We have the legendary Dr. Izzy Moore who is a world-leading researcher in Cardiff. Izzy has done a lot of work on gait-retraining and cadence changes. Today I pick Izzy's brain on how a recreational runner can change their running technique to help their performance, overcome a running injury and injury prevention. Izzy shares the latest research on gait retraining for injuries, specifically ITB friction syndrome, patellofemoral knee pain and stress fractures. To follow Izzy on Twitter click here 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 Check out our new website!! https://www.runsmarter.online To follow the podcast joint the facebook group Becoming a smarter runner click on the link: https://www.facebook.com/groups/833137020455347/?ref=group_header To find Brodie on instagram head to: https://www.instagram.com/brodie.sharpe/
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On today's episode, Gait Retraining for Performance, Treatment and Prevention with Dr Izzy Moore. 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, smarter runner. If you're like me, running is life, but more often than not, injuries disrupt this lifestyle. And once you are injured, you're looking for answers. and met with bad advice and conflicting messages circulating the running community. The world shouldn't be like this. You deserve to run injury free and have access to the right information. That's why I've made it my mission, to bring clarity and control to every runner. My name is Brodie Sharp, I am a physiotherapist, a former chronic injury sufferer, and a and your podcast host. I am excited that you have found this podcast and by default, become the Run Smarter Scholar. So let's work together to overcome your injury, restore your confidence, and start spreading the right information back into your running community. So let's begin today's lesson. We start off with- I have a fair few researchers planned for an interview over the next couple of weeks and we're kicking it off with Dr. Izzy Moore. I have been a massive fan of Izzy for a very long time. I do delve into the research quite a lot and her work often comes up, love what she publishes. I love the work around gait retraining which is why I decided to do an episode on it. professional background, gate retraining is essentially just seeing ways that you could change your running technique. and cues that you can use and little modifications in order to shift load or change angles, change forces, all that kind of stuff. And hopefully the end product of this episode is very practical for you. And I try and tailor every episode for the recreational runner because they're the main people who listen to this. I don't want this to turn into a physio podcast where it just goes straight over who doesn't have the who doesn't know the terminologies and the jargon so hopefully this episode still applies to you. If you aren't familiar with the term cadence I recommend you go back to episode number six where we talk about cadence and understanding cadence. and its importance. So hopefully you have because over the last couple of weeks I have prompted people to go back to episode 1 and listen to the first 10 and then for bonus points probably go through the first 20 because they're very key universal principles. It's essential that you know the foundation stuff before we move forward into more detailed episodes. So yeah, if you haven't already, go back, start episode 1, but then when you talk about cadence and then this episode will make a lot more sense because we essentially dive into the research pretty quickly and I try my best to redirect a lot of the jargon to something a lot more practical that anyone any fun I can understand So we talk about gait retraining and how you can manipulate your running, how you can manipulate your technique in order to enhance things like performance and to help your recovery for particular injuries and we touch on prevention at the end and we covered so much today. I'm really happy with how the end product came out and the value that we delivered. So hopefully you enjoy and without further ado, here is Izzy Moore. Dr. Izzy Moore, I've been pumped to get you onto this podcast ever since we organized when we can have a time to chat. I have been following your work very closely and happy, well, I'm really pumped to dive into this content. So let's start with thanks for coming onto the podcast. Thanks, thanks for inviting me, Brady. It's great to have the opportunity to talk about research. Yeah, you're very welcome. Can we just start off with, if people don't know much about you, talk about kind of what you do with your level of research and what you're working on at the moment? Yeah, sure. So I'm Dr Izzy Moore at Cardiff Metropolitan University. I'm currently a reader in human movement and sport medicine. I did my PhD at the University of Exeter looking at economical running. So essentially trying to find out what how our running technique may influence the amount of oxygen we consume and loosely therefore how that makes us efficient and then I kind of transitioned a little bit more into looking at how we can try and change running style and focus on not just performance but also rehabilitation or injury risk prevention so I've transitioned into kind of gait retraining and looking at how we can instruct people to change their gait and what's the most effective way to do that. So that's been my more recent research has been in that area. We've got one study we've recently published looks at what's the best way to cue people to change their running style and we've got a follow-up study that I need to pull my finger out and write. as well as several other papers which have looked more kind of economical running, which came off the back of my PhD. Oh, and I heard as well that your interest with gait retraining came off the back of your own personal experiences dealing with some knee issues as well. Can you talk about that? Yeah. So, um, I've ruptured, uh, my anterior cruciate ligament in both my left and my right knee. Um, Yeah, I did the first one at age 14, the second one at age 18. And I did them playing football or soccer, depending on which country you're from. I managed to get back playing football both times, but then it was during my PhD, I had kind of a significant swelling flare up, if you will, of my oldest knee-operated knee, which was about nearly 10 years old at that point. So... I decided, so I was running on the treadmill doing a pilot study for my PhD in the lab. There's a mirror in front of me. So I kind of thought I should probably look at how I run. Considering that's what my PhD is on. And I kind of, yeah, I had quite a lot of typical things, I guess you could say a lot of torso lean forwards. So I was in... quite large amounts of anterior pelvic tilt. I had almost a kind of crossover gait and fairly straight leg when I was hitting the ground. So I wasn't too surprised that my knee wasn't particularly happy with me. So I went through a period of, I was actually doing a study on barefoot running, a minimalist footwear at the time. So I actually just took my shoes off and let my body do what it wanted, and then put my shoes back on and kind of used a similar running form and that helped me get back to running and then I kind of chose academia rather than playing a lot of football. But it has allowed me to keep running every now and then when I feel like it. So I do change up my gait a lot when I'm running to kind of offload my knees because they're clearly my weak spot in my body. I'm used to kind of just going for a run and manipulating certain elements of it, depending on how my body feels that day. Yeah. And I know from my experiences as well, if I've been through like similar things, it tends to retain and you have a bit more interest moving forward and like reading about it and helping other people with that same situation as well. So have you found the same thing? Yeah, definitely. And I think there were some, um, who are very much, no, you can't change gaits. It's too hard to change how someone runs. It's so ingrained in them. Whereas I'm the opposite, I kind of do it every time I go for a run. It does take a lot of cognitive load to do, but I think over time and with practice, it becomes a lot easier. And it's certainly something that I think is useful for runners. to understand a bit about and you know, so if they are feeling slightly fatigued or a bit of pain, you can either try and run through it or you can maybe alter something about what you're doing to help kind of maybe lessen the load for your run. And it's very hard to do research in this kind of thing, but I guess just intuitively from personal experience and speaking to other coaches and clinicians. I think this is a lot of what people advise anyway, is having a few things in your toolkit when you're out running, um, just to put variation through your body in, in terms of the loading patterns. Um, I think that, that's a nice way forward. Yeah. I think we'll, we'll explore that a little bit more from what I know about the research at the moment, well from reading a couple of your papers and a couple of others is when someone wants to run if we have like a recreational runner, some will like, there's this thought of self-optimization, like someone will naturally just try and adopt a running style that's particularly efficient or economical for them based on you know their dimensions, based on their like weight, based on their stiffness or strength and that kind of thing. Do you have the same kind of understanding or the same reasoning? with that method or do you think differently? Yeah, I think self-optimization also occurs through having greater exposure and kind of accumulating that exposure. So I think there are some that will be far better at getting closer to it and producing a gate that lowers the amount of oxygen they need. But we know that there's a really good study by De Ruta and colleagues which has shown that trained runners versus untrained runners, the trained runners have, they were much closer to their optimal cadence and so that's the cadence that has the lowest auction cost compared to the untrained runners who were about eight percent away from using the cadence that they potentially should use I think there's an exposure element to that optimization. But I do think, you know, we're never going to be bang on optimal. We run, you know, you pick up injuries. And so over time that optimal may shift. So what is optimal when we're younger may not be the same when we're older, when strength we know declines, greater injuries stack up in our history. So it's probably a constant change going on. And some people may be better listeners of their body and their effort levels than others to achieve that optimum. Wow, and 8% away from the optimal is quite a lot. And I know that based on research, like you have to adjust maybe five to 10% anywhere between there to see a real change. And I guess from like a question from like what a recreational runner would look for or ask and a lot of the audience that I do have are recreational runners. So it might be my job within this interview to try and clarify a few of the terms that we do use and a bit of the jargon that's thrown out there. But if a recreational runner wants to increase their performance, which I'm assuming like a lot of runners out there will fit a lot of runners out there. myself included, should we be consciously trying to change or correct our technique or should we constantly try and find something to improve on with our technique or are we just wanting just to get more exposure and then you know ideally over time self-optimize? Yeah that's um so that you know I have no research to kind of lean on that would point in either I think some people take to changing their running style a lot better than other people and I don't think changing your running style will ever match the kind of benefits of just doing lots and lots of running and doing a really good running training program. I think it's a way of if you're misusing it as a fine tuning kind of mechanism so I would probably go along with the lines of getting into running first following your running training program and then once you're in the rhythm of doing that then you potentially look there's a nice simple way of trying to calculate what your optimal cadence may be based on your heart rate. We've put a spreadsheet together that can help with that. So it's probably once you're kind of into running a little bit, you're kind of in your rhythm with your training, you could then kind of look to, okay yeah I know what my rhythm of running is, my cadence, now may be a good time to just check in to see if it's as good as it could be. Some people will just never be able to change their running style as effectively as just doing more training is for them. there is a kind of personal preference that I think some of it comes down to. Yeah. I should probably clarify. Like when we're talking about cadence, we're talking about the amount of steps someone takes per minute and someone can be turning their legs over really, really quickly and taking faster shorter steps without necessarily changing their running speed. And, um, before we started recording, you're talking about like treadmills, very, uh, a good way of doing that based on what we've just discussed so far, it almost seems like we can almost assess that answer based on like an individual. Like if an individual seems to be outside their optimal rate, then we might want to change their cadence just to see if they're one of those types of runners that are like in tuned and can, or has like a lot of body awareness that they can make those changes and see if they feel better. And then if they do, maybe try and set them or maybe fine tune that that's gonna be a more ideal cadence for them. Whereas there might be others where you try and change their cadence to a more optimal and they particularly struggle with, like that's kind of that adjustment. And you might say for them, okay, maybe we just need a bit more experience, a bit more exposure, become a bit more maybe coordinated or just slowly allow your body just to naturally take on that more economical state. Would you agree with that? Yeah, you know, we recently just put a book chat together which essentially recommends an individual assessment, like you've just said, above trying to look through the literature and go, oh well, here's the perfect running form, these are leaps. Kenyan distant runners seem to run like this and I should do the same. We recommend kind of stepping away from that and doing as you say it's on an individual level and what works for that individual athlete and what works for one person isn't necessarily the answer for another person and ultimately there is, you know, we're definitely not in a place where we can say there is a perfect running form. in terms of performance for distance running and I don't think that we'll ever find that because people vary so much. We know that even just between males and females there are differences and unfortunately a lot of people don't separate the data between males and females so we actually know very little about female distance running gait in Kampalsen too. to male running gait, let alone trying to generalize across the whole of males and the whole of females. So definitely the advice for now is to focus on what works for you and an individual assessment rather than just going off what you've heard is a perfect running form. Yeah, and I think that makes sense based on like how different people run and how different people are, like with their body shapes and their strength and what sort of running goals they have and we've kind of established that there is no perfect running form but on the other side, is there a running trait or running style that you might see in clinic, someone running on a treadmill that displays a certain characteristic, is there kind of like a trait that you might identify and say straight away, oh, we might need to change that. Is there any like, you know, kind of like... Danger trades where you're like, no, we need to change this. This needs to be a high priority. Not really, if I kind of, again, I've done, like you say, a lot of recreational athletes, when I've assessed their gait, they are always keen to go, so what do I need to be able to run faster, run for longer? And I always see the biomechanics more as kind of fine-tuning, because it takes a lot to be able to change your running gait. It's not a quick fix. and takes a lot of motivation on the runner. It's easier to change your shoes, which I think is why footwear gets a lot of publicity and gets good marketing because it's a quick... people see it as potentially a quick fix, whereas changing your running gait isn't. But I guess if they seem to be having very long strides, that could be something you can manipulate. relatively quickly in people with a metronome. So if they're running on a treadmill, you can just set a metronome app on your phone and just get them to run in time with a beat. And if you quicken that beat up, most people can comfortably alter their cadence to a certain level. And you could just see, you know, what's their perceived effort while they're doing that? What's their heart rate like while they're doing that? To see if there are large effects potentially going on with oxygen costs, because we can use heart rate to some degree as a bit of a surrogate measure for oxygen cost, if you're doing kind of steady state, endurance running. So the cadence, I guess, is a nice, quick one. And when you manipulate cadence, you do manipulate quite a few things in terms of your expectancy, some different different ways that they'll hit the ground with their leg because you shorten their cadence they're probably not going to be reaching out in front of them as much so that might help lower the impact forces they experience. It can also often lower the knee forces that they experience so for a lot of runners with the knee being the most commonly injured or certainly body sight with the most pain in runners that could be a both maybe a performance and potentially, um, gary training method for rehabilitation kind of pain purposes as well. Yeah. And I think when it comes to the performance side of things, if someone isn't, if it's going all over their head when we're talking about cadence, I do have a cadence episode, like it's within the first 10 episodes of the podcast. So they can go back and review that before coming back and listening to this. But, um, This is where it ties in really nicely because we're talking about performance like any runner or most runners want to help increase performance. And the way you can do that for a distance runner is to improve your running economy. So that's, you know, traveling at the same speed, but not using as much oxygen. And one of the ways you can measure that is measuring through your heart rate and can be a very accurate description of whether you're working. whether you're working optimal or whether you're working harder, if you do change a few things. And what you're saying is you can change your cadence up, up 5% or 10% and then readjusting just to see if there's any change in your heart rate. And if it starts to lower your heart rate, then you might be getting closer to an optimal running cadence, which leads to a more economical. run, which means you're not using as much oxygen, which means you can perform better if you're traveling at that cadence. So I guess that's where it works really nicely. And this is where your Excel spreadsheet that you're talking about is really handy because you can plug in those variables. And then once you know those two pieces of data, the heart rate and the cadence and correlating the two, you can tell a lot from where your ideal cadence might lie and your ideal performance. So that's really nice. That ties in really, really well. Then we'll sort of just touched on like recovery or if you are injured, what we can do. So let's dive into that a little bit more with like injury specific kind of stuff. Once you are injured and what can we tell about like gait retraining in order to help our recovery? So yeah, there's been kind of almost explosion of gait retraining studies, most of which are focused on rehabilitation rather than prevention. And so they focused on injuries such as tibial stress fractures, patellofemoral pain and iliotibial band syndrome. And there's been some very nice studies conducted by main group of American researchers which have shown it to be fairly effective at reducing pain, so whether that be through knee pain or ITB pain and that can happen just within a couple of weeks of between six to eight sessions of gait retraining and that running and kind of newly adopted running style through that gait retraining program seems to persist for one month and three after. So it looks like a potentially effective avenue but again effective for some people and not as effective as others. So we do see group level changes but within that there'll be variation in terms of the style that people are able to produce and also the pain reduction that they're able to feel. And if we're using these gait retraining cues Are we as runners, are we decreasing the load through the body or are we just like redistributing it to other muscles and other joints? Potentially a little bit of both but definitely redistribution. So for example if we're changing how someone hits the ground with their foot, so you can go from a rear foot striker to a forefoot striker, we know that rear foot strikers place a lot more load through the knee, whereas if you hit with the forefoot or the toes hit the ground first. that puts a lot more load through the ankles. So for patellofemoral pain, for example, there has been a study where they've looked to change their gait to a forefoot strike and that's helped reduce the pain. But as a consequence, they did report some calf discomfort in the first few sessions or week or so. Because of that, your tissues aren't used to that load to the same degree. So often I think particularly with the clinicians I speak to, they wouldn't just do gait with training. So if they know that they're going to be loading the ankle or the calf a lot more, they would also look to incorporate some exercises focusing on the calf tendon unit to help the tissues accommodate that load. And when you're talking about, cause you did mention really nicely that the increasing cadence has been shown to reduce loads in the knee joint, which can help things like knee pain because it might reduce like an over stride. Is it the same cue that's used for like you're saying, ITB syndrome or stress fractures? Is that the main gait retraining cue that they're using? So yes, but also for tibial stress fractures they also look at the tibia acceleration. So they put an accelerometer on the tibia and you can essentially use it as a surrogate measure of the impact going through the tibia and then they use real-time feedback to ask people to lower their tibia acceleration but we know that certainly Again, these are studies that have only been done on males. We, male runners, if we reduce their stride length, and so therefore increase their cadence, their tibial acceleration is lowered. So cadence manipulations do a lot of things, and so potentially could be useful for tibial stress fractures, patella femoral pain. For ITB syndrome, has the potential to go a little way in helping it, but they tend to focus a lot more on trying to get your knees pointing forwards, because you tend to see with individuals with ITB syndrome, maybe a lot of hip abduction, so that their leg is kind of being drawn to the midline of their body. So what the Gaby training tries to do is create a bit of separation between the knees as they're running. um to try and get their lower limb nice and almost straight underneath the pelvis rather than coming across the midline of the body. Yeah and Tom Goon talks about that really nicely he talks about the knee window and if the knees are kind of brushing together particularly in female runners um trying to I guess widen that window open that window to make sure the knees aren't touching each other and as a result the knees are facing a little bit more forward and there's not on the ITB, which I found it has been a really nice cue for me personally when I'm working with runners. So going back to the stress fracture when you're talking about the tibial acceleration, the actual change that you are creating is increasing running cadence, but what you're saying is the effect is different because we're not really necessarily, we're not changing the overstride. We're more addressing how quickly the... the shin is accelerating through space. Is that right? Yeah. So the main risk factor is perceived to be the tibia acceleration. Um, one way of changing that is through cadence, but also, uh, people probably do adopt a kind of flatter foot contact. So rather than going for again, that out and out heel, rear foot strike, with the cues that they do and with, if they use cadence, the foot will potentially come a bit flatter. And that might help decrease the acceleration of the tibia as they collide with the ground. Yeah, that makes sense. And so if we're redistributing, if we're making these changes and we're distributing the loads more to other areas of the body, Um, I think that's where having like a tailored approach or having like a, a health professional incorporate their opinion because we don't necessarily want the load being redistributed to an area that can't take that load because then we're leading to other issues. And for an example, like if we're, um, adopting someone who is, it was a heel strike, we're adopting more of a flat foot or a four foot contact. a lot more of the load is going through the Achilles or the plantar fascia or the ankle and foot and could potentially lead to things like calf strains or Achilles, tendinopathies or like heaven forbid like a stress fracture. Would you agree with that? Would you say that like making these slight adjustments, we want to make sure that the other joints are able to handle that load and therefore incorporating these gait retraining tips with a performance, or like with a strength and conditioning program for say is warranted? Yeah, I think that's probably a nice safe way to try and look to change your running style. And I'd also say that you don't want to go right, I usually run, you know, do my 5k run, I'm just gonna do my 5k run, manipulate my cadence for the whole time. we'd suggest gradually building it in, so you know for a minute I'm going to focus on this gateway training strategy, so I'm going to increase my cadence for a minute and I'll go back and slow it down for another minute and so you're kind of increasing your exposure to that different loading pattern over time, so I know a lot of runners don't like the the thought of decreasing how much they're running or how far they're running. So if you don't want to change that part of your running program, you just want to change your gait. You definitely want to do it in a structured, graduated exposure way and supplementing that with some exercises that focus on different body areas. Like I say, from a strength conditioning perspective. Um, would also be an effective way to what you don't want to do is obviously get injured because you've changed your running style. Um, so you don't want to be doing it too quickly. Um, and with your body, uh, not able to tolerate those different loads. That's a very good point. And it's almost like the, from what we know about, like how the body adapts, we want to make sure there's not like a, a spiking load. We want to make sure that. the body is adapting, like we're not exposing the body, like to greater loads that exceeds adaptation capacity. Almost similar to how someone might want to transition to a lesser, lighter shoe to increase performance. We wanna make sure that transition is very gradual. And when you're referring to gait retraining or increasing your cadence, that kind of stuff, it makes sense that we can. you know, increase it in slow bouts and slowly increasing your exposure to that new cadence and that way, if it's gradual enough, the body will adapt and become more accustomed and then it reduces the risk of any spikes in load because the body's getting stronger along the way. Is that kind of what you were referring to? Yeah. And I think, um, it's almost this principle of variability and varying that mode. So, um, You use the example of footwear, there's a really nice study which showed that people who ran and alternated between two pairs of running shoes during their running program seem to have a lower injury risk than those who just ran in the same pair constantly. So it kind of suggests that producing different loads going through the body is a good approach. because your body becomes more accustomed to the variability and perhaps has a greater tolerance for a wider range of loads. And I think you can do that through changing your footwear, changing the surface, the gradient and so on that you run, but you can also do that through manipulating your running gait. And these are all just ways of varying that load. And I think it's about kind of making... Like say changing that tissue tolerance and making, I guess, more of a robust runner who can accommodate those, those changes that they may face, um, you know, running on the road and having to then run on the grass and so on. And that not being detrimental to their, to their body. Very good point. And I like how you say robust runner because. I like to say that an injury will arise almost at your weakest link depending on your training history and your running style, that kind of thing. And if you are subjecting your body to this variability, what you're doing is you're almost identifying the weak links and almost building up all the weak links that you might have because you might become accustomed to a certain running speed, a certain type of shoe that you run in, a certain terrain that you're used to. from that norm, that's when your weak links are exposed. But if you're continuously trying to, um, keep the body guessing and adjusting and having a high variability in your training, then you're building up that resiliency and you're becoming a more robust runner and exposing yourself to that wide range. Um, that that's really cool. And it's really cool that you can use. different running techniques as well as shoes, as well as strength training, as well as changing your terrain, as well as, um, introducing Hills and all that kind of thing in order to, uh, tick off, like all these, uh, addressing all these weak links. That's a really nice way of putting it. Yeah, that's just, it's like having, it's another tool in your tool kits. Um, you know, for example, whenever I run downhill, um, I probably go to the extreme of shortening my stride length. because and therefore quickly my cadence to almost know that my knees are my weak link. So there are times when it's useful to expose them and there's times when actually maybe I can do my best to protect them to some degree to not overexpose them. So it's definitely you know all of these things are good to have in that toolkit and some will find. running on different surfaces they really enjoy. Some will find going and getting nice, shiny, different shoes is something that they really enjoy, and others will just being like to change and adapt their running gait. So it can really be individualized for the runners, not just in terms of how you change your gait, but also whether you would use gait retraining to do that, or you'd use the surface or footwear to do that. Yeah, some benefits of having your insight and your understanding and awareness around adjusting your, um, running. And like you said, just having a lot of tools in your toolkit. Uh, I wanted to explore the injury prevention side of things. So we've, we've touched on performance and we've kind of touched on injury really nicely and recovery. When we're talking about performance, this could, uh, when we're talking about prevention, this could be a really, um, easy answer for you because when I was talking to Chris Brammer on a couple of weeks ago, and I talked about this, is there any running style or anything that we can adopt to reduce risk of injury? He kind of alluded to overstriding being one, and there's sort of emerging evidence around a contralateral hip drop or that hip adduction, so those knees getting closer together. With his answer, would you agree or would you have anything to add or would you disagree? There's certainly, I think, preventions a lot. It's a lot harder to study in terms of just the sheer numbers that you need. And so the research is, as Chris kind of mentioned, is emerging. It's certainly not as much that we know in comparison to doing it from a rehabilitation standpoint and just trying to reduce pain. The cadence again, always gets a nod. Although I'm not particularly aware of studies that have done a prevention-based study on it. I know that there's one recently that looked at reducing loading rates. So that's kind of how quickly you develop force in the impact phase. It's kind of the... the mindset of Professor Irene Davies in America. She's very keen on kind of forefoot running and reducing your loading rate. And they actually found that implementing that in untrained runners, kind of at the beginning of a running program, reduced their injury rate for the next 12 months. It's the only study that's kind of done that approach of changing gait. and seeing whether it will prevent injuries. But again, that study comes with the caveats that it decreased the occurrence of patellofemoral pain, but there was a slight increase in occurrence of Achilles tendonopathy when you look at the kind of breakdown of injuries, so which you would expect when you try and reduce your loading rate, because what typically happens is you run more on your toes and with a slightly shorter... stride length and faster cadence. So there's always caveats to this kind of research that overall it might be effective for injury rates but when you delve deeper into the specific injuries it's not all injuries. There will be no running style that can kind of decrease all injuries because the load has to go somewhere. That's just the nature of running. There is always a load and it's just where you try and distribute it. The load has to go somewhere. I've just wrote that down. Good. Because it really illustrates this whole topic and having such insight and having such understanding about your body and how strong your body actually is. You might be making certain adjustments that addresses all your strong points, but in the opposite way, like you might just be making changes that you think is for the better, but you're actually exposing more load. to a WECO point or to a part of the body which the load can't handle. And it's tough that the prevention side of things is so hard to study and hard to come up with a conclusion because it's a question all the recreational runners are after. They're just like, what can I do to reduce my risk of injury because all the runners, they hate being injured, but unfortunately it's not as easy to come up with an answer. So I guess what... the, to summarize the prevention side of things is there are ways that we can apply, uh, some different running techniques to an individual, but, uh, in order to prevent injury, but it's just that tailored advice, um, based on like sound science and sound advice is, it might be required as just finding that tailored advice for the individual is where we might, um, have the problem. Yeah, definitely. It's certainly an area that needs more research in it. But it's kind of why I focus on the rehabilitation side of things. I'm much more comfortable saying, okay, you've got pain. From my biomechanical knowledge and my anatomical knowledge, this might be a useful strategy, but it's so hard to predict if someone will get an injury. that I kind of almost shy away from changing gate too much if they don't have an injury because you know maybe at least based on how they're running and what they're doing currently they're okay and there's always that possibility some people go oh I've going to change my gate now and I'm just going to keep running the same amount and they'll get injured as a result of that so it's always a bit of a tricky one. Definitely the kind of individual approach and trying to take in as much as possible by knowing that they're running history, their training program and supplementing that with appropriate exercises, with the gait changes, understanding their footwear, understanding what terrain they run on. You kind of need all of these factors, I think, to really start grappling with what is the best thing to target for prevention. Cause it may be that their running style isn't the thing that you need to target. It's just their training program or just getting them onto a different surface rather than tweaking their gate. So it's not, this doesn't always need to be the answer to change their running style. Yeah. And I'm glad you said that because it's all about becoming a smart runner and making smarter training decisions and having more awareness around if you do make slight changes, what effect that has on the body. And, If there's kind of two main things to take away from this, it was, it's kind of to build on your knowledge around what certain effects have and what certain changes have and making those smarter decisions. There's that side of things. And then the other take home message that I've, I really like is what you're talking about with variability and making sure you have a wide range of, or like you're exposing yourself to a wide range of different forces and different surfaces and different environments. In order to. become a robust runner and a more resilient runner. As we wrap up here, is there any other take home messages that we haven't necessarily discussed that you want the recreational runner or the audience to take away? I guess, you know, one thing, if you do try and look into gateway training, don't think you need to come up with very fancy, fancy cues to do that, you know. often just telling someone we want you to run four foot, we want you to increase your cadence and just being very explicit with a kind of clear instruction, you know our research showing that that's more effective. I think some people try and you know come up with very bizarre analogies and cues that people don't really know how to interpret so keep it simple would be my advice. Great. And as a runner, if you are looking to try and adjust your cadence, one of my, um, tips were just to be like we were talking about before, just running on a treadmill because if you haven't worked on increasing your cadence before in the past, a lot of people just naturally speed up. And then they're getting out of breath and you know, they're not too sure what's going on, but the treadmill, uh, is a way that to know that you're traveling at the same speed. And then if you're adjusting your cadence or maybe Just like a metronome just having a beat and just stepping to that rhythm Can be a really nice environment to try and train or Change up your cadence and see how you feel. Would you agree with that? Yeah, absolutely certainly if you're not used to changing cadence or knowing the kind of Speed, you know inherently that you're running at treadmills are a really effective way of manipulating cadence It's what we always use in research so that we can control the speed and as many things as possible. So it's definitely the place I'd start. Yeah, very cool. Dr. Izzy Moore, if people are loving what you're saying and want to learn more about you, is there anywhere else they can go to reach out or just see what you're publishing or what you're posting? Any social media? Anything else if people want to follow you? Yeah, I'm on Twitter. Only social media I have, so I'm Izzy Moore PhD on Twitter. Fantastic. I'll add that in the show notes. We'll finish up there. This has been extremely fascinating for me and I'm sure the audience would agree. Thanks for taking your time to come on and share your knowledge and a big thanks to you so much for like all you do for the running research and people like me who want to know where the research is leading. And I do deep dives into publications all the time and your name constantly pops up. So personally, I wanna say a big thanks to all the work that you've been doing. Thank you very much. Thanks for the invite to speak. It's always nice to actually... disseminate our research in things other than papers. So thanks for really interesting questions and discussion. It's been great. Thanks for listening to another episode of the Run Smarter podcast. I hope you can see the impact this content has on your future running. If you appreciate the mission this podcast is creating, it would mean a lot to me if you submit a rating and review. If you want to continue expanding your knowledge, please subscribe to the podcast and get instant notifications when a new episode comes out. 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