1 00:00:00,400 --> 00:00:03,920 You're listening to episode 218 of the Marathon Running Podcast. 2 00:00:04,040 --> 00:00:06,240 In this episode, we're going to talk about all things 3 00:00:06,240 --> 00:00:16,560 tendinopathy. This is the Marathon Running 4 00:00:16,560 --> 00:00:19,120 Podcast by Letty and Ryan from We Got the Runs. 5 00:00:19,440 --> 00:00:22,440 Join us in our running community for weekly content that is 6 00:00:22,440 --> 00:00:26,240 motivational, educational and inspirational and that the 7 00:00:26,240 --> 00:00:29,080 Marathon Running Podcast take you from the starting line to 8 00:00:29,080 --> 00:00:37,520 the finish line and beyond. Hey runners, and welcome to 9 00:00:37,520 --> 00:00:39,920 episode 218. My name is Letty. 10 00:00:39,920 --> 00:00:42,960 I am your solo flying host today, one more time recording 11 00:00:42,960 --> 00:00:45,680 from Germany. Thank you so much for tuning in. 12 00:00:45,880 --> 00:00:49,280 If you're new, I'm usually accompanied by my husband, Ryan. 13 00:00:49,440 --> 00:00:52,360 We do this podcast together and have been doing it for the last 14 00:00:52,720 --> 00:00:56,240 over four years. We are in Season 5 and now we 15 00:00:56,240 --> 00:00:58,920 also have a YouTube channel that we've had for about two months 16 00:00:58,920 --> 00:01:00,880 where we post different type of content. 17 00:01:00,880 --> 00:01:03,280 It's more entertaining. Shoe Reviews. 18 00:01:03,440 --> 00:01:05,319 Gear. Reviews finding the perfect 19 00:01:05,319 --> 00:01:08,800 running bra, finding the perfect running shorts and vlogs. 20 00:01:08,800 --> 00:01:11,800 So it's that sort of entertaining content. 21 00:01:12,320 --> 00:01:14,880 And if you want to check us out, you can just simply type at 22 00:01:14,880 --> 00:01:18,040 running podcast into the YouTube search bar and it'll take us 23 00:01:18,040 --> 00:01:21,520 take you right to us. So enough said about that. 24 00:01:22,040 --> 00:01:26,320 In today's episode we are going to talk to a physical therapist 25 00:01:26,320 --> 00:01:28,760 and it's been a while that we've had one on. 26 00:01:29,080 --> 00:01:32,440 At the very beginning of our podcast, we used Brody Sharp, 27 00:01:32,440 --> 00:01:37,320 the Australian physiotherapist a lot until he got famous and 28 00:01:37,320 --> 00:01:40,440 busy. And you know, that's how life 29 00:01:40,440 --> 00:01:42,080 goes and we are very happy for him. 30 00:01:42,080 --> 00:01:44,480 But we haven't been able to really click with any other 31 00:01:44,600 --> 00:01:47,520 physical therapists. There's a lot of misinformation 32 00:01:47,520 --> 00:01:50,560 out there and we'd rather not bring anyone on than somebody 33 00:01:50,560 --> 00:01:54,640 that we can't fully trust. However, Turning Point, we have 34 00:01:54,640 --> 00:01:58,640 actually been able to track one down on Instagram. 35 00:01:59,000 --> 00:02:03,520 His name is Doctor Andrew Moran and he's very knowledgeable. 36 00:02:03,680 --> 00:02:07,120 We've been watching his Instagram and his website for 37 00:02:07,120 --> 00:02:11,320 quite a while and figured why not give it a shot and see if we 38 00:02:11,320 --> 00:02:13,600 can work out some episodes with him. 39 00:02:13,600 --> 00:02:17,080 He was very generous with his time and willing and able to 40 00:02:17,080 --> 00:02:21,320 participate in our podcast. So now hopefully in the future, 41 00:02:21,320 --> 00:02:24,400 we'll have somebody to turn to when it comes down to running 42 00:02:24,400 --> 00:02:27,240 injuries. And today we're going to start 43 00:02:27,240 --> 00:02:28,680 with the first one. We're going to talk about 44 00:02:28,680 --> 00:02:31,400 tendinopathy and all that it entails. 45 00:02:31,400 --> 00:02:35,160 So without any further ado, I'm now going to play my 46 00:02:35,160 --> 00:02:38,400 conversation with Doctor Andrew Moran. 47 00:02:44,120 --> 00:02:47,000 All right, so I'm on here with Andrew Moran, doctor physical 48 00:02:47,000 --> 00:02:49,880 therapy and running coach at Strong Runner Racing. 49 00:02:49,880 --> 00:02:52,160 Andrew, thank you so much for joining me today. 50 00:02:52,160 --> 00:02:54,480 Thanks. For having me letty, I'm really 51 00:02:54,480 --> 00:02:56,640 excited to talk all all things tendinopathy. 52 00:02:57,120 --> 00:02:59,880 Yes, yay. So before we hop into that 53 00:02:59,960 --> 00:03:03,760 favorite topic of many runners, unfortunately by force, let's 54 00:03:03,760 --> 00:03:06,800 talk about you a little bit and talk about your experience and 55 00:03:06,800 --> 00:03:12,480 how you know so much about this. Yeah, it's, it's a kind of a fun 56 00:03:12,480 --> 00:03:16,240 story, maybe a little bit unique in regards to those that end up 57 00:03:16,240 --> 00:03:19,520 in the running scene or really the endurance scene as a whole. 58 00:03:20,640 --> 00:03:23,880 I myself, I grew up as a team sports athlete, so baseball, 59 00:03:23,880 --> 00:03:27,320 basketball, I grew up in Phoenix, AZ where you can kind 60 00:03:27,320 --> 00:03:30,560 of play sports all year round where now I live in Minnesota 61 00:03:30,560 --> 00:03:33,880 where seasons really have an impact on what you do. 62 00:03:33,960 --> 00:03:37,480 I think as a youth athlete, but especially as us as runners, it 63 00:03:37,480 --> 00:03:39,920 really changes the game and how you can go about training and 64 00:03:39,920 --> 00:03:41,240 the creativity you have to bring to that. 65 00:03:41,480 --> 00:03:44,240 That's me being glass half full for it gets really Dang cold in 66 00:03:44,240 --> 00:03:46,320 the winter and you have to figure out how to not like fall 67 00:03:46,320 --> 00:03:47,520 and slept on the ice when you're running. 68 00:03:48,680 --> 00:03:55,680 No, But yeah, for me it was more of a point in college when I had 69 00:03:55,680 --> 00:03:59,040 a couple bad injuries which lended me or lended itself to me 70 00:03:59,040 --> 00:04:02,960 getting involved in the rehab space and getting interested 71 00:04:02,960 --> 00:04:05,920 where I tore my one of my quadricep muscles. 72 00:04:05,920 --> 00:04:09,640 And then I also had an ACL tear. And it really forced me to think 73 00:04:09,640 --> 00:04:11,120 about how do I want to stay active? 74 00:04:11,120 --> 00:04:12,680 Do I want to do things differently? 75 00:04:13,120 --> 00:04:16,440 I'm looking for more of sub maximal ways to train and just 76 00:04:16,440 --> 00:04:19,839 stay active and have fun. And so I fell into the running 77 00:04:19,839 --> 00:04:25,120 scene after a 1/2 marathon that I did and I'll never forget it. 78 00:04:25,120 --> 00:04:27,400 It was a, a race where I, I finished it and I said that was 79 00:04:27,400 --> 00:04:29,120 the hardest thing I've ever done in my life. 80 00:04:29,240 --> 00:04:32,760 And I was so perplexed by it. I was like, I've trained hard, 81 00:04:32,760 --> 00:04:36,080 I've done competitive sports, played all the way in through 82 00:04:36,280 --> 00:04:38,520 competitively with baseball into college, right? 83 00:04:38,520 --> 00:04:40,720 So I've had some experience playing sport and working hard 84 00:04:40,720 --> 00:04:43,000 and whatnot. But there was something about 85 00:04:43,000 --> 00:04:45,640 this Dang half marathon and I couldn't quite figure it out. 86 00:04:46,560 --> 00:04:49,200 So that got me curious and I discovered that there's a whole 87 00:04:49,200 --> 00:04:51,200 world of running. So I fell into the running scene 88 00:04:51,200 --> 00:04:54,320 a little bit later in life. So I, I'd say I've been training 89 00:04:54,320 --> 00:04:56,560 consistently for about 8 years now. 90 00:04:57,600 --> 00:05:01,480 And really for me, the interests of what it means to train and 91 00:05:01,480 --> 00:05:04,440 stay healthy and have fun and enjoy the sport melded really 92 00:05:04,440 --> 00:05:06,600 well with my professional interests as a doctor, physical 93 00:05:06,600 --> 00:05:09,720 therapy. So that's where I, I kind of set 94 00:05:09,720 --> 00:05:12,880 out on this journey to learn as as much as I could and from the 95 00:05:12,880 --> 00:05:15,480 best in the, in the country and I'm in the United States. 96 00:05:16,560 --> 00:05:20,400 And, and so really that, that was the beginning of what I have 97 00:05:21,160 --> 00:05:23,360 seemingly created and just fell into. 98 00:05:23,560 --> 00:05:25,920 We're traveling around learning from some of the, the better 99 00:05:25,920 --> 00:05:29,160 people like Jay de Sherry and Brian Heiderscheit, Chris 100 00:05:29,160 --> 00:05:31,800 Johnson, some of these guys that have really gone before us and, 101 00:05:31,800 --> 00:05:36,640 and paved the way. So it's, it's a fun place to be. 102 00:05:36,640 --> 00:05:39,840 I I pinch myself all the time because it's I I love it so so 103 00:05:39,840 --> 00:05:42,160 much. But beyond that trying to stay 104 00:05:42,160 --> 00:05:45,920 active myself doing training. Mainly Rd. races but fell into 105 00:05:45,920 --> 00:05:47,960 the try scene a little bit lately which has been fun too. 106 00:05:47,960 --> 00:05:50,440 Just did my first half Iron Man recently in Chattanooga so it's 107 00:05:50,440 --> 00:05:53,560 been a fun space. Wow, congratulations. 108 00:05:53,760 --> 00:05:57,960 I love it when people make the jump from running to an Iron Man 109 00:05:57,960 --> 00:06:00,640 or half Iron Man or whatever 'cause you know it's a whole 110 00:06:00,640 --> 00:06:03,640 different challenge, especially for us that are busy, have full 111 00:06:03,640 --> 00:06:06,280 time jobs and everything. But I also like that you're 112 00:06:06,800 --> 00:06:10,960 passion comes from experience and your own injuries, etcetera. 113 00:06:10,960 --> 00:06:15,160 So we're in good hands here. And I asked you to suggest a 114 00:06:15,160 --> 00:06:20,000 topic for our runners and maybe you picked one that's the most 115 00:06:20,000 --> 00:06:22,880 common, I'm assuming injury. So maybe talk about the topic of 116 00:06:22,880 --> 00:06:25,200 tendonopathy, just to kind of give us an overview of what it 117 00:06:25,200 --> 00:06:27,720 is and how often this type of injury occurs. 118 00:06:28,760 --> 00:06:31,760 Yeah, when we were discussing this, I, I thought tendonopathy 119 00:06:31,760 --> 00:06:35,400 would be a great place to start, probably because it's my 120 00:06:35,400 --> 00:06:38,240 favorite. So I'm a little biased in 121 00:06:38,240 --> 00:06:39,840 clinic. This is the most common thing 122 00:06:39,840 --> 00:06:44,080 that I see by and large. And my, my caseload as a, as a 123 00:06:44,080 --> 00:06:48,680 physical therapist is probably 70 to 80% runners and then 20 to 124 00:06:48,680 --> 00:06:52,040 30% everything else. And I would say the majority of 125 00:06:52,040 --> 00:06:55,960 what I see is tendinopathy. So luckily or unfortunately, as 126 00:06:56,000 --> 00:06:58,840 I feel pretty well versed in this, but again, there's some 127 00:06:58,840 --> 00:07:01,200 great research that has been done. 128 00:07:01,760 --> 00:07:03,520 And that's what I really what I wanted to bring to you guys 129 00:07:03,520 --> 00:07:06,240 today and your, your listeners. Because there's some, some 130 00:07:06,240 --> 00:07:10,240 simple things that can go a very, very long way in terms of 131 00:07:10,240 --> 00:07:13,600 better understanding what it is and understanding how to go 132 00:07:13,600 --> 00:07:15,880 about working with it. Or when do you seek someone out 133 00:07:15,880 --> 00:07:19,120 or how do you go about all the moving parts that come with, 134 00:07:19,120 --> 00:07:22,120 with training, undoubtedly. So tendinopathy, right? 135 00:07:22,120 --> 00:07:26,520 It's this umbrella term that is relatively new in, in regards to 136 00:07:26,520 --> 00:07:28,680 injury. A lot of times we'll hear 137 00:07:28,680 --> 00:07:31,800 tendonitis, tendinosis kind of thrown around a little bit, 138 00:07:32,480 --> 00:07:35,800 which is all very good. Tendinopathy is a little bit 139 00:07:35,800 --> 00:07:39,160 more of an updated term where it describes overall just pain or 140 00:07:39,160 --> 00:07:42,360 disorder of the tendon. And the really the big rationale 141 00:07:42,360 --> 00:07:45,120 without getting chew into the weeds right away, is that we've 142 00:07:45,320 --> 00:07:49,480 a little bit better understood how tendinopathy is happening or 143 00:07:49,480 --> 00:07:52,680 what is going on. And what we know to be true is 144 00:07:52,680 --> 00:07:56,600 it's less, we think less of an inflammatory condition where we 145 00:07:56,600 --> 00:08:00,880 used to say tendonitis implies or implicates that the tendon is 146 00:08:00,880 --> 00:08:05,320 inflamed and has inflammatory properties that are driving the 147 00:08:05,320 --> 00:08:08,720 symptoms. Whereas now it seems like it's a 148 00:08:08,720 --> 00:08:12,600 little bit different. Tendinosis would describe more 149 00:08:12,600 --> 00:08:14,400 of a chronic state of inflammation. 150 00:08:14,800 --> 00:08:16,680 Now, some might hear that and they say, well, what? 151 00:08:16,680 --> 00:08:18,520 Why get bogged down by the terms, right? 152 00:08:18,520 --> 00:08:21,240 What's all kind of describing the same thing, but just in 153 00:08:21,240 --> 00:08:23,760 terms of when you're talking about this, the tendinopathy 154 00:08:23,760 --> 00:08:27,120 term more accurately describes what we believe to be going on 155 00:08:27,120 --> 00:08:30,680 at this point. So as far as you know, you and I 156 00:08:30,680 --> 00:08:34,440 and when you're out training, when you think about pain or, or 157 00:08:34,440 --> 00:08:36,640 a tendon that hurts, that's what we're talking about. 158 00:08:36,880 --> 00:08:39,760 So thinking about like your patellar tendon or right beneath 159 00:08:39,760 --> 00:08:44,800 your kneecap, your Achilles tendon, your glutamine tendon, a 160 00:08:44,840 --> 00:08:48,520 tibialis posterior tendon, those are the things, those are the 161 00:08:48,520 --> 00:08:51,280 areas that often times runners will get bogged down with when 162 00:08:51,280 --> 00:08:54,480 they have tendinopathy. OK. 163 00:08:54,480 --> 00:08:58,320 So then can you, I mean, obviously we all know chronic is 164 00:08:58,400 --> 00:09:00,280 ongoing. It's been going on for longer 165 00:09:00,280 --> 00:09:03,560 than a certain amount of time. But let's talk about how we 166 00:09:03,560 --> 00:09:06,560 would even know it's the tendon when it comes to these injuries. 167 00:09:07,960 --> 00:09:11,000 100% So that's, that's probably one of the most important things 168 00:09:11,000 --> 00:09:14,920 that people can take away from this talk today is understanding 169 00:09:15,040 --> 00:09:16,760 what am I working with here, right. 170 00:09:17,280 --> 00:09:22,320 Luckily for us, tendon has very, very clear hallmarks that we can 171 00:09:22,320 --> 00:09:24,840 understand better as runners as we're going out and training. 172 00:09:25,440 --> 00:09:29,880 And so the the really diagnostically to paint a little 173 00:09:29,880 --> 00:09:31,400 bit broader picture, then we'll go narrow. 174 00:09:31,840 --> 00:09:35,040 You could go get an MRI, right? But that's not going to be the 175 00:09:35,040 --> 00:09:38,360 preceding or the the best way to diagnose a tendon injury. 176 00:09:38,640 --> 00:09:41,520 It might show you something on an MRI, but really tendon 177 00:09:41,520 --> 00:09:45,200 related pain is best diagnosed from a loading standpoint. 178 00:09:45,760 --> 00:09:49,360 So how much you use a tendon or when you dose it with load or 179 00:09:49,360 --> 00:09:52,320 you put force through it, that's gonna really tell you if it's a 180 00:09:52,320 --> 00:09:54,560 more of a tendon related injury or something else? 181 00:09:54,880 --> 00:09:57,400 The most common example would be at the knee, right? 182 00:09:57,400 --> 00:10:00,360 Sometimes people will think, OK, is it patellar tendinopathy or 183 00:10:00,360 --> 00:10:03,280 is it patellofemoral or kneecap pain, something like that. 184 00:10:04,000 --> 00:10:07,040 So what we do, and this is what I'll do in clinic often times is 185 00:10:07,040 --> 00:10:09,120 we load it by doing a series of tests. 186 00:10:09,120 --> 00:10:13,400 Often times a hop right things that are very specific to 187 00:10:13,400 --> 00:10:17,000 runners, maybe a step down. And then often times you'll see 188 00:10:17,000 --> 00:10:19,840 very precisely it's right on the tendon. 189 00:10:19,840 --> 00:10:23,160 And if you were to think on yourself, even maybe if you're 190 00:10:23,160 --> 00:10:25,520 listening to this right now, if you were to go to the bottom of 191 00:10:25,520 --> 00:10:28,520 your kneecap, the patellar tendon runs right from the 192 00:10:28,520 --> 00:10:32,080 kneecap to what's called the tibial tuberosity or just a 193 00:10:32,080 --> 00:10:34,440 really kind of Bony prominence on the lower leg. 194 00:10:34,440 --> 00:10:37,400 The top part of the lower leg, it's really only about a couple 195 00:10:37,400 --> 00:10:40,720 few inches long, but you'll feel there's this very kind of 196 00:10:40,720 --> 00:10:44,080 narrow, maybe half an inch wide strip. 197 00:10:44,360 --> 00:10:48,520 That's the tendon, right? Tendon pain doesn't often refer 198 00:10:48,520 --> 00:10:51,600 or really ever refer outside of its distribution. 199 00:10:52,080 --> 00:10:54,680 So tendon pain is very, very specific. 200 00:10:55,080 --> 00:10:57,480 So that's just in terms of like you thinking about location and 201 00:10:57,480 --> 00:10:59,600 yourself. If you have an acre pain, how it 202 00:10:59,600 --> 00:11:01,880 behaves is probably even more important. 203 00:11:02,480 --> 00:11:05,200 The biggest thing to know with tendon related pain is that it 204 00:11:05,200 --> 00:11:08,640 has a warming up effect. So oftentimes in clinic when I'm 205 00:11:08,640 --> 00:11:11,160 talking with a runner or let's say we're working with someone 206 00:11:11,160 --> 00:11:13,720 in a coaching capacity and it's. Like I got this little niggle or 207 00:11:13,720 --> 00:11:17,040 ache and pain. You can diagnose or just better 208 00:11:17,040 --> 00:11:20,000 understand what this is even if you're not in person, because 209 00:11:20,000 --> 00:11:21,520 that's how consistent it presents. 210 00:11:22,080 --> 00:11:25,800 If you go out and execute a run, often times the pattern would be 211 00:11:26,040 --> 00:11:29,440 it starts out feeling a little stiff or sore, maybe achy, and 212 00:11:29,440 --> 00:11:31,720 it could be even having low levels of pain depending on the 213 00:11:31,720 --> 00:11:35,640 stage of the tendinopathy. But it undoubtedly warms up. 214 00:11:36,200 --> 00:11:38,320 So as you continue to run, it'll loosen up. 215 00:11:38,320 --> 00:11:39,920 You'll get out there. You'll be like, oh, OK, maybe 216 00:11:39,920 --> 00:11:42,400 I'm fine now to continue to execute the run. 217 00:11:42,680 --> 00:11:46,120 And then perhaps later in the day, in that afternoon or in 218 00:11:46,120 --> 00:11:48,680 that evening, you might have a spike in symptoms. 219 00:11:48,880 --> 00:11:50,960 It won't be anything too, too terrible. 220 00:11:51,240 --> 00:11:53,600 But nonetheless, you'll feel like, OK, now I just stiffened 221 00:11:53,600 --> 00:11:56,320 up a little bit after I've sat down or relaxed after my run 222 00:11:56,320 --> 00:11:59,280 later in the day. So this warming up phenomenon 223 00:11:59,560 --> 00:12:02,040 just about always takes place in tendinopathy. 224 00:12:02,440 --> 00:12:05,880 And then you'll have this like residual response later on in 225 00:12:05,880 --> 00:12:09,000 the day accompanied with very pinpoint symptoms. 226 00:12:09,000 --> 00:12:10,760 That's a good. Place to start in terms? 227 00:12:10,840 --> 00:12:12,240 Of understanding if it's tendinopathy. 228 00:12:14,000 --> 00:12:17,520 That's interesting, that kind of warming up effects. 229 00:12:17,520 --> 00:12:20,240 We also see that with plantar fasciitis, right? 230 00:12:20,240 --> 00:12:21,640 Except for we don't get that in the day. 231 00:12:21,640 --> 00:12:25,720 It's always worse than the mornings. 100% yes. 232 00:12:25,720 --> 00:12:28,080 And that's like the cousin of tendinopathy, right? 233 00:12:28,080 --> 00:12:32,080 Because it's this sort of fascia dense sort of tissue on the 234 00:12:32,080 --> 00:12:34,560 bottom of your foot. And a lot of times that can be 235 00:12:34,560 --> 00:12:37,600 super stiff in the morning because when we fall asleep, a 236 00:12:37,600 --> 00:12:40,200 lot of times you'll sleep and not in a stretched position. 237 00:12:40,200 --> 00:12:41,200 This is kind of an awkward angle. 238 00:12:41,200 --> 00:12:42,520 I'm showing you Letty on the video here. 239 00:12:42,520 --> 00:12:45,080 But if you think about like when you fall asleep, you're usually 240 00:12:45,080 --> 00:12:48,360 going to be pointing your toes. So that first few steps in the 241 00:12:48,360 --> 00:12:50,200 morning, you do the opposite of that. 242 00:12:50,200 --> 00:12:53,240 And that fascia underneath usually is like, oh, OK, that's 243 00:12:53,240 --> 00:12:55,800 new movement for me. Again, once you warm it up, it 244 00:12:55,800 --> 00:12:58,480 feels a little bit better. So it has some similarities in 245 00:12:58,480 --> 00:13:01,240 that regard to tendinopathy, even though it's what we call 246 00:13:01,240 --> 00:13:04,320 more of a fasciopathy. So but yeah, you're right. 247 00:13:04,320 --> 00:13:07,120 It's it's kind of in that like similar realm, so to speak. 248 00:13:07,960 --> 00:13:09,600 OK, wow. OK, great. 249 00:13:09,600 --> 00:13:13,320 So then let's talk a little bit about causes for tendinopathy. 250 00:13:13,320 --> 00:13:15,320 You were talking about overloading perhaps. 251 00:13:15,320 --> 00:13:20,440 So how does that happen? Yeah, usually it's too much, too 252 00:13:20,440 --> 00:13:25,800 soon, too quick type of a thing. And so this is where you could 253 00:13:25,800 --> 00:13:29,640 go on a macro level, you could go back to what we did early on 254 00:13:29,640 --> 00:13:33,920 in our youth and this is where the research gets interesting 255 00:13:33,920 --> 00:13:36,000 and will get practical again. I always like to zoom out big 256 00:13:36,000 --> 00:13:38,680 scale and then go narrow. Let's do that here again. 257 00:13:38,680 --> 00:13:42,200 So essentially what we know to be true with tendinopathy is if 258 00:13:42,200 --> 00:13:45,240 you're finding yourself doing a lot of jumping sports growing up 259 00:13:46,280 --> 00:13:48,920 or cutting, changing direction things, which by the way are 260 00:13:48,920 --> 00:13:51,920 phenomenal and I encourage all youth athletes. 261 00:13:51,920 --> 00:13:54,160 I have a few kids in my own newborn, very new. 262 00:13:54,160 --> 00:13:55,840 It's hard to think about him doing sports right now because 263 00:13:55,840 --> 00:13:58,560 he's so tiny. But that's one of the biggest 264 00:13:58,560 --> 00:14:01,880 gifts you can give to your kids is having them do ball sports 265 00:14:01,880 --> 00:14:05,400 for so many reasons, specifically bone health to 266 00:14:05,400 --> 00:14:07,000 reduce injury risk for bone health stuff. 267 00:14:07,000 --> 00:14:09,400 I know we're not talking I'm about that right now, but that's 268 00:14:09,400 --> 00:14:12,320 how you can kind of start to have some early signs of 269 00:14:12,320 --> 00:14:15,640 tendinopathy is if you really hit it hard early on. 270 00:14:16,000 --> 00:14:19,360 Now, the caveat there is it might not express itself until 271 00:14:19,360 --> 00:14:22,040 later in life and it might not ever express itself. 272 00:14:22,040 --> 00:14:25,240 If you can stay strong and your tendons are nice and resilient. 273 00:14:25,240 --> 00:14:28,480 And as long as you handle your, your training load fairly 274 00:14:28,480 --> 00:14:31,000 sensibly, meaning there's not too many spikes, which is hard 275 00:14:31,000 --> 00:14:35,040 at times, I know, but that's, that's the precursor, like all 276 00:14:35,040 --> 00:14:37,840 the background noise. Now when we get into running, 277 00:14:37,840 --> 00:14:40,120 usually later in life, or maybe you're a cross country runner 278 00:14:40,120 --> 00:14:42,280 and you're listening to this, then it would apply to you also. 279 00:14:42,560 --> 00:14:45,480 But a lot of runners might get into running maybe in adulthood 280 00:14:45,480 --> 00:14:47,560 when they kind of realize that, wait, there's something I can do 281 00:14:47,560 --> 00:14:48,920 here. And it's fun, it's competitive, 282 00:14:49,000 --> 00:14:52,320 there's community, la, la, la. That's where often times if 283 00:14:52,320 --> 00:14:56,040 there's too quick of a training spike, training spike meaning 284 00:14:56,760 --> 00:14:59,760 volume to much. So maybe your long run is a big 285 00:14:59,760 --> 00:15:04,280 jump or you take a look at your, your time training or weekly 286 00:15:04,280 --> 00:15:07,280 volume in terms of mileage and that's a little bit too spiked 287 00:15:07,280 --> 00:15:10,680 too quickly. That is usually what comes on. 288 00:15:11,680 --> 00:15:14,040 And and let's get a little bit more specific on training load 289 00:15:14,040 --> 00:15:18,640 for a second here, because with tendons a lot of times the most 290 00:15:18,640 --> 00:15:23,000 challenging thing you can do is things are are loads, I should 291 00:15:23,000 --> 00:15:27,640 say that are faster, faster loads are more loads to the 292 00:15:27,640 --> 00:15:30,560 tendon. So to make that practical, it 293 00:15:30,560 --> 00:15:33,280 would be more of an interval session or an interval session 294 00:15:33,280 --> 00:15:36,600 accompanied by hills. That's probably gonna be more 295 00:15:36,600 --> 00:15:40,640 load than like a long run, for instance, if a long run is easy. 296 00:15:41,040 --> 00:15:44,560 But regardless, spiking a training volume in any of those 297 00:15:44,560 --> 00:15:47,440 regards where maybe your tendons aren't very prepared for that 298 00:15:47,440 --> 00:15:51,280 load, that's what's typically gonna cause it to be predisposed 299 00:15:51,280 --> 00:15:53,600 to a tendinopathy. Or it could just bring it on 300 00:15:53,600 --> 00:15:56,680 with symptoms at that point. OK, wow. 301 00:15:57,200 --> 00:16:02,000 And then so once we realized that, obviously I've heard about 302 00:16:02,000 --> 00:16:04,920 and talked to other people about the downward spiral, right? 303 00:16:04,920 --> 00:16:09,040 If you experience that, are you supposed to back off completely 304 00:16:09,040 --> 00:16:13,160 or kind of just do a little bit at a time less? 305 00:16:13,880 --> 00:16:16,160 Yep, I'm so glad you asked that question because it's a really 306 00:16:16,160 --> 00:16:17,960 good one and there's a good answer for it. 307 00:16:17,960 --> 00:16:22,960 Like in terms of it's good news, it's it's with tendinopathy. 308 00:16:23,480 --> 00:16:25,000 I always like to try to phrase this. 309 00:16:25,040 --> 00:16:29,360 Carefully, it's one that you don't want to train through, but 310 00:16:29,360 --> 00:16:34,600 you can train with, right? You can train with tendinopathy 311 00:16:34,600 --> 00:16:36,960 without landing yourself in a worse position. 312 00:16:37,680 --> 00:16:42,120 Sometimes it takes if you have a maybe a fairly reactive tendon, 313 00:16:42,400 --> 00:16:44,680 sometimes you have to tinker with your load a little bit like 314 00:16:44,680 --> 00:16:46,520 we described. Maybe if you have a patellar 315 00:16:46,520 --> 00:16:50,280 tendinopathy, we know that going downhill increases the loads of 316 00:16:50,280 --> 00:16:52,480 the knee significantly. So you might have to think, 317 00:16:52,480 --> 00:16:53,840 well, OK, maybe I'll hit the trail. 318 00:16:53,840 --> 00:16:56,560 Like when I, when I say trail in Minnesota, it's like a paved, 319 00:16:56,560 --> 00:16:59,080 just straight trail for some people can be like up and down 320 00:16:59,080 --> 00:17:01,960 in the mountains. So maybe more like a little more 321 00:17:02,600 --> 00:17:05,319 level terrain, right? That's ways you can modify your, 322 00:17:05,319 --> 00:17:08,800 your load specifically depending on the, the point in the body. 323 00:17:08,800 --> 00:17:10,400 If it's hip, if it's knee, it's if it's foot. 324 00:17:11,240 --> 00:17:14,640 So with tendinopathy, a lot of times you can stay training 325 00:17:14,680 --> 00:17:19,079 regardless as long as you can train at a level that's not 326 00:17:19,079 --> 00:17:22,400 spiking your symptoms. And when I say symptoms think 327 00:17:22,400 --> 00:17:26,119 like on a zero to 10 scale, maybe three to four out of 10 or 328 00:17:26,119 --> 00:17:28,319 less. And we're seeing that nice warm 329 00:17:28,319 --> 00:17:30,960 up phenomenon and it's not getting worse later in the day. 330 00:17:30,960 --> 00:17:34,040 Within 24 hours, you know you're managing it pretty well. 331 00:17:34,560 --> 00:17:36,640 So a lot of times with tendinopathy, you can rehab it 332 00:17:36,640 --> 00:17:39,800 and do the right things while avoiding the negatives, which 333 00:17:39,800 --> 00:17:43,240 would be doing doing too much. So that's the encouraging thing 334 00:17:43,240 --> 00:17:45,680 for runners a lot of times if you have some early signs of 335 00:17:45,680 --> 00:17:47,640 tendinopathy. It doesn't mean you have to hit 336 00:17:47,640 --> 00:17:50,000 the brakes. I like that. 337 00:17:50,000 --> 00:17:52,480 I mean, I guess we all like that because as runners, you know, 338 00:17:52,480 --> 00:17:55,360 it's really hard for us to back off and quit training for 339 00:17:55,360 --> 00:17:57,720 whatever marathon as the load increases. 340 00:18:00,760 --> 00:18:05,560 All right, so now from our sponsor, Tifosi Optics. 341 00:18:05,640 --> 00:18:09,480 Tifosi, the brand name is the Italian word for superfan, and 342 00:18:09,480 --> 00:18:11,440 that's who they make the eyewear for. 343 00:18:11,440 --> 00:18:13,720 Their slogan is live your passion. 344 00:18:14,000 --> 00:18:17,200 They have a ton of different glasses on their website, which 345 00:18:17,200 --> 00:18:21,280 are anything from polarized sunglasses to bike riding 346 00:18:21,280 --> 00:18:23,880 sunglasses, really cool designs. 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That's RUNUR dot run and use 376 00:19:56,160 --> 00:20:01,960 code RUNUR under score MRP 2420% off. 377 00:20:04,360 --> 00:20:06,840 So let's just backtrack a little bit. 378 00:20:06,840 --> 00:20:11,040 Perhaps you can tell us about some self tests or home tests 379 00:20:11,040 --> 00:20:14,880 that we can do ourselves if we have pain to make sure it's not 380 00:20:14,880 --> 00:20:17,280 quote UN quote runner's knee or whatever else. 381 00:20:17,280 --> 00:20:19,800 It could be. So, so that way, you know, we 382 00:20:19,800 --> 00:20:22,440 can avoid having to go to the doctor because we're all busy. 383 00:20:23,800 --> 00:20:27,400 We are all busy, yes. So this is where you know, I, I 384 00:20:27,400 --> 00:20:30,720 would be remiss if I didn't throw the disclaimer out that 385 00:20:30,720 --> 00:20:32,880 it's always going to be specific to the individual, right? 386 00:20:34,080 --> 00:20:37,520 So if these will help guide you and these are some of the things 387 00:20:37,520 --> 00:20:39,760 that I do in clinic. However, sometimes it's nice to 388 00:20:39,760 --> 00:20:42,720 have a sounding board, maybe even a running buddy who's had 389 00:20:42,720 --> 00:20:44,440 something go on like this before. 390 00:20:45,000 --> 00:20:47,840 If you really aren't quite sure, then go find APT who's 391 00:20:47,840 --> 00:20:50,040 experienced with runners just that'll be good to have in your 392 00:20:50,040 --> 00:20:52,880 corner regardless or find someone on you know that, you 393 00:20:52,880 --> 00:20:57,120 know, But that being said, right, when we look at the most 394 00:20:57,120 --> 00:21:00,280 common areas for tendinopathy, thinking like the Achilles 395 00:21:00,280 --> 00:21:05,400 tendon, there's really no better way to look at dosing it to test 396 00:21:05,400 --> 00:21:09,600 it than doing a single leg hop. And so, and for instance, maybe 397 00:21:09,600 --> 00:21:11,960 if we use that example, pulling that string a little bit, let's 398 00:21:11,960 --> 00:21:14,640 say I have, I'm thinking I might have Achilles tendinopathy. 399 00:21:14,840 --> 00:21:17,840 It's very pinpoint. It's stiff in the morning. 400 00:21:17,840 --> 00:21:21,120 It, it, it warms up on a run. All that same pattern is going 401 00:21:21,120 --> 00:21:23,520 on. What I might do in clinic is I 402 00:21:23,520 --> 00:21:25,760 might have that runner start with, let's see if we can do a 403 00:21:25,760 --> 00:21:28,520 double leg calf raise without causing symptoms or listening 404 00:21:28,520 --> 00:21:30,960 any symptoms. So that would just be standing, 405 00:21:30,960 --> 00:21:32,280 right, going up on your tip toes. 406 00:21:32,280 --> 00:21:34,560 I'd have them do that and look at how high they can get, if 407 00:21:34,560 --> 00:21:38,240 there's good symmetry side to side or not, right. 408 00:21:38,440 --> 00:21:41,480 If that all goes pretty well and or maybe they have very low 409 00:21:41,480 --> 00:21:44,360 level symptoms and they're like, yeah, this is feeling OK, then 410 00:21:44,360 --> 00:21:46,840 I'll kind of push it further. Then we'll do maybe a weight 411 00:21:46,840 --> 00:21:48,720 shift to where I'd have them go up on two. 412 00:21:48,720 --> 00:21:51,480 Then I'd have them weight shift over to the involved side and 413 00:21:51,480 --> 00:21:54,720 slowly lower on that side. If that goes well, then we go to 414 00:21:54,720 --> 00:21:59,040 single leg, a single leg calf raise and do that for at least 415 00:21:59,040 --> 00:22:00,960 10 repetitions just to demonstrate. 416 00:22:00,960 --> 00:22:02,480 Do they have some strength there? 417 00:22:02,480 --> 00:22:06,040 And then how does that level of load aggravate or not aggravate 418 00:22:06,040 --> 00:22:09,080 the tendon? If all of that keeps going well, 419 00:22:09,360 --> 00:22:11,320 then we say great, you're ready to test some hops. 420 00:22:12,160 --> 00:22:16,080 The cool part about hops are, and this is just that, the hops 421 00:22:16,080 --> 00:22:19,400 just being like landing and, and taking off and landing on the 422 00:22:19,400 --> 00:22:22,000 same leg. The cool part about hopping is 423 00:22:22,000 --> 00:22:25,720 that we know that if you can perform a single leg hop, that 424 00:22:25,720 --> 00:22:28,200 is more than the loads that you're going to be dosed with 425 00:22:28,200 --> 00:22:32,080 from a running standpoint. So in clinic, it gives us a ton 426 00:22:32,080 --> 00:22:35,720 of upside and confidence if a runner can perform a single leg 427 00:22:35,720 --> 00:22:38,760 hop because we know that that load is going to be greater than 428 00:22:39,160 --> 00:22:42,040 more of us is skipping motion of running from from one leg to the 429 00:22:42,040 --> 00:22:46,240 next, if that makes sense. So if they're able to progress 430 00:22:46,240 --> 00:22:49,520 through a double leg calf raise, go to a single leg calf raise, 431 00:22:49,520 --> 00:22:52,280 then we try some hopping, which would be double leg hopping. 432 00:22:52,600 --> 00:22:54,760 And then if we can get to that Holy Grail of single leg 433 00:22:54,760 --> 00:22:56,800 hopping, we know we're in a really, really good spot. 434 00:22:58,480 --> 00:23:00,400 OK. That's, that's super helpful. 435 00:23:00,400 --> 00:23:02,960 So that's for the Achilles one, right? 436 00:23:02,960 --> 00:23:04,600 Or is that also for the knee one? 437 00:23:05,520 --> 00:23:08,080 It does have a lot of carryover. I would do a couple other things 438 00:23:08,080 --> 00:23:11,360 to infuse in there with the knee for the patellar tendon, but a 439 00:23:11,360 --> 00:23:13,840 lot of times I'll use single like hopping as kind of a nice 440 00:23:13,840 --> 00:23:17,320 outcome measured overall test for running in itself because 441 00:23:17,320 --> 00:23:21,360 it's very applicable to runners. For the knee itself, I would 442 00:23:21,360 --> 00:23:25,160 also look at doing some sort of step down because that's going 443 00:23:25,160 --> 00:23:26,880 to challenge that knee a little bit more. 444 00:23:27,480 --> 00:23:31,280 So I would do a like a six inch, which is typically 6 stair 445 00:23:31,280 --> 00:23:33,040 height, so six or seven inches or so. 446 00:23:33,240 --> 00:23:36,280 I would have someone do a runner do a nice controlled step down 447 00:23:36,280 --> 00:23:39,480 while keeping all of the leg on the symptomatic side and then 448 00:23:39,480 --> 00:23:41,520 coming back up and doing a series of those. 449 00:23:41,880 --> 00:23:44,640 If they can do that with pretty good control and without too 450 00:23:44,640 --> 00:23:48,080 much of A spike in symptoms, then we might have them try like 451 00:23:48,080 --> 00:23:52,160 a squat jump, so going a little bit deeper into a knee bend to 452 00:23:52,160 --> 00:23:56,600 better dose the patellar tendon. And if that goes well, same 453 00:23:56,600 --> 00:23:58,960 thing, single leg hop with a little bit more knee bend. 454 00:23:58,960 --> 00:24:01,840 And if all of those go well, then we're we're pretty much in 455 00:24:01,840 --> 00:24:03,760 a good spot to try out some running or do a return to run 456 00:24:03,760 --> 00:24:05,880 program. OK, awesome. 457 00:24:05,880 --> 00:24:09,480 And any other areas where you see runners experience 458 00:24:09,480 --> 00:24:12,280 tendonitis? Or is it mostly the ankle and 459 00:24:12,320 --> 00:24:14,920 and knee? Those are gonna be the most 460 00:24:14,920 --> 00:24:17,600 common, however. Yeah, you can have a gluteal 461 00:24:17,600 --> 00:24:20,600 tendinopathy, which is essentially just the side of 462 00:24:20,600 --> 00:24:22,120 your hip. If you ever think about glute 463 00:24:22,120 --> 00:24:25,480 meat exercises, the the monster walks, everyone's favorite like 464 00:24:25,480 --> 00:24:26,560 band work. Those right. 465 00:24:26,840 --> 00:24:28,560 That was some sarcasm if you didn't catch it. 466 00:24:28,960 --> 00:24:31,560 Those are just grueling and painful, but we do them right. 467 00:24:32,840 --> 00:24:36,000 So there, that's where. That can be another spot that 468 00:24:36,000 --> 00:24:39,880 can be fairly tricky or finicky because it really deals with how 469 00:24:40,040 --> 00:24:42,640 how much control can you have through your hips. 470 00:24:42,680 --> 00:24:45,040 A lot of times you hear runners describe like, oh, I feel like 471 00:24:45,040 --> 00:24:47,160 my hips drop or they're off or something. 472 00:24:47,840 --> 00:24:50,640 Usually during the late stages of a long run or during a 473 00:24:50,640 --> 00:24:54,040 marathon, you'll feel that way. Well, a lot of times what what I 474 00:24:54,040 --> 00:24:57,800 always hear people describe is my race, my race finish photos 475 00:24:57,800 --> 00:25:00,200 look so bad, right? And it's like, of course you do, 476 00:25:00,200 --> 00:25:03,480 you just ran like 20 at that .26, probably not finishing the 477 00:25:03,480 --> 00:25:05,520 .2 yet miles. Of course things feel like 478 00:25:05,520 --> 00:25:07,320 fatigue. So I try to give some people 479 00:25:07,320 --> 00:25:10,240 some slack, but that's where usually you'll see maybe 480 00:25:10,240 --> 00:25:12,800 mechanics get a little looser towards the later stages of a 481 00:25:12,800 --> 00:25:15,480 run. So in essence, your glutamide 482 00:25:15,480 --> 00:25:17,920 tendinopathy, where I'm getting at here, your glutamine 483 00:25:17,920 --> 00:25:20,480 tendinopathy is if you have a lack of control and maybe your 484 00:25:20,480 --> 00:25:24,720 opposite side hip wants to drop significantly relative to your 485 00:25:24,720 --> 00:25:28,240 involved side, that's where you can experience some discomfort 486 00:25:28,240 --> 00:25:30,400 there too. So again, I would go back to a 487 00:25:30,400 --> 00:25:33,040 single leg hop 'cause that's gonna mimic it fairly well. 488 00:25:33,320 --> 00:25:37,880 I'll have people do a full, I'll call them like the long lever 489 00:25:37,880 --> 00:25:41,400 side planks to where you're on your side with like a side plank 490 00:25:41,400 --> 00:25:45,000 position and trying to hold that while lifting the top leg. 491 00:25:45,000 --> 00:25:48,920 That's a really good way to dose the glutamine muscle and into 492 00:25:48,920 --> 00:25:52,240 the glutamine tendon. Those are a couple other 493 00:25:52,240 --> 00:25:53,960 precursors. And then again, we'll go back to 494 00:25:53,960 --> 00:25:57,280 the single leg hop. OK, so the single leg hop is 495 00:25:57,280 --> 00:26:00,680 something I want to get back to you after asking you this next 496 00:26:00,680 --> 00:26:02,240 question. Let's talk a little bit about 497 00:26:02,240 --> 00:26:06,160 prognosis of tendinopathy, how long the healing? 498 00:26:06,320 --> 00:26:07,840 Obviously everybody is different, right? 499 00:26:07,840 --> 00:26:11,240 But if you just have it, how long of a recovery time do you 500 00:26:11,240 --> 00:26:13,320 have to expect? Yeah. 501 00:26:13,320 --> 00:26:15,320 So obviously there's going to be variation there. 502 00:26:15,880 --> 00:26:17,560 To start out, age does play a role. 503 00:26:18,160 --> 00:26:20,600 And the good thing about I think age with runners is that we can 504 00:26:20,600 --> 00:26:22,080 train pretty much forever, right? 505 00:26:22,080 --> 00:26:24,000 A lot of times the runners that I'm working with either in 506 00:26:24,000 --> 00:26:26,600 clinic or from a coaching standpoint, it's hey, look, I 507 00:26:26,600 --> 00:26:29,360 want to run forever as long as I can keep moving and it's like a 508 00:26:29,360 --> 00:26:32,040 healthy thing for me. I'm in this for the long haul. 509 00:26:32,040 --> 00:26:36,520 So the good news is there's a lot of upside here with in 510 00:26:36,520 --> 00:26:38,480 regards to getting better from a tendinopathy. 511 00:26:40,320 --> 00:26:43,920 That being said, if someone is in there, you know, 1617 years 512 00:26:43,920 --> 00:26:46,240 old, they're probably going to bounce back quicker if they're a 513 00:26:46,240 --> 00:26:49,200 cross country athlete as opposed to maybe someone who's 65. 514 00:26:50,040 --> 00:26:52,880 So there's a little bit of layering there to consider. 515 00:26:53,160 --> 00:26:55,600 The other thing which is even more important from my 516 00:26:55,600 --> 00:26:57,480 experience, is how early you catch it. 517 00:26:58,440 --> 00:27:01,000 So if you're finding yourself having some discomfort and some 518 00:27:01,000 --> 00:27:05,560 pain, if you can catch it within the first, maybe one to 2-3 519 00:27:05,560 --> 00:27:08,000 weeks, perhaps it goes so much faster. 520 00:27:08,240 --> 00:27:11,240 So at that point, we're probably looking at maybe a month, four 521 00:27:11,240 --> 00:27:13,840 to six weeks to where you can be on the other end of it. 522 00:27:14,720 --> 00:27:18,240 And that's where you can catch the negative stimuli and include 523 00:27:18,240 --> 00:27:20,680 enough of the positive stimuli to leave it in the rear view 524 00:27:20,680 --> 00:27:23,080 mirror. If it's been going on for a 525 00:27:23,080 --> 00:27:24,800 while. And this is the pattern 526 00:27:24,800 --> 00:27:27,600 sometimes that I'll see and clinic, it's, you know, I felt 527 00:27:27,600 --> 00:27:29,520 like it was fine. It kind of reared its head 528 00:27:29,520 --> 00:27:32,920 during my last marathon training cycle, but and it was really 529 00:27:32,920 --> 00:27:35,240 annoying maybe in peak phase of training when I was really 530 00:27:35,240 --> 00:27:38,640 trying to get some key tempo runs in and Polish off some race 531 00:27:38,640 --> 00:27:40,720 pace work. And it's like, okay, I'll taper 532 00:27:41,080 --> 00:27:43,080 and then I'll raise and hopefully doesn't bother me. 533 00:27:43,080 --> 00:27:46,200 If you find yourself being in that kind of paradigm and it 534 00:27:46,200 --> 00:27:48,800 happens multiple training cycles in a row, then it could take 535 00:27:48,800 --> 00:27:51,320 longer, right? So instead of like a four to six 536 00:27:51,320 --> 00:27:54,680 week type of prognosis, you might be looking at double that. 537 00:27:54,920 --> 00:27:56,600 So you might be looking at a two to three month. 538 00:27:56,600 --> 00:27:59,040 If you're all in working on doing the right things, it might 539 00:27:59,040 --> 00:28:02,240 take that long. So it really just depends how 540 00:28:02,280 --> 00:28:05,320 much you would be in for working on it and how open you are to 541 00:28:05,320 --> 00:28:07,120 rearranging your training program. 542 00:28:07,120 --> 00:28:09,520 That's really what's gonna dictate how fast it would go. 543 00:28:10,120 --> 00:28:12,520 Yeah, yeah. And I mean, key, key for all the 544 00:28:12,520 --> 00:28:15,200 listeners here is also do not ignore the niggle, right? 545 00:28:15,200 --> 00:28:17,720 If you feel a niggle, then maybe look into it because then you 546 00:28:17,720 --> 00:28:20,840 can get in a path of healing. All right. 547 00:28:20,840 --> 00:28:24,440 So thank you for that. And you know, let me go back to 548 00:28:24,440 --> 00:28:28,800 that single race hop in order to avoid tendonitis and you know, 549 00:28:28,800 --> 00:28:30,920 just in general injuries from your experience. 550 00:28:31,160 --> 00:28:34,600 It seems like the single leg. Hop would be something that we 551 00:28:34,600 --> 00:28:38,960 should maybe implement into our lives just to keep us strong. 552 00:28:38,960 --> 00:28:42,280 Is is that am I on to something here or is that not true? 553 00:28:42,600 --> 00:28:45,200 I like, I like where you're headed, but this is this is 554 00:28:45,200 --> 00:28:48,720 maybe a little bit of my personal experience as a PT. 555 00:28:49,280 --> 00:28:51,720 And then from a coaching standpoint too, you see this all 556 00:28:51,720 --> 00:28:54,720 the time of when is the right time to do plyos, right? 557 00:28:54,720 --> 00:28:56,680 Because a single like hop is by definition going to be a 558 00:28:56,680 --> 00:28:59,680 plyometric. And this is where I think you 559 00:28:59,680 --> 00:29:02,240 look at the Gen. pop where everybody, we want everyone to 560 00:29:02,240 --> 00:29:05,360 have good health. We want people to have reactive 561 00:29:05,360 --> 00:29:08,960 strength, right? Plyos are so fantastic for so 562 00:29:08,960 --> 00:29:12,600 many reasons, great for bone health, again, like all those 563 00:29:12,600 --> 00:29:15,320 very good things. Now with runners, we're in a 564 00:29:15,320 --> 00:29:17,400 little bit different category. So we would kind of take that 565 00:29:17,400 --> 00:29:20,000 for general population, put that on the shelf for a second for 566 00:29:20,000 --> 00:29:21,400 runners. We're getting a ton of 567 00:29:21,400 --> 00:29:24,560 plyometric load every single day we're running, right. 568 00:29:25,000 --> 00:29:28,560 And so we kind of have to think about that in regards to how 569 00:29:28,560 --> 00:29:32,000 much load should we be dosing ourselves with and when is it 570 00:29:32,000 --> 00:29:35,120 constructive and when is it no longer constructive. 571 00:29:35,880 --> 00:29:38,360 And So what I'll do often times from a programming standpoint is 572 00:29:38,360 --> 00:29:41,640 I'll find myself telling runners like, hey, let's let's maybe 573 00:29:41,640 --> 00:29:45,800 incorporate some plyos on a lighter basis in the base phase 574 00:29:45,800 --> 00:29:49,360 of training or even in the off season to really kind of pre 575 00:29:49,360 --> 00:29:52,200 treat and develop some resilience and capacity. 576 00:29:52,520 --> 00:29:55,600 And then we'll shift into more of what's heavy slow resistance, 577 00:29:55,600 --> 00:29:58,440 which is where the bread and butter is for tendinopathy. 578 00:29:58,560 --> 00:30:02,040 So thinking like heavier and slow and controlled exercises 579 00:30:02,040 --> 00:30:05,840 and lifts and movements. And then we might resume some 580 00:30:05,840 --> 00:30:10,120 plyometrics after your race. So let's say you just race your 581 00:30:10,120 --> 00:30:12,960 marathon that first week. You don't want to even like 582 00:30:12,960 --> 00:30:14,480 move. You're thinking about like, OK, 583 00:30:14,480 --> 00:30:15,680 I, I don't even want to look outside. 584 00:30:15,680 --> 00:30:17,800 And then you start to get the bug again, like, OK, I, I think 585 00:30:17,800 --> 00:30:18,720 it's time to get out there again. 586 00:30:19,080 --> 00:30:22,400 Usually that second to third week, we'll start to say, great, 587 00:30:22,400 --> 00:30:24,320 let's let's do our first return to run. 588 00:30:24,320 --> 00:30:26,560 Just kind of go out there, do something loose, unstructured 589 00:30:26,560 --> 00:30:28,440 almost. And then we'll try to do a 590 00:30:28,440 --> 00:30:32,040 little bit more heavier lifting in plyometrics while training is 591 00:30:32,040 --> 00:30:34,360 more loose. So there is some intelligence 592 00:30:34,360 --> 00:30:37,040 that you can layer in with when you dose plyometrics to make 593 00:30:37,040 --> 00:30:38,600 sure you don't lose that capacity. 594 00:30:38,880 --> 00:30:41,920 But then go been going back to that runner who you know, 595 00:30:41,920 --> 00:30:44,600 they're they're doing some interval work, some tempos. 596 00:30:44,600 --> 00:30:47,480 We we don't want to necessarily be layering in plyos when the 597 00:30:47,480 --> 00:30:49,800 race is in four to five weeks, right? 598 00:30:49,960 --> 00:30:51,720 Because you really need to make sure you're not doing anything 599 00:30:51,720 --> 00:30:55,000 to tip the scales in an unfavorable way to land yourself 600 00:30:55,000 --> 00:30:56,560 having some symptoms and some pain. 601 00:30:56,760 --> 00:30:57,960 Does that kind of make sense? Yeah. 602 00:30:58,320 --> 00:30:59,720 Makes sense. And it looks like we're being 603 00:30:59,720 --> 00:31:01,560 back to a heavy strength training. 604 00:31:01,560 --> 00:31:04,240 So you know, for my last question, I want to ask you what 605 00:31:04,240 --> 00:31:08,640 are your top 3-4, whatever favorite exercises for runners 606 00:31:08,640 --> 00:31:12,160 to do in order to stay strong and what muscles are we working 607 00:31:12,160 --> 00:31:14,840 with here in order to avoid tendon injuries? 608 00:31:15,640 --> 00:31:17,120 Yep. And I that's a great question. 609 00:31:17,120 --> 00:31:19,560 So I have to go back to the study and I believe it was 20, 610 00:31:19,880 --> 00:31:24,720 2012 with Dorn's group where they looked at the the three 611 00:31:24,720 --> 00:31:28,720 main areas that as runners, as distance runners that we're 612 00:31:28,720 --> 00:31:31,160 going to be dosing ourselves with from a loading standpoint 613 00:31:31,160 --> 00:31:33,480 the most. And what we learned was that it 614 00:31:33,480 --> 00:31:35,560 was the calf muscle complex was number one. 615 00:31:36,000 --> 00:31:39,000 When we break that down even further, it's the Soleus muscle 616 00:31:39,000 --> 00:31:41,400 and then the medial head of the gastroc and then the lateral 617 00:31:41,400 --> 00:31:43,840 head of the gastroc. All three of those would be the 618 00:31:43,840 --> 00:31:48,840 calf muscle complex. That would be #1 And so this is 619 00:31:48,840 --> 00:31:51,520 where when I'm programming strikes for runners, I, you 620 00:31:51,520 --> 00:31:53,680 know, I'll, if my, any of my peeps are listening to this, 621 00:31:53,680 --> 00:31:56,880 they'll laugh because every single week it's a calf raise or 622 00:31:56,880 --> 00:32:01,440 it's a heavy soleus exercise. And just on repeat, they're 623 00:32:01,440 --> 00:32:04,520 never going anywhere just because it's undoubtedly the 624 00:32:04,520 --> 00:32:07,640 most important thing you can do. And really, it's just about 625 00:32:07,760 --> 00:32:10,960 heavy isometrics. Tendons love isometrics. 626 00:32:11,200 --> 00:32:14,880 And then also the, the slowness of the movement is very, very 627 00:32:14,880 --> 00:32:18,760 key to and to keep it simple, a lot of times a three seconds up, 628 00:32:19,200 --> 00:32:22,640 a pause in the middle, and then a three seconds down is a really 629 00:32:22,640 --> 00:32:24,560 good way to think about doing your strength training from a 630 00:32:24,560 --> 00:32:27,680 tendon standpoint. So if you're doing a calf raise, 631 00:32:27,920 --> 00:32:31,040 quite literally, you would line up and do up with slow and 632 00:32:31,040 --> 00:32:32,920 controlled manner up for three seconds. 633 00:32:33,200 --> 00:32:36,160 I'll have them hold for two or three seconds and then slowly 634 00:32:36,160 --> 00:32:39,760 back down for three seconds. Tendons absolutely love that and 635 00:32:39,760 --> 00:32:41,440 eat that up. It's like medicine for it. 636 00:32:42,440 --> 00:32:45,400 So that's, that's probably one of my favorites for the Achilles 637 00:32:45,400 --> 00:32:48,480 tendon, bearing in mind that the capsules are complex through the 638 00:32:48,480 --> 00:32:51,120 Achilles is the number one area that we're going to be loading 639 00:32:51,120 --> 00:32:55,760 ourselves when we go on run. The the second would be the 640 00:32:55,760 --> 00:32:58,120 quadriceps. So following in line with that 641 00:32:58,120 --> 00:33:01,920 study in 2012, we know the quads are #2 in terms of the biggest 642 00:33:01,920 --> 00:33:05,920 or the second biggest task and responsibility with absorbing 643 00:33:05,920 --> 00:33:07,920 load. And so then we'll be going to 644 00:33:07,920 --> 00:33:11,480 open up the the possibility for so many quad exercises. 645 00:33:12,000 --> 00:33:14,640 What I like to do is I'll typically find myself 646 00:33:14,640 --> 00:33:21,240 gravitating towards a some sort of squat variation or I really 647 00:33:21,240 --> 00:33:23,560 love a good like heavy loaded step up. 648 00:33:24,520 --> 00:33:27,160 And so to be more conservative, since we're talking about 649 00:33:27,160 --> 00:33:30,200 tendinopathy, I would say a step up would be a no brainer. 650 00:33:30,960 --> 00:33:34,240 And before you think step up sounds like so lame and like 651 00:33:34,240 --> 00:33:37,440 you're going to an aerobics class, this is how it should be 652 00:33:37,440 --> 00:33:41,280 different where if you can grab a step that's anywhere from 8 to 653 00:33:41,280 --> 00:33:45,960 10 inches and you hold on to some heavier weights so both 654 00:33:45,960 --> 00:33:47,520 hands are holded. So for instance, if I were to 655 00:33:47,520 --> 00:33:50,880 make this challenging, I have no symptoms right now, I might go 656 00:33:50,880 --> 00:33:54,760 up to the dumbbell rack and grab maybe some 40s or some 50s. 657 00:33:54,760 --> 00:33:59,040 So right away that's going to be 80 to 100 lbs plus body weight. 658 00:33:59,360 --> 00:34:00,760 That's how you're, you're, you can tell. 659 00:34:00,760 --> 00:34:03,240 OK, I'm doing some work here and I'm having to force my 660 00:34:03,240 --> 00:34:07,360 quadriceps to really or be challenged, but then also 661 00:34:07,360 --> 00:34:09,719 control that load. And we know for sure the 662 00:34:09,719 --> 00:34:13,120 patellar tenant is getting a really good dose of load there. 663 00:34:13,880 --> 00:34:16,560 So you can make a step up really, really challenging. 664 00:34:16,560 --> 00:34:19,480 Now, granted, if you hear this for the first time, I would 665 00:34:19,480 --> 00:34:21,960 start with just, hey, maybe I, maybe I try this body weight for 666 00:34:21,960 --> 00:34:23,440 a little bit just to see how that feels. 667 00:34:23,679 --> 00:34:26,320 Maybe I grab some 10, some fifteens and work your way up. 668 00:34:27,080 --> 00:34:29,120 But that's a really good one for the for the knee and for the 669 00:34:29,120 --> 00:34:32,440 quadriceps specifically. And then for the gluten meat, a 670 00:34:32,440 --> 00:34:35,159 lot of times I'll go back to that side plank variation that I 671 00:34:35,159 --> 00:34:38,560 love. So doing a full side plank and 672 00:34:38,560 --> 00:34:40,840 doing that for holds to give it isometric load. 673 00:34:41,199 --> 00:34:43,320 And then I also love banded variation. 674 00:34:43,320 --> 00:34:48,440 So single leg hydrants, banded toe taps where you're really 675 00:34:48,440 --> 00:34:51,280 focusing on the stance leg being the challenging one. 676 00:34:52,040 --> 00:34:54,920 Those are really, really good alongside that monster walk. 677 00:34:54,920 --> 00:34:57,080 So sidesteps with the band around your knees. 678 00:34:57,080 --> 00:34:58,240 Those are all really good ones too. 679 00:34:58,920 --> 00:34:59,920 OK, awesome. Thank you. 680 00:34:59,960 --> 00:35:03,600 And do you have anything else that you feel like our listeners 681 00:35:03,600 --> 00:35:07,640 should know about tendinopathy that's important for runners? 682 00:35:09,320 --> 00:35:11,600 You know, I think it's it's one of those things just the the 683 00:35:11,600 --> 00:35:15,880 take home is once you understand what it is, knowing that you 684 00:35:15,880 --> 00:35:19,240 don't have to hit the vanity button right, continuing to run 685 00:35:19,240 --> 00:35:22,440 at a nice easy. Pace is is a really good thing 686 00:35:22,440 --> 00:35:26,080 to to consider it the the phrase you can't go wrong. 687 00:35:26,080 --> 00:35:29,080 Getting strong comes into play for sure, right? 688 00:35:29,240 --> 00:35:33,120 And not being afraid to try to strengthen the area that is 689 00:35:33,120 --> 00:35:35,400 actually dealing with the the symptoms. 690 00:35:35,880 --> 00:35:37,960 So this is one where you get nervous often times. 691 00:35:37,960 --> 00:35:40,200 Should I shy away from it? I don't, I want to be careful. 692 00:35:40,640 --> 00:35:43,240 I don't want to overdo it too much in regards to strength 693 00:35:43,240 --> 00:35:46,120 training. In fact, it's that exact mindset 694 00:35:46,120 --> 00:35:48,880 that can be the challenge or or to the detriment of the runner. 695 00:35:49,240 --> 00:35:52,280 So a lot of times with tendonopathy, it's managed 696 00:35:52,280 --> 00:35:55,640 training load perhaps maybe make your runs easy pace for two or 697 00:35:55,640 --> 00:35:58,640 three weeks while you really supplement your strength 698 00:35:58,640 --> 00:36:02,480 training that that in itself could help so many people 699 00:36:02,480 --> 00:36:05,320 dealing with patellar really Achilles, all these 700 00:36:05,320 --> 00:36:06,720 tendinopathies that we're describing. 701 00:36:07,720 --> 00:36:10,640 That's awesome. And I guess my real last 702 00:36:10,640 --> 00:36:13,800 question is a little bit about you as a running coach, because 703 00:36:13,800 --> 00:36:16,960 we don't see that often that APT is also running coach, which is 704 00:36:16,960 --> 00:36:20,600 awesome for us runners. Who are your people? 705 00:36:20,600 --> 00:36:24,640 Who do you coach? Who are you open to coaching and 706 00:36:24,640 --> 00:36:28,440 what will they get when they sign up with you as APT? 707 00:36:29,760 --> 00:36:30,840 Sure. Yeah. 708 00:36:30,840 --> 00:36:35,080 And this is where I, I, it's, it's funny, I think back like 709 00:36:35,080 --> 00:36:39,280 how seamless it is to be APT and a running coach. 710 00:36:40,280 --> 00:36:42,280 I've had some good mentors over the years that have kind of 711 00:36:42,280 --> 00:36:44,000 steered me towards that direction and encouraged me to 712 00:36:44,000 --> 00:36:47,080 consider doing it. So I definitely have, you know, 713 00:36:47,080 --> 00:36:49,040 some people to think in that regard. 714 00:36:49,040 --> 00:36:52,720 But yeah, it's, it's just been such an amazing experience that 715 00:36:52,720 --> 00:36:54,800 way. Because as you can imagine, and 716 00:36:54,800 --> 00:36:57,320 as we all know, sometimes there's some aches or pains that 717 00:36:57,320 --> 00:36:59,240 come up and it's what do I do with that? 718 00:36:59,240 --> 00:37:02,240 Right? So that's a lot of times those 719 00:37:02,240 --> 00:37:04,320 are the runners that I end up coaching or working with. 720 00:37:04,320 --> 00:37:07,040 They'll reach out and kind of say, hey, you know, I, I have 721 00:37:07,040 --> 00:37:08,920 this thing and I, I've been pretty good. 722 00:37:08,920 --> 00:37:12,000 I have some big goals. I really want to BQ or even 723 00:37:12,000 --> 00:37:13,760 maybe it's just like, hey, I want to get into running. 724 00:37:13,760 --> 00:37:15,200 And I feel like I'm nervous to do that. 725 00:37:15,200 --> 00:37:18,400 But there's this thing like some discomfort that comes every time 726 00:37:18,400 --> 00:37:22,520 I try to build up or it's the person who's really nervous 727 00:37:22,600 --> 00:37:24,520 around that. So I want to do this, but I want 728 00:37:24,520 --> 00:37:26,680 to go about it the right way because I don't want to get 729 00:37:26,680 --> 00:37:27,880 injured. I don't want to get hurt. 730 00:37:28,520 --> 00:37:30,360 Those are a lot of the people who I end up working with. 731 00:37:31,000 --> 00:37:34,640 And the fun part is I, I can think of, you know, a handful 732 00:37:34,640 --> 00:37:37,560 right off the top of my head where their stories are 733 00:37:37,560 --> 00:37:39,480 incredible competitive athletes, right? 734 00:37:39,800 --> 00:37:42,680 We're talking like sub three hour marathon goals, like some 735 00:37:42,680 --> 00:37:45,480 pretty speedy people. But it's hey, I had a a bone 736 00:37:45,480 --> 00:37:50,040 stress injury in the past and it really just completely derailed 737 00:37:50,040 --> 00:37:52,240 my whole year when I had a stress fracture. 738 00:37:52,240 --> 00:37:54,640 So I want to do everything I possibly can to make sure that 739 00:37:54,640 --> 00:37:58,560 doesn't happen again. And so that's, that's where I, I 740 00:37:58,560 --> 00:38:01,080 really feel like I get to come alive because it's great. 741 00:38:01,080 --> 00:38:04,440 We know what is true in regards to the literature on this sort 742 00:38:04,440 --> 00:38:06,720 of thing. And how do we position almost 743 00:38:06,720 --> 00:38:09,520 your annual training cycle in a way to where you're 744 00:38:09,520 --> 00:38:12,920 supplementing your training load is, is intelligent, it's 745 00:38:12,920 --> 00:38:15,760 systematic, but then also bobs and weaves with you a little bit 746 00:38:15,760 --> 00:38:17,400 because we know life throws curveballs. 747 00:38:18,080 --> 00:38:21,840 So those are usually the people who end up reaching out where 748 00:38:21,840 --> 00:38:26,040 they have interest in reducing injury quite a bit, or maybe 749 00:38:26,040 --> 00:38:28,320 I've had something to nervous about and they're not sure if I 750 00:38:28,320 --> 00:38:30,560 should I train, should I do a marathon on this cycle or should 751 00:38:30,560 --> 00:38:32,880 I wait, right? Those are really fun for me 752 00:38:32,880 --> 00:38:35,120 'cause I get to be able to walk them through that and kind of 753 00:38:35,120 --> 00:38:37,640 use both sides of my brain from a coach standpoint and also a 754 00:38:37,760 --> 00:38:40,440 physical therapist standpoint just to help people feel 755 00:38:40,440 --> 00:38:41,880 confident, right, 'cause running is fun. 756 00:38:41,880 --> 00:38:45,080 And like we're saying, we can do this pretty much forever, so why 757 00:38:45,080 --> 00:38:48,160 not think about it that way? And so those are usually the 758 00:38:48,160 --> 00:38:50,520 people I end up lining up with. I love it. 759 00:38:50,520 --> 00:38:52,800 And if our audience is interested in reaching out for 760 00:38:52,800 --> 00:38:56,800 you, how can they find you best? I'd say Instagram's probably the 761 00:38:56,800 --> 00:38:59,680 best way. I'm pretty active on on social 762 00:38:59,680 --> 00:39:01,920 media, mainly Instagram, I would say. 763 00:39:03,080 --> 00:39:04,960 So if you're ever interested in chatting or maybe you have a 764 00:39:04,960 --> 00:39:07,480 question about like, hey, this hurts, right? 765 00:39:08,320 --> 00:39:10,160 Yeah, shoot me a message. I'm always happy to be in 766 00:39:10,160 --> 00:39:12,440 people's corners cuz I know it can be a challenging landscape 767 00:39:12,440 --> 00:39:14,840 out there. But yeah, any questions on 768 00:39:14,840 --> 00:39:16,800 anything that we've talked about today, feel free to reach out on 769 00:39:16,800 --> 00:39:19,400 Instagram. Sometimes it's, hey, I, I need 770 00:39:19,560 --> 00:39:21,200 to, I need to see someone in my area. 771 00:39:21,200 --> 00:39:24,080 Like is there anybody you know, I, I liked what I heard today. 772 00:39:24,160 --> 00:39:26,280 I want that in my area. Sometimes it's knowing who to 773 00:39:26,280 --> 00:39:28,560 see. Should I see this person or that 774 00:39:28,560 --> 00:39:31,400 person or this massage therapist or a Cairo or PT? 775 00:39:32,000 --> 00:39:34,680 There's a lot that can be gleaned and a lot of good people 776 00:39:34,680 --> 00:39:36,760 out there from a rehab professionals perspective. 777 00:39:36,760 --> 00:39:39,480 So I'm happy to be in people's corners in that regard. 778 00:39:39,480 --> 00:39:41,280 Or if it's just like, hey, I got some goals. 779 00:39:41,280 --> 00:39:42,400 I was curious to chat about them. 780 00:39:42,400 --> 00:39:44,800 Yeah, Instagram is great. Perfect. 781 00:39:44,800 --> 00:39:48,880 And for those of the people that are listening, obviously I'll 782 00:39:48,880 --> 00:39:50,200 link your stuff in the show notes. 783 00:39:50,200 --> 00:39:51,680 But what is your Instagram handle? 784 00:39:52,320 --> 00:39:58,800 It's Dr. dot DREW dot DPT, or so Doctor Drew DPT. 785 00:39:59,400 --> 00:40:02,160 Doctor Drew DPT OK, thank you so much for coming on. 786 00:40:02,160 --> 00:40:04,640 We hope to have you on on more topics that. 787 00:40:05,440 --> 00:40:07,240 Would be a blast. Thanks for sitting down with me 788 00:40:07,240 --> 00:40:09,480 Letty, and always happy to talk injuries and tendons. 789 00:40:09,480 --> 00:40:10,880 All things running so appreciate it. 790 00:40:16,600 --> 00:40:18,760 Thank you so much Drew for speaking with us. 791 00:40:18,760 --> 00:40:22,640 We really appreciate your time and also your expertise. 792 00:40:22,960 --> 00:40:26,640 I'm glad that you gave us some pointers as to how to diagnose 793 00:40:26,640 --> 00:40:30,280 something if we have a niggle, so that way at least we can see 794 00:40:30,280 --> 00:40:33,120 if we're on the right path. For anyone that has any 795 00:40:33,120 --> 00:40:35,600 questions for Drew directly, I'm going to link all his 796 00:40:35,600 --> 00:40:38,520 information in our show notes so that way you guys can have 797 00:40:38,520 --> 00:40:41,440 access. Stay tuned for next week. 798 00:40:41,440 --> 00:40:43,760 We are going to have another podcast that I haven't 799 00:40:43,760 --> 00:40:46,520 determined what it will be yet, but hopefully it'll be something 800 00:40:46,520 --> 00:40:49,920 super, super awesome. Thank you guys for tuning in and 801 00:40:49,920 --> 00:40:52,440 until next week, have a great week of running. 802 00:40:57,160 --> 00:40:59,680 Thanks for tuning in. For more information and 803 00:40:59,680 --> 00:41:01,640 marathon running news, please head to 804 00:41:01,640 --> 00:41:06,920 www.marathonrunningpodcast.com and we'll be back next week. 805 00:41:19,480 --> 00:41:22,160 Are you looking for the perfect apparel that mirrors your love 806 00:41:22,160 --> 00:41:25,000 for running? 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