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Sports Chiro Luke Nelson | Returning From Injury, Smarter Rehab & Building Resilient Runners
396 Plays6 days ago
Luke Nelson is back for one of our deepest conversations yet.
After the response to his first appearance on the podcast, we wanted to go beyond injury diagnosis and dive into the practical decisions that actually keep runners healthy and get them back to doing what they love.
We unpack why injuries are rarely as simple as they first appear, how stress, sleep and life outside of running influence recovery, and why return-to-run programs shouldn't finish the moment you can jog for 30 minutes.
Luke also shares how he approaches rebuilding trail runners, including when to reintroduce hills, technical terrain, speed work, strength training and plyometrics. Along the way we discuss the rise of AI coaching, why gait changes are often overprescribed, and the growing prevalence of low energy availability (LEA) and REDs in endurance athletes.
To finish, Luke opens up about his own injury and the lessons he's taking from experiencing rehab from the athlete's perspective.
In this episode we cover:
• Why most running injuries are more complex than they first appear.
• The role stress, sleep and life load play in pain and recovery.
• How to build an effective return-to-run program.
• Reintroducing hills, technical trails and speed after injury.
• When running gait matters, and when it probably doesn't.
• How strength training and plyometrics improve performance and resilience.
• The opportunities and limitations of AI-generated training plans.
• Recognising low energy availability (LEA) and RED-S.
• What Luke has learned from his own rehabilitation journey.
If you haven't already, we'd recommend listening to Luke's first appearance on the Pod before this episode, as the two conversations complement each other well.
Listen to the first Podcast on Spotify
Listen to the first Podcast on Apple
***Don’t forget, use code PEAK at Bix’s website for 20% off Bix products, exclusive to PPP listeners!***
Thanks for tuning in to Peak Pursuits! Connect with us on Instagram @peakpursuits.pod to share your thoughts, questions, and trail stories. Until next time, keep hitting the trails and chasing those peak pursuits!
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Transcript
Introduction of Guest and Recap
00:00:15
Speaker
Hello and welcome to the People's Shoots podcast. My name is James Sieber and today we have a guest that is here for round two and has become one of, if not my favorite person to talk about when it comes to keeping runners healthy, that is sports chiropractor Luke Nelson.
00:00:29
Speaker
Now, if you haven't already listened to our first conversation together, which was in November of 2025, I'd really recommend starting there. In that episode, we covered the foundations of running injuries, strength training for runners, common myths and how to choose the right practitioner.
00:00:43
Speaker
that This episode really builds on that discussion. This time we go much deeper into the practical side of staying healthy and getting back into running.
Deep Dive into Injury Complexities
00:00:51
Speaker
Some topics that we cover are why experienced practitioners think differently about injuries and why they're rarely as simple as they seem, but also not getting caught in the trap of always looking to overcomplicate what could just be a simple answer.
00:01:04
Speaker
how stress, sleep, and life load influence pain and injury risk, the biggest mistakes runners make during return to run programs, how to safely progress back to trails after return to run programs, including hills and technical terrain, whether running gait actually matters and when it's worth changing, the role of strength training, apply metrics, the growth of ai coaching and where it fits alongside human coaching, low energy availability, and REDIS, why there's more common than we may think. A couple of recent studies that came out showing that the at-risk was up to as much as 54%. And finally, Luke also shares his own learnings at the moment in his own injury process.
00:01:43
Speaker
As always, there are plenty of practical takeaways you can apply to your own running. I really enjoyed this one. i always learned so much talking to Luke. He's incredibly insightful, but has an ability to simplify things so that we can all understand them.
00:01:57
Speaker
With that, let's get into the podcast with Luke Nelson. Luke, welcome back to the podcast. Thanks for jumping on for your second time. Yeah, thanks for thanks for having me again as ah as a repeat guest. They obviously weren't inundated with with um negative reviews and and complaints after our first appearance. So it's good to be good to be back with you, mate.
00:02:16
Speaker
Yeah, no complaints. we had had a lot of feedback like in in a positive sense. I think people enjoyed the like the depth of knowledge that you can bring to it and like just sharing that different style of of perspective um as As you know, working with a lot of runners and trail runners, we like to do a lot and think we can do everything. So I think it's good to kind of share a bit of more of ah why maybe you should be bit more forward planning with how we do things and and consider it. so i think it was good.
00:02:42
Speaker
Yeah, I think i think we we all learn something from each other, don't we, really? Like I learn from my my runners and, and um yeah, we can't know everything about everything. So that's why I do enjoy listening to to other people and experienced runners and coaches talking like yourself because I think it adds to my understanding as ah as a health professional about treating and and seeing runners and and and, again, when things are ah in my scope and and outside of my
Evolving Practice and Multifactorial Injuries
00:03:08
Speaker
scope. So, yeah, I think it i think it benefits benefits all of us really.
00:03:12
Speaker
Well, that brings me very nicely onto the first thing I wanted to ask. You've been in practice for over 20 years. like You have your own place. kind of it feels like you've sort of moved a little bit with how it's gone. But in recent years, like how do you say your practice has changed in the most ways, like specifically with working more with more runners? Yeah.
00:03:32
Speaker
Yeah, it's an interesting question because I was just on another podcast last night actually and and what this is more sort of dealing with how the profession and and even sports medicine has has changed over the the few decades that I've been involved and it really comes down to you know initially in early in my practice and even you know previously with sports medicine it became i guess focused on the injury and you know what tissue is involved what the diagnosis is but as I've sort of gone through the years and it sort of involved or sort of evolved into more an understanding of the actual person so that you know you can have patellofemoral pain or achilles tendinopathy but
00:04:14
Speaker
a greater understanding and of of that that actually the the factors that go into that um within the individual. So, you know, their their stress, their sleep, their recovery, their nutrition, um their capacities, their training loads, all these sort of things all play a really important role. And that's where I've really enjoyed my my time working working with runners and sort of going down that side going down that path um because there's you know there's it's every we always sort of we've got a saying that every injury is is always multifactorial and and it's my job as the clinician to be a bit of a detective really and and investigate you know why why james your your knee has has become problematic all of a sudden um and delve into that those contributing factors because i think that then allows us to then you know dictate management based off that if we we know what's
00:05:04
Speaker
contributed to it in the first place then then obviously we can work out how to address those but also stop it from happening again because that's I think you know running injuries are very common but they they can also be quite quite recurrent as well so they're happening again and again so learning learning from those mistakes and and not to say that that i've I've cracked the code, it's certainly not but um I hope one day we do but um again things can be a lot more complex the more you you delve into them but yeah sort of got naturally drawn into more running injuries as as i also got more into into running myself personally so it's sort of the the people who I enjoy working with and and who really make my job enjoyable and make me love my job is is you know being surrounded by by runners all day.
00:05:50
Speaker
feel like it would be easy for you to lose a lot of time talking about running. I know I will. Oh, I've got to got to watch it got to watch the schedule once we start talking about sound talking about shoes and and races and everything else. i Yeah, I've got to be i got to be quite careful of my time there. So before I know it, oh, we're half an hour behind. So, yeah absolutely, got to keep on point.
00:06:08
Speaker
When you're thinking about injuries that come through the clinic from runners, are there any that fall into the, this is often just exactly what it looks like, and these are the ones that are more multifactorial and hard it's harder to look through?
00:06:21
Speaker
ah Honestly, no. Honestly, no. Because because again, it it really comes down to it comes down to that individual. You know, the simple ones and that that can be across all injuries really. Well, I'd say i'd say bone stress injuries are often ones where there there are multiple things at, you know, boiling up behind the scenes there. So that they tend to be a little bit more complex. um especially more the higher risk bone stress injuries so those ones there are often there's some more digging around but you know whether it be your patellofemoral pains or your achilles tendinopathy you know sometimes the the runner everything's going well in their lives that they're doing you know everything's great but they've just done way too much they've just jumped into a you know a generic program that they decided to update or they've they've you know decided that they're going to run a marathon in five weeks or these sort of things there where they've just done way too much too soon and those ones can be a little bit easier to solve. It's like, well, you've done just too much. Let's calm this down and and and build on from there. But that can be, yeah, not necessarily injury-specific. I can see that across across all. So i think that um and probably, again, as I get more into this, it's realising that things are a bit more complex. Like it's it's not not as simple as what I once, you know, thought it was and, you know, even things like, oh,
00:07:38
Speaker
you know Achilles tendinopathy well yeah all you need to do is just you know do some calf raises and you'll be fine um but there's plenty of people out there that have got excellent calf capacity um you know they might have hormonal issues that contributing to it or or metabolic issues that are doing that they might have that might be diabetic um um these sort of things there that can can can lead to it so I think yeah I'd like to say things have got more simple as I've gone but it really doesn't um and it it does i like that I like that sort of the the that it keeps me always keeps me on my toes but it but it can be quite um demanding you know cognitively sometimes like I just sort of sometimes you just think i just like a just a stock standard something really simple um so I can switch my brain off but that doesn't really happen much unfortunately so
00:08:23
Speaker
No, something that I've noticed with the practitioners I've gone to that seem to be the most experienced and skilled, like yourself, is that when you present, and I'm often a complex case, I don't know why, I wish I wasn't, but whenever I talk about something to them, I can just see their brain ticking through and the cogs turning. And like, it's not it's not just them getting stuck on the first thing they've heard, which I feel like is easy to to do, but it's like, okay, how could this actually be connected to this or and interconnect differently? And it's ah it's definitely... um It's a mark of of a very good practitioner, but can also imagine it quite tiring.
00:08:54
Speaker
yeah Yeah, it is. And and and i guess sometimes like it's ah we've we've got to sometimes not over-assume things as well too and and not, I guess, sometimes over-connect. um I've probably been guilty of that in the past. It's like, oh yeah, you had this, so therefore that led to this. And sometimes it can just be chance that that's that that's occurred. So yeah, there's there's lots of, as you said, there's lots of cogs that are that are ticking over in in our heads when we're talking to someone and and examining someone. um But we've But yeah, like I said, I enjoy that that detective side of things in in in work at my work.
00:09:26
Speaker
Can it be tricky to get the information out of the person in front of you, especially if they're someone that's newer to being treated?
Communication and Stress Impact on Injuries
00:09:33
Speaker
Yeah, it can be. I think that that's um yeah coincidentally also on this this but podcast I was on last night, you know, they they asked me, you know, what was one of the skill that new clinicians should, um you know, really invest in and and and that was communication. So the ability to to talk to people and be able to extract that information from them. um I like to, and again, you know, with my new patients, especially I'll send them a form that they they're filling out. So it just gives them time to, and it's quite detailed. It gives them time to to talk through all these things.
00:10:04
Speaker
And then that allows our then our discussion then to be more conversational. And I just have a piece of paper that I'm writing writing stuff down on. And i think that again, like i always sort of allow a good, you know, 10 or 15 minutes sometimes just to talk through with with my runners. So i don't rush that that process because it sort of just allows them to talk and and and often, you know, they they often haven't really been heard from in in that sense in that they've been, they have been often rushed and, and you know, okay, well where's the saw, show me where it's saw, right, jump on the table. um so So actually having that time to to discuss. So I mean, probably the only time that you might, you know, you might get a person like that is they're a bit more upfront or blunt sort they've been dragged in by someone else. But that's pretty, that's pretty rare where they're like, I don't know why I'm here, blah, blah, blah. That's pretty rare that i get someone I get someone with that. They're they're usually, yeah, happy to happy to converse and, and um yeah, tell me tell me all about it and especially when it's, you know, expressing interest in in in what they do and that's not necessarily with running. It could be gymnastics or, or you know, sports that I don't do. that it' um Yeah, that's something I probably don't,
00:11:12
Speaker
have an issue with um and then some sometimes for some it might be steering the conversations. You do get some that tend to, that can go on for a long time. So you're just like, all right, let's just, you know, keep keep things on track a little bit there I don't need to know about what their father-in-law did for work and that that sort of thing. so um but So, but yeah, so having that discussion is is really important and and that that comes down to obviously, you you know, injury specific and then talking about um their goals and their training, um what's going on in their life in terms of from, ah you know, stress, work work what work-wise, or all these sort of things, you know, nutritional-wise, all these these contributors that that may have actually led them to utter to being here.
00:11:52
Speaker
Something you've mentioned a couple of times is like accounting for stress. And I feel like it's something that we say all the time and stress is stress and you've only got so much space in the bucket, et cetera. But when you say like thinking about all the things that add stress, what are talking about? Like what is that for the person listening? name So it is hard to quantify, right? And I guess one of the things that I'll ask on my new patient form intakes is I'll get people just to rate their stress out of 10. And that's not like a validated outcomes measure. So for those listeners out there, that's something that's been studied with research studies looking at, is that a valid questionnaire? So I simply just ask a score out of 10 and then if I'm seeing scores on there that are, you know, 6, 7 and above, then that for me is conversational starter then with the runner to sort of say, oh, look, I've noticed you put your stress out of, you know, 8 or 9 out of 10 there. You know, you're happy to tell me what's going on there. And again, you don't have to be prying too much into what's happening in their love life or what have you, but it's just sort of asking about, you know, what's going on? Is this something that's, that's new, has been hanging around for, you know, been a while, is this likely going to finish soon or is this like this is just general life? So, and then it's up to them to disclose the details of that. But I think that can be really important. Again, going back to the initial question you asked me about things that's changed in my practices, you know, just seeing how,
00:13:19
Speaker
common that is like I just last night had a ah patient and she's she's been she had an acute low back flare-up um she's going overseas with her friends today tonight um she had a flare-up of her low back acute low low back a couple of weeks ago and then she had a little bit of a little bit of flare-up a couple of days ago and because she's going on this flight she's really worried about it she's thinking oh my gosh how am I going to get through this and you know, and she was, she said when she had this flare up, she was crying and she was, you know, all upset. And then I spoke to her, it's like, oh you know, how's it feeling today? She's like, oh no, it feels, feels fine. Like, you know, once I, she and she said it herself, like once I stopped crying, I'm like, you know, I'm not okay. Cause I'd sort of been educating her about it and the pain, you know, started to, started to ease off. And so for her, it was just just, again, re-emphasizing that, that again, this stress plays a big role in, in this, this nervous system being really wound up and, and, and being in pain. So stress has got to,
00:14:11
Speaker
you know i think a lot of us would know that stress has got a wide ranging effect on on on health conditions including number one including pain so it can it can you know essentially ramp up and turn up the volume on pain as ah as i'll describe to to my patients but then just from ah a hormonal point of view and things that can change their our ability to absorb training obviously important as as runners is is something that's uh that's that's impaired and look i've certainly seen a number of injuries and you know, a few few that stand out would be, you know bone stress injuries that have happened off the back of, you know, spouses passing away, and pets passing away, you know, relationship breakups, all these sort of things there. And then, you know, lo and behold, a few weeks like training has been fairly constant, but a few weeks later then things happen. And and yeah, so it's something that again, I've just been, yeah, a lot more, lot more in um ah realizing the importance of and and the value of that. But again, it it is hard to quantify, um but I think it's just the acknowledgement that, yeah, stress can have an impact. And then that the hard thing then goes is, well, what do you do about that? It's just like, we're just stress less, right? You know, just just don't stress. um
00:15:16
Speaker
But I think that, ah number one, if the stress is something that can't be controlled, you know, what are some things that can be put around it or or at least, The realization that, you know, whilst you're going through this distressful phase that perhaps this is not the time to be to be training hard or to, you know, really be pursuing this this this marathon or this this ultra goal that you've got coming up, um maybe you can't, your body, you just can't train that that hard. And you know often if they're coming into me with injury that's not so you know hard a buy-in for them and not so hard a stretch and I think i think that runners tend to understand that um but um it's the same thing with you know with with changing sleep as well it's it's it's it's easier said than done like to say just sleep more um you know that that can be a very difficult thing for some people to do and the same same thing with stress too so it's I wish it was easy but but but it's not.
Training Adjustments and Holiday Challenges
00:16:06
Speaker
One of the things I see is that when people are going away on holiday and they think that it should be the most relaxing time, that's actually the time when they get the most things go wrong and they're out of routine, they're sleeping different, they're drinking likely or they're eating worse food. And it's this supposed to be perfect scenario, but it's the complete opposite of them.
00:16:25
Speaker
I um holidays for me are always a horrible foot time for training like it it's it's never like I'm with family and the kids so number one there's the guilt of of going away from them because at least you know when I'm at home I've got my own routine you know i drop the kids off at school or during my work break at lunchtime I don't have to ask permission whereas on holidays I'm like do you mind if I go for this two-hour run now or fitting that in in and then as you said like i don't want to eat now because I'm going to go for a run in in two hours and and yeah it's it's never good um so there's there's two things i see with with runners going on holidays one is they don't they they miss training um because it's just too hard for them or number two is they've got all this time and they cram in extra and it's like uh and this is not not the runners that that i coach um it's the ones that are just left to their own accord they don't have anyone overseeing them they don't have a coach and they've just decided well i've got
00:17:14
Speaker
well, this holiday now I'm going to run six, seven days a week and then they come back, you know, a few weeks later, it's like, oh, my knee's a bit sore. Why is this happening? so So they're probably the two scenarios. so I think if you can, for our listeners out there, if you can nail training when you're on holidays, well, well good good on you because that's ah's a pretty bloody hard thing to to do right. And i'm I'm not on the expectation as well with my runners that that everything goes perfectly, even at the best of times when they're home but especially on holidays. Yeah.
00:17:39
Speaker
Something you said during that about the the guilt of you taking the time away. like As a coach, I have this conversation with my athletes that are parents all the time, but I'm not a parent. So it's like, I do my best to put themselves in their shoes, but you literally can put yourself in those shoes because that is for you.
00:17:53
Speaker
when When you've got someone that that has, let's say like a really common one is Two Bays Try Run in Victoria. Like that's normally like early to mid-January Christmas period going over it. People are training for the 28K or the 56K. They really want to get the training in, but they're at this like battle where they also need to spend time with their family and their spouse, et cetera. How do you go around like getting like like caught that conversation with them and trying to make them not try and force everything in?
00:18:19
Speaker
Yeah, I think, um and it's funny actually because Rowan always puts up like the statistics of, you know, how many people downgrade and there's often quite a few that, you know, and when I say downgrade, I shouldn't say that that that it's about making the swap from 56 to the 28, not that the is easy, but... um But yeah, people swapping the distance because they just think, oh gosh, it's great Christmas. And and um so I think it all comes down to really what what you know what the goals are. Like I think that um you know we feel guilty, but but maybe that wasn't ah wasn't a realistic goal to be setting at that at that time of year. Like if you want to be enjoying time with your family and friends and and want to be going out late with work parties, then that's fine like that's life right we're not you know most of us aren't professional athletes so we still need to live your life um and that's that's you know again something i've always i've always said is you need to you need to live your life right that's uh and so just realizing that again like trying to cram in you know training for a for a 56 when you've got all those things going on can end disaster too right so you just you know we said late nights you know not eating as well um that's that's a recipe for for injury so um i think that yeah relaying that that guilt and saying you know it's it's okay it's it's not a failure and and um you know ah ah going off that like just mo modifying the plan like runners think that that's that's
00:19:35
Speaker
that some some runners ah that i've I've spoken to think that that's failure when they have to change something but it really isn't like you know a plan and I'm sure you've had this discussion with your athletes too a plan is is in pencil it's not set in stone right it's designed to be flexible and designed to to be changed around around life and and things that that are happening um and it's it's not if we have to ease a session, if we have to skip a session, if we have to shorten ah a long run because something's happening, well that's just that's just part of it, that's part of adjusting and and that's where unfortunately you know there are um personality types that are more prone to injury so you know a lot of
00:20:12
Speaker
type A personalities which are naturally drawn to running. They can be very rigid and and and sticking with a plan and they actually are more prone to getting injured. That a personality trait that that can lead to to injuries because they are inflexible with what's happening there. You know, despite everything that's going on in their life, they think that, ah, Yeah, I haven't slept very well, blah, blah, blah. I'm not feeling great. But you know what? I'm going to do this session anyway and I'm going to nail it and I'm going to you know, punish myself for and that's when things go wrong. So so i think that we need to be we need to be flexible with with um with our athletes and with ourselves. Yeah.
00:20:47
Speaker
I've been debating whilst you've been talking if I ask this question because want it to come across wrong. not from yo You understand what say.
AI in Training and Return to Run Programs
00:20:54
Speaker
When you are seeing people, particularly runners, coming into the clinic, one of the things we're seeing the most at the moment is the rise of all the AI training platforms. And this is not meant to be a knock on them whatsoever. This can can come from the coaches as well. But Over the last, say, three, four years, we've seen Runner coming in, ChatGPT and Claude and other platforms that are there. Have you noticed any sort of changes in injuries or any kind of low spikes or anything that you can, if you, yeah, thinking back to them?
00:21:20
Speaker
ah Yeah, look, I'd i'd say that, um you know, and and whilst there are people and and probably there's a bias from my point of view, right, because I'm i'm usually dealing with injured runners. so So the people that come in to see me are the ones that things haven't gone well for.
00:21:33
Speaker
But for every one that's followed an AI program and got injured, there could be another 10 out there that that that haven't, right? So I think there's a bias from my point of view to slam um AI programs and say they're stupid.
00:21:45
Speaker
um So, you know i i know, I know people that have followed AI programs and, and you know, they've been able to to get what they want. But I think the the the main issue with AI programs is where I've seen is that they have often started people too high. So, they' you know, sometimes a return to running...
00:22:05
Speaker
returning people higher than what they've been doing before. So um so there's ah there's that that mismatch and there's probably then the also the inflexibility as well that that it comes with that. When something happens, if you skip a session, if you know you need to modify things, there's there's some inflexibility in in flexibility through there.
00:22:21
Speaker
I think that that will get better. like I think that there's you know a lot of the AI programs will be able to, you know there'll be prompts that will be able to fit in and it will be able to to adjust these things. And I think that And I know we were talking about this recently that I think that um AI will help enhance like a lot of good coaches and and and health professionals. It'll probably do away with a lot of the poor ones. um So, you know, the people that are I guess have the knowledge and and be able to implement that stuff in there, I think it'll make them make them better. But I think a purely reliance on it, certainly at this stage is not is not um yeah there's a lot of things There's a lot of things that can can go can go wrong with that. um so
00:23:01
Speaker
and but But in saying that, like, you know, AI programs aren't and and even generic running programs are not new. They've been around for eons, right? So people have followed other people's programs and and it's it's no different ah no different to that. um I think that the main issue is just making sure things are matched. That's that's where the the main problem problem lies Yeah.
00:23:22
Speaker
Cool. I'm glad that didn't backfire asking that one. I see it all the time. Like a load of people have come to me from using ChatGPT or Runner and that's been their way to get into the sport. Like they've started running and they've gone, on what do I do now? I'm not ready to pay X for this coach and this is a free way or a very cheap way to do it. And that's great. Yeah.
00:23:40
Speaker
Yeah. i mean it's yeah it's It's like, you know, Fitzinger's running program or, you know, like books that have been around for for decades. It's no different to to following following one of those, is it really? and And again, like the rigidity of those, it's like there's certainly nothing on that piece of paper that says if you miss this, then then what what do you do? yeah my first My first marathon, my first two marathons that I did, I did offer Marcus Bacchus,
00:24:05
Speaker
um bacu um yeah ah marcus marcu um um um I just forget his surname, the father of threshold training. um can't believe I'm fucking his name. But I followed that. Amaris Bakken, that's it. I followed his his programs and they did me pretty good. I got through got through my my first few. So I think that there's there's ah there's certainly a place for them, but it's finding that individual.
00:24:29
Speaker
Yeah. That brings us on to one of the things that I've been obviously with my own own rehab and and seeing more is the return to run programs and how they can differ. Obviously we said about it is really important about where you come into them, making sure you don't come in too high and meet the athlete where it is, but also the specific injury where it needs to be. So what are the mistakes you see with return to run programs and how do they differ depending on the injury that you're being presented with?
00:24:54
Speaker
So there's there's a few things that that i'll I'll consider when when making ah a return to to run program because there's certainly plenty of plenty of generic um ones out there. So um number one, I guess we can talk through each thing and then we can go into how that might modify it. But ah the first one is is the injury. What are we dealing with here? Is this bone injury? Is it a tendon injury? Is it a muscle injury? Is it a joint injury? um that that can dictate you know whether to progress slower or progress quicker. um
00:25:24
Speaker
the The other factors that we've got to consider is, is there a race coming up? yeah right So what are our what are our time pressures through here? So how I return someone to running that has a marathon in six weeks versus someone that you know doesn't have a race at all can be very different. And it and is always a matter of mitigating risk as well. And I always discuss this with my runners as well. It's like, You know, we, we we and you can never give an exact figure of, you know, their percentage chance of getting injured, but we can say this is a more risky option, this is a less risky option, you know, which which would you know which would you prefer? um Goals is obviously important as well. Like if someone just sort of said to me, they're like, look, I just want to be pain free. I don't want to get, you know, I'm going to go slow with that ah with that runner in terms of their their progressions. um You know, for them, they've said to me that pain is really important. They don't want to be in pain versus someone that says, this is my one shot at a sub three. I want to be able to, I want to hit this and I'm happy to take lots of risks to get there. I'm happy to be in pain. Then then we are going to progress their, you know, return to run program faster.
00:26:26
Speaker
um Experience can make a difference. So those that are more experienced, ah you know, are running experience are probably likely going to tolerate a faster return. So we can speed up their their return to to running there versus someone that doesn't have much experience. And when I say not as much experience, usually less than that you know less than a year. If they haven't been running for, for if they haven't been long running longer than a year, then I'm going to progress them likely little slower because they probably don't have um yeah the the capacity to to be able to handle um a a quicker jump a quicker rise in in uh in running um the injury history is another consideration too so if someone's been riddled with injuries it's like i've gone from this injury to that injury to this one here then i'm going to progress them a little bit more slowly uh versus someone that's like well this is the first injury i've had or it's been years since i have then we can we can um move things on little bit quicker
00:27:18
Speaker
um their overall health. So, you know, the healthier their individual, the the more likely that they're going to be able to tolerate, you know, a faster return to run versus if they've got a lot of other comorbidities and and health issues, um you know, metabolic, hormonal, those sort of things there that ah that that we might go a bit slower with with them. We've already spoken about stress, that that the role that that can play. So if someone's very high stress at the moment um and and their their recovery is not great, so their sleep and their nutrition as well, that's not very good, then I'm not going to progress them. I suggest that we don't progress them as as quickly.
00:27:53
Speaker
um Their overall physical physical capacity, so you know I do um strength testing and and that sort of stuff. So if i've got someone that's got, you know coming back from an Achilles tendinopathy they've got poor calf capacity then I'm probably not going to progress them as as fast as as someone that's coming back that has excellent calf capacity and can probably handle that that jump a lot a lot better um and then you know the other consideration obviously is how long they've missed as well like are we talking have they just missed two weeks or have they missed two months um so the longer obviously the longer then the more that that that running condition that we've we've lost um and other things like you know I guess they're other small factors like running gate as well like is there anything that that might predispose them to that happening that we're seeing from a running gate um point of view so they're they're probably some of the things that are going into my head when I'm when I'm constructing ah a return to running program and it is a it is always a matter of of mitigating risk so you know there's never we can never give someone a guarantee that they're going to be you know pain free and and never going to have injury again but there are riskier options and less riskier options is is what i'll what I'll put to them um And again, it's it's that informed discussion as well too. So it's not just me telling someone what to do. And I think that's that's something that I've also also learned is the importance of that of a joint decision making. And it also sort of you know covers my butt a bit. If we you know we've opted to go for a more risky option and something happens, it's so don't turn around and say, well, that was your fault. It's like, well, no, we spoke about that. Like this was one of the downsides of this happening. So So, yeah, I've i've found that that's that's something i've I've probably changed over time as well. there's more a discussion on that.
00:29:33
Speaker
How much do you think gait comes into injuries and and especially the recurrence of injuries? Is it something that you really try to to to analyze and check and to change with people?
Gait Analysis and Running Techniques
00:29:43
Speaker
So it's something that with running gate, it's something that, you know, I've said that I check as often, if not more than than what I ever have. So I will still look at it, but I'll actually intervene probably less than what I had in in the past. So I guess I've sort of learned to sort of say, yeah, that's that's normal or that's a real outlier here or something that we need to we need to change.
00:30:03
Speaker
So I'm probably, um yeah, less less likely to intervene now. I think that that running technique does, so how someone runs does ah dictate where those stresses can be placed. um And so you add that on top of other layers and that that then can can become a problem. and But in terms of,
00:30:27
Speaker
sorting you know intervening there as one of those layers it's it's probably not one of the big you know ticket items that I would say that oh that's that's going to just going to just going to cure your injury straight away mean for some some and anecdotally I've seen it it's like oh yeah that was a a big change for me and that's the thing that really stopped me from becoming you know issues but I think the the biggest thing is is you know from ah from a from hierarchy point of view is is the training loads and getting and getting that right. um That's ah a really big one. So the the running gate is so can can certainly. i mean, the the classic example is, um and I had someone just the other day actually, and she's been getting ongoing calf issues and, you know, we assessed her and she's she's a four-foot runner and she's a natural four-foot runner, which is not that common. um um And it's like, okay, well,
00:31:14
Speaker
Just know that, you know, we've got two options here. One is we build up those calves because she did have some reduced calf capacity there and from our testing cycle. One is we leave your technique the way that it is and we we build this up um and then we see how you go. And if you still have issues with that, then we can modify that.
00:31:31
Speaker
Well, number two is we say, all right, let's revert to you know to but to to work on that foot strike and go more a midfoot mid-foot landing through there, which is not easy to to do. um and um And so, yeah there's that there's that sort of, again, two options to to go with through there. And we decided to go, again, with the discussion with her, decided to go with the building the capacity because I'd argue that should be done anyway. um and as ah as a trial runner that's super important well as a runner it's super important anyway but um so so that that's a good example and and again the other ones that i've seen where they've they've had recurrent calf issues they've got their forefoot landing but they've been told by someone that that's something that they should have done and so they're running up on their tiptoes and not even heels not even touching the ground and for them it's like ah this this we're changing straight away now like this we're working on and get down off those those heels and lo and behold you know instead of feeling like the calves are going to explode at 15 k's they can now get through 24 k's without any issues so um so it's yeah something that i'll always assess but but not intervene as often um yeah do do you get people coming through that have actively tried to change how their foot strikes and that has caused an injury
00:32:42
Speaker
ah Yes, yeah. And and well you know a few of them, the most notable ones being being changing their foot strike, which doesn't happen that often. And that's why when I saw this run, I said, oh, have you tried to change this or is this something someone has told you to do? And she's like, no, this is this is how i've I've always naturally run.
00:32:59
Speaker
um And so that's probably the big one and that's why I don't ah don't often cue when I'm changing running technique, and often I don't often cue foot strike like as in if someone's landing on a heel which is perfectly fine, um I'm not cueing them to land on their toes because I've seen it just goes too far too far the other way. I've seen so many runners that have just that you know come in and they're just running on their tiptoes because that's what someone said or they read that on a blog somewhere that that's what they need to do. so um yeah so that's where i have seen it cause some injuries um other ones other sort of types of cues that i've that i've seen yeah i've seen some interesting stuff there's some interesting stuff out there for sure so on the uh on the the interwebs about changing technique and you know reducing vertical oscillation like basically doing groucho marks running or grounded running there's there's someone out there that sprucks that he's got quite a big reach and i yeah it's it's
00:33:53
Speaker
it's It's interesting, um but um certain headset so i'll I'll be political and say yeah say that. i'll be going for Yeah, certainly not something i'll ah yeah I'm ah' directing my runners towards for sure.
00:34:04
Speaker
The return to run, once somebody has got to the point where they're back to doing this continuous running and they've run 30 minutes for the first time, I feel like roughly there is where a lot of practitioners will finish. like That's where the return to run program is done, whether you're a physio, a podiatrist, a sports car, or whatever it is.
00:34:22
Speaker
And then sometimes that athlete, if they're lucky, they have a coach. And if they're lucky, at that coach understands reloading, but quite often they either don't because they haven't had that education or they don't have a coach.
00:34:33
Speaker
And so given that we're talking to trail runners here, obviously everyone always runs on the road, but how do you then go from running your first 30 minute easy run getting back on the trails? Like what considerations do people need to be put into place?
00:34:46
Speaker
Yeah, well, this is, this is you know, I guess why i um naturally found myself evolving into into coaching for that exact reason because I would release these runners into the wild um and let them to their own accords and lo and behold, then they'd, you know, come back with with with re-injury again. and And to be fair to them, like how are they to know? There's no school of running to teach us what what, you know, how much we should load and that's that's that's what coaches are for, yeah. So yeah so I think I'd love... i love my runners to have a coach um and that way then there's a there's ah a transition a hand over to over to the coach and say look okay james is ready to run now we've built up to this sort of point these are some of the things we just need to watch this is what he's had had issues with here um you know good to take over from here but i'll i'll be sort of you know in the background if you need to ask me any questions and and uh and go from there so it's not just a clear cut of goodbye that's it yeah you handball off that there's still you know, happy to be involved in the background through here and and um ensure that there's anything and and make it more a collaboration rather than, you know, than this ends and then your yours here. I think it's more like a, you know, a graph where and even getting the coach involved in the early run to return to run process. So it's like, you know, health professional here, coach here in terms of their involvement, but then it starts to sort of tip tip this way where the the coach is having a greater input and and the health professional is there to, again, just to to provide some some small input so so that's sort of how the transition I like to like to occur. um When it comes to trail runners getting out there I i think that that trail runners ah overestimate or underestimate I should say that the the stress that that hills can play on the body and hills is it's just another form of intensity it's just another form of speed work really in terms of increasing that demand on the on the body
00:36:35
Speaker
um And in terms of how early we put the put the hills in, um again, it it comes down to a lot of those factors that we were talking about before, right? And going through all those sort of things, you know, um have they got a race they've really got to build up for? We've got to put some hills in there. Okay, we're going to take some risks here. have they got good calf capacity, quad capacity, you know tissue healed really well, that ankles you know settle down quite nicely, they'll be handled the technical terrain, all right let's let's get them back in there. So so I think that one thing we've got to be careful of is that gradual introduction of um of elevation and there's no like there's no sort of set formula like even in terms of mileage increase right we've all heard the 10% rule but you know 10% of is 100 meters so how are you going to increase there and conversely 10% of you know 100K 110K and so they can be sort of bigger bigger jumps through there at the at the extremes.
00:37:28
Speaker
So you know I generally sort of say like early in the process you know increasing up to up 30% is fairly fairly safe from ah when when you're building up from nothing in terms of mileage, um duration and then elevation so we can make those changes but obviously as we get more, um bigger then those percentages need also need to are to decrease. um So that that that could return quite soon. So if someone's, you know, um and say if we've got someone with a calf or Achilles, you know, we might hike the uphills and we might say we'll run the downhills um early on if we need to really need to get some elevation in or if we've got someone that's coming back from patellofemoral pain or ITB or or um um a patella tendon issue, we might say we we actually might use a tourette the treadmill and say well let's get on the treadmill let's do some elevation elevation there drop it down to flat elevation flat and that saves us then having to do the downhill or otherwise we we just walk those walk those downhills um a bit slower so so we can there's a few few different ways we can we can do that and so i'd love to say there's ah a given formula that that i use um but uh it's it's um and it's I wouldn't be a podcast without saying it depends, which I know people hate people want certainty. um But there's some general rules anyway to consider what we've what we've just discussed, ah gone through there.
00:38:46
Speaker
And as how you finish that, talking about elevation, we're not just talking about downhill or the uphill. We're talking about like both individual but also connected and how that that goes. And that is really dependent upon why you're injured in the first place. But feel like it's it's an easy thing to think, oh, i I can go on the treadmill and go uphill. That's fine. But as you said, if that's for a calf, that could be a really bad thing to go and do.
00:39:08
Speaker
yeah Yeah, exactly right. And that's where I think yeah over the over the years a greater appreciation for for elevation. I think you know I was always um and to be honest, like the the research you know is is always sort of more investigated speed and and you know pace, what the effect that has on on different tissues. But there's there's probably less of that light shone on um on the the effect of elevation. and And now with the rise of the increasing rise of of trail and and mountain running, I think that's that's only going to get more. There's you know more and more research now coming into that area, which is which is fantastic.
00:39:43
Speaker
When we are thinking about incline and decline, what other structures, what tissue bones is are getting stressed by those movements individually, just going up or just going down?
00:39:55
Speaker
Yeah, so and going up, we we think about there's a greater demand on the things that propel us, right? So the things that that that are going to shoot us forward and once we start to pop the incline up, they're working harder to get things going going up there. So usually that means the calves and the Achilles are the things there. Calf Achilles' feet, they're the things that propel us propel us up.
00:40:15
Speaker
um There is also an increased demand on the hip flexors because they've got to bring bring those hips high. and There's an increased work on the adductors as well and they serve a very multi-purpose role during during running. They're an interesting group the adductors and then when we're going downhill what's happening downhill is we've got we've got a lot of flight time so we're in the air for a long time we don't we're not on the ground for very long um so we've got a lot of lot of vertical oscillation and we're coming down real hard so because we've got that that increase in flight time it's our body weight increase so normally when we run it's you know 2.2 times body weight but on some of declines you know we're getting upwards of of three times you know four times body weight slamming down into the into the yeah the surface there and the quads are the things that stop us the knees are the things that stop us from falling flat on our faces So they're working quite hard as we're going downhill to decelerate us. So that's where we sort of say, yeah, all those structures going up and then it's the yeah the quads downhill plus also the demand on, you know, when we're going downhill, the demand on balance. So things like ankles have to work, you know, pretty hard. um It's pretty rare that I see runners sprain their ankle going uphill. um It's usually the the downhill, you know, really quick ground contact times, unstable terrain um with a lot of lot of flight time and yeah, that's where we see things go go wrong there.
00:41:36
Speaker
When you are talking about someone and then they're bringing back in the trails, are you talking much about technicality of terrain and being mindful of that? Is is that is that a much of a factor? it It is and that's something, again, something I've i've learned more over time as well and appreciation appreciation for that. So obviously, you know, early on we want to go with things that are more groomed and and a bit more predictable and then advancing to, um you know, what what we're likely to face in the race or what someone may have been may have been running before. So yes, I think we want to do a gradual gradual transition into into that. um
00:42:11
Speaker
where we make that transition well I think that I like to sort of if someone's recovered so someone's but recovered let's take a case example of someone's recovered from an ankle injury right so we need to get them running on the flat first and even getting their volume up so getting their volume up on the on the flat because what what we're going to have to do is if we if we've got a trail runner say and we need to say all right we've a trail runner we need to get them up to they've got a 50k ultra coming up um So with say there's, you know, 800 meters of elevation, so nothing nothing too crazy there, but um we do have to get that elevation at some point, but we've got to get the distance up. We've got to get the time on that time and their feet. So what we want to do first is, all right, they've missed this this much training.
00:42:52
Speaker
They've fallen a bit behind here. Let's just get some some easy flat miles in them because we're going to have to increase the demand on the body by doing that. um So let's get them sort of comfortable at that. you know maybe we're getting all right we're sort of getting close to being back on track now. We're up to you know two hours of of for our long run there. And then we might sort of say, all right, now let's start to put some put some elevation in there. So then this next sort of you know couple of weeks, we're putting the elevation in there trying to get that elevation to match the profile of of the ah course later on down through here.
00:43:21
Speaker
and then probably the last thing i'll put in is that then is the terrain so i think for me it's probably you know one of the the the least important in terms of the and i'm not not being dismissive of it but in terms of tissue loads it's probably you know we think volume then um then the elevation and then then it's the the surface that's probably the hierarchy through there that we want it we want to get someone back into and and in terms of where things are going to go wrong is is probably in those in that in that order so that's how i'm i'm building someone back yeah and i think i completely see that from a from a practical perspective like yes there is the skill there's the coordination there is a like being of efficiency over the technical terrain but if you've run on a flat riverbed that's rocky but never done any hills in your training it doesn't matter how technically proficient you are you're in trouble um even for a relatively it's really flat race
00:44:12
Speaker
That's exactly right and so I'd probably prefer to go again like in that hierarchy rather than going, you know, if someone sort of said, oh, well, what about going on a flat and and, you know, and challenging terrain? It's like, well, no, like I said, that that that probably comes later on down that down the process but but again, it also depends on what what the runner's got access to as well too, yeah. So if they're like, well, I don't have anywhere flat or i don't have anywhere with nice groomed trails, it's all, you know, it's all pretty pretty rough stuff that I've got to be running through so technical terrain so that that that that can certainly play a role in it as well.
00:44:41
Speaker
The fact that we haven't spoken about in that example is speed work, which yeah obviously people are going to want to be bringing back in, but back in for a trail runner.
00:44:52
Speaker
And let's say that they have a race coming up, but they don't have a crazy time pressure on it. let's say I've got, it's 12, 16 weeks away. So you've got a bit of time. How, how do you think about bringing in speed and how it interplays with elevation?
00:45:04
Speaker
Yeah, so I think that um speed work again is i' I'm usually trying to get the runner from from a volume perspective, you know, once they're getting to 40 or 60 minutes continuous, then then that's where I'm starting to think about speed work or elevation.
00:45:20
Speaker
Now, I always explain to runners that they are sort of the icing on the cake and and you know the the volume and getting that in there is is really the cake and then the the rest of it is like a sprinkling on top because I think i think a lot of runners, especially road runners, they think that's how you know they overvalue speed work. They think that speed work is the thing that will that will get them there um and so educating them that know that that's not the case and that's where we sort of want to get to that point. Now, if we're working on um speed and elevation, it probably comes down to the athlete that's in front of me and that like if if we've got really short period of time and we've got a really you know we've got uh we've got to get a lot of elevation up there i'm probably going to opt for that i'm probably going to say look let's just forget any fast stuff let's just just get on the trails let's start to to get some some ups and downs there we can we can use that as you know we can do some some steady efforts on on hills and and we can do some harder downhill efforts if we want to you know be we really working those quads so so it's it's It's very rare that I would put both in. um And again, it probably comes down to the specificity of the the event trail. I'd opt for probably elevation over over speed if we're really pressed for time. um And road runners, I'd probably opt for speed over elevation.
00:46:35
Speaker
um that so if they if they're not really running a a particularly hilly hilly race. so But when I say hilly race, it's pretty laughable, isn't it, when Sydney Marathons consider hilly race with 400 metres of elevation and, you know, you guys are doing events that have they've got thousands. So, yeah, we can't we can't complain. Yeah.
00:46:51
Speaker
when When you've got a ah ah time you want to hit and you're not willing to sacrifice your pace up the hill, you can definitely feel it. yeah Yeah, absolutely. yeah that And that's the other thing too. Again, we can use that. like we can We can hike up hills. So I think that's that's the so the difference between when you're dealing with road runners and trail runners like trail runners. they're not afraid to to walk up hills and it's part of a strategy too, it's part of a race. like Whereas and road runners don't don't like that very much. You tell them they need to walk up a hill, they're like, what? I just need to just need to keep going. So they don't want to take it take a break. So yeah,
Strength and Plyometric Training
00:47:25
Speaker
it's different. Working with different populations is is some provides some nuances.
00:47:29
Speaker
When people come into your clinic and and you work out that the injury is likely from a lack of capacity, Obviously, we start talking about strength training and that can be from a body weight and into a loaded perspective. How how do you go if somebody has never been in a gym environment before, they've never done any strength or they've just sort of kind of been little bit in and out. How do you go bringing that conversation in and then getting them bought into that process?
00:47:52
Speaker
So I think, it again, it comes down to education with the runner as to if we've done some testing and and that usually involves some form of capacity testing. So i've I've got some numbers that I like to see my runners hit on certain tests um and you know we're testing a certain strength quality there. And and obviously if they're deficient in that, and and I think that's playing ah a role in their in their issue,
00:48:16
Speaker
then it's not hard to sort of communicate that as to why they why they need to to do that. um And so that the buy-in is is greater. And I'd sort of say, I'd certainly say my compliance over the years has has been better when it comes to people doing their exercises. And for any of my runners out there that listening, um and you know who you are when you when you haven't done your exercises, but There are certainly still people that you know that that do find it hard or they don't prioritize it. um But generally speaking, it's it's been better. and And that's probably come down to my communication of the importance of it. So rather than just handing someone a sheet of paper and saying, oh, just go and do these, it's like, well, this is why we're doing why we're doing these and you know link it back to why why they've come in in the first place and and also pinning it to their goals down the track. Well, this is going to help you to you get there. Um, I think that sometimes like it's hard not to get to, um, you know, runners want to run and and that's their their primary activity. So they're not there to to be bodybuilders. They're not there. You know, they often don't like that. Um, and you, you've got to sometimes take a step back and it's like, all right, look, this is the, the the gym is to support their running. It's, it's not, it's not another thing. It's not another sport. It's, it's, it's to support it.
00:49:30
Speaker
um And so we don't want to sort of, I guess, overemphasize the importance of of things. and And I sometimes have to take a bit of a step back because obviously I'm um ah ah a flag bearer and a waiver for strength training, um but it's not for it's not always for everyone. um not you know Not every runner can can afford to fit that in. um I'd love love it if they did, but um yeah, you've sort of got to realize that it's their support, the running.
00:49:56
Speaker
And once someone's started to build up that capacity, like is it something that you encourage that this is going to have to be a long term thing? Like it's not ah a four, six week rehab plan. This is a, this is more of a permanent solution. yeah You see, it's it's the I call it the yeah the gateway drug. the yeah the yeah and And one of my favorite sayings from from Phil of Glasgow is, um rehab is training in the presence of pain.
00:50:22
Speaker
um So basically, you know when when we' got when we're putting someone through rehab, I like to look that too. It's not just doing a few banded exercises and you know um body weight stuff that's as simple as anything and people like, is this even doing anything? you know We really want to train and that's where I sort of you know educate other health professionals on and and is is you know we always train around the injury. So, okay, well, we can't do this now. What can we do? We can't run. Well, can we cross train? We can keep those cardiovascular demands going through there. You know, we can't do any calf-based stuff, but what about knee-based stuff? We can do these things there. So we always want to be, again, training. And so um so that's the that's the first part is is always making it making it challenging. And then, as I said, the the second part to that is that's ah it's the um it's the gateway gateway drug that once we get started on it, then it's just like, all right, well, now this this becomes then your... you know performance enhancement and this is what stops you from coming in to see me again broken. so and And I'd say the compliance with that is is is again generally pretty good. like I think runners are pretty getting very well educated now out there. We've got you know resources like this for with podcasts and social media and so I think a lot of runners know that they should be strength training they just don't often know where to start or what to do or how to schedule it like they they they sort of sometimes overthink it um but you can keep it you know quite simple and just to just to get it done
00:51:43
Speaker
And when someone is like, let's, let's say, because a lot of people listen to this will be be parents that be working full time. The idea of adding something new into their routine is, is quite a big barrier. So often, like how are you saying to people, this is, this is probably the simplest way to add this into your routine or just to get them to be consistent with it.
00:52:04
Speaker
Yeah, and and look, there might not be times when I'll say, look, we're not going to be doing this now. Like if ah if I've got someone that's got, you know, marathon in a race, a key race in three weeks' time and they're like, all right, what should I be putting in? I'm like, well, we aren't putting this in now. Like if I've got someone if i've got someone that's that's overtraining, that's under fuel, you know, we've got, you know, low energy availability or Red S, those sort of things happening, then again, it's not like let's just pour more training into this cup already ah that's already overflowing or onto the scales that's already tipped in in ah in excess there. So, So it's not just simply a matter of adding of adding more in. um So how do we, know, how do we put that in there? Well, it can be just as simple as doing one exercise, right? So it's relevant to their issue. So we've got someone that's coming in with with an Achilles issue and, and you know, we say, well, we need to be getting that calf strength up. Let's just start with calf raises, start with some weighted calf raises, make them challenging, add enough weight, you know, which people often are under do and let's do that you know let's go two reps in reserve so you're getting close to close to failure there so you feel like you can only do two more reps by the time you get to the end we'll do three reps of three sets of that and um and then we'll do that do that twice a week and that's the simplest sense you know how long does that take that'll take you five six minutes do you reckon you could fit that in into your day there you know we could do that straighter after a run if that if that's what you want to do it's not the you know it's not the the best timing for it but if it means getting it done better to do it then than it is to not to do it at all. So let's start with that rather than heaps someone and this is where I've been guilty of this in the past too of giving someone people too much. It's like well there's is there's 10 exercises to do there it's like and they come back and I have done zero. ah So I think starting starting simple and and just starting with a low dose and then as they start to pick that up it's like all right yeah, um I've got the hang of that now. i'm I'm into a routine. What what else can i what else can I do? What else can I put in? And sometimes I get runners asking me that. It's like, okay, yeah, I've got that and good now. What what else do you think I can i can add in there? So um yeah, so that that's often how. just Just start real simple and make it relevant to you know the injury or or the the weakness that you get. Like if you're always getting calf cramping, you're getting hamstring cramps and in races, we we'll target that and go after them first and then you can start putting other stuff in after that.
00:54:14
Speaker
I think people listening to this might go, well, I don't have waiter at home. And the beauty of like, you can get pretty much anything on marketplace for very cheap, or you can buy this stuff and came up, but you can also just get a backpack and throw whatever you've got at home in to put some weight into it and use and use that. And maybe it's not the perfect solution, but there's a lot of ways around it.
00:54:32
Speaker
Yeah, and I think, look, there's certainly one thing that COVID taught me was that, you know, to use what what we've got around the house, like when gyms closed and, you know, yeah we had the fortunate instance here in Victoria, didn't we, of having some very strict lockdowns. So, um people weren't able to get to the get to the gym. So, we had to get creative at at home. So, I had spouses I had kids jumping on people's back and and piggybacking on their back there there's you know there's 30 kilos on your back on your back right there plus your body weight let's get let's get on a step and let's get moving through there plyometrics plyometrics are a fantastic exercise that can be dosed from from someone from a beginner level to doing just some you know sub maxible double leg pogos on the spot there
00:55:11
Speaker
um and and ramping up to things like you know single leg bounding and and making things challenging there. You need zero equipment for that. um And there's there's actually some good studies to show the performance benefits of of even just doing some simple plyometrics that that can actually help improve your your running time. so So I think that that's that's certainly one that's – and the great thing about that is they're quick. They're quick to do and they don't take up a lot of energy to do it. They generally don't give – in in the the DOMS as well that you'll get from some of the heavy lifting. So they're an easy and easy sort of – another gateway exercise that we can use.
00:55:45
Speaker
As you're saying that it's it's making me think that like there are different types of strength. And obviously we chatted in the last podcast about, or briefly, about the muscular endurance side that came out of Tom Evans and Ruth Croft UTMB last year. But when when somebody does...
00:55:59
Speaker
um they they get stuck in, the they have the gateway drug has has worked for them. And they start to think about, okay, how do I progress? i see How do i actually, i want to get to the gym and I want to start lifting, but what's what comes first? What's important? What what steps do I take?
00:56:15
Speaker
how How would you suggest someone go through that? and Yeah. So usually, you know, if I'm assessing a runner and and, you know, again, we touched on it last time in terms of the different strength qualities, but it's just for our our listeners out there, go back and listen to episode one. Now, we've got sort of different, when we say strength, you know, it' these there's different types of strength. So we talk about, you know maximal strength. That's the ability to, you know, to to lift something really heavy and do it with repetitions. Then we've got things like more dynamic strength. That's being able to do it a bit more faster. Then we've got explosive strength. That's, ripped now again, do it faster again. and then reactive strength which is being able to do it again and again and again and then we've got endurance about then that's the ability to sustain that even even longer so so when we're looking with someone if if um um um i'm assessing a runner and they've got you know low levels of strength qualities across all those so we've done some tests we've done some hop tests we've done some some isometric tests and we found that yeah an endurance test and they're poor across the board. We're starting them with maximal strength and that's doing heavy weights and doing it for reps. um And that basically helps to lift all tides. So that that does starting with that. can improve everything everything else.
00:57:26
Speaker
um And so that's where again if if runners are like wondering where to start and what to do, i would say some some weighted exercises, some resistance exercises would be that would be a good place to a good place to start. you know We used to sort of say you know there used to be ah a um a rule with you know starting on plyometrics or something like ah you know you can you can only do plyometrics if you can you know back squat your body weight or just things like that and i was like that's you don't need to do that like you could you can start plyometrics at any any point you want really that's such a ah long spectrum you can do easy stuff like you know tall to short landings and and and that sort of thing right through to the the more complex stuff but yeah we don't need to provide more hurdles to uh to to do into there but um so they can be started again but yeah maximal strength is usually where i'm where i'm starting someone
00:58:14
Speaker
And you've mentioned plyometrics. As we move towards the reactive strength side of things, there are so many benefits of plyometrics from by bone loading to performance. where Where should people be starting off and and thinking about progressions and and do they need to get lost in the number of contacts they're doing in a session?
00:58:31
Speaker
Yeah, yeah think I think you do need to consider the contacts. Like I think for for beginners, you know, sometimes starting at, you know, and so when we say contacts, that's how many times your feet are touching touching the ground on on one side. So if we're starting with with beginners, you know, we might start with 50 or 60 contacts and then progressing through over time you get a bit more advanced and and tolerating that, getting up to 100, 120 contacts. But it also depends on, you know, without getting too technical but there's like intensive and extensive plyometrics basically you know um the in terms of the demand so something like a just a sub-maximal jump on the spot is very different to even a maximal jump on the spot or something like a a depth landing where we're jumping from a height we're hitting the ground and then we're jumping up onto another onto another um a landing through there or or a yeah a drop hop um so there quite a higher demand and so once you start to move into those more challenging exercises then the volume can also come down a little bit so i don't i don't mean to sort of make things more complicated but um
00:59:35
Speaker
But just starting out, you know, for for our listeners out there that want to start with something, you can start with, you know, 20 seconds of submaximal pogo jumps and and do three sets of that. um And then as you get better at that, then you can start to make those more explosive and you might drop down to eight or 10 reps. So you're really going after those and you stick with your three or four four sets of that.
00:59:54
Speaker
And then you can work on to single leg stuff, so hot so on the spot um and yeah and then then going on from from there. So don't want to make it too complicated, but we can – yeah. It's good because it it is it's a very different thing from a submaximal little kind of hop on the – or double leg hop on the spot compared to going and bounding and and doing – depth jumps, like you say, and and you can very easily, but completely accidentally cause yourself more harm than good by doing them. So it is good to kind of talk through how it can be introduced. And then when we are thinking about trail running specifically, how, how would you see plyometrics that can be used to benefit someone's trail performance and also trail capacity?
01:00:35
Speaker
Yeah, well I think i think they're they're number one, i mean they're they'rere they're important for runners full stop so whether you're on trail or whether you're on the road, they they help to improve neuromuscular coordination and we used to think that that they're they're great for tendons but it's actual in actual fact they're not really the best for tendons but that they certainly help neuromuscular coordination so so that all runners need that. Then in terms of for trail runners, we mentioned before, especially on that that downhill component, that quick ground contact time and and then also you know potentially some um unstable surfaces and and some change of direction occurring through there. So that's where we can use things like you know drop hops and drop landings or you know drop into into ah a hop or into different directions as well that can be added because that's that's a unique demand for trail runners is the is the change of direction like road runners just run in a straight line the far you know the biggest they need to turn is if they're overtaking someone um whereas trail runners are having to make hard turns and So that's a demand on a different muscle set, um especially when it comes to, yeah, ankles um and outside of hips there as well. So adding some change of direction into those plyometrics can be quite useful for trail runners.
01:01:53
Speaker
Yeah, I think definitely considering once you build up a base of plyometrics, thinking about how you can do it laterally or diagonally because we are constantly moving laterally and diagonally when we're on trails. It's not just a nice straight line as you do on the roads.
01:02:09
Speaker
No, I mean, a good one for trail runners is ah is a skater jump. So for those that don't know, it's sort of like imagine you're ice skaters and you're basically jumping from from one leg to the other and you can or you can basically just just hop from from from side to side there, just really quick ground contact times. And that's that's a great one for for especially strengthening the yeah the ankles or even just hopping from from side to side. that's ah that's another good That's another good one. I'll give that quite regularly as part of part of ankle rehab to get used to that that that quick change of direction.
Nutrition, Energy Availability, and RED-S
01:02:35
Speaker
Yeah, before as well, you touched on low energy availability, LEA and RED-S, relative energy deficiency in sport. I'm guessing that is something that you do see come through the clinic, especially when you're looking at at bone injuries. when When someone's coming in and you're you're suspecting that they might be in a state of low energy availability, and we've seen some recent studies about the potential prevalence of it as well.
01:02:58
Speaker
It's obviously quite a hard conversation to have a lot of people may may be completely ignorant of it and it's completely accidental and for other people it could be like a a restrictive or or kind controlling aspect. So how do you go about those conversations as opposed as as it pertains to injuries?
01:03:13
Speaker
Yeah, I think there's there's certainly a a nuance around that as well too. I think there's, um and propa again, probably learned from mistakes there, like you've got to be careful about accusations, like you're not accusing them of of doing something. It's more being inquisitive in asking or sort of framing it in the terms of, you know, I've seen a number of runners in the past and and these are some of the the things that they they might not quite get right or these are things that that that they need to improve on or, you know, that they might not be quite aware of. And so sort of bringing it more into that instance rather than delving straight into, oh, well you you're clearly not eating enough. um It's also something that, you know, again, working in that space, like i I'm more and more but frequently referring to to sports dietitians to review that. and And that's where, like, if i've I've got an inkling, you know, certainly if I've got someone with a high bone stress injury, I'm sending them off straight away. If I've got someone with multiple
01:04:04
Speaker
low risk bone stress injuries you know that's the second one that they've had i'm sending them off as well um you know someone that's that's that um and and you some of the clinical ah so some of the flags that that would show up to to me is a lot of recurrent injuries um uh reporting know a lot of fatigue tiredness uh recurrent infections These are the things that might then open the the further questioning about things like menstrual health or or food habits. like I do, again, ask on my my intake forms, you know what how would you rate your diet out of 10? But there's a lot of, again, there's no that's not a validated outcome measure and really what what does a 10 mean? But I'm um'm certainly...
01:04:48
Speaker
i'm I'm not, if someone's putting a nine, it doesn't that but doesn't mean they've got an amazing diet, but if someone's putting a a two or a three, then I'm certainly going, well, what's going on here? Why have you marked your you diet as ah as a three? why Why do you think it's so bad?
01:05:00
Speaker
um And so, yeah, it's probably something, and and again, i've I've been with the runners that I coach using more um ah the the peak questionnaire, which is, ah developed by an endocrinologist, Nikki Key. And and um so that's been quite good to to for the runner to do on their own. It sends me the the copy of the results there. and And so if there's something that I think that is not quite showing up, then I'm i'm sending off to...
01:05:27
Speaker
to a um to someone. But these these are tricky because they can stay you know hidden for very for a very long time. um you know the The runner can be you know ah performing amazingly um even on an LEA and Red S as well too um until things all crashing down you know we can't tell by the look of someone just because someone looks lean or looks you know potentially overweight that doesn't mean that they're that they're fueling correctly and and that's where you know this recent study that we we put a post up about on trail runners like the high prevalence you know this is looking at female trail runners but you know 50 percent were were um you know had the had ah a potential um issue of lea these weren't
01:06:06
Speaker
medically diagnosed but performed off surveys but you know upwards of 50% which is massive amount out there that that are just under fueling and um and the the interesting thing was there that a number of those were actually overweight um that so were classified as overweight so they're not just you know your lean runners that ah that are ah that ah um are under fueling. so So I think that looks certainly can't can't tell us. so But I'm probably listening um for for things that might pop up. um And, yeah, so that that does that answer the question going back to what we said initially? Yeah.
01:06:38
Speaker
Yeah, no, it does. And i I think of it, to me, performance nutrition, eating for your sport is a skill. And there's no reason why we should inherently and understand or have the knowledge to be able to do this and meet the demands of what we're trying to do. It's a bit like, as we said, once you finish Return to Run program, when you put that into the wild, why would the runner understand low tolerance for how to bring things back into them? Because you're not educated in it. So i think it's, yeah. Yeah.
01:07:03
Speaker
and And that's where like one of my runners that I coached like just sent me and a message last night. It was a link to ah to a um a story on on carb loading and how runners don't don't do it. And she said, you know, her comment was it's like I can't believe so many runners don't do this. And it's like, well, to be fair, like they don't they don't know. Like that they don't know what they don't know. So, you know, carb loading Again, if unless they've had a coach or they've had someone just seen a dietitian or read good quality information to know about that but then again, what what they should be eating during the day is, you know, i was never taught that at school where there's no said there's no there's no school of running so there's nowhere to to say this is how much we we should be ah should be consuming.
01:07:42
Speaker
Would you advise anyone listening to this to do something like the peak questionnaire that you said? Yeah, I think i think there's there's very little harm that could be could be done done for it. i'm I'm careful with choosing my words there because there there might be some people that that that could can um there could be some problems with because it's a lot of people misconstrue LEA and RED-S as having an eating disorder, but that's that's not necessarily that it's not necessarily the case. And I think there's a lot of stigma around, you know, still around eating disorders, and unfortunately. um And, um but, but I think thankfully that's, that's being more normalized with, with a lot of other, other, other conditions as well. So, so I think that there, there's, there's probably, i' probably prefer that to be done under the, the guidance of someone, whether that be you know a health professional that that can then interpret the the results. Because it's one thing to do a test, but what's the point of doing it if you're not going to act off it as well? So I think for our listeners out there, if there's some suspicions or curiosity about, well, am I eating enough?
01:08:47
Speaker
go see a good sports dietitian and they they can they can yeah can go through all that with you and then they can give you action to to follow from that. This comes back to a conversation we had in our first interview about how to choose a good sports practitioner. When you're looking for a sports dietitian to work with, is there anything that you are looking for like as it specifically is for runners?
01:09:11
Speaker
um I think, well, certainly word mouth goes well, doesn't it, right? Like, you know, I think i think within within the running community, um you know, we're all pretty good like that in terms of, you know, suggestions that people people already already use. So, you know, ah'd I'd suggest, I mean, i can I can give you names, but to to suggestive... um uh you know in the in the community that you're in it's like hey does anyone have you know a good sports dietitian that they can they can speak to and i think again it's it's not an admission of that again you've got an eating disorder and anything i think it's ah it's an admission of like really wanting to to because it's a big thing that can be left on the table from it from nutrition counter right so like if you're under fueling it you're going to be underperforming and
01:09:51
Speaker
training in races and and so I think that's a sign of of really yeah doing your due diligence. so So I'd recommend reaching out to the communities that you that you're a part of or if you've got a health professional asking asking who they can they could recommend um and sending you on to to someone there.
01:10:07
Speaker
Yeah, it is it is tricky though because I feel like, as you said, if you were to put a message out who has a sports dietitian, the immediate assumption is still the eating disorder side of things. it's not the It's not the idea of I'm trying to optimize performance. Mm-hmm.
01:10:22
Speaker
Because that's exactly what it like. You might be eating enough, but just be eating the wrong things at the wrong time. Or you could get a little more out of your recovery if you did this. Or are you trying to eat 150 grams of carbs an hour and your gut keeps throwing it back up? like, well, maybe let's educate on what you specifically can tolerate and what form, et cetera. So there's so many other avenues to it, but I just feel like are stuck on that.
01:10:43
Speaker
i like i I do agree with that and and and that's why again like to see that be broke down as I'm sure with all the sports dietitians out there that um that um because I've had some that are like do I really you know do i really need that and and you're like look no you do go and go and see that and then you know I've never had anyone that's come back to me disappointed. It's it's because I've said to them, I said, worst thing says worst thing that comes out of it is you're doing well. keep Keep that up. That's not something we need to address. But I would say that there'd be very few runners that I would send from the first off visit that they're saying, no, you're all good. Continue on there. So yeah think we could all do a bit a bit better in that.
01:11:20
Speaker
And I'd also say if you've worked with somebody in the past, your needs change and the demands what you're doing change as well. So it is something where having a a checkup, whether it's follow up with the same person every couple of years or so, it it is definitely worth it just because something was right in the past. It might not necessarily be now.
01:11:37
Speaker
Absolutely. I should have probably got some money from Sports Artition Australia to to promote. So it's a SDA.com.au. I don't know what their website is, but yeah. it It's definitely worthwhile. Yeah. Awesome.
Personal Aspirations and Rehabilitation Insights
01:11:53
Speaker
Luke, that's been brilliant. i think there's ah there's a lot of information we've kind of, we've, we've really, we've pushed through. We've actually got to everything that I thought we would get to mostly. um But yeah, I think hopefully everyone listening has got a lot to take out from this.
01:12:06
Speaker
Are we going to see you on the trails in the future? I was listening to one of your old podcasts where you mentioned that you wanted to do one hundred k at some point. Yeah, yeah, I yeah i i do hope so. I'm sort of don't have, um as you well know, i'm I'm dealing with my own running injury at the moment, which I've just started running back from. I had a chondral defect, unfortunately, after after um Ballarat Marathon. So I've been sort of documenting that and and it's it's no secret what I've been going through. been I've been quite open and transparent about that and and I've had a
01:12:37
Speaker
pretty good run, excuse the pun, for, you know, the 17, 18 years that I've been running, but this one is made up for it. So, yeah, eight weeks off running, gradual rehab, returning back to it and, yeah, getting back into the third run today, talking about the walk-run program that I've got. So, going through that all myself at the moment, which has been a good learning experience. But that sort of left my... you know, sort of cleared the goals for the rest of this year and next year. So I actually had a patient yesterday that talking about the Surf Coast Century and, yeah, I'm thinking, oh, could this be 27? Because I've always said it, I've done a 56 but yet to the 100. So, yeah, 27 could be the year. So, yeah. I like this. That sounds good. Just, just quickly on that, you going through your own rehab, as I, as I found with mine, like I'm sure you're taking lessons from it and being able to at least apply or just think a bit differently. Is there anything that stands out so far about your experience going through this, this rehab that you've, yeah. Yeah, there has been. I mean, can honestly say it's been a good experience. Like I actually, know, this is the longest time I've had off running in eight weeks. I think it helped me finishing the race and doing okay in that race to then have, I guess, some closure there. Like I think it probably would have been harder to take had I... you know, had this injury before the race and not being able to do it. So think that did give me some closure. And so, you know, have accepted it quite well. And I think, you know, I had on my podcast, a psychotherapist Freya. And one of the things that she said that runners often struggle with, and I see it too, that it's their identity, it's who they are, it's what they do, and it's the only thing that they see themselves as. But I guess having her on preconditioned me to realize that, yeah, I'm not just a runner. I'm a coach, I'm a health professional, I'm a dad, I'm a husband, know, a friend. So it's given me, it's given me a lot of, yeah, I guess taking a step back and, and realize that no, there's other things going on in in my life. But then even just from a, from a rehab point of view. So I guess, yeah, some of the challenges that you face, some of the things that go through your head, the, the sometimes the, you know, unsure of, of where you're going and, and, you know, what's, what's, what's happen with your body. Am I, am I going to be to run another marathon and that I don't know either with this particular injury unfortunately it's one of those ones that doesn't really heal it just it can stay there and it can settle down and I may not ever have issues with it again or I may not be to run another marathon so there's there's that uncertainty as well too that it goes through it goes through your head so um you know greater appreciation for for the the benefits for cross training as well um that's something that I've I've always used but um
01:15:34
Speaker
I guess just having a personal experience of it as well. It's like, oh yeah, this you know this particular session on the bike or these doing these sort of things, it's a really, you know and I've actually got to enjoy the bike. I used to do triathlons years ago and and um ditch that because it took too long, but I've actually enjoyed the stationary, get short, sharp, 45-minute sessions done and and yeah, I've got to, especially in winter.
01:15:54
Speaker
When it's cold raining outside here and in ah in in in Melbourne, it's been it's been quite so quite nice actually. So yeah, so lots lots of lots of things that i've I've learned along the way and I think that will help make me ah a better runner and and ah and ah help me as ah a health professional and and as a coach as well. Definitely. I think it's it's a very powerful place when you realize that you can want to do something a lot, like you can want to run and reach these goals, but you don't need that.
01:16:18
Speaker
That's not who you are and it doesn't say anything about you if you can or can't do it. That's exactly exactly right. So, yeah, I think that's been ah it's been a good day good good lesson and, and yeah, lots of lots of silver linings to it.
01:16:30
Speaker
Perfect.
Closing Remarks and Call to Action
01:16:31
Speaker
Luke, thank you for your time tonight. I really appreciate it. It's good to catch you up again and hope yeah hopefully everyone listening enjoys it. Good luck on the return and we'll see you at Surf Coast. Yes, thank you, mate. Cheers. Thanks, mate.
01:16:42
Speaker
Wonderful. Thanks again to Luke for coming on to do that second episode. The first episode we recorded, we got about halfway through the questions that we wanted to. And so it was definitely due time to come back on and have a bit of a deeper discussion.
01:16:54
Speaker
If you enjoyed today's episode, the biggest favour you can do for us is leave a rating or review wherever you listen to your podcasts and share this episode with someone who you think would get something out of it. We've all had our injury.
01:17:05
Speaker
journeys. We've all known someone going through injury and maybe some of the other topics in here might resonate with you or with somebody that you run with. And I'd like to take this moment to thank everyone who's listened to the podcast and sharing the episodes with friends. It generally makes such a huge difference and helps us keep bringing these conversations to you guys. So thank you so much.
01:17:23
Speaker
If you've got any questions, topics you'd like us to cover or guests you'd love to hear from, send us a message on Instagram. We read everything and a lot of our episodes come directly from your suggestions. Thanks again for listening. We'll catch you on the next episode of PPSU.