← The Peter Attia Drive

#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.

May 26, 2025 1h 44m 72 insights
<p><a href="https://peterattiamd.com/kylerbrown/?utm_source=podcast-feed&amp;utm_medium=referral&amp;utm_campaign=250526-pod-kylerbrown&amp;utm_content=250526-pod-kylerbrown-podfeed"> View the Show Notes Page for This Episode</a></p> <p><a href="https://peterattiamd.com/subscribe/?utm_source=podcast-feed&amp;utm_medium=referral&amp;utm_campaign=250526-pod-kylerbrown&amp;utm_content=250526-pod-kylerbrown-podfeed"> Become a Member to Receive Exclusive Content</a></p> <p><a href="https://peterattiamd.com/newsletter/?utm_source=podcast-feed&amp;utm_medium=referral&amp;utm_campaign=250526-pod-kylerbrown&amp;utm_content=250526-pod-kylerbrown-podfeed"> Sign Up to Receive Peter's Weekly Newsletter</a></p> <p>Kyler Brown is a sports rehab chiropractor who specializes in injury recovery, pre- and post-surgical rehabilitation, and guiding clients from rehab back to peak performance. As co-founder of the private training program 10 Squared alongside Peter, Kyler shares his approach to injury prevention and performance optimization—highlighting how overlooked movement patterns can quietly lead to chronic issues over time. He outlines a practical framework for assessing and treating individuals, highlights the importance of understanding movement dynamics and asymmetries, and discusses personalized rehab strategies through real-world case studies. The conversation also explores the psychological side of recovery, including the role of fear and mental barriers in rehabilitation. Kyler shares actionable tools to evaluate movement patterns and implement training strategies that support long-term strength and health.</p> <p>A companion video series demonstrating exercises for common problem areas—such as the lower back, neck, shoulders, and knees—is available exclusively to subscribers on the show notes page.</p> <p><strong>We discuss:</strong></p> <ul type="disc"> <li>The personalized rehab strategy for Peter's shoulder surgery that sparked creation of a training program called 10 Squared [3:00];</li> <li>Training for the marginal decade: why precision and purpose are essential for quality of life [11:00];</li> <li>The Centenarian Decathlon: how training for long-term capacity enhances both current and future quality of life [18:00];</li> <li>How the shortcomings of conventional rehab and performance systems led to the creation of 10 Squared, a personalized training model focused on long-term physical capacity and individualized care [23:45];</li> <li>Case study: how personalized assessment and treatment at 10 Squared helps uncover the root causes of injuries [31:00];</li> <li>The role of the "core" in movement and injury prevention, and the importance of training stability before strength [40:15];</li> <li>The layered assessment process used at 10 Squared to determine whether a person is ready to perform dynamic movements [47:45];</li> <li>Case study: the rehab plan designed to treat a hamstring injury while preserving fitness and preventing reinjury [51:45];</li> <li>Training approach for clients with minimal training history: risk reduction, habit-building, and long-term consistency [55:30];</li> <li>How to train foot reactivity, tendon resilience, and explosive capacity in a safe, progressive way [1:00:00];</li> <li>Peter's foot and ankle pain: how to diagnose, treat, and strengthen the lower extremities [1:04:15];</li> <li>How fear and perception influence recovery, what drives back pain, and when to choose surgery vs. treatment [1:13:15];</li> <li>Could AI and app technology eventually deliver an individualized rehab and training experience? [1:22:30];</li> <li>Kyler's professional evolution from traditional chiropractic care to a degree-agnostic, performance-based rehab philosophy [1:25:00];</li> <li>How 10 Squared provides precision rehab and training in a remote format [1:30:30];</li> <li>How Peter resolved a severe back pain flare-up using DNS-guided isometric exercise instead of passive treatments [1:33:15];</li> <li>How to identify and treat common joint pain (neck, back, knee, shoulder) using a rehab framework that strengthens supporting structures and helps avoid surgery [1:39:00]; and</li> <li>More.</li> </ul> <p>Connect With Peter on <a href="https://twitter.com/PeterAttiaMD">Twitter</a>, <a href="https://www.instagram.com/peterattiamd/">Instagram</a>, <a href="https://www.facebook.com/peterattiamd/">Facebook</a> and <a href="https://www.youtube.com/channel/UC8kGsMa0LygSX9nkBcBH1Sg">YouTube</a></p>
Actionable Insights

1. Train for Longevity

Adopt a deliberate, athlete-like training approach to prepare for and enjoy your later decades of life, focusing on maintaining physical capacity.

2. Adopt Long-Term Training

Shift your training mindset from short-term performance to a long-term strategy, building a robust foundation for future physical challenges.

3. Train for Extreme Longevity

Aim for peak fitness in your nineties, as this non-linear goal will make achieving fitness in your fifties feel significantly easier and more attainable.

4. Assess Activity Risk/Reward

Evaluate the risk and reward of physical activities, adjusting your approach as you age, similar to how investment strategies change over time due to reduced tissue quality and increased injury risk.

5. Calibrate Training Precisely

Ensure your training is precise and calibrated to your specific joint nuances, movement patterns, and body sensations, rather than just putting in effort without direction.

6. Build Capacity, Prevent Injury

Develop robust physical capacity and ‘insulation’ around your body to prevent injuries, which can otherwise accumulate and lead to a decline in overall health.

7. Use It Or Lose It

Actively maintain your physical capacities like jumping, mass, and strength, because if you don’t use them, you will lose them over time, leading to reduced physical ability.

8. Prioritize Training Consistency

Maintain consistent training, even during vacations or busy periods, as consistency is paramount for long-term gains and preventing muscle atrophy.

9. Conduct In-Depth Initial Assessment

Invest sufficient time in an in-depth initial assessment to thoroughly understand your movement patterns, strengths, and weaknesses, which is crucial for effective remote training and problem-solving.

10. Build From Your Foundation

Identify your weakest foundational areas (your ‘floor’) and prioritize building them up, even if other areas are strong, to create a balanced and robust physical capacity.

11. Demand Strength Building in Rehab

Insist on a rehab approach that consistently builds strength, as this is crucial for long-term improvement, movement optimization, empowerment, and creating resilience against future minor injuries.

12. Prioritize Rehab Skillset

When choosing a rehab professional (chiropractor, physical therapist, strength coach), prioritize their individual skillsets and approaches over their specific degree or credential.

13. Seek One-on-One Strength Rehab

Choose rehab clinics that offer one-on-one sessions and incorporate weights and strength training, as this indicates a focus on building lasting strength rather than just repetitive, passive drills.

14. Seek Diverse Toolset Practitioners

Look for rehabilitation practitioners who possess a wide range of tools and modalities (e.g., adjustments, dry needling, active release) and know when and how to apply each one strategically.

15. Modalities Enable Active Rehab

Utilize various therapeutic modalities (e.g., injections, manual therapy) to create a temporary window of reduced pain and safety, allowing you to then actively retrain movement patterns and build strength.

16. Coordinate All Care Teams

Ensure all members of your care team (strength coaches, physical therapists, sport coaches) communicate and coordinate to create a unified plan that supports healing and prevents re-injury.

17. Understand Injury Causes

Understand that injuries and pain are multifactorial, often compounded by emotional stress, and that pain is a brain-perceived threat, not always indicative of structural damage.

18. Pain Doesn’t Mean Injury

Understand that pain is a signal from your brain indicating something is amiss, but it doesn’t always mean you have a structural injury or are ‘broken.’

19. Empower Through Pain Understanding

Empower yourself by understanding the rational reasons behind your fear or pain, as this knowledge can help reduce anxiety and improve your ability to address the issue.

20. Manage Stress for Pain

Recognize that emotional and mental stress can heighten your brain’s perception of threat, making you more sensitive to pain, so managing stress is crucial for pain reduction.

21. Address Psychological Pain Factors

Identify and address external, cultural, psychological, or emotional stressors that contribute to pain, seeking therapy or other support when necessary, even if these factors cannot always be ‘fixed.’

22. Avoid Fear-Mongering Practices

Be wary of practitioners who use imaging findings to instill fear and push unnecessary, long-term treatment packages, as this can make you feel more frail and afraid without genuinely helping your condition.

23. Don’t Over-rely on Imaging

Do not let imaging findings (e.g., wear and tear on an MRI) dictate your entire clinical plan, as many findings are normal age-related changes and don’t always correlate with pain or dysfunction.

24. Develop Deep Core Stability

Focus on developing your deep core stabilization system, involving the diaphragm, pelvic floor, and small spinal muscles (multifidi), to create stiffness and support at the right time for dynamic movement.

25. Strengthen Pelvic Floor

Strengthen your pelvic floor, as it is crucial for intra-abdominal stability and preventing compensatory rotations and tilts in the body when the diaphragm or pelvic floor are not functioning optimally.

26. Develop Dynamic Stability

Cultivate dynamic stability to efficiently transmit force to the outside world and safely absorb force from it, optimizing performance and reducing injury risk.

27. Train in Three Dimensions

Perform strength exercises in multi-planes of motion (e.g., lunging sideways or backward) to prepare your body for the three-dimensional movements of daily life, rather than just linear exercises.

28. Use Heavy Isometrics

To prepare your nervous system and tissues for explosive, powerful movement, start with long-hold, heavy overcoming isometrics in various positions to build tendon readiness and stiffness.

29. Progress to Deloaded Plyometrics

After building foundational strength with isometrics, progress to deloaded plyometrics (e.g., band-assisted pogos) to train speed and quickness without full body weight, bridging to full athletic movements.

30. Prioritize Speed Early

For youth athletes, prioritize training for speed, athleticism, and coordination as a foundational platform before focusing heavily on strength, as speed is harder to develop later in life.

31. Engage in Randomized Play

Regularly engage in randomized, unpredictable games and play to stimulate neuroplasticity and provide rehearsed, varied load to tissues like the Achilles and foot, preventing loss of capacity.

32. Play with Kids for Future

View playing with young children as a practical way to train for future physical activities, observing their movements to inform your own long-term fitness goals.

33. Improve Landing Mechanics

Practice sticking landings by improving your rate of force absorption, ensuring all tissues (arch, Achilles, IT band, hip, core) create stiffness simultaneously, and maintaining organized balance for optimal landing position.

34. Test Single-Leg Stability

Assess your single-leg stability and function; if you are strong on two legs but significantly weaker or less stable on one, it indicates a major balance and control issue that needs addressing.

35. Address Foot/Ankle for Upstream Pain

For chronic knee, hip, or spine issues, address foot and ankle function first, as a stiff or weak foot can compromise shock absorption, forcing other joints to compensate and take a beating.

36. Improve Stiff Foot Mobility

If you have rigid, stiff feet, focus on exercises that improve foot mobility and teach the separation of rear foot and forefoot to enhance shock absorption and prevent upstream issues.

37. Specific Foot/Ankle Isometrics

For mobile feet lacking stiffness, perform exercises like a front foot hover in a split squat, plantar flexing to a calf raise, and holding to build strength and stability in tendons at different lengths.

38. Recognize Tendon Pain Pattern

Be aware that tendon pain often manifests as stiffness and soreness upon waking, which improves with movement, indicating tendons’ need for blood flow and motion for healing.

39. Be Patient with Tendon Healing

Understand that tendons heal slowly, often taking months to regenerate, so patience and consistent, targeted rehab are crucial for recovery.

40. Avoid Unprepared High-Impact

Refrain from suddenly engaging in high-impact, novel activities like pogo sticking without proper preparation, as tendons can be easily overloaded and take a long time to heal.

41. Prioritize Post-Pregnancy Rehab

Advocate for and seek out robust rehabilitation pathways for women immediately post-pregnancy (vaginal or C-section) to address body changes and restore physical health, rather than delaying care.

42. Prehab During Pregnancy

If you become pregnant, proactively engage in prehabilitation exercises such as foot strengthening and core stability work to prepare your body for the physical changes and demands of pregnancy and childbirth.

43. Strength Train for Tendon Health

Middle-aged women, especially endurance athletes, should prioritize strength training to improve tendon health, muscle fiber quality, and overall muscle mass, which are often lacking.

44. Address Functional Asymmetries

Identify and address functional asymmetries (e.g., from scoliosis or post-pregnancy changes) that can lead to compensatory movement patterns and overuse injuries in other areas of the body.

45. Understand Running Mechanics

Recognize that running is a unilateral, single-leg rotation propulsion drill, involving reciprocal movement of the spine, pelvis, and feet, which must work in unison for efficient movement.

46. Tailor Training to Risks

Before adding new activities, assess your individual risk factors (e.g., Achilles injury risk for jump rope) and integrate smart, targeted strengthening into your program to mitigate those risks.

47. Protect Injured Area, Train Elsewhere

When an area is injured or undergoing treatment like PRP, protect that specific site from stress but continue to train other parts of the body to maintain overall fitness and support healing.

48. Prioritize Healing Time

After an injury or intervention, prioritize sufficient healing time and avoid rushing back to activity, even if it means temporary cessation of your sport, to ensure full recovery and prevent re-injury.

49. Address Underlying Dysfunctions

For injuries like tendinopathy, address foundational underlying movement patterns and dysfunctions contributing to the issue, alongside considering interventions like PRP for tissue regeneration.

50. Use Gentle Post-Op Isometrics

After surgery, use gentle but targeted isometric exercises to load tissues in a specific way, building a ‘roll cage’ of support muscles around the joint to absorb force without stressing healing structures.

51. Prehab Rotator Cuff

Before shoulder surgery, engage in intensive rotator cuff work, especially targeting the supraspinatus, to strengthen the muscles around the joint.

52. Prioritize Core, Scapular Stability

Before surgery or for general shoulder health, focus on aggressive core stability training and improving how your scapula interacts with your ribs, as these significantly affect shoulder movement and stability.

53. Strengthen Rotator Cuff

Strengthen your rotator cuff muscles as much as possible to potentially avoid or delay shoulder surgery, especially if you have a known labral tear.

54. Diligently Follow Rehab Rules

Strictly adhere to all post-operative and rehabilitation instructions, as patient compliance is crucial for minimizing risk and achieving optimal recovery outcomes.

55. Seek Comprehensive Rehab Plan

When seeking rehabilitation, look for a clinic that offers a comprehensive plan focused on increasing your capacity over time, rather than just isolated services or passive modalities.

56. Avoid Passive Rehab

Be wary of rehab clinics that primarily rely on passive modalities like ultrasound or table treatments, as they may not effectively build strength and long-term capacity.

57. Seek Personalized Rehab

Avoid generic, cookie-cutter rehab handouts; instead, seek out personalized physical therapy with accountability and nuanced instruction tailored to your specific needs.

58. Centralize Rehab Oversight

Ensure you have one primary professional overseeing all your training and rehabilitation variables, acting as the central coordinator to prevent conflicting advice and optimize your progress.

59. Integrate Rehab with Enjoyment

Ensure your rehabilitation exercises are integrated with activities you love and want to do, as tedious and boring routines are unlikely to be sustained long-term.

60. Six-Pack Not Core Stability

Understand that a prominent rectus abdominis (six-pack) does not equate to deep core stability, especially for multi-planar movements involving tilting and rotating.

61. Integrate Core with Motion

Progress core stability training to include dynamic movements like kicking, running, or throwing, ensuring the deep stabilization system functions effectively during motion, not just in static stiffness.

62. Improve Core for Muscle Freedom

Enhance deep core stability to prevent compensatory tightening of other muscles (like biceps or traps) that try to stabilize, thereby restoring freedom of movement and reducing perceived threat.

63. Activate Deep Stabilization

Focus on activating your deep stabilization system to ensure all body parts move in unison, which can resolve movement problems and lead to greater robustness and strength.

64. Exercise as Diagnostic Test

View exercises not just as training, but as diagnostic tests; observe how your body performs and responds to specific movements to identify weaknesses and guide your program.

65. Adapt Workouts for Travel

Adapt your workout program to your travel environment (e.g., hotel gym, no equipment) to maintain consistency and prevent loss of fitness while on vacation.

66. Evaluate Nerve Symptoms Immediately

If experiencing lower back pain with motor weakness or loss of bowel/bladder function, seek immediate medical evaluation, as nerve pressure can lead to permanent damage over time.

67. Test Conservative Back Pain Interventions

For mechanical low back pain without weakness, try conservative interventions like muscle work or McKenzie exercises as a diagnostic step; even temporary positive responses indicate a path for healing.

68. Use McKenzie Protocol for Discs

For disc-related nerve pain, explore the McKenzie protocol, a system of gentle arching and pumping movements in various positions designed to take pressure off the disc and encourage recentering.

69. Seek Conservative Spine Surgeons

When dealing with back pain, seek spine surgeons who prioritize conservative management and waiting periods (after ruling out acute weakness) before recommending surgery, as this is often a sign of a better surgeon.

70. Understand Pain’s Inhibitory Effect

Recognize that pain can cause your brain to enter ‘preservation mode,’ inhibiting normal movement and strength, even if there’s no structural damage, to protect the perceived threat.

71. Use Specific Loading for Spasm

For back pain and muscle spasm, engage in specific, high-force isometric loading exercises in precise positions to neurologically inhibit overactive muscles and restore normal function.

72. Therapeutic Exercise for Pain

When medically safe, use therapeutic exercises to address pain and tension, as strategically loading the body can engage the nervous system and provide relief similar to passive treatments like massage.