1 00:00:00,700 --> 00:00:03,400 This episode of the doctors are running podcast is sponsored by 2 00:00:03,400 --> 00:00:06,400 our friends at running warehouse for this year's Earth Day 3 00:00:06,400 --> 00:00:09,000 running Warehouse is celebrating by amplifying sustainable 4 00:00:09,000 --> 00:00:10,900 styles. From all your favorite Brands, 5 00:00:11,400 --> 00:00:14,200 we've been loving the Nike Dri-FIT and Saucony outpace 6 00:00:14,200 --> 00:00:16,400 shorts which have been comfortable, super breathable 7 00:00:16,400 --> 00:00:19,500 options for spring running. We're also big fans of Brands 8 00:00:19,500 --> 00:00:22,700 like John G and Patagonia which not only make excellent apparel 9 00:00:23,000 --> 00:00:25,300 but also pivot some of their sails towards environmental 10 00:00:25,300 --> 00:00:28,100 causes check out the sustainable Styles today. 11 00:00:28,100 --> 00:00:31,200 Not only will you look good but you also feel good knowing 12 00:00:31,200 --> 00:00:33,900 you're running sustainably to find the collection, visit the 13 00:00:33,900 --> 00:00:35,800 link in our description or head straight to running 14 00:00:35,800 --> 00:00:45,900 warehouse.com. Everyone, welcome to the doctors 15 00:00:45,900 --> 00:00:50,100 running podcast where we a group of doctors of physical therapy, 16 00:00:50,600 --> 00:00:53,200 discuss the art and the science of the stuff we're putting on 17 00:00:53,200 --> 00:00:56,100 our feet. I'm Andrea Myers and I'm here 18 00:00:56,100 --> 00:00:59,200 during a solo episode of the podcast today to talk about the 19 00:00:59,200 --> 00:01:03,100 role that Error plays in developing injury. 20 00:01:03,700 --> 00:01:07,600 Unfortunately, running related, Intrigue remains all-too-common, 21 00:01:07,600 --> 00:01:10,300 despite improvements in training, methods shoe 22 00:01:10,300 --> 00:01:12,800 technology and access to information. 23 00:01:13,400 --> 00:01:16,600 Research has found that the rate of injury and Runners really 24 00:01:16,600 --> 00:01:20,500 hasn't changed much since the 1970s which is shocking. 25 00:01:20,500 --> 00:01:24,300 When you think about all of the improvements in training, 26 00:01:24,300 --> 00:01:31,200 knowledge, shoes, that have come in those decades and the 1970s, 27 00:01:31,200 --> 00:01:34,300 but unfortunately, people are still getting injured quite 28 00:01:34,300 --> 00:01:38,100 frequently. The numbers are up to 70% of 29 00:01:38,200 --> 00:01:42,000 Runners experience or running related injury, which is way too 30 00:01:42,000 --> 00:01:45,500 much. So training error is reasonably 31 00:01:45,500 --> 00:01:48,400 thought to play a major role in running related injury. 32 00:01:48,800 --> 00:01:52,600 So today, I'm going to discuss what the research says how that 33 00:01:52,600 --> 00:01:56,100 compares to our clinical experience as pts and coaches 34 00:01:56,500 --> 00:01:59,800 and what you Runners can take away from this. 35 00:02:00,000 --> 00:02:03,500 Seven to, hopefully help yourselves avoid getting injured 36 00:02:03,500 --> 00:02:07,100 in the first place. I've been a PT for 17 years in a 37 00:02:07,108 --> 00:02:10,199 coach for 10 years and I can certainly attest. 38 00:02:10,199 --> 00:02:11,700 That training error is a problem. 39 00:02:11,700 --> 00:02:15,400 I've encountered frequently with my patients and clients and with 40 00:02:15,400 --> 00:02:19,400 a little bit of Education, I think that people can really 41 00:02:19,400 --> 00:02:22,900 avoid some of these common training errors and hopefully 42 00:02:22,900 --> 00:02:27,700 avoid injury as well. So today's subjective is, if you 43 00:02:27,700 --> 00:02:30,700 have had a running related injury, Do you feel that 44 00:02:30,700 --> 00:02:32,300 training error? Was a part of it. 45 00:02:32,800 --> 00:02:35,000 If so, what was the specific error? 46 00:02:35,500 --> 00:02:37,600 You can leave a comment on YouTube. 47 00:02:37,600 --> 00:02:42,200 Send us an email at doctors of running at gmail.com or leave us 48 00:02:42,200 --> 00:02:43,800 a comment through the podcast apps. 49 00:02:43,800 --> 00:02:47,600 If you can So we're going to move into our main segments now. 50 00:02:47,600 --> 00:02:50,900 And first we're going to talk about well what are the specific 51 00:02:50,900 --> 00:02:54,600 variables that are involved in training error and what does the 52 00:02:54,600 --> 00:02:58,700 research say about how those variables do or don't relate to 53 00:02:58,700 --> 00:03:02,500 developing an injury? So the most common variables 54 00:03:02,500 --> 00:03:06,000 that research looks at is volume intensity and frequency 55 00:03:06,700 --> 00:03:11,600 unsurprisingly and as Runners we know that volume intensity and 56 00:03:11,600 --> 00:03:13,300 frequency interact with each other. 57 00:03:13,300 --> 00:03:17,400 So you can imagine that there is Individual influence on running 58 00:03:17,400 --> 00:03:21,700 related injuries. Hard to a man examine, as, with 59 00:03:21,700 --> 00:03:25,500 many performance related topics. There are too many dependent 60 00:03:25,500 --> 00:03:28,600 variables to draw solid conclusions regarding the role. 61 00:03:28,600 --> 00:03:31,300 One factor has in the development of injury. 62 00:03:32,000 --> 00:03:35,100 So, let's start by just defining these terms. 63 00:03:35,100 --> 00:03:40,000 So, volume, of course, is defined as miles or kilometers 64 00:03:40,000 --> 00:03:44,600 run per week, intensity. When researchers say intensity, 65 00:03:44,600 --> 00:03:47,500 they mean pay. Pace so minutes per mile or 66 00:03:47,500 --> 00:03:51,300 minutes per km depending on who's writing the paper and then 67 00:03:51,300 --> 00:03:55,100 frequency means how many runs per week, you're running five 68 00:03:55,100 --> 00:03:58,700 times a week, two times a week, seven times a week. 69 00:03:59,700 --> 00:04:03,900 We all can see how frequency might contribute to developing 70 00:04:04,000 --> 00:04:07,200 an injury if it's increased too quickly. 71 00:04:08,100 --> 00:04:13,800 So there was a systematic review by Nielsen, l in 2012 called 72 00:04:13,800 --> 00:04:17,200 training error and running. That entering and they looked at 73 00:04:17,200 --> 00:04:20,300 these topics. So a few of the things that they 74 00:04:20,300 --> 00:04:25,000 found, first of all, related to volume rapid increases in 75 00:04:25,000 --> 00:04:30,700 volume, at what they found was more than 30%, may increase 76 00:04:30,700 --> 00:04:34,200 injury risk. They also found several studies 77 00:04:34,200 --> 00:04:37,000 that found that running more than 40 miles, a week, is 78 00:04:37,000 --> 00:04:41,400 associated with an increased injury risk, but not all you can 79 00:04:41,400 --> 00:04:44,300 imagine depending on the type of Runners they were looking at, 80 00:04:44,900 --> 00:04:48,600 for some People 40 miles a week is like a recovery week and for 81 00:04:48,600 --> 00:04:52,900 other people 40 miles a week is their biggest week leading into 82 00:04:52,900 --> 00:04:56,100 a marathon. So depends on the type of 83 00:04:56,200 --> 00:04:59,900 Runners there including in their studies did they include a lot 84 00:04:59,900 --> 00:05:04,100 of elite athletes where 40 miles a week is no big deal or did 85 00:05:04,100 --> 00:05:07,700 they include a lot of newer runners or if they're running 40 86 00:05:07,700 --> 00:05:12,600 miles a week that maybe their Peak mileage of the year and one 87 00:05:12,600 --> 00:05:15,300 that they only achieve for one or two weeks. 88 00:05:15,400 --> 00:05:18,300 Weeks leading into a marathon. So that's where we're just 89 00:05:18,300 --> 00:05:22,300 looking at volume or just looking at any one of these 90 00:05:22,300 --> 00:05:27,900 variables can make, it difficult to determine the influence of 91 00:05:27,900 --> 00:05:33,100 that variable on the development of Entry, moving on to intensity 92 00:05:33,100 --> 00:05:36,500 studies, that looked at intensity or Pace have 93 00:05:36,500 --> 00:05:39,700 inconsistent results. And the author said that the 94 00:05:39,700 --> 00:05:42,900 main reason for that is because intensity was self-report. 95 00:05:42,900 --> 00:05:47,100 And so, first of all, The subjects in the studies were 96 00:05:47,100 --> 00:05:50,400 self-reporting how fast they were running, and they were 97 00:05:50,400 --> 00:05:55,200 self-reporting how fast they ran in previous training sessions, 98 00:05:55,700 --> 00:06:00,300 so whether or not, they accurately recalled how fast 99 00:06:00,300 --> 00:06:03,800 they Grant and all of their sessions was one potential 100 00:06:03,800 --> 00:06:07,100 problem. The other thing is studies that 101 00:06:07,100 --> 00:06:12,500 just look at PACE don't completely capture Runners 102 00:06:12,500 --> 00:06:15,900 Fitness level so they were just looking at well, People who are 103 00:06:15,900 --> 00:06:19,800 in faster than eight minute, miles versus people who ran 104 00:06:19,800 --> 00:06:23,400 slower than eight minute miles were people in one of those two 105 00:06:23,400 --> 00:06:25,800 groups, more or less likely to get injured. 106 00:06:26,400 --> 00:06:30,100 Well, depending on the runner 8 minutes, a mile could be there, 107 00:06:30,100 --> 00:06:33,800 easy, run Pace. Or it could be their 5K pace. 108 00:06:34,200 --> 00:06:38,200 So again, you know, you need to get more information. 109 00:06:38,200 --> 00:06:43,400 Regarding, what those Paces mean to have a better understanding 110 00:06:43,400 --> 00:06:46,900 of how those pieces. Or may not relate to that 111 00:06:46,900 --> 00:06:50,100 Runners injury. And then thinking about 112 00:06:50,100 --> 00:06:52,500 frequency, how many runs per week. 113 00:06:53,000 --> 00:06:56,200 So again, it depends on the type of Runner you're talking about, 114 00:06:56,600 --> 00:07:00,700 if a lot of the subjects in a particular study were Elite 115 00:07:00,700 --> 00:07:06,400 Runners, then 5 to 7 days. A week is pretty common, but if 116 00:07:06,400 --> 00:07:10,200 you were talking about a newer group of Runners who again, 117 00:07:10,300 --> 00:07:13,700 maybe were building up to five days a week. 118 00:07:14,100 --> 00:07:16,800 Those Runners might I have been more likely to get injured 119 00:07:16,800 --> 00:07:21,000 running, five days a week has compared to more experienced or 120 00:07:21,000 --> 00:07:22,700 Elite Runners were five days a week. 121 00:07:22,708 --> 00:07:26,000 Might be like what they do on a recovery week. 122 00:07:26,000 --> 00:07:31,600 So again, it's one of the major limitations with just looking at 123 00:07:31,600 --> 00:07:35,900 these static measurements or static variables is that they 124 00:07:35,900 --> 00:07:40,400 don't give you a full picture of that person's training. 125 00:07:40,400 --> 00:07:47,100 So the authors and the study in the Review also concluded that 126 00:07:47,200 --> 00:07:50,900 it wasn't possible to do to determine the relationship 127 00:07:51,000 --> 00:07:54,500 between frequency and injury due to inconsistent results. 128 00:07:55,600 --> 00:07:59,500 They did find also unsurprisingly that newer 129 00:07:59,500 --> 00:08:02,800 Runners are at greater risk of injury likely for several 130 00:08:02,800 --> 00:08:06,000 reasons. So, one of the main reasons is 131 00:08:06,000 --> 00:08:09,500 if you're new to running, your body is experiencing all of 132 00:08:09,500 --> 00:08:12,700 these new. Stresses new stresses on your 133 00:08:12,700 --> 00:08:17,200 muscle tendon bone fashion, your cardiovascular system. 134 00:08:17,600 --> 00:08:22,800 So if somebody has just started running, do they even possess 135 00:08:23,200 --> 00:08:26,800 the appropriate? Strength range of motion, 136 00:08:26,800 --> 00:08:32,299 flexibility to run with. You don't want to say proper 137 00:08:32,299 --> 00:08:36,400 form, but to run with good enough form where they're less 138 00:08:36,400 --> 00:08:38,500 likely to get injured. Do they have sufficient 139 00:08:38,500 --> 00:08:42,100 dorsiflexion range of motion? Are they able to hop on one 140 00:08:42,100 --> 00:08:45,200 foot? Can they perform 20 to 25, 141 00:08:45,200 --> 00:08:50,600 single leg calf raises, things like that, make it more or less 142 00:08:50,600 --> 00:08:54,400 likely that somebody's going to get injured during another 143 00:08:54,400 --> 00:08:57,600 Factor. That you see in newer Runners is 144 00:08:57,600 --> 00:09:01,000 that they may have inefficient form or decreased running 145 00:09:01,000 --> 00:09:02,800 economy again because they're new to it. 146 00:09:02,800 --> 00:09:07,500 And so their bodies and nervous systems haven't figured out the 147 00:09:07,500 --> 00:09:11,400 most efficient way to run yet. And as we all know that process 148 00:09:11,400 --> 00:09:16,000 takes years, if not decades to really become a master of 149 00:09:16,000 --> 00:09:20,000 running the other. Another thing for newer Runners 150 00:09:20,000 --> 00:09:24,000 is that any increase in training is going to be a big increase? 151 00:09:24,500 --> 00:09:29,700 If Eddie starts running. Let's say two miles two or three 152 00:09:29,700 --> 00:09:33,300 days a week, so their weekly mileage has four to six miles. 153 00:09:33,800 --> 00:09:38,000 Even just adding one mile to each of their runs is going to 154 00:09:38,000 --> 00:09:41,200 be a pretty big increase compared to somebody who's 155 00:09:41,200 --> 00:09:44,400 already running 20 or 30 miles a week. 156 00:09:44,700 --> 00:09:47,800 Adding a mile to three runs a week. 157 00:09:47,800 --> 00:09:51,300 Is going to be a much smaller percentage of their total 158 00:09:51,300 --> 00:09:55,700 training volume. The other factor that might make 159 00:09:55,700 --> 00:09:59,000 new Runners at greater risk of injury is that they just have 160 00:09:59,000 --> 00:10:02,600 less knowledge regarding training and recovery and a lot 161 00:10:02,600 --> 00:10:06,100 of new Runners running. Feels terrible to them one 162 00:10:06,100 --> 00:10:07,800 because they're running too hard. 163 00:10:08,800 --> 00:10:12,400 Their heart rate is too high for how easy they're supposed to be 164 00:10:12,400 --> 00:10:17,400 running, but they just don't know what's normal soreness or 165 00:10:17,400 --> 00:10:22,000 what could be a sign of an injury new Runners are less 166 00:10:22,000 --> 00:10:25,400 likely to have a code. So they're more just like 167 00:10:25,400 --> 00:10:28,000 running with friends or doing it on their own they don't know 168 00:10:28,000 --> 00:10:30,900 what to expect and they don't know what to be on the lookout 169 00:10:30,900 --> 00:10:34,000 for. So all of these factors 170 00:10:34,000 --> 00:10:37,700 contribute to why newer Runners are probably a group or newer 171 00:10:37,700 --> 00:10:39,900 Runners are at greater risk of injury. 172 00:10:41,100 --> 00:10:45,400 Another thing that they found in the systematic review in 2012 is 173 00:10:45,400 --> 00:10:49,400 that greater running experience May decrease the risk of injury, 174 00:10:49,900 --> 00:10:52,900 which also May bias the results of studies on. 175 00:10:53,100 --> 00:10:56,400 Running related injury. So, if you have a study on 176 00:10:56,400 --> 00:10:59,600 running related injury, and let's say, it's looking at 177 00:10:59,900 --> 00:11:03,900 training volume. If you're studying includes a 178 00:11:03,900 --> 00:11:07,900 lot of experience to Runners, your injury rates, may be 179 00:11:07,900 --> 00:11:11,100 different than if your study included a lot of newer Runners. 180 00:11:11,800 --> 00:11:18,000 So again, anytime you hear that a study found something, and we 181 00:11:18,000 --> 00:11:21,900 talk about this all the time on the podcast, and in the articles 182 00:11:21,900 --> 00:11:25,500 that we write You have to dive deeper well who were the 183 00:11:25,500 --> 00:11:31,000 subjects are the subjects similar enough to you if you're 184 00:11:31,000 --> 00:11:34,100 trying to learn about yourself or if you're a clinician or the 185 00:11:34,100 --> 00:11:37,800 subjects of this study, similar enough to your patient 186 00:11:37,800 --> 00:11:42,800 population that you can apply the study's results to your 187 00:11:42,800 --> 00:11:46,800 patient population. So if you have a study that has 188 00:11:46,900 --> 00:11:50,900 a bunch of Runners with more running experience, Those 189 00:11:50,900 --> 00:11:56,200 Runners may be less likely to get injured then a study that 190 00:11:56,200 --> 00:12:00,700 includes a bunch of new Runners. Another reason that more 191 00:12:00,700 --> 00:12:03,800 experienced Runners are less likely to get injured as they 192 00:12:03,800 --> 00:12:07,900 have a larger base to build on which helps them absorb acute. 193 00:12:07,900 --> 00:12:09,800 Training load better than newer Runners. 194 00:12:10,100 --> 00:12:13,000 I'm going to talk about that a little more a little bit later, 195 00:12:13,400 --> 00:12:17,800 but if you think about somebody who has been running for 15 196 00:12:17,800 --> 00:12:22,800 years and they've been Been running, 50 miles a week for the 197 00:12:22,800 --> 00:12:26,500 past five years. Let's say those Runners have 198 00:12:26,500 --> 00:12:31,100 such a big base to build on and not just in terms of their 199 00:12:31,100 --> 00:12:34,900 cardiovascular fitness, but they're muscular strength or 200 00:12:34,900 --> 00:12:40,100 neuromuscular coordination. Their tendons ability to absorb 201 00:12:40,100 --> 00:12:43,800 loading, everything. They're running economy that 202 00:12:43,800 --> 00:12:48,500 they're going to absorb changes in their training, better than 203 00:12:48,500 --> 00:12:53,200 newer runners. That's something that for some 204 00:12:53,200 --> 00:12:56,000 of these training programs. Look at, and, for example, 205 00:12:56,000 --> 00:12:59,600 training Peaks, gives you at ESS score, which is your training 206 00:12:59,600 --> 00:13:02,300 stress score. And it looks at a cute training 207 00:13:02,300 --> 00:13:06,300 load and chronic training load and that can help an athlete or 208 00:13:06,300 --> 00:13:11,300 coach manage their overall training to make sure that 209 00:13:11,300 --> 00:13:16,000 you're staying in that sweet spot of building Fitness but not 210 00:13:16,000 --> 00:13:20,200 overeating or conversely not doing enough to actually 211 00:13:20,300 --> 00:13:22,900 actually build Fitness, but I'll get to that in a minute. 212 00:13:23,800 --> 00:13:28,000 Another reason that more experienced Runners may have a 213 00:13:28,000 --> 00:13:32,800 lower risk of injury is that they may just be better attuned 214 00:13:32,800 --> 00:13:36,700 to their bodies. So they know if they start 215 00:13:36,700 --> 00:13:39,900 feeling a little pain in their foot, they need to pay more 216 00:13:39,900 --> 00:13:43,600 attention to it and if it doesn't go away over a day or 217 00:13:43,600 --> 00:13:47,100 two or if it's getting worse they'll probably back off if 218 00:13:47,100 --> 00:13:50,000 they're training or they might cross train. 219 00:13:50,300 --> 00:13:54,600 Whereas a new Runner might not know to pay that much attention 220 00:13:54,600 --> 00:13:58,300 to little twinges that they feel because sometimes when you're 221 00:13:58,300 --> 00:14:01,700 near to running like I said everything just hurts especially 222 00:14:01,700 --> 00:14:04,500 if you're not building up slowly enough. 223 00:14:05,100 --> 00:14:11,200 So experienced Runners have so many factors going for them that 224 00:14:11,600 --> 00:14:13,900 helps decrease their risk of injury. 225 00:14:14,000 --> 00:14:19,900 So when they're included in studies they they can skew the 226 00:14:19,900 --> 00:14:22,000 results. It's in a particular direction. 227 00:14:22,700 --> 00:14:26,400 So, overall, the authors of the systematic review concluded that 228 00:14:26,400 --> 00:14:30,100 it's not possible to identify, which training errors were 229 00:14:30,100 --> 00:14:34,100 related to running related injury because again, there was 230 00:14:34,100 --> 00:14:36,500 just too much variability in these studies. 231 00:14:36,800 --> 00:14:40,700 Some studies found a relationship between volume and 232 00:14:40,700 --> 00:14:42,400 injury. Some studies found a 233 00:14:42,408 --> 00:14:46,300 relationship between intensity or Pace and injury but others 234 00:14:46,300 --> 00:14:50,600 found the opposite and again just too many pounding 235 00:14:50,600 --> 00:14:55,100 variables, particularly more experienced Runners versus less 236 00:14:55,100 --> 00:14:58,700 experienced Runners types of runners. 237 00:15:00,800 --> 00:15:04,800 That just made the it difficult for these authors of the 238 00:15:04,800 --> 00:15:07,700 systematic review to make solid conclusions. 239 00:15:08,900 --> 00:15:13,500 So, if the research on static variables, is inconclusive, what 240 00:15:13,500 --> 00:15:17,900 about changes in training load? I mean, to most people that 241 00:15:17,900 --> 00:15:22,100 sounds logical or right. It's not just oh this person 242 00:15:22,100 --> 00:15:27,700 runs 40 miles a week, so they're more likely to get injured but 243 00:15:27,800 --> 00:15:30,800 it might be. Oh, this person has been running 244 00:15:30,800 --> 00:15:34,600 40 miles a week, but they decided this week they're going 245 00:15:34,600 --> 00:15:39,500 to run 65 miles a week or they decided they're To run 80 miles 246 00:15:39,500 --> 00:15:42,800 a week. Those sudden increases in 247 00:15:42,800 --> 00:15:48,100 training load logically would be more likely to lead to injury 248 00:15:48,500 --> 00:15:50,900 but what does the research say about that? 249 00:15:51,500 --> 00:15:55,800 So in 2018 damn stead at all, did a systematic review on 250 00:15:55,800 --> 00:15:58,200 exactly. That weather changes in training 251 00:15:58,200 --> 00:16:01,500 load, have a relationship with running late related injury. 252 00:16:02,300 --> 00:16:05,500 And they concluded that there was very limited evidence that 253 00:16:05,500 --> 00:16:08,400 changes in training loader its associated with injury. 254 00:16:09,100 --> 00:16:13,900 And very interestingly they specifically found no evidence 255 00:16:13,900 --> 00:16:17,400 to support the 10% rule, you know the rule that we've all 256 00:16:17,400 --> 00:16:19,900 heard, we're okay. If you're going to increase your 257 00:16:19,900 --> 00:16:25,500 weekly mileage, don't do it by more than 10% that role. 258 00:16:25,500 --> 00:16:28,100 They found no evidence to support that. 259 00:16:28,600 --> 00:16:31,700 And they also found that there is no, well, defined threshold 260 00:16:31,700 --> 00:16:33,600 for increases in training volume. 261 00:16:34,800 --> 00:16:38,300 But one thing they said was future studies are needed, of 262 00:16:38,300 --> 00:16:42,100 course, to better define the role of changes in training 263 00:16:42,100 --> 00:16:44,500 parameters and their relationship to injury. 264 00:16:45,100 --> 00:16:48,500 These systematic reviews are relying on other studies that 265 00:16:48,500 --> 00:16:51,800 are done and they're just reviewing the collection of 266 00:16:51,800 --> 00:16:55,100 evidence that's out there and drawing conclusions, but if 267 00:16:55,100 --> 00:16:59,500 there aren't a lot of high-quality studies to review, 268 00:17:00,100 --> 00:17:03,500 then the power of a systematic review is going to be reduced 269 00:17:03,700 --> 00:17:08,099 and that was Kind of the the case here where there just 270 00:17:08,099 --> 00:17:13,599 weren't a lot of studies that have looked at changes in 271 00:17:13,599 --> 00:17:16,700 training load and their relationship to injury. 272 00:17:16,700 --> 00:17:20,800 So it makes sense. That changes in training load 273 00:17:20,800 --> 00:17:24,200 may lead to injury as opposed to static measures like weekly 274 00:17:24,200 --> 00:17:28,300 mileage or training Pace but designing studies to measure 275 00:17:28,300 --> 00:17:31,600 changes in training load. May be more complicated because 276 00:17:31,600 --> 00:17:35,400 you would need to, they would need to Prospective studies, 277 00:17:35,400 --> 00:17:39,300 probably meaning your sign people up and then you follow 278 00:17:39,300 --> 00:17:43,600 them for a certain period of time because then you'd be able 279 00:17:43,600 --> 00:17:45,800 to capture all of their training data. 280 00:17:46,200 --> 00:17:51,900 I mean most of us now some of us use Garmin Connect or Strava or 281 00:17:51,900 --> 00:17:55,500 we upload our training somewhere so it would be possible to do 282 00:17:55,500 --> 00:18:00,800 like a retroactive data dump, but again designing these 283 00:18:00,800 --> 00:18:03,400 studies that are looking at changes could be a little more 284 00:18:03,400 --> 00:18:07,100 complicated. And so moving on to types of 285 00:18:07,100 --> 00:18:11,000 injury, we know that some injuries are more likely to be 286 00:18:11,000 --> 00:18:15,100 related to changes in volume and others are more likely to be 287 00:18:15,100 --> 00:18:20,200 related to changes in training pace and Nielsen at all, the 288 00:18:20,200 --> 00:18:23,500 same researcher who wrote the first systematic review that I 289 00:18:23,500 --> 00:18:26,800 discussed wrote a clinical commentary on this topic. 290 00:18:26,800 --> 00:18:31,300 So interestingly, and I think what they wrote makes a lot of 291 00:18:31,308 --> 00:18:33,600 sense. At least to me as a clinician 292 00:18:33,600 --> 00:18:38,300 when you About it, volume-based injuries tend to occur at the 293 00:18:38,300 --> 00:18:42,000 front of the knee. So patellofemoral pain syndrome, 294 00:18:42,200 --> 00:18:48,100 IT band syndrome, patellar tendinopathy, they found that. 295 00:18:48,100 --> 00:18:52,200 These injuries were more likely to to occur in marathon runners 296 00:18:52,200 --> 00:18:54,600 as compared to those running shorter races. 297 00:18:55,700 --> 00:19:00,100 So then as a clinician you can think, okay? 298 00:19:00,100 --> 00:19:04,400 If you have someone a runner who comes in and they have Pain in 299 00:19:04,400 --> 00:19:07,900 the front of their name and while you're talking to your 300 00:19:07,900 --> 00:19:11,600 patient, you're trying to get an understanding of what factors 301 00:19:11,600 --> 00:19:14,500 could have contributed to them, developing this entry. 302 00:19:14,700 --> 00:19:19,500 Knowing what these authors are in this clinical commentary, you 303 00:19:19,500 --> 00:19:23,000 might start thinking. Okay well was this a 304 00:19:23,000 --> 00:19:26,300 volume-based entry? So you might start asking 305 00:19:26,300 --> 00:19:30,700 questions related to that. Have you increased your weekly 306 00:19:30,700 --> 00:19:34,200 mileage? Has your training changed at 307 00:19:34,200 --> 00:19:38,100 all? All regarding like the volume of 308 00:19:38,100 --> 00:19:43,300 running that you're doing. In contrast, Pace injuries tend 309 00:19:43,300 --> 00:19:47,400 to occur below the knee meaning like the calf, the ankle and the 310 00:19:47,400 --> 00:19:50,800 foot and that makes sense when you think about it. 311 00:19:50,800 --> 00:19:55,800 So if somebody is doing more running at a higher pace, you're 312 00:19:55,800 --> 00:19:59,400 going to have greater propulsive forces required to run it. 313 00:19:59,400 --> 00:20:03,200 That faster Pace, the gastrocnemius and the Soleus are 314 00:20:03,200 --> 00:20:07,100 the greatest contributors to propulsion and propulsive forces 315 00:20:07,100 --> 00:20:09,800 are greatly increased at faster paces. 316 00:20:11,400 --> 00:20:16,500 Plantar fasciitis is also a pace related injury. 317 00:20:17,500 --> 00:20:20,200 We know that the greatest biomechanical strain on the 318 00:20:20,200 --> 00:20:25,300 plantar fascia occurs in late stance, phase meaning like right 319 00:20:25,300 --> 00:20:29,600 before push off where you're transitioning from your mid foot 320 00:20:29,600 --> 00:20:34,400 to your forefoot and your big toe is bending to help you push 321 00:20:34,400 --> 00:20:40,000 off the ground and when your first MTP joint that's the joint 322 00:20:40,000 --> 00:20:42,100 your big toe joint when it's Extension. 323 00:20:42,600 --> 00:20:46,600 That's when the plantar fascia is stretched the most and it's 324 00:20:46,600 --> 00:20:51,300 also where you've got the most strain on your planter fashion. 325 00:20:51,800 --> 00:20:56,400 So again, faster running greater strain on the plantar fascia. 326 00:20:57,300 --> 00:21:01,500 Another Pace related injury that these authors identified is 327 00:21:01,500 --> 00:21:04,900 Achilles tendinopathy, which interestingly, enough is the 328 00:21:04,900 --> 00:21:09,300 most common injury in Elite Runners, which I guess makes 329 00:21:09,300 --> 00:21:10,800 sense. If you think about Elite 330 00:21:10,800 --> 00:21:15,300 runners, H tend to spend a lot of time running fast regardless 331 00:21:15,300 --> 00:21:22,000 of what event they were doing. Gastrocnemius injuries are also 332 00:21:22,000 --> 00:21:26,600 more common at age, 40 and that's actually the focus of 333 00:21:26,600 --> 00:21:29,100 Matt's research. So definitely check out our 334 00:21:29,100 --> 00:21:32,600 podcast episode on Masters Runners for more information on 335 00:21:32,600 --> 00:21:37,300 that. So gastrocnemius Soleus plantar, 336 00:21:37,300 --> 00:21:41,100 fasciitis, Achilles tendinopathy, all of these. 337 00:21:41,300 --> 00:21:45,000 Trees were identified as Pace related injuries by these 338 00:21:45,000 --> 00:21:49,200 authors. So a major drawback of this 339 00:21:49,200 --> 00:21:53,300 paper that they wrote is that they looked at a, you know, all 340 00:21:53,300 --> 00:21:56,300 the studies that are out there on your running related injuries 341 00:21:57,200 --> 00:22:01,900 but only have actually less than half of the running related 342 00:22:01,900 --> 00:22:06,300 injuries that were in these papers were categorized as Pace 343 00:22:06,300 --> 00:22:11,000 or volume based in trees. So there's this whole other mass 344 00:22:11,000 --> 00:22:14,900 of Of running a related injuries out there that they didn't 345 00:22:14,900 --> 00:22:20,000 consider to be related to Pace or volume like meniscal tears, 346 00:22:20,000 --> 00:22:24,400 sacroiliac joint, pain, back pain, hip pain. 347 00:22:24,400 --> 00:22:30,300 So their discussion is a little bit limited, but I think it this 348 00:22:30,400 --> 00:22:34,900 provides useful information to both Runners and clinicians in. 349 00:22:34,900 --> 00:22:37,400 Just kind of guiding your thinking too. 350 00:22:37,900 --> 00:22:41,200 Well, okay, they have pain here. They have this. 351 00:22:41,300 --> 00:22:45,100 Hurry and what potentially could have caused in and what's the 352 00:22:45,100 --> 00:22:49,200 solution to get rid of it. And then make sure that it 353 00:22:49,200 --> 00:22:54,300 doesn't come back in the future. There's one more article that I 354 00:22:54,300 --> 00:22:57,600 want to discuss before getting into some more clinical 355 00:22:57,700 --> 00:23:04,100 discussions of training error in 2018, Johnston at all examined, 356 00:23:04,100 --> 00:23:07,300 95 endurance athletes. So they weren't all Runners. 357 00:23:07,300 --> 00:23:10,900 They were cyclist, rowers swimmers triathletes and Runners 358 00:23:11,700 --> 00:23:15,500 and it was a prospective study. Meaning they signed these 359 00:23:15,500 --> 00:23:19,300 athletes up for the study and then they followed them for 52 360 00:23:19,300 --> 00:23:22,200 weeks. And they were looking at their 361 00:23:22,200 --> 00:23:26,200 training data, they're looking at whether or not they developed 362 00:23:26,200 --> 00:23:30,800 a new injury during that time, and they actually found that 363 00:23:30,800 --> 00:23:35,900 injury in the previous 12 months was associated with developing, 364 00:23:35,900 --> 00:23:39,900 a new injury, and the highest group highest risk was for those 365 00:23:39,900 --> 00:23:44,200 with three or more previous and injuries, and of course, this 366 00:23:44,200 --> 00:23:46,700 makes logical sense. If you've had an injury in the 367 00:23:46,700 --> 00:23:51,100 past, if you haven't fully addressed all of the actors that 368 00:23:51,100 --> 00:23:55,900 caused that previous injury, you may be more likely to have that 369 00:23:55,900 --> 00:24:01,200 injury, come back or develop a different injury as a result of 370 00:24:01,200 --> 00:24:06,100 compensation for that old entry. Another interesting thing they 371 00:24:06,100 --> 00:24:10,200 found which gets us back to what I was talking about with acute 372 00:24:10,200 --> 00:24:13,600 and chronic training load. Is they found that the lowest 373 00:24:13,600 --> 00:24:18,200 risk of injury occurred when a cute training load was low to 374 00:24:18,200 --> 00:24:21,500 moderate and chronic training load was moderate to high. 375 00:24:22,000 --> 00:24:25,700 What does that mean? So acute training load refers to 376 00:24:25,700 --> 00:24:29,800 your current weeks training and the way they determine that is 377 00:24:30,000 --> 00:24:34,900 it depends on each. Researchers or like training, 378 00:24:34,900 --> 00:24:39,700 Peaks uses its own proprietary formula, but rpe rate of 379 00:24:39,700 --> 00:24:42,100 perceived exertion heart rate data. 380 00:24:42,600 --> 00:24:48,100 If you're a cyclist, they'll use power data, might use Pace 381 00:24:48,100 --> 00:24:51,300 related to your lactate threshold, but your acute 382 00:24:51,300 --> 00:24:55,100 training load is the sum of the load of your current weeks 383 00:24:55,100 --> 00:24:59,400 training and then chronic training load is the average of 384 00:24:59,400 --> 00:25:01,700 the last four to six weeks training. 385 00:25:02,200 --> 00:25:05,800 For example, the researchers use the last for training Peaks uses 386 00:25:05,800 --> 00:25:09,100 the last six. So, what does that mean? 387 00:25:09,700 --> 00:25:13,400 It emphasizes the need for athletes to have a big training 388 00:25:13,400 --> 00:25:16,900 base. Meaning, you can't just like, 389 00:25:17,400 --> 00:25:20,100 hop off the couch and decide to start training for a marathon. 390 00:25:20,100 --> 00:25:24,500 And I think we all know that, but it also means that if you've 391 00:25:24,500 --> 00:25:31,000 been consistently running, like 10 to 20 miles a week, you can't 392 00:25:31,000 --> 00:25:34,000 just decide that you're going to dive into marathon training. 393 00:25:34,400 --> 00:25:38,800 You need to slowly. Build up to To Greater mileage 394 00:25:38,800 --> 00:25:41,000 before starting to train for something hard. 395 00:25:41,000 --> 00:25:46,900 Like a marathon, it's also means that people who have a high 396 00:25:46,900 --> 00:25:52,600 chronic training load are more able to absorb increases in 397 00:25:52,600 --> 00:25:56,200 their acute training load because they have that bigger 398 00:25:56,200 --> 00:25:59,200 base. So an increase in their training 399 00:25:59,200 --> 00:26:03,600 load is not going to be as impactful as an as for somebody 400 00:26:03,600 --> 00:26:08,000 who's maybe been running 15 or 20 miles a week and then Let's 401 00:26:08,000 --> 00:26:13,100 say suddenly jumps to 40 miles a week or someone who's been doing 402 00:26:13,100 --> 00:26:18,200 one faster, training session a week, suddenly jumps to 3. 403 00:26:18,800 --> 00:26:25,100 So building up that bass long before you have a goal event is 404 00:26:25,100 --> 00:26:29,700 really key for helping reduce injury risk. 405 00:26:29,700 --> 00:26:32,400 And I would really encourage people who are thinking about 406 00:26:32,800 --> 00:26:36,900 running a marathon someday. Don't just think about it, as 407 00:26:37,500 --> 00:26:40,800 Okay, I'm going to get my twelve to sixteen week plan and then 408 00:26:40,800 --> 00:26:43,300 I'll be ready. If you know you want to do a 409 00:26:43,300 --> 00:26:47,800 marathon in 2024, start gradually building up your 410 00:26:47,800 --> 00:26:52,500 training base now like slowly increase your weekly volume 411 00:26:53,200 --> 00:26:57,500 slowly increase. Some longer Tempo, runs that way 412 00:26:57,500 --> 00:27:03,000 when it's time to actually do that 12 or 16 week Marathon 413 00:27:03,000 --> 00:27:06,400 specific training block, you're going to have that base. 414 00:27:06,400 --> 00:27:09,400 That's going to let your Body absorb that training so much 415 00:27:09,400 --> 00:27:12,500 more easily. So just keep that in mind. 416 00:27:12,500 --> 00:27:16,000 If, you know, you've got a marathon as your goal or even, 417 00:27:16,000 --> 00:27:18,900 if a half marathons, your goal and you've been running five, 418 00:27:18,900 --> 00:27:23,000 k's the better base, you build, before you start doing that 419 00:27:23,000 --> 00:27:26,600 specific work, the more successful, you're likely to be 420 00:27:28,000 --> 00:27:31,800 So I've talked a lot about the research that's out there 421 00:27:31,800 --> 00:27:34,600 regarding training error and development of entry. 422 00:27:35,000 --> 00:27:37,900 And the research is, you know, kind of disappointing. 423 00:27:38,900 --> 00:27:42,900 There aren't a lot of solid conclusions that can be taken 424 00:27:42,900 --> 00:27:46,500 from the research which is often the case, anytime you're talking 425 00:27:46,500 --> 00:27:50,700 about medicine or sport performance because when you're 426 00:27:50,700 --> 00:27:55,600 dealing with people it's so hard to reduce people to a single 427 00:27:55,600 --> 00:28:00,200 variable there are so So many factors that go into why 428 00:28:00,200 --> 00:28:04,400 somebody might get injured and it's hard to design a study to 429 00:28:04,400 --> 00:28:09,900 tease out, just the effect of one variable on the rate of 430 00:28:09,900 --> 00:28:14,900 injury. So as often occurs in healthcare 431 00:28:14,900 --> 00:28:19,700 and Medicine, the research might not be super strong for a given 432 00:28:19,700 --> 00:28:24,800 intervention, but our clinical experience can help guide us in 433 00:28:24,800 --> 00:28:29,300 what to do for somebody. When the research doesn't have a 434 00:28:29,300 --> 00:28:33,500 clear answer and certainly physical therapists, and coaches 435 00:28:34,800 --> 00:28:39,400 have lots of experience in. Well, what factors tend to lead 436 00:28:39,600 --> 00:28:44,800 to somebody getting injured and I can say in my experience, both 437 00:28:44,800 --> 00:28:50,300 as a physical therapist, and as a coach and as an athlete and 438 00:28:50,300 --> 00:28:54,700 adequate recovery in general is one of the biggest factors in 439 00:28:54,700 --> 00:28:58,600 people getting in turn and when I I see a recovery. 440 00:28:58,600 --> 00:29:02,600 I'm not just talking about like recovery days or rest days, rest 441 00:29:02,600 --> 00:29:05,900 days are important, but so is active recovery. 442 00:29:06,000 --> 00:29:10,800 Meaning instead of taking a day, completely off exercise, still, 443 00:29:10,800 --> 00:29:15,100 get out and move whether that's going for a walk or going for an 444 00:29:15,100 --> 00:29:20,700 easy bike ride or an easy swim. I have certainly found since 445 00:29:20,700 --> 00:29:24,900 getting them back into running the past few years that I need 446 00:29:24,900 --> 00:29:30,000 active recovery days as opposed to Days off when I was cycling. 447 00:29:30,400 --> 00:29:35,200 I needed a day off a week and I was also training, you know, 15 448 00:29:35,200 --> 00:29:38,400 to 20 hours a week. So I didn't need a day off, but 449 00:29:38,500 --> 00:29:43,100 for running, I think because of the high impact nature of 450 00:29:43,100 --> 00:29:48,200 running, I do better when I have active recovery days as opposed 451 00:29:48,200 --> 00:29:51,800 to days completely off. So that's something to learn 452 00:29:51,800 --> 00:29:55,500 about yourself. When the goal of a rest or 453 00:29:55,508 --> 00:29:59,200 recovery day is recovery. You what helps you get? 454 00:29:59,200 --> 00:30:06,000 There isn't doing nothing or is it doing something very easy, 455 00:30:06,000 --> 00:30:10,200 that moves your body and helps you recover helps you recover 456 00:30:10,200 --> 00:30:14,100 for the next day's training and in a couple days for your next 457 00:30:14,100 --> 00:30:16,200 hard day. So that's something to think 458 00:30:16,200 --> 00:30:20,100 about, with regard to yourself because what works for me, isn't 459 00:30:20,100 --> 00:30:21,600 going to work for the next person. 460 00:30:21,600 --> 00:30:24,700 So the better, you understand how you respond to training the 461 00:30:24,700 --> 00:30:27,400 better, another really important. 462 00:30:27,500 --> 00:30:31,400 Factor in recovery is sleep. You can do the best training in 463 00:30:31,400 --> 00:30:35,800 the world, but if you're only sleeping for hours a night, your 464 00:30:35,800 --> 00:30:39,100 body isn't going to be able to absorb the training you're 465 00:30:39,100 --> 00:30:41,700 doing. Because of course, sleep is when 466 00:30:41,700 --> 00:30:45,400 our bodies actually repair. So that's when our muscles get 467 00:30:45,400 --> 00:30:48,000 built back up. Again, that's when our immune 468 00:30:48,000 --> 00:30:51,300 system goes to work, that's when growth hormone goes to work. 469 00:30:51,800 --> 00:30:56,800 So if, if you're sleeping for hours a night, and you have a 470 00:30:56,800 --> 00:31:00,300 big, And goal. You really need to figure out 471 00:31:00,300 --> 00:31:02,500 how you're cutting, get a little more sleep. 472 00:31:02,600 --> 00:31:06,000 Otherwise you're setting yourself up for injury. 473 00:31:06,000 --> 00:31:09,300 Burnout getting sick. So sleep is key. 474 00:31:10,100 --> 00:31:14,000 Another thing that's related to recovery that, I don't think a 475 00:31:14,000 --> 00:31:16,200 lot of people acknowledge is stress. 476 00:31:16,900 --> 00:31:23,100 So if you have a crazy job or if life at home, is really crazy, 477 00:31:23,100 --> 00:31:26,600 or if it's a combination of all of the above, if you're stressed 478 00:31:26,600 --> 00:31:30,900 all the time, You're not going to be able to absorb the 479 00:31:30,900 --> 00:31:34,900 training you're doing, because the hormones that are involved 480 00:31:34,900 --> 00:31:38,600 in, stress are going to interfere with your training. 481 00:31:38,600 --> 00:31:43,100 So if you have, if you know that the next three months are, just 482 00:31:43,100 --> 00:31:46,600 going to be super stressful because of what's going on at 483 00:31:46,600 --> 00:31:50,900 work or what's going on in your family or whatever, that might 484 00:31:50,900 --> 00:31:53,500 not be the best time to train for a marathon. 485 00:31:53,508 --> 00:31:59,000 So and I think it also is Important to just give yourself 486 00:31:59,000 --> 00:32:02,800 some Grace in terms of. You really can't do everything 487 00:32:02,800 --> 00:32:06,900 all at once. So if you've got a lot going on 488 00:32:06,900 --> 00:32:11,500 in your life let yourself back off a little bit on training 489 00:32:11,500 --> 00:32:16,500 don't stop because exercise is a great stress reliever but you 490 00:32:16,500 --> 00:32:20,100 can't expect that. You're going to perform at 100%. 491 00:32:20,300 --> 00:32:24,000 If you're majorly stressed out in a bunch of other factors. 492 00:32:24,000 --> 00:32:28,000 So now just take all of that into account when Planning your 493 00:32:28,000 --> 00:32:31,800 training and thinking about how you're responding to training 494 00:32:32,100 --> 00:32:36,800 and how well you're a covering on a similar topic of rest. 495 00:32:38,300 --> 00:32:42,500 I it's a pretty common thing the weekend warrior, right? 496 00:32:42,500 --> 00:32:45,900 People who are super busy during the week, they maybe get a 497 00:32:45,900 --> 00:32:50,000 couple like 30 minute runs and and then on Saturday and Sunday, 498 00:32:50,000 --> 00:32:52,700 they really hit it hard. They do a hard workout on 499 00:32:52,700 --> 00:32:56,300 Saturday with intervals, then they go do their long run on 500 00:32:56,300 --> 00:33:01,100 Sunday. And that is setting you up for 501 00:33:01,100 --> 00:33:07,100 getting intern because your body is just not accustomed to that 502 00:33:07,100 --> 00:33:12,800 huge dose of exercise Saturday and Sunday, followed by low 503 00:33:12,800 --> 00:33:19,200 activity during the week. So if like some people just have 504 00:33:20,000 --> 00:33:24,000 lives and jobs where it's impossible to exercise during 505 00:33:24,000 --> 00:33:28,700 the week, you might think about how you can Balance out what you 506 00:33:28,700 --> 00:33:32,700 do on the weekend so that you're less likely to get injured. 507 00:33:33,100 --> 00:33:38,600 And that might mean, maybe doing a shorter interval day on 508 00:33:38,600 --> 00:33:42,800 Saturday and then doing your long run, but making sure that 509 00:33:42,800 --> 00:33:46,600 you keep it really easy because I know that a lot of us. 510 00:33:46,800 --> 00:33:51,100 It's so easy to run a little too fast on our easy, long run days, 511 00:33:51,500 --> 00:33:55,600 but it's those long, slow days. That give us the best metabolic 512 00:33:55,600 --> 00:34:01,100 benefits in terms of fat burning and other factors that help 513 00:34:01,100 --> 00:34:05,700 improve our interns. Another thing that I see all the 514 00:34:05,700 --> 00:34:09,900 time is people training it in appropriate places. 515 00:34:10,400 --> 00:34:15,199 So your training Paces should be based on your current Fitness, 516 00:34:15,900 --> 00:34:20,000 not a goal race time. Like, if you're doing a marathon 517 00:34:20,000 --> 00:34:26,400 in four months and your goal is to run, let's say, 3:30, your 518 00:34:26,400 --> 00:34:30,000 pace is four months out. Shouldn't be based on what 519 00:34:30,000 --> 00:34:33,199 you're hoping to run. Your pace is, should be based 520 00:34:33,199 --> 00:34:34,300 on. Current Fitness. 521 00:34:34,300 --> 00:34:37,199 And how do you figure out your current Fitness? 522 00:34:37,199 --> 00:34:43,500 Well, you could do a time trial like a mile or even like a mile 523 00:34:43,500 --> 00:34:46,500 and a half time. Trial can be a good test of your 524 00:34:46,500 --> 00:34:49,199 aerobic fitness. And then there are a bunch of 525 00:34:49,199 --> 00:34:54,900 calculators online where you can input that time and get your 526 00:34:54,900 --> 00:34:59,500 training Paces because they're basically using those Paces to 527 00:34:59,500 --> 00:35:03,400 estimate your VO2 max and setting your Paces from the 528 00:35:03,400 --> 00:35:08,700 They're the other thing I've seen is some people are using 529 00:35:08,700 --> 00:35:13,800 training Paces based on a race that they did six months ago or 530 00:35:13,800 --> 00:35:18,800 even a year ago and that may or may not be their current Fitness 531 00:35:18,800 --> 00:35:23,100 level, you might be fitter than you were the at that time or you 532 00:35:23,100 --> 00:35:25,800 might be less fit. And now all of your training 533 00:35:25,800 --> 00:35:29,900 Paces are too aggressive meaning when you're doing, what you 534 00:35:29,900 --> 00:35:32,900 think is like elect a threshold interval. 535 00:35:33,500 --> 00:35:37,900 You're really doing an interval like your 5K pace and that can 536 00:35:37,900 --> 00:35:41,400 lead to a lot of frustration. Because, of course, you're not 537 00:35:41,400 --> 00:35:46,500 going to be able to do threshold type intervals at 5K Pace. 538 00:35:46,500 --> 00:35:48,100 It's going to feel like you're dying. 539 00:35:48,600 --> 00:35:54,500 So I really encourage people test yourself often to determine 540 00:35:54,500 --> 00:35:59,200 your current Fitness, like I have my athletes test every 8 to 541 00:35:59,200 --> 00:36:03,200 12 weeks, if they're not racing, sometimes more. 542 00:36:03,400 --> 00:36:07,900 Often that depending on their situations just so you can get a 543 00:36:07,900 --> 00:36:11,500 sense of where the current Fitness is and make sure that 544 00:36:11,500 --> 00:36:17,000 those zones are correct. Another common training error 545 00:36:17,000 --> 00:36:21,100 that I see is people use an inappropriate mix of high and 546 00:36:21,100 --> 00:36:25,500 low intensity sessions. So some people can handle three 547 00:36:25,500 --> 00:36:30,600 workouts a week and recover between them just fine and get 548 00:36:30,600 --> 00:36:33,200 fitter and they don't get injured and they don't get sick. 549 00:36:33,400 --> 00:36:38,900 And some people need to and some people need, maybe one every 550 00:36:38,900 --> 00:36:43,400 five days and the only way to figure that out is to try but 551 00:36:43,400 --> 00:36:47,900 it's always better to start on the easier side than the harder 552 00:36:47,900 --> 00:36:51,000 side. I think for most people to 553 00:36:51,000 --> 00:36:55,500 harder workouts a week is the right amount, but you have to 554 00:36:55,500 --> 00:36:57,800 recover enough between hard sessions. 555 00:36:58,100 --> 00:37:02,100 Otherwise your again could be setting yourself up for injury. 556 00:37:03,900 --> 00:37:07,500 I've seen a lot of posts on social media lately about the 557 00:37:07,500 --> 00:37:10,900 importance of consistency and training and I really liked that 558 00:37:10,900 --> 00:37:13,000 people are talking about consistency. 559 00:37:13,600 --> 00:37:19,800 So if you can't do your prescribed training because 560 00:37:20,300 --> 00:37:25,700 every few weeks, you either get sick or something starts hurting 561 00:37:25,700 --> 00:37:30,100 or you just feel exhausted. That is a sign that something in 562 00:37:30,100 --> 00:37:33,800 your training needs to be adjusted, you shouldn't have of 563 00:37:33,800 --> 00:37:37,400 these like high peaks where you're training a ton and then 564 00:37:37,400 --> 00:37:41,400 crashes where you have to take three or four days off because 565 00:37:42,100 --> 00:37:48,200 you're tired or sick or injured, that is a sign that your 566 00:37:48,200 --> 00:37:51,000 training volume, your training intensity, the amount of 567 00:37:51,000 --> 00:37:55,100 recovery or getting something needs to change, or it could be 568 00:37:55,100 --> 00:37:57,600 a sign that you're not sleeping enough or you're not eating 569 00:37:57,600 --> 00:38:01,600 enough or, you know, one of those recovery factors is 570 00:38:01,600 --> 00:38:05,400 missing in your training. But if you are one of those 571 00:38:05,400 --> 00:38:09,800 people who has that pattern, a lot where you're needing to take 572 00:38:09,800 --> 00:38:13,800 several days off, because you just feel totally exhausted. 573 00:38:14,500 --> 00:38:17,300 Talk to your coach. If you have one, if you don't 574 00:38:17,300 --> 00:38:20,900 have a coach think about where you could dial back your 575 00:38:20,900 --> 00:38:25,200 training so that it's something you can handle consistently 576 00:38:25,200 --> 00:38:29,600 rather than having to take all of this unplanned time off. 577 00:38:30,900 --> 00:38:35,000 Another thing I see a lot in the clinic is people who get injured 578 00:38:35,100 --> 00:38:36,800 adding a new variable and training. 579 00:38:37,200 --> 00:38:40,600 And when I say new variable, it could be someone who's a 580 00:38:40,600 --> 00:38:44,600 roadrunner suddenly decided to take up trail running, or 581 00:38:44,600 --> 00:38:50,300 someone who normally only rides on or runs on flat roads starts 582 00:38:50,300 --> 00:38:55,900 running in the Hills or someone who always used to run on this 583 00:38:55,900 --> 00:39:00,300 nice perfect bike. Path is now running on. 584 00:39:00,400 --> 00:39:03,300 Uncrowned Country Roads, you know that are higher in the 585 00:39:03,300 --> 00:39:08,100 middle could be shoes that are significantly different from 586 00:39:08,100 --> 00:39:10,700 their usual shoes. Let's say somebody decided to 587 00:39:10,700 --> 00:39:14,700 try minimal shoes, whereas previously they were running in 588 00:39:14,700 --> 00:39:19,300 more traditional like 10 or 12. Mm, drops use any of these new 589 00:39:19,300 --> 00:39:22,800 variables, have the potential to cause injury. 590 00:39:23,500 --> 00:39:27,600 If some for the first example, someone suddenly starts trail 591 00:39:27,600 --> 00:39:31,800 running, you can immediately think about Of the new physical 592 00:39:31,800 --> 00:39:33,700 challenges related to doing that. 593 00:39:34,200 --> 00:39:38,400 Now, you're on uneven terrain often Trails have a lot of 594 00:39:38,400 --> 00:39:42,800 elevation change. The softness of the terrain is 595 00:39:42,800 --> 00:39:46,800 variable so you could be running on really hard packed dirt for a 596 00:39:46,800 --> 00:39:49,800 half mile and then you're on Sand that has your sliding all 597 00:39:49,800 --> 00:39:53,000 over. So these new challenges. 598 00:39:53,300 --> 00:39:59,600 If you start doing too much of it too fast could lead to an 599 00:39:59,600 --> 00:40:02,600 injury. Similarly, if the type of 600 00:40:02,600 --> 00:40:06,600 terrain you're running on changes, whether you're doing 601 00:40:06,600 --> 00:40:10,500 more Hills, which is often the case people suddenly decide, 602 00:40:10,500 --> 00:40:14,600 they need to add more elevation change into their training like 603 00:40:14,600 --> 00:40:18,800 if they're training for a hilly race that could cause muscle 604 00:40:18,800 --> 00:40:23,000 strain. Also, I am so living here in 605 00:40:23,000 --> 00:40:26,000 Connecticut, it's pretty hilly, but I've had a number of 606 00:40:26,000 --> 00:40:29,900 patients, who let's say go on vacation to somewhere flat like 607 00:40:29,900 --> 00:40:33,800 Florida. And they come back with often IT 608 00:40:33,800 --> 00:40:37,600 band pain because they're not used to running on dead flat 609 00:40:37,600 --> 00:40:41,000 terrain. They're used to that variability 610 00:40:41,000 --> 00:40:46,500 in Step length, joint, angles, muscle challenge. 611 00:40:46,600 --> 00:40:51,900 And all of a sudden they're on dead flat roads with no change 612 00:40:51,900 --> 00:40:56,200 in any of those running factors and now they're feeling pain 613 00:40:56,200 --> 00:40:59,600 somewhere. So, keep that in mind, if you 614 00:40:59,600 --> 00:41:02,700 sign up for it, A dead flat marathon and you live somewhere 615 00:41:02,700 --> 00:41:05,700 hilly. You need to start doing a lot of 616 00:41:05,700 --> 00:41:09,400 training on flat terrain but you need to ease into it. 617 00:41:09,400 --> 00:41:15,100 So your body gets used to then crowned roads are another common 618 00:41:15,500 --> 00:41:19,900 problem here in Connecticut. They're everywhere, they make 619 00:41:19,900 --> 00:41:23,500 you run kind of crooked. So I encourage people to switch 620 00:41:23,500 --> 00:41:28,600 sides when they can safely or drive somewhere where the maybe 621 00:41:28,600 --> 00:41:31,100 they can run on a bike path or There are sidewalks. 622 00:41:31,100 --> 00:41:34,200 It's okay to run on crowned roads a little bit. 623 00:41:34,200 --> 00:41:38,500 But if all of your training is done on a crowned road, you 624 00:41:38,500 --> 00:41:42,000 could be setting yourself up for an injury, just due to the 625 00:41:42,000 --> 00:41:46,000 asymmetry of those roads. And, you know, we've talked 626 00:41:46,000 --> 00:41:51,600 plenty about shoe changes, and we know that shoes themselves do 627 00:41:51,600 --> 00:41:55,200 not cause injury, but it's the biomechanical factors, 628 00:41:55,200 --> 00:41:59,900 associated with those shoes that could contribute to developing 629 00:41:59,900 --> 00:42:00,600 an interest. Hurry. 630 00:42:01,200 --> 00:42:05,300 So the main thing is, if you're running in one type of shoe, 631 00:42:05,900 --> 00:42:10,100 don't suddenly change to a shoe that is different enough. 632 00:42:10,100 --> 00:42:14,200 In terms of the biomechanical challenges, it's going to put on 633 00:42:14,200 --> 00:42:16,000 your body, the minimal Minimalist. 634 00:42:16,000 --> 00:42:20,100 Shoes are a great example of that, but even so let's say 635 00:42:20,100 --> 00:42:23,000 you've been running in Minimalist Shoes and you decide 636 00:42:23,000 --> 00:42:25,000 that your feet need a little more protection. 637 00:42:25,500 --> 00:42:28,800 And you go from a zero, drop shoe to a 12 millimeter drop 638 00:42:28,800 --> 00:42:31,800 shoe that could potentially. Really cause an injury as well 639 00:42:31,800 --> 00:42:33,800 because again, it's a new stimulus. 640 00:42:33,800 --> 00:42:38,800 And if your body isn't ready for that stimulus, it could cause 641 00:42:38,800 --> 00:42:45,300 some pain and lastly which and this is a huge topic which I 642 00:42:45,300 --> 00:42:50,100 won't get into but inadequate nutrition under fueling you 643 00:42:50,100 --> 00:42:52,400 could be doing everything in the world, right? 644 00:42:52,700 --> 00:42:57,000 But if you aren't taking in enough food, hydration 645 00:42:57,000 --> 00:43:01,000 electrolytes you could easily set yourself up for For entry. 646 00:43:01,600 --> 00:43:05,300 And I would really encourage you to check out our podcast that we 647 00:43:05,300 --> 00:43:09,500 did with saline Yeager and Gentiles in 2022. 648 00:43:09,800 --> 00:43:12,700 So we talked a lot about the importance of nutrition, 649 00:43:12,700 --> 00:43:17,400 particularly for female athletes and we've also got our nutrition 650 00:43:17,400 --> 00:43:21,300 reviews on the doctors running website and Jen. 651 00:43:21,300 --> 00:43:26,000 Explain it breaks down what the different macronutrients are why 652 00:43:26,000 --> 00:43:30,100 we need them, how much we need and what are some good sources 653 00:43:30,100 --> 00:43:33,500 of them. But if you're not feeling your 654 00:43:33,500 --> 00:43:38,000 body, your body is going to start taking from your own body 655 00:43:38,000 --> 00:43:41,300 to fuel your training and eventually your body will start 656 00:43:41,300 --> 00:43:44,500 to break down. So make sure that you're getting 657 00:43:44,500 --> 00:43:48,400 enough nutrition for what you're doing so that you can keep 658 00:43:48,400 --> 00:43:51,000 training and not get sidelined by an issue. 659 00:43:52,600 --> 00:43:57,800 So I hope that you found some useful information today about 660 00:43:57,800 --> 00:44:02,100 how training error can possibly contribute to injury. 661 00:44:02,800 --> 00:44:06,600 I hope I've cleared up some misconceptions that are out 662 00:44:06,600 --> 00:44:10,900 there about what does or does not contribute to injury. 663 00:44:11,400 --> 00:44:14,800 Thank you so much for listening. I hope you'll leave us a review 664 00:44:14,800 --> 00:44:19,300 on YouTube. Facebook, Instagram, send us an 665 00:44:19,300 --> 00:44:21,500 email at doctors of running head. 666 00:44:21,700 --> 00:44:24,900 Gmail.com, we love to hear your feedback. 667 00:44:24,900 --> 00:44:27,100 Thank you for listening and see you next time.