotate your tires so you don't get a flat spot or overwear on one spot. If you don't, yeah, they can wear out prematurely. And so that's what we're seeing here with these overuse injuries. People are doing too much without enough variety, and they get that sort of overuse or bald spot, early wear on their tires or on their body. That's the so overuse injury. So ways that you can reduce the risk of overuse injury, more varied exercises, and then also making sure that you're doing the correct amount of training or exercise for the person. And the amount of exercise is not just how many days you go to the gym. It's how much stuff you're doing in those days and what kind of stuff. Right. So all of that is to say the training load or the amount of exercise that a person's doing is the primary factor that determines their injury risk as it goes up, particularly out kicking their coverage, what they can tolerate right now. That is what increases injury risk. Primarily this form argument is kind of silly because it you Know, instead of thinking like, oh, you weren't doing too much, you were just doing it wrong. That would beget like an acute injury. Right. Something catastrophic or whatever. We just don't see that it is possible obviously to have an acute injury. Those are mostly accidents that happen in the gym.

[Interviewer]

Like something falls on your foot.

[Dr. Jordan Feigenbaum]

Yeah. And in fact, you look at people under the age of 18, 75% of their injuries are dropping a weight on themselves. This goes down as people get older and older and older. But people can fall, people can, you know, other stuff can happen. But the majority are overuse injuries, which is a training load or exercise load related thing. So the way I think about technique is that it should be somewhat repeatable. We look at elite athletes and how they lift, for example, there are variations in all dimensions, all three dimensions, slightly forward, twist, whatever. There's slightly different rep to rep, but they're mostly repeatable. Each rep looks somewhat similar, but not a carbon copy. But repeatable. That's criteria one. Criteria two. Is the technique efficient? How much extra energy are you putting into the implement to lift it versus other stuff that doesn't actually cause the weight to move? This would be like loss of balance. This would be like the bar or the dumbbell or whatever starting the wrong place, extra wasted energy. This is mostly for performance, not for injury risk reduction, but mostly for, hey, can you lift the most weight, for example? Yeah. So it might not be important for, for many folks, but for a person who competes in powerlifting, it's important for us.

[Interviewer]

Sure.

[Dr. Jordan Feigenbaum]

And then the third part, last criteria is does it meet the points of performance that you've determined ahead of time? So for a squat, for example, how deep should you go? We're going to set an arbitrary standard of below parallel or to parallel, or for another person above parallel. You're just setting up these arbitrary constraints, right. For how you do the exercise so that you can compare like to like, you can gauge your progress. You can make sure that you're doing it the same way each single time. That's the way I think about technique. It's the rep model. Is it repeatable, is it efficient, does it meet the points of performance? Then it's probably good enough. Technique perfect. I don't know what that is.

[Interviewer]

Well, isn't it variable based on anatomy a little bit too?

[Dr. Jordan Feigenbaum]

Right.

[Interviewer]

Because your range of motion is limited by your anatomy to some degree, it's

[Dr. Jordan Feigenbaum]

going to look different. To your point, I can come up with a model for an exercise like this is the most efficient model of exercise. Right. Build muscle or lift the most weight. Right. Efficient. It's the most efficient. Right. So in a squat, the bar, whether you held in the front or back or whatever, it would be over your center of balance, which is somewhere in the middle of your foot. Right. And you wouldn't lose balance on the way down. And the amount of knee flexion and hip flexion would be carefully timed. So the bar stayed in a vertical line on the way down. Like all these things. Right. None of that has anything to do with injury risk. Right. Because the human body is very adaptable. We can, if we're given a stressor at an appropriate dose, adapt to just about anything. Just about anything. Right. Where our muscles adapt by getting stronger and bigger. Our ligaments and tendons adapt by getting thicker and more resilient. Right. Our bones adapt by getting more dense. There's even data in like 15 year old weightlifters where they get vertebral end plate thickening on their vertebra.

[Interviewer]

Really?

[Dr. Jordan Feigenbaum]

Yeah. As an adaptive response. Right. Their anterior cruciate ligament gets thicker, hypertrophied due to the force that they're forced to absorb. Tennis players and their dominant serving arm grow longer. Right. Than their other non dominant arm. And it's like these are all adaptive processes to better suit you for the task that you're doing.

[Interviewer]

Right.

[Dr. Jordan Feigenbaum]

So the analogy I like to use for injury risk is you're overdrafting your account. You got 12, you got $1,000 in the account. You try to draft 1200 out, well, you can get an overdraft fee, which we call an injury. The technique thing has nothing to do with your balance and what you're trying to take out. It's, oh, you swipe the card with your left hand, not your right hand. You swipe the card wrong. And I'm like, well, that sounds silly. Yeah, it's just an overdraft fee. That's the best way. I can kind of describe this.

[Interviewer]

What about like deadlifts and RDLs? I think people worry a lot about injuring their backs.

[Dr. Jordan Feigenbaum]

Totally average human is going to have a back injury at some point in their life. Right. Or low back pain, whether or not it's from an activity or, you know, happened with unknown cause or whether it's from trauma. Right. We don't, we don't know when you look at the actual evidence on competitive powerlifters. Right. So powerlifting is a sport. We use that term sport charitably, because I don't know how athletic we are. But it is an organized set of rules that people agree to participate in where you do the squat bar on your back, squat down, bench press, everyone knows what that is. And deadlift, picking a bar up from the, from the ground. You have three attempts in each discipline to lift the most amount of weight, heaviest total, best attempt between all three disciplines wins. There's weight classes, age classes, etc. When you look at data on powerlifters who have to do the deadlift, right. The injury risk is again, two to four injuries per thousand participation hours. And you compare that to CrossFit to bodybuilding, to Olympic weightlifting, where you don't actually have to do the deadlift in order to participate in the sport. It's the same injury rate. So if deadlifts were uniquely injurious, you'd expect to see a spike in power lifters, especially in low back. But as it turns out, just humans have a couple hotspots for injury anyway. Shoulders, knees, backs. And that doesn't seem to matter if you exercise or not. Those are just the most commonly injured or commonly reported areas of pain in humans. And so what I think happens is that most people, especially as they age, have had some incidence of low back pain from something, whether it's from sport, whether it's just from some unknown cause. And so the area remains underdeveloped, under trained. And now you have somebody like me saying you should deadlift, you know?

[Interviewer]

Yeah.

[Dr. Jordan Feigenbaum]

Or some sort of hinge, Romanian deadlift, something like that.

[Interviewer]

Sure.

[Dr. Jordan Feigenbaum]

Dumbbells, kettlebells, barbell, I don't care. Do something. Right. And they're like, I haven't done that before. And I've been kind of restricting myself from anything that loads that area. And then they get a little overzealous the first time that they go in. They do too much, too many reps, too many sets at too high of a weight. So effectively they try to withdraw $1200. They had $1000 in the account. That's a general experience that when people report back pain from those specific types of exercise, it's not that the exercise itself is uniquely injurious outside of like loading the area. Right. Which. It's just that the dose was too high.

[Interviewer]

Yeah.

[Dr. Jordan Feigenbaum]

And further, I'd say I think the risk of not doing those exercises is actually higher of the risk of doing them. Meaning, like if you're unprepared to interact with your physical environment in a way, we have to bend over, pick something up, whether it's kids, groceries, something. I'd prefer to be prepared for that.

[Interviewer]

Yeah. Well, interesting. I don't know if you Know Jordan, the other Jordan, Jordan Syed. He does. He does his deadlifts with a rounded back, which is like, antithetical to what people think about deadlifts, because he's like, I want flexibility and I want to be able to, like, lift my kid from the crib because it's sort of not exactly from. It's actually almost a deficit. And he. He's fine. Like, it's. It is a way to do it if you want to.

[Dr. Jordan Feigenbaum]

Yeah. People say, oh, you can't live with the rounded back. You're gonna explode a disc or whatever. You know, it's like you could do it with no weight, right? You just like bend over round your back and then stand back up. And they're like, yeah. And I'm like, could you do with the PVC pipe? And they're like, yeah. And I'm like, do you think you could do it with an empty barbell, you know, in your back when it explodes? Like, well, yeah. And I'm like, okay. So what you've told me then is the technique itself, the form itself is not the injurious agent, it's the load. Not necessarily just the weight. But how many reps of that weight do you do and how well prepared are you for the task that you're being asked to do? And then that kind of clicks for them. They're like, oh, shoot.

[Interviewer]

So you can do it. Just.

[Dr. Jordan Feigenbaum]

We're not a car.

[Interviewer]

Just don't overdraft.

[Dr. Jordan Feigenbaum]

Yeah, don't overdraft. Well, look again, we're not a car. We're not like brake pads that wear down. You gotta replace them every now and again, you know, in fact, it'd be like you'd be driving around in a car and your tires would get thicker as you drive. That's how we respond to exercise. We get better at. At tolerating the things that we've been exposed to, but we just have to start with a moderate or conservative type of dose. And I think to Jordan, the other Jordan OJs, sort of. Maybe we don't use that if we're in la. To. To his point. Yeah. Like, if he thinks he's going to be bending over the rounded spine, do it. Do it rounded. I think when people on the Internet see somebody deadlift with a cat back, you know, rounded back, and they're like, injury waiting to happen. Some of that's like, aesthetic to them. Like, I don't like the way that looks.

[Interviewer]

Yeah.

[Dr. Jordan Feigenbaum]

The other thing is, like, plenty people deadlift like that. No pain. Other people deadlift Perfectly have pain. Right. It's more complicated than that. It just depends on how well you are prepared for that. From a coaching standpoint, I'm like, that's probably not the most efficient way to lift. And to that I feel relatively confident outside of very unique cases. Constant Constantinov, I think he recently passed away a few years ago. He held at the time one of the highest deadlifts ever done. Conventional. So feet inside of his hands, nine hundred and something pounds and deadlifted on purpose with the rounded back.

[Interviewer]

Wow.

[Dr. Jordan Feigenbaum]

And people were like, what do you do? Is your skeleton made of adamantium? Whatever. He goes, he goes, no, it's an advantage for me. And I'm like, oh, interesting. So, yeah, some people will find, yeah, we'll find different strategies to do the task. But the, the premise remains humans are very adaptable. Don't let your knees go over your toes. Like, well, what if you're a catcher?

[Interviewer]

There's that, there's that, that YouTuber. Knees over toes.

[Dr. Jordan Feigenbaum]

Yeah. It's like if you have to get into a position where your knees are over your toes for sport, for life or whatever, you prefer to be prepared for it. Right. If you have to pick something off the ground, you prefer to be prepared for it.

[Interviewer]

So really there's no, like, strict rules. It's about efficiency and. And essentially just not overdrafting, not overdoing it.

[Dr. Jordan Feigenbaum]

Yeah. I think the biggest takeaway is like, making sure that the dose of training is well suited to you. So my goal, if I put on, like my personal trainer or strength coach hat, is how do I get the person to do the most amount of exercise possible? Right. The highest training load, two biggest bottlenecks, time. And the second one is what can they tolerate right now? Their physiological tolerance or recovery capacity. I can't out kick that second one. Right. I can't out kick that second one because that's when I think injury risk starts to go up. Not because of how they're doing the exercise, but just the amount of exercise that they're doing. So I think that's a nice way to frame it.

[Interviewer]

Are weighted vest useful first?

[Dr. Jordan Feigenbaum]

I think all exercise is good. Big fan. You like it? I love it. Scratch, you know, fitness kink. Let's go. The thing with weighted vests are that they are billed to be a replacement or supplement for resistance training. Right. And so they would load the skeleton in such a way that prevents bone mineral density loss. They load the muscles, or to force the muscles to work hard enough to prevent sarcopenia and increase strength and hypertrophy and this, that and the other. One study doesn't do any of that. And we've had like pretty robust studies on this using far heavier weights than people would be otherwise wearing from either her particular weighted vest. And we're talking about 50 body weight people are wearing, right, for like eight hours a day, for example. This goes back to a research group out of Gothenburg, Sweden. Are you familiar with the Gravitostat theory?

[Interviewer]

No.

[Dr. Jordan Feigenbaum]

There's a bunch of theories about how we regulate body weight like humans. And so this gravity stat theory is that, look, the bones sense how much you weigh.

[Interviewer]

Yes, I've heard the theory. I didn't know that was the name of it.

[Dr. Jordan Feigenbaum]

Ye, yeah, yeah. And so then if you gain too much weight, the bones will start releasing this unknown chemical that causes you to eat less, move more, whatever. And this was thought because they implanted weights inside of a belly of a mouse, of rats rather. And the rats who had the implanted weights lost the proportional amount of weight otherwise. So they were like, all right, there's our rodent data, let's translate this to humans. We're going to make humans wear weighted vests for eight hours a day, 12 hours a day, and see do they lose weight, does their bone mineral density increase or whatever. So a number of studies have been done. None of that happens. Weighted vests can be useful for a few things. One, if you are trying to target a particular heart rate zone during some conditioning, like walking, running, whatever, adding load certainly can do that. The problem is if it's not, you know, it's not a very structured program, most people, when they add a weighted vest, won't exercise for as long, right? And so like, while the increased pace or the increased intensity of the certain exercise that you do is maybe good or maybe just, you know, different, you're gonna do less of it. So that's, that's problem one, but doesn't always have to be trade off. Could be, yeah, potentially. Potentially could be. That's thing one. Thing two, it's not heavy enough for people to generally use for resistance training as a resistance training replacement. On the other hand, if you were at Stuck at Home, it's Covid time and you're like, look, I gotta find a way to exercise my legs in a way that's challenging to me. So I'm like, all right, well what if you did split squats with a 30 pound vest on? Maybe that gets you somewhere near failure in the 10 to 15 or 10 to 20 rep range. Whereas normally without the vest you could have done 50.

[Interviewer]

Right.

[Dr. Jordan Feigenbaum]

Right. So potentially use potential use case there. Right. But it doesn't burn more calories, really, because again, people will end up exercising for a shorter period of time or doing less total work. And to the extent that exercise has an effect on weight management anyway, it's pretty modest. So, like, can kind of put that to the side. Doesn't really increase bone mineral density, although

[Interviewer]

that's what people say. That's the, that's the whole thing.

[Dr. Jordan Feigenbaum]

The calorie thing?

[Interviewer]

No, the bone mineral density.

[Dr. Jordan Feigenbaum]

Oh, yeah. No. Like definitively no. Like hard. No. And, and, and I say that relatively confidently because even like heavy resistance training, we think it does its best work when people do this early in life. Really maximizes that sort of mountaintop of bone mineral density, which is going to go down as you age. And then the secondary effect after you do early in life is later in life. It makes that decline slower. All way heavier than weighted vests. There's this thing, it's called osteogenic index. Basically refers to how much strain is placed on the bone to cause it to increase bone mineral density. Heavy resistance training. Very high plyometrics where you're landing. High impact. Yep. Very, very high. Weighted vest. Not high because it's not heavy enough is the problem.

[Interviewer]

Because I notice when I don't, I'm not good about wearing it because I just forget. But if I go for a walk, I have to come and take it off after my, like, one circle around the neighborhood because I. And then I'll keep walking, but, like, I would not be able to continue as long as I normally would.

[Dr. Jordan Feigenbaum]

Yeah. And so, you know, there are maybe some unique conditioning benefits to be had by working in different intensity ranges. Right. Zone two versus zone three. Zone four. Mostly performance related. Not related. Right. But for bone mineral density. Yeah. I feel pretty confident in saying, like, it's not enough. And I actually don't know if it's beneficial in, in any real meaningful way. And my fear is that people will buy the, the, the weighted vest and then not do the stuff like lift weights, for example.

[Interviewer]

If you like that clip with Dr. Jordan Feigenbaum, check out the full episode right here.