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The Physio insights Podcast by Runeasi
Welcome to The Physio Insights Podcast by Runeasi, your trusted space for real conversations at the intersection of science and sport.
Every two weeks, we sit down with passionate clinicians, biomechanists, and rehab experts to share the insights, tools, and stories shaping the future of running performance, injury recovery, and movement science.
🔍 Created for physical therapists, gait geeks, and rehab specialists who care deeply about helping athletes move better, faster, and stronger.
Hit subscribe and elevate your clinical game!
Welcome to the Physio Insights podcast presented by Runeasy. I'll be your host, doctor Jimmy Picard. I'm a physical therapist, running coach, and team member here at Runeasy. On this show, we have real conversations with leading experts, digging into how we recover from injuries, train smarter, and use data to better guide care. Whether you're a clinician, coach, or an athlete, we're here to explore what really matters in rehab and performance.
Jimmy:Let's dive in. All right, Gabby, welcome to the podcast. It's great to have you here.
Gabby:Thank you for having me.
Jimmy:Of course. Well, to get started, why don't you just give us an introduction, tell us a bit about yourself, tell the listeners I know a bit about you, but I'd love to hear you introduce yourself.
Gabby:Yeah, so my name is Gabby Kalighi. I am based right outside of Boston, and I own a practice called the Run Rx in Somerville in Massachusetts. And we are a out of network practice where we specialize in working with runners in both the physical therapy and the personal training setting. And we utilize very heavily gait analysis in the way we evaluate runners both at Eval and throughout their care. My background, kind of how I got to today, I had a background in exercise science.
Gabby:So I was an undergrad exercise science major. I worked, I spent a little time working as a personal trainer before I went back to physical therapy school and ended up working in the general setting for a while, busy setting, and then landed. I really was always interested in working with anything that had to do with the biomechanics of sport, repetitive use injuries. I was actually by trade, I was actually soccer, basketball, lacrosse. So I wasn't really a big runner until I got into college and got into running but I was super interested in like either going the golf route or the running route.
Gabby:I was super interested in the breakdown in the biomechanics of certain injuries and especially repetitive use injuries. And as a runner, especially was leaning towards that. So I ended up working at the Spaulding National Running Center for a long time for four years where we were guided sort of by research that was being done in house around minimalist footwear and we spent a lot of time working with runners and transitioning them over into minimalist footwear as well as doing some pretty in-depth gait retraining. So we worked through a pretty structured protocol with that where we would be doing a lot of work off treadmill, strengthening the runner, strengthening their calves to get them prepared for this style of running based on the research at the time that minimalist footwear and forefoot striking would reduce impacts in runners. So we would do kind of a prep phase and then we would do a gait retraining and a transition to forefoot phase as well.
Gabby:And I learned a lot in that time and it exposed me a lot to, you know, to the research and a lot was going on and also really got me into finding my own autonomy and getting a lot of reps with runners and seeing what was working and seeing what didn't work. I was also simultaneously spending a lot of time training general active adults but a lot of runners as well, more in the straight setting. And decided that I kind of wanted to separate and do my own thing because I was finding that I wanted to have my own autonomy and the way we approached working with runners. And the big thing I found is that, you know, the current insurance based setting was kind of failing a lot of the people that I was working with. They were getting denied being able to come in because they were being told that you can do all the functions of day to day life.
Gabby:But you know, what I knew for them was that running was a massive massive part of their life. And it's really for all active individuals, but definitely for runners where sometimes their goals are being told like, well, that's not important by the insurance company. And they were being discharged at points where I would have loved to keep working with them. I felt like I had the ability to continue to create a positive influence on their health and their fitness. And so I opened the Ren Rx in 2021, kind of tail end of the pandemic.
Gabby:We have grown now to three physical therapists and as our name states, we really have just dove into our niche of working with runners and really specializing in working with them. And we definitely have kind of a broader mission of not only to serve this population, we kind of say runners and the modern athlete. While we see mostly runners, we do just see a lot of people when we define the modern athlete as people who want to take part in higher level activities sustainably through their life. Whether that's CrossFit or higher ups or hiking or being the weekend warrior or frisbee, whatever it may be. So we wanted to serve those people and we wanted to specialize in runners, but we also really wanted to transform how healthcare and fitness were serving those people and kind of shifting the culture of things being really reactive and fragmented to being more proactive and holistic and more human centered and giving runners the chance to not just rehab with us in a more effective way, but also maintain long term relationships with us so that we can be a part of their ongoing care and help them not just get better and return from injury, but to get back into hitting some performance goals or long term sustainability goals or whatever it may be.
Jimmy:Yeah. All right. I'm curious. Yeah. So, you graduated from PT school and one of your first jobs out of school is working at the National Running Center.
Jimmy:Is that right? Yeah. Yes. And when you said you were doing the gait retraining and kind of working with runners in that context, were you dealing with, like injured runners at that time when you were doing that intro to barefoot running style stuff and the strength work to prepare them for barefoot or forefoot running strike or was that healthy populations?
Gabby:For the most part, it was injured. We would definitely get some people who maybe were not having a ton of pain in the moment but could have potentially been referred to us for some reason, but for the most part those were injured individuals. And it was a lot of times, you know, especially with the commitment to such a big task such as gait retraining and changing the way somebody moves, it tended to be the people who had failed in many other ways and were looking for some, you know, last ditch effort to how I can address these running pains that I'm having.
Jimmy:Yeah, and so while you were there doing this or doing that, sounds like, well, was there some frustration with like kind of like the way you were doing it? Or did you feel like there are more options than just the one at the time or just overall like a good learning experience as you're kind of navigating that?
Gabby:Yeah, I mean, an excellent learning experience. At the time that I kind of shifted over to working there, and again, when you're working like right within the research zone, you're usually, there's some element of research that's being the focus. And so I actually, when I came in, didn't know a ton beyond like the very basics around minimalist and barefoot running and you know, this was a few years after the big blow up of Vibram and minimalist footwear and I think that that came on really hard and it wasn't like, you know, I think there was even lawsuits around, you know, people were getting injured because we didn't accommodate our feet to doing this and everyone just started buying these shoes. So that's what I knew and I learned a lot about minimalist footwear and just footwear in general, which is always a really, you know, important conversation as part of the larger running injury conversation. But I learned a lot about footwear and then really a lot about, you know, the motor control and the really clear motor elements of gait retraining and movement retraining for sure.
Gabby:And it was a moment, I look back on and I learned so much, but it's funny how much I've shifted since in my perspective on how much and should we gait retrain, as well as my perspective on, you know, where people should land in some of the extreme debates within running physical therapy, like maximalist versus minimalist, forefoot strike versus heel strike. And a lot of it is just like, I've digested a lot of the research and then like we're gonna land in the middle somewhere. Yeah. And we have this research that we know and a lot of time that can combat one another. But kind of it helps guide by by kind of finding somewhere in the middle and then recognizing what is out there to help us serve the runner which at the end of the day is the person that's in front of us and the research is there but we need to work for that person.
Gabby:So it definitely introduced me a lot to sort of the more extreme opinions and then had me kind of shift my opinion on it. When I opened my practice initially, we did a lot of gait retraining. It was kind of what I knew. It was like, okay, gait retraining is one of these tools that we have and we can change the way people move. But I've since really shifted away from that and I think many people have.
Gabby:Yeah. Just kind of respecting the runner and everyone's unique way of moving.
Jimmy:Yeah, I think it's interesting because there's all these camps out here, like you said, there's the minimalist camp, the maximalist. And I remember graduating from PT school and I feel like HOKA's were just like becoming the thing. And I remember one of my instructors being like, just seems like such a bad idea. You have this huge stack, you're going to roll your ankle, what's going to happen? Then also, yeah, the camps between like, do, yeah, when we see somebody run, is this, do we need to change the way they run to help them get out of pain?
Jimmy:Is there an ideal way to run? Or on the other side is, do we just do some interventions, some strength work, something to build up the runner to tolerate the way they are running and not change their gait at all? And yeah, you kind of see like there's a lot of nuance there because there's, at least personally, like I see value in, yeah, maybe manipulating gait subtly to unload specific tissues while at the same time doing some strength intervention or something like this to build it up, to tolerate more. It sounds you've kind of like, yeah, gone from, you've moved around a bit.
Gabby:Yeah, I think where I land now and it lands me more in just a place of flexibility is that I like to stay off of the extremes. And in fact, I'm more extremely passionate about being neutral. And understanding these extremes and recognizing them. But yeah, recognizing that, you know, we need to sort of take each runner as they come and we can't as rehab professionals or as trainers be standing too extremely in one of these camps because you know what, there's going to be a case where it just doesn't apply. In fact, I have still had a number of people where I've maybe transitioned them to a more minimalist shoe or a forefoot strike.
Gabby:I have found at times there's been, you know, compartment syndrome I've seen it work well with at times and it's usually never the first line of defense is the big thing we talk about. But if I'm having a runner who's coming to us and they've tried everything and they're at the end of the line and we can try retraining gait in some way in a very educated way and it's, you know, what do we have to lose at that point? Then yeah, we'll try it. Run Easy is really great in being able to do that because we can do it with true live biofeedback. So we're not feeling like we're just throwing things at the wall and hoping they stick.
Gabby:We can actually see is this actually helping at least with the metrics of running health and then obviously taking some feedback from the runner. But I think especially when it comes to gait retraining, the way my perspective has shift coming back to how the standard practice of physical therapy insurance is limiting is that I don't know that people were failing in physical therapy because they weren't changing their way they move or they had a faulty way of moving. I think it was because the standard physical therapy setting doesn't load the runner enough at the end of physical therapy to prepare them for the tasks that they want to do. That could just be, you know, the clinic and the setting, but it and it could just be the insurance limitations around like getting them to a point where their bodies are super resilient to hold up to the type of sports that they want to be able to Yeah.
Jimmy:I almost see it as like a problem with the profession in general of like kind of underloading or yeah, maybe it's like the system at large that like puts this pressure on us to like get patients better in X amount of time or within X amount of visits. But yeah, I think like there's a lot of truth in what you said there. And really quickly, you touched on, yeah, using tech to help you kinda uncover what the runner or how the runner is doing, how they're moving. I think you used the term, like, the runner's health or something like that. If we back up to your time at the National Running Center, you had access to like force plated treadmills and all that stuff there.
Jimmy:So you got into kind of monitoring runners with tech a while ago. Was that experience like?
Gabby:It was great because, you know, when we started using RunEasy, it certainly made the sudden need to digest data a little bit smoother, less of a steep curve because it can be a lot. But yeah, we would get, you know, we'd have the lab, the fully instrumented, the full lab treadmill and we would, you know, get the data from those treadmills brought up to us. To be honest, in that setting, was a lot of data and numbers and like these kind of printouts of like the biomechanic researcher data. A lot of similar themes to what we look at with the RunEasy, but it's a lot to digest when it would be brought to us. But, you know, we'd be able to see the difference in what was going on.
Gabby:The runner would run barefoot and with shoes on, so shod and and barefoot. And and then we would just be able to see the differences and the primary things being that kind of that impact curve that would happen that tended to happen more often in the shod runner. The runners are hitting the ground a little bit harder because the background there was the research had shown that more cushion, more stack meant harder forces into the ground and therefore harder forces back up at the runner. And it kind of in like the Renese speak, it's that that absolute value of impact magnitude would be the number that the research was showing was higher. So yeah, a lot of data that was very heavy sometimes to interpret, definitely even for the PT, but certainly for the patient.
Jimmy:Yeah, so back then, were you translating that data, interpreting it for the patient and educating them on that? What did that look like?
Gabby:Yeah, we would. We would walk them through the difference of the shot and the barefoot running along with the researchers there. We would show to them how the impacts were less when running in barefoot. Now, fast forward to even recent research, and the belief there is any way we can reduce impact with a runner means less impact, less injury, which is a logical theory. Now we're kind of learning that that's not the only thing that contributes to it, the pull of the muscle on the bone is actually a major contributor to load on the tibia, which can lead to bone stress injuries.
Gabby:And you know, what we also know as know, PTs that work with runners a lot is that different footwares load the body in different ways. So maybe something up the chain at the knee that lesser impact is helpful, but is it gonna put a lot more load on the foot and ankle and is there a history there? And then just the understanding that, you know, in performance to run fast, you have to kind of put a lot of force into the ground to then propel yourself forward. So kind of looking at some of this data and thinking about it in a larger scale and specific to the runner is very helpful.
Jimmy:Yeah. It's like an interesting thing. I don't want to get hung up on the barefoot stuff, but I think I'm old enough to like, yeah, I worked at a running shoe store when Born to Run came out and when, and yeah, I bought into the Kool Aid, I had a pair of Vibram Five Fenders for a little bit. And to this day, I'm wearing a barefoot shoe right now. Yeah,
Gabby:and we love that for walking around.
Jimmy:And that's what I found like pretty quickly as like especially in my early 20s when I was racing competitively trying to run fast, it was quickly apparent that a barefoot shoe is not the way to do that. But then of course you see these outliers like whoever was the Kenyan marathoner or whatever that wanted barefoot in the Olympics and it's like, okay, there's one person but I grew up wearing cushioned shoes and all of this. But yeah, I think it goes back to yeah, like those extremist camps of like, so there's nuance here. It's like there's both sides of the coin. So then yeah, from moving forward in your journey here, it's like you left the National Running Center and went and started your own business.
Jimmy:What that process like? Because that's maybe a little scary, like what was that like?
Gabby:It was scary, but it was very energizing. What I can say is that like many in this profession, it can be a high burnout profession. Honestly, at the point that I opened the business, was questioning if this is what I wanted to do. And so yes, scary, but honestly very energizing. And I realized that I wasn't burnt out by the profession so much as I was by the way we were applying what we do.
Gabby:Yeah. And feeling as though, you know, I wasn't treating people the way I wanted to be able to, I wanted to have more time with them and I wanted to be able to see them a little longer than I might and see them through to the end. So yeah, scary but very energizing. And at the end of the day, it's a sport where people are very, very passionate. And what I found is the business grew very naturally because there's a lot of people who are really passionate and value this.
Gabby:So they really value putting the time into staying healthy and having longevity. I think I remember very distinctly the first, one of the very first runners I saw when I started working with runners and he brought me, he handed me a book, he gave it to me and I still have it. And I'm actually right now blanking on the book. But it was about how exercise is so crucial in cognitive development Spark, yes, so there it he handed me that book Spark and he told me, he's like, I want you to read this book, you're familiar with it? I was like, no.
Gabby:Told me for the, he'd been gone through a long, long time of injuries not being getting better and lots of time off the road not being able to run. He told me for the first time in my life, I'm checking off anxiety, depression on my health history when I check-in for appointments because I haven't been able to run. And that has stuck with me forever is that like the system you know wants us to get people back to being just status quo but we're not appreciating this element of it and what just generally exercise, but especially what running means to so many people. It's their mental health. It's their it's their physical health.
Gabby:It's their mental health. It's their social circles. It's their run clubs and the people they're with. And so when they're able to go out there and do that, it just affects them on such a level that I think when you realize when you're in this world of working with runners and you realize how passionate they are, you realize how much they're willing to make the effort and come work with a specialist to make sure that they can do this now and long into life.
Jimmy:So when you started the business, and I can relate to your experience of like, being burnt out or at least on the verge of burnout, and then feeling that energizing quality of like, yeah, digging into starting your own thing and like, yeah, gaining that autonomy to talk to the patient the way you want to, to spend the time with them the way you want to. But when you started, yeah, was the goal was that the original goal was like to provide the space for the runner specifically to be with you from like injury to performance through that spectrum? Was that kind of what you're setting out to do?
Gabby:Yeah, for sure. I think especially with the runner and probably many different sports or golf, whatever it may be, that people get really passionate about these things. And the runner specifically, what I've found when I talk to new patients or interested patients is the very common thing I hear from people is, you know, again, many of the times they've had failed PT in the past and common themes I hear is that they just didn't understand me as a runner. You know, don't think unless that rehab professional is a runner in some way and that's a spectrum, you know, how we identify how many whether it's you run 15 miles a week or 70, but like identifies as a runner, they don't quite grasp the holistic piece of it. So you know, runners are being told to just stop running because that person is more of a generalist, they just don't understand the depths of you know, the ways that that affects them emotionally but also it could be counterintuitive to, well, you know, they're getting weaker by not running actually and you're telling them their root cause is that they need to get stronger.
Gabby:So I hear all the time that people are just not feeling heard or they're just, they're kind of, I hear these discharge points that feel so like not okay. Know, they spent ten weeks working in rehab and those whole ten weeks they were not running. And then they got to the point where within this, the last PT appointment when they're being loaded a little bit but not heavily, they're being told, okay, you graduated, go back to running now. And if that person's a 70 mile week on average runner, I mean, at some point, you know, yeah, they're good jumping around maybe or doing some basic exercises in PT, but are they gonna hold up once they get out to the road? So those are some of the common things hear and why I felt like it was so important to provide a home for runners where runners knew that they were talking to people who understood them holistically, you know, the way that they approach running, what running means to them, but also understands the clinical approach to it and the way we treat running injuries, the way we train with runners and really have a true understanding of the ways that we can get people better.
Jimmy:Yes, so you kind of emphasize the value of the running specific PT with your practice. Do you train your staff in a specific way to help like educate them on how to do this stuff or are you just like picking people who are already have those qualities?
Gabby:Yeah, I mean definitely a requirement to work with us is that you have to be a runner.
Jimmy:Noticed on your website, everyone's PRs are listed on there. Yeah, So
Gabby:everyone's PRs are listed and you know, I've hired before in the past and if you can't tell me the basics of like what interval training is or a tempo run or what the measurements are of the track, you probably aren't gonna be able to talk to a lot of our people. Again, that's not all runners.
Jimmy:It's hard to understand what the runner is going through if you don't know that. Because like, I don't know, I'm sure this is the case with you guys. But like, a large part of like my subjective exam is going through their training history and looking at what they've been doing. Yeah, if you don't know what the different training intensities look like, it's hard to interpret that and it's kind of like meaningless.
Gabby:Or just if to you it feels insane to run 70 miles a week, then how can you truly treat that person holistically and not be like this person's a little crazy. Like, no, that's nothing. We see that all the time. I get it, we got get you to 70.
Jimmy:Yeah, it's kind of like when I was in Salt Lake and I'd have like somebody try to consult me for a climbing specific injury, I would just very quickly, I can't talk the lingo. I have no idea what a V six, I'm like, I don't know what a V six is. And that patient is not gonna do well with me because of that. And so they need to get their climbing specific PTs. I think at least my experience with that world is they understand that because normal PT with a pulley injury is going to get confused pretty quickly.
Gabby:Right.
Jimmy:But I think the runners like they have, maybe it's like we're starting to pick up on that in the running world where like, yes, I need a running specific PT. Do you feel, where do you feel like we are as a community there? Do you feel like there's like where runners are starting to value that, they are valuing that?
Gabby:Very much so. I mean, I think, again, even when people are looking when we when I chose to kind of really niche down to running, that's actually a little scary.
Jimmy:Thought exactly when you said that, I was just flashbacking to like that advice being given to me starting my business being like, are you sure I should do that? Like I'm just like really limiting myself by doing this, but yeah, keep going.
Gabby:No, it is very scary when you're opening a business to be that niche down. And it's not that if a CrossFitter found me, I wouldn't have them in. I feel very well equipped as a CSCS to work with those people for sure. And especially in the setting we have with the time we have being not limited by insurance. But when I know it pays off is when I've had calls with people where they say, oh my god, I found your website.
Gabby:This is exactly what I've been looking for. And again, we see all runners. So it's not just the 70 miler. It could be the person who just wants to be able to go to run club every week or, you know, the hobby runner who just likes to run an annual marathon and they don't have time goals but it's really important to them. So when I hear people call and say, oh my god, this is what I've been looking for, that's the goal is to make sure runners feel like here's where you should be going if running is important to you and you have an injury related to that.
Gabby:Same thing with staff and bringing staff in. I had a staff member in an interview say, I thought I was being punked when I found your website and I was looking for a job, like this is exactly what I wanna work Like
Jimmy:it was just too good to be true.
Gabby:Yeah, and so I think as more and more, there's more and more performance based settings popping up and it's no longer unique anymore to just be performance based. And people have passions in every walk of life. Think finding people that they can resonate with that are specialized to them is only going to help our care for them be much more efficient and holistic. Again, just the way we know to talk to runners. And so yeah, when I hire, we might need to get some people up to speed a little bit more.
Gabby:Most people are not coming from a setting where they see 95% runners. Most people are coming from a setting where they're in a general practice and they're the running PT there. They're like the go to for runners and their caseload maybe has like 40% runners at the end of the day. So we'll train them a little bit more on gait analysis and interpreting data and things like that, but at the core of it, I just need a person who gets it and knows how to speak the language and be able to work with runners in a holistic way.
Jimmy:Yeah, I love it. So then you kind of mentioned this just a second ago, but using gait analysis or getting your staff using gait analysis and the RunEasy system, like how do you feel like that is influencing your patient care, buy in, things like that?
Gabby:Yeah, I actually I've been using RunEasy now for a little over two years. And, you know, in the spirit and our mission, it was we wanted to be the anti healthcare, the anti sterile tech and helpful tech was always something I was on the look, on the hunt for. And a lot of it was it's hard to access. So I spent the first two plus years not having any tech and it was really just qualitative video gait analysis. But we started using RunEasy and it's honestly, it's so helpful in how we both evaluate runners as well as reevaluate as well as holding ourselves accountable as to seeing change and seeing progress.
Gabby:So, you know, I think we still we like to, again, as the specialty people working with runners, gait analysis if it's appropriate, meaning if they can run physically because they're not in excruciating pain or we don't believe there's a bone stress injury, we put them on the treadmill and we analyze their gait at the evaluation. That's basically a standard musculoskeletal exam as far as we see it. And so I think using it, it's A, very helpful to be able to have it be very digestible to the runner. But for us as the PT, it allows us to kind of break down the information and bring them in collaboratively to talk through the story of what's going on. And we really emphasize a lot when I'll talk to frustrated runners who have had failed experiences in the past or frustrating experiences in the past, sometimes they won't even know.
Gabby:I'll ask them what was the PT you're working with? What was their working diagnosis? What did they think? It was like, oh, I actually don't know. I don't even Oh my
Jimmy:god, it's so funny when that happens. Frustrating. But yeah.
Gabby:It is. Even then, you know, I also tell my staff is like, diagnosis is great. If we can say like, okay, this is clearly Achilles tendinopathy, that's helpful. But we more focus on the why of what's going on through the data in the exam versus the what. And especially when you have a runner who's got a long history of injury or the, you know, many runners it's like, oh, have, well, I have this, they have the list, I have the hip and also my foot and also this knee and the right knee and the left foot.
Gabby:And that can feel really overwhelming if your approach is just to be like, well, let's work on the foot and let's work on the hip. And talking through the ways we're going to fix each thing and instead we really just try to tell them the story through the data and the exam and the history of like, all right, here's what we see that's happening. Yeah, you're hitting the ground really hard and that's not necessarily a bad thing but what we're seeing is you're not absorbing the shock well and that's a place that we need to explore and we need to work on or, you know, we've had the runners who are the super bouncy high performer runners and it's like, yeah, you're a really bouncy runner. We could see that now with the data. It's not right or wrong, it's the way you run and you haven't been strength training or doing plyometric training and what's going on is that you're going up really high in the air and you don't have the strength and the power to back it up.
Gabby:You're hitting the ground really hard and you're having to absorb it. So we can tell that person that like we're not going to get caught up in the nitty gritty of each individual thing you're dealing with but here's what we know, we need to work on your ability to absorb shock, here's how we're gonna do it. And the hope is if we can be consistent with working on this, that ankle, that hip, that all of these things bothering you can start feeling better as we get to the root cause instead of trying to overwhelm with tackling each individual issue.
Jimmy:Yeah, so there's like, it sounds like you put a lot of value in changing the narrative or at least like giving structure to the narrative for them. So when they leave like a session, like an eval with you guys, they have a good understanding of what's going on, but most like you said, most importantly, why it's going on.
Gabby:Yeah. Yeah. And I think all the time, especially with runners, but anybody, they get on WebMD or if they're a runner, they've had a number of injuries. So like, well, yep, I know what it is. It's runner's knee.
Gabby:I'm like, okay, do you know how to get it better? Because runner's knee is just the diagnosis, but what's the journey? What do we have to do to get this runner's knee better? Why is the runner's knee happening? Know, and so I think it actually by getting to tell the story can provide some relief for the runner and often for us, especially a frustrated runner bed and PT.
Gabby:The last thing I need to wanna do for that person is give them the same thing they were doing before. Yeah.
Jimmy:And that's something where you're like, because a lot of times those people are coming, maybe they're expecting some quick fix, like you're the guru or yes, some magical exercise that they just Yeah. Nobody's prescribed to them yet.
Gabby:Yeah, and so yeah, I just think it's a really great way to be able to show them a little bit more about like, here's your physical story and your history. And it also lets us tell a story with being very transparent. Like, this is kind of my working hypothesis based on what we see. But we'll travel this route. This is what we think we need to do.
Gabby:Let's work on it. And now let's evaluate again and see where we're at and see if we need to shift or see if what we're doing is working. But I think the thing that's most stressful for runners who are constantly injured or have had failed PT or elsewhere is just not knowing what the path forward is. And very often I will tell people when I talk to them coming in, I'm very confident we can find some actionable or unique or different path for you by using some of the data that we're able to capture with running and jumping.
Jimmy:Yes, all right. So and with tech and data from RunEasy, like you're going to always do this as part of your assessment and then you're looking at the metrics to help guide intervention and help plan out the story you're telling with the patient. Are you using any other tech to help with this?
Gabby:Not really any other special tech right now. We've just started using the jump modules. So, you know, I know the force plates are really big. Essentially, we're kind of using the jump module to fill that role and being able to look a lot more at the capacity of the runner, especially the plyometric capacity where kind of coming back to like incomplete rehab that happens a lot. That's where I think a lot of things stopped short is is that ability.
Gabby:But right now, far as the tech we're using, that's the big one. We are using a platform now where for our home exercise programming where it's actually a platform that also the runner can sync all their wearables to. So envisioning a situation where coming back to that holistic look, if runner comes in, we see their home, we have their home program, but we can also see what their sleep has been in the last week, what their recovery has been, and how that pairs up against that heavy, maybe they're doing a lot of heavy mileage. If a runner, even when we see runners in the performance and prevention and training setting, if there's any frustrations around like, I don't know, I'm just out there and I'm feeling slow and why? And I can say, well, looks like you've been sleeping four hours.
Gabby:What's been going on? Maybe it's time to like take a breather and take some rest and then we can really still continue to treat in a very, very holistic way and go above and beyond what the standard has been in the past and dive deeper into opportunities and suggestions that we can give that runner beyond just the basics.
Jimmy:That's awesome, yeah. So you're digging in more into more than just like training volume and training load, looking at like life load, stress, sleep. I'm just curious, like from a clinician standpoint, do you, are you digging into diet, nutrition, things like that? Or do you pass that on?
Gabby:Yeah, I mean, for sure. I mean, we're treating runners, so bone stress injuries are always at the very, very top of our mind. So nutrition has to be a piece of it. So, you know, I think as runners ourselves and as more sports focused PTs, we all have that base knowledge at the very least where we can make recommendations about, you know, very generally, I can say, I feel like you're under fueling or over fuel. Very rarely over fueling, more under fueling.
Gabby:But yeah, we like to be able to speak on it the basics. There are some people who you don't realize they don't even know the basics of timing around running and things like that. But when it gets beyond the basics, we have a really good referral network with some more sports and running focused nutritionists that we'll refer to. So definitely it's an important topic when it comes to certain injuries like bone stress, and we'll cover the basics of it. But once we feel like it's above our pay grade, we kind of start pushing them off to the right person.
Gabby:There's just one thing I've learned working with runners and even the nutritionists we've worked with, can't really just assume. We've had people where the nutritionist is saying, You actually need to eat more. Gained weight but actually the reason that you've taken on weight is because you need to eat more. So for me, I don't know the intricacies of that. So that's kind of where we'll call it in the people that we want to refer to.
Gabby:We really prioritize a smooth handoff with that too and not having patients kind of running around navigating the healthcare system blindly. We want to make sure there's a very clear and smooth handoff with anything like that.
Jimmy:Yeah, can you tell them, dig into that a little bit more? So you kind of see the PTO is almost like the quarterback he's helped, like you're helping guide care in more than just the injury. You're looking at all this other stuff like even into the performance side of things. So yeah, can you talk on that?
Gabby:Yeah, for sure. I forget where I heard this, but at some point I heard somebody reference that the PTs are kind of like your primary care provider to orthopedic injury, which I very much agree with. So depending on the state of Massachusetts, we do have direct access and we're obviously out of network, so people can access us first. I tell people all the time, especially if they're concerned about even bone stress injury, if I talk to them on the phone and I think maybe it could be that, I think a lot of times based in the standard thought process, they think, oh, I have to go get an x-ray and then an MRI. And I was like, you know what, we're pretty good at figuring out if it's bone or not.
Gabby:Why don't you come see us? And if we think it's that, we're gonna put you in the right direction. And even with that, one of the things we really prioritize, this is I find to be a very big gap in running healthcare and just the way this information is being provided is as running VTs, we know the ins and outs of both stress injuries and the timelines and the expectations. What we'll find is if runners have gone to a doc that maybe we don't know well or don't work with runners is that they come back to us with more questions than answers. We will hand them off and we give them a sheet or a question.
Gabby:Are the questions to ask in your doctor's appointment. What grade is it? How long am I off running? These are the questions that I don't think get answered by MDs who maybe don't work with runners as much. So we really like to make sure that we're handing people off and being the point person, working with runners in Boston as we've created like a really great network of doctors, nutritionists and sports psychologists that we really truly trust.
Gabby:And so we wanna help be the person that can refer people out. And it's part of why I think being able to work with people over a longer period of time is so great because what I know is, let's say they're coming in for rehab and you know, the point of the standard discharge and many standard healthcare practices, we obviously want to rehab them beyond that. I want you to be actively progressing your running while we're rehabbing and say, all right, here's what the next two to three weeks looks like. Let's spread out our visits, go run. And maybe the last few weeks or months of rehab, maybe it's a longer timeline, but it's less visits where, okay, I want to actually check-in with you.
Gabby:If you're like that 50 to 60 mile a week runner, great. If you're running 10 miles a week without pain right now, that's not me being able to say, great, we won, we did it. You know, you're not where you want to be. So let's check-in on a monthly basis and make sure as you're increasing your volume that you're feeling good, that we're treating anything that's popping up and navigating your strength plan accordingly. And then we find a lot of people that just continue to work with and that can look really different.
Gabby:It can be that just like they trust us so much that and they want us to hold them accountable and they train with us or have continuity care with us on a weekly basis or we have a lot of people who will just check-in more on a monthly basis. And that session can be any number of things. It can be put me through a workout, update my exercises, or it consultative. Could Like let's figure out why I'm just feeling suddenly off. We can get them on the run easy.
Gabby:We can talk them through the running volume they're doing. And what found is that our staff had ended up being the go to person for many of the people who have grown to trust us that when something pops up here or there, they're either getting right in our schedule or they're emailing that person versus going to the primary care or the orthopedic and we can kind of help whatever's next. Because at the end of the day, you you go to the primary, they don't know anything about your orthopedic injury. Then you go to the ortho and at the end of the day, they probably just end up in our lab anyways. Trying to cut out some of these steps within the healthcare system.
Jimmy:Yeah, and it sounds like since you've been in business now four years, is that right?
Gabby:Yeah, four and a half years. Four and
Jimmy:a years, yeah. It's like, you've been able to build trust in the community and show them the value. It sounds like you don't even have to, it's not like you're pitching this. It's like they experience it and they wanna stick around. It's like, you're not having to convince them to stay working with you, they actually want to continue the journey because you've become like that valuable to them.
Jimmy:Is that right?
Gabby:Yeah, there's a trust. I think it's a trust thing. I think, they develop a lot of trust in working with us and us celebrating their wins. You know, even just going back to working with the runners, it's really great to get a runner back to running without pain. And then what even feels more awesome is like six months later when they send you the of themselves with the medal at the finish line.
Gabby:Yeah. Just a great feeling. And to be able to have influence on that and and have have them feel like they have a person in their corner that they can go to is really important that they trust and is kind of like their coach and their go to. There's a lot of people I think that consume healthcare in a way that they've got like they've got this guy and that lady and oh I've got my massage person and this person that's a common thing that we see but we're finding that more and more people who don't necessarily work that way are starting to work that way with us and that like, we're their go to when something goes awry.
Jimmy:I find it very flattering when somebody refers to me as their physical therapist. Like, yeah, exactly. Yeah,
Gabby:and we love that.
Jimmy:Yeah, great feeling.
Gabby:That's the goal.
Jimmy:Then yeah, what you just said, remind me of a quote I love, which is a good coach makes you want to have him around, but not need him. A bad coach makes you need him, but not want to have him around.
Gabby:Right, for sure. And we're really big with the way we work with people on empowering people is something we talk about a lot. When we talk about what the end of a rehab phase with us looks looks like, it looks hard and challenging at the end. And what we talk about internally is like, I actually want that person to be lifting heavier than they did before they came in here so that they don't just leave here with an injury feeling better, but they're empowered with how to access strength training, how to load their bodies. And then they leave with that empowerment of like, I was only carrying five pound dumbbells doing those lunges and I've been challenged now to be getting up to the 30s and the 40s.
Gabby:Whether or not we get them under a barbell, we'd love to. But really empowering people and challenging people to push themselves a little harder with the strength training because I think, A, we know it's beneficial, the physiology of it, but also just the empowerment of it, think is really great. But you're right, they also, you know, they really rely on us to be able to progress them in a healthy way or guide them into what's next. And they're motivated to go out and push themselves and then they come back and say, all right, cool, I'm doing more than I did before, what else can I work on? So yeah, I think that we definitely resonate that we see that Yeah, a
Jimmy:and you've brought this up multiple times, it's like the discharge process and like getting towards the end of care and I think off air we talked a little bit about how most people get discharged too soon, you brought that up as well. How do you navigate that? When do you feel like, is there objective data you're looking for? Things that run easy, is there strength testing, is there just subjective report? What's helping you guide that process?
Gabby:Yeah, I mean, I think at the base of it, it's, you know, pain is better and I'm back at least 90% to where I want to be. And we'll definitely use the run easy to help, especially with, you know, the jumping testing. Considering we're not making major changes to how people run for the most part, doing the reassessment with the gait analysis is helpful to kind of pick apart and see maybe, great, we've fixed, we worked on that, here's another thing we can now work on. So it's almost like ability to hit that next tier of a goal. So it does provide that insight and the jump testing is new to us.
Gabby:So we haven't really brought it into that like discharge point, but it certainly helps with, is it safe to run? Are we dealing with a massive asymmetry here left to right? Is there confidence beyond just objectively watching them single leg squat, single leg jump? Are they actually really asymmetrical here or what's going on? But even internally, we've even stopped talking about the word discharge in the way we kind of usually think of it.
Gabby:It's really just, again, the relationship with us can look like that initial 10 to 12 visits of rehabbing and then also let's spread things out. Let's see you through. You can come see me once a week or once a month now as you get up to that 70 miles a week, let's say. And then at that point I was like, if you wanna keep working with us, you could still come in and we can work with you with strength training or we can do this kind of consultative monthly thing where we get to reassess and redirect. Cool, you're working on a lot, like here's the next thing we can address and to help people achieve more so those performance goals as well.
Gabby:And so yeah, we almost are like doing away with the idea of a district. It's not as clean because of the way we spread it out.
Jimmy:It sounds more like it's a transition versus a district. Yeah. It's like they're there for like they're essentially there for their for life. It sounds like, right? And then if we circle back to like, we briefly touched on this with camps of gait analysis.
Jimmy:I am just curious of your because you started from the extreme or learning under that extreme of minimalism and barefoot running, manipulating gait, changing gait to help a runner get out of pain, You said you're more in the middle now, but like what actually does that look like?
Gabby:Yeah, we don't lead with it. I would say that being said, the gait analysis is still really helpful in understanding ways we can implement things in the strength exercise and mobility world. And it's helpful for us to just gain more insight into the type of runner they are. Are they a super bouncy runner? Are they a more grounded runner?
Gabby:So it helps gain insight really more in guide strength and what we're doing exercise wise and we lead with that. But there are certainly times when we will make tweaks if we feel like it's appropriate. It's usually more things like lean, trunk lean, maybe stride length or foot position under body, where is foot landing relative to body versus, you know, I always think of when we were doing really intense gait retraining, this one runner that I I worked with who just had a lot of inversion. She was actually not having pain at the time, but we were just trying to correct that inversion by way of the protocol and trying to clean everything up. And I watched the mental breakdown of the frustration of this perfectionist runner who wasn't having pain, but we were spending thirty minutes on the treadmill trying to fix this very nuanced little angle of how she hit the ground.
Gabby:And I think it was sending her into a spiral and it was just kind of like, this really worth it?
Jimmy:It kind of goes back to like what you're talking about with how you work with your runners and changing this narrative. It's like when the focus becomes something like that, that story gets like ingrained in the runner's head.
Gabby:Yeah, and then they're spiraling. And then there's a very certain type of personality many runners take, which is like a type A personality. Yeah. So yeah, that can be frustrating. But so we we steer clear of any sort of major, like, transverse plane rotational changes.
Gabby:I'm not making cues or changes around pelvic drop when you cannot feel that. I have to slow it down to super slow mo for you to see what's happening. Great. That can be just part of how you run. And also, let's just let's hit you some serious side planks and lateral hip loading and single leg stability and single leg motor control.
Gabby:And if you're doing that all really well, then I'm not concerned so much what's going on with the qualitative look at it. So things like wear foot land, forward lean, we work a lot with the perinatal population and so there can be some really clear changes around posture with running with them where they're really hyperextended because of either being pregnant or being postpartum and how that pressure management can work. Types of peoples, we may make slight changes to where we're like, kind of just let's get your ribs down over you a little bit more, get your feet under you versus the Olympic trial qualifier who is running super, super fast and he's hyperextended. What am I going to do? He's running as efficiently as possible.
Gabby:I'm not going in and trying to fix what's not broken over there. So there are certainly moments where we could use it, but it's certainly not our first line of defense. It's more just like a tool in our toolbox if we want to reach for Yeah.
Jimmy:So it sounds like you first and foremost, like come at it from with a view of like optimism. You're not like pointing out all these flaws and negatives, negative like you run terribly, you're doing this really badly and trying to change it. That right?
Gabby:Yeah, for sure. I think I always reference like the idea of Craig's test when I learned it in PT school, you know, measuring antivergent or like, why are we measuring something we can't change, right? Like unless I cut off your femur and twist it around, I can't change that. And then I realized why we do it and it's because, you know, people are going and consuming fitness or working with professionals, they're telling them to point your toes straight ahead and point your knees straight ahead when their body and their structure doesn't allow for it. So it just gives us insight into how that person moves and being able to work around
Jimmy:Yeah, I feel like it was something I struggled with as a clinician early on was that you sound really smart when you do all that other stuff. When you point out all the flaws and you show that you tell them like all these things that we can work on. And I guess it was like an insecurity of mine where I I like felt bad about that. Like didn't believe that and I wanted to treat a different way. But I do feel like the the PT world has like shifted as well and is embracing and we're more accepting of like the role of like as like Greg Lehman would say like movement optimism, there's more than one right way.
Jimmy:Yeah.
Gabby:For sure.
Jimmy:Awesome. Yeah. That's I love to hear that. I'd like, what's next for the RUN Rx? What do you have planned?
Jimmy:You've done sounds like amazing things out there. Like, is there anything coming down the pipe for you guys?
Gabby:You know, we are, you know, we're growing within our space and we're always growing clinically and wanting to learn. Coming back to like the tech that we're using, one thing that I've always been passionate about is ways we can better serve people remotely and virtually, I think. I've never been a big believer in if you can go see a physical therapist in person that you should consume them virtually. I think it limits us. But I also see that a lot of times that our runners are consuming fitness professionals online that are not necessarily qualified.
Gabby:So, you know, what I really dream about is the idea of utilizing the advancements in tech and with the ability to serve people in different capacities, whether it's somebody who's living in a rural area who doesn't have access to certain professionals, or if it's just that we have somebody who wants to consume us in a different way. The ability to try to start utilizing, I think while in the past I've viewed that it's really hard to be a PT or to work with people virtually, What I'm seeing is some of the capacity that we have now with tech actually may make it a lot more efficient with our time. So to me, it's a way that we can reach more people with our expertise. And I think it also, again, we have a very twofold mission of changing the model for both the patient and the client, but also the PTs who maybe are burnt out by healthcare and giving flexibility in the way we work with people. And so that's kind of what I think is our vision long term is trying to add some sort of service where people all over can consume us and we can kind of share our expertise with people who want to access us in many different ways.
Jimmy:I feel like that's a common thing like you hear now it's like moved across country recently and I like I'm an eval with somebody after this that's in Salt Lake City and I think like he I was his physical therapist when I was there. He wants to keep that relationship going and I think for a lot of these running, especially with the community of patients that we work with that the virtual stuff works surprisingly well. Like you said, if you have a good local person, go to your good local person. I think for, especially like you got a group of therapists there that you trust and that you know are good, it's like, yeah, why not share that with as many people as you can?
Gabby:Yeah, I think that's kinda, it comes back to the trust idea of like, yeah, I do have a person I could access locally, but I trust you and I wanna work with you. And yeah, we've had, we have a long standing training client we've with who recently moved and is now continuing with us virtually. I think in the post COVID world, you see telehealth became this big thing. And I will be the first to admit that I played devil's advocate of like, what can we do virtually? Like, I can't really help people virtually and what tech is helping is actually maybe opening that up to be more effective and that's super helpful.
Jimmy:Yeah. This is more like insider info. So we'll see if this gets edited out. But with with RunEasy, I've been experimenting with like our remote app where I have like three belts out in the wild right now with runners I coach or like rehab coaching clients where I can do a fully virtual assessment now and get the data from the RunEasy. And it's incredible.
Jimmy:Like it opens up so much more to get objective data across the country. And then I think in the space that we work in with the time that we're able to give to the patients, there's tremendous value in it.
Gabby:Right. And you know, even with what we're using, this dashboard that we're using where we're prescribing HEP, but also it can connect people's wearables that Most people are collecting data on themselves all day, every day in the form of Garmin watches and AuraRings and Apple Health data. We can find ways to just take all this stuff and put it into a piece of paper for me. Like, I can have a way more effective session with you. I can really know how to update your programming or update what you're doing based on that.
Gabby:So I hope it opens up a window where that people all over can access the person they trust most, whether they're local or whether they're not.
Jimmy:It's funny, in a way it sounds a bit like grandiose, but I think it's like, it's You not see concierge medicine going this way with like doctors being on call and like doing more virtual stuff.
Gabby:I took a course at CSM that actually it was about innovation in healthcare and the quote was like, if there's any industry that needs a dose of innovation, it's healthcare. And I would agree. And so I think it's good to have these big grandiose thoughts of what we could do to make this a better process and be a better service for people.
Jimmy:Yeah, so I think like the profession seems like needs more people like you doing things like you're doing, moving us forward because we talked about this on our, like the first time I met you where we talked about PT just being an undervalued service for the most part, like with a $20 copay, 40 copay for a long time, I feel like that that's what we, the world or the community perceives as the value of PT is a $20 or $40 copay.
Gabby:Yeah, and I don't think until we do something, I don't think that's going to change. I think the insurance systems and the healthcare, the way the healthcare is in this country, it's not going to change unless we kind of put ourselves out there and show people our value. And so I think that's something that we find to be very important. What I know is the people that we've had the chance to work with, they see it. And at the end of the day, as long as those people see it, that's all that matters.
Gabby:But I do think that like as physical therapists, we are so undervalued within the healthcare setting until the person finds the PT that they trust most and realizes that they can be such a big influence on their life and their longevity and how they move and how they feel. We talk about it all the time like, yeah, if you want to work with me every week, I believe very strongly that you'd feel better than you did if you didn't. I know that, you know. If I had the chance to work with every one of you every week for an hour, I do feel confident that all of our staff would be able to make sure that you feel better, you move better, you're stronger and you have more longevity. So being able to get access to that and that level of skill, think is super important.
Jimmy:Yeah, it seems as though when you give motivated PT the space to operate in that way, they're going to do really good things. You put them in a box and you give them a patient every 15 minutes, we've seen what happens. So. Yeah, I think
Gabby:It's rarely the PT, it's more so the structure that they're working and operating under.
Jimmy:100%. Yeah. Well, Gabby, I think that's a great place to put a bow in this. Yeah. I would say is keep doing what you're doing, keep pushing the profession forward for us.
Jimmy:Where can people learn more about you in the Run Rx?
Gabby:Yeah, so again, we are in the Boston area. We're in Summerville just right outside of Boston. We are on Instagram therunrx and you know our website is run.vrxmovement.com. We do have a virtual training platform so people who are not local to Boston, we offer a virtual training program that we designed on our website. But yeah, if you're local, we're right there in Somerville and hopefully if you're not, we have some stuff coming down the road that we can offer.
Jimmy:Awesome, love it. Yes, if you're local, go get some kombucha from you guys too.
Gabby:Yes, Kombucha and cold brew. That's the top off. That's the cherry on top to be the.
Jimmy:Yeah. All right, Gabby. Well, great chatting and yeah, we'll talk soon.
Gabby:Yeah. Likewise. Thanks, Jimmy.
Jimmy:That's it for today on the Physio Insights podcast presented by RunEasy. Would you like to share an interesting case, insight, or have a thought about the podcast? Comment below and don't forget to follow us for more episodes.