Speaker 1: 0:00

So you're thinking about running but not sure how to take the first step. My name is Brian Patterson and I'm here to help. Welcome to Brian's Rompod. Hey there, fellow Rolands, welcome back to Brian's RunPod and I'm your host, brian Patterson.

Speaker 1: 0:35

In the second part of our three-episode chat with Sophie and Lydia from the Stronger Stride podcast, we're diving into the world of physiotherapy. I started by sharing my thoughts and how rewarding it is for physios to witness the positive changes in their clients after prescribing specific exercises. It's got to be incredibly satisfying, right? I'm sure you'll find this episode super interesting, and if you haven't listened to the first one, don't worry, you can always scroll back in my catalogue. So, without further ado, let's get into it Because I haven't listened to the first one, don't worry, you can all scroll back in my catalog. So, without further ado, let's get into it because I haven't run. Well, I'm sure maybe, lydia, you'll. You'll see this that you know, when you see people sort of not be able to do certain things and suddenly you do this prescription and then they come back in two weeks later and they and they're feeling a whole lot better, or you can see that the range of movement and what they're able to do is a lot better. That must be very rewarding as a physio.

Speaker 2: 1:31

Oh, it's so great, like it's such a satisfying thing and like, yeah, I get so much joy out of that. I think that's what I love about being a physio, because you know, like movement is so important to our mental health. I think, um, for me, my most enjoyable thing about being a physio which you know, is looking at the physical body, but my favorite thing is, like the impact that has on our mental health, and I really believe that we don't have our mental health without our physical health and sort of vice versa. And so, yeah, seeing patients progress through their rehab and stick to the plan and and get better is like so wonderful.

Speaker 2: 2:09

And I think, um and I say this to patients quite a lot I'm like it's really tough. Like what you're going through, like not being able to move, not being able to get your heart rate up, get sweaty, get those endorphins from exercise is really tough, and I think it can be hard sometimes, depending on, like, exactly what the ecosystem is of that particular individual. But a lot of the time, runners are surrounded by you know, they've got their runners and they're all their running friends and then when they're injured, they don't have their running circle and the only people they have to talk about. The injury is often like partners or families that may not be involved in running so might not really quite understand the loss that they're experiencing and the struggle yeah, what they're going through, yeah um, which is really tough.

Speaker 2: 2:51

And then you know they've got their physio saying you can't do this, you can't do this, and now you have to go and do calf raises, which like they're kind of really boring, like they're not that exciting and that much fun. They're definitely way more fun things to do at the gym or way more fun rehab exercises, uh, but that's just not how it goes. Like a lot of the time you know rehab is boring. The progress is really slow.

Speaker 2: 3:13

You have to be really patient, um and so seeing patients progress through their rehab, stick to the plan, get better, um, and then also feel like empowered about, like the fact that they can get stronger, overcome things like, is really satisfying and really rewarding. And I really see that like not only have they built strength in their achilles tendon or their gluteal tendon or whatever it is, they've also built some sort of mental resilience because they've learned about doing boring things and they've learned about being patient and they've had to diversify their activities and learn how to pause, like as much as I'd rather not get injured. I see so much value in struggle because it it becomes really rewarding when you can like look back and move through that.

Speaker 1: 3:59

I mean the. The thing I learned is that I saw Aaron the physio sort of thing but and I was sort of hobbling along and whatever. But the thing I learned is that there has to be a commitment on the patient's side and I kind of think the only way I'm going to get better is if I increase the number of sessions. I'm going to get better if I A increase the number of sessions I'm going to do because obviously the tendon, as you all know, or Sophie will know, is the thing it needs to be put under a particular load. It's not a case of just resting it.

Speaker 1: 4:37

So I went from two to four and then I noticed immediately you know the benefit and you know and I could do certain things. You know, and by the end you know he was prescribing me Bulgarian splits and that kind of thing. So I think you know it's all very well, you know someone like Lydia to or a physio to prescribe stuff. But also on the patient, they have to have that buy-in to get better sort of thing. It's not just a once every couple of weeks, do you agree, sophie?

Speaker 3: 5:13

Yeah, I think that's super important. I think what really helps with that is if you, as the patient, understand why you're doing what you're doing, because I think it could be really hard if you didn't have this understanding. You might think okay, my glute tendon hurts my hip hurts, whatever it is. I'm going to have some rest because that makes it feel better. When I'm not running, it doesn't hurt. When I'm not walking, it doesn't hurt. So this is the solution.

Speaker 1: 5:32

Once.

Speaker 3: 5:32

I've rested enough, it's not going to hurt anymore and then I can go back to running and things have just healed and recovered. But we just know physio or practitioner explains the process of strengthening and increasing your capacity and getting your tendons to handle more load, and all those concepts.

Speaker 3: 5:49

I think once you understand it, it's probably more likely that you're going to buy in, because, as runners, we love running right. So if there's something that can get us back to doing that quicker, then we're probably going to take that on board. So, yeah, once you understand that concept, I think it's much easier to get on board with it. In saying that, you know, as Lydia said, car races hard, boring. Bulgarian split squats are very hard.

Speaker 3: 6:08

So you can understand why people don't want to do it and runners love to be outside exploring and not stuck inside a gym. So, yeah, if we can make it relatively efficient, but understanding why it's so important, I think it's really helpful.

Speaker 1: 6:19

So, okay, we've moved to the injury, the nasty bit, and so, on the strength side, what would you advise new runners in terms of doing on the strength side, sophie?

Speaker 3: 6:34

Yeah, I think it's as with most of these things. It's very individual, right. It will depend on their injury history, kind of history in the gym. Have they lifted weights before? Are they totally new to that as well? But if we talk about just general principles, we need to get to a point where we can lift relatively heavy. Now, if you've never, walked into a gym before. You don't have to pick up the heaviest weight and try and do some covariance split squats with it.

Speaker 3: 6:57

But we want to get to a point, after you know six, eight, 12 weeks, where we're starting to lift a decent amount of load. So starting with relatively light weights. Let's say, for example, if you were doing a goblet squat holding a weight in front of your chest, grab a dumbbell. That's five or six or eight kilos and see how that feels for 10 reps.

Speaker 3: 7:12

If it feels really easy and you feel like you could do that all day long, then you probably need to go a little bit heavier. If you get to your 10 reps feeling like you're at your complete maximum and you can't finish that last repetition because it's so heavy, you might've gone a little bit overboard there. So trying to find that appropriate intensity where you're getting enough load and stimulus so you're getting these great adaptations, but not so much where you're going to hurt yourself, is really important. So a little bit of trial and error in those early stages to work out what that intensity or what that weight looks like, and if we think more broadly about just general exercises that are important for runners to complete, obviously the lower body is really important.

Speaker 3: 7:46

If we think about movement patterns some form of squat, some form of deadlift or hinge, something that involves working just one leg at a time, some sort of single leg movement like a lunge or a step up or anything, where you're just on one leg and then, of course, lots of calf raises as well. Those four types of movements are really good place to start for most runners I don't know if I've really got uh.

Speaker 1: 8:07

Uh. There's one question that kind of always puzzles me, but sometimes you do get some prescriptions where you're doing let's say, maybe you know, uh, 15 to 20 reps, so maybe endure muscle endurance, as opposed to, let's say, um, there's kind of the lower end, eight to ten um reps, um, on the strength side. So is there a benefit of doing, you know, in muscle endurance sessions like there's 15 to 20 reps, or really is it something you know, you? You as a, as a runner, you need to be focusing on the eight to ten um.

Speaker 3: 8:45

Sophie yeah, liz and I both feel quite strongly about this um relatively heavy weights, so yeah to the low rep lids. Do you want to chat about your thoughts on this?

Speaker 2: 8:57

Yeah, absolutely. I mean, there's lots of research on strength training and it's pretty clear in the research what the sort of rep ranges we are we should be hitting in order to have a strength adaptation or a strength benefit, uh three to six sets of somewhere between like three to eight reps I would say on average, like those sort of like sets and like one to three rep efforts, is probably more if you're like a power lifter or a strength performance athlete.

Speaker 2: 9:35

I wouldn't be worrying about that as much if you're a runner, but roughly three to four sets of six to eight reps is going to be the magic place for pretty much any runner and most athletes, I would say. Um, it's not to say that those endurance is completely worthless though, because if you're a beginner getting into the gym, sometimes I will prescribe higher reps for a patient to just actually get familiar with the movement pattern. And we know that if we're trying to have more of a neurological benefit so like a neuromuscular adaptation, which is like, um, making a movement pattern really familiar in our body many, many, many reps is actually the best way to go. So sometimes that can be really valuable. Doing a low intensity, so like less weight and higher reps yeah um, for a beginner at the start.

Speaker 2: 10:21

The other place that actually can be helpful is when we are doing a bone loading program. So we're trying to actually adapt our bones and we're doing something like a plyometric. Sometimes we might do like a moderate or low to moderate intensity plyometric, like a pogo hop at like a low amplitude for up to 20 reps yeah and we might do three sets of 20 um.

Speaker 2: 10:46

We know that with our bones um, and I guess you know this is a complex area and probably quite niche and for the most part we don't need to worry about it too much, unless you have like low bone density or recovering from a bone stress injury, um, but we can tolerate sort of like 60 to 80 repetitions of some kind of bone loading movement and get benefit from that.

Speaker 1: 11:10

Yeah, um, which you're going to be breaking up in multiple sets, but you can have quite a higher volume compared to pure strength which is targeting the bone but also the muscles and tendons, which you know it's one of those conversations where I'm going to say it depends yeah, yeah if, in doubt, for the most part it's going to be six to eight reps, yeah, so if you're unsure, go six to eight reps and then ask your physio or your exercise physiologist or your health professional yeah, right, and you did touch on something there which was plyometrics, which which was something that my physio did, actually prescribed, like he got me doing the pogo one which was going, I did like 30 seconds on one leg and then 30 seconds on the other leg, that's quite, you know, it's quite intense, quite intense.

Speaker 1: 12:05

And then also, um, he got me to do go from jump from one foot to the other on, let's say, meter apart, or maybe a meter a bit apart, sort of thing. Just go from side to side and just do it really quickly, like if you were, you know, going jumping across something sort of things. Oh, you know, and he just wanted so he could get that load into the side of the glutes. I don't want to make this podcast all about my injury, but he just sort of gave an example of the sort of the plyometric side. So I just wondered if one of you could sort of like say as to why would that be a benefit to runners? Because you do see it, you know, let's say, either on YouTube videos or on the web, as to how it's beneficial.

Speaker 3: 12:44

Yeah, I think that's really important. What you touched on there was kind of, I guess, vertical plyometrics, where you're just going up and down, and then also there's lateral side to side ones and from the bone health point of view, bones really like that variety of different loads from side to side, forward and back, all those kind of movements. So that's really important. But in terms of plyometrics in general, they're a really important part of rehab and also performance. That's often missed.

Speaker 3: 13:05

Often you have an injury and then you do some strength training and then you go back to running, but running is just a series of single leg hops right. So we need some sort of capacity to be able to perform that movement. And what plyometrics do really well is they utilize what's called the Achilles spring, so your Achilles at the back of your heel that attaches to your calf. It's a really powerful kind of elastic movement. So if you imagine an elastic band you pull on that, there's lots of tension. You get this really nice recoil or bounce effect from that. So if we have the ability to utilize that by practicing these kinds of plyometric movements and getting our Achilles better adapted to that, then we'll be more efficient runners because our muscles won't have to work as hard because our Achilles tendon and other tendons are doing some of that work and they're really efficient and a great way to move more efficiently.

Speaker 3: 13:50

So from a performance perspective they're really important. I think what can be done kind of wrong with plyometrics is again similar to the strength training is just getting that dosage or that loading right. And some people, some people might, you know, they might do some skipping rope for five minutes or something like that and, as I said before, you've got this kind of 60 to 80 contacts. That is a really appropriate amount of load for these biometrics. If we go over that load, the bones get a little bit bored and you're not really getting that same adaptation anymore so spending five or ten minutes on the skipping rope isn't quite the same effect.

Speaker 3: 14:19

Getting some more um, low dosage, more intentional movements like those pogo hops, or stepping up on a box and then landing from that box, jumping up as high as you can. There's lots of different variations. There's kind of a biometric continuum, starting from really basic movements such as if you have a band above your head, holding onto that band and doing the pogo hops that you referenced before yeah, it's a little, a little bit of load off.

Speaker 3: 14:40

It's a really nice way to practice that movement and then you can get into more complicated single leg, lateral, all sorts of different movements off boxes and things like that, but making sure that the movement is done with really good technique right, we're not spending lots of time on the ground. We're trying to be really efficient by just touching the ground really lightly and spending more time in the air than we do on the ground. Help kind of practice that movement pattern and get our tendons and our lower limb structures ready for that load. Anything that I missed this?

Speaker 2: 15:08

no, that's, that's fantastic. Yeah, I think what you said about you know, often we think, oh, plyometrics like that must be good yeah start skipping.

Speaker 2: 15:16

I'll use my jumper, like it's so frustrating and so sad because there's like so much good intention there but you're just totally missing the mark, unfortunately, and like so many things that runners tell me they're like oh, I'm so good, I did my exercises and you know, they're doing a car phrase while they're brushing their teeth, which is like such a common thing that I hear runners doing. And not to minimize the toothbrush car phrase, as, as we call it, um, because if that's all you're doing, it's better than nothing. Um, but you could be using that time so much more efficiently. And it's not that like bad and it's not that like feels dilly, it's just like, hey, we can do it better. And like we have amazing science and really great understanding of how our structures can adapt and tolerate the demands of running better. So let's use it. And like, if you're going to spend 10 minutes a day doing something, like, let's make it the best, most efficient 10 minutes.

Speaker 1: 16:11

Yeah to a bingo that's programmed to plyometrics, but obviously do some kind of research as to how you can incorporate it as part of your exercise program.

Speaker 3: 16:30

Yeah, just being mindful again about that individual approach. If you've already got a really high training load and maybe you haven't done much strength training, then adding plyometrics can be just another load to add, right. So maybe we're then overdoing it. So so depends on where you're at with your training. I would generally suggest starting off with some strength training, so making sure you're getting your calf raises in first, and progressing to the plyometrics once you've got that solid base, just because they're relatively high and demanding load. And if you're already on that cusp of injury, then maybe that's the thing that pushes you over the edge.

Speaker 1: 16:59

So definitely important, but seek some advice from a coach who understands how to best incorporate those into your specific now, as I said, sort of, I kind of touched on at the beginning of the podcast this kind of transitions into, uh, cadence, because that was the podcast I was listening to and l think Lydia was doing it, wasn't it? I didn't quite get to the end, but what, in your opinion, is it that sort of people get a bit sort of crossed up about sort of thing in terms of cadence? Is it because it's not an exact science, like I think you said? But at the same time, there are the benefits as well.

Speaker 2: 17:39

Lydia, yeah, yeah, cadence is an interesting one and we definitely see, I guess. Firstly, cadence is how many steps we take per minute, and it's a metric that some runners like to track and, as a physio, it's something that sometimes I prescribe an adjustment in cadence to help offload a certain area of a patient's body and sometimes to improve a runner's running economy, so like they're running efficiency. Um, it's a. It's a really interesting area.

Speaker 2: 18:10

We know that cadence does actually have quite a strong impact on how we run and so typically, if we increase someone's cadence, they you're gonna have to take shorter steps because they're taking steps and they tend to transition from more of like a heel strike to a forefoot strike. That on its own, is often not not necessarily that valuable. I think that used to be something that people really believed was going to be really impactful to perform better and reduce their injury. There was this real idea that, like heel striking is bad and everyone should run on their forefoot. We know from the research that that is not the case, that you can be an elite athlete and heel strike or forefoot strike.

Speaker 1: 18:49

Yeah.

Speaker 2: 18:50

Unless you're a short distance sprinter.

Speaker 1: 18:53

Yes.

Speaker 2: 18:54

On their forefoot, but for any sort of like middle to longer distance running, it can be either yeah, and we don't see a strong correlation of injuries. What we do see, though, is injuries in slightly different areas. So we know that if you're more forefoot dominant, you tend to load up more your foot, your ankle, calf, achilles, whereas if you're in your heel, you tend to have a knee in the hip.

Speaker 2: 19:16

So, you can get injured in all of those areas, and how you run might just determine where your injury is. But whether you will or won't get an injury is about how much running you do, yeah.

Speaker 1: 19:27

Yeah.

Speaker 2: 19:30

In saying that we see quite commonly so the load is like overstrained right and often this can increase the load on like our knee in particular, like our patella andoral joint, um, and often like our our lateral hip, which I spoke a bit about in the podcast. So we do see some association with certain biomechanical positions that do tend to cause a little bit more pain, in particular the knee and the lateral hip, with those lower cadences and so often and totally and some evidence does tell if we increase our cadence we often can reduce our knee pain yeah so it doesn't mean that if you have knee pain, the first thing you should do is increase your cadence.

Speaker 2: 20:16

Yeah, um, I would absolutely speak to a physio who can assess your knee and actually do a running assessment. Um, in saying that, I've had a lot of success with patients increasing cadence, reducing their knee pain very quickly, pain that's been around for many, many months, debilitating pain. They can't run. Simply increasing their cadence gets rid of that pain. Sometimes the pain goes down to their foot, their ankle, their calf, their Achilles, but usually that happens if we get too aggressive with increasing that cadence. So I wouldn't just be like, oh, I'm going to just go and adjust how many steps to take a minute. I'm going to take really short steps or really long steps. Definitely get someone to actually look at how you're running.

Speaker 2: 20:59

But I would say if you're not experiencing pain like it's not broken, don't try and fix it. But if you are really interested, you know it is possible that a little adjustment in your cadence may improve your running economy. And for the average patient that I see, that usually looks like increasing the cadence. So usually taking shorter steps as opposed to taking longer. I don't think I've ever told someone to lower their cadence. It's basically only ever increase. That would be the most success I've had. Yeah.