0:00

Ready, set,

0:03

go! This is episode 337 with

0:07

doctor of physical therapy, professional

0:09

triathlete, and strength and endurance

0:11

coach, Caitlin Alexander. Welcome

0:22

to the Strength Running Podcast. I'm your

0:25

host, Coach Jason Fitzgerald, and my singular

0:27

goal is to help you improve your

0:29

running by getting stronger, racing faster, preventing

0:32

more injuries, and achieving more of your

0:34

goals. I'm a monthly columnist for

0:36

Trail Runner Magazine, a 239 marathoner,

0:38

and a top 10 finisher in the 3,000

0:41

meter steeplechase when I competed for

0:43

Connecticut College. You can learn more

0:46

about me and strength running at

0:48

strengthrunning.com. Now if you enjoy

0:50

this show, please support our partners who

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Our guest today is Dr.

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Caitlin Alexander, a physical therapist,

2:52

professional triathlete, and certified triathlon

2:54

and running coach. She is

2:57

the owner of HUE, that's

2:59

H-U, performance.com, located in downtown

3:02

Boulder, where she offers professional

3:04

bike fitting, physical therapy services,

3:06

and coaching, including via virtual

3:09

consultations. Caitlin was previously a

3:11

guest three years ago on episode 179 of

3:14

the podcast to discuss long-term injuries.

3:16

And in this episode, we're answering

3:19

your questions about becoming more injury

3:21

resilient, how to address specific injury

3:23

problems, how to navigate pain, what

3:26

to do about injuries after a

3:28

break, lower back pain, and a

3:30

lot more. Now, if injuries are

3:32

your kryptonite, I feel your pain. I've

3:35

had Achilles tendinopathy, IT

3:37

band syndrome, plantar fasciitis, SI

3:39

joint problems, pulled muscles, and

3:42

all kinds of other injuries. But we

3:44

can structure your training in

3:46

ways to automatically build injury

3:48

resilience directly into your

3:51

running program. Go to strengthrunning.com/prevention,

3:53

and I'll help you make

3:55

2024 your healthiest year yet.

4:00

now without further delay, please

4:02

enjoy my conversation with Dr.

4:04

Caitlin Alexander. I

4:06

am excited to chat with you and just

4:08

sort of go over all of these different

4:10

listeners submitted questions. But congrats

4:13

on the new business and starting to

4:15

do this for yourself. That's so exciting.

4:17

Thank you. It is really exciting.

4:19

Obviously, there's like, there's

4:22

a little more, it's more time consuming

4:24

than, you know, working at like, kind of

4:26

under someone at a clinic. But it's, I

4:28

always equate it to like, well,

4:31

this is like paying someone else's mortgage

4:33

and paying rent. So you're like investing

4:36

in your own business and your own brand. So that, that's

4:38

really meaningful for me. So it's

4:40

all work that I love to do.

4:43

Yeah. And you get to do things

4:45

your way now, like the Caitlin approach

4:47

with all your experience working with all

4:49

these endurance athletes. And, you know,

4:52

you becoming a pro triathlete, I think

4:54

last year, if I'm not mistaken, and

4:56

you're really putting all your experience to

4:59

work. So I think it's awesome. No,

5:01

thank you very much. So

5:03

I have an exciting episode planned for

5:05

today. I think it's exciting. I love

5:08

talking to physical therapists, probably

5:10

because I was a very injury prone

5:12

runner at the height of

5:14

my competitive days. And I

5:16

sort of wished I could just sit down

5:18

with a PT and ask them a whole

5:20

bunch of questions from time to time. So

5:24

my listeners get to live vicariously through

5:26

this conversation. So I have

5:28

sent you a whole bunch of questions. And

5:31

I kind of want to think

5:33

of this as sort of

5:35

like speed dating, except it's with a

5:37

PT. And you're talking about your running

5:39

problems. I fully recognize

5:42

Caitlin that we are not going

5:44

to solve everyone's injury issues today.

5:46

Some of these are serious problems, actually

5:49

go see a good physical therapist, preferably

5:51

one who actually works with endurance

5:54

athletes, especially if it's

5:56

a more serious problem. But I think for

5:58

small issues, we all should be pretty good

6:00

as athletes at dealing

6:03

with little niggles and little bits of soreness

6:05

and things as they come up. I know

6:07

when you sent me that list of questions, I was like, this

6:09

is perfect, because these are questions that I get all the

6:11

time, like almost on a weekly basis. And I was like,

6:13

it would be good to just kind of like, have

6:16

all the answers in one place for people. Yes. So

6:18

that's what we're going to do right now.

6:20

So let's get started. This

6:23

is a good one, because I think this is

6:25

going to resonate with a lot of listeners. Here's

6:27

the question. I have a

6:29

limited amount of time to devote to

6:32

training. So I'd like information on efficient

6:34

injury prevention. Most advice is generic. So

6:36

I'm looking for specifics on how to

6:38

stay healthy without a lot of time

6:41

investment. That's a good one. I

6:44

say that a lot of this really depends, I guess, on

6:46

your, your level of commitment

6:49

to the sport and I

6:51

guess your competitiveness

6:53

or, you know, how experienced

6:55

you are. But there are

6:58

a lot of really simple ways that

7:00

just, you know, from a daily basis

7:02

you can go about ensuring

7:04

that you are giving

7:06

your body all the tools that it needs to adapt

7:08

to the training stress and to recover. And a big

7:11

factor is sleep. And it's

7:13

something that a lot of a lot of

7:15

runners don't think about because, you know, they're so

7:17

concerned with what's hot on the market and,

7:19

you know, what new like cream

7:21

can they put on to decrease pain? What new

7:24

foam roller can they buy? Things like that. But

7:26

sleep is where our body recovers,

7:29

where our cells and

7:31

tissues repair and heal themselves.

7:34

And so if you're not getting high quality sleep,

7:36

if you're not getting enough sleep, all

7:38

of those things can be kind of detrimental

7:40

to your progress as

7:42

a runner and your overall risk

7:44

for injury. So sleep is the number one

7:47

thing. The second thing is nutrition.

7:49

And I kind of tie hydrated in

7:51

with this as well. You know, nutrition,

7:54

what we intake, what we fuel our

7:56

bodies with determines the health of our tissues and

7:58

the health of our cells. So if you're not getting You're not

8:00

eating enough if you're not eating high quality foods. All

8:02

of the. Things kind of. My sleep can

8:04

really be detrimental to your tissue. How.

8:07

Hydration. It's a big once you.

8:09

It's because our. our tissues

8:11

are sasha think a fascist mean

8:13

up of like a percent water

8:15

on and so dehydration as. A

8:18

huge factor in. The. Development

8:20

of. Injuries and dehydration and

8:22

a skinny as like. For.

8:24

Blood flow. Ah, and so he knows

8:26

you're not hydrating while on a daily

8:29

basis. You know your tissue can get

8:31

mad a down, the Sasha can get

8:33

manage thousand sticky and things just don't

8:35

end up fighting inviting really well on.

8:37

So those three things. Don't cost

8:39

anything and they don't cost a lot of

8:41

time. The things that your time doing. On

8:44

your your daily life. Anyway, And

8:47

so those are kind of my top three. Tips

8:50

for reducing injury risk.

8:52

There are other things as well and the know. I

8:55

knew. Talk about censoring a lot with

8:57

this thing. the strengthening podcasts. That is

8:59

obviously a big one, but I know

9:01

a lot of runners who don't have

9:03

time to do anything but work. Together.

9:06

Family and run and so they don't have

9:08

a lot of extra time to devote to

9:10

all of these little things that I think

9:12

there are still ways you can implement some

9:14

of that into your. Daily routine and.

9:17

The snap and to be super time consuming

9:19

and the a lot of the runners that

9:21

I work with on if you get them

9:23

like. A strength that or even like

9:25

a pre one activation set the. Longer

9:27

smell. Fifteen. Twenty

9:29

minutes the chances of them doing it

9:32

are pretty loud and so I'm always

9:34

finding ways to can only get the

9:36

most bang for our buck. Was like.

9:38

A. Couple. Simple things that you can do that take.

9:41

Five. To seven Minutes before you

9:43

gloucester runs Letter: that's like some

9:45

for that namic mobility seek with

9:47

some sort of muscle activation and.

9:50

I I really believe in a lot of activation

9:52

worker for the last month. I think of it

9:54

almost like priming your muscles to take unload. The

9:57

you know, especially when you wake up early morning things

9:59

are kinda sleepy. You've been obviously

10:01

sleeping. Before

10:03

you put on your running shoes and head off the door,

10:05

do something for five to seven minutes. Just

10:08

kind of like wake your brain up and your nervous system

10:10

up and also introduce some load to those tissues. If

10:13

you've been sitting all day at work, that's another

10:15

opportunity for you to like, okay,

10:18

before you put on your running shoes and head off the door, do some

10:20

dynamic mobility work so that, you know,

10:23

we are taking your muscles and your

10:25

joints through the range of motion required

10:27

for running so that your body is

10:29

more prepared to take on that load

10:31

when you head off the door. Running

10:33

is a stressful sport and I remind this

10:35

to all of the runners that I see

10:37

in the clinic and it's

10:40

stressful for the body and we want to do

10:42

everything that we can to make sure that our

10:44

body is prepared to take on those demands. So

10:47

I have a confession. I went running this

10:49

morning and I didn't do a warm up

10:51

beforehand. I got out of my car

10:53

after sitting down for probably about 25 minutes. And

10:56

it was the hardest 10 minutes of running

10:59

I might have ever experienced in like

11:01

25 years of running probably

11:04

because, you know, it's first thing in the morning.

11:06

I've been sitting for a while and

11:09

I've been so used to doing a warm up.

11:11

That's like one of the things I'm very consistent

11:13

with. Sometimes a little

11:16

bit less if I'm doing a group run with a bunch

11:18

of people and they just take off and okay, I guess

11:20

I'm doing what the crowd's doing now. But

11:23

it was not good, Caitlin. It was not

11:25

good. And it was

11:27

just this very visceral reminder that

11:30

it's hard to go from couch to running. There's

11:33

really a good place for

11:35

a helpful bridge in between being

11:37

sedentary and out there running

11:40

your normal, you know, easy pace, your

11:42

zone two effort, whatever that might be.

11:45

So I'm glad you brought that up. Let's

11:47

move on to our second question. And

11:50

this one is a little bit more specific. This

11:53

person says I struggle with tendonitis, but

11:56

I don't have any issues when I'm

11:58

running consistently. It happens when I come

12:00

back. slowly after a break every time.

12:03

During that break, I'm active but not

12:05

training. What's going on here and how

12:07

could this runner break this cycle? This

12:09

is actually a really common thing and this is

12:11

a great example of why

12:13

tendons need load for their

12:15

health. And so it sounds to

12:17

me like this might be kind of

12:19

like a tendinopathy that's not quite rehabbed

12:21

to its fullest potential, especially

12:25

if it kind of keeps coming back

12:27

when you stop introducing that load. But

12:29

tendons need load to adapt so they

12:31

don't really do well with rest. Obviously,

12:33

rest, when you decrease that

12:36

that stressful exposure to the tendon, yes,

12:38

you can decrease the pain. But

12:40

the second you get back to running, the

12:42

pain and symptoms are probably going to come

12:44

back. The load is really helpful for

12:46

tendon remodeling and also to

12:49

just help kind of, you

12:52

know, get those tendons robust

12:55

to adapt to that load. And

12:57

so what's happening when you

12:59

take a rest, obviously the pain is decreasing, things

13:02

are kind of going back to normal, but you

13:04

didn't do anything to change the load capacity of

13:06

the tissue or the tendon or the muscle, that

13:08

muscular tendinous unit. And so when you

13:10

get back to running, you know, perhaps

13:13

taking that time off, maybe, you know, you

13:15

have a little bit of like disusatrophy or

13:17

things of kind of, you know, if you're

13:19

not kind of keeping up with some of

13:21

the strength routines, things can kind of get

13:23

a little bit weaker. And so when you

13:25

go back to running, you're reintroducing the exact

13:27

same load and then the tendon is having

13:29

a hard time handling

13:31

the demands. And so over

13:34

the course of like gradually introducing the

13:36

running back, the tendon can adapt

13:39

and get stronger and the pain

13:42

can decrease. But, you

13:45

know, starting out that running program from

13:47

like a big break off, it

13:49

is pretty common to, especially if

13:51

you have that tendinopathy, that's not quite

13:54

rehabbed fully, to have

13:56

those symptoms come up. And so I

13:58

think the best thing to do to... kind of

14:01

mitigate that and resolve that. Obviously

14:03

go see a good rehab

14:05

specialist, a good physical therapist who you

14:08

know can kind of get you on a tendon

14:10

loading protocol and get that tendon super strong and

14:13

robust so that's that's not an issue down the

14:15

road. The other thing too is during that time

14:17

off when you're not running, introducing a little bit

14:19

of load to the tendon through some strength

14:21

programming and so that it is you know

14:23

remodeling and it is adapting and it is

14:26

prepared to take on the demands of running

14:28

when you do get back into

14:30

running after that break. How

14:32

much time does it take for a

14:34

tendon to start experiencing some of that

14:36

atrophy that you mentioned because I think

14:38

you know if you take a week

14:41

off after your goal race and then

14:43

you gradually get back into training that's

14:45

not really the amount of time that's

14:47

necessary to cause all kinds of tendon

14:49

deterioration is it? I mean how much

14:51

time is actually required? No, definitely

14:54

not a week. I mean we're talking like you

14:56

know at like a month to

14:59

anything longer than that and it's not really

15:01

like the tendon that atrophy is because tendons

15:03

don't really atrophy but the muscle that is actually

15:05

just a tendon. That kind

15:07

of whole unit can decrease

15:09

the capacity for it to take on load. And

15:12

so taking a week off you know

15:14

it's not really enough to do anything you're not

15:16

even from a fitness perspective you're probably not going

15:18

to lose that much fitness. I

15:21

do want to caveat all this by saying

15:23

that I am a firm believer in taking

15:25

a true off season you know at least

15:27

a couple weeks because we really need to

15:30

give our bodies the time and

15:32

all the energy to heal

15:34

from the season and to

15:36

repair these tissues so that they are in

15:39

a healthy state when you get back

15:41

into your next season. And

15:43

what would some examples be of loading

15:45

the tendon? Is it

15:48

only strength training? Would you consider

15:51

some plyometric like activity like

15:53

hopping or some you know

15:55

relatively low load plyometrics like

15:57

that during this time off?

16:00

How do you think about that? I would

16:02

say it really depends on the

16:04

irritability of the tendon and how

16:07

reactive it is. If

16:09

you're not experiencing any symptoms, then yes,

16:11

I would say plyometrics can be really

16:13

helpful and you can probably start this

16:15

sooner than if you were dealing with

16:17

a reactive tendinopathy. But

16:20

I am a heavy believer in strength

16:22

training. There's a lot of good research

16:24

out there for heavy, slow resistance training

16:26

for tendinopathy. I'm loading with

16:30

heavy weight slowly. If

16:33

you're dealing with an

16:35

achilles tendinopathy, for example,

16:38

going through some sort of calf raise sequence

16:40

with a lot of weight and slowly.

16:44

We used to think that eccentrics were the

16:46

way to go for tendinopathy, but newer research

16:48

is showing that eccentrics and concentric both have

16:50

their benefits. If

16:53

you're dealing with a reactive tendinopathy

16:55

that is symptomatic and

16:57

that is to bring on your symptoms

16:59

too much, I always kind of go

17:01

back to something simple like an isometric, which is

17:03

basically just like holding

17:05

a position without

17:07

changing the muscle length.

17:09

For example, holding

17:12

a calf raise with weight, not

17:14

going up and down. Something simple like

17:16

that, where you're still inducing load into the tendon,

17:19

but we're not stressing it out by

17:21

shortening and lengthening the muscle and tendon unit.

17:25

Something like that, if you're dealing

17:27

with a high hamstring tendinopathy, you

17:29

could do some things like super

17:32

simple starting basic with a

17:34

hamstring bridge exercise. If

17:38

you are not dealing with a reactive tendinopathy, you could

17:40

get kind of into some heavier things

17:43

like squats, deadlifts, rear foot

17:45

elevators with squats, things like that with weight.

17:48

That can be really helpful too. I was

17:50

going to ask you if there was a hierarchy

17:52

of least stressful to most stressful

17:54

ways of loading a tendon. It

17:57

seems like it's maybe the isometric type

18:00

of exercise and then you move on

18:02

to either an eccentric or concentric motion.

18:06

And then finally, perhaps the plyometric

18:08

type exercises might be the most

18:10

stressful. Is that somewhat accurate

18:12

and would you add anything to it? I

18:15

would say that that's pretty accurate. Eccentric

18:17

just from like a fatigue standpoint

18:19

tends to be the most stressful

18:22

just because you are

18:24

when you lengthen. So eccentric

18:26

basically is like the

18:28

lowering phase in a squat or the

18:30

lowering phase in a heel raise. So

18:33

things are lengthening under load. And what happens when

18:35

we lengthen under load is less

18:37

and less motor fibers are recruited but

18:40

we are still inducing the same load to

18:42

those muscle fibers. So they

18:44

just get a lot more stress. You

18:46

can get a lot more sore from

18:48

eccentric contraction exercises versus concentric and isometric.

18:53

And yes, plyometric I would say is probably

18:57

just because of the elasticity

19:00

needed in the tendon and the force production

19:02

needed to do a plyometric exercise like that

19:05

and the amount of body weight going

19:07

through. So like what

19:09

we say like three to four times your

19:11

body weight when you are running per step

19:13

that goes through your kinetic chain kind

19:16

of same thing when you are hopping. And so for

19:19

really reactive tendinopathy, it's not something I

19:21

gravitate towards first unless I know that

19:24

it's going to be stable and it's not going to flare up

19:26

after. With you talking about

19:28

eccentric and concentric calf raises, it

19:30

was giving me flashbacks to the

19:32

build a better runner workshop that

19:34

we both attended last year. Do

19:37

you remember when I probably mistakenly

19:39

volunteered to go in front of a

19:41

bunch of physical therapists and go do

19:43

a bunch of calf raises until failure

19:45

and I didn't actually

19:47

last very long and it

19:49

was like some people fear public speaking.

19:52

I fear exposing my

19:54

physical weaknesses

19:57

or imbalances in front of 30 physical.

20:00

therapist and it was it

20:02

was like the scariest moment for me in my life. You

20:05

were a good guinea pig for all of us. I'm

20:08

glad I could be a guinea pig. All right

20:11

well thank you for for going deep a little

20:13

bit on tendon health. I think I think for

20:15

anyone who might be dealing with any

20:17

kind of tendon injury especially Achilles tendinopathy. I

20:20

know that seems to be an injury

20:23

that afflicts a lot

20:25

of masters male runners for some

20:27

reason and I think that's going

20:29

to be really helpful for them. That kind of

20:31

ties into one of the other questions just

20:34

about like runners and

20:37

running as we age but we can get to

20:39

that. There is some running and aging questions that

20:41

we're going to get to. Let's

20:44

talk about an issue that I

20:46

know very little about. This is

20:48

a runner who has consistently lower

20:50

back pain after long runs especially

20:52

long runs on trails. It just

20:54

seems like a rare type of

20:56

discomfort for an endurance runner.

21:00

I don't think any of my clients

21:02

have ever complained about lower back pain. So I'm

21:05

just curious like from your perspective what

21:08

do you think might be going on

21:10

here for a runner who is experiencing

21:12

lower back pain but particularly on long

21:14

runs especially on long runs on trails?

21:17

It's not actually as uncommon as you

21:19

think and oftentimes it's just

21:21

a motor control issue or a

21:24

form related issue. The trail

21:26

thing is interesting just

21:29

because the benefit of trail

21:31

running is the dynamic nature

21:33

of it and that you know not every foot

21:35

strike is the same so you're varying up the

21:39

type of load and the muscle

21:41

recruitment every step. But

21:44

low back pain with

21:46

running when it's a form related issue

21:49

is most likely related to any kind of

21:53

like hyperextension of the lumbar spine. So what

21:56

happens when we hyperextend is we compress the

21:58

vertebrae which we call the lumbar spine. can

22:00

lead to some like joint discomfort. You

22:04

know, if someone is running, like I call it running

22:06

in the back seat, or they're running too

22:08

upright, almost leaning back, that can cause

22:10

a lot of lumbar compression, just vertebrae

22:12

compression. Or if they're

22:14

leaning too far forward and then the moment arm

22:16

for all those muscles on the back of the

22:19

spine increases. And so now there's more work that

22:21

they have to do to keep the body upright.

22:24

Those are two kind of more postural issues that

22:26

can lead to low back pain. When

22:29

it comes to a motor control issue, especially

22:32

if it's happening in the long run, if

22:34

any kind of pain is coming on at some point later

22:36

in a run, I think fatigue. That's

22:38

just the first thing that like kind of

22:40

hits my mind. What is fatiguing in the

22:43

kinetic chains that's causing these issues? And

22:45

so with low back pain, it kind of comes on later

22:47

in a run. It very

22:49

well could be a strength

22:52

issue or a motor control issue

22:54

of either the core, so

22:57

your ability to resist that rotation while you're

22:59

running or the hips. So

23:01

are you using your lumbar spine to

23:03

help with extension? Are

23:07

you using your lumbar spine to help with pelvic

23:10

stabilization in the frontal plane, so that side to

23:12

side hip drop? The

23:15

lumbar spine tends to be the victim in

23:17

a lot of circumstances when we

23:20

do have pain because things above and below

23:22

the changes aren't working as they should. So

23:24

for example, if a runner has some sort

23:26

of weakness with

23:30

the lateral hip that's causing one hip to drop

23:32

down and over the course of a run, things

23:34

fatigue and that gets a little bit worse and

23:37

now the lumbar spine, it can lead to a

23:39

lot more lateral flexion and helps to have kind

23:41

of a common thing for that. So

23:44

I can see that a lot and I see that

23:46

sometimes with like unilateral low back pain, so just one

23:48

sided. If you're using

23:50

your lumbar spine to extend your hip, kind

23:53

of help out with the glute max. If

23:55

the glute max is fatiguing over

23:58

the course of a run. then

24:00

your lumbar spine can kind of make up for that. We

24:04

can tie in hip flexors too. If

24:06

it's a postural issue or tightness

24:09

in the front of the hip that can

24:11

make it challenging for you to extend through

24:13

the actual hip joint and then you might

24:15

over extend through the lumbar spine to compensate.

24:17

So there's a bunch of different things that

24:19

can lead to low back pain. It's

24:21

never just usually one simple answer,

24:25

but those are just kind of a couple

24:27

common things that I see. How would a

24:29

runner go about figuring out if their

24:32

form is contributing to this problem?

24:34

Should they like take video

24:36

of themselves? And

24:38

then I guess my follow up question to that is, if

24:41

it happens later in a long run,

24:43

do you have to take video of

24:45

yourself after 90 minutes, two hours running

24:47

or go to the

24:49

gym and film yourself for the first couple

24:51

of minutes on a treadmill? That seems to

24:53

me maybe like you might be missing the

24:55

problem because you're not experiencing all that fatigue

24:57

at the end of a long run, which

24:59

like you said, might be the thing that's

25:01

really driving the problem. Yeah, that's

25:04

a great point. And this is why

25:06

sometimes I have runners come in and

25:09

have them do a run before they come into the

25:11

clinic. And then we'll do a little video analysis just

25:13

to see what their form looks like. And

25:16

so, I have seen runners come in for

25:22

a running in analysis and I have them

25:24

hop on the treadmill and they're really fresh.

25:26

You still might be able to see things

25:29

that could be contributing to that low back pain

25:32

later into a run, but they may not

25:34

be experiencing symptoms at that point. It's kind

25:36

of like a good analogy is like, if

25:39

you were to go to a party and I had

25:42

you just like stand on your foot,

25:44

stand on the outside of your foot, like

25:46

for three hours while you're at the party,

25:49

you probably wouldn't feel anything for like the first 20,

25:51

30 minutes. You just be

25:53

like, okay, this is kind of weird. But after

25:55

an hour, after an hour and a half, after

25:57

two hours, standing on that outside of

25:59

your foot. you may start to feel

26:01

some things. So it could be something where like, yes,

26:04

you can see those movement patterns fresh,

26:06

but it may not be causing issues

26:09

until you get later down the road when you

26:11

cheat kind of, you know, targeting

26:13

the same things and hitting the same things and then

26:15

it becomes an issue. So

26:18

from a strength perspective, what kind of

26:21

exercises or more broadly, even

26:23

approach to strength training might

26:26

be the most effective at dealing with these issues?

26:29

Is it as simple as just, you

26:31

know, some of your more traditional weightlifting

26:33

exercises, or do you need

26:35

some more targeted types of isolation

26:37

movements? How do you think about that?

26:40

It depends on what the root issue

26:42

is. You know, if it's

26:44

something form-related, postural control-related, sometimes

26:47

you can remediate that

26:49

with some simple movement cues. You

26:52

know, change isn't gonna happen overnight. It

26:54

can take weeks, it can take months to change running

26:57

form. And I'm

26:59

never usually trying to change things really drastically.

27:01

There's always more of just like an intrinsic

27:03

feeling, you know, to

27:05

help improve. But, you

27:07

know, simple running cues can help with

27:09

some of the form-related issues. If

27:12

it's more of like a pure strength or

27:14

a motor control, and I mentioned the word

27:16

motor control before, but motor control is basically

27:18

how your nerve system can

27:21

move your body, that basically

27:23

is the simplest way to describe it. And

27:25

so, you know, you may not necessarily have

27:28

like a gross motor weakness in a muscle. You

27:30

may just not be, your brain just may not

27:33

know how to utilize those movement

27:35

patterns, or to utilize

27:37

that part of your body when you're running. So

27:40

I think, you know, general strength

27:42

training exercises can be really helpful,

27:44

but I think the biggest hole

27:49

that I see in a lot of strength programming

27:51

is the lack of single leg work. And

27:53

if I, you know, if I have a runner that

27:55

comes in here, one of the first questions

27:57

I'm asking them is if they are on a regular.

28:00

strength program or if they kind of do anything on their own.

28:02

And then I kind of dive a little bit deeper to see

28:04

what they're doing, kind of what things

28:06

look like, what exercises they're doing. And

28:08

the biggest issue I see is that not a lot of runners

28:11

are doing pure single leg work. And

28:13

they might think, you know, a lunge is single leg

28:15

or doing like a Bulgarian split squat is single

28:18

leg, but technically yes, but

28:20

technically no, because you

28:22

really need an exercise that's gonna challenge your

28:24

balance and stability in all three planes of

28:26

motion. And those exercises don't really

28:29

do that. Most of the

28:31

programming that I do for a lot of

28:33

my runners involve single leg work. So we're

28:35

working in all three planes of motion. We're

28:37

challenging the rotational stability of the hip, the

28:39

rotational stability of the foot and ankle and

28:41

really challenging the balance because running is a

28:43

single leg sport. And if you can't stand

28:46

on one leg and balance and do a single

28:48

leg squat or hop on one leg, it's like

28:50

the chances of you being able to go out and

28:52

run 10, 15 miles, like

28:55

completely pain-free. I mean, there are

28:58

plenty of runners that can run pain-free and can't

29:00

do a single leg squat, but for most of

29:02

us, like those are just low hanging fruit

29:04

areas that you can really work on to

29:06

improve like your running efficiency and decrease your

29:08

injury risk. Let's spend

29:10

30 seconds on single leg squats

29:13

because pistol squats, single

29:15

leg squats, I love this exercise,

29:18

but it's one of the hardest body

29:20

weight exercises that you could potentially do.

29:23

How do you think about getting a

29:25

runner to be somewhat

29:28

competent at a pistol squat? Because

29:30

it's, like I said, it's just almost

29:32

impossible for most of us. It is,

29:34

and I actually don't program a lot

29:36

of pistol squats just because the range

29:39

of motion required to do a pistol

29:41

squat is not very functional for running.

29:44

I mean, it's amazing if you have the ankle

29:46

mobility, like the ankle dorsiflexion mobility

29:48

and the hip mobility and the panel mobility

29:50

and the strength to do a single leg

29:53

pistol squat. It requires so many skills. So

29:55

many skills in balance is another one, but

29:58

I don't think it's a requirement to

30:00

run healthy. A lot of the

30:02

single life stuff that I do is, you

30:04

know, very balance oriented and then

30:06

once the runner gets good at that balance

30:08

of stability then we can load it with

30:11

weight but we're moving in different place of

30:13

motion so it's not just sagittal plane straight

30:15

forward and back. Like we're adding twists, we're

30:17

adding side bends, we're adding overhead presses, reaches,

30:19

things like that that are making

30:22

that runner work outside of the normal

30:24

forward and back sagittal plane movement that

30:26

every runner does when they go out.

30:30

If single leg exercises have a

30:32

strong role to play in keeping

30:35

you healthy, do you

30:37

like to program any exercises where

30:39

you have off balance weight

30:41

where you might be doing an exercise and

30:43

you're only holding weight on your left side

30:46

or your right side? Yeah, it

30:48

depends on the exercise and it depends

30:50

on what the goal is for that

30:52

exercise. So if I want to really

30:54

load up that lateral hip like gluteus

30:56

medius, gluteus minimus TFL and really

30:58

get that pelvic stability going, I will put

31:01

weight in the opposite hands because that increases

31:03

the moment arm for that

31:05

pelvis and those muscles can work and just

31:07

increase increases the load. If

31:09

I don't want to do that or I want to keep kind

31:11

of help with keeping their center of

31:14

mass over their base of support then I'll put it

31:16

in the same arm but it really

31:18

just depends on what your goal is for the exercise. Yeah,

31:20

and speaking about strength training, how

31:23

do you determine if someone is either too

31:25

sore or tired to actually get in

31:27

the gym and lift some weights? So for example,

31:29

one runner likes to do his

31:32

long run on Saturdays and then he lifts

31:34

on Sundays but he's often bringing a lot

31:36

of fatigue into those lifting sessions and his

31:39

actual question is, are there any general

31:41

predictors to say it is time for

31:43

a complete rest day or

31:45

is it pretty much idiosyncratic for each

31:48

runner? That's a great question. I

31:50

think it really depends on each runner and

31:52

it depends on where they are in their

31:54

training program. So if your whole goal with

31:56

the strength session, say you're like early season,

31:58

you know, you don't have any. big race

32:00

is coming up, but your whole goal

32:02

is force production in the gym and

32:04

heavy lifting. You're probably not going

32:06

to get a lot out of it going into

32:08

the session really, really fatigued after a long run.

32:10

So that might be an opportunity where maybe you

32:13

should move the session to another day after like

32:15

an easier run or a shorter run. If

32:18

your goal, if you're trying to, you

32:20

know, get the most bang for your buck

32:23

out of a strength session and you really

32:25

want to challenge like your neuromuscular system and

32:27

your stability and your balance and you're going

32:29

into the strength session a little fatigued, that

32:31

can actually sometimes be beneficial because you're getting

32:33

more out of it because the body's already

32:35

fatigued going into it. So it's a little

32:37

bit more challenging. But I

32:39

would say in general, like if you're

32:41

going into a strength session and

32:43

you're tired, just like even like

32:45

cognitively fatigued and you're

32:47

struggling to keep your balance, things

32:49

just aren't feeling like they're functioning

32:51

well. You're struggling to produce the

32:53

force to lift a heavy weight. And

32:58

you feel like you're not really getting much

33:00

out of the session. It's probably a good

33:02

idea to just call it rather than continuing

33:04

to push and potentially, you

33:07

know, increasing your risk for

33:09

injury. Yeah. So there's like

33:11

so many red flags with that, like

33:13

you talking about feeling off balance and

33:17

not being able to lift the same amount of

33:19

weight that you might have been able to lift

33:21

previously. That just strikes

33:23

me as like there's some real

33:25

neuromuscular fatigue going on. And

33:28

you just want to be careful, especially if you're

33:30

doing single leg work, if you're doing off balance

33:32

work. Because that's where I think some of the

33:35

injuries can occur in the weight room is

33:37

when you're not doing a bicep curl,

33:39

you know, you're actually doing something challenging

33:42

with your legs in

33:44

an off balance or single leg environment,

33:47

and you're tired and your neuromuscular system

33:50

is fried. That's the scenario

33:52

that makes me nervous as a coach. Absolutely.

33:54

Or if you're handling heavy

33:56

weight, like barbells in place,

33:58

like things, it's just. just for

34:01

your own CFC, it's probably not the best

34:03

thing to really push through. Yeah,

34:05

because like lifting heavy weight or even just

34:07

like having good balance, that is,

34:10

you know, when we say neuromuscular, it's like, it's

34:13

a combination of skills that require

34:15

your brain to really activate

34:17

those muscles. And if your brain isn't

34:19

really doing its job, then there's

34:22

some serious fatigue going on, you know, and,

34:25

you know, there's a kind

34:27

of a coaching principle I learned a long

34:30

time ago, where if you're

34:32

not feeling quite good going into

34:34

a workout, and you do a couple

34:36

single leg balance exercises, and you're falling

34:39

all over the place, that's a really

34:41

good indication that you might be too

34:43

fatigued to actually go do the faster

34:45

workout. Because, you know, when I think

34:48

about faster workouts, they're actually very similar

34:50

in my mind to heavy strength training

34:52

sessions, very high load,

34:55

very stressful, and they're

34:57

going to require a lot of that

34:59

neuromuscular coordination, that when you're fatigued is

35:01

one of the first things to go.

35:03

Yeah, that neural fatigue is huge, and it

35:05

is a really important thing to monitor.

35:08

I do a lot of triathlon

35:10

training. So I'm, you know, my training

35:12

time between swim, bike and run. And

35:15

I think running and swimming are

35:17

two of the most kind of

35:19

neuromuscular exercises, there's just a lot

35:21

of a lot of

35:23

techniques that goes into both. And you

35:26

can tell when things feel off, especially

35:28

in the water, when your stroke doesn't

35:30

feel quite right, your body position is

35:32

not optimal, and you just like neurally

35:34

feel tired. And, you know,

35:36

any instances with swimming and with running,

35:38

if your form is deteriorating, if you're

35:41

falling apart, it's probably not a

35:43

good idea to push through. Yeah,

35:45

I actually had this same experience on

35:47

a long run this past weekend where,

35:49

you know, I was about two

35:51

minutes, two miles from being done, and I could

35:54

just feel that my form was just starting to

35:56

fall apart, because I was getting really tired, I

35:58

was running a little bit too fast. fast in

36:00

the middle. And I kind

36:03

of shut it down a little bit. You know, I was like, Oh,

36:05

I'm I don't feel smooth.

36:07

I don't feel like I have any kind

36:10

of, you know, this nice rhythm to my

36:12

stride. And it just started feeling very choppy.

36:15

And that to me is a red flag that

36:17

hey, if you go on for another

36:19

510 miles, or if you start

36:21

to do something really hard, that

36:24

is, you know, this risky danger zone

36:26

in my mind. Absolutely.

36:28

Speaking of just injuries and, you

36:32

know, actual pain that you're experiencing, how do

36:34

you know when a pain is just a

36:36

niggle that that maybe you can ignore and

36:38

you can run through? Because I think every

36:40

runner knows that if you'd never ran through

36:42

anything, you'd probably never run

36:44

at all. So when do

36:46

you know you can ignore something? And how

36:49

do you know when the pain is something which might

36:51

be serious, and needs to actually be

36:53

rested? So I like to

36:55

talk a lot about stable versus

36:57

unstable pain. And a lot of

36:59

runners kind of inherently know when

37:01

something feels stable and when something

37:03

feels unstable. When I say

37:05

unstable, I mean, like unpredictable, you

37:08

can't you don't quite know when it's going to hit,

37:10

you don't know how it's going to respond to a

37:12

run, you don't know how it's going to feel later,

37:15

or if it's going to flare up on you. Stable

37:17

pain is very predictable. You know, you know,

37:20

for tendinopathy, for example, a little achy,

37:22

a little stiff at the beginning of

37:24

the run, warms up, feels

37:26

good, after the run gets a little

37:28

bit stiff again, that is stable. And

37:31

usually, the more stable types of

37:33

pains are okay to run through. And I'm

37:35

a firm believer in running

37:38

being a part of your rehab program, I think

37:40

for a lot of different injuries running can and

37:42

should be a part of your rehab program, you

37:44

just may need to dial back the volume and

37:46

intensity. But when I'm dealing

37:49

with runners who have, who

37:51

are symptomatic, and want to continue to

37:53

run, I usually have three main criteria

37:55

for running

37:58

with pain or symptoms. or

38:00

any kind of injury and that is the

38:03

pain should not get worse

38:06

throughout a run. So you know

38:08

typical like tendinopathy type pain

38:11

will usually feel worse in the beginning of a run

38:13

and get a little bit better and improve and warm

38:15

up as you continue on your run. Bone

38:17

pain so bone

38:20

stress injuries, stress fractures, stress

38:22

reactions, things like that. They don't

38:24

warm up so they tend to get worse throughout a

38:26

run or you know throughout any kind

38:28

of impact related activity and that's usually

38:30

a big risk. So the

38:32

pain should not get worse as you're running.

38:35

While you're running it should be no more than

38:37

like a three out of ten. So it's like

38:39

the pain scale just subjectively.

38:41

The pain should not

38:44

be significantly

38:46

increased after a run. So if it feels

38:48

okay during a run but you finish and

38:50

like an hour later you're hobbling around that's

38:52

probably a red flag that that load was

38:55

too much or you know the volume the

38:57

intensity or maybe you know things are just

38:59

too symptomatic and flared up for you to

39:01

run at this point in time. The

39:04

pain should also not be lasting for like a couple

39:06

days after a run. So if you get a little

39:08

bit of soreness after a run but by the next

39:10

morning it feels okay that's okay

39:13

but it that pain and that increase

39:16

in symptom should not be lingering for like two

39:18

to three days after a run. And the

39:20

last and most important thing is you

39:23

know you shouldn't be running through any pain

39:25

that's changing your stride. So if you feel

39:27

like you're having to compensate and change

39:30

the way that you're running maybe land with your foot

39:32

in a different way maybe you know have have

39:34

a different kind of posture to

39:36

hold to kind of mitigate your symptoms.

39:39

It's a big red flag that what you're doing

39:41

what you're doing is probably too much load for

39:44

whatever kind of tissues that that's involved to

39:46

handle. I was gonna ask you

39:48

about compensating by changing your form so I'm glad

39:50

you covered that one that that to me is

39:53

like one of the biggest

39:55

red flags because if you're running in a

39:58

different way then you're normally used to it. are

40:00

running, it might feel good

40:02

with whatever little niggle that you might be

40:04

experiencing, but you're putting yourself at this increased

40:06

risk of developing some kind of other problem

40:09

because you're running in a way that your

40:11

body really isn't designed to. So

40:13

I'm glad you mentioned that. Now

40:16

let's talk about training as we get older,

40:18

which is something that we briefly touched on

40:20

earlier. But you know, what do

40:22

we need to look out for or work on

40:24

as we get older? And I had a listener

40:26

ask, I'm in my 50s and do strength and

40:28

core training in addition to running, I'd like

40:30

to continue running long distances but want

40:32

to stay as injury free as possible.

40:35

What should I be thinking more strategically about as

40:37

I get into my late 50s and 60s? Yeah,

40:41

so I mean, we kind of touched on

40:43

this earlier, earlier in the episode, but just

40:45

all of those little things that you can

40:47

do to stay healthy, you know, making sure

40:50

you're getting adequate sleep and good quality sleep,

40:52

making sure your nutrition is adequate and good

40:54

quality, you're fueling yourself, making

40:57

sure you're staying hydrated, that's especially

40:59

an important one as we age,

41:01

because our our cirrhosis receptors aren't

41:03

as strong and so it's

41:06

easier to get dehydrated as we age.

41:10

The other one too, in terms

41:12

of strength training, and I put

41:14

this in my runners program, pretty

41:16

much every single runners program, but especially if they're

41:18

above the age of 30, are any kind of

41:21

lower extremity strength work, especially like

41:23

calf raises, so muscle or exercises

41:26

to strengthen gastrocnemius and

41:28

soleus, those are your two big planar

41:30

flexor muscles. The

41:32

incidence of calf strains, calf tears,

41:34

any kind of calf injury as

41:36

we age goes up exponentially. I

41:38

was reading a research article just kind of

41:40

like looking at these questions because

41:43

I wanted to see like, you know,

41:45

exactly what the research

41:47

said, but by the

41:49

time we hit age 30, what's what

41:52

is called sarcopenia, which

41:54

is basically like age induced

41:57

muscle atrophy and decreased strength.

42:00

By the time we hit age 30, the muscles

42:02

in our distal extremities start to atrophy first.

42:04

So we're talking about like grip strength in

42:07

our hands, you

42:09

know, strength of the intrinsic muscles in our foot,

42:11

and then plan our foot chin strength,

42:13

so hip strength. And so any

42:15

runner that's above the age of 30 that

42:17

comes into my clinic, they have chest raises

42:19

on their program for that reason. And

42:22

everyone thinks that, you know, well, I run,

42:24

so my calves must be strong, right? You

42:27

know, running makes my chest strong, but that's

42:29

actually not really the

42:31

case. Running, especially distance running,

42:33

doesn't inherently make our

42:36

muscles strong because it's such

42:38

an elastic activity. So

42:40

we're really, when we're running,

42:42

we are kind of moving

42:44

in and out of positions

42:46

based on that, like, the

42:48

elasticity of our tendons and our tissues.

42:50

And so we're not really targeting like the

42:53

pure strength of the muscles like we would

42:55

if we were like sprinting

42:57

or doing some other field

43:00

event and track. And

43:02

so it's extra important as we age that

43:04

we are implementing that strength programming and to

43:06

stay healthy and even just for healthy hormone

43:09

levels, especially for like women

43:11

premenopausal, postmenopausal. There's a lot

43:13

of good research out there for strength

43:15

training just to help maintain healthy

43:17

hormone levels. Can you build

43:20

stronger muscles through certain types of

43:22

running? And you mentioned sprinting, and

43:24

I was going to get to

43:26

that, but I'm thinking more specifically

43:29

like hill sprints or uphill strides

43:31

where you're running either as fast

43:33

as you can or, you know, maybe 800 meter

43:35

mile race pace. So

43:38

very much like a controlled sprint and

43:40

you're going up some kind

43:43

of incline, whether it's slightly gradual on

43:45

an uphill stride or you're trying to

43:47

find the steepest hill possible. For

43:49

a hill sprint, is that taking

43:51

the place of some kinds of strength

43:54

training or is this distance

43:56

runner just really hoping to not

43:58

do calf raises? I

44:01

think there's a time and a place for

44:03

health sprints and I think they can be

44:05

helpful to build power Especially prepping for like

44:07

a hilly race or a trail race or

44:09

something like that, but they they definitely don't

44:11

replace strength training in a gym

44:14

most importantly because You're

44:17

still moving in that sagittal plane, right?

44:19

So we're not really challenging the muscles

44:22

Like the stabilizing muscles in the other two planes

44:24

of motion and so it's still important for you

44:26

to get in a gym and work on those

44:28

weaknesses And you're still

44:30

really using that elastic system when you're you're running

44:32

up a hill You're basically just doing kind of

44:34

like almost kind of like plyometric single

44:37

leg hops So

44:39

we're not quite targeting things in the same way that

44:41

like a heavy squat or heavy deadlift would okay

44:43

I'll lift weights Caitlin. I will I'll do

44:45

it You're

44:48

the lead you're like the last person that needs

44:50

to be convinced to do that. I know well

44:52

I love saying that I'm just

44:54

such a great cheerleader for strength training, but

44:57

I'm such a runner I would rather go

44:59

run another couple miles than go into the

45:02

gym and and do my strength training But

45:05

I've been getting in the gym Caitlin. I've

45:07

been consistent for over a month now and

45:09

I'm starting to feel really good. So There's

45:13

that so good. Let's move

45:15

on to our next question. Actually, I want to

45:17

I want to go back a little bit You

45:19

know, you mentioned a lot of lower leg work

45:21

important for older runners It

45:24

also seems like you know all of

45:26

these principles with injury resilience

45:28

with building durability with taking care

45:30

of our bodies It's almost

45:32

like we just have to take

45:34

that up a level when we start getting older

45:37

like Sleep just as

45:39

important perhaps even more important as you

45:41

get older staying hydrated You mentioned your

45:43

thirst mechanism being decreased later

45:45

in life Is it really just paying

45:48

more attention to the things that we

45:51

runners sort of already know we should

45:53

be focusing on to stay healthy I

45:55

think that's a big part of it. Yeah, and

45:57

it and it's You know that

46:02

every tissue, every joint in our body goes through

46:04

this natural aging process, whether we like it

46:06

or not. And, you know, as we age,

46:08

we may just have to pay

46:10

closer attention to some of these things. We may have

46:12

to spend a little more time to prep before we

46:14

go out and run. We may have to do a

46:17

little more mobility work after. But,

46:19

you know, if that means

46:21

that you can stay healthy while running and

46:23

run longer and later into life, then for

46:25

me, that is like, undoubtedly

46:27

worth it. Yeah, well, you know,

46:29

I know I mentioned that I didn't do a

46:31

warm up before my run this morning. But

46:34

warming up is generally something I'm very

46:36

consistent with. And I have found that

46:39

the older I get, the more I

46:41

need a good warm up before I'm

46:43

ready to even run my normal easy

46:45

pace. You know, I've found that, especially

46:47

in the last couple years, maybe this

46:50

because I recently turned 40, that my

46:53

first mile of my easy runs, which I

46:55

always just run according to feel I'm just

46:57

getting into it, you know, no pace expectations.

47:00

I have found that mile getting

47:02

progressively slower over the last two

47:04

years or so, because I just

47:06

need that extra 510 minutes to

47:08

get into a groove. And

47:11

that to me is just such

47:14

a good everyday example of the

47:16

aging process. And if I want

47:18

to stay healthy, I've got to prioritize that warm up.

47:21

And I think a nice little hack is

47:23

just take your first mile super easy. You

47:25

know, that's part of the warm up to

47:27

yep, or go walk for 510

47:29

minutes before you even start to

47:31

like briskly walk. So that can be

47:34

a great way to warm up to and kind

47:36

of open up your stride a little bit. But

47:39

I, I think just because

47:41

of the inherent stressful nature of

47:43

running, you know, all the little things that we

47:46

can do to make things feel good from the

47:48

first step, I think are really, really important.

47:50

So if that means, like I said before,

47:52

you know, doing some short dynamic

47:54

mobility drill or doing a little band

47:56

work muscle activation, whatever your preferred exercise

47:59

is. when I do

48:01

that before I go out and run. From the first

48:03

step I feel like things are online and things are

48:05

clicking versus when I go out and run and

48:08

I don't do you know all of this stuff before everyone

48:10

there are definitely days where I don't

48:12

stop. If I'm really rushed and trying

48:14

to fit it in between things and

48:16

I definitely notice when I don't

48:18

and I feel different about that but when

48:20

I don't you know that first smile like

48:22

you said always just doesn't quite clip doesn't

48:24

feel right I don't quite feel like my

48:26

body's responding and I'm taking it super

48:29

slow and then I kind of use into it and feel

48:31

good but when I do take those extra five to ten

48:33

minutes before I go out and run and do

48:35

those things from the first step I feel good

48:38

and so it's like I said

48:40

because of the inherent stressful nature of running

48:42

you know and we

48:44

talk about decreasing injury risk if that's

48:46

one way to do it whether it's that first

48:48

mile you know your forms not quite right

48:51

things just aren't quite online if

48:53

we can mitigate that with some of those things before you

48:55

go out and run that could be a way to

48:57

decrease injury risk as well. As

48:59

a triathlete do you find that running

49:02

is is probably the the discipline that

49:04

requires a more thorough warm-up and and

49:06

maybe swimming and cycling it's a little

49:09

bit easier to jump back into it?

49:12

I think so and I

49:14

think so for sure because it

49:16

is impact related versus swimming and

49:18

cycling are low to zero impact

49:22

but you know when I do a

49:24

bike right I do a lot of brick workouts which

49:26

are basically you know bike to run workouts

49:28

just you know prepping your body

49:30

for the demands of a triathlon race. I

49:33

feel really good when I get off the bike and

49:35

run because things are warmed up things are online my

49:37

muscles are working versus if I just

49:39

go out straight and like do an open run

49:41

without any kind of warm-up it does it does

49:44

take a lot of time for me to feel

49:46

good and warm into it and it could also

49:48

just be because I'm tired so I'm doing three

49:51

different sports but I want to

49:53

take a little detour right

49:55

after I graduated college I had

49:57

a three-month period where I fancied

49:59

my myself a triathlete. When

50:02

I was running brick workouts, Caitlin, I

50:05

found that I

50:07

could run so fast off the

50:09

bike with such a low perceived

50:12

rate of exertion, like

50:14

literally 30 to 45 seconds

50:16

faster a mile. And it

50:19

would almost be like concerning to me. What

50:21

is going on there? Can you explain that

50:24

physiological phenomenon to me? Like, am I

50:26

just so warmed up, but not

50:28

tired from running because I wasn't running, I

50:30

was coming off the bike, that

50:32

I was just so primed just to run pretty

50:34

fast. What's happening there? I think it sounds to

50:37

me like you kind of missed your calling there.

50:40

You should have seen me in the water, Caitlin. I am

50:42

a runner. I just I'm at the

50:45

bottom of the pool. I just think we

50:47

can work on that we can work on that. No,

50:50

but I mean, I mean, that

50:52

is fantastic that that, you

50:54

know, you fall better running

50:56

off the bike than you did kind

50:58

of like for an open run. And that just

51:01

kind of goes to show how well you're

51:03

able to preserve your running form under

51:05

some fatigue. And that's a big predictor when it

51:07

comes to triathlon and being able to run well off the bike.

51:09

And that's like a whole other topic

51:12

for discussion. But, you know,

51:14

your muscles are primed, your muscles are

51:16

warmed up, there's blood flow, your heart

51:18

is warm, your cardiovascular

51:20

system is rubbed up, all of those

51:23

things can contribute to

51:25

you just getting off the bike and feeling like

51:27

you're ready to run. So

51:29

that's impressive. Well, that was also

51:31

2006. So we'll see if

51:33

maybe I can do that again at some

51:35

point. I've got

51:38

one more question for you, Caitlin. And

51:41

this is an interesting one, because this

51:43

is really going to pull from your

51:45

PT experience working with clients. What

51:48

percentage of all injuries do you

51:50

estimate to be related to training

51:52

load error? I

51:55

would say probably 85 to 90%. And

52:00

so when we say training load error, when

52:03

I say that, I mean running too

52:07

many miles, too

52:09

quickly, too much intensity before

52:11

you're actually ready to handle that. It's

52:13

basically training too much. Yeah.

52:16

So I will say when I think of training

52:18

load error, I think of, you know, you have

52:21

your training plan that you're following. Are

52:23

you doing everything within that training

52:26

plan to maximize your body's ability

52:28

to adapt? To the training plan.

52:31

And so if you have a training plan written for

52:33

you, maybe it's, you know,

52:35

a period where it's a little bit higher volume, but

52:38

you have other stressors outside of

52:40

running, you know, stressors that

52:43

work, stressors with life, stressors in

52:45

school, emotional stressors, psychosocial stressors, things

52:47

like that. That to me is

52:49

all kind of like training

52:51

load. And so all those things are

52:54

inhibiting you from being able to

52:57

adapt to this running related

52:59

load. And then it's probably too much running

53:01

related load for you, if that makes

53:03

sense. And so

53:06

most of the injuries that I see in here

53:08

are some sort of training load error, rather

53:11

it's like an absolute error or relative error.

53:13

You know, things outside of training are

53:16

making this current training load too much for

53:18

you. I love this, Caitlin.

53:20

Yeah. I want to talk

53:23

a little bit more about the difference

53:25

between absolute and relative load because I

53:27

don't think too many runners think about relative

53:29

load. I think we only think about our

53:31

training, how many miles we're running, our one

53:34

to two workouts per week, our long

53:36

run distance, but we don't

53:38

take into consideration, you know,

53:40

the fact that we might be having relationship

53:43

drama that's causing us a lot of stress

53:45

in our life, or we might have just

53:47

gotten laid off at work. And

53:49

all these things, you know, I think of it

53:51

as like stress load. And

53:55

all that stress has to

53:57

be processed by your body. And

53:59

you You only really have space for so much of

54:01

it. And I think when I look back on my

54:04

own personal running, you know,

54:06

I only realized in hindsight that I was

54:08

able to run so much because I didn't

54:10

really have too many other stressful things going

54:12

on in my life. And I have much

54:14

more respect now for parents,

54:16

for, you know, people with demanding jobs

54:18

who are also trying to train really

54:20

well because they're just juggling so much.

54:23

Yeah, just the stress, your body

54:26

really can't differentiate between training stress,

54:28

emotional stress, psychological stress.

54:31

You know, when you're in a state

54:33

of hypnosynthetic, you know, hypnosynthetic nervous

54:35

system state and you've got excessive

54:37

cortisol flowing through your

54:40

vessels, your body just

54:43

perceives all of that as stress. And so I like

54:45

to think of it as like a battery level. So

54:48

like where, you know, battery level

54:50

that encompasses everything, where is that battery level

54:52

when you're starting this training program? You know, if

54:55

you're all the way at 100% and you

54:57

are fired and ready to go, you might be able to

54:59

take on a little bit more training load. But if

55:01

you're only operating from 50%, that

55:04

training load that you can tolerate at 100%

55:07

might be too much for you. And so

55:09

then in those instances, that is still to

55:12

me a training load error because what you're

55:15

doing outside of running is not

55:17

allowing your body to respond to

55:19

the training and to adapt to it. So

55:22

you're just incurring massive fatigue

55:24

and your body's dealing with

55:26

cortisol from, you know, your professional stress.

55:30

And I think it's also helpful to

55:32

recognize that when we say stress, it's

55:34

almost like you could almost put in, you

55:37

know, stress hormones in place of

55:39

the word stress because that's really what our

55:41

body is dealing with. We're not dealing with

55:43

stress. We're dealing with the stress

55:45

hormones that our body is releasing and

55:48

that is the stressful part of it.

55:50

Yeah. And cortisol is catabolic

55:52

to your tissues. I mean, this is

55:55

one thing I talk with a lot of my

55:58

patients about who may be considering like, for example,

56:00

like a core injection, you know, for it to

56:02

treat an injury or to decrease pain or things

56:04

like that is like cortisol, cortisone,

56:06

all of those things can be

56:08

catabolic to your tissues, meaning that

56:10

they can cause tissue breakdown and

56:13

they can also kind of increase like this inflammatory

56:15

response, like especially a lot of cortisol,

56:17

you know, in your blood. And

56:20

so all of those things just make it really

56:22

challenging for your body to

56:24

adapt to and to repair

56:26

tissues and, you know, get things

56:28

stronger to handle the demands

56:30

of stressful sport like running. Yeah,

56:32

very important as for anyone who's

56:34

really going after a big training

56:36

block, you know, I know we're

56:38

gonna publish this sort of at the

56:41

height of Boston Marathon training. A lot

56:43

of runners right now are deep

56:45

in their Boston training. For

56:47

anyone who's going after a PR or

56:49

really has high expectations of themselves, having

56:52

this kind of understanding of the outside

56:55

stressors that could impact your training, I

56:57

think is super important and will really

56:59

help you navigate your training in a

57:01

much more productive way. Caitlin,

57:04

I'm glad we could we could figure

57:06

out injuries today for all runners so

57:08

no one is ever going to get

57:10

hurt again. This was so productive. Well,

57:13

it's it's I always like

57:15

to say reduce injury risk

57:17

or injury risk reduction versus injury

57:19

prevention. I hate the term injury prevention because

57:21

there really there really is no way to

57:23

100% effectively prevent an injury

57:25

but hopefully

57:28

listeners will find all of these

57:30

tips applicable to like their current life and

57:33

their current training status and be able to implement some

57:35

of these things to like, you know, help

57:37

continue a healthy running journey. Yes, we're all

57:39

about risk reduction. We're never gonna get it

57:42

to zero. I think anytime you're banging

57:44

out long runs and workouts, you're

57:46

gonna have to accept certain amount

57:49

of risk. Well, Caitlin, thanks so

57:51

much for your expertise. As always, this

57:53

is like the three-year anniversary from the

57:55

first time you're on the podcast. So

57:57

this was fantastic and congrats

57:59

again. on starting your own business,

58:01

folks can check that out at qperformance.com

58:05

if I have that

58:08

URL right. Is there anywhere else you'd

58:10

like to send folks? Yeah,

58:13

so they can check out my website and

58:15

all my offerings there and you said it

58:17

correctly. Nice job. You can

58:19

also check me out on Instagram,

58:21

Kate Alexander, C-A-I-T Alexander. And check

58:23

out the show notes because all those

58:25

links will be right there in the

58:27

show notes. So, Caitlin, thank you so

58:29

much. Thank you so much, Jason. And

58:33

that's our show. Thank you for listening. And

58:35

if you're a fan of my work on

58:37

the podcast in this episode, please consider leaving

58:39

a review or supporting our sponsors. Use

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right, my friends, that's the podcast. Thank you

1:02:11

for listening. Thanks for being part of this

1:02:13

community. And thank you for being so passionate

1:02:15

about this sport. We'll talk to you in a bit.