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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, I'm releasing a previously published exclusive patron, Ask Me Anything. Enjoy. Welcome to the only podcast delivering and deciphering the latest running research to help you run smarter. My name is Brody. 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 running 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. Four questions here. Our first one comes in from Laura. So Laura says, stress fractures. How can I design a week of training with three stress fractures below my ankle? That sounds like a horrible scenario. She adds, my options are spin bike, elliptical, and of course strength training. I used to run six days plus one spinning day. Thank you. Thanks for your question, Laura. um I'm sorry that you have to... manage this. It's hard for me to answer in absolutes for this question because I would like to know a lot more detail. I'd like to know what stress fractures like which bones, what's being affected, what um degree of stress fractures they are, how far along you are in your healing, what you can do that's symptom free, what you have tried doing in the past that has brought on symptoms like all of those things are very crucial. to delivering, okay, this is exactly what you should do. So I'm going to talk in a few general principles, but hopefully you walk away with this with a good action plan based on where you're at. And yeah, just trying my best to help you out. So let's start off with why stress fractures are different. why, why one stress fracture is different from another stress fracture. It depends on grade, depends on how far through that pathology it is. because you can have a bone stress reaction, which is just the initial onset. There might be some edema or some swelling around the bone, just some early, early signs that the bone isn't really tolerating the load that you're putting it through or it's had inadequate recovery. But you can also have grade two, grade three, like a complete fracture. uh All those sorts of things will differ. But there are also bones. If you get a stress fracture in a certain location can be considered a high risk and some can be considered a low risk. And I've talked about this on the mainstream podcast, but just as a general, a brief summary. If you have, if we're talking below the ankle, so you have your navicular bone, which is a bone that's within the foot. That is what we deem a high stress, a high risk stress fracture. because it has a very, very poor, poor blood supply, which means if it is undergoing a reaction, if it is undergoing some bony stress, it takes a very, very long time to heal because blood is the delivering the nutrients. And so if it's, if it's not getting a lot of the nutrients purely based on its anatomy, purely based on its design, just naturally just not getting a lot of blood flow. If it progresses to a complete fracture, it is a long time. of rest and recovery. And so we don't want it to get to that stage. That's why it's a high risk, but a bone closer to that would be like maybe one of your metatarsal bones or like a cuboid or something like that, subject to stress reaction, and they can be considered low risk because they've got higher blood supply and the healing times are a bit quicker. So just as an example, these are this is why I can't answer in absolutes, but it also gives you a bit more understanding about the pathology of these sort of this sort of condition. I will also say if you are managing three stress fractures or like concurrently, I would definitely take any sort of treatment plan on the I'll take it on the conservative side, because that's a lot to deal with. It's a lot to manage. um And the general principles of a stress fracture Um, are different to what I might suggest if it's just something to do with a tendon or muscle or ligament, any overloaded, overused, repetitive strain type of injuries that occur in those tissues. We have the, the 10 universal principles we have, you know, pushing into some levels of pain, like a one or a two, or sometimes a three out of 10 during exercise is okay. provider that returns back to baseline shortly after and symptoms improve week by week. That's sort of the pain rules and the management guidelines we use for a lot of these overuse injuries. But for stress fractures, completely different. You want to be asymptomatic, no pain, no stiffness um during or the next day or that night. Like we want to make sure that everything remains symptom free so that we know that the load that you're putting through the bone is tolerated. And then we slowly build up from there to see if we do gradually increase the strain and the stress on the bone. If it remains symptom free, it means that we're loading it appropriately. So some ideas I have for you, Laura. um Initially, I know you said spin, bike, elliptical, strength train, they're in your arsenal. um So I'll get to those specifically, but if someone else is managing a stress fracture, or if you want to broaden your horizons, I might suggest a swimming pool. So you can do swimming or you can do pool running. You get like a inflatable belt and you just submerge yourself in the water and you just kick. So you're sort of mimicking that running action. There's been some research to show that water running helps sort of preserve a lot of your running cardiovascular fitness. It looks very similar. It feels a lot different like through When it comes to load through your body is extremely different, but you're probably some preserving that specific type of cardio when it comes to your heart and lungs and that sort of stuff. So if you wanted more things in your arsenal, swimming takes all of the weight off the leg, all the weight off the ankle and those bones so that they have time to heal. And you can still get a good cardio workout. If you go swimming and you just use your arms and, or you just like, um, very slowly kicking your legs in the water and you're not pushing off the end of the pool or you do it with your unaffected side, that's fine as well. But um if you're doing those sort of things, you're getting a good cardio workout. You're going to feel good afterwards and it's not putting any stress through that area. You can also do just upper body in the gym. So seated on a bench, you can do shoulder press, bicep curls, you can do flies, you can do a whole bunch of things. And again, your foot is offloaded. But you can also do machines in the gym where you can work your legs without putting stress through the foot. two exercises that has come to mind would be your uh seated hamstring curl and your seated knee extension. the, um the weight that's being applied is around the tibia. So what you're pushing is that big foam pad that goes on your calf when you curl it under and onto your shin when you extend the knee against resistance. So you're working your hamstrings and your quads and preserving a lot of that strength without putting any load through the foot. So there's some really good ideas for you. um In the initial stages, you're probably way past this stage, but just for you, if you have a bit of a setback or if You are at this stage or if someone else is listening and has a stress fracture that's they need to completely offload, these are options for you. So you could do swimming three times a week. You could do this strength training three times a week, leave one rest day and all the while completely offloaded for the foot and ankle. But then let's progress. So the next stage would be starting to load a little bit through the foot and seeing how it's tolerated. And like I say, we want to be symptom free during, symptom free afterwards and the next day. uh You mentioned the spin bike, Laura. So you can go on the spin bike. You can do it all seated to start with. That's what I would do. I wouldn't stand up on the pedals just yet. I would stay seated. I would go really easy resistance. I'd do that twice a week, 20 to 30 minutes or something along those lines and see if that's tolerated. Then you could do 30, 40 minutes to slowly progress if asymptomatic. And you can even start replacing the pool if you wanted to and substitute it with the bike a couple of times a week. And why I say that is because you're starting to push down on the pedal. You're starting to put like maybe 10%, 15 % of your body weight through there as you um complete that pedal stroke. The light to the resistance, uh reduced load is going through those pedals, which is why I said easy resistance. It could be 5 % of your body weight, but As soon as you up the resistance and as soon as you stand up on the pedals, we're getting closer to, you know, 70 times your body weight, 70 % of your body weight, um maybe 80 % of your body weight. Those sorts of things we do want to be mindful of and make sure they're two completely different things. Seated low resistance compared to high resistance standing up on the pedals. Those are two different loads through your foot. So We want to start on the conservative side and then slowly ramp up the intensity, slowly ramp up the time spent standing up on the pedals and take from there. We do also, if you do have a gym and you have options, the cardio options, you can also do it, use a rower, which would be very, very similar to the amount of load that goes through the foot and ankle. Say if you're standing up on the pedals, it's like a certain percentage of your body weight, but if you're pushing off a rower, yes there is strain and stress going through the foot and ankle. ah It is against resistance, you're doing a double leg though, so again you're halving that particular load and depends how much resistance is in there, how much you need to push off, but is a good option. You could do two minutes on the rower and then do 10 minutes on the bike and you can cycle through those 10 times and just see how that's tolerated. Um, or you could do the row out in between your sets in your strength training. So you might want to superset it and have those two minutes on the row as kind of rest. Um, or while you're working your arms quite a lot when you're on the roll up, but you could do like a shoulder press, you could do flies. Um, you could even do like a knee extension and then superset it, go onto the row. Do two minutes on the row and then go back to those previous exercises to do the second set. And you sort of do. rotations of those. That's an option for you, but this is the stage where we're starting to put a little bit of load through the foot and ankle and seeing how it's tolerated. If it's tolerated really well and you're progressing through standing on the pedals and doing higher resistance, heavier resistance and it's feeling fine, we can then move on to the next stage. The next stage I would consider is like strength training for the lower limb, but we're starting to do stuff in standing. So we're now applying load in a standing position through the foot and ankles. So that can be things like squats, lunges. ah We can do calf raises. We can all do this double leg, start with body weight, see how it's tolerated because that would be half your body weight going through that in standing. um And I say half because it's one time is your body weight through your feet, but you've got a bit of tough when it comes to each leg. So start with body weight, see if that's tolerated. Then you gradually add the weights from there. Um, this is probably where you can get, um, the elliptical, we can start involving the elliptical. It's actually better than the elliptical at this stage, because if you're doing strength training and you know, it takes 20 minutes or something, that's like 20 minutes of changing up the load, sitting, standing, moving around. But if you're spending 20 minutes on the elliptical, that's 20 minutes on your feet, some repetitive motion. It's actually quite a bit of strain through the foot and ankle, but um I would start strength training. do the squats, lunges, calf raises. If you're tolerating those well, I then say you're probably ready for the elliptical or you could use your steps per day, like the amount of steps or time on feet that you are outside of the gym, outside of your rehab. If you're tolerating that really well, then that might give me enough rationale to say, you know what, you could probably tolerate 20 minutes on the elliptical and let symptoms be your guide from there. Once you're doing that, ah you're tolerating walking throughout the day, you're tolerating your time on feed is quite substantial. You're doing your squats, calf raises, lunges, elliptical, everything seems to be responding really well. We can then say, all right, let's challenge you a little bit more because your goal is to get back to running. What does that look like? How do we bridge the gap? More so this is when I'd involve some sort of small jumps, double leg jumping, definitely to start. Don't just go into single leg hops, do some double leg jumping. You can use a skipping rope. You can use like a progression chart. So starting with five rounds of double leg jumping for 20 seconds and then a 60 second rest. on repeat five times. If that's well tolerated, then the next time you're doing a little bit more. So instead of doing 20 seconds, maybe doing 30 seconds, and then maybe instead of five rounds, you're doing eight rounds and then you're slowly building things up. If you get to 60 seconds, say four or five rounds of that, and you're tolerating that pretty well, I would then add small single leg hops. So the bulk of that would be double leg jumping. And then one or two sets of single leg hopping, maybe 10 seconds each side, four or five times. See how that's tolerated. And if that's really tolerated, then you are more than ready to start doing a walk run program, which, you know, there's plenty of apps out there and, um, catch the five Ks and all those sorts of things to guide you along that. Don't want to get into the details, but that's something you could do. And based on all of that. I've because this doesn't really answer your question, Laura. know I get it. You're asking about like, what does your week look like? I've then put together what something could look like on the caveat that I have no idea. I don't have enough information about your injury, but it might look like a Monday could be your elliptical and upper body. So you're doing like 20 or 30 minutes and then. combined with doing some upper body like shoulder press, bicep curls, tricep dips, all those sorts of things. The Tuesday could be your lower leg strengthening. So that could either be the open chain stuff that doesn't involve the ankle a whole lot, or it could be the squats and lunges and calf raises, depending where you're at at this stage. Wednesday could be your spin and also core work and what you're doing, your spin, the duration, the resistance, the amount of time standing up on the pedals will all have to depend on what stage you're at. A rest on Thursday would be pretty suitable. Then you go into Friday. So Friday would be a little bit more challenging cardiovascularly because you can do an elliptical and a spin session together on that day. So maybe 20 or 30 minutes for each and see how the foot's tolerated. Then Saturday you can do like can be your strength gym day where you can do upper, upper limb and also lower limb. So combining all of those and Sunday could be a long spin session. which depending it could be like 45 to 60 minutes. So with all of that considered, we're sort of spacing everything out, but you're doing two ellipticals, you're doing three spins, you're doing two strength sessions for the lower limb, you're doing two strength sessions for the upper limb, you've got some core exercises and you've got a rest day. hopefully that balances, balances things out well, and hopefully that at least gives you some understanding and If another patrons listening and they don't have a stress fracture, at least this sort of breaks down, hopefully gives you an understanding about my rationale. What I'm thinking about when I'm formulating what the next stage might be. It's always okay. How do we bridge the gap between where you are, how symptoms are behaving and where we want to get to? What's the logical, sensible next step? Um, because this same thing is applied to any injury, the same rationale is applied to any injury. So thanks for your question, Laura. And we'll move on to Joanne who has flooded the submissions with a whole bunch of questions. And I am more than happy to answer all of your questions, Joanne, essentially because there's not a lot of questions here uh and they're great questions. So I think down the stage, if it gets to a stage where there's a lot of questions being submitted and someone has asked multiple, I would probably just answer one or two. move on to someone else but for the time being because there's not a lot of patrons submitting questions more than happy to answer so um if you're listening and you do have a question in the blog section I might reach out on Facebook over the next week or two to just prompt a few other questions just because we need some questions for next month but thanks for asking Joanne the first one is it possible to understride I had a 3D gate analysis done a while ago and the report says overstride is reduced bilaterally and the chart shows less than ideal and she submitted a photo onto Facebook and she's wondering if she is misinterpreting this and says thanks again. Okay, Joanne, I do have the photo in front of me. But first of all, what is an overstride? So if you're listening to this and you're not entirely sure, If you are observing a runner from the side and witnessing where they very, very first make contact with the ground with their foot, often it's with their heel. We want to freeze that moment in time and say, okay, how far in front of the body are they making contact with the ground? We usually have a reference point, which is like the middle of your hips, which we assume is like your center of gravity or your center of mass, we draw a line straight down from that center of mass and then draw a line out to the foot to see how many millimeters or how many centimeters in front of the body is that foot. Because if it's too much, there's no number to say what is an overstride and what isn't, but if it's generally looking like it is quite far in front of the body, we would consider that an overstride and Uh, we'd probably want to change that in most circumstances, because if it is an overstride, you are accumulating a certain amount of breaking force and unnecessarily an unnecessary amount of breaking force that can be reduced if you just contact closer to your center of gravity. And so if you are producing these unnecessary breaking forces, produces more load than what we want, because we don't want to increase the load that goes through the body unnecessarily because a lot of these almost every overuse injury is load dependent. So if we can reduce the amount of load in some form, then it reduces your risk of injury. It's a lot more efficient. um I like to use the term. It's like hitting the accelerator as you're driving down the highway, but you've got your handbrake on really inefficient, not good for your engine, not good for your car. So why would you run and have a handbrake on? while you're trying to run fast or run efficiently. So we can do that by removing your overstride if it is there, if it is present. So let me talk through this image that Joanne sent for those who are listening. And if you wanted to check it out, it was during, let me see, let me see how you can find it. So I posted this on the 15th of July, 2023. I was asking patrons for some submissions, so the AMA submissions post, and in the comments there, Joanne put attached to the photo, but let me try and explain it. So they have certain measurements, which is the cadence, the step width, uh your the vertical displacement, so how far up and down the traveling, and also the category that they've labeled overstride, and placed Joanne's left and right foot into these categories and placed it on a graph, which is ranging between ideal, like there's an ideal sort of sweet spot, and then there's a too much or too less. So doing too, yeah, too much or too little in each of them, but a sweet spot in between. So when it comes to the cadence, the cadence was 188. I'm looking at actually so There's actually the vertical displacement, the time, time of toe off, the swing, the stance and swing ratio, the foot progression angle, and then there's overstride. Okay. So all of those things I just listed were ranked or like placed on that graph in the ideal. It seems like everything was ideal in the, um, the first things, but then the overstride, the category that is overstride, it seems like Joanne's below. Ideal not overstriding. It's not beyond and past the ideal, but it's under the ideal um gray zone. So let's break this down. Let me go back to my notes. When we think, um first of all, when it comes to your running cadence, your cadence is 188, which is the amount of steps that you take per minute. So you're taking short, fast steps, which is good for most. um And this will directly correlate to your contact time or your initial contact or your overstride. The higher your cadence, the shorter and quicker your steps. So you can't simply have a high cadence and have an over stride at the same time, because when you over stride, it takes a long time to over stride. And if you increase your steps per minute while traveling at the same speed, you simply don't have enough time to reach out in front of you. So that's why it's directly correlated, which is makes sense because you have a high cadence of 188 and you have a close contact underneath your body. So back to your question. um It says that you have over your overstride is reduced bilaterally, which just means that you contact closer to your center of gravity, closer than what's average or closer than what they have labeled ideal, which, you know, they've probably just picked out a generic number ah and bilaterally. So bilaterally this means it's happening on the right and the left. So um I would say there is definitely nothing wrong with that, provided that you are keeping yourself upright, which I'm assuming you are, because we do need to make some contact in front of your body. Some people might video themselves running from the side and freeze frame their initial contact and it's in front of their body and they're like, oh no, this is an overstride and I need to start contacting underneath my body. That's not how it works. You have to contact in front of your body. There has to be some, if you contact directly underneath your body or slightly behind your center of mass, you are, and you do that two or three steps in a row, you are hitting your face on the floor. You are falling forward because you do need a little bit of breaking force to keep you upright. The physics just simply doesn't work that way. If you, if you contact directly under your center of gravity, you will Every step slightly lean more and more forward, more and more forward, and then you'd lose control and then you'd fall flat on your face. So a little bit of a contact slightly in front of your center of gravity is not only common, but it's necessary to remain upright. It's this fine seesaw balance. So it seems yes, Joanne, you are contacting your center of, you're contacting your foot. closer to your center of mass than normal, but it is still in front of your body because you are still staying upright, I'm assuming. um So there's nothing wrong with that. There's no reason why you would change that. I can't see something biomechanically that would make me want to change that. So as long as you feel in control, as long as you feel like you're um doing it right, as long as you feel like it's... um you're not losing balance or if you're like leaning forward too much, if you feel in control, you're doing the right thing. So just a little lesson and a few other takeaways when it comes to overstriding and center of gravity and cadence and that sort of stuff. So hopefully a few takeaways for people who are listening. um Onto the under stride. We now have Joanne again, who asks, is it absolutely necessary to do more than one set of a strength exercise? I'm fine. I'm very happy to go to fatigue with one set, but I hate doing repeated sets. Not sure why I'd rather do a different exercise that targets the same muscle group than repeat the same exercise. What an interesting question. I've never heard this one before. Um, I heard, I have heard people getting bored and wanting to change their exercise, but not someone who's bored after one set or feeling compelled to change the exercise. Uh, okay. So We need to look at the lessons of adaptation. Adaptation means, uh you know, you get stronger through stimulus. You need uh enough stimulus to trigger adaptation. Then you need adequate recovery to foster that adaptation. And then you need to progress thereafter. So this is how we get stronger. This is how we get faster. This is how we develop and build on our qualities to outperform and Better yourself. I worry that with that particular approach of just doing one set and then doing another exercise with the same muscle group, I feel like that just won't be there. I feel like there won't be enough stimulus, enough repetition of the same thing to mark about a, um, a change or like a consistent, um, a consistent environment for their to trigger adaptation. I also worry it wouldn't be that progressive. Like, um, you need to adapt. It needs to be consistent enough for there to be an adaptation. Um, you can do different exercises, um, and you can work the same muscle groups, but just wouldn't be the same. Wouldn't be the same as repeating the same thing over and over and over again to elicit an adaptation. You don't want to spread yourself too thin, I guess is what I'm saying. And I see this with runners sometimes that I go through their strength program. say, Oh yeah, I do squats three times a week, but one of them is a variation. One of them is a sumo squat. One of them is a traditional back squat. And then I do split squats. Um, and then I do front squats sometimes and I just, you know, change that up. And when you look at them over the course of say like two months, they've done back squats, maybe two or three times they've done sumo squats three or four times. And like, it's just not enough to adapt to the thing. Um, so spreading themselves a bit too thin and I get it as well. Like we want to try and weigh up variety versus consistency because we want to have the consistency, um, or at least the compliance because we don't want to get bored and then not do any of these gym exercises altogether. So we want to be consistent. We want to be compliant, but if you are bored, we also want to offer the variety. it's trying to find the balance. Um, And I wish like, Joanne, you've put in here, um where was it? I'm not sure why, but I'd rather do different exercises. I wish we could dig a bit deeper and work out where that why is, because then I could provide some solutions. um But I'll run on some assumptions here, or at least give you some so that we can formulate, or we can maybe tap into that why and come up with some solutions for you. um So I obviously prefer doing the same exercise, doing three or four sets to elicit that, to take advantage of the adaptation response. um But if you're looking for variety, we can do say supersets, like you can do a squat, one set, and then go away and do something else for a while. You can go away and do upper body, core, another leg exercise, and then come back to your squats and do the second set. Sometimes that's a little bit, um, a little bit easier for you to tolerate. And, know, you sort of keeping things guessing it, changing up. You've got some variety there, but you're still by the end of the day, doing your three sets of the important exercises. And you can go away for, you know, 10 minutes. Sometimes I do that sometimes because I've got my home gym right here. I'll walk in, I'll do my chest press. one set, one set of six, come back to computer, and then I'll work on a YouTube video for 10 minutes, and then I'll go back in and I'll repeat that three times. um That's something that you can do if you want to. We call these supersets. If you want, you sort of pair two exercises together. So you do squats, then you do calf raises, then you do squats, then you do calf raises, and you sort of go between the two, but you could also do a circuit, like I sort of mentioned before. Find four or five exercises. and just do a lap, one set of each of those all the way around and then repeat that until you've done like three or four circuits. That's three or four sets for each that you'll still have the same amount of stimulus. You still have the same adaptation, um, bodybuilders or, um, you know, those who are really looking to fully enhance the adaptation process probably wouldn't do that, but this is where we weigh up the variety with consistency and that sort of stuff. So supersets, circuits, but also find exercises you enjoy. Like is it because you just don't enjoy some of them? We can change some things up. Also, if you get like better at them, if you see progress, that can also create enjoyment. I've had so many people really hate squats and deadlifts or just hate strength training in general. And then they commit to it and they see themselves getting stronger, they're lifting heavier, they're sort of, people are in by the amount of weights that they're lifting and then they start to enjoy it. So maybe it's a something that you need to sort of push through and get really good at in order to then see the enjoyment because you start to see the results and you start to impress other people. um If you if that sort of motivates you a bit. uh Similar to me, like I hated chest press, I hated chin ups, they got really, really good at chin ups and now I love them pretty much just because I'm good at them. The Also bear in mind, I'm just coming up with a few other options here. Bear in mind like the minimal dose for adaptation. You can do three sets. Like I hate doing lunges. I don't know why. I just hate that. Like the burn gets me really quickly. I feel great afterwards, but I just hate in the moment doing them and it gets, it's quite heavy at the moment. I've got 24 kilos on each side. Sometimes I wear a weighted vest as well. So all in all, it's looking like sometimes 50, 60 kilos, which is like, only weigh, how much do weigh now? 68 kilos. So getting very, very close to my body weight. It's almost like I'm taking myself, putting it over my shoulders and doing these lunges. uh And yeah, I just don't see, I don't look forward to doing them, but I only do them like once every four or five days. Sometimes the stretch is out to seven, but there is some consistency there, but I only do three sets of four on each side. So I count to eight, eight steps. Um, it takes, I don't know, 20, 30 seconds. It's not a lot at all. It's a very small dose, but I get stronger with them. If I do three sets of four, I get doms the next day, just because it is super heavy. Um, and when I am consistent enough with them, I can get heavier. Like I didn't just lunge this heavy overnight, it took years, but that consistency sort of got me there. And I'm doing that exercise with the minimal dose because I don't enjoy it that much, but maybe that helps get you across the line. um So my advice, my advice for you, Joanne, pick three exercises that are going to be the essentials. Be consistent and progressive with them. That would be your squats, deadlifts, calf raises. If you don't want to do the deadlifts, maybe do a lunge or a weighted step up or a split squat, something that looks similar to that, but pick three essential exercises. So I'm going to stick to these. I'm going to do three sets of, you know, six to eight. I'm going to be progressive with them. That's going to be my consistent ones. I'm going to superset and everything else I could do one set of that could be a bridges, your box jumps, your crab walks, like banded exercises, all those sorts of things you can do one set off, but keep going back to those three consistent exercises. And maybe that's in that would definitely be enough to keep you moving forward in terms of your progressions and enhancing your running and that sort of stuff. But hopefully it's a bit more enjoyable. So that would be my advice. Okay. Lastly, we have Joanne again, who asks compression socks, please help. Uh, when calves are feeling tired and get a bit twingy, it feels kind of comforting to run in them, them being the compression socks, but are they actually doing anything? Uh, I pulled up a meta analysis research paper because, you know, I usually. What a follow the research when it comes to this sort of stuff. Cause I do have my own opinions and beliefs on these sort of things, but I don't really want to say something that's just only my advice. Um. is, I don't know, if we do that, then it's just me being opinionated. don't want that. want an unbiased, um, science backed podcast episode with those sorts of resources. So, um, I found a meta analysis. It was in 2017. The title was compression garments for compression garments and recovery from exercise. And they compiled 23 peer reviewed studies and they looked at, you know, recovery for strength training. They used different compression garments, looking at compression, um, graded tights, stockings, knee socks, calf sleeves, arm sleeves, and whole body garments. And they found that when it comes to, this doesn't really answer your question just yet, Joanne, so bear with me, but the overall conclusion of the paper, was that for resistance training for resistance exercise, a significant small yet very likely beneficial effect of compression on recovery was observed when compared to the control group. This is just for resistance training. And it was after 24 hours of exercise. So 24 hours after doing it is when you'd start to notice that benefit. But for running, they said in contrast to the resistance exercise, no likely recovery benefits from compression garments were administered following running. So this finding is in agreement with previous research with the recent review of 23 trials using compression garments used during and after running reporting insignificant effects on recovery. In conclusion, this paper said that compression would seem to be most effective for improving long-term in brackets 24 hour recovery from exercise that elicits a large degree of muscle damage, such as resistance or plyometric exercise. A large, very likely beneficial effect also exists for next day cycling performance. So they did look at cyclists to see if they're doing back to back hard, hard efforts. And it seems like compression stockings or compression sleeves, tight socks did have some sort of effect. So it doesn't really answer your question, Joanne, but I thought I'd it out there that's the only compression socks compression socks article that I could find that is like a large systematic review it's it's always nice to look at those but you say your calves are feeling a bit twingy and you have comfort in them but are they actually working so my advice first of all before even considering the compression socks try and find out why they're feeling twingy I don't know how often your calves are feeling twingy but they shouldn't feel twingy So let's try to investigate why they're feeling that twingy in the first place. Let's address the issue so that it doesn't keep happening because if it does keep happening and you are constantly getting calf twinges, let's just say it's once a month or once every couple of weeks, something definitely needs to change. Something needs to change in your training or your recovery or your intensity or something, because we don't want to just feel compelled. every time you get this twinge to put on a compression stocking and make it feel better because then we're just masking symptoms. We're putting a bandaid on something that's, we're putting a bandaid on the alarm bells in your body telling you that there's something in your training that you're doing wrong or that you need to pay attention to because there will often be something mechanical or hydration. Like I'm starting to, um, weigh up the relevance of your hydration status when muscles start feeling twingy, spasmy, crampy, just getting tight. I'm starting to ask more clients now what their hydration status is like and people are starting to see benefits with addressing their hydration. But anyway, we'll mostly be mechanical. um And yeah, we want to try and sort of investigate further. For most of these things like I think the compression stocks, compression stockings come in the same line as foam rollers, stretches, massage guns, water immersion, like hot, cold therapies. Um, and where I sit on that is if it feels good, do it. Like you've said that you've noticed a benefit when using the compression stockings. I would say continue doing it provided my first bit of advice about the training and diving deeper into that, but just recognize these sort of things are for short term only. We can't use it as a bandaid every time it pops up and think that we're doing the right thing. If it continues popping up, we want to do the long-term stuff rather than just always putting a bandaid on it. But sometimes we need a bandaid. Sometimes we need to do something that makes us feel good, makes it feel nice and those sorts of things. So, you know, I wouldn't say dismiss it. um because most of these things, the stretches, the foam rollers, the massage guns, there's not a lot of evidence for them. In fact, I haven't come across any compelling evidence to say that it helps with muscle soreness, recovery, performance, injury prevention. I'm yet, yet to see it. But if it feels good for you, there's nothing to say that you shouldn't do them. So when it comes to recovery, you didn't ask this, but I'm going to deliver it anyway. um I usually follow Shona Halston, who I interviewed on the podcast, who has this recovery pyramid, looking at the base of the pyramid, and then working your way up. So if you want to enhance your recovery, this is what you need to do. The base of that pyramid is sleep. You need a good night's sleep. You need to be sleeping well to recover well. On top of that, methods like cold water, immersion, hot, cold therapies, those sorts of things. I've actually got it in the run smarter book. Do I get it off my shelf and go through it? Just give me one second. Okay. Got it here. Page 385 for all those who have the book. Um, the bottom tier, the bottom of the pyramid, the base of the pyramid, the one you need to pay the most attention to is nutrition and hydration, sleep and downtime. So all of those help you recover both physically and psychologically. So like. decrease your stress, getting enough nutrients, getting enough hydration, getting enough sleep. um You need to do those things well before you move up the pyramid. The second layer is water immersion. So there is good evidence to show that that does help recovery, but helps you bounce back the next day. If you're doing back to back, like if you're in the Olympics or something and, or a cyclist and doing back to back, um, races, this would be something you do. Above that is Um, active recovery and stretching. like moving around, having this active session after the, after your workouts to then cool down the body. Then there's massage therapy on top of that. Then above that, we're looking at cryo chambers and infrared, which there's not a lot of evidence on. Um, so this is like the top of the pyramid. And then at the very peak of the pyramid, we're looking at other fads. So the fads being foam rolling, massage guns. All that sort of stuff. um I'm guessing compression socks would be in there somewhere, but we want to make sure we're doing all the other stuff really, really well. There's no point getting up out of bed an hour or half an hour earlier to do some stretching, foam rolling and all that sort of stuff. You'd rather do the things well, stay in bed the extra hour or the extra half hour um because that's taking care of the base of the pyramid. So. Thanks, Shona for that. Thanks, Joanne for the question. I will say to finish this off, um just make sure the long term stuff is there. So the long term stuff would be your training, the balance within your training, making sure you are getting the right balance between load and recovery, making sure the intensity distribution in your training is well balanced. General guide 80 20 80 % of your weekly training should be really, really low. really, really slow and then 20 % to push into harder efforts. If you are trying to troubleshoot some calf soreness or calf twinges, um factor in these variables. So speed, hills and your shoe heel drop. So we can back off the speed or look at if speed was a contributing factor. We can look at hills, was hills a contributing factor to the twinges? And if it is twingy, Make sure we keep to the flats and your heel drop if you're running on the flats and the heel drop in your shoe, which is the difference in height between your heel and your forefoot. If you have a 10 millimeter heel drop that will help offset the calves. If it is feeling a bit twingy compared to a zero mill drop mill drop. So thanks Joanne. We have all these questions answered. I hope that helped. This is um, This was a really nice episode. Covered a range of different topics, even though someone might not ask these questions, even though someone might not have these injuries or these problems, hopefully just listening to me, we go to take a lot of the stuff that goes on in my head has helped you rationalize your training, helped rationalize how you might deal with an injury in the future. Um, I try and answer these questions, taking a few tangents, just to try and help everyone. 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 prioritizing your running wisdom.