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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, we have a previously recorded Ask Me Anything exclusive release. Welcome to the only podcast delivering and deciphering the latest running research to help you run smarter. My name is Brodie. I'm an online physiotherapist treating runners all over the world, but I'm also an advert runner who just like you have been through vicious injury cycles and when searching for answers, struggled to decipher between common myths and real evidence-based guidance. But this podcast is changing that. So join me as a run smarter scholar and raise your running IQ so we can break through the injury cycles and achieve running feats you never thought possible. coming in and very excited to dive into them. There's a different variety of questions here, which I think you might enjoy. um Let's start off with Rebecca. Rebecca chimes in and has wrote in her questions on the blog in the Run Smarter app. If you're looking for questions to have answered, you just need to go to the Run Smarter app, go to blog, then go into the Patreon community and then you'll have your um exclusive topics that you can suggest. And you also have your ask me anything questions that you can submit. And Rebecca has done just that and has said, I have been rehabbing my knee strain on my own for many months. It continues to get worse after listening to your PES and Serene podcast episode. That seems to be the most accurate. That seems to most accurately describe what I have been experiencing. Is it better to seek professional physio support or to find a doctor to ask and determine if it is bursitis? I'm tiring of unsuccessful rehab attempts. Thank you Brody. Thanks for reaching out Rebecca. Hopefully this reaches you in time. Um, let's start off with a PES and serine sort of tendinopathy. Cause I did do an episode on this and you can refer back to that on the run smarter main feed if you wanted to learn more about it, but If you were to feel the back of your knee, and then feel the inner part of the back of the knee, you'll see that there's a lot of stringy bow stringy kind of tendons around there. And there's three main tendons. And those make up, they sort of spiral together and sort of make up your pes anserene, because they have a very common attachment. And sometimes those bowing and um joining of the tendons together in that, that one region can become irritated. And I've had that I've had this in the past and Rebecca, I'm going to not assume that you have this because you know, who knows? It seems like you've listened to the episode and you might think that it sort of fits your pattern and it may very certainly, but I would definitely get it checked out for a number of reasons. one, you said you've had it for many months. It doesn't need to go on for that long to you said that it's getting worse. So I would definitely ASAP get some professional advice and accurately determine, um, what it could be, and then come up with the best plan moving forward. And so it's a, it's an interesting question of, okay, should I seek out a physio or should I seek out a doctor? Um, you can get a really, really good doctor. you can get a really good physio and vice versa. so finding someone that you trust, someone who may be trustworthy in the past, would gravitate more towards them as a whole. I would say this really isn't my bias, but I would say a physio would be more, um, the first point of contact for these types of injuries. Um, doctors are very generalist and, or generic, I should say, and may be a bit unsure of a diagnosis and may refer you either to a physio or refer you to scans to which how reliable scans might be is questionable in itself. But a physio, like say you can have some poor physios out there, but if you have a good trusted running based physio, they will quite easily diagnose what it should be. um Pesancerein is different from bursitis um and differentiating the two should be fairly easy. Although there may be some overlapping symptoms which may muddy the waters a little bit. But nonetheless, they can come up with a good plan for you. The right exercises, the right activity modifications, the right running modifications, and then determine where to from here. And if symptoms continue to get better, then you know, you're on the right track. We don't need to do this for months. This doesn't need to get worse. We can start seeing improvements week by week to know that we're on the right track. Um, so that would be my advice. Find a trusted physio. If you don't have a trusted physio, I suggest try to find one, um, and make a new mission. Cause if your goal is to run for decades to come, niggles are going to come up. And if those nickels get worse, we don't need to be injured for months and months at a time. We can just see our trusted physio and they can provide the right diagnosis information moving forward um to help you. So ah if you listen to that episode, or if you haven't listened to the PES, anterine episode, um one exercise that I really, really like and really helped me with my PES anterine issue was Resisted hamstring curls. So most people are familiar with a prone hamstring curl where you lie in your stomach and you curl the weights uh as you flex your knee. Most gyms have a prone hamstring curl machine and that works really, really well for this injury. However, when your legs are out straight and you start that initial hamstring curl movement, It's the first like 10, 15 degrees where that lower hamstring works the hardest. You sort of bias the lower part of the hamstring. Then as you curl, it's sort of the whole unit starts to work and the middle part of the hamstring, the upper part of the hamstring will then kick in. But we want to try and bias the distal part of the hamstring, the one that's closest to your knee. And so what I like to do as an exercise is lay down on that prone hamstring curl machine, have my legs completely straight and just slightly bend in the most slow controlled fashion, slightly bending that to about 10, 15 degrees. So the legs are still quite straight, just a little bit bent and then we slowly release it back to the start and just work within that range of movement. That, if it is a tendinopathy, we know that with tendinopathies they like slow, heavy progressive load. So this offers that slow, heavy resistance that works really, really well. And if that's tolerated and you start noticing improvement, get heavier time under tension a bit longer and yeah, discontinue seeing improvements beyond that. So that would be my advice in terms of seeking out a physio or a doctor. That'd be my advice in terms of the exercises. If you do that exercise and symptoms continue to get worse. um You know, it might be start you might may have started with an exercise too aggressive, or like say it might be something else. It could be bursitis. And if identified, um usually like a steroid injection is or, yeah, steroid injection would usually be the most effective approach for that. But monitor your load, monitor your running loads, monitor your speed as well. um I know in that podcast episode I did speed was really effective. So I really peeled back my speed efforts and just kept everything really slow. I widened my step with a little bit. Did a lot of cycling and swimming at that time to sort of keep healthy. But yeah, it was a very patient process. But once I started doing the right things, I started seeing improvements week by week. So thanks for your question, Rebecca. Next one comes in from Steve, who says during your rehab, When can you reintroduce a back-to-back running days? Are there certain milestones that should be reached prior to the reintroduction? In my case, I've been running every other day for several months at an average of about 80 to 90 kilometres a month as I've rehabbed my Achilles tendonopathy and I've battled that I've been battling since 2020. They're all easy runs, though I've added a decent amount of hills to the runs, thanks. Good to hear from you, Steve. I'm glad things are going well with you. um Great question as well, because no matter what injury people have, um I think people have the same question of when to reintroduce back-to-back running days. um I couldn't really think of a lot of milestones, um depending on the dosage of the back-to-back running days. I guess one of the obvious milestones would be that your symptoms after one day of running needs to return back to baseline relatively quickly. In most cases, we're talking less than 24 hours, but to be on the safe side with introducing back to back running days, you probably want to be less than 12 hours. If it's less than 12 hours, I would say, yep, definitely. If it is your goal to introduce back to back running days, you're more than ready to start doing that. So it's not necessarily about the mileage or the speed or any, hills or anything that you can battle because you know, running is very flexible. We can say back to back running days. As an example, you can run 10 Ks on Wednesday and then Thursday do a one minute run, one minute walk 10 times. And that's counting as a back to back running day. And it's all about trial and error. I can't stress this enough with back to back running days, cause you never really know. Yes, we can pay attention to symptoms after that bout of exercise to know if you've returned back to baseline and we can use that to justify attempting, but we're never going to know unless we try but that try should start off with being really conservative. And so my guidelines for most on average would be do your run that you can tolerate like you say, Steve, you're doing runs every second day, I would find a day in the week where it's sort of like a moderate run. And that might be six, seven, eight Ks. And then the next day do something that's really easy, like 50 % of the duration. So it might be like a three K easy run, make sure it's slow, make sure it's short. And then we can just say on the Thursday, do we go to Thursday? Day three, I should say, um have a rest day, observe your symptoms. make sure things are still back to baseline. And then we can comfortably say that was successful with that attempt, that trial and take it from there, building the volume up. that 3K might turn into 4K might turn into 5K, but I will say with it moving forward, just to be on the safe side, you want to keep day two. So run on day one, day two should be like a recovery run. It should be one of the light to a session. If you wanted to do hills and speed and long stuff, make it day one. Don't make it on the day two because hypothetically you could do a run on day one, say moderate, moderate run and slightly elevate symptoms. But it's so slight that you don't know. Like it's not, it hasn't been a part of your awareness. It's not that severe. It's gone from like a one to say a 0.5. But that 0.5 irritation could really amplify if you do a speed session or if you do a lot of hills or a really long session that, you know, it's challenging you, it's really pushing you that can have a possibility to really exacerbate things. Whereas if you do a run on a, if you do a moderate run or even like a speed session on day one and you really push your capabilities on a day one, And then day two, slightly elevated, but not enough to enter your awareness. And it's just a slow, easy recovery run. Then we don't have that overreaction. And yes, it might then be severe enough to be in your awareness, but it's like maybe a one or a one and a half out of 10. And it returns back to baseline relatively quickly. And then we, we quickly catch that we learn from that and say, okay, whatever it was day one, day two, the combination of that. I didn't. agree didn't agree with me right now. So let's make some adjustments for the future. That's how it's a perfect illustration of how trial and error should be working and how us runners, if we are returning back to running or for rehabbing a certain way, that's how we should be approaching this particular structure. Really like that question, Steve, hope things go well for you. Keep me updated over the next couple of weeks. ah Now we have one coming in from Tasha. Tasha says Hi Brody. What do I need to work on to keep my lower back muscles from getting tight when running? The longer the run, the tighter it gets. When I end my run, I have difficulty with forward flexion, so to spending forward, for several moments after. When I finally bend forward at the waist, my back will release after about 30 to 60 seconds. What can I add to my rehab exercises to prevent, manage, improve this issue? Thank you. Thanks for your question, Tasha. It's an odd one, because I don't get too many lower back stiffness, tightness symptoms with runners. It's not that common. let me answer this question, assuming that it is muscular in nature, because you do say, you know, my muscles get tight and I feel like they get tighter. uh doesn't seem like it's anything to do with the joints or anything to do with discs or ligaments or anything like that. And, you know, knowing you personally with your professional background, I'm assuming that's accurate. um Let's say that it is muscular. My first bit of advice, I've got a few dot points here. My first bit would be okay, stretches can help, I guess, um some flexion based exercises or stretches before even during and after can be helpful. I like to do some sort of rotations. So lying on your back, bending your knees, rocking your knees side to side, just to get a little bit more mobility. A child's pose can be okay at stretching the lumbar flexors, or you could just sit in a chair and just bend forward and fold over and sort of just do some lateral flexion side to side, just getting those muscles a little bit more. um a little bit limber, I guess you could say. And throughout the run, as things start getting tighter, like you say, the characteristics is it just gets tighter and tighter when I run. Maybe find two points within the run where you'd stop, do some light stretches and then get back into it. But that's a trial and error. I say it all the time, trial and error, but that might not help you, but it could be a game changer for you. I don't know, maybe give it a try. I would stretch for 15 to 30 seconds, 60 seconds max, and then see if you personally notice benefit with doing those sorts of things before, during and after. Part of me thinks also like if you are a type of runner that has a low cadence, um lower than optimal, maybe you're hitting the ground too hard, like your erector spinae muscles, which is the ones that ah run alongside your spine on each side. They really work hard when you hit the ground. Even if you were just walking. And I used to do this when I was at physio. um I used to feel my erector spinae and I used to walk from side to side. So when I impacted my heel on my right side, I just feel my erector spinae on the left side really just tighten up and activates it's meant to keep you upright. m And then vice versa hit the ground with the left. And the right will switch on and the left will relax. And it's all just has this combination. So that really grips those muscles. And if we have a harder ground reaction force, that is harder, the muscles need to really work. part of me thinks might not be in your case, Tasha, but for those listening, if you experienced similar symptoms, maybe increasing your cadence into an optimal range, reduces the ground impact force, reduces the amount of gripping and tightness that those lower back muscles need to experience. So maybe that's something for whoever's listening to give it a try. Now the next part that I think is ah make sure you're running relaxed. This might be counterintuitive to a lot of physios and runners and what they may have been told because when it comes to posture, like I say, not a lot of runners get a lot of posture issues, they don't get neck pain, shoulder pain, upper back pain, lower back pain, any of those postural muscles, very rarely does it do those type of muscles get tighter and tighter and tighter and tighter. But you may be led down the path of thinking that your posture is off, thinking that your posture is weak, thinking that um there's something you need to change about your posture. And consequently, you tighten things up. A physio might say, oh, you need to make sure that you're activating your core properly or activating your glutes properly or um tilting your pelvis is another one that I often hear when you run. Don't try and do any of those things. In my experience, that's just going to make things less economical as a runner and people tighten up and they do start getting lower back tightness, neck pain. upper back tightness because they're so rigid in their movements and those muscles are really being overactive. Like I say, when you when I walk and feel my erectus spinae muscles, if I hit with my right heel, the left side really fires up, but the right side really relaxes. And it should be this back and forth. But if you're trying to activate your core, if you're trying to tilt your pelvis, engage your glutes the entire time you run, there's none of that. activate, relax, activate, relax type of pattern. it just, it's all just activate and then everything gets really sore, really fatigued, really rigid. And these type of symptoms start manifesting. I'm not sure if that's you Tasha, um but just where my brain goes when people write in their experiences and their symptoms and signs and those sorts of things. So if you feel like that is you try to run relaxed, try to. um just do what feels natural. And most people, they run to their natural abilities. They usually try to, they usually gravitate towards something that's their most efficient. Now our next point might seem a little bit more, uh a bit counterintuitive to what I just said, but it is back strengthening exercises. So I've gone through stretches, told you to reduce your impact forces, maybe run relaxed, but also, Strengthening can really help. Um, I've had lower back issues in the past and I've done some lower back strengthening. That's worked wonders on me. I just had it recorded a success story with, um, a PhD success story with Mark and not sure when that episode comes out and when this episode comes out, but nonetheless, um, you might hear it in a couple of weeks. Um, he was talking about lower back pain that he had, and I assigned this back exercise and he was magnificent for a week. Like it only took him a couple of days of doing that exercise and he was running fit. Um, he was amazed and I was amazed to be honest. Um, but you're saying it sounds counterintuitive cause you're saying Brody, okay. You're saying I should run relaxed, but I should tighten up and strengthen my back muscles. Um, back muscles, most of the back muscles are, well, you got two types of back muscles. Some of your postural muscles. that are designed to stay switched on for a very, very long period of time. And some are designed to not be activated for a long period of time. Instead are designed to really have this big forceful one-off movement for a couple of seconds and then relax. So if you have to pick up a heavy box, these big back muscles switch on so you can do that, put it down, you're done. But when you stand, Your body just doesn't fold over. So there are muscles there that activate for a long period of time and designed to activate for a long period of time. But when you run relaxed, we're getting those postural muscles to activate and we're getting those big powerful muscles to relax. Because as soon as you get those big powerful ones that are designed to lift something heavy and then relax, as soon as they are activating for a long period of time, they are going to become really sore really quickly. But some strengthening exercises helps build up the capacity of those muscles, helps build up the capacity of all the muscles in the lower back so that the big powerful muscles don't need to play the role of the postural muscles. The postural muscles are strong enough to do things on their own and don't require the big muscles to stay switched on, if that makes sense. And so the exercise I really like is called Lumbar hyper extensions where um mainly at the gym, you can do a home setup, but you have, you're essentially resting your pelvis on an incline so that you're standing at sort of a diagonal, a 45 degree diagonal, and you can fold yourself over uh almost like an arm of a couch. If you were to do something at home where you're a complete plank straight, your heels are fixed against a wall or something so it's not going to move and you've got your resting your hips against the back of a couch or the arm of a couch and then you fold yourself down and then you arch yourself back up. You are using your back muscles to against your body weight resistance to go into extension and you're really working all of those back muscles to strength. You can start off with isometrics so you don't need to fold yourself down and then arch yourself up. You can just hold that position that the plank straight position and do that for 20 seconds. Do that five times and see how challenging that is for you. But eventually you want to progress to folding down and arching up and doing three sets of 10 or three sets of 12. Me with my newborn, Mackenzie is just about to turn. Oh, she turned five months yesterday. um the, my lower back really was shot for the first couple of weeks. And I made a dedicated effort to do more and more back strengthening exercises. Cause for decades, my back has been a vulnerable point of mine and this exercise has really saved me. Um, I do it slightly different because of the, just the arrangement I have in my gym. So I am completely perpendicular to the floor, um, raised off the floor. have my, um, plyo box that I lean over. and my ankles are just hooked to my barbell. And so I'm completely straight, completely perpendicular parallel, sorry, parallel, completely parallel to the floor with my hips fixated on the plyo box and my upper torso just floating in space. I'm now at the point where I have a 10 kilogram weighted vest on and I do those hyperextensions. I'll do four sets of 12. try to go slowly, try to go through range of movement and yeah, my lower back just really responds well to that. um So Tasha, assuming that this is muscular, can try some stretches before, during and after, see if that's of benefit. Maybe increase cadence and reduce impact forces. Try to run relaxed if you feel like you're tensing up and trying to activate or position or do any unnecessary postural stuff. and there's the strengthening side of things. Hopefully you enjoyed, so we'll catch you next time. If you are looking for more resources to run Smarter or you'd like to jump on a free 20 minute injury chat with me, then click on the resources link in the show notes. There you'll find a link to schedule a call plus free resources like my very popular injury prevention five day course. You'll also find the Run Smarter book and ways you can access my ever-growing treasure trove of running research papers. Thanks once again for joining me and well done on prioritising your running wisdom.