On this episode Brodie discusses the confusion runners often make during an injury flare-up. Runners often misinterpret weakness when it fact, it could be just an increase in structure sensitivity. When progressing a return-to-running program and executing your rehab exercises, it's not uncommon for a hiccup and mild flare-up to occur. This is often followed with pain & irritation when attempting activity that was once well managed. This can be interpreted as weakness and without recognising the difference, runners often go through high amount of frustration, anger & confusion. (Apple users: Click 'Episode Website' for links to..) Become a patron! Receive Run Smarter Emails Book a FREE Injury chat with Brodie Run Smarter App IOS or Android Podcast Facebook group Run Smarter Course with code 'PODCAST' for 3-day free trial.
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.
:
on today's episode, weakness versus sensitivity. Welcome to the Run Smarter podcast. The podcast helping you overcome your current and future running injuries by educating and transforming you into a healthier, stronger, smarter runner. If you're like me, running is life, but more often than not, injuries disrupt this lifestyle. And once you are injured, you're looking for answers and met with bad advice and- conflicting messages circulating the running community. The world shouldn't be like this. You deserve to run injury free and have access to the right information. That's why I've made it my mission, to bring clarity and control to every runner. My name is Brodie Sharp. I am a physiotherapist, a fighter, and a fighter. former chronic injury sufferer and your podcast host. I am excited that you have found this podcast and by default become the Run Smarter Scholar. So let's work together to overcome your injury, restore your confidence and start spreading the right information back into your running community. So let's begin today's lesson. Weakness versus sensitivity. First of all, welcome back. Thank you for the last week or so. People sending out their love asking how my foot pain is going. It's going well. I think I'm almost back to pain free running. There was one moment that I decided to go for a 3K recovery run. And I was running along a trail. that I wasn't familiar with. There was a lot of loose rocks and things and it was quite uneven. And I told myself, look, if I roll my ankle and flare up this foot, will I be okay with that? Do I wanna take on this risk? And I was walking for a lot of it through most of the uneven surfaces, but decided to take on the risk and during a uneven, but not as uneven as the rest of the track, decided to do some jogging. and didn't roll my ankle but placed my weight way too far on the outside of my foot, which significantly flat out my foot. I thought I was back to square one and that was about two weeks ago, three weeks ago at the time of recording, but it settled very quickly. It was almost like a different type of pain, but yeah, scary moments for a little bit there and Now it's pretty much all better. I'm back to playing basketball actually, played basketball for the first time in a couple of years and my foot was 100% fine. So running 4Ks now, 5Ks here and there and working a lot on cycling because I have an event coming up. But all things are good. So thank you for reaching out and sending your love and asking how it's going. It's going very well, thank you. Also yesterday at the time of recording, I did my first in-service. So I went to QV physiotherapy in the city in Melbourne, and I was their guest speaker to teach them around why runners get injured and what we can do about it. And that was a lot of fun. I'll probably look to be doing more of that in the future because I just had a blast. Just love talking about this and good to be in person rather than jumping onto Zoom and... spilling my knowledge on other podcasts through looking through screens. So yeah, that was a blast. And also today hasn't arrived yet, but I'm getting a new microphone and I thought I'd spoil myself a little bit and the success of the growing podcast. I think I might upgrade and find myself a better quality microphone. So looking forward to that. Hopefully you guys can tell the difference once it comes. Okay now. I have a new idea for the next three episodes. They're all gonna have verses in them. And today is a roundabout pain, but it's weakness versus sensitivity. And then I've got two other episodes coming up around other verses. But I thought this would be a new idea, a new concept. Not sure how long this will take. Won't be as long as other episodes. But I thought of this idea along with other people. asking these similar questions and hearing the clients that I see online, they have similar thoughts that go into their mind around this weakness versus sensitivity, because often misinterpreted and when it is misinterpreted, there can be a lot of doubts, a lot of thoughts of anxiety and not too sure what to do from here. It's just if someone starts misinterpreting their symptoms. I think I need to do an episode on it. So what do I mean when it comes to weakness versus sensitivity? I think the best way I could describe it is through an example. Let's just say we have someone with, we'll say plantar fasciitis, but we can substitute this for any injury. Let's say this person is recovering from plantar fasciitis, have spent three months or so building up their running tolerance, like their return to run program. and they've built up a lot of strength doing their calf raises and loading up the fascia, increasing its capacity and slowly building up their tolerance, finding success, but slowly getting up. Let's say they've built up to 10 Ks. Then one day they've overdone things. Maybe they've ran too fast or maybe they've spent some time loading up the plan of fascia outside of running, maybe doing barefoot walking a bit too much. And then all of a sudden it flares up and out of nowhere. their plan of fashion is a little bit sore, a little bit sore in the morning, they're like, oh damn, I've overloaded something here, but that's okay, I've built up strength, everything's fine, and then they go and do their 10K run, and this significantly flares them up. And they say, what the hell, have I lost strength like I did 10Ks last week? Why can't I do 10Ks currently? Why is it flaring up? Have I lost this strength? And then maybe I need to start a few steps back, and so. in three or four days time, they try 5Ks and it flares up. Already a thought would be, oh my God, I've lost so much strength. I can't believe it, all this work that I've done. And then a few days later, a 30 minute barefoot walk, let's say they're walking around the house in bare feet and that flares them up. And they think all these months of putting in this hard work, doing my calf raises, building up the strength, the return to running, and now I feel like I'm back to square one. all that strength has gone in the period of two weeks. And yeah, I have to start back at square one and that can introduce a lot of thoughts and a lot of frustrations. It's, and if you can, if you're interpreting this as a loss of strength or a growing weakness, it can be very frustrating. And you can substitute this for proximal hamstring tendinopathy. I think I might put this episode into the my proximal hamstring tendinopathy podcast. because it is a lesson everyone needs to know. But to substitute any injury, could be with a shoulder injury if someone's a swimmer. It could be just with knee pain if you're a runner or a cyclist. And so what's actually happening here? Are we losing strength? Is it weakness? I don't think so. In reality, well, I know so, because in reality, what's happening is there's not a decrease in strength, there is an increase in sensitivity. to that area, the pain receptors are heightened and the structure still remains the same. If it's a tendon, if it's a fascia, if it's the joint, if it's a knee joint, nothing's really changed. There's no, if you were to scan it before, scan it after, there's no, you won't be able to see any signs of weakness. But what you will be able to notice is that the pain receptors are a little bit heightened. Everything's a little bit sensitive. And so... This doesn't mean that we ignore these pain signals and press on and run through because we're thinking, oh, it's just pain signals, that's fine. We actually need to pay attention to it. It doesn't mean that we ignore these pain signals. What it does mean is that we, in this sensitive state, we need to find your new temporary adaptation zone and start training within that. And it might be in the short term, it might be for a week or two, but we need to find that because the more and more sensitive your injury gets, the lower and lower that new temporary adaptation zone becomes. And if we use this example, if say we did that, um, uh, back to that plantar fasciitis, if someone were to overdo things, maybe they walked too much, um, and 10 Ks was fine. All of a sudden there's a little bit of a flare up. The sense, sensitive structure is a little bit painful, I'd say okay, let's just for today, let's do 3k's and see how we go. And then all of a sudden if 3k's is your new adaptation zone, things will settle down relatively quickly, then the next attempt you can go to 5k's, then the next you can do 7, then the next you can do 10, and then we just like within two weeks we haven't, we're back to back to our 10k usual. However, if we try and find that adaptation zone say ah maybe our new adaptation zone is 7Ks and that flares it up. Then we dropped again, but then we drop our new adaptation zone is even lower because it becomes more sensitive and more irritable. So we really need to pay attention to this. We'll talk about that in a second. But a lesson that we need to know in this particular state, it isn't weak, it is just sensitive. It's really... The pain receptors, like I said, are heightened and we just need to really pay attention to it. So this helps us transition into exactly what we should do and how we can find our new adaptation zone while our structure is particularly sensitive. The first thing I wanna say is we might need to transition away from running just for a couple of days and start doing things that help. hit our adaptation zone in different ways, so like strength training, if we use like a knee for example, we might, maybe any sort of running might be too much for it in this irritated sensitive state. So maybe we need to do say some slow but heavy squats or lunges, maybe that's fine and that's enough to hit that adaptation zone. If we use plantar fascia, plantar fasciitis, maybe we back calf raises with our toe extended with a folded up towel underneath our toes, which is found to be really beneficial for plantar fascia. Maybe we find something. It's all about finding that adaptation zone, maybe recruiting a little bit of experience or a coach or a health professional to help you through this process. But depending on the level of irritation, that current state, you want to be more and more cautious about the first thing that you dive into. The first thing that you trial to see if you can tolerate it. If it's a very mild flare up, very mild symptoms, then you can probably test out 50 to 75% of your current capacity and see how that goes. If it's really sensitive, really irritable, you're probably looking at something at around about 15% of your current or just something completely different. Like I said, instead of doing running, we might need to back off running completely and do some strength training. And that's only in the short term while all these pain receptors and things start settling down. And then we slowly start returning back to what we were doing. So it is a bit of a trial and error. Does depend on your current capacity before the flare up. Does depend on the significance or the level severity of your flare up. But all in all, we're being proactive along the way. And these thoughts of... you've lost all that progress, you're back to square one. We really wanna avoid those negative thoughts because that can spiral out of control as well. We wanna avoid pushing through the flare up more. I illustrated that before and I'll say that again, because then the structure just becomes more and more sensitive. Without a structure and without the right method or the right process and the right guidance, you might find yourself a bit astray. So recruiting some help can be effective as well. And you can return back a lot quicker. So I think it's worth mentioning now, there are certain factors throughout life and throughout your day to day, which can affect sensitivity of a structure. And I see this in a lot of people that have chronic pain. I've seen this in a lot of people that might have a really sensitive injury and are really worried about pain signals. They're very hyper vigilant about pain signals. There are certain influences throughout the day which turn up your pain dials. And I listened to another podcast last week and they explained that quite well. There are certain factors that just have pain intensity dials and certain things can turn up those dials and just make things really sensitive. So all of a sudden, like a small stimulus triggers quite a lot. And so I've got a few dot points here. I might be repeating myself, you might already know this. One is poor diet. So if you're eating a lot of junk food, a lot of sugar, stuff that isn't good for you, this can circulate a lot of, or foster a heightened sensitivity. Just general lifestyle being inactive, sedentary behavior, lack of social interaction, these sort of unhelpful social behaviors can be really detrimental and can spark sensitivity. Definitely poor sleep. That sleep does help the body rejuvenate and helps settle a lot of things down. It helps regulate a lot of hormones and a lot of, yeah, just hormones that are circulating throughout the body. and then your emotions and your thoughts that you attribute to certain things. If you're constantly focusing on the negative, you're constantly hypervigilant, if you're constantly anxious about flaring up a certain area, we know this with our pain science episodes, it's gonna spark more sensitivity. And when you learn to say, forget about an area, the process and the healing time is, it's a lot quicker. And so, You could be running your 10 Ks with your plantar fasciitis and be thriving. But all of a sudden, if you're starting to, uh, be quite anxious, if your diets letting go, if you're on the couch all the time, just watching TV, eating potato chips and having those really unhealthy sedentary lifestyles that can help that can not help, but it can spark a lot of that sensitivity and turn up those dials within the body and all of a sudden what might be a little spark of pain in someone now becomes a flare up or becomes a very significant pain they need to pay attention to. So be familiar with this sensitivity and it can just spark out of nowhere. I think the first time I really heard this in detail was in the podcast, Empowered Beyond Pain and they mainly talk about low back pain and chronic low back pain or say chronic. osteoarthritis of the knees and hips and they recognise that some low back pain or pain signals can just flare up out of nowhere and there is a link between all those things that I discussed around poor diet, poor social interactions, poor thoughts, behaviour, stress anxiety, all those things have real connections with why all of a sudden there's a flare up and so... We need to keep this in mind. We need to consider this and just recognise that if there is, if you are particularly sensitive, if there are a lot of flare ups that don't make sense, but you do have a lot of anxiety around a particular injury, these are the things that need to be considered. Okay. What is weakness then? If we're doing weakness versus sensitivity, we're looking at what turns up those dials, what contributes a lot to that sensitive structure. But what about that weakness? What's? what contributes to weakness. And I can't really follow evidence, I haven't seen a lot, but talking about durations, we're looking at long durations of under loading, we'll start to slowly trickle into some weakness because weakness is the capacity that you can currently tolerate. Every joint, every muscle, every ligament will have a certain load capacity. If you overload it, it will start to break down rather than build up. Everyone, every structure in the body has its limit. And that's what we call strength. That's what we call like tolerance. It's what we call resilience. But if we have this plantar fasciitis and it has a certain level of strength, what will actually cause it to be weaker? And that is long periods of under loading. I think around about three weeks, if you're constantly under loading it, that's when weakness will start to creep in. and start to slowly contribute to less and less strength. However, this will happen a lot quicker with periods of say bed rest, or if you're put in a cast, or if you're really, really under loading it, it will happen a lot sooner. People are amazed when they get out of hospital, they've spent three days, complete bed rest, and they look at the condition of their legs, and they're just sticks. Just because you have spent so long. just complete offloading, complete bed rest. Those who have been in a cast, let's say if they've had a broken bone as a kid, or if they've had to be in a cast for whatever particular reason, or they've been on crutches and having to completely offload a certain structure for say seven to 10 days. And then they look at the amount of atrophy, like how much muscle is wasted away in that short period of time, it's astounding. And that's because you've gone completely offloading. So it will happen a lot quicker if you do that complete offload. But weakness will generate slower through indirect activity like cross training and just keeping the body engaged, keeping the body strong in other ways. And what I can think about, let me throw an example, if we have plantar fasciitis and we need to spend some considerable time off because it will flare up just some really low levels of walking will help maintain a lot of strength that is gained without there being much offloading. If you wanted to spend time in a cast or on crutches or in bed for an extended period of time, the plantar fascia strength will downgrade very, very quickly. However, if you're just walking around, if you're on your feet, that process will take a lot longer to... weakness will take a lot longer to manifest itself. And so I hope that makes sense. It's not going to get weaker in the period of two days or a week because there's a significant flare up. The structure itself will still be able to tolerate a lot, but it's just extremely sensitive. I hope the difference between the two has been quite reassuring for you. If you had these, maybe you can reflect in the past when injuries might've occurred. I know there's several times like my proximal hamstring will flare up and all of a sudden sitting for half an hour will flare it up and I'm like, oh damn, but doing the right things three days in a row after that and I'm back to sitting for, you know, four or five hours. It's not the fact that I've got stronger in that time. It's the fact that it's become less sensitive. So have a, have a think back over the last couple of years when you might've had an injury, if you might've had a flare up or sensitive period in your life. Yeah, I think just have it gives you a bit more control, a bit more, a bit more, um, it'll help you interpret your symptoms a little bit more. So just bear that in mind. Um, so I've got my note here to do a bit of a recap, but I think I already just did that. It's a, it's a simple concept once you learn it, but I think learning it is a tricky part because people can get quite confused. Next time we're going to look at more of the training aspect and we're going to look at variety versus specificity. So how specific you need to be in your training versus being more resilient to having more variety. There's a tight balance there, which I'm excited to talk through because it's not something I usually talk about, but I think will be an interesting conversation. So looking forward to bringing you that next time. Thanks once again for listening. To take full advantage of the knowledge you are building, you need to download the Run Smarter app. This contains all of my free access podcast episodes. written blogs and ebooks along with my paid video courses all neatly housed into categories for you to easily navigate through and find content you're interested in. Also be sure to check out the show notes for links to the podcast Facebook group and links to learn more about becoming a podcast patron who contribute $5 Aussie per month to get and a complete back catalogue of Patreon only podcast episodes, which you can access within the app. Also on the app you can even find a link that takes you to my online physio clinic, where I assess and treat runners from all over the world, so I can be on standby if you ever need one-on-one physiotherapy assistance. Once again, thank you for listening and becoming a Run Smarter Scholar, and remember, knowledge is power.