Eric Hegedus is a Professor, physical therapist, clinician scientist and researcher with a brand new publication titled: Comprehensive return to competitive distance running: A clinical commentary (2021). Today, Eric talks about his new publication and the role he finds himself in working with competitive runners. We investigate the contents of the paper including key insights to return to running safely. Eric begins talking about the important of Training Impulse (TRIMP) when cross-training and transitioning into low volume running. We also discuss the 6 phases an athlete should complete when returning to running from injury. We also dive into strength test, fitness capacity tests and psychological readiness when returning from injury. Finally, Eric delivers the 4 most common mistakes he sees runners make that contribute to injury. Become a patron! Receive Run Smarter Emails Book a FREE Injury chat with Brodie Run Smarter App IOS or Android Podcast Facebook group Run Smarter Course with code 'PODCAST' for 3-day free trial.
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On today's episode, a comprehensive look at Return to Running with Eric Hegadis. 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 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. Thanks Run Smarter Scholars for joining me once again. I have Eric Hegetus on the episode today. And like I said, last episode, I was stoked to have him. I was, we finished the recording and I just felt so good that we, like, I was learning myself a lot of things along the way, which always is a good sign. That's a good episode, but I just couldn't find any downtime in this particular conversation with Eric. Where it was just. a whole bunch of value the whole way through and yeah, really insightful. And I think we kind of just threw ideas off each other and, um, different insights and different knowledge from different backgrounds. And yeah, it was just a jam packed one. So Eric Hegadis is a professor. He is a PT, a physical therapist, a clinician scientist and a researcher. I first found out about him through this mountain land running clinic podcast. And he was what they do on that particular podcast is interview researchers who have just released publications on running and he was one of the guests and his new paper was, or is titled comprehensive return to competitive distance running. clinical commentary which we'll talk about. It was released 2021 this year and mainly working around competitive athletes, competitive distance runners, but a lot of parables and a lot of takeaways for recreational runners no matter what distance and what injury you might be facing and so very thorough comprehensive look into how to return back to pain-free running. And yeah, we discuss a whole bunch of things today. We talk about, we talk about the paper to start with, but then we delve into TRMP, your training impulse. We talk about cross training while injured and how to phase into more and more running and less and less cross training. We talk about the mindset. We talk about psychological status when it comes to return from injury. We talk about what type of running is appropriate. And then we finish off with some of Eric's common mistakes that he sees with his competitive runners when it comes to injuries and, um, injury prevention and injury mistakes that they make. It was just jam packed. Like I said, you're going to absolutely love it. Looking forward to bring it to you. Let's get it underway. Eric Hegades. Welcome to the podcast. Thanks for joining me today. Thanks for having me. What an honor to be on this podcast. Brilliant. Let's, let's talk about your article because I actually shared it with. a lot of my community, I did like a small post about some of the best takeaways with this clinical commentary. So the title was comprehensive return to competitive distance running. First, before we get started into the actual content, do you mind talking about how this idea came about and why this particular topic? Yes, like most of the research or clinical commentaries that I make, it came out of clinical practice. So in my last job, I spent a fair amount of my clinical time working with distance runners and was, and again, this was now 12 years ago that I was at my previous job in the beginning, the standard of care, so not being satisfied is what sort of stimulated me to move forward. We had an athlete, and I'll call her Amy, although that wasn't her name, but she was chronically broken. So it was, she was a very good high school runner, and then it was one injury after another, never finished a whole season without injury. to work better as a team. So it was myself, two really good distance coaches who were creative in their approach to the rehab component, a biomechanist and an exercise physiologist. And we were able to get her for her senior year not only to win a conference championship, but she also PR'd. And so we were... first of all happy for her, but also maybe a little impressed with ourselves. Of course. That somebody, yeah, somebody who'd been broken for three years now all of a sudden could compete and at the highest level. And so then we started to think, so let's re-examine that. What did we do right and what would we modify? And so that resulted in... this same team writing the paper plus two distance runners, uh, who had been injured and treated by us. And the, so those are all the authors on that paper. Um, and, and I think the important thing was for us. Knowing that every patient is individual and has their, their individual story, which is very important is this article is a guide and not a recipe. It's not a protocol. Okay. Can you maybe explain, because like when it comes to research and publications like most people that listen to this podcast are just recreational runners. They don't have much of a health professional background. And so can you maybe just explain what the clinical commentary is in relation to all the other publications that someone might find? Certainly, yes. Thanks for that question. So, research comes in many forms, and it's even ranked by certain levels of evidence. Clinical commentaries are a chance for clinicians who have put together a series of clinical observations and have lots of experience. with a certain population and in our case it was distance runners to make a make to pull together some evidence that already exists but make a comment about how we think rehabilitation from running should go and so the gap we were trying to fill is many of your recreational runners who get injured will go to a that physio will do rehab, strength and conditioning, relief pain, improve range of motion, all of those things. And then when you're pain free, sometimes it is, hey, just go ahead back to running. And then in many cases, and I know your recreational runners have experienced this, but so did our competitive runners. They go back and continue to do the same thing that caused them injury in the first place and find out that they're re-injured again. So there's a gap between being pain-free and having normal range of motion and normal strength and actually returning to running, um, and, and this, this commentary fills that gap, we think. Yeah. I do think there is, well, there needs to be space for these sort of articles to come out because. expert opinions are very important, especially someone who's been in working with runners or being in the field for such a long period of time and having the, the gift of experience. And so it's having expert opinions, which isn't evidence-based and those who, like I was guilty of it in my early years, just doing everything that's evidence-based and everything that's, um, like have systematic reviews attached to it, but there needs to be somewhere between the two because some aspects of research actually can't be studied that well in a really rigorous double-blinded control trial. So it's really nice to find experts like you and your team that have been working with athletes and try these things and find that things really work and then producing a publication to share it to the world. I think that's really important. And I'm going to turn the tables and ask you a question. When you did straight evidence-based practice, did you find that? limiting in some cases. Well, it has to be limiting because there's so there's only so much literature available. Um, but not only was I following just that, but I was also disregarding or thinking it's ineffective for stuff that hasn't been published either, like say, um, stretching or foam rolling or those sort of components that either there's no literature or there is literature saying it's ineffective. I was really just like, Um, disregarding it and saying, no, you should be avoiding this altogether. But in fact, there's actually room for that as well. There's room for stretching. If it feels good for you, there's, there's room for foam rolling and massage and all those sort of passive treatments, if it really feels good for the athlete. And so I found myself being a little bit more wise, a little bit more open, a little bit less biased to like just purely evidence-based stuff and yeah, seeing better results, better, better outcomes, you could say. Yes, I think, I think we, we both come over time with experience to view evidence base instead of, uh, a yes or a no, instead of a dichotomous thing that you're either using evidence or you're not that, that evidence has many layers to it, like an onion that you can peel back and use in different ways if you're creative. Yeah. Especially with topics around say diet. I have a lot of runners that are like, do more episodes on diet or low sugar or Um, what's going to be the best fuel for me to complete an ultra marathon. And I'm very nervous because the, the science, like the actual literature has been published is like, you know, it just varies, it varies for the individual. And so my best approach for that is just relying on experts who have worked with. Athletes and worked with and done so many different things and have learned along the way to just trust their opinion and interview them. And that's kind of like my answer rather than me relying on my own. beliefs in my own research that I find. Yeah, great. I think talking about me way too much. Let's, um, let's talk about the, the first thing in the paper that I really enjoyed was this concept of. Trimp. Um, can you maybe explain that and how it can be so relevant for an injured runner? Yes, so there are many ways to calculate your load in a week. And so most runners just say, well, that's easy. I calculate my load as I ran 15 miles this week. And so therefore, that's my load. But that doesn't take into account speed, magnitude of your efforts. So we started to think what measure is out there that not only a clinician but a recreational runner could use to kind of gauge their load. And then, and the important part of gauging your load is number one that you understand when you were healthy. This is the load that you were running at in a pain free way. And then when you're injured. It helps you set goals. It helps you progress appropriately. But it needs to be, it can't always be, you know, a treadmill test for VO2 max or running efficiency. Not everybody has access to that. So, TRMP is training impulse. And we are typically doing some measure of load, like the distance that you ran, your rate of perceived exertion and for those out there who don't know what rate of perceived exertion is, it's basically rate your effort during that workout on a 1 to 10 scale and then you take your distance by that RPE number and you get your TRMP or a very usable measure of load and so that measure allows you to today, but I ran it much faster and my RPE was higher, or I took a longer, but slower run my RPE was lower. You can get very similar trips from those two approaches. I have, um, I've talked about this on the podcast in the past, but over the last few months I've actually implemented something like this over the weeks and calculated my weekly trip. I didn't call it a trip until I realized that's what it was actually called. I just called them arbitrary exercise units, but, um, recognize like that over the last few weeks that. Like if you do a workout at like most of my long runs, easy runs, I would classify as a three out of 10. That's, that's what I would mainly rank it as, but how quickly your trim can escalate if your workout is like a five out of 10 compared to a three. It's only just a, a slow bump up in intensity. But the trim score just like really quickly accumulates and you know, even just doing it for 20, 30 minutes can really, um, it just goes to show how intensity is really, really important rather than just purely focusing on mileage and like I was saying at the start, it's good to have a reference point of, okay, what your trim score, what you can currently tolerate or what you could tolerate pre-injury so that you have kind of like that baseline or that reference point to refer to when you are. returning back from injury. I couldn't agree with you more. And the key thing is to have it be easy and usable because if it's, if it's too complex, people don't use it. Yeah. And I think I will do an episode in the future, well, very close in the future about the intensity of like one to 10 and some, I guess, some good characteristics around describing what that is, because a lot of runners, especially recreational runners that haven't had experience with this before, it's like, well, what's a three out of 10? What's a five out of 10? So, um, Hang tight with me listeners. I'll, I'll do an episode in a lot more detail with that, but I have a question. If someone is injured, can we apply the trim score to their running, but can we also apply it to their cross training and how can we combine the two? Yeah. Great question. And thank you for asking that. So I can clarify a little further. Um, yes, uh, you can do, you can use the trim when you are doing your cross training. It works on a bicycle. A. stair climber, a rowing machine, all of those things. It is easily transferable. And so in the early stages, when perhaps all of your return to sport training is cross training, that's a good time to be able to say, because I know even recreational runners get nervous about getting out of shape because they're not running, but I would say in fact, the Trimp. Uh, from a good, hard interval bike workout, um, will, will still keep you in, in not the same shape as running, but really close so that you wouldn't miss it. And so would, because we're working out like minutes of exercise. If you run for 10 minutes at a three out of 10, that's 30. Trimp on your trim score. Do we apply that same? Like is. 10 minutes on the bike at what they're perceived would be a three. Is that, would that just equate exactly the same? Yes, it is a way to equate, but of course, you know, the problem, the problem, if we did not have the rate of perceived exertion as part of trim is if you just compared 10 minutes of running versus 10 minutes of biking, um, all of your guests would find 10 minutes of biking far easier. Uh, and less for that 10 minutes, they were biking straight uphill. Yeah. Um, but, but yes, uh, yeah, the beauty of the trim is it does translate. And again, you would have to work much harder on the bike in 10 minutes to get an RPE of eight, let's say, then you would with running to achieve an RPE of eight. Oh. or go at a very easy intensity on the bike, but go a lot further in order to achieve the same trim score, which I like how you can play with the numbers and kind of massage the numbers a bit to your outcome, which I find a really helpful process because you can look back on your previous week and calculate all of your trim scores and come up with a number. So you're, you know, you're referring back and coming up with a figure, but you can also re-engineer this in a way that you say, okay, I have maybe a run tomorrow, but it's a Sunday and I can only do this amount of trim. So let's just say like a hundred, um, on your score. And so you can actually forecast what your intensity should be and how far you can run in order to make those goals. So you're using this trim for both the past and also for the future planning, um, which I find really helpful if maybe someone might need a coach in order to, to help them with those numbers initially. but can be extremely effective. Yeah, I think you're correct. And actually the authors of this paper, three of us did a study in the past looking at energy expenditures and foot strike pattern on a curved treadmill as opposed to a flat treadmill. So I won't tell you and bore you with the outcomes of that study and all that we did. But what we did find on there, that's of interest to your runners, I think, who are recreational runners is competitive runners get used to sort of estimating the difficulty of their workout, right? They might call it a tempo run or a threshold run and might not call it an RPE. But what we found in that study just as a side finding was that those people who practice more often at understanding their effort level were more accurate and more consistent than recreational runners. So all that tells me is recreational runners should be using that RPE scale and as you use it you get better at it. And as you get better at it then it's a better monitor of Yeah. And I think someone's reference point might be extremely different to another runner, but as long as your reference point itself is consistent, then you know, you're going to get a consistent number and you're only referencing yourself, whether it's past and future. So as long as you identify, okay, when I have this feeling, when it's this effortless, this is a four, um, and you just have that as your reference point, then. you can't go wrong with measuring that against yourself, whether it's easier from there or whether it's harder from there. And when it comes to a safe return to running for from injury, like if you have that same reference point, then you really can't go astray. You're correct. I want to talk about within the bulk of the paper talks about phases of returning back to running. And so this is for injured runners, injured competitive runners, and it might get to a point where their injury is so severe that they can't tolerate any amounts of running or very, very low amounts of running. And so the phase one of, um, these phases is just cross training only. And I want to ask like the, the next phase up is going from cross training only to quite limited running, but also the vast majority is still cross training. So you're slowly introducing running. How do we know when we're ready for that phase? When are we ready to go from only cross training to starting out or trying to see if we can tolerate just low amounts of running? Yeah. What, what a, um, insightful and fantastic question because that is, that is, how do you know when you're ready to go to the next stage? And if it were, if it were a recipe that we were giving your, you and your audience, there would be, you're only ready to progress when you do A, B, and C, but what we are relying on and what we hope is that anybody who is injured is actually working with a physio or a team of folks to get to the next stage because there's You know, there are things there are different things you can use to judge the next stage one of them is trim One of them is your pain level One of them would be your irritability and what I mean by that is not whether you're grouchy with the people in your life. Irritability from a physio standpoint is if you have an injury that with a very mild stimulation hurts for hours and hours and hours and ruins your sleep that night and even into the next morning you're still hurting from a very small effort. That is a highly irritable condition and it is not wise to progress with a highly irritable condition. So irritability is one thing. Your mental state is something you have to be ready to take the next step. You have to not be fearing to take the next step. And then you can also do some sort of fitness testing or physical performance testing. And fitness testing would be, oh, gosh, there's a, you know, different fitness tests using bikes like the Wingate test and other tests that your physio will know. They will test you but also it will be proof to yourself that you're ready to take the next step. And there are also physical performance tests. So if you're having knee pain, patellofemoral pain, somebody might say, you know, when we did this single leg A couple of weeks ago you said your pain was 7 out of 10 during that step down maneuver. What is it today? So you repeat that test and then say, okay, it's now down to 4 out of 10 and its irritability is low. We think we're ready for the next step. So it's all of those things that go into determining when you go to the next stage, which is why I think you should be working with someone rather than, rather than sort of reading, um, something on the internet that says, you know, do this latest coolest recovery, uh, technique and it will, and it makes everyone better. Right. Yep. Totally agree. And it goes to show just like having someone on your team, because especially if it's an experienced running coach or a health professional, they're designed to like, based on your specific injury. know some sort of what requirements, what's required of that tissue for running and then trying to kind of mimic, I guess, tests like Achilles, you know, jumping on the spot or like hopping or like you say, for a knee, it might be doing weighted step ups and trying to challenge the structure in a way that sort of mimics the mechanics and the loads of running. And then to see what the response is like afterwards. And then based on the interpreting symptoms and interpreting like how much the recovery has behaved over the past couple of weeks that can then make the decision of not only, okay, you're ready for running, but also, okay, let's try out this volume of running, which might be extremely gradual. Particularly I find you talked about the mental state, which we'll go into a bit more detail in a second, but if someone's really fearful of running, well, let's just do a 30 minute walk, are you fearful of that? And then saying, Hey, how about in that walk, let's just do 15 seconds of jogging on the spot, or let's just do 15 seconds of jogging and see how that feels just to calm them down a lot more. But that might be what's required based on the irritability or the risk you want to take with that certain injury. Stress fractures is another example of something you want to approach very gradually and pay attention to the symptoms. So very important to have someone on their team, um, while we're on this topic of the phases, so the phase one from cross training only to the next phase. Do you maybe just want to go into detail about the specific like sub phases, I guess, within phase two of returning to higher volumes of running? Sure. Um, so there, there are six phases. Um, that, that was sort of, uh, Oh, I don't know arbitrary number that we pick six phases and that was based on experience. So Phase two you're still doing mostly cross training and by mostly cross training, I mean only five to twenty five percent of your workout is actual running and then in phase three, you know, your the cross training is still the dominant thing and it's and only about 30 to 50 percent of your training is running. Then all of a sudden in phase four, that relationship flips. Now you're doing more running, greater than 50 percent running, and still cross-training. Very often in phase four is when overground running is happening. When we talk about running in the previous phases, we had the benefit of having a weight altering treadmill. So we would use that weight altering treadmill to in effect change the individual's body weight and not everyone has access to that. And then phase five is you're all over ground running but you're just increasing your intensity. And then, you know, the last phase is you're, you're sort of uninhibited and striving to perform again. So those are, those are the phases that we sort of took people through and six phases, you could make them five or seven or eight if you wanted to. Yeah. Um, you're talking about like the final phases, introducing intensity, introducing speed. I know I've had a fair few listeners ask the question, like when I'm injured and I'm returning to running and most of my volumes, well, all of my running is now just a really slow intensity. How do I know when I'm ready for speed work? Um, I guess this is where that, that trim concept comes into it because then you can have that intensity. Um, aside from calculating the trim, is there any other cautious or guidelines, um, tips that you might have for someone? to who is ready to introduce higher intensity efforts and introduce speed, anything that you might want to include? Sure. Yeah. So I would say that if you're working with a good physio, you are as certain that you're ready to do speed as the physio is. And what do I mean by that? Well, we've already said that the way that you progress from one stage to another is hopefully that a test and sometimes they're not taxing on the cardiovascular system like a single leg hop repeated hop for an Achilles injury. But sometimes it is you know I want to on the bike we are going to do 10 minutes as hard as you can possibly go on the bike as hard as you can possibly go. And you can do that early on in the phases. And so you are in effect, and I know it doesn't feel like that because you're not running, but you are in effect gearing your system for faster muscle activation and to get ready for speed running. And so I do think that you, all along as you're tested, somewhere in that protocol should be maximum effort activities. Because not only did that does that prove to the physio that your condition's not irritable, that you're getting in better shape? But it also proves to you as the patient that you are able to do more than perhaps you thought and are not fearful of maximum effort activities. I think if that never happens in your rehab process, if you've never done a maximum effort activity on the bike, for example, all of a sudden you get to phase five and you're like, Everything that we've done up until now has been slow motion and it should not have been. It should have been, if you're doing a stair climber, which, you know, is no, um, impact at some point, you should have proven to yourself that you can go very hard on that and, and trim is what quantifies very hard. Hmm. Well said. Very well said. And I think it's the same discussion when. talking about, okay, I'm doing cross training only, how do I know when I'm ready for low amounts of running? I think it's the same process when someone's talking about, okay, I'm doing slow running, 100% of my running is extremely slow, what can I do to in? What should I do? Or how do I know if I'm ready for speed? You can do fitness tests, you can do capacity tests. And like the same discussion like a physio would know when what tests to administer and then pay attention to symptoms to see if you're ready for low amounts of speed work, it might be like kettlebell swings or something more power based like box jumps or something that includes a bit faster movements, speed, power plyometrics, and then paying attention to that behavior. And this is all dependent on the specific injury, but can then give us enough evidence or enough confidence to say, all right, let's start and then the process starts again, it was slow amounts of speed, slowly introducing interval sessions and sticking to those same, same trim kind of scores. I really, really liked that. Really liked that answer. Great, thank you. Yeah, and I think, you know, even with stress fractures, which are a scary injury, right? And they happen a lot if you run distance, so, you know, they're not unheard of. People get fearful when they hear the word fracture, and that is a normal reaction. And so if you've never... shown that patient, if you've never worked together to see that you're ready to start running, the first run is a very sort of scary thing. But, you know, I know you wouldn't, Brody and I wouldn't either. I wouldn't have someone run unless I could understand that they could absorb impact on that leg without having lots of pain. And so how would you test that, you do single leg hopping and bounding kind of work to, and that shows again, since, you know, the patients and the physios are working side by side, it shows both of us that you are ready to accept single leg weight and force into that limb and, and not hurt, right? So it shouldn't, it just shouldn't be a mystery that you're ready to do speed. If it is a mystery, That means that you haven't been tested throughout and you should do that. Regardless of what phase you call it, you should be re-examining throughout where you are. Yeah, I think it definitely shouldn't be a misery and we shouldn't be taking high risks. There's a way to slowly introduce things to reduce the amount of risk. I'm curious about the... you talked about the mental state, like someone might be quite fearful returning to... whatever next level next challenge ahead of them, whether it's introducing running or introducing speed work. And I guess for the recreational out recreational runners out there to understand what about if they're really strong, what about if they can tolerate running where more than confident they can tolerate running, but they're quite fearful, why is that important? Well, because it because it of course, and I know you know the answer to this, but thank you for asking me anyway. I do my best. Yes. And so that things like anxiety and fear, which are very normal, right? The research and again, I would I need to qualify this answer. Research would say that there is fear and anxiety in every athlete after an injury. And those are things, they are related to fear of re-injury. Anxiety about when I go back to competing, will I be as good as my old self? If it's a team sport, will my teammates see me as the injured person? Will I still have my same skill level? Will I? So there's all sorts of questions that are very normal that, you know, in the old days we just used to ignore them because we used to just think, well, physios are responsible for the biomechanics and the musculoskeletal issues here. We don't deal with that other stuff. And then we realized that other stuff was as important or more important than the physical things we were working on because, you know, you can... You can be in fantastic shape, a very strong runner. And if we've never proven to you that you are ready to go back and to compete, if we have never proven to each other that you're ready to go back and do that, your fear of movement and re-injury will markedly impact your performance. And, and again, the qualifier there is, I think that to be the case, but there is not oddly great research in runners about that. It's just not as prevalent as it is in the cutting sports where people tear their anterior cruciate ligament. You'll find categories like injury prevention, running misconceptions, strength and performance, and of course, injury specific information. You've already learned a lot listening to the podcast. Why not kick it up one more gear through the Run Smarter app. It's, it's an interesting topic. I think we can have an entire episode on this. And if someone is quite fearful, if their injury is ready for running, like if they're strong enough, but a lot of fear exists within them, they might move differently, they might be more tense, but on the other side of things from what the listeners will know about pain science, cause I've done a fair few episodes on that, and it's one of my particular interests. Um. Acceptable. We do allow acceptable amounts of pain returning to running. It doesn't need to be pain free. It can be like reduced, what we call acceptable amounts, as long as there's no flare up afterwards and it's recovering back to baseline symptoms quite quickly. But if someone is fearful, highly anxious, those thoughts, emotions actually amplify pain signals. And so it can actually, if we go for a run and it's, if you're in a nice calm confident state, it might be a two out of 10, but that might highly escalate if you are very, very fearful, because the brain starts to prioritize this as a threat, it starts to, you know, create a lot of perpetuating thoughts and kinesophobia and all this sort of stuff that really creates high levels of pain. And then it's really irritable afterwards, and it's not as successful. And that can kind of perpetuate fear and anxiety moving forward for the next attempt of running. And is there anything that runners can do in order to if they are one of those really high, highly anxious, fearful individuals, is there anything they can do within the rehab to help improve their confidence levels or minimize that psychological side of things? Yeah, so there are a bunch of things that we can do and of course, I won't go into this because you have other episodes, right? There's some good literature to back pain science education that you know the physios Discussion of pain science with their runner I also think that The testing and the maximum effort things that we talked about early or has a I hate to call it an inadvertent side effect because I'm so used to this side effect that it's not inadvertent anymore, but what I found was testing and showing people what they're capable of so they don't have to guess reduced a lot of that fear and anxiety. between patient and physio is incredibly important because it doesn't matter if I think my patient is ready to go to the next phase. If they haven't joined me in that process, then they are likely to have greater reports of pain, movement anomalies that in themselves might cause pain. So that's what I would say. Do you have other things that you do clinically? Um, clinically, no, I don't really necessarily do outcome measures and things, but I think, like you said, having that open and honest discussion, because if you're honest with the runners, the runners are going to be honest with you. And some runners might be holding back apprehensions or, you know, fearful tendencies. But if you're upfront and honest, then that's going to, um, come forth. And then if they do realize, or if they do communicate that they're anxious, then One of the most powerful tools I think is just education and saying, all right, so the demands with 30 seconds of running is going to be this. However, you are doing all of this in the gym and point them to an even greater demand, say if they're doing weighted step ups or if they're doing a hopping jump rope, all that sort of thing. And then pointing to those, the demands of 30 seconds of running is going to be nowhere near what you're already tolerating. And then that. can kind of like point them to evidence to help calm down their anxieties and kind of reassure them that way. But if they still feel apprehensive, then just working their way through that rehab ladder, maybe there's more rungs in that rehab ladder to help build up their confidence. And I think that's extremely important. Obviously, working with competitive runners, like you have is a different story, because you have competition, and you have a team that you're relying on and not trying to let down your team, there's a lot of psychological factors in there that I'm not used to dealing with, but I'm mainly referring to those who think they're going to flare up their injury or think that they're going to, you know, do more damage or another injury is going to arise and just allaying their fears with education, just building up their confidence that way. Yeah. I couldn't agree more. I wanted to finish up with any common miss like mistakes that you find runners making. or misconceptions that you see within the running community. Maybe it is when returning from injury, maybe it's around injury prevention. First of all, we'll start with mistakes. Any common mistakes that you see athletes making. Yes, and okay, so your audience needs to understand that I love working with runners. They're one of my favorite populations to work with, if not my most favorite population to work with. Yep, here we go. But I do see, yeah, so all of that said, I do see some very common things that runners do that sort of, when I was new to working with runners 12 years ago, they stuck out to me as different in the running population, right? And so, the first I would say is that people are in too big a hurry many times to get back to running. And the first day that they would have a pain-free day, they would go out and run 10 miles, even though they hadn't run 10 miles in three months. So, in a big hurry. to return to running and I'm hoping our discussion of TRMP and alternate ways to be ready for a return to run helps a little there. The other thing that I see is I think they believe that when pain is gone you're better. So that's the other thing. And I think with a good physio, what you're trying to get at is relieving pain, but also to understand the reason why the pain began in the first place. Was it a training error? Was it equipment? Was it nutrition? Was it is it the way that you move? Are your biomechanics such that? Every time I return you to running, when you get to a certain mileage, you're going to get a metatarsal stress fracture. Right? And you could be pain-free now, but if we haven't corrected some of those things, the likelihood that you'll be in pain again is high. I would say the other one, and this is my own bias, so freely acknowledged, way too much use of the swimming pool and aqua jogging. I'm not a fan of either, which I'm happy to talk more about. Uh, doesn't mean I never use it. It means I rarely use it. And then I would say that the final error is, and I get this, especially in recreational runners, right? Very often it's your favorite, most fun form of exercise. You want to be able to work into your busy life, the ability to just come home. Or go out at lunch throw your shoes on and run and when you get back you feel Fantastic and you're ready for the rest of your day or you're ready for going out that night or whatever it happens to be but Then if that's what you do, I think you're missing the fact that Runners are athletes and I know that sounds like why would you say such an obvious thing because there was a time when runners were were runners and athletes were people who played basketball and football, right. Um, or, or soccer. And so I think many runners don't give strength training the credence it probably deserves and make time for it in their, in their training schedule. So many good points there. I wanted to delve into all of them. I don't think we have time. I will talk about the, that hurry. that people do have, I think that's such an important one because I work with a lot of injured runners. And when I'm working with them and they're in pain and they're not running because of their pain, I ask what are their goals? And their number one goal is I just wanna run pain-free no matter what distance, I love running, that's all I wanna do. And then maybe it's in a couple of weeks, they're back to pain-free running and they say, so Brody, there's a marathon in 10 weeks, do you think I'm ready? And you just, you know, you have to talk them down from that. But it's, I think it's human nature of a runner. They just, you know, as soon as they feel great, they're looking for that next challenge, which is fantastic, but you do need to be very sensible. And I think when people are pain free, it's very hard for them to be sensible. They're only sensible when they're in pain, because it's such a high motivator. But can, can we answer this one really quickly? If you have, if you are returning from injury and you now are pain free and talk about using that trim, is there a. method, how much trim should we be improving? Is it 10% per week? Is it more than that? Is there any guidelines around that? Yeah, what, and again, another great question. So the evidence based answer, if evidence based is black and white, like we discussed earlier is we don't know. Dr. Tim Gabbott has done a lot of research about that, about this acute to chronic workload ratio, right, that when you exceed, if you look at your TRMP over four weeks and you exceed that TRMP by 50 percent, so if you do 150 percent of your TRMP in that next week, your likelihood of injury goes way up. And so... Again, 150% acute to chronic workload ratio seems to cause injury. Um, when he made that statement, he did not say that 150% was the number across every single sport because there hasn't been data gathered across every single sport. So I still use that as a rough guide. I still use no more than 10%. as a rough guide. But again, I've worked with some elite athletes that can handle more than that and have not a severe injury and not one that's highly irritable. And so we may progress more. But I think if you're looking for rough outline of those out there, I would say look at your four-week trim and try not to exceed that this week by more than 50 percent. And then, um, you know, no more than 10% a week. Good number also. Yeah. A good, um, safe advice there as well, but like we do know that there are some resilient runners out there, the phenomenon, and we do know that there are some injury prone runners out there for whatever particular reason, but I think if you are implementing this trim method, you at least have data. So if you are injured, you can look back and say, all right, oh, I increased by 15%. let me overcome this injury, then next time, let me not exceed it by 15%. Let me just go below that and stick around, you know, 10 to 12. And you then have evidence for yourself as a runner, as an individual, instead of trying relying on evidence that accumulates a whole bunch of different runners, along with those say, resilient runners that just don't seem to break down and, um, it's just comparing yourself against yourself and it's also listening to your body as well. If you try to. increase by 15%. And before you get to an injury, if you feel yourself a little bit more tired than usual, a bit more lack of motivation, you just feel a bit more stiff and sore and just not really eager to get out there, maybe that's a sign that you are ramping up too much and you catch yourself early enough before an injury arises. And then you can say, look, I don't really respond well to that increase, that percentage increase like other runners might. So let me just go a bit lower than that. I think You're, it's the best to compare against yourself and having the data to compare against yourself is the best. And so calculating that mileage, calculating the trim is probably the best way to do that. And as we wrap up, are there any other final takeaways, anything we maybe haven't talked about or any final just messages that you want the listeners to. To catch. Well, I think, I think there's a future episode here on prediction of injury. So how. How does that athlete know when they're teetering on the edge of getting injured? That's a whole nother discussion for a whole nother day. Um, and it's very complex, but you're right. You mentioned some things that are very key there from, from the physical to the psychosocial, to the things like sleep and stress and those sorts of things. Uh, the way they change can make you more prone, but I would say final takeaways from this session, please strength train if you're a recreational runner. Uh, Please work with a physio and ideally a team of people if you can as you try to progress safely back not only from this pain episode but to prevent pain episodes from recurring again in the future. I would say find somebody, this may sound a bit of snobbery but it's not meant to. If you're going to work with somebody that actually works with runners, then who has better advice for you than, well, just rest until it, until the pain goes away and then you can start running again. Um, and then, and then try to enjoy more and look at your watch less. I would say, yeah, runners are too hard on themselves these days and they hold themselves very accountable. They hold themselves to a very high standard. And if you just learn to enjoy, not compare yourself to others and just love the process, I think it's not only more enjoyable, but your body thanks you in the long run as well. I think you're exactly right there. Running is a, is a wonderful and a beautiful and a, you know, exciting sport. Um, running has let me run places where the, the beauty was awe inspiring. And I know it has for you also, and many of your runners out there and to miss. to miss that beauty because I was worried about being 10 seconds off my mile time just seems like a waste to me. Eric, this was a very heavy hitting interview. I think it was just jam packed of value the entire time. And so the listeners are going to absolutely love this. So thank you very much for coming on. Thank you for the research that you do. And yeah, it's a lot of value in this episode today. So thank you very much. Brody, thank you and thank you for answering my questions. Great insight as well. And that concludes another Run Smarter lesson. I hope you walk away from this episode feeling empowered and proud to be a Run Smarter scholar. Because when I think of runners like you who are listening, I think of runners who recognize the power of knowledge, who don't just learn but implement these lessons, who are done with repeating the same injury cycle over and over again. who want to take an educated, active role in their rehab, who are looking for evidence-based, long-term solutions, and will not accept problematic quick fixes. And last but not least, who serve a cause bigger than themselves and pass on the right information to other runners who need it. I look forward to bringing you another episode and helping you on your Run Smarter path.