1 00:00:10,120 --> 00:00:12,680 Hello everyone and welcome to the Doctors Running Podcast, 2 00:00:12,680 --> 00:00:15,160 where we, a group of doctors of physical therapy, discuss the 3 00:00:15,160 --> 00:00:17,320 art and science of running and the stuff that we put on our 4 00:00:17,320 --> 00:00:19,480 feet today. I'm Nathan Brown. 5 00:00:19,480 --> 00:00:22,160 I'm going to be doing a solo episode and we are starting 6 00:00:22,160 --> 00:00:25,640 something a little bit new that if you all like this, this is 7 00:00:25,640 --> 00:00:27,520 something that we can bring back. 8 00:00:27,520 --> 00:00:30,760 And ultimately, what it's going to be is a little of a research 9 00:00:30,760 --> 00:00:33,680 review into a certain topic. And So what I'm going to be 10 00:00:33,680 --> 00:00:36,240 doing today is taking three articles that exist in the 11 00:00:36,240 --> 00:00:39,160 literature that we think are relatively important, that are 12 00:00:39,160 --> 00:00:42,040 all on a similar topic. We're going to run through what 13 00:00:42,040 --> 00:00:45,160 each of those articles say and what they do and then kind of 14 00:00:45,160 --> 00:00:47,480 talk about some of the implications for what it might 15 00:00:47,480 --> 00:00:51,040 mean for us as a runner or for you as a physical therapist who 16 00:00:51,040 --> 00:00:54,120 works with runners or someone in a run and shoe store and how you 17 00:00:54,120 --> 00:00:55,760 talk about the influence of footwear. 18 00:00:55,760 --> 00:01:01,560 So the topics can be so varied. And today we are going to be 19 00:01:01,560 --> 00:01:04,440 going into some of the research on running related injuries. 20 00:01:04,560 --> 00:01:07,360 We're talking about risk factors for running related injuries, 21 00:01:07,360 --> 00:01:10,480 the prevalence and incidence of running related injuries, and 22 00:01:10,480 --> 00:01:13,840 how we can conceptualize these when we as runners try to figure 23 00:01:13,840 --> 00:01:17,480 out why am I getting injured or why did I get injured, What sort 24 00:01:17,480 --> 00:01:19,720 of things should be going through your mind and how you 25 00:01:19,720 --> 00:01:23,360 process what is leading to the injury that you've had? 26 00:01:24,240 --> 00:01:27,960 So before we get into that, what I want to invite you all to do 27 00:01:27,960 --> 00:01:30,720 first is to enter the giveaway that we're doing. 28 00:01:30,720 --> 00:01:34,160 Thanks to Rain Warehouse, they have given us eight $100.00 gift 29 00:01:34,160 --> 00:01:37,120 cards to give away one per week. So this is another week where 30 00:01:37,120 --> 00:01:38,600 we're going to be giving away a gift card. 31 00:01:38,840 --> 00:01:42,280 So if you are, if you're not already, please take the time to 32 00:01:42,280 --> 00:01:46,320 follow us and subscribe on our podcast channels as well as on 33 00:01:46,320 --> 00:01:47,880 YouTube. And then once you do it, when 34 00:01:47,880 --> 00:01:50,720 the YouTube video comes out, which releases on Sundays, when 35 00:01:50,720 --> 00:01:53,480 the YouTube video comes out, you'll go to the video for this 36 00:01:53,680 --> 00:01:57,200 cast and then you'll answer the subjective question below. 37 00:01:57,200 --> 00:01:59,640 So the subjective this week we want to hear from you. 38 00:01:59,640 --> 00:02:02,400 What research topics are you interested in? 39 00:02:02,560 --> 00:02:05,200 What sort of realms do you want to hear directly from the 40 00:02:05,200 --> 00:02:07,600 literature and kind of what it's saying? 41 00:02:07,600 --> 00:02:09,479 So that's our our question for the Today. 42 00:02:09,680 --> 00:02:13,000 The second one that I want to throw out there, you can also 43 00:02:13,000 --> 00:02:16,400 answer this if you want is when you think back and reflect on 44 00:02:16,400 --> 00:02:18,920 any injuries you've had in the past, what do you feel like have 45 00:02:18,920 --> 00:02:23,000 been the main contributors to the etiology or the cause of 46 00:02:23,000 --> 00:02:25,160 those injuries? I'd love to hear your 47 00:02:25,160 --> 00:02:27,360 perspective on what you think were the kind of those tipping 48 00:02:27,360 --> 00:02:29,280 points and the things that brought you to the point where 49 00:02:29,280 --> 00:02:31,080 you had a running related injury. 50 00:02:32,400 --> 00:02:34,960 All right, now, with that other way, let's get into the topic 51 00:02:34,960 --> 00:02:37,560 for this week, which again is running related injuries. 52 00:02:37,640 --> 00:02:40,320 How often are they happening, where are they coming from? 53 00:02:40,400 --> 00:02:42,640 That kind of stuff. So I have three articles for us 54 00:02:42,640 --> 00:02:43,960 that we're going to go through together. 55 00:02:44,200 --> 00:02:46,240 The first one is an oldie but a goodie. 56 00:02:46,240 --> 00:02:52,080 It comes from 2007 from Van Gant and his colleagues. 57 00:02:52,280 --> 00:02:54,840 They put out a systematic review called Incidents and 58 00:02:54,840 --> 00:02:57,840 Determinants of Lower Extremity Running Injuries and Long 59 00:02:58,040 --> 00:03:00,720 Distance Runners. A systematic review. 60 00:03:00,880 --> 00:03:03,480 If you aren't familiar with what systematic review is, what it 61 00:03:03,480 --> 00:03:06,880 does is it says there's all of these studies out on a certain 62 00:03:06,880 --> 00:03:09,400 topic, in this case running related injuries in the 63 00:03:09,400 --> 00:03:12,240 determinants of lower extremity injuries and long distance 64 00:03:12,240 --> 00:03:14,360 runners. So what we want to do is instead 65 00:03:14,360 --> 00:03:17,560 of just taking all of these studies in singularity, we're 66 00:03:17,560 --> 00:03:19,760 going to read all the studies out there and we're going to 67 00:03:19,760 --> 00:03:23,800 find out which ones look at similar topics and then give a 68 00:03:23,800 --> 00:03:27,760 systematic approach of analyzing all of those studies and then 69 00:03:27,760 --> 00:03:30,320 summarizing the results in a systematic review. 70 00:03:30,840 --> 00:03:34,480 So again with this study, they read hundreds of articles these 71 00:03:34,480 --> 00:03:37,400 authors did and they made sure that the articles were of high 72 00:03:37,400 --> 00:03:41,480 enough quality to include and were consistent enough across 73 00:03:41,480 --> 00:03:44,320 each other to make sure that the results could be compared and 74 00:03:44,320 --> 00:03:46,840 then they summarize the results in their systematic review. 75 00:03:47,240 --> 00:03:51,320 So what this study ended up doing was included seventeen 76 00:03:51,320 --> 00:03:53,920 different articles that looked at injury prevalence and 77 00:03:53,920 --> 00:03:57,040 incidents and where these injuries were occurring and then 78 00:03:57,040 --> 00:03:58,520 started to summarize the results. 79 00:03:59,440 --> 00:04:03,080 And one of the things that they did was identified the common 80 00:04:03,120 --> 00:04:06,480 risk factors for injury that these studies assessed. 81 00:04:06,800 --> 00:04:09,000 So I'm going to give their list of these things. 82 00:04:09,000 --> 00:04:11,800 But this doesn't mean that these were found to be risk factors. 83 00:04:11,960 --> 00:04:14,920 These were risk factors that were analyzed as a part of this 84 00:04:14,920 --> 00:04:16,519 study. So they broke down the risk 85 00:04:16,519 --> 00:04:20,320 factors into four different categories, systemic factors, 86 00:04:20,600 --> 00:04:24,760 training factors, health factors and lifestyle factors. 87 00:04:25,080 --> 00:04:28,320 So systemic factors are things that are just innate within you, 88 00:04:28,320 --> 00:04:32,040 so your age, your height, your sex, things like that. 89 00:04:32,880 --> 00:04:35,400 That was the systemic factors and they would look where their 90 00:04:35,400 --> 00:04:37,680 differences and injury prevalence that were found in 91 00:04:37,680 --> 00:04:40,960 those other 17 studies that they were analyzing. 92 00:04:41,040 --> 00:04:42,520 The second was the training factors. 93 00:04:42,520 --> 00:04:44,800 So these are going to be things like your frequency, your 94 00:04:44,800 --> 00:04:47,800 intensity, the the distance that people were running within a 95 00:04:47,800 --> 00:04:51,720 session and over long periods of time, it was all about kind of 96 00:04:51,720 --> 00:04:54,560 those training factors and what goes into different kinds of 97 00:04:54,560 --> 00:04:57,160 running. They also looked at health 98 00:04:57,160 --> 00:05:01,000 factors. So this was looking at 2 main 99 00:05:01,000 --> 00:05:02,440 things. One of them was history of 100 00:05:02,440 --> 00:05:05,120 previous injury. And so they had time stamps of 101 00:05:05,120 --> 00:05:09,200 when these injuries happened, namely in the last year and the 102 00:05:09,200 --> 00:05:10,960 last six months in the last couple years. 103 00:05:11,720 --> 00:05:13,280 And then the other thing they looked at was kind of 104 00:05:13,280 --> 00:05:16,560 comorbidities or longer standing health conditions. 105 00:05:16,560 --> 00:05:19,520 But the way that they did that, most of the studies included in 106 00:05:19,520 --> 00:05:24,160 the systematic review looked at at more of the comorbidities or 107 00:05:24,160 --> 00:05:27,480 other health factors or health conditions was through 108 00:05:27,480 --> 00:05:31,000 medication use or if they reported being sick in a time 109 00:05:31,000 --> 00:05:32,680 frame that was close to the study. 110 00:05:32,680 --> 00:05:36,160 So even just a cold. But the medications were used as 111 00:05:36,280 --> 00:05:39,760 a marker of do you have a health condition that is requiring you 112 00:05:39,760 --> 00:05:42,600 to take medications? Obviously something to consider 113 00:05:42,600 --> 00:05:45,280 in there are, there are plenty of health conditions that are 114 00:05:45,280 --> 00:05:49,800 are not treated medicinally through pharmaceuticals and 115 00:05:49,800 --> 00:05:52,280 they're also people who approach their care without it. 116 00:05:52,360 --> 00:05:55,200 So there are, there's some things missing when it comes to 117 00:05:55,200 --> 00:05:58,640 health factors and comorbidities and whether they contributed to 118 00:05:58,640 --> 00:06:01,640 injury. The final section was lifestyle 119 00:06:01,640 --> 00:06:05,240 factors, which was kind of what is your alcohol use, Do you 120 00:06:05,400 --> 00:06:07,560 smoking? What are your other activities 121 00:06:07,760 --> 00:06:09,600 that you're involved in? Are you just a runner or do you 122 00:06:09,600 --> 00:06:12,960 also participate in soccer and tennis and these other types of 123 00:06:12,960 --> 00:06:15,640 sports? So they assessed all of those 124 00:06:15,640 --> 00:06:19,120 factors and the results from 17 different studies that looked at 125 00:06:19,120 --> 00:06:21,800 these sort of risk factors. And ultimately this study came 126 00:06:21,800 --> 00:06:24,360 out with some pretty interesting findings. 127 00:06:25,680 --> 00:06:29,240 As you could kind of if if you haven't looked at systematic 128 00:06:29,240 --> 00:06:33,280 reviews in the past, a lot of times it's difficult to have 129 00:06:33,280 --> 00:06:37,520 super strong conclusions when something is is complex and 130 00:06:37,520 --> 00:06:41,400 individualized, is running because the cause of an injury 131 00:06:41,640 --> 00:06:45,240 may be the people who were included in all these different 132 00:06:45,240 --> 00:06:46,400 studies. There's going to be differences. 133 00:06:46,400 --> 00:06:51,000 So it's going to be hard to have really hard and fast causes for 134 00:06:51,000 --> 00:06:53,760 injury or risk factors that were very clear. 135 00:06:54,080 --> 00:06:57,000 So what I'll say first are some of the ones that were a little 136 00:06:57,000 --> 00:06:58,920 bit lower on the confidence scale. 137 00:06:59,320 --> 00:07:02,400 There were small connections between these two between these 138 00:07:02,480 --> 00:07:05,200 things and injury. Some of those smaller 139 00:07:05,200 --> 00:07:08,240 connections were if you had an increased age, there was an 140 00:07:08,240 --> 00:07:11,400 increased equivalence or incidents of running related 141 00:07:11,400 --> 00:07:14,400 injuries. Females tended to get injured 142 00:07:14,400 --> 00:07:17,160 more than males. Increased alcohol use had a 143 00:07:17,160 --> 00:07:21,640 higher overall dosage or higher all overall amount of running 144 00:07:21,640 --> 00:07:24,600 related injuries, but they were very small and not very 145 00:07:24,600 --> 00:07:26,320 confident. Recommendations. 146 00:07:27,520 --> 00:07:32,160 The two things that were able to give strong correlations between 147 00:07:32,440 --> 00:07:35,600 these factors and running related injuries where the a 148 00:07:35,600 --> 00:07:40,320 history of a previous injury within the last 12 months and if 149 00:07:40,320 --> 00:07:43,040 you were running more than 40 miles per week. 150 00:07:43,240 --> 00:07:46,280 So they found that these people with higher mileage were getting 151 00:07:46,280 --> 00:07:49,400 injured more often. On surface level, it makes sense 152 00:07:49,400 --> 00:07:52,000 that if you're running more, you have more opportunities to 153 00:07:52,000 --> 00:07:54,800 sustain a running related injury, which are often in the 154 00:07:54,800 --> 00:07:57,280 realm of I'm going to use the term overuse and that's a whole 155 00:07:57,280 --> 00:08:01,680 complicated loaded phrase, but that those were the two things, 156 00:08:01,680 --> 00:08:05,880 history of a previous injury and over 40 miles a week. 157 00:08:06,360 --> 00:08:08,480 A complicating factor to this, or I think that brings some 158 00:08:08,480 --> 00:08:12,440 nuance to it, is that there was also a protective factor for 159 00:08:12,440 --> 00:08:14,880 people with overall higher weekly mileage. 160 00:08:15,680 --> 00:08:19,240 And so this kind of gets to this conversation on lifetime miles 161 00:08:19,240 --> 00:08:23,320 and lifetime adaptations. So for people who had high 162 00:08:23,320 --> 00:08:26,320 weekly mileage for a long period of time, they're found to be a 163 00:08:26,320 --> 00:08:28,760 protective factor against sustaining a running related 164 00:08:28,760 --> 00:08:32,240 injury compared to people who are newer runners who are also 165 00:08:32,240 --> 00:08:34,000 running more than 40 miles per week. 166 00:08:34,200 --> 00:08:37,840 So again, it's not just running 40 miles per week, it's who is 167 00:08:37,840 --> 00:08:40,280 running 40 miles per week. And were they ready to do that? 168 00:08:40,919 --> 00:08:43,039 Really important thing from something like a systematic 169 00:08:43,039 --> 00:08:46,200 review in this nature is it's observational in nature. 170 00:08:46,360 --> 00:08:50,480 They did not control anything. These studies didn't try to give 171 00:08:50,480 --> 00:08:53,400 these people these exercises and other people know, exercise and 172 00:08:53,400 --> 00:08:55,440 see who gets hurt. They didn't say, hey, you run 40 173 00:08:55,440 --> 00:08:57,800 miles per week, you run 20 miles per week, let's see who gets 174 00:08:57,800 --> 00:08:59,320 injured. They didn't control anything, 175 00:08:59,320 --> 00:09:01,760 They're just observing. So all of these things that I 176 00:09:01,760 --> 00:09:05,280 just said in terms of risk factors are all correlations, 177 00:09:05,280 --> 00:09:08,720 they're not causations. And so although there were some 178 00:09:08,760 --> 00:09:12,920 potential connections in terms of correlation between previous 179 00:09:12,920 --> 00:09:17,800 history of injury and and more than 40 miles per week and even 180 00:09:17,800 --> 00:09:20,440 alcohol use and things like that, it doesn't mean that those 181 00:09:20,440 --> 00:09:23,040 things cause injuries. It's just there's more of a 182 00:09:23,040 --> 00:09:26,000 connection and more a higher prevalence in people who fall 183 00:09:26,000 --> 00:09:29,000 into those categories. It might sound semantics, but 184 00:09:29,000 --> 00:09:32,640 it's important when it comes to trying to diagnose and be super 185 00:09:32,640 --> 00:09:34,800 confident in kind of what you're doing moving forward. 186 00:09:35,600 --> 00:09:38,680 So again, the biggest things from this study I kind of laid 187 00:09:38,680 --> 00:09:42,120 out in those large things. So that's the 2007 article. 188 00:09:42,120 --> 00:09:45,480 It gets cited a lot in the literature as a way to look back 189 00:09:45,480 --> 00:09:48,080 at the prevalence of injuries. There's two other things from 190 00:09:48,080 --> 00:09:50,240 the study I want to say. One of them was they looked at 191 00:09:50,240 --> 00:09:53,160 where do the most common injuries happen in runners. 192 00:09:53,400 --> 00:09:57,840 The what they found was that most of the injuries overall 193 00:09:57,840 --> 00:10:00,800 happened at the knee. But the highest number one 194 00:10:00,880 --> 00:10:04,440 region of a running related injury was the Achilles tendon 195 00:10:04,840 --> 00:10:08,480 followed by Patel for moral pain syndrome, the patellar tendon 196 00:10:08,520 --> 00:10:10,280 and medial tibial stress syndrome. 197 00:10:10,280 --> 00:10:13,560 So they kind of had those top four where your Achilles 198 00:10:13,560 --> 00:10:16,920 tendinopathies pain in that Achilles tendon by the heel, 199 00:10:17,400 --> 00:10:19,680 followed by Patel for moral pain syndrome which is kind of a 200 00:10:19,680 --> 00:10:22,560 broad scoping pain around the Patella. 201 00:10:22,560 --> 00:10:25,880 So usually it's on the medial side, on the inside of that 202 00:10:25,880 --> 00:10:29,640 kneecap, Then patellar tendon pain or patellar tendinopathy, 203 00:10:29,800 --> 00:10:33,200 that's that tendon that connects the bottom of your kneecap down 204 00:10:33,200 --> 00:10:36,480 to your shin bone or your tibia. And then medial tibial stress 205 00:10:36,480 --> 00:10:39,640 syndrome, which is all a lot of people call it shin splints, but 206 00:10:39,640 --> 00:10:42,440 it's irritation to the bone in the tibia. 207 00:10:43,400 --> 00:10:47,640 And so those are your top regions for injury based on the 208 00:10:47,640 --> 00:10:50,040 systematic review. The other thing that they found 209 00:10:50,040 --> 00:10:52,800 is the what what they they were looking at, What's the 210 00:10:52,800 --> 00:10:56,320 prevalence, how often do people get injured and what's the 211 00:10:56,320 --> 00:10:59,480 incidence over a period of time? How often do things come up and 212 00:10:59,480 --> 00:11:01,560 how often do people get injured in a certain period of time? 213 00:11:02,000 --> 00:11:06,280 But they found that within a year, somewhere between 19.4 and 214 00:11:06,280 --> 00:11:10,960 79.3% of runners get injured. So in these 17 studies, they 215 00:11:10,960 --> 00:11:14,160 found a range. Some studies said 19 .4%. 216 00:11:14,280 --> 00:11:18,200 Some studies were up at almost 80% of runners would get injured 217 00:11:18,440 --> 00:11:22,520 in a given year. That's a huge range, but we'll 218 00:11:22,520 --> 00:11:24,040 come back to that big range in a second. 219 00:11:24,880 --> 00:11:27,760 I was doing some math and if we look at the number of runners 220 00:11:27,920 --> 00:11:30,760 that or number of people who are running in the United States 221 00:11:30,760 --> 00:11:33,280 right now, usually it's somewhere between, it's around 222 00:11:33,280 --> 00:11:36,280 60 million people, 47 to 60 million. 223 00:11:36,280 --> 00:11:40,720 So if we go on the lower end of the number of people who run and 224 00:11:40,720 --> 00:11:45,160 the lower per, you know, prevalence of 19.4%, that's 225 00:11:45,160 --> 00:11:49,600 still 9.12 million people who are getting injured per year. 226 00:11:50,240 --> 00:11:54,240 That's a pretty wild statistic. It's a lot of people who are 227 00:11:54,240 --> 00:11:55,840 getting injured. That doesn't mean they're all 228 00:11:55,840 --> 00:11:57,760 going to need care. And that gets into this. 229 00:11:57,760 --> 00:12:02,880 Why does this range exist from 19.2 to 80% of people 'cause 230 00:12:02,880 --> 00:12:05,640 that's either 2 to 10 or 8 in 10 people. 231 00:12:06,000 --> 00:12:08,920 And one of the things that we'll get into in the next study that 232 00:12:08,920 --> 00:12:13,720 we're going to talk about is how these studies define a running 233 00:12:13,720 --> 00:12:17,680 related injury. Sometimes it's as simple as did 234 00:12:17,680 --> 00:12:20,400 you feel pain or did you have any discomfort on a run? 235 00:12:20,560 --> 00:12:23,840 Sometimes that's check the box, yes, that's a running related 236 00:12:23,840 --> 00:12:26,160 injury. If that's what the study defined 237 00:12:26,160 --> 00:12:28,760 as a running related injury. I personally don't fall into 238 00:12:28,760 --> 00:12:32,520 that category of that being an injury, but just for the sake of 239 00:12:33,000 --> 00:12:35,320 where these studies were coming from, it can be all the way on 240 00:12:35,320 --> 00:12:37,520 that end of the spectrum. On the other end of the 241 00:12:37,520 --> 00:12:41,320 spectrum, it could be that you sought care from a professional 242 00:12:41,480 --> 00:12:44,160 or a medical professional because of pain that you were 243 00:12:44,160 --> 00:12:46,760 having related to running. So that's probably going to be 244 00:12:46,760 --> 00:12:49,800 those studies that are more in the 20% range because their 245 00:12:49,800 --> 00:12:54,560 definition of an injury is one that they actually took the time 246 00:12:54,560 --> 00:12:57,760 and resources financially to go see a medical professional. 247 00:12:57,960 --> 00:13:01,080 So you see this big range among these 17 studies. 248 00:13:01,280 --> 00:13:04,400 But the point is, even if it is on that 20%, there's a lot of 249 00:13:04,400 --> 00:13:06,160 people getting injured and running. 250 00:13:06,160 --> 00:13:08,240 And we got to figure out what are these things that are 251 00:13:08,240 --> 00:13:11,160 causing injury and how can we conceptualize them and just be 252 00:13:11,160 --> 00:13:14,280 smarter as runners that we can get all these health benefits 253 00:13:14,280 --> 00:13:17,200 that we do this thing for anyway instead of getting injured and 254 00:13:17,200 --> 00:13:20,040 not being able to participate in the thing that we love to do. 255 00:13:20,600 --> 00:13:23,680 All right, so that's the Van Gant article from 2007. 256 00:13:23,920 --> 00:13:27,520 We're gonna move on to our next article, and this is much newer. 257 00:13:28,280 --> 00:13:32,200 This one is from this year, 2024. 258 00:13:32,200 --> 00:13:34,640 It just came out. It's called the running related 259 00:13:34,640 --> 00:13:40,160 injuries among more than 7000 runners in 87 countries, the 260 00:13:40,160 --> 00:13:43,040 Garmin Run Safe Run Health Study. 261 00:13:43,360 --> 00:13:46,880 So if you know what Garmin is, you can kind of guess where they 262 00:13:46,880 --> 00:13:50,200 may have gotten this data from. So what they did is they were 263 00:13:50,200 --> 00:13:55,000 able to people agreed to participate in a study across 87 264 00:13:55,000 --> 00:13:58,880 countries and they got to track whether they were having 265 00:13:58,880 --> 00:14:00,720 injuries. Oh, sorry, this is by Nielsen 266 00:14:00,720 --> 00:14:04,280 and colleagues and it came out this year in JOSPT, the Journal 267 00:14:04,280 --> 00:14:06,000 of Orthopaedic and Sports Physical Therapy. 268 00:14:06,200 --> 00:14:09,160 We'll we'll probably link all of these three articles below. 269 00:14:09,160 --> 00:14:11,480 So if you don't, you don't need to write them down, we'll try to 270 00:14:11,480 --> 00:14:15,560 link them for you so that you can have easier access to them. 271 00:14:15,960 --> 00:14:20,040 So again, this is they're looking at what sort of running 272 00:14:20,040 --> 00:14:24,120 related injury prevalence or percentage or ratios were there 273 00:14:24,240 --> 00:14:27,720 among over 7000 runners, It's actually like 7600. 274 00:14:27,920 --> 00:14:31,440 So pretty high amount of people participating in the study. 275 00:14:31,640 --> 00:14:35,280 And the way that they did it is they had Garmin data from all of 276 00:14:35,280 --> 00:14:39,160 these people and they also were able to send for anyone who 277 00:14:39,160 --> 00:14:42,680 agreed to participate a weekly survey where they answered a 278 00:14:42,680 --> 00:14:45,040 couple questions. And so this is where we can get 279 00:14:45,040 --> 00:14:48,400 into that question of like hey, how is running injury defined 280 00:14:48,600 --> 00:14:51,560 and how does that influence the statistics we see of how many 281 00:14:51,560 --> 00:14:54,280 people are getting hurt. So in this study, I'm going to 282 00:14:54,280 --> 00:14:59,120 read it verbatim for you. The the runners were given this 283 00:14:59,120 --> 00:15:02,360 question once a week. It said in the past week, have 284 00:15:02,360 --> 00:15:06,120 you had a musculoskeletal injury or have you experienced a 285 00:15:06,120 --> 00:15:11,000 problem to muscle, tendon or bone that is fully or partially 286 00:15:11,000 --> 00:15:13,920 caused by running? And then the runners had three 287 00:15:13,920 --> 00:15:15,760 choices. They could either say that they 288 00:15:15,760 --> 00:15:22,000 were injury free, that they were uninjured but had problems, or 289 00:15:22,000 --> 00:15:25,400 #3 they were injured, so they had one of those three options. 290 00:15:25,720 --> 00:15:30,000 So you'll notice that they have three or two main terms injured 291 00:15:30,240 --> 00:15:34,680 and problems and so they also defined those for the runners. 292 00:15:34,840 --> 00:15:38,960 So when they defined problem, it says it's less severe than an 293 00:15:38,960 --> 00:15:41,640 injury that was painful and irritating. 294 00:15:41,840 --> 00:15:46,840 But running continues in full. So we like to call these niggles 295 00:15:47,520 --> 00:15:50,040 where you've got a little something, maybe the inside of 296 00:15:50,040 --> 00:15:52,880 your foot, an arch of your foot, the Achilles, your knee. 297 00:15:53,120 --> 00:15:55,640 It feels a little weird, but you don't back down your training, 298 00:15:55,640 --> 00:15:57,920 you don't back down your intensity, you just keep on 299 00:15:57,920 --> 00:15:59,480 moving. That's what they consider a 300 00:15:59,480 --> 00:16:01,480 problem. So if you had that, you would 301 00:16:01,800 --> 00:16:06,000 score yourself a #2. The injury was defined as more 302 00:16:06,000 --> 00:16:10,000 severe than a problem which we just talked about and was and is 303 00:16:10,000 --> 00:16:14,040 something painful and irritable leading to a reduction in 304 00:16:14,040 --> 00:16:18,600 running activity, for example, volume, intensity or frequency. 305 00:16:18,840 --> 00:16:22,240 So the way that this study defined an injury and the 306 00:16:22,240 --> 00:16:27,120 prevalence of injury that came from this later was if you had 307 00:16:27,120 --> 00:16:29,600 to alter your training plan at all. 308 00:16:29,600 --> 00:16:31,800 So it didn't include seeking care. 309 00:16:31,800 --> 00:16:33,840 It didn't mean stopping running completely. 310 00:16:33,840 --> 00:16:37,920 It could have meant that I was supposed to go do a Six Mile 311 00:16:37,920 --> 00:16:41,520 tempo and then instead I was having that little niggle in my 312 00:16:41,520 --> 00:16:43,840 knee. So I actually just did a three 313 00:16:43,840 --> 00:16:46,280 mile tempo or I decreased my intensity. 314 00:16:46,560 --> 00:16:49,880 Once you would have altered, you would have been able to score 315 00:16:49,880 --> 00:16:51,440 yourself differently on this study. 316 00:16:52,000 --> 00:16:54,680 So think about what you think that means for what was the 317 00:16:55,280 --> 00:16:58,320 injury prevalence or ratios that they found in this study. 318 00:16:58,320 --> 00:17:00,120 But before we get there, I want to tell you a little bit more 319 00:17:00,120 --> 00:17:02,960 about the 7000 runners that they had in the study. 320 00:17:02,960 --> 00:17:08,599 So they were and I should say this the 2007 article from Van 321 00:17:08,599 --> 00:17:10,880 Gant. They also were really looking at 322 00:17:10,880 --> 00:17:14,640 recreational runners that it was not a competitive or elite 323 00:17:14,760 --> 00:17:18,079 field. It was all non professional and 324 00:17:18,079 --> 00:17:22,400 recreational runners. But in this study seven greater 325 00:17:22,400 --> 00:17:27,520 than 75% of the runners in this study ran a 5K faster than 29 326 00:17:27,520 --> 00:17:30,120 minutes. So most of them fall into that 327 00:17:30,640 --> 00:17:35,640 that range of of pacing and speed and over 50% of them were 328 00:17:35,640 --> 00:17:41,280 between 20 and 29 minutes. The other 25% were in the 17 to 329 00:17:41,280 --> 00:17:44,800 20 minute 5K. So a lot of it would I would 330 00:17:44,800 --> 00:17:48,280 consider faster runners in this study for people running less 331 00:17:48,280 --> 00:17:51,720 than a 30 minute mile, but most of them in would consider 332 00:17:51,720 --> 00:17:57,160 themselves recreational. The average age of the of the 333 00:17:57,160 --> 00:18:01,560 participants were 46.3. The average deviation between 334 00:18:01,560 --> 00:18:04,320 this was between 36 and 56 years old. 335 00:18:04,480 --> 00:18:08,920 So a lot of people in my stage of life and a little bit further 336 00:18:08,920 --> 00:18:15,360 on the, there was 76.2% of these runners were males and 22.9% 337 00:18:15,360 --> 00:18:18,240 were females. And this I think is maybe the 338 00:18:18,240 --> 00:18:22,040 most interesting statistic of the people who chose to 339 00:18:22,040 --> 00:18:24,880 participate and this was voluntary and they did kind of a 340 00:18:24,880 --> 00:18:27,080 convenience sampling, meaning they sent it out and who wants 341 00:18:27,080 --> 00:18:31,240 to do this? 53.8% had an injury within the 342 00:18:31,240 --> 00:18:35,400 last three months. So if we look back at the Van 343 00:18:35,400 --> 00:18:39,880 Gant article and we think about the fact that you know there was 344 00:18:41,400 --> 00:18:44,160 that one of the two things that could be more confidently 345 00:18:44,200 --> 00:18:47,120 prescribed as a risk factor was a previous injury in the last 346 00:18:47,720 --> 00:18:50,480 last year. The fact that over 50% of these 347 00:18:50,480 --> 00:18:55,000 people had an injury within the last three months maybe speaks 348 00:18:55,000 --> 00:18:57,480 volumes for the some of the results that we see in this 349 00:18:57,480 --> 00:18:59,800 study. In terms of region, I know that 350 00:18:59,800 --> 00:19:03,160 it said there, there were over 78 countries represented in this 351 00:19:03,160 --> 00:19:07,600 study. 96% of these countries fell within Europe or North 352 00:19:07,600 --> 00:19:09,800 America. There were some African 353 00:19:09,800 --> 00:19:14,680 countries in some South American countries, but 96% of them were 354 00:19:14,680 --> 00:19:18,320 in, in in Europe or North America. 355 00:19:19,640 --> 00:19:21,080 OK. The last thing I want to tell 356 00:19:21,080 --> 00:19:23,600 you about these people is why they were running. 357 00:19:23,600 --> 00:19:27,280 So I mentioned kind of their pacing, but over 50% of the 358 00:19:27,280 --> 00:19:31,080 people who participated shows that the primary reason that 359 00:19:31,080 --> 00:19:34,760 they ran was just for health. That was their primary reason. 360 00:19:35,320 --> 00:19:41,760 The other largest segment which was only 14% were people who 361 00:19:41,760 --> 00:19:44,800 were trying to compete or get fit. 362 00:19:44,800 --> 00:19:48,400 So those were the highest other two categories but most people 363 00:19:48,400 --> 00:19:51,360 in this study were just running to get fit which I think is just 364 00:19:51,360 --> 00:19:54,880 makes it super applicable for most of us and that as that's 365 00:19:54,880 --> 00:19:57,320 why most people are out there running. 366 00:19:58,200 --> 00:20:01,400 So what did they find? They found that the there was 367 00:20:01,600 --> 00:20:04,360 they basically what they did is they got all of these statistics 368 00:20:04,520 --> 00:20:08,320 through this weekly survey and then they took two main time 369 00:20:08,320 --> 00:20:12,360 points and they were like, who can survive without an injury up 370 00:20:12,360 --> 00:20:18,160 to after 1000 kilometers of running or 620 ish miles and how 371 00:20:18,160 --> 00:20:20,000 many people can survive without an injury? 372 00:20:20,000 --> 00:20:25,080 What percentage of people at 2000 kilometers of running or 373 00:20:25,080 --> 00:20:29,240 about 1200 miles? So if you think about that too 374 00:20:29,280 --> 00:20:34,040 in terms of timeline, you know if you're running 25 ish miles a 375 00:20:34,040 --> 00:20:38,880 week, 20 to 25, you're running about 100 miles a month which 376 00:20:38,880 --> 00:20:42,680 that means that if the time point for for me, if that's 377 00:20:42,680 --> 00:20:44,920 about what I run when I'm healthy. 378 00:20:45,360 --> 00:20:48,360 You know this is a study that's basically looking at did you get 379 00:20:48,360 --> 00:20:50,640 hurt in six months, did you get hurt in 12 months. 380 00:20:50,640 --> 00:20:53,200 But they didn't do it time based again they did it. 381 00:20:53,200 --> 00:20:55,400 If you're somebody who runs half that distance, it's going to 382 00:20:55,400 --> 00:20:58,960 take you a year to get those 600 miles and it would take you two 383 00:20:58,960 --> 00:21:00,240 years. So it's kind of a beautiful 384 00:21:00,240 --> 00:21:03,400 study in that way where it looks at incidents based on exposure 385 00:21:03,400 --> 00:21:06,320 to running at these two different time points. 386 00:21:06,800 --> 00:21:11,120 So ultimately what they found in this study is that after 1000 387 00:21:11,280 --> 00:21:16,680 kilometers, 57.6% of runners sustained some sort of injury as 388 00:21:16,680 --> 00:21:19,320 defined by the injuries definition that we just talked 389 00:21:19,320 --> 00:21:22,800 about meaning that they had to alter their training plan and at 390 00:21:22,800 --> 00:21:27,000 2000 kilometers just under 70% got injured. 391 00:21:27,240 --> 00:21:31,040 So this when we look at that previous Van Gant article, this 392 00:21:31,040 --> 00:21:35,040 look at 7000 runners falls more on that upper end of the 393 00:21:35,040 --> 00:21:39,040 spectrum of running injuries and bringing it to that kind of 58 394 00:21:39,160 --> 00:21:43,480 to 70% injury rate and prevalence, which means the 395 00:21:43,480 --> 00:21:49,120 survival rate was less than 50% after 1000 kilometers and just 396 00:21:49,120 --> 00:21:52,640 about 30% of people survived quote UN quote, without an 397 00:21:52,640 --> 00:21:54,760 injury. There's a cool graph in the 398 00:21:54,760 --> 00:21:56,840 study. It's a survival curve and it 399 00:21:56,840 --> 00:21:59,560 looks at how many people survive without an injury as they 400 00:21:59,560 --> 00:22:06,040 continued to continue to run. So I think, and one of the 401 00:22:06,040 --> 00:22:10,160 interesting caveats in this study is what they found between 402 00:22:10,160 --> 00:22:11,800 different countries. And I'm not going to go into the 403 00:22:11,800 --> 00:22:15,240 minutiae of this, but they found that certain groups of countries 404 00:22:15,440 --> 00:22:20,520 had significantly higher rates of injury both at 1000 and 2000 405 00:22:20,520 --> 00:22:25,160 kilometres and other countries had significantly lower injury 406 00:22:25,200 --> 00:22:28,520 prevalence. And the difference between those 407 00:22:28,520 --> 00:22:32,960 two was up to 30% difference between 1 country and another 408 00:22:33,040 --> 00:22:34,840 country. So the the country's the lowest 409 00:22:34,840 --> 00:22:39,920 risk, they had 30% less prevalence of injury and the 410 00:22:39,920 --> 00:22:43,160 other ones had 30% more, which is a huge range. 411 00:22:43,320 --> 00:22:45,240 Some of the reasons why this could have happened in this 412 00:22:45,240 --> 00:22:48,680 study was because they did not validate this questionnaire. 413 00:22:49,240 --> 00:22:53,040 OK, I'm going into like the weeds on some of this stuff, so 414 00:22:53,040 --> 00:22:54,720 forgive me for nerding out a little bit. 415 00:22:54,960 --> 00:22:57,800 But one of the things that they they have to do when you give 416 00:22:57,800 --> 00:22:59,960 out a questionnaire as a part of a studies, you have to validate 417 00:22:59,960 --> 00:23:03,080 the instrument and this was only validated in English. 418 00:23:03,080 --> 00:23:05,600 So regardless of what country you were in, you were sent the 419 00:23:05,600 --> 00:23:08,120 same question written in English. 420 00:23:08,280 --> 00:23:11,760 Which means that it's possible that when somebody who maybe 421 00:23:11,760 --> 00:23:14,680 English is your secondary language, there could be 422 00:23:14,680 --> 00:23:18,480 different cultural connotations to like pain or injury. 423 00:23:18,480 --> 00:23:22,120 Those meanings can elucidate different meanings and 424 00:23:22,120 --> 00:23:24,960 experiences and interpretations. Which means that they may have 425 00:23:24,960 --> 00:23:29,280 answered differently, not because that the experience was 426 00:23:29,280 --> 00:23:32,920 was remarkably different, but the definition just meant a lot 427 00:23:33,600 --> 00:23:37,040 a different meaning to them based on their understanding of 428 00:23:37,040 --> 00:23:42,440 what injury or pain is. The other thing that I'm curious 429 00:23:42,440 --> 00:23:45,320 about, and they didn't. Again, this is an observational 430 00:23:45,320 --> 00:23:48,640 study, not trying to draw conclusions about the why, but 431 00:23:48,640 --> 00:23:53,400 it's more just what is going on. I wonder too, in different 432 00:23:53,400 --> 00:23:56,840 regions of the world and the people who are having more or 433 00:23:56,840 --> 00:24:00,120 less injuries, if there are connections between lifestyle 434 00:24:00,440 --> 00:24:04,360 and the tissue capacity that you develop because of that 435 00:24:04,360 --> 00:24:06,000 lifestyle. For example, if you live in a 436 00:24:06,000 --> 00:24:09,720 country where commuting by walking is your typical way to 437 00:24:09,720 --> 00:24:13,120 get to work where there is much less driving commuting, maybe 438 00:24:13,120 --> 00:24:16,520 there's more physical labor, maybe tissue capacities in those 439 00:24:16,520 --> 00:24:20,160 people are increased. Or if you work an extremely 440 00:24:20,160 --> 00:24:23,240 physical job on the reversed end, then you're running becomes 441 00:24:23,240 --> 00:24:25,760 this tipping point where it leads to further injury. 442 00:24:25,960 --> 00:24:30,480 So I just think that's a could be an interesting thing to 443 00:24:30,480 --> 00:24:34,960 explore is what how does lifestyle play into prevalence 444 00:24:34,960 --> 00:24:37,120 of injury in recreational runners? 445 00:24:37,840 --> 00:24:39,280 All right, so we made it through two articles. 446 00:24:39,280 --> 00:24:42,400 We basically looked at these two broad scoping, hey, what? 447 00:24:42,520 --> 00:24:45,440 How many injuries are happening? Ultimately, there's a lot, At 448 00:24:45,440 --> 00:24:48,560 least 9 million people a year are getting hurt because of some 449 00:24:48,560 --> 00:24:52,360 sort of running related injury. And then recently, as much as 450 00:24:52,360 --> 00:24:54,800 this year, that's kind of being validated and shown, hey, people 451 00:24:54,800 --> 00:24:58,320 are having to at least at least alter the amount of training 452 00:24:58,320 --> 00:24:59,840 that they're doing because of an injury. 453 00:25:00,080 --> 00:25:03,120 But neither of these were able to start talking about why do 454 00:25:03,120 --> 00:25:05,440 running injuries happen. And that's the third article 455 00:25:05,640 --> 00:25:09,680 that I want to bring us to. So this is an article from 2017 456 00:25:09,680 --> 00:25:13,440 and it's kind of what's called like a conceptual framework 457 00:25:13,440 --> 00:25:17,200 article where this group of researchers worked together to 458 00:25:17,200 --> 00:25:20,840 create a framework to try to understand running related 459 00:25:20,840 --> 00:25:23,200 injuries. And these frameworks can be used 460 00:25:23,360 --> 00:25:25,800 both really what they're designed for. 461 00:25:25,800 --> 00:25:30,560 If you want to nerd out, they're designed to create testable 462 00:25:30,560 --> 00:25:32,920 factors from like a research perspective. 463 00:25:32,920 --> 00:25:36,000 So you can use this conceptual framework and then you can 464 00:25:36,000 --> 00:25:39,880 control for certain variables within that construct and then 465 00:25:39,880 --> 00:25:41,960 you can try to answer some further questions. 466 00:25:42,440 --> 00:25:46,320 But what you can also use it for is to conceptualize if you're 467 00:25:46,320 --> 00:25:48,640 APT or if you're a runner trying to figure out, hey, why am I 468 00:25:48,640 --> 00:25:51,520 hurt this framework. You can look at the factors on 469 00:25:51,520 --> 00:25:54,440 there and say, hey, have I had major changes in any of these 470 00:25:54,440 --> 00:25:56,680 factors? If you have, then that could 471 00:25:56,680 --> 00:25:59,520 help you maybe identify what sort of changes that you could 472 00:25:59,520 --> 00:26:01,720 make in the future to avoid it from happening again. 473 00:26:02,080 --> 00:26:05,880 So this study is called a framework for the Etiology of 474 00:26:05,880 --> 00:26:08,880 Running related injuries. Etiology like the cause, the 475 00:26:08,880 --> 00:26:10,640 root, what's where is it coming from? 476 00:26:10,880 --> 00:26:14,240 And this is Bertelsen and colleagues in 2017, 19. 477 00:26:14,960 --> 00:26:19,680 So they again go back and highlight that all of this sort 478 00:26:19,680 --> 00:26:25,160 of injury is going to really depend on so many factors that 479 00:26:25,160 --> 00:26:28,160 it's very individualized. They kind of recognize that in 480 00:26:28,160 --> 00:26:30,600 their, in this part of their study they you know the type of 481 00:26:30,600 --> 00:26:33,760 runner, how much experience there have, the injury 482 00:26:34,760 --> 00:26:38,240 experiences that they've had in the past, How long do these 483 00:26:38,240 --> 00:26:41,440 studies take to follow up, How do they define injuries that's 484 00:26:41,440 --> 00:26:43,920 going to change your injury prevalence like it's just going 485 00:26:43,920 --> 00:26:46,640 to be so different because of how who you include in these 486 00:26:46,640 --> 00:26:48,600 studies. So what they want to do is 487 00:26:48,600 --> 00:26:51,720 figure out how can we create a framework to study this a little 488 00:26:51,720 --> 00:26:54,440 bit more focused in certain populations. 489 00:26:55,320 --> 00:26:57,840 So here's the framework. We're going to talk about it. 490 00:26:58,160 --> 00:27:02,760 So they have kind of four different categories. 491 00:27:03,280 --> 00:27:07,080 One of them is the structure specific load capacity. 492 00:27:07,080 --> 00:27:09,160 So what is the capacity of the structure? 493 00:27:09,400 --> 00:27:11,800 Let's just say somebody has and you're trying to problem solve 494 00:27:11,800 --> 00:27:13,080 this on your own. Let's say somebody has an 495 00:27:13,080 --> 00:27:15,560 Achilles injury because that's the highest prevalence according 496 00:27:15,560 --> 00:27:19,520 to that Van Guenth article. If somebody has Achilles, you're 497 00:27:19,520 --> 00:27:21,520 asking what's the load capacity of that structure? 498 00:27:21,520 --> 00:27:25,400 Meaning how many times could I do a calf raise before the 499 00:27:25,400 --> 00:27:29,600 Achilles tendon fatigues to the point where it becomes inflamed 500 00:27:29,600 --> 00:27:31,840 and irritated. So what's the capacity of my 501 00:27:31,840 --> 00:27:34,880 Achilles tendon? Section B is the structure 502 00:27:34,880 --> 00:27:37,320 specific cumulative load. So this is going to bring in a 503 00:27:37,320 --> 00:27:40,200 lot of those training factors that we talked about in the Van 504 00:27:40,200 --> 00:27:44,000 Gan article. So how many times did I? 505 00:27:44,640 --> 00:27:47,320 Did I run, which means how many times did I impact load? 506 00:27:47,520 --> 00:27:49,960 And how am I running? Am I running on my forefoot? 507 00:27:50,160 --> 00:27:53,120 Am I running in a minimalist shoe that's going to change the 508 00:27:53,120 --> 00:27:56,760 cumulative load over the course of one run, over the course of 509 00:27:56,760 --> 00:27:59,200 one week, over the course of six months? 510 00:27:59,360 --> 00:28:02,640 What's the cumulative load on a specific structure? 511 00:28:02,680 --> 00:28:04,080 So that's kind of the second section. 512 00:28:04,600 --> 00:28:10,480 The third section is related to the structure specific load 513 00:28:10,480 --> 00:28:14,280 capacity in general and that's looking at what's the reduction 514 00:28:14,280 --> 00:28:18,320 in that load capacity over the course of a single session or 515 00:28:18,320 --> 00:28:22,520 the session of weeks or months. So if you haven't thought about 516 00:28:22,520 --> 00:28:25,600 this, it's worth thinking about when you exercise, when you lift 517 00:28:25,600 --> 00:28:28,520 weights, when you go for a run, you don't get stronger, you get 518 00:28:28,520 --> 00:28:31,400 weaker. We are breaking down our 519 00:28:31,400 --> 00:28:34,160 muscles. We are utilizing energy. 520 00:28:34,160 --> 00:28:38,080 We're depleting the energy that exists within muscles and all of 521 00:28:38,080 --> 00:28:40,840 those things. So within a session, within a 522 00:28:40,840 --> 00:28:43,760 run, within a lifting session, you're getting weaker, you're 523 00:28:43,760 --> 00:28:47,360 decreasing the capacity of the structure. 524 00:28:48,880 --> 00:28:52,920 So when all of those factors, the current capacity of the 525 00:28:52,920 --> 00:28:56,160 structure, the reduction that you brought it through by going 526 00:28:56,160 --> 00:29:00,920 and running and the cumulative load, when all of those things 527 00:29:00,920 --> 00:29:05,640 work together to exceed part A which is the load capacity, 528 00:29:05,880 --> 00:29:07,800 that's when you're going to get an injury. 529 00:29:08,400 --> 00:29:11,280 So another way to say this that I think that they summarized 530 00:29:11,280 --> 00:29:14,800 super well in the article is that injury occurs as the result 531 00:29:14,800 --> 00:29:19,400 of the runner possessing multiple risk factors and then 532 00:29:19,400 --> 00:29:23,200 participating and running under certain circumstances to a 533 00:29:23,200 --> 00:29:26,280 degree where the structures load is exceeded. 534 00:29:27,200 --> 00:29:29,800 So I'm going to put this another way too, just because I think 535 00:29:29,800 --> 00:29:32,880 that this is like a lot of word vomit, but I I think that 536 00:29:32,880 --> 00:29:36,360 there's a pretty easy way to conceptualize how I think about 537 00:29:36,360 --> 00:29:40,280 running related injuries and how this article conceptualizes it 538 00:29:40,280 --> 00:29:42,400 in the framework. Basically they're saying if 539 00:29:42,400 --> 00:29:47,560 you're running demands exceed your physical status, you're 540 00:29:47,560 --> 00:29:52,200 going to end up having a running related injury if you put, let's 541 00:29:52,200 --> 00:29:54,760 see, I'm not a big fisherman, but I know that there are 542 00:29:54,760 --> 00:29:59,160 certain like poundage pounds that each fishing line can can 543 00:29:59,160 --> 00:30:02,080 tolerate. If a fish that goes beyond that 544 00:30:02,080 --> 00:30:05,080 poundage of pole comes on there, you're going to snap the line 545 00:30:05,800 --> 00:30:09,040 because the demand of the fish is higher than the physical 546 00:30:09,040 --> 00:30:12,160 status of the fishing line. In the same way in running. 547 00:30:12,160 --> 00:30:14,240 We're saying that if you're running demands, the demand you 548 00:30:14,240 --> 00:30:17,640 put through all the tissues exceed your current physical 549 00:30:17,640 --> 00:30:20,640 status, you're going to have a running related injury. 550 00:30:21,080 --> 00:30:25,000 I think what's super important is that our physical status is 551 00:30:25,000 --> 00:30:28,200 not static. Any given day we can have a 552 00:30:28,200 --> 00:30:32,440 higher or lower physical status. The effects of our demands and 553 00:30:32,440 --> 00:30:35,960 running that we put on it a week ago can still influence your 554 00:30:35,960 --> 00:30:39,320 physical status a week later depending on how intense it was. 555 00:30:39,760 --> 00:30:42,240 So what I want to talk about really quick are what sort of 556 00:30:42,240 --> 00:30:45,120 things fall under running demands, What sort of things 557 00:30:45,120 --> 00:30:48,960 fall under physical status. So under running demands, it's 558 00:30:48,960 --> 00:30:50,920 going to be some of the things that we talked about from 559 00:30:50,920 --> 00:30:54,720 training factors in that first article, things like your weekly 560 00:30:54,720 --> 00:30:57,440 mileage or the duration of the running that you did over the 561 00:30:57,440 --> 00:30:59,320 course of a week, they're going to talk about your training 562 00:30:59,320 --> 00:31:01,600 intensity. So how high did your heart rate 563 00:31:01,600 --> 00:31:05,080 get and how long was it there for that period of time? 564 00:31:05,520 --> 00:31:07,240 It's going to be talking about your frequency. 565 00:31:07,360 --> 00:31:09,640 Are you running daily? Are you a three times a week 566 00:31:09,640 --> 00:31:11,200 person? Are you a two times a week 567 00:31:11,200 --> 00:31:14,960 person? It's going to be the influence 568 00:31:14,960 --> 00:31:19,480 of frequency is going to depend on your cumulative time running 569 00:31:19,480 --> 00:31:21,400 and your tissue adaptations over time. 570 00:31:21,680 --> 00:31:23,000 But we'll get into that in a second. 571 00:31:23,120 --> 00:31:26,040 But running frequency is a part of your running demand equation. 572 00:31:26,200 --> 00:31:28,760 What terrain you're on is part of your running demand equation. 573 00:31:28,920 --> 00:31:31,400 If you're normally running on flat surfaces, but then you go 574 00:31:31,400 --> 00:31:34,520 to these big hills, the demand on our body changes when we're 575 00:31:34,520 --> 00:31:36,240 running downhill versus running uphill. 576 00:31:36,240 --> 00:31:39,240 There are different biomechanical reasons or or 577 00:31:39,240 --> 00:31:41,720 demands that get put on our body, which means that different 578 00:31:41,720 --> 00:31:45,840 structures are stressed. And footwear selection, which we 579 00:31:45,920 --> 00:31:49,520 obviously love to talk about on this podcast, that is an A 580 00:31:49,520 --> 00:31:51,480 factor influencing your running demands. 581 00:31:51,480 --> 00:31:53,920 If you're wearing minimalist footwear, there is a higher 582 00:31:53,920 --> 00:31:56,880 demand on the bones in your feet as we've seen from all of the 583 00:31:56,880 --> 00:32:00,320 increased for people who don't transition well, there's a 584 00:32:00,320 --> 00:32:03,480 higher risk for stress fractures in the feet because there's a 585 00:32:03,480 --> 00:32:05,800 different demand in that sort of footwear. 586 00:32:05,880 --> 00:32:08,280 Whereas when you put on a super shoe, there's another new 587 00:32:08,280 --> 00:32:10,200 demand. It shifts load away from the 588 00:32:10,200 --> 00:32:12,120 foots. You might have potential for 589 00:32:12,120 --> 00:32:15,240 injury higher up because the demand is higher up high and 590 00:32:15,240 --> 00:32:18,000 it's lower down at the foot. Finally, running demands are 591 00:32:18,000 --> 00:32:19,440 going to depend on your bio mechanics. 592 00:32:19,440 --> 00:32:22,920 So I have the the, the opportunity and privilege to 593 00:32:22,920 --> 00:32:26,720 work with a lot of university athletes right now through my 594 00:32:26,720 --> 00:32:30,880 job and when I'm working with students and we're analyzing 595 00:32:31,120 --> 00:32:34,440 their gait, we're using a 3D gate analysis with all of the 596 00:32:34,440 --> 00:32:36,680 runners on the cross country and track teams. 597 00:32:37,400 --> 00:32:40,040 When I work with the the students, we talk about how 598 00:32:40,040 --> 00:32:45,480 there isn't a right way to run because it's not that there 599 00:32:45,520 --> 00:32:48,840 there isn't a right way to run. But running different ways 600 00:32:48,840 --> 00:32:52,680 shifts where the demand is on the body and if those structures 601 00:32:52,680 --> 00:32:56,000 aren't ready to handle it, then that mechanics for them may be 602 00:32:56,000 --> 00:32:58,440 problematic or it's something that they should really lean 603 00:32:58,440 --> 00:33:00,400 into. So there's no wrong way to run 604 00:33:00,400 --> 00:33:03,000 bio mechanically, but understanding that bio mechanic, 605 00:33:03,000 --> 00:33:07,120 your bio mechanics help dictate which structures have more 606 00:33:07,120 --> 00:33:09,720 demand on them. All right. 607 00:33:09,720 --> 00:33:11,720 And now let's talk about physical status and some of the 608 00:33:11,720 --> 00:33:14,080 things that play on that side of the equation. 609 00:33:14,280 --> 00:33:17,960 So if all those running demands, your mileage or the time on your 610 00:33:17,960 --> 00:33:20,320 feet and the terrain you're running on, your bio mechanics, 611 00:33:20,520 --> 00:33:24,080 if it exceeds the physical status which is going to be 612 00:33:24,080 --> 00:33:26,800 influenced by these following things, that's where you're 613 00:33:26,800 --> 00:33:29,800 going to have injuries. So physical status is going to 614 00:33:29,800 --> 00:33:31,600 include things like your running experience. 615 00:33:31,800 --> 00:33:33,840 Are you new within the first two years? 616 00:33:34,240 --> 00:33:37,600 I didn't mention this, but that Van Gan article did talk about 617 00:33:37,600 --> 00:33:40,320 new runners in the first two years having a higher, much 618 00:33:40,320 --> 00:33:43,000 higher risk of injury than those who have more experience. 619 00:33:43,200 --> 00:33:47,280 It also talked about the people who have a chronic increased 620 00:33:47,280 --> 00:33:50,680 running mileage per week having a protective factor. 621 00:33:51,120 --> 00:33:54,320 That's because over years and years and years of training, 622 00:33:54,480 --> 00:33:57,760 your bones adapt. Your tendons adapt, especially 623 00:33:57,760 --> 00:33:59,920 if you're supplementing it with the right sort of strength 624 00:33:59,920 --> 00:34:02,960 training. Previous injuries are another 625 00:34:02,960 --> 00:34:06,800 part of your physical status. If you had a recent hamstring 626 00:34:06,800 --> 00:34:09,960 strain, that hamstring load capacity is going to be lower 627 00:34:09,960 --> 00:34:12,400 than it was prior to an injury. And if you don't rehab it all 628 00:34:12,400 --> 00:34:14,239 the way, it could be problematic. 629 00:34:14,639 --> 00:34:16,520 What sort of sleep habits do you have? 630 00:34:17,199 --> 00:34:20,400 And this is where I said your physical status is not static. 631 00:34:20,760 --> 00:34:23,239 You could have had a great week of sleep and then you can have 632 00:34:23,239 --> 00:34:27,400 one poor night of sleep and that can really decrease the physical 633 00:34:27,400 --> 00:34:30,280 status and the healing that happens in the reset of the 634 00:34:30,280 --> 00:34:32,679 cortisol in your body and all of these things that happen when 635 00:34:32,679 --> 00:34:34,239 you sleep. If it doesn't happen, you're in 636 00:34:34,280 --> 00:34:38,040 a new state of physical status that day. 637 00:34:38,199 --> 00:34:40,520 Which is why sometimes with the runners that I work with as a 638 00:34:40,520 --> 00:34:44,120 coach, if they have a period where sleep is not coming easy, 639 00:34:44,120 --> 00:34:47,199 we'll pull back on some of the workouts until they get some the 640 00:34:47,199 --> 00:34:49,199 sleep that they need and then we ramp things back up. 641 00:34:50,040 --> 00:34:52,639 Anxiety and depression are part of your physical status. 642 00:34:52,880 --> 00:34:56,760 We hadn't we had an episode, oh probably a year ago talking a 643 00:34:56,760 --> 00:34:59,520 bit about anxiety and depression and sleep and some of these 644 00:34:59,520 --> 00:35:04,960 recovery related things. Stress is stress and so if you 645 00:35:04,960 --> 00:35:07,920 are in a very stressful season of life, I think about the 646 00:35:07,920 --> 00:35:12,160 season when I had just graduated and we had our first kid and 647 00:35:12,160 --> 00:35:14,760 just like what it was like to not get sleep and learning how 648 00:35:14,760 --> 00:35:18,800 to be a dad and starting a new job and moving into a new house. 649 00:35:18,960 --> 00:35:23,000 I had these huge life events that were happening that took a 650 00:35:23,000 --> 00:35:26,880 lot of demand of my mind and my heart and my time and there was 651 00:35:26,880 --> 00:35:30,560 a lot of stress related to that. Those things can play a role in 652 00:35:30,560 --> 00:35:33,440 your physical status. Again, that can go up and down 653 00:35:33,440 --> 00:35:35,080 depending on where you're at that day. 654 00:35:36,160 --> 00:35:40,400 Nutrition and Hydration 2 Seemingly obvious but very 655 00:35:40,400 --> 00:35:43,240 important factors where if those things are not dialed in, your 656 00:35:43,240 --> 00:35:47,280 physical status is going to dip down And I I feel like it's 657 00:35:47,400 --> 00:35:49,920 again, it's pretty obvious to say but if you're starting to 658 00:35:49,920 --> 00:35:53,640 train for a new distance, your first 5K, your first ten KA 659 00:35:53,720 --> 00:35:56,920 marathon half marathon, whatever it is and you're increasing 660 00:35:56,920 --> 00:36:00,760 these demands of your running but you're not matching it by 661 00:36:00,760 --> 00:36:02,960 increasing your nutrition and hydration. 662 00:36:03,200 --> 00:36:06,320 You're having this like static physical status, but increased 663 00:36:06,320 --> 00:36:09,680 running demand, and you can run into that running demands 664 00:36:09,680 --> 00:36:15,200 exceeding your physical status then other physical factors like 665 00:36:15,200 --> 00:36:17,880 strength and mobility. Do you are you strong enough to 666 00:36:17,880 --> 00:36:20,160 handle running? Do you have the mobility to move 667 00:36:20,160 --> 00:36:23,600 through motion that needs to happen with running, or are you 668 00:36:23,600 --> 00:36:26,200 having to compensate and put extra stress on other 669 00:36:26,200 --> 00:36:28,320 structures? There's a lot of things that 670 00:36:28,320 --> 00:36:31,720 play into our physical status. So if we go back to the 671 00:36:31,720 --> 00:36:34,720 conceptual framework, they're basically saying if you have a 672 00:36:34,720 --> 00:36:37,120 lot of these factors, maybe you didn't sleep well. 673 00:36:37,120 --> 00:36:38,880 It's been a really stressful time at work. 674 00:36:39,120 --> 00:36:41,320 And you know what? You just like didn't get to eat 675 00:36:41,320 --> 00:36:43,920 a lot the night before because you were getting a lot of work 676 00:36:43,920 --> 00:36:45,960 done and you didn't eat like you normally would. 677 00:36:46,200 --> 00:36:48,840 And then you go out the next day and you do the same workout that 678 00:36:48,840 --> 00:36:51,400 you've always done. Your running demands didn't 679 00:36:51,400 --> 00:36:54,600 change, but your physical status had maybe taken enough of a hit 680 00:36:54,760 --> 00:36:59,080 where it brought you to a new a new level where your demands 681 00:36:59,160 --> 00:37:02,200 outweighed your physical status. And I think that's why this 682 00:37:02,200 --> 00:37:05,040 framework is really helpful because you can think about 683 00:37:05,040 --> 00:37:08,080 where am I at today? How have all of these main 684 00:37:08,080 --> 00:37:11,280 factors of my sleep, my anxiety, my nutrition, hydration? 685 00:37:11,600 --> 00:37:13,720 Have I been doing my strength training routine? 686 00:37:13,880 --> 00:37:17,160 Is my mobility good? How much experience as a runner 687 00:37:17,160 --> 00:37:19,480 do I have my new? Maybe that means I can't ramp 688 00:37:19,480 --> 00:37:22,160 things up as quickly as somebody else who's been running for, you 689 00:37:22,160 --> 00:37:25,400 know, 30 years and they usually they've ran, you know, 50 690 00:37:25,400 --> 00:37:28,000 marathons over those 30 years, but they haven't been training a 691 00:37:28,000 --> 00:37:29,120 lot. They might be able to ramp up 692 00:37:29,120 --> 00:37:31,040 way quicker because of these cumulative loads. 693 00:37:31,520 --> 00:37:34,160 It's helpful to think How's my physical status today? 694 00:37:35,200 --> 00:37:38,120 What can my body handle? What sort of changes have I been 695 00:37:38,120 --> 00:37:41,520 making in my running demands? Are they exceeding my current 696 00:37:41,520 --> 00:37:43,800 physical status? Do I need to back things down 697 00:37:43,800 --> 00:37:46,440 because I haven't been getting enough food in? 698 00:37:46,440 --> 00:37:50,320 I haven't been drinking enough. I have so much stress going on. 699 00:37:50,800 --> 00:37:52,720 Be it. It's it's in practice of being 700 00:37:52,720 --> 00:37:56,640 honest with ourselves as runners and figuring out where am I at, 701 00:37:56,800 --> 00:37:59,840 what sort of things do I need to do to make sure that I'm 702 00:37:59,840 --> 00:38:01,720 matching those two things together? 703 00:38:02,520 --> 00:38:07,480 All right, So wrapping up those three articles talking about the 704 00:38:07,480 --> 00:38:09,240 prevalence of running related injuries and then 705 00:38:09,240 --> 00:38:11,480 conceptualizing how do they happen. 706 00:38:12,400 --> 00:38:14,960 The last note that I want to make before I go into my final 707 00:38:14,960 --> 00:38:18,240 section here is that if you're if you're a physical therapist 708 00:38:18,240 --> 00:38:20,840 or other healthcare provider working with runners, I also 709 00:38:20,840 --> 00:38:23,760 love this framework because so much of the conversation and 710 00:38:23,760 --> 00:38:28,200 working with runners doesn't need to center on those last 711 00:38:28,200 --> 00:38:31,040 couple physical status things like strength and mobility. 712 00:38:31,200 --> 00:38:34,160 That's kind of our wheelhouse, but I think it's so important to 713 00:38:34,160 --> 00:38:38,480 have them be self assessing all of these other realms of how 714 00:38:38,480 --> 00:38:42,080 they exist as a runner and and just bringing them on a journey 715 00:38:42,080 --> 00:38:46,120 of self discovery in analyzing these different factors that can 716 00:38:46,240 --> 00:38:49,760 be part of why they came to you in the 1st place with an injury. 717 00:38:49,920 --> 00:38:52,360 It's got to be holistic. It's got to be all-encompassing. 718 00:38:53,760 --> 00:38:56,440 So the last thing that I wanted to do is talk about the most 719 00:38:56,440 --> 00:38:59,400 common mistakes that I see that keep people from getting to the 720 00:38:59,400 --> 00:39:02,960 starting line for their race, based on the conversation and 721 00:39:02,960 --> 00:39:06,040 the blabbing that I've done for the last almost 40 minutes. 722 00:39:06,360 --> 00:39:09,040 These might sound obvious at this point in terms of my 723 00:39:09,040 --> 00:39:11,960 perspective and where I come from in working with runners, 724 00:39:12,000 --> 00:39:13,880 but I think that they're worth saying. 725 00:39:13,880 --> 00:39:16,840 I think one of the most common mistakes is that people do too 726 00:39:16,840 --> 00:39:19,320 much too soon. They ramp up their running 727 00:39:19,320 --> 00:39:23,920 demands because they say, you know what, I want to run a half 728 00:39:23,920 --> 00:39:27,000 marathon in a certain amount of time, but it's my first half 729 00:39:27,000 --> 00:39:29,240 marathon. So what people start to do is 730 00:39:29,240 --> 00:39:32,160 they train based on where they want to be versus where they are 731 00:39:32,160 --> 00:39:35,400 right now. So for example, if I wanted to 732 00:39:35,400 --> 00:39:39,400 go like, when I I did this to myself, I wanted to run an hour 733 00:39:39,400 --> 00:39:41,040 and a half marathon, half marathon. 734 00:39:41,040 --> 00:39:46,800 And I'd never done that before and I had ran 1/2 marathon, but 735 00:39:46,800 --> 00:39:50,200 it was like five years earlier and I had no idea what I was 736 00:39:50,200 --> 00:39:53,840 doing. So what I did is I found a 737 00:39:53,840 --> 00:39:57,400 training plan online and I was like, OK, I want to run an hour 738 00:39:57,400 --> 00:40:00,640 and a half marathon, half marathon, which means that, you 739 00:40:00,640 --> 00:40:04,040 know, I need to be doing my pacing at like a 6:50 to be able 740 00:40:04,040 --> 00:40:05,640 to do that and accomplish that goal. 741 00:40:05,880 --> 00:40:09,120 So I started running a lot of my runs, not all of them, but a lot 742 00:40:09,120 --> 00:40:12,760 of my runs down at that sub 7 pace or when there was a tempo, 743 00:40:12,760 --> 00:40:15,760 I'd run it down at a 630. I would just put myself as 744 00:40:15,760 --> 00:40:17,760 though I was already in shape to do the thing. 745 00:40:17,880 --> 00:40:20,200 That I wanted to do 3 months from now. 746 00:40:20,680 --> 00:40:24,280 And so we tend, not everybody, but a lot of people tend to do 747 00:40:24,280 --> 00:40:27,240 too much too soon and start to take the goal that they want to 748 00:40:27,240 --> 00:40:29,880 be in three months, six months, even a year. 749 00:40:29,880 --> 00:40:33,200 And say because I want to run a sub four marathon, I need to 750 00:40:33,200 --> 00:40:36,000 start training at 9 minutes per mile all the time now. 751 00:40:36,160 --> 00:40:37,280 And that's just not how it works. 752 00:40:37,280 --> 00:40:39,280 You train where you're at, not where you want to be. 753 00:40:39,440 --> 00:40:42,120 And if you train where you're at now, you will more gradually 754 00:40:42,120 --> 00:40:45,400 increase your running demands so that your physical status can 755 00:40:45,400 --> 00:40:48,480 come along for the ride. Your body needs to go through 756 00:40:48,480 --> 00:40:51,240 cardiovascular and musculoskeletal adaptations to 757 00:40:51,240 --> 00:40:53,840 make sure that you're tolerating the running that you want to do. 758 00:40:54,640 --> 00:40:57,760 So mistake number one, doing too much too soon and trying to 759 00:40:57,760 --> 00:41:01,080 shoot for your goal instead of training exactly where you're 760 00:41:01,080 --> 00:41:03,920 at. The second one is that people 761 00:41:03,920 --> 00:41:07,960 don't fully rehab a previous injury and I would also put that 762 00:41:07,960 --> 00:41:10,840 kind of slash not listening to your body. 763 00:41:11,200 --> 00:41:15,560 And so as we noticed in that Van Goen article, one of the two 764 00:41:15,560 --> 00:41:17,920 things that was a high risk factor for running related 765 00:41:17,920 --> 00:41:21,760 injuries was a previous injury. And as we noticed in that most 766 00:41:21,760 --> 00:41:25,800 recent article from 2024 / 50% of the people had already come 767 00:41:25,800 --> 00:41:28,560 in injured, which probably meant that they were part of that 768 00:41:28,560 --> 00:41:31,280 group that got reinjured during the study. 769 00:41:31,280 --> 00:41:37,200 In fact again a little minutia thing is that they there was 3 770 00:41:37,200 --> 00:41:41,040 to 5% of people within the study who reported an injury on the 771 00:41:41,040 --> 00:41:43,360 first week, which means that they didn't start the study 772 00:41:43,360 --> 00:41:48,280 healthy. So again, the second problem 773 00:41:48,280 --> 00:41:51,840 that people have is that they do not fully rehab a previous 774 00:41:51,840 --> 00:41:56,680 injury. If you have, I had mentioned 775 00:41:56,680 --> 00:42:00,720 hamstrings before, but I just because Achilles are so common, 776 00:42:01,240 --> 00:42:04,280 Achilles tendon irritation and injuries, we're going to talk 777 00:42:04,280 --> 00:42:07,440 about that. So with into me and they have 778 00:42:07,440 --> 00:42:09,240 had a history of Achilles tendon. 779 00:42:09,320 --> 00:42:12,280 We want to when I bring them through testing, I bring them 780 00:42:12,280 --> 00:42:16,840 through maximal endurance like calf raise testing to make sure 781 00:42:16,840 --> 00:42:18,720 that their Achilles has endurance. 782 00:42:18,920 --> 00:42:22,200 I also want to bring them through power testing and making 783 00:42:22,200 --> 00:42:25,480 sure that they can tolerate bounding and that they can also 784 00:42:25,480 --> 00:42:28,760 lift very heavy and tolerate those loads when it comes to a 785 00:42:28,760 --> 00:42:31,240 tendon related injury, we've talked about this on the podcast 786 00:42:31,240 --> 00:42:33,360 a lot. It can take up to nine months 787 00:42:33,360 --> 00:42:36,160 for the collagen, which is that like a tensile structure. 788 00:42:36,360 --> 00:42:38,720 So we talk about physical status of the structure itself. 789 00:42:38,920 --> 00:42:41,800 If you really want a strong tendon after a tendinopathy and 790 00:42:41,800 --> 00:42:45,040 tendon injury, you need to do your rehab for nine months. 791 00:42:45,200 --> 00:42:48,840 You can't give up and many people forsake that. 792 00:42:49,040 --> 00:42:51,360 And then it might be their Achilles that gives out again, 793 00:42:51,360 --> 00:42:53,400 but it might be something completely different because 794 00:42:53,400 --> 00:42:56,800 they're compensating due to the body avoiding use of that 795 00:42:56,800 --> 00:42:59,480 structure. Same thing is true if you if you 796 00:42:59,480 --> 00:43:01,920 end up having a pretty significant hamstring strain 797 00:43:02,120 --> 00:43:05,600 you're going to potentially develop some very early weakness 798 00:43:05,600 --> 00:43:08,160 and atrophy of the hamstring and even of the gluteal muscles. 799 00:43:08,320 --> 00:43:12,440 If you don't fully rehab and get yourself back small adaptations 800 00:43:12,440 --> 00:43:15,120 and compensations are going to be problematic. 801 00:43:16,240 --> 00:43:19,600 The final issue that I think that people that keeps people 802 00:43:19,600 --> 00:43:22,920 from the starting line is that they over emphasize the 1% 803 00:43:23,120 --> 00:43:27,960 instead of focusing on the 99% that is is very important. 804 00:43:27,960 --> 00:43:31,960 So what I mean by the 1% is people over emphasize the need 805 00:43:31,960 --> 00:43:39,560 to do foam rolling, the need to excuse excuse me, the need to 806 00:43:39,560 --> 00:43:43,720 have certain running shoes, the need to go get massages to use 807 00:43:43,720 --> 00:43:48,280 sauna, even bio mechanics and overemphasizing that. 808 00:43:48,440 --> 00:43:51,680 I think that people put so much attention to the 1% that they 809 00:43:51,680 --> 00:43:55,720 don't pay attention to the 99, which this is such a boring 810 00:43:55,720 --> 00:43:57,640 answer, but what's your sleep like? 811 00:43:57,840 --> 00:44:00,560 Are you eating the right foods, and are you eating enough to 812 00:44:00,560 --> 00:44:03,000 fuel the demands that are you're being put on your body? 813 00:44:03,200 --> 00:44:05,280 Are you doing some sort of strength routine? 814 00:44:05,480 --> 00:44:09,040 Are you tempering your runs and not trying to reach for where 815 00:44:09,040 --> 00:44:11,360 you want to be, but training where you're at? 816 00:44:11,520 --> 00:44:16,960 It's all about that 99% and not the 1% of fancy things, All 817 00:44:16,960 --> 00:44:20,080 right, So there's our research review on running related 818 00:44:20,080 --> 00:44:23,200 injuries and the most common mistakes that keep people from 819 00:44:23,200 --> 00:44:24,680 getting to the starting line healthy. 820 00:44:25,920 --> 00:44:29,640 I am really curious to hear what y'all think about this format 821 00:44:30,720 --> 00:44:33,760 and kind of what depth you want us to go into these research 822 00:44:33,760 --> 00:44:35,840 studies. So in addition to the subjective 823 00:44:35,840 --> 00:44:39,160 questions from before, we'd love your feedback on if you want to 824 00:44:39,160 --> 00:44:42,880 see these this format of podcast continue some deeper dives into 825 00:44:42,880 --> 00:44:45,800 some of the literature and if So, what literature do you want 826 00:44:46,000 --> 00:44:49,560 and what do you want us to go into it so we appreciate you 827 00:44:49,560 --> 00:44:51,920 all. If you want to check out more of 828 00:44:51,920 --> 00:44:56,000 our stuff stuff, you can go to doctorsofrunning.com and we have 829 00:44:56,000 --> 00:44:59,080 everything there from all the links to our podcast episodes, 830 00:44:59,280 --> 00:45:02,360 all the articles that we're writing on shoes, and our 831 00:45:02,680 --> 00:45:06,040 reviews of other bio mechanics and rehabilitation related 832 00:45:06,040 --> 00:45:07,400 topics. Talk to you later.