Pros and Cons of Common Running Injury Therapies

Finn Melanson [00:00:13]: Hello, fellow runners. I'm your host, Finn Melanson, and this is the Run to the Top podcast, the podcast dedicated to making you a better runner with each and every episode. We're created and produced by the expert team of coaches at runnersconnect.net, where you can find the best running information on the Internet as well as training plans to fit every runner and every budget. Marika Liu, a physical therapist and founder of Exact Health, joins the show today to talk about the importance of injury prevention protocols for runners and the pros and cons of various therapeutic approaches in cases where you do find yourself injured. Specifically, we talk about the pros and cons of stretching, massage, taping, invasive treatments, and orthotics for therapy, and the overarching importance of injury prevention, and what you can do on a daily basis via running form drills and strength training to minimize risks. Marika, it's great to have you on the Run to the Top podcast. How are you doing today?

Guest [00:01:21]: I'm very well. Thank you. Thank you for having me.

Finn Melanson [00:01:24]: Oh, it's a pleasure to have you here, and there's a lot of topics that I'm very excited to get into. I think for just a a baseline intro to this conversation, curious about what prompted you to get into the world of physical therapy. What was your inspiration, and and what's kept you in it and excited about the profession?

Guest [00:01:44]: I always dread when people ask me this question because most physios started or got into physio because they had a injury or something like that. Now I'll be honest with you. I didn't have a clue what I wanted to study. But I loved sports. I loved being active. And I helped, I liked helping people. So my friend's mother said, why don't you become a physiotherapist? And at that point, I was living in the middle of nowhere in South Africa. So imagine the outback or like a proper desert area.

Guest [00:02:12]: There wasn't a physiotherapist there. There was one doctor for, like, 600 kilometers. So I thought, give it a go. Let's see what this is about. And, to be honest, at the beginning, I thought I was cheated because they all told me it was about sport. And all I had to do was walk old people in the hospital and get people to cough and spit out phlegm. So and then eventually, I got to actually the bits that I enjoyed, which was the sports side and helping people recover from musculoskeletal injuries and stuff like that. And then I found that actually, it suited me so well.

Guest [00:02:48]: And it it was just the perfect thing because because I love being active. It's awful when you can't do things. And I'm not even talking about sports. I'm just talking about being out there and doing things. If it's like walking your dog or something. And there's nothing better than actually helping people to achieve that. Again, you you have to see the joy of people's faces when they could do something simple again when they thought they couldn't do it. So yeah.

Guest [00:03:11]: No. It turned out to be brilliant in

Finn Melanson [00:03:13]: the end. We'll talk about Exact Health later, but this question, I guess, sorta leads to that point. Because you've you've spent some time in the industry, I'm curious to get your take on what you think has evolved the most or where at least part of the state of the art is in terms of knowledge and what PTs might be doing different, you know, in 2024 than they were doing even 5 or 10 years ago. What are your thoughts there?

Guest [00:03:38]: Well, I love the fact that you're very diplomatic when you say I've spent some time in the industry. I've been a physio for nearly 20 years now. So, yes. One of the things of having studied so long ago is that I would say nearly half of the stuff that we were taught is no longer or we now know is actually quite a bit of nonsense. So, we used to think that you could literally heal people with your hands. It's like it was all in touch. You had a magic touch. Turns out the research shows that, yeah, massage makes you feel better, but actually it has nothing to do with healing tissues and all of that.

Guest [00:04:14]: It actually works more on the nervous system and calms things down that way. And what the research now is showing that actually the thing that gets you to heal is not doing things to further aggravate that injury, plus then doing some strengthening or stretching depending on what the type of injury is, of course, to then help stimulate those fibers or whatever is injured to become strong again. And besides those two things, there are a few other things that might help a bit, most of it with pain management, which is useful as well. But there's a lot more you can do wrong by trying to throw too much at it. If you can get your rest bit right, not too much, not too little, plus whatever exercise you need to fix that thing, then you've got

Finn Melanson [00:04:58]: it. I I have to pinpoint something you said earlier there about massage the learning that massage mostly affects the nervous system. To somebody who is, more uneducated about this like myself, when I think nervous system, the stereotype I have in my mind is placebo effect. And so would you say that massage is more like a placebo effect type thing? Or are there real like, can you talk about those real tangible benefits to the nervous system?

Guest [00:05:23]: Absolutely. So, first of all, the nervous system does not equal placebo effect. Your nervous system is if you think about it, our bodies are imagine your body is like a car. It's quite useful except that, you need a driver. And the driver of the car is your brain. Now, everything happens in the brain. And it's funny how we don't we think of the nerves as well, I used to think of a nerve as something that just sends electrical signals and it's a little bit of a mystical thing. But it controls everything in the body, including your immune system even.

Guest [00:05:59]: So, the interesting thing with, people, for instance, who get spinal cord injuries, below the level of the spinal cord injury where the nerves don't function so well, their immune system is suppressed as well. So, it's even in little things like that that we don't normally think about. Now, when we think of a lot of injuries and things like muscle spasm and stuff like that, How much your muscle is contracted is also controlled via certain receptors and the nervous system. And if you can calm those down, and that's where massive massage comes in. It does a really job good job of that. It relaxes the muscle, and you get the spasm to go away. And, also, the same thing for pain. You know when you hit your elbow, the best thing to do is to rub it and you don't feel the pain.

Guest [00:06:44]: And it's literally you're giving it a different sensation and you this the senses that takes the message to the brain about the pain is slower than the ones for the pressure, so you're blocking the pain. Now, what people sometimes think is, well, if it's only going to help pain, then it's not useful. But actually, it is super useful because sometimes pain stops you from doing your rehab. Sometimes pain stops you from sleeping. And we know sleep is important for recovery. To be honest, pain just makes you miserable. So, if you can get rid of some of that pain, you're a nicer person to be around, you can actually sleep and it can get you doing your rehab. And something bizarre also about that is often when you have an injury, especially if you feel the injury is quite bad because it's been there for a long time, your brain can start to amplify that pain.

Guest [00:07:32]: So now the pain feels much, much worse than what it should feel. Or that injury is already better, but your brain still thinks it should make pain because you're still worried about it. And that's when things like massage can help normalize that system and actually get you to feel better.

Finn Melanson [00:07:50]: Wow. Yeah. And this is very top of mind for me right now on a personal level because I just had a race last weekend. It took about 10, 11 hours to complete. I was totally trashed at the end of it. And I'm always because I do a lot of these. So I'm I'm always experimenting with protocols after the fact to see which one kinda expedites recovery the most or at least on some sort of mental level, but leaves me feeling somewhat better and less foggy. And after this latest race, about 24 hours after the fact, I went into a 120 minute massage, followed maybe 6 hours later by, like, a 1 hour assisted static stretching session.

Finn Melanson [00:08:29]: And you could pick those apart as being quack or real, but, like, it was the best I ever felt post race in my life. Like, I'm it's probably overconfidence, but it was I almost felt like I was back to a pre race baseline in in a way. Like, I could have gone and run the next day, like, you know, 10 or 12 kilometers. So just to me, it's amazing. Like, that What you said there about sort of the calming down of the nervous system, permission for your body to function in certain ways again, that really resonated with me.

Guest [00:08:57]: And you know what? To that point, they've tasted so many different things, ice baths, different supplements you can take, and all of that for recovery. And so far, the only thing that stands up to the research that shows that it can help a little bit with your DOMS and everything is massage. So for everything that people say, oh, massage, placebo, whatever, for some reason, it helps the pain from DOMS and we don't actually know why. But also as to that point, now everything we do at Exact is always research driven, but we don't follow blindly just what the research says because to be honest, you can't do that. If you look at the research studies out there, they are never you can't use those results in the general population. That was quite specific. And if we think of just stretching, for instance, you know, a while ago, everybody kind of said, oh, stretching is a waste of time. It doesn't prevent injuries.

Guest [00:09:58]: And I sat there thinking, wait a second, where are you getting this data from? Because I can tell you that I've seen patients in my clinic where the only thing that was causing the injury was that they were just overly tight. But then I've seen others where it's not been a problem. And then when you look at that research, you go, ah, okay. So there this research said that, yes, under these circumstances, routine stretching didn't actually help, with injury prevention. But there's no ifs and buts to it. You know? It's very generic. There's no any physio will tell you that, yes, of course, not everybody in the population will respond the same way to X, Y, or Z. We are all different.

Guest [00:10:42]: So if you take, for instance, I am really, really flexible. My other half is the most inflexible person you will ever meet. That's me.

Finn Melanson [00:10:49]: Now Yeah. So I'm also super inflexible.

Guest [00:10:51]: So I don't know if you if you also find that for you, stretching is the most important part in your injury prevention. But, for me, strength training is. He does like a strength training exercise once every 3 months or something. But if he doesn't stretch, then he runs into trouble. Whereas I'm always flexible. I don't need to stretch. So it's it's about figuring out your own body really to an extent.

Finn Melanson [00:11:18]: Wanna talk a bit about Exact Health. And, you know, I think the over and you can take this wherever you want, but the overarching question I have is, you know, we have all of these ways to treat injuries, and here you've created an app that can be used to treat injuries. Talk about how that works. I have to imagine, to some extent, there is onus that is put on the patient, the the client, the person using the system to maybe do a bit more than they would in, like, a 1 on 1 relationship, like, in an office?

Guest [00:11:47]: Yes. But that's also where the magic lies to an extent. So quick recap on how the app came about. So I started a online physiotherapy practice in 2014 before people knew that it could be done. And to be honest, I wasn't sure either. But I realized that rehab is something you can do via video call. Fast forward a few years, COVID hits, and suddenly the whole world is online. Now, the way that I used to give my clients was I made videos on YouTube, still make videos on YouTube.

Guest [00:12:17]: You'll see me shorten nonsense there all the time. And the thing with that is one of your hideous videos will hit, say, for instance, calf strains and all of a sudden, every second patient you see is calf strain. And then I realized that, you know what, this is not rocket science. Again, we as physios like to think we've got a 6th sense when a patient walks in that door. That's nonsense. We're using algorithms in our head the whole time of, if they says yes to this, it's that. If you do this, then let's test this. You know, there's there's an if and but thing going on there.

Guest [00:12:48]: I realized that you can code this. You can literally put that algorithm of physio users into an app. And then the key point is that the patient needs to give feedback. So if you do an exercise or movement, you need to be able to say that, yeah, it was absolutely fine or no, actually, I felt more discomfort than this or it was this much effort. Yeah. And then the exercises has to be adapted according to that. And that's actually possible in app. So this is this is how the programs work.

Guest [00:13:16]: They are always set to start at the easiest level because that's a safe place to start testing. And that's kind of where we as a physio, when you walk in the door, we kind of look at you already and go, right, this guy needs to start at 0 or this guy looks rather fit. You can do a bit more so, yeah, we can start a bit higher. And then depending on the feedback, it adjusts the exercises until the person gets to the level we know you need to be able to run again.

Finn Melanson [00:13:42]: Yeah. Cool. And you've found that is this also preferential for for patients? Like, do they appreciate sort of the conveniences that are built in or talk about the trade offs there?

Guest [00:13:53]: Yeah. So some there there are definite trade offs. It's not for everybody. You need to be able to kind of want to do things on your own and you need to not need somebody to hold your hand. So although I've tried to again, being old really helps because I've heard nearly every single thing that worries somebody. And I've also had injuries myself. So, I know what worries you. So, we've tried to address those fears and those questions in articles and things in the app as well.

Guest [00:14:25]: But the nice thing about this is you don't have a specific time that you have to attend the physio. You can do it in your own time. You literally have control over know, how many repetitions and things you do. There's nobody shouting at you. The guideline is there for, this is what we're working towards, but you only do this and this and this if this and this and this works. So you always know kind of where you're going with that. So and I find that a lot of people, especially runners, actually do like to do their own thing. I mean, how many times do you take a training program and you start with it, but then you find that, my body doesn't actually respond to it exactly like this.

Guest [00:15:01]: I don't know who designed this program. Was it Darwin or somebody? And you've gotta adapt it. You know? And the app allows you that, which suits quite a lot of people then as well.

Finn Melanson [00:15:11]: Yeah. And one of the one of the biggest value propositions as I'm, you know, listening to you potentially is for people that don't have immediate access to great physios, PTs in their area. Like, I've I currently live in Salt Lake City, Utah, you know, Olympic City, a lot of I mean, every, like, square mile, there's probably, like, 10 to 1 physio to patient ratio. But I I do like, I can imagine rural parts of the country where, you know, not as thickly settled, you know, there's just not as many health care options, this would be amazing because you can kind of digitally reproduce that expertise and just port it right over the Internet. And that that is really cool to me.

Guest [00:15:53]: It is. And it's also that thing of now you get injured over the weekend and you don't know what to do. And it's often what you do in the 1st 3 to 5 days that can really either prolong your recovery or make it shorter. So it's a it's a nice resource also that you can start with something immediately if you have to even just wait to see a physio.

Finn Melanson [00:16:16]: Coming back to, you know, what we were talking about earlier with, like, massage, for example, I was just kinda perusing the website and looking at some of the topics on the blog. And one of the interesting ones that I'd love to talk about here, therapy approaches and the pros and cons of each. So, like, you've talked about stretching. We We talked about massage a moment ago, orthotics, invasive options, strength exercises. Maybe starting with stretching, like, where do where do you stand in terms of the pros and cons there and why?

Guest [00:16:46]: Okay. So I will probably get a lot of people shouting at me for whatever I say about stretching. So I'm just gonna put it out there. The first thing with all of these approaches, doesn't matter what we're talking about, is to remember that every single person's body is different. Now we're not just talking about shapes of bones or size or weight. We're talking about how flexible or supportive your ligaments are, how flexible or strong your, your muscles are. We're talking about things like whether you've had a baby or not, what age you are because you react super differently to things when you're in your twenties versus in your forties. Ask me.

Guest [00:17:25]: That hit me like a plank in my face because I didn't think I was gonna hit 40 ever. So it's about understanding that not all approaches works for everybody, but some people definitely benefit from some. So stretching wise, I would say, there's a minimum amount of flexibility that everybody needs to do their sports. Now for running, obviously, it's the leg muscles and everything that works the hardest, and that's going to be the bits that hit fight. But what you want to think about as a runner as well is what do you actually do for the other hours in your day? So say for instance, you're sitting in front of a laptop the whole day long, you're going to have tight hip flexors, you may even have a tight back. Depending on what job you do, you could have a tight upper back. So don't just focus on 5 or 6 muscles in your legs, Look at your whole body. How does that move? Do you get good movement through that? Because that can all just help to get you into a better movement pattern.

Guest [00:18:23]: But then with the stretching, you can either use it as part of your warm up, which is always a good idea, especially if you've sat down and kind of go into active stretches and stuff. But you could also use it like you did for relaxation and just getting things mobile again. But then it's really important to also follow that up with strength training at some point in your week. You actually get the control through those ranges of motion that you don't just go for how flexible I can be, but that you actually have control through that range as well to move well.

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Guest [00:21:27]: No. I'm not.

Finn Melanson [00:21:28]: They're they're based here in the US. Like, I have one right down the street from me in Salt Lake City. Like, basically, you you'll go there for 50 minutes and the you'll just sit on a table, and they will assist you through all of the various static stretches that you might wanna do for a particular area of your body. Like, if you have, like, tight TFLs or hip flexors that are overactive, like, they'll bring you through all those, movements, try to increase range of motion. Is that something that you would recommend? Like, this so static stretching might have a place for some people, or does it have to be dynamic?

Guest [00:22:00]: Oh, no. Absolutely. Static stretching definitely has a place. I mean, that is, again, one of the myths that it drives me nuts when people just say static stretching is bad for you. Everything is bad for you if you overdo it. So, it's all again about how you do it. So, yes, definitely you can get injured with static stretching. So, if you overstretch, 2 2 of the typical injuries you can get, 3 actually, is 1 insertional Achilles tendinitis or tendinopathy where you overstretch calf stretches.

Guest [00:22:29]: That's a common one. And typically, somebody will tell me that, I was trying to improve my squat form. So, I sat in a deep squat position for like 20 minutes in one go. Like, yeah. Come here. I'm impressed that just the Achilles got injured. The other one that is quite commonly injured with over stretching is the higher hamstring tendon, where it attaches to your sit bone. That's typically when people do long stretches to improve yoga.

Guest [00:22:55]: You see that often. And then the third one is the gluteal tendons, but that's more in females over the age of 40 who's also in the menopause because their tendons a little bit more prone to getting injured with that. So with static stretching, the research shows that it is actually better than dynamic stretching to get you to have better range of motion. But, obviously, we all know the bit about if you hold it for too long just before you exercise, then it can switch muscles off. But at that same point, there's research to show that if you hold it for 30 seconds even, but you follow that up with more dynamic movements, it does absolutely nothing to your performance. It's absolutely fine. So it's about being sensible about how you do it and when you do it.

Finn Melanson [00:23:39]: How about taping?

Guest [00:23:44]: So taping is an interesting one because I have found it work on myself, and I hate the fact that I may be prone to placebo. And when I think of how well it worked in those circumstances, it could only have been placebo. So taping is an interesting one. So, if we think of the Kinesio tape type things, that is not rigid enough to protect you against anything. It doesn't stop forces or anything. So if somebody tells you, oh, I tape up my Achilles to protect it, Or if I run behind somebody where both calves and Achilles tendons are taped, I just feel like doing putting my hands to my head because there's no ways that Kinesio Tape is going to protect you in those areas. What it can do is it makes you more aware of the area, so it may make you have better form. So I think that's what happened with me because I was having trouble with my the post tendons, which for me, a big problem is I over pronate.

Guest [00:24:42]: And I think just having the tape there, whenever I felt the pull, I just stopped myself. So I would

Finn Melanson [00:24:46]: go, oh, no.

Guest [00:24:47]: Don't don't go all the way in there. Don't go all the way in there. So it acted and it was literally within 2 runs that I managed to get over it. Well, I should say that wasn't my full rehab. That was my final bit that I was struggling with was getting back to the running bit, and the tape was a bit that helped me with that. It can also help with pain relief. Again, it just gives a different sensation to support everything. If you are going to use the rigid tape and you tape up really hard like they do with rugby players and football players, yes, that can give support, but I don't think you can run very far in that, to be honest.

Guest [00:25:22]: And if you need that much tape as a runner, you actually need to be doing your rehab rather.

Finn Melanson [00:25:27]: I think that that body awareness, body reminder benefit is really interesting. Could that could that even go as far as helping improve your form if you're looking to maintain a certain type of gait?

Guest [00:25:39]: That is not my specialty, but I'm pretty sure there's gonna be Kinesio whatever they're gonna call themselves with Kinesio something in their in their title, somebody who specializes in movement. There's too many names for them. And they will tell you that they've got techniques to do that. I definitely think there is a place for it with regards to those things. And I definitely think that with tape, it's always something that I would say try because it costs you nearly nothing and it's not dangerous. As long as you know that it's not something you should do instead of being sensible with your training and instead of your rehab. And if it decreases your pain by at least 50%, then I would use it. Why not? It makes you more comfortable.

Finn Melanson [00:26:24]: Does do things like acupuncture and dry needling and, like, the electric stimulation from that, does that fall into the category of invasive treatments?

Guest [00:26:35]: It depends on who you'd speak to. People who don't like needles, definitely. Others don't really see it that way. I would say it probably goes under invasive treatment, but it doesn't really have this any of the same side effects as, injections does, for instance, because you're not injecting a substance. And the thing with dry needling and acupuncture is that, again, we're not entirely sure how it works, but there is evidence that it can also work on the pain systems and the neurosystem. And they think that it's because you're putting metal into a system that's essentially water.

Finn Melanson [00:27:13]: So we're changing the, electric Ion balance? Yeah.

Guest [00:27:18]: That's the word. And that's why you get the reaction sis I don't know if you've had it in the past and you sometimes get, like, a muscle twitch.

Finn Melanson [00:27:27]: Yeah. I'd so, actually, for the first time in my life last night because I've been I've been throwing, like, the kitchen sink at all these recovery things. I did dry needling with e stim last night, and it was crazy. I don't I think I feel better. I don't know. But it I don't feel worse.

Guest [00:27:43]: What part of your body did you have it on?

Finn Melanson [00:27:46]: Both TFLs and, both glute muscles.

Guest [00:27:50]: Okay. Yeah. That is interesting when you have it in there.

Finn Melanson [00:27:53]: It was it was wild.

Guest [00:27:55]: Yeah. Yeah. Yeah. Yeah. When when an endurance runner tells you it was wild, it means it was super painful. So again, I did a lot of that. When did I stop? I switched to working just online 2019. Up until that, the 10 years before that I used a lot of dryneeding.

Guest [00:28:20]: I will say it works for certain things. It doesn't work for other things. So where I found that it worked the best was if the issue was either down to muscle spasm, that was the main reason for the discomfort, or, it was a long chronic pain thing. And often in those cases, it was as if it was magic with the chronic pain stuff. And it was as if a switch was switched off and the person suddenly had functioned back, which didn't make any medical sense. So for instance, I remember a guy who I treated him after my colleague treated him a week before. And when I looked at the notes my colleague wrote, I thought, I wonder if he was a bit tired and confused patient because there's no ways that this guy can be the guy that he wrote about because the guy he wrote about couldn't lift his foot up, had looked like he had nerve damage. So I just carefully asked the patient about, how was it last week? What could you do? It turns out, no, the notes were correct.

Guest [00:29:22]: According to him, after the dry needling and things was done, by the time he walked out the door, that could move. And you know what? If that was the only person that I'd seen that with, I would have thought that it was totally in his head. That's that's not possible. But I've I've literally seen people gain range of motion, which I thought, well, there's so much pain here. He can't move. It must be torn. And it turns out that, no, it was just muscle spasm stopping the movement. But the times that I found that it didn't work is when there was a proper acute injury.

Guest [00:29:55]: It's not magic in the sense if you've got something torn, it's not going to fix a tear within the treatment. If that makes sense. But if it's muscle spasm and pain stopping movement and nothing torn or properly injured, then it can make a big, big difference.

Finn Melanson [00:30:11]: Maybe the the last one in here. Obviously, I I have to imagine it is always sort of a last resort option, but, like, performing surgery, for example, on, like, a like a labrum muscle or doing something arthroscopic for the knee or, you know, if you have to do something crazy like an ankle fusion or like I mean, I have a family member that just did a total ankle replacement, which is wild. Yes. Are are you always advising with surgery, like, that is an absolute last resort? Like, outcomes from that are maybe uneven, so we don't advise going that route.

Guest [00:30:44]: It really, really depends on what it is, how it's impacting people. So, again, I will probably there are times I advise against it. There's times that I kind of go, why are you being so silly? Just go for it. So what I will say is that on the whole, with sports injuries like running injuries, we tend to be very impatient. And I blame the medical profession for that because we don't teach people how long it takes the body to heal. Like for instance, if you have a muscle tear, the quickest that it's gonna get you back to running, if it's a minor, minor muscle tear, it's gonna be 4 weeks. If you've done a proper job and you've properly torn your calf muscle, it's going to be at least 12 weeks, which is 3 months before you can start running. So that's a long time.

Guest [00:31:34]: And I always tell people to mark that on your calendar. Now, if we think of knee injuries, knee injuries, especially if it's like meniscus or things like that, it's cartilage. It's gonna take a lot longer because cartilage takes so much longer than muscle tissue to regenerate. So you have to give yourself at least 12 months of being sensible. Now that time that you try to ignore it and run on it and just make it worse and worse doesn't count as part of the 12 months. The 12 months starts at that point where you've gone, okay, fine. I'm accepting accepting that I'm injured, and I'm going to be sensible and switch to cycling or swimming and just be careful with the rehab and start building it up. Now, if you've done the sensible thing and you should really try to offload and not try to push things and it's not making progress, then absolutely.

Guest [00:32:21]: But I will always go for injections first, see a very good sports doctor first, sports medicine doctor because they are brilliant. They don't do surgery, and they know the latest injections and stuff. So they usually have a few more tricks up their sleeves that work. And then I would go for surgery if that's the option. The times that it drives me nuts that people don't want to go for surgery is typically in the older population again. So they're in their fifties, in their sixties, and they have a knee or a hip that stops them from being active. So now they are just walking, but they the doctor said that, no, I'm not replacing it now because then it will wear out more quickly. But you can't do what you want to be doing.

Guest [00:33:07]: So what do you want to do now? Sit around and mope for the next 10 years and then get heart disease or something because you can't be active? Or rather have that joint replacement and enjoy your next 10, 15 years and actually have a healthy life? So it's about kind of weighing up the different bits to it. And like, for instance, the ankle replacement. I really hope I never need one because they do scare me.

Finn Melanson [00:33:33]: But I have to keep

Guest [00:33:35]: it up.

Finn Melanson [00:33:35]: Yeah. I don't think I don't think it was a great outcome either. So I I think you're correct.

Guest [00:33:39]: Yeah. Well, and what I will say with those is you've got to give yourself mentally 2 to 3 years afterwards for your whole recovery time because that's how long it can take. So that's the other thing with surgery is it's not a quick fix. And you're going to have to put in a lot of work afterwards, depending on the type of surgery to get you back to to where you wanna be.

Finn Melanson [00:34:01]: Well, I think this is the perfect segue into the last topic I wanna discuss with you which is, building a protocol into your running lifestyle where prevention is key, and it's kind of always at the forefront. And hopefully, these these therapies are, not you don't need to frequently resort to them. When you think about, like, running form mistakes, preventing overuse injuries in the 1st place, strength training, maybe starting with running form mistakes, like, what do you see as something that this audience could implement, you know, immediately into their, like, day to day routine to make sure that, like, their movement patterns are correct and sustainable?

Guest [00:34:43]: So I think the first thing is to actually become aware of what you do when you run. Just take time to feel where is my body moving? Because it's often the case that you don't actually need somebody to do a fancy test or observe you running or anything at even. You can feel if something is twisting in quite a lot. Or if you can't feel that, get somebody to film you and then give you feedback on it and but then feel for yourself what you feel while you're doing it. Now with regards to running form, again, we know that there's nothing like a perfect running form, and we tend to choose the running style that takes the least energy for us. The only thing that really stands out in the research for increasing your risk of injury is if you heavily overstride. Now overstride is if you make contact with your heel first quite far out in front of your body. What happens when you do that? It's like a little bit of a breaking force with each step you give.

Guest [00:35:50]: So that ends up in more internal rotation of the hip. For some people, it makes the hip drop more. For others, it causes things to cross over more. So Yeah. By fixing that one factor of not over striding, you can actually then address all the other things that's been implicated in injury. And I don't know what you do to prevent that type of thing. But for me, what works best is I think about really just instead of trying to place my foot in a certain position, I just think of, can I make contact as close as possible under underneath myself? That I I don't think about what part of my foot I put down, but I rather think about, can I put it down nearly underneath myself while I run? And I I think about pulling my heel up to my bum more. I don't know.

Guest [00:36:34]: What do you find with your running stuff?

Finn Melanson [00:36:36]: Yeah. All of those things. And I also just find, like, if I really think about increasing cadence too, that helps a ton. That goes a long way. Like, those all of all of those things that you just mentioned kinda fall under the umbrella to me of, like, just, like, more steps.

Guest [00:36:53]: So here's a question to you now. I'm not very fit, but I've I've never been a fast runner. What do you think is the perfect cadence for people, and how do you go about increasing the cadence without dying on the spot?

Finn Melanson [00:37:08]: Well, I'll tell you. So I I am, talking the talk, but not necessarily walking the walk. So I have a I don't have a good cadence. My cadence is, like, 160. And I and I and I also manage to

Guest [00:37:20]: That is good as well.

Finn Melanson [00:37:22]: On my 4 and I somehow I I I have, like, a baseball, basketball, football background, so I still manage to land on my 4 foot too. Like, I'm over striding but still it almost becomes like a I jump almost when I'm running. And so there's like a bounce to it. So I'm at, like, 160. I to me, getting to 180 would be a huge win. Like, when I'm running with people who buy into that philosophy and I'm kind of pattern matching or I'm just kinda copying what they're doing, I will find that on those runs. Like, for me, the answer is running with people that have high cadences. I I tend to kinda get into their flow.

Guest [00:37:56]: Yeah. Yeah. Yeah. That is so interesting. So mine is also 160. That's why I'm like, what? How can you run so well in your 160? Okay. Only difference is I have no bounce. So Well, I think I'm

Finn Melanson [00:38:08]: paying for it. I mean, I I I have, like, overactive hip flexors. I think my hips have taken a beating. I think one of the reasons why my hips have taken such a beating in the last 5 to 6 years is because of my stride.

Guest [00:38:17]: That would absolutely make, make sense because to overstride plus be able to land on your forefront, you must be doing something amazing and you're, you know, higher up in the legs.

Finn Melanson [00:38:27]: Yeah. And my quads are, like I've I've done some tests and, like, my quads not only are my glutes inactive, but, like, my quads are inactive too. So there's just, like, my my hips are doing a lot.

Guest [00:38:37]: Yeah. Yeah. Yeah. Oh, that's interesting. But yeah. So over striding is definitely the one thing that I would say makes a big difference to people.

Finn Melanson [00:38:48]: How about, strength training? Because I I I've talked to some, like, coaches who are like, I don't see a place for it, but then there's this whole revolution happening where people do see a place for it and, you know, running is a punishing activity. Right? So if you can build resilience, there's a use case. Where where do you stand?

Guest [00:39:04]: So, yes. Again, it's an interesting one. So I think this I am leaning towards, again, like with the stretching, not necessarily everybody needs it, and you've gotta be careful when you put it in. But more people likely benefits from it than not. So here's the thing with it. If you are somebody who is habitually strong through everything you do in your day. So, you've always been active. You've not had long breaks, like for instance, that you weren't active and you've stayed fit through all and you do things that gives you good overall strength, I don't think you necessarily need to go and lift things in the gym.

Guest [00:39:48]: If you are somebody who sits all day long and you just intermittently go out for a run here and now, I think you can really benefit from, strength training because it's gonna give you coordination, it's gonna give you support, it's gonna give you balance as well, and it's gonna help your range of motion. The research is quite clear that one of the best ways to prevent overuse injuries especially is through strength training. So that is one aspect that has been tested quite a lot there. Now, there are 2 things that I want to highlight about that. The first is that typically people start looking for strength training plan when they're halfway through their marathon training because they start feeling niggles come on and they go, oh, I should be strength training. And then they add strength training into the marathon plan. And that is a massive mistake because the first of all, the reason you're likely getting niggles in your marathon training is because your body's struggling to cope. It's already overworked.

Guest [00:40:43]: So if you're going to add strength training on top of that, that is a recipe for disaster. If you start to feel niggles in your marathon plan, you actually need to take the the foot off the pedal and try some active recovery that you can find alternative ways to stay fit while your body recovers. And that's where it's really useful to speak to a physio because they can help you figure that out. So with strength training, it's also important to kind of have a pattern throughout the year that there's parts of the year where you're not gonna increase your running as much as other parts of the year. And that's when you can really build proper strength in your body. And the running should just be kind of a ticking over job there. You can you can get some distance in, some easy miles in, but you're not pushing yourself to the limit with the strength, with the running. But then as your running volume increases or your running intensity increases, you have to bring your strength training down and it has to become like a maintenance dose or something like that.

Guest [00:41:40]: It can even just be moves you do as part of your warm up at that point. Yeah. Because if it's gonna be high on both levels, you're just gonna end up with overuse injury.

Finn Melanson [00:41:51]: Well, Marika, this has been an awesome conversation. I have personally selfishly learned a ton, but I hope that the audience has too. This has been great. We'll make sure to link to Exact Health in the show notes. I think it's a great resource. Are there any final thoughts or calls to action that you have for listeners before we go?

Guest [00:42:12]: I think the most important thing that has helped me through the years is to understand that nobody's running plan or strength training plan or exercise plan is necessarily ever going to be 100% right for you. And this is for anything, even if your physio gives you something, You need to listen to your body. And if you learn to listen to your body and react in time, you can avoid most injuries. So, we're pretty much in marathon season now. If you're starting to feel niggles, don't feel that you have to do your training as per your plan. Just pull back, give yourself some permission to rest and recover actively, do something else, and then get back to your training. So if you adapt your plan, you'll have a better chance at staying injury free than if you try to follow things and feel that this is what you should be doing.

Finn Melanson [00:43:18]: Thanks for listening the Run to the Top podcast. I'm your host, Finn Melanson. As always, our mission here is to help you become a better runner with every episode. Please consider connecting with me on Instagram at wasatchfin and the rest of our team at runners connect. Also consider supporting our show for free with a rating on the giveaways, you can subscribe to our newsletter by going to runnersconnect.netbackslashpodcast. Until next time. Happy trading.