Evidence-based Ways to Stay Healthy as a Runner with Chiropractor Chantelle Maryuen

Guest [00:00:01]: Runners are quite big optimists for the most part. Right? And they're they're very motivated people. So a lot of the time, it's it's bringing them back to reality sometimes and telling them, k. You might need to cross train for a little bit before you load this in that way again. And that's a big piece of our job as clinicians. It's not just treating. It's, k, how am I gonna coach this person without making them feel like I'm putting a full stop to whatever we're doing here?

Cory Nagler [00:00:28]: It's the worst feeling as a runner getting injured. I would do just about anything to avoid the FOMO that comes from being sidelined, while you get to watch all your running friends set new PBs or going on fun social runs. It can be tricky though to know what prevention and treatment strategies actually work to keep you healthy. I'm lucky to have some really good care from Chantelle, the chiropractor reliant to keep me running pain free, who also just happens to be the guest on today's show. She works out of a Toronto clinic called the Runner's Academy, and I commute over an hour each way there to get advice that I know I can trust. Today, I'll ask Chantal about research based strategies for injury prevention and treatment, so that you don't need to leave your health to chance. We chat about how you can utilize chiropractors and physiotherapists to help with staying healthy, as well as discussing which prehab and rehab approaches are actually backed by science. There's nobody I trust more than Chantal to give good advice, so I'm really excited to share that advice with you.

Cory Nagler [00:01:32]: Hello, runners, and welcome to the Run to the Top podcast, where our goal is making you a better runner with each and every episode. I'm your showrunner, Corey Nagler. And I'm not an elite runner. But together, we'll explore new strategies and topics to take your running to the next level. This podcast is 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. Feels a little bit weird to not be having this conversation in the clinic, but, Chantelle, it is great to have you here for this conversation.

Guest [00:02:08]: Thanks for having me.

Cory Nagler [00:02:10]: Absolutely. Yeah. And this idea first got started when I saw a message from our editor on the podcast, Jeremy, who was talking about just how hard it is to know which treatment options are evidence based. So is that something you find a lot that your clients struggle to know which treatment options work?

Guest [00:02:26]: Oh, for sure. Especially with the rise in TikTok and social media in general and doctor Google. Right? You get a lot of different interpretations of what's what should be done, what shouldn't be done, from a treatment standpoint. And so everyone becomes, becomes their own doctor for a little bit until they realize something may or may not work, and then I find them in the clinic.

Cory Nagler [00:02:46]: We could open a whole can of worms and do an episode on TikTok running advice, but is there something that jumps to mind as you say that?

Guest [00:02:53]: Yep. Yep. Well, I mean, a lot of people come in asking about cadence. That's a huge, huge piece. I mean, even today, I've. And I did a run gait analysis today in the clinic, and they were telling me how they struggled about cadence, and they're in their head. They didn't know what was right and what was wrong because they read on Reddit versus versus TikTok. Like, there's 180, but then it differs based on females to male, stride length, height, gender in general.

Guest [00:03:22]: Right? So, I mean, the answer to that is there isn't really a huge answer around that because even in elite level athletes, cadence differs dramatically. So we try not to get people to focus or hyperfocus on cadence too much. That is unless they're injured and, you know, that's the only thing that's shown in the research is that, you know, if you have a a you know, if you can increase your cadence, then you can decrease the breaking forces that might be adding to injury. And that's the only time we discuss it. But, otherwise, it's not a major talking piece.

Cory Nagler [00:03:53]: Yeah. I think that's reassuring that there's a little wiggle room there, and I think it's it's not just TikTok. I think too even just looking at, like, your Garmin or the feedback can be easy to get fixated on that that one eighty number.

Guest [00:04:04]: Yeah. For sure. A 100%. Your your your Garmin device becomes your the coach in your head. Right? So it's easy to get fixated on little little data points like that.

Cory Nagler [00:04:14]: Alright. Well, if we've established that TikTok or Garmin are not the ideal points of advice for treatment options, I think it would be great to unpack a little what it is you actually do. So you're a chiropractor with the Runners Academy Clinic. Do you wanna maybe wanna tell us a little bit more about what that means?

Guest [00:04:30]: Yeah. For sure. So, Yeah. I'm a chiropractor. I work out of the Runners Academy. As Corey said. The Runners Academy has 2 locations, 1 in Hamilton and 1 in Toronto. I understand you mentioned there might be a US audience in this podcast.

Guest [00:04:46]: So I'm in Ontario, Canada. Hamilton and Toronto, Ontario, Canada. And as a chiropractor, I mean, we're we're primary care practitioners, meaning you can you can visit us, you know, off the street. You don't see your medical doctors. You get referred to see us. And we specialize in diagnosis evaluation of musculoskeletal issues, conditions, and any issues with the nervous system as well. A lot of people know us as adjusters or, quote, unquote, you know, crackers of the spine, but that's not necessarily the only thing we do. We do a lot of different modalities.

Guest [00:05:20]: We have a lot of tools in our toolbox. A lot of the time, especially at our clinic, we're very similar to, physiotherapists on staff. The only major differentiating feature is we are in school for 2 years longer than physiotherapists at least in Canada. So we're in school for 4 years. Physiotherapists are in school for 2 years. And we do learn x-ray reading and can refer out to x rays, in Ontario. So if that's a piece of the puzzle that we need to figure out, we can send you directly, for that. So there's also that piece as well.

Cory Nagler [00:05:49]: Yeah. I actually didn't know that piece about chiropractors having to go through those extra 2 years. Does that mean as a chiropractor, do you offer all the services of a physiotherapist, or is there any other differentiation?

Guest [00:06:03]: Well, they're I mean, we're all very similar people now. I mean, at at one point, physiotherapist couldn't adjust either, and now they can. There's something called NEFCAM certification that they can do, from what I understand, and then they can also adjust as well. So there's so many things that we both do. It's a very big gray area now in terms of what we can or can't do. So a lot of time when people ask me at the clinic, it's we're very similar people. If you have a preference for, adjustment, something that you've experienced in the past, something that might be helpful for you of the spine or extremities, we can definitely help you with that as a chiropractor. And then as well if there's, like, an X-ray reading component that might be helpful in differentiating pieces of a condition, then we can also do that too.

Guest [00:06:47]: But, otherwise, we're we're very similar people.

Cory Nagler [00:06:50]: Chantelle, I just wanna unpack a little what you mean by adjustments because after numerous sessions of going to the clinic, I can say that I always feel better after I go in, but we're not talking about a light massage that feels good here. So what does adjustment actually mean?

Guest [00:07:04]: So adjustment would mean, more of a thrust component in terms of what we would target for, joint mobilization. Joint mobilization or movement of a joint can be anywhere from, like, a rhythmic mobilization, which is more what we do actually in the clinic, Corey, or it can be, holding a joint at end range and applying a small thrust at the end. And sometimes you can hear, like, a cavitation or a cracking sound, quote, unquote, with that. And I do tell people it's not, you know, your bones breaking or anything scary like that. When they do hear something like that, it's just the joint creating a gapping moment and a small air bubble forming in the in the joint and then it dissolving into the fluid. So it doesn't mean anything in terms of, something scary per se. It just allows the joint to move better after, and you can do that, like I said, through joint mobilizations or through adjusting. So they both they both kind of are the same.

Cory Nagler [00:07:56]: Yeah. I'm always amazed how, the adjustments can be so painful and yet somehow still make you feel better afterwards.

Guest [00:08:04]: Yes. Ideally, we don't want them to be painful. Sometimes sometimes they can be depending on how acute the area is or or how or how tender the surrounding structures are. But usually, when you get a joint to move a lot better afterwards, you get a lot of relief, which is why some people come in wanting to hear that cracking sound. Right? Because they're so used to that being equivalent to lack of pain they feel afterwards, but that's not necessarily the case.

Cory Nagler [00:08:28]: Right. Okay. So cracking is something that you may have as a byproduct, but not necessarily something that you have to look for. Is that fair?

Guest [00:08:35]: Exactly. Yeah. And a lot of research to date to date on, spinal manipulation or extremity adjusting, the cracking sound can be a byproduct. Yes. It's that air bubble formation in the joint, but, yes, you don't have to hear it to get a successful result out of it.

Cory Nagler [00:08:50]: Very cool. Okay. And I I'm sure you have a variety of athletes coming into the clinic. Are there any particular injuries, especially from runners, that you tend to see a lot of?

Guest [00:08:59]: Oh, we see so many injuries. Obviously, like, we we probably see, like, probably 85 to 90% runners. So we do get a lot of lower extremity injuries, meaning from, like, pretty much low back down. I was thinking about that that question, and then I was wondering what's the most significant amount of injuries that I've seen? Maybe I'll think about the past week. And I think medial tibial stress syndrome or shin splints is one of the biggest ones as well as plantar fasciitis as of late. And, I mean, there's a lot of reasons for it, but definitely those injuries, as well, we see a lot of bone stress injuries walk into the clinic. And then when it comes to bone stress injuries as a whole can of worms that are opened up in terms of how did this happen. Right? Are we thinking potentially reds? Right? Relative energy deficiency in sport or, any other biomechanical issues that could have caused that to happen.

Guest [00:09:54]: So there's those two things that are major, but, otherwise, anything from the low back down, we see a lot of, a telophoral pain as well, tendinopathies, you name it, soft tissue, acute soft tissue injuries, strains, strains, sprains, and anything you can think of.

Cory Nagler [00:10:13]: So you throw out a lot of injuries there, and, I think many probably that I've dealt with myself and many that I have known other people who've dealt with. But I'm sure there's some overlap here in terms of those underlying causes. So you mentioned red s, underlying deficiencies in nutrition. You mentioned potentially biomechanical or form. Are there any other major contributors that might, you know, have overlap between some of these different injuries you mentioned?

Guest [00:10:40]: Oh, man. I mean, there's so much. Like, sometimes yeah. Like like you mentioned, gait form can be a a piece of the puzzle, whether you're creating an overload incident at a joint because of how you're landing and managing the forces of running. But those are, like, the major the major things. I mean, there's also well, actually, there's one more. There's load adaptation. Like, so, is there potential overtraining here? Right? Are you doing a little too much too soon? And most coaching circles, you kind of say, oh, there's a 10% rule.

Guest [00:11:10]: You shouldn't do more than 10% of the total load over a 2 week window, which isn't necessarily evidence based, but that's just kind of all coaches do this just in case. And then you and you get people who come off the couch and they wanna run a marathon tomorrow. Right? And so you do have cases where someone comes in with a stress injury and they've started upping their mileage to, you know, a 100% of what they were doing the previous week. Right? So, that's when the injuries injuries come out.

Cory Nagler [00:11:37]: Yeah. So maybe just to use a use case, I'll kind of call myself out because I think, think, since we started working together, I've probably come in on numerous occasions for IT band issues. So using that as an example, before even dealing with an issue, what are some of the things runners should be thinking about to prevent, encountering such an injury?

Guest [00:11:58]: Well, ideally, you should have some kind of strengthening program, and that that's huge with distance athletes. Right? Half the time you ask a person, do you have a strength program that you're involved with or you're following, and that's not really a thing. And, I mean, I don't blame them partly because mileage is high and time is high when you're putting in more mileage in your schedule. So why add more time for strength training? Right? So often strength capacity is a huge a huge, risk factor because you don't, you know, strengthen anything. Right? You're just running on it. And so as a result, you can get an overload injury from that. In addition to some kind of strength program, some mobility program of sorts would be helpful if you're particularly rigid in sore in joints that are in question that are causing the injury in the first place as well. It really depends on how you present, but strength is huge.

Guest [00:12:50]: It's one of the biggest things that we find no one does enough of in the clinic.

Cory Nagler [00:12:54]: Yeah. I think probably myself included, and I've become much better the last year or 2 at including that. But it is hard when you're putting in so much mileage to find time to get in the strength work as well.

Guest [00:13:04]: It is. And also with triathletes, like, a lot of a lot of people have walked in doing triathlon training, and you're fitting in 3 different sports in your schedule. They have families. They have kids, and they're like, I don't have time for strength, which is fair, but it's still something that should be, you know, taken into account. In which case, it's a it's a, how can we help you get this into your schedule if we gave you, let's say, top three exercises. Right? So that's a kind of motivational interviewing perspective from that point onward. But but, yes, to answer your original question, yes, strength is huge when it comes to reducing your injury risk. Yeah.

Cory Nagler [00:13:40]: And I like the top three exercises because I think that's one of the first things I always ask at the end of one of our sessions is always like, what are the exercises I focus on? If I have very little time in, like, 5 minutes, what should come at the top of the list?

Guest [00:13:53]: Yes. Exactly. And that's, like, a question I've I've begun to ask a lot more in, like, the beginning stages of visiting, or, sorry, someone visiting the clinic. And I ask them, okay. If I were to give you an exercise program, first of all, do you think you can do it? And if they say yes, and most often than not, they'll say yes because they're a motivated person, I'll ask, okay. What's realistic to you? Do you think you can do 3 exercises? Do you think you can devote half an hour? So at least most people can do 3. So that's the safe spot.

Cory Nagler [00:14:25]: I'm gonna go out on a limb here. And, Chantelle, I know you're a runner too, but my guess is probably however many exercises runners tell you they're gonna do, probably they're doing maybe 50% to be generous. Is that fair?

Guest [00:14:37]: Typically. But you depends on the personality. Some people do what I give them, and then they do extra stuff. So you get that personality in. And it's a lot of, like, k. We need to get you to, you you know, not do everything you see on TikTok plus the rehab that I've given you because now we're going to deal with another overload situation or this muscle isn't ready for this. You shouldn't be doing this, but they saw something online that looked really cool and, you know, it would be appropriate for their condition based on whatever they saw. And now they're doing double, triple the exercises on the exact same condition, and then things don't get better.

Guest [00:15:14]: So there's the other opposite end of the spectrum.

Cory Nagler [00:15:17]: Yeah. That doesn't surprise me at all. So I do eventually wanna get a little bit more into some specific exercises that you, think might be beneficial. But just curious before that, at a point in time when a runner is perfectly healthy, not injured, is there still reason to go in and see a physio or a chiro? And if so, what is the role of a of a, a physiotherapist or a chiropractor at that point in time?

Guest [00:15:43]: Yeah. So for sure. So just like getting, you know, your teeth cleaned. Right? You get check a check-in every once in a while or getting your car in for maintenance. And I mean, you don't have to do it every week by by all means. It depends on what you're dealing with. But sometimes checking in can give you a snapshot in time as to where your body's at, what biomechanics you might have developed that could be causing something that's starting up. It also helps us kind of see a pattern of what might be going on.

Guest [00:16:10]: So if you're coming in every, I don't know, 3 to 4 weeks for what we call like performance care. Right? So checking in every so often, and we see, okay, why is this glute continuously tight? Why are we always having to release it? What's going on that's causing this? So it can help you kind of nip things in the bud before they happen. Of course, there are people who come in just for injuries, which is fair too because, I mean, some people are limited by benefits, which is fair. So it's just a way to kind of reduce the amount of timing you take off in the long term when you can catch these things as they're about to happen. Mhmm. It it also helps with, you know, increasing mobility and, obviously, increasing range of motion when things are getting tight and congested, especially with runners, and they're feeling like they they can't get the stride length that they want, for example, because they're feeling everything's jammed and tight. So there's that component too.

Cory Nagler [00:17:04]: So if you have such a runner coming in, say they're perfectly healthy, no specific injury, but maybe are a little bit jammed in tight and just want things to be moving a bit better. Are there any general exercises you would say for the majority of runners are good, either prehab or strengthening?

Guest [00:17:21]: Yeah. So when it comes to, well, being jammed in tight, it depends on the the cause of it. I mean, the easy thing I could say is increase mobility. Right? So give you a mobilization exercise at that region. But if you're jammed in tight because it's an area of the body that's taking a lot of load or another area of the body is not doing its job, then, yes, it would be strict strictly some kind of strengthening program, or even even gait mechanics perspective, taking we could do is, like, you know, drills. Right? So sometimes it's also just being aware of how to move your body when you're running in different ways. The biggest area I find in runners, especially runners who do a lot of desk work is, their mid back kind of stiffening up, and being able to have reduced kind of rotation through the thoracic spine as they're running, and then they get, you know, difficulty getting that big breath of air and they're trying trying to take, those breaths while they're running. And so, I mean, thoracic mobility is always a good thing to add in, and in all directions.

Guest [00:18:22]: So a lot of people know of, like, cat camel or thread the needle. Those types of exercises help with getting some joint mobilization through the thoracic spine.

Cory Nagler [00:18:30]: Yeah. Those are good ones, and we've definitely discussed those. So I'll try to put something in the show notes describing those particular exercises. But moving to the other end maybe because I I think strength work, as much as a lot of runners may struggle to find the time, it's something I think we all kind of know is good for you. Are there any strategies for prevention or rehab you find are really overused or that in your opinion are maybe not as helpful as runners in general or, say, the TikTok world make them out to be?

Guest [00:19:01]: I mean, one of the one of the big things that are overdone, I'd say, in runners is stretching. So a lot of people come in saying that they're injured because they didn't stretch enough when often more than more often than not, it's a strength strength deficit that versus a flexibility deficit because runners need to be able to, spring. That's what running is. And if you, if you don't have the ability to spring well and you're just overly flexible, it's not really gonna help you with that forward propulsion movement. But, I'd say stretching is one of those overdone things for sure. More often than not, like I said before, you need some kind of strengthening, overstretching. And when it comes to strengthening, it's it's what areas are you strengthening other than the rehab. So rehab is based on what deficits you're are found in the clinic in the clinic.

Guest [00:19:49]: Outside of that, it's do you have some lateral, like, core stability program? Do you have a, anterior and posterior core stability, type of program and, especially with the foot, foot core strengthening. So a lot of people forget that and they think the core is just, you know, their their abs, their 6 pack abs sorry, 8 pack in some people, but a lot of the time, it involves their their foot as well.

Cory Nagler [00:20:16]: And so you wanted to maintain good foot strength or hygiene, whatever you wanna call it. Again, looking at example of a healthy runner without a specific deficit. Are there a few exercises that are really helpful in that regard?

Guest [00:20:31]: Yeah. So one of the big ones that I suggest is, like, a short foot short foot exercise, not only to get into your foot a little bit better, but also to understand what it's like to get the foot tripod down which is your first basically your first toe knuckle, your 5th toe knuckle, and your heel and how to be able to, to get that when you're in stance phase. So more often than not, I'll say I'll teach a person how to get into short foot or windlass mechanism of the foot and then I'll teach them how to do it single legged afterwards doing functional movements. So like a Bulgarian split squat for example, right? So that they can recruit that that foot strength they've developed and incorporate it into a running running form, running mechanics instead of just, you know, wiggling their toes around, not knowing what they're doing with it.

Cory Nagler [00:21:18]: You mean that's not gonna strengthen my foot if I just wiggle my toes?

Guest [00:21:22]: I mean, it might make you good at wiggling your toes. But, I mean, you don't wiggle your toes like that when you're running as much. So it's like, how can you take this and apply it to the big picture of what your demand is in your sport? And so that's kind of the progression that I would follow. But, definitely, if you can't get into your short foot I mean, also, if you can't even open and close your toes, right, there's also that too. There's a the same amount of muscles in your hands as you have in your feet, but we definitely don't know how to recruit into our feet very well. And by all means, I'm not saying everyone has to grip pens with their feet like they do with their hands, but you should be able to get into the foot musculature as easily as you can into your hands when needed. So it's a huge a huge piece of this is, can you get into your toes? And then can you recruit it for that short foot, windlass mechanism in running gait mechanics?

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Cory Nagler [00:25:34]: Do you have any opinion on that?

Guest [00:25:36]: So at the clinic, we like prescribing more active isolated stretching over stretching stretching, as a cool down strategy. And for those who might not know what active isolated stretching is, it basically recruits your body's natural reflex when it comes to contracting a muscle and relaxing a muscle. So what you would do is you would actively, let's say your hip, actively bring your leg up towards you if you're lying down and then you would passively pull that leg towards you for 2 seconds and then relax and do it again, let's say 10 repetitions. So what that does is it allows you to get a bit of a a bit more mobility in, for example, in this case, your hamstring after you've already contracted your hip flexor. So whenever your hip flexor contracts, your hamstring naturally relaxes. You can get a little bit more mobility through it without fighting through your muscles, but also you get better joint mobility because it's a repetitive motion just like a joint mo so we prefer that suggesting that over just doing a static stretch for the most part.

Cory Nagler [00:26:39]: So I I do like that, but I was actually thinking more like a a jogging cool down, like if you have a structured workout at the tail end of it. So I guess probably regardless of the run, it might be good to incorporate some of those exercises. But even before then, do you need a period of reduced running, or is it okay as long as you build in some of those, specific stretches to to skip that?

Guest [00:27:00]: Oh, specifically for cooling down? If you're doing a a hard workout, yes, you definitely need some kind of recovery jog. Right? If you're coming in from a already long run where you're running pretty, like, easy, you don't necessarily need a recovery jog from that. But, yeah, if you're doing a hard workout, definitely getting the heart rate down and getting things to slow down a bit before you go into a cool down of any sort would be helpful.

Cory Nagler [00:27:22]: Okay. Cool. And, another practice I think might be popular among a lot of runners, probably when you're already starting to get into the stage of injury, but, this would be more on the medication side, like Ibuprofen or Voltaren or painkillers like Advil. Is that something you would ever recommend, or is that something that's strictly either placebo or counterproductive?

Guest [00:27:47]: It depends, like most things. As a chiropractor, I can't really really give medical advice in terms of medications, but I can comment on soft tissue injuries, acute soft tissue injuries, and how you can manage them in relation to your question. And there's a new acronym that's not just RICE. It's called peace and love. And I think it was published in a study in 2019 by Du Bois and Escoillier. And it talks about in the first one to one to 3 days of an acute soft tissue injury, so let's say a strain, you wanna avoid anti inflammatories, which would incorporate some of the medication that you've mentioned here already because that would delays tissue healing. And so we used to be super afraid of any type of inflammation when it came to an acute injury. I mean, ankle sprains for 1.

Guest [00:28:38]: Throw ice on it. Right? Now there isn't as much evidence, like, around ice or heat necessarily helping with, you know, injury and making it heal faster. Instead, there's a lot of thought around trying to embrace the inflammation. You can you can elevate the area. You can protect the area. You can compress it a little bit, but not really inhibiting it by anti inflammatories is one one piece of the puzzle, at least for soft tissue injuries, acute soft tissue injuries.

Cory Nagler [00:29:09]: So high level without going into the entire acronym, what is peace and love, and how should you treat it then?

Guest [00:29:15]: So peace refers to the immediate immediate, effects of an injury from 1 to 3 days. So they would stand for protect, elevate, avoid anti inflammatories, compression, and education. So that's what they would say you'd do for the 1st 1 to 3 days of an acute injury. After that, you'd apply what they say love. So subs so you'd think about load, optimism, vascularization, and exercise after that. So you wanna be able to apply some load to the area and get some light mobility around that area within that one to after that, sorry, after that one to 3 day kind of window. And then you can start loading it more so you can get back to whatever you're doing a lot quicker.

Cory Nagler [00:30:03]: I love that in the acronym, it actually includes within it avoid anti inflammatories within the 1st one to 3 days. It's a very direct answer to the question.

Guest [00:30:11]: It is. Yeah. It's it's very helpful. It's very helpful acronym, but one that not everybody knows about. Because that that's a big question I get in the clinic too is, should should I throw ice on it? Should I put heat on it? And more often than not, I just say, I mean, whatever feels good or I say if you're gonna do ice or heat, alternate ice and heat. So at least what you're doing is you're getting, contrast bathing like, results, meaning you're getting vasoconstriction, vasodilation to help get that blood flow into that joint to encourage the inflammation and heal and healing in that area.

Cory Nagler [00:30:43]: Interesting. So if I were to ask which is more productive, ice or heating, or are there certain instances in which you should choose 1 or the other? Is the answer really just alternate the 2?

Guest [00:30:56]: Truth is there isn't a huge there isn't a huge way to say there's an answer for it. But what I usually say is, yeah, alternate if you're going to and you like doing it. Or if it's a chronic issue where there's a lot of tension and they're getting headache from it, sometimes they'll say you can apply a little bit of heat only because it helps with relaxation. But that's, yeah, that's it. I don't think there's a lot of evidence around saying one's superior to the other right now.

Cory Nagler [00:31:20]: Yeah. Alright. I wanna get more into the treatment side of things. When a a runner is, say, already going through some type of issue, whether that's a niggle or an injury, and coming into the clinic, are there any particular types of treatment that you find are very effective for many different runners and injuries? So I know we talked about adjustments as being one as an example.

Guest [00:31:43]: Mhmm. So depending on the issue, I do a, and most people at the clinic, most practitioners at the clinic apply similar things, but I do soft tissue therapy through active release techniques. There's also acupuncture. So everyone, for the most part, our clinic has done McMaster's no functional medical acupuncture program, and so we all apply acupuncture for sure. And then a lot of it's also, you know, exercise, gait retraining. It depends on the issue. But if it was for an acute acute issue other than, you know, applying peace, I'd also probably do a little bit of acupuncture to help promote blood flow. And if there's anything around that area that's, like, presenting as weak or the muscle testing presents as a little shaky, it could be a little stronger.

Guest [00:32:35]: I'll apply the neurofunctional acupuncture through electric stimulation to help kind of, quote, unquote, wake wake that area up so that you can then function a little bit better when you leave even though we're still waiting for that tissue to calm down and heal.

Cory Nagler [00:32:48]: Yeah. I I I think I do have to call out for any listeners who are gonna be very confused about McMaster, that this is a university in in Canada and not some kind of treatment acronym.

Guest [00:32:58]: That's a good call out.

Cory Nagler [00:33:01]: So you did talk about, a few things there, including acupuncture, which I know I've I've found personally helpful. One related treatment, maybe not specific to running, but for athletics in general a lot, is cupping. That's something I've heard thrown around. Is is that something you ever use at the clinic?

Guest [00:33:20]: Yep. I'll occasionally use cupping as well. Not in the traditional sense where you're, you know, lighting a fire in a glass cup and applying it to skin, but I'll use silicone cups. And then, usually, I'll apply lotion to the area and glide the cup over that area. It's great for areas that don't move well or over a joint that, like, we notice what we call trophic changes. So you notice that joint doesn't move well. So as a result, the tissue around it gets a bit congested. If you if you feel tissue, not everyone does, but people like me do.

Guest [00:33:54]: If you feel tissue quality, usually it should feel a little bit softer, a little bit smoother. It can glide. You can pull the skin. There's no sensitivity or pulling sensation with it. Sometimes you can get a little bit of that tissue trophic change and cupping really helps with opening that up. Especially in people who do not like acupuncture and a lot of acupuncture is, like, getting blood flow into that tissue, you can really do cupping around that area and it's a lot it, it provides a very similar result without having to stick a needle in a person.

Cory Nagler [00:34:23]: Mhmm. It it's funny you bring up needles because, again, coming back to our editor, Jeremy,

Guest [00:34:29]: part

Cory Nagler [00:34:29]: of the reason he was even thinking about this is because of a friend who was talking about getting cortisone injections for an ongoing injury. And I know this is a more controversial one because it is, in a sense, a quick fix, but also that has some side effects. So I I'm sure the answer has some level of it depends baked in. But, you know, including some of those contingencies, do you have any thoughts on on using cortisone injections to treat running injuries?

Guest [00:34:58]: Yes. Like you said, it depends. But, sometimes it can help with the inflammation. Right? So it can decrease pain, but it might not completely resolve what the cause was. So for example, bursitis, that's one thing that people like, using it for, which can help. It can help calm down the inflammation for sure at the site of the injection, but, what caused the bursitis? Right? So sometimes it's a maybe you have a bursitis there because other than trauma hitting it, there's an overload situation. And you see that a lot in greater trochanteric pain syndrome, so that's basically, you know, lateral hip pain and usually the gluteal muscles. The idea is they're they're they're pulling a lot at that bursa and causing the bursa to undergo some friction and then be inflamed.

Guest [00:35:50]: And so while you could inject it to take the swelling away, it might come back. So more often than not, people who get injections have to go back from hearing about it. Obviously, I don't administer them. But from hearing that, usually, oh, every 6 months I go in and they give me my injection or or it came back. I have to go back and it's been a year. Right? So, when it comes to that, it's also trying to have a practitioner in your corner who can think a little bit outside the box as to why it even started up in the 1st place versus just relying on the, injection itself.

Cory Nagler [00:36:23]: And would that practitioner be someone like yourself, or is there a different type of physician?

Guest [00:36:29]: Someone like myself, but someone who's able to look at things, biomechanically as well as just on the table. Right? Especially because on the table, we see different things than when we see people moving. So that's why we're often in a gym at our clinic. We're not we're rarely always in the treatment room.

Cory Nagler [00:36:48]: Yep. So I I think I've kinda gone a bit back and forth during this episode between sort of the that prehab or when you're not injured or some of the more treatment side in in which of those are evidence based or work. Just to bring them together, where do you maybe draw that line between maintenance and treatment, especially because I know a lot of the treatment strategies you mentioned can actually be used for both? Mhmm.

Guest [00:37:13]: Honestly, it it oh, like I said, it depends. But, at some point, no matter the amount of exercise you do, things stay the same. And so that's when the treatment might be more helpful at least to get things moving so that exercise can then be more helpful for you. So for example, in, let's say, your hips aren't moving well. Right? Your hips' sticky. You feel like you can't lift that leg up as well as you'd like. Your stride isn't as long. Right? And you're doing all your you're doing your your active isolated stretching and you're doing your hip mobilizations and it's not working for you.

Guest [00:37:54]: So that's when the hands on perspective might be helpful to help open things up so you can gain that range so then you can do your exercises and maintain that range on your own.

Cory Nagler [00:38:04]: Okay. So in that sense, are we saying then that typically, even if you're healthy after a certain period of time, it makes sense to take a more aggressive treatment approach, or is it really more case specific?

Guest [00:38:19]: It's pretty case specific. It really depends on it depends on what the person's able to do on their own and what they need help with. So the hands on's more like, what can this person what can this person benefit from that they can't do themselves right now?

Cory Nagler [00:38:33]: Yeah. And do you find for the people who come into your clinic, for those that you've been working with for a long period of time, do they tend to come in with a lot of the same issues, or do you find them getting a lot of different injuries or nickels?

Guest [00:38:46]: Typically, they're different injuries more often than not. If it's the same issue, then I go back to the drawing board because that means, to me, I haven't resolved it really because there's something else going on that I need to address, depending on the issue. But, typically, it's new issues for the most part.

Cory Nagler [00:39:06]: Okay. So if somebody is chronically injured, but it's different injuries each time, is there any way to identify the root cause or or to be proactive in preventing it, or is it more of a whack a mole where you really have to address the injury as it comes?

Guest [00:39:23]: Well, it depends on the injuries too, but, sometimes it's due to it's, you know, due to their whatever they do in there every day. Right? So a lot of people come in with injuries when they experience a load greater than what their capacity is. So that could be a desk worker. Right? Sitting at their desks, doing the desk marathon that they haven't trained for, and then coming in and they have neck pain and upper back pain, or they have thoracic outlet syndrome, they have numbness and tingling down their arm. In which case, it's what are we doing at our desk that could be causing some of these symptoms that are a collection of the same issue. Right? Even that even though we say, let's say their shoulder hurts, their neck hurts, they have headaches, they're getting numbness and tingling, and they're different injuries, they're all from the same pattern. Right? So in that case, take take more breaks at your desk, offload the tissues, do an upper back strengthening program so you can handle the load of sitting at your desk, stuff like that. From a running perspective, it's let's say we see that you're, a heavy supinator on one side and you have IT band syndrome and you have lateral lateral hip pain or you have fibularis pain or you have a, you know, a 5th metatarsal stress injury, those are all injuries that are linked to the same biomechanical cause.

Guest [00:40:38]: In which case, it's, can we help with this hyper supination that we're experiencing through the foot? And that's where that biomechanical lens comes into play.

Cory Nagler [00:40:48]: Is that if there's kind of a common cause for different injuries, is that what you would say is the most common is a biomechanical deficiency?

Guest [00:40:56]: I typically find that. Special well, I mean, especially with working with runners. Right? Especially with an injury that keeps coming back, especially when they're running. Or it's an injury that they feel, you know, after a run only or the day after a run only or, like, you know, the usual during a run. But if it's very running specific, it's usually some kind of biomechanical or strength based issue.

Cory Nagler [00:41:21]: Mhmm. And you you also brought up the idea of desk workers and how that causes particular issues, myself included. Obviously, there is the mobility and the stretching and warm up around your runs. But during the day, is there anything you can do to help to alleviate some of those concerns?

Guest [00:41:38]: Specifically for desk workers? So, the biggest thing in research is, you know, taking breaks because what happens so okay. So backing up. There's a saying in rehab, it's not the load that breaks you down. It's a load you're not prepared for. Right? So at your desk, realistically, is anyone trained to sit for 8 hours in the same position doing the exact same repetitive movement? No. No one's trained for it. So the best way you can reduce that load is to take a break from it so that your body can recover and then apply the load again, AKA go back to your desk after about a half an hour break. The other thing is you're sitting at your desk and you, let's say, forward head posture, shoulders are rolled forward, you're getting tired, right, because your mid back can only hold so much.

Guest [00:42:24]: You can do the opposite of that as a break. So you can get a band, you can do banded pull aparts. Right? You can pull the band apart, open things up, go back to your desk after. You might feel a lot better because now you've engaged muscles that have been stretched forward and fatigued in a while, and now your brain's more aware of them to help you with not letting that kind of forward head posture, shoulder rounding to kind of come back into play. That is if that's what's, like, causing some of the symptoms that you're experiencing if you are experiencing pain. So that's one thing that I usually suggest for desk workers, the banded pull up parts, chin tucks. So tucking your chin in help a little bit with getting your deep neck flexors activated if you tend to have that head falling forward, as well as just general, like, thoracic thoracic mobility to just wake things up in a different movement pattern than just sitting.

Cory Nagler [00:43:14]: And does the timing of these exercises matter? Just because as you describe these, I'm imagining it could be a little bit awkward to be in the office and suddenly pull out your band to do these pull aparts.

Guest [00:43:24]: Sometimes it's as simple as changing your position too. Right? So you don't have to necessarily do it every every hour on the hour and be that one person in the office doing banded exercises. But, sometimes you can just shift your posture too, and that also kind of resets the area too if that's the case. But, typically, we say around every every 40 minutes or so, you should try to take a break.

Cory Nagler [00:43:44]: Yeah. I think good advice, general practice, even putting running injuries aside.

Guest [00:43:49]: Yes. Exactly. People have to work, and most people work at their desks or in front of a computer. So that's also an overuse injury that we see too.

Cory Nagler [00:43:57]: Yeah. In in terms of, like, what's an injury versus what's maybe a general strain or niggle, what do you think runners can look for as a clear sign that, wow, I I need to take serious intervention or go see someone right away versus more general overload or or more of a yellow flag?

Guest [00:44:16]: So it's especially with runners, it's if your pain doesn't get better with rest, especially over 3 days because 3 days is usually the amount of time that DOMS takes to heal, which is kind of normal controlled pain. Right? It doesn't get better with rest. If you're single leg hopping, that's usually our screen for a person to get back running. If you're single leg hopping and it's quite painful, you can't single leg hop, that's your sign that you should probably not be running and you should get it checked out, and it might be an injury in that case.

Cory Nagler [00:44:49]: This is why we start every session with a single leg hop?

Guest [00:44:52]: Yeah. See if you can do it or not. And I have patients who come in, and they're like, oh, I could single leg hop. It's not that bad an issue. Right? And it's like, well, kind of. Yeah. You're you're right. I mean, if you're running, you need to be able to load on one leg after the other.

Guest [00:45:06]: Right? And if you can't do that well in a hop, then how can you do that for thousands and thousands of steps over and over again?

Cory Nagler [00:45:12]: I think the runner's mentality a lot of the time is even if you can wince in single leg hop, it's like, well, I can do it. So I'm good to go with my long run.

Guest [00:45:20]: Yeah. Exactly. Everyone everyone thinks like that. They're runners are quite big optimists for the most part. Right? And they're they're very motivated people. So a lot of the time, it's it's bringing them back to reality sometimes and telling them, k. You might need to cross train for a little bit before you load this in that way again. And that's a big piece of our job as clinicians.

Guest [00:45:41]: It's not just treating. It's, k, how am I gonna coach this person? I know their personality so they can get better, without making them feel like I'm putting a full stop to whatever we're doing here. And that's that cross training lens comes into play with that because you're still able to do what you wanna do. You're still working towards your goal in a different way.

Cory Nagler [00:46:02]: Yeah. I think we're optimists, and I'm also speaking about myself here, but I think we also tend to be quite stubborn as well.

Guest [00:46:08]: Oh, yeah. For sure. But it it's, I mean, it's fun to work with runners because they'll also do their homework for the most part. Right? More often not, I have to pull a runner back from doing things than, like, really tell them you have to do your exercises, at least at our clinic. And, I mean, I think a lot of that also is because you I do that kind of motivational interviewing piece where I see, like, what what can you do and what can you not do so we can make sure you can do it.

Cory Nagler [00:46:37]: Yeah. And and, Chantal, you've got an audience of many runners here who are very active in this board and who definitely do their own homework and maybe suffer some of that same optimism and stubbornness as myself. So as a final takeaway, if any of them are wondering sort of high level, what are the things I should be focusing on to make sure that I can stay healthy and and pain free? What what are some of those key principles you might leave them with?

Guest [00:47:01]: K. So make sure you have well, first of all, make sure you have somebody in your corner that you can go to if you have an injury. Make sure you have some kind of strength program, foot core strengthening, abdominal core strengthening. And, if you're having a niggly injury with running or a niggly issue with running that keeps coming back, get someone to look at how you move and see if that can help help you with figuring things out from that standpoint.

Cory Nagler [00:47:27]: That's phenomenal advice. And I mentioned we do have a large American following, but we do have some athletes in Canada as well. So if anyone wants to learn more about yourself or, about your clinic, where can they find that out?

Guest [00:47:39]: Yep. So, my Instagram is the runners chiro. Our clinic is the runners academy. We have a website, and we also have an Instagram page. So you're welcome to check us out there.

Cory Nagler [00:47:49]: Awesome. Thanks so much. And we'll link all of that in the show notes. So check it out if you are looking for a physiotherapist or a chiropractor in Toronto. But, Chantelle, thank you so much for joining me today.

Guest [00:47:59]: You're welcome. Thanks for having me, Corey.

Cory Nagler [00:48:15]: Thanks for listening to the Run to the Top podcast. I'm the showrunner at Runners Connect, where as always, our mission is to help you become a better runner with every episode. You can connect with me on Instagram at Corey underscore Nagler. Birth your Strava by searching Corey Nagler, and please consider connecting with the rest of our team at runnersconnect.net. If you're loving the show, you can help us reach more runners by leaving a rating on Spotify or Apple Podcasts. Lastly, if you want bonus content, behind the scenes experiences with guests, and premier access to contests, and consider subscribing to our newsletter by going to runnersconnect.netforward/ podcast. I'll see you on the next show, but until then, happy running, everyone.