Chris is a UK based physio and researcher. His past research has focused on running technique for injury prevention and performance. On today's episode he shares all his research findings in a way any runner can understand and apply. Click here for Chris' Website Follow Chris on Twitter Click here for the 5-Day Injury Prevention Challenge If you would like to support the podcast and participate in future Q&As sign up for $5US per month at https://www.patreon.com/therunsmarterpodcast To follow the podcast join the facebook group: https://www.facebook.com/groups/833137020455347/?ref=group_header To find Brodie on instagram head to: https://www.instagram.com/brodie.sharpe/
Expand your running knowledge, identify running misconceptions and become a faster, healthier, SMARTER runner. Let Brodie Sharpe become your new running guide as he teaches you powerful injury insights from his many years as a physiotherapist while also interviewing the best running gurus in the world. This is ideal for injured runners & runners looking for injury prevention and elevated performance. So, take full advantage by starting at season 1 where Brodie teaches you THE TOP PRINCIPLES TO OVERCOME ANY RUNNING INJURY and let’s begin your run smarter journey.
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On today's episode, injury technique insight for injury prevention and performance with Chris Brammer. Welcome to the Run Smarter podcast, the podcast helping you overcome your current and future running injuries by educating and transforming you into a healthier, stronger and smarter runner. My name is Brodie Sharp. I am the guy to reach out to when you finally decided enough is enough with your persistent running injuries. physiotherapist, the owner of the Breakthrough Running Clinic and your podcast host. I'm excited to bring you today's lesson and to add to your ever-growing running knowledge. Let's work together to overcome your running injuries, getting you to that starting line and finishing strong. So let's take it away. Okay, I first heard about Chris Brammer on another podcast, as I seem to always find my guests these days. Chris has an exceptional insight into injury prevention and performance when it comes to running technique. He is a physiotherapist, but he's also been a researcher since 2011 and has built amazing insight throughout that time. He's had access to top athletes and top technology and resources, which he'll discuss in a second. Today, we're going to dive into how running technique can or how, what you need to know about running technique, I should say, regarding your injury prevention and performance. There's a lot of misconceptions out there. So Chris does a really good job of debunking a lot of that and giving you a lot of insight that a lot of runners don't know. And a lot of physios don't know, to be honest. So you're in for a treat today before we get started I did mention last episode that it's quite important that you go back to season one and listen to the first 10 episodes especially because this podcast is designed to teach you the universal principles to overcome injuries and. Episode one to 10 we break down 10 principles that any runner needs to know or should know. If you want to reduce your risk of injury and I've had a good response to that so make your way through those first 10 I want to see the usual downloads that I get for every new episode I want to say the first 10 episodes get very close to that number which it was doing very well for the first 30 episodes now we're getting up to the 60s and people are just. finding the podcast and starting in. There's a lot of episodes out there, not too sure where to start. People usually just start with the latest ones and work their way from there. So here's a bit of a reminder that the first season is a crucial one and best to even listen in to the early ones on season two strength training. It's really essential and ties in really well with what Chris discusses today. The other thing I will mention is I'll put a link into the show notes today. Over the last couple of days, I've designed the five day injury prevention challenge, which you sign up for, uh, entry email and then you will receive over the next five days, one email a day, going through, um, principles and tasks and challenges to, um, strengthen your injury prevention intelligence. And you walk away from the five day challenge. Um, feeling invigorated, feeling like you have control over your running injuries. We delve into a lot of really practical stuff and yeah, hopefully while the people that are going through at the moment, I've had amazing feedback. They're loving it. They're learning a lot. So if you are interested and you don't follow me on social media, so you don't know what I'm talking about, I will include the link in the show notes, simply just enter your email and then straight away automatically you start receiving emails. Over the next five days. So yeah, that's one other thing I need to talk about. What else? That's about it. This could have been a very complicated topic. We could easily dive into the nitty gritty science based stuff and get quite technical, which most physios are interested in. But what tailoring for you, which is mainly the recreational runner. So Chris did a fantastic job of keeping everything in a level that most. recreational runners would understand and it's just value packed. So you're going to love it. So without further ado, here is Chris Brava. Chris, thanks for coming on to the run smarter podcast. Uh, glad that you could, we could negotiate these time zones and get you on. Can we just start off with you introducing yourself and where you're from and kind of your, uh, background in research and your profession. Yeah, of course. So obviously all of your listeners who probably don't know me. My name's Chris Brammer and I'm actually a physiotherapist, but I'm also a researcher in biomechanics. And my work is predominantly focused around working with runners from elite levels through all the way to recreational levels and people just starting up running for the first time. So I'm based in Manchester in the UK. And from a physio perspective, As I said, I work with runners, but I also work with and have done for the last, I think, seven years now, worked with British Athletics and Team GB. And so that's given me a great opportunity to work with some really fantastic athletes from across the world. And at the same time, I think one of the unique things to what I do as a clinician is where I am, I'm very fortunate that we have full biomechanics setups in clinics. So if you've ever seen those video games created with like little reflective markers stuck we have a nice indoor lab where we can do that to people to have a look at how you run and try and understand movement patterns and forces that are acting on the body and what that's doing to a performance and injury perspective. So that's a really unique aspect of what we do sort of clinically to be able to look at people's running. So I'd say in summary, the thing of my work of what I quite like to pride myself on being is being able to combine that. practical aspect with the underlying research of the mechanics. Sounds like a great opportunity to have access to that sort of technology and could help enhance your skills as well, just purely because you have access to that technology. Oh yeah, I mean to have it is an absolute luxury and we were very fortunate that we were, our centre where we work is called the Manchester Institute of Health and Performance, if you ever want to have a Google of it. Effectively, I don't know how much you guys know about football or soccer over here, but and how much you follow it, but our building was funded by Manchester City Football or see football group as they like to be known. So we're at a really real luxury that we have a massive indoor track. It's like 80 meters long force plates through the ground and 3D cameras around the building. And so yeah, it gives us a great chance to combine the sport that I love with the science, which I also love. As a researcher, have your topics that you've researched, have you focused or narrowed in on any specific topics? Yeah, so my research started, I pretty much started doing academic research back in 2011. And one of our first areas that we wanted to focus in on was looking at the difference between performance standards in running to try and understand if high performance endurance runners move different. to those people who are at a lower performance status. And ideally we wanted to use this information to hopefully inform the way we can advise people on what they could do from a technique perspective or from a training perspective to influence that. And then I think from looking at performance, we've then started to move more towards then looking at what causes injury and the biomechanical patterns associated with various different types of injuries like your shin splints, your runner's knee. And then what we can do about that. And if we can retrain and teach people to run a little bit different, to improve symptoms. So, you know, quite all encompassing from performance now straight through into running related injuries and hopefully applicable to most people's situations. Yeah. And there are two topics that almost every runner wants to, wants to know about. I know with my Facebook group, I have people. ask a question before they enter the group. It's like, what do you want to know more about? And I reckon 80% ever covers like increasing performance or injury prevention. And so having you on as a guest is gonna be fun to talk about. What I thought we would jump into to start with is like, if you have a runner that comes in for a running analysis, let's probably steer away from like, the fancy gadgets and that kind of thing. If you had say a treadmill, some cameras, that kind of thing. Um, what would, uh, any, an example, what would an assessment look like? Would you look at strength? Would you look at flexibility and then jump them on a treadmill or what exactly would that look like? Okay. So on all of my assessments, um, so we do loads of different assessments. So we go from the real fancy stuff to even doing like remote stuff where people can just send us videos of them running. And effectively all our assessments will start with a sit down conversation with the individual runner to try and get a, and paint a picture of their routine and what they do on a day to day life basis. So I can understand the social context of how you try to combine training with work, injury histories, and even how you structure your training. And we use this as an opportunity to try and, so, so for me, If I take a step back a little bit, running related injuries and running performance, they're influenced by a massive number of factors, not just the way people run and not just our running biomechanics. So I like to build a picture through having a in-depth conversation about, you know, everyone's lifestyle to try and understand where all of these different contributors to that performance are. So we can hopefully make more holistic advice. So sometimes someone might come to me and ask me for performance advice. about their biomechanics, but in reality, their training week might be structured of just lots of long slow easy runs without any specific lactate threshold runs or specific VO2 sessions. So, you know, I like to build a picture first to understand what can contribute that before we look at biomechanics. And then, you know, going on from that, what we do is jump, I like to jump them on the treadmill first. So before I even look at someone clinically and do any sort of strength assessments, I like to see people run and get a view of different angles. So we'd literally look at side on from both the right and left and then rear on. They're my three important views in terms of, I like to see the movement patterns that are occurring in both of them frames. And only after that would I start to then delve into asking the questions of, okay, why are we moving in this way? What do we need to look at from an assessment and a strength? based perspective. And the reason I do it this way is because there's so many different contributors from strength and range of movement and anatomy that can influence how we run and give us all our little unique intricacies that I have to first, I feel like I have to first form that picture of how you're running, whether or not certain things could be a problem or could be improved. And then I delve into understanding why are those things happening. And would you then do any further tests after the runner, after you assess them running? Yeah, so a nice example that I'd use is, is say for example, somebody who's got, running with what I call like a crouched running game. So whether they're running with an over stride, they're not really creating any, momentum into the air. So you see these runners that they look like they sat down when they're running And I call that a crouched running gait now one of the things we found clinically is that can be related to a person's way of trying to use muscle forces throughout the body and in particular and I then would like to assess okay How strong are they around the hip or how strong are they around the foot and ankle complex? Because with these type of runners we often find around that calf complex you know, lower limb musculature, they often demonstrate strength deficits, which mean that they then go into a running position or run with a gait that's trying to recruit different muscles and avoid the ankle. So that's so someone with a crouch running gait for me, I'd then look at, okay, how many calf raises can you do to failure? And how much force can we create? Just using a simple test like calf raise on a leg press, and to try and then understand is there a particular influence to that movement pattern that we might be able to either not even necessarily change directly, but also give someone some advice on, you know, strength and conditioning routines and things that they could incorporate. And yeah, and the types of tests that we use will just vary completely. Again, if someone's hip cuts in across the midline, we might look at the strength around the outside of the hip. If the trunk is rotating. Um, and the rotating their chest left to right excessively, we might use some tests to look at core muscle strength. Um, you know, various tests depend on what we see. Cool. I love that. It's, it's like you're solving a puzzle and what you're trying to do is uncover just like more pieces as you try and solve that puzzle, which, which is what I really love why you start with the sit down conversation and you go through their routine, you go through their history, their injury history and, um, just delve into. them as a person and then your next step is getting them on the treadmill because you could be wasting a fair bit of time doing like strength tests and length tests and things. If it doesn't influence their running because it might not directly reflect like you might have someone who has one ankle slightly stiffer than the other but then you get them on the treadmill and they're biomechanically like equal and it's kind of just like a waste of a test. So the the method that you go with and the order that you go with makes a whole lot of sense because then you're analyzing them as a runner to start with and then saying, okay, why are they moving that way? And then you'll follow up with, um, the tests that might be reflective of that just to uncover more of those puzzle pieces. That's really cool. Yeah, definitely. I think the puzzle concept is a, is a really big important point for people to remember running performance and running injuries are like effectively this jigsaw components. And, you know, I think it's too easy for us to get bogged down and think specific things like a restricted ankle is important when actually that might not be impacting on that puzzle. So really I like to try and look at this picture of where I'm trying to get a person to, and then assess where all the different pieces are from a nutrition perspective, a strength perspective, a biomechanics perspective. And I think it's a good idea for every runner to remember that really. And if you do have a runner. If you're like looking at their videos and you're analyzing this runner, is there anything, any like big rocks that you're looking for rather than just like really small, really small pebbles? Is there like some overarching metrics that you might specifically hone in on? Yeah, so I go through almost like a structured assessment process of I'll look at set key, key different biomechanics, which I'll explain to you which ones I look for. before I even go to any of these subtle intricacies. Because I think there are key things that can, and we know from science, have an impact upon performance and can influence injury. And then there are other things where I feel like we just stare at the picture too much that we start to pick out pieces of the picture that don't necessarily relate to injury or performance. And the trick is making sure we stick to the obvious and don't go down the road of these subtle intricacies that actually that they're so fine and so might not have an impact on performance or injury. So the way in which I like to start is, is get a simple side on view of someone running and you could call me a reductionist physio or a cliche physio, but where I like to start looking is around the pelvis and the spine. And in particular, what I'd look for is whether or not someone's got excessive pelvis rotation. So you can sort of see from side on that they might, as they run along, be really like twisting and spinning the pelvis and trunk as they move forward. And why I like to look at this is because often this twist and rotation can be a sign of somebody who's excessively breaking as they hit the ground. So if they land with a really stiff lower leg and break, one of the first points where that might manifest is in this pelvis then spinning on top of that leg. So, you know, if I see that with someone, I might start thinking, okay, is this something that's contributing to them breaking that I can look at further down? Or if there's not, then it might give me a sign of, okay, maybe we've got some deficits around their ability to control the rotational movements as they run. So it informs what I do on the subsequent assessment. And then from a trunk perspective, now trunk is a really interesting one for me. And it's one that I've had some good effects with. adapting and changing with people on occasions. And the way I think of like your trunk or your chest movements is effectively, it's like a Goldilocks effect, where we're looking for just the right amount of movement. Now, if you have somebody who leans really far forward when they run, or we call that an excessive forward lean, what can happen is it can shift your mass too far ahead of your body. And as a result, I mean, if you stand up and try it yourself, what you'll want is you'll almost feel this sensation that you want to fall forward. Now, if too much of that is occurring, every time you run, you're either going to fall flat on your face. You're going to keep speeding up indefinitely or the most common thing of what we do is we then reach our leg out and slam the brakes on to try and catch ourselves and prevent ourselves from falling. So this forward lean has an impact on causing us to break more. Alternatively, What we have is a lot of people think that they should be going out and running really upright and nice and tall. Because you know, that's what they told the elite runners do. You know, and in some respects, some of my research, I think, has contributed to saying elite runners run more upright. But actually, the reality is they still have a slight forward lean. If you are too upright and you lift that chest and try and run too tall when you run, what you do is you reduce the ability to actually use the hip muscles or the glute muscles. to help absorb and push yourself forward. And all you then do is shift the forces down to the knee and ankle. So for me, you know, you've got this Goldilocks effect of getting the right amount of trunk lean to avoid falling over and breaking, or to avoid the fact that I might then overload the knee and ankle. So like I'd always say to people, it's feeling like you have a subtle drift in your chest forward, and you're almost trying to carry your chest forward as you run. you know that's what I'd like to look for at the trunk. And then the other real main obvious ones are where is that foot landing in relation to your center of mass? So have we got somebody who's got a huge overstride where that foot is really far out in front of them? And you know that for me is one of the big things and the nice things to change about people because we know this overstride is linked to greater breaking and the only way to to compensate for the potentially greater braking forces on an over stride is to then, you know, sink and really have to bend through your knee, which would lead to, you know, an opposite effect of then overloading the knee. So, trunk and pelvis position are the first ones and then looking at that over stride and where that foot is in relation to your center of mass. Because I believe that if you get it right, the lower leg that should really be viewed as our suspension spring as we run. If you know, if it's too much of an overstride, you've not got enough suspension in the system. And, you know, as a consequence to deal with the breaking, some people can then increase that suspension and sink too much as they run, which overloads muscle systems. Okay. Those are the two obvious in there. And in terms of like cadence, would you assess that as like high on the priority list or is that fairly low? So, Cadence is this mythical number of 180 that's like passed around, we should all be trying to attain for 180 steps per minute. Now, the problem with this is that some people, if you're really tall or you're really small, you might either take less steps or more steps. So the 180 doesn't apply to everyone, it's kind of on an individual basis as to whether or not it applied. But having said that, when we do look at biomechanics, often we can, by changing somebody's cadence, adjust many of these biomechanical patterns that can cause injury. So it's one thing I look at a bit further down the line once I've established if we need to change something. If we feel like you don't need to change anything or there's nothing there that could be improved, I probably wouldn't bother with the cadence simply aiming for 180 steps per minute without having any sort of biomechanical error, should we say, what that might do is just cause you to waste more energy by then spinning your legs over too much. So I think the first approach would be, is this something we need to change? And second approach would be, could we look at adjusting the cadence for that? Yeah, I totally agree with that. And when I first graduated, they did say magic numbers 180. we now know that it's kind of like a general range and that range is different for every individual. And I do like to say that cadence can be a huge game changer for someone, especially if their cadence is really, really low. But for the majority of people, they've kind of self-optimized and hit a nice sweet spot anyway. And like you said, we don't need to change it unless we need to change something. And for a lot of runners, we could do the assessment and realize that nothing does need to be changed. Yeah, I think, you know, there was something to really hit that home is there was a really good study that came out quite a few years ago now, but what they looked at was people's optimal step rate range. And they checked this by looking at their running economy and how many steps per minute they were taking and adjusted the step rate. And effectively what these people found was there's like this sweet spot, whereas there was just, you know, and a lot of people were running close to that sweet spot already. in terms of the most economical step rate for them. And if they adjusted that or changed the step rate too much, all of a sudden it just made the people's run in like uneconomical. So basically, you know, the message there is if you mess around with something like step rate and you don't need to, you could potentially worsen your performance. Yeah. I did have a, um, a listener, Andre, who was, um, talking about, he wanted to increase his cadence. Um, and he's a very experienced runner, but he wanted to raise his cadence from 170 to 185 at a five minute pace. And he wanted to know if there was any particular strategies that you would advise, but from what you're saying, it sounds like it would just depend on the individual and wouldn't necessarily enhance performance. Yeah, definitely. You've got to be very careful because... If you like the mechanical patterns that I talk about in terms of the overstride and the position of the foot related to your center of mass. If that's already what we'd say in the in the optimized realm. All that's going to happen is if you increase the step rate further, you're going to cost yourself more energy because you've got to spin your legs over faster like Roadrunner. And so I'd first of all look at is there something that you can do from a mechanical perspective or does anything need changing from a mechanical perspective before you think of changing step rate. But if you did want to go ahead and somebody wanted to go and have a try at changing the step rate, what I'd probably say is monitor your heart rate data to see if it changes your heart rate for a given running pace. Because if it makes it go up, that's like a crude way of suggesting that it might have a negative impact on your performance because you're working harder. And then second of all, you know, the practical. ability to actually do that is, you know, I generally would start people nice and easy using a audible metronome So you can download little metronome apps or one of the one that I use is called Metro timer I think it's free to download and you can set that to the new beat. So often I would let people And I think our infield way of training someone was to give them this metronome Let them listen to it while they're running for the first five minutes and try and match their feet to that beat And then, cause it can be really annoying and actually people pick up these skills quite quickly is you can shut that beat off and then try and just keep the feel of that type of running going and only reintroduce it if you feel like you're losing that ability to do that step break. I love that. And while we're on that topic is, can you think of any other devices or any other like assessment tools that a recreational runner could use on themselves Like if they don't have a health professional, like filming them and analyzing them and slow mowing everything or having reflectors on them, is there anything they can do at home with a phone or with something quite basic to assess themselves, any key metrics? Yeah, so there's quite a few different things that you could do. You could do like a self gate analysis or self like. view of yourself running and with our remote assessments, that's one of the things we ask people to do is record the videos in that way and simply just like propping your phone up on a on a tripod or You know a nice little method for me is like you stick your phone in a shoe So it forms a little running related tripod and then you can record like slow-mo videos of yourself running side-on or running away or towards the camera so you can have a bit of a look of what you're doing biomechanically there. But in terms of other metrics as well, is there's a lot of, you know, a lot of the watches have various different ability to monitor different aspects of your running. And, you know, some of this data is really accurate. Some of it is not so accurate, but it's fairly reliable. So you can monitor change on that. But... They have nice little metrics such as looking at your cadence, the watch's camera will record, they'll look at your ground contact time, which is basically how long you're in contact with the ground. And what you wanna see there is as you're getting faster, you want that ground contact time to come down lower. And some of them will also give you balance between the right and left. So how much time you're spending on the right foot relative to the left, which can be a nice sign of any sort of injury deficits unresolved issues that you still have that's causing you to favor one side or be stiffer on one side. And then there are all other metrics. One that I particularly like playing around with at the moment is with the Garmin watches and in particular if you have their triathlon heart rate monitor, they have something called the vertical ratio that they put on there, which is effectively the relationship or the ratio between how much time you spend in the air and how much ground you cover. So from a performance perspective, what you really want to do is be making sure that the time that you spend in the air is covering the most ground possible rather than just bouncing up and down on the spot, which would be a very energy costly. So Garmin have this nice vertical ratio thing on there that you can look back on. And I quite like that one as it is a neat little performance indicator at the moment. Great. That's awesome. And if we were to backtrack a little bit, going back to this running assessment, looking at someone on a treadmill, um, we, you mentioned the big things that you look for straight away, which be like hips, seeing if the hips are stable looking at their overall posture to see if there's much of a forward lean and then a, um, the forward contact, the initial contact, if it's too far forward of their center of mass, um, If everything's looking quite good, do you ever delve into more of the smaller pebbles with the problems? Do you ever look at things like ankle alignment or pronation or step width, that kind of stuff? Okay. So there's some small pebbles that we will delve into, but I think there's also quite a lot of myths around these small pebbles. So in particular, pronation is a huge one that. shoe companies accidentally or maybe purposefully contributed to this myth that we think pronation or what people say is pronation is a bad thing and you don't want too much pronation and we should be prescribing certain shoes based on pronation. But effectively that's a myth. Currently there is very limited scientific evidence to suggest foot pronation reduces performance or impacts upon injury. And in actual fact your foot muscles, and particularly the fascial band on the bottom called your plantar fascia, they're very useful at storing and returning energy. So what we know is when a person pronates, that plantar fascia will store energy, which it will then return as you toe off to spring for the next gait cycle. So actually pronation can be useful in a lot of instances for storing and returning energy as you run. And therefore, if you work on a way of reducing or stopping pronation, you effectively stop the foot from functioning in a way that it's supposed to. So, you know, I will look at that with people, but then we have this conversation where actually, you know, there's no scientific evidence to link this to injury, and you might really not wanna be delving into trying and changing that. In terms of the small pebbles that I might look at is, Say for example, we find really subtle changes in someone's like knee positioning or the hip positioning or whatever. If we find a small change, I might use that instead of trying to change the way you run, I might from a clinical perspective think, okay, is there a reason why you're moving in this way? So is this some sort of subtle underlying strength deficit that we haven't addressed yet? And could this be contributing to your injury or performance? If it's not contributing to your injury or performance, and I can't think of a plausible way that it, that it would be, I would pretty much ignore that as a fact, because you know, you're changing stuff that's unlikely to have an impact further down the line. Yeah. And I'm glad you touched on that, especially around pronation, cause there's a huge misconception out there. And I do think a lot of shoe companies have purposely, um, put that in there as like a marketing ploy. And I do think it's very simple for a shoe company just to measure someone's like, or look at someone's pronation and say, okay, you need this type of shoe. It seems to be a very simplistic model that just isn't backed by evidence whatsoever. So as a runner, if we're looking at say hip, knee, ankle alignment, should it be a goal for them to try and achieve more alignment? What we've got to remember here is that everybody's body is shaped subtly different and nobody is perfectly symmetrical. So to aim for the perfect symmetry and perfect alignment, we might just be chasing that sort of golden pot at the end of the rainbow, so to speak. The thing that we're never really going to reach and achieve. There are some obvious things that I think we should be looking to really try and work on though. And in particular, some of the biomechanical patterns that are linked to injury include this thing called pelvic drop, or some runners have described it to me as what they call hip dip. And it's effectively where, if you imagine your pelvis was a shelving unit, and when you land on one leg, the opposite side of that shelving unit drops away. And that is what we call pelvic drop. And then the other aspect is we call hip adduction. So it's where that knee then cuts across the midline of the body and people, you'd almost sometimes you might have experienced this yourselves is where you clip your knees together. So you run in almost like knock kneed with the thighs banging together. Those two features I think from an alignment perspective that there is evidence to link them to or associate them to injury. and they can increase the stress on the body and the lower limbs. So from my perspective, I like to change that. And the way I change that is either looking at your hip strength, or maybe using the cadence there as they can be sort of good interventions to hopefully try and improve them sort of areas. But you've got to take it into perspective of how much running you're actually doing and whether or not it is a risk factor for you. Because if you don't do very much running, it probably doesn't really matter. in the way that you run and how your technique is at that moment in time. Because the stress you're applying to your body might not be big enough to contribute to injury. However, I would say like, you know, as, as we start to push ourselves to higher demand training, those have from an alignment perspective, the pelvis and hip are the one, two things that I'd start to look at. Yeah, cool. And it's nice how you start with that sit down conversation, like you said, because they could have a huge spike in training load. and all of a sudden have knee pain and then you have a look at them running on a treadmill and you can see that their hips are dropping or their knees cutting in and you can be like oh this is probably the cause where that might not be the case it might just be a peak in training load and all we need to do is settle the sensitivity down and get them on a better well-structured running program and not have to change anything about their technique and they're all better but if they receive misguided information from like another health professional or a running coach or someone that says, yeah, you're getting this pain because your knee is cutting in and because you've got all these malaligned joints that could create a lot of fear and create a lot of anxiety for a runner. Would you agree with that? Oh, a hundred percent. That is, that is why I think it's so important to have that conversation. And a really nice example of this is. I assess biomechanics, a lot of people always think I'm going to give them a biomechanical solution and not long ago I had this patient who turned up to me, he had started to experience IT band syndrome and pain around the outside of his knee and he was adamant that it was his biomechanics and we sat down and had a conversation and I was just like okay tell me about your normal running routine, what do you do? And this guy he tells me like oh I run three days a week and I have done for the last three years. And I generally would run on a Monday, Wednesday and a Friday. And I was like, okay, so how did this problem start? And he's like, okay, well, we went away on a, on a, on a running holiday, um, for a bank holiday weekend. Um, and then I did a six mile run on the Friday. Then we did 10 miles on the Saturday. Sunday, we did a 12 mile long run. And then on the Monday, when I came to try and do an eight miles, I started to notice at the end, my knee was really sore. So I sat there and I was just like, well, hang on a minute, let's backtrack a minute. I thought you run three days a week. Normally. And all of a sudden you've gone on this bank holiday weekend and you've done four days back to back of really high volume running. You say, Oh yeah, you know, I didn't think of it like that. But effectively this person, he didn't have a biomechanical problem. It was just that all of that sudden huge change in what they did from a training perspective that led to normal structures getting overloaded. Um, you know, analogy I use to people is like, you know, you don't go from working part-time to working seven days a week for. 12 months a year because otherwise you break down stress. It's the same from a running perspective. Very true. I'm curious to know your thoughts on this because I'm here to learn as well. I find myself often correcting people's narrow step width if they have maybe like a crossover pattern when they are running, if they are injured, if they have like ITB friction syndrome, or if they have maybe shin splints, something along those lines. Would you? if someone is injured with that particular sort of injury, would widening their step width be something that you might try with them? So step width is an interesting one and one that I've played around with for the last few years now. Now the reason people think step width is important is because there was a couple of biomechanical studies that came out and showed if you change people's step width, so make them run wider or narrower, ideally you don't want to make them run narrower, but if you make them run wider that it'll offload. things like the shin and the IT band. But from my experience with this, this came from two separate studies that were predominantly around biomechanical modeling studies. So basically very complicated mathematical studies, but only looked at healthy people and didn't really trial this out in injured subjects. So I understand the concept was there. And we started to try and use this with some injured runners, but I never really found that it got me the, these theoretical gains. It didn't really seem to change people's symptoms. And the one thing that, you know, patients reported time and time again is that when you try and make them run with a wider step with, it just feels really weird. And they take that forward, just feeling really strange time and time again. So I've not really had any success with it. And I don't think, there's enough evidence there to show me a way to one, integrate it into practice for all of us and two, that it's going to offer me really big benefits in terms of injury and biomechanical outcomes. Now, how I've found that you can change step with quite well is actually through subtly changing someone's cadence. So even if you increase the cadence by less than 5%, what can happen is you can get a a concurrent change in their step width. And really why I think this happens is because it changes the muscle activity around the hip muscles. So as you then bring the leg back down underneath the body, the hip muscles will actually start to put that pelvis and that foot position in a more, well, into a wider position in that initial contact. So rather than go and manipulate step width, my first go-to is actually think, can I change the rotation of that pelvis by using step rate instead, and even just subtle changes to the step rate. Cool, and I think that makes a ton of sense. If there's, I think also if you're increasing your cadence and you're trying to tick the legs over quicker, it takes more time to reach across to the other side and have that kind of crossover step pattern. Whereas if you're trying to tick them over quicker, you're not gonna have any other option but to contact. Yeah. In the, I guess, less of a narrow step width and yeah. I think what you find on that is like when, when people have this narrow crossover, often they have almost like a low P stride. So they reach out too far. What you'll notice is that pelvis on the lead leg tends to rotate really far towards that leg. We do this when we walk really well, but from a running perspective, we shouldn't rotate our pelvis too much. So because the pelvis rotates. then you're automatically in quite a narrow position. So, you know, if you did this in standing, just reach your leg out and rotate that pelvis towards that front leg, you find that step width is really narrow. So if you do it, focus on, you know, bringing the leg back down quicker and changing that step rate, the muscles will bring that pelvis back into that neutral position, which we want from running. So it just automatically gives you that wider step width. Yeah. And I do agree with you, what you said before, when you tell someone to widen their step with, I, I almost, almost every runner I say that to, uh, will naturally like overcorrect. And they're just like running like side shifting side to side. And it's just a crazy, um, overcorrection. And so, um, when I do say it to people, I'm like, it is the most subtle difference. Um, I want you just to change it by like an inch or two. Um, please don't, because everyone seems to be jumping on the moon after that and like, you know, almost like ice skating, you know, they go side to side. Um, I'm curious, I didn't have this written down, but, um, while you're just talking about strength and that around the hips, from my understanding, it seems that someone, if someone was to have a hip drop or like then their knees are cutting in and brushing against each other, it seems like strength doesn't do a whole lot to change their biomechanics once they get back to actually running. And if someone is injured, let's just say they have, knee pain or hip pain and we take them off the treadmill, we strengthen them up, we put them back on the treadmill. They feel a lot better because what they're doing is increasing the muscle capacity rather than actually changing biomechanics. Is that, would I be saying that correct or do you have another view? So I've mixed views on that. So the first one is generally with a lot of strengthening that we do from a physio perspective is yeah, you're right. We don't necessarily change biomechanics of someone. All we do is get the tissue structures more robust to, um, to cope with, um, what you're going to do to it. What I always say to people is like, we're going to make you so strong. You can just run through brick walls because effectively that's what we are generally doing with a lot of strengthening. However, you know, science would say that if we change strength or we just look at strength, it doesn't necessarily relate to someone's biomechanics, which is true. But. The relationships and how strength influences mechanics is a lot more complex than simply saying A plus B equals C. Strength is one aspect that I feel is necessary for you to be able to produce a movement. If you don't have the baseline strength qualities, I can't expect you to then use that muscle group to perform a function when you go out to run. Because at the end of the day, you need strength to overcome the forces that are applied to the body. So a minimum amount of strength is necessary. But what we're finding, and some of our research is currently trying to look at these complex patterns between how strength and biomechanics interrelate. And what you really find is that there's huge amounts of varying influences that can make this picture appear. So a nice example here would be, if somebody's got a really weak hip, that might not change their hip mechanics because what they might have gone out and done is self-optimized their step rate and really increase the cadence. So now the strength requirements that they need around that hip are lower and they can function perfectly fine. So your strength and your naturally adapted cadence are two factors that might influence the overall outcome. So you know to avoid going into much more complex discussions on that, I think a minimum strength is required. but it's amongst a whole topic of, or amongst this multiple interactions between different aspects that then influences the biomechanics that are output. And I think the listeners, if they've listened to previous episodes of this podcast, they should have been drilled in the message time and time again, the strength is very important for runners, and it's a crucial piece. Um, so if I could try and, uh, summarize what you were just saying. So strength is definitely important, but might not, might not necessarily be for the goal of changing biomechanics. But what you're doing is you're just overall improving the quality of how your muscles are firing and how the neurons are firing just to create that, that better quality of running. Yeah, exactly. You're making the tissues more able to cope with running and give them the ability to actually. perform the task better. Yeah, cool. As we come to a close, I did want to touch on just, hopefully you can summarize in a nice neat little way, when it comes to running technique, is there any changes or is there any link or correlation to injury rates when it comes to someone's overall biomechanics? Yeah. So again, this is like quite a debated one, but yes, there are certain biomechanics such as your overstride, increased braking, pelvis drop and hip cutting across the body that are linked to future injury development. Um, this is very much an emerging area. So there's a lot of associations where injured runners look like this. So it might mean that actually they run a bit different because they're injured, but there are some evidence that starting to link certain biomechanical patterns to injury. But as I say, the difficulty in this is because your biomechanics are going to interact with what you do from a training perspective. It's part of this whole jigsaw puzzle. You don't necessarily get you don't get injured because just one piece of that puzzle isn't there. It's usually because there's multiple different pieces, like biomechanics plus a muscle muscles are poorly conditioned and not strong enough to cope with the stress plus a you've done too much too soon perspective. So yeah, it does link to it, but it's usually because there's other contributors alongside. So it's not necessary for you to just change biomechanics. You could train smarter, build tissue qualities first, for example. Which is why it's been so hard for science and research to try and make this correlation because injuries aren't just as simple as, um, you know, changing biomechanics or a certain way that you're running. It's just the, there's so many different factors that come into it. So the three that you had there was a hip drop. So if you're contacting on the ground with your right foot, what you're saying is the left side, the left hip is getting closer to the ground and that kind of like you said, that shelf kind of tilting the hip cutting across. So those knees rubbing together, you could say, and then that over stride where the someone's reaching too far forward when they make that initial contact. And that in a sense would create more breaking force. Is that right? Yeah, that's perfect. Those are the key spot on things that, you know, this emerging evidence that's linking that to future injury development. Great. And how about performance? So from a performance perspective, those same things are linked to reduced performance. I think your biggest one is going to be the overstride. Because if you spend more time breaking, you've got to regenerate that force to go forward. And other than that, From a performance perspective, it's trying to avoid sinking too much on the ground. So, from a scientific perspective, we call this lower limb stiffness. And what we find is those high-performant runners, they are what we'd say is in inverted commas, stiffer as they hit the ground. But effectively what that means is they don't sink with each stride and they're better able to apply force into the ground and move into the next step. And I view that as your suspension spring as you run. You don't want too soft of a suspension because that's just gonna cost you too much energy. But at the same time, you don't want it to be too firm. You wanna get a nice spring as you move into each step where you just, you don't sink too much, you spend less time on the ground. Well said. And I think it's, if someone can kind of relate it to efficiency, like if you're slopping down onto the ground and there's more movement from contact, yeah, making a higher or lower center of gravity, move up and down. Whereas if you're creating a stiffer leg, then you're not necessarily needing to absorb a lot of that load and then release a lot of that load. It's a lot more of an efficient process. And what I like to do when I'm looking at runners is get them hopping on one side, one after the other, and see if they like maybe 10 hops on the left side, then 10 hops on the right side, and just see how efficiently they can spring up and try and get them to do it quite quickly with quite a high cadence or high tempo. and can depict really well whether someone can create that stiffness. And so that's also another test that someone could do quite nicely at home and can kind of be a correlation with strength would you say if someone is really struggling to create that leg stiffness strength might just be might help them? Yeah I think that's a really nice way of testing it and definitely there's a huge strength component there. the stronger your muscle tissues are and the more force they can generate, the more easily they can resist that sinking as you hit the ground and create the stiffness. And I think Rich Blygrove, he published a couple of years ago now a really nice review on whether strength can improve performance. And actually through strength training alone, you could get up to like an 8% improvement in running economy. So yeah, and this was fundamentally one of the reasons of why that would happen. is more muscle force means you can apply that stiffness and keep your spring moving efficiently going forward. Yeah. He's a champion when it comes to strength and performance for runners. And I did interview him, um, earlier in when this podcast very first start. So if someone doesn't or hasn't listened to that episode, I think it's around 14 or 15 episode 14 or 15. So, um, really, he does really well illustrating like what sort of strength exercises, like how to. Prioritize like dosages how to structure it into your weekly running routine that sort of thing and obviously Understanding the benefits of strength for runners. So really good if you haven't listened to that one yet Great, I think we will finish up there Chris. Is there any other take-home messages or anything that we haven't really come across in this chat today that you want the listeners to Take away. Well, I think my summary key messages would be, look for the obvious, don't change things unless it's absolutely staring you in the face, don't worry about foot pronation too much, and don't think, and also a real key one that we didn't touch on, is don't worry about changing foot strike patterns. You know, rear foot, forefoot, it doesn't matter how you land, but what I would say is if you go around and start messing with foot strike patterns, you are more likely to get injured. So those would be my three take homes. And I think finally, if in doubt, and if you have any more questions or are concerned about your running form and whether or not it's causing running injuries, I really seek advice from a specialist running physio who understands the sport. Obviously people like Brody and myself really do understand how to fit this into that puzzle, hopefully to give you more practical advice. Yeah, great. And when it does come to things like running technique, um, like you said, focus on the obvious, but also focus on, is it a training era? Like make sure you like the client that you, um, Illustrated before and they're convinced it's a biomechanics issue. Um, maybe just, uh, have a look at what you've done in the last couple of weeks. Have a look at your training schedule. Have a look to see if there might've been an overload cause that could be the answer because that's a very empowering kind of approach to your recovery. But if someone, if you go to a physio who says, Oh, your glutes aren't firing, your hips are dropping, you're doing all this. You're pronating your feet a week. It can be very disempowering and very, like anxiety driven to receive that kind of information, which isn't really helpful as a, if you want to have a proactive recovery. So make sure that you're educated on the right type of things. Make sure you're listening to Chris and myself. With that said, is there any way someone can go who loves, loves your stuff, loves the conversation and wants to find out more about you or learn more about what you're working on? Yeah. So, you know, there's a couple of different methods. You can contact myself via our, our sort of physiotherapy clinic website, which is extra mile health.com. We put our research articles on there and it's a nicest way of getting directly in touch with myself or seeing what services we offer. Or, I'm generally pretty active on Twitter. So you could follow me at Chris Brammer. Um, and hopefully you like running and you'll hit biomechanics because that's generally a lot of what I'd talk about. But yeah, those are the two methods. Why, if you want to, um, find out more or get in touch, feel free. Fantastic. And I know we didn't touch base on a lot of foot strike patterns and like it's overall importance, but, um, if you're a loyal listener and listen to other episodes, you'll, um, by all means, you'll know, uh, the right answer for that one. So Chris, thanks for taking the time to come on and share your wisdom. I actually learned a whole bunch, which is really, really cool. And hopefully the runners out there took away a lot as well. So once again, thanks for coming on. Well, thanks for having me. Thanks for listening to another episode of the Running Smarter podcast. I hope you can see the impact this content will have on your future running. If you want to continue expanding your knowledge, please subscribe to the podcast and keep listening. If you want to learn quicker, jump into the Facebook group titled Become a Smarter Runner. If you want tailored education and physio rehab, you can personally work with me at brea Thank you so much once again, and remember, knowledge is power.