Greg Lehman is a physiotherapist, Chiro & strength and conditioning coach. He teaches courses to health professionals on biomechanics, with pain science & running rehab. Greg had previously wrote a blog titled: 'Running is Rehab: When doing is the fixing' and this is exactly what we dive into today. We delve into this term and what it actually means. Greg lists the benefits of continuing to run within your rehabilitation and consequences if it is ignored. Greg also clarifies how much running is too based based on your injury symptoms. We also answer your patron questions, including: How do we know when we are ready to incorporate tempo runs, intervals and hills when injured? Will tape & braces help my return to running? You can find Greg's website, twitter & instagram here along with his website on OA for runners. (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.
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In today's episode, running is rehab, when doing is the fixing with Greg Lehman. 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 Brody Sharp. I am a physiotherapist, a former chronic injury sufferer, and your podcast host. I am excited that you have found this podcast and by default become the Run Smarter Scholar. So let's work together to overcome your injury, restore your confidence and start spreading the right information back into your running community. So let's begin today's lesson. I have a great episode today. I just got off our Zoom call with Greg and loved having him on. I've been wanting to have him on for a while. He is a physiotherapist. He's also done some chiro in the past. And he is also a strength and conditioning specialist and done some research in exercise biomechanics as well. So a wealth of knowledge. He loves Twitter. His posts are very informative, but also loves a bit of controversial banter and debate over Twitter as well. If you want to go follow him, you definitely can. I'll include those in the show notes. But one blog that he wrote and published really resonated with me and wanted him to come on to discuss it. And the title of the blog was Running is Rehab When Doing is the Fixing. And if you are injured or not, you would definitely benefit from this interpreting symptoms, interpreting pain, how much is acceptable and busting a couple of myths along the way. And so, yeah, Greg was a pleasure to talk to. I thought there would be some areas of disagreement, but it seems like we did come to general conclusions with a lot of things, his leniency towards certain things might be a little bit more lenient than what I might advise. But yeah, it's good to get other people's perspectives as well. So I hope you enjoy this episode. Let's take it away. Greg Lehman, welcome to the Run Smarter podcast. Thanks for joining us today. Yeah. Thanks for having me. You're very welcome. If there's anyone who isn't familiar with you, can you maybe just start off with who you are, where you're from and how your careers kind of progress to where it is today? Yeah. So I'm in Toronto, Canada. I'm a physio. Right now I used to be, like I did lots of training. I'm very inefficient, I guess. So I did like a master's in exercise biomechanics. Then I did a chiropractic degree and then I went back for physio. So, you know, primarily I'm a clinician. I was a clinician for 15 years. Past few years been a lot less. I still see patients, you know, online and in person but mostly I go around and teach my course about, you know, biomechanics, injury, pain, performance, all that stuff. Of course, I haven't done that in a year. You know, I still view myself as doing that. Of course. We can't change how, like how you identify yourself based on lockdown. Yeah. So the topic of today is running his rehab and I based this off one of your blogs that you did and I saw it on Twitter. So I guess to start off with exactly what is meant by, or what was your intention when you. say in the terms running is rehab. What does that mean exactly? Yeah, it's a, it's a bit of a reaction to something I heard ages ago with the physio saying, you know, something like people need to like earn the right to run or something, meaning they had to do all this extra work to prepare their bodies and all of these things. A really negative viewpoint on how people adapt to the stresses of running, you know, uh, And I was like, no, the best thing to prepare you for running is running, right? You gotta get the dosage right. There's a lot of other things, but if you have a good coach or you're good at managing your volume and your recovery and all of that stuff and speed workouts you do and your other workouts, then that's the best way to get prepared for running. And it holds true for rehab. Like if you're injured, running or some sort of like, running program should be part of it unless it's like, you know, well, even if it's a stress, I was gonna say a stress fracture, even a stress fracture just means you probably have to get off of it for a few weeks, sometimes quite often longer, but then running has to be part of your rehab. That's the way you, like you apply stresses to the body and the person adapts and running has to be a huge part. There's a role for other things, but running should be the primary part of getting back to running. Yeah, it's a good way to kind of reframe a lot of our ideas and what we think rehab actually is, and a lot of people think that while they're injured, okay, I can't run, let me, let me go, uh, do some other things and then returning to running should be the goal. It should be like at the end when in fact, we're, we're wanting to reframe a lot of this and make running a part of the rehab, make it a part of the process and so the, I guess it's. it shouldn't just be like this, this goal. It's more a part of the rehab. Yeah, that's the idea. And sometimes the primary part, like in the physical world, we get caught up in thinking, Oh, I'm going to find something that looks wrong with you, a weakness or a tightness or something just, just different. And we were like, then we have to fix that with the, we have to fix that in the person, you know, get them stronger in some place. And I just, I think those. exercises have a role, but again, I think that they're secondary. And surprisingly with the research, you never see it. There's a few studies, it's not in runners where you never see a good study like this. Someone does, actually there was one study, nevermind. I forgot it. It's my friend, friend of mine did this one. How did I forget that? Where like you take a group of people, this is one paper by JF Esquilier where one group just does, they're injured. They just slowly get They'd listen to their body. They slowly build up another group does that. And then they change how they run. Like they, they take shorter steps or land more softly and the other group gets exercises and there's no difference between the groups, right? The most important thing was that everyone just slowly built back up their run. I'm glad you mentioned that because that is one of my favorite studies of all time. And I actually created a podcast episode on it around, you know, patella femoral pain. What's the best ways of. I'm strategizing and recovering from it. Um, I think when you talk about running should be the primary focus within the rehab, as well as, you know, the secondary of strength exercises and what other cross-training rehab advice they have. It makes me think of. Feel like health professionals that aren't runners or that aren't really proficient with seeing runners, they'll very quickly dismiss or very quickly advise not to run rehab, do your strength work and then return back to running. Whereas it seems that those who are more proficient with seeing runners or those health professionals that are runners themselves are more inclined to keep them running as much as possible. Do you see that same pattern? Yeah, absolutely. It just depends on your philosophy. If you view yourself as a physio or a healthcare provider who's like a mechanic, we have to fix people first and then they get to run, then yeah, you're gonna hold them back. But if you realize you can do a lot of training, where you're still running and that's, that's part of the stimulus to adapt. Yeah. So I would agree with what you're saying. So what are the benefits of continuing to run through injury if we're doing so adequately, if we're following the right steps? I guess, what are the consequences if we don't run during rehab and what are the benefits if we do? I mean, I think the benefits are massive, like just the health benefits that people get. And right now, just the social benefits, people often, When you're a runner, and I don't actually, I don't consider myself a runner anymore, but when I was, you know, for eight years just running, and that's all I did, when you run six days a week, that's what you do. And when you take that away from someone, that's pretty horrible. So as a physio, I don't wanna do that. I want people to be able to get all the benefits from it. And then the other idea, if you're injured, again, running is like, Injury is just, it's difficult, but we know that treatment is often applying some stress and we hope the person adapts in a positive way. And running is a great stress to do that. You just gotta get the dosage right. The negatives of this is, and it's always as a clinician, you're always like, well, what am I missing? Is there something that I need to be doing? is running insufficient, is an insufficient catalyst to get the right adaptation. And it might be for things like bone density, right? That would be an example where I would think that we need something else. Or if someone has an Achilles tendinopathy and they're getting older, and we know with age, you tend to lose some calf strength and you can get less stiff in the Achilles, that... might be worthwhile of adding some specific load to the Achilles. Although what's interesting, you still might be able to use running to do that. Could be hops and skips and running up hills. You still might be able to find some way to get a different type of stress on the Achilles. So I'm always open to, I have a bias here, but I'm always open to challenging that bias. Like when is running alone insufficient? And so I tend to like... extra stuff just to cover my ass and cover all of our bases. Even like there's some redundancy built in there on purpose with all my treatment programs. If you were using Achilles as an example and we're using running as a primary, um, as a primary method of rehab, just for example, like say they've overdone things, they've done too many, too many hills or they've done too much speed work and then they've got this sore Achilles. one of the primary methods that you might be suggesting is to, okay, let's back off for a couple of days. Let's reduce your mileage. Let's reduce, yeah, speed maybe, and then wait for those symptoms to settle down, still continue running, but doing some slow conservative runs. And then once symptoms are more stable, then we slowly start to reintroduce speed work and the tendon kind of adapts along the way, pay attention to symptoms along the way. Then we can... perhaps like structure something really nice where we integrate now speed. Now we're integrating Hills. Then we're integrating a lot of like, um, more intense stuff. And like along that journey, the rehab, like the 10, the tendon will adapt to that rehab and it use running as that primary method, would that be a similar? So I would always do that. Right. What you said. Um, but because we're never quite certain what needs to be done. The other argument is that we need some sort of heavy load on the tendon. to cause the tendon to adapt in a way. And when I say adapt, what I mean is like, you change the quality of the tendon. So the tendon actually gets stiffer, right? And stores energy better. And what we think in order to change the tendon quality itself, you need heavy resistance training, like 70% of your max. So running hasn't really been shown to change that. The debate is, we don't know if that has to be done. But because it's so simple to add and you get other health benefits and maybe performance benefits, I would add the basic strength training as well. Plus what you just said. Okay. The other consequences, if we're coming back to it with not using running as a part of your rehab, one thing that I can think of is while you're deconditioning a whole bunch of the other tissues in the body as well, if you're not running and just going back to do doing some basic rehab and basic exercises, but. A very crucial part would also be the fear of returning to running. If say your last run that you did, you say strained a hamstring or you strained a calf muscle or your Achilles got sore, then you have all this time off and you've rehab, you rehab, you rehab. Sometimes if we know much about pain and pain science, which I've done ton of episodes on a lot of people get this real apprehension, a lot of fear returning back to running and fear of re-injuring it. And that fear itself is really hindering for recovery. Yeah, absolutely. And the fear often leads to sort of a rumination or a hypervigilance where I think there's a subset of people and I'm kind of like this. So I'm not judging anyone or I'm judging myself where you take that little inkling, that niggle in your knee, that might be a one out of 10 or a two out of 10 and that fear and that worry and the rumination, the hypervigilance. you can really turn it into something disabling sometimes. And I do have a few patients like this where we just kind of talk it out and use running to build their confidence again. And they know that their flare-ups are sometimes a little bit of tissue and a little bit of their nervous system freaking out. And it's neat that they can almost talk themselves off of that edge and take their five out of 10 pain into the good old one or two that well everyone has. I think I share that same experience when it comes to returning from injury with hypervigilance, like your first couple of runs back, like I've had foot issues and like Achilles issues and every step is like, how's my foot, how's my foot, how's my foot, how's my foot. Like every single step when you first returned back to running, but after one or two successful runs back, that just goes away, but for some people it doesn't go away in it. In fact, if that leads to another flare up, it leads to more worry, it leads to more fear and it leads to more hypervigilance. And can be a really tricky spot to get out of. Yeah. Especially if they're coached or a therapist, clinician tells them like, you shouldn't be running unless you're 100% pain free. And of all the runners I've worked with, like everyone has episodes or weeks where there there's something going on, but they just manage their training and you can still, you can still run through these things. It's such a positive messaging. Well, let's dive into that. bit more specifically, because I guess the devil's in the details here with using running as a part of our rehab. And we know that we can obviously overdo things and running can actually make things worse, but we need to follow some clear guidelines. Like a runner needs to follow some guidelines to make sure running is successful as a part of their rehab. And so what do we need to focus on? Are there any general rules regarding pain levels or regarding strength? tests or something beforehand before we can start incorporating running? So, not really. There's no, like, this is the thing I always argue with people with this stuff, sorry. But everyone's like, they wanna have some screening program to see who's cleared to start running again, as if there's these tests and they don't exist, right? Like the best screen for running is running. That's it. How do I know if I'm ready to run? Go and run. 50 meters, walk for a minute, do it five more times. All right, let's see how you feel tomorrow. No changing symptoms tomorrow. All right, let's do it again and just slowly build up, something as simple as that. That's when someone's really starting from, they took maybe a few weeks off or something like that, there was a real issue. And then at the same time, you also, this is where you have to be a good clinician. You do wanna rule out sinister. So if you're worried about things, like you want to make sure if you have anterior growing pain, especially if you're a female and maybe, you know, you're not eating as much as you should, even losing weight and you have some, you know, issues with your period and that, like that, those are times where you want to definitely shut that shit down. Cause that can be like, that's some sinister pathology. That's possibly a femoral neck stress fracture. Right? So those things. we're not gonna be macho here and hammer into pain. We can be more cautious with that. But if it's more like my calf is sore and it's the muscle or it's the knee or it's this tendon and it's been going on for months and you know what it is and there's nothing really sinister, that's when you start poking a bit into discomfort and start progressing from there. Okay. But other than that, sorry, you mentioned the strength test. There's no tests. Yeah. People try to think that, no, there's nothing. In the past, I've liked to use just like quick hopping, like can you hop on one side and see if there's any like real apprehension or if there's real imbalances from like right to left, like you can see someone's really healthy and rigid on one side and then they're really sloppy and like really cautious to absorb and produce like force on that side. And I've used that as a quick little test. And I usually say if you can't really hop equal on one side, then you really probably shouldn't be running. Would you disagree with that? It depends, if it was something like an ACL tear, something where there's some massive trauma, but even as symmetries, like even with that, I would like that's, there's nothing wrong with that test. You could certainly do that, but if you have them go run a minute and they feel okay, especially if they warm up and it starts to feel better, you know, what would you rather listen to? Like how they feel when they run or the, or the hop test. Unless the hop test is that's a good test for stress fractures as well. So if you're worried about that type of stuff, if that's really painful and, and sure. And it, and it, you know, it growing pain or something like that. Uh, yeah, then we're not running. Yeah. And during your running, like during your rehab, are there, what indications do you like to follow? What advice do you like to provide regarding like pain during pain afterwards? Um, just 24 hours post-run, what sort of advice do you have on that regard? So it's, it's actually, it's a tough one. Like it almost depends where you are in your training and your goals. You know, um, so we, we know that you can poke into discomfort and still be running for a few weeks, uh, when things hurt. And so if you have a race that's coming up, even training and the pain you have kind of stays the same when you're run. and it doesn't really get worse the next day. So the pain is stable. Then I would say, keep going and then do your race. But then we probably want to back off after the race and see if we can settle this down. So it's like, what we're sort of learning is it's okay to run with some discomfort. I'm just not sure it's ideal. Right? Does that make sense? But if it's earlier in the season, why don't we work on things and figure out. like what's going on and why you're so sensitive. So then we back off a bit, see if we can decrease the pain to no pain and then slowly build back up. I think most of the listeners would be say, recreational runners who aren't really in season, not necessarily training for something at the moment, just love running and love running, you know, three to five times a week and are injured and just want some advice around what pain levels to pay attention to. So this is what I'd say like, You can go for a run, you can be sore and you can get new aches and pains all the time. You go for a run, your knees kind of sore for 10 minutes. If it warms up and goes away or you hardly notice it during the run, great. That's something that pain is normal, really common, probably not a problem. If that pain starts to really get in the way of your running where that's all you're thinking about, I would say like my general rule of thumb, and there's no science here. If someone looks at you and knows you're in pain, that's probably too much. Like you should have to tell someone that you're sore. That would be the idea. So if you're like limping or doing things differently than you normally would, and if the next day, like, you know, at three in the afternoon, it's definitely worse than it used to be. Don't worry about the morning doesn't count. The first 10 minutes, forget about that. For over 30, you're probably sore. It's just like, it's just what happens. So if like, if it gets worse the next day, if you can, if it gets worse as you're running, yeah, then, and it's not tolerable, like, where it changes how you run, then it's too much. I love your leniency when it comes to these sort of things. Yeah, it can be so for the first couple of minutes in the morning, it's fine as long as it doesn't hang around. Oh yeah, like I honestly ask the people you work with, like over 30 everyone's like that. Yeah. And then, and then same thing, and you will ever run your own business, but like, you know, don't judge the run by the first 10 minutes. You can be sore there. And then if, say you do, I used to always get this with my knee and I didn't ever really have a lot of knee pain, but I would always have, not always, every few weeks, about 10 to 15 minutes during a run, my knees would be killing me. Like I'd have to walk. And what I used to do was skip, hop, shuffle, run backwards, run super fast, run slow, and then it would go away. But it was literally 11 out of 10. I remember being in a half marathon. It was my best one ever, but hopping, like skipping for about 200 meters, it came on at 4K. And then it was gone at five. Like, but it was honestly nine out of 10, excruciating pain. Like weird stuff sometimes, like know that you can have these things and just do something different. Go, you know, shuffle a little bit, run faster. I guess doing something different and a long. the way just like learning more about your body and learning what pain levels are acceptable and what pain levels aren't acceptable just through time. But no, keep in mind that pain is totally normal. Pain is okay. And it's okay to poke into pain like you're saying. Yeah. I mean, I always say like, you can poke the bear. Just don't hump the shit out of it, which is like difficult. So it's how you find that line is hard. And there are a subset of people. who if I was working with, I'd probably pull them back more than they would wanna pull themselves back. It seems to like, there's some research on flexibility, not like physical flexibility, but mental flexibility and injury where you get caught up in thinking, I have to do all of my workouts at these spaces or this intensity, and you get too rigid with your training and you're more likely to get injured. So giving yourself a break too. There's a subset of people who just have to like. their coach has to pull them back. So if you're one of those people and don't listen too much to this. Yeah. Well, this is kind of my, um, my worry that some people are going to listen to this and then they're going to be going doing way too much. It's getting way too soon to say, Greg said, it's fine. I know. I guess if, is there something that they can, is there a rule that they can kind of implement? I guess one of the things I think about is week by week, it shouldn't be getting worse. Like your pain symptoms shouldn't be. on average, shouldn't be getting worse week over week. If anything should be exactly stable or getting better on the improve. Would you agree with that? Yeah, absolutely. And then if they are stable and your volume's increasing and you're doing more workouts, that's success as well. Yeah, so you're continuing to build things up and you continue to build up your weekly mileage, but symptoms are stable, if not getting a little bit worse or a little bit better. Yeah. Okay. That's it. Yeah. I trained for a marathon with an Achilles tendinopathy for like four months. And it was that same idea. Yeah. Still building up, building up pain really stayed the same the whole time. Yeah. Well, that, yeah. And we know, I guess through research and Joe Cook talks about this all time. Like if you, if you increase your mileage and tendon symptoms stay exactly the same, that's a success. That's the tendon not being grumpy. It's not being angry. It's actually responding quite well to your increase in load. Yeah. Yeah. Great. Um, but week over week, if things are getting worse and you're like, Oh, two weeks ago, I was running at a three out of 10 pain now to six, then probably we need to manipulate something or change something within your running. Yeah. Yeah, totally. I mean, I, I guess the people I see more often are those who've been told just to shut it all down, you can never run again. You've got to be 100% pain free, you know, all of these things. And I'm like, Oh no, that's, do you want to run? Let's go run today. I'm curious to hear your answers on a couple of these patron questions. Um, Jesse asks one, but then a whole bunch of other patrons jumped on to second that so Melissa and Rachel also wanted to know the same answer. How much of a, like when you are injured and you're returning to running or you're trying to keep running within your program, how much base should you build up before you start to incorporate tempo runs, interval runs, hills? I'm curious to know your thoughts on this one. So with questions like this, like injury wise, I'm again, I don't think it matters that much, especially if you're smart, like a lot of the problem with the plans, like with books, they probably are a bit too aggressive for most people. Like I would be comfortable if someone just did a walking program and then started a simple learn to run program where they, your first 5K. without a lot of speed work. And then you slowly threw in strides, but I think he could throw in strides, you know, like 50 meter intervals, like almost the first, you know, three or four weeks and stuff like that. I don't think you need to do like a six month base building stuff. You just have to be smart. Like, especially if you haven't done anything fast in a long time. But if you're 23 and you're a female who played soccer competitively, you know, a year ago and for 10 years before that, you're gonna be able to add some speedy stuff, you know, quite quick. So like, I don't think there's any, I don't think there's no hard or fast rules here. It's almost what you've done before in the past. And I think you can quickly, but here people will say, here, sorry, I'm all over the place here. If I was pressed, I would say most people could start some speedier stuff quite quickly within the first month of running. And I know this because people go and they join like an ultimate Frisbee league, an ultimate, not Frisbee, an ultimate league or, you know, dodgeball or soccer. And what do you do? What do you do during those sports? Do you do a jog? In sprinting, right? We can do this. It's not like, oh, I've got to do three months of base. Now that's injury-wise. Performance-wise, I don't know. I like get a coach. But I mean, there's, I, I am a big fan of like just getting mileage and just running a lot and running slowly and being patient. Yeah. The thing I would also add is if we're talking about tempo, if we're talking about hills, if we're talking about like speed work, it's not this dichotomous like, okay, now's the time when I can start incorporating speed. It can just be the slowest gradual like... like you can implement speed so slowly and so carefully. Like you say, as long as you're smart and as long as you're sensible, speed might be, you know, 10 seconds faster per K than what you're previously doing, or it doesn't necessarily be a sprint. And same with hills, it doesn't need to be, okay, now I can sprint up this hill that takes me 60 seconds. It could just be a gradual kind of, like very gradual incline that lasts like 20, 30 seconds. And... If you're successful with that, then you can start doing a little bit more. And if you're successful with that, then you can start doing a little bit more. And so I'm always a big fan of this trial and error and pay attention to symptoms along the way, and it doesn't necessarily be like, it's not this dichotomous. Yes. No. Now I implement this now implement this. It can just be a experiment. It can just be a smart, sensible reintroduction of this very gradual speed or very gradual hill, and then see how you feel. Um, sounds sensible, doesn't it? Would you agree? Yeah, no, I'm all over it. Yeah. And I guess the same, Jesse also asked about like, implementing multiple days in a row, like consecutive days rather than like every second day. I guess it's the same answer, isn't it? Isn't it just the same as just trial it and see how it goes? Yeah, I'm a huge fan of high frequency. And often when I... work with patients, if they want to build volume, that's how we do it. We add more days per week rather than longer runs and sometimes do doubles. And these, so running twice a day, and these are for people only running 30K per week, but if they have trouble getting over seven or 8K in their long run, you can do, you know, that Saturday night you do a 6K run, and then in the morning you do an 8K run. It's kind of a double, six in the morning and four at night. So I like the high frequency stuff. That's what they're asking about. Like it's okay to add more, uh, more days per week, but same thing, just slowly build. If they're injured and they're trying to return back to high mileage, um, when it's, when is it okay to start introducing doubles or when is it okay to start introducing consecutive days? Oh, like right away. Like that's so, so that's the, that's it. That's why there's so many different paths here. Like someone's like identity might be running and they just like to get out and do it. So part of their rehab would be if they used to run every day, like an hour and a half or an hour, two hours, what we would do is they, every day they're gonna get dressed for their run, just as if they're doing their regular training and they're gonna go out and they're gonna run two kilometers, but they're gonna be out walking for the other 50 minutes. Yeah, that's how you do it. And then you just turn more of that walk into a run. And if they have a long run in there, then how we sneak that long run is again, we do some doubles. We has a fun with them. This episode is sponsored by the Breakthrough Running Clinic. Did you know I help assess and treat injured runners all over the world with my own online physio clinic? I always encourage runners to invest in their own knowledge first, but sometimes it's nice to have a helping hand and expert opinion. So you can sign up to work with me for a one week or one month physio package. at brea Or if you are unsure if online physio is right for you, I'll include a link in the show notes that gives you access to my calendar to book a free 20 minute injury chat. So you can talk one-on-one with me about your injury to see if you're on the right track and discuss all your rehab options. Another patron question. So Anelie asks, what are your thoughts on if they are injured, returning to running, uh, using support, like using braces or using tape to help someone reintroduce their running? What are your thoughts? Yeah. I'm fine with all that tape stuff. I know a lot of people hate it. People feel it's a crutch. The thing is it's, it's not that powerful in either direction, meaning if it works for you and it feels better, then go ahead. And then. Cause it's not something that's gonna negatively affect you in the longterm. I can't see it doing that at all. So it's totally fine. It's like an orthotic or wearing a stiffer shoe for a while. If you have four foot pain, you know, you can try these different things. There's just, there's too many benefits from running to say no to something that helps you run more. I just, there's too many rules. Yeah, if it works, do it. If someone hasn't ran for a while, I know a lot of people think that running on softer surfaces is like a more gradual reintroduction than going straight to harder surfaces. What are your thoughts on this? It's actually really complicated because we do know that if you run on something that's softer, the way you'll react to that is to stiffen up your legs. So... in some measures, it's this, what your bones feel or what the joints and what tissues feel is, is actually harder in a way, but other measures that might be less. And we don't know which measure is the most important for, for injury. So it goes back to what you just said, just give it a try. Experiment. Right. That's it. As long as it's not. Yeah. If you go run on the beach and bare feet, I guarantee your feet will be sore. Cause I mean, you'll be using your calf muscles and your small muscles or foot way differently. One of the ways I like to explain it is the body needs something rigid to propel off. That's how we become efficient. That's how we perform. That's how we move forward. And when something soft underground, we're trying to push into that ground to try and find that firm surface to push off of. And every time the softer it gets, the harder it is to try and find that firm thing. And so the harder we have to push to find that. And then it's really, and builds up a lot of loads and builds up a lot of requirements for the leg to achieve that. Yeah, I would say do it all. Try it all. Don't do it all. Try it all and then see how you feel. That's better. Okay. Next one. Christine said, oh, I'm curious for your, um, your answer for this one. If poor form and muscle imbalance got me injured in the first place, how do I make sure that I'm not reinfor- reinforcing bad habits when I've returned to running? Yeah, this is where I mean, my colleagues don't agree with me. I don't really, I don't believe in muscle imbalances. I don't know how anyone would identify them. I'm not really worried about it. I mean, an imbalance left to right doesn't really matter. You're running on one leg anyway. Like, yeah, it doesn't matter what the other one is doing that much. Yeah. You can, we see tons of asymmetries and plenty of runners. We can adapt to that. So I know you might've got injured before. Uh, and I know you might've been told it was because of your poor running form or imbalances, but it, it may not have been, there could have been other reasons. So he, and so what was once a problem is probably not a problem this time around. Yeah. That would, that would be my argument. I'd be, uh, I'm in, I'm in agreement with that answer and I'm happy you answered in that way and perhaps Christine, maybe take it with a grain of salt when someone tells you those sorts of things, I know. If you, if you see a therapist, a therapist is trying to look for things to make sense of why you got injured or make sense of, or maybe prioritize the importance of following their advice of following some, um, their, I guess, strength exercises or yeah, just adhere to their program by using language like that. Or there's an imbalance says your glutes aren't switching on your hips are too stiff or something like that. It's, it's very unhelpful and, um, poor language from the health professional side of things, and it can be, can spark a lot of fear in runners. I know runners that say my glutes aren't switching on. I'm trying to activate them while I'm running and I just don't feel them. I don't feel the fatigue in my glutes or don't feel the activation. My glutes when I run it just drives me crazy. So maybe take it with a grain of salt and exactly what Greg was saying. People are very successful with muscle imbalances if we can identify them in the first place, but people are very successful because it's a one-legged sport. Yeah. It's just one of those terms you always hear physio say, like, where's the imbalance and they, they can't, they can't really explain it. Yeah. Right. Yeah. I mean, 20 years old people, they'd be like, Oh, that my VMO is not firing and I'm too strong on the outside of my quads, you know, and that we know that's not really true. Yeah. I guess if you were to do say capacity tests where you do calf raises or you do hopping and you You look at the power or endurance and strength of one side and there is an imbalance compared to one compared to the other side. That's totally fine. You're only just going to be operating and running within the capabilities of the quote, unquote weaker side compared to the stronger side, but you're still going to be a successful runner. Would that make sense? Yeah. Okay. Great. Um, Steve, our last patron question chimed in just at the last moment here. I think he submitted this like a couple of hours ago, but he said, Do you have a better rule of thumb than the 10% rule when someone is injured and returning to running and wanting to build up some sort of mileage? What's your, what's your answer? Uh, no, I mean, uh, yes. Um, the problem with the 10% rule is weird. I teach a running course and, and if you, what, if you say someone's running 30 kilometers per week, uh, if you apply the 10% rule, I like, I think it's at 17 weeks. they're at over 100K. And no one could do that. That's just, it's just absurd, right? It's too much. The way you could view the 10% rule is, it's like, if you're only running five kilometers to start, it'll be really hard to build up your mileage if you go 10% per week, right? So at low levels, it's not enough. And then if you're running 100K per week, you can't be adding 10 kilometers and then 11 kilometers per week. So there's an issue with it. So I wouldn't get caught up with that. But so I wouldn't, I tend to do things more like minutes, you know? Like I would build someone up like five minutes a week or so until you get to like 20 minutes, if you've never been running, till you get to 20 minutes and then plateau for a while. and then see how you go for a few weeks and then start building up again and then plateau for a while. And then at some point, and this is, you know, I think Brody, you're talking about this, you're gonna figure it out for yourself where you shine. Like not everyone can run 160 kilometers per week, right? Not everyone can run 80 kilometers per week. There's gonna be some point where 40 to 60 might be the area that you feel healthiest and strongest and happiest. And then you just... you'll just go up and down in there where you're, where you're just plateauing and then you have a deload week and then you slowly build up five to 10 minutes per week. But so that doesn't really answer the 10% rule, but cause I don't get the 10% rule. I guess it's worth highlighting that the 10% rule has a lot of flaws and it doesn't, first of all, it doesn't incorporate intensity. We don't, it doesn't incorporate speed. It only just incorporates like mileage, I guess, but it's flawed in the periods of someone who's just starting out, it's way too gradual and it's flawed in the ones who are doing a lot of Ks in the first place because yeah, it's just a very, very blanket rule that has, you can poke a lot of holes into it. But yeah, it's worth knowing because it is very common. A lot of people follow that rule just because they read it on the internet or they find it easy to follow, I guess. But great. Thanks to everyone for submitting those questions. In your blog, when we talk about running as rehab. There's a couple of summary points that I just want to touch on just to kind of sum up. You should have read it again, eh? Yeah. I read that last year, two years ago. I don't know when I read it. It doesn't matter. I can remind you. So there's a couple of summary points, which would be a nice way of closing out the episode. So number one was to find your current capacity. Number two was then progress this. Number three was to avoid types of runs that aggravate. And so... with number three types of runs that aggravate, what would be an example of something that would aggravate an example of something that wouldn't aggravate? What's the characteristics? What's the behavior looking like? That's what's so neat. Like often people think about speed. You always have to run slower. No, there are times where people hate, like they're just not tolerating that slow, easy jog. And so... Okay, for a little bit, don't do that. Mix it up, change up your paces. Like they don't like the monotony. So if you normally run a five minute kilometer, run some at 530, run some at 450, like change up your paces. Do pickups like every kilometer, do a hundred meters of strides. It's kind of a lot, but, so change around. But then there's people where you just can't do that 10 by 400 meter hard session. So mix that up and do that. That's where you might be doing, you know, 3k repeats, where you just do two times 3k instead of the, you know, the old 10 by 400. So it's, it's really, like you said, just trial and error and changing it. And just because you can't tolerate something now doesn't mean it's always off limits. It's just a temporary, temporarily backing off and then reintroduce it later. Yeah. It goes back to like one of the running courses I did with J for Schoolie. He, he used this graph and said that all running injuries will get aggravated by certain things. There's the range of movement, like some increase the range of movement of a joint and that might irritate it repetition. So some injuries say like ITV friction syndrome is just the repetitive nature of the same thing over and over and over again. And the other one was load. And so like increasing the load would potentially like flare up this injury. And so. depending on your symptoms, you could say like, they might not respond to the repetition. So those long, slow, um, recovery runs or the long runs on the weekend that aren't really, that are really low intensity that might actually be worse for some people than if you were to do like a sprint session, sometimes that might actually be good for them. And like say patella femoral pain or like that sometimes like load is, it responds better. but that repetition side, probably not so much. And so, yeah, it's good triangle, a whole bunch of different runs and just seeing how you respond, use it as an experiment. Yeah, you often hear that with the ITV stuff. I had a colleague, she was a runner in a physio and she had someone like do a whole marathon with just intervals. It was like one kilometer hard, one kilometer hard. Right. And they wanted to do it, they did it. And sometimes you see like, with ITV friction syndrome, sometimes on a flat, say trail run, they do really well because they're changing up that repetition. They're changing directions. They're slightly moving in different ways every step. And so they can be quite successful. So another thing that people might try, um, summing up this, this blog summary, the point number four was be flexible. So progress isn't necessarily linear. Um, anything you want to add on that? No, that that's the stuff I was talking about that research on. people who are more, I guess, type A or perfectionists where, you know, God be flexible. Like it's good to have a coach and, or to follow a plan, but know that they don't always apply to you and to your circumstances at that period in your life. So, yeah, work around it. Yep. And number five, just add other workouts or potentially add, add other workouts. Would that, any suggestions that you might have? Uh, so again, when you're returning and running, this is the idea, like keep your routine, if you run six days per week, still get dressed, go out there. And then in, instead of doing a run session, go and hike or walk hard people. I think we don't sell the benefits of a hard walk sometimes. Yeah. Or what I wrote an article a long time ago, it was for like triathlon Canada was the benefits of a warmup, but not for the sake of doing a warmup. It was just like. do four warmups in your run. So you do like hops and skips and shuffles, run a kilometer, do it again, another warmup, run a kilometer, do another warmup. And by the end, it's like really hard to do a warmup because you wanna just run, right? But here you are doing lunges and squats and A skips and B skips and shuffles and karaoke. And like, it's like you said, it's just, it's another different stress. And sometimes... our body likes it and your heart's still working. So you're getting benefit there. Yeah. I think a hard walk uphill is quite taxing and it's quite hard on the body and it's good cardio workout. It's good for pumping the calves and still builds up a lot of load in the body. So good thing that we might wanna try. And the last point in this blog summary was know that it's okay to poke into pain. And after talking to you, I think your poke is a lot harder than my poke, but I guess the... the rule is still there. Yeah. All right, good. Anything else that you want to touch on, anything you want to clarify on or anything we haven't talked about that you think the listeners and the runners out there will benefit from? The poke in the pain, again, like this is, it depends on who you are, that's the thing. So like if you're more avoidant and you've been backing off and you're still waiting for everything to be 100%. then you're probably the right person to poke into pain. But if you've been struggling and you've already been poking into pain and you really push things too much and you tend to like endure and grin and bear it, then backing off might be the thing for you. And then anytime you poke into pain, you gotta know what the hell's going on. You gotta know why, as much as you can, why you have pain. If it's something weird going on, things we don't want to poke in. And that's what I mean by like, you know, stress fractures like that. That would be the biggest one for, for people to be most worried about. I think those we tend not to poke for, for the high risk ones. Yeah. And I do think a lot of runners can recognize when they might need a coach or a health professional to guide them when they might need a bit of accountability. When they know the rules, they know what they can do and what they can't do, but then end up just. not being sensible and just doing something anyway. And they don't really have a lot of control, self-control. And they really thrive with having a coach, having a health professional say, okay, these are the runs, this is what we're doing today. This is what we're doing tomorrow and following that. And so that could be really good advice as well. Yeah, working with a coach is good. Or if your healthcare provider knows your coach, like I kind of work with a coach in Kingston and sees people and we're on the same page and it's fantastic. Yeah. Sometimes. I just, I'm pretty sure I just say the same things that he's already told them. Yeah. And sometimes that's good. Sometimes confirmation. Yeah. So if the listeners are wanting to learn more about you, um, perhaps follow a lot of the content that you put out. Where's the best places for them to go? Uh, my website is gregglayman.ca. Twitter is good. That's if I'm online or like on social media, it's there. Instagram is. Every now and then it's like running related. Mostly it's like my trampoline and skateboarding now because I made a pivot. I'm starting to run a bit more. But so Instagram is not the best unless you want to see old men flipping. Yeah. So those are the big ones. Oh, and if you are a runner and you have knee osteoarthritis, I always forget this. I created this last year. It's my... my volunteer work. It's a whole website called OA Optimism, like OA for osteoarthritis for just to keep people active who have knee osteoarthritis. And I'm a huge proponent of like, people with knee OA running, or either starting running or keeping running. Yeah, that has a lot of information to a lot of them are just general principles about pain and rehab and exercise. So fantastic. I'll add that in the Shineites as well. Yeah, I never go on that. I haven't updated it in a while, but it's timeless. Yes, yes. Fantastic. Greg, thanks for coming on, sharing all your wisdom and enlightening a lot of our runners who are interested in trying to return to running. Thanks very much. Yeah, thank you. Good luck, everyone. 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