350 ‒ Injury prevention, recovery, and performance optimization for every decade

Kyler and Peter used the 8-week window before a scheduled surgery to prepare the shoulder. They focused on the supraspinatus, which is critical for humeral head depression, and the serratus anterior for scapular positioning. They also did aggressive core work to ensure the scapula had a stable base. Kyler notes that this prehab allowed the surgeon, Alton Barron, to perform a repair that was stable but not overly tight, because he trusted the surrounding musculature. This is a departure from typical prehab, which is often minimal or generic. The success relied on constant communication between Kyler and Alton, with Kyler providing objective metrics on strength and stability.

This protocol was a collaboration between Kyler and surgeon Alton Barron. Alton performed a repair that was stable but not overly tight, trusting the muscular support built during prehab. Kyler had provided Alton with specific metrics on Peter's rotator cuff and scapular strength. The decision to remove the sling early was made jointly. Kyler emphasizes that this is not standard care; most surgeons default to 4-6 weeks in a sling to cover liability. The early isometrics were 'very gentle but targeted,' focusing on activating muscles without creating shear forces on the labrum. Peter was instructed to avoid any movements that could stress the repair, such as dangling the arm with weight. The result was a full recovery with preserved range of motion.

Kyler explains that tendons adapt slowly and need progressive loading. He uses the mid-thigh pull as an example: the bar is set at mid-thigh height against pins, and the person pulls maximally without the bar moving. This loads the entire posterior chain and grip isometrically. For Peter's foot tendinopathy, he used a front-foot-elevated split squat with the front foot actively plantar flexing, creating an isometric hold at a specific ankle angle while demanding core stability. This targeted the tendon at the length where it was weak. He emphasizes that isometrics are the starting point; after several weeks, the tendon is ready for deloaded plyometrics. This approach is safer than immediately jumping into explosive movements, which often causes injury in deconditioned individuals.

Kyler describes this as the bridge between isometrics and full plyometrics. He uses the example of band-assisted pogo hops: a band is anchored overhead, and the person holds it while jumping, so the band pulls upward, lightening the load. This trains the quickness and stiffness needed for activities like jumping or reacting to uneven ground. He emphasizes that many people skip this step and go straight to full jumping, which often leads to injury. This progression is part of his strategy to maintain 'play' and reactivity into old age, as he noted that kids naturally do these movements but adults lose them.

Kyler shares a case of a patient with a disc herniation and an annular tear. Initially, McKenzie extension exercises centralized her leg pain, indicating the disc was responding. However, the annular tear caused local pain with extension, so they had to stop McKenzie and switch to core stabilization (DNS). He emphasizes that McKenzie is both a treatment and a diagnostic tool: the response to the movement guides decision-making. He recommends that anyone with nerve pain seek a certified McKenzie practitioner, as they are trained to differentiate between discogenic and other causes. He also notes that even with a herniated disc, surgery is not always necessary; many resolve with conservative care over 4-10 weeks.

Kyler explains that many people mistakenly equate core stability with a six-pack (rectus abdominis). True stability comes from the deep system that pressurizes the abdomen. He uses the analogy of a race car chassis: a stiff chassis transmits power to the wheels efficiently. Similarly, a stable core allows force to be transmitted from the legs to the arms without energy leaks. He shares the story of Peter's acute back pain being resolved by a DNS isometric leg press: by creating maximal intra-abdominal pressure and pushing against an immovable object, the nervous system overrode the pain-spasm cycle, and the back muscles relaxed. This demonstrates how loading the stabilization system can be therapeutic. Kyler emphasizes that DNS is a key part of his approach at 10 Squared, and he uses it to address the root causes of many injuries.

Kyler describes using PRP for Jill's proximal hamstring tendinopathy. After diagnosing the tear on MRI, they decided on PRP because she had a goal of running the Boston Marathon and needed a robust solution. He emphasizes that PRP alone is not enough; they had to protect the area post-injection, doing only exercises that didn't stress the hamstring, while simultaneously addressing the pelvic and core dysfunctions that caused the tendinopathy. They coordinated with her physical therapist and running coach to ensure a gradual return to running. Kyler notes that the success of PRP depends heavily on the rehab surrounding it. He also mentions that for some pro athletes, PRP can be a tool to accelerate healing when time is limited.

Kyler and Alton collaborated closely, with Kyler providing detailed metrics on Peter's prehab progress—specifically the strength of the supraspinatus, serratus anterior, and core stabilizers. This gave Alton confidence that the shoulder had a robust 'roll cage' of muscular support, allowing him to perform a repair that was stable but not overly tight. The decision to remove the sling early was contingent on Peter's strict adherence to movement restrictions: no reaching, no loading the repair, only gentle isometrics in safe ranges. Kyler emphasizes that this approach is not for everyone; it requires a surgeon willing to trust the rehab team and a patient who will follow rules meticulously. The result was a full recovery without the typical mobility deficits.

Kyler explains that the magic word is 'capacity.' He asks, 'Are you building me back to what I want to do?' This means understanding the patient's specific goals—whether it's surfing, running, or playing with grandkids—and designing a program that progressively loads tissues to meet those demands. He criticizes clinics that offer a menu of services (cupping, dry needling, adjustments) without a cohesive plan. The plan must account for the individual's weaknesses, injury history, and desired activities. He gives the example of a surfer with a shoulder issue: they needed to make his shoulder robust in the specific positions required for paddling and popping up, not just generic rotator cuff exercises. This approach requires one-on-one attention and a long-term perspective, which is rare in traditional settings.

Using Peter's wife Jill as a case study, Kyler details how her right knee pain flared up after running two marathons close together. He explains the concept of the 'spinal engine,' where the spine, pelvis, and feet work in reciprocal rotation to propel the body forward. Jill had a subtle scoliosis and a proximal hamstring tendinopathy on the left side, which altered her pelvic rotation. This caused her to 'dump' into the right knee repeatedly, creating a repetitive stress injury. The right knee pain was a symptom of the left hamstring and pelvic asymmetry. An MRI confirmed tendinopathy in the proximal hamstring and a nearby hip rotator. Kyler also notes that pregnancy can permanently change pelvic mechanics, contributing to such issues. The solution involved addressing the hamstring with PRP, correcting pelvic mechanics through DNS-based core work, and coordinating with her running coach to avoid flare-ups.

Kyler explains that to maintain the ability to react to uneven surfaces or play sports, you need to train in three dimensions and recruit high-threshold motor units. However, most people are not ready for heavy or fast movements. He starts with long-duration isometrics at various joint angles, such as the mid-thigh pull against an immovable bar, to remodel tendons and prepare them for force. After several weeks, he introduces deloaded plyometrics, like band-assisted pogo hops, where the band reduces body weight, allowing the nervous system to train speed and the stretch-shortening cycle without full impact. Finally, he progresses to full body-weight plyometrics. He uses this with Peter for his foot tendinopathy and with clients to prevent falls. He emphasizes that this is not just for athletes; it's essential for anyone who wants to walk on uneven terrain or play with kids.

Kyler explains that when the brain perceives threat—whether from a physical stressor, emotional stress, or past experience—it can trigger pain even in the absence of tissue damage. He gives the example of low back spasms coinciding with life stressors like a wife going into labor or job insecurity. He emphasizes that an MRI finding like a disc bulge is not a death sentence; many asymptomatic people have them. The key is to rule out red flags (weakness, loss of bowel/bladder control) and then use conservative interventions to show the patient that movement is safe. He uses the McKenzie protocol as a diagnostic tool: if a specific movement centralizes pain, it indicates a mechanical issue that can be treated with exercise. He also shares the story of Peter's back pain being resolved with a DNS isometric leg press, demonstrating how loading the nervous system can override pain signals. The goal is to empower patients with education and a plan, not to make them feel frail.