Training modifications to reduce injury

Finn Melanson [00:00:14]: 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 are created and produced by the expert team of coaches@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. We all know that injuries are the biggest impediment to our continued progression and improvement. The longer you can get in uninterrupted training, the more consistently you'll improve. That said, there's a lot we can do, or at least should be doing, to modify our training to reduce the risk of injury. To help us dig deep into exactly what these elements are, we're interviewing Ethan Pastor. Ethan is a doctor of physical therapy and certified strength and conditioning specialist who has extensive experience working with runners one on one to keep them healthy and building back safely from existing injuries. We're going to cover when it's okay to run through an injury and when it's not, and how to go about it safely. The most important modifications you can make to your training to decrease injury risk, how to deal with pain management when returning from an injury, and much more. This is a great interview for any new runner, but also a great reminder for any experienced runners as well. Let's jump in. Today's episode is sponsored by Magnesium Breakthrough from Bioptimizers. Their industry leading magnesium supplement helps you sleep better and reduce stress. Head to Magbreakthrough.com runtothetop to learn more and save 10%. Timeline Nutrition has developed a groundbreaking product called Mitopure that revitalizes your mitochondria, which create energy in nearly every cell in your body. Head to Timelinenutrition.com to learn more. To get us started, tell us a little bit about yourself and how you got into helping runners with their injuries.

Guest [00:02:29]: Sure. So, my name is Ethan Pastor. I'm a physical therapist. I'm originally from St. Louis, Missouri. Half my life there, my other half in the DC area. I went to high school in DC. Grew up playing lots of sports, including cross country, ended up diving in college. So that was kind of my big sport in undergrad and then became a physical therapist. And now I specialize in sports injuries.

Finn Melanson [00:02:56]: Okay, to kick things off, generally, what are some of the most common injuries you see in the runners you work with?

Guest [00:03:05]: So, probably the big things that I normally see, I see a lot of Achilles tendinopathies. Tendinopathies in general are probably the most common injury or tendonitis is something you may have heard more often, but I call them tendinopathies. If it's been more than a week, I tend to call it a tendinopathy, which is a terminology thing. But yeah, like an Achilles tendinopathy, hamstring tendinopathies, or patellar tendinopathies as well. And usually the root cause of those is almost always a training error or overtraining or lack of strengthening other injuries that I see a lot of are pentafascitis shin splints or medial tubial stress syndrome, if you want the technical term, or just a generalized hip pain. There's a few different things in the hip that can be causing pain, but we'll just call it generalized hip pain as well. And then as far as what's causing all these injuries, so they're most common in novice runners. Not that it doesn't happen in more advanced runners and it happens all the time in advanced runners, but most common in novice runners and most common after taking a break from running and then trying to get back too soon into running and upping your mouth too quickly.

Finn Melanson [00:04:17]: Do you advise runners who have injuries to always take time off? Or are there times when you think you can or maybe even should try to maintain a little bit of running?

Guest [00:04:29]: Yeah, so I don't love telling runners to take time off because then they hate me. But for some injuries, it's necessary. So if something like a stress factor, that's something that you just can't run through, but there's very few besides like a stress fracture or something that like a broken bone, something that it's truly being made worse by running. Most things you can still do some running or at least start with some running. So what I usually tell people is it's time to take some relative rest, not absolute rest, because sometimes I'll never see them again when I tell them that. So relative rest means decreasing your mouth significantly and then maybe focusing more on training, basically increasing your intensity so you're not losing your base. So you're still staying pretty fit, but you're decreasing your mouse enough to recover from your injury. So that's usually my first plan if that doesn't work. So for a few weeks in and that's not working, then we can consider absolute rest from running and then just strictly stick to cross training. But I don't like to take people away from what they love right away. We always like to try decreasing miles first. You wouldn't want to be doing a lot of hill training.

Finn Melanson [00:05:40]: What are some of the modifications you'd make if you were going to keep running? What can you change to make it more conducive to staying injury free?

Guest [00:05:50]: Another way you can train the surface that you're change, the surface that you're running on could be just switching from gravel to grass to just get a little bit more load dispersion. And then another way would be not even the terrain, but you could just change your shoes. So most people don't necessarily have to change their shoes. Actually, 70% to 80% of the people are fine in almost any shoe. But there's a good 20 30% of people that are either in the wrong shoe or they do have a specific foot type that you can go to a local running store and get fit to the shoe that works for your foot. So that's that select few. I don't think that's for everybody, but there is a select few. If you have a super high arch or you have a super low arch or a specific foot like deformity, that's when you want to get custom shoes or custom insoles for your shoes.

Finn Melanson [00:06:45]: Do you consider other training methods like cross training for recovery and to increase performance?

Guest [00:06:53]: Yeah, so this is kind of what I love, is when we have a chance to do something different and cross training just to touch on. Cross training, first off, is it should be included in just about everybody's training program. If you're not already doing it, I highly recommend it because running seven days a week is generally not a good idea, and it's been shown in the literature to be a risk factor for injury. So you're putting yourself at risk right away if you're running seven days a week. So that means you need to mix in at least one, preferably two rest days a week, if you're training five days a week. If you're training three days a week, you're having a few more rest days. But when I tell people to take a rest day, I always prefer an active rest day. So an active rest day is an opportunity to do cross training, or if you're injured, also an opportunity to do some cross training. So different options for cross training, the best option for you is always the one that you enjoy, because otherwise you're probably not going to do it. For me, I enjoy swimming, so I swam my whole life. I end up diving in college, so swimming is something that I enjoy. Not everybody's a great swimmer, so swimming is not perfect for everybody. But other options include rowing, like on an ergometer, not necessarily in the water, but rowing on an ergometer because it decrease the impact as well as biking. And then another good option that people don't think about very often is you can do cardio with weight training. So if you do like a really high rep weight training program, that can turn into more cardio than it is anaerobic if you're keeping your weight really low and you're doing higher reps, and that's generally what I like to recommend for my runners. If they're trying to mix in some weight training as part of their cross training program, they're going to be better off doing higher reps, lower weight, because what I tell people is like a one rep max power clean isn't very beneficial for a marathon runner because when are you doing a ten second sprint in a marathon? Not very often. You want to do something that's going to take a few minutes with your weight training, so you still want to do weight training, you just want to do something that's specific to your sport. And for running, it's usually like higher reps because as you get tired, you want to train your muscles while they're tired. You don't want to be only stressing anaerobically when you're doing your weight training, because you're not stressing your muscles anaerobically with running, you're almost exclusively stressing your aerobic systems. And then maybe at the end of the race when you're kicking, you want to be training your anaerobic muscles, and that's what we have our interval training for as well.

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Guest [00:11:29]: If you have a tough, like a tempo run, which would for me is usually your hard day when it comes to running, I would try to definitely not do strength training before that. If you're going to do some light strength training afterwards, that'd be fine. Or like I said, recovery days are usually the best time to do your strength training. It depends on how much strength training you want to do and how aggressively you're doing strength training. Because if you're doing it really as like a side thing and you're not what's the word? If it's not an integral part of your training program and it's not making you really sore the next day, then you can do it almost any day except for probably avoid doing it on your higher mileage days. But if it's something that you're really putting a lot of effort into and you're feeling sore for the next one or two days, you got to strategize where in your week you're going to put that strength training day. Because you don't want to be sore going into your hardest day or highest mileage day either. So you got to make sure you give at least a full day to recover from strength training. That doesn't mean you're not exercising that day. That just means that shouldn't be the hardest day of your week.

Finn Melanson [00:12:39]: So what is runner's knee and how do you go about treating it?

Guest [00:12:44]: Runner's knee? Yeah. Runners knee is kind of like a junk term. So to be more specific, if you want to call it patellar femoral pain syndrome, that combines a few different pathologies into one, it's usually dealing with the patellar femoral joint. So either there's an issue with tracking of the patella or sometimes it's just a patellar tendonitis issue. It's all just sometimes lumped together. So ways to cross train for that. So one of the biggest things that I like to do with people with that pathology is working on balance. So that's really important. So you're building up the neuromuscular control and proprioception around the joint to help protect it. And that should help with getting back to running sooner, as well as working on eccentric strengthening, which I haven't touched on yet. So, eccentric strengthening, this will contribute to a number of the other injuries as well, particularly our overuse injuries and the tendons or tendonitis. Eccentric strengthening is the negative portion. So if you think about doing a bicep curl, the concentric portion is when you're actually curling the weight, and the eccentric portion is when you're bringing the weight down. And so when it comes to the quad, the eccentric portion is when you're doing the descending portion of the squat. The concentric portion is when you're standing up. So when we're dealing with particularly a patellar tendonitis or tendinopathy, as well as patella femoral pain, I almost always will do some eccentric strengthening with those patients. So the way we can do that is we have a few different ways. I like to do it on a leg press. That's kind of the easiest way, especially if you're doing it on your own, either a leg press or a leg extension machine where you're going out with both legs and on the way back, you're just doing the descending portion with one leg and you're actually stronger eccentrically than you are concentrically. So you can go pretty heavy with that and stay strong and maintain your strength. I've actually had some patients, some non runners, get back to weightlifting and feel like their squat is stronger after doing a few weeks of eccentric strengthening, because you can actually go really heavy with eccentric strengthening without damaging anything because you're stronger eccentrically, and it's strengthening your tendons. So that's when you think about attendinitis or tendinopathy gold standard, always first thing you should be thinking about is eccentric strengthening. If you're not sure how to do it, just type in the muscle type know into our little Google because usually there's a number of good YouTube videos on these. Type in Achilles eccentric strengthening, type in hamstring eccentric strengthening or quad eccentric strengthening and there should be a number of good examples. Oftentimes a lot of physical therapists will put some stuff out on YouTube.

Finn Melanson [00:15:18]: How do you deal with pain management when it comes to returning from an injury?

Guest [00:15:24]: Yeah, so pain can always be a good guide. Your body's pretty smart, so it's usually going to tell you when something's not a good idea for you. So that's a good place to start. Pain is not always a guide. So for instance, with eccentric strengthening, sometimes those exercises will be painful. It doesn't mean they're bad, it just means that you're strengthening something that's damaged and it's going to be a little bit painful. As far as cross training, like what we talked about earlier in terms of cardio activities that you can do when you're injured something like a stress fracture or shin splints where you're having an actual bone reaction, you want to definitely be avoiding impact as much as possible. So getting in the pool I know a lot of people don't love swimming, but swimming is almost always a really good option when it's not a good idea to swim. So that's a good question too. Like a really bad hamstring tendonitis or really bad hamstring tendonopathy that every time you're kicking, it's hurting your body's smart. It's telling you, hey, this is not the right thing for me to be doing. It doesn't mean you need to be out of the pool, it just might mean maybe you shouldn't be swimming. So maybe you can try some walking in the pool, really drop it down as far as you can. Make things as easy as possible goal. Because if you find something that you can do, you can always make things harder in the future. So if you find something like just walking in the pool and you can do that for a few days, like, okay, things are starting to feel better, then you can progress to running in the pool, then you can progress to, if you're comfortable swimming, actually doing a little bit of swimming as well. That's why I always tell people is to break it down as much as you possibly can and make things really easy the first day, because we can always make things really hard.

Finn Melanson [00:17:06]: How do you determine the training intensity when coming back from an injury? What factors, for example, do you take into consideration?

Guest [00:17:15]: Yeah, so let's start with age. So as you get older, I think definitely decreasing your miles is a good idea. It doesn't mean you can't train hard though. So like I said, earlier. I think a big mistake that a lot of runners make is just going for miles at a moderate pace and just trying to do as many miles as you can slowly. I think what's really important, something that a lot of people should think about, is increasing your intensity and decreasing your miles. So finding at least two days a week, I don't know how many days a week everyone's training, but if you're training five days a week, two of those days should be either a tempo run or a track workout, something with pretty high intensity. And then you can still do your long slow runs, but you're at least getting a little bit of higher intensity, which will overall decrease your miles, especially as we get older. And we need less miles and a little bit less banging of your joints, especially if you had a history of shin splints or a history of stress fractures and you're trying to protect yourself from re injuring. You want to decrease your miles, but you want to stay fit. So the best way to do that is to up your intensity. And as far as finding the right workout for you, that'd be something you go to. If you're an older runner, then you've been doing it for a long time, so that part is good. You have some experience, but if you're not sure, I would always address a coach or address someone with a little bit more background than you if you have questions. As far as, again with age, so taking days off when it comes back to active recovery, I think it becomes even more important to avoid those absolute rest days and find an active recovery option for you. I mentioned a few earlier in terms of swimming, biking, rowing, and yoga is also a really good option, especially as we get older and everything gets tighter. Yoga, I love yoga. I used to never do it, but then I realized how hard it was. So now I try to force myself to do it and it keeps you a little bit more mobile and it keeps things feeling good. I always feel significantly better after doing yoga on a rest day than after laying on the couch on a rest day. It's just night and day difference. So I highly recommend that as well as any other active recovery option you want to choose and also make sure you're doing something you enjoy. So go for a hike, do something fun. It doesn't always have to be the same thing every week. In terms of gender, I think one of the biggest things to think about for male versus female runners is we're going to notice a lot more hip issues with female runners, and especially when we're talking about proximal hip strength with our Glutes, significantly more problematic with female runners. So we want to have that proximal hip control as you're impacting the ground, because every time you take a step in running, you're standing on one leg. And the most control you're getting when you're standing on one leg, you do have control of the ankle and the knee, but you're getting most of your stability at the hip. So if you have weak hips or your hips aren't doing what they're supposed to be doing, or not fragging correctly, you work on that.

Finn Melanson [00:20:24]: What are some of your best bits of advice or recommendations when it comes to adjusting your training to stay healthy? Is there anything we haven't covered yet in the conversation? Anything we missed?

Guest [00:20:37]: So one thing I wanted to touch on before I go is definitely nutrition. So I'm not a nutritionist, I'm a physical therapist. So if you want specific questions, I'm not the right person to go to. But if you're having trouble recovering, especially if you're thinking about maybe adding active recovery days in and taking away absolute rest days, that means you need more calories because you're doing more work and finding the right calories is really important. So I always recommend the first step you should take is to take a week, maybe even two weeks. Depends how serious you are about it. Just write down everything you eat for that week and I guarantee you're going to find some issues in your diet after you do that for a week. And then you may have the some of them are pretty basic, some of them are just like, oh yeah, I didn't eat any vegetables for three days in a row, maybe you should change that. And some of them are a little bit more complicated where you're like, I already have a pretty good diet, but you want to optimize it. That's when you start thinking about talking to a sports nutrition and going the next step, but always start doing it yourself. And then once you start to hit that roadblock, then you can start to talk to a nutritionist or talk to someone with a little bit more background in that area. And yeah, the only other thing I want to touch on real quick in terms of running, which may have already been said in one of the other podcasts, but I just want to say real quick about orthotics because that's kind of like a hot topic we always recommend. I always recommend getting even though I can make Orthotics, I always recommend an over the counter first because they cost twenty dollars to fifty dollars stops, and the ones that we make or the ones that you'll get from Podiatrists can run up to $400. And if you look at the research, it says pretty clearly that there's very little difference unless you have a really specific foot type with a significant deformity, there's very little difference between an over the counter Orthotic and the custom made $400 orthotic so. Try even a couple over the counter ones before you give up. And then once you've gone through a couple and maybe you haven't found the right option for you. That's when you can talk to a podiatrist or a physical therapist about making a custom one. But save yourself a little bit of money if you're having some of these plantar fasciitis or one of these injuries that can benefit from orthotic. And don't go straight to the most expensive option. Even though sometimes it looks fancy and it looks nice, there's some cheaper options for you all.

Finn Melanson [00:23:08]: Thanks for listening to 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 Wasatch, Finn, and the rest of our team at Runners Connect. Also consider supporting our show for free with a rating on the Spotify and Apple podcast players. And lastly, if you love the show and want bonus content, behind the scenes experiences with our guests and premier access to contests and giveaways, then subscribe to our newsletter by going to RunnersConnect. Net backslash podcast. Until next time, happy training. Sam.