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Chris is a UK based physio and researcher. His past research has focused on running techniques for injury prevention and performance. In today's episode, I talk with Chris about his opinion on the load versus capacity relationship to reduce the risk of injury. Chris details the sequence of events from acute fatigue, to microscopic tissue damage, macroscopic tissue damage, tissue failure and eventually, injury. Our conversation dives into the factors that influence loads such as training errors, rapid changes, footwear and terrain, along with factors that influence the body's capacity like age, previous injury, sleep and psycho-social factors. Click here to find Chris on Twitter Check out Chris' website https://www.extramilehealth.com/ 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.
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On today's episode, a deep dive into load versus capacity with Chris Brammer. 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 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. the weather today for the first time in probably about two or three years. So luckily I had my interview with Chris Brammer a couple of weeks ago when I was feeling fine and all I need to do is just get through this intro with a bit of a nasally congested voice. So hopefully you don't have to hear too much of this. So I'll be brief. Chris Brammer is primarily a researcher focusing on running related injuries. If the name rings a bell, I had him on episode 61. The title was Running Technique Insight for Injury Prevention and Performance. If you want to listen to that to get to know more about him and his research and what he's doing. I had a fascinating discussion with Chris Brammer talking about load versus capacity. It is a universal principle that I talk about on this podcast all the time. But when writing and preparing for the Run Smarter book, I was reviewing his chapter. in the book that I love all so much. It's titled, The Science and Practice of Middle and Long Distance Running by Richard Blagrove and Philip Hayes. And yeah, like I said, Chris Brammer writes a chapter in this, the chapter was called Common Overuse Injuries in Runners and has a great take on load versus capacity, which has a slight slant on just the universal principles that I usually teach and was a fascinating discussion. We just... ran with this topic and delved into a lot of places I didn't think we would. Um, and that's just what you get when you have two passionate people, uh, on a fascinating topic, we just run with it and hopefully deliver some great content because I know I loved it. Hopefully you will too. Okay. Enough with me. Uh, I'll leave Chris Brammer's, uh, social media links and websites in the, the links in the show notes and let's get it underway. Chris Brammer, welcome back to the Run Smarter Podcast. Thank you very much for having me back on Brody. It is a pleasure. It feels like it's been ages since we last spoke. I know, right? So you are on episode 61 and we're up to episode 230 odd now. And so it's been, it has been a long time. What has there been many developments in your career? Or have you been working on anything in particular since you were on last? Oh, well. Me being me, I like to keep myself incredibly busy. So we have had lots going on. I think clinically it's been pretty busy because we've been changing around our gate lab, which I think as you know, I like to do biomechanics assessments on people. So we've been doing some renovation works there. We finally got some false plates in the grass so we can look at people run over grass now, look at football players. cutting and changing direction, which I think is quite an interesting one. And then from a sort of research perspective for me, we've got a lot of different projects. One of the ones at the moment we're doing is, I think since we last spoke, we published an article looking at the effect of speed on tissue stress, particularly looking at what happens to the Achilles tendon and the knee as we run faster. And now we're trying to sort of build on that a little bit more and see what happens as we get tired and as we fatigue. And we've got some various other projects that we sort of working on, but I'd prefer to try and keep a bit more of a surprise if I can. Well, definitely keep them busy. And I constantly see your papers when I'm, you know, talking to runners trying to delve into research, trying to write my own book and constantly coming across your chapters as you write and publications that you make and you do keep yourself extremely busy. But It just goes to show that your knowledge itself is world class and particularly I want to refer to this topic this episode as a particular chapter that you wrote about load versus capacity and most of the. Injury episodes that I have most of the injury prevention topics that I have always comes back to this one kind of concept about load versus capacity and I wanted to address it. in an entire episode and a little bit more, maybe complexity or nuances to it as well. Um, so I thought we might just get started in your mind when it comes to this, like load versus capacity model, how do you like to describe it when it comes to runners specifically and preventing their risk of injury? Yeah. Yeah, it's an interesting one. So I think load versus capacity is one of these concepts that are talked about a lot amongst professionals and amongst the scientific literature. And effectively in its simplest form, what we're basically saying is injury is the result of this seesaw balance between the load we apply to our body or what we call as tissue stress or the things we do to our body. and on the other end of the seesaw being our capacity, which we refer to as our ability to tolerate this stress. And in theory what we're saying is if the stress we apply to our body outweighs our ability to tolerate that stress, we get injured. And that's the simplest way of viewing it, but for me it's when you read around these topics and look into them, I think it's a little bit more nuanced than that. And for me, I think the chapter that you're referring to is a piece in a book by Rich Blygrove and Phil Hayes. And in there, I drew this figure, which was trying to represent how I view this load capacity relationship. And for me, what I think happens is as runners, we go into any sort of run or training bout, and we have a particular capacity to begin with as we start that session. what happens is we apply stress to our bodies and our tissues begin to gradually fatigue. And once we hit a point of fatigue, we can get little bits of micro damage that, that build up within tissues. If that micro damage is pushed further, that can lead to microscopic damage. And then ultimately we gradually reduce our capacity in a training bout. which can perhaps then push us to this progressive development of injuries. So rather than it being like one particular thing of tip and a seesaw, I think it's more of this accumulation of how stress gradually fatigues our tissues resulting in injury development. And What I tried to represent with this figure is this idea that if we then back off running and we allow ourselves some time to recover, we can restore that load capacity so we can become stronger and take our... and reverse these damage or these changes. So hopefully we get stronger and go into our next bouts. But I think... One of the important things for us as runners and what I try to say to people to that I think is a really important thing to remember is when we say load applied to our body is we very easily just think that's just running so it's the stress that we get from impacting the pavements and often we neglect the fact that there are other aspects in our lives that can also contribute to load such as psychological stresses and and what we're doing in our day-to-day lives that also adds up to the stress that's placed on our body. And these are other things that can affect our ability to tolerate training. So for me, load is not just physical, but it's also that psychological and that environmental concepts that are applied to us that happen all the time. And it's how we balance that load to sort of allow ourselves time to recover and hopefully restore our capacity that allows us to tolerate more and more training. I think it's... is that continual change that we have from being ready to go, fatigued, and then hopefully recovering and ready to go again. Yeah. And I think, uh, in its most. simplistic term is kind of what I was describing earlier in the podcast. Like one of my very first episodes or the first episode is adaptation education, which I sort of. Mention the load versus capacity and you know, your every muscle tendon joint has a certain capacity that it can tolerate. And if you exceed it, then it increases your likelihood of injury. Um, which sort of, if I have that simplistic term, it kind of, like you say, it's kind of like that seesaw. either too much or you know just under you're safe or you're unsafe and you either do too much it causes injury or not enough and or there's kind of like that sweet spot in between that sort of adaptation zone that I encourage the runners to sort of train within but what you're saying is there's a little bit there's a there's a bit of a gray area in between that training sweet spot and to become fatigued and that can be okay but as you progress into that grey zone and sort of push your bodies and push your capabilities it slowly gets into beyond acute fatigue and gets into sort of microscopic damage and then sort of progresses from there into like macroscopic damage and then eventually failure and injury. So if there is that grey zone in there between the sort of sweet spot and overload injury, if there's that gray zone, those sort of levels, should we be avoiding those gray levels or do you think that there's some benefit to poking into those danger levels? Yeah, I think this like... I never want people to be afraid that I'm going to go out and cause little bits of damage to tissues as I run or do activity because I actually think working into that realm of causing microscopic tissue damage is really important for us because it is actually where it gives our body a stimulus to adapt so we know that stress and strain applied to our body forces us to become stronger and adapt And that I think is really then essential for us to experience and encounter if we are to build up tolerance to training and to running and be able to sort of tolerate more. And I think that the biggest example of this will be like, you know, you've done a track session or you've done an interval session and you haven't done one for a very long time. and often when we do that to ourselves the next morning we end up walking down the stairs sideways because everything's sore, everything's stiff, I can't go forwards. That for me is a demonstration of what happens when we have pushed ourselves into that realm of microscopic tissue damage but it's a really powerful stimulus to get those tissues to adapt. And now if we recover appropriately, what we know is the next time we go to a track session, we do a little bit better on that track or interval session, and we wake up the next morning after that and we're not as sore. And that's that process of our body adapting to those stimulus, or that stimuli, to become stronger. I think the more important point for me and what I try to express to the runners that I work with, is that... is how we interpret that information our body gives us and tells us after we have pushed ourselves into those sort of grey areas. Because I think that's really key for us to avoid injury, is when we can wake up, we can feel those tightnesses, those sorenesses, and acknowledge that that's our body telling us we've done a little bit too much, I perhaps need a little bit more time to recover. And if we listen to our body appropriately there and adapt our training accordingly, I actually think that's what stops us progressing further down this sort of damage. So the whole point of like trying to move away from simply a seesaw perspective for me came from working with a lot of runners who might have really sort of ramped up their training volume one week and then not started to encounter any injuries or niggles until three weeks later. And often we can't really understand why we then get injured three weeks later when we might have done less. because we always seem to feel like this should be an inciting event, one particular moment when we knew that seesaw tipped and we got injured, but for me it's like it doesn't really work like that, it's when we stress our body too much we progress into this area of damage. If we recover, great, we go back to the start, we become stronger and we can go again. But if we don't give ourselves that recovery time, the next time we go out to run, we might be entering that run with less tissue capacity that we had at the beginning. So even then an easy state run, which has always been easy for us. might actually not be as easy for our tissues and could be progressing the level of fatigue that our tissues are encountering. So for me it was really important to sort of, or what I like to try and express to people is that it's this balance between how we recover and hopefully return robust, or if we just accumulate fatigue over and over and over and over again, so that three weeks later an easy run could be what tips us over the edge. something for people to be afraid of, I just think really for me, when I've gone throughout all of science and tried to be as really complicated in my injury prevention programs and what we should be doing, I ultimately come back to this very simplistic view that our body will inherently tell us what it can and can't tolerate. based on these signs and symptoms as we push ourselves into bits of damage. And whether we get injured is whether or not we choose to listen and adjust or whether we just ignore it and keep trying to like push on regardless. So yeah, probably a long winded answer to the question of I don't want people to be worried about that. It's something that is normal. It's just how we respond to it. Yeah. It's good that you give that example. And I think people can then start reflecting in their own training, like how their body's feeling, because as you said before, the first stage of that kind of gray zone is just acute fatigue, which is very common in a lot of runners. But then that next stage is that microscopic tissue damage, which could be attributed to doms or like, you know, that's still very productive. I'm not. Not a lot of recreational runners would experience a lot of doms in their training. They just go out nice easy. They just keep everything quite conservative. Maybe push themselves to fatigue. but they wouldn't necessarily wake up with sore calves or quads unless they've had a pretty high quality workout or, you know, a lot of heels incorporated really push themselves. But good to know that is beneficial. And you mentioned the importance of recovery, like those recovery phases are sort of to repair your body out of those gray zones and back into a sort of a healthier zone. But if that recovery is inadequate, then potentially you've gone from that microscopic damage gray area and not necessarily fully repaired out of the gray zone and you're hitting fatigue, you're hitting that first stage of the gray zone a little bit earlier than what you might have expected in your training cycle and therefore you ramp back into those gray zones a learning to listen to the body would be a really nice way of, I guess, ensuring that you've fully recovered and you're not sort of dancing too much in that gray zone because flirting with it a little bit too long could over strain or overstress the body. I guess if we are listening to our body. asking us to be more in tune, would there be any particular warning signs or subtleties that may mean that we're not necessarily recovered and we should be a little bit more careful with our training loads? Yeah definitely, I mean... we can go into like the simplest way for us to really try and listen to ourselves in that respect and for me that is, like I said before, I think our body gives us these messages that tells us whether or not we're ready to run so that might be something in terms of muscles feel particularly tight or sore and that can be, it can be bilateral so both sides but often sometimes you might find I'm never a real believer that muscles are just tight. I think things start to get tight for a reason, not necessarily that, oh, I need to stretch them and they'll feel better. For me, tightness is usually a bit of a fatigue-based warning sign. And that I'd start to listen to and think like, mm, okay, that's not usually tight, that doesn't usually feel that way. Perhaps that's my body telling me it needs a little bit more time to recover. So that can be one of the simplest ways. Again, another one is almost listening to how you feel from a psychological motivation perspective. So you know if people have had a big 12-hour working shift and they've been rushed off the feet all day, they're absolutely knackered and they know that got a run planned in for that evening, sometimes your body can be like, you know what? I really don't feel up to this run today, I'm knackered, I just want to go home and rest. and as runners we think, I'm gonna just push through it, I'm gonna get it done anyway but I actually think that mental fatigue is another warning sign of your body telling you that maybe I need to actually take some time for myself today and move my run back to tomorrow so I think that's another one And then you could go scientific for those people who like to monitor metrics and things like that. And I do think things like monitoring your sweet sleep quality off your watch and your heart rate variability. I know they're not, you know, they have some sort of errors within those, but I do think they can be quite nice signs to say, is my body recovering well? If that sleep quality is changed, is not as good as it usually would, or that resting heart rate in the morning is elevated compared what you'd routinely see at, that can be more of a scientific and for those people who like numbers way of monitoring if they're sort of fatigued and ready to go. And you know, it's not then just straightforward as saying don't do anything, like sit at home, protect yourself. I do think we have stuff we can do, so I say to the runners that I work with is if your body's giving you those warning signs but you still feel like you want to some cross training so just thinking okay instead of the easy run I'm going to go for an easy swim or an easy cross train or I might even just add in just my weight session for this point of the week. I think there are ways we can adapt our training to also allow us what I guess we'd call active recovery. One of the things I like to do with my runners and clients is, you know, based on symptoms, we just modify the plan. Like you might have a training plan in place, but it's just a template. And it's almost on the assumption that everything goes well. That's what we follow. But if things don't go so well, and you do feel a bit fatigued or tired or you all of a sudden lack your motivation, then it's worth modifications. And that might be modifying the training session. So you can still run maybe. know, shorter duration, lower intensity, maybe, you know, change things up with some walk runs. Uh, but like you say, cross-training as well within the realms of like options out there. Yeah. You know, I think what you say about plans is a really important one is like we, we always like to stick to a plan, but plans are designed in a perfect world and we don't live in a perfect world. So I say to people, plans are just rough guidelines that are generally meant to be broken. Hmm. Yep, for sure. And I think the psychological motivation side of things is a good sign as well, particularly if it's a change, like someone, if it's cold, if it's middle of winter and you're not feeling particularly motivated, that might be normal. Like that might for a runner for some runners out there, they might not like starting a run, but then they love it once they're out there and moving. But if all of a sudden a run that you're usually quite enthusiastic about is all extra kind of resistance, mental resistance to get started. Maybe check with yourself and see if that's a sign. Maybe check with your muscle soreness. Maybe check your previous training to see if maybe you've overstretched a little bit and just keep in mind, like you say, like sometimes these injuries can surface. Weeks after you've had a harder training session or you've pushed yourself because some people... Well, most of us would consider like, okay, if you over train, you get injured. But if you over train two weeks ago, that's way out of the realms of possibility for something to pop up now. So that's, um, really good insight to have. You know, I've had this number of times, like I can remember a recent patient that I had who came in and they had some pain around an area of a bone. It turned out that they had developed a stress fracture in the foot, but they couldn't understand why. And they were like showing me the stave. I'm like, I've not changed my training. And they'd consistently run just like 15 miles a week. But then... Exactly three weeks prior to that there was this spike in training where they had run a 40 mile week which coincided with annually from work they'd gone away on into the hills and just ramped up the training and then Gone back to their normal after that and it wasn't until a little while later that actually that injury surfaced and you know that was It was really nice to actually be able to use their data to show them where that all of a sudden that spike likely come which would put them into that sort of fatigue state. And so it's important to sort of consider a wider thing with what you've done. Good example. Speaking of the load versus capacity sort of equation relationship, the load side of things most runners will know, the too much too soon, like the weekly mileage, the speed workouts, and making sure that the intensity and the duration just doesn't have major spikes, but when we're talking about the load stuff specifically, is there any other components that you think runners may miss? Maybe something that's maybe not in the forefront of their mind that they actually may be overloading themselves without realising it? Yeah, so I think when it comes to the load that's applied to our body, what I say to people is like the big 90 per cent is that like the obvious ones that we need to get right in the beginning. And then there are like the subtle one percenters that add into the equation, but I probably wouldn't worry about as a primary cause. I'd think about them later down the line if everything else was fine. Those big 90 percenters for me are, as you say, things like the training loads or the total volume, the speed that they do. But also adding into that is that lifestyle. So it's how much have you been on your feet walking all day is like how much work have you had to then take on in terms of what you've done outside of running. Those are the big real obvious ones that add to that cumulative fatigue so going on a walking holiday and spending all your time out you know doing big four hour walks with your dog or being on your feet every single, for 12 hours and not having to sit down, that for me is adding to that 90% as there's load applied to the body that's resulting in fatigue, that I think what we tend to do is compartmentalize as running and life as two separate things, when in actual fact they're all part of the same thing. So those are the obvious ones for me hitting that load. And then it moves you more towards those, like what are those additional one percenters that can change the load that's applied to my body? And that for me can be things like the terrains that we choose to run on. They're gonna change the stress that's applied to our body in a very subtly different way. I'll give you an example, one patient of mine always run on trails because that's where their home is, around lots of trails, lots of nice different variable surfaces, then in the summer they go away on holiday to a holiday home where they can only run on tarmac and all of a sudden they every summer they tend to go away do the same training but on a completely different surface. which is changing the stress that's applied to the body and then it always coincides with them developing niggles. So... and that's something that they didn't consider really within the load that's applied to the body. It's an easy one to fix so the way we're doing that is trying to encourage a bit more tarmac running in the yearly routine rather than just the holiday so it's not as big as a shock but that's one of those things that can suddenly change. The same with things like footwear for me, it's when you go from using one shoe all the time to suddenly changing that shoe, that's again one and then, you know, me being me, my bias is always gonna revert back to biomechanics as well and thinking, is that giving me these subtle changes to tissue stress? But it's important for me to emphasise though, that these are like those small percenters, that influence load and I think really what we've got to get right as runners first is think, okay, is there anything warpingly obvious in my lifestyle or in my training that I've... completely just missed or ignored here that has contributed first of all. I think incorporating lifestyle into that 90% is. a really good tip for a lot of runners because I can think of a couple that I'm working with at the moment who have had career changes where they've gone from sitting to standing for like manual labor, even just standing on your feet for most of the day. And they're still trying to keep up with their weekly mileage. They're still trying to say, I need to get from 30 miles per week to 35 miles per week and like still continue that trajectory. But lifestyle, their job description outside of that for eight hours of the day has been than what they were previously doing. And so it's good that needs to be factored in because I've seen runners in particular that have kept their training consistent and symptoms pop up or flare ups happen just because of that change. Particularly structures below the knee with standing like calf, Achilles, plantar fasciitis, those sorts of things. Yeah, I mean, I think we can also view the reverse as well, like when people have gone from like solely standing all the time to now doing increased amounts of sitting. I think that also has a huge negative impact on the body. I think one of my favourite phrases I use with patients at the moment is sitting is the new smoking. Because I actually think if we spend so much of our prolonged time, especially now with homework and sat in front of a desk, I actually think it slowly deconditions muscles as well. So not only do we, can we have like this scenario where we put in too much load on the system. during our day-to-day work in life, we can also have this scenario where we're not putting the same, we're not putting enough load on the system and therefore it's slowly getting a little bit weaker and they're not going to tolerate the running that we do. So it's important to just view each end of that spectrum, I think. Yeah. When you're talking about terrain as well, it made me think of, um, I started In the first like two or three years of me being a runner, I moved house and found a nice 5k loop around this river. And the bank was just very gently sloped in towards the water and it seemed flat. You look at it and it was It seemed flat but within a couple of weeks I started getting pain on the inside of my right ankle and it was just once I realized it was just that gentle slope was just every single step because I ran in the same anti-clockwise loop every time and I was encountering that same slope every time that I was just putting more stress on that part of the ankle compared to the other side. And once I realized it totally went away once I one day ran clockwise the other day counterclockwise and then like alternate that pain just went away without me changing any mileage. And so good example that terrain has a significant impact. The other one I wanted to raise when you're talking about footwear was There's a paper out there where they had 14 runners change from a traditional running shoe to giving them like barefoot style shoes. And they gave them the instructions on how to like gradually transition into these minimalist shoes and 12 out of the 14 runners got injured and they reviewed them at follow-up. And I don't think any of them actually followed the recommended guidelines, which just goes to show what runners do. You know, they get new shoes. They, you know, consider. the ways to transition appropriately, then they don't really follow them and then end up with an injury. Yeah. Do you know? Changing shoes like that is an interesting one, especially the barefoot one where we talk about transitioning into a barefoot shoe because some people will sell us this idea that it makes us stronger if we do that. And again, that goes straight back to this whole concept of load capacity because changing a shoe changes the load that's applied to our body. And in barefoot running or minimalist running, it drastically changes the load applied to the body. So what I can do is really rapidly progress along this continuum of micro damage to micro damage to tissue failure. So the only way you can adapt for that if you're making real big changes is you've got to do it slower. So you've got to accept that I can't necessarily combine that change in shoe with the same volume I did before. You've got to really like take away from that volume to be able to adapt to it. And the wild people would say that you know, we get stronger feet from barefoot running, yeah, I agree, we do, but the process of getting to that point where you can tolerate the stress that you used to is not straightforward and you have to take several steps back in order to work that way up. So. I think for us as runners it's really important to first acknowledge that if we're making a big drastic change somewhere we've got to adapt for that and super compensate for that somewhere else in what we do, be that our training volume or more recovery in some respects. We can't just change something and go back to exactly what we used to do, the body just doesn't really work like that. So I think that is an important thing for us to always bear in mind because we are very quick as people to change stuff, yet be fixated in what we always do from a training perspective in other ways. Yeah, especially when those adjustments are so abrupt, like using that example of having those runners wearing traditional shoes to going to, I think it was close to, I think it was... some vibram fire finger like really minimalist barefoot style and having something so abrupt such an extreme needs so much time and you know you can eventually adapt but like I say it takes a whole bunch of time. We'll flick the switch from load. to capacity. So you're saying that yes, training loads, speeds, overall volume and lifestyle is like that 90% of what you need to focus on with the 1% as being footwear terrain, those kind of changes that we need to look out for. On the load on the capacity side of things, what are the influences? What are the changes that can influence and manipulate our ability to tolerate those loads that some runners might be missing. Yeah, so If we go to capacity then and we're talking about this ability to tolerate that stress and strain that's applied to our body. Now there's a lot of different factors here that can influence that. And what I think is really important straight up to get runners to really remember is that these constructs or these factors that influence our capacity to tolerate load will change all the time. So they're never the same every single day that we're going in to run in. So if we are fatigued we're going to have a lower capacity for our tissues to function, our muscles to function and therefore they're going to be less tolerant to stress. And if you've only slept five hours the night before it's really easy to see how fatigue has just changed as you've gone into your next run. So that's one example of how these will always change over time which is important to be aware of. Now other things that I think can influence our capacity are the stuff that we as physios would commonly like to try and manipulate with people. So it might be like structural properties of a tissue, of a muscle, and in its simple form that's why we advocate the use of strength training. Because we think that if we get stronger muscles we can make stronger tendons, stronger bones that are all more likely to tolerate... the stress. So I think that is an important one, is that what's actually that tissue like and that global muscular strength, muscular endurance. And then there are other subtle factors that I think sometimes we can't always account for or we can't always change, but we can account for. And that would be things like age. So if we're an older runner, um, you know, we're not perhaps going to recover as quickly as those young 18 year old spring chickens. And whereas we can't change age, what we can do is take steps to adapt to that and to accommodate for that, i.e. include strength training to maintain tissue function, or acknowledge that I might just need a little bit more recovery from a really intense workout until I'm ready to go again. We can adapt for it. And then... You know, a big one for me is previous injuries. So I always delve into people's injury histories and medical histories as well to see if there are any factors there that could influence someone's ability to tolerate stress. And I think from a previous injury perspective, often as soon as we get injured, we get negative adaptations in terms of our body just doesn't function as well or the tissue doesn't function as well as it used to and we commonly just wait for symptoms to change and then we'll go back to running. Because we'll be like, symptoms are calm, I'm gonna go straight back to running, I'm fine now. And what often we don't acknowledge or account for is how that can change the function of muscles or the actual stress tolerance of the tissue. And we don't fully restore that. We're very quick to just make a decision of symptoms. So I think for me, when I work with patients, I really like to delve into that history of what the previous injury has been like, and then look at the function of different tissues to start thinking, okay, well have we got a vulnerability here or something that we haven't fully addressed, like an underlying issue that we've not fully ironed out the creases on, that's almost hindering our ability to tolerate that stress going forward. So there's a lot of factors in there really that are intrinsic to us as individuals but also are dynamic and changing that we can... influence I think as physios in the routines that we adopt. is to click on the Patreon link in the show notes. Step 2 is to follow the instructions to subscribe and instructions on how to join the private Facebook group. You can cancel at any time. Step 3, log back into your Run Smarter app and all the Patreon episodes will be unlocked for you to binge on. Step 4 is to keep active in the private Facebook group that is designed only for our patrons by voting on future podcast topics, submitting questions to future guests, interacting in our Facebook Live episodes and helping me out with your feedback whenever I need your assistance for future podcast steps. So sign up and say hi to your new Patreon family and we'll see you there. It would be such an easy world if you said, okay, my legs can tolerate the capacity of them can be a 50 mile a week and then they'll get stronger and then next week they can have the capacity to tolerate a 52 mile a week and just work in that equation. But if you're looking at, like you say, capacity is dynamic and that's because lifestyle factors and all those factors that you mentioned in play are so... they're constantly fluctuating. Like you have, your sleep is never consistent. It changes here and there, stress levels, your age, obviously. How about, how would you explain the role of the psychological stuff, the stress, like when someone's stress, anxious, worried? people might not consider that as a component within how someone's capacity to tolerate training is actually involved. And is there, is there a way you like to explain that to your runners? Yeah, I mean, so from a, from a stress perspective, uh, the, we know that there's more and more emerging evidence that's linking psychological stresses and even sleep behaviors to injury development. Um, now the exact physiological mechanisms of how that happens and how that affects hormones and the body and the tissues is way beyond the scope of my brain and my profession, but the way I like to try and explain stress to people is that, you know, stress can have a influence on whether or not our tissues fully recover, first of all, so therefore whether or not it's going to tolerate what we do the next day. is also gonna influence my fatigue levels. So when I'm in a run, how much of that run I can keep functioning normal or function at my best without overstressing tissues. So psychological stresses influence how my tissues respond and how ready they are to perform and also how I perform within that run. And not only that is I think it's important sometimes to have the tough conversation that I have with some of my clients and think that those stresses that we have in our lifestyles, are we using training to try and manage that stress in too much of a negative way? I.e. we train in too hard to really try and burn off some of that stress. So that's a bit of a difficult conversation of asking ourselves like, look, am I changing my behaviour in terms of how I have to get this run done today? And I have to run this run hard because I'm trying to escape my stress. That's another question that I would sort of raise with people that I work with. And then also, I just explained that, you know, I think one of the easiest things for us to understand is that, or accept, is that we know stress levels influence hormones in the body, and how these hormones in the body are going to influence our recovery and tissues can be a negative. So it's important for us to not just... balance our psychological stressors with our physical activity that we do, but also take steps to look after our mental health in ways more broad than just running, i.e. taking time for yourself and doing other activities that are true recovery activities, rather than replacing a psychological stressor with running which is just a physical stressor. So there's those two ways, is the way of saying like, look, it affects our tissues, but also is it affecting the way that we behave and manage our tissues? And that I think takes us as individuals to have a look at and probably a serious think about how we are managing our running. Yeah, and A lot of these questions that I'm answering to you, a lot of it's coming back to the topic of recovery, making sure recovery is adequate, making sure that the tissues aren't being, you know, pushed fatigue too often. And the way when you when you mentioned the hormones, I was talking to Dr. Izzy Smith a couple of years ago about this and she was saying that there's, you know, your Cortisol and noradrenaline are like your exercise hormones or they're your spring into action hormones and whether when you do have those hormones circulating around the body, the body really struggles to enter recovery mode and with that recovery mode so important to you know bounce back after an exercise if you are stressed, anxious, worried, fearful like those same hormones circulate the body the body kind of thinks it's in exercise mode already for action all the time and just doesn't get that recovery mode that it needs. And so someone goes for a run and then goes to work and there's a high stress environment. They go home, family dramas, high stress. It's constantly the body's craving this recovery mode and you're just not getting it. And if that stress is leading into poor sleep, then the next day another run, it's just like the body's just getting overloaded with this. physical and psychological stress, which eventually just, you know, pours out into an injury. And when you're talking about the relationship of stress hormones, but then the importance of recovery, it's like, it all ties into the lifestyle of a runner and like making these sort of sensible decisions, understanding this concept to make the important decisions to reduce your risk of injury. Yeah. You know, I think more and more like for me, when it's all about how do we manage injury as a whole. I actually think it comes back to this concept of just having a balanced lifestyle holistically. I just think that, you know, if things aren't balanced in terms of your home life, your work life and your training life and your extracurricular activity life, I think that's when problems start to happen. You know, so it's about trying to keep our whole environment in... a level state of homeostasis where everything is equally balanced and is nicely in order and if you push one element of anything in your life, know that it's going to have a knock-on effect on another part. So I like to sort of keep things balanced and only push one thing at a time really, to keep yourself mentally and physically fit. If they've listened to my conversation with Eric Hegadis, I had him on the podcast a couple of weeks ago for the second time. And he mentioned that they're doing some research. He's got a little bit of an inkling around four key areas that if you're rating poor on all four of those areas, then The likelihood of a injury happening is very, very high. And he mentioned just muscle soreness, generic muscle soreness. He mentioned fatigue. He mentioned sleep and he mentioned stress. And so those four domains, if you're ranking poorly in all of those four domains at once, like the, the likelihood just goes through the roof of an injury coming unless you really like address it, have some interventions to follow that up. And what you're talking about, just that lifestyle. if it's muscle soreness, fatigue, you know, that can mainly be around your training, but sleep and stress, that's more about like, the more I guess the overall lifestyle, but you're looking at objective markers, but you're also looking at subjective markers listening to your body when it comes to the stress and the sleep side of things, the fatigue side of things. So it's all kind of interplaying and you know the more people I talk to the more this all kind of the whole generic concept of the runner as a whole starts to make a whole lot more sense. Interesting that you say that because like over the years when we've worked with various athletes on various different altitude camps one of the things we'd always do is what we call morning monitoring where athletes would come in and they'd like write on a score sheet of where they score in those different domains and you would gradually see over time that the areas of like self-reported muscle soreness or fatigue or sleep quality, if those started to gradually change or gradually worsen, you would start to see a higher frequency of those athletes coming into the physio room and starting to report little niggles and it was always just like this progression from green light go to always getting some warning signs here and then before you know it this could snowball out of to manage an injury. So very, very simple monitoring things like that, I think are fantastic because they do seem to hold true in terms of injury development. I'd definitely like to see some more of the research really affirm that. Yeah, it's so hard for a runner. when things are feeling good, when they're not injured, but they're not sleeping that great, to just keep running, to just keep training the way they would, and then if like their stress becomes a little bit higher or not as well managed as before, it's so easy just to keep your running, because even if you are stressed, if you've got like these work dramas and these family dramas, you know, you use running as an escape sometimes, and it's such a... It's so hard for the runner to have the control and discipline to say, I'm not ranking well in these domains, even though I'm feeling totally fine, let me make the right training decisions and be a bit more sensible. It's very, very hard to see unless someone's made that mistake time and time again. And they've said, I recognize this pattern here. Let's, you know, dial the intensity back and make the sensible adjustments. It's very rare to see. Yeah, I always think those, some of, you know, when you watch some of the best athletes in the world, what I think they get really good at doing is identifying how far they can push themselves before they start to tip that red line into that injury domain. And they're very good at noticing those subtle warning signs. And I think that's perhaps what makes them so elite is because they are so in tune with it, they know how hard they can push on that day. And whereas some of us might not, and that's when we get injured and we just don't get the consistency and training. So it is about learning when it's about to, when the warning signs of a. Well said, Chris, as we're wrapping up, is there any final comments, any final takeaways, the runners who are looking to reduce their risk of injury? Um, any, any final words that they'll need to hear that we haven't already discussed? Yeah. I mean. Final words or final tips, I'd probably just put that right down into just reminding people and remembering of what I say to most people as my three key domains of how to stay injury free. And first of all, it is number one, train smart, listen to your body, learn when you need to adapt to that plan. Number two is recover. Look after yourself. Accept that recovery is a holistic concept, not just. away from running or time away from running, it's time away from stress too. And then finally would be make sure you try to actively build a robust system and to develop this load capacity. I used cross-training, use strength training to do that. And those would be my three key takeaway summary tips I would probably want people to take from this. Yeah. And I think that tip three to be robust is kind of that. Tip that you set the start not to shy away from fatigue, not to shy away from those gray zones because that develops that, you know, builds upon your athletic development in a lot of different ways. And so very good final tips there. And I've got your Twitter, I've got any other links that you want me to include in the show notes for listeners if they want to learn more about you or more about running. I guess like, you know, if people wanted to ever ask questions or get in touch, I can intermittently active on social media. Twitter is probably the one I use the most with my Twitter handle at ChrisBrama and alternatively, you know you can contact me via our company which is extramuralhealth.com and that tends to be where we'll pick up emails and Try and help you out in any way that we can so I'm always Love to chat all things sports science running and injuries. That's my world I can tell. And it's always, um, always good to have you on. I think I can chat about these sort of topics all day. And like I say, it's your absolute world class and yeah, you're changing the world with all the stuff that you're doing, all the research and publications that are out there and you're helping a lot of runners. So thanks for coming on, taking some time and educating some runners. No, thanks a lot for having me. And that concludes another Run Smarter lesson. I hope you walk away from this episode feeling empowered and proud to be a Run Smarter scholar. Because when I think of runners like you who are listening, I think of runners who recognise the power of knowledge, who don't just learn but implement these lessons, who are done with repeating the same injury cycle over and over again, who want to take an educated active role in their rehab, who are looking for evidence-based long-term solutions and will not accept problematic quick fixes. And last but not least, who serve a cause bigger than themselves and pass on the right information to other runners who need it. I look forward to bringing you another episode and helping you on your Run Smarter path.